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| Document # | |
|---|---|
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Updates to No Legal Obligation to Pay for or Provide Services and Examples of Application of Government Entity Exclusion (Pub. 100-02, chapter 16, sections 40 and 50.3.3 and newly created section 40.7) and Claims Submitted for Items or Services Furnished to Medicare Beneficiaries in State or Local Custody Under a Penal Authority (Pub. 100-04, chapter 1, section 10.4) |
R13011BP |
| Updates to No Legal Obligation to Pay for or Provide Services and Examples of Application of Government Entity Exclusion (Pub. 100-02, chapter 16, sections 40 and 50.3.3 and newly created section 40.7) and Claims Submitted for Items or Services Furnished to Medicare Beneficiaries in State or Local Custody Under a Penal Authority (Pub. 100-04, chapter 1, section 10.4) | R13011CP |
| This transmittal updates Chapter 33, Organ Procurement Organizations (OPOs) and independent Histocompatibility Laboratories (Labs) Cost Report, Form CMS-216-94, effective for cost reporting periods ending on or after December 31, 2024. | R11P233i |
| This transmittal updates Chapter 40, Hospital and Hospital Health Care Complex Cost Report (Form CMS-2552-10), by clarifying and revising the existing instructions and by revising existing edits. Effective dates vary. | R12763CP |
| Update to Billing Requirements for Intensive Outpatient Program (IOP) Services for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) | R23P240i |
| Allow Payment for Healthcare Common Procedure Coding System (HCPCS) Code G2211 when Certain Part B Preventive Services are Provided on the Same Day | R13015OTN |
| Updates to the Medicare Carrier System (MCS), the Viable Information Processing Systems Medicare Systems (VMS) and the Common Working File (CWF) Processes to Capture and Further Automate the Medicare Secondary Payer (MSP) Processes. | R13016MSP |
| Adjustments in the Medicare Adjudication Portal (MAP) for 837D Dental Claims (Phase 2) | R13027OTN |
| Update to the Internet Only Manual (IOM) Publication (Pub.) 100-04, Chapter 18 Section 60.3 and Chapter 32 Sections 11.3.5, 60.4.1, 60.5.2, 320.2 and 412.1 for Coding Revisions to the National Coverage Determinations (NCDs) - April 2025 (2 of 2) Change Request (CR) 13828 | R13025CP |
| OIG HHS/Reports | Document # |
|---|---|
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Twelve Selected States Did Not Accurately Calculate the Federal Share of Medicaid Collections Subject to the Increased COVID-19 Federal Medical Assistance Percentages |
A-06-23-09002 |
| Indiana Made at Least $56 Million in Improper Fee-for-Service Medicaid Payments for Applied Behavior Analysis Provided to Children Diagnosed With Autism | A-09-22-02002 |
| Medicaid Gross Spending on 10 Selected Diabetes and 2 Selected Weight Loss Drugs Totaled More Than $9 Billion in 2023, an Increase of 540 Percent From 2019 | A-05-24-00016 |
| Some Selected Skilled Nursing Facilities Did Not Comply With Medicare Requirements for Reporting Related-Party Costs | A-07-21-02836 |
| Providers Used Medicare Part D Eligibility Verification Transactions for Permissible Purposes | A-05-22-00022 |
| Some HHS Requirements for Vetting Mobile Apps Were Not Followed Prior to the Release of the AHRQ Question Builder App | A-18-22-09008 |
| Medicare Home Health Agency Provider Compliance Audit: Bridge Home Health | A-05-23-00017 |
| Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Triple-S Advantage, Inc., (Contract H5774) Submitted to CMS | A-04-21-07095 |
| Total Medicare Part B Spending on Lab Tests Decreased in 2023, Driven in Part by Less Spending on COVID-19 Tests | OEI-09-24-00350 |
| Medicare Claims Processing Manual? | Document # |
|---|---|
| Chapter 3 - Inpatient Hospital Billing | clm104c03 |
| Part B Hospital (Including Inpatient Hospital Part B and OPPS) | clm104c04 |
| Federal Register/Notice | Document # |
|---|---|
| Agency Information Collection Activities: Submission for OMB Review; Comment Request | 2024-30444 |
| Agency Information Collection Activities: Proposed Collection; Comment Request | 2024-30502 |
| Privacy Act of 1974; Matching Program | 2024-30522 |
| Agency Information Collection Activities: Submission for OMB Review; Comment Request | 2024-30619 |
| Agency Information Collection Activities: Proposed Collection; Comment Request | 2024-30620 |
| Medicare Program; Rural Community Hospital Disemonstration Program: Solicitation of Additional Participants | 2024-30719 |
| Federal Register/Rule | Document # |
|---|---|
| Medicare Program; Calendar Year (CY) 2025 Home Health Prospective Payment System (HH PPS) Rate Update; HH Quality Reporting Program Requirements; HH Value-Based Purchasing Expanded Model Requirements; Home Intravenous Immune Globulin (IVIG) Items and Services Rate Update; and Other Medicare Policies; Correction | 2024-30169 |