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Thursday, November 16, 2023




Claims, Pricers, & Codes

MLN Matters® Articles





Unprecedented Efforts to Increase Transparency of Nursing Home Ownership

The Biden-Harris Administration is taking additional action to empower nursing home residents and their families to make informed decisions about care and to hold nursing homes accountable for the service they provide by requiring nursing homes to disclose additional ownership and management information to CMS and states and making this information public.

The final rule will require disclosure of new information to shine a light on private equity ownership.

More Information:


Hospital Price Transparency: Use Required CMS Template Layout to Encode Hospital Standard Charge Information 

CMS finalized new Hospital Price Transparency requirements in the CY 2024 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System final rule. Starting July 1, 2024, hospitals must:

  • Adopt a CMS template layout
  • Encode their standard charge information using our technical specifications and data dictionary

GitHub Repository

We recently launched the Hospital Price Transparency – Data Dictionary GitHub repository where you can:

  • Access templates and technical instructions
  • Get technical support

January 17 Webinar

Register for a webinar on January 17 from 2–3:30 pm ET. We’ll:

  • Review new requirements 
  • Present examples of how to encode standard charge information in the CMS template layout
  • Demonstrate the GitHub repository


Quality Payment Program: Preview Your Performance Information by December 12

Doctors & Clinicians: Now through December 12 at 8 pm ET, preview your 2022 performance information before it appears on the Medicare.gov compare tool and in the Provider Data Catalog. Learn more about the 2022 Preview Period and public reporting at Care Compare: Doctors and Clinicians Initiative.


Medicare Participation for CY 2024

Learn about the advantages of participating in Medicare and changes for CY 2024. Your Medicare Administrative Contractor sent you a postcard with a link to the announcement (PDF)

See Annual Medicare Participation Announcement for more information.


Hospice: New Requirement for Physicians Who Certify Patient Eligibility

Effective May 1, 2024, for Medicare to pay for hospice services, the following physicians must enroll in Medicare or opt out:

  1. Hospice medical director or the physician member of the hospice interdisciplinary group who certifies the patient’s terminal condition
  2. Patient-designated attending physician (if they have one) who certifies their terminal condition

If you’re currently enrolled or opted out, you don’t need to do anything.

This new requirement:

  • Only applies to Fee-for-Service Medicare
  • Doesn’t prohibit the patient’s independent attending physician from treating them while in hospice and billing for these services under Part B
  • Applies to all written or oral certifications under § 418.22(c) 

Hospices can quickly verify a physician’s enrollment or opt-out status using the CMS ordering and referring data file (ORDF), which lists all Medicare-enrolled and opted-out physicians. We’ll modify the ORDF to create a separate column with this status.

More Information:


Medicare Ground Ambulance Data Collection System: CY 2024 Final Policies, Printable Instrument, & FAQs

See the Spotlight on the Ambulances Services Center for information on final policies from the CY 2024 Physician Fee Schedule (PFS) final rule, including:

  • Extending 3 existing add-on payments to the ambulance base and mileage rates under the Ambulance Fee Schedule through December 31, 2024
  • Finalizing changes to the Medicare Ground Ambulance Data Collection System (GADCS):
    • Adding the ability to address partial year responses from ground ambulance organizations
    • Introducing a minor edit to improve the reporting consistency of hospital-based ambulance organizations 
    • Implementing 4 technical corrections to typos to the GADCS Instrument

CMS posted updated GADCS resources with changes from the CY 2024 PFS final rule:


CMS Health Information Handler Helps You Submit Medical Review Documentation Electronically

Learn about the CMS Health Information Handler (CMS HIH), a free service to help you upload and submit your medical documentation electronically to your Medicare Administrative Contractor using the following formats:

  • Portable document format (PDF)
  • Extensible markup language (XML)
  • JavaScript object notation (JSON)

Respond electronically to prior authorization and additional document requests: 

  • Unlimited number of transactions
  • Fast, safe, and secure environment
  • Easily accessible

The benefits of the CMS HIH include:

  • Hosted on CMS Amazon Web Services cloud
  • Adheres to all CMS security and privacy standards
  • Accommodates small or large users

Contact cmshih@cms.hhs.gov to learn more, and get started.


National Rural Health Day: Address Unique Health Care Needs 

Americans living in rural areas, Tribal nations, the territories, and other geographically isolated areas have unique health care needs (see Rural Health). On National Rural Health Day, get the latest news on rural health programs and policy.

More Information:


Lung Cancer: Help Your Patients Reduce Their Risk 

People who smoke cigarettes are 15 to 30 times more likely to get or die from lung cancer than people who don’t smoke (see CDC). During Lung Cancer Awareness Month and the Great American Smokeout®, talk with your patients about how they can lower their lung cancer risk. 

Medicare pays for:

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

More Information:



Skilled Nursing Facility: Appropriate Use of Place-Of-Service Codes

In a report, the Office of the Inspector General found that providers didn’t always comply with federal requirements when reporting the place-of-service code on a claim line. Review the revised Skilled Nursing Facility 3-Day Rule Billing (PDF) fact sheet, and learn how to: 

  • Use the appropriate place-of-service codes for Part A inpatients 
  • Learn more about place-of-service codes frequently associated with extended care services 

For more information, see Medicare Payment Systems: Skilled Nursing Facility Prospective Payment System.



Claims, Pricers, & Codes

Vagus Nerve Stimulators: Transitional Pass-through Status for HCPCS Code C1827 — Updated

For all dates of service starting January 1, 2023, and when used in combination with CPT code 64568, CMS granted transitional pass-through payment status for HCPCS code C1827 (Generator, neurostimulator (implantable), non-rechargeable, with implantable stimulation lead and external paired stimulation controller).

CMS will reopen all claims submitted for C1827 with dates of services starting January 1, 2023, and reprocess them if needed. You don’t need to take any action.

More Information:



MLN Matters® Articles

Home Health Prospective Payment System: CY 2024 Update 

Learn about changes effective January 1, 2024 (PDF):

  • 30-day period payment rates
  • National per-visit amounts
  • Cost-per-unit payment amounts used to calculate outlier payments


Provider Enrollment Changes to the Medicare Program Integrity Manual 

Learn about changes to the manual effective January 1, 2024 (PDF):

  • Medicare enrollment of marriage and family therapists and mental health counselors
  • Other provider enrollment policy updates like denial reasons and revocations


Separate Payment for Disposable Negative Pressure Wound Therapy Devices on Home Health Claims

Learn about changes effective January 1, 2024 (PDF):

  • Separate payment for HCPCS code A9272 on type of bill 032x, instead of 034x
  • Deductible and coinsurance apply


Allowing Audiologists to Provide Certain Diagnostic Tests Without a Physician Order — Revised 

CMS added 2 new CPT codes effective January 1, 2024 (PDF)



Home Health Agency Perspectives on Innovation: Panel Materials

Get materials from the November Expanded Home Health Value-Based Purchasing Model panel:

Panelists review how their agencies are introducing new approaches to care delivery and fostering organizational culture where staff can thrive under value-based care. The discussion highlights strategies related to information systems, internal incentives, and leadership.


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