May 2019 Medicare Transmittals and Other Updates

on Tuesday, 28 May 2019. All News Items | Outpatient Services | Miscellaneous | Medicare Coverage | Coding | Billing


Notice of New Interest Rate for Medicare Overpayments and Underpayments -3rd Qtr Notification for FY 2019

The Medicare contractors shall implement an interest rate of 10.375 percent effective April 17, 2019 for Medicare overpayments and underpayments.

Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment

International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs)

A maintenance update of International Classification of Diseases, 10th Revision (ICD-10) conversions and other coding updates specific to National Coverage Determinations (NCDs). These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received.

Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update

Claim Status Category and Claim Status Codes Update

Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes – July 2019 Update

Updates the HCPCS code set for codes related to drugs and biologicals.



Implementation to Exchange the List of Enrollment in Electronic Medical Documentation Requests (eMDR) for Registered Providers via the Electronic Submission of Medical Documentation (esMD) System

Introduces the enrollment process for the providers who intend to get their Additional Documentation Request (ADR) letters electronically (as eMDR) through their registered Health Information Handler.

Re-implementation of the AMCC Lab Panel Claims Payment System Logic

Because CMS no longer has payment logic to roll up panel pricing for organ or disease-oriented panels (also known as Automated Multi-Channel Chemistry or AMCC tests), laboratories must report the HCPCS code for the AMCC panel test where appropriate and not report separately the tests that make up that panel.

Documentation of Evaluation and Management Services of Teaching Physicians

A change in policy of documentation for teaching physicians providing evaluation and management (E/M) services.

Implementation of the Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM)

Effectuates changes to the SNF Prospective Payment System (PPS) that are required for the PDPM. These changes were finalized in the FY 2019 SNF PPS Final Rule (83 FR 39162). SNFs billing on Type of Bill (TOB) 21X and hospital swing bed providers billing on TOB 18X, (subject to SNF PPS) will be subject to these requirements.

Reporting the HCPCS Level II Modifiers of the Patient Relationship Categories and Codes

Provides educational information regarding reporting of the HCPCS Level II code modifiers for the Patient Relationship Categories and Codes (PRC).

Additional Processing Instructions to Update the Standard Paper Remit (SPR)

Effective October 1, 2019, MACs will mask the Patient Control Number field (also named the Patient CNTRL Number) or the Patient Account Number (ACNT) field on any print file used to create an SPR for mailing if it contains a HICN or SSN in accordance with the Social Security Number (SSN) Fraud Prevention Act of 2017.



Proper Use of Modifier 59

Clarifies existing policy on the proper use of Modifier 59. Revised article to correct updated CPT code.



National Coverage Determination (NCD90.2): Next Generation Sequencing (NGS)

CMS covers diagnostic laboratory tests using next generation sequencing when performed in a CLIA-certified laboratory when ordered by a treating physician and when specific requirements are met.

Delay in Final Chimeric Antigen Receptor (CAR) T-cell therapy National Coverage Determination

CMS will not be issuing a final National Coverage Determination on CAR T-cell therapy for cancer today (5-17-19), but a decision is forthcoming.



CMS outlines comprehensive strategy to foster innovation for transformative medical technologies



Medicare Fast Facts

Medicare Fast Facts resources this month include:

  • Payment for Outpatient Services Provided to Beneficiaries Who Are Inpatients of Other Facilities



2020 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Acute Care Hospital (LTCH) Prospective Payment System Proposed Rule

Fact Sheet for Proposed Rule -

BFCC-QIO Contract Awarded for 12th Scope of Work to Start July 2019

The 11th Scope of Work is coming to an end. On April 30th KEPRO and LIVANTA were again awarded the BFCC-QIO contracts for the 12th Scope of Work (SOW) that will run from 2019 – 2023

Temporary Pause of BFCC-QIO Short Stay and HWDRG Reviews

CMS has temporarily paused the performance of both Short Stay reviews and Higher Weighted Diagnosis-Related Group (HWDRG) reviews by the Beneficiary and Family Centered Care Quality Improvement Organizations (BFCC-QIOs). CMS took this action to procure a new BFCC-QIO contractor. Going forward, Short Stay reviews and HWDRG reviews will resume with a single organization performing reviews on a national basis. CMS anticipates a contract award to be issued by the 3rd quarter of calendar year 2019.

Local Coverage Determination (LCD) Process Modernization Qs & As

Describes recent changes to the LCD process.

System Edits Will Be Activated for OPPS Providers with Multiple Service Locations

On July 1, 2019, CMS will begin enforcing edit requirements for Outpatient Prospective Payment System (OPPS) providers with multiple service locations submitting claims to Medicare.

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