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MACs Resume Medical Review

Thursday, June 3, 2021



MLN Matters® Articles




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Medicare Shared Savings Program: Submit Notice of Intent to Apply by June 7

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.

More Information:


Clinical Diagnostic Laboratories: Key Dates for New & Reconsidered Test Codes

CMS offers opportunities for clinical diagnostic laboratories to provide input for calendar year 2022 on:

Key Dates

More Information:


Clinical Diagnostic Laboratories: Private Payor Rate-Based CLFS Resources

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.


MACs Resume Medical Review on a Post-payment Basis

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.


CMS Celebrates Pride Month

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.

More Information:




Improper Payment for Intensity-Modulated Radiation Therapy Planning Services

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.


MLN Matters® Articles


International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs) – October 2021

Learn about updated ICD-10 conversions. (PDF)


National Coverage Determination (NCD) 110.24: Chimeric Antigen Receptor (CAR) T-cell Therapy

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.


National Coverage Determination (NCD) Removal

Learn about the removal of 6 NCDs. (PDF)


Quarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment

Learn about updates effective July 1, 2021. (PDF)




Medicare Disproportionate Share Hospital — Revised

CMS revised the Medicare Learning Network Medicare Disproportionate Share Hospital (PDF) fact sheet to update information on uncompensated care payments for eligible hospitals.




Hospice Quality Reporting Program: May Forum Materials

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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