This week in Medicare updates—3/15/2023
Medicare Advantage Denial Notice
On March 3, CMS published an updated version of the Integrated Denial Notice (IDN) Form to its website. The updated version reflects nondiscriminatory language now required on CMS forms and notices. CMS published the new Spanish version of the form to the same page on March 13.
February 2023 Livanta Claims Review Advisor
On March 8, Livanta published its February 2023 edition of the Claims Review Advisor. This month’s edition covered the first year of review findings for higher-weighted DRGs. Livanta’s review found that 88% of higher-weighted DRG claims were approved for the higher-weighted DRG submitted.
Medicare Part B Inflation Rebate Guidance: Use of the 340B Modifier
On March 8, CMS revised a Fact Sheet regarding the use of the 340B modifiers (TB and JG) in implementing the Part B inflation rebate program, as units of 340B drugs are excluded from the rebates. CMS added CAHs, Maryland All-Payer or Total Cost of Care Model hospitals, and non-excepted off-campus provider-based departments to the list of providers types that should report the TB modifier for drugs acquired through the 340B program for claims with dates of service starting no later than January 1, 2024. CMS also updated an FAQ on the program to further clarify modifier use.
HCPCS Quarterly Update File Available
On March 8, CMS published the April 2023 HCPCS Quarterly Update File for download from its website.
Revision to State Operations Manual (SOM) Hospital Appendix A - Interpretive Guidelines for 42 CFR 482.21, Quality Assessment & Performance Improvement (QAPI) Program
On March 9, CMS published a Memorandum to state survey agency directors regarding new interpretive guidance for the hospital QAPI program. This guidance emphasizes CMS’ focus on ensuring hospital leadership and governance are involved in the prioritization and oversight of the program. The memo includes the revised text in Appendix A of the manual, which details what CMS wants surveyors to look for to determine a hospital’s compliance with these requirements.
Effective date: Immediately. Please communicate to all appropriate staff within 30 days.
April 2023 Integrated Outpatient Code Editor (I/OCE) Specifications, Version 24.1
On March 10, CMS published Medicare Claims Processing Transmittal 11896 regarding the April updates to the I/OCE.
Effective date: April 1, 2023
Implementation date: April 3, 2023
April 2023 Update of the Hospital Outpatient Prospective Payment System (OPPS)
On March 10, CMS published Medicare Claims Processing Transmittal 11897 regarding the April updates to the OPPS. Updates include 23 proprietary laboratory analyses (PLA) coding changes, a slew of updates to COVID-19 vaccine codes, updated language in the manual pertaining to various modifiers, and more.
Effective date: April 1, 2023
Implementation date: April 3, 2023
OIG COVID-19 PHE Flexibilities End Date
On March 10, the OIG published a Post regarding the end of its COVID-19 PHE flexibilities when the PHE ends on May 11. The OIG outlined which flexibilities it put in place, what those flexibilities allowed, and when those will end. The flexibilities include refraining from subjecting providers to administrative sanctions for reducing or waiving cost-sharing obligations for telehealth services, exercising certain enforcement discretions in order not to impose administrative sanctions for certain remuneration related to COVID-19 that was covered under blanket waivers, and more.