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Billing Instructions for Home or Residence Services: FY 2023 Changes
Billing Instructions for Home or Residence Services: FY 2023 Changes
December 2022
Beginning in 2023, the two Evaluation and Management (E/M) visit families that were titled “Domiciliary, Rest Home (e.g., Boarding Home), or Custodial Care Services” and “Home Services” have been merged into one E/M code family.
The new family is titled “Home or Residence Services,” and the codes in this family will be used to report E/M services provided to a patient in their home or residence, an assisted living facility, group home (that is not licensed as an intermediate care facility for individuals with intellectual disabilities), custodial care facility, or residential substance abuse treatment facility. There are no changes to the included care settings from each respective family, rather the current care settings for each of the current families are being included within the new, merged family.
SUMMARY OF CHANGES: The purpose of this Change Request is to update the Internet-Only Manual with new billing instructions for Home or Residences Services codes. Effective January 1, 2023, the two Evaluation and Management visit families titled “Domiciliary, Rest Home (e.g., Boarding Home), or Custodial Care Services” and “Home Services” have merged into one single code family. This new code family is titled “Home or Residence Services,” and the place of service codes that can be billed with this code family are being revised.
EFFECTIVE DATE: January 1, 2023
*Unless otherwise specified, the effective date is the date of service.
IMPLEMENTATION DATE: January 3, 2023
Read more HEREInpatient & Long-Term Care Hospital Prospective Payment System: FY 2023 Changes
Inpatient & Long-Term Care Hospital Prospective Payment System: FY 2023 Changes
December 2022
This MLN Matters Article is for inpatient hospitals, including Long-Term Care Hospitals (LTCH),
billing Medicare Administrative Contractors (MACs) for inpatient hospital services they provide
to Medicare patients.
Learn about updates effective October 1, 2022, for:
- Inpatient Prospective Payment System (IPPS)
- Long-Term Care Hospital Prospective Payment System
- Certain hospitals CMS excludes from the IPPS
Short-term Acute Care Hospitals: Program for Evaluating Payment Patterns Electronic Reports
Short-term Acute Care Hospitals: Program for Evaluating Payment Patterns Electronic Reports
December 2022
Third quarter FY 2022 Program for Evaluating Payment Patterns Electronic Reports (PEPPERs) are available for short-term acute care hospitals. These reports summarize provider-specific data for Medicare services that may be at risk for improper payments. Use the data to support auditing and monitoring activities.
More Information:
Visit the Distribution Schedule webpage to find out how to get your report
Visit the PEPPER Resources webpage to review the user's guide, recorded training sessions, FAQs, information on a new Severe Malnutrition target area, and examples of how other hospitals are using the report
Medicare NCCI Policy Manual Effective January 1, 2023
Medicare NCCI Policy Manual Effective January 1, 2023
December 2022
CMS updates the NCCI Policy Manual for Medicare Services once a year. The NCCI Policy Manual should be used by Medicare Administrative Contractors (MACs) as a general reference tool that explains the rationale for NCCI edits. The most current policy manual, effective Jan. 1, 2023, was posted on Dec. 1, 2022. Additions and revisions to the manual are noted in red font. Additional prior versions of the National Correct Coding Initiative Policy Manual for Medicare Services are available in the Medicare NCCI Policy Manual Archive.
Medicare NCCI webpages:
Learn more HERE
HHS Continues Biden-Harris Administration Progress in Promoting Health Equity in Rural Care Access Through Outpatient Hospital and Surgical Center Payment System Final Rule
HHS Continues Biden-Harris Administration Progress in Promoting Health Equity in Rural Care Access Through Outpatient Hospital and Surgical Center Payment System Final Rule
November 2022
Policy - Hospitals - Rural health
This final rule will allow Critical Access Hospitals (CAHs) and small rural hospitals to convert to a Rural Emergency Hospital (REH), which may be a more sustainable option for rural hospitals facing closure and supports access to care in rural and underserved communities.
An REH is a new Medicare provider type that furnishes outpatient services, emergency services, and observation care. In this rule, Medicare will also pay hospital outpatient departments to provide remote behavioral health services to people at home, which will improve access to care in rural communities and promote health equity.
Learn more HERE
OCR Releases New Recognized Security Practices Video
OCR Releases New Recognized Security Practices Video
November 2022
In recognition of National Cybersecurity Awareness Month, OCR has produced a new video this October for organizations covered under the HIPAA Rules on Recognized Security Practices. This presentation is intended to educate the health care industry on the categories of recognized security practices and how entities regulated under the HIPAA Rules may demonstrate implementation.
Watch video HERE
Inpatient & Long-Term Care Hospitals: Learn What’s New for Fiscal Year 2023
Inpatient & Long-Term Care Hospitals: Learn What’s New for Fiscal Year 2023
October 2022
CMS issued the Fiscal Year 2023 Hospital Inpatient Prospective Payment System (IPPS) and Long‑Term Care Hospital (LTCH) Prospective Payment System (PPS) final rule to update IPPS hospital and LTCH Medicare payment policies. See a summary of key provisions effective October 1, 2022:
- IPPS payment rate update of 4.3%; LTCH PPS payments increase by approximately 2.4%
- Hospital Inpatient Quality Reporting Program: adopted 3 health equity-focused measures and summarized feedback received on our approach to measuring health care quality disparities
- Feedback received on reporting social determinants of health
- New hospital designation and additional quality measure reporting to drive improvements in maternal health outcomes and health equity
- Permanent 5% cap on annual wage index decreases
- Graduate medical education: changed policies, including increased flexibility for rural hospitals that participate in a rural track program
Inpatient Psychiatric Facilities: Learn What’s New for Fiscal Year 2023
CMS issued the Fiscal Year 2023 Inpatient Psychiatric Facilities (IPF) Prospective Payment System final rule to update IPF payments, wage index, and policies. See a summary of key provisions effective October 1, 2022:
- Updated payment rates by 3.8% with estimated payments to increase by 2.5% after productivity adjustment
- Applied a permanent 5% cap on wage index decreases
Inpatient Rehabilitation Facilities: Learn What’s New for Fiscal Year 2023
CMS issued the Fiscal Year 2023 Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) final rule to update Medicare payment policies and rates. See a summary of key provisions effective October 1, 2022:
- Updated IRF PPS payment rates by 3.9% with estimated overall payments to increase by 3.2% after productivity and outlier adjustments
- Applied a permanent 5% cap on annual wage index decreases
Expanded quality data reporting on all IRF patients, regardless of payer
Learn more HERE
Calendar Year (CY) 2023 Physician Fee Schedule (PFS)
Calendar Year (CY) 2023 Physician Fee Schedule (PFS)
October 2022
Provider Types Affected
This MLN Matters Article is for physicians, Ambulatory Surgical Centers (ASCs), and suppliers
billing Medicare Administrative Contractors (MACs) for ASC services they provide to Medicare
patients.
Provider Action Needed
Make sure your billing staff knows about:
• Updates to the ASC payment system in October
• New Outpatient Prospective Payment System (OPPS) device pass-through code
• Newly established HCPCS codes for drugs and biologicals
• New skin substitute products low-cost group or high-cost group assignment
Learn more HERE
Ambulatory Surgical Center Payment System: October 2022 Update
Ambulatory Surgical Center Payment System: October 2022 Update
October 2022
Provider Types Affected
This MLN Matters Article is for physicians, Ambulatory Surgical Centers (ASCs), and suppliers
billing Medicare Administrative Contractors (MACs) for ASC services they provide to Medicare
patients.
Provider Action Needed
Make sure your billing staff knows about:
• Updates to the ASC payment system in October
• New Outpatient Prospective Payment System (OPPS) device pass-through code
• Newly established HCPCS codes for drugs and biologicals
• New skin substitute products low-cost group or high-cost group assignment
Learn more HERE
How to Use the Medicare National Correct Coding Initiative (NCCI) Tools
How to Use the Medicare National Correct Coding Initiative (NCCI) Tools
October 2022
This booklet provides information about using the Medicare National Correct Coding Initiative (NCCI) Tools.
Table of Contents
1. What is the Medicare NCCI?
2. Using the NCCI Tools
3. Using the NCCI Policy Manual for Medicare
4. Resources
Select a Chapter from the list at the top of the tool to learn how to use the Medicare NCCI tools. In this document, “you” means billing providers, facilities, and suppliers.
Open Booklet HERE
Learn more about the Medicare National Correct Coding Initiative (NCCI) Edits HERE
Legal Implications of a Cyber-Attack
By: HHS 405(d) Task Group Members
Legal Implications of a Cyber-Attack
By: HHS 405(d) Task Group Members
September 2022
The average cost of a cyber-attack continues to rise, hitting an all-time high last year (according to one leading report) of $4.24M, a 10% rise from 2019’s average cost.
Healthcare remained the industry with the highest average cyber-attack costs for the eleventh year in a row. And the FBI reported that the health sector was hardest-hit by ransomware cyber-attacks in 2021. Some of the costs are harder to measure, such as reputational impact.
Beyond the measurable cost associated with technical containment and remediation, a portion of this cost is attributable to fulfilling legal obligations.
Read More HERE
Updated COVID-19 Vaccines Providing Protection Against Omicron Variant Available at No Cost
Updated COVID-19 Vaccines Providing Protection Against Omicron Variant Available at No Cost
September 2022
The Department of Health & Human Services (HHS), through CMS announced that people with Medicare, Medicaid, Children’s Health Insurance Program coverage, private insurance coverage, or no health coverage can get COVID-19 vaccines, including the updated Moderna and Pfizer-BioNTech COVID-19 vaccines, at no cost, for as long as the federal government continues purchasing and distributing these COVID-19 vaccines.
The FDA has authorized the Moderna and Pfizer-BioNTech updated vaccines that target the original COVID-19 viral strain and two Omicron variants (BA.4/BA.5) that are currently the most prevalent in the U.S. Individuals are eligible for their updated vaccine shot at least two months after completing at least their primary vaccination series (two doses of Pfizer-BioNTech, Moderna, or Novavax, or one dose of Johnson & Johnson)—regardless of how many monovalent COVID-19 boosters they have received to date.
CMS issued 4 new CPT codes effective August 31, 2022:
Code 91312 for Pfizer-BioNTech COVID-19 Vaccine, Bivalent Product:
- Long descriptor: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use
- Short descriptor: SARSCOV2 VAC BVL 30MCG/0.3ML
Code 91313 for Moderna COVID-19 Vaccine, Bivalent Product:
- Long descriptor: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 50 mcg/0.5 mL dosage, for intramuscular use
- Short descriptor: SARSCOV2 VAC BVL 50MCG/0.5ML
Code 0124A for Pfizer-BioNTech COVID-19 Vaccine, Bivalent - Administration – Booster Dose:
- Long descriptor: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation, booster dose
- Short descriptor: ADM SARSCV2 BVL 30MCG/.3ML B
Code 0134A for Moderna COVID-19 Vaccine, Bivalent - Administration – Booster Dose:
- Long descriptor: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 50 mcg/0.5 mL dosage, booster dose
- Short descriptor: ADM SARSCV2 BVL 50MCG/.5ML B
Visit the COVID-19 Vaccine Provider Toolkit for more information, and get the most current list of billing codes, payment allowances, and effective dates.
CMS issues hospital IPPS final rule for FY 2023
CMS issues hospital IPPS final rule for FY 2023
August 2022
The Centers for Medicare & Medicaid Services today issued a final rule that updates the inpatient prospective payment system rates by 2.6% in FY 2023 compared to FY 2022. The increase reflects a 4.1% market basket update, less 0.3 percentage point for productivity, plus 0.5 percentage point required by statute. The update also includes a 1.7 percentage point cut for outlier payments. In addition, CMS finalized decreases in disproportionate share hospital payments ($300 million), new medical technology payments ($750 million), and enhanced Low-Volume Hospital and Medicare Dependent Hospital payments ($600 million) due to the statutory expiration of these programs.
Among other provisions, the final rule:
- Returns to using the most recent data available for rate setting, but with several modifications to account for the COVID-19 pandemic.
- Permanently applies a budget-neutral 5% cap on any decrease to a hospital’s wage index from the prior fiscal year.
- Uses more than one year of Worksheet S-10 cost report data to determine uncompensated care costs, specifically FY 2018 and FY 2019 data to distribute FY 2023 payments and a three-year average for FY 2024 and beyond.
- Uses a modified policy for direct graduate medical education full-time equivalent cap calculations.
In addition, CMS finalized revisions to the objectives and measures for the Medicare Promoting Interoperability Program, including making prescription drug monitoring program queries mandatory, and adding a new antimicrobial use and resistance surveillance measure.
View the CMS FY 2023 IPPS Final Rule Home Page here
For files related to the Long-Term Care Hospital PPS, please visit here
HHS 405(d) Aligning Healthcare Industry Security Approaches Program
HHS 405(d) Aligning Healthcare Industry Security Approaches Program
July 2022
On July 13th the HHS 405(d) program released a new cybersecurity resource based on organization sizes. The "How to Implement Patching" guide for small, medium, and large Healthcare and Public Health Organizations explains the importance of regularly updating your systems by applying security updates provided by the software or device manufacturer.
Find your size below!
- How to Implement Patching – Small
- How to Implement Patching – Medium
- How to Implement Patching - Large
Myth Versus Fact
The 405(d) program resources address the importance of users being extra careful and encrypting content when sending and receiving emails that contain sensitive and private data, especially protected health information (PHI).
CPT® Orthopoxvirus and monkeypox coding & guidance
Effective for Immediate Use
CPT® Orthopoxvirus and monkeypox coding & guidance
Effective for Immediate Use
July 2022
New Current Procedural Terminology (CPT®) codes have been created that streamline the reporting of orthopoxvirus and monkeypox testing and immunizations currently available on the United States market.
The American Medical Association (AMA) has announced an update to Current Procedural Terminology (CPT®), the nation’s leading medical terminology code set for describing health care procedures and services, that includes a new laboratory test code for the orthopoxvirus and two codes for the vaccines being utilized to prevent monkeypox infection.
These new CPT codes are effective for immediate use and are designed to clinically distinguish the diagnostic test and vaccinations for monkeypox to support data-driven tracking, reporting and analysis necessary for resource planning and allocation during the public health response to the outbreak.
Laboratory test code
- 87593 Infectious agent detection by nucleic acid (DNA or RNA); orthopoxvirus (eg, monkeypox virus, cowpox virus, vaccinia virus), amplified probe technique, each
Product code
- 90622 Vaccinia (smallpox) virus vaccine, live, lyophilized, 0.3 mL dosage, for percutaneous use
- 90611 Smallpox and monkeypox vaccine, attenuated vaccinia virus, live, non-replicating, preservative free, 0.5 mL dosage, suspension, for subcutaneous use
CPT® Evaluation and Management (E/M) Code and Guideline Changes
effective January 1, 2023
CPT® Evaluation and Management (E/M) Code and Guideline Changes
effective January 1, 2023
July 2022
E/M revisions to code descriptors & guidelines 2021-2023
On Nov. 1, 2019, the Centers for Medicare and Medicaid Services (CMS) finalized a historic provision in the 2020 Medicare Physician Fee Schedule Final Rule. This provision includes revisions to the Evaluation and Management (E/M) office visit CPT® codes (99201-99215) code descriptors and documentation standards that directly address the continuing problem of administrative burden for physicians in nearly every specialty, from across the country.
After these revisions were implemented, the CPT Editorial Panel approved, for 2023, additional revisions (PDF) to the rest of the E/M code section. These revisions seek to provide continuity across all the E/M sections allowing for the revisions implemented in the E/M office visit section in 2021 to extend to all other E/M sections.
2023 summary of revisions to the E/M code descriptors and guidelines:
- E/M Introductory Guidelines related to Hospital Inpatient and Observation
- Care Services codes 99221-99223, 99231-99239, Consultations codes 99242-99245, 99252-99255, Emergency Department Services codes 99281-99285,
- Nursing Facility Services codes 99304-99310, 99315, 99316, Home or Residence Services codes 99341, 99342, 99344, 99345, 99347-99350
- Deletion of Hospital Observation Services E/M codes 99217-99220
- Revision of Hospital Inpatient and Observation Care Services E/M codes 99221-99223, 99231-99239 and guidelines
- Deletion of Consultations E/M codes 99241 and 99251
- Revision of Consultations E/M codes 99242-99245, 99252-99255 and guidelines
- Revision of Emergency Department Services E/M codes 99281-99285 and guidelines
- Deletion of Nursing Facility Services E/M code 99318
- Revision of Nursing Facility Services E/M codes 99304-99310, 99315, 99316 and guidelines
- Deletion of Domiciliary, Rest Home (eg, Boarding Home), or Custodial Care Services E/M codes 99324-99238, 99334-99337, 99339, 99340
- Deletion of Home or Residence Services E/M code 99343
- Revision of Home or Residence Services E/M codes 99341, 99342, 99344, 99345, 99347-99350 and guidelines
- Deletion of Prolonged Services E/M codes 99354-99357
- Revision of guidelines for Prolonged Services E/M codes 99358, 99359, 99415, 99416
- Revision of Prolonged Services E/M code 99417 and guidelines
- Establishment of Prolonged Services E/M code 993X0 and guidelines
View the January 2023 CPT® Evaluation and Management (E/M) Code and Guideline Changes here
OCR fines 11 healthcare orgs for HIPAA right-of-access cases
OCR fines 11 healthcare orgs for HIPAA right-of-access cases
July 18, 2022
The HHS Office for Civil Rights on Friday said it has settled nearly a dozen investigations of allegations of HIPAA Right of Access Initiative violations.
WHY IT MATTERS
OCR's enforcement actions include some substantial monetary penalties for the following healthcare providers and compelled them to furnish patients with timely copies of their health records.
THE LARGER TREND
The 11 new cases bring the total number of settlements to 38 since OCR began enforcing the HIPAA Right of Access Rule in 2019. Despite the more rigorous enforcement, however, some patients are still forced to sue to gain access to their own healthcare information.
ON THE RECORD
"It should not take a federal investigation before a HIPAA-covered entity provides patients, or their personal representatives, with access to their medical records," OCR Director Lisa J. Pino said in a statement. "Health care organizations should take note that there are now 38 enforcement actions in our Right of Access Initiative and understand that OCR is serious about upholding the law and peoples' fundamental right to timely access to their medical records."
View HHS Office for Civil Rights Right of Access Initiative here
COVID-19: Novavax Vaccine, Adjuvanted — New Codes
COVID-19: Novavax Vaccine, Adjuvanted — New Codes
CMS issued 3 new CPT codes effective July 13, 2022
The FDA authorized emergency use of the Novavax COVID-19 vaccine, Adjuvanted for the prevention of COVID-19 disease in patients 18 years and older:
Code 91304 for vaccine product:
- Long descriptor: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, preservative free, 5 mcg/0.5 mL dosage, for intramuscular use
- Short descriptor: SARSCOV2 VAC 5MCG/0.5ML IM
Code 0041A for vaccine administration, first dose:
- Long descriptor: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, preservative free, 5 mcg/0.5 mL dosage; first dose
- Short descriptor: ADM SARSCOV2 5MCG/0.5ML 1ST
Code 0042A for vaccine administration, second dose:
- Long descriptor: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, preservative free, 5 mcg/0.5 mL dosage; second dose
- Short descriptor: ADM SARSCOV2 5MCG/0.5ML 2ND
Visit the COVID-19 Vaccine Provider Toolkit for more information, and get the most current list of billing codes, payment allowances, and effective dates. Note: You may need to refresh your browser if you recently visited this webpage.
Joint Cyber Advisory TLP White: North Korean State-Sponsored Cyber Actors Use Maui Ransomware to Target the Healthcare and Public Health Sector
Joint Cyber Advisory TLP White: North Korean State-Sponsored Cyber Actors Use Maui Ransomware to Target the Healthcare and Public Health Sector
North Korean State-Sponsored Cyber Actors Use Maui Ransomware to Target the Healthcare and Public Health Sector
July 2022
The Federal Bureau of Investigation (FBI), Cybersecurity and Infrastructure Security Agency (CISA), and the Department of the Treasury (Treasury) are releasing this joint Cybersecurity Advisory (CSA) to provide information on Maui ransomware, which has been used by North Korean state-sponsored cyber actors since at least May 2021 to target Healthcare and Public Health (HPH) Sector organizations.
This joint CSA provides information—including tactics, techniques, and procedures (TTPs) and indicators of compromise (IOCs)—on Maui ransomware obtained from FBI incident response activities and industry analysis of a Maui sample. The FBI, CISA, and Treasury urge HPH Sector organizations as well as other critical infrastructure organizations to apply the recommendations in the Mitigations section of this CSA to reduce the likelihood of compromise from ransomware operations. Victims of Maui ransomware should report the incident to their local FBI field office or CISA.
The FBI, CISA, and Treasury highly discourage paying ransoms as doing so does not guarantee files and records will be recovered and may pose sanctions risks. Note: in September 2021, Treasury issued an updated advisory highlighting the sanctions risks associated with ransomware payments and the proactive steps companies can take to mitigate such risks. Specifically, the updated advisory encourages U.S. entities to adopt and improve cybersecurity practices and report ransomware attacks to, and fully cooperate with, law enforcement. The updated advisory states that when affected parties take these proactive steps, Treasury’s Office of Foreign Assets Control (OFAC) would be more likely to resolve apparent sanctions violations involving ransomware attacks with a non-public enforcement response.
View the Detailed Advisory Here
Teaching Physicians, Interns, & Residents Guidelines
Teaching Physicians, Interns, & Residents Guidelines
Teaching Physicians, Interns, & Residents Guidelines MLN Booklet
July 2022
What’s Changed?
- Updated teaching settings to include any telehealth service or procedure through audio/video real-time technology
- Added content about interpreting diagnostic radiology and tests if a physician other than a resident does the interpretation or review
- In residency training sites outside a Metropolitan Statistical Area (MSA), teaching physicians, as required, may use audio/video real-time technology when the resident does services
- Added content about psychiatric services under an approved Graduate Medical Education (GME) Program, including documentation
- Medicare Part A pays graduate medical training programs separately when total time determines office or outpatient Evaluation and Management (E/M) visit level, which includes the resident’s time providing services with a teaching physician present
- When total time decides the office or outpatient E/M visit level, only include teaching physician-presence time
- After providing the service, you must document the medical record with the teaching physician’s physical or virtual presence, including telehealth services, only in residency training sites outside an MSA
- Starting January 1, 2022, teaching physicians may use only Medical Decision Making (MDM) when selecting E/M visit level for time-based office and or outpatient E/M visits under the primary care exception
- During the PHE, we expanded the residents’ services list
- After the PHE, we’ll no longer include levels 4–5 office or outpatient E/M visits in the primary care exception
- For all teaching settings during the PHE, teaching physicians may direct care and review services each resident provides during or at once after each visit through audio/video real-time technology
Access Teaching Physicians, Interns, & Residents Guideline Here
Quarterly Update to the National Correct Coding Initiative [NCCI] Procedure-to-Procedure [PTP] Edits, Version 28.2, Effective July 1, 2022
Quarterly Update to the National Correct Coding Initiative [NCCI] Procedure-to-Procedure [PTP] Edits, Version 28.2, Effective July 1, 2022
June 2022
NCCI third quarter edit files are available on these Medicare NCCI webpages:
Office of the Inspector General (OIG) to Review a Medicare Administrative Contractor (MAC) Cost Report Settlements with Audit
Office of the Inspector General (OIG) to Review a Medicare Administrative Contractor (MAC) Cost Report Settlements with Audit
June 2022
Report Number (W-00-22-35886)
The Office of the Inspector General (OIG) to review a single Medicare Administrative Contractor (MAC), and based on the results, they may expand this work to other MAC’s.
OIG’s objective will be to:
(1) quantify the extent to which the MAC amends audit adjustments after cost reports have been audited and settled, and whether the audit adjustments contain obvious errors or are inconsistent with the law, regulations and rulings, or general instructions;
(2) quantify the effect of amended audit adjustments; and
(3) gain an understanding of the types and/or causes of amended audit adjustments.
People’s Republic of China State-Sponsored Cyber Actors Exploit Network Providers and Devices
People’s Republic of China State-Sponsored Cyber Actors Exploit Network Providers and Devices
June 2022
Alert (AA22-158A)
Common vulnerabilities exploited by People’s Republic of China state-sponsored cyber actors PRC state-sponsored cyber actors readily exploit vulnerabilities to compromise unpatched network devices. Network devices, such as Small Office/Home Office (SOHO) routers and Network Attached Storage (NAS) devices, serve as additional access points to route command and control (C2) traffic and act as midpoints to conduct network intrusions on other entities. Over the last few years, a series of high-severity vulnerabilities for network devices provided cyber actors with the ability to regularly exploit and gain access to vulnerable infrastructure devices. In addition, these devices are often overlooked by cyber defenders, who struggle to maintain and keep pace with routine software patching of Internet-facing services and endpoint devices.
Top network device CVEs exploited by People’s Republic of China state-sponsored cyber actors:
- Cisco
- Citrix
- DrayTek
- D-Link
- Fortinet
- MikroTik
- Netgear
- Pulse
- QNAP
- Zyxel
ONC's Cures Act Final Rule Highlighted Regulatory Dates
ONC's Cures Act Final Rule Highlighted Regulatory Dates
June 2022
Empowering Patients with Their Health Record in a Modern Health IT Economy
The patient is at the center of the 21st Century Cures Act. Putting patients in charge of their health records is a key piece of patient control in health care, and patient control is at the center of HHS' work toward a value-based health care system. The ONC Cures Act Final Rule implements interoperability requirements outlined in the Cures Act. Patients need more power in their health care, and access to information is key to making that happen.
2023 ICD-10-CM Official Guidelines for Coding and Reporting
2023 ICD-10-CM Official Guidelines for Coding and Reporting
June 2022
The Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS), two departments within the U.S. Federal Government’s Department of Health and Human Services (DHHS) provide the following guidelines for coding and reporting using the
International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). These guidelines should be used as a companion document to the official version of the ICD-10-CM as published on the NCHS website. These guidelines are a set of rules that have been developed to accompany and complement the official conventions and instructions provided within the ICD-10-CM itself. These guidelines have been approved by the four organizations that make up the Cooperating Parties for the ICD-10-CM: the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), CMS, and NCHS.
2023 ICD-10-CM Files
2023 ICD-10-CM Files
June 2022
The 2023 ICD-10-CM files below contain information on the ICD-10-CM updates for FY 2023. These 2023 ICD-10-CM codes are to be used for discharges occurring from October 1, 2022 through September 30, 2023 and for patient encounters occurring from October 1, 2022 through September 30, 2023.
CPT® Appendix T and Modifier 93: Audio-only medical services
CPT® Appendix T and Modifier 93: Audio-only medical services
May 2022
Make sure your billing staff knows about these changes:
• New COVID-19 CPT vaccines and administration codes
• CPT proprietary laboratory analyses (PLA) coding changes effective July 1, 2022
• New CPT Category III codes effective July 1, 2022
Effective July 1, 2022 Update of the Hospital Outpatient Prospective Payment System (OPPS)
Effective July 1, 2022 Update of the Hospital Outpatient Prospective Payment System (OPPS)
May 2022
Make sure your billing staff knows about these changes:
• New COVID-19 CPT vaccines and administration codes
• CPT proprietary laboratory analyses (PLA) coding changes effective July 1, 2022
• New CPT Category III codes effective July 1, 2022
2023 ICD-10-PCS Official Guidelines for Coding and Reporting
2023 ICD-10-PCS Official Guidelines for Coding and Reporting
May 2022
The 2023 Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS), two departments within the U.S. Federal Government’s Department of Health and Human Services (DHHS) provide the following guidelines for coding and reporting using the International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS). These guidelines should be used as a
companion document to the official version of the ICD-10-PCS as published on the CMS website. The ICD-10-PCS is a procedure classification published by the United States for classifying procedures performed in hospital inpatient health care settings.
Table of Contents
A. Conventions .......................................................................3
B. Medical and Surgical Section Guidelines ...................................5
2. Body System ..............................................................5
3. Root Operation..........................................................5
4. Body Part ...............................................................13
5. Approach ...............................................................16
6. Device ....................................................................17
C. Obstetrics Section Guidelines...............................................18
D. Radiation Therapy Guidelines.............................................18
E. New Technology Section Guidelines.......................................19
F. Selection of Principal Procedure...........................................20
2023 ICD-10-PCS Files
2023 ICD-10-PCS Files
May 2022
The 2023 ICD-10 Procedure Coding System (ICD-10-PCS) files below contain information on the ICD-10-PCS updates for FY 2023. These 2023 ICD-10-PCS codes are to be used for discharges occurring from October 1, 2022 through September 30, 2023.
AHA Resource on ICD-10-CM Coding for Social Determinants of Health
AHA Resource on ICD-10-CM Coding for Social Determinants of Health
April 2022
Hospitals and health systems are working to address their patients’ social needs and the broader social determinants of health in the communities they serve. This includes societal and environmental conditions such as food, housing, transportation, education, violence, social support, health behaviors and employment.
Any clinician can document a patient’s social needs
Congress Passes 72-Hour Federal Breach Reporting Law for Critical Infrastructure
Congress Passes 72-Hour Federal Breach Reporting Law for Critical Infrastructure
March 2022
As part of a larger spending bill signed by President Biden on March 15, 2022, Congress passed the Cyber Incident Reporting for Critical Infrastructure Act (CIRA) to increase funding for the federal Cybersecurity and Critical Infrastructure Agency (CISA). CIRA requires companies considered to be in a “critical infrastructure” sector to notify CISA within 72 hours of a significant cyber incident and, in the case of ransomware, within 24 hours of making a payment. CISA may look to the 16 industries considered “vital” to the United States’ physical and economic security and public health or safety:
- Chemical
- Commercial facilities
- Communications
- Critical Manufacturing
- Dams
- Defense Industrial Base
- Emergency Services
- Energy
- Financial Services
- Food and Agriculture
- Government Facilities
- Healthcare and Public Health
- Information Technology
- Nuclear Reactors, Materials, and Waste
- Transportation Systems
- Water and Wastewater Systems