This week in Medicare updates–2/15/2017
Medicare Market Shares of Mail Order Diabetes Test Strips From July Through September 2016
On February 6, the OIG published the second of three Reports regarding the Medicare market shares of diabetes test strips for the periods April - June 2016, July - September 2016, and October - December 2016. The second report fulfills MIPPA's mandate for OIG to assess the market shares of diabetes test strips for the 3-month period after implementation of the current round of the National Mail-Order Program (i.e., the National Mail-Order Recompete), which started on July 1, 2016.
New and Closed Corporate Integrity Agreements
On February 8, the OIG published information regarding a new Corporate Integrity Agreement with Meir Daller, MD, and Gulfstream Urology, PA, of Ft. Myers, Florida. It also closed cases with the following providers:
- LHC Group Inc. of Lafayette, LA
- Vanguard Healthcare, LLC, of Brentwood, TN
- American Medical Response, Inc., of Greenwood Village, CO
- Universal American Corp. (d/b/a Today's Health) of Rye Brook, NY
- Nationwide Medical, Inc., of Agoura Hills, CA
- Novo Nordisk Incorporated, of Princeton, NJ
- WellCare Health Plans, Inc., of Tampa, FL
New OIG Civil Monetary Settlements
On February 8, the OIG published information on multiple Provider Self-Disclosure Settlements reached in January 2017 for alleged Civil Monetary Penalties violations, including:
- Quest Diagnostics, Incorporated, which agreed to pay $315,093.35. OIG alleged that one of its laboratories in New Jersey paid remuneration in the form of greater than fair market value rent for space, which was related to a medical practice that referred patients to Quest.
- Staten Island University Hospital (SIUH), which agreed to pay $1,132,489.61. OIG alleged that SIUH knowingly submitted claims to Medicare for walk-in and home-drawn lab services that were performed at one of SIUH's outpatient lab facilities that it knew or should have known were false because they lacked sufficient documentation.
- Planned Parenthood Great Plains and Comprehensive Health of Planned Parenthood Great Plains (PPGP) of Kansas, which agreed to pay $18,808.92. OIG alleged that PPGP submitted claims to Medicaid where the services were provided by advanced registered nurse practitioners (ARNP) but were billed improperly under a supervisory physician's name, along with other issues.
- St. Joseph Hospital, Breese, of the Hospital Sisters of the Third Order of St. Francis, Illinois, which agreed to pay $421,692.35. OIG alleged that SJHB knowingly presented to federal healthcare programs claims for items or services that it knew or should have known were false or fraudulent.
In addition, the OIG reported that after it disclosed conduct pursuant to its corporate integrity agreement, Pediatric Services of America, Inc., agreed to pay $197,556.66 for allegedly violating the Civil Monetary Penalties Law, as it allegedly employed an individual that it knew or should have known was excluded from participation in federal healthcare programs.
Advance Care Planning (ACP) Implementation for Outpatient Prospective Payment System (OPPS) Claims
On February 10, CMS published Transmittal 1795 to implement system changes necessary to process ACP services for OPPS claims. CMS has made CPT code 99497 for ACP separately payable for Medicare OPPS claims when the service meets the criteria for separate payment under OPPS. The change in policy will be implemented through the annual Medicare Physician Fee Schedule Database update.
Pub. 100-16 Medicare Managed Care Chapter 1 Update
On February 10, CMS published Transmittal 125 to update guidance indicating that certain Medicare Cost plans in areas where there is adequate competition from Medicare Advantage plans could not renew beginning in contract year 2017. Because of new legislation, non-renewal of cost plans affected by competition is being delayed, and such plans can continue to operate through 2018.
Effective date: February 10, 2017
Implementation date: February 10, 2017
Clinical Laboratory Fee Schedule - Medicare Travel Allowance Fees for Collection of Specimens
On February 10, CMS published Transmittal 3717 to revise the payment of travel allowances when billed on a per-mileage basis using HCPCS code P9603 and when billed on a flat rate basis using HCPCS code P9604 for calendar year 2017.
Effective date: January 1, 2017
Implementation date: May 12, 2017
Guidance on Implementing System Edits for Certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)
On February 10, CMS published Transmittal 1797 to establish and implement edits that will auto deny claims paid for HCPCS codes unless the DMEPOS supplier has been identified as accredited and verified on their CMS-855S or the DMEPOS supplier is currently exempt from meeting the accreditation requirements.
Effective date: July 1, 2017
Implementation dates:
July 3, 2017 - Analysis
October 2, 2017 - Coding, Testing and Implementation
Revision to State Operations Manual (SOM) Appendix PP - Incorporate revised Requirements of Participation for Medicare and Medicaid certified nursing facilities
On February 10, CMS published Transmittal 167 regarding revisions made to the regulation language per the final rule for long-term care facilities published October 4, 2016. Only the regulation text was revised.
Effective date: February 10, 2017
Implementation date: February 10, 2017
Extension of the Transition to the Fully Adjusted Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Payment Rates under Section 16007 of the 21st Century Cures Act
On February 10, CMS published Transmittal 3716 to provide instructions regarding the implementation of revised 2016 DMEPOS fee schedule amounts based on changes mandated by section 16007 of the 21st Century Cures Act.
Effective date: July 1, 2017
Implementation date: July 3, 2016