Compliance Monitor (9/13/2024)

• mRNA vaccines made by Pfizer-BioNTech and Moderna on August 22, 2024 

• Novavax COVID-19 Vaccine, Adjuvanted on August 30, 2024 

• Pfizer-BioNTech and Moderna COVID-19 vaccines include a monovalent (single) component that corresponds to the Omicron variant KP.2 strain of SARS-CoV-2 

• Novavax COVID-19 Vaccine, Adjuvanted includes a monovalent (single) component that corresponds to the Omicron variant JN.1 strain of SARS-CoV-2 

• CPT codes 91318–91322 effective August 22, 2024 (Note: no change to payment allowances from last season for 91318–91319) 

• CPT code 91304 effective August 30, 2024  

To combat fraud, waste, and abuse under the hospice benefit, CMS will expand prepayment medical review this September in Arizona, California, Nevada, and Texas. To help reduce burden on compliant providers, initial review volumes will be low and adjusted based on results.  

If you’re noncompliant, we may implement extended review or take additional administrative actions. 

Visit Hospice for coverage information. 

The Centers for Medicare & Medicaid Services is offering a 4-minute, animated explainer video for hospice providers. This video describes Hospice Outcomes and Patient Evaluations (HOPE), the timepoints, their data collection timeframes, and introduces the symptom follow-up visit (SFV), if triggered during a HOPE timepoint. HOPE data collection will be required for the Hospice Quality Reporting Program (HQRP) beginning on October 1, 2025 (FY 2026). 

Watch the video 

The Centers for Medicare & Medicaid Services (CMS) is offering a web-based training course that provides a high-level overview of how data elements within CMS patient/resident assessment instruments are used to construct quality measures (QMs) across post-acute care (PAC) settings. The course also discusses the relationship between these data elements and Quality Reporting Program (QRP) QMs, QM calculation, and how to access reports and use QM data for quality improvement. To access the training, click on the following link: https://pac.training/courses/data_elements_2024/#/ 

If you have questions about accessing resources or feedback regarding trainings, please email the PAC Training Mailbox. Content-related questions should be submitted to the HH QRP Help Desk  

There may be confusion over whether some noninvasive osteogenesis stimulators comply with the DME 3-year expected life requirement. Effective August 28, 2024, CMS suspended prior authorization requirements for HCPCS codes E0747, E0748, and E0760.  

We’ll provide additional direction about this requirement in future notice and comment rulemaking.  

More Information: 

• DME Center webpage: Read the full notice 

• Prior Authorization and Pre-Claim Review Initiatives webpage: See recent updates 

Use the Medicare Revalidation List to find out if you need to revalidate your enrollment record. CMS usually posts revalidation due dates 6–7 months in advance, but we’ll establish your date at least 90 days in advance. A due date of “TBD” means that we haven’t set your due date, and you don’t need to do anything now. 

We won’t issue new revalidation due dates for November 2024 – April 2025 and will resume in May 2025. 

See Revalidations (Renewing Your Enrollment) for more information.  

Get the National Correct Coding Initiative (NCCI) fourth quarter edit files, effective October 1, 2024, on these Medicare NCCI webpages: 

• Procedure-to-Procedure Edits 

• Medically Unlikely Edits 

• Add-on Code Edits 

On August 30, 2024, OSHA published in the Federal Register a Notice of Proposed Rulemaking (NPRM) for Heat Injury and Illness Prevention in Outdoor and Indoor Work Settings. This is a significant step toward a federal heat standard to protect workers. The proposed standard would apply to all employers conducting outdoor and indoor work in all general industry, construction, maritime, and agriculture sectors where OSHA has jurisdiction. The standard would require employers to create a plan to evaluate and control heat hazards in their workplace. It would clarify employer obligations and the steps necessary to effectively protect employees from hazardous heat. The ultimate goal is to prevent and reduce the number of occupational injuries, illnesses, and fatalities caused by exposure to hazardous heat. 

OSHA encourages the public to participate by submitting comments. The NPRM is available on the Federal Register web page at https://federalregister.gov/d/2024-14824 and at www.regulations.gov, which is the Federal e-Rulemaking Portal. You may submit comments and attachments electronically at www.regulations.gov, Docket No. OSHA-2021-0009. Follow the instructions online for making electronic submissions. Comments must be submitted by December 30, 2024.  

Learn about claims status category and code updates effective July 1, 2024: 

• Accredited Standards Committee (ASC) X12 code lists, including added, changed, or deleted codes 

• Examples of the ASC X12 276 and ASC X12 277 request and response transactions 

• Instruction to your Medicare Administrative Contractor (PDF) 

Medicare Administrative Contractors will adjust claims you bring to their attention. 

This is a recently added item to the OIG work plan 

https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000881.asp

The workshop will explore current opportunities for improving equitable diagnosis within the U.S. healthcare system, with emphasis on populations at greatest risk of harm from diagnostic errors. 

• Day 1: Monday, September 23, 8:30am – 4pm ET 

• Day 2: Tuesday, September 24, 8:30am – 12:30pm ET 

Learn more and register for the workshop.