Thursday, May 22, 2025
News
- Discarded Drugs: Get Updated Lists
- Medicare Provider Payment & Utilization Public Use Files: Annual Update
- Medicare Fee-for-Service Geographic Variation Public Use Files & Interactive Dashboard: Annual Update
- CMS Fast Facts: Annual Update
Compliance
- Skilled Nursing Facilities: Identify & Prevent Improper Part D Payments for Drugs
- Psychiatric Care: Prevent Claim Denials
Claims, Pricers & Codes
News
Discarded Drugs: Get Updated Lists
CMS updated 2 files on the Discarded Drug webpage:
- Drugs with Increased Applicable Percentage (PDF)
Orphan Drugs with Increased Applicable Percentage for Calendar Quarters in 2024 (PDF)
Medicare Provider Payment & Utilization Public Use Files: Annual Update
CMS updated Provider Payment and Utilization Public Use Files to include data for CY 2023. These provider-level data products summarize service utilization and payments in the Medicare Fee-for-Service (FFS) and Part D programs:
- Medicare Physician & Other Practitioners datasets: services and procedures that physicians and other health care professionals provide to Medicare FFS beneficiaries
Medicare Part D Prescriber datasets: prescription drugs that individual physicians and other healthcare professionals prescribe; paid under the Medicare Part D Prescription Drug program
Medicare Fee-for-Service Geographic Variation Public Use Files & Interactive Dashboard: Annual Update
CMS updated CY 2023 spending and quality indicator data for the Medicare Fee-for-Service (FFS) population:
- Medicare FFS geographic variation public use files: include demographic, spending, utilization, and total standardized per capita spending data for CY 2007–2023 at the state and county levels and breakdowns for beneficiaries under 65 and 65 and older
- Interactive dashboard: contains a subset of this information, with data available for CY 2019–2023
CMS Fast Facts: Annual Update
CMS updated the CMS Fast Facts to include data for 2022–2025. Use this quick reference statistical summary for information on Medicare and Medicaid enrollment, utilization, expenditures, and Medicare provider counts.
Compliance
Skilled Nursing Facilities: Identify & Prevent Improper Part D Payments for Drugs
In a report, the Office of the Inspector General found that Medicare Part D improperly paid for drugs during Part A skilled nursing facility (SNF) stays. Drugs prescribed for a Part D-enrolled patient aren’t covered by Part D if Part A or B can pay for them.
Learn how to avoid improper payments. See the SNF Billing Reference educational tool to find out when to bill your patients prescription drugs to Part A, instead of their Part D drug plan.
Psychiatric Care: Prevent Claim Denials
In 2023, the improper payment rate for outpatient psychiatry services was 13.5%, with a projected improper payment amount of $186.1 million (see 2023 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF)). Learn how to bill correctly for these services. Review the Outpatient Psychiatric Care provider compliance tip for more information, including:
- Billing codes
- Denial reasons and how to prevent them
- Covered and non-covered services
- Service frequency and duration
- Resources
Claims, Pricers & Codes
Medicare Physician Fee Schedule Database: July Update
See the instructions to your Medicare Administrative Contractor (MAC) (PDF) attachment to learn about the July quarterly updates to the Medicare Physician Fee Schedule Database, including:
- New codes
- Procedure status changes
- Short descriptor code revisions
- Payment policy indicator changes
Your MAC will give you 30-days notice before they implement these changes. After that, they’ll adjust claims that you bring to their attention.
For more information, see the Medicare Claims Processing Manual, Chapter 23 (PDF), section 30.1.
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