cms medicare holiday schedule 2022

Sept 26 2. 2022 Holiday Schedule. Eliminated use of history and exam to determine code level (instead there would be a requirement for a medically appropriate history and exam). In addition, we are finalizing a policy to update this fee amount annually by the percent change in the CPI-U. .gov CMS is proposing to require that OTPs use a service-level modifier for audio-only services billed using the counseling and therapy add-on code and document in the medical record the rationale for a service being furnished using audio-only services, in order to facilitate program integrity activities. For a fact sheet on the CY 2023 Quality Payment Program changes, please visit (clicking link downloads zip file): https://qpp-cm-prod-content.s3.amazonaws.com/uploads/2136/2023%20Quality%20Payment%20Program%20Final%20Rule%20Resources.zip, For a fact sheet on the Medicare Shared Savings Program changes, please visit:https://www.cms.gov/files/document/mssp-fact-sheet-cy-2023-pfs-final-rule.pdf, CMS News and Media Group This alert provides a summary of the Medicare Part D disclosure requirements, including a review of: The employers subject to Medicare Part D . Washington's Birthday: Monday, Feb. 20. https://www.federalregister.gov/public-inspection/current, https://qpp-cm-prod-content.s3.amazonaws.com/uploads/1517/2022%20QPP%20Proposed%20Rule%20Overview%20Fact%20Sheet.pdf, Federally-facilitated Exchange Improper Payment Rate Less Than 1% in Initial Data Release, Fiscal Year 2022 Improper Payments Fact Sheet, CY 2023 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule with Comment Period (CMS 1772-FC), Fiscal Year 2023 Inpatient Rehabilitation Facility Prospective Payment System Final Rule (CMS-1767-F), Fiscal Year 2023 Medicare Inpatient Psychiatric Facility Prospective Payment System Final Rule (CMS-1769-F). Finally, we are working to address commenters thoughtful feedback and questions regarding the operational aspects of billing and claims processing for these services. We are also finalizing our proposals to codify and clarify various laboratory specimen collection fee policies in 414.523(a)(1). This budget reflects the Administration's commitment to serve families across the country, with investments in priority areas, such as maternal health, data and research, tribal health, and early child care and learning. An official website of the United States government Section 3713 of the CARES Act established Medicare Part B coverage and payment for a COVID-19 vaccine and its administration. In the CY 2023 HH PPS proposed rule (87 FR 37605), CMS provided data analysis on Medicare home health benefit utilization, including overall total 30-day periods of care and average periods of care per HHA user; distribution of the type of visits in a 30-day period of care for all Medicare fee-for-service (FFS) claims; the percentage of periods that receive the LUPA; estimated costs for 30-day . Read More JK and J6 Medicare Part B Ask-the-Contractor Teleconference For additional Customer Contact Center closures due to scheduled training exercises, refer to: Scheduled Contact . 625 0 obj <>stream Home Health 60-day Episode Calendar Schedule SOC Date End of Episode 01/01 thru 03/01 01/02 thru 03/02 01/03 thru 03/03 01/04 thru 03/04 01/05 thru 03/05 01/06 thru 03/06 01/07 thru 03/07 01/08 thru 03/08 CMS is also finalizing the proposal to permit the use of audio-only communication technology to initiate treatment with buprenorphine in cases where audio-video technology is not available to the beneficiary, and all other applicable requirements are met. or ASC Drug Fees are also located on the CMS ambulatory surgical center (ASC) payment page. Finally, we are working to address commenters thoughtful feedback and questions regarding the operational aspects of billing and claims processing for these services. These proposals, in addition to existing policies, provide three years for ACOs to transition to reporting the three eCQM/MIPS CQM all-payer measures under the APP. or D.O.) The following provisions demonstrate CMSs commitment to addressing health equities in rural and vulnerable populations. 100-04, chapter 16, 60.1., did not have corresponding regulations text and some of the manual guidance is no longer applicable. CMS is proposing to allow RHCs and FQHCs to bill for TCM and other care management services furnished for the same beneficiary during the same service period, provided all requirements for billing each code are met. Under the primary care exception specifically, only MDM would be used to select the visit level to guard against the possibility of inappropriate coding that reflects residents inefficiencies rather than a measure of the time required to furnish the services. Section 122 of the CAA reduces, over time, the amount of coinsurance a beneficiary will pay for such services. At present, the addition of any procedure beyond the planned colorectal screening (for which there is no coinsurance) results in a beneficiarys having to pay coinsurance. We believe the CPM HCPCS codes will improve payment accuracy for these services, prompt more practitioners to welcome Medicare beneficiaries with chronic pain into their practices, and encourage practitioners already treating Medicare beneficiaries who have chronic pain to spend the time to help them manage their condition within a trusting, supportive, and ongoing care partnership. Section 90004 of the Infrastructure Investment and Jobs Act (Pub. This modification in our finalized policy necessitates multiple changes to our claims processing systems, which will take some time to fully operationalize, but audiologists may use modifier AB, along with the finalized list of 36 CPT codes, for dates of service on and after January 1, 2023. Lastly, in light of questions we have received from interested parties, we are finalizing as proposed to codify in our regulations, and make certain modifications and clarifications to, the Medicare CLFS travel allowance policies. Before sharing sensitive information, make sure youre on a federal government site. We are also finalizing revisions to 414.504(a)(1) to indicate that initially, data reporting begins January 1, 2017 and is required every 3 years beginning January 2023. The federal . Over the last several years, Medicare payment rates for physicians and mass immunizers for administering certain preventive vaccines (flu, pneumonia and hepatitis B vaccines) have decreased by roughly 30%. Preventive Vaccine Administration Services. and also establishes the professional qualifications for these practitioners. School makeup days will be used in the order listed. How the costs of furnishing flu, pneumococcal, and hepatitis B vaccines compare to the costs of furnishing COVID-19 vaccines, and how costs may vary for different types of health care providers. Some examples include reconstruction of the jaw following fracture or injury, tooth extractions done in preparation for radiation treatment for cancer involving the jaw, or oral exams preceding kidney transplantation. For CY 2022, in response to numerous stakeholder questions and to promote proper therapy care, CMS is proposing to revise the. Origin and Destination Requirements Under the Ambulance Fee Schedule. In contrast, PFS rates paid to physicians and other billing practitioners in facility settings, such as a hospital outpatient department (HOPD) or an ASC, reflect only the portion of the resources typically incurred by the practitioner in the course of furnishing the service. For most services furnished in a physicians office, Medicare makes payment to physicians and other professionals at a single rate based on the full range of resources involved in furnishing the service. For calendar quarters beginning January 1, 2022, the CAA requires manufacturers of drugs or biologicals payable under Part B without a Medicaid Drug Rebate Agreement to report ASP data. CMS also proposed and sought comment on payment for other dental services that were inextricably linked to, and substantially related and integral to, the clinical success of, an otherwise covered medical service, such as dental exams and necessary treatments prior to organ transplants, cardiac valve replacements, and valvuloplasty procedures. Spending time (more than half of the total time spent by the practitioner who bills the visit). Considering the increased needs for mental health services and feedback we have received, we are finalizing our proposal to create a new General BHI code describing a service personally performed by CPs or clinical social workers (CSWs) to account for monthly care integration where the mental health services furnished by a CP or CSW are serving as the focal point of care integration. However, Medicare currently pays for dental services in a limited number of circumstances, specifically when that service is an integral part of specific treatment of a beneficiary's primary medical condition. 574 and as required by PAMA, we will increase this amount by $2 for those specimens collected from a Medicare beneficiary in a SNF or by a laboratory on behalf of an HHA, which will result in a $10.57 specimen collection fee for those beneficiaries . It can be seen at: Noridian Medicare JF Part A Fee Schedules. That occurs next on Monday, Feb. 20, when federal agencies observe Washington's Birthday (as the third Monday in February is designated in U.S. law). You are legally blind. Based on comments received, CMS is finalizing an increased applicable percentage of 35 percent for this drug. The refund amount is the amount of discarded drug that exceeds an applicable percentage, which is required to be at least 10%, of total allowed charges for the drug in a given calendar quarter. Accordingly, CMS is proposing to include a specific definition for PODs, as well as make explicit the requirement for PODs to report and self-identify. We are finalizing the addition of 414.523(a)(2) Payment for travel allowance to reflect the requirements for the travel allowance for specimen collection. You are a child or teenager. The potential conflict of interest between providers and reporting entities is the heart of the Open Payments program, so quick and clear identification of physician-owned businesses would be beneficial. Heres how you know. Then, in subsequent years, the limit is updated by the percentage increase in Medicare Economic Index (MEI). An official website of the United States government. Payment for Medical Nutrition Therapy (MNT) Services and Related Services. CMS is proposing to reduce burden and streamline the Shared Savings Program application process by modifying the prior participation disclosure requirement, so that the disclosure is required only at the request of CMS during the application process, and by reducing the frequency and circumstances under which ACOs submit sample ACO participant agreements and executed ACO participant agreements to CMS. That is, for services furnished on or after January 1, 2022, the coinsurance amount paid for planned colorectal cancer screening tests that require additional related procedures shall be equal to a specified percent (i.e., 20% for CY2022, 15% for CYs 2023 through 2026, 10% for CYs 2027 through 2029, and zero percent beginning CY 2030) of the lesser of the actual charge for the service or the amount determined under the fee schedule that applies to the test. As part of the ongoing updates to E/M visit codes and related coding guidelines that are intended to reduce administrative burden, the AMA CPT Editorial Panel approved revised coding and updated guidelines for Other E/M visits, effective January 1, 2023. . CMS is engaged in an ongoing review of payment for E/M visit code sets. ; 2023 CMS is finalizing exclusions to this definition as required by statute for drugs that are either radiopharmaceuticals or imaging agents, drugs that require filtration during the drug preparation process, and drugs approved on or after the date of enactment of the Infrastructure Act (that is, November 15, 2021) for which payment under Part B has been made for fewer than 18 months. Several thousand payments in the general payments category are flagged by reporting entities for publication delay in each program year. CMS also solicited comments on whether there are other drugs with unique circumstances that may warrant an increase in the applicable percentage. Start Preamble AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. We are proposing to remove the requirement that the medical nutrition therapy referral be made by the treating physician and update the glomerular filtration rate (GFR) to reflect current medical practice. The calendar year (CY) 2023 PFS final rule is one of several rules that . In this rule, CMS finalized refinements to the payment amount for preventive vaccine administration under the Medicare Part B vaccine benefit, which includes the influenza, pneumococcal, hepatitis B, and COVID-19 vaccine and their administration. The AMA provides final rule summary (PDF) of the 2023 Medicare Physician Payment Schedule and Quality Payment Program (QPP). Codifying these proposals and revised policies in new regulations at 42 CFR 415.140. CMS is also clarifying that any service furnished primarily for the diagnosis and treatment of a mental health or substance use disorder can be furnished by auxiliary personnel under the general supervision of a physician or NPP who is authorized to furnish and bill for services provided incident to their own professional services. An entity may submit one or both types of record for ownership. -425. or D.O.). CMS's testing guidance, originally issued in 2020 and also revised on September 23, 2022, reiterates that residents who leave the facility for 24 hours or longer should be treated like new admissions. . Through review of questions and feedback that we received, we have identified some instances where changes and clarifications to the instrument could improve clarity and be less burdensome to respondents. This includes resubmitting corrected claims that . Medicare Advantage Quality Improvement Program. We are also proposing to modify the threshold for determining whether an ACO is required to increase its repayment mechanism amount during its agreement period. However, this process is not available for companies that do not have any records to report. Medically reasonable and necessary tests ordered by a physician or other practitioner and personally provided by audiologists will not be affected by the direct access policy, including the modifier and frequency limitation. First, we are expanding Medicare coverage for certain colorectal cancer screening tests by reducing the minimum age payment and coverage limitation from 50 to 45 years. In addition, we have been asked to consider certain flexibilities regarding the cost reporting requirement for these types of facilities. That no other E/M visit can be billed for the same patient on the same date as a critical care service when the services are furnished by the same practitioner, or by practitioners in the same specialty and same group to account for overlapping resource costs. This provision permits CMS to apply a payment limit calculation methodology (the lesser of methodology) to applicable billing codes, if deemed appropriate. the federal holiday schedule tables in the ViPS Medicare System (VMS) on an annual basis. The finalized direct access policy will allow beneficiaries to receive care for non-acute hearing assessments that are unrelated to disequilibrium, hearing aids, or examinations for the purpose of prescribing, fitting, or changing hearing aids. View the ASC procedures and payment amounts grouped by the Core-Based Statistical Area (CBSA) code. CMS is proposing to begin the payment penalty phase of the AUC program on the later of January 1, 2023, or the January 1 that follows the declared end of the PHE for COVID-19. The following provisions demonstrate CMSs commitment to addressing health equities in rural and vulnerable populations. We observe most federal holidays, as well as select additional corporate holidays. ACOs accepting performance-based risk must establish a repayment mechanism (i.e, escrow, line of credit, surety bond) to assure CMS that they can repay losses for which they may be liable upon reconciliation. Split (or shared) visits could be reported for new as well as established patients, and initial and subsequent visits, as well as prolonged services. Subsequent to the publication of the CY 2022 PFS final rule, which implemented changes to the RHC payment limit as required by the Consolidated Appropriations Act, 2021, interested parties requested clarification regarding the timing of cost reports used to set the RHC payment limit. CMS is finalizing our interim final policy (85 FR 19276) that the expanded list of covered destinations for ground ambulance transports was for the duration of the COVID-19 PHE only. or Physicians services paid under the PFS are furnished in a variety of settings, including physician offices, hospitals, ambulatory surgical centers (ASCs), skilled nursing facilities and other post-acute care settings, hospices, outpatient dialysis facilities, clinical laboratories, and beneficiaries homes. endstream endobj startxref The travel allowance is paid only when the nominal specimen collection fee is also payable. We grouped these changes and clarifications into four broad categories: editorial changes for clarity and consistency; updates to reflect the web-based system; clarifications responding to feedback from questions from interested parties and testing; and typos and technical corrections. file delivery for Medicare Advantage or Illinois Medicaid claims. Lastly, CMS is finalizing the proposal to permanently cover and pay for covered monoclonal antibody products used as pre-exposure prophylaxis for prevention of COVID-19 under the Medicare Part B vaccine benefit. The Telehealth Originating Site Facility Fee has been updated for CY 2023, which can be found with the list of Medicare Telehealth List of Services at the following website: https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes. Specifically, in accordance with section 1833(h)(3)(B) of the Act, we are finalizing to include in our regulations the following requirements for the travel allowance methodology: (1) a general requirement, (2) travel allowance basis requirements, and (3) travel allowance amount requirements. Payment is also made to several types of suppliers for technical services, most often in settings for which no institutional payment is made. SUMMARY: This notice announces a $688.00 calendar year (CY) 2023 application fee for institutional providers that are initially enrolling in the Medicare or Medicaid program or the Children's Health Insurance Program (CHIP); revalidating their Medicare, Medicaid, or CHIP enrollment; or adding a new . We are also seeking comment on how to address scenarios where a physician or practitioner of the same specialty/subspecialty in the same group may need to furnish a mental health service due to unavailability of the beneficiarys regular practitioner. Please feel welcome to reach out to our team if you have any questions. These include: Medicare Ground Ambulance Data Collection System. See the below for the following updates: Updated Pricing for codes G0339, G0340, 0275T, 0598T & 0599T effective January 1, 2022. NC Medicaid Division of Health Benefits. Start Preamble AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice. Specifically, we are finalizing revisions to 414.507(d) to indicate that for CY 2022, payment may not be reduced by more than 0% as compared to the amount established for CY 2021, and for CYs 2023 through 2025, payment may not be reduced by more than 15% as compared to the amount established for the preceding year. Section 405 of the CAA also requires that beginning July 1, 2021, the ASP-based payment limit for billing codes representing Cimzia (certolizumab pegol) and Orencia (abatacept) as identified in a July 2020 OIG report adhere to the lesser of methodology. Secure .gov websites use HTTPSA The service(s) can be billed using the codes audiologists already use with the new modifier, and include only those personally furnished by the audiologist. Under the so-called primary care exception, Medicare makes PFS payment in certain teaching hospital primary care centers for certain services furnished by a resident without the physical presence of a teaching physician. This applies to Medicare Part A and Part B. CMS is also proposing to require use of a new modifier for services furnished using audio-only communications, which would serve to certify that the practitioner had the capability to provide two-way, audio/video technology, but instead, used audio-only technology due to beneficiary choice or limitations. Program of All-Inclusive Care for the Elderly (PACE) Regional Preferred Provider Organizations (RPPO) Special Needs Plans. In accordance with section 4(b) of the Protecting Medicare and American Farmers from Sequester Cuts Act, we are finalizing certain conforming changes to the data reporting and payment requirements at 42 CFR part 414, subpart G. Specifically, we are finalizing revisions to 414.502 to update the definitions of both the data collection period and data reporting period, specifying that for the data reporting period of January 1, 2023 through March 31, 2023, the data collection period is January 1, 2019 through June 30, 2019. %%EOF CMS is also proposing to extend the start date for compliance actions to January 1, 2023, in response to stakeholder feedback. Payment for Attending Physician Services Furnished by RHCs or FQHCs to Hospice Patients. These RVUs become payment rates through the application of a conversion factor. Holiday Name Calendar Date Legal Banking Holiday Observed Date BCBSIL Holiday Observed Date* New Year's Day 2022 . This online disclosure is due sixty (60) days after the first day of each plan year, and for calendar year plans it should be made by March 2, 2022 (but see Timing of the Disclosure to CMS Form below). We are also seeking comment on whether stakeholders believe there are other codes that should be included in this definition to inform future rulemaking. Pub 100-04 Medicare Claims Processing Centers for Medicare & Medicaid Services (CMS) Transmittal 10872 Date: July 2, 2021 . As noted above, the rebased and revised MEI weights were not used in CY 2023 PFS ratesetting. Payment is also made to several types of suppliers for technical services, most often in settings for which no institutional payment is made. This flexible effective date is intended to take into account the impact that the PHE for COVID-19 has had and may continue to have on practitioners, providers and beneficiaries. Physician-owned distributorships (PODs) are a subset of group purchasing organizations, but are not specifically defined in the Open Payments regulation. .gov We are exploring how these policies interact with the Shared Savings Programs other benchmarking policies. %PDF-1.6 % Given the ongoing stakeholder interest in this issue, the proposed rule includes a comment solicitation to obtain information on the costs involved in furnishing preventive vaccines, with the goal to inform the development of more accurate rates for these services. Christian. March 3: Social Security payments for those who receive both SSI . CMS is also soliciting comment on: (1) whether additional documentation should be required in the patients medical record to support the clinical appropriateness of audio-only telehealth; (2) whether or not we should preclude audio-only telehealth for some high-level services, such as level 4 or 5 E/M visit codes or psychotherapy with crisis; and (3) any additional guardrails we should consider putting in place in order to minimize program integrity and patient safety concerns. We finalized new HCPCS codes, G3002 and G3003, and valuation for chronic pain management and treatment services (CPM) for CY 2023. CMS is proposing to make regulatory changes to implement the new reporting requirements. Medigap (Medicare Supplement Health Insurance) Medical Savings Account (MSA) Private Fee-for-Service Plans. The statute provides coverage of MNT services that may only be provided by registered dietitians and nutrition professionals when referred by a physician (an M.D. Updates to the Open Payments Financial Transparency Program. CMS is proposing to make conforming technical changes to the regulatory text related to COVID-19 vaccines for RHCs and FQHCs. Based on comments received. clinical laboratories, and beneficiaries homes. Weekends: The customer service department is Closed on Saturday and Sunday. Dataset. Requiring Manufacturers of Certain Single-Dose Container or Single-Use Package Drugs to Provide Refunds with Respect to Discarded Amounts. The Clinical Laboratory Fee Schedule (CLFS) provides for a nominal fee for specimen collection for laboratory testing and a fee to cover transportation and personnel expenses (generally referred to as a travel allowance) for trained personnel to collect specimens from homebound patients and inpatients (not in a hospital). Establishing specific rebuttal procedures in regulation for providers and suppliers whose Medicare billing privileges have been deactivated. In the 2022 CMS Behavioral Health Strategy (https://www.cms.gov/cms-behavioral-health-strategy), CMS included a goal to improve access to, and quality of, mental health care services and included an objective to increase detection, effective management, and/or recovery of mental health conditions through coordination and integration between primary and specialty care providers. In CY 2017 and 2018 PFS rulemaking, CMS received comments that initiating visit services for behavioral health integration (BHI) should include in-depth psychological evaluations delivered by a clinical psychologist (CP), and that CMS should consider allowing professionals who were not eligible to report the approved initiating visit codes to Medicare to serve as a primary hub for BHI services. Federal government websites often end in .gov or .mil. CMS is proposing several provider enrollment regulatory revisions that will strengthen program integrity while assisting Medicare beneficiaries. Since January 1, 2002, registered dietitians and nutrition professionals have been recognized to provide and bill for MNT services, meaning nutritional diagnostic, therapeutic, and counseling services. You have a disability. These proposals would result in lower required initial repayment mechanism amounts, and less frequent repayment mechanism amount increases during an ACOs agreement period, thereby lowering potential barriers for ACOs participation in two-sided models and increasing available resources for investment in care coordination and quality improve activities. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, Access to CMS Systems and Identity Management (IDM) System, Plan Reference Guide for CMS Part C/D Systems, MAPD Plan Communications User Guide (PCUG), 2022 Quarterly Enrollment & Payment Certification Schedule (PDF), 2023 Quarterly Enrollment & Payment Certification Schedule (PDF), Year 2022 MARx Monthly Calendar (text) (PDF), Year 2022 MARx Monthly Calendar (color) (PDF), Year 2023 MARx Monthly Calendar (color) (PDF), Year 2023 MARx Monthly Calendar (text) (PDF), Annual Election Period Begin and End dates, MA Full-Dual Notification File (transmitted only to MA Organizations and Cost Plans). CMS is also proposing to extend the start date for compliance actions to January 1, 2023, in response to stakeholder feedback. Rural HealthClinics (RHCs) and Federally Qualified Health Centers(FQHCs), Chronic Pain Management and Behavioral Health Services. With the proposed budget neutrality adjustment to account for changes in RVUs (required by law), and expiration of the 3.75 percent payment increase provided for CY 2021 by the Consolidated Appropriations Act, 2021 (CAA), the proposed CY 2022 PFS conversion factor is $33.58, a decrease of $1.31 from the CY 2021 PFS conversion factor of $34.89. That is, the Medicare payment limit for the drug or biological billing code would be the lesser of: (1) the payment limit determined using the current methodology (where the calculation includes the ASPs of the self-administered versions), or (2) the payment limit calculated after excluding the non-covered, self-administered versions. Share sensitive information only on official, secure websites. Individuals who intend to view and/or listen to the meeting do not need to register. When the PTA/OTA furnishes eight minutes or more of the final unit of a billing scenario in which the PT/OT furnishes less than eight minutes of the same service. The continued arrangements build on the temporary telehealth items introduced as part of the Government's response to the COVID-19 pandemic, and will continue to enable all Medicare eligible Australians to access telehealth (video and phone) services for a range of (out of hospital . However, we solicited comments on the potential use of the proposed updated MEI cost share weights to calibrate payment rates and update the GPCI under the PFS in the future. SUMMARY: This notice announces a $631.00 calendar year (CY) 2022 application fee for institutional providers that are initially enrolling in the Medicare or Medicaid program or the Children's Health Insurance Program (CHIP); revalidating their Medicare, Medicaid, or CHIP enrollment; or adding a new . We are proposing to expand coverage of outpatient pulmonary rehabilitation services, paid under Medicare Part B, to beneficiaries who were hospitalized with COVID-19 and experience persistent symptoms, including respiratory dysfunction, for at least four weeks after hospitalization.