This week in Medicare—7/24/2024
2025 ICD-10-CM
On July 9, CMS published the 2025 ICD-10-CM files to its website, including POA exempt codes, the conversion table, addendums, coding guidelines, and more.
These codes will be used for discharges occurring from October 1, 2024, through September 30, 2025.
Updated OIG Work Plan
On July 15, the OIG updated its Work Plan with the following new items:
- Medicare Payments for Clinical Diagnostic Laboratory Tests in 2023
- Follow-up Review of DMEPOS Provided by Suppliers During Inpatient Stays
Medicare Prescription Payment Plan Final Part Two Guidance
On July 16, CMS published a Memorandum to announce the Medicare Prescription Payment Plan: Final Part Two Guidance, which primarily addresses Part D enrollee education, outreach, and communications related to the Medicare Prescription Payment Plan.
CMS changed a few of the policies in the final version from the proposals included in the draft guidance, which was released in February. The changes include allowing Part D sponsors to develop their own methodology for identifying Part D enrollees likely to benefit from the program throughout the plan year, clarifying how Part D plans that exclusively charge $0 cost sharing for covered Part D drugs to all plan enrollees can offer that option, and modifying a requirement about how Part D sponsors will send program election request forms.
CMS published a Fact Sheet, Press Release, and updated program Timeline on the same date.
Changing the Frequency of No-Pay Medicare Summary Notice (MSN) Mailings from Every 90 Days to Every 120 Days
On July 16, CMS published Medicare Claims Processing Transmittal 12718, which rescinds and replaces Transmittal 12664, dated May 31, to add the VMS maintainer as the responsible party to business requirement 13627.7 and to add provider education to this CR. The provider education will be published through the MLN Connects newsletter.
The original transmittal was issued to change the frequency of MSN mailings from every 90 days to every 120 days.
Effective date: October 1, 2024
Implementation date: October 7, 2024
Thirteenth General Update to Provider Enrollment Instructions in Chapter 10 of Medicare Program Integrity Manual
On July 18, CMS published Medicare Program Integrity Transmittal 12717 regarding updates to several enrollment topics in the manual. These include denials and revocations, deactivations, reassignment of benefits, ownership, model letters, and more. There are 112 pages of manual text included with the transmittal, and changes are noted in red where applicable.
Effective date: August 19, 2024
Implementation date: August 19, 2024
Quarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment
On July 18, CMS published Medicare Claims Processing Transmittal 12721 regarding the quarterly updates to the CLFS. The update includes new codes, deleted codes, and a reminder about the delayed CLFS data reporting period for clinical diagnostic laboratory tests that are not advanced diagnostic laboratory tests.
CMS published MLN Matters 13717 on the same date to accompany the transmittal.
Effective date: October 1, 2024
Implementation date: October 7, 2024
Revisions to Home Health Edit Matching Claims to Notices of Admission (NOA)
On July 18, CMS published One-Time Notification Transmittal 12723 regarding an issue with claims related to reason code 19963 where the claim from and claim through dates may inadvertently cause the NOA to get purged from the systems and the claim would be returned in error. This transmittal implements a process to ensure home health claims submitted more than 24 months from the date of admission are not returned in error.
Effective date: January 1, 2025 – Claims received on or after this date
Implementation date: January 6, 2025
Implementation of CWF Edits to Prevent Duplicate Payments for Compression Bandaging Systems
On July 18, CMS published One-Time Notification Transmittal 12725 regarding the implementation of editing to deny lymphedema compression treatment bandaging HCPCS Level II A codes when there is a duplicative payment made for the same date of service for a claim containing CPT codes 29581 or 29584 for a beneficiary with a diagnosis of lymphedema.
CMS revised MLN Matters 13286, originally published on January 24 alongside a previous CR, to add in this implementation information.
Effective date: January 1, 2025
Implementation date: January 6, 2025
Update to the Patient-Driven Payment Model (PDPM) Claim Editing
On July 18, CMS published One-Time Notification Transmittal 12726, which rescinds and replaces Transmittal 12714, dated July 11, to revise the effective and implementation dates to split this CR with the October 2024 release so FISS can begin work on this CR in the October release.
The original transmittal was issued regarding an update to the current claims processing edit to allow for the subsequent claim submission containing the same admission date when the prior claim was processed as a no pay claim.
Effective date: October 1, 2024; January 1, 2025
Implementation date: October 7, 2024 – Analysis, Design, and Coding; January 6, 2025 – Testing and Implementation