Monday, February 24, 2025
Compliance
Claims, Pricers & Codes
- Discarded Drugs & Biologicals: Orphan Drugs with Increased Applicable Percentage for Calendar Quarters in 2023
- Hospital Outpatient Prospective Payment System: Correcting Error to Code C1739
Events
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.
Claims, Pricers & Codes
Discarded Drugs & Biologicals: Orphan Drugs with Increased Applicable Percentage for Calendar Quarters in 2023
CMS posted an updated list of billing and payment codes (PDF) for orphan drugs that qualify for a 26% increased applicable percentage for calendar quarters in 2023. To qualify, a drug must meet all 3 of the following requirements:
- Designated as an orphan drug under section 526 of the Federal Food, Drug, and Cosmetic Act
- Approved by the FDA exclusively for indications within the designated rare disease or condition
- Furnished to fewer than 100 unique beneficiaries per calendar year
Visit Discarded Drugs for more information.
Hospital Outpatient Prospective Payment System: Correcting Error to Code C1739
CMS will correct an error found in the January 2025 Update of the Hospital Outpatient Prospective Payment System and the January 2025 Integrated Outpatient Code Editor Specifications Version 26.0 for HCPCS code C1739:
- Correct long descriptor is (Tissue marker, probe detectable any method (implantable), with delivery system)
- Change will be made in the April 2025 software update with a January 1, 2025, effective date
- Short descriptor won’t change
Hospitals don’t need to take any action.
Events
Medicare Cost Report E-Filing System Webinar — March 19
March 19, 2025, from 1–3 pm ET
Learn about new and upcoming functionality for Medicare Part A cost reports and hospice cap determinations in the Medicare Cost Report e-filing (MCReF) system, including:
- Ready-made Provider Statistical & Reimbursement summary reports on the home page
- New dashboard for tracking hospice cap status, review dates, and documentation for cap determinations
- Tips and reminders on common questions, like how to e-file Home Office Cost Statements, get feedback on cost report exhibits, and avoid common problems
- Quick refresher on how to e-file one cost report or many
The webinar will include a live Q&A session and an opportunity to provide feedback. You may also send questions in advance to OFMDPAOQuestions@cms.hhs.gov with “MCReF Webinar” in the subject line. We’ll answer your questions during the webinar or use them to develop educational materials.
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