This week in Medicare updates – 11/15/2017
Memorandum: Revisions to State Operations Manual (SOM) Hospital Appendix A
On October 27, CMS revised a Memorandum to state survey agency directors that was originally published September 6, 2017, clarifying guidance under Appendix A of the SOM. The revisions from October 27 include a change to the Average Daily Census (ADC) timelines. Facilities that have been operating for less than 12 months at the time of the survey should calculate their ADCs by using a denominator of no less than three months even if the facility has not been operational for three months.
CMS Hospital Value-Based Purchasing (VBP) Program Results for Fiscal Year 2018
On November 3, CMS published a Fact Sheet on the VBP Program for 2018. The fact sheet provides a general overview of the program, a guide to how to compute the VBP score, and a look at new program requirements for FY 2019. Those requirements include the removal of the Patient Safety for Selected Indicators Composite (PSI 90) from the Safety domain and the addition of a risk-standardized elective primary total hip and total knee replacement complications measure to the Clinical Care domain.
Additional Hospital Appeals Settlement Process Options
On November 3, CMS updated its Hospital Appeals Settlement Process website with the announcement of an additional settlement option for providers and suppliers with appeals pending at the Office of Medicare Hearings and Appeals (OMHA) and the Medicare Appeals Council at the Departmental Appeals Board.
CMS will offer a low volume appeals settlement option to appellants with fewer than 500 Medicare Part A or Part B claim appeals and a total billed amount of $9,000 or less per appeal pending at OMHA and the Council combined as of November 3, 2017. CMS will settle eligible appeals at 62% of the net allowed amount if certain other conditions are met.
OMHA will also expand the Settlement Conference Facilitation Process for appellants deemed ineligible for the low volume option. CMS will release further details about these options in the coming weeks.
Updated Corporate Integrity Agreement Documents
On November 6, the OIG published information on new Corporate Integrity Agreements with the following organizations:
- Pacific Health Corporation; Aesculap Hospital Corporation; AMISUM Inc.; Anaheim General Hospital Corporation and Anaheim General Hospital, Ltd., d/b/a Anaheim General Hospital; Health Investment Corporation; Jupiter Bellflower Doctors Hospital, d/b/a Bellflower Medical Center; Los Angeles Doctors Hospital Corporation, d/b/a Lost Angeles Metropolitan Medical Center; Newport Specialty Hospital; of Los Angeles, California
- Bethany Lutheran Home, Inc., of Council Bluffs, Iowa
- Blackstone Medical Inc.; Orthofix International, N.V.; of Lewisville, Texas
- Hill-Rom, Inc., of Chicago, Illinois
Updated List of Excluded Individuals and Entities (LEIE)
On November 7, the OIG updated its LEIE with an updated LEIE database for download and lists of October 2017 Exclusions and Reinstatements.
Comment Request: Evaluation of the Partnership for Patients 3.0, Report of Hospital Death Associated with Restraint or Seclusion
On November 7, CMS published a Comment Request in the Federal Register regarding the following information collections:
- Evaluation of the Partnership for Patients (PfP) 3.0
- Report of a Hospital Death Associated with Restraint or Seclusion
Comments on the above information collections are due January 8. 2018.
CY 2018 Participation Enrollment and Medicare Participating Physicians and Suppliers Directory (MEDPARD) Procedures
On November 8, CMS published Medicare Claims Processing Transmittal 3917, which contains information for contractors about the CY 2018 participation enrollment effort. The following documents are attached to the transmittal:
- A participation announcement
- A blank participation agreement
The transmittal also instructs contractors to place the new fees from the Physician Fee Schedule and anesthesia conversion factors on their websites once the Physician Fee Schedule Final Rule is put on display.
Effective date: December 8, 2017
Implementation date: 30 days following the close of the annual participation enrollment process for BR 10351.18; November 8, 2017 for all other requirements
Therapy Cap Values for Calendar Year 2018
On November 9, CMS published Medicare Claims Processing Transmittal 3918, which rescinds and replaces Transmittal 3886, dated October 20, 2017, to replace the therapy cap calendar year date in the policy section. The revised transmittal also is no longer considered sensitive/controversial and may now be posted to the Internet.
Effective date: January 1, 2018
Implementation date: January 2, 2018
Update to Rural Health Clinic (RHC) All Inclusive Rate (AIR) Payment Limit for Calendar Year 2018
On November 9, CMS published Medicare Claims Processing Transmittal 3919, which rescinds and replaces Transmittal 3880, dated October 13, 2017, to include provider education on updates to the CY 2018 payment limit for RHCs. CMS also notes that the transmittal is no longer sensitive/controversial and may now be posted to the Internet.
Effective date: January 1, 2018
Implementation date: January 2, 2018
New Medicare Card: Help Notify Your Patients
On November 9, CMS published a Notice in MLN Connects regarding a process for notifying Medicare beneficiaries about the new Medicare cards. CMS is offering posters, tear-off sheets, or fliers to display in provider offices. Providers should register through the CMS website to obtain these materials.
ICD-10 and Other Coding Revisions to National Coverage Determinations (NCDs)
On November 9, CMS published One-Time Notification Transmittal 1975 regarding a maintenance update of ICD-10 conversions and other coding updates specific to NCDs, including adding and deleting certain diagnosis codes from NCDs.
Effective date: April 1, 2018 - unless otherwise noted in requirements
Implementation date: December 29, 2017 for local MAC edits; April 2, 2018 - for shared system edits (except FISS exception for requirements 1, 8, 12, 19, 21); July 2, 2018 - FISS only for requirements 1, 8, 12, 19, 21
Recovery Audit Program Review Topics
On November 9, CMS posted a List on the Provider Resources page for the Recovery Audit Program of review topics the have been proposed (but not yet approved) for Recovery Audit Contractors to review. The topics include:
- Inpatient Rehabilitation Facility Stays: Meeting Requirements to be Considered Reasonable and Necessary
- Respiratory Assistive Devices: Meeting Requirements to be Considered Reasonable and Necessary
- Excessive or Insufficient Drugs and Biological Units Billed
CMS said it will be updating the list on a monthly basis starting this month.
New Positron Emission Tomography (PET) Radiopharmaceutical/Tracer Unclassified Codes
On November 9, CMS published Medicare Claims Processing Transmittal 3911 regarding two new PET radiopharmaceutical unclassified tracer codes that were created to help alleviate inordinate spans of time between when a coverage determination is made and when it can be fully implemented. These codes can be used temporarily pending the creation of permanent CPT codes that would specifically define their function.
Effective date: January 1, 2018
Implementation date: December 11, 2017 - A/B MAC; April 2, 2018 - FISS
Partial Settlement of 2-Midnight Policy Court Cases
On November 9, CMS published One-Time Notification Transmittal 1969 to provide instructions to MACs on how to ensure hospitals receive additional payments due to a CMS settlement agreement, which is related to four court cases challenging the imposition of a 0.2% downward adjustment to the Inpatient Prospective Payment System (IPPS) beginning in FY 2014.
Due to the partial settlement agreement, certain providers listed in an attachment to the transmittal will be eligible for an interest adjustment factor applied in Pricer when determining payments for discharges occurring between June 1, 2017 to May 31, 2018.
Effective date: December 11, 2017
Implementation date: December 11, 2017
Off-Cycle Update to the Long Term Care Hospital (LTCH) Prospective Payment System (PPS) Fiscal Year 2018 Pricer
On November 9, CMS published Medicare Claims Processing Transmittal 3912, which corrects the LTCH PPS wage index values in the LTCH Price for Core-Based Statistical Areas (CBSAs) 25980 through 49740 for FY 2018.
Effective date: October 1, 2017
Implementation date: January 2, 2018
Claim Status Category and Claim Status Codes Update
On November 9, CMS published Medicare Claims Processing Transmittal 3916 to update 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 Acknowledgement transactions.
Effective date: April 1, 2018
Implementation date: April 2, 2018
Care Coordination Services and Payment for Rural Health Clinics (RHCs) and Federally Qualified Health Centers
On November 9, CMS published MLN Matters 10175 to accompany Transmittal 1899, published August 11, 2017, regarding instructions for payment to RHCs billing under the all-inclusive rate (AIR) as well as payment to Federally Qualified Health Centers billing under the prospective payment system for care coordination services for dates of service on or after January 1, 2018.
Effective date: January 1, 2018
Implementation date: January 2, 2018
Home Health Prospective Payment System (HH PPS) Rate Update for CY 2018
On November 9, CMS published MLN Matters 10310 to accompany Transmittal 3888, published October 20, 2017, regarding multiple rate updates under the HH PPS for 2018. These rate updates include:
- 60-day national episode rates
- National per-visit amounts
- Low Utilization Payment Adjustment add-on amounts
- Non-routine medical supply payment amounts
- Cost-per-unit payment amounts used for calculating outlier payments
Effective date: January 1, 2018
Implementation date: January 2, 2018