2024-10-17-MLNC

CMS made an edit to the Hospital and Hospital Health Care Complex Cost Report (CMS-2552-10) for inpatient psychiatric facilities to ensure you’re using an appropriate cost reporting methodology for periods starting on or after October 1, 2024. Read guidance (PDF) on all-inclusive cost reporting, including:

Description of new cost reporting edit
Temporary use of an alternate cost reporting methodology
FAQs

No-Pay Medicare Summary Notice Mailing Frequency Changed to Every 120 Days

The frequency of No-Pay Medicare Summary Notices (MSNs) changed from every 90 days to every 120 days effective October 7, 2024. Remind your patients that they can go digital to get their MSNs electronically.

More Information:

Health Literacy: Help Your Patients Get Information & Services

Nearly 90% of adults struggle with health literacy, which is how well they can find, understand, and use information and services to make health-related decisions for themselves and others. Racial and ethnic minority groups, people with lower income or education, older Americans, and non-native English speakers are more likely to have limited health literacy and may have trouble:

Understanding medication instructions
Managing their chronic diseases
Getting preventive services

During Health Literacy Month, learn how you can help patients with limited health literacy, including:

Using plain language
Sharing resources in different languages
Taking time to review information

More Information:

Introduction to Language Access Plans web-based training
Improving Care for People with Limited English Proficiency (PDF) infographic

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

Claims, Pricers, & Codes

National Uniform Billing Committee: New Codes Effective July 1

See the instruction to your Medicare Administrative Contractor (PDF) for information on new codes effective July 1, 2025:

Condition code KX (documentation on file): Requirements specified in the medical policy are met
Value code 92 (invoice cost of drug or biologic): Revenue category 0636 is required

PrEP for HIV Billing: CMS Requires Diagnosis Codes

If you’re a physician or health care practitioner, you should include at least one valid ICD-10-CM diagnosis code on prescriptions you send to pharmacies to help them prepare their Medicare Part B claims.

There are multiple diagnosis codes that may be appropriate when you’re billing for PrEP, including codes for:

Encounter for HIV pre-exposure prophylaxis
Encounter for screening for human immunodeficiency virus
Increased risk factors

For Information:

PrEP for HIV & Related Preventive Services webpage
Medicare Part B Coverage of PrEP for HIV Prevention (PDF) fact sheet
PrEP for HIV National Coverage Determination (PDF) technical FAQs for pharmacies

Events

HCPCS Public Meeting — November 6–8

Wednesday, November 6 – Friday, November 8, 2024, from 9 am – 5 pm ET

Attend a virtual public meeting for the second biannual 2024 HCPCS coding cycle. Visit HCPCS Level II Public Meetings for more information, including:

Meeting materials
Guidelines

MLN Matters® Articles

Ambulatory Surgical Center Payment Update – October 2024 — Revised

Learn what’s changed (PDF):

Updated the HCPCS codes in tables 3 and 6
Added a new subsection b in Section 5 for skin substitute product descriptors

Publications

Medicare Preventive Services – Revised

Learn what’s changed:

Alcohol misuse screening and counseling: clarified frequency policy
Flu shot and administration: updated flu season vaccine codes for 2024–2025
Pneumococcal shot and administration: added CPT code 90684 effective June 27, 2024, with an implementation date of October 1, 2024
Prolonged preventive services: added information on the “substantive portion” and how it relates to prolonged preventive services
Sexually transmitted infection (STI) screening and high intensity behavioral counseling to prevent STIs:
- Removed CPT code 0353U effective June 30, 2024
- Added CPT code 0455U effective July 1, 2024
- Clarified frequency policy

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