Medicare Compliance & Reimbursement

Plus: Add these other updates to your wheelhouse.

With COVID policies changing daily, you may have missed the latest round of federal offerings. Take a look at new updates that impact your Medicare reimbursement and compliance.

See New Reimbursement Details on COVID-19 Infusions

You can expect a little more money in your pocket when you administer monoclonal antibody infusions to Medicare beneficiaries with COVID-19, says the Centers for Medicare & Medicaid Services (CMS) in a May 6 release on the change.

Now: Nationally, the average payment will go up from $310 to $450 in most healthcare locales, CMS indicates. The agency also plans to “establish a higher national payment rate of $750 when monoclonal antibodies are administered in the beneficiary’s home, including the beneficiary’s permanent residence or temporary lodging (e.g., hotel/motel, cruise ship, hostel, or homeless shelter),” the release notes.

Why? Fresh data on the costs of administering COVID treatments to sick patients were a big part of the informed decision CMS made to boost the payment rates, the agency says.

CMS has also updated its coding resources, which lists the various monoclonal antibody treatments, CPT^® codes, effective dates, and new payment allowances. Access the chart at http://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/covid-19-vaccines-and-monoclonal-antibodies.

IPPS and LTCH Proposed Rule Are Chock Full of COVID-Related Goodies

On May 10, CMS published the Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) proposed rule for fiscal year (FY) 2022 in the Federal Register. And though there’s a lot to unpack in the proposed rule, there are a few “key priorities” that aim to “close health care equity gaps and support greater access to life-saving diagnostics and therapies” during the COVID-19 public health emergency (PHE), CMS says in a fact sheet on the rule.

NCTAP: As part of its proposals, CMS plans to extend the New COVID-19 Treatments Add-on Payment (NCTAP) until the PHE ends.

“During the COVID-19 PHE, CMS established the New COVID-19 Treatments Add-On Payment (NCTAP), which increased IPPS payments for certain COVID-19 treatments to incentivize hospitals to provide those treatments,” note attorneys Ernessa B. McKie, Morgan A. Pollard, and Victoria L. Stephenson with law firm Baker & Hostetler LLP in online legal analysis.

Conversely, CMS intends to “discontinue the NCTAP for discharges on or after October 1, 2021 for a product that is approved for new technology add-on payments beginning FY 2022,” the proposed rule says.

Pay rates: Because COVID-19 and fallout from the PHE impacted the FY 2020 inpatient hospital payment data, CMS proposes to use the FY 2019 numbers instead to determine FY 2022 inpatient utilization. But the agency is also looking at another option, too.

“We are also considering, as an alternative to this proposal, the use of the same FY 2020 data that we would ordinarily use for purposes of FY 2022 ratesetting, and which we may consider finalizing based on consideration of comments received,” CMS says in the rule.

HCP vaccination measure: In an effort to boost health care personnel (HCP) vaccination rates, CMS wants to add a new quality measure to its reporting programs. For both the LTCH Quality Reporting Program and Hospital Inpatient Quality- Reporting (IQR) Program, CMS proposes to adopt a new COVID-19 vaccination coverage measure for HCPs, the fact sheet mentions.

CMS is accepting comments on the proposed rule through June 28. Read the rule and comment at http://www.federalregister.gov/documents/2021/05/10/2021-08888/medicare-program-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals-and-the.

LTC Facilities Must Now Report Weekly Vax Numbers to CDC

Because the most vulnerable beneficiaries have been disproportionately impacted by COVID-19, CMS is expanding its vaccination program — and tightening subsequent vaccination reporting requirements for Long-Term Care (LTC) facilities and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs-IID), the agency says in a release.

Update: In an interim final rule, CMS announced that LTC facilities and ICFs-IID must now report their weekly COVID-19 vaccination status information — for both residents and staff — to the Centers for Disease Control and Prevention’s (CDC) National Health Safety Network, a fact sheet notes.

Why? These facilities are already sending weekly reports on COVID testing, cases, and deaths to the CDC, and CMS feels this extra mandate will help identify facilities in need of extra funding, resources, and federal assistance.

“These new requirements reinforce CMS’ commitment of ensuring equitable vaccine access for Medicare and Medicaid beneficiaries,” says Lee Fleisher, MD, CMS chief medical officer and director of CMS’ Center for Clinical Standards and Quality (CCSQ) in a release. “Our goal is to increase COVID-19 vaccine confidence and acceptance among these individuals and the staff who serve them.”

Heads up: This new policy only impacts LTC facilities and ICFs-IID, but CMS indicates that it’s considering expanding the reporting requirement to “other congregate care settings, such as psychiatric residential treatment facilities (PRTFs), group homes and assisted living facilities.”

The requirements go into effect on May 21; CMS will accept public comments until July 12.

Review the rule published in the Federal Register on May 13 and comment at http://www.federalregister.gov/documents/2021/05/13/2021-10122/medicare-and-medicaid-programs-covid-19-vaccine-requirements-for-long-term-care-ltc-facilities-and.