Thursday, April 21, 2022
- Hospice Quality Reporting Program: Key Dates & Measure Change
- Ambulance Ground Transport: Comparative Billing Report in April
- Hospices: Aggregate & Inpatient Caps under the Value-Based Insurance Design Model
News
Hospice Quality Reporting Program: Key Dates & Measure Change
CMS updated the Public Reporting: Key Dates for Providers webpage to help you prepare for Hospice Quality Reporting Program refreshes through November 2022.
Public reporting for the Hospice Visits in the Last Days of Life (HVLDL) measure begins this May. It replaces the Hospice Visits When Death is Imminent (HVWDII) measure. Learn more about the measure development process.
Ambulance Ground Transport: Comparative Billing Report in April
In late April, CMS will issue a Comparative Billing Report (CBR) on Medicare Part B claims for ambulance ground transport. Use the data-driven report to compare your billing practices with those of 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.
For More Information:
- View a webinar recording
- Visit the CBR website
- Register for a live webinar on May 11 from 3–4 pm ET
Hospices: Aggregate & Inpatient Caps under the Value-Based Insurance Design Model
Is your Medicare patient enrolled in a Medicare Advantage plan that’s participating in the Value-Based Insurance Design (VBID) Model’s Hospice Benefit Component? If so, you can’t include your Medicare Advantage plan payments for these patients in calculating your aggregate and inpatient cap payments for January 1, 2021–December 31, 2024, the performance period of the Model component.
More Information:
- Section 90 Medicare Benefit Policy Manual, Chapter 9 (PDF)
- VBID Model Hospice Benefit Component Billing & Payment webpage
- Calendar Year 2021 Technical and Operational Guidance
Compliance
Medicare Provider Compliance Newsletter
Learn about guidance to address billing errors (PDF):
- Hospice certification and recertification of terminal illness
- Refills of durable medical equipment, prosthetics, orthotics, and supplies: items provided on a recurrent basis
- Total hip arthroplasty: medical necessity and documentation requirements
DMEPOS Items: Medical Record Documentation
For Medicare to cover any Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) item, the patient’s medical record must include enough documentation to justify the need for:
- Type and quantity of items ordered
- Frequency of use (or replacement if applicable)
The medical record should include the patient’s diagnosis and:
- Condition duration
- Clinical course (worsening or improving)
- Prognosis
- Nature and extent of functional limits
- Other therapeutic interventions and results
- Experience with related items
The medical record may include records from hospitals, nursing facilities, home health agencies, and other health care professionals.
See Section 5.9 of the Medicare Program Integrity Manual, Chapter 5 (PDF) for more information.
Events
CMS Health Equity Symposium — April 28
Thursday, April 28 from 1–2:30 pm ET
During the symposium, the Office of Minority Health will discuss:
- How CMS is operationalizing health equity across all our programs, including Medicare, Medicaid, the Children’s Health Insurance Program, and the Health Insurance Marketplaces
- HHS and CMS equity plan initiatives, including the importance of data collection, the connection to stakeholder and partner efforts to improve health equity, and additional health equity information and updates
We’ll post materials on the Webinar & Events webpage.
MLN Matters® Articles
Update to Publication 100-04, Chapter 18 and Publication 100-02, Chapter 15, Section to Add Data Regarding Novel Coronavirus (COVID-19) and its Administration to Current Claims Processing Requirements and Other General Updates
Learn about updates to the Medicare Claims Processing and Benefits Policy Manuals (PDF):
- Added payment processing instructions for COVID-19 vaccines
- Added COVID-19 to the list of preventive vaccines that we cover without coinsurance or deductible
- Streamlined the process to enroll as a centralized biller
Publications
Medicare Modernization of Payment Software — Revised
Do you submit institutional claims to Medicare Administrative Contractors? Share these updates with your software vendor (PDF):
- ICD-10 software
- Web pricer
- Java conversion schedule
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