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COVID-19: Changes for Medicare Advantage Plan Claims Starting January 1

Thursday, November 4, 2021




MLN Matters® Articles






COVID-19 Vaccines for Children

CMS now covers the Pfizer-BioNTech COVID-19 Vaccine for children ages 5 – 11. Health care providers and other entities administering COVID-19 vaccines:

  • Must provide vaccines regardless of the patient’s health coverage
  • Can’t charge patients for the vaccine or administering it, including deductibles and coinsurance

More Information:


COVID-19 Vaccine & Monoclonal Antibody Products: Changes for MA Plan Claims Starting January 1, 2022

If you vaccinate or administer monoclonal antibody treatment to patients enrolled in Medicare Advantage (MA) plans on or after January 1, 2022, submit claims to the MA Plan. Original Medicare won’t pay these claims.

More Information:


Multi-Factor Authentication Requirement for PECOS

CMS will implement Multi-Factor Authentication (MFA) for the Provider Enrollment, Chain, and Ownership System (PECOS) on January 3, 2022. PECOS will use the same MFA methods as the Identity & Access Management System (I&A). Users who have set up MFA in I&A won’t need to do additional setup for MFA in PECOS.

There’s a 60-day grace period to set up MFA. The grace period countdown starts with a user’s first login after January 3. By April 21, all users must access these systems using MFA. To prepare and set up an MFA account, log in to the Identity & Access Management System. View this MFA Presentation for more information.

If you work on behalf of other providers, be sure to enable the appropriate surrogacy connections. Learn how with the I&A Quick Reference Guide.




Medicare Clinical Laboratory Fee Schedule Private Payor Data Collection & Reporting Webinar — November 10

Wednesday, November 10 from 3:30 – 4:30 pm ET

Register for this webinar.

Learn key information about clinical laboratory fee schedule private payor data collection and reporting requirements:

  • Next data reporting period is January 1 – March 31, 2022
  • Reporting is based on the original data collection period, January 1 – June 30, 2019

Visit the PAMA webpage for more information.


COVID-19 Vaccine Webinar for Rural Communities — November 15

Monday, November 15 from 1 – 2:30 pm ET

Register for this webinar.

To recognize National Rural Health Day, CMS is hosting a webinar for community partners and providers working in rural areas. Learn more about COVID-19 from CMS, FDA, CDC, and two community partners. The agenda includes:

  • Resources, toolkits, and information
  • Health care workforce mandates
  • Health care coverage for the vaccine


MLN Matters® Articles


Manual Updates for Clarification on the Election Statement Addendum and Extension of the Hospice Cap Calculation Methodology

Learn about changes to the Medicare Hospice Benefit Policy Manual, including (PDF):

  • Hospice election statement addendum update
  • Signature requirements when a patient dies, revokes the election, or you discharge them
  • Hospice cap calculation update from 2025 to 2030

Make sure your billing staff knows about these changes.


Fiscal Year (FY) 2022 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) PPS Changes

Learn about FY 2022 changes, including (PDF):

  • IPPS updates
  • LTCH PPS updates
  • Updated list of hospitals CMS excludes from the IPPS

Make sure your billing staff knows about these changes.




Medicare Billing: 837P & Form CMS-1500

Learn about changes to Medicare billing, including (PDF):

  • New Test Transaction Tool
  • Late claims exceptions
  • New electronic filing exceptions
  • New waiver request criteria




PAC Quality Reporting Programs: Updated 3-Course Training Series for Section GG

CMS is offering an updated web-based training series on assessing and coding Section GG. The courses are for providers in the following post-acute care (PAC) settings:

  • Home Health Agencies (HHAs)
  • Inpatient Rehabilitation Facilities (IRFs)
  • Long-Term Care Hospitals (LTCHs)
  • Skilled Nursing Facilities (SNFs)

Each course includes interactive exercises to test your Section GG assessment and coding knowledge. The 3 courses in the series are:

If you have technical questions or feedback on the training, please email the PAC Training Mailbox. Submit content-related questions to:

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