This week in Medicare updates—1/19/2022
Skilled Nursing Facility (SNF) Claims Processing Update to Fiscal Year End Edits
On January 5, CMS published One-Time Notification Transmittal 11178, which rescinds and replaces Transmittal 11060, dated October 22, 2021, to revise the effective and implementation dates to move them up to the January release. The original transmittal was published regarding updates to the FISS for SNFs billing on TOB 21X and Swing Bed TOB 18X to ensure claims processing adheres to current policy for fiscal year end edits.
CMS published MLN Matters 12457 to accompany the transmittal.
Effective date: January 1, 2022
Implementation date: January 3, 2022
Nursing Home Staff Turnover and Weekend Staffing Levels
On January 7, CMS published a Memorandum to CMS Certified Nursing Home Operators regarding changes to information that will be posted for nursing homes on the Care Compare website. CMS will now be posting weekend staffing information and staff turnover information to the website starting in January 2022. It also reminds nursing homes to link employee identifiers when they are changed due to changes in the facility’s staffing data systems.
Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers, and state/regional office training coordinators within 30 days of this memorandum.
Rural Health Clinic
On January 10, CMS updated an MLN Booklet regarding rural health clinic (RHC) billing and payment. Updates were made to include new policies for 2022, such as billing for transitional care management and general care management services for the same patient during the same service period, reporting and getting payment for mental health visits via telehealth, and more.
Comment Request: Medicare-Funded GME Residency Positions in Accordance with Section 126 of the Consolidated Appropriations Act
On January 11, CMS published a Comment Request in the Federal Register regarding the submission of an information collection titled “Medicare-Funded GME Residency Positions in Accordance with Section 126 of the Consolidated Appropriations Act” for OMB review.
Comments are due to the OMB desk officer by February 10, 2022.
Comment Request: Notice of Research Exception under the Genetic Information Nondiscrimination Act; Disclosure and Recordkeeping Requirements for Grandfathered Health Plans under the Affordable Care Act
On January 11, CMS published a Comment Request in the Federal Register regarding the following information collections:
- Notice of Research Exception under the Genetic Information Nondiscrimination Act
- Disclosure and Recordkeeping Requirements for Grandfathered Health Plans under the Affordable Care Act
Comments are due by March 14, 2022.
Proposed Decision Memo: Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer’s Disease
On January 11, CMS published a Proposed Decision Memo regarding coverage for monoclonal antibodies directed against amyloid as a treatment for Alzheimer’s disease. CMS is proposing to cover FDA-approved monoclonal antibodies directed against amyloid for this purpose under Coverage with Evidence Development (CED) in NIH trials and in CMS-approved randomized controlled trials that satisfy detailed coverage criteria. All trials must be conducted in a hospital-based outpatient setting. For trials that include a beta amyloid PET scan as part of the protocol, CMS will cover one beta amyloid PET scan per patient as long as that patient did not previously receive a beta amyloid PET scan.
The only monoclonal antibody currently approved by the FDA for this purpose is Aduhelm, but the approval process created significant controversy, and CMS noted in a Press Release about this proposed decision memo that it is concerned about the potential for harm with this treatment, which is why it believes restricting coverage to CED for this treatment is the most appropriate coverage route at this time.
Comments on the proposed decision memo are due by February 10. CMS will announce its final decision by April 11.
NCD 270.3 Blood-Derived Products for Chronic, Non-Healing Wounds
On January 12, CMS published Medicare Claims Processing Transmittal 11171 and Medicare National Coverage Determinations Transmittal 11171, which rescind and replace Claims Processing Transmittal 11119 and National Coverage Determinations Transmittal 11119, dated November 10, 2021, to add HCPCS code G0465 to the instructions and to include additional information on HCPCS code G0460. This correction modifies the IOM attachment for the Claims Processing Manual. It also updates the background section for the Claims Processing Manual and business requirements 12403-04.1 through 12403-04.2.2 and 12403-04.3 through 12403-04.6. This correction only revises the Claims Processing Manual. The original transmittal was published regarding implementation for coverage of autologous platelet-rich plasma (PRP) infusions for the treatment of chronic non-healing diabetic wounds.
CMS revised MLN Matters 12403 to accompany the transmittals.
Effective date: April 13, 2021
Implementation date: February 14, 2022 - for MACs; January 3, 2022 - Shared Systems
CY 2022 Annual Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment
On January 12, CMS published Medicare Claims Processing Transmittal 11186, which rescinds and replaces Transmittal 11151, dated December 10, 2021, to revise the policy section to reflect the delay in the CLFS data reporting period for clinical diagnostic laboratory tests and the delay in the application of the 15% phase-in reduction. The original transmittal was published regarding the CY 2022 updates to the CLFS.
CMS revised MLN Matters 12558 on the same date to accompany the transmittal.
Effective date: January 1, 2022
Implementation date: January 3, 2022
Update to the Internet Only Manual Medicare Claims Processing Manual, Chapter 3, Section 40.2.4 IPPS Transfers Between Hospitals
On January 12, CMS published Medicare Claims Processing Transmittal 11189, which rescinds and replaces Transmittal 10952, dated August 19, 2021, to correct the patient discharge status in the Claims Processing Manual, Chapter 3, Section 40.2.4 (A) to Patient Discharge Status Code 82 when a readmission is planned. The original transmittal was published regarding updates to the manual to change the language for acute care and post-acute care transfers and discharge patient status codes so the language in the manual is consistent with the definitions of discharges and transfers as defined in 42 CFR 412.4(a) and (b).
Effective date: September 20, 2021
Implementation date: September 20, 2021
ICD-10 and Other Coding Revisions to NCDs - April 2022 (CR 1 of 2)
On January 12, CMS published One-Time Notification Transmittal 11179, which rescinds and replaces Transmittal 11068, dated October 21, 2021, to revise the attachment for NCD 110.24, CAR-T, to add business requirement 12480.10.1 by adding generic unspecified procedure codes, to clarify coverage and claims processing in the policy section, and to revise the implementation date. The original transmittal was published regarding maintenance updates of ICD-10 conversions and other coding updates for NCDs.
CMS revised MLN Matters 12480 on the same date to accompany the transmittal.
Effective date: April 1, 2022 - unless otherwise specified in individual requirements
Implementation date: February 14, 2022 - for MAC only correction BR 12480.10.1; November 23, 2021 - for MAC BRs except BR 12480.10.1; April 4, 2022 - Shared System Maintainers
Laboratory Tests Subject to Exceptions from Laboratory DOS Policy
On January 13, CMS published an updated Download Link for the latest list of laboratory tests subject to exceptions to the Laboratory DOS Policy defined at 42 CFR §414.510(b)(5) to reflect the January updates.
Supreme Court Upholds Omnibus COVID-19 Health Care Staff Vaccination Rule
On January 13, the Supreme Court ruled to allow the Omnibus COVID-19 Health Care Staff Vaccination interim final rule to proceed, thereby making the requirements in the rule mandatory in all states except for Texas.
CMS published a Press Release on the same date applauding the Supreme Court’s decision.
On January 14, CMS published a Memorandum to state survey agency directors on enforcement actions and survey directives to ensure compliance with the rule in states other than those whose previous injunction was lifted in December. The memo also does not apply to Texas. CMS also posted Download Links for provider-specific guidance on compliance with the rule.
Medicare COVID-19 Vaccine Shot Payment
On January 13, CMS updated its Medicare COVID-19 Vaccine Shot Payment webpage to note that the FDA updated the EUA for the Pfizer-BioNTech vaccine on January 3 to authorize the use of a single booster dose for all patients 12 years and older and immunocompromised patients 5-11 years old.
Updates to Lists Related to DMEPOS Conditions of Payment
On January 13, CMS published an Update in the Federal Register regarding the updated HCPCS codes on the Master List of DMEPOS Items Potentially Subject to Face-to-Face Encounter and Written Order Prior to Delivery and/or Prior Authorization Requirements.
Dates: This implementation is effective on April 13, 2022. Prior authorization will be implemented in three incremental phases, with the final phase being national implementation. Phase 1 includes one state per jurisdiction and is effective April 13, 2022. Phase 2 includes four states per jurisdiction and is effective July 12, 2022. Phase 3 is nationwide and is effective October 10, 2022.
Correction Notice: CY 2022 OPPS and ASC PPS Final Rule
On January 13, CMS published a Correction Notice in the Federal Register regarding corrections to typos and technical errors from the CY 2022 OPPS and ASC PPS Final Rule. Corrections affect an incorrect wage index assignment for CMHCs resulting in an inaccurate payment impact estimate, incorrect APC assignments for certain CPT codes, errors in the “Drugs and Biologicals with Pass-Through Payment Status Expiring after CY 2022” table (Table 39), and more.
Effective date: Effective January 13, 2022
Applicability date: The corrections in this correcting document are applicable beginning January 1, 2022.
CY 2022 Telehealth Update Medicare Physician Fee Schedule
On January 14, CMS published One-Time Notification Transmittal 11175 regarding updates to telehealth services for 2022. There are two additional modifiers (FQ and FR) as well as a handful of coding changes and reminders about the use of Place of Service codes 02 and 10.
Effective date: January 1, 2022
Implementation date: April 4, 2022
Clinical Laboratory Fee Schedule - Medicare Travel Allowance Fees for Collection of Specimens
On January 14, CMS published Medicare Claims Processing Transmittal 11184 regarding the CY 2022 changes to the travel allowance amount for HCPCS codes P9603 and P9604.
Effective date: January 1, 2022
Implementation date: February 2, 2022
April 2022 Update to the MS-DRG Grouper and MCE Version 39.1 for the ICD-10 Diagnosis Codes for COVID-19 Vaccination Status and ICD-10 PCS Codes for Introduction or Infusion of Therapeutics and Vaccines for COVID-19 Treatment
On January 14, CMS published Medicare Claims Processing Transmittal 11174 regarding implementation of new ICD-10 codes to the MS-DRG Grouper and MCE to reflect new codes for COVID-19 vaccination status and codes for the introduction or infusion of therapeutics (including vaccines) for COVID-19 treatments. The update also adds an MCE edit for “unspecified” ICD-10-CM diagnosis codes where there are other diagnosis codes available in that diagnosis code subcategory that further specify anatomic site.
Effective date: April 1, 2022
Implementation date: April 4, 2022
Internet-Only Manual (IOM) Updates for Critical Care, Split/Shared Evaluation and Management Services, Teaching Physicians, and Physician Assistants
On January 14, CMS published Medicare Claims Processing Transmittal 11181 and Medicare Benefit Policy Transmittal 11181 regarding changes to the Claims Processing Manual and Benefit Policy Manual to reorganize information and manualize updates to policies for critical care services, split/shared evaluation and management services, teaching physicians, and physician assistants as finalized in the CY 2022 Medicare Physician Fee Schedule Final Rule.
Effective date: January 1, 2022
Implementation date: February 15, 2022
New Waived Tests
On January 14, CMS published Medicare Claims Processing Transmittal 11188 regarding new CLIA-waived tests. There are 13 new tests included in this update.
Effective date: April 1, 2022
Implementation date: April 4, 2022
Renewal of COVID-19 PHE
On January 14, ASPR published a Notice announcing that the COVID-19 PHE has been extended effective January 16, 2022. This will extend the PHE and all applicable waivers tied to it for an additional 90 days.
Comment Request: Bid Pricing Tool (BPT) for Medicare Advantage (MA) Plans and Prescription Drug Plans (PDP)
On January 14, CMS published a Comment Request in the Federal Register regarding the submission of an information collection titled, “Bid Pricing Tool (BPT) for Medicare Advantage (MA) Plans and Prescription Drug Plans (PDP)” for OMB review.
Comments are due to the OMB desk officer by February 14, 2022.
Comment Request: Model Medicare Advantage and Medicare Prescription Drug Plan Individual Enrollment Request
On January 14, CMS published a Comment Request in the Federal Register regarding an information collection titled “Model Medicare Advantage and Medicare Prescription Drug Plan Individual Enrollment Request.”
Comments are due by March 14, 2022.