Thursday, March 21, 2024
- New Initiative to Increase Investments in Person-Centered Primary Care
- Marriage and Family Therapists & Mental Health Counselors: Get Information about Billing Medicare
- Electronic Funds Transfer: Revised CMS-588 Required on May 1
- Health-Related Social Needs FAQs
- Promote Kidney Health During National Kidney Month
- Changes to the Laboratory National Coverage Determination Edit Software: July 2024 Update
- Medicare Claims Processing Manual Updates – HCPCS Billing Codes & Advance Beneficiary Notice of Non-coverage Requirements
News
New Initiative to Increase Investments in Person-Centered Primary Care
On March 19, HHS, through CMS, announced a new voluntary model that empowers primary care providers in eligible Accountable Care Organizations (ACOs) to treat people with Medicare using innovative, team-based, person-centered proactive care. A key part of the Biden-Harris Administration’s efforts to further promote competition in health care, the ACO Primary Care Flex Model (ACO PC Flex Model) will provide a one-time advanced shared savings payment and monthly prospective primary care payments (PPCPs) to ACOs. The advanced shared savings payments provide ACOs with needed resources and flexibility to cover costs associated with forming an ACO (where relevant) and administrative costs for required model activities. PPCPs will be distributed by ACOs to primary care practices, giving them improved resources and flexibility to provide care that best suits individuals’ needs.
The ACO PC Flex Model is a five-year voluntary model that will begin on January 1, 2025. CMS is planning to select approximately 130 ACOs to participate in the model. Organizations interested in participating must first apply — either as new ACOs or renewing ACOs — to the Shared Savings Program. Shared Savings Program Applications are open May 20, 2024 - June 17, 2024. The ACO PC Flex Model Request for Applications is planned to be released in the second quarter of 2024.
More Information:
Marriage and Family Therapists & Mental Health Counselors: Get Information about Billing Medicare
For dates of service starting January 1, 2024, you can bill Medicare independently for services you furnish for the diagnosis and treatment of mental illnesses. Medicare Part B pays for these services at 75% of what we pay clinical psychologists under the Medicare Physician Fee Schedule. Visit Marriage and Family Therapists & Mental Health Counselors to get answers to these questions:
- What criteria must I meet to enroll in Medicare?
- I meet these criteria, how do I enroll in Medicare?
- Where can I find information about Medicare-covered services?
- How do I bill for these services?
- Where can I get more information?
Electronic Funds Transfer: Revised CMS-588 Required on May 1
Do you need to request electronic funds transfer (EFT) for your Medicare payments? Use the revised CMS-588 EFT application (PDF).
Medicare Administrative Contractors will accept current and revised versions of the form through April 30, 2024. Starting May 1, 2024, you must use the revised form.
Minor updates include:
- Correcting page numbers
- Revising form instructions and data element titles for clarity
- Removing the Authorized/Delegated Official Title data element
- Adding a box for reporting the chain home office number
- Making the email address data element in Part V of the form optional
Learn how to become a Medicare provider or supplier.
Health-Related Social Needs FAQs
CMS published Health-Related Social Needs FAQs (PDF) about 4 services in the CY 2024 Physician Fee Schedule final rule:
- Caregiver training
- Social determinants of health risk assessment
- Community health integration
- Principal illness navigation
For more information, visit Physician Fee Schedule.
Promote Kidney Health During National Kidney Month
Risk factors for chronic kidney disease (CKD) include diabetes, high blood pressure, heart disease, and obesity (see CDC). These conditions continue to disproportionately affect minority populations. During National Kidney month, talk with your patients about their risk factors.
Medicare covers preventive services for CKD risk factors, including:
- Cardiovascular disease screening tests
- Diabetes screening
- Diabetes self-management training
- Intensive behavioral therapy (IBT) for cardiovascular disease
- IBT for obesity
- Medicare Diabetes Prevention Program (PDF)
Find out when your patient is eligible for most of these services. If you need help, contact your eligibility service provider.
More Information:
- CDC Chronic Kidney Disease Initiative webpage
- CMS Office of Minority Health resources:
- Chronic Kidney Disease Disparities: Educational Guide for Primary Care (PDF)
- Coverage to Care Get Preventive Care webpage
- Chronic Care Management (PDF) toolkit
- Chronic Kidney Disease (PDF) data snapshot: Learn about disparities in Medicare patients
- Preventive & Screening Services webpage: Get information for your patients
MLN Matters® Articles
Changes to the Laboratory National Coverage Determination Edit Software: July 2024 Update
Learn about edit software updates (PDF) effective July 1, 2024:
- New and changed codes
- How to find coding information
Your Medicare Administrative Contractor will adjust claims they processed in error that you bring to their attention.
Medicare Claims Processing Manual Updates – HCPCS Billing Codes & Advance Beneficiary Notice of Non-coverage Requirements
Learn about coding and requirements (PDF):
- Use HCPCS codes G0402, G0438, and G0439 for billing initial preventive physical examination (IPPE) and annual wellness visit (AWV) services
- Don’t bill CPT codes 99381–99397 for IPPE or AWV services
Give your patients an Advance Beneficiary Notice of Non-coverage for certain preventive services like services in the CPT code range 99381-99397
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