Thursday, October 14, 2021
- Pneumococcal Conjugate Vaccine, 20 Valent
- DATA 2000 Waiver Training Payments Still Available for Rural Health Clinics
- Medicare Ground Ambulance Data Collection System Webinar: Volunteer Organizations — October 14
- Medicare Ground Ambulance Data Collection System Webinar: Public Safety Organizations — October 21
- Changes to the Laboratory National Coverage Determination (NCD) Edit Software for January 2022
- January 2022 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files & Revisions to Prior Quarterly Pricing Files
- Quarterly Update for the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP) — January 2022
- Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 28.0, Effective January 1, 2022
- National Coverage Determination (NCD 110.24): Chimeric Antigen Receptor (CAR) T-cell Therapy – This CR Rescinds and Fully Replaces CR 11783 — Revised
- Health Equity Web-Based Trainings
- SNF Quality Reporting Program: Section O: O0100. Special Procedures, Treatments, and Programs Web-Based Training
View this edition as a PDF (PDF)
News
Pneumococcal Conjugate Vaccine, 20 Valent
Medicare began covering Pneumococcal conjugate vaccine, 20 valent on October 1. CMS suggests submitting separate claims for this vaccine (HCPCS code 90677).
- Part A Medicare Administrative Contractors (MACs) will hold these claims until the April 2022 system update
- Part B MACs began processing these claims on October 4
- CMS will deny claims for vaccines provided July 1–September 30 (before it was covered by Medicare)
DATA 2000 Waiver Training Payments Still Available for Rural Health Clinics
HRSA continues to accept applications for payment from Rural Health Clinics (RHCs) employing buprenorphine-waivered providers under the Drug Addiction Treatment Act of 2000 (DATA 2000) Waiver Training Payment Program.
The program gives RHCs the opportunity to apply for a $3,000 payment for each eligible employed provider who attained a DATA 2000 waiver on or after January 1, 2019. Approximately $1.5 million in program funding remains available for RHCs and will be paid on a first-come, first-served basis until funds are exhausted.
HRSA is collaborating with the Substance Abuse and Mental Health Services Administration (SAMHSA) to process these applications. For more information, the program provides a video and FAQs.
Compliance
Non-Physician Outpatient Services Provided Before or During Inpatient Stays: Bill Correctly
An Office of Inspector General report found that Medicare improperly paid for non-physician outpatient services provided shortly before or during inpatient stays. Review the FAQs on the 3-Day Payment Window for Services Provided to Outpatients Who Later Are Admitted as Inpatients (PDF) MLN Matters Article to help you bill correctly for these services.
Additional resources:
- Medicare Benefit Policy Manual, Chapter 6 (PDF), Section 20.4
- Medicare Claims Processing Manual, Chapter 12 (PDF), Sections 90.7, 90.7.1
- CY 2012 Medicare Physician Fee Schedule Final Rule
Events
Medicare Ground Ambulance Data Collection System Webinar: Volunteer Organizations — October 14
Thursday, October 14 from 2–3 pm ET
Register for this Zoom webinar.
Target Audience: Volunteer ground ambulance organizations
Learn about the Medicare Ground Ambulance Data Collection Instrument instructions and questions related to volunteer staff, including how to report:
- Labor hours
- Costs associated with volunteers
You may send questions in advance to AmbulanceDataCollection@cms.hhs.gov with “October 14 Volunteer Organizations Webinar” in the subject line. During the call we’ll answer questions submitted in advance and live questions in the “chat” box.
More information:
- Presentation (PDF)
- Ambulances Services Center webpage – includes lists of organizations that must collect data starting in 2022
- CY 2022 Physician Fee Schedule (PFS) proposed rule
- CY 2020 PFS final rule
- Bipartisan Budget Act of 2018
Medicare Ground Ambulance Data Collection System Webinar: Public Safety Organizations — October 21
Thursday, October 21 from 2–3 pm ET
Register for this Zoom webinar.
Target Audience: Ground ambulance organizations that also provide safety services, such as fire and police
Learn about Medicare Ground Ambulance Data Collection Instrument instructions and questions related to public safety-based ambulance organizations including how to:
- Describe your organization’s public safety services
- Report on staff, facilities, and vehicles with both ground ambulance and public safety roles
You may send questions in advance to AmbulanceDataCollection@cms.hhs.gov with “October 21 Public Safety Organizations Webinar” in the subject line. During the webinar, we’ll answer questions submitted in advance and live in the “chat” box.
More information:
- Presentation (PDF)
- Ambulances Services Center webpage – includes lists of organizations that must collect data starting in 2022
- CY 2022 Physician Fee Schedule (PFS) proposed rule
- CY 2020 PFS final rule
- Bipartisan Budget Act of 2018
MLN Matters® Articles
Changes to the Laboratory National Coverage Determination (NCD) Edit Software for January 2022
Read the quarterly release of the edit module for clinical diagnostic laboratory services (PDF).
January 2022 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files & Revisions to Prior Quarterly Pricing Files
Learn about quarterly updates to the following pricing files (PDF) effective for dates of service:
- January 1–March 31, 2021: January 2021 ASP and ASP Not Otherwise Classified (NOC)
- April 1–June 30, 2021: April 2021 ASP and ASP NOC
- July 1–September 30, 2021: July 2021 ASP and ASP NOC
- October 1–December 31, 2021: October 2021 ASP and ASP NOC
- January 1–March 31, 2022: January 2022 ASP and ASP NOC
Quarterly Update for the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP)— January 2022
Learn about DMEPOS updates (PDF):
- We didn’t add or remove any ZIP or HCPCS codes for October–December 2021
- We’ll post January–March 2022 updates on or around January 1, 2022
Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 28.0, Effective January 1, 2022
Learn about replacement files for NCCI practitioner PTP edits for October 1, 2021 (PDF).
National Coverage Determination (NCD 110.24): Chimeric Antigen Receptor (CAR) T-cell Therapy – This CR Rescinds and Fully Replaces CR 11783 — Revised
Learn new information about using the KX modifier (PDF):
- Use the KX modifier when you send claims for CAR T-cell therapy services to show that you provided the service in an FDA Risk Evaluation and Mitigation Strategies approved facility
- Your MAC only allows CAR T-cell therapy services when the line item contains the KX modifier
Multimedia
Health Equity Web-Based Trainings
Take Medicare Learning Network (MLN) web-based training courses to learn about health equity:
- Modernizing Health Care to Improve Physical Accessibility – New
- Achieving Health Equity
- Improving Health Care Quality for LGBTQ People
More Information:
- MLN Web-Based Training webpage
- CMS Office of Minority Health webpage
SNF Quality Reporting Program: Section O: O0100. Special Procedures, Treatments, and Programs Web-Based Training
Get an overview of assessment and coding of Section O: O0100. Special Procedures, Treatments, and Programs in this web-based training course (0:30). This course is for Skilled Nursing Facilities (SNFs) and includes interactive exercises to test your knowledge.
Questions?
- Accessing the course or feedback regarding the training: email PACTraining@EconometricaInc.com
- Content-related questions: email SNFQualityQuestions@cms.hhs.gov
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