This week in Medicare updates—5/2/2018
Update to RAC review of Periodic Interim Payment Providers
On April 20, CMS posted an Update to its Recovery Audit Program Recent Updates page to communicate that Medicare fee-for-service RACs are approved by CMS to review Periodic Interim Payment (PIP) Providers under CMS New Issue #0001 MS-DRG Validation. Facilities receiving PIPs will receive additional documentation requests (ADR) within six months of the date of service for claims under review.
Feedback on New Direction Request for Information (RFI) Released, CMS Innovation Center’s Market-Driven Reforms to Focus on Patient-Centered Care
On April 23, CMS issued a Press Release regarding the release of comments submitted in response to the CMS Innovation Center’s New Direction RFI from last fall. CMS collected over 1,000 responses to this RFI, and the agency said it will use these comments to inform and drive its initiatives to improve the quality of healthcare while reducing unnecessary cost. CMS is sharing this feedback publicly to promote transparency and facilitate further discussion. As one of the first initiatives developed from this feedback, CMS said it will develop a potential model for direct provider contracting. The comment files, while very large, are available for download through the Innovation Center website.
Proposed Rule: FY 2019 Inpatient Prospective Payment System
On April 24, CMS published a display copy of the 2019 Inpatient Prospective Payment System proposed rule, which will appear in the Federal Register on May 7. Among the many policies in the rule, CMS is proposing an overhaul of the Meaningful Use program, significant reductions to reporting requirements for quality initiatives, and a possible method of reimbursing providers for chimeric antigen receptor T-cell (CAR-T) therapy. CMS proposes reducing the number of Meaningful Measures by removing a total of 19 measures from the five hospital quality and value-based purchasing programs and de-duplicating another 21 measures. The rule also contains a proposal which aims to increase transparency by requiring hospitals to post a list of their standard charges online.
The rule proposes increasing the operating payment rate for acute care hospitals who successfully participate in the Hospital Inpatient Quality Reporting Program and EHR incentive program by 1.75%. It projects that the IPPS operating payments will increase by approximately 2.1%. CMS is also proposing to increase uncompensated care payments by $1.5 billion.
CMS is specifically requesting information on certain aspects of the rule, including any suggestions for how CMS can revise the Conditions of Participation related to interoperability, information on barriers preventing providers from being transparent with their patients about out-of-pocket costs, and feedback on quality measures for CMS to adopt or discard.
The rule initiates a 60-day public comment period which will end on June 25. CMS also published a Press Release and a Fact Sheet about the proposed rule.
2018 Registration Guide for the CMS Web Interface & CAHPS for MIPS Survey
On April 25, CMS posted a Booklet regarding registration for the CMS Web Interface and CAHPS for MIPS Survey process for the 2018 performance year of the Merit-based Incentive Payment System (MIPS). The booklet provides information on who needs to register and how to register for participation in MIPS using the CMS Web Interface and how to administer the CAHPS for MIPS survey. There are step-by-step instructions on these processes and instructions for modifying information and canceling registration for both of these elements of the MIPS program.
An Introduction to Group Participation in the Merit-based Incentive Payment System in 2018
On April 25, CMS posted Slides for a presentation on the general requirements and processes for participating in MIPS in 2018 as a group. The slides include an overview of group participation in MIPS, information on MIPS milestones, a guide to registration in MIPS, details on data submission, a list of resources for participants, and a glossary.
CMS Administrator Verma Unveils New Strategy to Fuel Data-Driven Patient Care, Transparency
On April 26, CMS issued a Press Release to announce the new Data Driven Patient Care Strategy as part of the MyHealthEData initiative. The strategy has three priorities: putting patients first, making more data available, and taking an application programming interface (API)-approach to exchanging data with CMS partners to improve healthcare for all beneficiaries. As part of this strategy, CMS will be releasing 2015 Medicare Advantage Encounter Data to researchers for the first time.
CMS also released a Fact Sheet on this initiative and posted a Transcript of CMS Administrator Seema Verma’s speech regarding this initiative at the Health Datapalooza on the same date.
Comment Request: Skilled Nursing Facility and Skilled Nursing Facility Cost Report
On April 26, CMS published a Comment Request in the Federal Register regarding the information collection titled, “Skilled Nursing Facility and Skilled Nursing Facility Cost Report.” Comments are due by June 25, 2018.
Proper Use of the KX Modifier for Part B Immunosuppressive Drug Claims — Reminder
On April 26, CMS posted a Reminder in the MLN Connects newsletter regarding clarifications on the use of the -KX modifier when billing for immunosuppressive drugs. CMS also provided a list of resources to help further clarify proper use of the -KX modifier.
Extension of the Payment Adjustment for Low-Volume Hospitals and the Medicare-Dependent Hospital (MDH) Program Under the Hospital IPPS for Acute Care Hospitals for Fiscal Year 2018
On April 26, CMS published an Extension of a Payment Adjustment and a Program in the Federal Register regarding changes to the payment adjustment for low-volume hospitals and to the MDH program under the IPPS for FY 2018 in accordance with the Bipartisan Budget Act of 2018. The provisions in the document are applicable for discharges on or after October 1, 2017 and on or before September 30, 2018.
Effective date: The extensions are effective April 24, 2018.
Comment Request: Medicare Credit Balance Reporting Requirements
On April 27, CMS published a Comment Request in the Federal Register regarding an information collection titled “Medicare Credit Balance Reporting Requirements.” Comments on the information collection are due by June 26, 2018.
Quarterly Update for the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DME) Competitive Bidding Program (CBP) - July 2018
On April 27, CMS published Medicare Claims Processing Transmittal 4036 regarding the July quarterly update of the DME CBP files to implement necessary changes to HCPCS codes, ZIP codes, the single payment amount, and supplier files.
Effective date: July 1, 2018
Implementation date: July 2, 2018
Removal of KH Modifier from Capped Rental Claims
On April 27, CMS published Medicare Claims Processing Transmittal 4037 to update the ViPS Medicare System edits to remove the requirement to append the KH rental modifier on purchased capped rental durable medical equipment or parenteral/enteral items and services.
Effective date: October 1, 2018
Implementation date: October 1, 2018
Modifying FISS Part B Claims Overlap Edits
On April 27, CMS published One-Time Notification Transmittal 2074 to modify FISS Part B claims overlap edits related to outpatient Type of Bill (TOB) 13x overlapping TOB 12x and 85x overlapping other 85x repetitive services.
Effective date: October 1, 2018 - for claims received on or after October 1, 2018
Implementation date: October 1, 2018
Revision to the Skilled Nursing Facility (SNF) Pricer to Support Value-Based Purchasing (VBP)
On April 27, CMS published Medicare Claims Processing Transmittal 4040 to revise the record layout for the SNF Pricer interface to support Value-Based Purchasing. This change is being made to enable the Pricer to accept the necessary adjustment factor needed to apply the SNF VBP adjustment and capture the adjusted amount on the claim record.
Effective date: October 1, 2018
Implementation date: October 1, 2018
Comprehensive ESRD Care (CEC) Model Telehealth - Implementation
On April 27, CMS published Demonstrations Transmittal 196 regarding the implementation of the CEC Model, which is designed to identify, test, and evaluate new ways to improve care for Medicare beneficiaries with End-Stage Renal Disease.
Effective date: October 1, 2018
Implementation date: October 1, 2018
Phase 4 - Updating the Fiscal Intermediary Shared System (FISS) to Make Payment for Drugs and Biologicals Services for OPPS Providers
On April 27, CMS published One-Time Notification Transmittal 2071 to make a system change within the FISS and I/OCE necessary to make payment for drugs and biologicals to OPPS providers.
Effective date: January 1, 2016
Implementation date: October 1, 2018
Restoring Section 3.2.3 B. and Section 3.2.3 C. to Chapter 3 of Publication 100-08 in the Internet Only Manual (IOM)
On April 27, CMS published Medicare Program Integrity Transmittal 791 to add two sections back into the Medicare Program Integrity Manual after they were erroneously omitted from the IOM in CR 9809.
Effective date: May 29, 2018
Implementation date: May 29, 2018
Revisions to the Telehealth Billing Requirements for Distant Site Services
On April 27, CMS published One-Time Notification Transmittal 4026 to implement a requirement instructing providers to only use the GT modifier on institutional claims billed under CAH Method II.
CMS published MLN Matters 10583 on the same date to accompany the transmittal.
Inexpensive or Routinely Purchased Durable Medical Equipment (DME) Payment Classification for Speech Generating Devices (SGD) and Accessories
On April 27, CMS published Medicare Claims Processing Transmittal 4027 to ensure that the use of SGDs and accessories essential for SGDs will continue to be classified under the inexpensive or routinely purchased DME payment category.
Effective date: October 1, 2018
Implementation date: October 1, 2018
Update to the Hospital Transfer Policy for Early Discharges to Hospice Care
On April 27, CMS published One-Time Notification Transmittal 2055 to update the transfer policy for hospice care in accordance with the Bipartisan Budget Act of 2018’s modification to the law requiring that, beginning in FY 2019, discharges to hospice care will also qualify as a post-acute care transfer and will be subject to payment adjustments.
Effective date: October 1, 2018
Implementation date: October 1, 2018