This week in Medicare—2/21/2024
Activation of Validation Edits for Providers with Multiple Service Locations
On February 5, CMS revised Special Edition MLN Matters 19007 regarding systematic validation edits for OPPS providers with multiple service locations. CMS added new information about how to handle certain off-campus provider-based departments excepted from Section 603 payment policy.
Correction Notice: CY 2024 MPFS Final Rule
On February 12, CMS published a Correction Notice in the Federal Register regarding corrections to the CY 2024 Medicare Physician Fee Schedule (MPFS) Final Rule, which was published in the Federal Register on November 16, 2023. Corrections include inadvertently omitted services from the Telehealth Services list, code descriptors that had not been updated properly, typos in Quality Payment Program tables, and more.
This correcting document is effective February 12 and is applicable beginning January 1, 2024.
Medicare Generally Paid for E/M Services Provided via Telehealth During the First 9 Months of the COVID-19 Public Health Emergency That Met Medicare Requirements
On February 14, the OIG published a Report on Medicare payment for E/M services furnished via telehealth during the first nine months of the COVID-19 public health emergency (PHE). The OIG conducted this audit in response to the significant increase in E/M telehealth visits during the pandemic. The audit covered over $1.3 billion in Medicare Part B payments to providers for E/M services that were billed with CPT codes 99201-99205 and 99211-99215, as well as either place of service code 02 or modifier 95, G0, GQ, or GT.
Only five of the 110 sampled claims did not comply with Medicare requirements, resulting in $446 in improper Medicare payments. The OIG did not include any recommendations in the report because the five noncompliant claims were primarily caused by clerical errors or the inability to access records.
CMS Issues Part Two of Draft Guidance on New Medicare Prescription Payment Plan
On February 15, CMS published a Press Release to announce the release of Draft Guidance on the new Medicare Prescription Payment Plan, a provision of the Inflation Reduction Act that will allow people with Medicare prescription drug coverage the option to pay out-of-pocket costs in monthly payments. This is the second part of draft guidance released, and it focuses on outreach and education for Part D plan sponsors and CMS for the program. The first part of the guidance was released in August 2023.
CMS published a Fact Sheet on the guidance on the same date. Comments on the draft guidance are due by March 16.
Updated OIG Work Plan
On February 15, the OIG updated its Work Plan with the following new items:
- National Background Check Program for Long-Term Care Providers: A Final Assessment
- Comparisons of Average Sales Prices to Widely Available Market Prices for the Fourth Quarter 2023
Appropriate Use Criteria for Advanced Diagnostic Imaging Policy Update in the Calendar Year (CY) 2024 Physician Fee Schedule Final Rule
On February 15, CMS published One-Time Notification Transmittal 12508 regarding policy updates for the Appropriate Use Criteria for Advanced Diagnostic Imaging (AUC) program in the CY 2024 Physician Fee Schedule final rule. The transmittal instructs MACs and Shared System Maintainers to remove and archive system edits related to the AUC program, as the program is paused indefinitely for reevaluation.
Effective January 1, 2024, providers and suppliers should no longer include consultation information (codes G1000-G1024, modifiers MA-MH, modifier QQ) on Medicare fee-for-service claims. CMS plans to terminate these codes and modifiers after December 31, 2024. Claims for advanced diagnostic imaging services containing AUC G codes and modifiers should be processed as usual through CY 2024. For claims with dates of service on or after January 1, 2025, contractors are to remove all national and local edits related to the AUC program.
Effective date: January 1, 2024
Implementation date: January 3, 2025
Updating Chapter 3, Sections 200.5 - 200.8, Limitation on Recoupment; Medicare Overpayments Manual
On February 15, CMS published Medicare Financial Management Transmittal 12509 to update sections 200.5 – 200.8 of the Medicare Financial Management Manual. The transmittal discusses various provisions regarding limitations on recoupment for overpayments.
CMS published MLN Matters 11808 to accompany the transmittal.
Effective date: July 1, 2024 - HIGLAS SYSTEM CHANGES
Implementation date: July 1, 2024 - Same as the effective date
Documentation Requirements for Refillable Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)
On February 15, CMS published Medicare Program Integrity Transmittal 12512, which rescinds and replaces Medicare Program Integrity Transmittal 12468, dated January 18, to add BR 13480.5. CMS clarified that while the transmittal reiterates the regulatory framework for refillable DMEPOS, it does not mandate review of any particular policy or items.
The original transmittal was issued to implement documentation requirements for refillable DMEPOS in the 2024 Home Health Prospective Payment System final rule.
Effective date: January 1, 2024
Implementation date: February 19, 2024
Manual Updates to Chapters 1 and 17 of the Medicare Claims Processing Manual to Reflect Policies Finalized in the Calendar Year (CY) 2024 Physician Fee Schedule Final Rule
On February 15, CMS published Medicare Claims Processing Transmittal 12511 regarding revisions to Chapters 1 and 17 of the Medicare Claims Processing Manual that reflect policy changes in the CY 2024 Physician Fee Schedule final rule. Revisions include a new section on payment rules for rebatable drugs, updated reporting requirements for modifiers JW and JZ, and more.
Effective date: January 1, 2024
Implementation date: March 18, 2024
Medicare Preventive Services Educational Tool Updates
On February 15, CMS updated the Medicare Preventive Services MLN Educational Tool to revise information pertaining to annual wellness visits, colorectal cancer screenings, diabetes screening and self-management, flu shots, medical nutrition therapy, and more.
Report to Congress on the Reported Impact of Discarded-Drug Refunds on Biosimilar Biological Products
On February 16, the OIG published a Report to Congress regarding the impact of discarded-drug refunds on the licensure, market entry, market retention, or marketing of biosimilar biological products. The OIG conducted this audit only a few months after CMS began requiring manufacturers to provide discarded-drug refunds, so the report is solely based on consultations with CMS, the Food and Drug Administration, selected biosimilar drug manufacturers, and a relevant trade association.
The OIG concluded that the refunds have no known or expected impacts on the aforementioned factors for biosimilar biological products.