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Thursday, January 19, 2023



Claims, Pricers, & Codes




Additional Steps to Strengthen Nursing Home Safety and Transparency

As part of the continuing efforts under President Biden’s initiative to improve nursing home transparency, safety and quality, and accountability, HHS, through CMS, announced new actions to reduce the inappropriate use of antipsychotic medications and to bring greater transparency about nursing home citations to families.

See the full press release.


Increase in 2023 in Organizations and Beneficiaries Benefiting from Coordinated Care in Accountable Care Relationship

CMS announced that 3 innovative accountable care initiatives will grow and provide higher quality care to more than 13.2 million people with Medicare in 2023. More than 700,000 health care providers and organizations will participate in at least 1 of the 3 initiatives – the Medicare Shared Savings Program and 2 CMS Innovation Center accountable care model tests. This growth furthers achieving the CMS’ goal of having all people with Traditional Medicare in an accountable care relationship with their health care provider by 2030.

See the full press release.


DMEPOS: Updates to Face-to-Face Encounter & Written Order Prior to Delivery List

Get the updated DMEPOS Required Face-to-Face Encounter & Written Order Prior to Delivery List effective April 17, 2023, including 10 new items. Visit DMEPOS Order Requirements for more information.


Skilled Nursing Facility Provider Preview Reports: Review by February 16

Review your data by February 16, and contact CMS if you have questions. We’ll publish the data on Care Compare and in the Provider Data Catalog in April.  

Visit Public Reporting for more information.


Value-Based Insurance Design Model: Learn about the Hospice Benefit Component

Currently, when a patient enrolled in Medicare Advantage (MA) elects hospice, Fee-for-Service Medicare becomes responsible for coverage and payment of most services, while the MA plan remains responsible for certain services like supplemental benefits. Under the Hospice Benefit Component of the Value-Based Insurance Design (VBID) Model, participating MA plans are financially responsible for all Part A and B benefits, including the hospice benefit and supplemental benefits. CMS is assessing how this affects care delivery and quality of care, especially for palliative and hospice care.

For CY 2023, 15 participating MA organizations offer 119 plan benefit packages through the Model. We’ll send information and resources to affected hospices this month. Learn more about the Hospice Benefit Component  to prepare for future years.


Medicare Ground Ambulance Data Collection System: 5 Top Tips for Reporting

Starting January 1, 2023, selected ground ambulance organizations in Year 1 and Year 2  must report cost, utilization, revenue, and other information to CMS. Organizations that fail to report may be subject to a 10% payment reduction. Learn 5 top tips to help you report required data.

More Information:


Glaucoma Awareness Month: Act to Prevent Vision Loss

Half of people with glaucoma don’t know they have it (see CDC). Glaucoma Awareness Month is the perfect time to talk with your patients about reducing their risk of vision loss. Encourage these higher risk patients to get an annual screening:

  • Individuals with diabetes mellitus
  • Individuals with glaucoma in their family history
  • Black or African-Americans aged 50 and older
  • Hispanics or Latinos aged 65 and older

Medicare covers glaucoma screening for patients with Part B who meet at least 1 high-risk criteria.

More Information:



Home Health Rural Add-On Policy

Section 4137 of the Consolidated Appropriations Act, 2023 extends the rural add-on policy by providing an increase of 1% of the payment amount made for home health services provided in the ‘‘low population density’’ category for CY 2023.

Section 50208 of the Bipartisan Budget Act of 2018 requires providers to submit county codes on all home health prospective payment system claims starting on January 1, 2019. Home health agencies should continue to report value code 85 and an associated Federal Information Processing System (FIPS) state and county code on all claims.

View the Home Health Claims Processing Manual for more information.   


Claims, Pricers, & Codes

ICD-10 Code Files & MS-DRGs Version 40.1: April Update

Get the latest FY 2023 ICD-10 codes and grouper software effective April 1, 2023:

See the instruction to your Medicare Administrative Contractor.


Integrated Outpatient Code Editor: Version 24.R1

Get revised January 2023 Integrated Outpatient Code Editor files, including updates for:

  • Reinstatement of pass-through device codes C1824, C1982, C1839, C1734, and C2596 (APC, SI) previously set to expire December 31, 2022
  • Pass-through device offset payment amounts
  • Mid-quarter termination bypass list (edit 124) for audio-only telehealth codes
  • Daily mental health logic for remote mental health services

See the instruction to your Medicare Administrative Contractor.




Post-Acute Care Quality Reporting Programs: COVID-19 Public Reporting

Read the third edition COVID-19 Public Reporting tip sheets to learn about CMS reporting during the public health emergency:

Learn about:

  • Quality data submissions that are optional or excepted
  • Care Compare refreshes


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