Programs

Regulatory Updates

Total of 165 Records Returned

State: All

Home Oxygen: 3 New Claim Modifiers

Date Posted : 01/5/2023

Date Effective : 01/3/2023

Program: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies

CMS added 3 new modifiers for home oxygen use under national coverage determination (NCD) 240.2 to indicate the appropriate treatment regimen and presence of supporting documentation for each Medicare patient group:

  • Section B, Group I: modifier N1
  • Section B, Group II: modifier N2
  • Section D: modifier N3
Patients under NCD Section B, Group II and Section D have payment and recertification requirements that don’t apply to Group I. The new modifiers are effective January 1, 2023, and will be available in the April 2023 HCPCS code release. Your Medicare Administrative Contractor will provide more details.

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State: All

Telehealth Home Health Services: New G-Codes

Date Posted : 12/29/2022

Date Effective : 01/1/2023

Program: Home Health

Prior to January 1, 2023, data on telecommunications technology used during a 30-day period of care at the patient level was not collected on home health claims. Effective January 1, 2023, Home Health Agencies (HHAs) may begin voluntarily reporting the new telecommunications G-codes on HH claims with HH periods of care that start on or after January 1, 2023. On July 1, 2023, reporting these new codes will become mandatory with HH periods of care that start on or after July 1, 2023.

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State: All

Billing correctly: Power Mobility Devices

Date Posted : 12/15/2022

Program: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies

The Power Mobility Devices booklet explains how to properly document and bill for power mobility devices (PMDs). Follow these steps to bill for PMDs:

  • Obtain the Standard Written Order (SWO)
  • Make a prior authorization request
  • Complete a home assessment
  • Keep the following documents: SWO, face-to-face visit supporting documents, written home assessment report, and proof of delivery
  • Review all information to avoid improper payments
An Office of Inspector General report stated that Medicare improperly paid claims for PMD repairs. To properly bill for PMD repairs:
  • Show repairs are reasonable, necessary, or meet the requirements
  • Document labor time adequately
  • Show that DMEPOS suppliers must provide repair warrantees
  • Specify that wheelchair repair costs can’t exceed a certain amount over a device’s 5-year lifetime

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State: All

New Waived Tests for Home Health and Hospice

Date Posted : 08/4/2022

Date Effective : 10/1/2022

Program: Home Health, Hospice

Listed below are the latest tests approved by the Food and Drug Administration (FDA) as waived tests under CLIA (Clinical Laboratory Improvement Amendments of 1988). The CPT code, effective date and description for the latest tests approved by the FDA as waived tests under CLIA are as follows:

  • 82010QW, 82962, May 27, 2022, AmVentureX Inc. BioCoach Blood Glucose and Ketone Monitoring System;
  • 80305QW, June 07, 2022, Micro Distributing STATDIP One Step Drug Test;
  • 80305QW, June 07, 2022, Micro Distributing STATCup II One Step Drug Test Cup;
  • 87880QW, June 09, 2022, Clarity Diagnostics LLC Clarity Strep A Rapid Test Strip;

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State: All

Home Health & Hospice: Medicare Provider Resources

Date Posted : 11/17/2022

Program: Home Health, Hospice

November is Home Care & Hospice Month, is a great time to get familiar with these resources:

  • Medicare Payment System educational tool.
  • Hospital-based Hospice Medicare provider compliance tips.
  • Creating an Effective Hospice Plan of Care fact sheet.
  • Enhancing RN Supervision of Hospice Aides Services fact sheet.
  • Safeguards for Medicare Patients in Hospice Care fact sheet.

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State: All

Home Health Agencies – Free Medicare Home Health You Tube Videos

Date Posted : 11/3/2022

Program: Home Health

National Government Services (NGS) has a plethora of educational Medicare Home Health YouTube videos regarding billing and documentation. These videos are free, short in length and very informative. They contain information on home health eligibility criteria, homebound status, the advance beneficiary notice (ABN) and more. Please share these links with your clinical and billing staff as appropriate:

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