Tag: Medicare

Corrections to errors made by Medicare systems April 1

Medicare systems corrected three errors on April 1 affecting the payment of CY2021 claims. The errors were: Claims spanning January 1 were applying CY2020 rates in error Late Request for Anticipated Payment (RAP) penalties were not applying to outlier amounts  Late RAP penalties were being applied after the Value-Based Purchasing (VBP) adjustment when the VBP […]

AHA and AMA call for halt to pending Medicare spending cuts

Congress should prevent planned Medicare spending reductions triggered by the American Rescue Plan Act of 2021, the American Medical Association (AMA) said in a March 17 statement. The reduction, which could be up to 4%, would be enacted under the statutory Pay-As-You-Go (PAYGO) provision, which prevents new legislation from increasing the federal budget deficit. Congress […]

Biden names acting administrator for CMS

The Biden administration has named Liz Richter the acting administrator for CMS. Richter has served since 1990 and most recently served as deputy director of the Center for Medicare, according to CMS. Richter began in the Bureau of Policy Development working on inpatient hospital payment policy. She later worked on a variety of Medicare payment […]

Ensure patients are up to date on vaccines for influenza, pneumonia

In the midst of the COVID-19 public health emergency and the height of flu season, it is important to ensure patients in home health and hospice care are up to date on their influenza and pneumonia vaccines. A post on a Celerian Group Company (CGS)’s website reminds providers: Home health agencies can provide the influenza […]

MACs announce RAP workaround due to error message

An issue with RAP processing under the new no-pay RAP policies has led to some RAPs being returned to agencies, but Medicare Administrative Contractors (MACs) have determined a workaround, according to a message from CGS to providers last week. While its optional for you to report a Core-Based Statistical Area (CBSA) code using value code […]

CMS announces expansion of Home Health Value-Based Purchasing Model

CMS will expand the Home Health Value-Based Purchasing (HHVBP) Model, officials announced January 8, 2021. Currently implemented in nine states, the model has saved Medicare an average of $141 million annually, with an average improvement in quality scores of 4/6%, according to a news release. The HHVBP Model adjusts payments to agencies based on quality […]

Medicare codes issued for Moderna vaccine

The FDA recently issued an Emergency Use Authorization the Moderna COVID-19 vaccination, and Medicare will be covering the administration of the vaccine for the duration of the Public Health Emergency.  SNFs should only bill for administration codes when submitting claims to Medicare, and should not use these codes while the vaccine is free. CMS will […]

CMS unveils new model for Medicaid Managed Care Organizations

CMS’ Center for Medicare & Medicaid Innovation has an opportunity for Medicaid Managed Care Organizations (MCOs) to participate in the Global and Professional Options of the Direct Contracting Model. The model seeks to encourage “Medicaid MCOs to partner with providers and suppliers and implement care coordination programs that can improve quality and reduce Medicare fee-for-service […]

Home health agencies must enroll with state Part B Medicare Administrative Contractor to provide home infusion therapy

Beginning Jan. 1, home health agencies that wish to provide and bill Medicare Home Infusion Therapy (HIT) professional services for calendar year 2021, will be required to enroll with the Part B Medicare Administrative Contractor (A/B MAC) in their state. Home health agencies will no longer be able to bill professional HIT services on the […]

COVID-19 Vaccine Latest: Moderna vaccine approved, older adults 75+ next in line for shots

The Food and Drug Administration has issued an emergency use authorization (EUA) for Moderna’s COVID-19 vaccine for persons 18 and older. Meanwhile, a federal advisory committee voted Sunday to put seniors 75 and older among those next in line to get vaccinated. Unlike the Pfizer-BioNTech vaccine approved Dec. 11, which required specialty freezers, the Moderna […]