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October 2022 Compliance Education, COVID-19, and Other Updates
Published on Oct 26, 2022
20221026

Compliance Education Updates

MLN Educational Tool: Medicare Preventive Services

This MLN tool (link) was updated in September. Updates include pneumococcal shot resources, thirteen new bone mass measurement codes and three new hepatitis B screening codes.

MLN Educational Tool: Medicare Payment Systems

This MLN tool (link) was also updated in September to include updates for FY 2023 for:

  • The Acute Care Hospital Inpatient Prospective Payment System (IPPS),
  • The Hospice Payment System,
  • The Inpatient Psychiatric Facility Prospective Payment System (IPF PPS),
  • The Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS),
  • The Long-Term Care Hospital Prospective Payment System (LTCH PPS), and
  • The Skilled Nursing Facility Prospective Payment System (SNF PPS).
MLN Booklet: Chronic Care Management Services

This Booklet (link) has been updated. Substantive content changes are in dark red font and includes:

  • Beginning 2022, Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) can bill Chronic Care Management (CCM) and Transitional Care Management (TCM) services for the same patient during the same period,
  • In 2021 CMS added five codes to report staff-provided Principal Care Management (PCM) services under physician supervision, and
  • Beginning 2022 CMS replaced G2058 with 99439.

COVID-19 Updates

October 13, 2022: Update to COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers

This CMS document (link) was updated on October 13th. The waiver related to the Director of Food and Nutrition Services was terminated on 10/1/2022 per the FY 2023 SNF Prospective Payment System Final Rule (1765-F).

Other Updates

September 23, 2022 Award of Medicare Administrative Contractor (MAC) Contract for Jurisdiction M

On September 23rd, Palmetto GBA, the incumbent MAC for Jurisdiction M (JM) was again awarded the contract for the administration of Medicare Part A and Part B Fee-for-Service claims in the states of North and South Carolina, Virginia, and West Virginia. The claims volume in JM equates to more than $26.4 billion in Medicare benefit payments annually. Palmetto GBA will provide Medicare services to more than three hundred hospitals, approximately 75,000 physicians, and 3.2 million beneficiaries.

CMS Implements Temporary Increase in Payment under Medicare for Qualifying Biosimilars

Section 11403 of the Inflation Reduction Act provides for a temporary increase in the add-on payment for qualifying biosimilars from the current ASP plus an add-on of 6% of the reference biological product’s ASP to ASP plus 8% for a 5-year period. CMS noted in the Thursday, October 6th edition of MLN Matters (link) that “the goal of the temporary add-on payment for providers is to increase access to biosimilars, as well as to encourage competition between biosimilars and reference biological products, which may, over time, lower drug costs and lead to savings to beneficiaries and Medicare.”

If you are interested in learning more about biosimilars, there are two FDA resources:

  • FDA Biological Product Definition Fact Sheet (link), and
  • A Curriculum Materials for Health Care Degree Programs / Biosimilars (link). The “FDA’s curriculum materials are intended to help educate students in health care professional degree programs, for medicine, nursing, physician assistants, and pharmacy, as well as practicing professionals, to improve understanding of biosimilar and interchangeable biosimilar products and the regulatory approval pathway in the United States.”
CMS Request for Information (RFI): Developing a National Directory of Health Care Providers and Services

On October 7, 2022, CMS published an RFI in the Federal Register (link) seeking comments on the establishment of a National Directory of Healthcare Providers & Services (NDH). CMS believes an NDH would serve multiple purposes for the end user, for example:

  • Helping patients locate providers that meet their individual needs and preferences, and
  • A modern NDH “should enable healthcare providers, payers, and others involved in patient care to identify one another’s digital contact information also referred to as digital endpoints, for interoperable electronic data exchange.”

On October 7, 2022, CMS published an RFI in the Federal Register (link) seeking comments on the establishment of a National Directory of Healthcare Providers & Services (NDH). CMS believes an NDH would serve multiple purposes for the end user, for example:

    Beth Cobb

    October 2022 Monthly Medicare Transmittals, MLN Articles & Coverage Update
    Published on Oct 26, 2022
    20221026

    Medicare MLN Articles & Transmittals

    Inpatient Prospective Payment System Hospitals in the 9th Circuit: Updated Fiscal Years 2019 and 2020 Supplemental Security Income Medicare Beneficiary Data
    • MLN Release Date: September 29, 2022
    • What You Need to Know: Data for the Ninth Circuit’s jurisdiction has been updated based on Supreme Court decision in Azar v. Empire Health Foundation. This includes hospitals in Alaska, Arizona, California, Hawaii, Idaho, Montana, Nevada, Oregon, and Washington. Data for all other hospitals is unchanged.
    • MLN MM12906: (link)
    New Fiscal Intermediary Shared System Edit to Validate Attending Provider NPI
    • MLN Release Date: October 6, 2022
    • What You Need to Know: Make sure your billing staff knows about a new consistency edit that validates the attending provider NPI and that organizational NPIs cannot be used in place of individual NPIs, unless exception conditions are met.
    • MLN MM12889: (link)
    Medicare Deductible, Coinsurance & Premium Rates: Calendar Year 2023 Update
    • MLN Release Date: October 13, 2022
    • What You Need to Know: CMS advises to make sure your billing staff know about the calendar year 2023 rate changes. I would also encourage you to make sure your case management and social services staff are aware of this information too.
    • MLN MM12903: (link)

    Revised Medicare MLN Articles & Transmittals

    Changes to Beneficiary Coinsurance for Additional Procedures Furnished During the Same Clinical Encounter As Certain Colorectal Cancer Screening Tests
    • MLN Release Date: April 29, 2022 – Revised September 29, 2022
    • What You Need to Know: The article was revised to add the Other Amount Indicator “B2” for co-insurance reduction amount to the claim, modify edits that affects the co-insurance reduction amount, and report the applied coinsurance amounts in the c-insurance field.
    • MLN MM12656: (link)
    International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs)-January 2023 Update – 2 of 2
    • MLN Release Date: August 12, 2022 – Revised October 5, 2022
    • What You Need to Know: This article was revised to reflect a revised Change Request (CR) 12842. The update for NCD 150.3 (Bone Mineral Density Studies) was removed due to ICD-10 diagnosis codes that were added in error and restore ICD-10 diagnosis C91.92 that was removed in error to NCD 110.23 (Stem Cell Transplantation).
    • MLN MM12842: (link)
    October 2022 Update of the Ambulatory Surgical Center (ASC) Payment System
    • Transmittal Release Date: Transmittal 11610 released September 23, 2022 is being rescinded and replaced by Transmittal 11661 dated October 23, 2022
    • What You Need to Know: This transmittal has been updated to add HCPCS J1952 to table 2, attachment A, and correct the associated number of new codes identified in the policy section B.3.a from 10 to 11.
    • Transmittal 11661: (link)

    Coverage Updates

    Cochlear Implantation Final Decision Memo (CAG-00107R)

    On September 26, 2022, CMS published a final decision memo (link) for NCD 50.3 Cochlear Implantation. CMS has concluded there is sufficient evidence for cochlear implantation be “be covered for treatment of bilateral pre- or post-linguistic, sensorineural, moderate-to-profound hearing loss in individuals who demonstrate limited benefit from amplification. Limited benefit from amplification is defined by test scores of less than or equal to 60% correct in the best-aided listening condition on recorded tests of open-set sentence cognition.” Patient’s must also meet specific criteria detailed in the Decision Memo.

    Beth Cobb

    September 2022 Medicare Compliance, COVID-19 and Other Updates
    Published on Sep 28, 2022
    20220928

    Compliance Updates

    MLN Booklet: Chronic Care Management (CCM) Services

    This MLN booklet (link) was updated this month. Changes made to this booklet are highlighted in dark red font and include:

    • Beginning 2022, Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) can bill Chronic CCM and Transitional Care Management (TCM) services for the same patient during the same time period,
    • In 2021, CMS added five codes to report staff-provided Principal Care Management (PCM) services under physician supervision, and
    • Beginning 2022 G2058 was replaced with 99439.

    COVID-19 Updates

    September 12, 2022: COVID-19 Vaccines Providing Protection from Omicron Variant Available at No Cost

    CMS published a special edition MLN Connects (link) announcing that “people with Medicare, Medicaid, Children’s Health Insurance Program coverage, private insurance coverage, or no health coverage can get COVID-19 vaccines, including the updated Moderna and Pfizer-BioNTech COVID-19 vaccines, at no cost, for as long as the federal government continues purchasing and distributing these COVID-19 vaccines.”

    You will also find information in the newsletter about the four new CPT codes effective August 31, 2022, that CMS has issued for the Pfizer-BioNTech and Moderna Bivalent vaccines.

    September 13, 2022: CDC Clinical Outreach and Communication Activity (COCA) Call: Recommendations for Bivalent COVID-19 Booster

    The CDC held a COCA call (link) to discuss their new guidance on bivalent COVID-19 booster doses for people ages 12 years and older, included those who are moderately or severely immunocompromised. In the overview of the call the CDC noted that “Updated COVID-19 vaccines add an Omicron BA.4/5 spike protein component to the previous monovalent composition. These bivalent booster doses help restore protection that has waned since previous vaccination by targeting more transmissible and immune-evading variants. These boosters also broaden the spectrum of variants that the immune system is ready to respond to.” A recording of the call, slides and transcript are now available on this CDC webpage.

    September 20, 2022: CDC COCA Call: Evaluating and Supporting Patients Presenting with Cardiovascular Symptoms Following COVID

    In the “Overview” section on the CDC webpage (link), the CDC notes that of all of the post-COVID conditions (PCC) that people experience “cardiovascular symptoms and complications are among the most common and debilitating.” Presenters during this call outlined “the recommended clinical approach to identifying and managing cardiovascular complications in these patients.” A recording of the call and slides are now available.

    Other Updates

    National Correct Coding Initiative: October Quarterly Update

    In the Thursday, September 15, 2022 edition of MLN Connects (link), CMS encourages you to get the National Correct Coding Initiative (NCCI) fourth quarter edit files, effective October 1, 2022 and provides links to the Procedure-to-Procedure Edits, Medically Unlikely Edits, and Add-on Code Edits webpages.

    CMS Resources by Language

    Did you know that there is a collection of CMS resources categorized by language? This CMS webpage (link) was last modified on September 13th and includes resources in 18 languages “to help people make informed healthcare decisions and be active partners in their healthcare and the healthcare of their families.” These resources can be downloaded or ordered at no cost. A link to additional Medicare resources in 23 languages can also be found on this webpage. .

    Beth Cobb

    September 2022 Medicare Transmittals and MLN Articles
    Published on Sep 28, 2022
    20220928

    Medicare MLN Articles & Transmittals

    Exceptions to Average Sales Price (ASP) Payment Methodology – Claims Processing Manual Changes
    • MLN Release Date: August 30, 2022
    • What You Need to Know: Your billing staff need to be made aware of updates to Chapter 17 Section 20.1.3 (Exceptions to Average Sales Price (ASP) Payment Methodology) and Section 20.3 (Calculation of the Payment Allowance Limit for DME MAC Drugs) of the Medicare Claims Processing Manual
    • MLN MM12854: link)
    Changes to the Laboratory National Coverage Determination (NCD) Edit Software for January 2023
    • MLN Release Date: September 6, 2022
    • What You Need to Know: This article lists the lab specific NCDs with coding updates effective January 1, 2023.
    • MLN MM12888: link)
    Billing for Hospital Part B Inpatient Services
    • Change Request (CR) 12816 Release Date: September 8, 2022
    • What You Need to Know: The purpose of this CR is to provide billing instructions for hospital Part B inpatient services. Specifically, there are additions to the “Not Allowed Revenue Codes.” No policy change is being made in this CR. You can find more information in the following CMS manuals:
      • Section 10 Medicare Benefit Policy Manual, Chapter 6 (link): when to bill Part B for inpatient services
      • Section 70 Medicare Claims Processing Manual, Chapter 1 (link): time limitations for filing Part B claims
      • Section 240 Medical Claims Processing Manual, Chapter 4 (link): services allowed on inpatient Part B claims
    • CR 12816: link)
    October 2022 Update of the Hospital Outpatient Prospective Payment System (OPPS)
    • MLN Release Date: September 13, 2022
    • What You Need to Know: CMS advises that your billing staff should know about the new COVID-19 CPT vaccine and administration codes, redosing update for EVUSHELD™, and a new procedure to assess coronary disease severity using computed tomography angiography that is detailed in this article.
    • MLN MM12885: link)
    Ambulatory Surgical Center Payment System: October 2022 Update
    • MLN Release Date: September 26, 2022
    • What You Need to Know: Your billing staff needs to know about updates to the ASC payment system, a new OPPS device pass-through code, new HCPCS codes for drugs and biologicals, and new skin substitute products low-cost or high-cost group assignment.
    • MLN MM12915: link)

    Revised Transmittals & MLN Articles

    Quarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment
    • MLN Release Date: August 15, 2022 – Revised September 8, 2022 – Revised September 19, 2022
    • What You Need to Know: The article was revised on September 8th to reflect the change in CR 12870. Specifically, a note was added about code 0340U in dark red font on page 3 of the article. It was once again revised on September 19th to correct an acronym on page three.
    • MLN MM12870: link)

    Beth Cobb

    August 2022 Monthly COVID-19 and Other Medicare Updates
    Published on Aug 24, 2022
    20220824

    This article was updated on September 2, 2022.
    Please see correction below.

    COVID-19 Updates

    August 18, 2022: Roadmap for the End of the COVID-19 Public Health Emergency

    CMS published a blog (link), announcing their efforts to create a roadmap for the end of the COVID-19 PHE. CMS reminds you that “HHS Secretary Becerra has committed to giving states and the health care community writ large 60 days’ notice before ending the PHE. In the meantime, CMS encourages health care providers to prepare for the end of these flexibilities as soon as possible and to begin moving forward to reestablishing previous health and safety standards and billing practices.”

    Included in this CMS Blog is a list of fact sheets summarizing the status of Medicare Blanket waivers and flexibilities by provider type. The fact sheets include information about waivers and flexibilities that:

    • Have already been terminated,
    • Will be made permanent, or
    • Will end at the end of the PHE.

    CMS expects “that the health care system can begin taking prudent action to prepare to return to normal operations and to wind down those flexibilities that are no longer critical in nature.”

    The COVID-19 PHE declaration was last extended on July 15, 2022 (link). PHE declarations last for the duration of the emergency or 90 days and may be extended by the Secretary meaning the current COVID-19 PHE declaration will last until October 13, 2022.

    With the CMS release of a Road Map to wind down the COVID-19 PHE, it seems hospitals are being put on notice that the end of the PHE is near.

    Other Updates

    Friday, July 27, 2022: CMS Releases Three FY 2023 Final Rules

    In late July, CMS published Fiscal Year (FY) 2023 Final Rules. You can read about each of the Final Rules in related CMS Fact Sheets.

    • FY 2023 Inpatient Rehabilitation Facility (IRF) Prospective Payment System Final Rule (CMS-1767-F) CMS Fact Sheet: link
    • FY 2023 Medicare Inpatient Psychiatric Facility Prospective Payment System Final Rule (CMS-1769-F) CMS Fact Sheet: link
    • FY 2023 Hospice Payment Rate Update Final Rule (CMS-1773-F) CMS Fact Sheet: link
    Monkeypox & Smallpox Vaccines: New Product Codes

    CMS included the following guidance related to monkeypox and smallpox vaccines in the August 11, 2022 edition of MLN Connects (link).

    On July 23, the World Health Organization declared monkeypox a public health emergency, and HHS issued a statement regarding the Biden-Harris Administration’s actions to make vaccines, testing, and treatments available. CMS issued two new CPT codes effective July 26, 2022:

    Code 90611 for smallpox and monkeypox vaccine product:

    • Long descriptor: Smallpox and monkeypox vaccine, attenuated vaccinia virus, live, non-replicating, preservative free, 0.5 mL dosage, suspension, for subcutaneous use
    • Short descriptor: SMALLPOX&MONKEYPOX VAC 0.5ML
    Code 90622 for vaccinia (smallpox) virus vaccine product:
    • Long descriptor: Vaccinia (smallpox) virus vaccine, live, lyophilized, 0.3 mL dosage, for percutaneous use
    • Short descriptor: VACCINIA VRS VAC 0.3 ML PERQ

    When the government provides vaccines at no cost, only bill for the vaccine administration:

    • Do not include the vaccine codes on the claim when the vaccines are free
    • Patient cost sharing applies

    Your Medicare Administrative Contractor will give you more information soon about coverage and billing.

    CORRECTION: Monkeypox & Smallpox Vaccines: Include Product Code on Claims

    Initially, Medicare instructed to only bill for vaccine administration when you got the vaccine at no cost from the government. In the September 1, 2022 MLN Connects newsletter, these instructions were changed. These new instructions are to include these 3 elements on your claim, even if you get the vaccine from the government for free:

    1. product code (90611 or 90622)
    2. applicable ICD-10-CM diagnosis code
    3. administration code

    We’ll address the no cost government vaccine product payment adjustments during claims processing. You’ll see it on your remittance advice.

    Code 90611 for smallpox and monkeypox vaccine product:

    • Long descriptor: Smallpox and monkeypox vaccine, attenuated vaccinia virus, live, non-replicating, preservative free, 0.5 mL dosage, suspension, for subcutaneous use
    • Short descriptor: SMALLPOX&MONKEYPOX VAC 0.5ML

    Code 90622 for vaccinia (smallpox) virus vaccine product:

    • Long descriptor: Vaccinia (smallpox) virus vaccine, live, lyophilized, 0.3 mL dosage, for percutaneous use
    • Short descriptor: VACCINIA VRS VAC 0.3 ML PERQ

    Patient cost sharing applies. Your Medicare Administrative Contractor will give you more information soon about coverage and billing.

    Beth Cobb

    August 2022 Monthly Medicare Updates
    Published on Aug 24, 2022
    20220824

    Medicare MLN Articles & Transmittals

    Inpatient Psychiatric facilities Prospective Payment System (IPF PPS) Updates for Fiscal Year (FY) 2023
    • MLN Release Date: August 4, 2022
    • What You Need to Know: This MLN article provides Key Changes for FY 2023 related to market basket update, wage index update, IPF quality reporting programs, PRICER updates, provider specific file update, ICD-10-CM/PCS updates, COLA adjustment, and rural adjustment.
    • MLN MM12859: link)
    Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) – October 2022 Update
    • Transmittal 11544 Release Date: August 4, 2022
    • What You Need to Know: This Change Request (CR) was issued to amend the 2022 MPFS Final Rule payment files. Changes includes new HCPCS and CPT codes, codes that are no longer valid and changes to a short descriptor.
    • Transmittal 11544/Change Request 12869: link)
    New Waived Tests
    • MLN Release Date: August 4, 2022
    • What You Need to Know: information about CLIA requirements, new CLIA waived tests approved by the FDA and the use of modifier QW for CLIA-waived tests can be found in this MLN article.
    • MLN MM12841: link)
    Inpatient Rehabilitation Facility (IRF) Annual Update: Prospective Payment System (PPS) Pricer Changes FY 2023
    • MLN Release Date: August 5, 2022
    • What You Need to Know: CMS advises you to make sure your billing staff knows about changes to the Fiscal Year (FY) 2023 payment rates and wage index cap.
    • MLN MM12807: link)
    International Classifications of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs) – January 2023 Update
    • MLN Release Date: August 15, 2022
    • What You Need to Know: Your staff needs to be aware of newly available codes added to NCDs, separate NCD coding revisions and coding feedback.
    • MLN MM12822: link)
    International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs)-January 2023 Update – 2 of 2
    • MLN Release Date: August 15, 2022
    • What You Need to Know: This is the second of two MLN matters articles detailing January 2023 updates to NCDs.
    • MLN MM12842: link)
    Significant Updates to Internet Only Manual (IOM) Publication (Pub.) 100-05 Medicare Secondary Payer (MSP) Manual, Chapter 5
    • MLN Release Date: August 15, 2022
    • What You Need to Know: This article highlights key updates of importance for providers, for example, “Medicare is the secondary payer throughout the entire 30-month ESRD coordination period when a patient is eligible for, or entitled to, Medicare on the basis of ESRD. (See section 30.3.1.).”
    • MLN MM12765: link)
    Quarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment
    • MLN Release Date: August 15, 2022
    • What You Need to Know: You will find information about updated to Advanced Diagnostic Laboratory Tests (ADLTs), the next CLFS data reporting period, and new codes added to the National HCPCS file in this MLN article.
    • MLN MM12870: link)

    Beth Cobb

    July 2022 Monthly Medicare Updates
    Published on Jul 27, 2022
    20220727

    Medicare MLN Articles & Transmittals

    Change to the Laboratory National Coverage Determination (NCD) Edit Software for October 2022
    • MLN Release Date: June 24, 2022
    • What You Need to Know: CMS advises you to make sure your billing staff know about changes to the Laboratory NCD Edit Module for October 2022 and how to access the NCD spreadsheet that lists relevant changes.
    • MLN MM12803: (link)
    One-Time Notification: New Edit for PPS Outpatient and Inpatient Bill Types Receiving Outlier Payment When Device Credit is Reported
    • Transmittal Release Date: July 7, 2022
    • What You Need to Know: A new edit is being implemented to provide MACs with a way to review the charges and device reduction amount submitted on claims for fully or partially credited devices. Effective January 1, 2023, CMS will suspend outpatient and inpatient prospective payment claims getting an outlier payment when a device credit is reported. This will allow the MACs to review the charges and device reduction amounts for fully and partially credited devices.
    • Transmittal 11488 (Change Request 12769): (link)

    Coverage Updates

    July 6, 2022: Cochlear Implantation Proposed Decision Memo (CAG-00107R)

    CMS released a Proposed Decision Memo regarding the National Coverage Determination for Cochlear Implantation (50.3) (link). Among other things, CMS is proposing to expand coverage by broadening the patient criteria and removing the requirement that for individuals with hearing test scores of > 40 % and ≤ 60 %. The public comment period ends August 5, 2022.

    July 8, 2022: Home Use of Oxygen Final Decision Memo

    Per the Final Decision Memo (link), “Effective July 8, 2022, the MAC may determine reasonable and necessary coverage of oxygen therapy and oxygen equipment in the home for patients who are not described in section B or precluded by section C of this NCD. Initial coverage for patients with other conditions may be limited to the shorter of 90 days or the number of days included in the practitioner prescription at MAC discretion. Oxygen coverage may be renewed if deemed medically necessary by the MAC.”

    Compliance Updates

    Implanted Spinal Neurostimulators: Document Medical Records

    In a recent report, the OIG found that Medicare improperly paid claims for implanted spinal neurostimulators when providers did not provide sufficient documentation supporting medical necessity. You will find a link to the OIG report and helpful resources in the Thursday July 21, 2022, edition of their MLN Connects e-newsletter ( https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2022-07-21-mlnc">link).

    COVID-19 Updates

    Coding Long COVID

    CMS offered the following advice regarding coding Long COVID in the Thursday July 7, 2022, edition of MLN Connects (link):

    • For a post COVID-19 condition, unspecified, like Long COVID, use code DX U09.9. Add other codes for conditions related to the COVID-19 infection, like R50.9 for fever.
    • For a current COVID-19 infection, use code DX U07.1. Do not use code DX U09.9.
    • For a current COVID-19 infection and conditions from a previous COVID-19 infection, use code U09.9 with code DX U07.1. Add other codes for conditions related to the COVID-19 infection, like R06.02 for shortness of breath.
    • For more information, see pages 30-31 of ICD-10-CM Official Guidelines for Coding and Reporting: Fiscal Year 2022 (PDF).
    July 13, 2022: CDC Releases Resistant Infections Special Report

    The CDC released a report (link) detailing the negative effect of the COVID-19 pandemic on recent years of progress in the United States combating antimicrobial resistance (AR). In a related announcement, the CDC noted the report “concludes that the threat of antimicrobial-resistant infections is not only still present but has gotten worse – with resistant hospital-onset infections and deaths both increasing at least 15% during the first year of the pandemic.”

    July 15, 2022: COVID-19 Public Health Emergency Renewed

    CMS waited until late Friday, July 15th to post an extension of the COVID-19 public health emergency (PHE) (link). This extends the PHE for ninety days.

    Other Updates

    July 7, 2022: Special Edition MLN Connects – Physician Fee Schedule Proposed Rule release

    CCMS announced the release of the CY 2023 Physician Fee Schedule Proposed Rule in a special edition of their MLN Connects e-newsletter (link). You will find links to related fact sheets and the proposed rule in the newsletter. Comments are due to CMS by September 7, 2022.

    July 7, 2022: Appropriate Use Criteria (AUC) Penalty Phase Delayed Again

    CMS as posted the following notice on the AUC Program webpage (link), “The payment penalty phase will not begin January 1, 2023 even if the PHE for COVID-19 ends in 2022. Until further notice, the educational and operations testing period will continue. CMS is unable to forecast when the payment penalty phase will begin.”

    July 16, 2022: New Nationwide 988 Crisis Hotline

    HHS announced in a July 15th Press Release (link), the transition from the 10-digit National Suicide Prevention Lifeline to 988 “an easy-to-remember three-digit number for 24/7 crisis care…The 988 Suicide & Crisis Lifeline is a network of more than 200 state and local call centers supported by HHS through the Substance Abuse and Mental Health Services Administration (SAMHSA).”

    Beth Cobb

    June 2022 Medicare Transmittals and Proposed Rules
    Published on Jun 29, 2022
    20220629

    June 2022 Medicare Transmittals and Proposed Rules

    International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs)—July 2022
    • Article Release Date: May 9, 2022 – Revised June 21, 2022
    • What You Need to Know: This article details information about newly available codes, separate NCD coding revisions and coding feedback. It was updated on June 21, 2022, to reflect a revised Change Request (CR) 12705. The substance of the article did not change. NCDs updated includes:
      • NCD 20.31 Intensive Cardiac Rehabilitation (ICR) Programs,
      • NCD 20.31.1 Pritikin Program,
      • NCD 20.31.2 Ornish Program for Reversing Heart Disease,
      • NCD 20.31.3 ICR Benson-Henry Program,
      • NCS 90.2 Next Generation Sequencing (NGS),
      • NCD 160.18 Vagus Nerve Stimulation (VNS),
      • NCD 180.1 Medical Nutrition Therapy (MNT), and
      • NCD 270.3 Blood Derived Products for Chronic Non-healing Wounds
    • MLN MM12705: (link)
    International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs)—July 2021 Update
    • Article Release Date: May 18, 2021 – 2nd Revision June 22, 2022
    • What You Need to Know: This MLN was revised to reflect CR 12124 which changed the business requirements for NCD 90.2, Next Generation Sequencing. This change resulted in a new spreadsheet for this NCD by retaining all ICD-10 Not Otherwise Classified (NOC) diagnosis codes that had been proposed for deletion effective July 1, 2022. CMS advised that “Although we’re not moving forward with deleting the aforementioned ICD-10 NOC diagnosis codes from NCD 90.2, we continue to strongly encourage providers and laboratories to make sure they provide the best possible and most specific code on the claim in accordance with the implementation of ICD-10 in 2015. We’ll be monitoring these laboratory claims and may take future action to reinstate removal of these ICD-10 NOC codes.”
    • MLN MM12124: (link)
    July 2022 Update of the Ambulatory Surgical Center (ASC) Payment System
    • Article Release Date: June 9, 2022 – Revised June 24, 2022
    • What You Need to Know: This article was revised to remove two HCPCS codes from table 3 of the Change Request 12773 reducing the number of new codes from 16 to 14.
    • MLN MM12773: ((link)

    Medicare Proposed Rules

    On Tuesday, June 21, 2022, CMS published a Special Edition MLN Connects ((link) spotlighting the release of two Calendar Year (CY) 2023 proposed rules:

    • CY 2023 Home Health Prospective Payment System Rule Update and Home Infusion Therapy Services Requirements Proposed Rule (CMS-176-P), and
    • ESRD Facilities: CY 2023 Proposed Rule.

    The MLN connects includes links to Fact Sheets highlighting key provisions in each proposed rule. CMS is accepting comments through August 16, 2022, for the Home Health Proposed Rule and August 22, 2022, for the ESRD Facilities proposed rule.

    Beth Cobb

    June 2022 Medicare Transmittals and Coverage Updates
    Published on Jun 22, 2022
    20220622

    Medicare MLN Articles & Transmittals

    July 2022 Update of the Hospital Outpatient Prospective Payment System (OPPS)
    • MLN Release Date: May 31, 2022
    • What You Need to Know: This article includes information about new COVID-19 CPT vaccine and administration codes. You will also find details about new CPT proprietary laboratory analyses (PLA) coding changes and new CPT Category III codes effective July 1, 2022.
    • MLN MM127961: (link)
    Update to 'J' Drug Code List for Billing Home Infusion Therapy (HIT) Services
    • MLN Release Date: May 31, 2022
    • What You Need to Know: This article provides information about a new HCPCS drug code for payment beginning July 1, 2022, and updates to the list of home infusion drugs.
    • MLN MM12667: (link)
    July 2022 Update of the Ambulatory Surgical Center (ASC) Payment System
    • MLN Release Date: June 9, 2022
    • What You Need to Know: Effective July 1, 2022, there is a new CPT Category III Code, newly established HCPCS codes for drugs, biologicals and radiopharmaceuticals and new skin substitute products and low-cost/high-cost group assignment.
    • MLN MM12773: (link)

    Revised Medicare MLN Articles & Transmittals

    July 2022 Updates to the Hospital Outpatient Prospective Payment System (OPPS)
    • Article Release Date: May 31, 2022 – Revised June 16, 2022
    • What You Need to Know: This article was revised due to CMS rescinding Transmittal 11435 and replacing it with Transmittal 11457 to correct Table 1 in the attachment A, because it was missing some codes.
    • MLN MM12761: (link)

    Coverage Updates

    Surgical Dressings: Medicare Requirements

    Excerpt from May 26, 2022 edition of MLN Connects ((link)

    “Medicare covers primary or secondary surgical dressings:

    • When used to protect or treat a wound
    • If needed after you debride a wound
    • You must:
    • Include clinical information in patients’ medical records that demonstrates a reasonable and necessary need for the type and quantity of surgical dressings
    • Evaluate the wound monthly and update the record, unless you document why you can't do a monthly evaluation and how you're monitoring the patient's ongoing use of dressings
    • For more information, see the Surgical Dressings – Policy Article.”
    Beta Amyloid Positron Emission Tomography (PET) in Dementia and Neurodegenerative Disease Tracking Sheet

    On June 16, CMS posted a Tracking Sheet (link) regarding National Coverage Determination (NCD) 220.6.20 Beta Amyloid Positron Tomography in Dementia and Neurodegenerative Disease. CMS generated this NCD analysis based on stakeholder feedback during the finalization of the NCD for Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer’s Disease. The purpose of the NCD reconsideration is to determine if the current policy of one PET scan per patient per lifetime should be revised.

    Beth Cobb

    May 2022 Medicare MLN Articles and Transmittals Updates
    Published on May 25, 2022
    20220525

    Medicare MLN Articles & Transmittals

    Section 127 of the Consolidated Appropriations Act: Graduate Medical Education (GME) Payment for Rural Track Programs (RTPs)
    • Article Release Date: April 28, 2022
    • What You Need to Know: Your billing staff needs to be aware of a new definition for RTPs, changes in Section 127 of the Consolidated Appropriations Act (CAA), 2021, and the documentation requirements for hospitals requesting indirect and direct GME rate increases.
    • MLN MM12709: (link)
    Update of Internet Only Manual (IOM), Pub. 100-04, Chapter 15 – Ambulance
    • Article Release Date: April 28, 2022
    • What You Need to Know: This article reports an update to the Medicare Claims Processing Manual. It also provides background guidance on how ambulance providers should bill for Medicare Part B ambulance services when a patient dies before the ambulance arrives and when a patient dies after being loaded on the ambulance.
    • MLN MM12707: (link)
    Changes to Beneficiary Coinsurance for Additional Procedures Furnished During the Same Clinical Encounter as Certain Colorectal Cancer Screening Tests
    • Article Release date: April 29, 2022
    • What You Need to Know: Beginning January 1, 2022, CMS began to gradually reduce the coinsurance for any procedure beyond a planned colorectal cancer screening test until the procedure is completely free for dates of service on or after January 1, 2030.
    • MLN MM12656: (link)
    Calendar Year 2023 Modifications/Improvements to Value-Based Insurance Design (VBID) Model – Implementation
    • Article Release Date: April 29, 2022
    • What You Need to Know: Information in this article is for hospices, hospitals, and suppliers billing MACs for services provided to Medicare hospice patients enrolled in Medicare Advantage (MA) plans participating in the voluntary Value-Based Insurance Design (VBID) Model’s Hospice Benefit component.
    • MLN MM12688: (link)
    Quarterly Update for Clinical Laboratory Fee Scheduled (CLFS) and Laboratory Services Subject to Reasonable Charge Payment
    • Article Release Date: May 5, 2022
    • What You Need to Know: Links in this article will help you find updates pertaining to Advanced Diagnostic Laboratory Tests (ADLTs) and new codes effective July 1, 2022.
    • MLN MM12737: (link)
    International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs)---October 2022
    • Article Release Date: May 9, 2022
    • What You Need to Know: There are no policy changes in this ICD-10 quarterly update. Updates do include newly available codes.
    • MLN MM12705: (link)
    Revisions to Medicare Part B Coverage of Pneumococcal Vaccinations for the Medicare Benefit Policy Manual Chapter 15, Section 50.4.42
    • Article Release Date: May 9, 2022
    • What You Need to Know: CMS updated the Medicare coverage for pneumococcal vaccinations to align with the Advisory Committee on Immunization Practices (ACIP) recommendations that vary based on patient age and risk factors.
    • MLN MM12723: (link)
    Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) – July 2022 Update
    • Transmittal 11408 (Change Request 12747) Release Date: May 12, 2022
    • What You Need to Know: CR 12747 details information about new HCPCS and CPT codes, new G codes for the 180-day monitoring period for continuous glucose monitoring (CGM), and codes that are no longer valid.
    • Transmittal 11408 (CR 12747): (link)
    Elimination of Certificates of Medical Necessity & Durable Medical Equipment Information Forms
    • MLN Release Date: May 12, 2022
    • What You Need to Know: CMS published this Special Edition (SE) article to alert those that bill Durable Medical Equipment (DME) for services and supplies provided to Medicare patients that effective January 1, 2023, CMS will no longer require Certificates of Medical Necessity (CMNs) and DME Information Forms (DIFs)
    • MLN SE22002: (link)

    Revised Medicare MLN Articles & Transmittals

    New Waived Tests
    • Article Release Date: January 18, 2022 – Revised April 27, 2022
    • What You Need to Know: CR 12581 changed the HCPCS code for the Cardinal Health H. Pylori Rapid Test – Whole Blood/Serum Cassette (Whole Blood) to 86318QW. This MLN article was updated to reflect the code change.
    • MLN MM12581: (link)
    Update to Chapter 7, “Home Health Services”, of the Medicare Benefit Policy Manual (Pub 100-02)
    • Article Release Date: March 28, 2022 – Revised April 28, 2022
    • What You Need to Know: CR 12615 changed the background and policy sections of the CR’s business requirements and manual attachment. This MLN article was updated to reflect the changes.
    • MLN MM12615: (link)
    Mental Health Visits via Telecommunications for Rural Health Clinics & Federally Qualified Health Centers
    • Article Release Date: March 30, 2022 – Revised May 5, 2022
    • What You Need to Know: This article was revised to show that RHCs must include modifier CG on claims for mental health visits via telecommunications.
    • MLN SE22001: (link)

    Beth Cobb

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