- COVID-19: Patients Can Get Free Over-the-Counter Tests from Participating Providers
- Immunosuppressive Drug Coverage for Kidney Transplant Patients: Proposed Rule
- Diabetic Testing Supplies Ordering Guide
- Inpatient Rehabilitation Facilities: Care Compare March Preview Reports Reissued & April Refresh
- Long-Term Care Hospitals: Care Compare March Preview Reports Reissued & April Refresh
- Skilled Nursing Facilities: Care Compare April Preview Reports & Refresh
- May is National Asian American, Native Hawaiian, & Pacific Islander Heritage Month
- Outpatient Claims with Reason Code W7120 Returned in Error
- Eliminating Certificates of Medical Necessity & Durable Medical Equipment Information Forms — January 1, 2023
- Update of Internet Only Manual (IOM), Pub. 100-04, Chapter 15 - Ambulance
- Update to the Payment for Grandfathered Tribal Federally Qualified Health Centers (FQHCs) for Calendar Year (CY) 2022
- Section 127 of the Consolidated Appropriations Act: Graduate Medical Education (GME) Payment for Rural Track Programs (RTPs)
- New Waived Tests — Revised
- Update to Chapter 7, “Home Health Services,” of the Medicare Benefit Policy Manual (Pub 100-02) — Revised
News
COVID-19: Patients Can Get Free Over-the-Counter Tests from Participating Providers
From April 4, 2022, through the end of the COVID-19 public health emergency, Medicare covers and pays for over-the-counter COVID-19 tests at no cost to patients. Under this new initiative, we pay participating pharmacies and other health care providers directly.
More Information:
Immunosuppressive Drug Coverage for Kidney Transplant Patients: Proposed Rule
On April 22, CMS issued a proposed rule to update Medicare enrollment and eligibility rules that would expand coverage for people with Medicare and advance health equity. Section 402 of the Consolidated Appropriations Act, 2021, made a key change to Medicare enrollment rules. The proposed rule would establish a new immunosuppressive drug benefit to extend Medicare immunosuppressive drug coverage to certain people who have had a kidney transplant.
More information:
- Press release
- Fact sheet
- Proposed rule: Submit comments by June 27
Diabetic Testing Supplies Ordering Guide
Learn how to order diabetic testing supplies for Medicare patients who use home glucose monitors, and make sure they’re covered. Find out how to:
- Confirm patient eligibility
- Document the medical record
- Determine the number of test strips and lancets
- Learn why claims are denied
Inpatient Rehabilitation Facilities: Care Compare March Preview Reports Reissued & April Refresh
CMS reissued March preview reports to correct an error in the patient counts for each Patient Assessment Instrument measure. Review your data by May 27 before the June refresh.
View the April refresh of Inpatient Rehabilitation Facility Quality Reporting Program data on the Care Compare webpage and in the Provider Data Catalog.
To learn more, visit the Updates section of the Public Reporting webpage.
Long-Term Care Hospitals: Care Compare March Preview Reports Reissued & April Refresh
View the April refresh of Long-Term Care Hospital Quality Reporting Program data on the Care Compare webpage and in the Provider Data Catalog.
To learn more, visit the Updates section of the Public Reporting webpage.
Skilled Nursing Facilities: Care Compare April Preview Reports & Refresh
Review your preview report by May 30 before the July refresh.
View the April refresh of Skilled Nursing Facility Quality Reporting Program data on the Care Compare webpage and in the Provider Data Catalog.
To learn more, visit the Updates section of the Public Reporting webpage.
May is National Asian American, Native Hawaiian, & Pacific Islander Heritage Month
Over 7% of the U.S. population are Asian Americans, Native Hawaiians, and other Pacific Islanders. Uninsured rates vary among the different ethnicities in this group.
CMS is committed to policy and equity initiatives that help these communities find and use health care. During National Asian American, Native Hawaiian, and Pacific Islander Heritage Month, learn about the health needs of this population, and find out how to reduce health disparities.
More Information (including resources in additional languages for your patients):
- CMS Office of Minority Health, Health Observances webpage
- Medicare & You handbook
- Coverage to Care webpage
Claims, Pricers, & Codes
Outpatient Claims with Reason Code W7120 Returned in Error
A system error caused CMS to return the following outpatient claims with reason code W7120:
- Bill types 13X and 85X
- Designated surgical ranges 10000-69999 or 0000T-9999T
- Modifier PT
We’re bypassing reason code W7120 for these claims until we correct the issue in the July 2022 Integrated Outpatient Code Editor update. Resubmit claims that we returned in error.
Eliminating Certificates of Medical Necessity & Durable Medical Equipment Information Forms — January 1, 2023
Suppliers, billers, and vendors: Certificates of medical necessity (CMNs) and the durable medical equipment (DME) information forms (DIFs) are discontinued effective January 1, 2023. As a result, you can’t submit CMN and DIF forms or their electronic claim data elements with claims for dates of service on or after January 1, 2023. Suppliers must continue to submit CMN and DIF information for claims with dates of service before January 1, 2023.
CMS will provide additional information soon.
Events
CMS National Provider Enrollment Conference in Boston — August 16 & 17
Tuesday, August 16 & Wednesday, August 17 from 8 am to 5 pm ET
Boston, Massachusetts
Register for the conference at the Boston Convention and Exhibition Center. Take advantage of this opportunity to meet with CMS and Medicare Administrative Contractor provider enrollment experts.
If the date of the conference changes due to the ongoing pandemic, CMS will notify all registrants.
MLN Matters® Articles
Update of Internet Only Manual (IOM), Pub. 100-04, Chapter 15 - Ambulance
Learn how to bill for ambulance services when the patient dies (PDF):
- Before the ambulance arrives
- After being loaded on the ambulance
There aren’t any policy changes.
Update to the Payment for Grandfathered Tribal Federally Qualified Health Centers (FQHCs) for Calendar Year (CY) 2022
- Process to become a grandfathered tribal FQHC
- Prospective Payment System (PPS) payment rates
- Services not paid at the PPS rate
Section 127 of the Consolidated Appropriations Act: Graduate Medical Education (GME) Payment for Rural Track Programs (RTPs)
Learn about changes from Section 127 of the Consolidated Appropriations Act, 2021 (PDF):
- New program definition
- Calculations for interim rates and full-time equivalent limitations
- Effective date of exemption from rolling averages
- Indirect medical education intern-and-resident to bed ratio cap
New Waived Tests — Revised
Learn about waived tests approved by the FDA under the Clinical Laboratory Improvement Amendments of 1988 (PDF). We updated the HCPCS code for Cardinal Health H. Pylori Rapid Test - Whole Blood/Serum Cassette (Whole Blood) to 86318QW.
Update to Chapter 7, “Home Health Services,” of the Medicare Benefit Policy Manual (Pub 100-02) — Revised
Learn about requirements for nurse practitioners to document (PDF):
- Scope of practice
- Relationships they have with physicians
Publications
Medical Record Maintenance & Access Requirements — Revised
Learn about required information in the medical record (PDF) to justify referral for Medicare home health services.
Medicare Mental Health — Revised
Learn about new requirements, effective January 1, 2022, and recent updates (PDF):
- Use telehealth services to diagnose, evaluate, or treat certain mental health or substance use disorders in the patient’s home
- Nurse practitioners, certified nurse specialists, certified nurse-midwives, and physician assistants (PAs) may provide services on assignment, but they can’t charge more than the allowed limit
- We pay for PA professional services
- PAs may reassign their service payment rights and incorporate as a practitioners’ group
- For telehealth mental health services, we require an in-person visit within 6 months before furnishing services and every 12 months while the patient gets services, unless the risks and burdens outweigh the benefit
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