Thursday, January 25, 2024
- CMS Announces New Actions to Help Hospitals Meet Obligations under EMTALA
- CMS Announces New Model to Advance Integration in Behavioral Health
- Doctor & Clinician Utilization (Procedure Volume) Data on Medicare.gov Compare Tool: Now Available
- Continuous Glucose Monitor Supplies: Option to Bill for 90 Days
- Grandfathered Tribal Federally Qualified Health Centers: CY 2024 Rate
- Skilled Nursing Facility: Updates to Services Excluded from Consolidated Billing
- Poverty: Help Improve Access to Health Care
- Billing Requirements for Intensive Outpatient Program Services for Federally Qualified Health Centers & Rural Health Clinics
- HCPCS Codes Used for Skilled Nursing Facility Consolidated Billing Enforcement: April 2024 Quarterly Update
- How to Use the Office & Outpatient Evaluation and Management Visit Complexity Add-on Code G2211
- Refillable DMEPOS Documentation Requirements
News
CMS Announces New Actions to Help Hospitals Meet Obligations under EMTALA
HHS announced that, together with CMS, it will launch a series of actions to educate the public about their rights to emergency medical care and help support efforts of hospitals to meet their obligations under the Emergency Medical Treatment and Labor Act (EMTALA). As part of this comprehensive plan, the Department will:
- Publish new informational resources on CMS’s website to help individuals understand their rights under EMTALA and the process for submitting a complaint if they are denied emergency medical care
- Partner with hospital and provider associations to disseminate training materials on providers’ obligations under EMTALA
- Convene hospital and provider associations to discuss best practices and challenges in ensuring compliance with EMTALA
- Establish a dedicated team of HHS experts who will increase the Department’s capacity to support hospitals in complying with federal requirements under EMTALA
See the full press release.
CMS Announces New Model to Advance Integration in Behavioral Health
HHS, through CMS, announced a new model to test approaches for addressing the behavioral and physical health, as well as health-related social needs, of people with Medicaid and Medicare. The Innovation in Behavioral Health (IBH) Model’s goal is to improve the overall quality of care and outcomes for adults with mental health conditions and/or substance use disorder by connecting them with the physical, behavioral, and social supports needed to manage their care. The model will also promote health information technology (health IT) capacity building through infrastructure payments and other activities.
The model will launch in Fall 2024 and is anticipated to operate for eight years in up to eight states. CMS will release a Notice of Funding Opportunity for the model in Spring 2024.
More Information:
Doctor & Clinician Utilization (Procedure Volume) Data on Medicare.gov Compare Tool: Now Available
CMS added utilization data, specifically procedure volume, for the first time on the Medicare.gov compare tool’s profile pages for doctors and clinicians. The procedures initially added to profile pages were performed by doctors and clinicians for Original Medicare and Medicare Advantage patients in the last 12 months.
Utilization data was first published in downloadable format only in late 2017. This information is a subset of the “Medicare Physician & Other Practitioners – by Provider and Service” dataset and currently published in the Provider Data Catalog. A procedure volume data file is now available and includes the procedure category information currently publicly reported on the compare tool on Medicare.gov profile pages for doctors and clinicians.
The initial release of procedure volume data on doctor and clinician profile pages includes 12 procedures (additional procedures will be added periodically, as feasible):
- Hip replacement
- Knee replacement
- Spinal fusion
- Cataract surgery
- Colonoscopy
- Hernia repair – groin (open)
- Hernia repair (minimally invasive)
- Mastectomy
- Coronary artery bypass graft (CABG)
- Pacemaker insertion or repair
- Coronary angioplasty and stenting
- Prostate resection
More Information:
- Fact sheet (PDF)
- Care Compare: Doctors and Clinicians Initiative webpage
- Quality Payment Program (QPP) Service Center – If you have questions about public reporting:
- Email QPP@cms.hhs.gov
- Create a QPP Service Center ticket
- Call 866-288-8292
- Dial 711 to connect with a Telecommunications Relay Services Communications Assistant if you’re deaf or hard of hearing
Continuous Glucose Monitor Supplies: Option to Bill for 90 Days
Effective January 1, 2024, in addition to the current 30-day increments, you have the option to bill for 90-day increments for continuous glucose monitor supplies.
More Information:
- Diabetic Accessories & Supplies (including Glucose Monitors) Medicare Provider Compliance Tip
- Instruction to your Medicare Administrative Contractor (PDF)
Grandfathered Tribal Federally Qualified Health Centers: CY 2024 Rate
The CY 2024 grandfathered tribal Federally Qualified Health Center Prospective Payment System rate is $667.00 for medically necessary face-to-face visits.
CMS will adjust CY 2024 claims paid at the CY 2023 rate. You don’t need to take any action.
See the instruction to your Medicare Administrative Contractor (PDF).
Skilled Nursing Facility: Updates to Services Excluded from Consolidated Billing
CMS updated manuals to add marriage and family therapists and mental health counselors to the list of services excluded from skilled nursing facility consolidated billing effective January 1, 2024:
- Section 10.2 Medicare Benefit Policy Manual, Chapter 8 (PDF); see the instruction to your Medicare Administrative (MAC) (PDF)
- Section 20.1.1 Medicare Claims Processing Manual, Chapter 6 (PDF); see the instruction to your MAC (PDF)
Poverty: Help Improve Access to Health Care
People living in impoverished communities often have reduced access to resources to support a healthy lifestyle. Poverty disproportionately affects racial and ethnic groups, including American Indian or Alaska Native (24.5%), Black or African American (21.4%), and Hispanic or Latino (16.7%). Collect social determinants of health data with ICD-10-CM Z codes (PDF) to identify factors influencing health status, including poverty. During Poverty Awareness Month, learn about the importance of advancing health equity.
More Information:
- Coverage to Care: Roadmap to Better Care (PDF) and Get Preventive Care webpage
- CMS Framework for Health Equity 2022–2032 (PDF)
- Healthy People 2030 - Poverty webpage
Compliance
Opioid Treatment Program: Bill Correctly for Opioid Use Disorder Treatment Services
In a report, the Office of the Inspector General found that Opioid Treatment Program (OTP) providers didn’t always comply with federal requirements when they bill for opioid use disorder (OUD) treatment services, including intake activities. Review OTP Billing & Payment, and learn how to:
- Bill for OUD services
- Use the correct G-codes for treatment
MLN Matters® Articles
Billing Requirements for Intensive Outpatient Program Services for Federally Qualified Health Centers & Rural Health Clinics
Learn about Intensive Outpatient Program services (PDF):
- Scope of benefits
- Certification and plan of care requirements
- Payment policies
- Coding and billing requirements
HCPCS Codes Used for Skilled Nursing Facility Consolidated Billing Enforcement: April 2024 Quarterly Update
Learn about codes excluded from skilled nursing facility consolidated billing (PDF), including:
- Angiography
- Chemotherapy
- Radioisotope
- Customized prosthetic devices
- Blood clotting factors
Your Medicare Administrative Contractor will reopen and reprocess incorrectly paid claims with these codes that you bring to their attention.
How to Use the Office & Outpatient Evaluation and Management Visit Complexity Add-on Code G2211
Learn about changes to G2211 effective January 1 (PDF):
- Correct use of the code and modifier 25
- Documentation requirements for G2211
- Coinsurance and deductible
Refillable DMEPOS Documentation Requirements
Learn about the requirement to contact the patient (PDF) before you refill DMEPOS products.
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