Thursday, May 9, 2024
- HHS Releases New Data Showing Over 10 million People with Medicare Received a Free Vaccine Because of the President’s Inflation Reduction Act; Releases Draft Guidance for the Second Cycle of Medicare Drug Price Negotiation Program
- CMS Roundup (May 3, 2024)
- Medicare Shared Savings Program: Prepare to Apply & Register for June 5 Webinar
- Clinical Laboratory Fee Schedule Preliminary Gapfill Rates: Submit Comments by July 1
- Home Health Quality Reporting Program: Draft OASIS-E1 Instruments & Manual
- Mental Health: It’s Important at Every Stage of Life
- Part B Drug Payment Limits Overview
- Resource of Health Equity-related Data Definitions, Standards, and Stratification Practices
News
HHS Releases New Data Showing Over 10 million People with Medicare Received a Free Vaccine Because of the President’s Inflation Reduction Act; Releases Draft Guidance for the Second Cycle of Medicare Drug Price Negotiation Program
President Biden’s lower cost prescription drug law, the Inflation Reduction Act, is helping millions of seniors and families save money on health care costs and prescription drugs. The law took on Big Pharma to finally allow Medicare to directly negotiate with participating drug companies for the prices of covered prescription drugs, caps the cost of insulin at $35 for seniors, and makes recommended vaccines free for Medicare Part D enrollees. On May 3, 2024, the HHS Office of the Assistant Secretary for Planning and Evaluation published a new report showing that in 2023 more than 10 million people with Medicare Part D received a free vaccine thanks to the law – an increase from just 3.4 million people receiving covered vaccines in 2021.
More Information:
- Full CMS press release
- Medicare Drug Price Negotiation Program Draft Guidance (PDF) and fact sheet (PDF)
- Updated timeline of the Inflation Reduction Act (PDF)
CMS Roundup (May 3, 2024)
You may be interested in this topic from the CMS Roundup: CMS Initiates National Coverage Analysis for Implantable Heart Failure Management Device, Public Comments Open.
Medicare Shared Savings Program: Prepare to Apply & Register for June 5 Webinar
The Medicare Shared Savings Program will accept applications through the ACO Management System starting May 20, 2024. Apply no later than noon ET on June 17, 2024.
Accountable Care Organizations (ACOs) interested in Advance Investment Payments (PDF)or the ACO Primary Care Flex Model must first apply to the Shared Savings Program.
To learn more about the process, register for the upcoming June 5, 2024, webinar on Completing Phase 1 of the Application and Avoiding Common Deficiencies.
More information:
- Application Types & Timeline webpage
- Application Toolkit
- Key Application Actions and Deadlines (PDF)
- Email questions to SharedSavingsProgram@cms.hhs.gov
Clinical Laboratory Fee Schedule Preliminary Gapfill Rates: Submit Comments by July 1
CMS published preliminary gapfill rates (ZIP) for the Clinical Laboratory Fee Schedule (CLFS). Send your comments on these rate recommendations to clfs_inquiries@cms.hhs.gov by July 1, 2024.
Visit CLFS Annual Public Meetings for more information.
Home Health Quality Reporting Program: Draft OASIS-E1 Instruments & Manual
CMS posted draft Version E1 of the OASIS data set effective January 1, 2025:
More Information:
- OASIS Data Sets webpage
- OASIS User Manuals webpage
Mental Health: It’s Important at Every Stage of Life
Mental and physical health are equally important components of overall health. For example, depression increases the risk for many types of physical health problems, particularly long-lasting conditions like diabetes, heart disease, and stroke (see CDC). During Mental Health Awareness Month, recommend appropriate preventive services, including:
- Alcohol misuse screening and counseling
- Annual wellness visit
- Depression screening
- Initial preventive physical exam
Medicare covers preventive services, and your patients pay nothing if you accept assignment. Find out when your patient is eligible for these services. If you need help, contact your eligibility service provider.
More Information:
- Medicare & Mental Health Coverage booklet
- Behavioral Health Integration Services (PDF) booklet
- Opioid Use Disorder Screening & Treatment webpage
- Addressing & Improving Behavioral Health webpage
- Depression (PDF) data snapshot: Learn about disparities in Medicare patients
- Preventive & screening services webpage: Get information for your patients
Claims, Pricers, & Codes
Skilled Nursing Facility Prospective Payment System: Patient Driven Payment Model FY 2024 ICD-10 Code Mappings
CMS recently issued a correction notice associated with the FY 2024 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) final rule, which corrected errors in the ICD-10 mappings used to group patients into payment groups under the SNF PPS. These errors may have led to errors in payment for a limited number of SNF PPS claims. We encourage providers to recalculate HIPPS codes and adjust claims that meet the following criteria:
- Primary diagnosis listed in item I0020B of the patient assessment associated with the claim is also listed in Table 2 in the correction notice
- One of items J2300–J2330 is checked on the patient assessment associated with the claim
Events
HCPCS Public Meeting — May 28–30
Tuesday, May 28 – Thursday, May 30, 2024, from 9 am – 5 pm ET
Attend a virtual public meeting for the first biannual 2024 HCPCS coding cycle. Visit HCPCS Level II Public Meetings for more information, including:
- Meeting materials
- Guidelines
Publications
Part B Drug Payment Limits Overview
CMS published the Part B Drug Payment Limits Overview (PDF) to explain:
- Average sales price payment limit calculation
- Other Medicare Part B drug payment methodologies
Resource of Health Equity-related Data Definitions, Standards, and Stratification Practices
CMS released a resource document (PDF) of health equity-related data definitions, standards, and stratification practices.
More Information:
- CMS Framework for Health Equity
- The Path Forward: Improving Data to Advance Health Equity Solutions (PDF)
From Our Federal Partners
Providers Accepting CHAMPVA: Enroll in Direct Deposit Now
Are you a health care provider who submits claims to Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)? Enroll in direct deposit to get your claim payments by electronic funds transfer (EFT). Getting paid by EFT is convenient, but it’s also a federal requirement.
EFT is secure, efficient, and helps safeguard Veterans’ family members’ access to benefits.
If you haven’t already:
- Visit the VA Financial Services Center Customer Engagement Portal
- Enroll using the Payment Account Setup web form
Your payments will be automatically deposited into a bank account.
If you aren’t enrolled in EFT, your claims payments will be paused until you are. Make the move today.
For assistance with the webform, call 877-353-9791.
About CHAMPVA
CHAMPVA is a health care program for qualified spouses, widows(ers), and children of eligible Veterans. Through CHAMPVA, VA shares the cost of certain health care services and supplies with eligible beneficiaries.
More Information:
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