Medicare Program; Alternative Payment Model (APM) Incentive Payment Advisory for Clinicians-Request for Current Billing Information for Qualifying APM Participants, 48609-48610 [2022-17186]
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Federal Register / Vol. 87, No. 153 / Wednesday, August 10, 2022 / Rules and Regulations
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
42 CFR Parts 410 and 414
[CMS–6087–N]
Medicare Program; Suspension of
Required Prior Authorization for
Certain Durable Medical Equipment,
Prosthetics, Orthotics, and Supplies
(DMEPOS) Items Under Certain
Circumstances
Centers for Medicare &
Medicaid Services (CMS), Department
of Health and Human Services, (HHS).
ACTION: Suspension of prior
authorization requirements for specified
orthoses prescribed and furnished
urgently or under special circumstances.
AGENCY:
This document announces the
suspension of prior authorization for
specified orthoses items on the Required
Prior Authorization List that require
prior authorization as a condition of
payment under certain circumstances
when reported with certain modifiers.
Items subject to face-to-face encounter
and written order prior to delivery
requirements are not impacted by this
document.
SUMMARY:
The suspension of the prior
authorization requirement discussed in
this document took effect on April 13,
2022, when CMS published an
announcement on its website.
FOR FURTHER INFORMATION CONTACT:
Emily Calvert, (410) 786–4277.
SUPPLEMENTARY INFORMATION:
DATES:
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I. Background
In the December 30, 2015, final rule
(80 FR 81674) titled, ‘‘Medicare
Program; Prior Authorization Process for
Certain Durable Medical Equipment,
Prosthetics, Orthotics, and Supplies,’’
we implemented section 1834(a)(15) of
the Act by establishing an initial Master
List (called the Master List of Items
Frequently Subject to Unnecessary
Utilization) of certain DMEPOS that the
Secretary determined, on the basis of
prior payment experience, are
frequently subject to unnecessary
utilization and by establishing a prior
authorization process for these items.
In the November 8, 2019, Federal
Register (84 FR 60648), we published a
final rule titled, ‘‘Medicare Program;
End-Stage Renal Disease Prospective
Payment System, Payment for Renal
Dialysis Services Furnished to
Individuals with Acute Kidney Injury,
End-Stage Renal Disease Quality
VerDate Sep<11>2014
16:06 Aug 09, 2022
Jkt 256001
Incentive Program, Durable Medical
Equipment, Prosthetics, Orthotics and
Supplies (DMEPOS) Fee Schedule
Amounts, DMEPOS Competitive
Bidding Program (CBP) Amendments,
Standard Elements for a DMEPOS
Order, and Master List of DMEPOS
Items Potentially Subject to a Face-toFace Encounter and Written Order Prior
to Delivery and/or Prior Authorization
Requirements.’’ Through this November
2019 final rule, we harmonized the lists
of DMEPOS items created by former
rules and established one ‘‘Master List
of DMEPOS Items Potentially Subject to
Face-To-Face Encounter and Written
Orders Prior to Delivery and/or Prior
Authorization Requirements’’ (the
‘‘Master List’’). The November 2019
final rule was effective January 1, 2020.
In January 13, 2022, Federal Register
(87 FR 2051), we published a document,
titled, ‘‘Medicare Program; Updates to
Lists Related to Durable Medical
Equipment, Prosthetics, Orthotics, and
Supplies (DMEPOS) Conditions of
Payment.’’ Through the January 2022
Federal Register document, we updated
the Master List and selected certain
lower limb orthoses, lumbar sacral
orthoses, and power mobility devices to
be subject to required prior
authorization. The January 2022 Federal
Register document was effective April
13, 2022.
II. Provisions of the Document
In accordance with 42 CFR 414.234(f),
CMS may suspend DMEPOS prior
authorization requirement generally or
for a particular item or items at any time
and without undertaking rulemaking.
Due to the need for certain patients to
receive an orthoses item that may
otherwise be subject to prior
authorization when the 2-day expedited
review would delay care and risk the
health or life of the beneficiary, we are
suspending prior authorization
requirements indefinitely, under these
limited circumstances:
• Claims for HCPCS codes L0648,
L0650, L1832, L1833, and L1851 that
are billed using modifier ST, indicating
that the item was furnished urgently.
• Claims for HCPCS codes L0648,
L0650, L1833, and L1851 billed with
modifiers KV, J5, or J4, by suppliers
furnishing these items under a
competitive bidding program exception
(as described in 42 CFR 414.404(b)), to
convey that the DMEPOS item is needed
immediately either because it is being
furnished by a physician or treating
practitioner during an office visit where
the physician or treating practitioner
determines that the brace is needed
immediately due to medical necessity or
because it is being furnished by an
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48609
occupational therapist or physical
therapist who determines that the brace
needs to be furnished as part of a
therapy session(s).
Prior authorization will continue for
these orthoses items (HCPCS L0648,
L0650, L1832, L1833, and L1851) when
furnished under circumstances not
covered in this update, as well as all
other items on the Required Prior
Authorization List, available at https://
www.cms.gov/Research-Statistics-Dataand-Systems/Monitoring-Programs/
Medicare-FFS-Compliance-Programs/
DMEPOS/Downloads/DMEPOS_PA_
Required-Prior-Authorization-List.pdf.
The Administrator of the Centers for
Medicare & Medicaid Services (CMS),
Chiquita Brooks-LaSure, having
reviewed and approved this document,
authorizes Lynette Wilson, who is the
Federal Register Liaison, to
electronically sign this document for
purposes of publication in the Federal
Register.
Dated: August 5, 2022.
Lynette Wilson,
Federal Register Liaison, Centers for Medicare
& Medicaid Services.
[FR Doc. 2022–17187 Filed 8–9–22; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
42 CFR Part 414
[CMS–5537–N]
Medicare Program; Alternative
Payment Model (APM) Incentive
Payment Advisory for Clinicians—
Request for Current Billing Information
for Qualifying APM Participants
Centers for Medicare &
Medicaid Services (CMS), Health and
Human Services (HHS).
AGENCY:
ACTION:
Payment advisory.
This advisory is to alert
certain clinicians who are Qualifying
APM participants (QPs) and eligible to
receive an Alternative Payment Model
(APM) Incentive Payment that CMS
does not have the current billing
information needed to disburse the
payment. This advisory provides
information to these clinicians on how
to update their billing information to
receive this payment.
SUMMARY:
E:\FR\FM\10AUR1.SGM
10AUR1
48610
Federal Register / Vol. 87, No. 153 / Wednesday, August 10, 2022 / Rules and Regulations
Updated billing information
must be received no later than
November 1, 2022 (see SUPPLEMENTARY
INFORMATION for details).
FOR FURTHER INFORMATION CONTACT:
Tanya Dorm, (410) 786–2216.
SUPPLEMENTARY INFORMATION:
DATES:
I. Background
Under the Medicare Quality Payment
Program, an eligible clinician who
participates in an Advanced Alternative
Payment Model (APM) and meets the
applicable payment amount or patient
count thresholds for a performance year
is a Qualifying APM Participant (QP) for
that year. For payment years 2019
through 2024, an eligible clinician who
is a QP for a year based on their
performance in a QP Performance
Period earns a 5-percent lump sum APM
Incentive Payment that is paid in a
payment year that occurs 2 years after
the QP Performance Period. The amount
of the APM Incentive Payment is equal
to 5 percent of the estimated aggregate
paid amounts for covered professional
services furnished by the QP during the
calendar year immediately preceding
the payment year.
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II. Provisions of the Advisory
The Centers for Medicare & Medicaid
Services (CMS) has identified those
eligible clinicians who earned an APM
Incentive Payment in CY 2022 based on
their CY 2020 QP status.
When we disbursed the CY 2022 APM
Incentive Payments, we were unable to
verify current Medicare billing
information for some QPs and therefore
unable to issue the payment. In order to
properly disburse the APM Incentive
Payment, CMS is requesting assistance
in identifying current Medicare billing
information for these QPs in accordance
with 42 CFR 414.1450(c)(8).
We have compiled a list of QPs we
have identified as having unverified
billing information. These QPs, and any
others who anticipated receiving an
APM Incentive Payment but have not,
should follow the instructions to
provide CMS with updated billing
information at the following web
address: https://qpp-cm-prodcontent.s3.amazonaws.com/uploads/
1968/2022%20QP%20
Notice%20for%20APM%20
Incentive%20Payment%20
Zip%20File.zip.
If you have any questions concerning
submission of information through the
website, please contact the Quality
Payment Program Help Desk at 1–866–
288–8292.
All submissions must be received no
later than November 1, 2022. After that
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16:06 Aug 09, 2022
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time, any claims by a QP to an APM
Incentive Payment will be forfeited for
the CY 2022 payment year. To make
sure we have received all updated
billing forms, we will process remaining
CY 2022 APM Incentive Payments
during one payment cycle in the
beginning of 2023, based on updated
billing information for QPs received by
November 1, 2022. Payment processing
occurs one time after all forms have
been received.
The Administrator of the Centers for
Medicare & Medicaid Services (CMS),
Chiquita Brooks-LaSure, having
reviewed and approved this document,
authorizes Lynette Wilson, who is the
Federal Register Liaison, to
electronically sign this document for
purposes of publication in the Federal
Register.
Dated: August 5, 2022.
Lynette Wilson,
Federal Register Liaison, Centers for Medicare
& Medicaid Services.
[FR Doc. 2022–17186 Filed 8–9–22; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF COMMERCE
National Oceanic and Atmospheric
Administration
50 CFR Part 622
[Docket No. 100217095–2081–04; RTID
0648–XC199]
Reef Fish Fishery of the Gulf of
Mexico; 2022 Recreational
Accountability Measure and Closure
for Gulf of Mexico Red Grouper
National Marine Fisheries
Service (NMFS), National Oceanic and
Atmospheric Administration (NOAA),
Commerce.
ACTION: Temporary rule; closure.
AGENCY:
NMFS implements an
accountability measure (AM) for the red
grouper recreational sector in the
exclusive economic zone (EEZ) of the
Gulf of Mexico (Gulf) for the 2022
fishing year through this temporary rule.
NMFS has projected that the 2022
recreational annual catch target (ACT)
for Gulf red grouper will have been
reached by August 30, 2022. Therefore,
NMFS closes the recreational sector for
Gulf red grouper on August 30, 2022,
and it will remain closed through the
end of the fishing year on December 31,
2022. This closure is necessary to
protect the Gulf red grouper resource.
DATES: This temporary rule is effective
from 12:01 a.m., local time, on August
SUMMARY:
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30, 2022, until 12:01 a.m., local time, on
January 1, 2023.
FOR FURTHER INFORMATION CONTACT: Dan
Luers, NMFS Southeast Regional Office,
telephone: 727–551–5719, email:
daniel.luers@noaa.gov.
SUPPLEMENTARY INFORMATION: NMFS
manages the Gulf reef fish fishery,
which includes red grouper, under the
Fishery Management Plan for the Reef
Fish Resources of the Gulf of Mexico
(FMP). The FMP was prepared by the
Gulf of Mexico Fishery Management
Council and is implemented by NMFS
under the authority of the MagnusonStevens Fishery Conservation and
Management Act (Magnuson-Stevens
Act) through regulations at 50 CFR part
622. All red grouper weights discussed
in this temporary rule are in gutted
weight.
Following a recent red grouper stock
assessment, NMFS implemented
Amendment 53 to the Reef Fish FMP
(87 FR 25573, May 2, 2022), which
modified the allocation between the
commercial and recreational sectors,
and the sector catch limits. The new
assessment incorporated updated
historical recreational landings
estimates calibrated to the Marine
Recreational Information Program
(MRIP) Fishing Effort Survey (FES), the
current method for estimating
recreational effort. The previous
recreational catch limits were based on
an assessment that incorporated the
historical recreational landings
estimates generated using the prior
(MRIP) Coastal Household Telephone
Survey (CHTS), which produced
significantly lower estimates of
recreational effort. Under Amendment
53, the recreational annual catch limit
(ACL) is 1.73 million lb (0.78 million
kg) and the recreational ACT is 1.57
million lb (0.71 kg)(in MRIP FES units).
Subsequent to the Amendment 53 final
rule, NMFS implemented a final rule for
a framework action under the FMP (87
FR 40742, July 8, 2022) which further
revised the red grouper recreational
ACL to 2.02 million lb (0.92 million kg)
and the ACT to 1.84 million lb (0.83
million kg). This rule is effective August
8, 2022.
The Gulf red grouper recreational
ACL was exceeded in 2021 by
approximately 0.72 million lb (0.33
million kg) or 72 percent of the
recreational ACL. As specified in 50
CFR 622.41(e)(2)(ii), in the year
following a recreational ACL overage,
NMFS is required to maintain the red
grouper ACT in that following fishing
year at the level of the prior year’s ACT,
unless the best scientific information
available determines that maintaining
E:\FR\FM\10AUR1.SGM
10AUR1
]]>Agencies
[Federal Register Volume 87, Number 153 (Wednesday, August 10, 2022)]
[Rules and Regulations]
[Pages 48609-48610]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2022-17186]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Part 414
[CMS-5537-N]
Medicare Program; Alternative Payment Model (APM) Incentive
Payment Advisory for Clinicians--Request for Current Billing
Information for Qualifying APM Participants
AGENCY: Centers for Medicare & Medicaid Services (CMS), Health and
Human Services (HHS).
ACTION: Payment advisory.
-----------------------------------------------------------------------
SUMMARY: This advisory is to alert certain clinicians who are
Qualifying APM participants (QPs) and eligible to receive an
Alternative Payment Model (APM) Incentive Payment that CMS does not
have the current billing information needed to disburse the payment.
This advisory provides information to these clinicians on how to update
their billing information to receive this payment.
[[Page 48610]]
DATES: Updated billing information must be received no later than
November 1, 2022 (see SUPPLEMENTARY INFORMATION for details).
FOR FURTHER INFORMATION CONTACT: Tanya Dorm, (410) 786-2216.
SUPPLEMENTARY INFORMATION:
I. Background
Under the Medicare Quality Payment Program, an eligible clinician
who participates in an Advanced Alternative Payment Model (APM) and
meets the applicable payment amount or patient count thresholds for a
performance year is a Qualifying APM Participant (QP) for that year.
For payment years 2019 through 2024, an eligible clinician who is a QP
for a year based on their performance in a QP Performance Period earns
a 5-percent lump sum APM Incentive Payment that is paid in a payment
year that occurs 2 years after the QP Performance Period. The amount of
the APM Incentive Payment is equal to 5 percent of the estimated
aggregate paid amounts for covered professional services furnished by
the QP during the calendar year immediately preceding the payment year.
II. Provisions of the Advisory
The Centers for Medicare & Medicaid Services (CMS) has identified
those eligible clinicians who earned an APM Incentive Payment in CY
2022 based on their CY 2020 QP status.
When we disbursed the CY 2022 APM Incentive Payments, we were
unable to verify current Medicare billing information for some QPs and
therefore unable to issue the payment. In order to properly disburse
the APM Incentive Payment, CMS is requesting assistance in identifying
current Medicare billing information for these QPs in accordance with
42 CFR 414.1450(c)(8).
We have compiled a list of QPs we have identified as having
unverified billing information. These QPs, and any others who
anticipated receiving an APM Incentive Payment but have not, should
follow the instructions to provide CMS with updated billing information
at the following web address: https://qpp-cm-prod-content.s3.amazonaws.com/uploads/1968/2022%20QP%20Notice%20for%20APM%20Incentive%20Payment%20Zip%20File.zip.
If you have any questions concerning submission of information
through the website, please contact the Quality Payment Program Help
Desk at 1-866-288-8292.
All submissions must be received no later than November 1, 2022.
After that time, any claims by a QP to an APM Incentive Payment will be
forfeited for the CY 2022 payment year. To make sure we have received
all updated billing forms, we will process remaining CY 2022 APM
Incentive Payments during one payment cycle in the beginning of 2023,
based on updated billing information for QPs received by November 1,
2022. Payment processing occurs one time after all forms have been
received.
The Administrator of the Centers for Medicare & Medicaid Services
(CMS), Chiquita Brooks-LaSure, having reviewed and approved this
document, authorizes Lynette Wilson, who is the Federal Register
Liaison, to electronically sign this document for purposes of
publication in the Federal Register.
Dated: August 5, 2022.
Lynette Wilson,
Federal Register Liaison, Centers for Medicare & Medicaid Services.
[FR Doc. 2022-17186 Filed 8-9-22; 8:45 am]
BILLING CODE 4120-01-P
