This week in Medicare updates--2/15/2023
New State Codes for North Carolina
On February 6, CMS published One-Time Notification Transmittal 11838, which rescinds and replaces Transmittal 11695, dated November 9, 2022, to revise the title, background section, and business requirement by adding additional state codes for states including Delaware, Florida, Illinois, and more. The original transmittal was issued regarding new state codes for North Carolina in addition to the state code the state already uses.
Effective date: April 1, 2023
Implementation date: April 3, 2023
Technical Assistance Brief: Implementation of Inflation-Indexed Rebates for Part B Drugs
On February 7, the OIG published a Technical Assistance Brief regarding information for CMS on issues the OIG encountered in past work examining how much money Medicare could collect on inflation indexed rebates for certain Part B drugs. The OIG said its past efforts were similar to what CMS will have to do following the implementation of the Medicare Prescription Drug Inflation Rebate Program as mandated by the Inflation Reduction Act, and the OIG intends for the report to provide insights and potential solutions for CMS to consider as CMS implements this new program. The OIG said that it faced significant challenges in identifying products subject to Part B rebates and in excluding claims from Part B rebate calculations that were already subject to rebates or discounts under other programs. It suggested potential solutions to these problems in the brief.
Update to the Medicare Claims Processing Manual, Chapter 18, Section 10.2.2.1, to Clarify the Payment Method on Vaccines for Critical Access Hospitals (CAH)
On February 9, CMS published Medicare Claims Processing Transmittal 11843 regarding updates to the manual to clarify payment for pneumococcal pneumonia, influenza, hepatitis B, and COVID-19 vaccines at CAHs.
Effective date: March 9, 2023
Implementation date: March 9, 2023
Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2023 Update
On February 9, CMS published Medicare Claims Processing Transmittal 11848 regarding the quarterly update to the MPFSDB. The transmittal includes an attachment with a summary of changes for the April update.
Effective date: April 1, 2023
Implementation date: April 1, 2023
Medicare Claims Processing Manual Update to Chapter 12 for Code Updates and Substantive Portion Definition Finalized Through Rule-Making Processes
On February 9, CMS published Medicare Claims Processing Transmittal 11842 regarding changes to the manual to align with several coding, billing, and policy changes made through rule-making processes. This includes updates pertaining to the merging of the inpatient and observation evaluation and management (E/M) visit code families into one code family (Hospital Inpatient or Observation Care), changes pertaining to the deletion of CPT code 99318 (other nursing facility service), and the new definition for “substantive portion” as it pertains to the current split (or shared) visit policy.
Effective date: January 1, 2023
Implementation date: May 9, 2023
April 2023 Quarterly Update to HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement
On February 9, CMS published Medicare Claims Processing Transmittal 11849 regarding updates to the lists of HCPCS codes subject to consolidated billing under the SNF Prospective Payment System. This update includes the addition of a significant number of codes for blood clotting factors.
CMS published MLN Matters 13089 on the same date to accompany the transmittal.
Effective date: April 1, 2023
Implementation date: April 3, 2023
HHS Releases Initial Guidance for Medicare Prescription Drug Inflation Rebate Program
On February 9, CMS published a Press Release announcing the next steps in how HHS will implement the new Medicare Prescription Drug Inflation Rebate Program, which will require drug companies to pay rebates to Medicare when their prescription drug prices increase faster than the rate of inflation for certain drugs dispensed to Medicare beneficiaries. CMS provided guidance for pharmaceutical manufacturers of Part B and Part D rebatable drugs regarding topics such as determining which drugs will be included in this program and identifying payment amounts.
CMS is also requesting comment on the following topics:
- The process to determine the number of drug units for rebatable drugs
- Reduction of rebate amounts for certain Part B and Part D rebatable drugs in shortage and in cases of severe supply chain disruptions
- The process to impose civil monetary penalties on manufacturers of Part D rebatable drugs that fail to pay rebates
- Assuring accuracy of inflation rebate payments
CMS published a Fact Sheet on the Medicare Prescription Drug Inflation Rebate Program to accompany the press release. Comments are due by March 11.
Revisions to State Operations Manual Chapter 5
On February 10, CMS published State Operations Provider Certification Transmittal 212 regarding technical corrections to multiple sections of Chapter 5 of the manual. Changes apply to sections about the ASPEN Complaints/Incident Tracking System (ACTS) as well as sections on actions and reporting for potential neglect and abuse in nursing homes.
Effective date: October 21, 2022
Implementation date: October 24, 2022 except for 5060 - October 1, 2024 and 5075.9 - October 1, 2023