Thursday, September 16, 2021
- 2022 Annual Update for the Health Professional Shortage Area (HPSA) Bonus Payments
- Annual Clotting Factor Furnishing Fee Update 2022
- Home Health Notices of Admission – Additional Manual Instructions
- Implement Operating Rules – Phase III Electronic Remittance Advice (ERA) Electronic Funds Transfer (EFT): Committee on Operating Rules for Information Exchange (CORE) 360 Uniform Use of Claim Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC) and Claim Adjustment Group Code (CAGC) Rule – Update from Council for Affordable Quality Health Care (CAQH) CORE
- Influenza Vaccine Payment Allowances – Annual Update for 2021-2022 Season
- Quarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment
- Quarterly Update to Home Health (HH) Grouper
- Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) – October 2021 Update
View this edition as PDF (PDF)
COVID-19 Vaccines: Act Now
CMS announced last week that we’ll require staff within all Medicare and Medicaid-certified facilities to get COVID-19 vaccines. Make efforts now to vaccinate you and your staff so you’re in compliance when the rule takes effect. The higher the level of vaccination rates among you and your staff, the lower the infection rate is for your patients who depend on you for care. Get vaccinated and protect yourselves, your families, and your patients from COVID-19.
- CDC Benefits of Getting a COVID-19 Vaccine webpage
- CDC FAQs about COVID-19 Vaccination webpage: Information and facts, such as how long you’re protected and what is in the vaccine
- CDC Vaccinate with Confidence webpage: Resources to help you build confidence in the COVID-19 vaccine
- CDC COVID-19 Vaccination for Essential Workers webpage: Why it’s important to get your vaccines and where you can get them
- CMS COVID-19 Provider Toolkit: Payment, coding, and billing for vaccine administration
IRF Review Choice Demonstration: Submit Comments by October 8
CMS is continuing the Paperwork Reduction Act (PRA) approval process for the proposed Inpatient Rehabilitation Facility (IRF) Review Choice Demonstration. The required 30-day comment period is open. See the Federal Register Notice for information on how to comment.
Responses and updates from the 60-day public comment period are now available.
Implementation dates for the demonstration depend on PRA approval, the pandemic, and the public health emergency.
Medicare Quarterly Provider Compliance Newsletter
Learn about guidance to address billing errors (PDF):
- Glucose testing supplies
- Bone marrow or stem cell transplant: medical necessity and documentation requirements
- Negative pressure wound therapy: medical necessity and documentation requirements
Surgical Dressings: Medicare Requirements
Medicare covers primary or secondary surgical dressings:
- Used to protect or treat a wound
- If needed after debridement of a wound
The patient’s medical records should include clinical information to demonstrate reasonable and necessary need for the type and quantity of surgical dressings. Providers must evaluate the wound monthly and update the record, unless they document why they can't do a monthly evaluation and how they're monitoring the patient's ongoing use of dressings.
For more information, see the Surgical Dressings – Policy Article .
Claims, Pricers, & Codes
Average Sales Price Files: October 2021
CMS posted the October 2021 Average Sales Price (ASP) and Not Otherwise Classified (NOC) pricing files and crosswalks on the 2021 ASP Drug Pricing Files webpage.
National Stakeholder Call with the CMS Administrator — September 17
Friday, September 17 from 12:30 to 1 pm ET
You’re invited to join the CMS Administrator, Chiquita Brooks-LaSure, and her leadership team to hear key updates from her first 100 days in office. The Administrator’s vision is for CMS to serve the public as a trusted partner and steward, dedicated to advancing health equity, expanding coverage, and improving health outcomes. We invite you to join us for this first national stakeholder call to learn more about how you can partner with us as we implement our vision.
How to participate:
- Join Zoom
- Call 833-568-8864 (toll free); webinar ID: 161 910 6718; passcode: 891135
We want to hear from you. Submit questions in advance to Partnership@cms.hhs.gov.
Target audience: national and local stakeholders and partners.
MLN Matters® Articles
2022 Annual Update for the Health Professional Shortage Area (HPSA) Bonus Payments
Learn about automated payments for calendar year 2022 (PDF).
Annual Clotting Factor Furnishing Fee Update 2022
Learn about the $0.239 per unit fee. (PDF)
Home Health Notices of Admission – Additional Manual Instructions
Learn about updates for special billing situations (PDF).
Implement Operating Rules – Phase III Electronic Remittance Advice (ERA) Electronic Funds Transfer (EFT): Committee on Operating Rules for Information Exchange (CORE) 360 Uniform Use of Claim Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC) and Claim Adjustment Group Code (CAGC) Rule – Update from Council for Affordable Quality Health Care (CAQH) CORE
Learn about the next version of the Code Combination List (PDF).
Influenza Vaccine Payment Allowances – Annual Update for 2021-2022 Season
Learn about payment for flu shots. (PDF)
Quarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment
Learn about updates effective October 1 (PDF).
Quarterly Update to Home Health (HH) Grouper
Learn about software updates for the calendar year 2022 final rule (PDF).
Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) – October 2021 Update
Learn about new and updated codes (PDF).
DMEPOS Accreditation — Revised
Read new Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) supplier information (PDF) in this Medicare Learning Network fact sheet:
- Enrollment requirements
Independent Diagnostic Testing Facility (IDTF) — Revised
Read new information (PDF) in this Medicare Learning Network fact sheet:
- Clarified information on site visits, Section 1877 of the Social Security Act, global billing, separate technical component and professional component billing, skilled nursing facility resident transportation, and mammography services
- Added new policy information on the COVID-19 public health emergency and opioid treatment programs
- Updated CPT codes for transtelephonic and electronic monitoring services
- Get resources to advance health equity and help eliminate health disparities
Part D Coverage Determinations, Appeals, & Grievances Web-Based Training — Revised
See updated information in this Medicare Learning Network (MLN) web-based training course:
- Learn requirements
- Identify common problems
Visit the MLN Web-Based Training webpage for a current list of courses.
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