Latest on Medicare Payments, Policies and Practices

Why This Topic Matters

Keeping up with these CMS updates helps organizations align billing and documentation practices with current Medicare requirements and reduce avoidable claim problems. The article is especially relevant for teams responsible for inpatient notices, payer coordination, therapy billing, ESRD-related services, and vaccine coding transitions.

Article Sections

1. New Hospital-Issued Notice of Noncoverage

   Introduces a CMS model notice related to inpatient hospital coverage status and discusses its place within Medicare hospital billing guidance. Includes references to supporting transmittal and companion materials.

2. Online MSP Questionnaire Modified

   Describes CMS revisions to the model Medicare Secondary Payer questionnaire and where the updated materials may be found. Focuses on coverage identification and admission-time payer screening.

3. New HCPCS Level II Code for ESRD-Related EPO Billing

   Covers CMS guidance related to dialysis-associated billing updates, including a new HCPCS Level II code and related Medicare claims processing manual revisions. Also notes associated transmittal and companion reference materials.

4. Outpatient Therapy Edits

   Summarizes CMS updates connected to outpatient therapy service reporting and unit limitations under Medicare claims processing guidance. References revisions affecting outpatient rehabilitation and CORF/OPT services.

5. Replacement CPT Code for 90718

   Highlights a CPT code replacement referenced in Medicare contractor implementation guidance and related transmittal materials. The section points readers to supporting CMS communication about the change.