This week in Medicare updates–5/31/2017
Psychiatric Residential Treatment Facilities (PRTF) Frequently Asked Questions (FAQs)
On May 12, CMS published a Memorandum in response to questions received from PRTF basic surveyor training class attendees regarding survey expectations in applying the PRTF Condition of Participation (CoP) and regulatory requirements. Responses to FAQs are intended to support surveyor consistency.
Report: Medicare Could Save Millions by Eliminating the Lump-Sum Purchase Option for All Power Mobility Devices
On May 22, the OIG published a Report regarding Medicare’s lump-sum purchase option for all power mobility devices. The OIG recommends that CMS seek legislation to eliminate the lump-sum payment option for all PMDs, requiring suppliers to provide these devices on a monthly rental basis.
New Corporate Integrity Agreements
On May 24, the OIG published two new corporate integrity agreements with the following providers:
- James M. Crumb, MD, and Mobility Metabolism and Wellness, PC of Mobile, AL
- Mercy Hospital Springfield, Mercy Clinic Springfield Communities, and MHM Support Services of St. Louis, MO
Instructions to Process Services Not Authorized by the Veterans Administration (VA) in a Non-VA Facility Reported With Value Code (VC) 42
On May 24, CMS published Transmittal 3779, which rescinds and replaces Transmittal 3718, dated February 14, 2017, to correct a misinterpretation of the changes made with CR8198, Updating the Shared Systems and Common Working File (CWF) to no Longer Create Veteran Affairs (VA) “I” records in the Medicare Secondary Payer (MSP) Auxiliary File. This transmittal clarifies how Medicare contractors will process inpatient claims for services in a Non-VA facility that were not authorized by the VA. CMS also revised MLN Matters 9818 accordingly.
Effective date: October 1, 2013
Implementation date: April 3, 2017
Screening for the Human Immunodeficiency Virus (HIV) Infection
On May 24, CMS published Transmittal 3778, which rescinds and replaces Transmittal 3766, dated May 5, 2017, to update the description of the HCPCS codes in BR 9980.1.
Effective date: April 13, 2015
Implementation date: October 2, 2017
Required Workaround for Hospices Submitting Routine Home Care and Service Intensity Add-On (SIA) Payments at the End of Life
On May 24, CMS published Special Edition MLN Matters article 17014 to correct two errors found in the January 1, 2016 hospice payment revisions that could result in overpayments. It also provides hospices with a workaround to deploy when submitting certain claims to ensure proper payment.
Effective date: August 21, 2017
Implementation date: August 21, 2017
MEDCAC Meeting - Health Outcomes in Heart Failure Treatment Technology Studies
On May 25, 201, CMS posted minutes and a transcript from the March 22 MEDCAC Meeting examining what health outcomes in studies for heart failure treatment technologies should be of interest to CMS.
National Coverage Analysis (NCA) for Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD)
On May 25, CMS posted a Decision Memorandum regarding SET for Symptomatic PAD (CAG-00449N). CMS determined that the evidence is sufficient to cover SET for beneficiaries with intermittent claudication (IC) for the treatment of symptomatic PAD. Up to 36 sessions over a 12 week period are covered if all components of a SET program are met. Medicare Administrative Contractors (MAC) have the discretion to cover SET beyond 36 sessions over 12 weeks and may cover an additional 36 sessions over an extended period of time. A second referral is required for these additional sessions.
Update to Reporting Requirements for Appeals received by Medicare Administrative Contractors (MAC)
On May 25, CMS published Transmittal 719 to to revise the reporting requirements in sections 15.25.1.2 and 15.27.4 in Chapter 15 of the Medicare Program Integrity Manual, Pub. 100-08. This updates the reporting requirements for appeal cases received by the MACs in order to gain a better understanding of the numbers of cases and types of cases being appealed.
Effective date: June 27, 2017
Implementation date: June 27, 2017
Announcement of the Advisory Panel on Hospital Outpatient Payment Meeting
On May 25, CMS published a Notice in the Federal Register regarding the next Advisory Panel on Hospital
Outpatient Payment Meeting, which will be held August 21–22, 2017. CMS considers the advice of the panel as it prepares the proposed and final rules to update the Hospital Outpatient Prospective Payment System (OPPS) for the following calendar year.
Report: Minnesota Disbursed Only Part of Its Civil Money Penalty (CMP) Collections, Limiting Resources To Protect and Improve Care for Nursing Facility Residents
On May 26, the OIG released a Report on CMP collections received by the Minnesota Department of Human Services ($592,000). However, the state reimbursed nursing facilities only about 20% of the amount collected for expenditures incurred during the same time period. The OIG identified claims of $5,000 for nursing facility staff wages and supplies that were already supported by other funding sources.
Affordable Care Act Bundled Payments for Care Improvement Initiative - Recurring File Updates Models 2 and 4 October 2017 Updates
On May 26, CMS published Transmittal 104 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: October 1, 2017
Implementation date: October 2, 2017
ICD-10 Coding Revisions to National Coverage Determinations
On May 26, CMS published Transmittal 1854 regarding a maintenance update of ICD-10 conversions and other coding updates specific to national coverage determinations (NCD). These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received.
Effective date: October 1, 2017, unless otherwise noted
Implementation dates: 45 days from issuance - local system edits; October 2, 2017 - shared system edits
Percutaneous Image-guided Lumbar Decompression (PILD) for Lumbar Spinal Stenosis (LSS)
On May 26, CMS published Transmittal 196 and Transmittal 3787 to notify contractors that effective for dates of service on or after December 7, 2016, Medicare will cover PILD under Coverage with Evidence Development (CED) for beneficiaries with LSS who are enrolled in a CMS-approved prospective longitudinal study.
Effective date: December 7, 2016
Implementation date: June 27, 2017
Claim Status Category and Claim Status Codes Update
On May 26, CMS published Transmittal 3782 to update, as needed, the Claim Status and Claim Status Category Codes used for the Accredited Standards Committee (ASC) X12 276/277 Health Care Claim Status Request and Response and ASC X12 277 Health Care Claim Acknowledgment transactions.
Effective date: October 1, 2017
Implementation date: October 2, 2017
July 2017 Update of the Hospital Outpatient Prospective Payment System (OPPS)
On May 26, CMS published Transmittal 3783 regarding changes to and billing instructions for various payment policies implemented in the July 2017 OPPS update. The July 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 in the transmittal.
Effective date: July 1, 2017
Implementation date: July 3, 2017
Instructions for Downloading the Medicare ZIP Code File for October Files
On May 26, CMS published Transmittal 3784 to describe the process for updating the two Medicare ZIP Code files (ZIP5 and ZIP9) for the October 2017 quarter. The transmittal also describes the revision to and the process for downloading the Calendar Year-End ZIP Code files.
Effective date: October 1, 2017
Implementation date: October 2, 2017
Clarifying Date and Timing Requirements for Certain Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS)
On May 26, CMS published Transmittal 722 to clarify the instructions for conducting medical reviews of written orders provided for certain items of DMEPOS, as outlined in 42 CFR 410.38(g). The transmittal updates chapter 5 of the Medicare Program Integrity Manual, Pub. 100-08, which outlines the timing requirements for face-to-face encounters and written orders prior to delivery.
Effective date: June 27, 2017
Implementation date: June 27, 2017