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Thursday, November 10, 2022



Claims, Pricers, & Codes

MLN Matters® Articles

From Our Federal Partners




Teaching Hospitals: Phase 2 Section 131 Reviews — Submission Deadline November 18

Attention teaching hospitals: November 18, 2022, is the submission deadline for phase 2 reviews of non-reopenable cost reports under Section 131 of the Consolidated Appropriations Act, 2021. See the announcement (PDF) for more information.


Medicare Participation for CY 2023

Learn about the advantages of participating in Medicare and changes for CY 2023. Your Medicare Administrative Contractor sent you a postcard with a link to the announcement.


CMS Innovation Center’s Strategy to Support Person-centered, Value-based Specialty Care

In 2021, CMS established a goal to have 100% of Original Medicare beneficiaries and the vast majority of Medicaid beneficiaries in accountable care relationships by 2030 as part of the Center for Medicare and Medicaid Innovation’s (Innovation Center) strategic refresh. This means that beneficiaries should experience longitudinal, accountable care with providers that are responsible for the quality and total cost of their care. Accountable care requires access to and coordination of primary care and specialty care to meet the full range of patient needs. As the Innovation Center enters the second year of its strategic refresh, testing models and tools to improve access to high-quality, value-based specialty care is an area of critical focus.

Read the full blog.


DMEPOS: Appeals & Rebuttals Contractor Clarification

Palmetto GBA will continue processing all provider enrollment appeals and rebuttals for DMEPOS suppliers. Send them to:

National Supplier Clearinghouse

PO Box 100142

Attn: Hearings and Appeals

Columbia, SC 29202-3142

You can also email them to NSC.Appeals@palmettogba.com.

Contact Palmetto GBA at NSC.Appeals@palmettogba.com or 866-238-9652 if you have questions.


Lung Cancer: Help Your Patients Reduce Their Risk

People who smoke cigarettes are 15 to 30 times more likely to get or die from lung cancer than people who don’t smoke (see CDC). Lung Cancer Awareness Month and the Great American Smokeout® is a perfect time to talk with your patients about how they can lower their lung cancer risk.

Medicare covers:

Your patients pay nothing if you accept assignment. Find out when your patient is eligible for these services (PDF). If you need help, contact your eligibility service provider.

More Information:




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


Home Health Prospective Payment System Grouper: January Update

Get the January 2023 release (v04.0.23) (ZIP). See Home Health Prospective Payment System Grouper Software for a summary of changes, including:

  • Thresholds values for functional impairment levels
  • Functional impairment scoring for OASIS elements
  • Clinical group and subgroup assignments for diagnosis codes
  • Comorbidity subgroup lists for low and high comorbidity adjustment

More Information:


HCPCS Application Summaries & Coding Decisions: Drugs & Biologicals

CMS published the Third Quarter 2022 HCPCS Application Summaries & Coding Recommendations for drugs and biologicals. See HCPCS Level II Coding Decisions for more information.


HCPCS Application Summary for Continuous Glucose Monitoring: Updated

CMS updated the summary for continuous glucose monitoring in the revised First Biannual 2022 HCPCS Level II Final Coding, Benefit Category, & Payment Determinations (PDF) for non-drug and non-biological items and services. See HCPCS Level II Coding Decisions for more information.


MLN Matters® Articles


Telehealth Home Health Services: New G-Codes

Learn about 3 new G-codes for home health telecommunications technology claims (PDF) and these reporting requirements:

  • You may voluntarily report these codes starting January 1, 2023
  • You must report these codes starting July 1, 2023


From Our Federal Partners


Increased Respiratory Virus Activity, Especially Among Children

The CDC issued a Health Alert Network Health Advisory about early, elevated respiratory disease incidence caused by multiple viruses occurring, especially among children, and placing strain on health care systems. Co-circulation of respiratory syncytial virus, influenza viruses, SARS-CoV-2, and others could place stress on health care systems this fall and winter. This early increase in disease incidence highlights the importance of optimizing respiratory virus prevention and treatment measures, including prompt vaccination and antiviral treatment:

Considerations for health care providers:

  1. Recommend and offer vaccinations against influenza and COVID-19 for all eligible persons aged 6 months or older
  2. Use diagnostic testing to guide treatment and clinical management
  3. Treat patients with suspected or confirmed influenza who meet clinical criteria with influenza antivirals
  4. Treat outpatients and hospitalized patients with confirmed SARS-CoV-2 infection who are at increased risk for severe illness and meet age and weight eligibility requirements
  5. Get resources for patient education


Ebola Virus Disease Outbreak in Central Uganda: Update

The CDC issued a Health Alert Network Health Update to inform public health departments, public health laboratories, and clinicians in the U.S. about the ongoing outbreak of Ebola virus disease (EVD) in Uganda caused by Sudan virus (species Sudan ebolavirus). No suspect or confirmed EVD cases related to this outbreak have been reported in the U.S. or other countries outside of Uganda to date. However, as a precaution because of increasing cases in Uganda, CDC is raising awareness of this outbreak and the potential for importation of cases.

Read about:

  • Recommendations for clinicians
  • Recommendations and resources for public health departments
  • Clinical and laboratory biosafety considerations

More about Ebola virus disease

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