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MLN Connects Provider eNews for January 21, 2016

Medicare Learning Network, MLN Connects Weekly eNews logo


Thursday, January 21, 2016

MLN Connects® Events

Other CMS Events

Medicare Learning Network® Publications and Multimedia


Claims, Pricers, and Codes

View this edition as a PDF [PDF, 103KB]


MLN Connects® Events


IMPACT Act: Connecting Post-Acute Care across the Care Continuum Call — Register Now

Thursday, February 4 from 1:30 to 3 pm ET

To Register: Visit MLN Connects Event Registration. Space may be limited, register early.

The Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 requires the reporting of standardized patient assessment data by Post-Acute Care (PAC) providers, including skilled nursing facilities, home health agencies, inpatient rehabilitation facilities, and long-term care hospitals. It specifies that data elements must be standardized and interoperable to allow for the exchange and use of data among these PAC and other providers, including common standards and definitions to facilitate coordinated care and improved beneficiary outcomes. During this call, CMS subject matter experts and the Office of the National Coordinator for Health IT discuss the implications of the IMPACT Act for health information exchange across the care continuum.

For an overview of the IMPACT Act, watch the new MLN Connects video.


  • Requirements to standardize and make interoperable post-acute care assessment data elements
  • Using and exchanging clinically relevant assessment data for multiple purposes
  • Health Information Technology Standards - A Primer
  • CMS Data Element Library
  • Electronic health information exchange

Target Audience: Providers across the care continuum, including long-term/post-acute care and home and community-based service providers, acute and primary care providers, integrated delivery systems and representatives from other payment models, health IT vendors, and other interested stakeholders.

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


Other CMS Events


Comparative Billing Report on Domiciliary E/M Services Webinar

Wednesday, February 17 from 3 to 4:30 pm ET

Join CMS for an informative discussion of the Comparative Billing Report on domiciliary Evaluation and Management (E/M) Services (CBR201601), an educational tool designed to assist providers who submitted claims for established patient domiciliary or rest home E/M services using Current Procedural Terminology codes 99334 through 99337.  During the webinar, providers will interact directly with content specialists and submit questions about the report.


  • Overview of CBR201601
  • Coverage policy
  • Methods and results
  • References and resources
  • Question and answer session

Presenter Information:

  • Speakers: Cheryl Bolchoz, Cyndi Wellborn, Molly Wesley
  • Organizations: eGlobalTech and Palmetto GBA

How to Participate:

If you have questions about this webinar or CBR201601, visit the
CBR website or contact the CBR Support Help Desk at CBRSupport@eglobaltech.com or 800-771-4430.


Medicare Learning Network® Publications and Multimedia


PECOS FAQs Fact Sheet — Revised

A revised PECOS FAQs Fact Sheet is available. Learn about:

  • Information you need before beginning enrollment using the Provider Enrollment, Chain and Ownership System (PECOS)
  • Enrollment application issues
  • Revalidations


The Medicare Home Health Benefit Booklet — Revised

A revised The Medicare Home Health Benefit Booklet is available. Learn about:

  • Qualifying for home health services
  • Consolidated billing
  • Therapy services
  • Billing and payment




CMS Updates Open Payments Data and Improves Website

On January 19, CMS updated the Open Payments dataset, consistent with the values we published on June 30, 2015. The total value before this update was $9.9 billion. The updated Open Payments dataset reflects:

  • Changes made to records
  • Changes to delays in publication flags
  • Changes to disputed records
  • Records that were deleted

This financial data was submitted by applicable manufacturers and applicable group purchasing organizations. Every year, CMS will update the Open Payments data at least once to include updates from disputes and other data corrections made since the initial publication of the data. The updates affect all types of payments or transfers of value to physicians and teaching hospitals and physician ownership or investment interests.

The Open Payments Data website has been enhanced by adding:  

  • A homepage tool where you can search for a doctor by name
  • A snapshot of Open Payment facts
  • Sections to explore and download data

Visit the Open Payments website for more information. If you have questions, contact the Help Desk at openpayments@cms.hhs.gov or 855-326-8366, Monday through Friday, from 9 am to 5pm ET.


Open Payments System Downtime from January 21 through 26

The Open Payments system will be unavailable starting January 21 and will reopen on January 26, 2016, so CMS can improve how the system works: including industry registration, data submission, and review and dispute. While you will not be able to use the Open Payments system during this time, you will still be able to:

  • See Open Payments data and use the data search tool at our Open Payments Data website.
  • Register at our Enterprise Portal. If you need help registering, visit the Resources webpage.

Visit the Open Payments website for more information. If you have questions, contact the Help Desk at openpayments@cms.hhs.gov or 855-326-8366, Monday through Friday, from 9 am to 5pm ET.


LTCH Quality Reporting Program Data Submission Deadline: February 15

Long-Term Care Hospital (LTCH) Quality Reporting Program first, second, and third quarter CY 2015 Centers for Disease Control and Prevention (CDC) and LTCH Continuity Assessment Record and Evaluation (CARE) data must be submitted by February 15, 2016. For additional information, including a list of quality measure data that is due, visit the LTCH Quality Reporting Spotlight and Announcements webpage.


IRF Quality Reporting Program Data Submission Deadline: February 15

Inpatient Rehabilitation Facility (IRF) Quality Reporting Program Centers for Disease Control and Prevention (CDC) data for the first, second, and third quarter of CY 2015 and IRF- Patient Assessment Instrument (PAI) data for the fourth quarter of CY 2014 and first, second, and third quarters of CY 2015 must be submitted by February 15, 2016. For additional information, including a list of quality measure data that is due, visit the IRF Quality Reporting Spotlight and Announcements webpage.


Hospice, IRF, LTCH, SNF, HHA: QIES System Downtime from March 16 through 21

All Quality Improvement and Evaluation System (QIES) systems will be unavailable from Wednesday, March 16 after 8 pm ET through Monday, March 21, 2016. This downtime will affect all QIES connectivity and systems. The national database, Certification and Survey Provider Enhanced Reporting (CASPER) reports, and quick reference (QW) will not be available during this time. In addition, the following submission systems will be unavailable:

  • Hospice Item Set
  • Inpatient Rehabilitation Facility (IRF) -Patient Assessment Instrument (PAI)
  • Long-term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set
  • Minimum Data Set (MDS) and Payroll-Based Journal
  • Outcome and Assessment Information Set (OASIS)

Affected providers should make contingency plans to accommodate for this downtime.


LTCH and IRF Dry Run Readmission Reports Available

Long-Term Care Hospital (LTCH) and Inpatient Rehabilitation Facility (IRF) dry run reports for the All-Cause Unplanned Readmission Measure for 30 Days Post Discharge are available in the Certification and Survey Provider Enhanced Reporting (CASPER) reporting application:

  • Request step-by-step instructions for accessing LTCH reports
  • Request step-by-step instruction for accessing IRF reports

Data from CY 2013 and CY 2014 will be used when public reporting begins in Fall 2016 for this measure.


Update to IRF-PAI Training Manual V1.4

Section 4 Quality Indicators of the Inpatient Rehabilitation Facility (IRF) – Patient Assessment Instrument (PAI) Training Manual V1.4 is available on the IRF Patient Assessment Instrument webpage. Section 4 provides updates to Sections GG, J, and O that will be required beginning October 1, 2016.


Read More about What is Next for the EHR Incentive Programs

In a new blog post, CMS Administrator Andy Slavitt and HHS Acting Assistant Secretary Karen DeSalvo provide expanded insight into the future of Meaningful Use. Visit the Electronic Health Record (EHR) Incentive Programs website for more information on the programs.  


Help Protect the Vision of Your Medicare Patients

January is National Glaucoma Awareness Month. Most often, there are no early warning signs for Glaucoma, but it can lead to permanent vision loss if left untreated. Medicare provides glaucoma screening coverage for beneficiaries in at least one high risk group. Help protect your Medicare patient’s vision by recommending an annual glaucoma screening if appropriate.

For More Information:

Visit the Preventive Services website to learn more about Medicare-covered services.


Claims, Pricers, and Codes


January 2016 OPPS Pricer File Update

The Outpatient Prospective Payment System (OPPS) Pricer web page has been updated with Pricer file and outpatient provider data for January 2016, under “1st Quarter 2016 Files.”



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