This week in Medicare updates—4/26/23
Updated OIG Work Plan
On April 17, the OIG updated its Work Plan with the following new items:
- Use of Remote Patient Monitoring Services in Medicare
- Adverse Events Toolkit: Clinical Guidance for Identifying Harm
COVID-19 Health Care Fraud Enforcement Action
On April 20, the OIG published a variety of Releases regarding actions it has taken alongside the DOJ to crack down on fraudulent behavior during the COVID-19 PHE. In 2023, nationwide enforcement against this type of fraud has resulted in criminal charges against doctors and providers for false billings and Provider Relief Fund fraud, manufacturers for fake COVID-19 vaccination record cards, and individuals for fraudulent charges to Medicare for over-the-counter COVID-19 testing kits.
Religious Nonmedical Health Care Institution Provisions of the Consolidated Appropriations Act (CAA) of 2023
On April 20, CMS published Medicare Claims Processing Transmittal 11963 regarding a revision to the manual to include COVID-19 vaccine services in the definition of “excepted services” under the Religious Nonmedical Health Care Institution benefit.
Effective date: October 1, 2023 - Claims processed on or after this date
Implementation date: October 2, 2023
Telehealth Code Reporting and Date Matching Edit for Home Health Claims
On April 20, CMS published Medicare Claims Processing Transmittal 11964 regarding revisions to home health claim edits of telehealth services and matching dates. This change request removes a requirement to have a line item for an in-person visit on telehealth claims, excludes telehealth G-codes from medical policy parameters, and excludes contractor-initiated adjustments to home health claims from an edit requiring that the 0023 line item date matches when the claim admission date and from date match.
CMS published MLN Matters 13110 on the same date to accompany the transmittal.
Effective date: October 1, 2023 - Claims received on or after this date
Implementation date: October 2, 2023
Updates to Beneficiary and Provider Communications Manual, Chapter 6 - Provider Customer Service Program
On April 20, CMS published Medicare Contractor Beneficiary and Provider Communications Transmittal 11956 regarding revisions to Chapter 6 of the manual to remove duplicate sections, update references, revise language, and add new reporting requirements for MACs.
Effective date: May 22, 2023
Implementation date: May 22, 2023
COVID-19 FAQ on Medicare Fee-for-Service Billing
On April 20, CMS updated an FAQ regarding waivers and flexibilities during the COVID-19 PHE. The document was updated frequently throughout the PHE, and CMS now included a note at the top of the document to state that the guidance in the FAQ will expire with the end of the PHE on May 11. CMS is directing people to its emergencies page and coronavirus waivers page for continued information about the end of the PHE.
Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Patient-Driven Payment Model (PDPM) Claims Processing Updates to Current Editing
On April 21, CMS published Medicare Claims Processing Transmittal 11988 regarding updates to claims processing for SNF claims which modify editing for occurrence span code edits and update hospital overlap edits when billing during an interrupted stay where the hospital stay extends to the next month.
CMS published MLN Matters 13149 on the same date to accompany the transmittal.
Effective date: October 1, 2023 - Dates of service October 1, 2019, and after
Implementation date: October 2, 2023
HHS Making Medicare-Certified Hospice and Home Health Agency Ownership Data Publicly Available
On April 21, CMS published a Press Release to announce it has published ownership data for all Medicare-certified hospice and home health agencies nationwide. CMS previously released ownership data for hospitals and skilled nursing facilities, and CMS released data last April on mergers, acquisitions, consolidations, and changes of ownership from 2016-2022 for hospitals and skilled nursing facilities. This is part of an effort from the Biden administration to increase transparency and promote competition.
Medicare Policy Updates for Dental Services as Finalized in the Calendar Year (CY) 2023 Medicare Physician Fee Schedule (MPFS) Final Rule
On April 21, CMS published Medicare Benefit Policy Transmittal 11995 regarding updates to the manual to incorporate the new dental services policies that were finalized in the CY 2023 MPFS final rule. The manual includes the coverage policies for dental services as well as multiple examples of scenarios when dental services would or would not be paid per these new policies.
Effective date: January 1, 2023
Implementation date: May 12, 2023