CMS Updates Medicare Payment Policies; What’s New for Senior Care Providers?

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on July 6 to update payment policies and rates that will go into effect for services furnished on or after January 1, 2013. 

LeadingAge has a list of some key provisions that will affect senior care providers:

Primary Care and Care Coordination


“For CY 2013, CMS is proposing to create a new procedure code to recognize the additional resources required for a community physician to coordinate a patient’s care in the 30 days following discharge to the community from an inpatient hospital stay, skilled nursing facility (SNF) stay, and specified outpatient services,” writes LeadingAge.

Telehealth Services

Healthcare providers, including skilled nursing facilities, can bill Medicare for various services if the provider is in a location that’s been designated as a rural health professional shortage area, in a county that isn’t in a metropolitan statistical area (MSA), or is an entity that participates in selected Federal demonstration projects.


LeadingAge says the proposed rule adds new services to the list of those eligible for Medicare telehealth payments, including:

  • Annual alcohol misuse screening.
  • Brief behavioral counseling for alcohol misuse.
  • Annual face-to-face intensive behavioral therapy for cardiovascular disease.
  • Annual depression screening.
  • Behavioral counseling for obesity.
  • Semi-annual high intensity behavioral counseling to prevent sexually transmitted infections.

Application of Technical Standards to e-Prescribing in Nursing Homes

“There is no requirement that prescribers or dispensers implement e-prescribing; however, prescribers and dispensers who electronically transmit prescription and certain other information for covered drugs prescribed for Medicare Part D eligible beneficiaries, directly or through an intermediary, are required to comply with any applicable standards that are in effect,” says the rule. 

Recommended SHN+ Exclusives

DME Face-to-Face

“To help combat fraud and reduce improper payments in DME items, CMS is proposing to implement a face-to-face requirement as a condition of payment for certain high-cost DME covered items,” says CMS in the proposal. “This list includes many items that have been historically targets of Medicare fraud as identified by the OIG, MACs, GAO, the HEAT Strike Forces, and our program integrity experts. The requirement is one of the anti-fraud provisions in the Affordable Care Act and is consistent with similar face-to-face requirements for the Medicare home health and Medicaid DME benefit.”

Therapy Data Collection

CMS is proposing to implement a claims-based data collection process for therapy services to gather data about patient function and condition. The proposal will require therapists to include new codes and modifiers on claims for therapy services. Pay won’t be affected, but the new coding will convey information about patients’ functional limitations at the outset of therapy, periodically throughout therapy and at discharge from therapy. The collected data will be used primarily to design a new payment system for therapy services, says CMS.

More information on any of these provisions can be found at LeadingAge.

View the Department of Health and Human Services/CMS proposed rule.

Written by Alyssa Gerace

Companies featured in this article:

, ,