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Thursday, October 5, 2023


Claims, Pricers, & Codes





Administration Moves Forward with Medicare Drug Price Negotiations to Lower Prescription Drug Costs for People with Medicare

All 10 drug companies whose drugs were selected for price negotiation with Medicare for the first cycle of the program have decided to participate in those negotiations. These companies manufacture some of the costliest and most commonly used prescription drugs.

More Information:                                                                                


CMS Requests Public Input on Coverage of Over-the-Counter Preventive Services, Including Contraception, Tobacco Cessation, and Breastfeeding Supplies

The Departments of HHS, Labor, and the Treasury are seeking public input on how best to ensure coverage and access to over-the-counter (OTC) preventive services, including the benefits of requiring most health insurance plans to cover these services at no cost and without a prescription by a health care provider. This new Request for Information solicits comment on access to a range of OTC items recommended by experts for preventive care that can be purchased without a prescription, including contraceptives, tobacco smoking cessation products, folic acid during pregnancy, and breastfeeding supplies.

See the full press release.


Action Plan for Sickle Cell Disease Month

As we reflect on Sickle Cell Awareness Month, CMS reaffirms our commitment to improving access to and the quality and experience of care for individuals living with Sickle Cell Disease (SCD). Most individuals with SCD who have health coverage receive coverage through Medicaid, the Children’s Health Insurance Program, and/or Medicare. CMS recognizes the challenges that people living with SCD face and has released a Sickle Cell Disease Action Plan that outlines our efforts to eliminate barriers, reduce health disparities, and improve health outcomes for individuals with SCD.  

The Action Plan focuses on four key areas:

  1. Expanding coverage and access
  2. Improving quality and the continuum of care
  3. Advancing equity and engagement
  4. Examining data and analytics

More Information:


CMS Burden Reduction News & Insights Fall Newsletter

You may be interested in the Fall Burden Reduction Newsletter, which includes:

  • CMS HL7® FHIR® CONNECTATHON Slides and Recordings
  • Guidance on NPI Enumeration

New COVID-19 Treatments Add-On Payment Ended September 30

Through the New COVID-19 Treatments Add-On Payment (NCTAP), Medicare provided an enhanced payment for eligible inpatient cases that use certain new products with current FDA approval or emergency use authorization to treat COVID-19. The NCTAP was effective November 2, 2020 – September 30, 2023.


Clinical Laboratory Fee Schedule: Submit Your Comments 

Get the latest payment information on the Clinical Laboratory Fee Schedule (CLFS), and find out how and when you can comment:

Starting January 1, 2024, laboratories must report private payor data to CMS. Visit Clinical Laboratory Fee Schedule for more information, and find out if you’re a laboratory that must report. If so, learn when and how to report.

DMEPOS: New Provider Enrollment Appeals & Rebuttals Contractor Starts October 9

Starting Monday, October 9, 2023, send all DMEPOS provider enrollment appeals and rebuttals to Chags Health Information Technology LLC:

  • Fax: 866-4107404
  • Phone: 800-2459206
  • Email: PEARC@chit.com
  • Mailing Address: P.O. BOX 45266, Jacksonville, FL 32232

Friday, October 6 is the last day the National Supplier Clearinghouse will accept them. They’ll review and decide on appeals submitted before the transition date.

Contact ProviderEnrollmentARC@cms.hhs.gov if you have any questions about the transition.


Help Detect Breast Cancer Early 

Almost 99% of women diagnosed with breast cancer at the earliest stage live for 5 years or more (see data snapshot). During National Breast Cancer Awareness Month, talk with your patients about the best screening options to help detect breast cancer early.

Medicare pays for:

Your patients pay nothing if you accept assignment. Find out when your patient is eligible for their next screening. If you need help, contact your eligibility service provider.

More Information:


Claims, Pricers, & Codes

RARCs, CARCs, Medicare Remit Easy Print, & PC Print: October Update 

Get updated remittance advice remark codes (RARCs) and claim adjustment reason codes (CARCs), and watch for software updates if you use Medicare Remit Easy Print or PC Print.

More Information:


Medicare Provider Compliance Newsletter

Learn how to address and avoid common billing errors:

  • Hospital outpatient services
  • Hypoglossal nerve stimulation for obstructive sleep apnea: medical necessity and documentation requirements


Post-Acute Care Quality Reporting Programs: Brief Interview for Mental Status Video

CMS developed a brief interview for mental status video (03:23) to help you determine:

  • When to stop the interview
  • How to code the remaining items

Contact the PAC Training Mailbox with questions or feedback.

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