This week in Medicare updates—2/26/2020
Release of Additional Toolkits to Ensure Safety and Quality in Nursing Homes
On February 14, CMS published a Memorandum to state survey agency directors regarding the release of two new toolkits to aid nursing homes in caring for residents with dementia and to reduce common infections in nursing homes. The DREAM toolkit has a nurse handbook, leadership implementation guide, and several bedside tools to help facilities better understand the importance of high quality sleep as a way to improve the quality of life and care for residents with dementia. The H2T toolkit contains educational materials, graphics, images, and tools to help bedside staff apply practices which will help reduce infections in nursing homes.
Both toolkits will be available for free at the Civil Money Penalty Reinvestment Program website by February 28, 2020.
Effective date: Immediately. This information should be communicated with all survey and certification staff, their managers, and the state/regional office training coordinators within 30 days of this memorandum.
Updated OIG Work Plan
On February 18, the OIG updated its Work Plan with the following new items:
- Ensuring Dual-Eligible Beneficiaries' Access to Drugs Under Part D: Mandatory Review
- The Impact of Health Risk Assessments on Risk-Adjusted Payments in Medicare Advantage
- Medicare Capital Payments to New Hospitals
- Data Brief: Characteristics of Hospitals With Wage Indexes in the Bottom Quartile for the Fiscal Year 2020 Inpatient Prospective Payment System
Comment Request: Proposed Repetitive, Scheduled, Non-Emergent Ambulance Transport (RSNAT) Prior Authorization Process and Requirements for a National Model
On February 19, CMS published a Comment Request in the Federal Register regarding the submission for OMB review of an information collection titled “Proposed Repetitive, Scheduled, Non-Emergent Ambulance Transport (RSNAT) Prior Authorization Process and Requirements for a National Model.” Comments are due to the OMB desk officer by March 20, 2020.
New Integrated Denial Notice
On February 19, CMS published new Downloads of the Integrated Denial Notice form to the MA Denial Notices page on its website. The new version of the notice includes revisions adjudication timeframes for Part B drugs, new language about requesting expedited appeals, information on asking for good cause extensions, and more. CMS recommends plans start using the new form immediately, but use will not be required until April 1, 2020.
Proposed Rule: Comprehensive Care for Joint Replacement Model Three-Year Extension and Changes to Episode Definition and Pricing
On February 20, CMS published a draft version of a Proposed Rule on extending the Comprehensive Care for Joint Replacement payment model and changing certain aspects of the program. Proposals in the rule include extending the model for an additional three years (through December 31, 2023), adding outpatient knee and hip replacements into the definition of a CJR episode, changing the target price calculation and the CJR reconciliation process, and more.
Comments on the rule are due 60 days after publication in the Federal Register, which is scheduled for February 24. CMS published a Fact Sheet on the proposed rule on the same date.
Updated Corporate Integrity Agreement Documents
On February 21, the OIG published information on a new Corporate Integrity Agreement with Diversicare Healthcare Services, Inc., of Brentwood, TN.
Implementation of Additional Requirement to add HCPCS and CPT - HCPCS/CPT as Paired Items of Service for Prior Authorization and Medicare Claims Processing for Part A, Part B, DME, and Home Health and Hospice
On February 21, CMS published One-Time Notification Transmittal 2438 regarding the implementation of claims processing requirements for prior authorization programs and Medicare claims processing to add HCPCS and CPT - HCPCS/CPT as paired items of service for future processing.
Effective date: July 1, 2020
Implementation date: July 6, 2020
Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP), and PC Print Update
On February 21, CMS published Medicare Claims Processing Transmittal 4536 regarding updates to the RARC and CARC lists as well as MREP and PC Print.
Effective date: July 1, 2020
Implementation date: July 6, 2020
ICD-10 and Other Coding Revisions to NCDs--July 2020 Update
On February 21, CMS published One-Time Notification Transmittal 2439 regarding the July 2020 coding updates to NCDs. The affected NCDs include NCD 90.2 (Next Generation Sequencing), NCD150.3 (Bone Mineral Density Studies), NCD190.3 (Cytogenic Studies), and more.
Effective date: July 1, 2020
Implementation date: March 24, 2020 - MACs; July 6, 2020 - Shared System Maintainers
Quarterly Update for the Temporary Gap Period of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP) - April 2020
On February 21, CMS published Medicare Claims Processing Transmittal 4532 regarding the quarterly update to the DME CBP files.
Effective date: April 1, 2020
Implementation date: April 6, 2020
Updates to Chapter 4 and Exhibit 8 in Publication 100-08
On February 21, CMS published Medicare Program Integrity Transmittal 943 regarding updates to various sections of Chapter 4 and Exhibit 8 in the manual. Changes include information about prioritizing investigations originating from an Accountable Care Organization referral, how to handle UCM outages, ways to minimize double recoveries by enhancing communication between UPICs and MACs, and more.
Effective date: March 24, 2020
Implementation date: March 24, 2020
Revisions to Multiple Appendices of State Operations Manual
On February 21, CMS published State Operations Provider Certification Transmittal 200 regarding revisions to several appendices within the State Operations Manual. These changes include new, revised, and deleted sections as well as information that has been moved within the manual. All changes pertain to updating the manual to reflect current regulatory language within the Medicare conditions, and more substantive interpretive guidance for several sections are pending and will be updated in a future release.
Effective date: February 21, 2020
Implementation date: February 21, 2020