2023-07-20-MLNC

CMS posted a proposed National Coverage Determination for Percutaneous Transluminal Angioplasty of Carotid Artery Concurrent with Stenting. View the Proposed Decision Memo, and submit comments by August 10.

Beta Amyloid Positron Emission Tomography in Dementia and Neurodegenerative Disease: Proposed National Coverage Determination

CMS posted a proposed National Coverage Determination for Beta Amyloid Positron Emission Tomography in Dementia and Neurodegenerative Disease. View the Proposed Decision Memo, and submit comments by August 16.

CMS Posts Program Year 2022 Open Payments Data to CMS.gov

CMS posted the Program Year 2022 Open Payments data to CMS.gov. The posting includes updated data submitted and attested to by applicable manufacturers and group purchasing organizations that are required to annually report payments or transfers of value made to certain health care providers. Get information about the Open Payments Program.

Value-Based Insurance Design Model: CY 2024

Starting in CY 2024, the Value-Based Insurance Design (VBID) Model’s hospice benefit component will cover hospice election start dates from January 1, 2021 – December 31, 2024. This fall, CMS will share more detailed, provider-specific information about CY 2024.

We haven’t made any changes for CY 2023. Continue to use these resources for current information about the VBID Model’s hospice benefit component for CY 2023:

CY 2023 VBID Hospice Provider Letter and Checklist
VBID Model Hospice Benefit Component, including information about checking eligibility, billing, and payment

DMEPOS Suppliers: When & Where to Submit Electronic Funds Transfer Authorization Agreement Form

Effective August 21, you must submit an EFT Authorization Agreement CMS-588 form:

When you enroll for the first time
If you currently get paper checks in any jurisdiction, and take 1 of these actions:
- Change information
- Revalidate
- Reactivate

Submit the form to the national provider enrollment (NPE) contractor for your state:

New Domestic N95 Respirator Payment Adjustments

Learn about new payment adjustments to hospitals for Medicare’s share of the additional costs of domestic National Institute for Occupational Safety and Health (NIOSH)-approved surgical N95 respirators compared to non-domestic respirators.

Medicare Providers: Deadlines for Joining an Accountable Care Organization

To participate in an Accountable Care Organization (ACO) for performance year 2024, work with an ACO to join their participant list. ACOs must submit their lists to CMS by August 1 at:

Noon ET for the Medicare Shared Savings Program
11:59 pm ET for the ACO Realizing Equity, Access, and Community Health Model (ACO REACH)

Participant taxpayer identification numbers can’t overlap multiple ACO participant lists. Resolve any overlaps by September 5.

More Information:

Application Types & Timeline
Email questions to SharedSavingsProgram@cms.hhs.gov or ACOREACH@cms.hhs.gov

Compliance

Inpatient Admission Before Part A Entitlement: Bill Correctly

Use pre-entitlement billing instructions for inpatient admissions when you:

Admit the patient before their Medicare Part A entitlement date
Discharge them after their Part A entitlement effective date

How We Calculate Your Payment

CMS calculates the number of utilization days from the patient’s Part A entitlement date through the discharge, transfer, or death date, and we reimburse you based on the amount of billed covered charges. If we pay you under the Inpatient Prospective Payment System, we calculate the Diagnosis Related Group from the patient’s admission date.

Billing & Claims Tips

Room & Board Revenue Codes = 010X – 016X
Admission Date = Patient’s formal inpatient admission date
Statement Covered Period From Date = Effective date of Part A entitlement
Statement Covered Period Through Date = End date of the inpatient stay
Covered Days with Value Code (VC) 80 = The number of days in the Covered From to Covered Through date range
Accommodation Days/Units = The number of days reported in VC 80
Only include room and board charges for the days the patient had Part A entitlement
Don’t bill the patient or anyone else for days of care before the patient’s Part A entitlement, except for days above the outlier threshold
Report all revenue codes from the admission date through the discharge, transfer, or death date as covered charges
Include surgical procedure codes from the admission date to the discharge, transfer, or death date
Include diagnosis codes from the admission date to the discharge, transfer, or death date
Include the Part A entitlement date In the Remarks

More Information:

Medicare Benefit Policy Manual, Chapter 4: Learn about psychiatric benefit day reduction and lifetime limitation for inpatient psychiatric facilities
Section 40 Medicare Claims Processing Manual, Chapter 3

MLN Matters® Articles

Activation of Validation Edits for Providers with Multiple Service Locations — Revised

Learn what’s new, including:

Round 5 testing
National implementation starting August 1

Publications

Telehealth Services — Revised

Learn what’s changed:

Updated information on:
- End of the COVID-19 public health emergency
- CY 2023 and telehealth policies
Added information on:
- G-codes
- Consent for care management and virtual communication services

CMS changed this link. If you previously bookmarked it, update your link.

Multimedia

Post-Acute Care: Brief Interview for Mental Status Video

Watch the Brief Interview for Mental Status video (22:11) to learn about this cognitive assessment:

Interview strategies
Targeted guidance for accurate coding using patient and resident scenarios

More Information:

For questions about accessing the video or feedback, contact PAC Training
For content questions, contact HH QRP Help Desk, IRF QRP Help Desk, LTCH QRP Help Desk, or SNF QRP Help Desk

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