2023-05-18-MLNC

Following the end of the PHE, can hospitals bill for outpatient physical therapy (PT), occupational therapy (OT), speech language pathology (SLP) services, Diabetes Self-Management Training (DSMT), or Medical Nutrition Therapy (MNT) provided to beneficiaries in their homes through telecommunication technology by hospital-employed staff?

In context of the end of the PHE, we have received a number of inquiries from interested parties regarding the expiration of this policy. We have reviewed all of the relevant guidance, including applicable billing instructions and external feedback, and recognize the confusion around these policies. We also recognize that the therapists and many of the other practitioners who provide these services remain on the list of distant site practitioners for Medicare telehealth services.

However, for DSMT services, we understand that some other types of hospital clinical staff, beyond those identified as eligible distant site practitioners for Medicare telehealth, can provide these services in some cases. To allow these services to continue to be furnished to patients in their home through telecommunication technology through the end of CY 2023, we are exercising enforcement discretion in reviewing the telehealth practitioner status of the clinical staff personally providing any part of a remotely furnished DSMT service, so long as the practitioner is otherwise qualified to provide the service.

Through the end of CY 2023, PT, OT, SLP, DSMT, MNT providers should continue to bill for these services when furnished remotely in the same way they have been during the PHE.

After the end of the PHE, how often will Medicare provide payment for a subsequent nursing facility or subsequent inpatient visit when furnished via Medicare telehealth?

We have received a number of inquiries from interested parties regarding temporarily continuing our suspension of these frequency limitations beyond the end of the PHE, specifically our requirement that CPT codes 99231-99233 may only be furnished via Medicare telehealth once every 3 days, and our requirement that CPT codes 99307-99309 may only be furnished via Medicare telehealth once every 14 days. We are exercising enforcement discretion and will not consider these frequency limitations through December 31, 2023, as we anticipate considering our policy further through our rulemaking process.

Will teaching physicians be allowed to use virtual presence and bill for services involving residents in residency training sites outside of a MSA after the PHE ends?

CMS is exercising enforcement discretion to allow teaching physicians in all teaching settings to be present virtually, through audio/video real-time communications technology, for purposes of billing under the PFS for services they furnish involving resident physicians. We are exercising this enforcement discretion through December 31, 2023, as we anticipate considering our policy for services involving teaching physicians and residents further through our rulemaking process.

Advancing Health Equity Through The CMS Innovation Center: First Year Progress And What’s To Come

Health Affairs published a blog by the CMS Innovation Center, outlining its health equity strategy, progress made over the last year, and additional areas of focus in the future.

The Innovation Center launched a new health equity initiative in 2022, proposing to:

Develop new models and revise existing models to promote and incentivize equitable care
Increase participation of safety net providers
Increase collection and analysis of equity data
Monitor and evaluate models for health equity impact

Power Seat Elevation Equipment on Power Wheelchairs: Coverage, Coding, & Payment

CMS issued a national coverage decision that – for the first time – establishes power seat elevation for power wheelchairs as durable medical equipment, eligible for coverage by the Medicare program.

Learn about coverage, coding, and payment.

Medicare Shared Savings Program: Apply for January 1 Start Date by June 15

Accountable Care Organizations (ACOs): Apply for the Medicare Shared Savings Program through the ACO Management System by June 15 at noon ET. See the Application Toolkit to get resources for the upcoming application submission cycle.

We’re offering a new Advance Investment Payments (PDF) option to encourage providers in rural and underserved areas to join together as ACOs.

More Information:

Application Types & Timeline
Key Application Actions and Deadlines
Email questions to SharedSavingsProgram@cms.hhs.gov

Inpatient Rehabilitation Facility Services: Review Choice Demonstration

Beginning August 21, 2023, CMS will implement the Review Choice Demonstration for Inpatient Rehabilitation Facility (IRF) Services in Alabama. These IRF providers can choose either 100% pre-claim review or 100% postpayment review during the selection period, July 7 – August 6, 2023.

We plan to expand the demonstration to additional states and Medicare Administrative Contractor jurisdictions at a later date.

Women’s Health: Talk with Your Patients About Making their Health a Priority

During National Women’s Health Week and National Osteoporosis Month, recommend appropriate preventive services to help your patients improve their health. Medicare covers preventive services to help support a healthy lifestyle, including:

Your patients pay nothing if you accept assignment. Find out when your patient is eligible for these services. If you need help, contact your eligibility service provider.

More Information:

Osteoporosis (PDF) and Breast Cancer Screening (PDF) data snapshots: Learn about disparities in Medicare patients
CDC Women’s Health webpage
Preventive & Screening Services webpage: Get information for your patients

Claims, Pricers, & Codes

COVID-19: Reporting CR Modifier & DR Condition Code After Public Health Emergency — Reminder

The COVID-19 public health emergency (PHE) ended on May 11, 2023. In general, providers should only report the CR modifier and DR condition code during a PHE when a formal waiver is in place. So, you shouldn’t use the CR modifier or DR condition code for most claims with dates of service on or after May 12, 2023.

There are 2 exceptions:

DMEPOS Suppliers

Continue to use the CR modifier and COVID-19 narrative on claims for supplies and accessories associated with certain DMEPOS items provided during the PHE.

Skilled Nursing Facility & Swing Bed Providers

For benefit period and qualifying stay waivers, submit condition code DR for inpatient claims with admission dates before May 12, 2023. For more information, see Section 10 of the Medicare Claims Processing Manual, Chapter 38 (PDF).

See Medicare Billing for COVID-19 Vaccine Shot Administration for more information.

Events

Skilled Nursing Facility: Minimum Data Set Resident Assessment Instrument Training

Take this CMS virtual training program to learn about:

Skilled nursing facility (SNF) Minimum Data Set 3.0 Resident Assessment Instrument v1.18.11 Manual and Item Set
SNF Quality Reporting Program reporting requirements that will go into effect October 1, 2023
Standardized patient assessment data elements: We’ll implement across post-acute care settings for more consistent reporting and evaluation

The training program has 2 parts:

Part 1: Learn — View pre-recorded training webinars to learn about new or revised items and guidance before the live event. A capstone case study gives you additional coding practice.
Part 2: Practice — Register for live, virtual workshop sessions on June 21 between 12:30 – 5 pm ET. Practice coding scenarios for select data elements covered in Part 1.

More Information:

SNF Quality Reporting Program Training: See training resources (ZIP), including acronym list, Action Plan worksheet, Case Study documents, resource guide, and PDF versions of the training webinars
Email PAC Training Mailbox with questions about accessing resources or training feedback
Email SNF QRP Help Desk with content questions

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