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Thursday, January 18, 2024




MLN Matters® Articles




CMS Finalizes Rule to Expand Access to Health Information and Improve the Prior Authorization Process

As part of the Biden-Harris Administration’s ongoing commitment to increasing health data exchange and strengthening access to care, CMS finalized the CMS Interoperability and Prior Authorization (PDF) final rule (CMS-0057-F). The rule sets requirements for Medicare Advantage organizations, Medicaid and the Children’s Health Insurance Program (CHIP) fee-for-service programs, Medicaid managed care plans, CHIP managed care entities, and issuers of Qualified Health Plans offered on the Federally-Facilitated Exchanges, (collectively “impacted payers”), to improve the electronic exchange of health information and prior authorization processes for medical items and services. Together, these policies will improve prior authorization processes and reduce burden on patients, providers, and payers, resulting in approximately $15 billion of estimated savings over ten years.

More Information:

Acute Hospital Care at Home Data Release

A public release of the data submitted to CMS as part of the Acute Hospital Care at Home initiative will be available beginning on January 16, 2024. CMS plans to release data through the Research and Data Assistance Center. This data release consists of data from November 27, 2020, through March 30, 2023.

More Information:

CMS Roundup (Jan 12, 2024)

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

  • Second Annual Evaluation Report on End-Stage Renal Disease Treatment Choice Model
  • Proposals for the 2024 CMS Health Equity Conference, May 29–30
  • Efforts to Address Health Disparities in Rural Communities
  • Final Evaluation Report for Next Generation Accountable Care Organization Model

Medicare Part B Vaccine Administration: CY 2024 Payment Amounts

CMS updated the Part B payment amounts for CY 2024 preventive vaccine administration for:

  • COVID-19
  • Flu
  • Hepatitis B
  • Pneumococcal

The update reflects:

  • Annual increase in the Medicare Economic Index
  • Geographically-adjusted vaccine administration rates for HCPCS codes G0008, G0009, G0010, 90480, and M0201
  • Payment rates for administering Part B preventive vaccines in the patient’s home

More Information:

Glaucoma Awareness Month: Act to Prevent Vision Loss

Half of people with glaucoma don’t know they have it (see CDC). During Glaucoma Awareness Month, talk with your patients about reducing their risk of vision loss. 

Medicare covers glaucoma screening for patients with Part B who meet at least 1 high-risk criteria: 

  • People with diabetes mellitus
  • People with glaucoma in their family history
  • Black or African Americans aged 50 and older
  • Hispanics or Latinos aged 65 and older

Encourage your patients who meet these criteria to get an annual screening.

Find out when your patient is eligible for these screenings. If you need help, contact your eligibility service provider.

More Information:



Immunization Strategies for Long-Term Care: Stories from the Field Webinar — January 31

Wednesday, January 31 from 2–3 pm ET

Register for this webinar.

Target Audience:

  • Quality Innovation Network-Quality Improvement Organizations and nursing home leaders
  • Directors of nursing and infection preventionists interested in collaborating with their staff

Despite the vulnerability of nursing home residents to COVID-19 infection, only 37% of nursing home residents were up to date with their COVID-19 vaccinations as of December 31, 2023. Join this CDC and CMS webinar to hear directly from nursing home teams that have developed successful strategies to:

  • Overcome COVID-19 vaccine hesitancy and fatigue
  • Schedule onsite vaccination clinics
  • Address staff turnover to make sure residents get vaccinated timely

If you have questions, contact dvacsupport@bizzellus.com


Medicare Cost Report E-Filing System Webinar — February 14

Wednesday, February 14 from 1–2:30 pm ET

Register for this webinar.

Target Audience: 

  • Medicare Part A providers 
  • Entities that file cost reports for providers 

Learn about new and upcoming functionality for Medicare Part A cost reports in the Medicare Cost Report E-Filing (MCReF) system: 

  • Download provider and statistical reimbursement summary reports
  • Use optional electronic cost report exhibit templates to get immediate feedback about potential issues, along with faster acceptance and tentative settlement; see new exhibit templates for:
    • Medicare bad debt listing
    • Medicaid eligible days
    • Charity care charges
    • Total bad debt 

You may send questions in advance to OFMDPAOQuestions@cms.hhs.gov with “MCReF Webinar” in the subject line. We’ll answer your questions during the webinar, or use them to develop educational materials.


MLN Matters® Articles

Hospital Outpatient Prospective Payment System: January 2024 Update

Learn about payment system updates for January (PDF):

  • COVID-19 vaccine and administration codes
  • Covered devices for pass-through payments
  • Inpatient-only list 
  • Services:
    • Covered dental rehabilitation procedures
    • Marriage and family therapist
    • Mental health counselor 
  • Drugs, biologicals, and radiopharmaceuticals (If you think Medicare paid you incorrectly because we retroactively corrected payment rates for drugs and biologicals, you may ask your Medicare Administrative Contractor to adjust these claims)
  • Skin substitutes
  • Pricer logic and wage index policies
  • Revenue code reporting for cardiac computed tomography CPT Codes 75572, 75573, and 75574 (We identified and corrected an issue that returned certain claims with these codes; you can resubmit them)
  • Coverage determinations (we’ll adjust claims you submitted before we implemented retroactive changes from the January pricer if you bring them to our attention)

Specimen Collection Fees & Travel Allowance: 2024 Update

Learn about policy updates and reminders (PDF).


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