Thursday, July 20, 2023
- Percutaneous Transluminal Angioplasty of Carotid Artery Concurrent with Stenting: Proposed National Coverage Determination
- Beta Amyloid Positron Emission Tomography in Dementia and Neurodegenerative Disease: Proposed National Coverage Determination
- CMS Posts Program Year 2022 Open Payments Data to CMS.gov
- Value-Based Insurance Design Model: CY 2024
- DMEPOS Suppliers: When & Where to Submit Electronic Funds Transfer Authorization Agreement Form
- New Domestic N95 Respirator Payment Adjustments
- Medicare Providers: Deadlines for Joining an Accountable Care Organization
Percutaneous Transluminal Angioplasty of Carotid Artery Concurrent with Stenting: Proposed National Coverage Determination
CMS posted a proposed National Coverage Determination for Percutaneous Transluminal Angioplasty of Carotid Artery Concurrent with Stenting. View the Proposed Decision Memo, and submit comments by August 10.
Beta Amyloid Positron Emission Tomography in Dementia and Neurodegenerative Disease: Proposed National Coverage Determination
CMS posted a proposed National Coverage Determination for Beta Amyloid Positron Emission Tomography in Dementia and Neurodegenerative Disease. View the Proposed Decision Memo, and submit comments by August 16.
CMS posted the Program Year 2022 Open Payments data to CMS.gov. The posting includes updated data submitted and attested to by applicable manufacturers and group purchasing organizations that are required to annually report payments or transfers of value made to certain health care providers. Get information about the Open Payments Program.
Starting in CY 2024, the Value-Based Insurance Design (VBID) Model’s hospice benefit component will cover hospice election start dates from January 1, 2021 – December 31, 2024. This fall, CMS will share more detailed, provider-specific information about CY 2024.
We haven’t made any changes for CY 2023. Continue to use these resources for current information about the VBID Model’s hospice benefit component for CY 2023:
- CY 2023 VBID Hospice Provider Letter and Checklist
- VBID Model Hospice Benefit Component, including information about checking eligibility, billing, and payment
Effective August 21, you must submit an EFT Authorization Agreement CMS-588 form:
- When you enroll for the first time
- If you currently get paper checks in any jurisdiction, and take 1 of these actions:
- Change information
Submit the form to the national provider enrollment (NPE) contractor for your state:
Learn about new payment adjustments to hospitals for Medicare’s share of the additional costs of domestic National Institute for Occupational Safety and Health (NIOSH)-approved surgical N95 respirators compared to non-domestic respirators.
To participate in an Accountable Care Organization (ACO) for performance year 2024, work with an ACO to join their participant list. ACOs must submit their lists to CMS by August 1 at:
- Noon ET for the Medicare Shared Savings Program
- 11:59 pm ET for the ACO Realizing Equity, Access, and Community Health Model (ACO REACH)
Participant taxpayer identification numbers can’t overlap multiple ACO participant lists. Resolve any overlaps by September 5.
- Application Types & Timeline
- Email questions to SharedSavingsProgram@cms.hhs.gov or ACOREACH@cms.hhs.gov
Use pre-entitlement billing instructions for inpatient admissions when you:
- Admit the patient before their Medicare Part A entitlement date
- Discharge them after their Part A entitlement effective date
How We Calculate Your Payment
CMS calculates the number of utilization days from the patient’s Part A entitlement date through the discharge, transfer, or death date, and we reimburse you based on the amount of billed covered charges. If we pay you under the Inpatient Prospective Payment System, we calculate the Diagnosis Related Group from the patient’s admission date.
Billing & Claims Tips
- Room & Board Revenue Codes = 010X – 016X
- Admission Date = Patient’s formal inpatient admission date
- Statement Covered Period From Date = Effective date of Part A entitlement
- Statement Covered Period Through Date = End date of the inpatient stay
- Covered Days with Value Code (VC) 80 = The number of days in the Covered From to Covered Through date range
- Accommodation Days/Units = The number of days reported in VC 80
- Only include room and board charges for the days the patient had Part A entitlement
- Don’t bill the patient or anyone else for days of care before the patient’s Part A entitlement, except for days above the outlier threshold
- Report all revenue codes from the admission date through the discharge, transfer, or death date as covered charges
- Include surgical procedure codes from the admission date to the discharge, transfer, or death date
- Include diagnosis codes from the admission date to the discharge, transfer, or death date
- Include the Part A entitlement date In the Remarks
- Medicare Benefit Policy Manual, Chapter 4: Learn about psychiatric benefit day reduction and lifetime limitation for inpatient psychiatric facilities
- Section 40 Medicare Claims Processing Manual, Chapter 3
MLN Matters® Articles
Learn what’s new, including:
- Round 5 testing
- National implementation starting August 1
Learn what’s changed:
- Updated information on:
- End of the COVID-19 public health emergency
- CY 2023 and telehealth policies
- Added information on:
- Consent for care management and virtual communication services
CMS changed this link. If you previously bookmarked it, update your link.
Watch the Brief Interview for Mental Status video (22:11) to learn about this cognitive assessment:
- Interview strategies
- Targeted guidance for accurate coding using patient and resident scenarios
- For questions about accessing the video or feedback, contact PAC Training
- For content questions, contact HH QRP Help Desk, IRF QRP Help Desk, LTCH QRP Help Desk, or SNF QRP Help Desk
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