Thursday, September 30, 2021
- Flu Season is Here: Protect Your Patients, Yourself, & Your Loved Ones
- Clinical Laboratory Fee Schedule Updates
- October 2021 Integrated Outpatient Code Editor (I/OCE) Specifications Version 22.3
- October 2021 Update of the Hospital Outpatient Prospective Payment System (OPPS)
- October Quarterly Update for 2021 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule
View this edition as PDF (PDF)
News
Flu Season is Here: Protect Your Patients, Yourself, & Your Loved Ones
It’s flu season, and flu shots are the best way to protect your patients, yourself, and your loved ones. The CDC recommends annual flu shots for everyone 6 months and older. Reducing the spread of respiratory illness, like flu, this fall and winter is important during the COVID-19 pandemic. You may give the flu and COVID-19 vaccines at the same visit as recommended by CDC and the Advisory Committee on Immunizations Practices.
Medicare Part B covers 1 flu shot per flu season and additional flu shots if medically necessary. Your patients pay nothing if you accept assignment.
More Information:
- CMS Flu Shot webpage
- CDC Seasonal Influenza Vaccination Resources for Health Professionals
- Vaccines.gov
- Flu Shots: information for your Medicare patients
Clinical Laboratory Fee Schedule Updates
Get the latest payment information on the Clinical Laboratory Fee Schedule (CLFS), and find out how and when you can comment:
- Calendar Year (CY) 2022 preliminary payment determinations: Visit the Payment Determinations section of the CMS CLFS Annual Public Meeting webpage. Submit comments by October 21 to CLFS_Annual_Public_Meeting@cms.hhs.gov.
- CY 2021 gapfill final Medicare Administrative Contractor recommendations: Visit the Gapfill Determinations section of the CMS CLFS Annual Public Meeting webpage. Submit requests for reconsideration by October 22 to CLFS_Inquiries@cms.hhs.gov. See the Gapfilling Schedule section for information on the determination process.
- 2021 Annual Laboratory Public Meeting voting results: Visit the Panel Recommendations section of the Advisory Panel on Clinical Diagnostic Laboratory Tests webpage.
- Medicare Advisory Panel on Clinical Diagnostic Laboratory Tests: Submit nominations to fill vacancies.
Starting January 1, 2022, laboratories can start reporting data to CMS. Visit the PAMA Regulations webpage for more information, and find out if you’re a laboratory that must report.
Compliance
Post-Acute Care Transfers: Bill Correctly
In a recent report, the Office of Inspector General (OIG) found Medicare improperly paid inpatient claims subject to the transfer policy. Many hospitals didn’t properly code inpatient claims as a discharge to home when patients resumed home health services within 3 days of discharge. Read the Review of Hospital Compliance with Medicare's Transfer Policy with the Resumption of Home Health Services & Other Information on Patient Discharge Status Codes (PDF) MLN Matters Article to bill correctly.
Visit the Fiscal Year 2021 Inpatient Prospective Payment System (IPPS) Final Rule webpage to stay up to date on the latest policy changes and payment updates. Learn more about:
- Adjustment bills involving time limitations for filing claims: section 130.1.1 of the Medicare Claims Processing Manual, Chapter 1 (PDF)
- Transfers between IPPS Hospitals: section 20.1.2.4 of the Medicare Claims Processing Manual, Chapter 3 (PDF)
- Decisions and determinations regarding claim reopening and revision: Medicare Claims Processing Manual, Chapter 34 (PDF)
MLN Matters® Articles
October 2021 Integrated Outpatient Code Editor (I/OCE) Specifications Version 22.3
Learn about claims processing updates (PDF).
October 2021 Update of the Hospital Outpatient Prospective Payment System (OPPS)
Learn about changes to payment policies and billing instructions (PDF).
October Quarterly Update for 2021 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule
Learn about changes to payment policy (PDF).
Multimedia
Part C Organization Determination, Appeals, & Grievances — Revised
See updated information in this Medicare Learning Network (MLN) web-based training course:
- Learn requirements
- Identify common problems
Visit the MLN Web-Based Training webpage for a current list of courses.
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