- Hospital Price Transparency: Download Machine-Readable File Sample Formats & Data Dictionaries
- Medical Review After the COVID-19 Public Health Emergency: New FAQ
- Flu Shots & COVID-19 Vaccines: Each Visit is an Opportunity
- DMEPOS: Corrected 2022 Fee Schedule Amounts
- Hospital Part B Inpatient Services Billing
- Outpatient Prospective Payment System Payment Rate for HCPCS Code Q5124
- Provider Enrollment Instructions: Seventh General Update
- ICD-10 & Other Coding Revisions to National Coverage Determinations (NCDs): April 2023 Update
- Home Health & Hospice: Medicare Provider Resources
- Independent Diagnostic Testing Facility (IDTF) — Revised
Download voluntary sample formats and supporting data dictionaries from Hospital Price Transparency Resources to make your standard charges public in a machine-readable file. The sample formats use a standardized set of data elements. They reflect input from the CY 2022 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System proposed rule solicitation and a technical expert panel of industry experts from various hospitals, technology, and academia.
Effective January 1, 2021, each hospital operating in the U.S. is required to provide publicly-accessible standard charge information online about the items and services they provide in 2 ways:
- Comprehensive machine-readable file with all items and services
- Display of 300 shoppable services in a consumer-friendly format
For more information, see Hospital Price Transparency.
Read the new FAQ about how CMS’s review contractors (Medicare Administrative Contractors, Recovery Audit Contractors, and the Supplemental Medical Review Contractor) will conduct medical reviews after the COVID-19 public health emergency.
Did you know you can give flu shots and COVID-19 vaccines at the same visit? Every patient visit is an opportunity to promote:
- Flu shots: CDC recommends annual shots for everyone 6 months and older
- COVID-19 vaccines: updated vaccines should provide stronger protection against serious illness, getting infected, or spreading COVID-19
New for this flu season: Patients 65 and older should get a preferred vaccine if available. Preferred vaccines are potentially more effective than standard dose flu vaccines. There are 3 recommended vaccines:
- Fluzone High-Dose Quadrivalent vaccine
- Flublok Quadrivalent recombinant flu vaccine
- Fluad Quadrivalent adjuvanted flu vaccine
If 1 of these recommended vaccines isn’t available, give your patients a standard-dose flu vaccine instead.
Medicare Part B covers:
- Flu shot: seasonal flu shot and additional flu shots if medically necessary. Your patients pay nothing if you accept assignment.
- COVID-19 vaccine: no applicable copayment, coinsurance, or deductible.
You can now check eligibility (PDF) for the flu shot and COVID-19 vaccine. If you need help, contact your eligibility service provider.
- CMS Flu Shot webpage
- COVID-19 Vaccine Provider Toolkit
- CDC Influenza (Flu) webpage
- Medicare Part D Vaccines (PDF) fact sheet
- Flu shots and COVID-19 vaccine: Get information for your Medicare patients
CMS identified errors in the 2022 Medicare DMEPOS fee schedule amounts for some items in the non-contiguous areas of Alaska, Hawaii, Puerto Rico, and the Virgin Islands. We released revised fee schedule files on November 10.
Review instructions to bill Medicare Part B for inpatient services to prevent claim denials, including new information on allowed revenue codes. Remember to use a 12x type of bill. Find out about:
- When Medicare pays (PDF) (Section 10)
- Time limit for filing a claim (PDF) (Section 70)
- Services allowed on claims (PDF) (Section 240)
See the updated October 2022 OPPS addenda, which corrected information for HCPCS code Q5124:
- Status indicator: K
- Payment rate: $232.780
- Coinsurance: 20%
CMS will adjust claims with dates of service on or after October 1.
Tuesday, November 29 – Thursday, December 1 from 9 am – 5 pm ET
Attend a virtual public meeting for the second biannual 2022 HCPCS coding cycle. See HCPCS Public Meetings for agendas and more information.
MLN Matters® Articles
- Ownership disclosures
- Electronic funds transfers
- Special payment addresses
Learn about changes for April 2023 (PDF), including
- Newly available codes
- Coding revisions for NCDs 20.4 and 210.10
Medicare covers a wide range of home health and hospice services. November, Home Care & Hospice Month, is a great time to get familiar with these resources:
- Medicare Payment Systems educational tool: home health and hospice
- Hospital-Based Hospice Medicare provider compliance tips
- Creating an Effective Hospice Plan of Care (PDF) fact sheet
- Enhancing RN Supervision of Hospice Aide Services (PDF) fact sheet
- Safeguards for Medicare Patients in Hospice Care (PDF) fact sheet
Learn how indirect IDTFs are exempt from certain certification standards (PDF).
Check out CMS’s new Quality in Focus interactive video series. The series of 10–15 minute videos is tailored to provider types and aims to reduce the deficiencies most commonly cited during the CMS survey process, like infection control and accident prevention. Reducing these common deficiencies increases the quality of care for people with Medicare and Medicaid.
- Understand surveyor evaluation criteria
- Recognize deficiencies
- Incorporate solutions into your facility’s standards of care
See the Quality, Safety, & Education Portal Training Catalog, and select Quality in Focus.
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