Thursday, April 7, 2022
- Fiscal Year 2021 Program for Evaluating Payment Patterns Electronic Reports
- Preventive Services & Health Equity: Improve the Health of Minority Populations
- April 2022 Integrated Outpatient Code Editor (I/OCE) Specifications Version 23.1
- Claim Status Category and Claim Status Codes Update
- Mental Health Visits via Telecommunications for Rural Health Clinics & Federally Qualified Health Centers
- Update to Chapter 7, “Home Health Services,” of the Medicare Benefit Policy Manual (Pub 100-02)
- April 2022 Update of the Hospital Outpatient Prospective Payment System (OPPS)
- Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update
- Claims Processing Instructions for the New Pneumococcal 15-valent Conjugate Vaccine Code 90671 and Pneumococcal 20-valent Conjugate Vaccine Code 90677 — Revised
Fiscal Year 2021 Program for Evaluating Payment Patterns Electronic Reports
Fourth quarter fiscal year 2021 Program for Evaluating Payment Patterns Electronic Reports (PEPPERs) are available. Get user guides and recorded training sessions:
- Critical access hospitals
- Inpatient psychiatric facilities
- Inpatient rehabilitation facilities
- Long-term care hospitals
- Skilled nursing facilities
These reports summarize provider-specific data for Medicare services that may be at risk for improper payments. Use the data to support internal auditing and monitoring.
- Find out how to get your report
- Review FAQs
- Learn how other providers use the report
- Visit the Help Desk if you have questions or need help getting your report
- Send feedback or suggestions
Preventive Services & Health Equity: Improve the Health of Minority Populations
Health inequities historically affect underserved and marginalized communities. During National Minority Health Month, learn about preventive services, and find out how to advance health equity.
Medicare covers preventive services, and your patients pay nothing if you accept assignment. Learn how to check eligibility (PDF) for preventive services. If you need help, contact your eligibility service provider.
- Achieving Health Equity web-based training
- CMS Office of Minority Health, Health Observances webpage
- Mapping Medicare Disparities tool
- Preventive & Screening Services webpage: Get information for your patients
What’s the Comprehensive Error Rate Testing Program?
CMS created the Comprehensive Error Rate Testing (CERT) program to measure the rate of improper Fee-for-Service payments. The error rate measures payments that didn’t meet Medicare requirements; it doesn’t indicate fraud.
How does the CERT program work?
The CERT contractor reviews a sample of processed claims. If a claim doesn’t meet Medicare’s coverage, coding, and billing rules or the provider fails to submit medical records, it’s counted as a total or partial improper payment. Medicare Administrative Contractors analyze CERT error rates to reduce improper payments by updating their internal processes and educating providers.
Claims, Pricers, & Codes
April 2022 Integrated Outpatient Code Editor (I/OCE) Specifications Version 23.1
Learn about claims processing changes, effective April 1, 2022 for:
- Hospital outpatient departments
- Community mental health centers
- Non-outpatient prospective payment system (PPS) hospital providers
- Limited services when provided in a home health (HH) agency that isn’t paid under the HH PPS
- Hospice patients for non-terminal illness treatment
See the instruction to your Medicare Administrative Contractor (PDF).
Claim Status Category and Claim Status Codes Update
Learn about claims status category and code updates effective April 1, 2022:
- Get Accredited Standards Committee (ASC) X12 code lists, including added, changed, or deleted codes
- See examples of the ASC X12 276 and ASC X12 277 request and response transactions
- Find your Medicare Administrative Contractor’s (MAC's) website
See the instruction to your MAC (PDF).
MLN Matters® Articles
Mental Health Visits via Telecommunications for Rural Health Clinics & Federally Qualified Health Centers
Learn about regulatory changes and billing (PDF).
Update to Chapter 7, “Home Health Services,” of the Medicare Benefit Policy Manual (Pub 100-02)
Learn how CMS changed Medicare Benefit Policy Manual, Chapter 7 (PDF), including:
- Replaced requests for anticipated payments with one-time notices of admission
- Corrected and clarified who can certify and recertify
April 2022 Update of the Hospital Outpatient Prospective Payment System (OPPS)
Learn about updates effective, April 1, 2022 (PDF), including:
- Integrated Outpatient Code Editor
- HCPCS codes
- New COVID-19 CPT codes
Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update
Learn about the latest RARC and CARC code sets (PDF).
Claims Processing Instructions for the New Pneumococcal 15-valent Conjugate Vaccine Code 90671 and Pneumococcal 20-valent Conjugate Vaccine Code 90677 — Revised
Learn about claim adjustments for HCPCS code 90671 (PDF) with dates of service from July 16, 2021–March 31, 2022.
Advanced Practice Registered Nurses, Anesthesiologist Assistants, & Physician Assistants — Revised
Learn about recent policy changes affecting non-physician practitioners (PDF), including:
- Nurse practitioners (NPs), clinical nurse specialists (CNSs), and physician assistants (PAs) can certify Medicare patient home health benefit eligibility and oversee patient care plans.
- NPs, CNSs, certified nurse-midwives (CNMs), and PAs may provide services on assignment, but they can’t charge a patient more than amounts permitted under 42 CFR 424.55. If a patient pays more than these limits, the practitioner must refund the patient amount over the allowed charge.
- PAs meet statutory physician supervision requirements by collaborating with physicians and forming partnerships according to their state’s scope of practice laws.
- PAs bill the Medicare Program directly for their services and get paid like NPs and CNSs.
- PAs may reassign their services' payment rights and incorporate as a group of only practitioners in their specialty and bill the Medicare Program like NPs and CNSs.
- PAs must bill under their national provider identifier.
- We pay PAs for their professional services, including services and supplies provided incident to their services.
- We pay professional PA services provided in all rural and non-rural settings and areas; we make payment to them only if no facility or other provider bills or we didn’t pay for any other services they provided.
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