Thursday, August 8, 2024
- Transitional Coverage for Emerging Technologies — Final Notice
- Help Improve the Program for Evaluating Payment Patterns Electronic Reports & Comparative Billing Reports — Updated Request for Information
- Immunization: Protect Your Patients
- Clinical Laboratory Improvement Amendments: Reprocessing Denied Claims
- Skilled Nursing Facility Prospective Payment System: FY 2025 Pricer Update
- Mpox Caused by Human-to-Human Transmission of Monkeypox Virus in the Democratic Republic of the Congo with Spread to Neighboring Countries
- Ready to Get Paid via EFT for CHAMPVA Claims?
Final Payment Rule
Hospital Inpatient Prospective Payment System & Long-Term Care Hospital Prospective Payment System FY 2025 Final Rule
Learn about the FY 2025 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) final rule.
More Information:
News
Transitional Coverage for Emerging Technologies — Final Notice
CMS is committed to making sure people with Medicare have access to medical advancements that improve health outcomes and enhance health quality. CMS’ Transitional Coverage for Emerging Technologies (TCET) Pathway helps people with Medicare access the latest medical advances, enables doctors and other clinicians to provide the best care for their patients, and benefits manufacturers who create innovative technologies. With support from policymakers, trust from patients and providers, and meaningful collaboration with manufacturers, CMS aims to improve the care and quality of life for people with Medicare while enhancing and encouraging innovation.
CMS issued a final procedural notice outlining a Medicare coverage pathway to achieve more timely and predictable access to certain new medical technologies for people with Medicare. The new TCET pathway for certain FDA-designated Breakthrough Devices increases the number of National Coverage Determinations (NCDs) that CMS will conduct per year and supports both improved patient care and innovation by providing a clear, transparent, and consistent coverage process while maintaining robust safeguards for the Medicare population. CMS anticipates accepting up to five TCET candidates per year and, for technologies accepted into and continuing in the TCET pathway, CMS’ goal is to finalize an NCD within six months after FDA market authorization.
See the full fact sheet for more information.
Help Improve the Program for Evaluating Payment Patterns Electronic Reports & Comparative Billing Reports — Updated Request for Information
CMS is taking steps to improve the effectiveness, accessibility, and design of the Program for Evaluating Payment Patterns Electronic Reports (PEPPERs) and Comparative Billing Reports (CBRs). You can help by responding to questions in the updated Request for Information by August 19, 2024.
See Medicare Fee-for-Service Compliance Programs for more information.
Immunization: Protect Your Patients
Fewer than 25% of adults get all their recommended vaccines, and minority populations have even lower vaccination rates (See CDC and NIH). During National Immunization Awareness Month, help increase your patients’ vaccination rates by recommending vaccines and how to access them.
Medicare covers the following vaccines:
Your patients pay nothing if you accept assignment. Find out when your patient is eligible for these vaccines. If you need help, contact your eligibility service provider.
More Information:
- Immunization and Vaccine Resources webpage
- Medicare Part D Vaccines (PDF) fact sheet
- CDC Adult Vaccination Resources webpage
For Your Patients:
- Vaccines.gov website
- Medicare.gov:
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
- Section 50.1.1 Medicare Benefit Policy Manual, Chapter 16 (PDF)
Claims, Pricers, & Codes
Clinical Laboratory Improvement Amendments: Reprocessing Denied Claims
CMS corrected a programming error that caused Part B laboratory service claims processed July 19–24 to deny. Your Medicare Administrative Contractor will reprocess affected claims within 30 days. You don’t need to take any action.
Skilled Nursing Facility Prospective Payment System: FY 2025 Pricer Update
CMS published payment rates effective October 1, 2024, in the FY 2025 Skilled Nursing Facility (SNF) final rule.
Effective FY 2023, CMS won’t reduce SNF final wage indexes by more than 5% compared to the prior FY. This doesn’t apply to new SNFs that open in FY 2025 because they didn’t have a prior wage index.
More Information:
- Section 30.5 Medicare Claims Processing Manual, Chapter 6 (PDF)
- Instruction to your Medicare Administrative Contractor (PDF)
Multimedia
Clinical Diagnostic Laboratory Tests: Medicare Advisory Panel Meeting Materials
CMS posted meeting materials from the Medicare Advisory Panel on Clinical Diagnostic Laboratory Tests:
- Recording from July 25, 2024 - Passcode: v9P8rC%Y
- Recording from July 26, 2024 - Passcode: G?=W7EmY
- Panel voting results (ZIP)
From Our Federal Partners
Mpox Caused by Human-to-Human Transmission of Monkeypox Virus in the Democratic Republic of the Congo with Spread to Neighboring Countries
The CDC issued this Health Alert Network Health Update to provide additional information about the outbreak of monkeypox virus (MPXV) in the Democratic Republic of the Congo (DRC); the first Health Advisory about this outbreak was released in December 2023.
No cases of clade I mpox have been reported outside central and eastern Africa at this time. Because there is a risk of additional spread, CDC recommends clinicians and jurisdictions in the U.S. maintain a heightened index of suspicion for mpox in patients who have recently been in DRC or to any country sharing a border with DRC (ROC, Angola, Zambia, Rwanda, Burundi, Uganda, South Sudan, CAR) and present with signs and symptoms consistent with mpox. These can include: rash that may be located on the hands, feet, chest, face, mouth, or near the genitals; fever; chills; swollen lymph nodes; fatigue; myalgia (muscle aches and backache); headache; and respiratory symptoms like sore throat, nasal congestion, and cough.
See the full Health Update for more information, including recommendations for clinicians on:
- Evaluation and diagnosis
- Treatment and prevention
Ready to Get Paid via EFT for CHAMPVA Claims?
If you see patients under the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), you must enroll in direct deposit (electronic funds transfer (EFT)) to get your payments. It’s a federal requirement.
2 steps to enroll in EFT:
- Visit the VA Financial Services Center Customer Engagement Portal
- Complete the Payment Account Setup webform to enroll:
- Review the Vendor Webform User Guide for step-by-step instructions
- Call 877-353-9791 if you need help with the webform
The VA will automatically deposit payments into your bank account. If you aren’t enrolled in EFT, the VA will pause your payments.
About CHAMPVA
CHAMPVA is a health care program for qualified spouses, widows, and children. Through CHAMPVA, VA shares the cost of certain health care services and supplies with eligible beneficiaries.
More Information:
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