Coverage Updates
February 29, 2024: Solid Organ Transplant Rejection Billing & Coding Articles Updated
CMS published an announcement indicating that the MACs have provided updated Solid Organ Transplant Rejection billing and coding articles. CMS notes “these updates restore the table of solid organ allograft rejection tests, as requested by interested parties, and removes the explanatory language that may have confused physicians and patients. The March 2023 articles have been removed and the new articles can be found on the Medicare Coverage Database
Full CMS statement: https://www.cms.gov/newsroom/press-releases/cms-statement-current-status-blood-tests-organ-transplant-rejection-0
March 6, 2024: CMS National Coverage Determination (NCD) Dashboard
CMS updated this document on February 15, 2024 and notes that they prioritize “NCD requests based on the magnitude of the potential impact on Medicare program and beneficiaries. As of February 15th, there are seven topics on the NCD Wait List, two Open NCDs, and 3 NCDs have been finalized in the past 12 months. Links to all NCDs are included in this document. https://www.cms.gov/files/document/ncd-dashboard.pdf
March 6, 2024: Allogeneic Hematopoietic Stem cell Transplantation (HSCT) for Myelodysplastic Syndromes (MDS) Final Decision Memo
CMS has published a final decision memo and has finalized the proposed HSCT for MDS using bone marrow or peripheral blood stem cell products and is adding coverage to the final NCD to include the use of umbilical cord blood stem cell products. https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&NCAId=312
Compliance Education Updates
March 7, 2024: Provider Compliance Fast Facts: Comprehensive Outpatient Rehabilitation Facility (CORF) Services: Prevent Claim Denials
CMS notes that the CORF Services improper payment rate in 2022 was 89.7% and advises you to review the CORF services provider compliance tip for information on requirements for claim payment, documentation requirements and example of improper payment, and links to additional resources. https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/fast-facts/comprehensive-outpatient-rehabilitation-facility-services-prevent-claim-denials
March 11, 2024: Updated CERT A/B MAC Outreach & Education Task Force PowerPoint
The goal of the A/B MAC Outreach & Education Task Force is to ensure consistent communication and education to reduce the Medicare Part A and Part B error rates. The Task Force PowerPoint presentation was updated on March 11th. In this six-slide presentation, the Task Force includes links to their most popular educational products and answers three questions:
- How are we reducing improper Medicare payments?
- How are the MACs and the CERT contractor different?
- What’s my MAC’s role in a CERT review?
CMS Resource: Understanding Medicare Advantage Plans
This CMS booklet tells you about how Medicare Advantage (MA) plans are different from original Medicare, how MA plans work, and how you can join a MA Plan. https://www.medicare.gov/publications/12026-Understanding-Medicare-Advantage-Plans.pdf
