Thursday, March 10, 2022
- COVID-19 Monoclonal Antibodies: Revised Emergency Use Authorization for EVUSHELD
- Program for Evaluating Payment Patterns Electronic Reports for Short-term Acute Care Hospitals
- Quality Payment Program: 2020 Performance Information on Care Compare
- Skilled Nursing Facilities: Submit Technical Expert Panel Nominations by March 16
- Long-term Care Hospitals: Reissued March 2022 Preview Reports
- Inpatient Rehabilitation Facilities: Reissued March 2022 Preview Reports
- Teaching Hospitals: Direct Graduate Medical Education Resets
- Colorectal Cancer: Screening Saves Lives
- Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 28.1, Effective April 1, 2022
- Internet Only Manual Update, Pub. 100-04, Chapter 11, Sections 20.1.4 and 30.3 Regarding the Cancellation of an Election and Billing for Services
- Gap Billing Between Hospice Transfers — Revised
COVID-19 Monoclonal Antibodies: Revised Emergency Use Authorization for EVUSHELD
On February 24, the FDA revised the emergency use authorization for tixagevimab co-packaged with cilgavimab (EVUSHELD™) to change the initial dose for the authorized use as pre-exposure prophylaxis of COVID-19 in certain adults and pediatric patients. For more information about dosage and administration, including information about dosing for patients who got the original lower dose, review the fact sheet (ZIP).
CMS created new code, Q0221, effective February 24:
- Long Descriptor: Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 600 mg
- Short Descriptor: Tixagev and cilgav, 600mg
Use the existing administration codes — M0220 and M0221.
Visit the COVID-19 Monoclonal Antibodies webpage for more information. Note: you may need to refresh your browser if you recently visited this webpage.
Program for Evaluating Payment Patterns Electronic Reports for Short-term Acute Care Hospitals
CMS released fourth quarter fiscal year 2021 Program for Evaluating Payment Patterns Electronic Reports (PEPPERs) for short-term acute care hospitals. These reports summarize provider-specific data for Medicare services that may be at risk for improper payments. Review PEPPER data with your management team to develop auditing and monitoring action items.
- Visit the PEPPER Resources webpage for the user's guide, recorded training sessions, FAQs, information on a new Severe Malnutrition target area, and examples of how other hospitals are using the report
- Visit the Help Desk if you have questions or need help getting your report
- Send feedback or suggestions
Quality Payment Program: 2020 Performance Information on Care Compare
CMS added new Quality Payment Program performance information to the Doctors & Clinicians section of the Care Compare webpage and in the Provider Data Catalog.
Visit the Care Compare: Doctors and Clinicians Initiative webpage to learn more.
Skilled Nursing Facilities: Submit Technical Expert Panel Nominations by March 16
CMS wants input on the Skilled Nursing Facility Value-Based Purchasing Program scoring methodology for services provided during fiscal year 2024. Visit the Technical Expert Panels webpage to submit a nomination, or learn more.
Long-term Care Hospitals: Reissued March 2022 Preview Reports
On March 7, CMS reissued preview reports related to the Care Compare refresh to correct errors with ventilator liberation rate and clostridium difficile infection outcome measures. Visit the Updates section of the Long-term Care Hospital Quality Reporting Program Public Reporting webpage to learn more.
Inpatient Rehabilitation Facilities: Reissued March 2022 Preview Reports
On March 7, CMS reissued preview reports related to the Care Compare refresh to correct errors with 2 functional measures and the clostridium difficile infection outcome measure. Visit the Updates section of the Inpatient Rehabilitation Facility Quality Reporting Program Public Reporting webpage for more information.
Teaching Hospitals: Direct Graduate Medical Education Resets
Hospitals with very low direct graduate medical education per resident amounts (PRAs) or resident caps may reset them if they train the required number of residents after December 27, 2020, or start a new residency program between December 27, 2020–December 26, 2025.
Find out if your hospital is eligible for a new PRA and resident caps under Section 131 of the Consolidated Appropriations Act, 2021 (PDF).
Colorectal Cancer: Screening Saves Lives
Colorectal cancer affects men and women of all racial and ethnic groups, and risk increases with age. During Colorectal Cancer Awareness Month, encourage screening to help find this cancer early, when treatment is most effective.
Medicare covers colorectal cancer screening, and your patients pay nothing if you accept assignment.
- Medicare Preventive Services educational tool
- CDC Colorectal Cancer webpage
- Preventive & Screening Services webpage: Get information for your patients
Implanted Spinal Neurostimulators: Document Medical Records
In a recent report, the Office of Inspector General found that Medicare improperly paid claims for implanted spinal neurostimulators when providers didn’t provide sufficient documentation supporting medical necessity. For dates of service on or after July 1, 2021, you must ask your Medicare Administrative Contractor to authorize these services before performing the procedure in the hospital outpatient department.
Learn what you need to include in patient medical records:
- Prior Authorization and Pre-Claim Review Initiatives webpage
- Section XVII Calendar Year 2021 Hospital Outpatient Prospective Payment System final rule
- Section 126.96.36.199 Prior Authorization Program for Certain Hospital Outpatient Department Services (PDF) operational guide
- 2021 Final List of Outpatient Department Services That Require Prior Authorization (PDF)
Claims, Pricers, & Codes
Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 28.1, Effective April 1, 2022
Find replacement files for NCCI practitioner PTP edits and the instruction to your Medicare Administrative Contractor (PDF).
MLN Matters® Articles
Internet Only Manual Update, Pub. 100-04, Chapter 11, Sections 20.1.4 and 30.3 Regarding the Cancellation of an Election and Billing for Services
Learn about updated manual language and hospice claims submission clarifications (PDF).
Gap Billing Between Hospice Transfers — Revised
Learn about system edits and Medicare Claims Processing Manual revisions to prevent gap billing (PDF). We clarified the key point on transfers to another location of the same hospice.
Collaborative Patient Care is a Provider Partnership — Revised
Learn coverage criteria and documentation for when you partner with others to care for your patient (PDF):
- If you don’t provide enough information to support medical necessity when you make referrals or write orders, the other provider or supplier may not get paid and therefore delay or deny care to your patient.
- You can give protected health information to other health care providers covered under the privacy rule to carry out treatment, payment, or health care operations. You don’t need the patient’s permission.
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