Thursday, January 6, 2021
- COVID-19 Vaccine Access in Long-term Care Settings
- SNF VBP: Nominate Technical Expert Panel Members by January 16
- COVID-19 Vaccine & Monoclonal Antibody Products: Changes for MA Plan Claims Started January 1
- January 2022 Update of the Ambulatory Surgical Center (ASC) Payment System
- Transvenous (Catheter) Pulmonary Embolectomy National Coverage Determination (NCD) Section 240.6
- Changes to the Laboratory National Coverage Determination (NCD) Edit Software for April 2022
- Implementation of the Capital Related Assets Adjustment (CRA) for the Transitional Add-on Payment Adjustment for New and Innovative Equipment and Supplies (TPNIES) Under the End Stage Renal Disease Prospective Payment System (ESRD PPS) — Revised
- Original Medicare vs. Medicare Advantage
- Medicare Learning Network® (MLN) Provider Compliance Products — Revised
- Opioid Treatment Programs (OTPs) Medicare Enrollment — Revised
The federal government is committed to ensuring that residents and staff in long-term care settings, like nursing homes, assisted living, residential care communities, group homes, and senior housing, have access to COVID-19 vaccines to get primary series and booster shots.
We encourage long-term care providers to consider the option that works best for their residents and staff when coordinating access to COVID-19 vaccines, either in the local community or on-site. The CDC has additional details on these options. Find Medicare billing and payment information.
As a reminder, through enforcement discretion, CMS will allow Medicare-enrolled immunizers, including but not limited to pharmacies working with the United States, to bill directly and get direct reimbursement from the Medicare program for vaccinating Medicare skilled nursing facility residents.
CMS is creating a technical expert panel to help develop quality and cost measures for the Skilled Nursing Facility (SNF) Value-Based Purchasing (VBP) program. Nominate people to serve on the panel by January 16. Visit the Technical Expert Panels: Currently Accepting Nominations webpage for more information.
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.
- Medicare Billing for COVID-19 Vaccine Shot Administration webpage
- Monoclonal Antibody COVID-19 Infusion webpage
CMS added the health maintenance organization paid claim and cost outlier threshold fields to the Inpatient Prospective Payment System (IPPS) Web Pricer. CMS will no longer release the IPPS PC Pricer applications.
For the best experience, access the Web Pricer through Google Chrome. You may also use Microsoft Edge or Mozilla Firefox, but not Microsoft Internet Explorer. Email your feedback on the IPPS Web Pricer to WebPricers@cms.hhs.gov using the subject line “IPPS Web Pricer.”
Tuesday, January 18 from 2 – 3 pm ET
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 “January 18 Q&A” in the subject line. We’ll update documents on our Ambulances Services Center webpage with answers to common questions from this session.
- Ambulances Services Center webpage: includes lists of organizations that must collect data starting in 2022
- CY 2022 Physician Fee Schedule (PFS) final rule
- CY 2020 PFS final rule
- Bipartisan Budget Act of 2018
- Payment offsets for HCPCS codes C1832 and C1833
- Changes to the ASC Covered Procedure List Policy for CY 2022
CMS removed the NCD for TPEs (PDF). Your Medicare Administrative Contractor will make TPE coverage determinations.
Learn about changes in the edit module’s quarterly release (PDF) and how to view them in the NCD spreadsheet.
Implementation of the Capital Related Assets Adjustment (CRA) for the Transitional Add-on Payment Adjustment for New and Innovative Equipment and Supplies (TPNIES) Under the End Stage Renal Disease Prospective Payment System (ESRD PPS) — Revised
- Treating patients
- Processing claims
- Filing appeals
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