- Medicare Physician Fee Schedule Database: April Update
- Home Health Prospective Payment System Grouper: April Update
- Extension of Changes to the Low-Volume Hospital Payment Adjustment & the Medicare Dependent Hospital Program
- National Coverage Determination: Cochlear Implantation
- Patient Driven Payment Model: Claim Edit Enhancements — Revised
News
Nutrition-Related Health Conditions: Recommend Medicare Preventive Services
National Nutrition Month® is the perfect time to encourage your patients to develop healthy eating and physical activity habits. Medicare covers 8 preventive services for nutrition-related health conditions like diabetes, chronic kidney disease, cardiovascular disease, and obesity:
- Annual wellness visit: health risk assessment and personalized prevention plan to keep patients healthy
- Cardiovascular disease screening tests: blood tests for cholesterol, lipid, and triglyceride levels to help detect conditions that may lead to a heart attack or stroke
- Diabetes screening: blood glucose laboratory test screenings for patients at risk for developing diabetes
- Diabetes self-management training: tips to help patients manage their diabetes, including eating healthy and being active, monitoring blood glucose, taking prescription drugs, and reducing risks
- Intensive behavioral therapy (IBT) for cardiovascular disease: blood pressure check, tips on eating well, and aspirin use to lower risk for cardiovascular disease
- IBT for obesity: initial screening for body mass index and behavioral therapy sessions, including dietary assessment and counseling to help patients lose weight by focusing on diet and exercise
- Medical nutrition therapy: nutrition and lifestyle assessment, individual or group nutritional therapy services, help managing lifestyle factors, and follow-up visits to help certain patients manage their diet
- Medicare Diabetes Prevention Program (PDF): specially trained coaches teach long-term behavior changes for diet and exercise and weight control strategies for eligible patients
Find out when your patient is eligible for some of these services. If you need help, contact your eligibility service provider.
More Information:
- Diabetes (PDF), Chronic Kidney Disease (PDF), and Obesity (PDF) data snapshots: Learn about disparities in Medicare patients
- Nutrition.gov: Learn about healthy eating
- Care Compare Tool: Find a registered dietitian or nutrition professional
- Preventive & Screening Services webpage: Get information for your patients
Compliance
Advance Care Planning: Bill Correctly for Services
In a recent report, the Office of the Inspector General found that Medicare providers who billed for advance care planning (ACP) services in an office setting didn’t always comply with federal requirements. Review the revised Advance Care Planning (PDF) fact sheet, and learn how to:
- Document discussions
- Follow time-based coding requirements
More Information:
- Billing and Coding: ACP local coverage article
- ACP local coverage determination
Claims, Pricers, & Codes
Medicare Physician Fee Schedule Database: April Update
See the attachment in the instruction to your Medicare Administrative Contractor (PDF) to learn about the April quarterly changes to the Medicare Physician Fee Schedule Database:
- New codes
- Procedure status changes
Home Health Prospective Payment System Grouper: April Update
Get the April 2023 release (v04.1.23) (ZIP). See Home Health Prospective Payment System Grouper Software for a summary of changes.
More Information:
- Section 80 Claims Processing Manual, Chapter 10 (PDF)
- Instruction to your Medicare Administrative Contractor (PDF)
Events
Ambulance Open Door Forum: Medicare Ground Ambulance Data Collection System — March 16
Thursday, March 16 from 2–3 pm ET
Attend the Ambulance Open Door Forum for updates and the top 5 tips for selected organizations in years 1–4.
More Information:
MLN Matters® Articles
Extension of Changes to the Low-Volume Hospital Payment Adjustment & the Medicare Dependent Hospital Program
The Consolidated Appropriations Act, 2023 extends certain temporary increases to the low-volume hospital payment adjustment and the Medicare Dependent Hospital Program (PDF) through September 30, 2024.
National Coverage Determination: Cochlear Implantation
Learn about covered cochlear implantation (PDF) services:
- Performed as part of FDA-approved category B investigational device exemption clinical trials for patients not meeting the coverage criteria
- As a routine cost in certain clinical trials for patients not meeting the coverage criteria
Patient Driven Payment Model: Claim Edit Enhancements — Revised
CMS deleted references to occurrence span code 74 and the M1 condition code (PDF).
Publications
Medicare Part B Inflation Rebate Guidance: Use of the 340B Modifier — Revised
Learn about the requirement to include a modifier (PDF) on claims for separately payable Part B drugs and biologicals acquired under the 340B Program. Find out what’s changed, including:
- Updated FAQs (PDF)
- Added provider types
Information for Patients
New Inflation Reduction Act Resources
President Biden’s new prescription drug law, the Inflation Reduction Act (IRA), provides meaningful financial relief for millions of people with Medicare by improving access to affordable treatments and strengthening the Medicare Program both now and in the long-run. CMS recently issued a social media toolkit that stakeholders can use to educate people with Medicare about the new insulin benefit and additional vaccines available at no cost. The toolkit includes text and graphics in both English and Spanish.
Help get information into the hands of patients who need it:
- 7 Things to Know About Medicare Insulin Costs
- Saving money with the IRA
- Information about insulin costs and coverage
More Information:
- FAQs about Medicare Insulin Cost-Sharing Changes in the Prescription Drug Law (PDF)
- Timeline of the Drug Price Negotiation Program implementation process (PDF)
- CMS new prescription drug law implementation timeline (PDF)
- Additional resources
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