This week in Medicare updates—3/25/20

MAC COVID-19 Test Pricing

On March 12, CMS published a Fact Sheet regarding the payment amounts for the COVID-19 testing as reported by HCPCS codes U0001 and U0002. MACs are responsible for developing the payment amount for these codes until Medicare establishes national payment rates. While the payment amounts differ by a few cents between MACs, they are generally approximately $35.91 for U0001 and $51.31 for U0002.

 

Medicare Fee-for-Service Response to the Public Health Emergency on the Coronavirus

On March 16, CMS published Special Edition MLN Matters 20011 regarding information on waivers for providers and suppliers in the wake of the Trump administration’s national emergency declaration on March 13. These actions include waiving the 3-day prior hospitalization requirement for coverage of a SNF stay, relaxed timelines on items such as Minimum Data Set assessments and OASIS transmission, waiving the 25-bed limit for CAHs and the 96-hour length of stay limit, and more. 

On March 18, CMS revised the transmittal to include information about the telehealth waiver. 

CMS published a Press Release to accompany the transmittal. 

 

AMA Fact Sheet: Reporting Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) Laboratory Testing 

On March 16, the AMA published a Special Edition CPT Assistant Fact Sheet regarding a new CPT code to describe laboratory testing for SARS-CoV-2. The new code, 87635, is effective immediately, but it will not be included in the CPT 2020 publication. It will be published in the CPT 2021 code set in the Microbiology subsection of the Pathology and Laboratory section.

 

Updated OIG Work Plan

On March 16, the OIG updated its Work Plan with the following new items:

• Medicare Part B Payments to Physicians for Co-Surgery Procedures
• Medicare Hospital Payments for Claims Involving the Acute- and Post-Acute-Care Transfer Policies

 

Updated Civil Monetary Penalties and Affirmative Exclusions

On March 16, the OIG published an updated List of Civil Monetary Penalties and Affirmative Exclusions, including: 

• On January 22, Dominic Tolitano, M.D., of Wood Dale, Illinois, reached a $130,253.98 settlement agreement with the OIG to resolve allegations that Tolitano submitted claims for HCPCS code 93965 when that procedure was already included as a component of a procedure for which Tolitano submitted claims for using HCPCS code 93970/93971 for the same beneficiary on the same date of service. 
• On January 22, SeniorCare Emergency Medical Services, Inc., of Bronx, New York, reached a $1,231,854.09 settlement agreement with the OIG to resolve allegations that it billed Part B for ambulance transportation to and from SNFs when such transportation was already covered by SNF consolidated billing. 
• On February 3, Kentucky Pain Management Services, LLC, of Hazard, Kentucky, reached a $230,685.82 settlement agreement with the OIG to resolve allegations that it submitted claims to Medicare for specimen validity testing, a noncovered service. 
• On February 10, Maryland General Hospital, Inc., d/b/a UM Medical Center Midtown Campus, of Baltimore, Maryland, reached a $106,965 settlement agreement with the OIG to resolve allegations that it violated EMTALA by failing to provide an appropriate screening exam and stabilizing treatment when a 22-year-old patient presented to the ED with a face contusion/lip abrasion but refused to sign discharge forms after stating she was homeless and refused to exit the premises. She was escorted out of the hospital by UMMC security wearing only a hospital gown and socks. She returned to the ED via ambulance the next day after she was found outside in 30-degree weather. She was told to go to a shelter if she didn’t have a place to stay and was discharged without receiving a medical exam or treatment. 
• On February 18, Mark R. Robbins, M.D., and Mark Robbins M.D., PA d/b/a Vascular Tyler, of Tyler, Texas, reached a $71,168.20 settlement agreement with the OIG to resolve allegations that Robbins submitted claims for HCPCS code 93965 when that procedure was already included as a component of a procedure for which Robbins submitted claims for using HCPCS code 93970/93971 for the same beneficiary on the same date of service.

 

Medicare Expanded Telehealth Benefits for Beneficiaries During COVID-19 Outbreak

On March 17, CMS published a Fact Sheet regarding expanded Medicare telehealth coverage during the COVID-19 outbreak. As of March 6, 2020, Medicare will temporarily pay clinicians for telehealth services for beneficiaries residing across the country. This includes patients outside of rural areas and patients in their homes. The fact sheet provides guidance on the types of services available and how to bill for those services.

CMS published an FAQ and a Press Release on the same date to accompany the fact sheet.

 

OIG Policy Statement Regarding Waiving Telehealth Cost-Sharing During COVID-19 Outbreak

On March 17, the OIG published a Policy Statement announcing it will not subject physicians or other practitioners to administrative sanctions for reducing or waiving any cost-sharing obligations federal health care program beneficiaries may owe for telehealth services during the time period subject to the COVID-19 public health emergency. 

The OIG published a Fact Sheet on the same date to accompany the policy statement. 

 

Information for PACE Organizations Regarding Infection Control and Prevention of COVID-19

On March 17, CMS published a Memorandum to all Programs of All-Inclusive Care for the Elderly (PACE) organizations regarding guidance on infection control and prevention in light of the COVID-19 pandemic. CMS will allow PACE organizations to use remote technology as appropriate for certain activities that would normally occur on an in-person basis. It also reminds PACE of its responsibilities to provide all required Medicare and Medicaid services and discusses how PACE organizations should handle scenarios where PACE participants or caregivers may show symptoms of a respiratory illness. 

CMS published a Press Release on the same date to accompany the memo.

 

Missouri Should Improve its Oversight of Selected Nursing Homes’ Compliance with Federal Requirements for Life Safety and Emergency Preparedness

On March 17, the OIG published a Review of whether Missouri ensured that selected nursing homes participating in Medicare or Medicaid complied with requirements for life safety and emergency preparedness. The OIG found deficiencies at all 20 of the nursing homes reviewed related to a variety of life safety deficiencies (e.g., building exits, fire detection and suppression systems, smoking policies, etc.) and emergency preparedness deficiencies (e.g., written plans, emergency power, emergency communications, etc.). The OIG concluded that these deficiencies occurred due to a variety of factors, including inadequate management oversight as well as frequent staff turnover. Missouri also did not adequately follow up on deficiencies previously cited.

The OIG recommends Missouri follow up with the 20 deficient nursing homes to verify corrective actions have been taken regarding the identified life safety and emergency preparedness deficiencies and it made other procedural recommendations regarding developing standardized life safety training, more frequent surveys, and follow-up at nursing homes with a history of multiple high-risk deficiencies. Missouri disagreed with findings and stated it did not see the correlation between the OIG recommendations and causes for deficiencies, such as inadequate oversight and high staff turnover. The OIG maintains all findings and recommendations are valid.

 

New ICD-10-CM Code for COVID-19, April 1, 2020

On March 18, the CDC published a Notice announcing that the new ICD-10-CM code, U07.1 (2019-nCoV acute respiratory disease) will be effective April 1, 2020, instead of the previously scheduled date of October 1, 2020. This off-cycle update is unprecedented but reflects the urgent need to capture reporting of this condition in claims and surveillance data.

 

CMS Adult Elective Surgery and Procedures Recommendations

On March 18, CMS published Guidance on limiting all non-essential planned surgeries and procedures. The guidance includes a table of tiers of procedure types and the accompanying CMS recommendations on whether to postpone the surgery or procedure. 

CMS published a Press Release on the guidance on the same date.   

 

Advance Beneficiary Notice of Noncoverage (ABN) Form

On March 18, CMS published an Update to its FFS ABN Form webpage to note that the new ABN, Form CMS-R-131, is currently awaiting OMB approval for renewal. CMS will provide instructions when it does get approved. The current ABN form should continue to be utilized until CMS provides further instruction.

 

April Quarterly Update for the 2020 DMEPOS Fee Schedule

On March 20, CMS published Medicare Claims Processing Transmittal 10004 regarding the quarterly updates to the DMEPOS fee schedule. 

CMS published MLN Matters 11702 on the same date to accompany the transmittal. 

Effective date: April 1, 2020

Implementation date: April 6, 2020

 

Quarterly Update for the Temporary Gap Period of the DMEPOS Competitive Bidding Program (CBP)--July 2020

On March 20, CMS published Medicare Claims Processing Transmittal 10006 regarding the quarterly update to the DME CBP files with changes to HCPCS codes, zip codes, single payment amounts, and supplier files. 

Effective date: July 1, 2020

Implementation date: July 6, 2020

 

Update to the Internet Only Manual Publication 100-04, Chapter 3, Section 90.4.2

On March 20, CMS published Medicare Claims Processing Transmittal 10002 regarding an update to Chapter 3 of the manual involving billing for liver transplant and acquisition services. It instructors contractors to use claims data to determine if coverage criteria specified in the National Coverage Determinations Manual has been met. 

Effective date: April 20, 2020

Implementation date: April 20, 2020

 

April 2020 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files

On March 20, CMS published Medicare Claims Processing Transmittal 10003 regarding new ASP and Not Otherwise Classified drug pricing files for Part B drugs as issued on a quarterly basis.

CMS published MLN Matters 11701 on the same date to accompany the transmittal.

Effective date: April 1, 2020

Implementation date: April 6, 2020

 

Updated Corporate Integrity Agreement Documents

On March 20, the OIG published information on a new Corporate Integrity Agreement with Longwood Management Company, of Los Angeles, CA. 

 

HCPCS Codes Subject to and Excluded From Clinical Laboratory Improvement Amendments (CLIA) Edits

On March 20, CMS published Medicare Claims Processing Transmittal 10009, which rescinds and replaces Transmittal 4542, dated March 6, 2020, to revise the background section removing the first instance of code 0091U. The original transmittal was issued regarding codes for 2020 that are either subject to or excluded from CLIA edits. 

On March 9, CMS published MLN Matters 11640 to accompany the transmittal. 

Effective date: April 1, 2020

Implementation date: April 6, 2020