Thursday, November 30, 2023
- Quality Payment Program: Preview Your Performance Information by December 12
- HIV: Screening is Knowledge
- Resubmit Telehealth Claims with Modifier CS
- Federally Qualified Health Center Prospective Payment System: CY 2024 Pricer
- Rural Health Clinic CY 2024 All-Inclusive Rate
- Beta Amyloid Positron Emission Tomography in Dementia and Neurodegenerative Disease
- ESRD & Acute Kidney Injury Dialysis: CY 2024 Updates
- Medicare Physician Fee Schedule Final Rule Summary: CY 2024
- Medicaid and CHIP Renewals: Patient-Centered Messaging for Clinical Offices and Health Care Settings
News
Quality Payment Program: Preview Your Performance Information by December 12
Doctors and clinicians: Now through December 12 at 8 p.m. ET, preview your 2022 performance information before it appears on the Medicare.gov compare tool and in the Provider Data Catalog. Learn more about the 2022 Preview Period and public reporting at Care Compare: Doctors and Clinicians Initiative.
HIV: Screening is Knowledge
The CDC estimates that 1.2 million people in the U.S. had HIV in 2021, and about 13% didn’t know they had it (see CDC). Screening is the only way to know for sure if they have HIV. Knowing their status helps them choose options to stay healthy. On World AIDS Day, talk with your patients about HIV prevention and screening.
Medicare pays for HIV screening, and your patients pay nothing if you accept assignment. Find out when your patient is eligible for this screening and learn about screening frequency. If you need help, contact your eligibility service provider.
More Information:
- HIV/AIDS (PDF) data snapshot: Learn about disparities in Medicare patients
- CDC HIV webpage
- Administration for Community Living HIV/AIDS webpage
- HIV screenings: Get information for your patients
Claims, Pricers, & Codes
Resubmit Telehealth Claims with Modifier CS
The following Rural Health Clinic (71X) and Federally Qualified Health Clinic (77X) telehealth claims were incorrectly returned to provider with edit W7123:
- Preventive services that have cost sharing waived
- HCPCS code G2025 billed with modifier CS
CMS addressed this issue. Resubmit these claims with modifier CS to your Medicare Administrative Contractor.
Federally Qualified Health Center Prospective Payment System: CY 2024 Pricer
Based on data through June 2023, the CY 2024 Federally Qualified Health Center (FQHC) Prospective Payment System base payment rate is $195.99, which is 4.7% higher than 2023. Find your geographic adjustment factor (ZIP).
More Information:
Rural Health Clinic CY 2024 All-Inclusive Rate
CMS updated the rural health clinic (RHC) all-inclusive rate for CY 2024:
Independent & Provider-Based RHCs in Hospital with 50 or More Beds
The payment limit per visit is $139.00.
Specified (Grandfathered) Provider-Based RHCs with April 1, 2021, Established Payment Limit
For RHCs that continue to meet the qualifications in section 1833(f)(3)(B) of the Act, the payment limit per visit is the greater of these amounts:
- Your payment limit per visit starting January 1, 2023, increased by 4.6%
- The national statutory CY 2024 payment limit per visit of $139.00
More Information:
- Section 20.2 Medicare Claims Processing Manual, Chapter 9 (PDF)
- Instruction to your Medicare Administrative Contractor (PDF)
MLN Matters® Articles
Beta Amyloid Positron Emission Tomography in Dementia and Neurodegenerative Disease
CMS removed NCD 220.6.20 (PDF) from the Medicare National Coverage Determination Manual, effective October 13, 2023. Your Medicare Administrative Contractor will make coverage determinations.
ESRD & Acute Kidney Injury Dialysis: CY 2024 Updates
Learn about changes effective January 1, 2024 (PDF):
- Rate updates and policies for the ESRD Prospective Payment System
- Payment for renal dialysis services provided to patients with acute kidney injury in ESRD facilities
Medicare Physician Fee Schedule Final Rule Summary: CY 2024
Learn about changes to (PDF):
- Telehealth services
- Evaluation and management visits
- Behavioral health services
- Dental and oral health services
- Therapy services
- Diabetes self-management training services
- Community health integration services
- Principal illness navigation services
- Social determinants of health
- Caregiver training
Information for Patients
Medicaid and CHIP Renewals: Patient-Centered Messaging for Clinical Offices and Health Care Settings
CMS released a new toolkit to help you share information about Medicaid and Children’s Health Insurance Program (CHIP) renewals with patients. There’s also information on how to help patients transition to other health coverage options if they’re no longer eligible for Medicaid or CHIP. This toolkit includes ready-to-use resources like:
- FAQs
- Recorded phone and hold messages
- No reply text messages and push notifications for patient portals
- E-newsletter and patient portal messages
We encourage you to use these resources at your office’s front desk and in lobby or waiting areas, the billing department, patient portals, and other places. For more materials on Unwinding and Returning to Regular Operations after COVID-19, see outreach and educational resources.
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