This week in Medicare updates–05/04/2016
Provider Reimbursement Manual, Part 2, Provider Cost Reporting Forms and Instructions, Chapter 44, Form CMS-224-14
On April 22, CMS released a transmittal regarding Chapter 44, Federally Qualified Health Center (FQHC) Cost Report, Form CMS-224-14, which implements the Patient Protection and Affordable Care Act, section 10501(i)(3)(A), establishing a PPS for cost reporting periods beginning on or after October 1, 2014. These new instructions and forms must be filed by freestanding FQHCs and FQHCs previously reported as part of a SNF complex or home health agency complex. FQHCs that are part of a hospital healthcare complex must use the Form CMS-2552-10.
Effective date for new material: October 1, 2014
View Transmittal R1P244.
Indian Health Services (IHS) hospital payment rates for calendar year 2016
On April 22, CMS released the annual update of IHS payment rates for calendar year 2016. The attached recurring update notification applies to Chapter 19, Medicare Claims Processing Manual, section 100.3.4, 100.4.2, and 100.5.
Effective date: January 1, 2016
Implementation date: May 23, 2016
View Transmittal R3495CP.
Chapter 4, Medicare Managed Care Manual, Benefits and Beneficiary Protections
On April 22, CMS released a transmittal updating Chapter 4 of Medicare Managed Care Manual to reflect clarifications and to provide more robust guidance (most of which was previously issued via Health Plan Management System memos and in the CY 2016 and CY 2017 Call Letters). This update moved three sections to different chapters as part of Medicare Drug and Health Plan Contract Administration Group reorganization of the Medicare Managed Care Manual overall. In addition, Chapter 4 was updated to meet the most up-to-date CMS writing guidelines, such as changing the words "Chapter" and "Section" to the more appropriate lowercase versions, "chapter" and "section." Red italics indicate differences between the current version and the previous version.
Effective date: April 22, 2016
Implementation date: April 22, 2016
View Transmittal R121MCM.
Medicare policy clarified for prolonged drug and biological infusions started incident to a physician's service using an external pump
On April 25, CMS released a special edition MLN Matters article regarding how drugs and biologicals not usually self-administered should be billed to Medicare if they are furnished "incident to" a physician's services rendered to patients while in the physician’s office or the hospital outpatient department. It is intended for all physicians and hospital outpatient departments submitting claims to MACs for prolonged drug and biological infusions started incident to a physician's service using an external pump. Note that this article does not apply to suppliers’ claims submitted to DME MACs.
View MLN Matters SE1609.
Rescission and replacement of transmittal regarding reclassification of certain DME HCPCS codes in competitive bidding programs (CBP)
On April 26, CMS rescinded Transmittal 1638, dated March 23, and replaced it with Transmittal 1644 to omit the Medicare Summary Notices in business requirement 8822.1.1.2 and to renumber the Provider Education Table business requirement. The original change request provided instructions of the upcoming reclassification of certain DME HCPCS codes included in the Round 2 and Round 1 Recompete DMEPOS CBPs from the inexpensive and routinely purchased DME payment category to the capped rental DME payment category.
Effective date: July 1, 2016
Implementation date: July 5, 2016, for VMS, CWF and DME MACs; October 3, 2016, for FISS, A/B MACs and HHH MACs
View Transmittal R1644OTN.
Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) discusses treatment resistant depression (TRD)
On April 26, CMS posted materials for the MEDCAC panel meeting, scheduled to take place on April 27. The purpose of this meeting is to obtain the MEDCAC's recommendations regarding the definition of TRD in clinical research as well as advise CMS on the use of the definition of TRD in the context of coverage with evidence development and treatment outcomes. MEDCAC panels do not make coverage determinations, but may advise CMS how to use evidence as the basis for any future coverage decisions.
View the materials for the meeting.
Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the physician fee schedule, and criteria for physician-focused payment models
On April 27, CMS released a proposed rule repealing Medicare sustainable growth rate methodology and outlining its specific plans for a new physician payment system, following the trend to increase value-based payments and unifying its varied quality, value, and EHR programs. MIPS will be measured across four performance categories. Not all providers would be required to follow MIPS. CMS proposes providers who participate in Advanced APMs be exempt from MIPS and also qualify for a 5% Part B incentive payment.
View the proposed rule.
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New quality measures on Nursing Home Compare
On April 27, CMS added six new quality measures to the Nursing Home Compare website as part of an initiative to broaden the quality information available on that site. For the first time, CMS is including quality measures that are not based solely on data that are self-reported by nursing homes. These new measures, which are based primarily on Medicare claims data submitted by hospitals, measure the rate of rehospitalization, emergency room use, and community discharge among nursing home residents.
View the fact sheet.
View the press release.
Visit the Nursing Home Compare website.
Making principal diagnosis codes mandatory for Notice of Election (NOE) to be accepted
On April 28, CMS released a change request that will prevent NOEs from being accepted without a principal diagnosis in accordance with the Medicare Claims Processing Manual.
There is currently no edit in FI Shared Systems to prevent NOEs from being accepted without a principal diagnosis.
Effective date: January 1, 2016
Implementation date: October 3, 2016
View Transmittal R3502CP.
Billing of vaccine services on hospice claims
On April 28, CMS released a change request making changes to Original Medicare systems and providing billing instructions to allow hospices to submit institutional claims for vaccine services.
Effective date: October 1, 2016
Implementation date: October 3, 2016
View Transmittal R3503CP.
Medicare coverage of substance abuse services
On April 28, CMS released a special edition MLN Matters article, which summarizes the available substance abuse-related services and provides reference links to other online Medicare information with further details about these services.
View MLN Matters SE1604.
Florida physical therapy practice claimed unallowable Medicare Part B reimbursement for some outpatient therapy services
On April 28, the OIG posted a report stating that a Florida physical therapy practice located in Vero Beach, Florida, properly claimed Medicare reimbursement on 86 of 100 beneficiary claim days sampled. However, the practice improperly claimed Medicare reimbursement on the remaining 14 beneficiary claim days. These deficiencies occurred because the practice did not have adequate policies and procedures in place to ensure that it billed for services that complied with Medicare requirements. On the basis of the sample results, the OIG estimated that the practice improperly received at least $52,000 in Medicare reimbursement for outpatient physical therapy services that did not comply with certain Medicare requirements for calendar years 2012 and 2013.
View the report.
Enhanced enrollment screening of Medicare providers: Early implementation results
On April 28, the OIG posted a report detailing a study in which it obtained data from CMS on enrollment and revalidation applications submitted for the one-year period before the implementation of enhanced screening procedures, March 25, 2010, through March 24, 2011, and the one-year period after the implementation of enhanced screening procedures, March 25, 2012, through March 24, 2013. For the latter period, the OIG reviewed detailed results of 16,022 site visits conducted by CMS's National Site Visit Contractor. In addition, it examined CMS' and its contractors' policies and procedures for enrollment, and surveyed or interviewed CMS and contractor staff involved in the enrollment process.
View the report.
CMS awards contracts for the DME Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program Round 2 Recompete and National Mail-Order Recompete
On April 28, CMS announced the Round 2 Recompete and national mail-order recompete contract suppliers for Medicare’s DMEPOS Competitive Bidding Program. This program has been in effect since 2011 and is an essential tool to help Medicare set appropriate payment rates for DMEPOS items, save money for beneficiaries and taxpayers, and ensure access to quality items.
View the fact sheet.
Proposed collection; comment request
On April 29, CMS posted a notice in the Federal Register stating that it is accepting comments on: CMS–10286, Notice of Research Exception Under the Genetic Information Nondiscrimination Act; CMS–10488, Consumer Experience Survey Data Collection. Comments are due June 28.
View the notice in the Federal Register.
Leave a comment.
Submission for OMB Review; comment request
On April 29, CMS posted a notice in the Federal Register stating that it is accepting comments on: CMS–10406, Probable Fraud Measurement Pilot; CMS–10572, Information Collection for Transparency in Coverage Reporting by Qualified Health Plan Issuers; and, CMS–P-0015A, Medicare Current Beneficiary Survey. Comments are due May 31.
View the notice in the Federal Register.
Leave a comment.
Approval of the Institute for Medical Quality's Ambulatory Surgical Center (ASC) Accreditation Program
On April 29, CMS posted a final notice in the Federal Register announcing its decision to approve the Institute for Medical Quality as a national accrediting organization for ASCs that wish to participate in the Medicare or Medicaid programs. An ASC that participates in Medicaid must also meet the Medicare conditions for coverage as required under our regulations. This final notice is effective April 29 through April 29, 2020.
View the notice in the Federal Register.