This week in Medicare—5/22/2024
Updated OIG Work Plan
On May 15, the OIG updated its Work Plan with the following new item:
Making Care Primary (MCP) Model Implementation
On May 15, CMS published Demonstrations Transmittal 12643, which rescinds and replaces Transmittal 12567, dated April 5, to add BR 13392.99, delete BR 13392.45, and edit BRs 13392.14, 13392.12.1.1, 13392.2.1, 13392.18, 13392.19, and 13382.2.6.
The original transmittal was published to implement the MCP Model.
Effective date: July 1, 2024
Implementation date: April 1, 2024 - Analysis, Design and Coding; July 1, 2024 – Complete Coding, Testing, and Implementation; October 7, 2024 - Implementation of BR 13392.12.4 for CWF only.
Revisions to Chapter 12 (The Comprehensive Error Rate Testing (CERT) Program) of Publication (Pub.) 100-08 (Medicare Program Integrity Manual) and Deletions to Exhibit 34 in the Exhibits Chapter of Pub. 100-08
On May 16, CMS published Medicare Program Integrity Transmittal 12642 regarding revisions to sections 12.5, 12.6, 12.7, and 12.10.2 in Chapter 12 of the Medicare Program Integrity Manual.
The key revisions include the following:
- Changing the payment adjustment completion date for all CERT identified overpayments and underpayments
- Clarifying language for how CERT handles appealed claims that have been dismissed or cancelled
- Changing the deliverable schedule for Annual Certification of CERT information.
- Clarifying that error code 99 (no response) will be assigned after 60 days when no documentation has been received beginning in report year 2026
Effective date: June 17, 2024
Implementation date: June 17, 2024
Twelfth General Update to Provider Enrollment Instructions in Chapter 10 of CMS Publication (Pub.) 100-08
On May 16, CMS published Medicare Program Integrity Transmittal 12639 regarding the twelfth general update to enrollment policies in Chapter 10 of the Medicare Program integrity Manual. The transmittal clarifies several provider enrollment topics, including certified provider/supplier enrollment, reassignments, and model letters.
Effective date: June 17, 2024
Implementation date: June 17, 2024
Update to Pub. 100-04 Medicare Claims Processing Manual, Chapter 23, Section 60.3 Gap-filling Durable Medical Equipment Prosthetics Orthotics Supplies (DMEPOS) Fees
On May 16, CMS published Medicare Claims Processing Transmittal 12645 to update the gap-filling DMEPOS fees to include update factors for gap-filling purposes.
CMS published MLN Matters 13617 on the same date to accompany the transmittal.
Effective date: June 17, 2024
Implementation date: June 17, 2024
Guiding an Improved Dementia Experience (GUIDE) Model Implementation
On May 17, CMS published Demonstrations Transmittal 12647, which rescinds and replaces Transmittal 12563, dated April 1, to revise BRs 13412.7.1.1, 13412.30. 13412.2.1, 144.12.6.1, and 13412.7. The transmittal also revises background and policy sections updating the cadence of CSRS files from monthly to bi-weekly.
CMS specialty/operations contractor shall deliver the provider participant and beneficiary alignment production files on or about July 19, 2024.
The original transmittal was issued to implement the GUIDE Model, a demonstration testing alternative payment models and support for people with dementia and their caregivers.
Effective date: April 1, 2024 - Analysis, Design and Coding; July 1, 2024 - Testing and Implementation
Implementation date: April 1, 2024 - Analysis, Design and Coding; July 1, 2024 - Completion of Coding, Testing and Implementation