This week in Medicare updates—2/2/2022
Vaccination Expectations for Surveyors Performing Federal Oversight
On January 25, CMS published a Memorandum to state survey agency directors regarding vaccination requirements for surveyors. CMS is expanding on the exclusionary criteria for all surveyors entering provider and supplier locations to include vaccination status. Unvaccinated personnel should not participate as part of an onsite survey team, although they may be used for offsite survey or enforcement activities. However, certified providers and suppliers are not allowed to ask surveyors for proof of vaccination status as a precondition for entry.
Effective date: Within 30 calendar days of issuance. This policy should be communicated to all survey and certification staff and managers immediately.
Medicare Shared Savings Program Continues to Grow and Deliver High-Quality, Person-Centered Care Through Accountable Care Organizations
On January 26, CMS published a Press Release regarding the annual summary of the Medicare Shared Savings Program. CMS projects that over 11 million people with Medicare will be served by Shared Savings Program ACOs in 2022, and the Shared Savings Program will have a total of 483 ACOs in 2022.
Method of Payment and Cost Settlement for Inpatient Services for Hospitals Participating in the Rural Community Hospital Demonstration
On January 27, CMS published One-Time Notification Transmittal 11243 regarding the payment methodology for Round 4 of the Rural Community Hospital Demonstration, which allows up to 30 small rural hospitals not eligible to be designated as CAHs to receive payment for Medicare inpatient services under a cost-based methodology. The transmittal also includes the list of participating hospitals, performance periods for all hospitals, the methodology for establishing enhanced interim payments and conducting final cost report settlements, and requirements for the MACs regarding collaboration with a separate audit contractor.
Effective date: May 1, 2020
Implementation date: March 29, 2022
Program Integrity Manual Updates related to Monitoring use of the NOA and Corrective Action Plans
On January 27, CMS published Medicare Program Integrity Transmittal 11218 regarding updates to the manual to remove references to RAP suppressions and revise various sections based on updates to the UPIC and I-MEDIC processes.
Effective date: February 28, 2022
Implementation date: February 28, 2022
Quarterly Update for CLFS and Laboratory Services Subject to Reasonable Charge Payment
On January 27, CMS published Medicare Claims Processing Transmittal 11221 regarding the quarterly update to the CLFS. Updates include 17 new proprietary laboratory analysis (PLA) codes effective April 1, 2022.
CMS published MLN Matters 12612 on the same date to accompany the transmittal.
Effective date: April 1, 2022
Implementation date: April 4, 2022
Updates to Medicare Benefit Policy Manual and Medicare Claims Processing Manual for Opioid Treatment Programs and New Modifier for Audio-only Services
On January 27, CMS published Medicare Claims Processing Transmittal 11219 and Medicare Benefit Policy Transmittal 11219 regarding updates to the manuals to reflect changes for OTPs made in the 2022 Medicare Physician Fee Schedule final rule which allow the use of telehealth (both audio-only and audio/visual) for counseling for this service during and after the COVID-19 PHE. OTPs should use modifier FQ for services provided using audio-only telecommunications using HCPCS code G2080, and they should use modifier 95 when reporting counseling and therapy provided using audio-video telecommunications using HCPCS code G2080.
Effective date: January 1, 2022
Implementation date: March 1, 2022
January 2021 Quarterly Update to the IPPS and Long Term Care Hospital (LTCH) FY 2021 PPS Pricers
On January 28, CMS published Medicare Claims Processing Transmittal 10543, which rescinds and replaces Transmittal 10514, dated December 11, 2020, to add business requirement 12072.4 and to add additional information in the policy section. The original transmittal was published internally regarding updates to the IPPS and LTCH Pricer software and is no longer sensitive, so therefore it is now being posted on the internet.
Effective date: October 1, 2020 - For FY 2021 Rate and Table changes; November 2, 2020 - For IPPS New COVID-19 Treatment Add-On Payment (NCTAP)
Implementation date: January 4, 2021