This week in Medicare updates–3/8/2017
Comment Request: Home Health Agency Survey and Deficiencies Report; Medicare Prior Authorization of Power Mobility Devices Demonstration; and more
On February 27, CMS published a Comment Request in the Federal Register regarding the following information collections:
- Final Peer Review Organizations Sanction Regulations in 42 CFR Sections 1004.40, 1004.50, 1004.60, and 1004.70
- Home Health Agency Survey and Deficiencies Report
- Certification Statement for Electronic File Interchange Organizations
- Security Consent and Surrogate Authorization Form
- Medicare Prior Authorization of Power Mobility Devices Demonstration
- Registration, Attestation, Dispute & Resolution, Assumptions Document and Data Retention Requirements for Open Payments
National Coverage Analysis (NCA) for Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) (CAG-00449N)
On March 2, CMS posted a Proposed Decision Memorandum regarding its consideration for SET for PAD. CMS proposes that the evidence is sufficient to cover SET for beneficiaries with intermittent claudication (IC) for the treatment of symptomatic PAD. Beneficiaries must have a face-to-face visit with the physician responsible for PAD treatment to obtain the referral for SET. At this visit, the beneficiary must receive information regarding cardiovascular disease and PAD risk factor reduction, which could include education, counseling, behavioral interventions, and outcome assessments.
Payment for Oxygen Volume Adjustments and Portable Oxygen Equipment
On March 3, CMS posted Transmittal 3730, which rescinds and replaces Transmittal 3679, dated December 16, 2016, to add BR.9848.10. CMS also released MLN Matters 9848. The transmittal updates Chapter 20, Section 130.6 of the Medicare Claims Processing Manual to provide additional instructions in processing claims for oxygen and oxygen equipment.
Effective date: April 1, 2017
Implementation date: April 3, 2017
April Quarterly Update for 2017 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule
On March 3, CMS posted Transmittal 3729 and MLN Matters 9988 with the latest DMEPOS fee schedule quarterly update to implement fee schedule amounts for new codes and correct any fee schedule amounts for existing codes. The quarterly update process for the DMEPOS fee schedule is located in Pub. 100-04, Medicare Claims Processing Manual, chapter 23, section 60.
Effective date: April 1, 2017
Implementation date: April 3, 2017
April 2017 Update of the Hospital Outpatient Prospective Payment System (OPPS)
On March 3, CMS posted Transmittal 3728, which describes changes to and billing instructions for various payment policies implemented in the April 2017 OPPS update. The April 2017 Integrated Outpatient Code Editor (I/OCE) will reflect the HCPCS, Ambulatory Payment Classification (APC), HCPCS Modifier, and Revenue Code additions, changes, and deletions identified.
Effective date: April 1, 2017
Implementation date: April 3, 2017
April 2017 Update of the Ambulatory Surgical Center (ASC) Payment System
On March 3, CMS posted Transmittal 3726 and MLN Matters 9998, which describe changes to and billing instructions for various payment policies implemented in the April 2017 ASC payment system update. As appropriate, this notification also includes HCPCS updates.
Effective date: April 1, 2017
Implementation date: April 3, 2017
Gender Dysphoria and Gender Reassignment Surgery
On March 3, CMS posted Transmittal 194 and MLN Matters 9981 to inform contractors that coverage determinations for gender reassignment surgery will continue to be made by the local Medicare Administrative Contractors (MAC) on a case-by-case basis. On August 30, 2016, CMS issued a final decision memorandum on gender reassignment surgery for gender dysphoria. The DM did not create or change existing policy, and CMS did not issue a national coverage determination (NCD).
Effective date: August 30, 2016
Implementation date: April 4, 2017
Affordable Care Act Bundled Payments for Care Improvement Initiative - Recurring File Updates Models 2 and 4 July 2017 Updates
On March 3, CMS posted Transmittal 170 to update the participating hospital files, episodes, and prospective bundled payment amounts associated with the Bundled Payments for Care Improvement initiative, Model 2 and Model 4.
Effective date: July 1, 2017
Implementation date: July 3, 2017
Provider Reimbursement Manual Part 2, Provider Cost Reporting Forms and Instructions, Chapter 29, Form CMS-222-92
On March 3, CMS posted Transmittal 14 and Form CMS-222-92. Transmittal 14 rescinds and replaces Transmittal 13, dated February 17, 2017. CMS posted the new transmittal to change the effective date from “cost reporting periods ending on or after September 30, 2016,” to “cost reporting periods ending on or after December 31, 2016.” The only other change in this transmittal is the Julian date for the ECR specification date on page 29-504, which has changed from 2016274 to 2016366.
Effective date: On or after December 31, 2016