This week in Medicare updates—8/16/2023
Update to Hospice Payment Rates, Hospice Cap, Hospice Wage Index, and Hospice Pricer for FY 2024
On August 10, CMS published Medicare Claims Processing Transmittal 12193 regarding updates to hospice payment rates, caps, wage index, and pricer for FY 2024. These changes were made via the FY 2024 Hospice Payment Rate Final Rule and are being implemented via this transmittal.
CMS published MLN Matters 13289 on the same date to accompany the transmittal.
Effective date: October 1, 2023
Implementation date: October 2, 2023
Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - October 2023
On August 10, CMS published Medicare Claims Processing Transmittal 12194 regarding instructions to the contractors to retrieve the quarterly update files for the MPFSDB from the CMS mainframe on or around August 18 and use that to update their systems.
Effective date: October 1, 2023
Implementation date: October 2, 2023
Annual Update of HCPCS Codes Used for Home Health Consolidated Billing Enforcement
On August 10, CMS published Medicare Claims Processing Transmittal 12197 regarding the January 2024 update to the list of HCPCS codes used to enforce consolidated billing of home health services. This update adds HCPCS code A9272 (wound suction, disposable, includes dressing, all accessories and components, any type, each) to the HH consolidated billing non-routine supply code list.
Effective date: January 1, 2024
Implementation date: January 2, 2024
Combined Common Edits/Enhancements Modules (CCEM) Code Set Update
On August 10, CMS published Medicare Claims Processing Transmittal 12190 regarding the regular updates to the CCEM code set.
Effective date: January 1, 2024
Implementation date: January 2, 2023
Quarterly Update to Home Health Grouper
On August 10, CMS published Medicare Claims Processing Transmittal 12199 regarding the January 2024 update to the Home Health Grouper.
Effective date: January 1, 2024 - Claim “from” dates on or after this date
Implementation date: January 2, 2024
New Place of Service (POS) Code 27 - “Outreach Site/Street”
On August 10, CMS published Medicare Claims Processing Transmittal 12202 regarding the creation of a new POS code 27 for “Outreach Site/Street.” This code should be used to help identify care rendered to those who may be unable to access brick and mortar settings and to potentially allow for tracking of care through outreach sites. The code’s definition is “a non-permanent location on the street or found environment, not described by any other POS code, where health professionals provide preventive, screening, diagnostic, and/or treatment services to unsheltered homeless individuals.”
Effective date: October 1, 2023
Implementation date: January 2, 2024
Outpatient Rehabilitation Claims Returned in Error
On August 10, CMS published a Notice in MLN Connects regarding a claims processing issue where outpatient rehabilitation claims for remote therapeutic monitoring reported under CPT codes 98980 and 98981 were being returned in error with reason code W7072. This affected claims with revenue codes 42X, 43X, or 44X on TOBs 22X, 23X, 34X, and 85X. CMS is instructing providers affected by this between January 1 - June 30, 2023 to resubmit claims returned in error.
Annual Clotting Factor Furnishing Fee Update 2024
On August 10, CMS published Medicare Claims Processing Transmittal 12201 regarding the annual update to the clotting factor furnishing fee, which will be $0.250 per unit in 2024, the same amount that it was in 2023.
Effective date: January 1, 2024
Implementation date: January 2, 2024
ICD-10 and Other Coding Revisions to NCDs–October 2023 Update
On August 11, CMS published One-Time Notification Transmittal 12207, which rescinds and replaces Transmittal 12017, dated May 4, to revise the NCD 210.1 Prostate Cancer Screens attachment and to remove business requirement 13166.3 at the request of CWF since CPT 0395U in NCD 210.1 is being deleted in its entirety and was added to the NCD in error. The original transmittal was published regarding the regular quarterly updates to ICD-10 conversions and other coding updates for NCDs.
Effective date: August 7, 2023 - BRs 1&2; October 1, 2023 - BR 3 only
Implementation date: August 7, 2023 - BRs 1&2; October 2, 2023 - BR 3 only - for DOS on and after 1/1/2023
Medicare Paid Independent Organ Procurement Organizations Over a Half Million Dollars for Professional and Public Education Overhead Costs That Did Not Meet Medicare Requirements
On August 11, the OIG published a Review regarding whether organ procurement organizations (OPO) complied with Medicare requirements for reporting professional and public education overhead costs. The review followed prior OIG audits which showed two OPOs in California failed to meet these requirements. In this audit, the OIG found that 36 of the 300 sampled professional and public education overhead costs did not meet Medicare requirements and were therefore unallowable. Issues involved misunderstandings of Medicare requirements and staff who made administrative errors or were not aware that costs did ot meet Medicare requirements. The OIG determined that $664,295 of the $50.9 million paid for professional and public education overhead costs included in the sample were unallowable.
The OIG recommends CMS instruct the MACs to recover the unallowable Medicare payments and update applicable Medicare requirements to clarify which types of professional and public education overhead costs are unallowable. CMS concurred with the recommendations and said it is reviewing its regulations and guidance to enable updates as needed to ensure OPOs report these costs appropriately.