2024-06-13-MLNC

Accountable Care Organizations (ACOs) interested in Advance Investment Payments (PDF)or the ACO Primary Care Flex Model must first apply to the Shared Savings Program.

More information:

Application Types & Timeline webpage
Application Toolkit
Key Application Actions and Deadlines (PDF)
Email questions to SharedSavingsProgram@cms.hhs.gov

Men’s Health: Encourage Your Patients to Prioritize Their Health

Men’s Health Week is the perfect time to talk with your patients about preventable health issues, and encourage early detection and treatment. Medicare covers preventive services, including:

Alcohol misuse screening and counseling
Cancer screening: colorectal and prostate
Cardiovascular disease: screening tests and intensive behavioral therapy (IBT)
Counseling to prevent tobacco use
IBT for obesity

Find out when your patient is eligible for services. If you need help, contact your eligibility service provider.

More Information:

Hypertension (PDF), Obesity (PDF), Prostate Cancer (PDF), and Tobacco Use (PDF) data snapshots: Learn about disparities in Medicare patients
Preventive & Screening Services webpage: Get information for your patients

In 2022, the improper payment rate for hospital beds and accessories was 22.7%, with a projected improper payment amount of $14.5 million (see 2022 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF), Tables G2 and K4). Learn how to bill correctly. Review the hospital beds and accessories provider compliance tip for more information, including:

Coverage requirements:
- Variable height feature
- Electric powered hospital bed adjustments
- Side rails
Documentation requirements
Resources

Claims, Pricers, & Codes

ICD-10-PCS Procedure Codes: FY 2025

Get FY 2025 ICD-10-PCS procedure codes effective for discharges on or after October 1, 2024.

Events

Clinical Laboratory Fee Schedule Annual Public Meeting: Now Virtual-Only on June 25

Tuesday, June 25, 2024

Note: The CMS Central Office is currently closed. We canceled the in-person option for this meeting.

See Annual Public Meeting Regarding New and Reconsidered Clinical Diagnostic Laboratory Test Codes for CY 2025 to learn more. You don’t need to register to view or listen to the meeting virtually.

MLN Matters® Articles

Hospital Outpatient Prospective Payment System: July 2024 Update

Learn about payment system updates effective July 1, 2024 (PDF):

New codes
Covered devices for pass-through payments
Drugs, biologicals, and radiopharmaceuticals
Skin substitutes

HCPCS Codes Used for Skilled Nursing Facility Consolidated Billing Enforcement: October 2024 Quarterly Update

Learn about codes excluded from skilled nursing facility consolidated billing (PDF), including:

Chemotherapy
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.

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