News
Compliance
Claims, Pricers & Codes
- Method II Critical Access Hospitals
- Incarcerated Beneficiaries: Update to National Uniform Billing Committee Condition Code 63
MLN Matters® Articles
Publications & Multimedia
News
FY 2026 SNF VBP Program: Download Your August 2025 Performance Score Reports
Download your August 2025 Performance Score Reports for the FY 2026 Skilled Nursing Facility (SNF) Value-Based Purchasing (VBP) Program from iQIES. The reports include the incentive payment multiplier CMS will apply to your Part A claims. For FY 2026 claims payments, we’ll multiply the adjusted federal per diem rate by your incentive payment multiplier.
Starting in the FY 2026 Program year, we’re expanding the SNF VBP Program to assess performance on multiple quality measures rather than a single measure of all-cause hospital readmissions. Performance is based on 4 quality measures:
- SNF 30-Day all-cause readmission
- SNF health care-associated infections requiring hospitalization
- Total nursing staff turnover
- Total nurse staffing hours per resident day
Submit corrections until August 31. See the Confidential Feedback Reporting & Review and Corrections webpage for more information.
Questions?
- Contact iqies@cms.hhs.gov about report access
- Contact SNFVBPquestions@cms.hhs.gov about the program
Compliance
Skilled Nursing Facilities: Identify & Prevent Improper Part D Payments for Drugs
In a report, the Office of the Inspector General found that Medicare Part D improperly paid for drugs during Part A skilled nursing facility (SNF) stays. Drugs prescribed for a Part D-enrolled patient aren’t covered by Part D if Part A or B can pay for them.
Learn how to avoid improper payments. See the SNF Billing Reference educational tool to find out when to bill your patients prescription drugs to Part A, instead of their Part D drug plan.
Claims, Pricers & Codes
Method II Critical Access Hospitals
Some Method II Critical Access Hospitals may be experiencing denials with Fiscal Intermediary Shared System (FISS) reason codes 31006 and 31007 indicating that providers do not have a reassignment on file in the Provider Enrollment, Chain, and Ownership System (PECOS). Medicare Administrative Contractors will reprocess these claims within approximately two weeks and Method II CAHs do not need to take any action. Additional information to ensure eligible health care providers accurately reassign their benefits to Method II CAHs will be issued shortly.
Incarcerated Beneficiaries: Update to National Uniform Billing Committee Condition Code 63
CMS updated information on condition code 63 effective July 1, 2025. Use this code to indicate services rendered to a prisoner or patient in state or local custody.
More Information:
- Patients in Custody Under a Penal Authority (PDF) fact sheet
- Instruction to your Medicare Administrative Contractor (PDF)
MLN Matters® Articles
Bypassing Common Working File Edits on Inpatient Medicare Part B Ancillary 12X Claims: Effective Date Change
Learn about updates to the effective date (PDF) for claims processed on or after January 5, 2026. Your Medicare Administrative Contractor will have time to reprocess claims you resubmit that they previously rejected in error.
Publications & Multimedia
Medicare Preventive Services — Revised
CMS added information:
- Alcohol misuse screening and counseling:
- Crisis support contact information
- Safety planning for patients at risk for suicide
- Follow-up contacts intervention
- Counseling to prevent tobacco use: ICD-10 code Z72.0 effective October 1, 2024
- Depression screening:
- Crisis support contact information
- Safety planning for patients at risk for suicide
- Follow-up contacts intervention
- Hepatitis C screening: HCPCS code G0567 effective June 27, 2024
- PrEP using antiretroviral therapy to prevent HIV infection: information about lenacapavir
- FAQ: billing the office and outpatient evaluation and management visit complexity add-on HCPCS code G2211 with Medicare Part B preventive services
Combating Medicare Parts C & D Fraud, Waste & Abuse — Revised
CMS updated this web-based training course, including:
- Penalties for violating specific laws
- Real-world fraud, waste, and abuse examples
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