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Thursday, June 6, 2024


Claims, Pricers, & Codes

MLN Matters® Articles




CMS Roundup (May 31, 2024) 

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

  • Updated Health Equity Fact Sheet Outlining Goals and How Health Equity Actions Align with CMS’ Six Strategic Pillars
  • Fifth Annual Report on Evaluation of Bundled Payments for Care Improvement Advanced Model
  • Request for Applications for Participants in the Accountable Care Organizations Primary Care Flex Model
  • Diabetes Impact Report Summarizing Advances Made in Improving Diabetes Care
  • Request for Applications for the Second Cohort of Individuals for the Enhancing Oncology Model
  • Final Evaluation Report for the Oncology Care Model

Quality Payment Program: 2022 Performance Information on Medicare.gov Compare Tool

CMS added new 2022 Quality Payment Program performance information to clinician and group profile pages on the Medicare.gov compare tool and in the Provider Data Catalog. For more information, visit Care Compare: Doctors and Clinicians Initiative.

Skilled Nursing Facility Value-Based Purchasing Program: June Confidential Feedback Reports

Download your June Quarterly Confidential Feedback Reports for the FY 2025 Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP) from iQIES. The report contains facility and stay-level data for the SNF 30-Day All-Cause Readmission Measure for FY 2023.

Submit corrections until July 3. See Confidential Feedback Reporting & Review and Corrections for more information.


Medicare Providers: Deadlines for Joining an Accountable Care Organization 

To participate in an Accountable Care Organization (ACO) for performance year 2025, work with an ACO to join their participant list. ACOs must submit their lists to CMS by August 1 at:

Participant taxpayer identification numbers can only appear on one ACO participant list. Resolve any overlaps by September 5.

More Information:

Advancing Health Equity During Pride Month

Members of the LGBTQI+ community face unique health care challenges that often vary by race, ethnicity, and income. Certain social determinants of health contribute to poorer health outcomes, mental health disparities, and barriers to accessing care (PDF). During Pride Month, help address the unique health care challenges facing this community.

More Information: 


Claims, Pricers, & Codes

DMEPOS: Clarification of Claim Liability for Overlapping Inpatient Hospital Stays 

CMS clarified that the denial liability for these claims should be assigned to the provider. Payment for DMEPOS provided during an inpatient stay is included in the hospital reimbursement and isn’t separately payable. Medicare Administrative Contractors will adjust claims you bring to their attention.

See the instruction to your Medicare Administrative Contractor (PDF).

Integrated Outpatient Code Editor Version 25.2 

CMS posted the July 2024 Integrated Outpatient Code Editor files. Learn about claims processing changes effective July 1, 2024.

See the instruction to your Medicare Administrative Contractor (PDF).

National Correct Coding Initiative: July Update

Get the National Correct Coding Initiative (NCCI) third quarter edit files, effective July 1, 2024, on these Medicare NCCI webpages:


MLN Matters® Articles

National Coverage Determination 200.3: Monoclonal Antibodies for the Treatment of Alzheimer’s Disease

Learn about coverage for monoclonal antibodies for the treatment of Alzheimer’s disease (PDF) effective April 7, 2022:

  • FDA-approved monoclonal antibodies
  • Criteria for coverage
  • Coding information
  • Claims processing instructions

Medicare Administrative Contractors will adjust claims you bring to their attention.



Medicare Preventive Services — Revised

Learn what’s changed. CMS added ICD-10 code Z11.59 for hepatitis C screening.

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