From CMS:

CMS is committed to crushing fraud, waste, and abuse. The WISeR Model, which stands for Wasteful and Inappropriate Service Reduction, will help meet this goal, while supporting people with Original Medicare to receive safe and appropriate care and protecting federal taxpayers.

Through WISeR, CMS will partner with companies specializing in enhanced technologies to test ways to provide an improved and expedited process for reviewing the medical necessity of select items and services shown to have little to no clinical benefit and that are particularly vulnerable to fraud, waste, and abuse.

With this announcement, CMS has issued a Request for Applications (RFA) for companies interested in participating in the model.

Find more information on the WISeR Model webpage, as well as the model press release and factsheet.

Send questions about the model to WISeR@cms.hhs.gov.

On March 20, CMS released an update of the Medicare Benefit Policy Manual that revises and clarifies payment policy information for Rural Health Clinics and Federally Qualified Health Centers.

Some Key Updates Include:

• Starting January 1, 2025, RHCs and FQHCs must include costs for hepatitis B vaccines on their annual cost reports.
• CMS no longer requires RHC productivity standards starting with cost reporting periods ending after December 31, 2024.
• RHCs and FQHCs can continue to bill for non-behavioral health telehealth services by reporting HCPCS code G2025, including services you provide using audio-only technology, through December 31, 2025.
• CMS includes Principal Illness Navigation Peer-Support and Advanced Primary Care Management in RHC's and FQHC's care coordination services.

There are several additional important updates that RHCs and FQHCs should be aware of.

Make sure your billing staff knows about the 2025 updates to the Medicare Benefit Policy Manual, Chapter 13. 

Source:

Medicare Learning Network, MLN Matters 13946

• Hepatitis B vaccines are paid like other Part B preventive vaccines effective January 1, 2025.
• New claim-based payments for Part B preventive vaccines and their administration are effective July 1, 2025.  RHCs and FQHCs will need to annually reconcile payments with the facilities' actual vaccine and vaccine administration costs on their cost reports.

If you have not already, we encourage you to subscribe to the MLN Connects ® newsletter for more information and updates from CMS.

November is Lung Cancer Awareness Month. A perfect time to revisit this topic!

Tobacco use is the leading cause of preventable disease, disability, and death in the U.S., and smoking causes almost a half a million deaths per year.

Rural NC Road in Autumn. Photo used with permission

U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. 

The Quality Payment Program (QPP) Small Practices Newsletter is a monthly resource that provides small practices (15 or fewer clinicians) with program updates, upcoming QPP milestones, and resources to support their continued participation and success in QPP. The newsletter is sent on the 2nd Tuesday of each month.

CMS identified phishing scams for medical records. This may include scammers faxing you fraudulent medical records requests to get you to send patient records in response; see example (PDF).

Medicare pays for opioid use disorder (OUD) screenings performed by physicians and non-physician practitioners.  If you diagnose your patient with OUD, they also pay for treatment services.

National Healthcare Decisions Day exists to inspire, educate and empower the public and providers about the importance of advance care planning.  It is an initiative to encourage patients to express their wishes regarding healthcare and for providers and facilities to respect those wishes, whatever they may be.  (Source: https://theconversationproject.org/nhdd/)

Today we bring you some news from the Center for Medicare and Medicaid Services (CMS) 2024 Physician Fee Schedule Final Rule. CMS has finalized a new stand-alone G Code (G0136) to pay for administering an SDOH risk assessment, no more than once every 6 months:

G0136: Administration of a standardized, evidence-based SDOH assessment, 5-15 minutes, not more often than every 6 months.