Thursday, February 3, 2022
- COVID-19: Letter to Health Care Facility Administrators on Health Care Worker Vaccination Rule
- COVID-19 Vaccine & Monoclonal Antibody Products: Changes for Medicare Advantage Plan Claims Started January 1 — Reminder
- Expedited Review Process for Hospital Inpatients in Original Medicare
- Internet-Only Manual Updates for Critical Care Evaluation and Management Services
- Quarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment
- National Coverage Determination (NCD) 270.3 Blood-Derived Products for Chronic, Non-Healing Wounds — Revised
COVID-19: Letter to Health Care Facility Administrators on Health Care Worker Vaccination Rule
Read the Health Care Worker Vaccination Rule letter that CMS issued to health care facility administrators (PDF).
COVID-19 Vaccine & Monoclonal Antibody Products: Changes for Medicare Advantage Plan Claims Started January 1 — Reminder
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
Home Health Low Utilization Payment Adjustment Threshold: Bill Correctly
In a recent report, the Office of Inspector General found that Medicare improperly paid some claims for home health services with 5–7 visits in a payment episode. Review the Medicare Home Health Benefit (PDF) and Home Health Prospective Payment System (PPS) booklets to properly bill for services slightly above the low utilization payment adjustment threshold.
Visit the Home Health PPS webpage to stay informed about the latest policy and payment updates:
- Calendar Year 2021 Home Health PPS final rule
- Section 10.6 Medicare Benefit Policy Manual, Chapter 7 (PDF)
- Section 10.1.17 Medicare Claims Processing Manual, Chapter 10 (PDF)
- Section 6.2 Medicare Program Integrity Manual, Chapter 6 (PDF)
Claims, Pricers, & Codes
SNF Consolidated Billing Codes for CY 2022
CMS updated HCPCS codes and Medicare Physician Fee Schedule designations to accurately pay for Part A Skilled Nursing Facility (SNF) stays that begin during calendar year (CY) 2022. View the updates:
- Part A: see General Explanation of the Major Categories (PDF), including additional exclusions not driven by HCPCS codes
- Part B
For more information, see sections 20.6 and 110.4.1 of the Medicare Claims Processing Manual (104), Chapter 6 (PDF) and the official instruction to your Medicare Administrative Contractor (PDF).
Provider Compliance Virtual Focus Group — February 24
Thursday, February 24 from 1–4 pm ET
Register by Friday, February 18.
How can CMS improve its processes and eliminate unnecessary requirements for medical review and prior authorization? Join us on February 24, and let us know.
Target audience: physicians, non-physician practitioners, billing specialists, suppliers, associations, coders, medical review contractors
MLN Matters® Articles
Expedited Review Process for Hospital Inpatients in Original Medicare
Learn about updates (PDF) to section 200 of the Medicare Claims Processing Manual, Chapter 30, including:
- Hospital responsibilities
- Detailed Notice of Discharge
Internet-Only Manual Updates for Critical Care Evaluation and Management Services
Learn about critical care services provided during the global surgery period (PDF) and updates to section 40 of the Medicare Claims Processing Manual, Chapter 12, including:
- Using modifier FT
- Billing requirements, claims review, and adjudication
Quarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment
Learn about instructions and new codes, effective April 1, 2022 (PDF), and the reporting delay for private payor data.
National Coverage Determination (NCD) 270.3 Blood-Derived Products for Chronic, Non-Healing Wounds — Revised
Learn about HCPCS codes G0465 and G0460 for autologous platelet rich plasma (PDF).
Medicare Preventive Services — Revised
Learn about updates to preventive services, including:
- Mammography screening: added ICD-10 code C84.7A, effective October 1, 2021
- Medicare Diabetes Prevention Program: added information about the first ongoing maintenance session interval requirement and waived supplier enrollment application fee
- Pap tests screening: added ICD-10 codes Z92.850, Z92.858, and Z92.86, effective October 1, 2021
- Pneumococcal shot: added CPT code 90671, effective July 16, 2021, and CPT code 90677, effective July 1, 2021
- Screening pelvic exams: added ICD-10 codes Z92.850, Z92.858, and Z92.86, effective October 1, 2021
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