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COVID-19: Changes to Nursing Home Visitation & Survey Activities

Thursday, November, 18, 2021


Claims, Pricers, & Codes


MLN Matters® Articles

Information for Medicare Patients




CMS Repeals MCIT/R&N Rule; Will Consider Other Coverage Pathways to Enhance Access to Innovative Medical Devices

On November 12, CMS rescinded the Medicare Coverage of Innovative Technology and Definition of “Reasonable and Necessary” (MCIT/R&N) final rule because of concerns that the provisions in the final rule may not have been sufficient to protect Medicare patients. By rescinding this rule, CMS can take action that will better address those safety concerns in the future… Read the full press release.


Changes to Nursing Home Visitation COVID-19 (Revised) & COVID-19 Survey Activities

CMS is continuing to promote health and safety and address the impacts of the COVID-19 public health emergency on nursing home residents and their families by issuing memos that revise guidance for nursing home visitation and address the backlog of complaint and recertification surveys… Read the full news alert.

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Annual Medicare Participation Open Enrollment Period

Did you know that 98% of providers participate in Medicare? Between now and December 31, you can decide if you want to participate in Medicare for 2022. Visit the Annual Medicare Participation Announcement webpage for more information.


It’s Not Too Late to Vaccinate

During this busy time of year, your patients may forget to get their flu shot. According to the CDC and the Advisory Committee on Immunization Practices, you should continue offering the flu shot as long as influenza viruses are circulating locally. Help protect your patients from the flu by using every office visit as an opportunity to remind them to get their flu shot.

Medicare Part B covers 1 flu shot per flu season and additional flu shots if medically necessary. Your patients pay nothing if you accept assignment.

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Post-Acute Care QRP: Job Aids & Pocket Guides

Companion job aids can help you understand specific guidelines and clinical considerations for coding GG0130. Self-Care items:

  • Eating
  • Oral Hygiene
  • Toileting Hygiene
  • Shower/Bathe Self
  • Upper Body Dressing
  • Lower Body Dressing
  • Putting On/Taking Off Footwear

Find the job aids in the Downloads section of the Quality Reporting Program (QRP) Training page for each post-acute care setting:

Pocket guides designed to be worn behind your identification badge provide a quick reference for important terms and definitions. They can help you code accurately:


Quality Payment Program: 2020 Doctors & Clinicians Preview Period Open Until December 14

The Doctors and Clinicians Preview Period is open until December 14 at 8 pm ET. Preview your 2020 Quality Payment Program (QPP) performance information before it appears on Medicare Care Compare and in the Provider Data Catalog.

Access the secured preview through the QPP website. Medicare Shared Savings Program (Shared Savings Program) Accountable Care Organizations (ACOs) and Next Generation Model ACOs can preview their performance information in their 2020 Merit-based Incentive Payment System Performance Feedback Reports. Shared Savings Program ACOs can also review quality performance information on their previously-provided 2020 Quality Performance Reports.

More Information:

Questions about public reporting? Email QPP@cms.hhs.gov, or call 866-288-8292 weekdays 8 am – 8 pm ET (non-peak hours are before 10 am and after 2 pm ET). If you’re hearing impaired, dial 711 for a TRS Communications Assistant.


Lung Cancer Awareness: Help Your Patients Reduce Their Risk


Medicare covers lung cancer preventive services and screening. Talk to your patients about how they can lower their lung cancer risk during Lung Cancer Awareness Month and the Great American Smokeout®.

Your patients pay nothing for these services, if you accept assignment:

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Claims, Pricers, & Codes


Upcoming Quarterly Update to Home Health Grouper

Diagnosis code changes effective April 1, 2022 will affect the Home Health Grouper. Check the Home Health PPS Grouper Software webpage in early February for new software.




Medicare Ground Ambulance Data Collection System: Q&A Session — December 14

Tuesday, December 14 from 2 – 3 pm ET

Register for the session.

Do you have questions about the Medicare Ground Ambulance Data Collection System? Join this live Q&A session. You may also send your questions in advance to AmbulanceDataCollection@cms.hhs.gov with “December 14 Q&A” in the subject line. We’ll update documents on our Ambulances Services Center webpage with answers to common questions from this session.

More Information:


MLN Matters® Articles


2022 Annual Update of Per-Beneficiary Threshold Amounts

Learn about updates to the annual per-beneficiary incurred expenses amounts, now called KX modifier thresholds, and related policy for Calendar Year (CY) 2022 (PDF). The CY 2022 KX modifier threshold is $2,150 for:

  • Physical therapy and speech-language pathology services combined
  • Occupational therapy services


Low Utilization Payment Adjustment (LUPA) Add-on Amounts for Home Health (HH) Occupational Therapy Visits

Learn about changes to Original Medicare systems that allow LUPA add-on payments if an occupational therapy visit is the first visit in a period of care, including (PDF):

  • How the changes affect occupational therapists (OTs)
  • How CMS computes the OT’s LUPA add-on payment


Information for Medicare Patients


CMS Announces 2022 Medicare Part B Premiums

On November 12, CMS released the 2022 Medicare Parts A and B premiums, deductibles, and coinsurance amounts, and the 2022 Part D income-related monthly adjustment amounts. Most people with Medicare will see a 5.9% cost-of-living adjustment (COLA) in their 2022 Social Security benefits—the largest COLA in 30 years. This significant COLA increase will more than cover the increase in the Medicare Part B monthly premium... Read the full press release.

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