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Thursday, December 1, 2022



MLN Matters® Articles


From Our Federal Partners

Information for Patients




CMS Urges Timely Patient Access to COVID-19 Vaccines, Therapeutics

On November 22, CMS issued new guidance that highlights the need for health care providers and suppliers to ensure patients have access to the latest available COVID-19 vaccines and therapeutics. In particular, CMS is reminding nursing homes that they are required to offer the COVID-19 vaccines, including any updated COVID vaccines, to residents.

See the full news alert.


Quality Payment Program: Preview Your Performance Information by December 20

Doctors & Clinicians: Now through December 20 at 8 pm ET, preview your 2021 performance information before it appears on Medicare Care Compare and in the Provider Data Catalog.

Learn more about the 2021 Preview Period and public reporting at Care Compare: Doctors and Clinicians Initiative.


Clinical Laboratory Fee Schedule: CY 2023 Final Payment Determinations

View the CY 2023 Clinical Laboratory Fee Schedule final payment determinations. Ask CMS to reconsider payment amounts or basis of payment by January 28. We’ll review reconsiderations at the 2023 Annual Public Laboratory meeting.


HIV: Screening is Knowledge

According to the CDC, nearly 1.2 million people in the U.S. had HIV in 2019, and about 13% didn’t know they had it (see CDC). Screening is the only way to know for sure if a patient has HIV. Knowing HIV status gives patients powerful information to help them take steps toward better health. World AIDS Day is the perfect time to talk with your patients about HIV prevention and screening.

Medicare covers HIV screening, and your patients pay nothing if you accept assignment. Find out when your patient is eligible for this screening. If you need help, contact your eligibility service provider.

More Information:



LAAC & ICD National Coverage Determinations: Submit Proper Documentation

Shared decision-making (SDM) is an important part of person-centered health care. You work with your patient to make decisions that meet their needs based on:

  • Evidence-based information about available options
  • Your knowledge and experience
  • Patient's values and preferences

When you provide SDM for percutaneous left atrial appendage closure (LAAC) and implantable cardioverter defibrillators (ICDs):

  • Document the SDM encounters correctly in medical records before you implant.
  • Get preoperative documents from all providers before submitting medical records. While not mandatory, it speeds processing of your claims.

The Comprehensive Error Rate Testing (CERT) contractor reviews your claim documentation to determine if it meets SDM requirements. If it doesn’t, CMS will:

  • Issue an error for overpaid claims for these procedure codes
  • Recoup the overpayment


MLN Matters® Articles

National Fee Schedule for Medicare Part B Vaccine Administration

Learn about payment for CY 2023:

  • Updated amount and codes for vaccine administration
  • COVID-19 vaccine administration codes


New Waived Tests

Learn about billing for Clinical Laboratory Improvement Amendments waived laboratory tests:

  • Requirements
  • New tests approved by the FDA
  • Using modifier QW


New & Expanded Flexibilities for Rural Health Clinics & Federally Qualified Health Centers during the COVID-19 PHE — Revised

Learn about the 2023 payment rate for distant site telehealth services.


Home Health Claims: New Grouper Edits — Revised

CMS won’t return claims with this message, “Primary diagnosis identified as a code first code with condition present.”



Checking Medicare Eligibility — Revised

Learn about what's changed:

  • New Medicare Part B immunosuppressive drug benefit
  • Preventive services eligibility data


From Our Federal Partners

Biosimilars: Are They the Same Quality?

Use this infographic from the FDA to talk with your patients about biologics and biosimilars.


Information for Patients

Options When ESRD Coverage with Medicare Ends

Patients with Medicare because of ESRD currently lose coverage 36 months after a kidney transplant unless otherwise eligible for Medicare. When their coverage is about to end, CMS will mail them a letter to explain other coverage options, including:

  • Employer coverage
  • Health Insurance Marketplace®
  • Medicaid and the Children’s Health Insurance Program
  • Continuing Medicare coverage

If your patient doesn’t have or expect to get other health insurance, they may qualify for the new Part B immunosuppressive drug benefit. It only covers immunosuppressive drugs and no other items or services.

When your patient gets this letter, they need to:

  • Think about how they want to get their health coverage
  • Act to make sure they have health coverage when their Medicare coverage ends

Get information on ESRD for your patients.

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