This week in Medicare—9/27/2023
Marriage and Family Therapists (MFT) and Mental Health Counselors (MHC) Provider Enrollment FAQ
On September 13, CMS published an FAQ regarding enrollment procedures for MHCs and MFTs in light of proposals in the CY 2024 Medicare Physician Fee Schedule Proposed Rule that would expand coverage of services provided by MHCs/MFTs and provide payment under Part B for these services. While the proposals have yet to be finalized, the FAQ may be helpful for providers who wish to enroll in time to bill for services starting January 1, 2024. CMS said it would update the FAQ after the publication of the CY 2024 Medicare Physician Fee Schedule Final Rule should any changes be made to the proposed policies.
Checking Medicare Eligibility
On September 18, CMS revised an MLN Fact Sheet regarding how to check Medicare eligibility. It updated a section to add new eligibility services and added information about business associates under billing agencies, clearinghouses, or other software vendors.
New Place of Service (POS) Code 27 - “Outreach Site/Street”
On September 20, CMS published Medicare Claims Processing Transmittal 12254, which rescinds and replaces Transmittal 12202, dated August 10, to revise the original Place of Service 27 instructions to align with broader CMS efforts to address economic, social, and other obstacles impacting Medicare beneficiary healthcare access by revising the IOM as well as the policy section and business requirement 13314.2 and removing business requirement 13314.2.1. The original transmittal was published regarding the creation of a new POS code 27 for “Outreach Site/Street.”
Effective date: October 1, 2023
Implementation date: January 2, 2024
Updates to Nursing Home Care Compare Staffing and Quality Measures
On September 20, CMS published a Memorandum to state survey agency directors regarding updates to staffing and quality measures used on Nursing Home Care Compare to accommodate changes to the Minimum Data Set (MDS). CMS is also changing a penalty for providers who fail to submit staffing data or submit erroneous data will receive the lowest score possible for corresponding staff turnover measures. The memo also notes CMS is discontinuing the CMS-672 form since the data used to populate the form is being eliminated. Dates for all of these changes are included in the memo.
Effective date: Immediately.
Influenza Vaccine Payment Allowances - Annual Update for 2023-2024 Season
On September 20, CMS published Medicare Claims Processing Transmittal 12256, which rescinds and replaces Transmittal 12211, dated August 17, to add information regarding the ASP file and process for vaccine fees by deleting business requirement 13317.1 and adding business requirements 13317.4 through 13317.7. The original transmittal was published regarding the annual update to payment allowances for the influenza vaccine. Part B payment for the vaccine is based on 95% of the average wholesale price (AWP) except when furnished in hospital outpatient departments, rural health clinics, or federally qualified health centers, where payment is based on reasonable cost.
Effective date: August 1, 2023
Implementation date: October 2, 2023 - No later than September 30, 2023; November 1, 2023 - Business Requirement 3.1
Psychotherapy for Crisis Webpage
On September 20, CMS published a new Web Page regarding coverage of psychotherapy for crisis situations. The page discusses what is covered, who can furnish this service, how to bill, and more.
Reinforcement of Interpretive Guidance for Nurse Midwives
On September 21, CMS published a Memorandum to state survey agency directors regarding guidance for hospitals stating that nurse midwives may admit and provide care to non-Medicare beneficiaries without the oversight of an MD or DO. This is prohibited for Medicare beneficiaries under requirements at §482.12(c)(1), (2), and (4). The memo also discusses CAH requirements for physician review and signature of records or patients cared for by nurse practitioners, clinical nurse specialists, certified nurse midwives, or physician assistants. CMS does not have the authority to remove that requirement for inpatients at a CAH because it is a statutory requirement, and it does not have authority over that requirement for outpatients at a CAH because that is a matter governed by state law.
Effective date: Immediately.
January 2024 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
On September 21, CMS published Medicare Claims Processing Transmittal 12258 regarding information for the contractors on how to obtain and install the January 2024 quarterly ASP and Part B drug pricing files.
Effective date: January 1, 2024
Implementation date: January 2, 2024
Instructions for Retrieving the January 2024 Opioid Treatment Program (OTP) Payment Rates Through the CMS Mainframe Telecommunications System
On September 21, CMS published Medicare Claims Processing Transmittal 12259 regarding instructions to the contractors on downloading and implementing the annual OTP update file. The contractors will also need to be prepared to implement up to three revised OTP payment files in case of any errors or corrections.
Effective date: January 1, 2024
Implementation date: January 2, 2024
2024 Annual Update for the Health Professional Shortage Area (HPSA) Bonus Payments
On September 21, CMS published Medicare Claims Processing Transmittal 12260 regarding instructions for obtaining the files for the automated payments of HPSA bonuses for 2024.
Effective date: January 1, 2024
Implementation date: January 2, 2024
Updated ICD-10-CM FY 2024 Conversion Table
On September 21, the CDC published an updated Download Link for the ICD-10-CM FY 2024 Conversion Table, which is effective on October 1, 2023.