Compliance Monitor (12/09/2024)

CMS posted a notice in the Federal Register to announce a $730.00 calendar year (CY) 2025 application fee for institutional providers that are initially enrolling in the Medicare or Medicaid program or the Children’s Health Insurance Program (CHIP); revalidating their Medicare, Medicaid, or CHIP enrollment; or adding a new Medicare practice location. This fee is required with any enrollment application submitted on or after January 1, 2025, and on or before December 31, 2025. 

Read the notice 

CMS finalized changes to add a standard into Condition of Participation §484.105, Acceptance-to-service policy, in the Final Calendar Year (CY) 2025 Home Health Prospective Payment System (HH PPS) Rate Update.  This regulatory change is effective on January 1, 2025. 

CHAP is revising our Home Health Standards of Excellence to incorporate this regulatory change, and we will also make our updated manual available as soon as possible.  Until then, providers are responsible for developing their policy to demonstrate compliance with §484.105(i) as of January 1, 2025. 

Read the CHAP Update Notice  

The extension related to telehealth and face-to-face services, including Medicare telehealth flexibilities, is set to expire in 2024 for home health and hospice providers. Congress extended telehealth flexibilities for Medicare patients through December 31, 2024. This also includes the DEA extension of telehealth flexibilities for prescribing controlled medications through December 31, 2024.  

Providers should be winding down their telehealth processes and be ready to return to pre-pandemic in-person visit practice. 

Thursday, December 12, 2024, at 1-2 pm ET 

Register for this webinar. 

CMS will host a webinar on an Introduction to Hospice Outcomes and Patient Evaluation. Subject matter experts will answer questions as time permits. 

Visit the Hospice Quality Reporting Program for more information. 

The language access requirements on meaningful access and effective communication of the Section 1557 final rule went into effect on July 5, 2024  

The U.S. Department of Health & Human Services (HHS), Office for Civil Rights (OCR), issued a “Dear Colleague” letter - PDF to help federally funded healthcare providers, plan grantees, and others better understand their civil rights obligations under the new final rule on Section 1557 of the Affordable Care Act (“Section 1557”).  Section 1557 provides nondiscrimination protections by requiring covered entities (e.g., recipients of Federal financial assistance, programs administered by HHS, and entities established under Title I of the Affordable Care Act (ACA)) to provide language assistance to individuals with limited English proficiency (LEP) or disability. 

Read the notice 

The November 2024 quarterly refresh for the Hospice Quality Reporting Program is now available on Care Compare. 

For additional information, please see the FY2025 Hospice Wage Index Final Rule at https://www.cms.gov/Center/Provider-Type/Hospice-Center. Please visit the Hospice Background and Announcements webpage to review the Claims-Based Measures Questions and Answers downloadable (PDF) for more information on the HCI and HVLDL. 

Get the January 2025 release (Version 06.0.25 (ZIP)). See Home Health Prospective Payment System Grouper Software for a summary of changes. 

More Information: 

• Claims Processing Manual, Chapter 10 (PDF), section 80 

• Instruction to your Medicare Administrative Contractor (PDF) 

The CY 2025 blood clotting factor furnishing fee is $0.258 per unit. CMS updates this fee annually based on the percentage increase in the consumer price index for medical care. 

More Information: 

• Average Sale Price Billing Resources webpage 

• Medicare Claims Processing Manual, Chapter 17 (PDF), section 80.4.1 

• Instruction to your Medicare Administrative Contractor (PDF) 

Medicare Deductible, Coinsurance, & Premium Rates: CY 2025 Update 

Learn about CY 2025 updates for Medicare Part A and Part B (PDF). 

November 25, 2024: As required by statute, CMS posted the 2024 Measures Under Consideration (MUC) List. One hundred percent of the 41 measures on the list use digital data sources, advancing the CMS National Quality Strategy goal of prioritizing the development of interoperable and digital quality measures. Additionally, 37% of the measures address person-centered care, with the goal of enhancing the health, well-being, and overall care experience of those we serve. CMS makes these measures publicly available to seek input. Information on the process, including deadlines, can be found here. 

There are 5 measures on the MUC list for Home Health Care as follows: 

There are no hospice measures on the MUC list for the 2024 cycle 

Fall 2024 Semiannual Report to Congress 
   
The Fall 2024 Semiannual Report to Congress highlights OIG’s work focusing on the most significant and high-risk issues in health care and human services related to HHS programs and operations during the semiannual reporting period of April 1 through September 30, 2024. The semiannual reports are intended to keep the HHS Secretary and Congress informed of OIG’s crucial findings and recommendations.  
Read the Full Report 

Read the Press Release 

In 2023, the improper payment rate for glucose monitors was 13.5%, with a projected improper payment amount of $103.2 million (see 2023 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF), Appendices D, G, K, and N). Learn how to bill correctly for these services. Review the Diabetic Accessories & Supplies (including Glucose Monitors) provider compliance tip for more information, including: 

• Billing codes 

• Denial reasons and how to prevent denials 

• Continuous glucose monitor coverage indications 

• Refill and documentation requirements 

• Resources 

Learn about claims status category and code updates effective November 1, 2024: 

• Get Accredited Standards Committee (ASC) X12 code lists, including added, changed, or deleted codes 

• See examples of the ASC X12 276 and ASC X12 277 request and response transactions 

See the instruction to your Medicare Administrative Contractor (PDF). 

 CE/CME accreditation of up to 1.5 CE/CME for this webinar is available.  

AHRQ will host a webinar on December 3, 2024, from 3:00 – 4:30 p.m. ET that delves into the intersection of technology, healthcare, and equity. The Federal expert panel will explore some of the latest frameworks, data, and tools to inform and advance health and digital healthcare equity. 

Register here