Thursday, May 19, 2022
- Biosimilars: Safe, Effective, & May Reduce Patient Costs
- PECOS Scroll Functionality
- Clinical Laboratory Improvement Amendments: Unpaid Certificate Fees
- Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB)
- Mental Health: Help Address Disparities
- Elimination of Certificates of Medical Necessity & Durable Medical Equipment Information Forms
- International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs)–October 2022 Update
- Revisions to Medicare Part B Coverage of Pneumococcal Vaccinations for the Medicare Benefit Policy Manual Chapter 15, Section 22.214.171.124
- Chronic Care Management Services — Revised
- Home Health Quality Reporting Program: Draft OASIS-E Guidance Manual
Biosimilars: Safe, Effective, & May Reduce Patient Costs
Biosimilars are safe and effective for treating many illnesses, including chronic skin diseases, inflammatory bowel diseases, arthritis, kidney conditions, diabetes, and cancer. Get an FDA Overview of Biosimilar Products. Bookmark FDA’s Biosimilars webpage and materials for health care providers and patients.
Additional FDA resources you may find helpful:
PECOS Scroll Functionality
Starting July 5, PECOS will validate that you’ve read and acknowledged certification terms and conditions before you electronically submit your Medicare enrollment application. You must review and scroll through each text box with certification requirements before you can click accept on the following pages:
- Remote E-sign
Clinical Laboratory Improvement Amendments: Unpaid Certificate Fees
If your laboratory gets a pink slip with a bill for a Clinical Laboratory Improvement Amendments (CLIA) fee, pay it within 2 weeks of the notice date. If you don’t pay it within this time, your CLIA certificate will terminate and you can’t test or get paid for testing. The fastest way to credit your account is to pay at pay.gov.
Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB)
See attachment I of the instruction to your Medicare Administrative Contractor to learn about changes to the MPFSDB:
- New HCPCS and CPT codes
- New G codes for the 180-day monitoring period for continuous glucose monitoring
- Codes that are no longer valid
These changes are effective for dates of service on and after January 1, 2022.
Mental Health: Help Address Disparities
Depression affects about 16 million American adults every year. Frequency varies by age, sex, race, ethnicity, and geographic area. During Mental Health Month, learn about preventive services, including depression screening and alcohol misuse screening & counseling, 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.
- Medicare Mental Health booklet
- Achieving Health Equity web-based training
- Roadmap to Behavioral Health (PDF)
- CMS Behavioral Health Strategy webpage
- Preventive & Screening Services webpage: Get information for your patients
Collaborative Patient Care is a Provider Partnership
Learn about coverage criteria and documentation when you partner with others to care for your patient (PDF):
- If you don’t provide enough information to support medical necessity when you refer or write orders, the other provider or supplier may not get paid, which can cause delays or no treatment for your patient
- You must provide documentation and information to other health care providers to support their claims for services or items
- You can give protected health information, without patient authorization, to other health care providers covered under the privacy rule to carry out treatment, payment, or health care operations
MLN Matters® Articles
Elimination of Certificates of Medical Necessity & Durable Medical Equipment Information Forms
Effective January 1, 2023, CMS is discontinuing certificates of medical necessity (CMNs) and durable medical equipment (DME) information forms (DIFs) (PDF):
- For services on or after January 1, 2023: Don’t submit CMN or DIF forms or their electronic claim data elements with the claims, or we’ll reject your claims and return them to you
- For services before January 1, 2023: Submit CMN and DIF forms or their electronic claim data elements with the claims, if required
International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs)–October 2022 Update
Learn about changes effective October 1, 2022 (PDF):
- New codes
- National coverage decision coding revisions
- Coding feedback
There aren't any policy changes in this update.
Revisions to Medicare Part B Coverage of Pneumococcal Vaccinations for the Medicare Benefit Policy Manual Chapter 15, Section 126.96.36.199
Learn about updated Medicare coverage for pneumococcal vaccinations (PDF) to align with the Advisory Committee on Immunization Practices recommendations, which vary based on patient age and risk factors. Check eligibility (PDF) to see if your patients got their pneumococcal shot. If you need help, contact your eligibility service provider.
Chronic Care Management Services — Revised
Learn about billing and coding changes (PDF):
- In 2021, CMS added 5 codes to report principal care management services provided by staff under physician supervision
- Starting in 2022, Rural Health Clinics and Federally Qualified Health Centers can bill chronic care management and transitional care management services for the same patient during the same time
- Starting in 2022, 99439 replaced G2058
Home Health Quality Reporting Program: Draft OASIS-E Guidance Manual
CMS posted a draft guidance manual (PDF) for version E of the Outcome and Assessment Information Set (OASIS) data set, effective January 1, 2023.
- OASIS User Manuals webpage
- OASIS Data Sets webpage, including a log of changes
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