This week in Medicare updates–8/16/2017
Update to Hospice Payment Rates, Hospice Cap, Hospice Wage Index and Hospice Pricer for FY 2018
On August 4, CMS published CMS Medicare Claims Processing Manual Transmittal 3828, which updates the hospice payment rates, wage index, and Pricer for FY 2018. It also updates the hospice cap amount for the year ending October 31, 2017.
This transmittal was initially classified as sensitive; it was reclassified, re-communicated, and posted on the Internet on August 11.
Effective date: October 1, 2017
Implementation dates: October 2, 2017
Notification of Final Rule Published-- Survey Team Composition and Investigation of Complaints
On August 4, CMS issued a memorandum to State Survey Agency Directors regarding Survey Team Composition and investigation of complaints. This memorandum is to make State Survey Agency Directors aware that the final rule for the Prospective Payment - System and Consolidated Billing for Skilled Nursing Facilities (SNF) for FY 2018, SNF Value Based Purchasing Program, SNF Quality Reporting Program, Survey Team Composition, and Correction of the Performance Period for the NHSN HCP Influenza Vaccination Immunization Reporting Measure in the ESRD QIP for PY 2020 was issued in the Federal Register on July 31, 2017.
The regulations discussed are effective October 1, 2017.
Financial Year (FY) 2018 Inpatient Psychiatric Facilities Prospective Payment System Update
On August 7, CMS published Notice with Comment Period in the Federal Register announcing an upcoming update to the prospective payment rates for Medicare inpatient hospital services provided by inpatient psychiatric facilities (IPFs), including freestanding IPFs and psychiatric units of an acute care hospital or critical access hospital.
Comments are due by October 6.
These changes are applicable to IPF discharges beginning October 1, 2017 through September 30, 2018.
Updated Provider Self-Disclosure Settlements
On August 7, the OIG published information on several new Provider Self-Disclosure Settlements, including:
- UMC Physicians of Texas agreed to pay $3,364,079 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that UMCP improperly filed claims with Federal healthcare programs for: (1) evaluation and management services; and (2) Doppler and Ultrasound testing services that were upcoded, not rendered, or otherwise not supported by the record
- Volunteer Medical Services Corps of Lansdale (VMSCL), Pennsylvania, agreed to pay $26,795.70 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that VMSCL staffed its ambulance transport services with an individual who had not maintained registrations of his Emergency Medical Technician certification with the appropriate state authority and then submitted claims and received payment from Federal healthcare programs for those transport services. VMSCL self-disclosed its conduct to OIG.
- Arvada, Colorado Fire Protection District (AFPD), Colorado, agreed to pay $30,494.36 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that AFPD staffed its ambulance transport services with two individuals whose paramedic certifications were expired and then submitted claims and received payment from Federal healthcare programs for these improperly staffed ambulance transport services. AFPD self-disclosed its conduct to OIG.
- Calvert Physical Therapy and Sports Fitness Center (Calvert), Maryland, agreed to pay $368,740.59 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Calvert submitted claims to Medicare, Medicaid and TRICARE for therapeutic services that required direct one-to-one patient contact when the physical therapist was treating more than one patient at the same time, and submitted claims to Medicare for patient re-evaluations when the physical therapist was recertifying Medicare patients' existing plans of care. OIG further alleged that Calvert improperly submitted claims to Medicare, Medicaid, and TRICARE for physical therapy services that failed to meet documentation requirements for time spent with patients and modalities used to treat patients. Calvert self-disclosed its conduct to OIG.
Updated List of Excluded Individuals and Entities (LEIE)
On August 7, the OIG updated its LEIE. Along with issuing a new downloadable database, OIG also offered a list of Exclusions, Reinstatements, a Monthly Supplemental Archive, and Profile Corrections.
Video-- Eye on Oversight: The Importance of OIG Audits
On August 7, the OIG released a new educational video about the independence of OIG audits. The video features Deputy Inspector General Gloria Jarmon and highlights her work to save lives and protect critical HHS programs.
Revisions to the Home Health Pricer to Support Value-Based Purchasing and Payment Standardization
On August 7, CMS published MLN Matters MM10167 to supplement Medicare Claims Processing Manual Transmittal 3829, published on August 4. The transmittal revises the record layout for the home health Pricer interface to support new payment and data initiatives, and add consistency editing to ensure the accurate reporting of site of service G-codes on home health visit line items.
Effective date: January 1, 2018
Implementation dates: January 2, 2018
Next Generation Accountable Care Organization (NGACO) Year Three Benefit Enhancements
On August 7, CMS published MLN Matters 10044 , to supplement Demonstrations Transmittal 177, issued August 4. The Transmittal and MLN Matters are about CMS’ Next Generation ACO model, which CMS says is aimed at improving the quality of care, population health outcomes, and patient experience for Medicare beneficiaries using fee-for-service.
Effective date: January 1, 2018
Implementation dates: January 2, 2018
Provider-Based (PB) Determination
On August 7, CMS published MLN Matters MM10095 to supplement CMS Manual System Transmittal 1891, which was published on August 4. The MLN Matters and Transmittal are to advise Medicare Administrative Contractors (MACs) to use the electronic PB checklist to perform uniform reviews of PB applications.
Effective date: November 6, 2017
Implementation dates: November 6, 2017
October Quarterly Update to 2017 Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement
On August 7, CMS published MLN Matters MM10163, to supplement Medicare Claims Processing Transmittal 3825. The MLN Matters provides additional information regarding updates to the lists of HCPCS codes that are subject to the consolidated billing provision of the SNF Prospective Payment System (PPS).
Effective date: October 1, 2017
Implementation dates: October 2, 2017
Hospice Request for Certification and Supporting Regulations
On August 8, CMS published a Notice in the Federal Register about a data collection and solicitation regarding identification and screening forms used to initiate the certification process and to determine if a hospice provider has sufficient personnel to participate in the Medicare program. Comments are due by October 10.
Screening for Hepatitis B Virus (HBV) Infection
On August 8, CMS published a revised version of MLN Matters MM9859 to accompany Medicare Claims Processing Transmittal 3831, issued on August 4. The CR release date, transmittal numbers, and the Web address of the CR are revised. Also, a clarification was made on page 3 to denote that HBV is not separately payable for ESRD TOB 72X unless reported with modifier AY. Another bullet point was added on page 3 to show that contractor pricing applies to G0499 with dates of service September 28, 2016 through December 31, 2017. All other information is unchanged.
Effective date: September 28, 2016
Implementation dates: October 2, 2017 - Analysis and Design
January 2, 2018- Testing and implementation
Financial Year (FY) 2018 Inpatient Psychiatric Facilities Prospective Payment System Update
On August 8, CMS published MLN Matters 10214 to accompany Medicare Claims Processing Transmittal 3826 , released August 4. The MLN Matters further explains coming updates to the 2018 Inpatient Psychiatric Facilities Prospective Payment System Update.
Effective Date: October 1, 2017
Implementation Date: October 2, 2018
Fiscal Year (FY) 2017 Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) PPS Changes
On August 9, CMS published CMS Medicare Claims Processing Manual Transmittal 3832, which rescinds and replaces Transmittal 3626 from October 19, 2016. This change order revises the out migration values for an attachment in the original transmittal.
CMS also published MLN Matters MM9723 on August 9 to supplement this transmittal.
Effective date: October 1, 2016
Implementation dates: October 3, 2016
Quarterly Influenza Virus Vaccine Code Update - January 2018
On August 9, CMS published an updated version of MLN Matters MM10196, supplementing Medicare Claims Processing Transmittal 3827. This article was revised on August 9, 2017, to correctly show in all appropriate places the code of Q2039. In the original article, Q0239 was mistakenly referenced in two places and that is corrected to show Q2039. All other information remains the same.
Effective date: August 1, 2017
Implementation dates: January 2, 2018
Implementation of the Transitional Drug Add-On Payment Adjustment
On August 9, CMS published MLN Matters MM10065, supplementing CMS Manual System Transmittal 1889, which implemented the Transitional Drug Add-on Payment Adjustment. It is a designation process for determining when a drug is no longer an oral-only drug; and including new injectable and intravenous products into the End Stage Renal Disease Prospective Payment System (ESRD PPS). Under the drug designation process, CMS provides payment using a Transitional Drug Add-on Payment Adjustment (TDAPA) for new injectable or intravenous drugs and biologicals that qualify.
Effective date: January 1, 2018
Implementation dates: January 2, 2018
ICD-10 Coding Revisions to National Coverage Determinations (NCD)
On August 9, CMS issued MLN Matters MM10184, which supplements One Time Notification Transmittal1875. Published July 27, Transmittal 1875 announced a maintenance update to the ICD-10 conversions and other coding updates specific to NCD. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received.
Edits to ICD-10 and other coding updates specific to NCDs will be included in subsequent quarterly releases and individual CRs as appropriate. No policy-related changes are included with the ICD-10 quarterly updates. The transmittal indicates that policy-related changes to NCDs continue to be implemented via the current NCD process.
Effective date: January 1, 2018
Implementation date: September 13, 2017- from Issuance for Local Edits;
January 2, 2018 - Shared System Maintainers
ICD-10-CM Official Guidelines for Coding and Reporting
On August 10, CMS and the National Center for Health Statistics (NCHS) published new guidelines for coding and reporting using the ICD-10 for fiscal year (FY) 2018. This release replaces the FY 2017 ICD-10-CM release.
New Corporate Integrity Agreements
On August 10, the OIG published information on a new Corporate Integrity Agreements with The Medical Center of Central Georgia, Inc., of Macon, GA. The agreement is effective August 2.
New Civil Monetary Penalties and Affirmative Exclusions
On August 10, the OIG published information on a new Civil Monetary Penalties and Affirmative Exclusion.
Jahan Imani, M.D., of Intermountain Medical Management, P.C. (IMM), a pain management specialist based in Utah, entered into a $399,895.92 settlement agreement with OIG, for allegedly inappropriately using modifier 59 or multiple units of HCPCS code G0431 when only a single unit may be billed per patient encounter.
Quarterly Update to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS)
On August 11, CMS published CMS Medicare Claims Processing Manual Transmittal 3833, a recurring update notification updating the consolidated billing list under the ESRD PPS.
Effective date: October 1, 2017
Implementation dates: October 2, 2017
Credentials of Reviewers
On August 11, CMS published Medicare Program Integrity Transmittal 737, instructing Medicare Administrative Contractors (MAC), Comprehensive Error Rate Testing (CERT), Medicare Recovery Audit Contractors (MRAC), and Zone Program Integrity Contractors (ZPIC) to ensure that complex reviews for the purpose of making coverage determinations are performed by Registered Nurses (RNs), therapists or physicians.
Effective date: September 12, 2017
Implementation dates: September 12, 2017