Medicare Compliance & Reimbursement

More documentation cutbacks are on the horizon.

As the Centers for Medicare and Medicaid Services (CMS) continues to churn out policies, proposals, and rules at an alarming rate, it’s easy to get bogged down in the rhetoric. However, since many updates and deadlines do impact the day-to-day operations of Medicare providers, you may want to review some changes and deadlines that could affect your practice procedures — and your wallet.

Keep these five items on your practice watch list:

1. Paperwork RFI: CMS wants to know what the public thinks of slimming down even more administrative burdens for healthcare providers in a new Request for Information (RFI) published in the Federal Register on June 11, with a commentary end date of August 12. Some of the agency’s perennial favorites on the table include: prior authorization details; coding documentation; reporting notes; rural provider policy changes; and dual-enrollment documentation.

Review the RFI at www.federalregister.gov/documents/2019/06/11/2019-12215/request-for-information-reducing-administrative-burden-to-put-patients-over-paperwork.

2. Hospital and CAH final rule extension: Back in 2016, CMS issued a proposed rule that aimed to innovate and update requirements for hospitals and critical access hospitals (CAHs) under the Medicare and Medicaid programs. It was supposed to be finalized this June, but that’s not happening, CMS indicates. Apparently, the extension is necessary because of “exceptional circumstances ... due to the complexity and substantive nature of the provisions” in the original proposal, the agency notes.

The final rule is now expected by June 16, 2020.

Read the details of the extension at www.federalregister.gov/documents/2019/06/11/2019-12216/medicare-and-medicaid-programs-hospital-and-critical-access-hospital-cah-changes-to-promote.

3. PACE rule: CMS updated its PACE program (Program for All-Inclusive Care for the Elderly) with a final rule last month. With more than 45,000 seniors currently enrolled in more than 100 PACE organizations in 31 states, the final rule supports more flexible coordination, technology, and innovation, a CMS fact sheet suggests. Highlights of the final rule include: more patient protections; the allowance of care delivery by nurse practitioners and physician assistants; technology implementations like telehealth and messaging; a “disruptive behavior” disenrollment option; Medicare Part D tie-ins; and a 30-day interdisciplinary plan of care deadline.

See the final PACE rule at www.federalregister.gov/documents/2019/06/03/2019-11087/medicare-and-medicaid-programs-programs-of-all-inclusive-care-for-the-elderly-pace.

4. Medicare Advantage and Part D finale: In a follow-up to its Part D proposal from last November, CMS solidified some Medicare Advantage and Part D pricing policies. The final rule, published in the Federal Register last month, offers the following major provisions: an outline of six protected Part D drug classes with exceptions; prohibition of “gag clauses;” an electronic real-time benefit tool (RTBT); Part D sponsors’ explanation of benefits requirement; and step-therapy regulations for Medicare Advantage.

Read the final rule at www.federalregister.gov/documents/2019/05/23/2019-10521/modernizing-part-d-and-medicare-advantage-to-lower-drug-prices-and-reduce-out-of-pocket-expenses.

5. Conscience rule: Despite federal challenges from state attorneys general in California and New York, the Department of Health and Human Services (HHS) “Protecting Statutory Conscience Rights” final rule is set to go into effect on July 22 — unless one of the cases forces a stay. “The rule implements full and robust enforcement of approximately 25 provisions passed by Congress protecting long standing conscience rights in healthcare,” says an HHS release.

The rule covers a variety of federal programs, including Medicare. It also gives the HHS Office for Civil Rights (OCR) investigative and enforcement powers, which it intends to use fully, a brief suggests.

Check out the details at www.federalregister.gov/documents/2019/05/21/2019-09667/protecting-statutory-conscience-rights-in-health-care-delegations-of-authority.