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Date
2014-07-10
Subject
MLN Connects Provider eNews for July 10, 2014

Medicare Learning Network, MLN Connects Weekly eNews logo

Thursday, July 10, 2014

 

MLN Connects™ National Provider Calls

 

Announcements

 

Claims, Pricers, and Codes

 

MLN Educational Products

 

 

MLN Connects™ National Provider Calls

 

ESRD Quality Incentive Program: Reviewing Your Facility's PY 2015 Performance Data — Last Chance to Register

Wednesday, July 16; 2-3pm ET

To Register: Visit MLN Connects™ Upcoming Calls. Space may be limited, register early.

During this MLN Connects™ National Provider Call, CMS experts will give a presentation on the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP). The ESRD QIP is a pay-for-performance initiative that ties a facility's quality scores to a payment percentage reduction over the course of a payment year (PY). On July 15, 2014, each dialysis facility will have access to a preliminary PY 2015 Performance Score Report (PSR) that “previews” how well it scored on the quality measures that CMS will use for determining any payment reductions.

This MLN Connects Call will focus on the steps dialysis facilities need to take to review the data CMS will use to evaluate performance as part of the PY 2015 program. After the presentation, participants will have an opportunity to ask questions of subject matter experts.

Agenda:

  • How to access and review a dialysis facility PSR
  • How CMS calculates facility ESRD QIP performance score using quality data
  • What a performance score means to a facility PY 2015 payment rates
  • When and where to ask questions regarding PSR, including how to submit one formal inquiry
  • Duty and responsibility to make ESRD QIP performance data transparent to patients
  • Where to access help and additional information

Target Audience: Dialysis clinics and organizations, nephrologists, hospitals with dialysis units, billers/coders, and quality improvement experts.

Continuing education credit may be awarded for participation in certain MLN Connects Calls. Visit the Continuing Education Credit Information web page to learn more.

 

Open Payments (the Sunshine Act): Registration, Review, and Dispute — Registration Now Open

Tuesday, July 22; 2:30-4pm ET

To Register: Visit MLN Connects™ Upcoming Calls. Space may be limited, register early.

As a physician or teaching hospital, are you aware of Open Payments (the Sunshine Act)? Now that you have completed Phase 1 of registration in the CMS Enterprise Portal, are you ready for Phase 2? Do you know that Phase 2 allows you to register in the Open Payments system, and then review and (if needed) dispute any of the data reported about you by the industry prior to public posting of the data?

During the time specified by CMS in Phase 2, physicians and teaching hospitals can voluntarily register with CMS to review information about payments or other transfers of value given to them by industry prior to public posting of the data. Physicians and teaching hospitals that choose to participate will initially need to register in the CMS Enterprise Portal (Phase 1 registration) in order to register in the Open Payments system to access and review the information submitted about them by industry and potentially dispute information with industry that they believe to be inaccurate or incomplete.

During this MLN Connects™ National Provider Call, CMS experts will give a brief introductory presentation about Open Payments and provide a step-by-step review of the registration and review and dispute process. This overview will be followed by answers to questions submitted prior to the call and an opportunity for participants to interact with our subject matter experts during a live question and answer session.

Agenda:

  • Brief Open Payments overview
  • Recap registration process in the CMS Enterprise Portal
  • Provide step-by-step instructions on how to register in the Open Payments system and participate in the review and dispute process
  • Answers to submitted questions
  • Live Q&A session

Target Audience: Physicians, teaching hospitals, professional organizations, physician staff and other interested parties. Additional information is available on the July 22 call web page.

Continuing education credit may be awarded for participation in certain MLN Connects Calls. Visit the Continuing Education Credit Information web page to learn more.

 

ESRD Quality Incentive Program: Notice of Proposed Rulemaking for PY 2017 and 2018 — Register Now

Wednesday, July 23; 2-3:30pm ET

To Register: Visit MLN Connects™ Upcoming Calls. Space may be limited, register early.

During this MLN Connects™ National Provider Call, CMS experts will give a presentation on the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP). The ESRD QIP is a pay-for-performance quality initiative that ties a facility's performance to a payment reduction over the course of a payment year (PY). This MLN Connects Call will focus on the ESRD Prospective Payment System (PPS) proposed rule with 30 day comment period, which includes rules for operationalizing the ESRD QIP in PY 2017 and PY 2018. A question and answer session will follow the presentation giving participants an opportunity to ask questions of subject matter experts.

Agenda:

  • ESRD QIP legislative framework;
  • Proposed measures, standards, scoring methodology, and payment reduction scale for PY 2017 and PY 2018
  • Methods for reviewing and commenting on the proposed rule
  • Question and answer session

Target Audience: Dialysis clinics and organizations, nephrologists, hospitals with dialysis units, billers/coders, and quality improvement experts.

Continuing education credit may be awarded for participation in certain MLN Connects Calls. Visit the Continuing Education Credit Information web page to learn more.

 

2015 Medicare PFS Proposals for PQRS, Value Modifier, EHR Incentive Program, and the Physician Compare Website— Register Now

Thursday, July 24; 1:30-3pm ET

To Register: Visit MLN Connects™ Upcoming Calls. Space may be limited, register early.

This MLN Connects™ National Provider Call provides an overview of the 2015 Physician Fee Schedule (PFS) proposed rule. This presentation will cover potential program updates to the Physician Quality Reporting System (PQRS). The topics covered include changes to reporting mechanisms, individual measures, measures groups for inclusion in 2015, criteria for satisfactorily reporting for an incentive, criteria for avoiding future payment adjustments, requirements for Medicare incentive program alignment, and satisfactory participation under the qualified clinical data registry option.

The presentation also provides an overview of the proposals for the value-based payment modifier, including how CMS proposes to continue to phase in and expand application of the value-based payment modifier in 2017 based on performance in 2015. The presentation also describes how the value-based payment modifier is aligned with the reporting requirements under the PQRS. This presentation further provides updates to Physician Compare and the Electronic Health Record (EHR) Incentive Program.

Agenda:

  • Proposed changes to PQRS individual reporting requirements and PQRS Group Practice Reporting Option (GPRO)
  • Proposed updates to Physician Compare and the EHR Incentive Program
  • Review of the proposed value-based payment modifier policies under the 2015 proposed rule
  • Plan for the future of the PQRS GPRO
  • Where to call for help

Target Audience:  Physicians, practitioners, therapists, medical group practices, practice managers, medical and specialty societies, payers, insurers.

This MLN Connects Call is being evaluated by CMS for CME and CEU continuing education credit (CE). Refer to the call detail page for more information.

 

New MLN Connects™ National Provider Call Video Slideshow, Transcript, and Audio Recording

A video slideshow, audio recording, and transcript are now available for the following calls:

  • May 19 — Individualized Quality Control Plan for CLIA Laboratory Non-Waived Testing, video slideshow
  • June 25 — New Medicare PPS for Federally Qualified Health Centers: Operational Requirements, audio and transcript

Call materials for MLN Connects™ Calls are located on the Calls and Events web page.

 

Announcements

 

Proposed Policy and Payment Changes to the Medicare Physician Fee Schedule for CY 2015

On July 3, CMS issued a proposed rule that would update payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2015. Medicare primarily pays physicians and other practitioners for care management services as part of face-to-face visits. Last year, CMS finalized a separate payment, outside of a face-to-face visit, for managing the care of Medicare patients with two or more chronic conditions beginning in 2015. Through this year’s rule, CMS is proposing details relating to the implementation of the new policy, including payment rates. In addition, CMS is proposing a new process for establishing PFS payment rates that will be more transparent and allow for greater public input prior to payment rates being set. Under the new process, payment changes will go through notice and comment rulemaking before being adopted beginning for 2016. CMS is also proposing to define screening colonoscopy to include anesthesia so that beneficiaries do not have to pay coinsurance on the anesthesia portion of a screening colonoscopy when furnished by an anesthesiologist.

The proposed rule also proposes changes to several of the quality reporting initiatives that are associated with PFS payments – the Physician Quality Reporting System (PQRS), Medicare Shared Savings Program, and Medicare Electronic Health Record (EHR) Incentive Program, as well as changes to the Physician Compare tool on the Medicare.gov website. Finally, the rule continues the phased-in implementation of the physician value-based payment modifier (Value Modifier), created by the Affordable Care Act, that would affect payments to physicians and physician groups, as well as other eligible professionals, based on the quality and cost of care they furnish to beneficiaries enrolled in the traditional Medicare Fee-For-Service program.

Sustainable Growth Rate (SGR)

The proposed rule does not include proposals or announcements on the PFS update or SGR as these calculations are determined under a prescribed statutory formula that cannot be changed by CMS. The final figures are announced in the final rule in November. The Protecting Access to Medicare Act (PAMA) of 2014 provides for a zero percent PFS update for services furnished between January 1, 2015 and March 31, 2015. In March (prior to the enactment of the PAMA), CMS estimated that the PFS update for CY 2015 would be -20.9 percent. In most prior years, Congress has taken action to avert a large reduction in PFS rates before it went into effect. The Administration supports legislation to permanently change SGR to provide more stability for Medicare beneficiaries and providers while promoting efficient, high quality care.

Provisions in the CY 2015 PFS proposed rule include:

  • Primary care and complex chronic care management 
  • Misvalued codes
  • Global surgery
  • Enhanced transparency in ratesetting
  • Telehealth services
  • Adjustments to malpractice Relative Value Units (RVUs)
  • Revisions to Geographic Practice Cost Indices (GPCIs)
  • Application of beneficiary cost sharing to anesthesia related to screening colonoscopies
  • Off-campus provider-based departments
  • Open Payments

CMS will accept comments on the proposed rule until September 2, 2014. For more information:

  • Proposed Rule
  • Fact Sheet: Proposed Policy and Payment Changes to the Medicare PFS for CY 2015
  • Fact Sheet: Changes for CY 2015 Physician Quality Programs and Other Programs in the Medicare PFS
  • Fact Sheet: Proposed Changes for the Physician Value-based Payment Modifier in the CY 2015 Medicare PFS Proposed Rule
  • Open Payments website

 

CMS Proposes Hospital Outpatient and ASCs Policy and Payment Changes for CY 2015

CMS issued the CY 2015 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Policy Changes and Payment Rates proposed rule [CMS-1613-P] on July 3. The proposed rule would update Medicare payment policies and rates for hospital outpatient department and ASC services, and update and streamline programs that encourage high-quality care in these outpatient settings. This proposal would continue the progress made so far in moving the OPPS from what currently resembles a hybrid of a prospective payment system and a fee schedule, to a more complete prospective payment system. CMS is proposing a policy finalized in the CY 2014 OPPS/ASC final rule with comment period regarding comprehensive Ambulatory Payment Classifications (APCs), for which implementation was delayed until CY 2015. CMS is proposing refinements and updates to this policy to make a single payment for all related or adjunctive hospital services provided to a patient in the furnishing of certain primary procedures, such as insertion of a pacemaker.

CMS proposes to update the OPPS market basket by 2.1 percent for CY 2015. The increase is based on the projected hospital market basket increase of 2.7 percent minus both a 0.4 percentage point adjustment for multi-factor productivity and a 0.2 percentage point adjustment required by law. 

The proposed rule also includes:

  • Comprehensive-APCs.
  • Proposed items and services to be “packaged” or included in payment for a primary service
  • Off-campus provider-based departments
  • Hospital outpatient outlier payment
  • Community Mental Health Center (CMHC) outlier payment
  • Part B drugs in the outpatient department
  • ASC payment update
  • Partial Hospitalization Program (PHP) rates
  • Proposed overpayment recovery and appeals process for Medicare Part C and Medicare Part D
  • Revision of the requirements for physician certification of hospital inpatient services
  • Hospital Outpatient Quality Reporting (OQR) Program
  • ASC Quality Reporting Program

CMS will accept comments on the proposed rule until September 2, 2014 and will respond to comments in a final rule to be issued on or around November 1, 2014. For more information:

  • Proposed Rule
  • Fact Sheet: CMS Proposes Hospital Outpatient and ASCs Policy and Payment Changes for 2015
  • Fact Sheet: CMS Proposes Hospital Outpatient and ASCs Quality Changes for 2015

 

Medicare Proposes Updates for the ESRD PPS, Quality Incentive Program, and DMEPOS

On July 2, CMS issued a proposed rule that would update Medicare policies and payment rates for End-Stage Renal Disease (ESRD) facilities, while strengthening incentives for improved quality of care and better outcomes for beneficiaries diagnosed with ESRD. The provisions would affect payments for outpatient maintenance dialysis treatments furnished on or after January 1, 2015 under the bundled ESRD Prospective Payment System (PPS).

Several provisions of the Protecting Access to Medicare Act of 2014 (PAMA) apply to the ESRD PPS. The most significant provisions that CMS proposes are the elimination of the drug utilization adjustment transition, a 0.0 percent update to the ESRD PPS base rate, and a delay in the inclusion of oral-only drugs used for the treatment of ESRD into the bundled payment until January 1, 2024. CMS would apply a proposed wage index budget-neutrality adjustment factor of 1.001306 which results in a CY 2015 ESRD PPS base rate of $239.33.

The rule also makes changes to the ESRD Quality Incentive Program (QIP) that provides payment incentives to dialysis facilities to improve the quality of dialysis care. Under the ESRD QIP, facilities are evaluated on a number of quality measures, which form the basis for calculating a Total Performance Score. Facilities that do not achieve a minimum Total Performance Score receive a reduction in their payment rates under the ESRD PPS of up to 2 percent. The rule proposes to expand the criteria used to evaluate quality of dialysis care by introducing one new quality measure for Payment Year (PY) 2017 and five new quality measures for PY 2018, and includes a number of programmatic proposals, including a new methodology for calculating facilities’ Total Performance Scores.

CMS is also proposing changes regarding Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) for CY 2015:

  • Proposing the methodology for adjusting DMEPOS fee schedule payment amounts using information from the Medicare DMEPOS Competitive Bidding Program (CBP)
  • Making alternative payment rules for DME and enteral nutrition under the Medicare DMEPOS CBP
  • Clarifying the statutory Medicare hearing aid coverage exclusion and specifying devices not subject to the hearing aid exclusion
  • Updating the definition of minimal self-adjustment regarding what specialized training is needed by suppliers to provide custom fitting services if they are not certified orthotists
  • Clarifying the Change of Ownership (CHOW) and providing for an exception to the current requirements
  • Revising the appeal provisions for termination of a contract and notification to beneficiaries under the Medicare DMEPOS CBP, and
  • Adding a technical change related to submitting bids for infusion drugs under the Medicare DMEPOS CBP

CMS will accept comments on the proposed rule until September 2, 2014. For more information:

 

Open Payments System Registration Begins Mid-July

In mid-July, physicians and teaching hospitals can begin registration in the Open Payments system. Although registration is voluntary for these groups, it is required if the physician or teaching hospital wants to access the data so that they can review and dispute what has been reported about them by applicable manufacturers and applicable group purchasing organizations (GPOs). Remember, registration for physicians and teaching hospitals is conducted in two phases for this first Open Payments reporting year:

  • Phase 1 (available at any time): Includes user registration in the CMS Enterprise Portal. Use the Phase 1 Step-by-Step CMS Enterprise Portal Registration for Physicians and Teaching Hospitals presentation for guidance on how to complete this portion of the registration; this resource is also posted on the Physicians and Teaching Hospitals pages of the Open Payments website.
  • Phase 2 (begins in mid-July): Allows physicians and teaching hospitals to register in the Open Payments system, delegate roles and responsibilities by nominating system users to fill specific user roles, and review and dispute data submitted by applicable manufacturers and applicable GPOs prior to public posting of the data. Note: Any data that is disputed, if not corrected by industry, will still be made public but will be marked as disputed. Learn more about the review and dispute process.

Registration in the Enterprise Portal is a separate process from registration in the Open Payments system. But, Enterprise Portal registration is a required first step to allow for registration in the Open Payments system when it becomes available in mid-July.

How to Prepare for Phase 2

  • Have your CMS Enterprise Portal user ID and password readily available (reminder, this was created in Phase 1);
  • Think about nominating individuals to interact with the Open Payments system on your behalf (such as, a physician or teaching hospital authorized representative/official);
  • Gather any records of payments, transfers of value, ownership or investments that you may have received between August 1, 2013 and December 31, 2013;
  • Ask your local industry representative if any organization they represent has reported to CMS any data on payments, transfers of value you have received, ownership or investment interests you have held; if so, ask for a copy;
  • Organize your industry contact information as you will be working directly with them to resolve any disputes or answer any questions you may have in regards to the data they’ve reported.

For more information:

  • Register for the July 22 MLN Connects™ National Provider Call
  • Visit the Open Payments website
  • Contact the Help Desk at openpayments@cms.hhs.gov. Live Help Desk support is available by calling 855-326-8366, Monday through Friday, from 7:30am to 6:30pm CT, excluding Federal holidays.

 

Open Payments Review and Dispute Process Begins in Mid-July

The data submission and attestation process is over for reporting entities. Next, the Open Payments review and dispute process will begin in mid-July. This marks the beginning of the initial 45-day period for physicians and teaching hospitals to review and initiate any disputes they may have with the data reported about them by applicable manufacturers and applicable group purchasing organizations (GPOs). Following the initial 45-day period, there will be an additional 15-day period for further dispute correction.

Two key activities will take place during the review, dispute, and correction period starting in mid-July:

  • Before CMS releases any data publicly, physicians and teaching hospitals (who are registered in the CMS Enterprise Portal and the Open Payments system) will review and, if necessary, initiate disputes relating to data submitted about them; and,
  • Applicable manufacturers and applicable GPOs will analyze these disputes and work with physicians and teaching hospitals to come to agreement on any necessary corrections.

If a physician or teaching hospital wants to participate in the review and dispute process for 2013 Open Payments data, CMS advises that registration in Enterprise Identity Management system (EIDM) and Open Payments is completed by the end of the initial 45-day review and dispute period.

For more information:

  • Register for the July 22 MLN Connects™ National Provider Call
  • Visit the Open Payments website
  • Contact the Help Desk at openpayments@cms.hhs.gov. Live Help Desk support is available by calling 855-326-8366, Monday through Friday, from 7:30am to 6:30pm CT, excluding Federal holidays.

 

Hospice Item Set Help and Available Resources

Hospice Item Set (HIS) data collection began July 1, 2014. All Medicare-certified hospices are required to submit a HIS-Admission record and HIS-Discharge record for each patient admission to their hospice. Hospices are not responsible for submitting any HIS records for patients that were admitted prior to July 1, 2014 but discharged after July 1, 2014. If a hospice attempts to submit a HIS-Discharge record for patients admitted prior to July 1, 2014, the record will be rejected by the Quality Improvement and Evaluation System (QIES) Assessment Submission and Processing (ASAP) system.

As providers begin HIS data collection and HIS record completion and submission, they should make sure they are aware of all resources available on the HQRP website. Specifically, providers should review content on the:

  • HIS web page for information on data collection for the HIS, including V1.01 of the HIS Manual and the video recordings of the HIS data collection trainings. For questions about materials on this web page, contact the Quality HelpDesk at HospiceQualityQuestions@cms.hhs.gov.
  • HIS Technical Information web page for information on processes for completing HIS records (including information on the Hospice Abstraction Reporting Tool (HART) software) and information on processes for submitting HIS records to the QIES ASAP system (providers will need to register for 2 different User IDs to submit data to the QIES ASAP system). For questions about materials on this web page, contact the Technical HelpDesk at 877-201-4721 or by email at help@qtso.com.

 

Delay in Implementing NCD for Single Chamber and Dual Chamber Cardiac Pacemakers

On August 13, 2013, CMS issued a final decision memorandum regarding coverage of implanted permanent cardiac pacemakers, single chamber or dual chamber, and determined they are reasonable and necessary for the treatment of non-reversible symptomatic bradycardia due to sinus node dysfunction and second and/or third degree atrioventricular block. On February 6, 2014, CMS directed Medicare Administrative Contractors to implement national coverage determination (NCD) 20.8.3 on July 7, 2014, for claims with dates of service on and after August 13, 2013, for those beneficiaries who meet the specific coverage criteria. See MLN Matters® Article MM8525.

There is a temporary delay in implementing NCD 20.8.3.CMS will advise you of the new implementation date in the near future.

 

Groups: Remember to Register for 2014 PQRS GPRO Participation by September 30

Eligible professionals (EPs) who wish to participate in the 2014 PQRS program as a group practice can now register for the group practice reporting option (GPRO). When your group is ready to register, you can access the Physician Value-PQRS (PV-PQRS) Registration System at https://portal.cms.gov. You will need to use a valid Individuals Authorized Access to the CMS Computer Services (IACS) User ID and password to choose your group’s reporting mechanism. The registration system is open until September 30 for the 2014 PQRS program. Additional information about the 2014 GPRO registration is available on the CMS website.

Participating as a Group Practice
Group practices participating in the GPRO that satisfactorily report data on PQRS measures during the 2014 reporting period (January 1 through December 31) are eligible to earn the 0.5% incentive payment and will avoid the -2% 2016 PQRS payment adjustment. To earn an incentive for the 2014 PQRS program year and avoid the 2016 PQRS payment adjustment, group practices with 2 or more eligible professionals may register to participate in GPRO via:

  • Qualified PQRS registry
  • Directly from Electronic Health Record (EHR) using certified EHR technology (CEHRT)
  • CEHRT via data submission vendor

If your group has 25 or more eligible professionals, you can also participate in GPRO via:

  • Web interface (reporting Consumer Assessment of Healthcare Providers and Systems (CAHPS) for PQRS also required for groups of 100+)
  • CAHPS for PQRS via CMS-certified survey vendor (supplement to other PQRS reporting mechanisms)

Value Modifier
Groups of physicians with 10 or more EPs that want to participate in the PQRS as a group must register for a PQRS group reporting mechanism in the PV-PQRS Registration System. Please note that in order to avoid the -2% Value Modifier payment adjustment in 2016, the group must meet the criteria to avoid the 2016 PQRS negative payment adjustment.

Additional Resources
For additional information on how to register in the PV- PQRS Registration system, please visit the Self Nomination/Registration web page. For more information about how to participate in the 2014 PQRS program through the GPRO, review the 2014 PQRS GPRO Requirements document. For questions about how to register, contact the Quality Net Help Desk at 866-288-8912 (TTY: 877-715-6222), or by email: Qnetsupport@hcqis.org.

 

EHR Incentive Programs: Interactive Tool to Help Providers Understand 2014 CEHRT NPRM

In May 2014, CMS released a notice of proposed rulemaking (NPRM) that would grant flexibility to providers who are experiencing difficulties fully implementing 2014 Edition certified Electronic Health Record (EHR) technology (CEHRT) to attest this year. CMS has created an interactive decision tool that guides providers through their potential participation options for 2014. Providers answer a few questions about their current stage of meaningful use and Edition of EHR certification, and the tool displays the corresponding options proposed in the NPRM.

Under this proposal, valid only for the 2014 reporting year, providers would be able to use 2011 Edition CEHRT for either Stage 1 or Stage 2, would have the option to attest to the 2013 definition of meaningful use core and menu objectives, and use the 2013 definition CQMs. The proposed rule also includes a provision that would formalize CMS and the Office of the National Coordinator for Health Information Technology’s (ONC’s) recommended timeline to extend Stage 2 through 2016. If finalized, the earliest a provider would participate in Stage 3 of meaningful use would be 2017.

CMS and ONC invite the public to submit comments on the NPRM. Comments must be received by July 21, 2014 to be considered. Visit the CMS Newsroom to read the press release about the NPRM.

 

EHR Incentive Programs: Changes in the Vital Signs Core Objective in 2014

Did you know that the vital signs objective is different in 2014? This year there was an increase in patient age limit for recording blood pressure to age 3 and a removal of age limit requirement for height and weight for the Stage 1 objective. These changes mirror the requirements for the objective in Stage 2.

Meeting Vital Signs Requirements
To meet the vital signs requirements, you will need to record more than 50 percent for Stage 1 (80 percent for Stage 2) of all unique patients’ blood pressures (for patients age 3 and over only) and height and weight (for all ages) as structured data using one numerator and denominator. You need to record height and weight, and blood pressure of your patient, as applicable. The certified Electronic Health Record (EHR) technology will calculate Body Mass Index (BMI) and the growth chart based on age. You are also not required to update height, weight, and blood pressure for every visit by the patient. You can make the decision based on the patient’s individual circumstances.

New Exclusions in 2014 for Eligible Professionals
In both Stage 1 and Stage 2, you can be excluded from reporting this objective if you don’t meet certain requirements.

What are the Requirements and When are the Exclusions Applicable to You?

  1. If you see no patients 3 years or older, you are excluded from recording blood pressure;
  2. If you believe that all three vital signs of height, weight, and blood pressure have no relevance to your scope of practice, you are excluded from recording them;
  3. If you believe that height and weight are relevant to your scope of practice, but blood pressure is not, you are excluded from recording blood pressure; or
  4. You believe that blood pressure is relevant to your scope of practice, but height and weight are not, you are excluded from recording height and weight.

If you meet exclusion (3) or exclusion (4), you must both attest to the exclusion and report the numerator and denominator for the remaining elements of the measure.

More Information
For more information on the Record and Chart Vital Signs measure, review the specification sheets for Stage 1 and Stage 2. For information about other meaningful use measures, visit the Meaningful Use web page.

 

Claims, Pricers, and Codes

 

Barcoded Coversheets Required for CERT Documentation Submissions

For Comprehensive Error Rate Testing (CERT) documentation submissions to the CERT Documentation Contractor, a barcoded coversheet labels the documentation for the correct beneficiary and date(s) of service. Lack of a correct coversheet may result in denials if the CERT Documentation Contractor cannot identify the record.

  • Providers must include the barcoded coversheet in front of documentation, regardless of the media used
  • It should be placed in front of each record when submitting multiple records
  • It should be used when responding to a request for additional documentation
  • Providers should not use a barcoded coversheet from a previous request

 

New Schedule for CERT Documentation Requests as of May, 2014

Providers should respond to Comprehensive Error Rate Testing (CERT) documentation requests as soon as possible.  However, CERT will review documentation submitted after the deadline and providers might still benefit if CERT receives support for a claim. The schedule for CERT documentation requests is as follows:

  • Day 0: First contact via fax or email - provider has 45 days to respond
  • Day 30: Second contact via fax or mail - reminder letter - provider has 15 days left to complete the request
  • Day 45: Third contact via fax or mail - grants a 15 day extension
  • Day 60: Fourth contact via mail - grants a second 15 day extension prior to claim denial/payment recovery
  • Day 76: CERT denies claims without documentation

 

CERT Datasets Posted

The Comprehensive Error Rate Testing (CERT) program has posted three datasets to the data.cms.gov website. These datasets contain information on Medicare Fee-for-Service (FFS) claims reviewed by CERT for the 2011, 2012, and 2013 Medicare FFS Improper Payment Report periods. The data for each reviewed Claim IDentification number (CID) includes: claim type, claim line item number, span number, HCPCS procedure code, type of bill, DRG, diagnosis code, provider type, type of service, service from and through dates, error code, and review decision. 

 

Looking for CERT Information?

The CMS website provides information about the Comprehensive Error Rate Testing (CERT) program and links to CERT reports. The CERT Provider website provides links to helpful documents such as the Disaster Attestation Letter and an example of a Signature Attestation Letter.

 

Quarterly Provider Specific Files for the Prospective Payment System Now Available

The July, 2014 Provider Specific Files (PSF) are now available for download from the CMS website in SAS or Text format.  The files contain information about the facts specific to the provider that affect computations for the Prospective Payment System. The SAS data files are available on the Provider Specific Data for Public Use In SAS Format web page, and the Text data files are available on the Provider Specific Data for Public Use in Text Format web page. The Text data files are available in two versions. One version contains the provider records that were submitted to CMS. The other version also includes name and address information for providers at the end of the records.  

 

MLN Educational Products

 

“Medicare Signature Requirements - Educational Resources for Health Care Professionals” MLN Matters® Article — Released

MLN Matters® Special Edition Article #SE1419, “Medicare Signature Requirements - Educational Resources for Health Care Professionals” has been released and is now available in downloadable format. This article is designed to provide education on the availability of resources related to signature requirements for Medicare-covered services. It includes a variety of educational products along with a brief description, and additional information.

 

“ICD-9-CM, ICD-10-CM, ICD-10-PCS, CPT, and HCPCS Code Sets” Educational Tool — Released

The “ICD-9-CM, ICD-10-CM, ICD-10-PCS, CPT, and HCPCS Code Sets” Educational Tool (ICN 900943) was released and is now available in downloadable format. This educational tool is designed to provide education on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM); International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM); International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS); Current Procedural Terminology (CPT); and Healthcare Common Procedure Coding System (HCPCS) code sets. It includes a definition and payment information for each code set.

 

"The Medicare Overpayment Collection Process" Fact Sheet — Revised

The “Medicare Overpayment Collection Process” Fact Sheet (ICN 006379) was revised and is now available in downloadable format. This fact sheet is designed to provide education on the collection of Medicare provider and supplier overpayments. It includes the definition of an overpayment, an overview of the overpayment collection process, timeframes for the debt collection process for provider overpayments, and additional resources.

 

“Medicare Physician Fee Schedule” Fact Sheet — Revised

The “Medicare Physician Fee Schedule” Fact Sheet (ICN 006814) was revised and is now available in downloadable format. This fact sheet is designed to provide education on the Medicare Physician Fee Schedule (PFS). It includes the following information: physician services, Medicare PFS payment rates, and Medicare PFS payment rates formula.

 

“Medicare Ambulance Transports” Booklet — Revised

The “Medicare Ambulance Transports” Booklet (ICN 903194) was revised and is now available in downloadable format. This booklet is designed to provide education on Medicare ambulance transports. It includes the following information: the ambulance transport benefit; ambulance transports; ground and air ambulance providers and suppliers, vehicles, and personnel requirements; covered destinations; ambulance transport coverage requirements; Advance Beneficiary Notice of Noncoverage; and payments for ambulance transports.

 

MLN Product Available in Electronic Publication Format

The following educational tool is now available as an electronic publication (EPUB) and through a QR code. Instructions for downloading EPUBs and how to scan a QR code are available at “How to Download a Medicare Learning Network® (MLN) Electronic Publication” on the CMS website.

The “Medicare Quarterly Provider Compliance Newsletter [Volume 4, Issue 4]” Educational Tool (ICN 909012) is designed to provide education on how to avoid common billing errors and other erroneous activities when dealing with the Medicare Program. It includes guidance to help health care professionals address and avoid the top issues of the particular quarter.

 

 

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