Thursday, September 23, 2021
- CMS Launches New Medicare.gov Feature to Compare Nursing Homes by Vaccination Rate
- Drugs of Abuse Testing: Comparative Billing Report in September
- Cardiovascular Disease: Talk to your Patients about Screening
- Claims Processing Instructions for National Coverage Determination 20.33 – Transcatheter Edge-to-Edge Repair (TEER) for Mitral Valve Regurgitation
- National Coverage Determination (NCD) 270.3 Blood-Derived Products for Chronic, Non-Healing Wounds
- October 2021 Update of the Ambulatory Surgical Center (ASC) Payment System
- Medicare Clarifies Recognition of Interstate License Compact Pathways — Revised
- Medicare Vision Services — Revised
- Power Mobility Devices — Revised
- Transitional Care Management Services — Revised
View this edition as PDF (PDF)
News
CMS Launches New Medicare.gov Feature to Compare Nursing Homes by Vaccination Rate
CMS is making it easier to check COVID-19 vaccination rates for nursing home staff and residents with a new feature on Medicare.gov. This announcement makes vaccination data available in a user-friendly format to help people make informed decisions when choosing a nursing home for themselves or a loved one. CMS and the CDC continue using this data to monitor vaccine uptake among residents and staff and identify facilities that may need additional resources or assistance to respond to the pandemic.
More Information:
Drugs of Abuse Testing: Comparative Billing Report in September
In late September, CMS will issue a Comparative Billing Report (CBR) on Medicare Part B claims for drugs of abuse testing. Use the data-driven report to compare your billing practices with those of your peers in your state and across the nation.
CBRs aren’t publicly available. 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.
More Information:
- View a webinar recording
- Visit the CBR website
- Register for a live webinar on October 6 from 3-4 pm ET
Cardiovascular Disease: Talk to your Patients about Screening
Medicare covers cardiovascular disease screening tests, and your patients pay nothing if you accept assignment. During National Cholesterol Education Month and World Heart Day, talk to your patients about cardiovascular disease, cholesterol, and stroke.
More Information:
- Preventive Services webpage
- Million Hearts® website
- CDC Cholesterol webpage
- World Heart Day website
- Information for your patients on cardiovascular disease screenings
Compliance
DMEPOS Items: Ordering or Referring Practitioner Requirements
All claims for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) resulting from a practitioner’s order or referral must include the physician’s name. Additionally, they must provide medical records upon request. For more information, see section 10.4 of the Medicare Claims Processing Manual Chapter 26 (PDF).
Claims, Pricers, & Codes
ESRD Facilities: Bill Correctly for Cinacalcet Oral Drug
Beginning January 1, 2021, the cinacalcet oral drug is eligible for consideration as an ESRD outlier service:
- Report the number of tablets or pills, not the number of units (for example, milligrams)
- Report revenue code 250 with the national drug code
- Don’t use revenue code 0636 with HCPCS code J0604
More Information:
- MLN Matters Article MM12011 (PDF), page 7
- ESRD PPS Outlier Services webpage
- Medicare Benefit Policy Manual, Chapter 11 (PDF), §20.3.C
- Medicare Claims Processing Manual, Chapter 8 (PDF), §60.2.1.2
MLN Matters® Articles
Claims Processing Instructions for National Coverage Determination 20.33 – Transcatheter Edge-to-Edge Repair (TEER) for Mitral Valve Regurgitation
Learn how to submit TEER claims (PDF).
National Coverage Determination (NCD) 270.3 Blood-Derived Products for Chronic, Non-Healing Wounds
Learn about this NCD, effective April 13, 2021 (PDF).
October 2021 Update of the Ambulatory Surgical Center (ASC) Payment System
Learn about HCPCS updates (PDF).
Medicare Clarifies Recognition of Interstate License Compact Pathways — Revised
Read clarified language (PDF) about licenses that certain providers get through interstate licensing compact pathways.
Publications
Medicare Vision Services — Revised
Read new information (PDF) in this Medicare Learning Network fact sheet:
- Added language on cataracts, ambulatory surgical centers, and code Z13.5
- Added CPT codes 66988 and 66987
- Added glaucoma screening services billing revenue codes and type of service codes
- Get resources to advance health equity and help eliminate health disparities
Power Mobility Devices — Revised
Read new information (PDF) in this Medicare Learning Network booklet:
- Added information on policies, standard written orders, face-to-face encounters, and the master list
- Removed information on 7-element order; detailed product description, 45-day order time frame, face-to-face documentation receipt, delivery requirements, and date stamp
- Changed face-to-face exam to face-to-face encounter
Transitional Care Management Services — Revised
Read new information (PDF) in this Medicare Learning Network booklet:
- Added codes you can bill concurrently
- Added language about auxiliary personnel providing services under supervision
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