This week in Medicare—11/20/2024
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CMS Releases Report on Rural-Urban Health Disparities in Medicare
On November 12, CMS published a Report on the disparities in the quality of healthcare received by Medicare beneficiaries in rural and urban areas. The report discusses the following:
- Rural-urban differences in healthcare experiences and clinical care
- How rural-urban healthcare differences vary by race and ethnicity
- Historical trends in care quality for rural and urban residents
CMS Publishes White Paper on Reimagining Rural Health
On November 12, CMS published a White Paper on recommendations and possible next steps for addressing healthcare challenges in rural communities. The white paper highlights the need for rural health innovation and details lessons learned from testing rural models.
Third Evaluation Report of the Accountable Health Communities Model
On November 12, CMS published the third Evaluation Report for the Accountable Health Communities (AHC) model. The model ran from 2017 to 2023 and tested whether connecting people to community resources for their health-related social needs (HRSNs) improved care quality outcomes and/or reduced costs. The report details how the model decreased Medicare spending, emergency department visits, and inpatient admissions.
CMS Publishes Materials on its Patient Safety Strategy
On November 13, CMS published a Fact Sheet on its National Quality Strategy (NQS), a cross-cutting initiative to advance the agency’s goal of ensuring the highest quality care and best health outcomes for all individuals. Improving healthcare safety is a key component of the NQS, and CMS published an additional Fact Sheet on its three-point safety plan to promote zero preventable harm.
Revisions to Chapter 12 (The Comprehensive Error Rate Testing (CERT) Program) of Publication (Pub.) 100-08
On November 14, CMS published Medicare Program Integrity Transmittal 12959 to revise Chapter 12 of the Medicare Program Integrity Manual. The agency added clarification regarding administrative relief when documentation has been received by the CERT review contractor.
Effective date: December 17, 2024
Implementation date: December 17, 2024
Implementation of Changes in the ESRD PPS and Payment for Dialysis Furnished for Acute Kidney Injury (AKI) in ESRD Facilities for CY 2025
On November 14, CMS published Medicare Benefit Policy Transmittal 12962 regarding the implementation of rate updates and policies for the ESRD PPS for 2025. The transmittal also includes updates to payments for renal dialysis services provided to patients with AKI in ESRD facilities.
Effective date: January 1, 2025
Implementation date: January 6, 2025
Updates to the Publication 100-04 Claims Processing Manual in the Internet Only Manual (IOM) to Remove Obsolete Language Related to Medicare Fee-for-Service (FFS) Systems Claims Edits
On November 14, CMS published Medicare Claims Processing Transmittal 12961 to remove language in Chapters 3, 4, 12, and 32 of the Medicare Claims Processing Manual related to edits that were inactivated on October 1.
Effective date: October 1, 2024
Implementation date: December 17, 2024
January 2025 Annual Rural Emergency Hospital (REH) Monthly Facility Payment Amount
On November 15, CMS published Medicare Claims Processing Transmittal 12964 to furnish the annual REH monthly facility payment amount for CY 2025. The payment amount is $291,455 before the sequestration is removed and $285,625.90 after it is removed.
Effective date: January 1, 2025
Implementation date: January 6, 2025
Update to Medicare Deductible, Coinsurance and Premium Rates for Calendar Year (CY) 2025
On November 15, CMS published Medicare General Information, Eligibility, and Entitlement Transmittal 12963 to instruct contractors on how to updates claims processing systems with the new CY 2025 Medicare rates.
CMS published MLN Matters 13796 on the same date to accompany the transmittal.
Effective date: January 1, 2025
Implementation date: January 6, 2025
FY 2024 Improper Payments Fact Sheet
On November 15, CMS published a Fact Sheet on improper payment data for FY 2024. The Medicare Fee-for-Service estimated improper payment rate was 7.66%, or $31.70 billion, marking the eighth consecutive year this figure has been below the 10% threshold for compliance established by improper payment statutory requirements. The Part C rate (5.61%) and Part D rate (3.70%) were also below the 10% statutory threshold.
The fact sheet provides additional details on what Medicare considers to be an improper payment, what these rates mean, and how CMS works to combat improper payments across each federal healthcare program. More detailed data is available in the FY 2024 HHS Agency Financial Report.
Updated OIG Work Plan
On November 15, the OIG updates its Work Plan with the following new items:
- Medicare Advantage Health Risk Assessments - Continuity of Care
- Medicare Part B Drug Payments: Impact of Price Substitutions Based on 2023 Average Sales Prices
- Medicare Part B Payments for Skin Substitutes
- Medications for Opioid Use Disorder in Medicare in 2023: Annual Review
- Update: Average Sales Price Reporting for Skin Substitutes
- Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the Second Quarter of 2024
- Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the Third Quarter of 2024
- Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the Fourth Quarter of 2024
- Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the First Quarter of 2025
- Medicare Part B Payments for Incident-To Services