This week in Medicare—6/12/2024
Spring 2024 Semiannual Report to Congress
On June 3, the OIG published the Spring 2024 Semiannual Report to Congress. This report details the OIG’s work from October 1, 2023 – March 31, 2024, and it highlights over $2.76 billion in expected recoveries from OIG audits and investigations. The report was also restructured into a new format which the OIG said is more concise and focused while also aligning OIG activities with the top OIG management and performance challenges.
The OIG published a Press Release announcing the report on the same date.
Third Quarter NCCI Edit Files
On June 3, CMS posted the NCCI third quarter edit files for the Procedure-to-Procedure Edits, Medically Unlikely Edits, and Add-On Code Edits.
These are effective July 1.
Correction Notice: FY 2025 IPPS Proposed Rule
On June 4, CMS published a Correction Notice in the Federal Register regarding the FY 2025 IPPS Proposed Rule, which corrects typos and technical errors throughout the rule. These include typos in the tables identifying files used by applicants for new technology add-on payments, obsolete references regarding direct graduate medical education, and more.
July 2024 Quarterly ASP Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
On June 4, CMS published Medicare Claims Processing Transmittal 12670, which rescinds and replaces Transmittal 12547, dated March 14, to revise business requirements 13560.1.1, 13560.1.1.1, 13560.1.1.5, 13560.1.2, 13560.1.2.1, 13560.1.2.3, 13560.1.3, 13560.1.3.1, 13560.1.3.3, 13560.1.4, 13560.1.4.1, 13560.1.4.3, 13560.1.5, 13560.1.5.1, 13560.1.5.3 and 13560.3. This correction also removes business requirements 13560.1.1.2, 13560.1.2.2, 13560.1.3.2, 13560.1.4.2 and 13560.1.5.2 and adds business requirements 13560.6.15 and 13560.7.
The original transmittal was published regarding the quarterly updates to the ASP and Not Otherwise Classified drug pricing filed for Part B drugs.
Effective date: July 1, 2024
Implementation date: July 1, 2024
Billing and Payment for Telehealth Services with Place of Service (POS) 10
On June 6, CMS published Medicare Claims Processing Transmittal 12671 to notify the MACs that claims for covered telehealth services using POS 10 when the patient is located in their home (if payable by Medicare) should be paid at the Physician Fee Schedule non-facility rate. The transmittal revises the references in the manual to the code to implement this change.
Effective date: January 1, 2024
Implementation date: July 8, 2024
Billing and Payment for Telehealth Services with Place of Service (POS) 10
On June 6, CMS published One-Time Notification Transmittal 12672 regarding instructions for claims processing for replacement power or manual wheelchairs when the manufacturer either is no longer in business and thus the wheelchair no longer exists on the market or when there’s no availability for aftermarket repair or replacement parts to make the manufacturer’s equipment operable.
Effective date: July 8, 2024
Implementation date: July 8, 2024
October 2024 Quarterly Update to HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement
On June 6, CMS published Medicare Claims Processing Transmittal 12674 regarding updates to the lists of HCPCS codes subject to the CB provision in the SNF PPS.
CMS published MLN Matters 13661 on the same date to accompany the transmittal.
Effective date: October 1, 2024
Implementation date: October 7, 2024
Revisions to the State Operations Manual (SOM) Appendix M - Hospice
On June 7, CMS published State Operations Provider Certification Transmittal 222 regarding revisions to the manual to implement provisions related to the establishment of marriage and family counselors as interdisciplinary providers.
Effective date: June 7, 2024
Implementation date: June 7, 2024
Revisions to the State Operations Manual (SOM) Appendix G - RHC
On June 7, CMS published State Operations Provider Certification Transmittal 223 regarding revisions to the manual to implement provisions of the CY 2024 Physician Fee Schedule final rule. This affects language about what meets the definition for a nurse practitioner, certified nurse midwife, clinical psychologist, clinical social worker, and more.
Effective date: June 7, 2024
Implementation date: June 7, 2024