News, Skilled Nursing Facility

Update to Medicare Claims Processing Manual, Chapter 23, Section 60.3

For newly covered DMEPOS items paid on a fee schedule basis where a Medicare fee does not exist, the Centers for Medicare & Medicaid Services (CMS) uses a process to establish fees called gap filling. This allows Medicare to establish a price that aligns with the statutory requirements for the DMEPOS fee schedule.

On September 14, CMS released an MLN Matters article announcing updates to Chapter 23, Section 60.3 of the Medicare Claims Processing Manual regarding gap filling. Language was added to indicate that potential appropriate sources for gap-filling include verifiable information from supplier invoices and non-Medicare payer data.

Click here to read the full MLN article.