- CORRECTION: Monkeypox & Smallpox Vaccines: Include Product Code on Claims
- COVID-19: Novavax Vaccine Authorized for Patients 12–17 Years Old
- Medicare Shared Savings Program Saves Medicare More Than $1.6 Billion in 2021 & Continues to Deliver High-quality Care
- Increased Use of Telehealth for Opioid Use Disorder Services During COVID-19 Pandemic Associated with Reduced Risk of Overdose
- Sickle Cell Disease: What You Need to Know Video
- Healthy Aging: Recommend Services for Your Patients
- Influenza Vaccine Payment Allowances - Annual Update for 2022–2023 Season
- Quarterly Update to Home Health (HH) Grouper
- Introduction to Language Access Plans Web-Based Training
- Combating Medicare Parts C and D Fraud, Waste, & Abuse Web-Based Training — Revised
News
CORRECTION: Monkeypox & Smallpox Vaccines: Include Product Code on Claims
Our August 11 edition told you to only bill for vaccine administration when you got the vaccine at no cost from the government. The correct instructions are to include these 3 elements on your claim, even if you get the vaccine from the government for free:
- product code (90611 or 90622)
- applicable ICD-10-CM diagnosis code
- 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.
COVID-19: Novavax Vaccine Authorized for Patients 12–17 Years Old
On August 19, the FDA amended the Novavax COVID-19 Vaccine, Adjuvanted emergency use authorization to authorize the use for all patients 12–17 years old.
Visit the COVID-19 Vaccine Provider Toolkit for more information, and get the most current list of billing codes, payment allowances, and effective dates. Note: You may need to refresh your browser if you recently visited this webpage.
Medicare Shared Savings Program Saves Medicare More Than $1.6 Billion in 2021 & Continues to Deliver High-quality Care
CMS announced that the Medicare Shared Savings Program, through its work with accountable care organizations – groups of doctors, hospitals, and other health care providers – saved Medicare money, while continuing to deliver high-quality care. Specifically, the program saved Medicare $1.66 billion in 2021 compared to spending targets. This marks the fifth consecutive year the program has generated overall savings and high-quality performance results.
- Full press release
- Medicare Shared Savings Program webpage
- Calendar Year 2023 Medicare Physician Fee Schedule Proposed Rule - Medicare Shared Savings Program Proposals fact sheet
- Data.CMS.gov — 2021 Medicare Shared Savings Program Financial and Quality performance results
Increased Use of Telehealth for Opioid Use Disorder Services During COVID-19 Pandemic Associated with Reduced Risk of Overdose
The expansion of telehealth services during the COVID-19 pandemic was associated with individuals staying in treatment longer and reducing their risk of medically treated overdose, according to a new study.
Published today in JAMA Psychiatry, this study was a collaborative effort led by researchers at the National Center for Injury Prevention and Control, a part of the CDC; the National Institute on Drug Abuse, part of the National Institutes of Health; and CMS.
See the CMS press release for more information.
Sickle Cell Disease: What You Need to Know Video
CMS developed a new video on how to better support patients with sickle cell disease (SCD), including common health disparities and barriers to care. SCD is the most commonly inherited blood disorder. Although it occurs across all racial and ethnic populations, it disproportionately affects Black or African American and Hispanic or Latino patients.
During National Sickle Cell Awareness Month, learn about:
- Barriers to high-quality, continuous, and affordable health care
- Common health complications, including pain episodes or crises, Hand-Foot Syndrome, Acute Chest Syndrome, infection, eye disease, and stroke
- Common treatment options, including blood transfusion, intravenous therapy, and pain medications
For more information about health equity, visit the CMS Office of Minority Health webpage.
Healthy Aging: Recommend Services for Your Patients
Medicare covers many services. During Healthy Aging® Month, encourage your patients to adopt a healthy lifestyle. Recommend appropriate services, including:
- Preventive services
- Cognitive assessment & care plan services
- Chronic care management (CCM) services (PDF) booklet & CCM Health Care Professional Resources webpage
- Behavioral health integration services (PDF)
More Information for Your Patients:
- Preventive & screening services
- Cognitive assessment & care plan services
- Chronic care management services
- Behavioral health integration services
Compliance
DMEPOS Standard Written Order Requirements
Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers — follow requirements for standard written orders (SWOs):
- Keep the SWO from the treating practitioner on file
- Get the SWO before submitting a claim for all DMEPOS items
- Get the SWO before delivering certain items
- Submit completed SWOs for all DMEPOS services billed if there’s an audit
Review MLN Matters Article SE20007 (PDF) to learn what elements to include on the order and related documentation:
- Beneficiary name or Medicare beneficiary identifier
- General description of the item
- Quantity you’ll dispense, if applicable
- Order date
- Treating provider name or national provider identifier
- Treating provider signature
More Information:
- Standard Documentation Requirements for All Claims Submitted to DME Medicare Administrative Contractors (MACs) local coverage article
- Find SWO final rule FAQs on your MAC’s website: Noridian JA & JD, CGS JB & JC
- 42 CFR 410.38
Claims, Pricers, & Codes
Influenza Vaccine Payment Allowances - Annual Update for 2022–2023 Season
Get payment allowances and effective dates for the 2022–2023 season.
More Information:
- Flu Shot webpage: frequency, coverage, billing, coding, and resources
- Instruction to your Medicare Administrative Contractor (PDF)
Quarterly Update to Home Health (HH) Grouper
Get the HH Prospective Payment System Grouper software effective for dates of service on or after October 1, 2022 (type of bill 032x other than 32A or 320). Learn about new and deleted ICD-10-CM diagnosis codes.
More Information:
- Section 80 Claims Processing Manual, Chapter 10 (PDF)
- Instruction to your Medicare Administrative Contractor (PDF)
Multimedia
Introduction to Language Access Plans Web-Based Training
Learn about language access plans to provide high-quality care for your patients with limited English proficiency.
Combating Medicare Parts C and D Fraud, Waste, & Abuse Web-Based Training — Revised
Check out our revised training for:
- New definitions and information on where you can report
- Additional examples and information on laws
- Revised lesson questions
Information for Patients
How to Report a Medicare Complaint
CMS developed a video to share with your patients if they need to file a complaint, such as poor quality treatment or abuse.
2 Ways to File:
More Information:
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