CMS Industry News articles

The Centers for Medicare & Medicaid Services (CMS) released an additional list of Frequently Asked Questions (FAQs) to Medicare providers regarding the Department of Health & Human Services’ (HHS) Provider Relief Fund and the Small Business Administration’s Paycheck Protection Program payments, also referred to as coronavirus disease 2019 (COVID-19) relief payments.  The FAQs provide guidance to providers on how to report provider relief fund payments, uninsured charges reimbursed through the Uninsured Program administered by Health Resources and Services Administration, and Sm

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Centers for Medicare & Medicaid Services (CMS) announced sweeping regulatory changes that require nursing homes to test staff and offer testing to residents for coronavirus disease 2019 (COVID-19). Laboratories and nursing homes using point-of-care testing devices will be required to report diagnostic test results as required by the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). The new rules also require hospitals to provide COVID-19 cases and related data to the U.S. Department of Health and Human Services (HHS).

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Key proposals for 2021 performance year of the Quality Payment Program include:

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Payment files were issued to MACs based on the Calendar Year (CY) 2020 MPFS Final Rule, which was published in the Federal Register on November 15, 2019. These are effective for services provided between January 1, 2020, and December 31, 2020.

Below is a summary of changes in the October update to the 2020 MPFSDB. Three codes in the MPFSDB have revised short descriptors:

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The proposed 2021 Medicare Physician Fee Schedule released this week calls for cuts to laboratory reimbursement rates.

Issued by Centers for Medicare and Medicaid Services on Tuesday, the proposed fee schedule would cut overall pathology service payments by 9 percent compared to 2020 and independent lab services by 5 percent.

Among the largest scheduled cuts is to the professional component of pathology tissue examinations, which is slated to drop 12 percent to $34.52 to $39.34.

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MLN Article revised on August 24, 2020, to reflect an updated CR 11937 that includes additional COVID-19 codes 86408, 86409, 0225U, 0226U, effective August 10, 2020.

CR 11937 also added codes 0015M and 0016M, effective October 1, 2020.

The CR release date, transmittal number and link to the transmittal also changed. August 21, 2020

CR Transmittal Number: R10318CP

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Section 1834A of the Act, as established by Section 216(a) of the Protecting Access to Medicare Act of 2014 (PAMA), required significant changes to how Medicare pays for Clinical Diagnostic Laboratory Tests (CDLTs) under the CLFS. The CLFS final rule “Medicare Clinical Diagnostic Laboratory Tests Payment System Final Rule” (CMS-1621-F) was published in the Federal Register on June 23, 2016. The CLFS final rule implemented section 1834A of the Act.

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CMS is committed to taking critical steps to ensure America’s health care facilities continue to be prepared in response to the threat of the 2019 Coronavirus Disease (COVID-19).

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The Current Procedural Terminology (CPT) codes for these new tests must have the modifier QW to be recognized as a waived test. However, the tests mentioned on the first page of the list attached to CR 11916 (such as CPT codes: 81002, 81025, 82270, 82272, 82962, 83026, 84830, 85013, and 85651) do not require a QW modifier to be recognized as a waived test.

The CPT code, effective date and description for the latest tests approved by the FDA as waived tests under CLIA are the following:

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The Centers for Medicare and Medicaid Services (CMS) recently announced that it intends to resume both prepayment and postpayment medical reviews conducted by the Medicare Administrative Contractors, Supplemental Medical Review Contractors, and Recovery Audit Contractors, including those under the Targeted Probe and Educate program, on August 3, 2020:

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