This week in Medicare updates—8/30/2023
Activation of Validation Edits for Providers with Multiple Service Locations
On August 16, CMS revised Special Edition MLN Matters 19007 regarding systematic validation edits for OPPS providers with multiple service locations. CMS added new information about the practice location address screen for round 3 testing. The practice address sent on the claim in the MAP 171F screen must match the address found in the MAP 1AB1/MAP 1AB2 screens or else it will be returned to the provider.
CMS Issues Draft Guidance on New Medicare Prescription Payment Plan
On August 21, CMS published a Press Release to announce the release of Draft Guidance on the new Medicare Prescription Payment Plan, a provision of the Inflation Reduction Act that will allow people with Medicare prescription drug coverage the option to pay out-of-pocket costs in monthly payments. The program will start in 2025, and the draft guidance is geared toward Part D plan sponsors and pharmacies.
CMS published an FAQ on the program on the same date. Comments on the draft guidance are due by September 20.
Correction Notice: CY 2024 OPPS Proposed Rule
On August 22, CMS published a Correction Notice in the Federal Register to correct a table from the CY 2024 OPPS proposed rule regarding proposed surgical procedures for the ASC-covered procedures list. The previous version of the table ended with CPT code D7270. This correction adds eight more codes to the table.
Correction Notice: CY 2023 OPPS Final Rule
On August 24, CMS published a Correction Notice in the Federal Register regarding the CY 2023 OPPS Final Rule to make a handful of corrections to references where the numbers in the references weren’t italicized properly.
Changes to the Laboratory NCD Edit Software for January 2024
On August 24, CMS published Medicare Claims Processing Transmittal 12219 regarding the quarterly updates to the edit module for clinical diagnostic laboratory services. The changes include updates of ICD-10-CM codes across a variety of NCDs.
Effective date: January 1, 2024 - Unless noted differently in requirements
Implementation date: January 2, 2024
Quarterly Update for the DMEPOS Competitive Bidding Program (CBP) - January 2024
On August 24, CMS published Medicare Claims Processing Transmittal 12221 regarding the regular quarterly updates to the HCPCS codes, ZIP codes, and single payment amount files for the DMEPOS CBP files.
Effective date: January 1, 2024
Implementation date: January 2, 2024
Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) Updates for FY 2024
On August 24, CMS published Medicare Claims Processing Transmittal 12222 regarding the implementation of changes for IPFs as finalized in the FY 2024 IPF PPS Final Rule. This includes updates to quality programs, PRICER updates, and more.
On August 28, CMS published MLN Matters 13335 to accompany the transmittal.
Effective date: October 1, 2023
Implementation date: October 2, 2023