IPPS and LTCH Proposed Rule FY2023

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On April 18, 2022 the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule (CMS-1771-P) that provides updates to the fiscal year (FY) 2023 Long-Term Care Hospital Quality Reporting Program (LTCH QRP). This rule includes three Requests for Information (RFI) which include: future measure concepts for the LTCH QRP; inclusion of the new […]

March 2022 New COVID Codes

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On March 29, 2022, the FDA amended the Moderna COVID-19 vaccine emergency use authorization (PDF), including new packaging for vaccine boosters (blue cap). CMS issued new codes, effective March 29, 2022, for the vaccine booster and administration: Code: 91309 Long descriptor: Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, […]

IRF PPS Proposed Rule FY2023

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For FY 2023, CMS is proposing to update the IRF PPS payment rates based on the proposed IRF market basket update less a productivity adjustment. CMS is proposing a permanent cap on year-to-year wage index decreases. Additionally, CMS is soliciting comments on the methodology used to update the IRF facility level adjustments (specifically, the rural, […]

Physician Fee Schedule CY2022

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CMS issued the CY 2022 Medicare Physician Fee Schedule (PFS) final rule that updates payment policies, payment rates, and other provisions for services. This is a summary of key provisions, effective on or after January 1, 2022: Revises telehealth services under the Consolidated Appropriations Act, 2021; allows use of audio-only communications technology when furnishing mental health services […]

NCCI Resources

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CMS originally developed the Medically Unlikely Edit (MUE) program to reduce the paid claims error rate for Part B claims. The first edits were implemented January 1, 2007. Subsequently there have been quarterly updates increasing the number of edits. Visit the NCCI main page on the CMS site. National Correct Coding Initiative Policy Manual for […]

IRF PPS Final Rule FY2022

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The IRF prospective payment system (IRF PPS) Addenda along with other supporting documents and tables referenced in this final rule are available on the CMS website . Prior to 2020, each rule or notice issued under the IRF PPS has included a detailed reiteration of the various regulatory provisions that have affected the IRF PPS […]

CMS Inpatient Only List CY2022

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The 2022 List of inpatient only codes is Appendix E of the OPPS Final Rule. Table of contents for the Addenda (PDF) All the Addenda are available in a .zip file from CMS (click here to download)

ICD-10

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2022 ICD-10-CM (CMS) 2022 Code Descriptions in Tabular Order (ZIP) 2022 Addendum (ZIP) 2022 Code Tables, Tabular and Index (ZIP) On October 1, 2015, the ICD-9 code sets used to report medical diagnoses and inpatient procedures were replaced by ICD-10 code sets. The transition to ICD-10 is required for everyone covered by the Health Insurance Portability Accountability […]

IRF PPS Proposed Rule FY2022

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On April 7, 2021, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update Medicare payment policies and rates for facilities under the Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) and the IRF Quality Reporting Program (QRP) for fiscal year (FY) 2022. CMS is publishing this proposed rule consistent with the […]