2024-11-21-MLNC

CMS awarded the third 200 of 1,000 partially Medicare-funded physician residency slots (ZIP) to enhance the health care workforce and fund additional positions in hospitals serving underserved communities.

These graduate medical education residency slot awards will help address access to care challenges and workforce shortages in the highest need areas. This announcement is a critical step to advance health equity and access to care:

Approximately 70% of the new positions are for primary care and mental health specialties
90 of the residency slots are for primary care
50 slots are for psychiatry

Starting in January 2025, you can apply for additional residency positions under section 126 of the Consolidated Appropriations Act, 2021.

Visit Direct Graduate Medical Education, section 126: Distribution of Additional Residency Positions for more information.

CMS Roundup (November 15, 2024)

You may be interested in these topics from the CMS Roundup:

Health Insurance Marketplace Open Enrollment Period
New Webpage & Blog Share Updates on the Work of the Organ Transplant Affinity Group
Supplemental Evaluation Report for the Oncology Care Model
Report on Rural-Urban Health Disparities in Medicare
White Paper on Reimagining Rural Health
Accountable Health Communities Model Report Shows Reduced Spending, ER Visits & Hospital Admissions
Materials on our Patient Safety Strategy
Local Coverage Determination Issued for Treatment of Diabetic Foot and Venous Leg Ulcers
Key Concepts on Quality of Care & Multi-Payer Alignment

Hepatitis B Vaccine: Billing Requirement Update Effective January 1

The CY 2025 Physician Fee Schedule final rule updated the Medicare Part B billing requirement for the hepatitis B vaccine. CMS won’t require a physician’s order effective January 1, 2025.

Hospitals: Use Renewed Beneficiary Notices Starting January 1

The Office of Management and Budget renewed the following beneficiary notices:

Notice of Medicare Non-Coverage (NOMNC – CMS-10123)
Detailed Explanation of Non-Coverage (DENC – CMS-10124)

Hospitals must use the current notices until December 31, 2024, and are required to use the new NOMNC and DENC beginning January 1, 2025.

National Rural Health Day: Address Unique Health Care Needs

People living in rural areas, Tribal nations, territories, and other geographically isolated areas face unique health care challenges (see Rural Health). On National Rural Health Day, get the latest news on rural health programs and policy so you can better address your patients’ health care needs.

More Information:

Lung Cancer: Help Your Patients Reduce Their Risk

Tobacco use is the leading cause of preventable disease, disability, and death in the U.S., and smoking causes almost a half a million deaths per year (see data snapshot (PDF)). During Lung Cancer Awareness Month and the Great American Smokeout®, talk with your patients about how they can lower their lung cancer risk.

Medicare pays for:

Your patients pay nothing if you accept assignment. Find out when your patient is eligible for these services. If you need help, contact your eligibility service provider.

More Information:

CDC Lung Cancer Risk Factors webpage
CDC Lung Cancer Awareness webpage

Information for Your Patients:

Counseling to prevent tobacco use & tobacco-caused disease webpage
Lung cancer screenings webpage

Compliance

Mechanical Ventilation: Bill Correctly for Inpatient Claims

In a report, the Office of the Inspector General found that hospitals didn’t fully comply with Medicare requirements for claims with certain Medicare Severity Diagnosis-Related Groups that required more than 96 consecutive hours of mechanical ventilation. This resulted in $79 million in improper payments.

On your claims for mechanical ventilation, use the right procedure and diagnosis codes, including codes for the correct number of hours. Review the Ventilators provider compliance tip for more information.

Enteral Nutrition: Prevent Claim Denials

In 2023, the improper payment rate for Enteral Nutrition was 28.7%, with a projected improper payment amount of $43.2 million (see 2023 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF), Appendices D, E, G, and K). Learn how to bill correctly for these services. Review the Enteral Nutrition provider compliance tip for more information, including:

Billing codes
Denial reasons
Refill and documentation requirements
Resources

Events

Environmental Justice Thriving Communities Grantmakers Program — December 4

Wednesday, December 4, 2024, at noon ET

Join the Office of Climate Change and Health Equity and the Environmental Protection Agency’s Office of Environmental Justice and External Civil Rights to learn about the Environmental Justice Thriving Communities Grantmakers Program. The program offers subgrants for capacity building in communities affected by environmental or public health issues to eligible applicants, including nonprofit organizations. Topics include:

Air quality and asthma
Improving food access to reduce vehicle miles traveled
Emergency preparedness and disaster resiliency
Environmental job training for occupations that reduce greenhouse gases and other air pollutants

Optimizing Healthcare Delivery to Improve Patient Lives Conference — December 12

Thursday, December 12, 2024

CMS will convene change makers from the health care community and federal government to share new ideas, lessons learned, and best practices to reduce administrative burden and strengthen access to quality care.

MLN Matters® Articles

Home Health Prospective Payment System: CY 2025 Rate Update

Learn about updated payment rates (PDF) effective January 1, 2025:

30-day periods of care payments
National per-visit amounts
Disposable negative pressure wound devices
Cost-per-unit amounts used for calculating outlier payments

Publications

Medicare Preventive Services — Revised

CMS added PrEP for HIV coverage.

From Our Federal Partners

First Case of Clade I Mpox Diagnosed in the U.S.

The CDC issued this Health Alert Network Health Advisory to provide information about the first case of clade I mpox diagnosed in the U.S. and recommendations to clinicians about preventing, diagnosing, treating, and reporting mpox cases. On November 15, 2024, the California Department of Public Health confirmed the first reported case of clade I mpox in the U.S. No additional cases have been detected as of November 18, 2024. The risk of clade I mpox to the public in the U.S. remains low; however, clinicians should be aware of mpox symptoms, ask patients with comparable signs and symptoms about recent travel history and risk factors, and consider testing.

See the full Health Advisory for more information, including recommendations for clinicians.

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