All Fee-For-Service Providers
- October 2014 Average Sales Price Files Now Available
CMS has posted the October 2014 Average Sales Price (ASP) and Not Otherwise Classified (NOC) pricing files and crosswalks. All are available for download on the 2014 ASP Drug Pricing Files web page.
- Upcoming CMS MLN Connects™ National Provider Calls
For a description of a call, or to register, visit MLN Connects Upcoming Calls. Space may be limited, register early.
- Thursday, October 9; 1:30-3:00 PM ET: Hospital Appeals Settlement Update
- Wednesday, November 5; 1:30-3:00 PM ET: Transitioning to ICD-10
- Encore of QIO Program Provider Update Call - Tuesday July 29, 2PM ET
Thank you for your interest in the July 23rd Quality Improvement (QIO) Program Provider Update Call. Regrettably, our system was not adequately equipped for the overwhelming response to the call and we experienced a number of technical challenges delaying the event. As such, we are hosting a live encore presentation of the webinar, on Tuesday, July 29th at 2pm ET. This call will include a question & answer session, and will be recorded and made available for sharing and playback after the live event.Participants must register in advance of the event. To register, please click here: http://event.on24.com/r.htm?e=829998&s=1&k=20B515CE7A37FC56D06A688C81EE6B85
CMS Launches Next Phase of New Quality Improvement Program
On July 18, CMS awarded additional contracts as part of a restructuring of the Quality Improvement Organization (QIO) Program to create a new approach to improve care for beneficiaries, families and caregivers. QIOs are private, mostly not-for-profit organizations staffed by doctors and other health care professionals trained to review medical care and help beneficiaries with complaints about the quality of care and to implement improvements in the quality of care available throughout the spectrum of care. The new contracts being awarded to fourteen organizations represent the second phase of QIO restructuring. The awardees will work with providers and communities across the country on data-driven quality initiatives. These QIOs will be known as Quality Innovation Network (QIN)-QIOs.
QIN-QIO projects will be based in communities, health care facilities and clinical practices. They will drive quality by providing technical assistance, convening learning and action networks for sharing best practices, collecting and analyzing data for improvement. HHS National Quality Strategy (NQS) and the CMS Quality Strategy provide the framework for the contracts along with the companion, recommendations, and priorities.
Specifically, each QIN-QIO will work on strategic initiatives such as reducing healthcare associated infections, reducing readmissions and medication errors, working with nursing homes to improve care for residents, supporting clinical practices in using interoperable health information technology to enable the exchange of essential health information to improve the coordination of care, promoting prevention activities, reducing cardiac disease and diabetes, reducing health care disparities and improving patient and family engagement. QIN-QIOs will also provide technical assistance for improvement in CMS value based purchasing programs, including the physician value based modifier program.
As a result of the changes, some hospitals and providers will now work with a different QIO than in the past. The new QIN-QIO contracts were competitively awarded. The restructured program will continue to ensure that the entire country participates in strategic initiatives and that local practices are considered. The first phase of the restructuring – which CMS announced on May 9, 2014 –allows two Beneficiary and Family-Centered Care (BFCC) QIO contractors to perform the program’s case review and monitoring activities separate from the quality improvement activities performed by QIN-QIOs. CMS will introduce the program changes with the beginning of its five year, 11th Statement of Work – the QIO contracts cycle – on August 1, 2014.
Full text of this excerpted CMS press release (issued July 18) and information on the QIN-QIO awarded contracts.
- On and After April 1, 2014, Medicare Will Accept Only the Revised CMS 1500 Claim Form (02/12)
Medicare began accepting claims submitted on the revised CMS 1500 claim form (02/12) on January 6, 2014. Medicare will continue to accept claims submitted on the old CMS 1500 claim form (08/05) through March 31, 2014.However, on April 1, 2014, Medicare will accept professional and supplier paper claims on only the revised CMS 1500 claim form (02/12). On and after April 1, 2014, Medicare will not accept claims on the old CMS 1500 claim form (08/05). More information is available in the March 20 eNews.
- Hospital Inpatient Admission Order and Certification; 2 Midnight Benchmark for Inpatient Hospital Admissions: CMS-1599-F Final Rule
Feedback and questions on the two midnight provision for admission and medical review can be sent to IPPSAdmissions@cms.hhs.gov.
- 2013 Claim Denials Due to Beneficiary Incarceration Status
Follow us on Twitter! CMS has added the social media site Twitter to our communication and outreach program. Our main goal is to reach providers, suppliers, health professionals, and others interested in current and up-to-date information on the Medicare Fee-For-Service program. Messages on Twitter will include updates to rules & regulations, MLN products, notices of upcoming National Provider Calls, new web postings, and more.
Follow us at http://twitter.com/cmsgov and search the following hash tags:
- #CMSMLN for all MLN tweets,
- #CMSNPC for all National Provider Call tweets, or
- #MLNProducts for all tweets related to MLN products.
MLN Connects Provider eNews Spotlight
- Subscribe now to receive the weekly MLN Connects Provider eNews for the latest Fee-For-Service program information, event announcements (including National Provider Call announcements), claims and pricer information, and MLN educational product updates.
Medicare Fee-for-Service (FFS) Payment
- Fee Schedules - General Information
- Prospective Payment Systems - General Information
- Acute Inpatient PPS
- Ambulance Fee Schedule
- Ambulatory Surgical Center (ASC) Payment
- Clinical Laboratory Fee Schedule
- DMEPOS Competitive Bidding - Home
- Durable Medical Equipment, Prosthetics/Orthotics & Supplies Fee Schedule
- Home Health PPS
- Hospital-Acquired Conditions (Present on Admission Indicator)
- Hospital Outpatient PPS
- Inpatient Psychiatric Facility PPS
- Inpatient Rehabilitation Facility PPS
- Long-Term Care Hospital PPS
- PC Pricer
- Physician Fee Schedule
- Physician Fee Schedule Overview - Opens in a new window
- Physician Bonuses
- Skilled Nursing Facility PPS
Medicare Fee-for-Service Part B Drugs
- Competitive Acquisition for Part B Drugs & Biologicals
- Historical Part B Drug Pricing Files
- Medicare Part B Drug Average Sales Price
- Medicare Coverage - General Information
- Council for Technology & Innovation
- Clarification about Part B versus Part D Drug Coverage [PDF, 85KB]
- DMEPOS Competitive Bidding - Home
- End Stage Renal Disease (ESRD) Center
- ICD-9-CM and ICD-10
- Medicare Provider-Supplier Enrollment
- National Provider Identifier Standard (NPI)
- National Correct Coding Initiative Edits
- Quarterly Provider Updates
- SNF Consolidated Billing
- Supplier Directory - Opens in a new window
- Sustainable Growth Rates & Conversion Factors
- Versions 5010 and D.0 & 3.0
- Review Contractor Directory - Interactive Map
- Quality Improvement Organizations
- CMS Regional Offices