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MLN Connects Provider eNews for July 24, 2014

Medicare Learning Network, MLN Connects Weekly eNews logo

Thursday, July 24, 2014


MLN Connects™ National Provider Calls




Claims, Pricers, and Codes


MLN Educational Products



MLN Connects™ National Provider Calls


National Partnership to Improve Dementia Care in Nursing Homes: Improved Care Transitions —Register Now

Tuesday, August 19; 1:30-3pm ET

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

During this MLN Connects™ National Provider Call, speakers will discuss the role of physician leadership in working with hospitalists to improve care transitions and the importance of open communication between physicians and nurse practitioners across care settings. CMS subject matter experts will provide National Partnership updates, share progress of the Focused Dementia Care Survey Pilot, and discuss next steps. A question and answer session will follow the presentation.

The CMS National Partnership to Improve Dementia Care in Nursing homes was developed to improve dementia care through the use of individualized, comprehensive care approaches. The partnership promotes a systematic process to evaluate each person and identify approaches that are most likely to benefit that individual. The goal of the partnership is to continue to reduce the use of unnecessary antipsychotic medications, as well as other potentially harmful medications in nursing homes and eventually other care settings as well.


  • Partnership updates
  • Successful care transitions: Role of physician leadership and importance of open communication across care settings
  • Next steps

Target Audience: Consumer and advocacy groups, nursing home providers, surveyor community, prescribers, professional associations, and other interested stakeholders.

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




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), including information on the QIN-QIO awarded contracts.


Group Practices Should Access PY 2012 Supplemental QRURs from CMS

Confidential Program Year (PY) 2012 Supplemental Quality and Resource Use Reports (QRURs) for group practices with 100 or more eligible professionals that received group 2012 QRURs are now available. CMS encourages providers to access these reports on the CMS Enterprise portal, using an Individuals Authorized Access to the CMS Computer Services (IACS) User ID and password.

These PY 2012 Supplemental QRURs provide medical group practices with summary level and detailed drill down information on payment-standardized, risk-adjusted clinical episodes of care that are attributed to the medical group, including information about Medicare providers who care for the patient during the episode both inside and outside the medical group. The 2012 Supplemental QRURs are for informational purposes only and complement the quality and per capita cost information provided in the 2012 QRURs. The information contained in the 2012 Supplemental QRURs does not affect Medicare payment and is not part of the value-based payment modifier under the Medicare Physician Fee Schedule.

CMS will host an MLN Connects™ National Provider Call on August 13 from 1:30-3:00pm to discuss the confidential PY 2012 Supplemental QRURs. Registration will be opening soon.


Physician Compare e-Newsletter

On July 21, CMS launched Physician Compare Update, an e-newsletter dedicated solely to communicating Physician Compare related news, updates, alerts, and announcements. View the first issue and subscribe

The 2015 Physician Fee Schedule Proposed Rule (CMS-1612-P) continues to build on the phased approach for public reporting on Physician Compare. Information on the proposed updates is available in the fact sheet. CMS will accept comments on the proposed rule until September 2.


Comment Period Has Begun for CY 2015 Physician Fee Schedule Proposed Rule

On July 3, CMS placed the 2015 Physician Fee Schedule proposed rule on display at the Federal Register.  It was made available for comment on July 11. This proposed rule includes provisions for Relative Value Units (RVUs) for CY 2015 and other Medicare Part B payment policies to ensure that payment systems are updated to reflect changes in medical practice and the relative value of services.

The proposed rule also includes new provisions and updates, including policies related to:

PQRS Provisions
The proposed requirements for PQRS focus primarily on the 2017 PQRS payment adjustment, which is based on quality measures reporting data from the reporting period January 1, 2015 to December 31, 2015.

Submit Comments Today
CMS is accepting comments on the proposed rule until 5pm ET on September 2, 2014. Instructions for submitting comments on this proposed rule are available on Regulations.gov.


Review Your 2014 PQRS Interim Claims Feedback Data

If you are an individual eligible professional who has reported at least one Physician Quality Reporting System (PQRS) quality measure this year via claims-based reporting, you can now view first quarter data (January 2014 through March 2014) regarding your submission(s) using the 2014 PQRS Interim Feedback Dashboard.  The Dashboard will let you monitor the status of your claims-based measures and measures group reporting and see if you are meeting the PQRS reporting requirements. You can log-in and review your 2014 PQRS data on a quarterly basis. You can access the Dashboard through the Physician and Other Health Care Professionals Quality Reporting Portal, with Individual Authorized Access to the CMS Computer System (IACS) sign-in.

Dashboard Resources

The following CMS resources can help you access your 2014 PQRS interim feedback data:

The Dashboard only provides claims-based data for 2014 interim feedback. The Dashboard does not provide:

  • Final data analysis for full-year reporting
  • Indication of incentive eligibility or subjectivity to payment adjustment/value modifier
  • Data from other CMS programs
  • Data submitted via methods other than claims

Data submitted via other 2014 reporting methods will be available for review in the fall of 2015 through the final PQRS feedback report or the QRUR for 2014 PQRS GPROs.

For More Information about PQRS

For more information about participating in PQRS, visit the PQRS website. For additional support or questions, contact the QualityNet Help Desk.


EHR Incentive Programs: Learn More about Clinical Decision Support Interventions

Clinical Decision Support (CDS) is a key functionality of health IT that contributes to improved quality of care and enhanced outcomes by avoiding errors and adverse events, improving efficiencies, reducing costs, and enhancing provider and patient satisfaction. In Stage 1 of meaningful use, eligible professionals and eligible hospitals must implement one CDS rule. In Stage 2, eligible professionals and eligible hospitals must implement five CDS interventions and enable and implement functionality for drug-drug and drug-allergy interaction.

New CMS Guidance for Clinical Decision Support Interventions
Although the trigger intervention certification criteria require EHR technology to produce an alert at relevant points during patient care, the meaningful use objectives give providers flexibility in the types of CDS interventions they employ, and do not limit them to “pop-up” alert interventions.

Providers can meet the objectives by using other kinds of CDS, including, but not limited to:

  • Clinical guidelines
  • Condition-specific order sets
  • Focused patient data reports and summaries
  • Documentation templates
  • Diagnostic support
  • Contextually relevant reference information

For more information on CDS, review the Clinical Decision Support tipsheet and the new FAQ.


Claims, Pricers, and Codes


Correction to SNF Consolidated Billing Code Lists

Certain Healthcare Common Procedure Coding System (HCPCS) codes were not included in the 2014 annual update to the Skilled Nursing Facility (SNF) consolidated billing code editing lists. A correction to the coding lists will be implemented in October, 2014. The affected HCPCS codes for practitioner billing are Q2050 and the professional component of G0461 and G0462. The affected code for institutional provider billing is Q2050. If you have claims that have been erroneously denied, you should contact your Medicare Administrative Contractor to have the claims re-opened and re-processed.  


MLN Educational Products


“Internet-based PECOS Contact Information” Fact Sheet — Revised

The “Internet-based PECOS Contact Information” Fact Sheet (ICN 903766) was revised and is now available in downloadable format. This fact sheet is designed to provide contact information for technical assistance with Internet-based Provider Enrollment, Chain and Ownership System (PECOS). It includes a list of contacts and other resources.


MLN Products Available in Electronic Format

The following fact sheets are now available as electronic publications (EPUBs) and through QR codes. 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.


New MLN Educational Web Guides Fast Fact

A new fast fact is now available on the MLN Educational Web Guides web page. This web page provides information on Evaluation and Management services; Guided Pathways that contain resources and topics of interest; lists of health care management products; and easy-to-understand billing and coding educational products.  It is designed to provide educational and informational resources related to certain Medicare Fee-For-Service initiatives. Please bookmark this page and check back often as a new fast fact is added each month.



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