Thursday, April 14, 2022
- Launch of the Cross-Cutting Initiatives
- Value-Based Insurance Design Model: Medicare Advantage Organizations Pay for Hospice Care
News
Launch of the Cross-Cutting Initiatives
CMS announced a series of Cross-Cutting Initiatives (CCIs) that will drive the Centers’ and Offices’ strategic vision to advance health equity, expand coverage, and improve health outcomes. In addition to advancing the 6 strategic pillars that we announced last year, the CCIs aim to improve behavioral and maternal health coverage, drug price affordability, and rural health care delivery, along with strengthening quality improvement strategies and ensuring coverage for eligible individuals post-pandemic. The CCIs will also identify opportunities to streamline the consumer experience of our coverage programs and expand coverage, while leveraging data to drive innovation and person-centered care. We’re committed to track, monitor, and refine success measures for these initiatives in partnership with stakeholders and to report on progress.
More Information:
- CMS Strategic Plan webpage
- CCI fact sheet
- National Quality Strategy fact sheet
- Behavioral Health Strategy fact sheet
- Addressing & Improving Behavioral Health webpage
Value-Based Insurance Design Model: Medicare Advantage Organizations Pay for Hospice Care
Under the Hospice Benefit Component of the Value-Based Insurance Design (VBID) Model, participating Medicare Advantage Organizations (MAOs) retain responsibility for all Original Medicare services, including hospice care. MAOs must pay for:
- Non-hospice care provided to a hospice enrollee during a hospice stay, such as the items, drugs, or services that are furnished to treat a condition unrelated to the terminal illness and related conditions
- Other non-hospice care (items, drugs, or services) that are furnished after a hospice stay ends (in the event of a live discharge, including non-hospice care provided on the last day of the stay through the end of the calendar month that the hospice stay ends)
More Information:
- Section 90 Medicare Benefit Policy Manual, Chapter 9 (PDF)
- VBID Model Hospice Benefit Component Billing & Payment webpage
- Calendar Year 2021 Technical and Operational Guidance
Compliance
Collaborative Patient Care is a Provider Partnership
- If you don’t provide enough information to support medical necessity when you refer or write orders, the other provider or supplier may not get paid, which can cause delays or no treatment for your patient.
- You must provide documentation and information to other health care providers to support their claims for services or items.
- You can give protected health information, without patient authorization, to other health care providers covered under the privacy rule to carry out treatment, payment, or health care operations.
Claims, Pricers, & Codes
COVID-19: New Codes for Moderna Vaccine Booster Doses
On March 29, 2022, the FDA amended the Moderna COVID-19 vaccine emergency use authorization (PDF), including new packaging for vaccine boosters (blue cap). CMS issued new codes, effective March 29, 2022, for the vaccine booster and administration:
Code: 91309
- Long descriptor: Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.5 mL dosage, for intramuscular use
- Short descriptor: SARSCOV2 VAC 50MCG/0.5ML IM
Code: 0094A
- Long descriptor: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.5 mL dosage, booster dose
- Short descriptor: ADM SARSCOV2 50 MCG/.5 MLBST
For more information, visit the COVID-19 Provider Toolkit, and get the most current list of billing codes, payment allowances, and effective dates. (Note: you may need to refresh your browser if you recently visited these webpages).
Events
Medicare Cost Report E-Filing System: Interim Rate & Settlement Documentation Webinar — April 26
Tuesday, April 26 from 1–2:30 pm ET
If you’re a Medicare Part A provider or organization that files cost reports, attend this webinar to learn about new functionality in the Medicare Cost Report E-Filing (MCReF) system:
- View and download interim rate review, tentative settlement, and final or reopening settlement documentation completed by your Medicare Administrative Contractor
- Submit individual or bulk (chain providers) Medicare Part A cost reports for fiscal years ending on or after December 31, 2017
- Track the status of Medicare Part A cost reports with fiscal years ending after December 31, 2009
Send questions in advance to OFMDPAOQuestions@cms.hhs.gov with “MCReF Webinar” in the subject line. We’ll answer your questions during the webinar or use them to develop educational materials.
More Information:
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