Thursday, May 4, 2023
- FAQs on CMS Waivers, Flexibilities, and the End of the COVID-19 Public Health Emergency
- Guidance for the Expiration of the COVID-19 Public Health Emergency
- COVID-19 Over-the-Counter Tests
- Medicare Diabetes Prevention Program: Public Health Emergency Flexibilities Continue through December 31
- Transplant Eco-System: Role of Data in CMS Oversight of The Organ Procurement Organizations
- Expanded Home Health Value-Based Purchasing Model: April Newsletter & Performance Reports
- Religious Nonmedical Health Care Institution Benefit & COVID-19 Vaccines
- Clinical Laboratory Fee Schedule 2024 Preliminary Gapfill Rates: Submit Comments by June 26
- Mental Health: Recommend Medicare Preventive Services
- COVID-19: Reporting CR Modifier & DR Condition Code After Public Health Emergency Update
- Claim Status Category & Claim Status Codes
- Medicare Shared Savings Program: Navigating the Application Webinar — May 8
- HCPCS Public Meeting — May 30 – June 1
News
FAQs on CMS Waivers, Flexibilities, and the End of the COVID-19 Public Health Emergency
HHS is planning for the federal public health emergency for COVID-19 to expire at the end of the day on May 11, 2023. CMS issued FAQs for all CMS programs, including Medicare, Medicaid, the Children’s Health Insurance Program, and private insurance to help you prepare.
More Information:
- What Do I Need to Know? CMS Waivers, Flexibilities, and the Transition Forward from the COVID-19 Public Health Emergency fact sheet
- CMS Current Emergencies webpage
Guidance for the Expiration of the COVID-19 Public Health Emergency
The public health emergency (PHE) is expected to end on May 11, 2023. Read the Quality, Safety, & Oversight Memorandum to learn about:
- Expiration of emergency waivers related to minimum health and safety requirements for long-term care and acute and continuing care providers
- Timelines for certain regulatory requirements issued during the PHE
COVID-19 Over-the-Counter Tests
Learn about Medicare coverage of over-the-counter (OTC) COVID-19 tests during and after the public health emergency (PHE), which is expected to end on May 11, 2023.
Before May 11, patients can get up to 8 free OTC COVID-19 tests per month with no out-of-pocket costs.
After May 11:
- Patients will still have access to laboratory-conducted COVID-19 tests (like PCR tests). Eligible patients will continue to get these lab-conducted tests at no cost, and their annual deductible, coinsurance, and copayment won’t apply.
- OTC tests will still be available, but there may be out-of-pocket costs. Coverage of OTC tests may vary based on your patient’s insurance type.
More Information:
- Over-the-Counter COVID-19 Test Demonstration
- Coverage for Covid-19 Tests: Get information for your Medicare patients
Medicare Diabetes Prevention Program: Public Health Emergency Flexibilities Continue through December 31
CMS expects the COVID-19 public health emergency to end on May 11, 2023. But, Medicare Diabetes Prevention Program (MDPP) suppliers may continue to offer MDPP services virtually through December 31, 2023, as long as they maintain an in-person CDC organization code. This includes the ability to:
- Collect weight measurements for Medicare patients either through virtual technology, self-reported weight measurements, or both
- Provide all services virtually with no limit to virtual sessions provided
More Information:
- Federal Register notice
- Participants in the MDPP: CMS Flexibilities to Fight COVID-19 fact sheet
- Submit questions through the MDPP Supplier Support Portal
Transplant Eco-System: Role of Data in CMS Oversight of The Organ Procurement Organizations
CMS and the Health Resources & Services Administration remain committed to increasing organ procurement organization (OPO) performance. CMS has taken another step toward improving the organ transplantation system by providing the most recent data on OPO performance to drive improvement for all 56 OPOs to meet the growing need for lifesaving organs.
See the full blog.
Expanded Home Health Value-Based Purchasing Model: April Newsletter & Performance Reports
Read the April Home Health Value-Based Purchasing (HHVBP) Newsletter for the latest information, tools, and insights about the Expanded HHVBP Model.
Download your April 2023 Pre-Implementation Performance Report from iQIES. See instructions for accessing reports.
Religious Nonmedical Health Care Institution Benefit & COVID-19 Vaccines
Section 4138 of the Consolidated Appropriations Act, 2023 includes COVID-19 vaccine services in the definition of excepted services under the Religious Nonmedical Health Care Institution (RNHCI) benefit. CMS will treat claims containing only COVID-19 vaccine services as excepted services if the claim overlaps an RNHCI election period. This change is effective for claims processed on or after October 1, 2023.
More Information:
- Section 180 Medicare Claims Processing Manual, Chapter 3
- Instruction to your Medicare Administrative Contractor
Clinical Laboratory Fee Schedule 2024 Preliminary Gapfill Rates: Submit Comments by June 26
CMS published 2024 preliminary gapfill rates for the Clinical Laboratory Fee Schedule. Send your comments on these rate recommendations to clfs_inquiries@cms.hhs.gov by June 26, 2023.
Visit Annual Public Meetings for more information.
Mental Health: Recommend Medicare Preventive Services
20% of Americans experience mental illness each year (see CDC), and it disproportionately affects racial and ethnic minority groups (see CDC). During National Mental Health Month, recommend appropriate preventive services, including:
- Depression Screening
- Annual Wellness Visit
- Initial Preventive Physical Exam
- Alcohol Misuse Screening & Counseling
Medicare covers preventive services, and 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:
- Medicare Mental Health booklet
- Behavioral Health Integration Services booklet
- Depression data snapshot: Learn about disparities in Medicare patients
- Coverage to Care Roadmap to Behavioral Health
- Preventive & Screening Services webpage: Get information for your patients
Claims, Pricers, & Codes
COVID-19: Reporting CR Modifier & DR Condition Code After Public Health Emergency Update
The end of the COVID-19 public health emergency (PHE) is expected to occur on May 11, 2023. Since the CR modifier and DR condition code should only be reported during a PHE when a formal waiver is in place, plan to discontinue using them for claims with dates of service on or after May 12, 2023.
There are 2 exceptions:
DMEPOS Suppliers
Continue to use the CR modifier and COVID-19 narrative on claims for supplies and accessories associated with certain DMEPOS items provided during the PHE.
Skilled Nursing Facility & Swing Bed Providers
For benefit period and qualifying stay waivers, submit condition code DR for inpatient claims with admission dates before May 12, 2023. For more information, see Section 10 of the Medicare Claims Processing Manual, Chapter 38.
Claim Status Category & Claim Status Codes
Learn about claims status category and code updates effective March 1, 2023:
- Get Accredited Standards Committee (ASC) X12 code lists, including added, changed, or deleted codes
- See examples of the ASC X12 276 and ASC X12 277 request and response transactions
See the instruction to your Medicare Administrative Contractor.
Events
Medicare Shared Savings Program: Navigating the Application Webinar — May 8
Monday, May 8 from 1–2:30 pm ET
Accountable Care Organizations (ACOs): Learn how to use the application toolkit to prepare your application for the upcoming cycle. We’ll also discuss the new Advance Investment Payments option to encourage health care providers in rural and underserved areas to join together as ACOs.
Register for this webinar.
More Information:
- Application Types and Timeline
- Key Application Dates and Deadlines
- Email questions to SharedSavingsProgram@cms.hhs.gov
HCPCS Public Meeting — May 30 – June 1
Tuesday, May 30 – Thursday, June 1 from 9 am – 5 pm ET
Attend a virtual public meeting for the first biannual 2023 HCPCS coding cycle.
Visit HCPCS Public Meetings for more information, including meeting materials and guidelines.
MLN Matters® Articles
New Fiscal Intermediary Shared System Edit to Validate Attending Provider NPI — Revised
Learn how we verify attending physician information on a claim.
Publications
Electronic Cell-Signaling Treatment
Learn what Medicare covers instead of electronic cell-signaling treatment, including:
- Peripheral nerve blocks
- Transcutaneous electrical nerve stimulation
- Percutaneous electrical nerve stimulation
Medicare doesn’t cover electronic cell-signaling treatment:
- For metabolic, peripheral, or multiple neuropathies
- For neuropathies in patients with underlying systemic diseases
- With vitamin injections
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