This week in Medicare updates—2/1/2023
New Medicare Outpatient Observation Notice (MOON), Detailed Notice of Discharge (DND), and Important Message from Medicare (IMM) Forms Available
On January 23, CMS published new versions of the MOON, IMM, and DND forms to its Beneficiary Notices Initiative webpage. These forms are required for use no later than April 27, 2023.
Annual Therapy Code List and Dispositions Updates
On January 23, CMS published the CY 2023 Therapy Code List and Disposition Definitions download link to its website.
Updated Medicare Payment Systems MLN Educational Tool
On January 23, CMS updated an MLN Educational Tool regarding Medicare payment systems with the FY 2023 and CY 2023 regulatory changes established by the rule-making process.
Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Accreditation
On January 23, CMS updated an MLN Fact Sheet regarding DMEPOS accreditation to replace the national supplier clearinghouse (NSC) information with two new National Provider Enrollment (NPE) contractors effective November 7, 2022. CMS also added clarifying information about reporting enrollment information changes, such as change in ownership, adverse legal action, or change in practice location.
December 2022 Livanta Claims Review Advisor
On January 23, Livanta published the December 2022 edition of its Claims Review Advisor. This issue addresses the assignment of the principal diagnosis when a patient is admitted with both gastrointestinal hemorrhage and anemia.
Correction to Manual Instructions Update Established Under Change Request 10971 - Implementation of the Medicare Performance Adjustment (MPA) for the Maryland Total Cost of Care (MD TCOC) Model
On January 26, CMS published Medicare Claims Processing Transmittal 11807 to fix an issue caused by a previous change request where the chapter listed to designate the payer only codes utilized by Medicare was wrong. This transmittal fixes that issue by switching the instruction to the correct chapter.
Effective date: July 1, 2023
Implementation date: July 3, 2023
Update to Change Request 12636 Payment for Critical Access Hospitals (CAH) Ancillary Services Submitted on 12X Type of Bill (TOB) Claim
On January 26, CMS published One-Time Notification Transmittal 11813 regarding an update to the systems to allow for reimbursement for COVID, flu, pneumococcal pneumonia, and hepatitis B vaccines provided at CAHs when billed on revenue codes 0636 and 0771 on TOB 12X. Contractors will mass adjust CAH claims on TOB 12X with HCPCS codes M0249 and M0250 within 45 days of the implementation date of the transmittal.
Effective date: July 1, 2023
Implementation date: July 3, 2023
Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Medicare Benefit Policy Manual Chapter 13 Update
On January 26, CMS published Medicare Benefit Policy Transmittal 11803 regarding updates to Chapter 13 of the manual to reflect changes for RHCs and FQHCs made through 2022 and 2023 rule-making processes.
Effective date: January 1, 2023
Implementation date: February 27, 2023
Guidance for Rural Emergency Hospital Provisions, Conversion Process, and Conditions of Participation
On January 26, CMS published a Memorandum to state survey agency directors containing guidance on the new rural emergency hospital provider type. The memo outlines requirements on delivery of care, the conversion process for eligible facilities, survey guidelines, and the Conditions of Participation that facilities must meet to participate in the Medicare program.
Effective date: Immediately. Please communicate to all appropriate staff within 30 days.
Revisions to Hospice-Appendix M of the State Operations Manual and the Hospice Basic Surveyor Training
On January 27, CMS published a Memorandum to state survey agency directors regarding revisions to Appendix M and the CMS Hospice Basic Surveyor Training. CMS is changing the hospice survey process to focus on quality of care findings in the survey process. Surveyors who have previously taken the training on hospice surveys will take an abbreviated training that explains the new approach, while all surveyors who have not taken an earlier version of the training will take the full revised training.
Effective date: Immediately. Please communicate to all appropriate staff within 30 days.
Omnibus CR to Implement Policy Updates in the CY 2023 Physician Fee Schedule (PFS) Final Rule
On January 27, CMS published Medicare Benefit Policy Transmittal 11824, Medicare National Coverage Determinations Transmittal 11824, and Medicare Claims Processing Transmittal 11824 regarding the implementation of changes from the 2023 PFS Final Rule. This includes removing NCD 160.22 (Ambulatory EEG Monitoring) and expanding colorectal cancer screening coverage. The transmittals include instructions to the contractors on system changes and any necessary claims adjustments related to these updates.
Effective date: January 1, 2023
Implementation date: February 27, 2023 - requirements implementation date; April 3, 2023 - for release tracking purposes only