This week in Medicare updates—12/23/2020
SARS-CoV-2 Point of Care Testing and CLIA Certificate of Waiver (CoW) Applications
On December 11, CMS published a Q&A to clarify when facilities who submit CMS-116 applications for a CLIA CoW can begin SARS-CoV-2 POC testing. CMS is temporarily exercising enforcement discretion to enable these facilities to begin testing once they have submitted their applications but have yet to be assigned a CLIA number as long as their state does not have additional licensure requirements that must be met before testing can begin.
Updates to Pub. 100-09, Beneficiary and Provider Communication Manual, Chapter 6, Provider Customer Service Program
On December 14, CMS published Medicare Contractor Beneficiary and Provider Communications Transmittal 10519, which rescinds and replaces Transmittal 10455, dated November 13, 2020, to revise elements of the IOM. The original transmittal was issued regarding a variety of updates to Chapter 6 of the manual. These include updating links and references, adding social media reporting requirements, clarifying language about what inquiries are covered by the DDR, and more.
Effective date: December 16, 2020
Implementation date: December 16, 2020
Updates to Nursing and Allied Health Education Medicare Advantage Payment Policies
On December 14, CMS published One-Time Notification Transmittal 10520, which rescinds and replaces Transmittal 10486, dated November 19, 2020, to revise the implementation date from December 14 to December 21. The original transmittal was issued regarding instructions to MACs on how to compute and/or reconcile Medicare Advantage payments for allied health education.
Effective date: September 21, 2020
Implementation date: December 21, 2020
CMS Solicits Public Comment for New Demonstration to Offer Inpatient Rehabilitation Providers Flexibilities and Reduce Medicare Fraud
On December 14, CMS published a Press Release to announce it is seeking comment on a new demonstration for inpatient rehabilitation facility (IRF) services. The demonstration would use either pre-claim or post-payment review to ensure the right payments are made at the right time for IRF services as a method of reducing improper payments, reducing appeals, and improving IRF compliance. It would be implemented first in Alabama, then would expand to Pennsylvania, Texas, and California based on particularly high rates of fraud in those locations.
On December 15, CMS published a Comment Request in the Federal Register on the proposed collection of information for the demonstration. Comments are due by February 16, 2021.
Medicare Preventive Services
On December 14, CMS updated a Webpage regarding Medicare preventive services. The updates applied to the FAQ section. The page includes a thorough listing of preventive services and resources for providing those services.
FAQs: Application of OIG’s Administrative Enforcement Authorities to Arrangements Directly Connected to the COVID-19 Public Health Emergency
On December 14, the OIG updated an FAQ regarding changes to enforcement pertaining to arrangements that are directly connected to COVID-19. The new FAQ pertains to whether FQHCs can conduct free COVID-19 diagnostic testing at community health fairs and via mobile testing in underserved communities impacted by COVID-19.
Updated Effective Date for Pfizer-BioNTech Vaccine
On December 14, CMS published a Special Edition MLN Connects article regarding the EUA for the Pfizer-BioNTech COVID-19 vaccine. CMS published updated payment and coding information for the vaccine and noted that providers should only bill for vaccine administration when submitting claims to Medicare. Providers should not include the vaccine product codes when vaccines are free. Providers should report CPT code 0001A for the first dose of the Pfizer vaccine and CPT code 0002A for the second dose of the vaccine. Those codes are effective December 11, 2020. CMS also lists the codes for the Moderna vaccine but has not yet published effective dates8.
CMS also provided links to the EUA approval letter, an FDA fact sheet for providers administering the vaccine, and a communication toolkit for medical centers, clinics, and clinicians.
Updated OIG Work Plan
On December 15, the OIG updated its Work Plan with the following new items:
- Race and Ethnicity Data for Medicare Beneficiaries
- Supplier Acquisition Costs for Urinary Supplies
- Followup Review on Medicare Claims for Outpatient Services Provided During Inpatient Stays
ICD-10-CM FY 2021 Conversion Table
On December 16, the CDC published a Download Link for the January 2021 version of the FY 2021 ICD-10-CM Conversion Tables. Unless otherwise specified, each code in the table’s effective date is October 1 of the year listed.
COVID-19 FAQs on Medicare Fee-for-Service Billing
On December 16, CMS updated an FAQ regarding the latest guidance on billing for COVID-19. This round of updates included clarification on how to bill and code for high throughput lab testing under the new requirement that a majority of a lab’s COVID-19 CDLTs must be completed in two calendar days or less to qualify for the $25 Medicare add-on payment. It also updated information about scope of practice for supervising diagnostic tests, whether Medicare will require an order from a treating physician/NPP for flu or other tests, and changes to requirements for CDLTs.
CMS continues to update this document on a regular basis. Providers should review frequently for new information.
New Medicare National Uniform Billing Committee (NUBC) Type of Bill (TOB), Condition Code and Implementing Billing Codes for Opioid Treatment Programs
On December 16, CMS published Medicare Claims Processing Transmittal 10521 and Medicare Financial Management Transmittal 10521, which rescind and replaces Claims Processing Transmittal 10266 and Financial Management Transmittal 10266, dated August 6, 2020, to add Provider Type 34, note that CAHs are paid via the OTP fee schedule, and provide clarification on the 2020 OTP fee schedule file (attachment 1) versus the 2021 OTP fee schedule (new attachment 3). The correction also revises business requirement 11856.4.1 and only impacts pub. 100-04. The original transmittal was issued regarding the establishment of coding and payment rates for OTPs.
Effective date: January 1, 2021 - for claims received on or after 1/1/2021
Implementation date: January 4, 2021 - for all BRs except those noted for April 2021; April 5, 2021 - for BRs 04.8, 04.9, 04.9.1, 04.10, 04.10.1, 04.11.1, and 06.1.
Home Health Agency Provider Compliance Audit: Total Patient Care Home Health, LLC
On December 16, the OIG published a Review of whether Total Patient Care Home Health (TPC) complied with Medicare requirements for billing home health services. The OIG found that TPC billed Medicare incorrectly for 32 of the 100 home health claims reviewed. These issues pertained to services provided to beneficiaries who were not homebound or did not require skilled services. The OIG estimated that TPC received overpayments of at least $1.7 million for the audit period, which is now outside of the 4-year reopening period.
The OIG recommends TPC identify, report, and return any overpayments in accordance with the 60-day rule and strengthen procedures to ensure full compliance with home health billing requirements. TPC challenged the OIG’s original findings in which the OIG found 38 of the 100 sampled claims were incorrectly billed, and after further review, the OIG lowered its findings to incorrect billing for 32 of 100 claims and adjusted the findings for 13 claims.
Implementation of the New Ambulatory Surgical Center (ASC) Payment Indicator “K5”
On December 17, CMS published One-Time Notification Transmittal 10525, which rescinds and replaces Transmittal 10245, dated July 30, 2020, to remove the word “draft” from Attachment A. The transmittal is no longer sensitive and may now be posted to the internet. The original transmittal was issued regarding instructions to the MACs for implementation of new ASC payment indicator “K5.”
Effective date: January 1, 2021
Implementation date: January 4, 2021
Chapter 15 of Pub. 100-08 Manual Redesign - Additional Release of Chapter 10
On December 17, CMS published Medicare Program Integrity Transmittal 10524, which rescinds and replaces Transmittal 10345, dated September 11, 2020, to update multiple sections of the Chapter 10 attachment and to update the mailstop address in the manual. The original transmittal was issued regarding the reorganization of manual instructions in Chapter 15 (Medicare Enrollment) and movement of the instructions to Chapter 10.
Effective date: November 13, 2020
Implementation date: November 13, 2020
COVID-19 Infection Control for Psychiatric and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID)
On December 17, CMS published a Memo to state survey agency directors with an FAQ document to identify strategies and practices facilities can employ to help address COVID-19-related issues at these facilities. This includes methods of infection control; use of isolation/cohorting/PPE; transition and discharge during the PHE; strategies for interventions, mitigation, and training; engaging family, caregiver, support personnel, and community resources; and additional resource guides and web links applicable to this provider type.
Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers, and the state/regional office training coordinators within 30 days of this memo.
FAQs: CLIA Guidance During the COVID-19 Emergency
On December 17, CMS updated an FAQ regarding CLIA guidance during the PHE. CMS made changes to FAQs 14, 15, and 26. This includes updated language about whether CLIA-waived means facilities do not need CLIA certificates, an updated response on whether labs can develop an individualized quality control plan for COVID-19 test systems, and an update to note that there is an EUA for an at-home COVID-19 test kit.
Correction: Regulatory Clean Up Initiative
On December 17, HHS published a Correction Notice in the Federal Register regarding a final rule in which HHS is using AI technology to find errors in current regulations pertaining to incorrect citations, erroneous language, misspellings, and other typographical errors. This correction fixes typos and typographical errors in that rule.
Dates: Effective December 17, 2020.
COVID-19 Treatments Add-On Payment (NCTAP)
On December 18, CMS created a new Webpage regarding the COVID-19 NCTAP, which was established in the FY 2021 IPPS final rule. The page discusses regulatory sources for this payment, links to newly approved treatments, ICD-10-CM/PCS coding information, and additional resource links.
Medicare Hospital Provider Compliance Audit: Providence Medical Center
On December 18, the OIG published a Review of whether Providence Medical Center complied with Medicare requirements for billing inpatient and outpatient services for certain claims that were potentially at risk for billing errors. The OIG determined that Providence did not comply with requirements on 13 of the 100 claims reviewed. All 13 errors were due to inpatient claims that did not meet Medicare criteria for inpatient status. The OIG estimated that this resulted in overpayments of at least $325,241 for the audit period.
The OIG recommends Providence exercise reasonable diligence to identify, report, and return overpayments in accordance with the 60-day rule. The hospital disagreed with the OIG’s findings and said it believed the OIG’s independent medical review contractor misapplied applicable Medicare authority during the review. The OIG maintained its original findings were correct.
Comment Request: Appeals of Quality Bonus Payment Determinations
On December 18, CMS published a Comment Request in the Federal Register regarding the submission for OMB review of an information collection titled, “Appeals of Quality Bonus Payment Determinations.”
Comments are due to the OMB desk officer by January 19, 2021.
CY 2021 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment
On December 18, CMS published Medicare Claims Processing Transmittal 10523 regarding the CY 2021 update to the CLFS. The transmittal includes information about the delayed CLFS data reporting period for CDLTs, COVID-19 policy updates, mapping information, and more.
Effective date: January 1, 2021
Implementation date: January 4, 2021