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MLN Connects Provider eNews for July 31, 2014

Medicare Learning Network, MLN Connects Weekly eNews logo

Thursday, July 31, 2014

MLN Connects™ National Provider Calls




Claims, Pricers, and Codes


MLN Educational Products



MLN Connects™ National Provider Calls

How to Interpret Your 2012 Supplemental Quality and Resource Use Report — Registration Now Open

Wednesday, August 13; 1:30-3pm ET

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

This MLN Connects™ National Provider Call will provide an overview of the Program Year (PY) 2012 Supplemental Quality and Resource Use Reports (QRURs). These confidential reports are now available for group practices with 100 or more eligible professionals that received group 2012 QRURs. The 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. More information on the 2012 Supplemental QRURs is available on the Episode Grouping for Medicare and Supplemental QRURs web page.

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 encourages groups to access their PY 2012 Supplemental QRURs prior to this MLN Connects Call, via the CMS Enterprise portal using an Individuals Authorized Access to the CMS Computer Services (IACS) User ID and password. A quick reference guide for obtaining an IACS account or modifying an existing account is available on the Self Nomination/Registration web page.


  • Introduction
  • Presentation on 2012 Supplemental QRURs
  • Question & Answer Session

Target Audience: Physicians, physician group practices, practice managers, medical and specialty societies.

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.


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.


New MLN Connects™ National Provider Call Audio Recordings and Transcripts

Audio recordings and transcripts are now available for the following calls:

  • July 10 - Dialysis Facility Compare: Rollout of Five Star Rating, audio and transcript
  • July 16 - ESRD Quality Incentive Program: Reviewing Your Facility's PY 2015 Performance Data, audio and transcript

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



Get Ready for DMEPOS Competitive Bidding – Get Licensed

On July 15, CMS announced plans to recompete the supplier contracts awarded in the Round 2 and the national mail-order competition of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. If you are a supplier intending to bid, prepare now – don’t wait. Get licensed. Contracts are only awarded to suppliers who meet all state licensure requirements by the close of the bid window.

Steps to take now:

  • Have a copy of the required state license(s) on file with the National Supplier Clearinghouse (NSC) and in the Provider Enrollment, Chain and Ownership System (PECOS) for the physical location(s) that will be on your bid to provide the items in the product category(s).
  • Make sure your CMS-855S enrollment application is up-to-date with the NSC and in PECOS and indicates the products you furnish in the states where you provide the items.

For reference purposes, please review the DMEPOS State License Directory on the NSC website. The directory provides general state licensing requirements and contact information for each state’s licensing board or agency. The directory is only a guide. Licensing requirements change periodically, and it remains the responsibility of the bidding supplier to identify and obtain all required licenses. For more information about licensure requirements, please consult the appropriate license issuing agency listed on the guides or call the NSC at 866-238-9652.

See the complete message on the Round 2 and National Mail-Order Recompete Latest News and Announcements web page. Subscribe to CBIC email updates for the latest information on the DMEPOS Competitive Bidding program.


Hospice Item Set Record Submission Begins

All Medicare-certified hospices are required to complete and submit a Hospice Item Set (HIS) Admission record and a HIS-Discharge record for patient admissions on or after July 1, 2014. HIS record completion and submission is ongoing according to these timeframes:

  • Hospices have 14 days from admission to complete HIS-Admission records and 7 days from discharge to complete HIS-Discharge records.
  • Hospices have 30 days from a patient admission or discharge to submit the appropriate HIS record for that patient.

At this time, hospices should be preparing to submit HIS records for patient admissions in early July, or may have already submitted completed HIS records to the QIES ASAP system.

Hospices should note that the following are the most common data submission errors encountered by hospices that have started submitting HIS records:

  • 902: Invalid XML (invalid file name extension)
  • 904: Invalid XML (invalid structure or tags too long)
  • 907: Duplicate Record
  • 3020a: Invalid FAC ID
  • 3022: Required Items Missing

Additional information about these types of errors can be found in Section 5 of the Hospice Submission User’s Guide.

The HIS website contains useful materials, including the HIS training manual and the Final HIS Data Specifications. In addition, hospices may want to review the Hospice Training Modules available at www.qtso.com.


Don’t Forget to Complete Open Payments System Registration

Physicians and teaching hospitals can now register in the Open Payments system to review and dispute data submitted by applicable manufacturers and applicable group purchasing organizations (GPOs) prior to public posting on September 30. Remember, registration in Open Payments is voluntary. However, it becomes a requirement if a physician or teaching hospital wants the opportunity to review and dispute data reported about them for the 2013 reporting period. Note: The Open Payments system is optimized for the Windows platform. Therefore, to minimize potential performance issues, CMS strongly encourages the use of Internet Explorer 8 or higher during the Open Payments system registration process.

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. Once registered in the CMS Enterprise Portal and in the Open Payments system, physicians can delegate an authorized representative who can review and dispute data on their behalf. Authorized officials of teaching hospitals also have the ability to nominate authorized representatives. All authorized representatives can accept or reject a nomination.

Phase 2 (began on July 14): 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.

Learn more about Open Payments system registration and the nomination process by visiting the Registration, Physician, and Teaching Hospital web pages.


Complete Review and Dispute Process for Open Payments by August 27

The 45-day initial review, dispute and correction process ends on August 27, 2014. At this time, physicians and teaching hospitals should review and initiate any disputes they may have regarding the data reported about them by applicable manufacturers and applicable Group Purchasing Organizations (GPOs). Note: The remaining 15-day period (August 28 through September 11), is additional time that has been allotted for industry to submit dispute corrections.

Two key activities will take place during the review, dispute, and correction period:

  • Before CMS releases any data publicly, physicians and teaching hospitals (who are registered in the CMS Enterprise Portal and the Open Payments system) may 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.

In order to review or dispute data submitted by industry for the 2013 reporting period, physicians must be registered—and have reviewed any data reported about them—on or before August 27, 2014. Remember, registration in the CMS 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. Learn more by visiting the Dispute and Resolution web page.


Open Payments: Review Available Education Resources

Use the Open Payments User Guide to get a comprehensive understanding of the Open Payments system and requirements—specifically, registration and the review and dispute functionality in the Open Payments system. It can be downloaded on the Program Fact Sheets and User Guides web page.

In addition, CMS developed multiple Quick Reference Guides. The Quick Reference Guides are one page documents that provide basic instructional guidance. Quick Reference Guide topics include:

  • For Physicians: How to Register in the Open Payments system
  • For a Physician’s Authorized Representative: How to accept or reject a nomination as an authorized representative for a physician
  • For Teaching Hospitals: How to Register in the Open Payments system
  • For a Teaching Hospital’s Authorized Representative: How to accept or reject a nomination as an authorized representative for a teaching hospital
  • For Physicians and Teaching Hospital Representatives: How to review a record and initiate a dispute, if applicable

The Quick Reference Guides can be downloaded on the PhysicianTeaching Hospital and Dispute and Resolution web pages.


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

Eligible professionals (EPs) who wish to participate in the 2014 Physician Quality Reporting System (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  with 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 will be open until September 30 for the 2014 PQRS program. Additional information about the 2014 GPRO registration and how to register is available on the Self Nomination/Registration web page.

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

Value Modifier

In CY 2016, the Value Modifier will apply to groups of physicians with 10 or more eligible professionals and will be based, in part, on their reporting and performance on quality measures in CY 2014. These groups have two ways to participate in the PQRS in CY 2014 in order to avoid the -2.0 percent Value Modifier payment adjustment in CY 2016: group reporting or individual reporting.

  • Groups that want to report under the PQRS as a group must register to participate in the PQRS GPRO by September 30, 2014 and report successfully to avoid the CY 2016 PQRS payment adjustment and to avoid the -2.0 percent Value Modifier payment adjustment.
  • Alternatively, groups that want their EPs to report individually under the PQRS must have at least 50 percent of their EPs report successfully to avoid the -2.0 percent Value Modifier payment adjustment.
  • Groups between 10 and 99 EPs that satisfactorily report PQRS, could qualify for an upward or neutral payment adjustment in 2016 under the Value Modifier based on their performance on quality and cost measures in 2014.
  • For groups of 100 or more EPs that satisfactorily report PQRS in 2014, the Value Modifier could provide an upward, neutral or downward payment adjustment based on their performance on quality and cost measures in 2016.

For more Information about the Value Modifier, please visit the Value Modifier web page.

Additional Resources

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 at Qnetsupport@sdps.org.


ICD-10 Resources Spotlight: Road to 10

Looking for help planning and executing your ICD-10 transition? CMS has developed the Road to 10, a free online resource built with the help of physicians in small practices. Available on the Provider Resources web page, this tool is intended to help small medical practices jumpstart their ICD-10 transition. The Road to 10 can help you:

  • Understand the basics of ICD-10
  • Build an ICD-10 action plan to map out your transition
  • Answer frequently asked questions
  • Learn how ICD-10 affects your practice with tailored clinical scenarios and documentation tips for Family Practice and Internal Medicine, Obstetrics and Gynecology, Orthopedics, Cardiology, and Pediatrics

The Road to 10 is regularly updated, so check back frequently for new information.

Keep Up to Date on ICD-10

Visit the CMS ICD-10 website for the latest news and resources to help you prepare. Sign up for CMS ICD-10 Industry Email Updates.


Review the Combined 2015 CMS QRDA Implementation Guide

The Combined 2015 QRDA Implementation Guide for eligible professionals, eligible hospitals, and critical access hospitals (CAHs) to use for reporting electronic clinical quality measures (eCQMs) starting in the 2015 reporting year is now available on the eCQM Library Page. The 2015 Combined Implementation Guide provides technical instructions for Quality Reporting Document Architecture (QRDA) Category I & Category III reporting for the following programs:

  • Hospital Quality Reporting including the Electronic Health Record (EHR) Incentive Programs and Inpatient Quality Reporting (IQR)
  • Ambulatory programs including the Physician Quality Reporting System (PQRS), the Comprehensive Primary Care (CPC) Initiative, and Pioneer Accountable Care Organization (ACO)

CMS accepted public feedback on the draft guide from June 10, 2014 to July 8, 2014, and has made revisions accordingly for inclusion in this release. The CMS 2015 QRDA Implementation Guide is updated for the 2015 reporting year, and combines business requirements and information from three previously published CMS QRDA guides:

  • The 2014 CMS QRDA Implementation Guide for Eligible Hospital Clinical Quality Measures  
  • The 2014 CMS QRDA I Implementation Guides for Eligible Professionals Clinical Quality Measures
  • The 2014 CMS QRDA III Implementation Guides for Eligible Professionals Clinical Quality Measures

The new guide contains two main parts, as well as appendices that annotate changes:

  • Part A is the harmonized QRDA-I implementation guide for both eligible professionals and eligible hospitals/CAHs.
  • Part B is the QRDA-III implementation guide for eligible professionals.

Additional Resources

To learn more about CQMs, visit the Clinical Quality Measures web page. For questions about reporting requirements using the 2015 QRDA Implementation Guide, please refer to the specific program’s help desk or information center.


Claims, Pricers, and Codes


Mass Adjustment of OPPS Claims

Due to a publication error of the National Unadjusted Copayment associated with Ambulatory Payment Classification (APC) 0066, Outpatient Prospective Payment System (OPPS) claims with a payment associated with APC 0066 were not processed correctly. The problem has been corrected in the July 2014 OPPS Addendums A and B, as well as in the release of the July 2014 OPPS Pricer, for claims with dates of service on or after July 1, 2014.

For claims with dates of service of January 1, 2014 through June 30, 2014, Medicare Administrative Contractors (MACs) will be mass adjusting any claims processed in error by September 1, 2014 to issue corrected payments for all impacted OPPS claims.

Providers shall reimburse beneficiaries for any overpayment of beneficiary copayment received that was created by the correction of the National Unadjusted Copayment associated with APC 0066.


July OPPS Provider Specific Files Now Available

The Outpatient Prospective Payment System (OPPS) provider data for July 2014 is now available in the “Downloads” section of the OPPS Pricer Code web page under “3rd Quarter 2014 Files.”  


MLN Educational Products


MLN Web-Based Training Courses With Continuing Education Credits

The “Diagnosis Coding: Using the ICD-9-CM” Web-Based Training Course (WBT) was revised and is now available. This web-based training course is designed to provide education on the use of ICD-9-CM. It includes information on how to select accurate diagnosis codes from the ICD-9-CM volumes and how to use diagnosis codes correctly on Medicare claim forms. Continuing education credits are available to learners who successfully complete this course. See course description for more information.

The “Infection Control: Hand Hygiene” Web-Based Training Course (WBT) was released and is now available. This WBT is designed to provide an overview of the proper hand hygiene procedures for physicians and other health care professionals working with patients. It includes information on appropriate hand hygiene measures for outpatient and office settings, patient care areas, and surgical settings. Continuing education credits are available to learners who successfully complete this course. See course description for more information.

To access the WBTs, go to MLN Products and click on “Web-Based Training Courses” under “Related Links” at the bottom of the web page.


New Continuing Education Association Now Accepting MLN Web-Based Training Courses

The latest continuing education association to accept MLN web-based training (WBT) courses is the Practice Management Institute (PMI). PMI joins the AAPC, American Association of Medical Assistants (AAMA), the American Association of Medical Audit Specialists (AAMAS), the American Medical Billing Association (AMBA), the California Certifying Board for Medical Assistants (CCBMA), the Healthcare Billing & Management Association (HBMA), the Medical Association of Billers (MAB), the National Academy of Ambulance Coding (NAAC), and the National Center for Competency Testing (NCCT).

For more information about continuing education associations that accept MLN WBT courses, visit the Association Approvals for WBT Credits web page. If the association you belong to accepts outside credit sources and is not on the list, you should contact them to see if they are interested in working with the MLN. If they are interested, the association should email CMSCE@cms.hhs.gov.


MLN Products Available In Electronic Publication 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.”


New MLN Provider Compliance Fast Fact

A new fast fact is now available on the MLN Provider Compliance web page. This web page provides the latest MLN Educational Products and MLN Matters® Articles designed to help Medicare health care professionals understand common billing errors and avoid improper payments. Please bookmark this page and check back often as a new fast fact is added each month.



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