We’ve assembled the latest news for healthcare revenue cycle leaders to help you stay on top of industry challenges and adapt your revenue cycle management services.
Swing Bed Services Updated
CMS has released an updated MLN Fact Sheet on swing bed services requirements that addresses hospitals or critical access hospitals. It covers medical billing clarification that these providers can bill for bed and board, use of CAH facilities, drugs and biologicals, supplies, appliances and equipment and more [1].
Report on Evaluating Bundled Payments for Care Improved Advanced Model
In May, CMS released the fifth annual Evaluation Report, covering Bundled Payments for Care Improvement (BPCI) Advanced Model. This model has significant impact on revenue cycle management services and is built to test whether or not the act of holding participants financially accountable for care costs can reduce Medicare spending and maintain or improve care quality [2].
Update to the Combined Common Edits/Enhancements Modules (CCEM) Code Set
CMS has published Medicare Claims Processing Transmittal 12660, covering regular updates to the CCEM code set. These updates become effective October 1, 2024 and are implemented October 7, 2024. This update is pertinent for both inhouse medical coding and medical coding outsourcing [3].
Frequency of No-Pay Medicare Summary Notice (MSN) Shifts
Medicare Claims Processing Transmittal 12664 includes a change in the frequency of MSN mailings from every 90 days to every 120 days. This change is effective on October 1, 2024 and implemented on October 7, 2024 [4].
Hospital Outpatient Prospective Payment System (OPPS) Updated
CMS has announced in Medicare Claims Processing Transmittal 12665 that the July 2024 updated to the OPPS is available. These changes include new PLA codes, new CPT Category III codes, and product and administration codes for PEMGARDA and impact much of hospital billing and hospital coding [5].
Codes Covered and Excluded from CLIA Edits
In Transmittal 12653, CMS has announced updates to HCPCS codes that are excluded from and subject to CLIA edits. The announcement is accompanied by the publication of MLN Matters 13620 and can have significant impact on healthcare revenue cycle solutions [6].
Home Health Grouper Updated
CMS has released the quarterly update to home health grouper software in Medicare Claims Processing Transmittal 12654. This will be effective October 1, 2024. Anyone responsible for home health billing should make note [7].
Quarterly Update for July 2024 HCPCS File Published
The agency has released an updated link for the July 2024 update to the HCPCS file. This is a critical medical billing update for the quarter. All leaders responsible for medical coding in the USA should take time to review these updates [8] .
Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment Update Released
This medical billing update published in Medicare Claims Processing Transmittal 12657 was released on May 24. It rescinds and replaces transmittal 12606, adding business requirement 13613.3 and 13613.4. It was also accompanied by MLN Matters 13616 [9].
Provider Enrollment Instructions Updated
Through the Medicare Program Integrity Transmittal 12639, CMS has released the twelfth general update to the enrollment policies under the Medicare Program Integrity Manual, Chapter 10. The release clarifies various provider enrollment topics [10].
References
[1] “MLN Factsheet Swing Bed Services,” CMS, Available: https://www.cms.gov/files/document/mln006951-swing-bed-services.pdf.
[2] “CMS Bundled Payments for Care Improvement Advanced Model,” CMS, May 2024. Available: https://www.cms.gov/priorities/innovation/data-and-reports/2024/bpci-adv-ar5.
[3] “Combined Common Edits/Enhancements Modules (CCEM) Code Set Update,” CMS, 31 May 2024. Available: https://www.cms.gov/files/document/r12660cp.pdf.
[4] “Changing the Frequency of No-Pay Medicare Summary Notice (MSN) Mailings from Every 90 Days to Every 120 Days,” CMS, 31 May 2024. Available: https://www.cms.gov/files/document/r12664cp.pdf.
[5] “CMS,” July 2024 Update of the Hospital Outpatient Prospective Payment System (OPPS), 31 May 2024. Available: https://www.cms.gov/files/document/r12665cp.pdf.
[6] “Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Exclude from Clinical Laboratory Improvement Amendments (CLIA) Edits,” CMS, 23 2024 May. Available: https://www.cms.gov/files/document/r12653cp.pdf.
[7] “Quarterly Update to Home Health (HH) Grouper,” 23 May 2024. Available: https://www.cms.gov/files/document/r12654cp.pdf.
[8] “HCPCS Quarterly Update,” CMS, May 2024. Available: https://www.cms.gov/medicare/coding-billing/healthcare-common-procedure-system/quarterly-update.
[9] “Quarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment,” 24 May 2024. Available: https://www.cms.gov/files/document/r12657cp.pdf.
[10] “Twelfth General Update to Provider Enrollment Instructions in Chapter 10 of CMS Publication (Pub.) 100-08,” 16 May 2024. Available: https://www.cms.gov/files/document/r12639pi.pdf.
