Thursday, May 23, 2024
- Medicare Shared Savings Program: Apply by June 17 for January 1 Start Date
- Medicare Providers: Deadlines for Joining an Accountable Care Organization
- Institutional Providers: Medicare Enrollment & Certification Roadmap
- Improve Your Search Results for CMS Content
- ICD-10 & Other Coding Revisions to National Coverage Determinations: October 2024 Update
- National Coverage Determination 110.23: Allogeneic Hematopoietic Stem Cell Transplantation
- Hospice Claims Edits for Certifying Physicians — Revised
News
Medicare Shared Savings Program: Apply by June 17 for January 1 Start Date
The Medicare Shared Savings Program is now accepting applications through the Accountable Care Organization (ACO) Management System. Apply no later than noon ET on June 17, 2024.
ACOs interested in Advance Investment Payments (PDF) or the ACO Primary Care Flex Model must first apply to the Shared Savings Program.
To learn more about the process, register for the upcoming June 5, 2024 webinar on Completing Phase 1 of the Application and Avoiding Common Deficiencies.
More information:
- Application Types & Timeline webpage
- Application Toolkit
- Key Application Actions and Deadlines (PDF)
- Email questions to SharedSavingsProgram@cms.hhs.gov
Medicare Providers: Deadlines for Joining an Accountable Care Organization
To participate in an Accountable Care Organization (ACO) for performance year 2025, work with an ACO to join their participant list. ACOs must submit their lists to CMS by August 1 at:
- Noon ET for the Medicare Shared Savings Program
- 11:59 pm ET for the ACO Realizing Equity, Access, and Community Health Model (ACO REACH)
Participant taxpayer identification numbers can only appear on one ACO participant list. Resolve any overlaps by September 5.
More Information:
- Application Types & Timeline webpage
- Email questions to SharedSavingsProgram@cms.hhs.gov or ACOREACH@cms.hhs.gov
Institutional Providers: Medicare Enrollment & Certification Roadmap
Read the Provider Enrollment & Certification Roadmap (PDF) to learn about each step of the process, including timeframes and points of contact.
More Information:
Improve Your Search Results for CMS Content
If you’re using a search engine to find information on CMS.gov, include “CMS” in your search term to get optimal results.
Compliance
Medical Services Authorized by the Veterans Health Administration: Avoid Duplicate Payments
In a report, the Office of the Inspector General found that Medicare paid providers for medical services authorized and paid for by the Department of Veterans Affairs’ community care programs, resulting in duplicate payments of up to $128 million. We don’t pay for services authorized under Veterans Health Administration benefits.
More information to bill correctly:
- Medicare Secondary Payer (PDF) booklet
- Medicare Overpayments (PDF) fact sheet
- Medicare Benefit Policy Manual, Chapter 16 (PDF), Section 50.1.1
Claims, Pricers, & Codes
Pass-Through Device: Correct Returned Claims
Learn how to correct pass-through device claims that CMS returned with Reason Code W7098, “Claim with pass-through device lacks required procedure (RTP).”
For claims with a pass-through device code, include the corresponding procedure code from the device offset code pairs list. If the procedure and pass-through device codes aren’t paired on the list, resubmit the claim with HCPCS C1889 in place of the pass-through device code so your Medicare Administrative Contractor (MAC) can reprocess your claim.
For example: You billed HCPCS code 92920 for the procedure, but it’s not a corresponding procedure for the pass-through device HCPCS C1761. If your MAC returns the claim with Reason Code W7098, resubmit it using HCPCS code 92920 with HCPCS C1889 instead of C1761.
MLN Matters® Articles
ICD-10 & Other Coding Revisions to National Coverage Determinations: October 2024 Update
Learn about revisions effective October 1, 2024 (PDF):
- New codes
- Recent coding changes
National Coverage Determination 110.23: Allogeneic Hematopoietic Stem Cell Transplantation
Learn about expanded coverage for allogeneic hematopoietic stem cell transplantation (HSCT) effective March 6, 2024 (PDF):
- HSCT using bone marrow, peripheral blood or umbilical cord blood stem cell products
- Other indications for stem cell transplantation not otherwise specified
Your Medicare Administrative Contractor will adjust claims that you bring to their attention.
Hospice Claims Edits for Certifying Physicians — Revised
CMS added coding information for the referring provider name (PDF) for claims you submit on or after October 7, 2024, with dates of service June 3, 2024 or later.
From Our Federal Partners
Meningococcal Disease Cases Linked to Travel to the Kingdom of Saudi Arabia: Ensure Travelers are Current on Meningococcal Vaccination
The CDC issued a Health Alert Network Health Advisory to alert clinicians to cases of meningococcal disease linked to travel to the Kingdom of Saudi Arabia (KSA). Since April 2024, 12 cases of meningococcal disease linked to KSA travel: United States (5 cases), France (4 cases), and the United Kingdom (3 cases).
Recommendations for Healthcare Providers
- Recommend vaccination with MenACWY conjugate vaccine for people considering travel to KSA to perform Hajj or Umrah (pilgrims) in addition to routine meningococcal vaccination for adolescents and other people at increased meningococcal disease risk
- Maintain a heightened index of suspicion for meningococcal disease among symptomatic people who have recently been in KSA and among close contacts of people who have recently been in KSA, regardless of vaccination status
- Immediately notify state, tribal, local, or territorial health departments about any suspected or confirmed cases of meningococcal disease in the United States
- Preferentially consider using rifampin, ceftriaxone, or azithromycin instead of ciprofloxacin as prophylaxis for close contacts in the United States of meningococcal disease cases associated with travel in KSA
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