MLN Matters Tackles ASC Payment System Changes, Waivers for IPPS Hospitals, LTCHs, IRFs  

Regulatory upheaval continues amid the ongoing COVID-19 pandemic.

A series of MLN Matters articles posted to the Centers for Medicare & Medicaid Services (CMS) website earlier this month covered a variety of topics, including, of particular note, a rundown of changes made by the October 2020 update of the Ambulatory Surgical Center (ASC) Payment System.

Change Request 11963 informs providers about the changes, including updates to the HCPCS in the form of two new codes: one to describe the technology associated with vacuum aspiration of residual kidney stone debris following lithotripsy, the other to denote technology associated with temporary prostatic implants with anchors and incisional struts.

Also, MLN Matters noted, effective Oct. 1, 2020, eight other new HCPCS codes will go into use, specifically for reporting drugs and biologicals commonly utilized in the ASC setting. The article also described existing HCPCS codes that will start to receive Outpatient Prospective Payment System (OPPS) pass-through status, beginning in October; additional new HCPCS codes that are replacing codes scheduled for deletion at the end of the month; new descriptors; and slight changes to payment rates. To review the article in its entirety, go online to https://www.cms.gov/files/document/mm11963.pdf

A separate MLN Matters “Special Edition” article was published in order to outline certain provisions of the Coronavirus Aid, Relief, and Economic Security (CARES) Act that affect Inpatient Prospective Payment System (IPPS) hospitals, long-term care hospitals (LTCHs), and inpatient rehabilitation facilities (IRFs), with the most notable portion outlining the new (and controversial) policy that facilities seeking Medicare’s 20-percent increase in MS-DRG weighting for treatment of COVID-19 patients now must provide a positive lab test in the medical record.

“Positive tests must be demonstrated using only the results of viral testing (i.e., molecular or antigen), consistent with CDC (Centers for Disease Control and Prevention) guidelines. The test may be performed either during the hospital admission or prior to the hospital admission,” the article read. “For this purpose, a viral test performed within 14 days of the hospital admission, including a test performed by an entity other than the hospital, can be manually entered into the patient’s medical record to satisfy this documentation requirement. For example, a copy of a positive COVID-19 test result that was obtained a week before the admission from a local government-run testing center can be added to the patient’s medical record.”

In what MLN Matters described as “the rare circumstance” where a viral test was performed more than 14 days prior to the hospital admission, CMS will now “consider whether there are complex medical factors in addition to that test result for purposes of this documentation requirement.”

The article went on to note that the U.S. Department of Health and Human Services (HHS) is continuing to waive the requirements that patients treated in IRFs receive at least 15 hours of therapy per week, along with waiving payment adjustment to LTCHs under certain circumstances.

To review this article in its entirety, go online to https://www.cms.gov/files/document/se20015.pdf.