- Clinical Laboratory Fee Schedule & Laboratory Services Reasonable Charge Payment: Quarterly Update
- Home Dialysis Payment Adjustment & Performance Payment Adjustment for ESRD Treatment Choices Model: Updated Process
- Billing Medicare Part B for Insulin with New Limits on Patient Monthly Coinsurance — Revised
- Expanded Home Health Value-Based Purchasing Model: Updated Measure Calculation Resources
News
CMS Roundup (May 5, 2023)
You may be interested in these topics from the CMS Roundup:
- CMS Hosts 2023 Quality Conference Focusing on Solutions to Address America’s Health System Challenges
- CMS Releases Special Focus Report to Improve Care for People Receiving Hospice Services
Medicare Ground Ambulance Data Collection System: Report Information
CMS has 2 reminders for selected ground ambulance organizations required to report under the Medicare Ground Ambulance Data Collection System (GADCS):
Year 1 & Year 2
If you reported that your data collection period is January 1 – December 31, 2022, report your data to the GADCS portal by May 31, 2023 (you have up to 5 months after the end of your data collection period to report).
Year 3 & Year 4
Medicare Administrative Contractors sent letters about this requirement via email and regular mail to selected organizations. If you haven’t reported your initial data requirements, report the start date of your data collection period and contact information. You must start collecting data in 2023. Our system automatically calculates your organization’s continuous 12-month data collection period when you enter the start date.
More Information:
- Ambulances Services Center webpage
- Medicare Ground Ambulance Data Collection System webpage:
- Lists of ground ambulance organizations selected in Years 1 & 2 required to collect information starting in 2022 and report information starting in 2023
- Organizations selected in Years 3 & 4 required to collect information starting in 2023 and report information starting in 2024
- FAQs (PDF)
Compliance
Bill Correctly: Power Mobility Devices Repairs
Practitioner & DMEPOS Supplier Information on Power Mobility Devices (PDF) explains how to properly document and bill:
- Obtain the Standard Written Order (SWO)
- Make a prior authorization request
- Complete a home assessment
- Keep the following documents: SWO, face-to-face visit supporting documents, written home assessment report, and proof of delivery
- Review all information to avoid improper payments
An Office of Inspector General report stated that Medicare improperly paid claims for power mobility device repairs. To properly bill for repairs:
- Show they’re reasonable, necessary, or meet the requirements
- Document labor time adequately
- Show that DMEPOS suppliers provide repair warranties
- Specify that wheelchair repair costs don’t exceed a certain amount over a device’s 5-year lifetime
More Information:
- 42 CFR 414.210
- Section 110.2 Medicare Benefit Policy Manual, Chapter 15
MLN Matters® Articles
Clinical Laboratory Fee Schedule & Laboratory Services Reasonable Charge Payment: Quarterly Update
Learn about updates for laboratory billing (PDF):
- End of the COVID-19 public health emergency
- Next data reporting period
- General specimen collection fee increase
- New and discontinued HCPCS codes
Home Dialysis Payment Adjustment & Performance Payment Adjustment for ESRD Treatment Choices Model: Updated Process
Learn about claim line adjustments (PDF) for:
- Type of Bill 072X with condition codes 74 or 76
- Monthly capitation payments for CPT codes 90957–90962 and 90965–90966
Publications
Billing Medicare Part B for Insulin with New Limits on Patient Monthly Coinsurance — Revised
CMS added HCPCS codes J1811 and J1813 (PDF) to the insulin modifiers table.
Expanded Home Health Value-Based Purchasing Model: Updated Measure Calculation Resources
Use these updated resources to calculate Expanded Home Health Value-Based Purchasing (HHVBP) Model quality measures:
- Calculating Episode-Level Observed Values for the Total Normalized Composite Change Measures
- Risk Adjustment in the Expanded HHVBP Model
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