Thursday, June 4, 2020
- Trump Administration Unveils Enhanced Enforcement Actions Based on Nursing Home COVID-19 Data and Inspection Results
- Hospice Provider Preview Reports: Review Your Data by June 29
- Claim Status Category Codes and Claim Status Codes Update
- Implement Operating Rules - Phase III Electronic Remittance Advice (ERA) Electronic Funds Transfer (EFT): Committee on Operating Rules for Information Exchange (CORE) 360 Uniform Use of Claim Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC) and Claim Adjustment Group Code (CAGC) Rule - Update from Council for Affordable Quality Healthcare (CAQH) CORE
- Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update
- Summary of Policies in the Calendar Year (CY) 2020 Medicare Physician Fee Schedule (MPFS) Public Health Emergency (PHE) Interim Final Rules
- Value-Based Insurance Design (VBID) Model – Implementation of the Hospice Benefit Component
- Supplier Education on Use of Upgrades for Multi-Function Ventilators — Revised
- Therapy Codes Update — Revised
- International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs)--October 2020 Update — Rescinded
View this edition as PDF (PDF)
News
Trump Administration Unveils Enhanced Enforcement Actions Based on Nursing Home COVID-19 Data and Inspection Results
On June 1, under the leadership of President Trump, CMS unveiled enhanced enforcement for nursing homes with violations of longstanding infection control practices. This announcement builds on the previous actions CMS has taken to ensure the safety and security of America’s nursing homes as the nation battles Coronavirus Disease 2019 (COVID-19) and is a key step in the Trump Administration’s Guidelines for Opening Up America Again.
The Coronavirus Aid, Relief, and Economic Security Act provided additional funding to CMS for necessary survey and certification work related to COVID-19:
- CMS will allocate this funding based on performance-based metrics
- States will be required to perform on-site surveys of nursing homes with previous COVID-19 outbreaks and will be required to perform on-site surveys (within three to five days of identification) of any nursing home with new COVID-19 suspected and confirmed cases
- CMS will provide technical assistance through Quality Improvement Organizations
For More Information:
- State Survey Memo
- Letter to the Governors (PDF)
- State breakdown of the Nursing Home COVID-19 data (PDF)
See the full text of this excerpted CMS Press Release (issued June 1), including the full list of CMS public health actions for nursing homes on COVID-19.
Hospice Provider Preview Reports: Review Your Data by June 29
Two reports are available in your Certification and Survey Provider Enhanced Reports (CASPER) non-validation reports folder:
- Hospice provider preview report: Review Hospice Item Set (HIS) quality measure results from the fourth quarter of 2018 to the third quarter of 2019
- Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS®) provider preview report: Review facility-level CAHPS survey results from the fourth quarter of 2017 to the third quarter of 2019
Requests for CMS review of HIS or CAHPS data must be submitted by 11:59 pm ET on June 29 to be reflected in the next quarterly refresh, scheduled for August 2020. For more information, visit the Background and Announcements webpage.
Claims, Pricers & Codes
ICD-10-PCS Procedure Codes: FY 2021
FY 2021 ICD-10-PCS procedure code updates are posted on the 2021 ICD-10-PCS webpage, including a complete list of code titles. FY 2021 ICD-10-CM diagnosis code updates will be posted later this month.
Events
COVID-19: Lessons from the Front Lines Call — June 5
Fridays from 12:30 to 2 pm ET
These weekly calls are a joint effort between CMS Administrator Seema Verma, Food and Drug Administration (FDA) Commissioner Stephen Hahn, MD, and the White House Coronavirus Task Force. Physicians and other clinicians: Share your experience, ideas, strategies, and insights related to your COVID-19 response. There is an opportunity to ask questions.
To Participate:
- Conference lines are limited; we encourage you to join via audio webcast
- Or, call 833-614-0820; Access Code: 6583696
For More Information:
- Coronavirus.gov
- CMS Current Emergencies website
- Podcast and Transcripts webpage: Audio recordings and transcripts
Target Audience: Physicians and other clinicians.
MLN Matters® Articles
Claim Status Category Codes and Claim Status Codes Update
A new MLN Matters Article MM11699 on Claim Status Category Codes and Claim Status Codes Update (PDF) is available. Learn about updates for the Accredited Standards Committee (ASC) X12 276/277 Health Care Claim Status Request and Response and ASC X12 277 Health Care Claim Acknowledgment transactions.
Implement Operating Rules - Phase III Electronic Remittance Advice (ERA) Electronic Funds Transfer (EFT): Committee on Operating Rules for Information Exchange (CORE) 360 Uniform Use of Claim Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC) and Claim Adjustment Group Code (CAGC) Rule - Update from Council for Affordable Quality Healthcare (CAQH) CORE
A new MLN Matters Article MM11709 on Implement Operating Rules - Phase III Electronic Remittance Advice (ERA) Electronic Funds Transfer (EFT): Committee on Operating Rules for Information Exchange (CORE) 360 Uniform Use of Claim Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC) and Claim Adjustment Group Code (CAGC) Rule - Update from Council for Affordable Quality Healthcare (CAQH) CORE (PDF) is available. Learn about the next version of the Code Combination List.
Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update
A new MLN Matters Article MM11708 on Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update (PDF) is available. Learn about updates effective October 5.
Summary of Policies in the Calendar Year (CY) 2020 Medicare Physician Fee Schedule (MPFS) Public Health Emergency (PHE) Interim Final Rules
A new MLN Matters Article MM11805 on Summary of Policies in the Calendar Year (CY) 2020 Medicare Physician Fee Schedule (MPFS) Public Health Emergency (PHE) Interim Final Rules (PDF) is available. Learn about recent policy changes.
Value-Based Insurance Design (VBID) Model – Implementation of the Hospice Benefit Component
A new MLN Matters Article MM11754 on Value-Based Insurance Design (VBID) Model – Implementation of the Hospice Benefit Component (PDF) is available. Learn about billing and coverage for services provided to Medicare beneficiaries who elected hospice and are enrolled in Medicare Advantage plans participating in the model.
Supplier Education on Use of Upgrades for Multi-Function Ventilators — Revised
A revised MLN Matters Special Edition Article SE20012 on Supplier Education on Use of Upgrades for Multi-Function Ventilators (PDF) is available. Learn about suspended claims editing when there are claims for separate devices that have not met their reasonable useful lifetime.
Therapy Codes Update — Revised
A revised MLN Matters Article MM11791 on Therapy Codes Update (PDF) is available. Learn about additions to the therapy code list for the COVID-19 Public Health Emergency.
International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs)--October 2020 Update — Rescinded
MLN Matters Article MM11749 on International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs)--October 2020 Update is rescinded. Any coding changes to NCD 90.2, Next Generation Sequencing, are null and void.
Publications
Medicare Secondary Payer — Revised
A revised Medicare Secondary Payer Medicare Learning Network Booklet is available. Learn about:
- When Medicare pays first
- Exceptions
- How to gather accurate data from the beneficiary
- What happens if you fail to file correct and accurate claims
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