Knowledge Base Article

Medicare MLN Articles & Transmittals – Recurring Updates

Expedited Review Process for Hospital Inpatients in Original Medicare

• Article Release Date: January 21, 2022
• What You Need to Know: CMS has reformatted the current instructions for delivery of the Important Message from Medicare (IMM) and the beneficiary’s rights to an expedited review. While this MLN article notes in bold to “make sure your staff knows this is a reformatting of the current instructions and there are no policy or instructional changes,” following are three noteworthy clarifications:
• The effective date for the related Change Request is April 21, 2022.
• A new exception of who you would not provide an IMM to is the beneficiary that ends care on their own initiative by electing the hospice benefit.
• A new note indicates “the IM should only be given when an inpatient admission is pending or has occurred. It should not be given ‘just in case,’ such as a hospital delivering to all Medicare patients being treated in a hospital emergency room.”
• CMS has included a statement that “an IM must be delivered even if the beneficiary agrees with the discharge.”
• MLN MM12546: (link)

Internet-Only Manual Updates for Critical Care Evaluation and Management Services

• Article Release Date: January 22, 2022
• What You Need to Know: You will learn about critical care updates for a patient in a global surgical period and the use of modifier FT.
• MLN MM12550: (link)

Quarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment

• Article Release Date: January 27, 2022
• What You Need to Know: This article provides instructions for the April 2022 update to the CLFS and new codes effective April 1, 2022.
• MLN MM12612: (link)

International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs)—July 2022

• Article Release Date: February 10, 2022
• What You Need to Know: This article provides information about newly available codes, separate NCD coding revisions, and coding feedback.
• MLN MM12606: (link)

Gap Billing Between Hospice Transfers

• Article Release Date: February 10, 2022
• What You Need to Know: A new CWF edit will no longer allow gaps of care to occur during a transfer.
• MLN 12619: (link)

Omnibus Change Request to Remove Two NCDs, Updates Medical Nutritional Therapy Policy and Updates to Pulmonary Rehabilitation, (PR), Cardiac Rehabilitation (CR), and Intensive Cardiac Rehabilitation (ICR) Conditions of Coverage

• Change Request 12613/Transmittal 11272 Release Date: February 18, 2022
• What You Need to Know: Updates became effective January 1, 2022, by statute with an implementation date of July 5, 2022. Specific to PR, the CY 2022 MPFS final rule removed the requirements for direct physician-patient contact and expanded coverage of PR for beneficiaries with confirmed or suspected COVID-19 and experience persistent symptoms that include respiratory dysfunction for at least 4 weeks. The two NCDs being removed are:
• NCD 180.2 Enteral/Parenteral Nutritional Therapy, and
• NCD 220.6 Positron Emission Tomography (PET) Scans.
• Transmittal 11272: (link)

Revised Medicare MLN Articles & Transmittals

April 2022 Update to the MS-DRG Group and Medicare Code Editor Version 39.1 for ICD-10 Diagnosis Codes for 2019 COVID-19 Vaccination Status and ICD-10-PCS codes for Introduction or Infusion of Therapeutics and Vaccines for COVID-19 Treatment

• Article Release Date: Initial article January 19, 2022 – Revised February 8, 2022
• What You Need to Know: This article was revised to add two new procedure codes describing the introduction or infusion of therapeutics including vaccines for COVID-19 treatment, effective April 1, 2022.
• MLN MM12578: (link)