Thursday, December 12, 2024
News
- FY 2024 Medicare Fee-for-Service Improper Payment Rate
- Revised Home Health Change of Care Notice Form Effective February 1
- Skilled Nursing Facility Value-Based Purchasing Program: December 2024 Confidential Feedback Reports
- Institutional Provider Enrollment Application Fee: CY 2025
Compliance
Claims, Pricers, & Codes
Publications
From Our Federal Partners
News
FY 2024 Medicare Fee-for-Service Improper Payment Rate
CMS reported the national Medicare Fee-for-Service (FFS) improper payment rate in the FY 2024 HHS Agency Financial Report. See the Other Information section under Payment Integrity Report.
The 2024 national Medicare FFS improper payment rate is 7.66%, or $31.7 billion in improper payments. Most of these improper payments fall into 2 categories:
- Insufficient documentation
- Documentation provided didn’t sufficiently demonstrate medical necessity
More Information:
- Fiscal Year 2024 Improper Payments Fact Sheet
- 2024 Medicare FFS Supplemental Improper Payment Data Report
Revised Home Health Change of Care Notice Form Effective February 1
CMS improved the Home Health Change of Care Notice (HHCCN) form’s readability and design. Starting February 1, 2025, you must use the revised form to notify Medicare Fee-for-Service patients getting home health care benefits of plan of care changes.
The revised HHCCN is now available in Chinese, Vietnamese, and Korean, in addition to English and Spanish.
Skilled Nursing Facility Value-Based Purchasing Program: December 2024 Confidential Feedback Reports
Download your December 2024 Quarterly Confidential Feedback Reports for the FY 2026 Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP) from iQIES.
These reports include facility-level results for these measures for FY 2022, the FY 2026 SNF VBP Program baseline period:
- SNF 30-Day All-Cause Readmission
- SNF Healthcare-Associated Infections Requiring Hospitalization
- Total Nurse Staffing Hours per Resident Day
- Total Nursing Staff Turnover
We’ll use these results for the FY 2026 SNF VBP Program year scoring and incentive payment calculations taking effect October 1, 2025. We’ll include the data and results for the performance period for the FY 2026 SNF VBP Program year in the June 2025 Quarterly Confidential Feedback Reports.
Submit corrections until January 9, 2025. See Confidential Feedback Reporting & Review and Corrections for more information.
Questions?
- Contact iqies@cms.hhs.gov about report access
- Contact SNFVBP@rti.org about the program
Institutional Provider Enrollment Application Fee: CY 2025
Effective January 1, 2025, the application fee is $730 for institutional providers who are:
- Initially enrolling in the Medicare or Medicaid programs or the Children's Health Insurance Program (CHIP)
- Revalidating their Medicare, Medicaid, or CHIP enrollment
- Adding a new Medicare practice location
CMS requires this fee with any of these enrollment applications submitted from January 1 – December 31, 2025. See the notice for more information.
Compliance
Global Surgery: Bill Correctly
In a report, the Office of the Inspector General found that providers didn’t always comply with federal requirements when they bill for surgical services, including missing co-surgery and assistant-at-surgery modifiers. Review Global Surgery (PDF), and learn about:
- Coding
- Billing
- Payment
Claims, Pricers, & Codes
Rural Health Clinic CY 2025 All-Inclusive Rate
CMS updated the rural health clinic (RHC) all-inclusive rate for CY 2025. The payment limit per visit for independent and provider-based RHCs in hospitals with 50 or more beds is $152.00.
The payment limit per visit for specified provider-based RHCs with an April 1, 2021, established payment limit that continue to meet the qualifications in section 1833(f)(3)(B) of the Social Security Act is the greater of these amounts:
- Your payment limit per visit starting January 1, 2024, increased by 3.5%
- The national statutory CY 2025 payment limit per visit of $152.00
More Information:
- Medicare Claims Processing Manual, Chapter 9 (PDF), section 20.2
- Instruction to your Medicare Administrative Contractor (PDF)
Publications
Medicare Part B Inflation Rebate Guidance: Use of the 340B Modifier — Revised
Learn which modifier (PDF) 340B covered entities should discontinue or use starting January 1, 2025.
From Our Federal Partners
Get Your CHAMPVA Claims Paid with EFT
If you see patients under the Civilian Health and Medical Program of VA (CHAMPVA), you must set up electronic funds transfer (EFT) to get your claims paid. If you aren’t enrolled in EFT, your claims payments will pause. Getting paid by EFT is convenient, and it’s also a federal requirement.
Enrolling in EFT helps:
- Keep CHAMPVA claim payments secure, efficient, and compliant
- Protect Veterans’ family members’ access to benefits
2 steps to enroll in EFT, if you haven’t already:
- Visit the VA Financial Services Center Customer Engagement Portal
- Enroll using the Payment Account Setup web form; for assistance, call 877-353-9791
Your payments will be automatically deposited into a bank account.
About CHAMPVA
CHAMPVA is a health care program for qualified spouses, widows(ers), and children of eligible Veterans. Through CHAMPVA, VA shares the cost of certain health care services and supplies with eligible beneficiaries.
More Information:
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