2024-12-05-MLNC

Advanced Primary Care Management (APCM) services combine elements of several existing care management and communication technology-based services you may have already been billing for your patients. Starting January 1, 2025, you may use a new payment bundle that reflects the essential elements of advanced primary care, including:

Principal Care Management: disease-specific services to help manage a patient’s care for a single, complex chronic condition that puts them at risk of hospitalization, physical or cognitive decline, or death
Transitional Care Management (PDF)
Chronic Care Management (PDF)

Visit APCM Services to get answers to these questions:

What Are APCM Services?
Who Can Bill for APCM Services?
How Often Can I Bill for APCM Services?
What Are the APCM HCPCS Codes?
What Are the APCM Billing Requirements?
Can Auxiliary Personnel Provide APCM Services?
Where Can I Get More Information?

Flu Shots: There’s Still Time to Protect Your Patients

A seasonal flu shot is the best way to help protect against the flu. Vaccination rates for Medicare Fee-for-Service patients vary by race, ethnicity, and geographic area (see data snapshot (PDF)). During National Influenza Vaccination Week, encourage your patients to get flu shots, and find out how you can help reduce vaccination disparities.

Medicare Part B covers the seasonal flu shot and additional flu shots if medically necessary. Your patients pay nothing if you accept assignment.

Find out when your patients are eligible for the flu shot. If you need help, contact your eligibility service provider.

More Information:

Flu Shot & Administration educational tool
Respiratory Virus Vaccine Partner Toolkit webpage
Immunization and Vaccine Resources webpage
CDC Flu webpage
Vaccines.gov website
Flu shots: Get information for your patients

Compliance

Diabetic Accessories & Supplies: Prevent Claim Denials

In 2023, the improper payment rate for glucose monitors was 13.5%, with a projected improper payment amount of $103.2 million (see 2023 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF), Appendices D, G, K, and N). Learn how to bill correctly for these services. Review the Diabetic Accessories & Supplies (including Glucose Monitors) provider compliance tip for more information, including:

Billing codes
Denial reasons and how to prevent denials
Continuous glucose monitor coverage indications
Refill and documentation requirements
Resources

Claims, Pricers, & Codes

Claim Status Category & Claim Status Codes Update

Learn about claims status category and code updates effective November 1, 2024:

Get Accredited Standards Committee (ASC) X12 code lists, including added, changed, or deleted codes
See examples of the ASC X12 276 and ASC X12 277 request and response transactions

See the instruction to your Medicare Administrative Contractor (PDF).

National Correct Coding Initiative: January Update

Get the National Correct Coding Initiative (NCCI) first quarter edit files effective January 1, 2025, on these Medicare NCCI webpages:

MLN Matters® Articles

ESRD & Acute Kidney Injury Dialysis: CY 2025 Updates

Learn about changes effective January 1, 2025 (PDF):

Final policies
Payment for renal dialysis services that ESRD facilities provide to patients with acute kidney injury

Medicare Change of Status Notice Instructions

Learn about the change of status process for hospitals (PDF):

Appeal rights for eligible Medicare patients reclassified from an inpatient to outpatient receiving observation services
Medicare Change of Status Notice (MCSN) delivery requirements
New section 450 in the Medicare Claims Processing Manual, Chapter 30

The implementation date for the MCSN and new appeals process is February 14, 2025.