Knowledge Base Article

TRANSMITTALS

Update FISS Editing to Include the Admitting Diagnosis Code Field

• MLN Matters® Number: MM9753
• Related Change Request (CR) #: CR 9753
• Related CR Release Date: April 28, 2017
• Effective Date: October 1, 2017
• Related CR Transmittal #: R1832OTN
• Implementation Date: October 2, 2017
• https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM9753.pdf
• Affects providers submitting claims to Medicare Administrative Contractors (MACs) for services to Medicare beneficiaries.

Summary: Updates various system edits to look at the admitting diagnosis field. FISS editing is now being updated to ensure that all of the National Coverage Determination (NCD) edits within Reason Code ranges 3xxxx and 59xxx that are tied to the diagnosis code fields (other than the primary diagnosis field) include the admitting diagnosis field for Inpatient claims on Types of Bill (TOB) 011x, 012x, 018x, 021x, and 022x.

Screening for Hepatitis B Virus (HBV) Infection

• MLN Matters® Number: MM9859
• Related Change Request (CR) #: CR 9859
• Related CR Release Date: April 28, 2017
• Effective Date: September 28, 2016
• Related CR Transmittal #: R3761CP and R195NCD
• Implementation Date: January 1, 2018
• https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9859.pdf
• Affects physicians and other providers submitting claims to Medicare Administrative Contractors (MACs) for services to Medicare beneficiaries

Summary: Medicare will cover screening for Hepatitis B Virus (HBV) infection for certain individuals when performed with an FDA approved/cleared laboratory tests

REVISED: Revision to clarify language on page 3, under the “Professional Billing Requirements.” It now reads, only when services are ordered by the following provider specialties found on the provider’s enrollment record…

Implementing the Remittance Advice Messaging for the 20 Hour Weekly Minimum for Partial Hospitalization Program Services

• MLN Matters® Number: MM9880
• Related Change Request (CR) #: CR 9880
• Related CR Release Date: April 28, 2017
• Effective Date: October 1, 2017
• Related CR Transmittal #: R1833OTN
• Implementation Date: October 2, 2017
• https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM9880.pdf
• Affects Outpatient Prospective Payment System (OPPS) providers submitting Partial Hospitalization Program (PHP) claims to Medicare Administrative Contractors (MACs) for PHP services provided to Medicare beneficiaries.

Summary: Implements informational messaging, effective October 1, 2017, that conveys supplemental and educational information to the provider submitting claims for PHP services where the patient did not receive the minimum 20 hours per week of therapeutic services his plan of care indicates is required, on claims with line item date of service (LIDOS) on or after October 1, 2017.

New Physician Specialty Code for Advanced Heart Failure and Transplant Cardiology, Medical Toxicology, and Hematopoietic Cell Transplantation and Cellular Therapy

• MLN Matters® Number: MM9957
• Related CR Release Date: April 28, 2017
• Related CR Transmittal #: R283FM and R3762CP
• Related Change Request (CR) #: CR 9957
• Effective Date: October 1, 2017
• Implementation Date: October 2, 2017
• https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM9957.pdf
• Affects physicians and providers submitting claims to Medicare Administrative Contractors (MACs) for services to Medicare beneficiaries

Summary: Establishes new physician specialty codes for Advanced Heart Failure and Transplant Cardiology (C7), Medical Toxicology (C8), and Hematopoietic Cell Transplantation and Cellular Therapy (C9).

Payment for Moderate Sedation Services Furnished with Colorectal Cancer Screening Tests

• MLN Matters Number: MM10075
• Related CR Release Date: April 28, 2017
• Related CR Transmittal Number: R3763CP
• Related Change Request (CR) Number: 10075
• Effective Date: January 1, 2017
• Implementation Date: October 2, 2017
• https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10075.pdf
• Affects physicians and other providers submitting claims to Part A and B Medicare Administrative Contractors (MACs) for sedation services furnished with colorectal cancer screening tests.

Summary: Ensures accurate program payment for moderate sedation services furnished in conjunction with screening colonoscopy services for which the beneficiary should not be charged the coinsurance or deductible.

Office of Inspector General Report: Stem Cell Transplantation

• MLN Matters® Number: SE1624 Revised
• Article Release Date: May 1, 2017
• https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1624.pdf

Summary: This article was revised on May 1, 2017, to make a number of clarifications and to delete the table that had been in the article.

Update FISS Editing to Include All Three Patient Reason for Visit Code Fields

• MLN Matters® Number: MM9672 - Revised
• Related Change Request (CR) #: CR 9672
• Related CR Release Date: May 17, 2017
• Effective Date: Claims received on or after October 1, 2017
• Related CR Transmittal #: R1852OTN
• Implementation Date: October 2, 2017
• https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9672.pdf
• Affects providers submitting outpatient hospital claims to Medicare Administrative Contractors (MACs) for services to Medicare beneficiaries.

Summary: FISS edits to ensure all of the National Coverage Determination (NCD) edits within Reason Code ranges 3xxxx and 59xxx are tied to the diagnosis code fields including all three Patient Reason for Visit (PRV) fields for outpatient hospital claims on Types of Bills (TOB) 013x and 085x. CR9672 makes no policy changes.

New Common Working File (CWF) Medicare Secondary Payer (MSP) Type for Liability Medicare Set-Aside Arrangements (LMSAs) and No-Fault Medicare SetAside Arrangements (NFMSAs)

• MLN Matters® Number: MM9893
• Revised Related Change Request (CR) #: CR 9893
• Related CR Release Date: May 10, 2017
• Effective Date: October 1, 2017
• Related CR Transmittal #: R1845OTN
• Implementation Date: October 2, 2017
• https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9893.pdf
• Affects physicians, providers and suppliers submitting claims to Medicare Administrative Contractors (MACs) for services to Medicare beneficiaries.

Summary: Establishes two (2) new set-aside processes: a Liability Insurance Medicare Set-Aside Arrangement (LMSA), and a No-Fault Insurance Medicare Set-Aside Arrangement (NFMSA).

Clarifying Medical Review of Hospital Claims for Part A Payment

• MLN Matters Number: MM10080
• Related CR Release Date: May 12, 2017
• Related CR Transmittal Number: R716PI
• Related Change Request (CR) # 10080
• Effective Date: June 13, 2017
• Implementation Date: June 13, 2017
• https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10080.pdf
• Affects providers that submit institutional claims to Medicare Administrative Contractors (MACs) for inpatient hospital services provided to Medicare beneficiaries.

Summary: Clarifies the medical review requirements for Part A payment of short stay hospital claims (more commonly referred to as the "Two-Midnight" Rule) for MACs, Supplemental Medical Review Contractors (SMRC), Recovery Audit Contractors and the Comprehensive Error Rate Testing (CERT) contractors.

Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes – July 2017 Update

• MLN Matters Number: MM10107
• Related CR Release Date: May 18, 2017
• Related CR Transmittal Number: R3776CP
• Related Change Request (CR) Number: CR 10107
• Effective Date: July 1, 2017
• Implementation Date: July 3, 2017
• https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10107.pdf
• Affects physicians, providers and suppliers submitting claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries

Summary: The HCPCS code set is updated on a quarterly basis. Change Request (CR) 10107 informs MACs of updating specific drug/biological HCPCS codes.

July 2017 Integrated Outpatient Code Editor (I/OCE) Specifications Version 18.2

MLN Matters Number: MM10115

• Related CR Release Date: May 18, 2017
• Related CR Transmittal Number: R3777CP
• Related Change Request (CR) Number: 10115
• Effective Date: July1, 2017
• Implementation Date: July 3, 2017
• https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10115.pdf
• Affects providers who submit claims to Medicare Administrative Contractors (MACs), including Home Health and Hospice (HH+H) MACs, for services provided to Medicare beneficiaries.

Summary: The I/OCE is being updated July 1, 2017. The I/OCE routes all institutional outpatient claims (which includes non-Outpatient Prospective Payment System (OPPS) hospital claims) through a single integrated OCE.

OTHER MEDICARE ANNOUNCEMENTS

Medicare Program; Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model (CJR); Delay of Effective Date

• Published in Federal Register May 19, 2017
• https://www.gpo.gov/fdsys/pkg/FR-2017-05-19/pdf/2017-10340.pdf

Summary: This final rule finalizes May 20, 2017 as the effective date of the rule. It also finalizes a delay of the applicability date of the regulations from July 1, 2017 to January 1, 2018.