Centers for Medicare & Medicaid Services Education Update

The Centers for Medicare & Medicaid Services (CMS) will frequently publish educational items to help providers with compliance issues, known as the Provider Compliance Tips program, as well as other materials to help educate providers.  Recently, CMS has provided guidance on four items relevant to WOCN members, information about each of those items is provided below:

 

New Billable Codes for Caregiver Training
Starting in 2024 Medicare will pay for caregiver training services for caregivers involved in the treatment of Medicare patients, known as Caregiver Training Services (CTS).  The education will be covered if both of these conditions apply:

  • The training focuses on helping the patient meet the health and treatment goals they set with their doctor or other health care provider.
  • The patient needs a caregiver’s help for their treatment to succeed.

If the patient’s healthcare provider determines that caregiver training is appropriate for the patient’s treatment plan, the caregiver can get individual or group training sessions from the provider without the patient present.  CMS has created new education materials that are available to providers and facilities.  Ostomy education would be a covered condition and we encourage you to discuss billing options with your organization/ institution’s billing group.  Below is a description of each code:

  • 97550– Caregiver training in strategies and techniques to facilitate the patient’s functional performance in the home or community (e.g., activities of daily living [ADLs], instrumental ADLs [IADLs], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the patient present), face-to-face; initial 30 minutes.
  • 97551– Caregiver training in strategies and techniques to facilitate the patient’s functional performance in the home or community (e.g., activities of daily living [ADLs], instrumental ADLs [IADLs], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the patient present), face-to-face; each additional 15 minutes.
  • 97552– Group caregiver training in strategies and techniques to facilitate the patient’s functional performance in the home or community (e.g., activities of daily living [ADLs], instrumental ADLs [IADLs], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the patient present), face-to-face with multiple sets of caregivers.

 

Provider Compliance Tips for Surgical Dressings
In September 2023, the provider compliance tip for surgical dressings was updated using the latest Medicare Fee-for-Service (FFS) Supplemental Improper Payment Data. The information updated included the improper payment rates, denial reasons and specific guidance to assist meeting medical necessity requirements including physician evaluation, suitable instruction, treatment plan and monitoring. This tool is an example of a valuable educational and supportive resource on surgical dressings Medicare wants to share its availability with your members.

If you have any questions or interested in learning more about the Provider Compliance Tips tool, please visit the Medicare Learning Network home page.

 

Diabetic Shoes: Prevent Claim Denials
In 2022, the improper payment rate for diabetic shoes was 51%, and insufficient documentation accounted for 69% of improper payments (see 2022 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF), Appendices D, E, and G). Learn how to bill correctly for these services. Review the diabetic shoes provider compliance tip for more information, including:

  • Codes
  • Coverage limitations and requirements for therapeutic shoes
  • Documentation requirements and example of improper payment
  • Resources

 

Lymphedema Compression Treatment Items: New DMEPOS Benefit Category

Starting January 1, 2024, Medicare pays for lymphedema compression treatment items for Medicare Part B patients. CMS updated the following manuals with information on this new DMEPOS benefit category: