Multi-specialty Alert: Mandatory Reporting for Medicaid and CHIP — Action by January 1, 2024
New mandatory reporting requirements for Medicaid and CHIP effective January 1, 2024, require immediate action from clinical coders.
Action required by
January 1, 2024
Review the Action Required section below and ensure your team has completed all compliance steps before this date.
The Federal Register Final Rule (Policy ID: FR-2023-18669) introduces mandatory annual reporting requirements for state Medicaid and Children's Health Insurance Program (CHIP) programs, effective January 1, 2024. This rule emphasizes a shift from volume-based reimbursement to a quality-based approach, requiring states to report on designated core sets of quality measures.
What Changed This rule mandates that clinical coders and billing professionals understand the implications of the new reporting mandate, which focuses on specific health care quality measures. While specific CPT, HCPCS, or ICD-10 codes affected by this rule are not detailed, coding teams must stay informed about the quality measures that will influence coding and documentation practices. Adherence to existing Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs) that align with these measures is also anticipated.
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Quick answers
What are the new reporting requirements for Medicaid and CHIP?
States must report on designated core sets of quality measures annually.
How will this affect coding practices?
Coding practices must shift to reflect quality measures rather than volume of services.
What is the compliance deadline for these changes?
The compliance deadline is January 1, 2024.
Content summarized from publicly available federal publications including CMS, MAC contractors, and the Federal Register. CLV Intelligence is not affiliated with or endorsed by any government agency. This is not legal or medical advice.