This week in Medicare updates—8/24/2022
COVID-19 FAQs on Medicare Fee-for-Service Billing
On August 16, CMS updated its FAQs for Medicare providers regarding COVID-19 billing. CMS published two new FAQs in the document regarding Medicare coverage and billing for COVID-19 testing done solely for travel purposes.
CMS Discontinuing Use of Certificates of Medical Necessity (CMN) and Durable Medical Equipment Information Forms (DIF)
On August 17, CMS published a Press Release to announce it is discontinuing the use of CMNs and DIFs for claims with dates of service on or after January 1, 2023. CMS said it reached this decision due to stakeholder feedback that these forms are duplicative and burdensome, and CMS said that submission of these forms is particularly difficult for small or rural providers.
CMS previously announced this change in Special Edition MLN Matters 22002, which was revised on May 23.
Influenza Vaccine Payment Allowances - Annual Update for 2022-2023 Season
On August 18, CMS published Medicare Claims Processing Transmittal 11564 regarding the annual update to payment allowances for the influenza vaccine. Part B payment for the vaccine is based on 95% of average wholesale price (AWP) except when furnished in hospital outpatient departments, rural health clinics, or federally qualified health centers, where payment is based on reasonable cost.
Effective date: August 1, 2022
Implementation date: September 30, 2022 - No later than September 30, 2022; November 1, 2022 - business requirement 12856.3.1
2023 Annual Update for the Health Professional Shortage Area (HPSA) Bonus Payments
On August 18, CMS published Medicare Claims Processing Transmittal 11565 regarding the annual update to the files for the HPSA bonus payment. The final file will be available on or around November 7.
Effective date: January 1, 2023
Implementation date: January 3, 2023
Creating a Roadmap for the End of the COVID-19 Public Health Emergency (PHE)
On August 18, CMS published a Blog Post regarding actions it plans to take when winding down the COVID-19 PHE. The blog post included a reminder that CMS Secretary Xavier Becerra will give 60 days notice before ending the PHE, although this blog post does not serve as that notice. CMS is encouraging providers, however, to begin to plan for the end of the flexibilities introduced during the COVID-19 PHE which will not continue once the PHE ends.
CMS updated its COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers on August 18 to note which waivers will continue after the termination of the COVID-19 PHE. CMS also published a Fact Sheet on health care system resiliency to highlight its strategy for determining which waivers to continue or discontinue after the end of the PHE.
Annual Clotting Factor Furnishing Fee Update 2023
On August 18, CMS published Medicare Claims Processing Transmittal 11567 regarding the annual update to the clotting factor furnishing fee, which will be $0.250 per unit in 2023.
Effective date: January 1, 2023
Implementation date: January 3, 2023
OIG Advisory Opinion 22-16
On August 19, the OIG published an Advisory Opinion regarding whether the provision of a gift card for certain Medicare Advantage plan enrollees who complete specific steps in an online patient education program would be grounds for the imposition of sanctions under civil monetary penalties or exclusion authorities related to the anti-kickback statute and prohibition on beneficiary inducements. Under this arrangement, the Requestor–who operates a decision-making online learning tool educating patients on risks, benefits, and expectations regarding surgeries–would contract with certain Medicare Advantage (MA) organizations to offer the decision-making tool to the enrollees in those plans. The requestor would charge the MA plans on a per-member, per-month basis for the service. Enrollees who complete a survey and a module in the decision-making tool would receive a $25 gift card to a retailer. Enrollees would only be eligible for one gift card per year but may use the decision-making tool more than once. The gift card is not contingent on the enrollee undergoing surgery.
The OIG said that this arrangement would implicate the anti-kickback statute but would not implicate the prohibition on beneficiary inducements. Still, the OIG said it would not impose sanctions in this case due to a low risk of fraud and abuse.