Thursday, October 5, 2023
- Administration Moves Forward with Medicare Drug Price Negotiations to Lower Prescription Drug Costs for People with Medicare
- CMS Requests Public Input on Coverage of Over-the-Counter Preventive Services, Including Contraception, Tobacco Cessation, and Breastfeeding Supplies
- Action Plan for Sickle Cell Disease Month
- CMS Burden Reduction News & Insights Fall Newsletter
- New COVID-19 Treatments Add-On Payment Ended September 30
- Clinical Laboratory Fee Schedule: Submit Your Comments
- DMEPOS: New Provider Enrollment Appeals & Rebuttals Contractor Starts October 9
- Help Detect Breast Cancer Early
News
Administration Moves Forward with Medicare Drug Price Negotiations to Lower Prescription Drug Costs for People with Medicare
All 10 drug companies (PDF) whose drugs were selected for price negotiation with Medicare for the first cycle of the program have decided to participate in those negotiations. These companies manufacture some of the costliest and most commonly used prescription drugs.
More Information:
- Full HHS press release
- Selected Drugs for Initial Price Applicability Year 2026 (PDF) fact sheet
- CMS Statement
- Medicare Drug Price Negotiation webpage
CMS Requests Public Input on Coverage of Over-the-Counter Preventive Services, Including Contraception, Tobacco Cessation, and Breastfeeding Supplies
The Departments of HHS, Labor, and the Treasury are seeking public input on how best to ensure coverage and access to over-the-counter (OTC) preventive services, including the benefits of requiring most health insurance plans to cover these services at no cost and without a prescription by a health care provider. This new Request for Information (PDF) solicits comment on access to a range of OTC items recommended by experts for preventive care that can be purchased without a prescription, including contraceptives, tobacco smoking cessation products, folic acid during pregnancy, and breastfeeding supplies.
See the full press release.
Action Plan for Sickle Cell Disease Month
As we reflect on Sickle Cell Awareness Month, CMS reaffirms our commitment to improving access to and the quality and experience of care for individuals living with Sickle Cell Disease (SCD). Most individuals with SCD who have health coverage receive coverage through Medicaid, the Children’s Health Insurance Program, and/or Medicare. CMS recognizes the challenges that people living with SCD face and has released a Sickle Cell Disease Action Plan (PDF) that outlines our efforts to eliminate barriers, reduce health disparities, and improve health outcomes for individuals with SCD.
The Action Plan focuses on four key areas:
- Expanding coverage and access
- Improving quality and the continuum of care
- Advancing equity and engagement
- Examining data and analytics
More Information:
- Full blog
- How CMS is Addressing SCD (PDF) infographic
- Sickle Cell Disease: What You Need to Know video (01:50)
- The Invisible Crisis: Understanding Pain Management in Medicare Beneficiaries with Sickle Cell Disease (PDF) data highlight
CMS Burden Reduction News & Insights Fall Newsletter
You may be interested in the Fall Burden Reduction Newsletter (PDF), which includes:
- CMS HL7® FHIR® CONNECTATHON Slides and Recordings
- Guidance on NPI Enumeration
New COVID-19 Treatments Add-On Payment Ended September 30
Through the New COVID-19 Treatments Add-On Payment (NCTAP), Medicare provided an enhanced payment for eligible inpatient cases that use certain new products with current FDA approval or emergency use authorization to treat COVID-19. The NCTAP was effective November 2, 2020 – September 30, 2023.
Clinical Laboratory Fee Schedule: Submit Your Comments
Get the latest payment information on the Clinical Laboratory Fee Schedule (CLFS), and find out how and when you can comment:
- CY 2024 preliminary payment determinations (ZIP): Submit comments by October 27 to CLFS_Annual_Public_Meeting@cms.hhs.gov.
- Final Medicare Administrative Contractor 2023 gapfill recommendations for CY 2024 (ZIP): Submit payment reconsideration requests by October 27. Once CMS posts the final, complete CY 2024 CLFS fee schedule, the gapfilled payment amount is final.
- Medicare Advisory Panel on Clinical Diagnostic Laboratory Tests: Submit nominations to fill vacancies.
Starting January 1, 2024, laboratories must report private payor data to CMS. Visit Clinical Laboratory Fee Schedule for more information, and find out if you’re a laboratory that must report. If so, learn when and how to report.
DMEPOS: New Provider Enrollment Appeals & Rebuttals Contractor Starts October 9
Starting Monday, October 9, 2023, send all DMEPOS provider enrollment appeals and rebuttals to Chags Health Information Technology LLC:
- Fax: 866-410‐7404
- Phone: 800-245‐9206
- Email: PEARC@c‐hit.com
- Mailing Address: P.O. BOX 45266, Jacksonville, FL 32232
Friday, October 6 is the last day the National Supplier Clearinghouse will accept them. They’ll review and decide on appeals submitted before the transition date.
Contact ProviderEnrollmentARC@cms.hhs.gov if you have any questions about the transition.
Help Detect Breast Cancer Early
Almost 99% of women diagnosed with breast cancer at the earliest stage live for 5 years or more (see data snapshot). During National Breast Cancer Awareness Month, talk with your patients about the best screening options to help detect breast cancer early.
Medicare pays for:
- Mammography screening
- Clinical breast exam during screening pelvic exams
Your patients pay nothing if you accept assignment. Find out when your patient is eligible for their next screening. If you need help, contact your eligibility service provider.
More Information:
- Screening Pap Tests & Pelvic Exams (PDF) booklet
- CDC Breast Cancer webpage
- Mammograms and cervical & vaginal cancer screenings: Get information for your Medicare patients
Claims, Pricers, & Codes
RARCs, CARCs, Medicare Remit Easy Print, & PC Print: October Update
Get updated remittance advice remark codes (RARCs) and claim adjustment reason codes (CARCs), and watch for software updates if you use Medicare Remit Easy Print or PC Print.
More Information:
- Sections 40.5, 60.2, and 60.3 Medicare Claims Processing Manual, Chapter 22 (PDF)
- Instruction to your Medicare Administrative Contractor (PDF)
Publications
Medicare Provider Compliance Newsletter
Learn how to address and avoid common billing errors (PDF):
- Hospital outpatient services
- Hypoglossal nerve stimulation for obstructive sleep apnea: medical necessity and documentation requirements
Multimedia
Post-Acute Care Quality Reporting Programs: Brief Interview for Mental Status Video
CMS developed a brief interview for mental status video (03:23) to help you determine:
- When to stop the interview
- How to code the remaining items
Contact the PAC Training Mailbox with questions or feedback.
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