Thursday, May 29, 2025
News
- Inpatient Hospital Admissions: Transferring Medical Review Responsibilities for Short Stay Claims
- Medicare Shared Savings Program: Apply Now
MLN Matters® Articles
- National Coverage Determination 20.36: Implantable Pulmonary Artery Pressure Sensors for Heart Failure Management
- Qualifications for Speech-Language Pathologists Providing Outpatient Speech-Language Pathology Services
From Our Federal Partners
News
Inpatient Hospital Admissions: Transferring Medical Review Responsibilities for Short Stay Claims
Starting September 1, 2025, the Medicare Administrative Contractors will assume responsibility for conducting patient status reviews of facilities to determine the appropriateness of Part A payment for short stay inpatient hospital claims. These reviews were previously conducted by the Beneficiary and Family Centered Care Quality Improvement Organization. While this change affects where medical record requests will be sent and the contractor making claim review decisions, the policy for assessing short stay inpatient admissions remains unchanged.
For more information, visit the Inpatient Hospital Reviews webpage.
Medicare Shared Savings Program: Apply Now
CMS is now accepting Shared Savings Program applications through the Accountable Care Organization Management System. Apply no later than noon ET on June 12.
More Information:
- Application Toolkit for the upcoming application submission cycle
- Application Types & Timeline webpage
- Key Application Actions and Deadlines (PDF)
- Email questions to SharedSavingsProgram@cms.hhs.gov
MLN Matters® Articles
National Coverage Determination 20.36: Implantable Pulmonary Artery Pressure Sensors for Heart Failure Management
Learn about coverage of implantable pulmonary artery pressure sensors (PDF) effective January 13, 2025:
- Criteria, including coverage with evidence development criteria
- Claims processing requirements
Your Medicare Administrative Contractor will adjust claims you bring to their attention.
Qualifications for Speech-Language Pathologists Providing Outpatient Speech-Language Pathology Services
Learn about updates (PDF) to the Medicare Benefit Policy Manual, Chapter 15, section 230.3 to match the regulatory provision for the qualifications of speech-language pathologists furnishing outpatient therapy services.
From Our Federal Partners
Providers Accepting CHAMPVA: You Must Enroll in EFT to Get Paid
If you treat patients who are covered by the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), you must sign up for direct deposit (electronic funds transfer (EFT)) to get paid. Getting paid by EFT isn’t optional, it’s a federal requirement.
Enrolling in EFT helps:
- Keep CHAMPVA claim payments secure, efficient, and compliant
- Protect Veterans’ family members’ access to benefits
2 steps to enroll in EFT:
- Visit the VA Financial Services Center Customer Engagement Portal
- Complete the Payment Account Setup webform; call Financial Services Center customer support at 877-353-9791 for help
About CHAMPVA
CHAMPVA is a health care program for qualified spouses, widows(ers), and children of eligible Veterans. Through CHAMPVA, VA shares the cost of certain health care services and supplies with eligible beneficiaries.
For more information, visit the CHAMPVA–Information for Providers webpage.
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