Thursday, February 8, 2024
- Medicare Shared Savings Program: Application Deadlines for a January 1, 2025, Start Date
- New Dental Specialty Codes for Medicare
- Hospices & Skilled Nursing Facilities: Report All Managing Employees
- Skilled Nursing Care & Skilled Therapy Services to Maintain Function or Prevent or Slow Decline: Reminder
- Help Address Heart Disease Disparities
News
Medicare Shared Savings Program: Application Deadlines for a January 1, 2025, Start Date
Accountable care organizations (ACOs): See Medicare Shared Savings Program Application Types & Timeline to learn about key dates for a January 1, 2025, start date. CMS will accept applications starting May 20 through the ACO Management System. Apply no later than June 17 at noon ET.
We offer advance investment payments (PDF) to encourage health care providers in rural and underserved areas to join together as ACOs. Learn about advance shared savings payments to build infrastructure, hire staff, and provide services and roles for community-based organizations.
More Information:
New Dental Specialty Codes for Medicare
CMS created new specialty codes for dentists to select when they enroll. See the instruction to your Medicare Administrative Contractor (PDF).
Hospices & Skilled Nursing Facilities: Report All Managing Employees
CMS recently clarified that hospice and skilled nursing facility medical directors and administrators are always considered managing employees for Medicare provider enrollment purposes. You must report all current managing employees. If you haven’t reported a medical director or administrator, report them now. See the Medicare Program Integrity Manual: CY 2024 Home Health Prospective Payment System Updates (PDF) MLN Matters Article for more information.
Skilled Nursing Care & Skilled Therapy Services to Maintain Function or Prevent or Slow Decline: Reminder
Medicare covers skilled nursing care and skilled therapy services under skilled nursing facility, home health, and outpatient therapy benefits when a beneficiary needs skilled care to maintain function or to prevent or slow decline, as long as:
- The beneficiary requires skilled care for the services to be provided safely and effectively
- An individualized assessment of the patient's condition demonstrates that the specialized judgment, knowledge, and skills of a qualified therapist are needed for a safe and effective maintenance program
Visit the Jimmo Settlement Agreement webpage for more information.
Help Address Heart Disease Disparities
Black or African American people with Fee-for-Service Medicare have the highest prevalence of hypertension out of all racial and ethnic groups (see data snapshot (PDF)). During American Heart Month and Black History Month, learn about the importance of prevention and care management to combat health disparities.
Medicare covers cardiovascular disease screening tests and intensive behavioral therapy for cardiovascular disease. 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:
- Preventive Services webpage
- Coverage to Care Resources for Partners and Providers webpage
- Million Hearts®: HHS initiative to avert 1 million preventable cardiovascular disease events in the next 5 years
- Ischemic Heart Disease (PDF) data snapshot: Learn about disparities in Medicare patients
- Cardiovascular disease screenings & behavioral therapy: Get information for your patients
Claims, Pricers, & Codes
ICD-10 Medicare Severity Diagnosis-Related Group Version 41.1
CMS updated the ICD-10 Medicare Severity Diagnosis-Related Group (MS-DRG) software package to accommodate 41 new procedure codes. Version 41.1 is effective for discharges on or after April 1.
Visit MS-DRG Classifications and Software for Version 41.1:
- Grouper software
- Definition of Medicare Code Edits
- Definitions Manual Files
More Information:
- New Procedure Codes Effective April 1 (PDF)
- Instruction to your Medicare Administrative Contractor (PDF)
Events
Medicare Ground Ambulance Data Collection System: Office Hours Session – February 29
Thursday, February 29 from 2–3pm ET
Register for this webinar:
Do you have questions about the Medicare Ground Ambulance Data Collection System (GADCS)? CMS and our contractors will address GADCS-related questions in real-time. While everyone is welcome to participate, this session will be most relevant to selected ground ambulance organizations in Year 3 and Year 4 of the GADCS as they begin reporting data to CMS in 2024.
This session will be divided into 2 topics:
- 2–2:30pm: GADCS instructions and how to respond to specific questions
- 2:30–3pm: User accounts, accessing the GADCS portal, and information technology issues
Visit Medicare Ground Ambulance Data Collection System for resources including:
- Printable version of the GADCS instrument in English and Spanish
- Updated GADCS User Guide
- Tip sheets on reporting and getting access to the GADCS, FAQs, and prior educational sessions
- Lists of ground ambulance organizations required to participate in Years 1–4
Publications
Medicare Ground Ambulance Data Collection System: Updated GADCS User Guide
CMS updated the step-by-step Medicare Ground Ambulance Data Collection System (GADCS) User Guide (PDF) to include changes that we finalized in the CY 2024 Physician Fee Schedule final rule.
More Information:
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