Thursday, November 12, 2020
- Home Health Prospective Payment System (HH PPS) Rate Update for Calendar Year (CY) 2021
- Implementation of Changes in the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Payment for Dialysis Furnished for Acute Kidney Injury (AKI) in ESRD Facilities for Calendar Year (CY) 2021
- International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs)--April 2021
- Manual Updates Related to the Hospice Election Statement and the Implementation of the Election Statement Addendum
- Updates to Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) Claims
Information for Medicare Patients
View this edition as a PDF (PDF)
News
Critical Care: Comparative Billing Report in November
CMS issued a Comparative Billing Report (CBR) on Part B claims for critical care. Use the data-driven tables to compare your billing and payment patterns with peers in your state and across the nation.
The public can’t view CBRs. Look for an email from cbrpepper.noreply@religroupinc.com to access your report. Update your email address in the Provider Enrollment, Chain, and Ownership System to ensure delivery.
For More Information:
- View a webinar recording
- Visit the CBR website
Raising Awareness of Diabetes in November
National Diabetes Month, Diabetic Eye Disease Month, and World Diabetes Day on November 14 promote diabetes awareness and the impact of diabetes on public health. Talk to your patients about their risk factors and recommend Medicare preventive services for detection and treatment.
For More Information:
- Medicare Preventive Services Educational Tool
- Medicare Vision Services (PDF) Fact Sheet
- Medicare Diabetes Prevention Program Expanded Model (PDF) Booklet
- National Diabetes Month webpage
- World Diabetes Day website
Visit the Preventive Services website to learn more about Medicare-covered services.
Compliance
SNF 3-Day Rule Billing
An Office of Inspector General (OIG) report found that Medicare improperly paid for Skilled Nursing Facility (SNF) services when patients didn’t meet the Medicare 3-Day inpatient hospital stay requirement. Review the Skilled Nursing Facility 3-Day Rule Billing (PDF) fact sheet to help you bill correctly. Additional resources:
- SNF Billing Reference (PDF) Medicare Learning Network Booklet
- Title 42 of the Code of Federal Regulations (CFR) § 411.400
- Medicare Benefit Policy Manual, Chapter 8 (PDF)
- Medicare Claims Billing Manual, Chapter 6 (PDF)
- Medicare Claims Billing Manual, Chapter 30 (PDF)
- Medicare Financial Management Manual, Chapter 3 (PDF), 70.3(C), 90, 100
Claims, Pricers & Codes
COVID-19: Non-Physician Practitioner Billing for CPT Codes 98966-98968
During the COVID-19 Public Health Emergency (PHE), non-physician practitioners who are eligible to bill Medicare directly, including registered dietitians and nutrition professionals, may bill for audio-only telephone assessment and management services:
- CPT codes 98966-98968
- Dates of service on or after March 1 until the end of the PHE
MLN Matters® Articles
Home Health Prospective Payment System (HH PPS) Rate Update for Calendar Year (CY) 2021
CMS issued a new MLN Matters Article MM12017 on Home Health Prospective Payment System (HH PPS) Rate Update for Calendar Year (CY) 2021 (PDF). Learn about rate and payment updates.
Implementation of Changes in the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Payment for Dialysis Furnished for Acute Kidney Injury (AKI) in ESRD Facilities for Calendar Year (CY) 2021
CMS issued a new MLN Matters Article MM12011 on Implementation of Changes in the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Payment for Dialysis Furnished for Acute Kidney Injury (AKI) in ESRD Facilities for Calendar Year (CY) 2021 (PDF). Learn about rate and policy updates.
International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs)--April 2021
CMS issued a new MLN Matters Article MM12027 on International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs)--April 2021 (PDF). Learn about ICD-10 conversions and coding updates.
Manual Updates Related to the Hospice Election Statement and the Implementation of the Election Statement Addendum
CMS issued a new MLN Matters Article MM12015 on Manual Updates Related to the Hospice Election Statement and the Implementation of the Election Statement Addendum (PDF). Learn about changes to the Medicare Benefit Policy Manual, effective for hospice elections beginning on or after October 1, 2020.
Updates to Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) Claims
CMS issued a new MLN Matters Article MM11992 on Updates to Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) Claims (PDF). Learn about a claims processing instruction update.
Publications
Provider Compliance Tips — Revised
CMS revised the following Medicare Learning Network fact sheets with provider compliance tips. Learn about coverage and documentation requirements to prevent claim denials.
- Pressure Reducing Support Surfaces (PDF)
- Urological Supplies (PDF)
- Walkers (PDF)
Information for Medicare Patients
2021 Medicare Part B Premiums Remain Steady
On November 6, CMS announced the 2021 monthly Medicare Parts A and B premiums, deductibles, and coinsurance amounts in which the Medicare Part B monthly premium remains steady. This news comes as Medicare Open Enrollment started on October 15, running through December 7 and follows the announcement that Medicare Advantage (or private Medicare health plans) and Part D prescription drug plan premiums are at historic lows, with hundreds of Medicare Advantage and Part D plans now offering $35 monthly co-pays for insulin starting in January 2021.
For More Information:
- Full text of press release
- Fact sheet
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