Medicare Part D Vaccines
Navigating Medicare Part D Vaccines: A Comprehensive Guide for Providers Medicare Part D provides essential coverage for a wide range of vaccines, crucial for preventing illnesses in the Medicare population. Understanding the distinctions between what Medicare Part D and Part B cover, as well as how to properly bill for vaccines under Part D, is […]
Chronic Care Management Services
Chronic Care Management (CCM) services are essential in the ongoing care of patients with multiple chronic conditions, offering continuous support and coordination of care to improve health outcomes and reduce healthcare costs. The Centers for Medicare & Medicaid Services (CMS) recognizes CCM as a critical service and provides reimbursement for these non-face-to-face services under the […]
Cardiac Device Credits Medicare Billing
In the realm of healthcare, the correct billing of cardiac device credits under Medicare is crucial for ensuring compliance and avoiding overpayments. These credits often arise when a cardiac device, such as an implantable defibrillator or pacemaker, is replaced due to a defect, recall, or other issues covered under a manufacturer’s warranty. Understanding the billing […]
Understanding Medicare & Medicaid for Dually Eligible Beneficiaries
Dually eligible beneficiaries are individuals who qualify for both Medicare and Medicaid, making them eligible for a broad range of healthcare services. These beneficiaries typically have limited income and resources, qualifying them for additional support to cover healthcare costs that Medicare does not fully pay. Here’s a detailed guide to understanding the benefits, billing practices, […]
A Prescriber’s Guide to Medicare Prescription Drug (Part D) Opioid Policies
Comprehensive Guide to Chronic Care Management (CCM) Services Chronic Care Management (CCM) services are essential in the ongoing care of patients with multiple chronic conditions, offering continuous support and coordination of care to improve health outcomes and reduce healthcare costs. The Centers for Medicare & Medicaid Services (CMS) recognizes CCM as a critical service and […]
Replacement Wheelchair Equipment When Manufacturers Exit the Business
Hospice Payment Rates and Cap Updates
The Centers for Medicare & Medicaid Services (CMS) has issued Change Request (CR) 13707, effective October 1, 2024, which introduces critical updates to hospice payment rates, the hospice wage index, and the hospice cap amount for the fiscal year (FY) 2025. These changes are essential for hospice providers to understand and implement as they impact […]
Separate Payment for Disposable Negative Pressure Wound Therapy Devices
Starting January 1, 2024, the Centers for Medicare & Medicaid Services (CMS) will implement a significant change under Change Request (CR) 13244, which introduces separate payments for Disposable Negative Pressure Wound Therapy (dNPWT) devices under the Home Health Prospective Payment System (HH PPS). This update marks an important shift in how these devices are billed […]
Refining Home Health Payment Reductions for Quality Data Submission
The Centers for Medicare & Medicaid Services (CMS) has issued an important update through Change Request (CR) 13241, which becomes effective on January 1, 2023. This update is designed to enhance the accuracy and efficiency of payment processes for Home Health Agencies (HHAs) that do not submit the required quality data. The update fully replaces […]
CMS Update: Key Changes in Home Health Claims Processing Effective January 1, 2024
The Centers for Medicare & Medicaid Services (CMS) has issued an important update, Change Request (CR) 13225, set to take effect on January 1, 2024. This update aims to enhance the accuracy and efficiency of processing home health (HH) claims. Here’s what you need to know: Removal of the Edit Bypass for Condition Code DR […]
