This week in Medicare updates—3/4/2020
New ICD-10-CM Code and Guidelines for 2019 Novel Coronavirus
On February 21, the CDC published an Announcement and Coding Advice for reporting encounters for the 2019 Novel Coronavirus (COVID-19). The WHO has created a new ICD-10-CM code, U07.1 (2019-nCoV acute respiratory disease) effective February 20, 2020. The code will be included in the October 1, 2020 update to the ICD-10 codes. The CDC also included guidance on coding associated infections, such as pneumonia, bronchitis, lower respiratory infections, and ARDS. Signs and symptoms should be assigned codes when a definitive diagnosis has not been established. Exposure to COVID-19 should also be coded with the appropriate Z codes.
Standard Elements for DMEPOS Order, and Master List of DMEPOS Items Potentially Subject to a Face-to-Face Encounter and Written Orders Prior to Delivery and/or Prior Authorization
On February 24, CMS published Special Edition MLN Matters 20007 regarding new provisions for DMEPOS orders and prior authorization that were created by the 2020 ESRD PPS final rule. The article details some of the elements required in orders or prescriptions for DMEPOS items, a list of written order/prescription definitions, an explanation of how the items subject to face-to-face encounters/written orders prior to delivery and/or prior authorization will be selected and published, and more.
Effective date: January 1, 2020
Implementation date: January 1, 2020
Comment Request: Home Health Agency Cost Report; Electronic Medical Documentation Interoperability (EMDI) Pre and Post Pilot Measures Survey; more
On February 24, CMS published a Comment Request in the Federal Register regarding the submission for OMB review of the following information collections:
- Home Health Agency Cost Report
- Electronic Medical Documentation Interoperability (EMDI) Pre and Post Pilot Measures Survey
- Durable Medical Equipment Medicare Administrative Contractor Certificate of Medical Necessity and Supporting Documentation Requirements
Comments are due to the OMB desk officer by March 25, 2020.
Comment Request: Emergency and Foreign Hospital Services and Supporting Regulation in 42 CFR Section 424.103
On February 24, CMS published a Comment Request in the Federal Register regarding the submission for OMB review of an information collection titled “Emergency and Foreign Hospital Services and Supporting Regulation in 42 CFR Section 424.103.” Comments are due to the OMB desk officer by March 25, 2020.
Comment Request: Medicare Plus Choice Program Requirements Referenced in 42 CFR 422.000 - 422.700; Medication Therapy Management Program Improvements - Standardized Format
On February 24, CMS published a Comment Request in the Federal Register regarding the following information collections:
- Medicare Plus Choice Program Requirements Referenced in 42 CFR 422.000 - 422.700
- Medication Therapy Management Program Improvements - Standardized Format
Comments are due by April 24, 2020.
Comment Request: Establishment of an Exchange by a State and Qualified Health Plans; End Stage Renal Disease Annual Facility Survey Form; more
On February 25, CMS published a Comment Request in the Federal Register regarding the following information collections:
- Establishment of an Exchange by a State and Qualified Health Plans
- End Stage Renal Disease Annual Facility Survey Form
- Virtual Groups for Merit-Based Incentive Payment System (MIPS)
Comments are due by April 27, 2020.
Comment Request: Medicare Part D Reporting Requirements; National Implementation of Hospice Experience of Care Survey (CAHPS Hospice Survey)
On February 26, CMS published a Comment Request in the Federal Register regarding the following information collections:
- Medicare Part D Reporting Requirements
- National Implementation of Hospice Experience of Care Survey (CAHPS Hospice Survey)
Comments are due by April 27, 2020.
CMS Selects Applicants for Participation in Innovative Payment Model with New Emergency Treatment and Transport Options
On February 27, CMS published a Press Release regarding the new Emergency Triage, Treat, and Transport (ET3) Model. CMS has selected 205 applicants across 36 states and the District of Columbia to participate in the voluntary five-year payment model. ET3 will test two new types of payments to ambulance suppliers, including payments for transporting a beneficiary to an alternative destination (such as a primary care doctor’s office or urgent care clinic) as well as payments for initiating and facilitating treatment in place by a qualified health care practitioner either in person or via telehealth.
Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2020 Update
On February 27, CMS published Medicare Claims Processing Transmittal 4540, which rescinds and replaces Transmittal 4525, dated February 14, 2020, to make two revisions to the April 2020 MPFSDB update attachment file. The original transmittal was issued regarding an update to payment files for the Medicare Physician Fee Schedule.
On February 27, CMS published a revised MLN Matters 11661 to accompany the transmittal.
Effective date: January 1, 2020
Implementation date: April 6, 2020
NCA Tracking sheet for Screening for Colorectal Cancer Blood-Based Biomarker Tests
On February 28, CMS published a Tracking Sheet to initiate an NCA to consider coverage of Epi proColon®, an example of a blood-based biomarker screening test for colorectal cancer. By issuing the tracking sheet, CMS initiates a 30-day public comment period on the topic. Comments are due by March 29, 2020. A proposed decision memo is expected at the end of August.