Thursday, June 3, 2021
- Medicare Shared Savings Program: Submit Notice of Intent to Apply by June 7
- Clinical Diagnostic Laboratories: Key Dates for New & Reconsidered Test Codes
- Clinical Diagnostic Laboratories: Private Payor Rate-Based CLFS Resources
- MACs Resume Medical Review on a Post-payment Basis
- CMS Celebrates Pride Month
- International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs) – October 2021
- National Coverage Determination (NCD) 110.24: Chimeric Antigen Receptor (CAR) T-cell Therapy
- National Coverage Determination (NCD) 210.3: Screening for Colorectal Cancer (CRC) - Blood-Based Biomarker Tests
- National Coverage Determination (NCD) Removal
- Quarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment
CMS is accepting Notices of Intent to Apply (NOIAs) for the Medicare Shared Savings Program January 1, 2022, start date. Visit the Application Types & Timeline and Application Toolkit webpages to help you prepare your applications.
If you intend to apply, you must submit a NOIA via the ACO Management System by June 7 at noon ET. This doesn’t bind your organization to submit an application. Each ACO should only submit 1 NOIA. After you submit a NOIA, submit your application from June 8-28 by noon ET.
- Shared Savings Program webpage
- Shared Savings Program final rule
- Email SharedSavingsProgram@cms.hhs.gov
CMS offers opportunities for clinical diagnostic laboratories to provide input for calendar year 2022 on:
- Establishing payment amounts for new or substantially revised HCPCS codes (ZIP)
- Reconsideration requests for Medicare payment
- June 3: Submit template (PDF) with name and presentation of speakers for annual meeting
- June 24: Virtual Annual Public meeting
- July 26: Comments due on 2021 Clinical Laboratory Fee Schedule (CLFS) gapfill preliminary determinations (ZIP)
- July 28-29: Virtual Advanced Clinical Diagnostic Laboratory Test panel meeting
- CMS CLFS Annual Public Meeting webpage, includes gapfill information
- Clinical Laboratory Fee Schedule Annual Payment Determination Process (PDF) educational tool
Are you an independent laboratory, physician office laboratory, or hospital outreach laboratory that meets the definition of an applicable laboratory under the Clinical Laboratory Fee Schedule (CLFS)? You must report information, including laboratory test HCPCS codes, associated private payor rates, and volume data. CMS recently updated resources:
- Summary (PDF): Overview of key terms and concepts, how to determine whether your laboratory is an applicable laboratory, and timeline
- FAQs (PDF): Responses to questions
- Collect data: January 1-June 30, 2019
- Analyze data: July-December, 2019
- Report data: January 1-March 31, 2022
For more information, visit the PAMA Regulations webpage.
Beginning August 2020, Medicare Administrative Contractors (MACs) resumed post-payment reviews of items and services with dates of service before March 2020. MACs may now begin conducting post-payment medical reviews for later dates of service. The Targeted Probe and Educate program (intensive education to assess provider compliance through up to 3 rounds of review) will restart later. The MACs will continue to offer detailed review decisions and education as appropriate.
June is Pride Month. CMS celebrates Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) persons and recognizes their unique health needs. Social determinants and discriminatory practices increase health disparities in this community. We’re committed to help improve the health of all minority, underserved, or disadvantaged populations.
- Health Observances webpage
- Sexual and Gender Minority Clearinghouse
- Improving Health Care Quality for LGBTQ People and Achieving Health Equity Medicare Learning Network web-based training
- CMS Office of Minority Health webpage
In a recent report, the Office of Inspector General determined that payments for outpatient Intensity Modulated Radiation Therapy (IMRT) didn’t comply with Medicare billing requirements. Hospitals billed separately for complex stimulations that are part of IMRT planning. Review the Medicare Claims Processing Manual, Chapter 4 (PDF), Section 200.3.1 to understand our guidance and avoid overpayments.
International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs) – October 2021
Learn about this determination (PDF) effective for claims with dates of service on or after August 7, 2019.
National Coverage Determination (NCD) 210.3: Screening for Colorectal Cancer (CRC) - Blood-Based Biomarker Tests
Learn about the addition of this test (PDF) effective January 19, 2021.
Quarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment
CMS revised the Medicare Learning Network Medicare Disproportionate Share Hospital (PDF) fact sheet to update information on uncompensated care payments for eligible hospitals.
Review materials (ZIP) from the May Hospice Quality Reporting Program Forum on the Hospice Outcomes & Patient Evaluation (HOPE) assessment. Visit the Provider and Stakeholder Engagement webpage for more information.
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