IRF-PAI Manual

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FY 2021 Information IRF-PAI (version 4.0 FINAL) – Effective October 1, 2020 (FY 2021), as proposed in the FY 2020 IRF PPS final rule. Change Table listing differences from the previous version December 2020 IRF-PAI Quarterly Q&As (PDF) FY 2020 Information IRF-PAI Manual Version 3.0 – This manual contains information regarding data collection on the IRF-PAI version 3.0, effective […]

COVID Vaccines and MMA COVID-19 Infusion Program

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Medicare Part B Payment for COVID-19 Vaccines and Certain Monoclonal Antibodies during the Public Health Emergency are found at CMS in the drug pricing section. We link to it below.  CMS has released a set of toolkits for providers, states and insurers to help the health care system prepare and assist in swiftly administering these products once […]

IRF Data Files from CMS (FY2021)

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FY 2021 IRF PPS Data Files – Final (ZIP) Includes: IRF Wage Index Final Rule – These files contain the urban and rural Core-Based Statistical Area FY 2021 IRF wage index tables. IRF Rate Setting Final Rule – This file contains data for each of the 1,118 inpatient rehabilitation facilities used to estimate the policy updates in […]

ICD-10

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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 Act (HIPAA). Please note, the change to ICD-10 does not affect CPT coding for outpatient procedures and physician services. Click […]

CMS Transmittals Index, 2004 – 2020

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What are Transmittals? Program transmittals are used to communicate new or changed policies, and/or procedures that are being incorporated into a specific Centers for Medicare & Medicaid Services (CMS) program manual. The cover page (or transmittal page) summarizes the new changed material, specifying what is changed. Each year’s transmittal page is linked below. Click on […]

CY2021 Physician Fee Schedule Proposed Rule

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CMS issued a proposed rule on August 3, 2020, on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, on or after January 1, 2021. This document is scheduled for publication in the Federal Register on August 17, 2020 Background on the Physician Fee Schedule Since […]

IRF PPS Final Rule FY2021

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CMS issued the annual update for the Inpatient Rehabilitation Facility Prospective Payment System on August 4, 2020. This final rule also includes making permanent the regulatory change to eliminate the requirement for physicians to conduct a post admission visit since much of the information is included in the pre-admission screening documentation. This flexibility was offered […]

OPPS Proposed Rule CY2021

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On August 4, 2020, the CMS proposed policies that aim to increase choice, lower patients’ out-of-pocket costs, empower patients, and protect taxpayer dollars. These proposed changes would build on existing efforts to increase patient choice by making Medicare payment available for more services in different sites of service and adopting policy changes under the Medicare […]

CMS Beneficiary Notices

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Both Medicare beneficiaries and providers have certain rights and protections related to financial liability under the Fee-for-Service (FFS) Medicare and the Medicare Advantage (MA) Programs. These financial liability and appeal rights and protections are communicated to beneficiaries through notices given by providers. Hospitals are required to deliver the Important Message from Medicare (IM), CMS-R-193 to all […]