Thursday, August 10, 2023
News
Immunization: Protect Your Patients
Fewer than 25% of adults get their recommended vaccines, and minority populations have even lower immunization rates (see CDC and NIH). During National Immunization Awareness Month, help increase vaccination rates for all Americans by addressing social and health inequities.
Medicare covers the following vaccines:
The Inflation Reduction Act improves coverage and lowers out-of-pocket costs for recommended vaccines. Your patients pay nothing if you accept assignment. Find out when your patient is eligible for these vaccines. If you need help, contact your eligibility service provider.
More Information:
- CDC Adult Vaccination Resources webpage
- Office of Minority Health Immunization and Vaccine Resources webpage
- Medicare Part D Vaccines (PDF) fact sheet
- COVID-19 vaccine, flu shots, pneumococcal shots, and hepatitis B shots: Get information for your patients
Claims, Pricers, & Codes
Outpatient Rehabilitation Claims with Reason Code W7072: Do You Need to Resubmit Claims?
CMS returned some institutional, outpatient claims with reason code W7072 in error between January 1 – June 30, 2023. These claims included:
- CPT codes: 98980, 98981 (either or both)
- Revenue codes: 42x, 43x, or 44x
- Type of bill:
- 22X or 23X: skilled nursing facilities
- 34X: home health agencies
- 85X: critical access hospitals
Resubmit claims that we returned in error.
MLN Matters® Articles
HCPCS Codes Used for Skilled Nursing Facility Consolidated Billing Enforcement: October 2023 Update
Learn about codes excluded (PDF) from skilled nursing facility consolidated billing, including:
- Chemotherapy
- Blood clotting factors
- Inclusion therapy
Publications
Expanded Home Health Value-Based Purchasing Model: New Resource & Updated FAQs
CMS posted resources for the Expanded Home Health Value-Based Purchasing Model:
- Calculating Episode-Level Observed Values for the Total Normalized Composite Change Measures: Learn about calculations and effects of risk adjustment in 2 examples and 13 patient scenarios
- FAQs (July 2023 edition): Understanding common terms and essential elements of the Model
Multimedia
Skilled Nursing Facility: Minimum Data Set Resident Assessment Instrument Training Materials
Get materials from the May Skilled Nursing Facility (SNF) Minimum Data Set 3.0 Resident Assessment Instrument v1.18.11 Guidance Training Program:
- Recordings:
- Part 1 pre-recorded training webinars
- Part 2 virtual coding workshop sessions
- Part 1 presentations (ZIP)
- Part 2 presentations (ZIP)
- Supplemental materials (ZIP):
- Acronym list
- Action plan worksheet
- Case study answer sheet, coding response sheet, and narrative
- Coding reference packet
- Resource guide
More Information:
- SNF Quality Reporting Program Training webpage
- Contact the PAC Training Mailbox with questions about accessing resources or training feedback
- Contact the SNF QRP Help Desk with content questions
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