This week in Medicare updates—4/15/2020
Guidance for Processing Attestation Statements from Ambulatory Surgical Centers (ASC) Temporarily Enrolling as Hospitals during the COVID-19 Public Health Emergency
On April 3, CMS published a Memorandum to state survey agency directors regarding how ASCs can temporarily enroll as a hospital during the COVID-19 public health emergency (PHE). The memo discusses the authority created by the 1135 emergency waiver to allow for these flexibilities as well as the process for working with the MAC to enroll as a hospital during the PHE.
Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers, and the state/regional office training coordinators immediately. This guidance will cease to be in effect when the Secretary determines there is no longer a public health emergency due to COVID-19. At that time, CMS will send public notice that this guidance has ceased to be effective via its website.
Fiscal Intermediary Shared System (FISS) Enhancement of PC Print Billing Software
On April 3, CMS published One-Time Notification Transmittal 10034, which rescinds and replaces Transmittal 2316, dated June 25, 2019, to revise business requirements 11070.1.16.1, 11070.1.17, and the implementation date. The original transmittal was issued to enhance the PC Print billing software utilized by the providers.
Effective date: July 1, 2019
Implementation date: July 1, 2019 - - Business Requirement (BR) 1, BR 1.1, BR 1.2, BR 1.3, and BR 1.4; October 7, 2019 - BR 1, BR 1.5, BR 1.6, BR 1.7, BR 1.8, and BR 1.10; January 6, 2020 - BR 1, BR 1.11 and 1.12; April 6, 2020 - BR 1, BR 1.9, BR 1.13, BR 1.14, BR 1.15, and BR 1.16; April 20, 2020 - BR 1.16.1 and 1.17
Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment
On April 3, CMS published Medicare Claims Processing Transmittal 10033, which rescinds and replaces Transmittal 10026, dated April 1, to revise the policy section removing the CLFS reporting period is delayed verbiage. This transmittal is no longer sensitive and may now be posted to the internet.
Effective date: April 1, 2020
Implementation date: April 6, 2020
Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2020 Update
On April 6, CMS published Medicare Claims Processing Transmittal 10039, which rescinds and replaces Transmittal 4540, dated February 27, to make MPFSDB file revisions for COVID-19. Updates for codes G2023, G2024, 87635, 98966, 98967, 98968, 99441, 99442, and 99443 have been added to the April 2020 MPFSDB update file and are listed in the CR attachment. 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
New Video Available on Medicare Coverage and Payment of Virtual Services
On April 6, CMS published a YouTube Video regarding common questions about the Medicare telehealth services benefit.
2021 Medicare Advantage and Part D Rate Announcement
On April 6, CMS published the 2021 Medicare Advantage and Part D Rate Announcement. CMS finalized changes to the methodologies used to pay MA organizations, PACE organizations, and Part D sponsors. This includes the continued phase-in of the 2020 CMS-Hierarchical Condition Categories (HCC) model, under which CMS will calculate risk scores for 2021 payments based on 75% of the risk score calculated with the 2020 CMS-HCC model and 25% of the risk score calculated with the 2017 CMS-HCC model. The rate announcement also includes information on changes to star ratings, encounter data/RAPS data risk scores, and more.
CMS published a Fact Sheet on the same date to accompany the rate announcement.
Hospital Experiences Responding to the COVID-19 Pandemic: Results of a National Pulse Survey
On April 6, the OIG published a Report on how hospitals are responding to the COVID-19 pandemic. The report is based on findings from brief telephone interviews conducted from March 23-27 with 323 hospitals across 46 states, the District of Columbia, and Puerto Rico. The OIG compiled a list summarizing areas of need for hospitals, including:
- Testing, supplies, and equipment
- Workforce allocation
- Facility capacity
- Financial assistance
- Centralized, reliable communication and information
The OIG is presenting this information to HHS to help provide HHS with information on ways the government can assist hospitals during this time.
Expanded Use of Ambulance Origin/Destination Modifiers
On April 7, CMS published a Notice in MLN Connects regarding an expanded list of destinations for ambulance transport and the accompanying modifiers to use for those origins and destinations.
Updated OIG Work Plan
On April 7, the OIG updated its Work Plan with the following new item:
Updated Corporate Integrity Agreements (CIA) Reportable Event Settlements
On April 7, the OIG updated its list of CIA Reportable Events with the following new settlement:
- On April 2, Envision Healthcare Corporation and its subsidiaries and affiliates reached a $50,250 settlement agreement with the OIG after disclosing conduct pursuant to its CIA where it paid remuneration to approximately 500 hospital senior executives nationwide in the form of Google Home Mini devices with Envision’s name printed on them.
Updated Corporate Integrity Agreement Documents
On April 7, the OIG published information on closed Corporate Integrity Agreements with:
- Ageless Men’s Health; Ageless Men’s Health Holdings, Inc.; Ageless Men’s Health, LLC; Ageless Men’s Health GA, LLC; Ageless Men’s Health NV, LLC; Ageless Men’s Health CA, LLC; Ageless Men’s Health, P.C.; and Ageless Men’s Health, PLLC; Total Orthopedics, LLC, of Germantown, TN
- Nason Medical Center, LLC; Bankfield Holding Company, LLC, of Charleston, SC
- Endo Pharmaceuticals Inc., of Malvern, PA
Updated Provider Self-Disclosure Settlements
On April 7, the OIG published an updated List of Provider Self-Disclosure Settlements, including:
- On March 10, The Maui Medical Group, Inc., of Hawaii, reached a $240,471 settlement agreement with the OIG to resolve allegations that it submitted claims for E/M services provided by a physician that were not supported by the medical record.
- On March 17, Klair Medicose, PLLC, reached a $1,495,002.51 settlement agreement with the OIG to resolve allegations that it submitted claims for Pulsed Stimulated Treatment, a non-covered service under Medicare.
- On March 23, Harbour Manor Health and Living Community, of Indiana, reached a $57,851.11 settlement agreement with the OIG to resolve allegations that it submitted claims for skilled nursing services provided by an individual without a valid nursing license.
- On March 25, Dartmouth-Hitchcock Clinic, of New Hampshire, reached a $22,947 settlement agreement with the OIG to resolve allegations that it provided psychotherapy and counseling services to Medicare beneficiaries and charged those beneficiaries for the services without billing Medicare on their behalf, without adhering to applicable limiting charges, without accepting assignment, and without properly documenting a decision to opt-out of the Medicare program.
- On March 25, The Trustees of Dartmouth College, of New Hampshire, reached a $53,940 settlement agreement with the OIG to resolve allegations that it provided psychotherapy and counseling services to Medicare beneficiaries and charged those beneficiaries for the services without billing Medicare on their behalf, without adhering to applicable limiting charges, without accepting assignment, and without properly documenting a decision to opt-out of the Medicare program.
Non-Emergent, Elective Medical Services, and Treatment Recommendations
On April 7, updated its Recommendations on postponing non-essential surgeries and procedures during the public health emergency. These recommendations have a tiered framework to prioritize services and care for those who need it most, and it includes a list of key considerations for providers when making these decisions.
CMS Dear Clinician Letter
On April 7, CMS published a Letter to clinicians regarding a variety of resources and information clinicians should be aware of throughout the public health emergency. This information covers billing and coding for testing, accelerated and advance payments, information on telehealth, workforce flexibilities, changes to the quality payment program, and more. The letter also provides links to various resources providing clinical and technical guidance for providers.
CMS Approves Approximately $34 Billion for Providers with the Accelerated/Advance Payment Program for Medicare Providers in One Week
On April 7, CMS published a Press Release regarding progress in the Accelerated and Advance Payment Program to send additional funds to Medicare providers to help them stay afloat during the public health emergency. CMS delivered nearly $34 billion in funding in one week and has reduced processing times for requests from 3-4 weeks down to 4-6 days. CMS received over 25,000 requests during that week.
Medicare Quarterly Provider Compliance Newsletter
On April 8, CMS published the Medicare Quarterly Provider Compliance Newsletter regarding two new reviews for the third quarter. These include a CERT review of lower limb orthosis-knee orthosis, which found issues with insufficient documentation, and a RAC review of swing-bed patient visits, which found issues with incorrect coding.
Guidance for Infection Control and Prevention of Coronavirus Disease (COVID-19) in Hospitals, Psychiatric Hospitals, and Critical Access Hospitals (CAH)
On April 8, CMS revised a Memorandum originally published on March 4 and previously revised on March 30 to state survey agency directors regarding guidance on infection control and caring for patients with COVID-19 or potential cases of COVID-19 in hospitals, psychiatric hospitals, and CAHs. The April revisions expand information on screening and visitation restrictions, discharges to subsequent care locations for patients with COVID-19, staff screening and testing policies, and return-to-work guidance.
Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers, and the State/Regional Office training coordinators immediately.
Guidance for Infection Control and Prevention of COVID-19 in Dialysis Facilities
On April 8, CMS revised a Memorandum originally published March 10 and previously revised on March 30 to state survey agency directors regarding guidance for dialysis facilities on infection control for COVID-19. The April revisions address an option to provide home dialysis training and support services to help some dialysis patients stay home and the establishment of SPRDFs.
Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers, and the state/regional office training coordinators immediately.
Emergency Medical Treatment and Labor Act (EMTALA) Requirements and Implications Related to Coronavirus Disease 2019
On April 8, CMS revised a Memorandum originally published on March 9 and previously revised on March 30 to state survey agency directors regarding the implications of COVID-19 on EMTALA requirements. The April revisions include additional guidance on patient triage and appropriate medical screening exams at alternate site locations.
Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers, and the state/regional office training coordinators immediately.
Guidance for Infection Control and Prevention of COVID-19 in Outpatient Settings: FAQs and Considerations
On April 8, CMS revised a Memorandum that was originally published on March 30 to state survey agency directors regarding guidance for ambulatory surgical centers (ASC), community mental health centers (CMHC), comprehensive outpatient rehabilitation facilities (CORF), outpatient physical therapy or speech pathology (OPT), rural health clinics (RHC) and federally qualified health centers (FQHC) on addressing potential and confirmed COVID-19 cases. The revisions address recommendations to mitigate transmission, visitor restrictions, cleaning and disinfection, issues related to supply scarcity, and partnerships with others in the community to conserve and share resources during the national emergency.
Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers and the State/Regional Office training coordinators immediately. This guidance will cease to be in effect when the Secretary of HHS determines there is no longer a Public Health Emergency due to COVID-19. At that time, CMS will publicly notify that this guidance has ceased to be effective via its website.
Guidance for Infection Control and Prevention of COVID-19 in Intermediate Care Facilities for Individuals with Intellectual Disabilities and Psychiatric Residential Treatment Facilities
On April 8, CMS revised a Memorandum originally published on March 30 to state survey agency directors regarding guidance on infection control and prevention in ICF/IIDs and PRTFs. The revisions address visitor and outside health care service provider screening, community activities, staffing, and more.
Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers, and the state/regional office training coordinators immediately.
CMS Responses to Questions Asked During the March 24 Call with the PACE Community
On April 9, CMS published an FAQ regarding responses to 31 questions that were asked on the March 24, 2020 PACE call. Topics addressed include clinical concerns, staffing, eligibility/enrollment/recertification, telehealth, quality and reporting programs, billing and payment, and CMS communications. The guidance supplements previous guidance issued on March 17 to PACE organizations.
COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers
On April 9, CMS published a Fact Sheet and Press Release regarding new blanket waivers it is issuing to help relax certain regulations in order to help hospitals, clinics, and other healthcare facilities boost their frontline staff to better fight the COVID-19 pandemic. The fact sheet includes 29 pages worth of changes to requirements across all provider types. Some of the relaxed requirements include:
- Allowing doctors to care for patients at rural hospitals and across state lines when necessary via telehealth without having to be physically present
- Allowing nursing practitioners to perform some medical exams on Medicare patients at skilled nursing facilities
- Waiving the entire utilization review condition of participation at §482.30 as long as waiving this is not inconsistent with the state’s emergency preparedness or pandemic plan
- Permitting occupational therapists from home health agencies to perform initial assessments on certain homebound patients
All facilities should review this document to determine which relaxed requirements apply to their specific needs. These waivers are blanket waivers and do not require any request or notification to any of CMS’ regional offices.
Effective date: Retroactive to March 1, 2020.
COVID-19 FAQs on Medicare Fee-for-Service Billing
On April 9, CMS published a FAQ regarding the latest guidance on billing for COVID-19. The guidance in this FAQ supersedes previously released FAQs from March on billing with and without the 1135 waiver. The new document also includes explanations on certain provisions from the CARES Act and the interim final rule on policy and regulation changes for COVID-19.
Artificial Intelligence Health Outcomes Challenge
On April 9, CMS published an Announcement that it will temporarily pause the Artificial Intelligence Health Outcomes Challenge until June 29, 2020 due to the COVID-19 pandemic. Those who have already submitted pretest data results will not need to resubmit.
Emergency Triage, Treat, and Transport (ET3) Model Delay
On April 9, published an Announcement that it will be delaying the start of the ET3 Model from May 1, 2020 until Fall 2020 due to the COVID-19 pandemic. Selected applicants should have been notified and will be required to complete a revised participation agreement once there is a new implementation date.
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 and Home Health and Hospice
On April 9, CMS published One-Time Notification Transmittal 10043, which rescinds and replaces Transmittal 10021, dated March 27, 2020, to revise business requirement 11516.1, remove Part B and DME from the title and policy sections, and to remove the program indicator from the attachment. The original transmittal was issued 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
Medicare Accelerated and Advance Payments State-by-State
On April 10, CMS published a Table regarding the accelerated and advance payments that will be made in an effort to increase cash flow to Medicare providers and suppliers during the public health emergency. The table provides information on the amounts that will be paid out per state to Part A and Part B providers as of Friday, April 4.
FY 2021 Hospice Payment Rate Update Proposed Rule
On April 10, CMS published a draft version of a Proposed Rule on the 2021 hospice payment rate update. Proposals include a 2.6% increase in hospice payments for 2021 and a proposed aggregate cap amount of $30,743.86. It also includes a proposal to adopt the OMB statistical area delineations made in 2018.
The rule is scheduled to be published in the Federal Register on April 15. Comments on the proposed rule are due no later than 5 p.m. on June 9, 2020. CMS published a Fact Sheet on the rule on April 10.
FY 2021 Inpatient Psychiatric Facility (IPF) Prospective Payment System (PPS) Proposed Rule
On April 10, CMS published a draft copy of the FY 2021 IPF PPS Proposed Rule. CMS proposes an IPF payment rate update of 2.6%, but because total estimated payments to IPFs are expected to decrease by 0.2% due to an updated outlier threshold amount, the total IPF payment increase would be 2.4% for FY 2021. CMS also proposes adopting the most recent OMB statistical area delineations and instituting a 5% cap on decreases for providers negatively affected by wage index changes. There are no proposed changes to the IPF Quality Reporting Program.
CMS published a Fact Sheet on the proposed rule on the same date. The rule is scheduled to be published in the Federal Register on April 14. Comments are due no later than 5 p.m. on June 9.
FY 2021 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Proposed Rule
On April 10, CMS published a draft copy of the FY 2021 SNF PPS Proposed Rule. CMS proposes an aggregate payment increase of 2.3% and a 5% cap on wage index decreases. The rule also contains proposed changes to case-mix classification code mappings, the adoption of the most recent OMB statistical area delineations, and a handful of changes to the SNF Value-Based Purchasing Program.
CMS published a Fact Sheet on the proposed rule on the same date. The rule is scheduled to be published in the Federal Register on April 15. Comments are due no later than 5 p.m. on June 9.
Applicability of Diagnoses from Telehealth Services for Risk Adjustment
On April 10, CMS published a Memorandum to all Medicare Advantage, Cost, PACE, and Demonstration Organizations to state that all organizations that submit diagnoses for risk-adjusted payment are allowed to submit diagnoses for these payments that arise from telehealth as long as the visits meet eligibility criteria for service type and a face-to-face encounter. The face-to-face encounter requirement can be met when services are provided using interactive audio and video telecommunications systems that permit real-time interactive communication.
Updated List of Excluded Individuals and Entities (LEIE)
On April 10, the OIG updated its LEIE with an updated LEIE database for download and lists of March 2020 exclusions, reinstatements, and profile corrections.
Quarterly Update to the Fiscal Year 2020 Inpatient Psychiatric Facilities Pricer
On April 10, CMS published Medicare Claims Processing Transmittal 10038 regarding an update to the IPF Pricer Software to include the new payment policy for COVID-19.
CMS published MLN Matters 11759 on the same date to accompany the transmittal.
Effective date: April 1, 2020
Implementation date: July 6, 2020
Claim Status Category and Claim Status Codes Update
On April 10, CMS published Medicare Claims Processing Transmittal 10045, which rescinds and replaces Transmittal 4460, dated November 15, 2019, to update the WPC website information in the background section. The original transmittal was issued regarding updates to claim status category and claim status codes.
On April 10, CMS revised MLN Matters 11467 to accompany the transmittal.
Effective date: April 1, 2020
Implementation date: April 6, 2020