Thursday, June 30, 2022
- CMS Issues Significant Updates to Improve the Safety and Quality Care for Long-Term Care Residents & Calls for Reducing Room Crowding
- COVID-19: Pfizer-BioNTech Vaccines for Children as Young as 6 Months — New Codes
- New Model to Improve Cancer Care for Medicare Patients: Apply by September 30
- Internet-Only Manual Update to Publication 100-04, Chapter 16, Sections 70.5, 70.8, and 70.9 to Remove References to the Clinical Laboratory Improvement Amendments (CLIA) Files
- Provide Ostomy Supplies Promptly
- Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP), and PC Print Update
- Changes to the Laboratory National Coverage Determination (NCD) Edit Software for October 2022
- Revisions to Medicare Part B Coverage of Pneumococcal Vaccinations for the Medicare Benefit Policy Manual Chapter 15, Section 50.4.4.2 — Revised
- International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs) ̶ July 2021 — Revised
Information for Medicare Patients
News
CMS Issues Significant Updates to Improve the Safety and Quality Care for Long-Term Care Residents & Calls for Reducing Room Crowding
As part of the Biden-Harris Administration’s initiative to promote the safety and quality of nursing home care across the country, CMS issued updates to guidance on minimum health and safety standards that long-term care (LTC) facilities (often called “nursing homes”) must meet to participate in Medicare and Medicaid. CMS also updated and developed new guidance in the State Operations Manual to address issues that significantly affect residents of LTC facilities. The surveyors who use these resources to perform both routine and complaint-based inspections of nursing homes are responsible for determining whether facilities are complying with CMS’ requirements.
More Information:
COVID-19: Pfizer-BioNTech Vaccines for Children as Young as 6 Months — New Codes
On June 17, 2022, the FDA amended the Pfizer-BioNTech COVID-19 vaccine emergency use authorization (PDF) to authorize use for all patients 6 months – 4 years old. Get important vial and dosing information. CMS issued new CPT codes effective June 17, 2022:
Code 91308 for vaccine product:
- Long descriptor: Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use
- Short descriptor: SARSCOV2 VAC 3 MCG TRS-SUCR
Code 0081A for vaccine administration, first dose:
- Long descriptor: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; first dose
- Short descriptor: ADM SARSCV2 3MCG TRS-SUCR 1
Code: 0082A for vaccine administration, second dose:
- Long descriptor: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; second dose
- Short descriptor: ADM SARSCV2 3MCG TRS-SUCR 2
Code 0083A for vaccine administration, third dose:
- Long descriptor: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; third dose
- Short descriptor: ADM SARSCV2 3MCG TRS-SUCR 3
Visit the COVID-19 Vaccine Provider Toolkit for more information, 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 this webpage.
New Model to Improve Cancer Care for Medicare Patients: Apply by September 30
The Biden Administration, through HHS and CMS, announced a new model aimed at improving cancer care for Medicare patients and lowering health care costs. The CMS Center for Medicare and Medicaid Innovation designed the Enhancing Oncology Model (EOM) to test how to improve health care providers’ ability to deliver care centered around patients, consider patients’ unique needs, and deliver cancer care in a way that will generate the best possible patient outcomes. The model will focus on supporting and learning from cancer patients, caregivers, and cancer survivors while addressing inequities.
If your oncology practice is interested in participating in the EOM, register and apply by September 30, 2022.
More Information:
Internet-Only Manual Update to Publication 100-04, Chapter 16, Sections 70.5, 70.8, and 70.9 to Remove References to the Clinical Laboratory Improvement Amendments (CLIA) Files
Starting July 25, CMS is removing references to “CLIA files” in the Claims Processing Manual, Chapter 16. Find information about CLIA test complexity categories on the FDA website. We don’t expect any policy, processing, or system changes.
See the instruction to your Medicare Administrative Contractor (PDF).
Provide Ostomy Supplies Promptly
CMS heard from Medicare patients living with an ostomy that they’ve run out of supplies. Incomplete standard written orders (SWOs) or delayed physician signatures can cause late shipments.
Prevent this issue by returning the signed, dated, and completed SWO promptly to the supplier.
If the supplier bills for an item without first getting a completed SWO, we’ll deny the claim as not reasonable and necessary. Valid prescriptions must have all the same elements as the SWO. There isn’t an annual requirement for a new SWO (or prescription).
A complete SWO must have all the following elements:
- Beneficiary’s name or MBI
- Order date
- Description of the item: general description (for example, wheelchair or hospital bed), brand name and model number, HCPCS code, or HCPCS code narrative
- For supplies, you may order all supplies at the same time, even if you bill separately (Note: If you don’t order these items at the same time, you must include an order for payment purposes)
- Quantity to be dispensed (if applicable)
- Treating provider’s name or NPI
- Treating provider’s signature
More Information:
- Medicare Provider Compliance Tips for Ostomy Supplies educational tool
- Standard Documentation Requirements for All Claims Submitted to Durable Medical Equipment Medicare Administrative Contractors local coverage article
- Ostomy Supplies local coverage article
- Ostomy Supplies local coverage determination
Events
Cancelled — CMS National Provider Enrollment Conference in Boston
CMS cancelled the August 16 and 17 provider enrollment conference due to the ongoing COVID-19 public health emergency.
MLN Matters® Articles
Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP), and PC Print Update
Learn about updated code sets (PDF):
- Latest RARCs and CARCs
- Where to find the official code lists
- What to do if you use MREP or PC Print
Changes to the Laboratory National Coverage Determination (NCD) Edit Software for October 2022
Learn about changes in this quarterly release (PDF):
- 12 NCDs with coding updates
- Spreadsheet that lists changes
Revisions to Medicare Part B Coverage of Pneumococcal Vaccinations for the Medicare Benefit Policy Manual Chapter 15, Section 50.4.4.2 — Revised
International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs) ̶ July 2021 — Revised
- Use the most specific code for your laboratory claims
- We’ll monitor these claims and may remove these codes in the future
Publications
Hospital Price Transparency — Updated Resources
CMS posted updated Hospital Price Transparency resources that give additional guidance for complying with regulations, including new recommendations and examples for machine-readable file displays:
Learn about changes to the regulations, effective January 1, 2022:
- Increased civil monetary penalties
- Changed requirements for state forensic hospitals
- Prohibited additional barriers to access machine-readable files
More Information:
- Hospital Price Transparency webpage
- Calendar Year 2022 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System final rule
Medicare Provider Enrollment — Revised
- Dates when PECOS and electronic health records users must use multi-factor authentication
- New PECOS scroll function
Information for Medicare Patients
No Surprises Act: Fact Sheets for Your Patients
Share information with your patients to help protect them from surprise billing. As of January 1, 2022, they have new billing protections when they get:
- Emergency care
- Non-emergency care from out-of-network providers at in-network facilities
- Air ambulance services from out-of-network providers
4 new No Surprises fact sheets:
- Health insurance terms you should know (PDF)
- What’s a good faith estimate? (PDF)
- How do I read my medical bill? (PDF)
- Health care notice & consent form — what to know before you sign (PDF)
For more information, visit the Ending Surprise Medical Bills webpage.
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