This week in Medicare updates—6/30/2021
Medicare Mental Health
On June 21, CMS updated an MLN Booklet on mental health services covered by Medicare to add clarifications to table 5 regarding nurse practitioner coverage requirements.
Guidance Related to Emergency Preparedness - Exercise Exemption Based on a Facility’s Activation of their Emergency Plan
On June 21, CMS revised a Memorandum, originally published September 28, 2020, to state survey agency directors regarding clarifications on testing exercise requirements in light of the COVID-19 PHE. Due to the continued PHE and the number of facilities still operating under disaster/emergency conditions, CMS is exempting any inpatient facility still operating under an activated emergency from the full-scale exercise requirement for 2021. If an inpatient facility resumed normal operating status in 2021, it is expected to complete its full-scale exercise in 2021 unless it reactivates the emergency plan during its 12-month cycle.
Effective date: Immediately. This policy should be communicated to all survey and certification staff, their managers, and the state/regional office training coordinators immediately.
Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - July 2021 Update
On June 21, CMS published Medicare Claims Processing Transmittal 10860, which rescinds and replaces Transmittal 10793, dated May 20, 2021, to revise elements of the MPFS database attachment. The original transmittal was published regarding the regular quarterly updates to the MPFSDB.
CMS revised MLN Matters 12289 on the same date.
Effective date: July 1, 2021
Implementation date: July 6, 2021
COVID-19 Vaccine Billing Update
On June 22, CMS updated its Billing for COVID-19 Vaccine Shot Administration webpage. Because CMS does not indicate which information is new, it is best to review the page and associated links in their entirety.
Featured Topic: Nursing Homes
On June 22, the OIG published a Featured Topic page for nursing homes. The page includes a summary of key goals in OIG nursing home oversight as well as a resource section which includes links to nursing home reports, information about Operation CARE, tables of unimplemented recommendations, and a link to information on top management challenges.
COVID-19 Had a Devastating Impact on Medicare Beneficiaries in Nursing Homes During 2020
On June 22, the OIG published a Data Snapshot regarding COVID-19 cases in nursing homes in 2020. Because nursing homes were not required to report COVID-19 cases and deaths that occurred before May 8, 2020, there is no readily available data on the impact of COVID-19 in nursing homes early in the pandemic. The OIG therefore pieced together data by identifying nursing home residents who either had a diagnosis code of B97.29 or U07.1 on a claim in 2020 as having COVID, and it labeled residents with a diagnosis code of Z20.828 as having likely COVID.
The OIG found that 42% of nursing home beneficiaries either had or were likely to have had COVID in 2020. This is a dramatic total compared to the general population, where approximately 6% of people in the United States had COVID by the end of December. The OIG also found that the overall mortality rate in nursing homes increased by 32% in 2020, and almost 1,000 more beneficiaries died per day in April 2020 than in the previous year. The OIG said this demonstrates the ongoing need for CMS to mitigate the effects of the pandemic in nursing homes and put policies in place to prevent similar outcomes in any future pandemic.
2022 Release of ICD-10-CM Codes
On June 23, the CDC published the 2022 ICD-10-CM Code Set files. There are 159 new codes, 20 revised codes, and 32 deleted codes. Changes include a new code, U09.9, for post-COVID-19 (sometimes called long-haul COVID), to report as secondary to specific codes for lingering conditions after the patient no longer has active COVID-19. There are also 13 new social determinants of health codes, new poisonings codes, and more.
These codes are effective October 1, 2021.
Medicare Lacks Consistent Oversight of Cybersecurity for Networked Medical Devices in Hospitals
On June 23, the OIG published a Report which examined whether and how Medicare accreditation organizations (AO) use their discretion to examine cybersecurity of networked devices during hospital surveys. The OIG defines networked devices as those designed to connect to the internet, hospital networks, and other medical devices to provide features that improve health care and increase providers’ ability to treat patients. The OIG found that CMS’ survey protocol does not include requirements for networked device cybersecurity and AOs don’t generally use their discretion to require hospitals to have cybersecurity plans. AOs said they will review mitigation plans for these devices if a hospital includes the devices as part of their emergency preparedness risk assessments, but AOs said most hospitals don’t identify device cybersecurity in these risk assessments.
The OIG recommends CMS identify and implement a way to address networked device cybersecurity in its quality oversight of hospitals in consultation with HHS partners and others. CMS concurred with the recommendation.
Comment Request: Solicitation for Applications for Medicare Prescription Drug Plan 2023 Contracts; Collection of Prescription Drug Data from MA-PD, PDP and Fallout Plans/Sponsors for Medicare Part D Payments
On June 23, CMS published a Comment Request in the Federal Register regarding the following information collections:
- Solicitation for Applications for Medicare Prescription Drug Plan 2023 Contracts
- Collection of Prescription Drug Data from MA-PD, PDP and Fallout Plans/Sponsors for Medicare Part D Payments
Comments are due by August 23.
Correction: Comprehensive Care for Joint Replacement Model Three-Year Extension Final Rule
On June 24, CMS published a Correction Notice in the Federal Register regarding technical errors from the Comprehensive Care for Joint Replacement Extension Final Rule, published May 3, 2021. The correction affects a provision for ambulatory surgical centers (ASC) where the original final rule erroneously claimed all model procedures for CY 2021 could be performed in ASCs and paid by Medicare. However, due to an exception to the ASC covered procedure list policy that excludes procedures that had been on the inpatient-only list, total ankle replacements are not paid for by Medicare when performed in the ASC. CMS is revising the paragraph in the preamble to reflect that only total knee arthroplasty and total hip arthroplasty are on the ASC covered procedures list, not total ankle replacement.
Dates: This correction is effective on July 2, 2021.
Correction: FY 2022 IPPS Proposed Rule
On June 24, CMS published a Correction Notice in the Federal Register regarding technical and typographical errors in the FY 2022 IPPS Proposed Rule. The corrections apply to some typos in footnotes and references to statutory citations, errors in list numbering, and errors in achievement thresholds and benchmarks for the Hospital Value-Based Purchasing Program.
Dates: These changes are effective June 24.
Comment Request: Medicare Part D Reporting Requirements
On June 24, CMS published a Comment Request in the Federal Register regarding the submission of an information collection titled “Medicare Part D Reporting Requirements” for OMB review.
Comments are due to the OMB desk officer by July 26, 2021.
Hospice Provider Compliance Audit: Northwest Hospice, LLC
On June 25, the OIG published a Review of whether Northwest Hospice complied with Medicare requirements for hospice services. The OIG found that Northwest did not comply with Medicare requirements for 19 of the 100 claims reviewed in the sample, as the OIG said the clinical documentation for those claims did not support the beneficiary’s terminal prognosis. The OIG estimates that Northwest received at least $3.9 million in unallowable Medicare reimbursement for these hospice services.
The OIG recommends Northwest refund the government for the portion of the $3.9 million in overpayments within the four-year claims reopening period, return any similar overpayments, and strengthen its policies and procedures to ensure that hospice services comply with Medicare requirements. Northwest disagreed with the OIG’s findings on 12 of the 19 claims the OIG said were paid in error. Northwest stated that for six of those 12 claims, its own physicians determined either the same month or the month immediately following the audit that the beneficiary should be discharged from hospice because the beneficiary’s disease was not following the expected trajectory. For those six claims, Northwest said it should not be faulted when its clinicians came to the same conclusion within a matter of days of the independent medical review contractor. For the other six cases, Northwest said the beneficiaries were eligible for hospice services as supported by an additional licensed physician’s review. After reviewing Northwest’s comments, the OIG maintained its original findings.
July 2021 Update of the Ambulatory Surgical Center (ASC) Payment System
On June 25, CMS published Medicare Claims Processing Transmittal 10858 regarding the July quarterly updates to the ASC payment system. Changes include eight new Category III CPT codes (most of which are for GI procedures), one new OPPS device pass-through code, eight new HCPCS codes for reporting drugs/biologicals in the ASC setting, and more.
CMS published MLN Matters 12341 on the same date to accompany the transmittal.
Effective date: July 1, 2021
Implementation date: July 6, 2021