Thursday, May 16, 2024
- Administration Acts to Improve Access to Kidney Transplants
- DMEPOS: Updated List of Items Potentially Subject to Conditions of Payment
- Lymphedema Compression Treatment Items: New DMEPOS Benefit Category
- Hospice: New Requirement for Physicians Who Certify Patient Eligibility Effective June 3
- Medicare Physician Fee Schedule Database: July Update
- Women’s Health: Talk with Your Patients About Prevention, Care, & Wellbeing
- Annual Wellness Visit: Social Determinants of Health Risk Assessment
- Clinical Laboratory Fee Schedule & Laboratory Services Reasonable Charge Payment: Quarterly Update
- Diabetes Screening & Definitions Update: CY 2024 Physician Fee Schedule Final Rule
- ESRD Prospective Payment System: Quarterly Update
- Updates for Split or Shared Evaluation and Management Visits
- Skilled Nursing Facility Quality Reporting Program: Social Determinants of Health Video
- Skilled Nursing Facility Quality Reporting Program: Annual Payment Update Webinar Materials
News
Administration Acts to Improve Access to Kidney Transplants
On May 8, HHS, through CMS, is announcing the Increasing Organ Transplant Access Model. The proposed model, which would be implemented by the CMS Innovation Center, aims to increase access to kidney transplants for all people living with ESRD, improve the quality of care for people seeking kidney transplants, reduce disparities among individuals undergoing the process to receive a kidney transplant, and increase the efficiency and capability of transplant hospitals selected to participate. This proposed model would build on the Biden-Harris Administration’s priority of improving the kidney transplant system and the collaborative efforts between CMS and the Health Resources and Services Administration to increase organ donation and improve clinical outcomes, system improvement, quality measurement, transparency, and regulatory oversight.
More Information:
DMEPOS: Updated List of Items Potentially Subject to Conditions of Payment
CMS updated the DMEPOS Master List:
- Added 76 items
- Deleted 3 items
If these items are selected for face-to-face encounter, written order prior to delivery, or prior authorization, you may be required to:
- Meet with your patient and give them a written order before delivering the item
- Ask your Medicare Administrative Contractor to authorize the item in advance
Learn more about extra order requirements:
- Face-to-face encounter and written order prior to delivery:
- Added 13 new items
- Deleted 1 item that was removed from the Master List
- Prior authorization:
- Added 9 new items
- Deleted 1 item that was removed from the Master List
- MLN Matters® Article SE20007 (PDF)
Lymphedema Compression Treatment Items: New DMEPOS Benefit Category
Starting January 1, 2024, Medicare pays for lymphedema compression treatment items for Medicare Part B patients. CMS updated the following manuals with information on this new DMEPOS benefit category:
- Medicare Benefit Policy Manual, Chapter 15 (PDF):
- Section 110.8: DMEPOS benefit category determinations
- Section 145: covered items, replacements, and frequency limitations
- Instruction to your Medicare Administrative Contractor (PDF)
- Medicare Claims Processing Manual, Chapter 20 (PDF):
- Section 181.1: payment policy
- Instruction to your Medicare Administrative Contractor (PDF)
Hospice: New Requirement for Physicians Who Certify Patient Eligibility Effective June 3
For Medicare to pay for hospice services, the following physicians must enroll in Medicare or opt out by June 3, 2024:
- Hospice medical director or the physician member of the hospice interdisciplinary group who certifies the patient’s terminal condition
- Patient-designated attending physician (if they have one) who certifies their terminal condition
CMS will deny hospice claims if the certifying physician isn’t in our PECOS hospice ordering and referring files by then.
If you’re currently enrolled or opted out, you don’t need to do anything.
This new requirement:
- Only applies to Fee-for-Service Medicare
- Doesn’t prohibit the patient’s independent attending physician from treating them while in hospice and billing for these services under Part B
- Applies to all written or oral certifications under § 418.22(c)
Hospices can quickly verify a physician’s enrollment or opt-out status using the CMS order and referring data file, which lists all Medicare-enrolled and opted-out physicians.
More Information:
- Hospice Certifying Enrollment Q&A (PDF)
- Hospice Claims Edits for Certifying Physicians (PDF) MLN Matters Article
- FY 2024 Hospice final rule
- Instruction to your Medicare Administrative Contractor (PDF)
Medicare Physician Fee Schedule Database: July Update
See the attachment in the instruction to your Medicare Administrative Contractor (PDF) (MAC) to learn about the July quarterly changes to the Medicare Physician Fee Schedule Database:
- New codes
- Procedure status changes
- Code short descriptor revisions
- Payment policy indicator changes
- Established codes that now have the TC and 26 modifiers
Your MAC will give you 30-days’ notice before they implement these changes. Then, they’ll adjust claims that you bring to their attention.
Women’s Health: Talk with Your Patients About Prevention, Care, & Wellbeing
During National Women’s Health Week and National Osteoporosis Month, encourage your patients to prioritize whole health—prevention, care, and wellbeing. Medicare covers preventive services to help support a healthy lifestyle, including:
- Bone mass measurement
- Cervical cancer screening
- Mammography screening
- Screening pap test
- Sexually transmitted infection screening & counseling
- Screening pelvic exam
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:
- Osteoporosis (PDF) and Breast Cancer Screening (PDF) data snapshots: Learn about disparities in Medicare patients
- CDC Women’s Health webpage
- Preventive & screening services webpage: Get information for your patients
Compliance
Diabetic Shoes: Prevent Claim Denials
In 2022, the improper payment rate for diabetic shoes was 51%, and insufficient documentation accounted for 69% of improper payments (see 2022 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF), Appendices D, E, and G). Learn how to bill correctly for these services. Review the diabetic shoes provider compliance tip for more information, including:
- Codes
- Coverage limitations and requirements for therapeutic shoes
- Documentation requirements and example of improper payment
- Resources
Claims, Pricers, & Codes
Home Health Claims: Additional Enforcement of Required County Codes
Effective October 1, 2024, you must report county codes (value code 85) on all home health claims with type of bill 032x.
More Information:
- Section 50208 Bipartisan Budget Act of 2018
- Office of the Inspector General Report
- Instruction to your Medicare Administrative Contractor (PDF)
Events
Overcoming COVID-19 Vaccine Payment Challenges Webinar — May 30
Thursday, May 30, 2024, from 2–3 pm ET
Register for this webinar.
Target audience: This webinar is open to Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs), nursing home leaders, medical directors, directors of nursing, and billing supervisors interested in overcoming vaccine payment challenges to maximize immunization rates for COVID-19 at their facilities.
The commercialization of COVID-19 vaccines following the end of the public health emergency has led to vaccine payment challenges for nursing homes. Join CMS and the CDC to:
- Hear directly from a Medicare payment expert
- Learn how QIN-QIOs are connecting nursing homes with pharmacies to provide vaccines and handle billing
- Get resources for navigating the vaccine payment process
If you have questions, contact dvacsupport@bizzellus.com.
MLN Matters® Articles
Annual Wellness Visit: Social Determinants of Health Risk Assessment
Learn about providing the social determinants of health risk assessment (PDF) during an annual wellness visit:
- Optional element
- Eligibility and billing requirements
Clinical Laboratory Fee Schedule & Laboratory Services Reasonable Charge Payment: Quarterly Update
Learn about updates for laboratory billing (PDF) effective July 1, 2024, including:
- Next private payor data reporting period: January 1 – March 31, 2025
- New and deleted HCPCS codes
Diabetes Screening & Definitions Update: CY 2024 Physician Fee Schedule Final Rule
Learn about updates to diabetes screening and definitions (PDF):
- Revised definition of diabetes
- Simplified screening frequency limits
- Added Hemoglobin A1c (HbA1c) test coverage
Medicare Administrative Contractors will reprocess claims you bring to their attention.
ESRD Prospective Payment System: Quarterly Update
Learn more about changes effective July 1, 2024 (PDF), including:
- Added Transitional Drug Add-On Payment Adjustment for HCPCS code J0911
- Updated list of outlier services
Updates for Split or Shared Evaluation and Management Visits
Learn about updates effective January 1, 2024 (PDF):
- Changes to what’s considered a substantive portion
- How to bill
Multimedia
Skilled Nursing Facility Quality Reporting Program: Social Determinants of Health Video
Watch an animated CMS video on Social Determinants of Health (SDOH) Items: Using Sources Other Than the Resident to Code (4 min) for skilled nursing facility (SNF) providers. Learn how to accurately determine when you’re allowed to use other sources for these SDOH items:
- A1005 – Ethnicity
- A1010 – Race
- A1110 – Language
- A1250 –Transportation
- B1300 – Health Literacy
- D0700 – Social Isolation
Visit SNF Quality Reporting Training for more information.
Skilled Nursing Facility Quality Reporting Program: Annual Payment Update Webinar Materials
Get materials from the March webinar on Achieving a Full Annual Payment Update:
Visit SNF Quality Reporting Training for more information.
Information for Patients
Mental Health & Substance Use Disorders: Updated Medicare.gov Content
May is Mental Health Awareness Month, and CMS updated our Mental Health and Substance Use Disorders content on medicare.gov. These updates are part of our broader Behavioral Health Strategy and make it easier for users to access mental health and substance use disorder information.
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