The Centers for Medicare & Medicaid Services (CMS) announced it will pay for a second COVID-19 booster shot of either the Pfizer-BioNTech or Moderna COVID-19 vaccines without cost sharing, as it continues to provide coverage for this critical protection from the virus. People with Medicare pay nothing to receive a COVID-19 vaccine, and there is no applicable copayment, coinsurance, or deductible. People with Medicaid coverage can also get COVID-19 vaccines, including boosters, at no cost.
CMS Finalizes 2023 Payment Changes For Medicare Advantage and Part D Plans
The Centers for Medicare & Medicaid Services (CMS) announced Calendar Year (CY) 2023 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (the Rate Announcement).
CMS Releases Billing Code For Preventive COVID-19 Antibody Treatment
On February 24, 2022, the U.S. Food and Drug Administration (FDA) revised the emergency use authorization for tixagevimab co-packaged with cilgavimab (EVUSHELD™) to change the initial dose for the authorized use as pre-exposure prophylaxis of COVID-19 in certain adults and pediatric patients.
North Carolina & Florida Home Health Agencies to See Review Choice Demonstration Changes
The Centers for Medicare & Medicaid Services (CMS) announced that beginning April 1, 2022, home health agencies in Florida (FL) and North Carolina (NC) will be subject to a 25% reduction in payment if they choose not to participate in Medicare’s ongoing Review Choice Demonstration (RCD).
CMS to Implement Claim Edit for Hospice Transfers
Effective July 1 2022, a claims processing edit to prevent gap billing between hospice transfers will be implemented. Per Change Request (CR) 12619 Gap Billing Between Hospice Transfers, a patient can change hospices only once per benefit period (60-day or 90-day). When the patient transfers to a different hospice, he or she continues in the same benefit period. To transfer hospice programs, the individual or representative must file, with the hospice from which care has been given and with the newly designated hospice, a statement that includes the following information:
