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Date
2014-08-07
Subject
MLN Connects Provider eNews for August 7, 2014

Medicare Learning Network, MLN Connects Weekly eNews logo

Thursday, August 7, 2014

 

MLN Connects™ National Provider Calls

 

CMS Events

 

Announcements

 

Claims, Pricers, and Codes

 

MLN Educational Products

 

 

MLN Connects™ National Provider Calls

 

How to Interpret Your 2012 Supplemental Quality and Resource Use Report — Last Chance to Register

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.

Agenda:

  • 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.

Agenda:

  • 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.

 

Continuing Education for Participation in MLN Connects™ National Provider Calls

Many professional organizations, associations, and licensing and certifying bodies award continuing education credit for participation in MLN Connects™ National Provider Calls, including:

  • American Academy of Professional Coders (AAPC)
  • American Association of Healthcare Administrative Management (AAHAM)
  • American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc. (ABC)
  • American College of Medical Practice Executives (ACMPE)
  • American Health Information Management Association (AHIMA)
  • American Medical Billing Association (AMBA)
  • Association of Professional Medical Billers & Administrators (APMBA)
  • Board of Certification/Accreditation (BOC)
  • The Commission on Dietetic Registration, the Credentialing Agency for the Academy of Nutrition and Dietetics, Commission on Paraoptometric Certification (CPC)
  • Medical Association of Billers (MAB)
  • Medical Management Institute (MMI)
  • Association of Registered Health Care Professionals (ARHCP)
  • National Center for Competency Testing (NCCT)
  • National Council of Certified Dementia Practitioners (NCCDP)
  • Professional Association of Health Care Office Management (PAHCOM)

For more information about continuing education credit for participation in MLN Connects Calls, please visit the MLN Connects National Provider Call Program Continuing Education Credit Information web page. If your organization is not on the list, contact them to see if they will award credit for participation in MLN Connects Calls. If they would like to have their information included on our web page, an officer or official representative should email us at MLNConnectsCalls@cms.hhs.gov.

 

New MLN Connects™ National Provider Call Audio Recordings and Transcripts

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

  • July 22 — Open Payments (the Sunshine Act): Registration, Review, and Dispute, audio and transcript
  • July 23 —ESRD Quality Incentive Program: Notice of Proposed Rulemaking for PY 2017 and 2018, audio and transcript
  • July 24 —2015 Medicare PFS Proposals for PQRS, Value Modifier, EHR Incentive Program, and the Physician Compare Website, audio and transcript

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

 

CMS Events

 

Special Open Door Forum: Medicare's Expanded Prior Authorization for Power Mobility Devices Demonstration

Tuesday, August 12; 2-3:30pm ET

CMS will host a Special Open Door Forum to allow Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers, physicians, treating practitioners and other interested parties to ask questions related to the Medicare Expanded Prior Authorization Demonstration for Power Mobility Devices (PMDs) Demonstration. See the announcement for more information and participation instructions.

 

Announcements

 

FY 2015 Payment and Policy Changes for Medicare Skilled Nursing Facilities

On July 31, CMS issued a final rule outlining FY 2015 Medicare payment rates for skilled nursing facilities (SNFs) under the Prospective Payment System (PPS). Based on changes contained within this final rule, CMS estimates that aggregate payments to SNFs will increase by $750 million, or 2.0 percent, from payments in FY 2014, which represents a higher update factor than the 1.3 percent update finalized for SNFs last year. This estimated increase is attributable to a 2.5 percent market basket increase, reduced by the 0.5 percentage point multifactor productivity adjustment required by law.

The final rule also includes:

  • Wage index update
  • Change of therapy assessment policy update
  • Civil money penalties

More information is available on the SNF PPS website.

Full text of this excerpted CMS fact sheet (issued July 31).

 

FY 2015 Payment and Policy Changes for Medicare Inpatient Psychiatric Facilities

On July 31, CMS issued the Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) final rule for FY 2015. The IPF PPS applies to inpatient psychiatric facilities across the United States, including both freestanding psychiatric hospitals and psychiatric units of acute care hospitals or critical access hospitals. The updated rates would generally be effective for discharges occurring on or after October 1, 2014. Under the final rule, payments to IPFs are estimated to increase by 2.5 percent compared to FY 2014.

The final rule also updates the Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program, which requires IPFs to report on quality measures or incur a reduction in their annual payment update. This rule expands the measure sets for use in future FYs and discusses CMS’s plans to collect data to help better target future measures.

The final rule also includes:

  • Federal per diem base rate
  • Wage index
  • Outlier fixed-dollar loss threshold
  • Electroconvulsive Therapy (ECT) payment
  • Cost of Living Adjustment (COLA)
  • Discussion of stand-alone IPF market basket for FY 2016
  • ICD-10-CM/PCS conversion

Full text of this excerpted CMS fact sheet (issued July 31).

 

FY 2015 Payment and Policy Changes for Medicare Inpatient Rehabilitation Facilities

On July 31, CMS issued a final rule updating FY 2015 Medicare payment policies and rates for the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) and the IRF Quality Reporting Program (IRF QRP). CMS estimates that aggregate payments to IRFs will increase in FY 2015 by $180 million, or 2.4 percent, relative to payments in FY 2014. This estimated increase is attributed to a 2.2 percent payment update, which includes a 2.9 percent market basket increase factor, reduced by a 0.5 percentage point multi-factor productivity adjustment and an additional 0.2 percentage point reduction as required by law. In addition, CMS will update the outlier threshold, increasing IRF PPS payments by an estimated 0.2 percent.

The final rule also includes:

  • Facility-level adjustment updates
  • ICD-10-CM conversion
    Further refinements to the presumptive compliance methodology
    New IRF-Patient Assessment Instrument (PAI) item for therapy data collection
  • New IRF-PAI indicator for arthritis diagnosis codes.
  • Changes to the IRF QRP

Full text of this excerpted CMS fact sheet (issued July 31).

 

FY 2015 Updates to the Wage Index and Payment Rates for the Medicare Hospice Benefit

On August 4, 2014, CMS issued a final rule to update the Medicare hospice wage index and Medicare hospice payment rates for FY 2015. Hospices serving Medicare beneficiaries will see an estimated 1.4 percent increase in their payments for FY 2015, or $230 million. See the fact sheet.

 

Vaccines Are Not Just for Kids

August is National Immunization Awareness Month. This national health observance provides an opportunity to raise awareness of immunization across the entire lifespan. Adults understand the importance of immunizations for kids, but many are unaware that they also need vaccines. Health care professionals play a critical role in educating their patients about recommended vaccines and ensuring that they are fully immunized. The Centers for Disease Control and Prevention is asking all health care professionals – whether you provide immunization services or not – to routinely assess the vaccine needs of your patients and make a strong recommendation for needed vaccinations. Medicare provides coverage for vaccines under Medicare Part B and the Medicare prescription drug plans (Part D). Read more.

 

Are You Providing an Annual Wellness Visit to Your Medicare Patients?

Under the Affordable Care Act, Medicare beneficiaries now receive coverage for an Annual Wellness Visit (AWV), which is a yearly office visit that focuses on preventive health. During the AWV, you will review a patient’s history and risk factors for diseases, ensure that the patient’s medication list is up to date, and provide personalized health advice and counseling. The AWV also allows you to establish or update a written personalized prevention plan. This benefit will provide an ongoing focus on prevention that can be adapted as a beneficiary’s health needs change over time. Help keep your patients as healthy as possible by encouraging them to have an AWV.

Don’t forget. Medicare also provides coverage for the Initial Preventive Physical Examination (IPPE), commonly known as the "Welcome to Medicare" Visit, a one-time service to newly-enrolled beneficiaries. The IPPE is an introduction to Medicare and covered benefits, with a focus on health promotion and disease detection. The IPPE must be performed within the first 12 months after the beneficiary’s effective date of their Medicare Part B coverage.

Important Note: Medicare provides coverage of the AWV and the IPPE as Medicare Part B benefits. The beneficiary will pay nothing for the AWV and the IPPE (there is no coinsurance, copayment or Medicare Part B deductible for these benefits).

Learn more:

 

Bundled Payments for Care Improvement Initiative

The Bundled Payments for Care Improvement initiative is comprised of four broadly defined models of care, which link payments for multiple services beneficiaries receive during an episode of care. Under the initiative, organizations enter into payment arrangements that include financial and performance accountability for episodes of care. These models may lead to higher quality and more coordinated care at a lower cost to Medicare.

Model 1 focuses on the acute care inpatient hospitalization. Awardees agree to provide a standard discount to Medicare from the usual Part A hospital inpatient payments. The first set of Awardees in Model 1 began in April 2013. Models 2 and 3 involve a retrospective bundled payment arrangement where actual expenditures are reconciled against a target price for an episode of care. Model 4 involves a prospective bundled payment arrangement, where a lump sum payment is made to a provider for the entire episode of care. The first set of participating organizations in Models 2, 3, and 4 were announced in January 2013. Over the course of the three-year initiative, CMS is working with participating organizations to assess whether the models being tested result in improved patient care and lower costs to Medicare.

Full text of this excerpted CMS fact sheet (issued July 31) with additional information on the initiative and four models.

 

LTCH Quality Reporting Program FY 2016 Second Quarter Submission Deadline is August 15

The long-term care hospitals (LTCH) FY 2016 second quarter data submission deadline for the LTCH Quality Reporting (QR) Program is August 15, 2014.

2nd Quarter 2014 – LTCH Care Data Set submission – Discharges from April 1, 2014 through June 30, 2014 should be submitted through the Quality Improvement and Evaluation System (QIES) Assessment Submission and Processing (ASAP) system:

  • Percent of Residents or Patients with Pressure Ulcers That Are New or Worsened (Short-Stay)

2nd Quarter 2014 - Healthcare-Associated Infections (HAI) data submission – Discharges from April 1, 2014 through June 30, 2014 should be submitted via the Center for Disease Control and Prevention’s (CDC) National Healthcare Safety Network (NHSN):

  • NHSN Catheter-Associated Urinary Tract Infection (CAUTI) Outcome Measure
  • NHSN Central Line-Associated Blood Stream Infection (CLABSI) Outcome Measure

To check the status of your data submissions, please check your data submission reports. For assistance running your reports please reference Additional Reconsideration Information for LTCH.

Additional information about the LTCHQR Program can be found on the LTCHQR Program website. For LTCHQR Program questions, contact the Help Desk at LTCHQualityQuestions@cms.hhs.gov. For questions regarding the CDC’s NHSN network, email NHSN@CDC.gov. For technical questions specific to the LTCH CARE 2014 release, email LTCHTechIssues@cms.hhs.gov.

To sign up for direct communications from the LTCH Quality Reporting Program, subscribe to the LTCHQR Program listserv. Enter and submit your email address. Then, select and submit Long Term Acute Care Hospitals Quality Reporting Programs.

 

IRF Quality Reporting Program FY 2016 First Quarter Submission Deadline is August 15

The Inpatient Rehabilitation Facilities (IRF) FY 2016 first quarter deadline for the IRF Quality Reporting Program (QRP) is August 15, 2014.

1st Quarter 2014 – IRF Care Data Set submission – Discharges from January 1, 2014 through March 31, 2014 should be submitted through the Quality Improvement and Evaluation System (QIES) Assessment Submission and Processing (ASAP) system:

  • National Healthcare Safety Network (NHSN) Catheter-associated Urinary Tract Infection (CAUTI) Outcome Measure (NQF #0138)
  • Percent of Residents with Pressure Ulcers That are New or Worsened (Short-Stay) (an application of NQF #0678)

1st Quarter 2014 - Healthcare-Associated Infections (HAI) data submission – Discharges from January 1, 2014 through March 31, 2014should be submitted via the Center for Disease Control and Prevention’s National Healthcare Safety Network (NHSN):

  • NHSN Catheter-Associated Urinary Tract Infection (CAUTI) Outcome Measure

To check the status of your submissions, please check your submission reports. For assistance running your reports or for additional information about the IRF Quality Reporting Program, see the IRF Quality Reporting website. For questions about IRF Patient Assessment Instrument (IRF-PAI) data coding or IRF-PAI data submission, call 800-339-9313 or email help@qtso.com. For questions about CAUTI data or submission, NHSN Registration, email NHSN@cdc.gov. For questions about Quality measure calculation, data submission deadlines, data items in the Quality Indicator section of the IRF-PAI, email IRF.questions@cms.hhs.gov.

To sign up for direct communications from the IRF Quality Reporting Program, subscribe to the IRF QRP listserv. Enter and submit your email address. Then, select and submit Inpatient Rehabilitation Facilities Quality Reporting Programs.

 

Extension of Temporary Moratoria on Enrollment of New Home Health Agencies, Home Health Agency Sub-units and Part B Ambulance Suppliers

On August 1, 2014, CMS published a notice in the Federal Register (CMS-6059-N ) announcing that the temporary moratoria on the enrollment of new Home Health Agencies, Home Health Agency Sub-units and Part B ambulance suppliers is being extended for an additional 6 months in certain geographic areas in Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey to prevent and combat fraud, waste, and abuse.

For more information see MLN Matters Article #SE1425, “Extension of Provider Enrollment Moratoria for Home Health Agencies and Part B Ambulance Suppliers.”

 

Part D Payment for Drugs for Beneficiaries Enrolled in Medicare Hospice

On July 18, 2014, CMS issued, “Part D Payment for Drugs for Beneficiaries Enrolled in Medicare Hospice,” a memorandum to Part D sponsors and Medicare Hospices. This modifies the March 10, 2014 guidance to Part D sponsors to place a prior authorization for all drugs for hospice beneficiaries. The revised guidance expects Part D sponsors to only use hospice prior authorization on the four categories of drugs that the Office of Inspector General, in consultation with hospice providers, identified as nearly always covered under the hospice benefit. The categories of drugs that will require hospice prior authorization are analgesics, antinauseants, laxatives, and antianxiety drugs. Hospices may use the “Hospice Information for Medicare Part D” form to provide the necessary information generally requested by Medicare Part D sponsors.

 

CMS to Release a Comparative Billing Report on Immunohistochemistry and Special Stains in August

CMS will be issuing a national provider Comparative Billing Report (CBR) on immunohistochemistry and special stains in August 2014. The CBR, produced by CMS contractor eGlobalTech, will contain data-driven tables and graphs with an explanation of findings that compare providers’ billing and payment patterns to those of their peers in the state and across the nation. The goal of these reports is to offer a tool that helps providers better understand applicable Medicare billing rules. These reports are only available to the providers who receive them.

Providers are advised to update their fax numbers in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) because fax is the default method of CBR dissemination. Providers should contact the CBR Support Help Desk at 800-771-4430 or CBRsupport@eglobaltech.com if they prefer to receive CBRs through the U.S. Postal Service. For more information, please contact the CBR Support Help Desk or visit the CBR website.

 

EHR Incentive Program: Learn More about the Stage 2 Electronic Notes Menu Objective

To help improve clinical processes, CMS included “Electronic Notes” as a menu objective in Stage 2 of the Electronic Health Record (EHR) Incentive Programs. The objective requires more electronic documentation of patient symptoms, treatments, circumstances, and other observations to give providers additional historical information to use throughout a patient’s treatment plan. Eligible professionals and eligible hospitals who select this menu objective are required to create electronic notes for more than 30 percent of their unique patients. The text of the notes must be searchable and may contain drawings and other content.

New Exclusion for Eligible Professionals
A new exclusion for the electronic notes menu objective has recently been released by CMS. Eligible professionals who have not had any office visits during the EHR reporting period may be eligible to claim an exclusion to this objective. There is no exclusion for hospitals. Remember: Starting this year, exclusions will no longer count towards the number of menu objectives needed to successfully demonstrate meaningful use. Providers cannot claim an exclusion for a menu objective if there are other menu objectives they can meet.

Additional Resources
For more information on Stage 2, visit the Stage 2 web page.

 

Tips to Streamline Your Open Payments System Registration

The Open Payments system registration is a voluntary process for physicians and teaching hospitals. However, it becomes a requirement if you want to review, and possibly dispute data submitted about you by applicable manufacturers and applicable group purchasing organizations (GPOs).

Helpful tips:

  • Use Internet Explorer versions 8-10, Chrome or Firefox browsers. Currently the Open Payments system is not optimized for the Safari browser
  • Understand that registration for physicians and teaching hospitals for this first reporting year requires registering in the CMS Enterprise Portal and then in the Open Payments system
  • Consider answering “optional” questions during the registration process (skipping these questions can slow your registration).  

To learn more about Open Payments system registration and the nomination process, visit the Program Registration, Physicians and Teaching Hospitals web pages. To understand the review and dispute process, visit the Dispute and Resolution web page.

For more information about Open Payments, please visit the Open Payments website. If you have any questions, email the Help Desk at openpayments@cms.hhs.gov or call 855-326-8366, Monday through Friday, from 7:30am to 6:30pm CT, excluding Federal holidays.

 

Correction to July 31 Article: Get Ready for DMEPOS Competitive Bidding – Get Licensed

In the July 31 eNews, the link to the complete message on the Round 2 and National Mail-Order Recompete Latest News and Announcements web page has been updated.

 

Claims, Pricers, and Codes

 

2015 ICD-9-CM and ICD-10-CM POA Exempt Lists Now Available

The 2015 ICD-9-CM and 2015 ICD-10-CM Present on Admission (POA) exempt lists are now posted:

The 2015 ICD-9-CM and ICD-10-CM POA exempt lists are identical to the 2014 ICD-9-CM and ICD-10-CM POA exempt lists. There were no changes.

 

Adjustment of Some Hospital Claims for Therapy Services

Certain hospital claims for therapy services processed between April 7 and July 28, 2014 may have been paid in error because Medicare claims processing systems did not apply the services to the therapy cap appropriately. The claims affected had one or more lines with revenue code 042x, 043x, or 044x with modifier GN, GO, or GP. The system problem was corrected on July 28 and the affected claims will be adjusted. No provider action is needed.

 

MLN Educational Products

 

“Protecting Access to Medicare Act of 2014” Podcast — Released

The “Protecting Access to Medicare Act of 2014 podcast was released and is now available.

This podcast is designed to provide education on the “Protecting Access to Medicare Act of 2014.” It includes a discussion of Medicare billing and claims processing information associated with this legislation. 

 

“Medicare Fee-For-Service (FFS) Claims Processing Guidance for Implementing International Classification of Diseases, 10th Edition (ICD-10) – A Re-Issue of MM7492” MLN Matters® Article — Revised

MLN Matters® Article #SE1408, “Medicare Fee-For-Service (FFS) Claims Processing Guidance for Implementing International Classification of Diseases, 10th Edition (ICD-10) – A Re-Issue of MM7492” was revised and is now available in downloadable format. This article is designed to provide education on the required use of the ICD-10 code sets for dates of service on and after October 1, 2015. It includes tables for providers regarding claims that span the periods where ICD-9 and ICD-10 codes may both be applicable. This article was revised to show the new ICD-10 implementation date of October 1, 2015.

 

Medicare Fee-For-Service (FFS) International Classification of Diseases, 10th Edition (ICD-10) Testing Approach” MLN Matters® Article — Revised

MLN Matters® Special Edition Article #SE1409, “Medicare Fee-For-Service (FFS) International Classification of Diseases, 10th Edition (ICD-10) Testing Approach” was revised and is now available in downloadable format. This article is designed to provide education on the testing approach that CMS is taking for the ICD-10 implementation. It includes information about the comprehensive four-pronged approach to preparedness and testing. The article was revised to show the new ICD-10 implementation date of October 1, 2015 and also updates the acknowledgement testing and end-to-end testing portions.

 

Special Instructions for the International Classification of Diseases, Clinical Modification 10th Edition (ICD-10-CM) Coding on Home Health Episodes that Span October 1, 2015” MLN Matters® Article — Revised

MLN Matters® Special Edition Article #SE1410, “Special Instructions for the International Classification of Diseases, Clinical Modification 10th Edition (ICD-10-CM) Coding on Home Health (HH) Episodes that Span October 1, 2015” was revised and is now available in downloadable format. This article is designed to provide education on further details regarding HH claims for episodes that span the October 1 date. It includes a summary table of scenarios.  The article was revised to show the new ICD-10 implementation date of October 1, 2015.

 

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.”

The “ICD-9-CM, ICD-10-CM, ICD-10-PCS, CPT, and HCPCS Code Sets” Educational Tool (ICN 900943) 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.

 

 

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