Knowledge Base Article

Medicare Transmittals & MLN Articles

October 3, 2024: Transmittal 12864 – Change Request (CR) 13800: October 2024 Update of the Ambulatory Surgical Center (ASC) Payment System

This CR replaced the September 5, 2024, Transmittal 12824. Updates included adding and removing HCPCS codes, adding new table 7 to add descriptor changes for HCPCS code A2024 and therefore, sub-section b. to policy section 5 has been added.  https://www.cms.gov/files/document/r12864cp.pdf

October 8, 2024: MLN MM13734: Inpatient & Long-Term Care Hospital Prospective Payment Systems: FY 2025 Changes – Revised

CMS made changes to the FY 2025 policies that apply to the wage index section of this MLN article.

https://www.cms.gov/files/document/mm13734-inpatient-long-term-care-hospital-prospective-payment-system-fy-2025-changes.pdf

October 11, 2024: MLN MM13734: Inpatient & Long-Term Care Hospital Prospective Payment Systems: FY 2025 Changes – Revised

In this third iteration of this MLN article, CMS has added language to information on page 4 regarding the FY 2025 wage index computation. https://www.cms.gov/files/document/mm13734-inpatient-long-term-care-hospital-prospective-payment-system-fy-2025-changes.pdf

October 15, 2024: MLN MM13590: Separate Payment for Essential Medicines – New Biweekly Interim Payments for the Inpatient Prospective Payment System

CMS advises making sure your billing staff knows about the payment adjustments for establishing and maintaining access to essential medicines, how providers can be paid (biweekly or annually), and how future payment will be determined. https://www.cms.gov/files/document/mm13590-separate-payment-essential-medicines-new-biweekly-interim-payments-inpatient-prospective.pdf

Coverage Updates

October 3, 2024: National Coverage Analysis (CAG-00468N): Transcatheter Edge-to-Edge Repair for Tricuspid Valve Regurgitation (T-TEER)

In March 2023, Abbot submitted a letter to CMS requesting a National Coverage Analysis (NCA) for T-TEER indicating “that a national coverage policy for T-TEER will ensure long-term, predictable, and consistent coverage for all Medicare beneficiaries.” The NCA focuses on the clinical indications for use of T-TEER among Medicare beneficiaries.

Abbott’s TriClip™ therapy received FDA approval on April 2, 2024. Effective October 1, 2024, this technology is eligible for a New Technology Add-On Payment in the hospital inpatient setting. CMS estimates there will be 150 cases using this device nationwide in FY 2025.

The public comment period ends November 2, 2024. https://www.cms.gov/medicare-coverage-database/view/ncacal-tracking-sheet.aspx?ncaid=316

October 30, 2024: Proposed Decision Memo (CAG-00466N): Implanted Pulmonary Artery Pressure Sensor (IPAPS) for Heart Failure Management

This proposed decision memo includes patient criteria, physician criteria, and that it be used under coverage with evidence development (CED). The public comment period ends November 29, 2024. https://www.cms.gov/medicare-coverage-database/view/ncacal-tracking-sheet.aspx?ncaid=313&=

Compliance Education Updates

September 2024: MLN006559: MLN Education Tool: Medicare Preventive Services

This tool was updated in September for the following Medicare Preventive Services:

• Alcohol misuse screening and counseling: clarified frequency policy,
• Flu Shot & Administration: Updates with the 2024-2025 flu season vaccine codes,
• Pneumococcal Shot & Administration: Added CPT code 90684, effective June 27, 2024, with an implementation date of November 25, 2024,
• Prolonged Preventive Services: Added information on the “substantive portion” and how it relates to prolonged preventive services, and
• Sexually Transmitted Infection (STI) Screening & High Intensity Behavioral Counseling (HIBC) to Prevent STIs: Removed CPT code 0353U, effective June 30, 2024, added CPT code 0455U, effective July 1, 2024, and clarified frequency policy

https://www.cms.gov/medicare/prevention/prevntiongeninfo/medicare-preventive-services/mps-quickreferencechart-1.html

October 24, 2024: OIG Report (OEI-03-23-00380): Medicare Advantage: Questionable Use of Health Risk Assessments Continues to Drive Up Payments to Plans by Billions

Per the OIG, in-home health risk assessments (HRAs) and HRA-linked chart reviews generated 63% of the estimated $7.5 billion in risk-adjusted payments. They also indicate that “diagnoses reported only on these types of records heighten concerns about the validity of the diagnoses or the coordination of care for MA enrollees.” https://oig.hhs.gov/documents/evaluation/10028/OEI-03-23-00380.pdf

Other Updates

September 30, 2024: Acute Hospital care at Home Initiative Fact Sheet

CMS released a report on the agency’s study of the Acute Hospital Care at Home (AHCAH) initiative, which allows certain Medicare-certified hospitals to treat patients with inpatient-level care at home.

October 2, 2024: BFCC-QIO Livanta has New Address

Effective October 7, 2024, Livanta’s mailing address for correspondence to its Beneficiary and Family Centered Care – Quality Improvement Organization (BFCC-QIO) Program changed. Their new address for U.S. postal mail is:

BFCC-QIO Program

Livanta LLC

PO Box 2687

Virginia Beach, VA 23450

You can learn more about Livanta LLC on their website at https://www.livantaqio.cms.gov/en.

CMS Case Study: Urinary Catheter Case: CMS’ Swift Action Saves Billions

CMS published this case study in response to identifying a concerning risk in urinary catheter billings attributed to a small group of 15 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) supply companies that had recently changed ownership.

https://www.cms.gov/files/document/cpi-urinary-catheter-case-study.pdf

October 31, 2024: Sickle Cell Disease Provider Toolkit