Thursday, June 23, 2022
- Ambulance Prior Authorization Model Expands August 1
- Orthoses Referring Providers: Comparative Billing Report in June
- Medical Records Correspondence Address
- Inpatient Rehabilitation Facility Provider Preview Reports: Review by July 15
- Long-Term Care Hospital Provider Preview Report: Review by July 15
- Cognitive Assessment: What’s in the Written Care Plan?
News
Ambulance Prior Authorization Model Expands August 1
On August 1, 2022, the Repetitive, Scheduled Non-Emergent Ambulance Transport Prior Authorization Model will expand to:
- Alaska, Arizona, Idaho, Kentucky, Montana, North Dakota, Ohio, Oregon, South Dakota, Utah, Washington, and Wyoming
- Nationwide for Railroad Retirement Board patients
Visit the Model webpage for the timeline, updates, and other information.
Orthoses Referring Providers: Comparative Billing Report in June
In late June, CMS will issue a Comparative Billing Report (CBR) on Medicare Part B claims for orthoses referring providers. 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 PECOS to make sure you get it.
More Information:
- View a webinar recording
- Visit the CBR website
- Register for a live webinar on July 6 from 3–4 pm ET
Medical Records Correspondence Address
Do you submit claims for durable medical equipment or Part B services? Tell CMS where to send correspondence for medical record requests and related inquiries by entering the address in PECOS.
Inpatient Rehabilitation Facility Provider Preview Reports: Review by July 15
Review your data by July 15, and contact CMS if you have questions about your scores. We’ll publish the data on the Care Compare webpage and in the Provider Data Catalog in September.
Visit the Updates section of the Public Reporting webpage for more information.
Long-Term Care Hospital Provider Preview Report: Review by July 15
Review your data by July 15, and contact CMS if you have questions about your scores. We’ll publish the data on the Care Compare webpage and in the Provider Data Catalog in September.
Visit the Updates section of the Public Reporting webpage for more information.
Cognitive Assessment: What’s in the Written Care Plan?
Do you have a patient with a cognitive impairment? Medicare covers a separate visit for a cognitive assessment so you can more thoroughly evaluate cognitive function and help with care planning. Any clinician eligible to report evaluation and management services can offer this service, including: physicians (MD and DO), nurse practitioners, clinical nurse specialists, and physician assistants.
The Cognitive Assessment & Care Plan Services (CPT code 99483) typically start with a 50-minute face-to-face visit that includes a detailed history and patient exam. Use information you gather from the exam to create a written care plan.
The resulting written care plan includes initial plans to address:
- Neuropsychiatric symptoms
- Neurocognitive symptoms
- Functional limitations
- Patient or caregiver referrals to community resources, as needed, with initial education and support
Effective January 1, 2022, Medicare pays approximately $283 (may be geographically adjusted) for these services when provided in an office setting.
Get details on Medicare coverage requirements and proper billing at cms.gov/cognitive.
Claims, Pricers, & Codes
Quarterly Update to the National Correct Coding Initiative [NCCI] Procedure-to-Procedure [PTP] Edits, Version 28.2, Effective July 1, 2022
NCCI third quarter edit files are available on these Medicare NCCI webpages:
MLN Matters® Articles
July Quarterly Update for 2022 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule
Learn about the updated Rural ZIP Code file (PDF) used for rural pricing in non-competitively bid areas starting July 1, 2022.
Publications
Medicare Diabetes Self-Management Training — Revised
Learn about changes to this service, including (PDF):
- Registered dietitians and nutrition professionals may provide services if they’re an accredited diabetes self-management training (DSMT) entity or represent an accredited entity
- Services require a referral from the physician or qualified non-physician practitioner (NPP) treating the patient’s diabetic condition
- You can’t provide DSMT and medical nutrition therapy (MNT) to a patient on the same service date, or incident to a physician’s or NPP’s professional services
- You may provide MNT and DSMT services as telehealth services when the registered dietitians or nutrition professionals act as distant site practitioners
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