You have until May 15 to review and dispute program year 2021 Open Payments data before CMS publishes it in June. Reviewing your data is voluntary but strongly encouraged. Log into the Open Payments system to review your data. If you have a dispute, work directly with the reporting entity to resolve it; we don’t mediate or facilitate disputes.

Accessing Your Account:

If you don’t have an account, register in the Open Payments system
If you haven’t accessed your account in 60 days or more, unlock your account in the CMS Portal
If you haven’t accessed your account in 180 days or more, call the Open Payments Help Desk

More Information:

Review and Dispute Timing and Data Publication Quick Reference Guide (PDF)
Open Payments website
Contact the help desk at openpayments@cms.hhs.gov or 855-326-8366 (TTY: 844-649-2766)

Ambulance Prior Authorization Model Expands June 1

On June 1, 2022, the Repetitive, Scheduled Non-Emergent Ambulance Transport Prior Authorization Model will expand to Connecticut, Indiana, Maine, Massachusetts, Michigan, New Hampshire, New York, Rhode Island, and Vermont.

Visit the model webpage for the timeline, updates, and other information.

Clinical Laboratory Fee Schedule 2023 Preliminary Gapfill Rates: Submit Comments by July 11

CMS published 2022 preliminary gapfill rates for the Clinical Laboratory Fee Schedule (ZIP). Send your comments on these rate recommendations to clfs_inquiries@cms.hhs.gov by July 11, 2022.

Visit the Annual Public Meeting webpage for more information.

Medicare Cards Without Full Names

Due to a character limit, some Medicare cards don’t display patients’ full names. According to section 10.2 of the Medicare Claims Processing Manual, Chapter 26 (PDF), you should, "Enter the patient's last name, first name, and middle initial, if any, as shown on the patient's Medicare card."

Your claims will still process using the name displayed on the patient’s Medicare card, even if it isn’t their full name.

CMS Releases Chronic Pain Experience Journey Map

The Chronic Pain Experience Journey Map (PDF) highlights barriers to accessing care that affect a person with chronic pain, their quality of care, and their quality of life. Working with our Federal partners, CMS is exploring how we can address these issues.

We recognize pain’s impact across our programs and identified the importance of effective treatment and management of pain in the CMS Behavioral Health Strategy.

Biosimilars Curriculum: Resources for Teaching Your Students

Do you need to educate health care students on biosimilars and interchangeable products? The FDA Biosimilar Curriculum Toolkit provides 2 levels of information to help students learn and apply:

Use the toolkit resources in your own training to teach students applicable concepts in the following degree programs:

Medicine
Nursing
Physician assistant
Pharmacy

Bookmark FDA’s Biosimilars webpage and materials for health care providers and patients.

Learn more in these FDA fact sheets:

Women’s Health: Talk to Your Patients About Preventive Services

During National Women’s Health Week and National Osteoporosis Month, encourage your female patients to make their health a priority. Medicare covers preventive services to address women’s unique health concerns, including:

Your patients pay nothing if you accept assignment. Learn how to check eligibility (PDF) for preventive services. If you need help, contact your eligibility service provider.

More Information:

Medicare Preventive Services educational tool
CDC Women’s Health webpage
Coverage to Care Prevention Resources: See flyer for women in 8 languages
Preventive & Screening Services webpage: Get information for your patients

Compliance

Home Health Low Utilization Payment Adjustment Threshold: Bill Correctly

In a report, the Office of Inspector General found that Medicare improperly paid some claims for home health services with 5–7 visits in a payment episode. Review home health prospective payment system (PPS) information to properly bill for services slightly above the low utilization payment adjustment threshold.

Visit the Home Health PPS webpage for additional resources and the latest policy and payment updates:

Calendar Year 2021 Home Health PPS final rule
Section 10.6 Medicare Benefit Policy Manual, Chapter 7 (PDF)
Section 10.1.17 Medicare Claims Processing Manual, Chapter 10 (PDF)
Section 6.2 Medicare Program Integrity Manual, Chapter 6 (PDF)

Events

HCPCS Public Meeting — June 7–10

Tuesday, June 7 to Friday, June 10 from 9 am to 5 pm ET

Attend a virtual public meeting for the first biannual 2022 HCPCS coding cycle.

More Information:

MLN Matters® Articles

Calendar Year 2023 Modifications/Improvements to Value-Based Insurance Design (VBID) Model – Implementation

Learn about updates to the Hospice Benefit Component for calendar year 2023 (PDF).

Changes to Beneficiary Coinsurance for Additional Procedures Furnished During the Same Clinical Encounter as Certain Colorectal Cancer Screening Tests

Learn how CMS will phase in reduced coinsurance starting January 1, 2022 (PDF).

National Coverage Determination (NCD) 210.14 Reconsideration – Screening for Lung Cancer with Low Dose Computed Tomography (LDCT)

Learn about changes to this NCD (PDF):

Expanded eligibility, including lowering the minimum age
Removed the restriction that a physician or non-physician practitioner must provide the counseling and shared decision making
Removed the requirement for facilities to participate in a registry

Quarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment

Learn about updates effective July 1, 2022 (PDF):

Delayed reporting period for clinical diagnostic laboratory tests
Updates to advanced diagnostic laboratory tests
New codes

Quarterly Update to the End-Stage Renal Disease Prospective Payment System (ESRD PPS)

Learn about changes to the outlier policy (PDF):

Revised list of services, including 27 national drug codes (NDCs), effective January 1, 2022
Updated mean unit cost for renal dialysis drugs that are oral equivalents to injectable drugs, effective July 1, 2022
Revised mean dispensing fee for qualifying NDCs, effective July 1, 2022

Mental Health Visits via Telecommunications for Rural Health Clinics & Federally Qualified Health Centers — Revised

Learn about including modifier CG on rural health clinic claims (PDF).

Information for Medicare Patients

Affordable Connectivity Program Lowers Cost of Broadband Services for Eligible Households

CMS is working to help build awareness about the Affordable Connectivity Program (ACP), a Federal Communications Commission program. Your patients who use telehealth services might ask you about the new long-term benefit to help lower the cost of broadband service for eligible households struggling to afford internet service.

The ACP provides:

Up to $30/month discount for broadband service
Up to $75/month discount for households on qualifying tribal lands
One-time discount of up to $100 for a laptop, desktop computer, or tablet purchased through a participating provider if the household contributes more than $10 but less than $50 toward the purchase price

The ACP is limited to 1 monthly service discount and 1 device discount per household.

Who’s Eligible?

Your patient’s household is eligible for the ACP if the household income is at or below 200% of the Federal Poverty Guidelines or if a member of the household meets at least 1 of the criteria outlined at https://www.fcc.gov/acp.

Your patients can enroll in 2 steps by:

Going to ACPBenefit.org to apply or print a mail-in application
Contacting their preferred participating ACP provider to select a plan, and they’ll apply the discount to the patient’s bill

Some ACP providers may ask your patients to complete an alternative application. Eligible households must apply for the program, and contact a participating provider to select a service plan.

More Information:

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2022-05-12-MLNC

News

Comprehensive Error Rate Testing Documentation Center Moved on April 13

Physicians, Teaching Hospitals, Physician Assistants, & Advanced Practice Nurses: Open Payments Review & Dispute Ends May 15

Ambulance Prior Authorization Model Expands June 1

Clinical Laboratory Fee Schedule 2023 Preliminary Gapfill Rates: Submit Comments by July 11

Medicare Cards Without Full Names

CMS Releases Chronic Pain Experience Journey Map

Biosimilars Curriculum: Resources for Teaching Your Students

Women’s Health: Talk to Your Patients About Preventive Services

Compliance

Home Health Low Utilization Payment Adjustment Threshold: Bill Correctly

Events

HCPCS Public Meeting — June 7–10

MLN Matters® Articles

Calendar Year 2023 Modifications/Improvements to Value-Based Insurance Design (VBID) Model – Implementation

Changes to Beneficiary Coinsurance for Additional Procedures Furnished During the Same Clinical Encounter as Certain Colorectal Cancer Screening Tests

National Coverage Determination (NCD) 210.14 Reconsideration – Screening for Lung Cancer with Low Dose Computed Tomography (LDCT)

Quarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment

Quarterly Update to the End-Stage Renal Disease Prospective Payment System (ESRD PPS)

Mental Health Visits via Telecommunications for Rural Health Clinics & Federally Qualified Health Centers — Revised

Information for Medicare Patients

Affordable Connectivity Program Lowers Cost of Broadband Services for Eligible Households