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We note that we address this in the CMS Claims Processing Manual, Chapter 12, section 30.6.9 F, stating that Physicians may bill initial hospital care service codes (99221-99223), for services that were reported with CPT consultation codes (99241-99255) prior to January 1, 2010, when the furnished service and documentation meet the minimum key component work and/or medical necessity requirements
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Additionally, aggregate amounts of demanded overpayment determinations, such as extrapolated overpayment demands, may be used to identify the amount of improper payments for a large set of claims for a particular provider or supplier and a certain time period, since error rates are extrapolated and applied to a universe of claims rather than individual claims
Beginning with the 2024 performance year, ACOs in the Shared Savings Program have the option to report the Medicare CQM under the APP on only beneficiaries eligible for Medicare CQMs as defined at 425.20, ( instead of their all payer/all patient population (88 FR 79329)
Flat or declining funding for medical research can set a precedent for lower funding in coming years because the FY 2026 budget will be built on the FY 2025 final budget as a baseline
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