Compliance

After five years of ICD-10 classification system code freezes, October 1, 2016 will see the system back on the routine cycle for annual updates. On March 9th and 10th, the ICD-10 Coordination and Maintenance committee met to review proposals for both ICD-10-CM and ICD-10-PCS. All PCS codes to date that have been approved as new, revised, and deleted have been compiled into a file for review under the Coordination and Maintenance Committee meeting materials. For the October 1, 2016 update, there are currently 75,625 PCS codes for the FY 2017 update, which includes 3,651 new codes and 487 revised code titles. Of the 3,651 new codes, 3,549 are cardiovascular system codes. These relate to unique device values, the addition of bifurcation as a qualifier, and additional specific body parts, as well as congenital cardiac procedures and placement of an intravascular neurostimulator. All of the revised code titles at this time have come from changing the number of coronary artery sites to the number of vessels, and the specification of the descending thoracic aorta. Additional new codes include the expansion of the body part detail in Removal and Revision of lower joints, and the addition of unicondylar knee replacement. The codes presented at this meeting were for implementation in October 2016 and will be added to the already-approved list There were 24 diagnosis proposals on the agenda for discussion such as: Clostridium Difficile: A proposal was presented to expand the code to differentiate recurrent C. difficile  enterocolitis from enterocolitis not specified as recurrent. Congenital sacral dimple: The American Academy of Pediatrics proposed a new congenital code so this condition can be accurately tracked. Myocardial infarction: Specify the types as defined by several professional cardiology organizations. A specific code was proposed for type 2 myocardial infarction due to demand ischemia or ischemic imbalance so that data can be captured. The additional myocardial infarction types (3, 4a, 4b, 4c, 5) would all be assigned to one ICD-10-CM code. There was much discussion on this proposal related to the code proposals as well as the indexing and impact on subsequent myocardial infarctions. This proposal was requested for inclusion in the 10/1/16 addenda. Zika virus was discussed, regarding a new code being created. NCHS/CDC is proposing it for inclusion in the 10/1/16 addenda which would be consistent with the World Health Organization’s ICD-10 update According to CMS, the coding update will be implemented on Oct. 1, 2016, and will include the “backlog of all proposals for changes to the code set proposed via the ICD-10 Coordination and Maintenance Committee process during the partial code freeze, and receiving public support.” The codes are posted on the Centers for Disease Control and Prevention National Center for Health Statistics website here: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2017/NewICD10CMCodes_FY2017.txt Review the Meeting Agenda here: http://www.cdc.gov/nchs/data/icd/topic_packet_03_09_16.pdf

On February 26th, CMS published a One-Time Notification, Transmittal 1630, Change Request 9540. This change request (CR) is the 6th maintenance update of ICD-10 conversions and other coding updates specific to national coverage determinations (NCDs) with   implementation date of July 5, 2016 for all Medicare Contractors The majority of the NCDs included are a result of feedback received from previous ICD-10 NCD CR7818, CR8109, CR8197, CR8691, CR9087, and CR9252. Some are the result of revisions required to other NCD-related CRs released separately. Edits to ICD-10 and other coding updates specific to NCDs will be included in subsequent, quarterly releases as needed. No policy-related changes are included with these updates as any policy-related changes to NCDs continue to be implemented via the current, long-standing NCD process The NCD’s updated per this CR are listed below: NCD20.29 - Hyperbaric Oxygen Therapy NCD90.1 - Pharmacogenomic Testing for Warfarin Response NCD110.18 - Aprepitant for Chemotherapy-Induced Emesis NCD150.3 - Bone Mineral Density Studies (See also Medlearn Matters SE 1525 04/12/16) NCD160.18 - Vagus Nerve Stimulation for Treatment of Seizures NCD160.24 - Deep Brain Stimulation for Essential Tremor NCD210.3 - Colorectal Cancer Screening Tests NCD210.14 - Screening for Lung Cancer with Low-Dose CT NCD230.18 - Sacral Nerve Stimulation for Urinary Incontinence NCD260.1 - Adult Liver Transplantation NCD110.4 - Extracorporeal Photopheresis NCD20.33 - Transcatheter Mitral Valve Repair NCD220.13 - Percutaneous Image-Guided Breast Biopsy NCD220.4 - Mammograms Read the details of this direction here: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2016-Transmittals-Items/R1630OTN.html?DLPage=1&DLEntries=10&DLFilter=R1630Otn&DLSort=1&DLSortDir=ascending  

At HHS, we’re working today with an eye on the horizon. We’re committed to building a health care system that provides better care, spends our health care dollars in smarter ways, and puts patients at the center of their care. Our aim is to strengthen health care so that it works for the health of every American. Our vision for this health care system is one where a patient can easily check their own medical record, where a patient’s different clinicians, from pharmacists to nurses to physicians, can more seamlessly work together to keep that patient healthy, and where treatment can easily be tailored to a specific patient’s needs. The key to unlocking that vision of a modern health care system is joining the data revolution that has already transformed so much of our society. Just recently, Secretary Burwell spoke at the 2016 conference of the Healthcare Information and Management Systems Society. She spoke about our need to unlock data to bring health care into the 21st century and how the security of patient data is essential to our progress. As she told the audience, “People should be able to easily and securely access their electronic health information and send it to any desired location. They need to be able to understand how their information can be shared and used. And they must be assured that this information will be effectively and safely used to benefit their health and that of their community.” Today, we’re taking a significant step to improve the safety of the data and security of life-saving medical devices across our health care system by announcing the membership of the Health Care Industry Cybersecurity Task Force. The members of this Task Force are leaders in government and private industry. They’re innovators in technology and pioneers in health care. They represent organizations of various sizes, and they hail from different parts of the country. Over the next year, these individuals will collectively look across industries and sectors to find the best ways organizations of all types are keeping data and connected medical devices safe and secure. They’ll discuss these ideas among themselves and, in the next year, they’ll report their findings to Congress and the public. They’ll also develop materials to share widely, ensuring every organization that plays a part in our health care system can protect the data that that is part of this system. As President Obama has made clear, cybersecurity is one of the most serious security challenges that our nation faces. So as we look to transform our health care system into one that works better for all Americans, we need to ensure it works safely for all Americans. We need to protect the data at the foundation of our health care system. That’s our commitment here at HHS, and it’s why we’re so excited to launch the Health Care Industry Cybersecurity Task Force.

On March 16, CMS released three special edition MLN Matters articles on submitting claims to MACs for chiropractic services provided to Medicare beneficiaries. Special edition MLN Matters article SE 1601 helps clarify the CMS policy regarding Medicare coverage of chiropractic services and documentation requirements for the beneficiary’s initial visit and subsequent visits to the chiropractor. Special edition MLN Matters article SE 1602 explains the Active Treatment modifier (AT), which was developed to clearly define the difference between active treatment and maintenance treatment. Special edition MLN Matters article SE1603 provides a detailed list of informational/educational resources that can help chiropractors avoid billing errors due to insufficient or inaccurate documentation. Read More: MLN Matters article SE 1601: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1601.pdf MLN Matters article SE 1602: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1602.pdf MLN Matters article SE1603: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1603.pdf

On March 11, CMS released a change request to display the list of telehealth services that were once available through the manual updates to now be displayed via a weblink going forward. CMS is also adding CRNAs to the list of Medicare practitioners who may bill for covered telehealth services. Lastly, the telehealth language has been removed from Pub 100.02, Medicare Benefit Policy Manual, Chapter 15, Section 270 and a reference added in text to see Pub 100.04, Chapter 12, Medicare Claims Processing Manual, section 190 for further information regarding telehealth services. Implementation date: April 11, 2016 Transmittal R3476CP here: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3476CP.pdf Transmittal R221BP here: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R221BP.pdf MLN Matters article MM9428 here: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9428.pdf

On March 11, CMS posted a transmittal stating it awarded Noridian Healthcare Solutions, LLC, a new contract for the administration of Medicare Fee-for-Service claims for DME, prosthetics, orthotics, and supplies in Jurisdiction A. The incumbent is NHIC, Corp. The Jurisdiction A DME MAC serves Medicare beneficiaries who reside in the states of Connecticut, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont, and the District of Columbia. Under this contract, Noridian will process and pay Medicare DMEPOS claims; process redetermination requests; respond to supplier inquiries; perform supplier outreach and education; and, review claims for medical necessity. Noridian will begin processing Jurisdiction A claims in May 2016 from its offices in Fargo, ND. Jurisdiction A includes over 8.2 million Medicare Fee-for-Service beneficiaries. The Jurisdiction A DME MAC will serve approximately 20,000 Medicare DMEPOS suppliers. This jurisdiction comprises nearly 18% of the overall national Medicare Fee-for-Service DMEPOS claims volume. The Jurisdiction A DME MAC contract includes a base year and four option years, for an anticipated duration of five years. The contract is a “cost plus award fee” contract; the award fee will be earned only if the contractor exceeds the base requirements of the contract. Effective date: December 16, 2015 Implementation date: July 1, 2016, for all cutover requirements outside of those related to system changes; July 5, 2016, for system changes View Transmittal R1634OTN here: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1634-OTN.pdf View MLN Matters article MM9546 here: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9546.pdf

CMS recently released an extensive revision of QIO Manual Chapter 9 related to QIO reviews in cases potentially involving sanction recommendations from the OIG for quality and EMTALA issues. The chapter has been renamed to include the reference to EMTALA. This update supersedes all the information in the October 3, 2003 version of Chapter 9, any previously issued Question & Answer guidance, and any previously issued TOPS, Standard Data Processing System, and Healthcare Quality Information System memos related to Chapter 9. Effective date: March 14, 2016 Implementation date: March 14, 2016 View Transmittal R139DEMO.

On March 17th, the Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) released a new interactive map to increase understanding of geographic disparities in chronic disease among Medicare beneficiaries. The Mapping Medicare Disparities (MMD) Tool identifies disparities in health outcomes, utilization, and spending by race and ethnicity and geographic location. Understanding geographic differences in disparities is important to informing policy decisions and efficiently targeting populations and geographies for interventions. “Our commitment to health equity begins with properly measuring the care people get and having an honest dialogue on how and where we need to improve,” said CMS Acting Administrator Andy Slavitt. “Today’s tool aims to make it harder for disparities to go unaddressed.” Racial and ethnic minorities experience disproportionately high rates of chronic diseases, and are more likely to experience difficulty accessing high quality of care than other individuals. The identification of areas with large differences in the proportions of Medicare beneficiaries with chronic diseases is an important step for informing and planning health equity activities and initiatives. The Mapping Medicare Disparities Tool features: A dynamic interface with data on the prevalence of 18 chronic conditions, end stage renal disease, or a disability; Medicare spending, hospital and emergency department (ED) utilization, preventable hospitalizations, readmissions, and mortality rates. The ability to sort by state or county of residence, sex, age, dual-eligibility for Medicare and Medicaid, and race and ethnicity. Built-in benchmarking features to investigate disparities within counties and across racial and ethnic groups, and within racial and ethnic groups across counties. “It’s not enough to improve average health care quality in the U.S.,” said CMS OMH Director Cara James.  “As the CMS Equity Plan lays out, we must identify gaps in quality of care at all levels of the health care system to address disparities. We are excited to share this new tool, which allows us to pinpoint disparities in health care outcomes by population and condition.” See the Medicare Mapping Disparities Tool here: https://www.cms.gov/About-CMS/Agency-Information/OMH/OMH-Mapping-Medicare-Disparities.html The Medicare Mapping Disparities Tool FAQ’s are here:https://www.cms.gov/About-CMS/Agency-Information/OMH/Downloads/MMDT-FAQs.pdf  

Beginning in 2016, claims for CT (Computed Tomography) scans identified by the CPT codes listed  below  (and by successor codes) that are furnished on non-NEMA (National Electric Manufacturers Association) Standard XR-29-2013-compliant CT scans must include modifier “CT” that will result in an applicable payment reduction. 70450-70498 71250-71275 72125-72133 72191-72194 73200-73206 73700-73706 74150-74178 74261-74263 75571-75574 CMS Change Request (CR) 9250 informs providers that effective January 1, 2016, a payment reduction of 5 percent applies to CT services furnished on equipment that is inconsistent with the CT equipment standard and for which payment is made under the physician fee schedule. When such payment reductions are made, MACs will supply: Claim Adjustment Reason Code 237 – Legislated/Regulatory Penalty. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Remittance Advice Remark Code N759 – Payment adjusted based on the National Electrical Manufacturers Association (NEMA) Standard XR-29-2013; and Group Code: CO (contractual obligation) The payment reduction increases 15 percent in 2017 and subsequent years. System attestation by providers will be verified through the periodic supplier accreditation process. Read the official instruction here: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3402CP.pdf