Thursday, June 1, 2023
- CMS Announces Plan to Ensure Availability of New Alzheimer’s Drugs
- COVID-19 Health Care Staff Vaccination Final Rule
- Medicare Secondary Payer Accident-Related Diagnosis Codes: How to Get Paid
- Hospitals: New Payment Adjustments for Domestic N95 Respirators
- Expanded Home Health Value-Based Purchasing Model: May Newsletter
- Improve Cognitive Health: Medicare Covers Services
- Ambulatory Surgical Center Payment System: July 2023 Update
- HCPCS Codes Used for Skilled Nursing Facility Consolidated Billing Enforcement: July 2023 Quarterly Update
- Updating Medicare Manual with Policy Changes in the CY 2020 & CY 2021 Final Rules
News
CMS Announces Plan to Ensure Availability of New Alzheimer’s Drugs
CMS Administrator Chiquita Brooks-LaSure announced how people can get drugs that may slow the progression of Alzheimer’s disease covered by Medicare. If the FDA grants traditional approval, then Medicare will cover it in appropriate settings that also support the collection of real-world information to study the usefulness of these drugs for people with Medicare.
See the full press release for more information.
COVID-19 Health Care Staff Vaccination Final Rule
CMS finalized staff education requirements while ending the COVID-19 staff vaccination requirements for Long-Term Care Facilities and Intermediate Care Facilities for Individuals with Intellectual Disabilities. These provisions were included in the “COVID-19 Vaccine Requirements for Long-Term Care (LTC) Facilities and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs-IID) Residents, Clients, and Staff” IFC, published May 13, 2021. The Requirements for Long-term Care Facilities/Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID) to provide education about and to offer COVID-19 vaccines to residents, clients, and staff will continue and are an important mitigation tool against COVID-19 as the health care system shifts away from the PHE phase of the pandemic.
See the final rule.
Medicare Secondary Payer Accident-Related Diagnosis Codes: How to Get Paid
When there’s an accident, another entity has responsibility for paying before Medicare for accident-related services. Sometimes, claims are mistakenly denied or rejected in these cases. Don’t deny your patient services, even if it takes some time to figure out who pays first.
Medicare Secondary Payer (MSP) is the term used when Medicare doesn’t have the primary payment responsibility. If you see no-fault, liability, or worker’s compensation MSP coverage information, including accident or injury related diagnosis codes, on the Medicare eligibility response, you must bill the primary payer first for services related to the accident or injury.
If there’s no MSP employer Group Health Plan coverage identified as primary, Medicare is the primary payer for those other services not related to the accident or injury.
If your claim is mistakenly denied or rejected, you can still get paid:
- Submit an appeal to your Medicare Administrative Contractor. Provide an explanation and any relevant reason codes to justify that the services performed aren’t related to the accident or injury on record.
- Part A providers: Submit adjustments with your appeal.
Find more information on how to get accident-related insurance claims paid in our MSP: Don’t Deny Services & Bill Correctly fact sheet.
Hospitals: New Payment Adjustments for Domestic N95 Respirators
CMS is providing payment adjustments (PDF) for domestic National Institute for Occupational Safety and Health (NIOSH)-approved surgical N95 respirators starting January 1, 2023, including:
- Cost reporting period changes
- Documentation requirements
- Biweekly interim lump-sum payments that will be settled on the cost report
Get Payment Adjustments for Cost Difference Between Domestic & Other N95 Surgical Respirators
- Submit an N95 supplemental cost reporting form to your Medicare Administrative Contractor for NIOSH-approved surgical N95 respirators you purchased during the cost reporting period. Table 70: Mock N95 Supplemental Cost Reporting Form gives an example of additional data hospitals would report on its supplemental cost reporting form.
- Payment adjustments are based on the estimated difference in reasonable cost for domestic respirators, compared to other respirators.
These payments are only for the Medicare share of the cost.
See the CY 2023 Hospital Outpatient Prospective Payment System final rule for more information.
Expanded Home Health Value-Based Purchasing Model: May Newsletter
Read the May Home Health Value-Based Purchasing (HHVBP) Newsletter for the latest information, tools, and insights about the Expanded HHVBP Model.
Improve Cognitive Health: Medicare Covers Services
Less than 50% of people with subjective cognitive decline discuss it with their provider (see CDC). During Alzheimer’s & Brain Awareness Month, talk with your patients about their cognitive well-being, including risk factors and early detection.
If your patient shows signs of cognitive impairment during a routine visit, Medicare covers a separate visit to more thoroughly assess their cognitive function and develop a care plan.
More Information:
- CDC Alzheimer’s Disease and Healthy Aging webpage
- Alzheimer’s Disease (PDF) data snapshot: Learn about disparities in Medicare patients
- Cognitive assessment & care plan services: Get information for your patients
MLN Matters® Articles
Ambulatory Surgical Center Payment System: July 2023 Update
Learn about payment system updates (PDF), including:
- New drug, biological, and procedure codes
- Corrected payment indicator for CPT code 0698T
- Additional skin substitute products
HCPCS Codes Used for Skilled Nursing Facility Consolidated Billing Enforcement: July 2023 Quarterly Update
Learn about codes excluded from skilled nursing facility consolidating billing (PDF), including:
- Chemotherapy
- Vaccines
Updating Medicare Manual with Policy Changes in the CY 2020 & CY 2021 Final Rules
Learn about updated billing instructions (PDF):
- Nursing facility visits code family
- Hospital inpatient or observation care code family
- Substantive portion of a split, or shared, visit
Publications
Medicare Preventive Services — Revised
Learn what’s changed:
- Medical nutrition therapy: coverage when patients get this therapy and diabetes self-management training in the same episode of care
- Ultrasound abdominal aortic aneurysm: information on risk factors
Medical Record Maintenance & Access Requirements — Revised
Learn what’s changed (PDF), including:
- Information on:
- Extended telehealth provisions
- Discontinued Certificates of Medical Necessity and DME Information Forms
- Reminder for independent diagnostic testing facilities to properly store medical records
Multimedia
Hospice Quality Reporting Program Web-Based Training — Revised
Need an overview of the Hospice Quality Reporting Program (HQRP)? Visit the HQRP Training and Education Library to take the following courses:
- Getting Started with the HQRP and Public Reporting
- HQRP Data Submissions and Reports
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