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November 2023 Medicare Coverage, Compliance Education and Other Updates

Published on 

Wednesday, November 29, 2023

 | Coding 
 | Documentation 
 | Medicare Coverage 
 | Billing 

Coverage Updates

 

October 30, 2023: MLN MM13017: Removal of a National Coverage Determination & Expansion of Coverage of Colorectal Cancer Screening – Revised

The initial release of this MLN article was February 2, 2023. Now in it’s third iteration, CMS has added clarifying information about the -KX modifier for screening colonoscopy claims in the context of a complete colorectal cancer screening. https://www.cms.gov/files/document/mm13017-removal-national-coverage-determination-expansion-coverage-colorectal-cancer-screening.pdf

 

November 20, 2023: MLN MM13429: Beta Amyloid Positron Emission Tomography in Dementia and Neurodegenerative Disease

On October 13, 2023 CMS published a Final Decision Memo announcing a final decision to remove this NCD and now permitting Medicare coverage determinations to be made by the MACs. Removing the NCD also removes the current limitation of one PET beta-amyloid scan per lifetime from the coverage requirements.

 

CMS notes in MLN article MM13429 that “your MAC will adjust any PET beta amyloid claims processed incorrectly that you bring to their attention, effective for claims with DOS on or after October 13, 2023. https://www.cms.gov/files/document/mm13429-beta-amyloid-positron-emission-tomography-dementia-and-neurodegenerative-disease.pdf

 

Compliance Education Updates

 

MLN Educational Tool: Medicare Payment Systems

CMS has updated this tool to include FY 2024 updates to the:

  • Acute Care Hospital Inpatient Prospective Payment System,
  • Hospice Payment System & Coverage,
  • Inpatient Psychiatric Facility Prospective Payment System,
  • Inpatient Rehabilitation Facility Prospective Payment System,
  • Long-Term Care Hospital Prospective Payment System, and
  • Skilled Nursing Facility Prospective Payment System.

Substantive changes to this tool are in dark red. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/html/medicare-payment-systems.html

 

October 2023: MLN Booklet: Independent Diagnostic Testing Facility

CMS has updated this booklet to include more information on several topics, including supervising physicians, interpreting physicians, and technicians. https://www.cms.gov/files/document/mln909060-independent-diagnostic-testing-facility.pdf

 

New and Updated CMS National Training Program (NTP) Products

You can order CMS products in bulk by visiting our product ordering website.

Other Updates

October 27, 2023: End-Stage Renal Disease Prospective Payment System Final Rule

For CY 2024, CMS is increasing the ESRD PPS base rate to $271.02, increasing total payments to ESRD facilities by approximately 2.1%.

 

November 1, 2023: Home Health Prospective Payment System Final Rule

CMS estimates that Medicare payments to HHAs in CY 2024 will increase in the aggregate by 0.8 percent, or $140 million, compared to CY 2023.

 

November 3, 2023: Memorandum re: Oversight of Rural Emergency Hospitals (REHs)

CMS published a memorandum to State Survey Agency Directors and Accrediting Organizations regarding REH surveys. Specifically, all REH surveys will be conducted by State Survey Agencies (SAs) for at least the first three years from the date on which the first REH has been certified. They also noted that a deeming option for the REH program will be considered by CMS after they have had adequate time and opportunity to effectively monitor and evaluate the program but will be no earlier than three years from the date on which the first REH has been certified.  https://www.cms.gov/files/document/qso-24-01-reh.pdf

 

November 6, 2023: Contract Year 2025 Policy and Technical Changes to the MA Plan Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly, and HIT Standards

https://www.cms.gov/newsroom/fact-sheets/contract-year-2025-policy-and-technical-changes-medicare-advantage-plan-program-medicare

 

November 9, 2023: MLN Connects Home Health and Hospice Services

In the Thursday, November 09, 2023 edition of MLN Connects, CMS provides links to several resources for home health and hospices services including:

  • Information about the Medicare Payment Systems for each service,
  • Updated Medicare Provider Compliance Tips, and
  • Information for your patients.

https://www.cms.gov/training-education/medicare-learning-network/newsletter/2023-11-09-mlnc#_Toc150328742

 

CMS Releases October 2023 Fast Facts

CMS Fast Facts includes summary information on total program enrollment, utilization, expenditures, and total number of Medicare providers including physician by specialty area. New in the October 2023 release is CY 2022 Medicare populations, CY 2024 deductible, coinsurance, and premium amounts, and October 2023 Medicare Prepaid Contracts. https://data.cms.gov/fact-sheet/cms-fast-facts

Article Author: Beth Cobb, RN, BSN, ACM, CCDS
Beth Cobb, RN, BSN, ACM, CCDS, is the Manager of Clinical Analytics at Medical Management Plus, Inc. Beth has over twenty-five years of experience in healthcare including eleven years in Case Management at a large multi-facility health system. In her current position, Beth is a principle writer for MMP’s Wednesday@One weekly e-newsletter, an active member of our HIPAA Compliance Committee, MMP’s Education Department Program Director and co-developer of MMP’s proprietary Compliance Protection Assessment Tool.

This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.