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NCCI Resources

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CMS originally developed the Medically Unlikely Edit (MUE) program to reduce the paid claims error rate for Part B claims. The first edits were implemented January 1, 2007. Subsequently there have been quarterly updates increasing the number of edits. Visit the NCCI main page on the CMS site. National Correct Coding Initiative Policy Manual for […]

IRF PPS Final Rule FY2022

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The IRF prospective payment system (IRF PPS) Addenda along with other supporting documents and tables referenced in this final rule are available on the CMS website . Prior to 2020, each rule or notice issued under the IRF PPS has included a detailed reiteration of the various regulatory provisions that have affected the IRF PPS […]

CMS Inpatient Only List CY2022

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The 2022 List of inpatient only codes is Appendix E of the OPPS Final Rule. Table of contents for the Addenda (PDF) All the Addenda are available in a .zip file from CMS (click here to download)

IRF PPS Proposed Rule FY2022

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On April 7, 2021, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update Medicare payment policies and rates for facilities under the Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) and the IRF Quality Reporting Program (QRP) for fiscal year (FY) 2022. CMS is publishing this proposed rule consistent with the […]

CMS Inpatient Only List CY2021

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The CMS Inpatient Only List is published in the Outpatient Prospective Payment System (OPPS) Final Rule as Addendum E. 2021 NFRM OPPS Addenda  (zip files, look for Addendum E) The specific set of items removed from this list are found here: Services Removed from the Inpatient Only (IPO) List for CY 2021 (zip file)

COVID Vaccines and MMA COVID-19 Infusion Program

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Medicare Part B Payment for COVID-19 Vaccines and Certain Monoclonal Antibodies during the Public Health Emergency are found at CMS in the drug pricing section. We link to it below.  CMS has released a set of toolkits for providers, states and insurers to help the health care system prepare and assist in swiftly administering these products once […]

IRF Data Files from CMS (FY2021)

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FY 2021 IRF PPS Data Files – Final (ZIP) Includes: IRF Wage Index Final Rule – These files contain the urban and rural Core-Based Statistical Area FY 2021 IRF wage index tables. IRF Rate Setting Final Rule – This file contains data for each of the 1,118 inpatient rehabilitation facilities used to estimate the policy updates in […]

CMS Transmittals Index, 2004 – 2020

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What are Transmittals? Program transmittals are used to communicate new or changed policies, and/or procedures that are being incorporated into a specific Centers for Medicare & Medicaid Services (CMS) program manual. The cover page (or transmittal page) summarizes the new changed material, specifying what is changed. Each year’s transmittal page is linked below. Click on […]

CY2021 Physician Fee Schedule Proposed Rule

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CMS issued a proposed rule on August 3, 2020, on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, on or after January 1, 2021. This document is scheduled for publication in the Federal Register on August 17, 2020 Background on the Physician Fee Schedule Since […]