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Thursday, October 12, 2023





CMS Roundup (Oct 6, 2023)

You may be interested in these topics from the CMS Roundup:

  • CMS Revises Civil Money Penalty Reinvestment Program to Advance Quality Care for Nursing Home Residents
  • CMS Announces 2023 Health Equity Data Access Program Grantees


Protect Your Patients: Give Them a Flu Shot

Make a strong flu shot recommendation at every patient visit. September and October are the best times for most people to get vaccinated. The CDC recommends annual flu shots for everyone 6 months and older.

Consider giving a preferred vaccine to your patients 65 years and older. Preferred vaccines are potentially more effective than standard dose flu vaccines. There are 3 recommended vaccines:

  1. Fluzone High-Dose Quadrivalent vaccine
  2. Flublok Quadrivalent recombinant flu vaccine
  3. Fluad Quadrivalent adjuvanted flu vaccine

If one of these recommended vaccines isn’t available, give your patients a standard-dose flu vaccine instead.

Medicare Part B covers the seasonal flu shot and additional flu shots if medically necessary. Your patients pay nothing if you accept assignment.

Find out when your patients are eligible for the flu shot. We give information for dates of service in the last 18 months:

  • CPT or HCPCS codes
  • Dates of service
  • NPIs who administered the shots

If you need help, contact your eligibility service provider.

More Information:


Direct Data Entry: 10-Digit Screen Expansion

Learn what you need to do to see expanded Fiscal Intermediary Shared System direct data entry screens. The monetary amount fields for claims billing and payment now allow up to 10 digits.


Medicare Preventive Services — Revised

Learn about code updates for these screenings:

  • Hepatitis B
  • Mammography
  • Prostate Cancer

Medicare Provider Compliance Tips — Revised

Learn what’s changed, including:

New Topics

  • Ambulatory Surgical Centers
  • Evaluation & Management
  • Hip & Knee Replacements
  • Pneumatic Compression Devices
  • Respiratory Assist Devices

Updates: Added Information About

  • Ambulance Services: the No Surprises Act
  • Diabetic Supplies: continuous glucose monitors
  • Lower Limb Orthoses: covered codes for ankle-foot orthoses
  • Ostomy Supplies: resource for providing supplies promptly
  • Skilled Nursing Facility Services: history and updates to the case mix prospective payment
  • Transcutaneous Electrical Nerve Stimulators: general requirements for chronic pain
  • Wheelchair Options: Medicare’s policy to cover seat elevation equipment and codes that require prior authorization

Additional Information

  • Documentation requirements and examples:
    • Anticancer Drugs
    • Comprehensive Outpatient Rehabilitation Facility Services
    • Diabetic Shoes
    • Enteral Nutrition
    • Lenses
    • Lower Limb Orthoses
    • Parenteral Nutrition
    • Patient Lifts
    • Spinal Orthoses
    • Surgical Dressings
    • Urological Supplies
    • Wheelchair Options
  • Preventing denials:
    • Enteral Nutrition Pumps
    • ESRD Clinic Services
    • Pressure Reducing Support Surfaces

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