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 […]
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 […]
The additions to the list begin on page 364 of this Federal Register article. https://public-inspection.federalregister.gov/2021-15496.pdf The complete list is due when the Outpatient Prospective Payment System (OPPS) Final Rule is issued.
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 […]
The CMS Inpatient Only List is published in the Outpatient Prospective Payment System (OPPS) Final Rule as Addendum E. 2021 NFRM OPPS Addenda (zip files, look for Addendum E) The specific set of items removed from this list are found here: Services Removed from the Inpatient Only (IPO) List for CY 2021 (zip file)
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 […]
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 […]
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 […]
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 […]