Thursday, February 9, 2023
- DMEPOS: Get Benefit Category Determinations
- Nurse Practitioners & Clinical Nurse Specialists: Update to List of National Certifying Bodies
- Help Address Heart Health Disparities
- Home Health: Revised Editing of Telehealth Claims
- HCPCS Application Summaries & Coding Decisions: Drugs & Biologicals
- Clinical Laboratory Fee Schedule & Laboratory Services Subject to Reasonable Charge Payment: Quarterly Update
- New Payment Adjustments for Domestic N95 Respirators
- Removal of a National Coverage Determination & Expansion of Coverage of Colorectal Cancer Screening
- Rural Health Clinic & Federally Qualified Health Center Medicare Benefit Policy Manual Update
News
DMEPOS: Get Benefit Category Determinations
Get new benefit category determinations for DMEPOS items in Section 110.8 of the Medicare Benefit Policy Manual, Chapter 15 (PDF).
See the instruction to your Medicare Administrative Contractor (PDF).
Nurse Practitioners & Clinical Nurse Specialists: Update to List of National Certifying Bodies
CMS added the Nurse Portfolio Credentialing Commission to the list of national certifying bodies for nurse practitioners and clinical nurse specialists.
More Information:
- Sections 200 & 210 Medicare Benefit Policy Manual, Chapter 15 (PDF)
- Sections 10.2.3.5 & 10.2.3.8 Medicare Program Integrity Manual, Chapter 10 (PDF)
- Instruction to your Medicare Administrative Contractor (PDF)
Help Address Heart Health Disparities
Black or African American patients have the highest prevalence of hypertension out of all racial and ethnic groups (see data snapshot (PDF)). American Heart Month and Black History Month is the perfect time to learn about preventive services, and find out how to address 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:
- Million Hearts®: HHS initiative to prevent a million heart attacks and strokes
- Cardiovascular disease screenings & behavioral therapy: Get information for your patients
Compliance
What’s the Comprehensive Error Rate Testing Program?
CMS created the Comprehensive Error Rate Testing (CERT) Program to measure the Fee-for-Service payment error rate. This identifies payments that don’t meet Medicare requirements; it doesn’t indicate fraud.
How does the program work?
The CERT contractor reviews a sample of processed claims. If a claim doesn’t meet Medicare’s coverage, coding, and billing rules, or the provider fails to submit medical records, it’s counted as a total or partial improper payment. Medicare Administrative Contractors analyze error rates to reduce improper payments, update their internal processes, and educate providers.
Claims, Pricers, & Codes
Home Health: Revised Editing of Telehealth Claims
From January 1 – February 6, 2023, CMS incorrectly returned claims with telehealth services if they didn’t include an in-person visit with the same revenue code (reason code 31869).
If we returned your claim, re-submit it to your Medicare Administrative Contractor.
HCPCS Application Summaries & Coding Decisions: Drugs & Biologicals
CMS published the Fourth Quarter 2022 HCPCS Application Summaries & Coding Recommendations (PDF) for drugs and biologicals. See HCPCS Level II Coding Decisions for more information.
MLN Matters® Articles
Clinical Laboratory Fee Schedule & Laboratory Services Subject to Reasonable Charge Payment: Quarterly Update
Learn about updates for laboratory billing (PDF):
- Next Clinical Laboratory Fee Schedule data reporting period
- General specimen collection fee increase
- New and discontinued HCPCS codes
New Payment Adjustments for Domestic N95 Respirators
Learn about cost reporting period changes starting January 1, 2023 (PDF):
- New payment adjustments for domestic National Institute for Occupational Safety and Health-approved surgical N95 respirators
- Biweekly interim lump-sum payments
Removal of a National Coverage Determination & Expansion of Coverage of Colorectal Cancer Screening
Learn about national coverage determination (NCD) 160.22 and colorectal cancer screening (PDF):
- Removed NCD 160.22 – ambulatory electroencephalographic (EEG) monitoring
- Lowered the minimum age for colorectal cancer screening (CRC) from age 50 to 45 for certain tests
- Expanded the definition of CRC screening tests and new billing instructions for colonoscopies under certain scenarios
- Updated 3 Medicare manuals
Rural Health Clinic & Federally Qualified Health Center Medicare Benefit Policy Manual Update
Learn about 2022 and 2023 updates and how CMS clarified existing policy (PDF).
Subscribe to the MLN Connects® newsletter. You can read previous issues in the archive.
View the Medicare Learning Network® Content Disclaimer and Department of Health & Human Services Disclosure.
The Medicare Learning Network®, MLN Connects®, and MLN Matters® are registered trademarks of the U.S. Department of Health & Human Services (HHS).
