Thursday, June 9, 2022
- CMS National Quality Strategy: A Person-Centered Approach to Improving Quality
- Strategy to Strengthen Behavioral Health Care
- Program for Evaluating Payment Patterns Electronic Reports for Short-Term Acute Care Hospitals
- Interns and Residents Information System (IRIS) XML Format
- LGBTQ+ Community: Help Address Disparities
- Update to 'J' Drug Code List for Billing Home Infusion Therapy (HIT) Services
- July 2022 Update of the Hospital Outpatient Prospective Payment System (OPPS)
CMS National Quality Strategy: A Person-Centered Approach to Improving Quality
Given the urgent need for action within the health care system and the lessons learned during the pandemic, CMS is taking an aggressive step forward as a national voice for quality. On April 12, 2022, we launched the CMS National Quality Strategy, an ambitious long-term initiative that aims to promote the highest quality outcomes and safest care for all individuals.
The CMS National Quality Strategy consists of 8 core goals:
- Embed quality into the care journey
- Advance health equity
- Promote safety
- Foster engagement
- Strengthen resiliency
- Embrace the digital age
- Incentivize innovation and technology adoption to drive care improvements
- Increasing Alignment
Read the blog to learn about the goals and next steps.
Strategy to Strengthen Behavioral Health Care
CMS shared our vision to make equitable, high-quality, affordable, data-informed care for mental health and substance use challenges available to the people served by our programs, as outlined in Health Affairs.
The CMS Behavioral Health Strategy consists of 5 bold and interrelated goals:
- Strengthen equity and quality in behavioral health care
- Improve access to substance use disorders prevention, treatment, and recovery services
- Ensure effective pain treatment and management
- Improve access to and quality of mental health care and services
- Utilize data to inform effective actions and measure impact on behavioral health
The CMS Behavioral Health Strategy seeks to remove barriers to care and services and to adopt a data-informed approach to evaluate our behavioral health programs and policies. The Strategy will strive to support a person’s whole emotional and mental well-being and promotes person-centered behavioral health care.
For additional details on the Strategy, visit the CMS Behavioral Health Strategy webpage.
Program for Evaluating Payment Patterns Electronic Reports for Short-Term Acute Care Hospitals
CMS released first quarter fiscal year 2022 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 use the report
- Visit the Help Desk if you have questions
- Send feedback or suggestions
Interns and Residents Information System (IRIS) XML Format
Teaching providers: You must submit IRIS data for all interns and residents you claim on your cost reports. For cost reports with fiscal year beginning on or after:
- October 1, 2021: Use the IRIS XML format to file your data.
- October 1, 2022: Make sure the total graduate medical education and indirect medical education full time equivalents reported on the IRIS match the total reported on your as-filed cost report. Medicare Administrative Contractors (MACs) will reject the cost report if this information doesn’t match.
See the instruction to your MAC (PDF), which includes a list of software vendors who submitted sample XML IRIS files that meet the new file format requirements. You’re not required to use them.
LGBTQ+ Community: Help Address Disparities
The lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community faces unique health disparities. While members are often stigmatized for their sexual orientation or gender identity and expression, their experiences vary by race, ethnicity, income, and other characteristics. During Pride Month, find out how you can help address these challenges.
- Improving Health Care Quality for LGBTQ People web-based training
- Achieving Health Equity web-based training
- CMS Office of Minority Health webpage
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
- 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
Update to 'J' Drug Code List for Billing Home Infusion Therapy (HIT) Services
Effective July 1, 2022, CMS added J1551 JB (Injection, immune globulin (cutaquig), 100mg) to payment category 2 (PDF). Find the related G codes and modifier.
July 2022 Update of the Hospital Outpatient Prospective Payment System (OPPS)
Learn about updates, including (PDF):
- New COVID-19 CPT vaccines and administration codes
- CPT proprietary laboratory analyses coding changes
- New CPT Category III codes
Medicare Preventive Services — Revised
Learn about updates to preventive services, including:
- Medical nutrition therapy: removed “treating” from physician referral requirement, effective January 1, 2022
- Hepatitis B shot: added CPT code 90759, effective January 11, 2022
- Lung cancer screening with low dose computed tomography: removed “written” from screening order requirements, effective February 10, 2022
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