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Thursday, August 3, 2023



MLN Matters® Articles



Medicare Dementia Care Model

The Biden-Harris Administration is taking further action on its commitment to promote care and support for people with Medicare living with dementia and their unpaid caregivers. On July 31, HHS, through CMS, announced its Guiding an Improved Dementia Experience (GUIDE) Model, which aims to improve the quality of life for people living with dementia, reduce strain on unpaid caregivers, and help people remain in their homes and communities through a package of care coordination and management, caregiver education and support, and respite services. The GUIDE Model will be tested by the Center for Medicare and Medicaid Innovation and is a key deliverable from President Biden’s April 2023 Executive Order on Increasing Access to High-Quality Care and Supporting Caregivers, as well as key goals of the National Plan to Address Alzheimer’s Disease (National Plan).

More Information:

Your Patient’s Medicare Beneficiary Identifier (MBI) May Change

CMS sent letters to people with Medicare who may have been affected by a recent data breach. We’re mailing approximately 47,000 new Medicare cards with a new MBI to those affected. Learn what to do if your patient’s MBI changes. 

Ask your patient for their new Medicare card if you get “invalid member ID” when checking Medicare eligibility. Access your Medicare Administrative Contractor’s secure internet portal to use the MBI look-up tool if your patient didn’t get a new Medicare card yet.


CMS Roundup (July 28, 2023)

You may be interested in these topics from the CMS Roundup:

  • CMS Innovation Center Seeks Input on Next Episode-Based Payment Model
  • CMS Releases First Annual Evaluation Report for the End-Stage Renal Disease Treatment Choices Model
  • CMS Updates Overall Hospital Quality Star Ratings, VA Hospitals Included for the First Time


Building on CMS's Accountable Care Vision to Improve Care for Medicare Beneficiaries

CMS had a blog published in the Health Affairs Forefront, outlining the agency's vision for Accountable Care Organizations (ACOs). This article describes progress in the CMS accountable care strategy and outlines areas CMS is exploring in 2023 to build on these efforts to accelerate the growth and reach of ACOs and support improved care experience, access, and quality for beneficiaries, especially those in underserved areas.


Home Health Agencies & Partial Hospitalization Programs: Program for Evaluating Payment Patterns Electronic Reports

Fourth quarter CY 2022 Program for Evaluating Payment Patterns Electronic Reports (PEPPERs) are available for home health agencies and partial hospitalization programs. These reports summarize provider-specific data for Medicare services that may be at risk for improper payments. Use the data to support auditing and monitoring activities.

More Information:


Skilled Nursing Facility Value-Based Purchasing Program: August Performance Score Report

Download your August Performance Score Reports for the Skilled Nursing Facility Value-Based Purchasing Program from iQIES, including the incentive payment multiplier CMS will apply to your Part A claims in FY 2024.

Submit corrections until August 31. See Confidential Feedback Reporting & Review and Corrections for more information.



Expanded Home Health Value-Based Purchasing Model: Revised July Interim Performance Reports

CMS reissued July Preliminary Interim Performance Reports for the Expanded Home Health Value-Based Purchasing Model in iQIES to correct display issues. See instructions for accessing reports.

We extended the deadline to submit a recalculation request to August 16.


MLN Matters® Articles

ESRD Prospective Payment System: October 2023 Update

Learn about changes effective October 1, 2023:

  • Billing J0889 for daprodustat under the Transitional Drug Add-on Payment Adjustment
  • New ICD-10-CM codes for:
    • Comorbidity payment adjustment
    • Acute kidney injury


Patient Driven Payment Model Claim Edits

Learn about edit updates for claims with dates of service on or after October 1, 2019:

  • Skilled nursing facilities billing on type of bill (TOB) 21X and hospitals billing swing bed TOB 18X
  • Hospitals billing during an interrupted stay


Processing Services During Disenrollment from the Program of All-Inclusive Care for the Elderly

Learn about billing for patients who disenroll from the Program:

  • How CMS handles payment
  • When to use condition codes and value code to prevent claims denials


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