This week in Medicare updates—10/20/2021
NCD 110.24: Chimeric Antigen Receptor (CAR) T-Cell Therapy
On October 6, CMS revised MLN Matters 12177 to add information on the use of the KX modifier on professional claims. The added information reminds providers to use the KX modifier when sending claims for CAR T-cell therapy services.
Effective date: August 7, 2019
Implementation date: September 20, 2021
CMS Releases 2022 Medicare Advantage and Part D Star Ratings
On October 8, CMS published a Press Release regarding the star ratings for 2022 Medicare Advantage and Part D Prescription Drug Plans. Approximately 68% of Medicare Advantage plans offering prescription drug coverage in 2022 will have at least a four-star rating, up from 49% of plans earning this rating for 2021. The average star rating for all Medicare Advantage plans with prescription drug coverage is 4.37% for 2022, an increase from the 2021 average of 4.06%.
CMS published a Fact Sheet on the star ratings on the same date.
Medicare Mental Health
On October 12, CMS revised an MLN Booklet on mental health coverage to update language in two tables on what certain providers are legally authorized to practice.
Notice of New Interest Rate for Medicare Overpayments and Underpayments - 1st Qtr Notification for FY 2022
On October 13, CMS published Medicare Financial Management Transmittal 11051 regarding the first quarter update to the interest rate on Medicare overpayments and underpayments. The Department of Treasury has changed the private consumer rate to 9.375%.
Effective date: October 19, 2021
Implementation date: October 19, 2021
Ambulance Inflation Factor (AIF) for CY 2022 and Productivity Adjustment
On October 13, CMS published Medicare Claims Processing Transmittal 11044 regarding the CY 2022 AIF, which is 5.1%. The 2022 ambulance fee schedule file will be available in November 2021.
Effective date: January 1, 2022
Implementation date: January 3, 2022
Correct Processing of Home Health Claims if the Request for Anticipated Payment (RAP) or Notice of Admission (NOA) Was More Than 30 Days Late and Correct Identification CAH Sub-Unit Discharges as Institutional Periods of Care
On October 13, CMS published One-Time Notification Transmittal 11047 regarding claims processing functions that will ensure there is no payment if the RAP or NOA receipt date is more than 30 days after the claim From date. It also fixes an oversight from PDGM implementation that excluded the CMS Certification Number (CCN) ranges of inpatient rehabilitation units or inpatient psychiatric units that are CAH-based. The system edits will be revised to ensure assignment of institutional payment groups to include the CAH-based units.
Effective date: January 1, 2021
Implementation date: April 4, 2022
Revisions to Chapters 3, 18, and 32 of the Claims Processing Manual to Update Coding
On October 13, CMS published Medicare Claims Processing Transmittal 11035 to update certain chapters in the manual with updated ICD-10-CM and ICD-10-PCS codes. These chapters address stem cell transplants, liver transplants, vagus nerve stimulation, and more.
Effective date: November 17, 2021 - Unless otherwise specified, the effective date is the date of service
Implementation date: November 17, 2021 - Unless otherwise specified, the effective date is the date of service
New/Modifications to the Place of Service (POS) Codes for Telehealth
On October 13, CMS published Medicare Claims Processing Transmittal 11045 regarding a new POS code (10) to describe telehealth when health services and health-related services are provided to a patient located in their home via telecommunication technology. It also revises the descriptor for POS code 02 (telehealth provided other than in the patient’s home).
CMS published MLN Matters 12427 on the same date.
Effective date: January 1, 2022
Implementation date: April 4, 2022
2022 Annual Update of HCPCS Codes for SNF Consolidated Billing (CB) Update
On October 14, CMS published Medicare Claims Processing Transmittal 11052 regarding the annual update to the coding files used for SNF CB. The new coding files should be provided to the CWF by November 1, 2021.
Effective date: January 1, 2022
Implementation date: January 3, 2022
Revisions to Certified Provider/Supplier Model Letters and Instructions for Processing Initial SNF Enrollment Applications
On October 14, CMS published Medicare Program Integrity Transmittal 11040 regarding revisions to model letters MACs use when processing provider/supplier enrollment applications and updates to MAC processing instructions for initial SNF enrollment applications.
Effective date: October 15, 2021
Implementation date: November 18, 2021
Claim Status Category and Claim Status Codes Update
On October 14, CMS published Medicare Claims Processing Transmittal 11034 regarding the updates to the Claim Status and Claim Status Category Codes used for the ASC X12 276/277 Health Care Claim Status Request and Response and the ASC X12 277 Health Care Claim Acknowledgment transactions.
CMS published MLN Matters 12299 to accompany the transmittal.
Effective date: October 1, 2021
Implementation date: October 4, 2021
Medicare Coverage of Pneumococcal Conjugate Vaccine
On October 14, CMS published a Note in MLN Connects reminding providers it will begin covering the pneumococcal conjugate vaccine, 20 valent, on October 1. The note includes billing instructions as well as information on when MACs will process these claims.
Comment Request: Independent Rural Health Clinic Cost Report; Bid Pricing Tool for Medicare Advantage Plans and Prescription Drug Plans; more
On October 14, CMS published a Comment Request in the Federal Register regarding the following information collections:
- Independent Rural Health Clinic Cost Report
- Bid Pricing Tool (BPT) for Medicare Advantage (MA) Plans and Prescription Drug Plans (PDP)
- Implementation of Medicare and Medicaid Programs;--Promoting Interoperability Programs (Stage 3)
Comments are due by December 13.
Application from the American Association for Accreditation of Ambulatory Surgery Facilities for Continued Approval of its Rural Health Clinic (RHC) Accreditation Program
On October 15, CMS published a Proposed Notice in the Federal Register to announce it has received an application from the American Association for Accreditation of Ambulatory Surgery Facilities for continued recognition as a national accrediting organization for RHCs that wish to participate in the Medicare or Medicaid programs.
Comments on the application are due by November 15.