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Thursday, October 26, 2023


Claims, Pricers, & Codes


MLN Matters® Articles


Information for Patients



Help CMS Improve Provider Resources — Respond by November 9 

CMS is conducting a study to help us improve your experience with Medicare program and billing resources. Share your thoughts with us by taking this survey by November 9. Responses are confidential, and the survey should take about 10 minutes to complete. Thank you for your time and valuable feedback.

CMS Roundup (Oct 20, 2023)

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

  • Update on the Executive Order to Lower Prescription Drug Costs
  • Information on Three National Coverage Determinations
  • Tools and Resources as Annual Medicare Open Enrollment Period Begins
  • Million Hearts Cardiovascular Disease Risk Reduction Model Final Evaluation

Nursing Facility Evaluation and Management Visits: Comparative Billing Report in October 

This month, CMS will issue a Comparative Billing Report (CBR) on Medicare Part B claims for nursing facility evaluation and management visits. Use the data-driven report to compare your billing practices with those of peers in your state and across the nation.

Look for an email from cbrpepper.noreply@religroupinc.com to access your report.

More Information:

  • View a webinar recording
  • Visit the CBR website, and register for a live webinar on November 8 from 3-4 pm ET


Claims, Pricers, & Codes

Conditional Payment Claims: Continue to Submit to Your Medicare Administrative Contractor 

Continue to submit conditional payment claims to your A/B or DME Medicare Administrative Contractor (MAC). This includes situations when there’s no Medicare Secondary Payer (MSP) record for a patient.

Don’t contact the Benefits Coordination & Recovery Center to create or update MSP records. You may provide MSP information on claims you submit to your A/B or DME MAC, and they’ll create or update these records.

See Section 40.6 of the Medicare Secondary Payer Manual, Chapter 5 for more information.

Home Health Consolidated Billing Enforcement: CY 2024 HCPCS Code 

Effective January 1, 2024, CMS will add the following HCPCS code to the home health consolidated billing non-routine supply code list: A9272 - wound suction, disposable, includes dressing, all accessories and components, any type, each.

See the instruction to your Medicare Administrative Contractor.

HCPCS Application Summaries & Coding Decisions: Drugs & Biologicals 

CMS published the 2023 HCPCS Application Summary for Quarter 3, 2023 Drugs and Biologicals. See HCPCS Level II Coding Decisions for more information.


Inpatient Rehabilitation Facility Prospective Payment System: Coverage Requirements Webinar — November 29 

Wednesday, November 29 from 1:30–2:30 pm ET

Register for this webinar.

During this webinar, CMS will:

  • Review Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) coverage requirements from pre-admission to discharge
  • Provide a refresher on existing payment requirements and answer common IRF PPS Helpdesk questions

After the webinar, we’ll post a recording on the IRF PPS webpage.


MLN Matters® Articles

Medicare Deductible, Coinsurance, & Premium Rates: CY 2024 Update

Learn about CY 2024 updates for Medicare Part A and Part B.

Processing Claims Affected by Retroactive 

Learn about affected home health agency and inpatient rehabilitation facility claims:

  • When certain claims are payable beyond the timely filing limit
  • How to handle claims when you can’t submit a patient assessment


Medicare Secondary Payer: Don’t Deny Services & Bill Correctly — Revised

Learn what’s changed, including:

  • Ongoing responsibility for medicals indicator
  • Billing in liability insurance situations


Information for Patients

2024 Medicare & You Handbook 

Share the 2024 Medicare & You Handbook with your patients and their caregivers. Encourage them to switch to electronic versions of the Handbook and Medicare Summary Notices.

New and important this year:

  • Saving money on prescription drugs
  • Lower costs for insulin and vaccines
  • Changes to telehealth coverage
  • Managing and treating chronic pain
  • Better mental health care
  • More times to sign up for Medicare
  • COVID-19 care

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