Legislation

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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News COVID-19 Vaccines: Act Now IRF Review Choice Demonstration: Submit Comments by October 8 Compliance Medicare Quarterly Provider Compliance Newsletter Surgical Dressings: Medicare Requirements Claims, Pricers, & Codes Average Sales Price Files: October 2021 Events National Stakeholder Call with the CMS Administrator — September 17 MLN Matters® Articles 2022 Annual Update for the Health Professional Shortage Area (HPSA) Bonus Payments Annual Clotting Factor Furnishing Fee Update 2022 Home Health Notices of Admission – Additional Manual Instructions Implement Operating [...]

From the Well  September Interim Session At the center of the West Virginia state Capitol is an area known as “The Well.” It is the informal gathering place for lobbyists, reporters, constituents and lawmakers. Centrally located between the chambers of the House of Delegates and Senate, “The Well” is often where information is shared, alliances are formed and deals are made.   Public Health   US Senate panel considers  Dr. Gupta as drug czar   Former West Virginia [...]

Biden-Harris Administration to Expand Vaccination Requirements for Health Care Settings New action will protect patients of the 50,000 providers and over 17 million health care workers in Medicare and Medicaid certified facilities The Biden-Harris Administration will require COVID-19 vaccination of staff within all Medicare and Medicaid-certified facilities to protect both them and patients from the virus and its more contagious Delta variant.  Facilities across the country should make efforts now to get health care staff vaccinated to make [...]

  AAOS Advocacy in Action Submitted comments to the regulatory agencies on Part I of the surprise billing rules issued to address implementation of the No Surprises Act.       Action Alert: Protect Access to Specialty Care     Orthopaedic surgeons, along with much of the physician community, are facing imminent cuts to Medicare payment. These cuts, when combined, will amount to an up to 10% reduction and would be significantly damaging to physician practices and access to [...]