This week in Medicare updates—5/22/2019
Educational Resources to Assist Chiropractors with Medicare Billing
On May 7, CMS published revised versions of Special Edition MLN Matters 1601, 1602, and 1603 to update sources of information regarding chiropractic services with additional references added to the Additional Information sections of the articles. CMS also deleted several resource references that are no longer available. The original articles were from a series of special edition articles for chiropractors originally published in response to a 2015 Special Open Door Forum call on improving documentation of chiropractic services. SE 1601 pertains to medical record documentation requirements for initial and subsequent visits. SE 1602 pertains to use of the -AT modifier for chiropractic billing, and SE 1603 contains a list of educational and informational resources to help chiropractors avoid common billing errors.
Comment Request: National Implementation of the In-Center Hemodialysis CAHPS Survey; Summary of Benefits and Coverage and Uniform Glossary
On May 13, CMS published a Comment Request in the Federal Register regarding the following information collections:
- National Implementation of the In-Center Hemodialysis CAHPS Survey
- Summary of Benefits and Coverage and Uniform Glossary
Comments on the information collections are due by July 12, 2019.
New CWF Edit for Part A Outpatient Medicare Advantage (MA), Health Maintenance Organization (HMO)
On May 15, CMS published One-Time Notification Transmittal 2308, which rescinds and replaces Transmittal 2211, dated December 13, 2018, to add BR 10813.7 and revise BR 10813.2. The original transmittal was issued to implement an edit that would prevent the systems from improperly paying Part A Outpatient MA and HMO claims.
Effective date: January 1, 2019
Implementation date: January 7, 2019
Final Rule: Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses
On May 16, CMS published a draft version of a Final Rule regarding Medicare Advantage and Part D drug pricing. The rule codifies existing policy that does not allow Part D sponsors to impose prior authorization and step therapy requirements for beneficiaries initiating therapy for antiretrovirals. It also finalized a statutory requirement that will prevent Part D sponsors from stopping or penalizing a pharmacy from telling enrollees about lower prices for obtaining a drug or biological.
The rule did not finalize a proposal which would have allowed Part D sponsors to exclude protected class drugs from the formulary if the price of the drug increased beyond a certain threshold or if the drug was merely a new formulation of an existing single-source drug or biological. It also did not implement a policy for 2020 that would re-define negotiated price as the baseline or lowest possible payment to a pharmacy.
CMS published a Fact Sheet and Press Release on the final rule on the same date. The majority of the provisions within the rule (with the exception of specific sections listed within the rule) are effective January 1, 2020.
Implementation of the Medicare Performance Adjustment (MPA) for the Maryland Total Cost of Care (MD TCOC) Model
On May 16, CMS published Medicare Claims Processing Transmittal 4308, which rescinds and replaces Transmittal 4257, dated March 14, 2019, to add a note to business requirements 10971.4 and 10971.9, and to show the correct chapter of Subsection 190 on the transmittal. The original transmittal was issued regarding the implementation of adjusted payment amounts for hospital claims in Maryland as part of the MD TCOC Model.
Effective date: July 1, 2019
Implementation date: July 1, 2019 - Coding and Implementation
Delay in Final Chimeric Antigen Receptor (CAR) T-cell Therapy National Coverage Determination
On May 17, CMS published a Press Release to announce the NCD for CAR T-cell therapy is delayed and will not be published as originally scheduled on May 17. However, a CMS spokesperson said a decision on a coverage policy is still forthcoming.
Quarterly HCPCS Drug/Biological Code Changes - July 2019 Update
On May 17, CMS published Medicare Claims Processing Transmittal 4306 regarding the quarterly updates to the HCPCS code set. The July updates include 10 new drug codes, one discontinuation, and one modification.
Effective date: July 1, 2019
Implementation date: July 1, 2019
Claim Status Category and Claim Status Codes Update
On May 17, CMS published Medicare Claims Processing Transmittal 4304 regarding the updates to claim status and claim status category codes in compliance with HIPAA regulations.
Effective date: October 1, 2019
Implementation date: October 7, 2019
Update the ICD-10 2020 Tables in the Common Working File (CWF) for Purposes of Processing Non-Group Health Plan (NGHP) Medicare Secondary Payer (MSP) Records and Claims
On May 17, CMS published Medicare Secondary Payer Transmittal 126 regarding instructions for the CWF to upload and implement the ICD-10 tables in the CWF for NGHP MSP claims transactions so they are ready for the October 2019 release.
Effective date: October 1, 2019
Implementation date: October 7, 2019
Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update
On May 17, CMS published Medicare Claims Processing Transmittal 4303 regarding updates to RARC and CARC lists and the MREP and PC Print with the most recent code lists and deactivation dates.
Effective date: October 1, 2019
Implementation date: October 7, 2019
Update to Publication 100-06 to Provide Language-Only Changes for the New Medicare Card Project
On May 17, CMS published Medicare Financial Management Transmittal 315 regarding changes to the manual to update language related to the new Medicare cards.
Effective date: June 18, 2019
Implementation date: June 18, 2019
Update to Publication 100-01 to Provide Language-Only Changes for the New Medicare Card Project
On May 17, CMS published Medicare General Information, Eligibility, and Entitlement Transmittal 124 regarding changes to the manual to update language related to the new Medicare cards.
Effective date: June 18, 2019
Implementation date: June 18, 2019
Update to Publication 100-14 to Provide Language-Only Changes for the New Medicare Card Project
On May 17, CMS published Medicare End Stage Renal Disease (ESRD) Network Organizations Transmittal 10 regarding changes to the manual to update language related to the new Medicare cards.
Effective date: June 18, 2019
Implementation date: June 18, 2019