2024-11-07-MLNC

Updates to the Frontier Community Health Integration Project Demonstration
Third and Final Cohort of States Participating in the States Advancing All-Payer Health Equity Approaches and Development Model
Sickle Cell Disease Provider Toolkit

Respiratory Viruses: Get Up to Date on Flu, COVID-19, & RSV Vaccines

Immunize against flu, COVID-19, and respiratory syncytial virus (RSV)—it’s the best way to protect patients against severe disease (see CDC). Make sure your patients know about their risk, and recommend vaccines to protect them.

Medicare Part B covers:

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

Medicare drug coverage (Part D) covers the RSV vaccine; it’s not covered by Part A or Part B. See Medicare Part D Vaccines (PDF).

People can get vaccines for the flu, COVID-19, and RSV at the same time. For example, when your patients get their annual flu vaccine, they can get the latest COVID-19 vaccine plus an RSV vaccine, if they’re eligible and have never been vaccinated against RSV.

Get resources for your patients from the Risk Less. Do More campaign, including fact sheets, digital banners, and social media messages.

More Information:

CDC Respiratory Illnesses webpage
Vaccines.gov website
Annual Influenza Vaccination (PDF) and Chronic Condition Prevalence among Medicare Fee-for-Service Enrollees with COVID-19 (PDF) data snapshots: Learn about disparities in Medicare patients
Flu Shots, Medicare & Coronavirus, and RSV Shots: Get information for your patients

Diabetes: Recommend Preventive Services

In 2022, 26% of Medicare Fee-for-Service patients had diabetes with rates varying by sociodemographic characteristics and geographic areas (see data snapshot (PDF)). During National Diabetes Month, talk with your patients about their risk factors and recommend services to prevent, detect, and treat diabetes.

Medicare pays for:

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

More Information:

CDC Diabetes webpage
Diabetes Prevalence Among Medicare Beneficiaries in the Community (PDF) infographic
Information for your patients:

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

Expanded Diabetes Screening: Claims for HCPCS Code 82947 Returned in Error

Effective January 1, 2024, Medicare covers the HbA1c test for diabetes screening (HCPCS code 82947) when billed with ICD-10 diagnosis Z13.1.

Some Medicare Administrative Contractors returned these claims in error. They’ll correct this issue on or around November 18, 2024. You may resubmit claims returned in error.

Home Intravenous Immune Globulin Items & Services: CY 2025 Rate Update

The CY 2025 payment rate for Q2052 (Services, Supplies, and Accessories used in the Home for the Administration of Intravenous Immune Globulin) is $431.83.

Discarded Drugs & Biologicals: Updated HCPCS Codes

CMS posted an updated list of billing and payment codes (PDF) only used for single-dose containers paid separately under Part B that may require the JW and JZ modifiers, depending on the setting. The list:

Is updated approximately semi-annually
Excludes codes assigned to one or more multiple-dose containers
Doesn’t include all drugs subject to the JW and JZ modifier policy

Events

Greenhouse Gas Reduction Fund Opportunities for the Health Sector Webinar — November 20

Wednesday, November 20, 2024, at noon ET

Join the Office of Climate Change and Health Equity and 2 of the Environmental Protection Agency’s Greenhouse Gas Reduction Fund (GGRF) grant recipients (Climate United Fund and Opportunity Finance Network) to learn about:

Plans to finance clean energy projects across the country
How the health sector can take advantage of this funding

Get information on previous GGRF webinars and other Inflation Reduction Act (IRA) opportunities relevant to the health sector on the Catalytic Program on Utilizing the IRA website.

Publications

Medicare Provider Compliance Tips — Revised

Learn what’s changed. CMS updated the improper payment rate and denial reasons for the 2023 reporting period and added new tips about:

Orthopedic Footwear
Permanent Cardiac Pacemaker Implant
Suction Pumps
Wheelchair Seating

Information for Patients

Medicare Prescription Payment Plan

The Medicare Prescription Payment Plan is a new payment option in the prescription drug law that works with an enrollee’s current drug coverage to help them manage their out-of-pocket Medicare Part D drug costs by spreading them across the calendar year. Starting in 2025, anyone with a Medicare drug plan or Medicare health plan with drug coverage (like a Medicare Advantage Plan with drug coverage) can use this payment option. All plans offer this payment option, and participation is voluntary.

If an enrollee selects this payment option, they’ll continue to pay their monthly plan premium (if they have one), and they’ll get a bill from their health or drug plan to pay for their prescription drugs (instead of paying the pharmacy). There’s no cost to participate in the Medicare Prescription Payment Plan.

Share information about the Medicare Prescription Payment Plan with your patients, particularly those who are prescribed high-cost drugs early in the year.

Help your patients learn more about this new program:

Encourage them to visit the Medicare Prescription Payment Plan webpage
Share the fact sheet and postcard
Order printed copies of the fact sheet and postcard to distribute in your office (see instructions (PDF))

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