This week in Medicare updates—8/5/2020
Updated Corporate Integrity Agreement Documents
On July 27, the OIG published information on new Corporate Integrity Agreements with the following organizations:
- Sterling Healthcare Opco, LLC D/B/A Cordant Health Solutions, of Denver, CO
- Indivior, Inc., of North Chesterfield, VA
- Cruz, William J. and Medscan PSC, of Guaynabo, PR
Updated OIG Work Plan
On July 27, the OIG updated its Work Plan with the following new item:
Comment Request: Clinical Laboratory Improvement Amendments (CLIA) Application Form and Supporting Regulations
On July 27, CMS published a Comment Request in the Federal Register regarding an information collection titled, “Clinical Laboratory Improvement Amendments (CLIA) Application Form and Supporting Regulations.” Comments are due by September 28, 2020.
Updates to Chapters 1-8, 10, 11, and Exhibits of Medicare Program Integrity Manual
On July 27, CMS published Medicare Program Integrity Transmittal 10228 regarding changes to the language in the manual to switch references to Program Safeguard Contractor (PSC) and Zone Program Integrity Contractor (ZPIC) over to Unified Program Integrity Contractor (UPIC),
Effective date: August 27, 2020
Implementation date: August 27, 2020
Medicare Updates Data on COVID-19 Impacts on Medicare Beneficiaries
On July 28, CMS updated a Data Snapshot regarding Medicare beneficiaries and COVID-19. The data provides information on Medicare beneficiaries based on encounters from January 1 to June 20, 2020. Claims used to provide this data had to have been received by July 17, 2020. The data now includes information on COVID-19 among Native American beneficiaries, and it shows that Native Americans have the second highest rate of hospitalization for COVID-19. Black beneficiaries have the highest rate of hospitalization. CMS said Native Americans were not previously included in data because there was not enough cases among that population to report. The snapshot includes other information such as:
- The average Medicare payment per fee-for-service Medicare COVID-19 hospitalization was $25,255, an increase of $2,000 from the previous data release. Medicare payments totaled $2.8 billion for COVID-19 hospitalizations by June 20, an increase of approximately $900 million since the previous month’s data release.
- Approximately 550,000 Medicare beneficiaries were diagnosed with COVID-19 between January 1 and June 20. The previous month’s data showed approximately 325,000 cases among Medicare beneficiaries, which represents an increase of 225,000 cases between May and June.
- Dual-eligible beneficiaries were hospitalized at a rate 4.5 times higher than beneficiaries with Medicare only.
CMS published a Press Release and FAQ on the data on the same date. It will continue to release this data on a monthly basis.
Emergency Declaration Blanket Waivers for Health Care Providers
On July 28, CMS updated the Fact Sheet providing the list of blanket waivers for health care providers during the COVID-19 public health emergency. Changes are highlighted with a red notation and include:
- An extended deadline for IPPS Wage Index Occupational Mix survey submission, which is now due to MACs no later than September 3, 2020. Revisions may then be submitted if needed by no later than September 10, 2020.
- CMS also updated this same information in provider-specific fact sheets for Hospitals and Teaching Hospitals, Teaching Physicians, and Medical Residents.
- Removal of a provision which had waived staffing data submission requirements for long-term care facilities. Staffing data must now be submitted through the Payroll-Based Journal System.
CMS continues to update this document, and organizations should review regularly for any changes.
COVID-19 FAQs on Medicare Fee-for-Service Billing
On July 28, CMS updated an FAQ regarding the latest guidance on billing for COVID-19. This round of updates includes information on billing for remote services (with a new decision tree on billing for services provided when the beneficiary’s home is serving as a PBD and the beneficiary is registered as a hospital outpatient), diabetes self-management training furnished via telehealth, reporting modifier -CS on claims for pre-surgery COVID-19 testing, billing for COVID-19 testing in an outpatient department prior to inpatient admission, payment for telehealth services furnished by physicians physically located outside the US, issues related to Shared Savings Program, and more.
CMS continues to update this document on a regular basis. Providers should review frequently for new information.
Implementation of Provider Enrollment Provisions in CMS-6058-FC - Phase 1 - Continued Removal/Moving of Instructions from Chapter 15 of Pub. 100-08 to Chapter 10 of Pub. 100-08
On July 28, CMS published Medicare Program Integrity Transmittal 10239, which rescinds and replaces Transmittal 10146, dated May 22, 2020, to revise several sections in Chapter 10 of Pub 100-08; change effective and implementation dates, and revise business requirements 11551.2,11551.3, 11551.4, 1551.4.2, 11551.10.1.1, 11551.13, 11551.13.1, 11551.13.1.2, and 11551.13.2. It also adds business requirements 11551.13.1.1 and 11551.13.1.2. The original transmittal was issued regarding implementation of provider enrollment provisions which require providers and suppliers to disclose certain current and previous affiliations with other providers and suppliers and which provide CMS with additional authority to deny or revoke a provider or supplier’s Medicare enrollment in certain circumstances. It also updates voluntary termination procedures for certified providers and suppliers.
Effective date: July 27, 2020
Implementation date: August 10, 2020
CMS Announces New ICD-10-PCS Codes for Therapeutics in Response to COVID-10 Public Health Emergency
On July 30, CMS published a Press Release regarding 12 new procedures codes to report the use of therapeutics such as remdesivir and convalescent plasma for treating hospital inpatients with COVID-19. The codes include:
- XW013F5 Introduction of Other New Technology Therapeutic Substance into Subcutaneous Tissue, Percutaneous Approach, New Technology Group 5
- XW033F5 ... into Peripheral Vein, Percutaneous Approach, New Technology Group 5
- XW043F5 ... into Central Vein, Percutaneous Approach, New Technology Group 5
- XW0DXF5 ... into Mouth and Pharynx, External Approach, New Technology Group 5
- XW033E5 Introduction of Remdesivir Anti-infective into Peripheral Vein, Percutaneous Approach, New Technology Group 5
- XW043E5 ... into Central Vein, Percutaneous Approach, New Technology Group 5
- XW033G5 Introduction of Sarilumab into Peripheral Vein, Percutaneous Approach, New Technology Group 5
- XW043G5 ... into Central Vein, Percutaneous Approach, New Technology Group 5
- XW033H5 Introduction of Tocilizumab into Peripheral Vein, Percutaneous Approach, New Technology Group 5
- XW043H5 ... into Central Vein, Percutaneous Approach, New Technology Group 5
- XW13325 Transfusion of Convalescent Plasma (Nonautologous) into Peripheral Vein, Percutaneous Approach, New Technology Group 5
- XW14325 ... into Central Vein, Percutaneous Approach, New Technology Group 5
These codes will go into effect with discharges on and after August 1, 2020. The files are available for download from CMS’ ICD-10-PCS page.
CMS and CDC Announce Provider Reimbursement Available for Counseling Patients to Self-Isolate at Time of COVID-19 Testing
On July 30, CMS published a Press Release to announce payment is available to physicians and health care providers to counsel patients at the time of a COVID-19 test about the importance of self-isolation after they are tested and before they are symptomatic. CMS will use existing E/M codes to reimburse providers eligible to bill CMS for counseling services regardless of where the test is administered.
CMS published a Provider Q&A on the policy on the same date. In the Q&A, CMS did not state the specific codes to use when billing for this service but instead referred providers to a general E/M Services Guide which predates the PHE. CMS also noted that full payment is available for this service during telehealth appointments.
CMS and the CDC published a Counseling Checklist, Talking Points, Post-Test Patient Information, and Contract Tracing Patient Information Sheet for providers to use when providing this type of counseling.
FAQs: Application of OIG’s Administrative Enforcement Authorities to Arrangements Directly Connected to the COVID-19 Public Health Emergency
On July 30, the OIG updated an FAQ regarding changes to enforcement pertaining to arrangements that are directly connected to COVID-19. The new FAQ pertains to discounted lodging for oncology patients if such patients would have had access prior to the public health emergency to free or discounted housing at a nonprofit lodging facility during chemo or radiation.
Implementation of Nurse Practitioners Certifying Diabetic Shoe Orders Under the Primary Care First (PCF) Model
On July 31, CMS published Demonstrations Transmittal 10260 regarding a policy change which would enable nurse practitioners to certify that an order for diabetic shoes is required, a practice normally prohibited by Medicare. It also includes information about the implementation of the Primary Cares First model, which will begin in January 2021.
Effective date: January 1, 2021
Implementation date: January 4, 2021
ICD-10 and Other Coding Revisions to NCDs--January 2021 Update
On July 31, CMS published One-Time Notification Transmittal 10261 regarding the maintenance update of ICD-10 conversions and other coding updates specific to NCDs. This quarters changes affect NCD 20.4 (Implantable Cardiac Defibrillators), NCD 90.2 (Next Generation Sequencing), NCD 50.3 (Cochlear Implants), and NCD 220.6.17 (PET for Solid Tumors).
Effective date: January 1, 2021
Implementation date: August 31, 2020 - A/B MACs; January 4, 2021 - Shared System
Penalty for Delayed Request for Anticipated Payment (RAP) Submission--Implementation
On July 31, CMS published Medicare Claims Processing Transmittal 10254 regarding implementation of policies for the Home Health Prospective Payment System related to RAPS. In CY 2021, the up-front split percentage payment made in response to the RAP will be zero for all HHAs for all 30-day periods of care beginning on or after January 1, 2021.
Effective date: January 1, 2021
Implementation date: January 4, 2021
Updating the CWF to Allow for a MSP Termination Date Greater Than Current Date Plus Six Months for Non-Group Health Plan (NGHP) MSP Auxiliary Records
On July 31, CMS published Medicare Secondary Payer Transmittal 10243 regarding an update to MSP edits to allow for termination dates greater than the current date plus six months for liability insurance, no-fault insurance, or workers’ compensation MSP records.
Effective date: January 1, 2021
Implementation date: January 4, 2021
2021 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Final Rule
On July 31, CMS published a draft copy of the 2021 SNF PPS Final Rule, which is scheduled to be published in the Federal Register on August 5. The rule finalizes a 2.2% increase to the aggregate payment to SNFs and also adopts revised OMB geographic delineations with a 5% cap on any decreases to the wage index from FY 2020 to FY 2021. CMS is also finalizing changes to ICD-10 code mappings used under PDPM effective October 1, 2020.
CMS published a Fact Sheet and Press Release on the final rule on the same date. Regulations are effective October 1, 2020.
2021 Inpatient Psychiatric Facility (IPF) Prospective Payment System (PPS) Final Rule
On July 31, CMS published a draft copy of the 2021 IPF PPS Final Rule, which is scheduled to be published in the Federal Register on August 4. The rule finalizes a 2.2% payment rate update and will adopt the most recent OMB geographic delineations with a 5% cap on any wage index decrease caused by the transition. The rule also finalizes updates to regulatory language allowing advanced practice providers (including physician assistants, nurse practitioners, psychologists, and clinical nurse specialists, to operate within the scope of practice allowed by state law by documenting progress notes in the medical record for patients they are treating.
CMS published a Fact Sheet and Press Release on the final rule on the same date. Regulations are effective October 1, 2020.
2021 Hospice Payment Rate Update Final Rule
On July 31, CMS published a draft copy of the 2021 Hospice Payment Rate Update Final Rule, which is scheduled to be published in the Federal Register on August 4. The rule updates the payment rate by 2.4% and finalizes adoption of the most recent OMB geographic delineations with a 5% cap on any wage index decrease caused by the transition. The rule also responds to comments on the modified election statement and new content requirements that had been finalized in the previous year’s rule.
CMS published a Fact Sheet and Press Release on the final rule on the same date. Regulations are effective October 1, 2020.