Thursday, September 19, 2024
News
- Resources & Flexibilities to Assist with the Public Health Emergency in Louisiana
- Skilled Nursing Facilities: Report Your Expanded Ownership, Management, & Related Party Data
- Hospice Outcomes and Patient Evaluation Assessment Tool: Version 1.00 Resources
- Hospital Price Transparency: Get Tools to Comply
- Risk Less. Do More. Get This Season’s Vaccines
- Help Reduce Health Disparities for Hispanic or Latino Patients
Compliance
Claims, Pricers, & Codes
- ACO REACH Model: Adjusting Claims
- Influenza Vaccine: Holding Claims for CPT Code 90658
- ICD-10 Medicare Severity Diagnosis-Related Group Version 42
News
Resources & Flexibilities to Assist with the Public Health Emergency in Louisiana
On September 12, 2024, Secretary Xavier Becerra determined that a public health emergency exists in Louisiana and has existed since September 10, 2024. CMS announced additional resources and flexibilities available in response to Hurricane Francine in Louisiana. CMS is working closely with the state to put these flexibilities in place to ensure those affected by this natural disaster have access to the care they need – when they need it most.
CMS stands ready to assist with resources and waivers to ensure hospitals and other facilities can continue to operate and provide access to care to those impacted by the consequences of the hurricane.
More Information:
Skilled Nursing Facilities: Report Your Expanded Ownership, Management, & Related Party Data
CMS will revalidate enrolled skilled nursing facilities (SNFs) from October – December 2024 to collect data on ownership, managerial, and related party information. Your Medicare Administrative Contractor will send you a revalidation notice:
- One-third of SNFs will get notices in October
- Two-thirds will get notices in November or December
You must report this data on the revised Medicare Provider Enrollment Application Form (CMS-855A). We’ll post the revised form and guidance later in September; see Become a Medicare Provider or Supplier.
Hospice Outcomes and Patient Evaluation Assessment Tool: Version 1.00 Resources
Get materials for the new Hospice Outcomes and Patient Evaluation (HOPE) assessment tool:
Hospital Price Transparency: Get Tools to Comply
As of July 1, 2024, your hospital must use a CMS template layout and data specifications for making public your standard charge information in a comprehensive machine-readable file (MRF). Starting January 1, 2025, you’re also required to encode additional data elements.
Use Hospital Price Transparency Tools to help you comply:
- Online Validator to check MRFs against the CMS template layout and data specifications
- MRF file naming tool
- TXT file:
- Generator tool to create the required file
- Technical specifications and requirements
- Example
Hospital Price Transparency regulations require each hospital operating in the U.S. to publish a comprehensive MRF with the standard charges for all items and services the hospital provides.
More Information:
- Register for the October 21 webinar on meeting the upcoming January 2025 requirements
- Watch the Online Validator Tool Demonstration video
- Visit the Data Dictionary GitHub Repository:
- Required CMS template layouts
- Data dictionary
- Examples of how to encode standard charges in the MRF
- Q&A discussion board
- Email questions to PriceTransparencyHospitalCharges@cms.hhs.gov
Risk Less. Do More. Get This Season’s Vaccines
Each year, millions of people get sick, and thousands need hospital care or die from respiratory infections caused by viruses (see HHS fact sheet). Vaccines help prevent these outcomes or lessen their severity. Help lower your patient’s risk of getting sick with a respiratory infection by encouraging them to get vaccinated.
Medicare Part B covers:
Find out when your patient is eligible for these vaccines. If you need help, contact your eligibility service provider.
Medicare drug coverage (Part D) covers the respiratory syncytial virus (RSV) shot (not Part A or Part B). See Medicare Part D Vaccines (PDF).
People can get vaccines for the flu, COVID-19, and RSV at the same time. When your patients get their annual flu vaccine, they can get the latest COVID-19 vaccine plus an RSV vaccine, if they’re eligible and have never been vaccinated against RSV.
Get resources for your patients from the Risk Less. Do More campaign, including fact sheets, digital banners, and social media messages.
More Information:
- CDC Respiratory Illnesses webpage
- Vaccines.gov website
- Annual Influenza Vaccination (PDF) and Chronic Condition Prevalence among Medicare Fee-For-Service Enrollees with COVID-19 (PDF) data snapshots: Learn about disparities in Medicare patients
Help Reduce Health Disparities for Hispanic or Latino Patients
Hispanic Americans are at greater risk of various health conditions due to a lack of preventive care and language barriers. During National Hispanic Heritage Month, increase your awareness of health disparities and learn about culturally and linguistically competent health care.
More Information:
- Introduction to Language Access Plans web-based training
- Latino Partners webpage
- Understanding the Health Needs of Diverse Groups of Hispanic Medicare Beneficiaries (PDF) data highlight
Compliance
Tracheostomy Supplies: Prevent Claim Denials
In 2022, the improper payment rate for patient lifts was 58.1%, with a projected improper payment amount of $17.7 million (see 2022 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF), Appendices E and G). Learn how to bill correctly for these services. Review the tracheostomy supplies provider compliance tip for more information, including:
- Denial reasons and how to prevent them, including refill requirements
- Documentation requirements and example
- Resources
Claims, Pricers, & Codes
ACO REACH Model: Adjusting Claims
CMS is aware of an issue that occurred on July 26, 2024, that affected some 2021 – 2024 professional claims for the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model. We’re working with our Medicare Administrative Contractors (MACs) to correct this issue.
Your MAC will reconcile the impacted claims, including:
- Adjusting or refunding amounts you owe
- Recouping funds we paid in error
You don’t need to take any action on these claims for the reconciliations to occur.
If you have questions or need additional information, contact your MAC.
Influenza Vaccine: Holding Claims for CPT Code 90658
CMS is aware of an issue affecting payment for CPT code 90658:
- Long descriptor: Influenza virus vaccine, trivalent (IIV3), split virus, 0.5 mL dosage, for intramuscular use
- Short descriptor: IIV3 VACCINE SPLT 0.5 ML IM
We’re holding claims for CPT code 90658 for dates of service on or after August 1, 2024, until October 7, 2024.
Your Medicare Administrative Contractor will reprocess any denied claims by November 1, 2024. You don’t need to take any action.
ICD-10 Medicare Severity Diagnosis-Related Group Version 42
Get updated ICD-10 Medicare Severity Diagnosis-Related Group (MS-DRG) Classifications and Software. CMS posted Version 42:
- Grouper and Medicare Code Editor software: mainframe and PC
- Definitions Manual: text and HTML
Version 42 is effective for discharges on or after October 1, 2024.
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