- CMS Continues Work on Behavioral Health
- Discarded Drugs and Biologicals: Updated FAQs on JW & JZ Modifiers
- Expanded Home Health Value-Based Purchasing Model: July 2023 Interim Performance Reports
- Subsequent Annual Wellness Visits: Comparative Billing Report in July
- Medicare Ground Ambulance Data Collection System: Submit Comments by September 11
- Clinical Laboratories: New Diagnostic Tests & Reporting Reminder
- Viral Hepatitis: Talk with Your Patients about Shots & Screenings
News
CMS Continues Work on Behavioral Health
Read the updated Behavioral Health Cross Cutting Initiative fact sheet to learn about recent accomplishments and proposals.
Discarded Drugs and Biologicals: Updated FAQs on JW & JZ Modifiers
CMS updated the Discarded Drugs and Biologicals – JW Modifier and JZ Modifier Policy FAQs to clarify:
- Applicability of the reporting requirements to:
- Various outpatient settings
- Certain Not Otherwise Classified billing codes
- How to use the JW and JZ modifiers when you prepare the dose with more than 1 single-dose container
We use the JW and JZ Modifiers to collect information on discarded drug amounts from drugs that are packaged in single-dose containers that are separately payable under Part B:
- Starting July 1, 2023, report the JZ modifier when there are no discarded amounts
- Report the JW modifier when there are discarded amounts
Expanded Home Health Value-Based Purchasing Model: July 2023 Interim Performance Reports
Download your July 2023 Pre-Implementation Performance Report from iQIES. See instructions for accessing reports.
For the CY 2023 performance year, you’ll get a report if you:
- Were Medicare-certified prior to January 1, 2022
- Have enough data for at least 1 quality measure
More Information:
- Expanded Home Health Value-Based Purchasing Model webpage: See Model Reports Section
- QIES/iQIES Service Center at 800-339-9313 or iqies@cms.hhs.gov: Register a user, or get help locating or downloading reports
Subsequent Annual Wellness Visits: Comparative Billing Report in July
CMS will issue a Comparative Billing Report (CBR) on Medicare Part B claims for subsequent annual wellness visits. Use the data-driven report to compare your billing practices with those of peers in your state and across the nation.
Look for an email from cbrpepper.noreply@religroupinc.com to access your report.
More Information:
- View a webinar recording
- Visit the CBR website
- Register for a live webinar August 9 from 3-4 pm ET
Medicare Ground Ambulance Data Collection System: Submit Comments by September 11
CMS issued the CY 2024 Physician Fee Schedule (PFS) proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the PFS and other Medicare Part B payment policy issues, including ambulance services. We’re revising regulations consistent with the Consolidated Appropriations Act, 2023, to extend 3 existing add-on payments to the ambulance base and mileage rates under the Ambulance Fee Schedule through December 31, 2024.
We’re also proposing changes to the Medicare Ground Ambulance Data Collection System Instrument:
- Adding the ability to address partial year responses from ground ambulance organizations
- Introducing a minor edit to improve the reporting consistency of hospital-based ambulance organizations
- Correcting 4 typos
We encourage you to review the rule and submit formal comments by September 11, 2023.
Clinical Laboratories: New Diagnostic Tests & Reporting Reminder
Learn about Medicare Advisory Panel on Clinical Diagnostic Laboratory Services recommendations for new clinical diagnostic laboratory tests for CY 2024:
- Video of July 19 meeting (3:22:51), Password: RO?H=Y6t
- Voting summary
Are You Ready?
Prepare to report private payor data starting January 1.
Viral Hepatitis: Talk with Your Patients about Shots & Screenings
Viral hepatitis is a serious public health threat. It’s a leading cause of liver cancer and causes more than 1 million deaths each year.
Hepatitis B is vaccine-preventable, and hepatitis C is curable (see CDC). World Hepatitis Day is an opportunity to encourage shots and screenings.
Medicare covers viral hepatitis screening and immunization services, including:
- Hepatitis B screening
- Hepatitis B shot & administration
- Hepatitis C screening
- Sexually transmitted infection (STI) screening & high-intensity behavioral counseling to prevent STIs
Your patients pay nothing if they meet coverage criteria, and you accept assignment.
More Information:
- CDC Viral Hepatitis webpage
- Hepatitis Disparities data snapshot
- Hepatitis B virus infection screenings, hepatitis B shots, hepatitis C screening tests, and STI screenings & counseling: Get information for your patients
Claims, Pricers, & Codes
HCPCS Application Summaries & Coding Decisions: Drugs & Biologicals
CMS published the Second Quarter 2023 HCPCS Application Summaries & Coding Recommendations for drugs and biologicals. See HCPCS Level II Coding Decisions for more information.
From Our Federal Partners
Biosimilars: Free Continuing Education Courses, Videos, & Resources from FDA
Biosimilars are safe and effective for treating many illnesses like chronic skin and bowel diseases, arthritis, macular degeneration, kidney conditions, diabetes, and some cancers. They increase access to lifesaving medications at potentially lower costs. Use the FDA searchable online database to get information about biological products. Explore resources, including:
FDA Funded Medscape Continuing Education Program Series
Physicians, nurses, and pharmacists free accredited continuing education courses:
- Biosimilars 101: A Primer for Your Practice
- Biosimilars in the Real World: Perspectives for Staying Within the Scope of Care
- Incorporating Biosimilars Into the Management of Patients With Immunological Conditions
- Putting the Patient into Perspective: Strategies for Educating Patients about Biosimilars
Don’t have a Medscape account? Sign up for free to access the courses.
Videos
- Biosimilar Medications – What Health Care Providers Need to Know (1:36)
- FDA Review and Approval Process for Biosimilar Medications (1:57)
- Interchangeable Biosimilars (1:35)
More Information:
- Overview for Health Care Professionals webpage
- Biosimilar curriculum materials for health care degree programs (no CE associated)
- Biosimilar Basics infographic (English and Spanish)
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