This week in Medicare updates–10/4/17
Information to be Posted on SNF Electronic Staffing Payroll-Based Reporting
On September 25, CMS posted a Memorandum regarding Payroll-Based Journal public use files, which will be accessible at https://data.cms.gov on November 1, 2017. The Nursing Home Compare website indicates whether providers have submitted data by the required deadline, and if providers have submitted complete, incomplete, or inaccurate data. Providers will now be able to link employee IDs for an employee that has changed employee IDs within a facility.
Process for Hospices to Submit a List of Claims Requiring Adjustments
On September 26, CMS published Special Edition MLN Matters 17029 addressing Medicare’s higher payment rate for hospice services at the routine home care (RHC) level of care for the first 60 days of service and payment of service intensity add-on (SIA) amounts at the end of life. Some claims involving RHC and SIA payments have been paid incorrectly. Hospices should submit adjustments on an individual basis to correct these errors.
Replaced Transmittal Revises Condition and Occurrence Code for Notice of Election Electronic Reporting
On September 26, CMS published Medicare Claims Processing Manual Transmittal 3866, which rescinds and replaces Transmittal 3813, dated July 27, 2017, to revise condition and occurrence codes in the manual.
Effective date: January 1, 2018 - Transactions received on or after January 1, 2018
Implementation date: January 2, 2018
Portable X-Ray Clarification - Patient Specific Reason for Portable X-Ray
On September 26, the OIG published a Report regarding Integrated Health Administrative Services, Inc.,in Mamaroneck, New York, which did not comply with certain Medicare Part B requirements for 21 of the 112 claims sampled by the OIG. The OIG estimates that Integrated improperly claimed at least $914,109 in Medicare reimbursement for unallowable portable x-ray services.
As part of their report, the OIG found a generic statement for each patient signed by the ordering practitioner regarding the need for a portable x-ray rather than the patient visiting a diagnostic service location. The OIG clarified with CMS representatives that the reason for a portable x-ray should be patient specific, but the OIG acknowledged this requirement was not clear and was not a basis of denials in this report. Providers of portable x-rays should be aware of this clarification and ensure a patient specific reason for traveling to the patient’s location is provided by the ordering practitioner.
Civil Monetary Penalties Settlement - Lab Test Cups Resulted in Remuneration and Prohibited Referrals
On September 28, the OIG published information on a settlement with Parallax Center, Inc., in New York, New York, which entered into a $64,203.30 settlement agreement with OIG. The OIG alleged that Parallax received improper remuneration from Millennium Health, LLC, in the form of point of care test cups, which resulted in prohibited referrals. The OIG further alleged that the referrals were prohibited because the remuneration created a financial relationship and that Parallax caused Millennium to present claims for designated health services that resulted from the prohibited referrals.
Advisory Panel on Hospital Outpatient Payment Recommendations
On September 28, CMS posted recommendations made by the advisory panel on hospital outpatient payment recommendations from the panel’s August 21, 2017, meeting. The panel made recommendations on the outpatient prospective payment system (OPPS) payment for drug-coated balloon angioplasty procedures, allogeneic hematopoietic stem cell transplantation, OPPS payment for drugs acquired under the 340B Program, packaging of drug administration services, and more.
Replaced Transmittal Corrects New Waived Test CPT Code
On September 28, CMS published Medicare Claims Processing Manual Transmittal 3867, which rescinds and replaces Transmittal 3812, dated July 27, 2017, to change a CPT code in the attachment from 83518QW to 82044QW. CMS also revised MLN Matters 10198 accordingly.
Effective date: October 1, 2017
Implementation date: October 2, 2017
Cost Reporting Clarifications Regarding Charity and Bad Debt
On September 29, CMS published Medicare Provider Reimbursement Manual Transmittal 11, Provider Cost Reporting Forms and Instructions, Chapter 40, Form CMS-2552-10 forms and instructions. The transmittal clarifies the definitions and instructions for uncompensated care, non-Medicare bad debt, non-reimbursed Medicare bad debt, and charity care to include uninsured discounts, as well as modifies the calculation relative to uncompensated care costs.
Effective date: Cost reporting periods beginning on or after October 1, 2013
Updates to Medicare’s Cost Report Worksheet S-10 to Capture Uncompensated Care Data
On September 29, CMS published Special Edition MLN Matters 17031 to provide guidance to 1886(d) hospitals by summarizing revisions and clarifications to the instructions for the Worksheet S-10 of the Medicare cost report.
Medicare Appeals; Adjustment to the Amount in Controversy Threshold Amounts for Calendar Year 2018
On September 29, CMS published a Notice in the Federal Register announcing the annual adjustment to the amount in controversy (AIC) threshold amounts for Administrative Law Judge (ALJ) hearings and judicial review under the Medicare appeals process. The new threshold amounts are effective for requests for ALJ hearings and judicial review filed on or after January 1, 2018. The calendar year 2018 threshold amounts are $160 for ALJ hearings and $1,600 for judicial review.
2018 Annual Update for the Health Professional Shortage Area (HPSA) Bonus Payments
On September 29, CMS published Medicare Claims Processing Manual Transmittal 3870 to provide files for the automated payments of HPSA bonuses for dates of service January 1, 2018 through December 31, 2018.
Effective date: January 1, 2018
Implementation date: January 2, 2018