This week in Medicare updates—3/1/2023
Extension of Publication for Final Rule: Medicare Secondary Payer and Certain Civil Monetary Penalties
On February 22, CMS published an Extension in the Federal Register to extend the timeline for publication of a final rule on potential civil monetary penalties for failure to meet Medicare secondary payer reporting obligations. The Proposed Rule was published on February 18, 2020, right at the beginning of the COVID-19 PHE. Due to delays resulting from the agency’s focus on the PHE as well as CMS’ desire to address the complexity of the policy and operational issues involved in this rule, CMS is extending the timeline for publishing the final rule by one year.
The deadline for publication of this final rule is now February 18, 2024.
HCPCS Level II Coding: FAQs for Single Source Drugs & Biologicals
On February 23, CMS published an FAQ regarding HCPCS coding for single source drugs and biologicals. The FAQ addresses why CMS is taking action on single source drug coding, what providers need to do, which codes CMS is establishing, and where to find additional information.
Significant Updates to Medicare Secondary Payer Manual, Chapter 3
On February 23, CMS published Medicare Secondary Payer Transmittal 11874 regarding updates to language in the manual to fix language that is out of date, including language related MSP policy and operational procedures. Revisions were made to sections about responsibility of providers where benefits may be payable under workers’ compensation, situations under the Competitive Acquisition Program, and more.
Effective date: March 24, 2023
Implementation date: March 24, 2023
The Supplemental Security Income (SSI)/Medicare Beneficiary Data for FY 2021 for IPPS Hospitals, Inpatient Rehabilitation Facilities (IRF), and Long-Term Care Hospitals (LTCH)
On February 23, CMS published Medicare Contractor Beneficiary and Provider Communications Transmittal 11870 regarding updated data for determining the disproportionate share adjustment for IPPS hospitals and the low-income patient adjustment for IRFs as well as payments as applicable for LTCH discharges.
Effective date: March 24, 2023
Implementation date: March 24, 2023
National Coverage Determination (NCD) 50.3 - Cochlear Implantation Manual Update
On February 23, CMS published Medicare National Coverage Determinations Transmittal 11875 and Medicare Claims Processing Transmittal 11875 regarding updates to the manuals with the revised eligibility criteria for the cochlear implantation NCD. CMS expanded coverage to beneficiaries who demonstrate limited benefit from amplification as defined by test scores of less than or equal to 60% correct on recorded tests of open-set sentence recognition.
Effective date: September 26, 2022
Implementation date: March 24, 2023
Extensions of Certain Temporary Changes to the Low-Volume Hospital Payment Adjustment and the Medicare Dependent Hospital (MDH) Program under the IPPS Provided by the Further Continuing Appropriations and Extensions Act, 2023, and the Consolidated Appropriations Act, 2023
On February 23, CMS published One-Time Notification Transmittal 11878 regarding implementation of sections of the Further Continuing Appropriations and Extensions Act, 2023 and the Consolidated Appropriations Act, 2023. This changes the low-volume hospital payment adjustment, includes instructions on whether hospitals need to notify their MACs about meeting criteria to receive this adjustment, and discusses MDH status requirements.
Effective date: December 17, 2022
Implementation date: March 10, 2023
Recordings, Scoresheet Available from MEDCAC Meeting on Coverage with Evidence Development (CED)
On February 23, CMS published the Recordings and Scoresheet from the MEDCAC meeting on CED which took place on February 13 and 14. The meeting was held to evaluate whether changes should be made to CED requirements.
CMS Updates Information Regarding End of COVID-19 PHE
On February 23, CMS updated the Provider Resources on the COVID-19 waivers webpage regarding the end of the COVID-19 PHE. CMS did not note where in the resource documents they updated or added new information, so the documents should be reviewed in their entirety for any new information.
Updates to Independent Renal Dialysis Facility Cost Report
On February 24, CMS published Provider Reimbursement Manual Transmittal 8 regarding updates to the independent renal dialysis facility cost report to revise existing instructions to exclude salaries and add instructions to one worksheet.
Effective date: ESRD changes effective for cost reporting periods beginning on or after January 1, 2023; changes to electronic reporting specifications are effective for cost reporting periods beginning on or after February 1, 2023