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News Flu Season is Here: Protect Your Patients, Yourself, & Your Loved Ones Clinical Laboratory Fee Schedule Updates Compliance Post-Acute Care Transfers: Bill Correctly MLN Matters® Articles October 2021 Integrated Outpatient Code Editor (I/OCE) Specifications Version 22.3 October 2021 Update of the Hospital Outpatient Prospective Payment System (OPPS) October Quarterly Update for 2021 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule Multimedia Part C Organization Determination, Appeals, & Grievances — Revised

Flu & Pneumococcal Vaccines: Expanded SNF Enforcement Discretion for Certain Pharmacy Billing Effective September 20, 2021, CMS exercised enforcement discretion for Skilled Nursing Facility (SNF) consolidated billing provisions related to flu and pneumococcal vaccines. This allows Medicare-enrolled immunizers, including pharmacies, to bill directly and get direct reimbursement from the Medicare program (including vaccine administration and product), whether these vaccines are administered at the same time (co-administered) with a COVID-19 vaccine or at different times. Visit the SNF: Enforcement Discretion [...]

Coverage without cost-sharing available for eligible people with Medicare, Medicaid, CHIP, and Most Commercial Health Insurance Coverage Following the FDA’s recent action that authorized a booster dose of the Pfizer COVID-19 vaccine for certain high-risk populations and a recommendation from the CDC, CMS will continue to provide coverage for this critical protection from the virus, including booster doses, without cost sharing. Beneficiaries with Medicare pay nothing for COVID-19 vaccines or their administration, and there is no applicable copayment, [...]

    Submitted formal comments on the proposed changes to the Medicare Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems for 2022, including abruptly reversing the Inpatient Only (IPO) List elimination. Submitted formal comments on the proposed changes to the Medicare Physician Fee Schedule for 2022, including reducing the conversion factor by 3.75 percent.       The Bone Beat New Episode Conversations on health policy issues affecting musculoskeletal care... Special Episode: Resident Involvement in Advocacy At the AAOS 2021 [...]

News CMS Launches New Medicare.gov Feature to Compare Nursing Homes by Vaccination Rate Drugs of Abuse Testing: Comparative Billing Report in September Cardiovascular Disease: Talk to your Patients about Screening Compliance DMEPOS Items: Ordering or Referring Practitioner Requirements Claims, Pricers, & Codes ESRD Facilities: Bill Correctly for Cinacalcet Oral Drug MLN Matters® Articles Claims Processing Instructions for National Coverage Determination 20.33 – Transcatheter Edge-to-Edge Repair (TEER) for Mitral Valve Regurgitation National Coverage Determination (NCD) 270.3 Blood-Derived Products for Chronic, [...]

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