- CMS Roundup (Apr. 5, 2024)
- Medicare Shared Savings Program: Application Toolkit Materials
- CMS Health Information Handler Helps You Submit Medical Review Documentation Electronically
- Help Improve the Health of Minority Populations
- COVID-19 Monoclonal Antibody: New Codes for PEMGARDA
- HCPCS Application Summaries & Coding Decisions: Drugs & Biologicals
- Extended & Large-Scale Emergency Resources
- Highly Pathogenic Avian Influenza Virus: Identification of Human Infection and Recommendations for Investigations and Response
Proposed Payment Rule
CMS Proposes New Policies to Support Underserved Communities, Ease Drug Shortages, and Promote Patient Safety
Learn about the FY 2025 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) proposed rule. See the IPPS and LTCH PPS rule and related files.
More information:
- Press Release
- Transforming Episode Accountability Model fact sheet (PDF) and FAQs
News
CMS Roundup (Apr. 5, 2024)
You may be interested in these topics from the CMS Roundup:
- Medicare Part B Quarterly Average Sales Pricing Files
- Minority Research Grant Program Notice of Funding Opportunity
- Progress in Specialty Care Strategy
- Impact of a New Quality Pathway on Patient Experience
Medicare Shared Savings Program: Application Toolkit Materials
Accountable Care Organizations (ACOs): See the Medicare Shared Savings Program Application Toolkit to get resources for the upcoming application submission cycle.
CMS will accept Shared Savings Program applications starting May 20 through the ACO Management System. Apply no later than noon ET on June 17.
More Information:
- Application Types & Timeline webpage
- Key Application Actions and Deadlines (PDF)
Email questions to SharedSavingsProgram@cms.hhs.gov
CMS Health Information Handler Helps You Submit Medical Review Documentation Electronically
Learn about the CMS Health Information Handler (CMS HIH), a free service to help you upload and submit your medical documentation electronically to your Medicare Administrative Contractor using the following formats:
- Portable document format (PDF)
- Extensible markup language (XML)
- JavaScript object notation (JSON)
Respond electronically to prior authorization and additional document requests:
- Unlimited number of transactions
- Fast, safe, and secure environment
- Easily accessible
The benefits of the CMS HIH include:
- Hosted on CMS Amazon Web Services cloud
- Adheres to all CMS security and privacy standards
- Accommodates small or large users
Contact cmshih@cms.hhs.gov to learn more, and get started.
Help Improve the Health of Minority Populations
National Minority Health Month is a time to reemphasize the importance of health care in racial and ethnic minority communities. Health disparities disproportionately affect people from historically marginalized communities, who often face greater health care challenges, including:
- Limited access to care
- Higher rates of chronic conditions
- Worse health outcomes
- Stigma and discrimination in health care settings
Take action to improve health equity, and help eliminate avoidable differences in health outcomes.
Medicare covers preventive services, and generally, your patients pay nothing if you accept assignment. Find out when your patient is eligible for services. If you need help, contact your eligibility service provider.
More Information:
- Mapping Medicare Disparities Tool
- Health Equity Technical Assistance webpage
- Preventive & screening services webpage: Get information for your patients
Compliance
Advance Care Planning: Bill Correctly for Services
In a report, the Office of the Inspector General found that Medicare providers who billed for advance care planning (ACP) services in an office setting didn’t always comply with federal requirements. Review Advance Care Planning (PDF), and learn how to:
- Document discussions
- Follow time-based coding requirements
More Information:
- Billing and Coding: ACP local coverage article
- ACP local coverage determination
Claims, Pricers, & Codes
COVID-19 Monoclonal Antibody: New Codes for PEMGARDA
On March 22, 2024, the FDA released an emergency use authorization for the PEMGARDA (pemivibart) investigational monoclonal antibody product for pre-exposure prophylaxis of COVID-19 in certain adults and adolescents.
Use 2 new HCPCS codes effective March 22, 2024:
- Product code Q0224
- Administration code M0224
Visit COVID-19 Monoclonal Antibodies for more information, and get the most current list of billing codes, including short descriptors, payment allowances, and effective & termination dates. Note: You may need to refresh your browser if you recently visited this webpage.
HCPCS Application Summaries & Coding Decisions: Drugs & Biologicals
CMS published the 2024 HCPCS Application Summary for Quarter 1, 2024 Drugs and Biologicals. See HCPCS Level II Coding Decisions for more information.
MLN Matters® Articles
Ambulatory Surgical Center Payment Update – April 2024
Learn about payment system updates (PDF) effective April 1, 2024:
- New codes
- Device code changes: Medicare Administrative Contractors (MACs) will reprocess certain claims with HCPCS codes C1602 and C1600
- iDose TR (travoprost intracameral implant) for treatment of glaucoma
- Payment weight correction for HCPCS code C9790: MACs will reprocess claims with dates of service from January 1 – March 31, 2024
- Drug and biological code changes and payment corrections: If you got an incorrect payment, you can ask your MAC to adjust the claim
- Skin code updates
Publications
Medical Record Maintenance & Access Requirements — Revised
Learn what’s changed (PDF). CMS added:
- Medical record information for teaching physicians and residents
Reminder for providers about signature requirements
From Our Federal Partners
Extended & Large-Scale Emergency Resources
Get resources for extended and large-scale emergencies, including information on mental health, staff burnout, and supplies:
- Executive Order on Increasing Access to High-Quality Care and Supporting Caregivers: describes steps to make sure behavioral health services are available for the health care workforce
- SAMHSA Disaster Technical Assistance Center: helps states, territories, and local entities respond to mental health needs
- SAMHSA Addressing Burnout in the Behavioral Health Workforce through Organizational Strategies: highlights how to prevent and reduce burnout among behavioral health workers
- Homeland Security Supply Chain Resilience Guide: describes how to analyze supply chains, enhance resilience, and inform logistics planning
Disaster Available Supplies in Hospitals: created by the Administration for Strategic Preparedness and Response to estimate supplies that may need to be immediately available during emergencies
Highly Pathogenic Avian Influenza Virus: Identification of Human Infection and Recommendations for Investigations and Response
The CDC issued a Health Alert Network Health Advisory to inform clinicians, state health departments, and the public of a recently confirmed human infection with highly pathogenic avian influenza (HPAI) A(H5N1) virus in the U.S. following exposure to presumably infected dairy cattle. The U.S. Department of Agriculture recently reported detections of highly pathogenic A(H5N1) virus in U.S. dairy cattle in multiple states. See a summary of interim CDC recommendations for preventing, monitoring, and conducting public health investigations of potential human infections with HPAI A(H5N1) virus.
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