Download voluntary sample formats and supporting data dictionaries from Hospital Price Transparency Resources to make your standard charges public in a machine-readable file. The sample formats use a standardized set of data elements. They reflect input from the CY 2022 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System proposed rule solicitation and a technical expert panel of industry experts from various hospitals, technology, and academia.

Effective January 1, 2021, each hospital operating in the U.S. is required to provide publicly-accessible standard charge information online about the items and services they provide in 2 ways:

Comprehensive machine-readable file with all items and services
Display of 300 shoppable services in a consumer-friendly format

For more information, see Hospital Price Transparency.

Medical Review After the COVID-19 Public Health Emergency: New FAQ

Read the new FAQ about how CMS’s review contractors (Medicare Administrative Contractors, Recovery Audit Contractors, and the Supplemental Medical Review Contractor) will conduct medical reviews after the COVID-19 public health emergency.

Flu Shots & COVID-19 Vaccines: Each Visit is an Opportunity

Did you know you can give flu shots and COVID-19 vaccines at the same visit? Every patient visit is an opportunity to promote:

Flu shots: CDC recommends annual shots for everyone 6 months and older
COVID-19 vaccines: updated vaccines should provide stronger protection against serious illness, getting infected, or spreading COVID-19

New for this flu season: Patients 65 and older should get a preferred vaccine if available. Preferred vaccines are potentially more effective than standard dose flu vaccines. There are 3 recommended vaccines:

If 1 of these recommended vaccines isn’t available, give your patients a standard-dose flu vaccine instead.

Medicare Part B covers:

Flu shot: seasonal flu shot and additional flu shots if medically necessary. Your patients pay nothing if you accept assignment.
COVID-19 vaccine: no applicable copayment, coinsurance, or deductible.

You can now check eligibility (PDF) for the flu shot and COVID-19 vaccine. If you need help, contact your eligibility service provider.

More Information:

CMS Flu Shot webpage
COVID-19 Vaccine Provider Toolkit
CDC Influenza (Flu) webpage
Vaccines.gov
Medicare Part D Vaccines (PDF) fact sheet
Flu shots and COVID-19 vaccine: Get information for your Medicare patients

Claims, Pricers, & Codes

DMEPOS: Corrected 2022 Fee Schedule Amounts

CMS identified errors in the 2022 Medicare DMEPOS fee schedule amounts for some items in the non-contiguous areas of Alaska, Hawaii, Puerto Rico, and the Virgin Islands. We released revised fee schedule files on November 10.

More Information:

Hospital Part B Inpatient Services Billing

Review instructions to bill Medicare Part B for inpatient services to prevent claim denials, including new information on allowed revenue codes. Remember to use a 12x type of bill. Find out about:

When Medicare pays (PDF) (Section 10)
Time limit for filing a claim (PDF) (Section 70)
Services allowed on claims (PDF) (Section 240)

See the Instruction to your Medicare Administrative Contractor (PDF).

Outpatient Prospective Payment System Payment Rate for HCPCS Code Q5124

See the updated October 2022 OPPS addenda, which corrected information for HCPCS code Q5124:

Status indicator: K
Payment rate: $232.780
Coinsurance: 20%

CMS will adjust claims with dates of service on or after October 1.

Events

HCPCS Public Meeting: November 29 – December 1

Tuesday, November 29 – Thursday, December 1 from 9 am – 5 pm ET

Attend a virtual public meeting for the second biannual 2022 HCPCS coding cycle. See HCPCS Public Meetings for agendas and more information.

MLN Matters® Articles

Provider Enrollment Instructions: Seventh General Update

Learn about updated provider enrollment instructions (PDF) for:

Ownership disclosures
Electronic funds transfers
Special payment addresses

ICD-10 & Other Coding Revisions to National Coverage Determinations (NCDs): April 2023 Update

Learn about changes for April 2023 (PDF), including:

Newly available codes
Coding revisions for NCDs 20.4 and 210.10

Publications

Home Health & Hospice: Medicare Provider Resources

Medicare covers a wide range of home health and hospice services. November, Home Care & Hospice Month, is a great time to get familiar with these resources:

Medicare Payment Systems educational tool: home health and hospice
Hospital-Based Hospice Medicare provider compliance tips
Creating an Effective Hospice Plan of Care (PDF) fact sheet
Enhancing RN Supervision of Hospice Aide Services (PDF) fact sheet
Safeguards for Medicare Patients in Hospice Care (PDF) fact sheet

Independent Diagnostic Testing Facility (IDTF) — Revised

Learn how indirect IDTFs are exempt from certain certification standards (PDF).

Multimedia

Quality in Focus Videos to Increase Quality of Care

Check out CMS’s new Quality in Focus interactive video series. The series of 10–15 minute videos is tailored to provider types and aims to reduce the deficiencies most commonly cited during the CMS survey process, like infection control and accident prevention. Reducing these common deficiencies increases the quality of care for people with Medicare and Medicaid.

Learn to:

Understand surveyor evaluation criteria
Recognize deficiencies
Incorporate solutions into your facility’s standards of care

See the Quality, Safety, & Education Portal Training Catalog, and select Quality in Focus.

Subscribe to the MLN Connects® newsletter. You can read previous issues in the archive.

This newsletter is current as of the issue date. View the complete disclaimer.

The Medicare Learning Network®, MLN Connects®, and MLN Matters® are registered trademarks of the U.S. Department of Health and Human Services (HHS).

2022-11-17-MLNC

MLN Matters® Articles