The Centers for Medicare & Medicaid Services (CMS) recently released the 2024-25 calendar for Medicare Advantage and Part D prescription drug plans. This calendar provides important information for healthcare providers, including deadlines for submitting claims, changes to payment rates, and upcoming quality reporting requirements. In this article, we will provide a comprehensive overview of the CMS 2024-25 calendar, highlighting key dates and changes that healthcare providers need to be aware of.

The CMS 2024-25 calendar is a valuable resource for healthcare providers, as it provides important information and deadlines that can impact their practice and patient care. By staying informed about these changes, healthcare providers can ensure they are compliant with CMS regulations and continue to provide high-quality care to their patients.

Now that we have covered the introduction, let’s delve into the specifics of the CMS 2024-25 calendar and explore the key dates, changes, and requirements that healthcare providers need to be aware of.

CMS 2024-25 Calendar

The CMS 2024-25 calendar contains important information for healthcare providers regarding Medicare Advantage and Part D prescription drug plans.

• Key Deadlines: Claim submission deadlines, payment rate changes.
• Quality Reporting: Upcoming requirements for quality reporting.
• Payment Updates: Changes to Medicare Advantage and Part D payment rates.
• New Codes: Introduction of new codes for services and procedures.
• Policy Changes: Updates to coverage and payment policies.
• Plan Options: Changes to available Medicare Advantage and Part D plans.
• Enrollment Periods: Important dates for enrollment and disenrollment.
• Appeals Process: Deadlines and procedures for filing appeals.
• Fraud and Abuse: Updates on fraud and abuse prevention measures.
• Resources and Support: Information on available resources and support for healthcare providers.

Healthcare providers should familiarize themselves with the CMS 2024-25 calendar to ensure compliance and provide the best possible care to their patients.

Key Deadlines: Claim submission deadlines, payment rate changes.

The CMS 2024-25 calendar includes important deadlines for healthcare providers to submit claims and stay informed about payment rate changes.

Claim Submission Deadlines:

• General Deadline: Claims for Medicare Advantage and Part D prescription drug plans must be submitted within 12 months from the date of service.
• Exceptions: There are some exceptions to the general deadline, such as claims for durable medical equipment (DME) and home health services, which have a 13-month submission deadline.
• Electronic Claims: Providers are encouraged to submit claims electronically, as electronic claims have a longer submission deadline of 15 months from the date of service.

Payment Rate Changes:

• Annual Updates: CMS updates payment rates for Medicare Advantage and Part D plans each year, typically effective January 1st.
• Rate Notifications: Providers will receive notification of payment rate changes through the CMS website and other official communications.
• Impact on Reimbursement: Payment rate changes can affect the amount of reimbursement providers receive for their services, so it’s important to stay informed about these changes.

Healthcare providers should carefully review the CMS 2024-25 calendar to ensure they are aware of all claim submission deadlines and payment rate changes. By staying informed and submitting claims promptly, providers can avoid delays in reimbursement and ensure they are receiving accurate payments for their services.

Quality Reporting: Upcoming requirements for quality reporting.

The CMS 2024-25 calendar includes upcoming requirements for quality reporting by healthcare providers.

Quality Reporting Programs:

• Medicare Quality Payment Program (QPP): The QPP is a CMS program that rewards eligible clinicians and group practices for providing high-quality care to Medicare patients. Participation in QPP is mandatory for certain providers, and it involves submitting data on quality measures and improvement activities.
• Value-Based Purchasing (VBP) Program: The VBP program is a CMS initiative that links a portion of Medicare payments to the quality of care provided by hospitals and other healthcare providers. Providers are evaluated based on their performance on specific quality measures, and those who perform well may receive higher payments.

Upcoming Changes:

• New Quality Measures: CMS regularly updates the quality measures used in the QPP and VBP programs. Providers should stay informed about these changes to ensure they are reporting on the most up-to-date measures.
• Increased Focus on Patient Experience: CMS is placing greater emphasis on patient experience as a quality measure. Providers will need to collect and report data on patient satisfaction, communication, and access to care.
• Alignment with MIPS: The QPP and VBP programs are being aligned with the Merit-based Incentive Payment System (MIPS), a CMS program that assesses and rewards clinicians and groups based on their performance on a variety of quality measures.

Healthcare providers should review the CMS 2024-25 calendar and stay informed about upcoming changes to quality reporting requirements. By participating in quality reporting programs and meeting quality standards, providers can improve patient care and potentially earn higher payments from CMS.

Payment Updates: Changes to Medicare Advantage and Part D payment rates.

The CMS 2024-25 calendar includes changes to payment rates for Medicare Advantage and Part D prescription drug plans.

Medicare Advantage Payment Rates:

• Annual Updates: CMS updates Medicare Advantage payment rates each year, typically effective January 1st.
• Rate-Setting Methodology: CMS uses a complex formula to set Medicare Advantage payment rates, considering factors such as the cost of providing care, the health status of enrollees, and the efficiency of plan operations.
• Impact on Plans: Changes in Medicare Advantage payment rates can affect the premiums, benefits, and provider networks offered by Medicare Advantage plans.

Part D Prescription Drug Payment Rates:

• Annual Updates: CMS also updates Part D prescription drug payment rates each year, typically effective January 1st.
• Rate-Setting Methodology: CMS uses a variety of factors to set Part D payment rates, including the average wholesale price of drugs, the cost of pharmacy services, and the negotiating power of Part D plans.
• Impact on Beneficiaries: Changes in Part D payment rates can affect the cost of prescription drugs for beneficiaries, as well as the availability of certain drugs on Part D formularies.

Healthcare providers and Medicare beneficiaries should stay informed about changes to Medicare Advantage and Part D payment rates to understand how these changes may impact their care and costs.

New Codes: Introduction of new codes for services and procedures.

The CMS 2024-25 calendar includes the introduction of new codes for services and procedures, which healthcare providers should be aware of to ensure accurate billing and reimbursement.

• Coding Updates: CMS regularly updates the Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes used to report services and procedures. These updates may include new codes for emerging technologies, treatments, and services.
• Impact on Billing: Using the correct codes is essential for accurate billing and reimbursement. Providers who use outdated or incorrect codes may experience delays in payment or denied claims.
• Staying Informed: Healthcare providers should stay informed about new codes and coding changes by reviewing CMS updates and guidelines, as well as participating in continuing education programs.
• Resources for Providers: CMS provides various resources to help healthcare providers stay up-to-date on coding changes, including online resources, webinars, and training materials.

By using the correct codes and staying informed about coding updates, healthcare providers can ensure accurate billing and reimbursement for their services, as well as provide the necessary information for quality reporting and patient care.

Policy Changes: Updates to coverage and payment policies.

The CMS 2024-25 calendar includes updates to coverage and payment policies that healthcare providers and beneficiaries should be aware of.

Coverage Changes:

• New Benefits: CMS may add new benefits or services to Medicare Advantage and Part D plans, expanding the range of covered care and prescription drugs.
• Changes to Existing Benefits: CMS may also revise or update existing benefits, such as changing the frequency or scope of coverage.
• Prior Authorization Requirements: CMS may implement or modify prior authorization requirements for certain services or medications, requiring providers to obtain approval before providing care or filling prescriptions.

Payment Policy Changes:

• Payment Rates: CMS may adjust payment rates for specific services or procedures, impacting the reimbursement providers receive for their care.
• Bundled Payments: CMS may introduce or expand bundled payment programs, where multiple services related to a single episode of care are reimbursed under a single payment.
• Quality-Based Payments: CMS may update the quality-based payment programs, such as the Merit-based Incentive Payment System (MIPS) and the Value-Based Purchasing (VBP) Program, to encourage providers to deliver high-quality care.

Healthcare providers and beneficiaries should stay informed about policy changes to understand how they may affect their practice, reimbursement, and access to care.

Plan Options: Changes to available Medicare Advantage and Part D plans.

The CMS 2024-25 calendar may include changes to the available Medicare Advantage and Part D plans, providing beneficiaries with new options and choices for their healthcare coverage.

• New Plans: CMS may approve new Medicare Advantage and Part D plans for the upcoming year, offering beneficiaries more options to choose from.
• Plan Changes: Existing Medicare Advantage and Part D plans may make changes to their benefits, premiums, cost-sharing, and provider networks. Beneficiaries should review their plan options carefully to ensure they are still meeting their needs and preferences.
• Discontinued Plans: Some Medicare Advantage and Part D plans may be discontinued or no longer offered in certain areas. Beneficiaries enrolled in discontinued plans will need to choose a new plan during the Open Enrollment Period.
• Special Needs Plans: CMS may introduce or expand Special Needs Plans (SNPs), which are Medicare Advantage plans designed for individuals with specific chronic conditions or disabilities.

Beneficiaries should stay informed about changes to Medicare Advantage and Part D plans by reviewing plan materials, attending informational events, and speaking with licensed insurance agents or brokers. By understanding their plan options, beneficiaries can make informed decisions about their healthcare coverage and choose the plan that best meets their needs and budget.

Enrollment Periods: Important dates for enrollment and disenrollment.

The CMS 2024-25 calendar includes important dates for enrollment and disenrollment in Medicare Advantage and Part D plans.

Initial Enrollment Period (IEP):

• Eligibility: Individuals who are first eligible for Medicare, typically at age 65, have a seven-month IEP to enroll in Medicare Advantage and Part D plans.
• Start Date: The IEP begins three months before the month an individual turns 65 and ends three months after the month they turn 65.
• Importance: Enrolling during the IEP ensures uninterrupted Medicare coverage and avoids potential penalties for late enrollment.

Annual Enrollment Period (AEP):

• Open Enrollment: The AEP is an annual period when all Medicare beneficiaries can review their coverage options and make changes to their Medicare Advantage and Part D plans.
• Dates: The AEP typically runs from October 15th to December 7th each year.
• Changes: During the AEP, beneficiaries can switch from Original Medicare to a Medicare Advantage plan, change their Medicare Advantage plan, or enroll in or change their Part D prescription drug plan.

Special Enrollment Periods (SEPs):

• Qualifying Events: SEPs allow individuals to enroll in or make changes to their Medicare plans outside the regular enrollment periods due to specific life events, such as moving, losing employer-sponsored coverage, or becoming eligible for Medicaid.
• Examples: Common SEPs include losing employer-sponsored coverage, moving to a new area, or becoming eligible for Medicare due to a disability.
• Deadlines: SEPs have specific deadlines and requirements, so it’s important to act promptly if you experience a qualifying event.

Understanding enrollment periods and deadlines is crucial for Medicare beneficiaries to ensure they have the coverage they need and avoid gaps in coverage or penalties.

Appeals Process: Deadlines and procedures for filing appeals.

The CMS 2024-25 calendar includes information on deadlines and procedures for filing appeals related to Medicare Advantage and Part D plans.

• Right to Appeal: Medicare beneficiaries have the right to appeal certain decisions made by Medicare Advantage and Part D plans, such as denied claims, coverage determinations, and disenrollment.
• Levels of Appeal: The appeals process typically involves multiple levels, starting with an internal review by the health plan and progressing to an independent review entity and, potentially, a judicial review.
• Timelines: Each level of appeal has specific deadlines for filing, so it’s important to act promptly if you wish to appeal a decision.
• Documentation: When filing an appeal, beneficiaries should provide relevant documentation and evidence to support their case, such as medical records, correspondence with the health plan, and any other pertinent information.

Understanding the appeals process and adhering to the deadlines can help Medicare beneficiaries protect their rights and access to necessary healthcare services. More detailed information about the appeals process, including specific deadlines and procedures, can be found on the CMS website and through resources provided by Medicare plans.

Fraud and Abuse: Updates on fraud and abuse prevention measures.

The CMS 2024-25 calendar highlights updates on fraud and abuse prevention measures to ensure the integrity of Medicare Advantage and Part D plans.

Increased Scrutiny:

• Enhanced Audits and Reviews: CMS will continue to加强审核和审查程序 to identify and investigate potential fraud and abuse cases.
• Data Analytics: CMS will utilize data analytics and artificial intelligence to detect suspicious billing patterns and identify providers or entities engaging in fraudulent activities.

New Initiatives:

• Provider Education and Training: CMS will provide education and training to healthcare providers and suppliers to enhance their understanding of fraud and abuse prevention measures.
• Collaboration with Law Enforcement: CMS will continue to work closely with law enforcement agencies to investigate and prosecute cases of Medicare fraud and abuse.

Beneficiary Protections:

• Empowering Beneficiaries: CMS will provide resources and information to Medicare beneficiaries to help them identify and report suspected fraud or abuse.
• Reporting Mechanisms: Beneficiaries can report suspected fraud or abuse through various channels, including online portals, phone hotlines, and mail.

By implementing these measures, CMS aims to protect Medicare beneficiaries and taxpayers from fraud and abuse, ensuring the long-term sustainability and integrity of the Medicare program.

Resources and Support: Information on available resources and support for healthcare providers.

The CMS 2024-25 calendar includes information on resources and support available to healthcare providers to assist them in their work and ensure they are up-to-date with the latest requirements and guidelines.

Educational Resources:

• Online Learning: CMS provides a wide range of online courses and tutorials on Medicare policies, coding, and quality reporting.
• Web-Based Training: Providers can access web-based training modules on various topics, including fraud and abuse prevention and care management.

Technical Support:

• Help Desks: CMS offers help desks and technical support lines to assist providers with billing and coding questions.
• Online Portals: Providers can access online portals to submit claims, check claim status, and receive updates.

Provider Engagement:

• Advisory Committees: CMS engages healthcare providers through various councils and workgroups to gather feedback and input on policy development.
• Provider Associations: CMS collaborates with provider associations and organizations to facilitate communication and address provider concerns.

By providing these resources and support, CMS aims to help healthcare providers navigate the complex Medicare landscape, enhance their understanding of program requirements, and improve the quality of care for Medicare beneficiaries.

FAQ

2024 Medicare Calendar: Frequently Asked Questions

Here are answers to some commonly asked questions about the 2024 Medicare calendar:

Question 1: When is the Medicare Annual Enrollment Period (AEP) in 2024?
Answer 1: The AEP in 2024 will run from October 15th to December 7th.

Question 2: What changes can I make to my Medicare coverage during the AEP?
Answer 2: During the AEP, you can make changes such as switching from Original Medicare to a Medicare Advantage plan, changing your Medicare Advantage plan, or enrolling in or changing your Part D prescription drug plan.

Question 3: When is the deadline to submit Medicare claims for services received in 2023?
Answer 3: The deadline to submit claims for services received in 2023 is typically 12 months from the date of service, except for certain services that have a 13-month submission deadline.

Question 4: What are some of the quality reporting requirements for Medicare providers in 2024?
Answer 4: In 2024, Medicare providers may be required to report on measures related to patient experience, care coordination, and the use of electronic health records, among others.

Question 5: How can I stay informed about Medicare policy changes and updates?
Answer 5: You can stay informed by regularly checking the CMS website, signing up for CMS email updates, or following CMS on social media.

Question 6: Where can I find resources and support as a healthcare provider serving Medicare beneficiaries?
Answer 6: CMS offers a variety of resources and support for healthcare providers, including online learning, technical support, and provider engagement opportunities.

This FAQ section provides answers to some common questions about the 2024 Medicare calendar. For more information, please visit the CMS website or consult with a qualified healthcare professional.

Now that you have a better understanding of the 2024 Medicare calendar, here are some tips to help you prepare for the upcoming year:

Tips

Make the Most of Your Medicare Coverage in 2024

Here are four practical tips to help you make the most of your Medicare coverage in 2024:

Tip 1: Review Your Coverage Options During the Annual Enrollment Period (AEP).
The AEP is your opportunity to review your current Medicare coverage and make changes if necessary. You can compare plans, switch to a different plan, or enroll in a Part D prescription drug plan.

Tip 2: Understand Your Medicare Costs and Billing.
Familiarize yourself with your Medicare costs, including premiums, deductibles, and copayments. Keep track of your medical expenses and submit claims promptly to ensure you receive timely reimbursement.

Tip 3: Stay Informed About Medicare Changes.
Medicare policies and guidelines are subject to change. Stay informed by regularly checking the CMS website, signing up for CMS email updates, or following CMS on social media.

Tip 4: Take Advantage of Medicare Resources and Support.
CMS offers a variety of resources and support for Medicare beneficiaries, including online tools, educational materials, and help desks. Don’t hesitate to reach out for assistance if you have questions or need help navigating your Medicare coverage.

By following these tips, you can ensure that you are getting the most out of your Medicare coverage in 2024.

By following these tips and staying informed about Medicare changes, you can ensure that you are receiving the best possible care and coverage in 2024 and beyond.

Conclusion

The CMS 2024-25 calendar is an essential resource for healthcare providers and Medicare beneficiaries to stay informed about important deadlines, policy changes, and quality reporting requirements. By understanding the key dates and updates outlined in this article, providers can ensure they are compliant with Medicare regulations and continue to provide high-quality care to their patients.

Medicare beneficiaries should also take advantage of the resources and support available to them to make informed decisions about their coverage and ensure they are receiving the best possible care. By reviewing their coverage options during the Annual Enrollment Period, understanding their costs and billing, staying informed about Medicare changes, and taking advantage of available resources, beneficiaries can make the most of their Medicare coverage in 2024.

As we move into 2024, it is important for both healthcare providers and beneficiaries to work together to ensure the delivery of high-quality healthcare services. By staying informed, asking questions, and advocating for their needs, Medicare beneficiaries can play an active role in their own healthcare and ensure they are receiving the best possible care.