- MLN Connects Provider eNews for August 11,2016
- Medicare Announces Participants in Effort to Improve Access, Quality of Care in Rural Areas
- Affordable Care Act Payment Model Continues to Improve Care, Lower Costs
- ESRD QIP PY 2020 Proposed Rule: New Fact Sheet and Video
- CMS to Release a CBR on Positive Airway Pressure Devices, Respiratory Assist Devices and Accessories in August
- TEP on IMPACT Act Quality Measures: Nominations due August 21
- ESRD QIP PY 2020 Proposed Rule Call-In Session — August 16
- Global Surgery Proposed Data Collection Town Hall — August 25
- IMPACT Act: Data Elements and Measure Development Call — August 31
- National Partnership to Improve Dementia Care and QAPI Call — September 15
- Timely Reporting of Provider Enrollment Information Changes MLN Matters® Article — New
- IRFs: Improving Documentation Positively Impacts CERT Web-Based Training Course — New
- Physician Compare Call: Addendum — New
- RHCs HCPCS Reporting Requirement and Billing Updates MLN Matters Article — Revised
- MLN Guided Pathways Provider Specific Medicare Resources Booklet — Revised
- PECOS Technical Assistance Contact Information Fact Sheet — Revised
On August 4, CMS announced the participants in the Frontier Community Health Integration Project (FCHIP) Demonstration, an effort to increase access to care for Medicare beneficiaries in areas of the country where access to health services can be limited because of distance from providers. Ten Critical Access Hospitals (CAHs) in Montana, Nevada, and North Dakota will participate in the demonstration, which begins this August.
The demonstration will provide financial incentives for care coordination activities for local CAHs to reduce unnecessary admissions and readmissions across their networks of care. Specifically, the demonstration aims to:
- Support the CAH and local delivery system in keeping patients within the community who might otherwise be transferred to distant providers
- Test whether payments for certain services will enhance access to care for patients, increase the integration and coordination of care among providers, and reduce avoidable hospitalizations, admissions, and transfers
- Test new CAH activities in three service categories: skilled nursing care, telehealth, and ambulance services
For more information, visit the Frontier Community Health Integration Project Demonstration webpage. See the full text of this excerpted CMS press release (issued August 4).
The Independence at Home Demonstration continues to provide high quality primary care services for chronically ill Medicare beneficiaries in the home setting while saving the Medicare program money, according to a new analysis released on August 9. The CMS analysis found that, for the second performance year, Independence at Home participants saved Medicare more than $10 million – an average of $1,010 per beneficiary – while delivering higher quality patient care in the home. CMS will award incentive payments of $5.7 million to seven participating practices that succeeded in reducing spending while improving quality.
In the second performance year, 15 practices served more than 10,000 Medicare beneficiaries. According to the CMS analysis, all 15 practices improved quality from the first performance year in at least two of the six quality measures for the demonstration. Four practices met the performance measures for all six quality measures.
For more information:
See the full text of this excerpted CMS press release (issued August 9).
In the CY 2017 End-Stage Renal Disease (ESRD) Prospective Payment System proposed rule, CMS proposes changes to the ESRD Quality Incentive Program (QIP) for Payment Years (PYs) 2018, 2019, and 2020. For More Information:
- Proposed Rule – Submit comments by August 23, 2016
- ESRD QIP 2020 Proposed Rule MLN Connects® Video
- Preview of Payment Year 2020 Proposed Rule Fact Sheet
- Register for the ESRD QIP PY 2020 Proposed Rule Call-In Session on Thursday, August 16 from 2 to 2:30 pm ET
CMS to Release a CBR on Positive Airway Pressure Devices, Respiratory Assist Devices and Accessories in August
CMS will issue a national supplier Comparative Billing Report (CBR) on Positive Airway Pressure Devices, Respiratory Assist Devices and Accessories in August 2016. The CBR, produced by CMS contractor eGlobalTech, will focus on suppliers that provide positive airway pressure devices and respiratory assist devices and accessories to Medicare beneficiaries. CBRs contain data driven tables with an explanation of findings that compare supplier’s billing and payment patterns to those of their peers in their state and across the nation.
CBRs are only accessible to the providers who receive them; they are not publicly available. Providers should update their fax numbers in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) because faxing is the default method for disseminating the reports. Contact the CBR Support Help Desk at 800-771-4430 or CBRsupport@eglobaltech.com with questions or to receive CBRs by mail. For more information, visit the CBR website.
Nominations are due August 21 for a Technical Expert Panel (TEP) on quality measures to satisfy the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) – transfer of health information and care preferences when an individual transitions:
- Transfer of information at post-acute care admission, start, or resumption of care from other providers/settings
- Transfer of information at post-acute care discharge or end of care to other providers/settings
Visit the Technical Expert Panels webpage for more information.
Proper payment and sufficient documentation go hand in hand. The CMS Provider Minute: Preventive Services video includes pointers to help you avoid claim denials. Learn how to submit the correct documentation for:
- Time spent providing a service
- Record of billed service
- Physician signature
This video is part of a series to help providers of all types improve in areas identified with a high degree of noncompliance.
The 2017 General Equivalence Mappings (GEMs) are available, along with the ICD-10-CM and ICD-10-PCS code updates:
Thursday, August 16 from 2 to 2:30 pm ET
In the CY 2017 End-Stage Renal Disease (ESRD) Prospective Payment System proposed rule, CMS proposes changes to the ESRD Quality Incentive Program (QIP) for Payment Years (PYs) 2018, 2019, and 2020. Register for this call-in session to pose questions and receive clarification.
CMS must protect the rulemaking process and comply with the Administrative Procedure Act. Only comments formally submitted through the process outlined by the Federal Register will be taken into consideration by CMS. See the proposed rule for information on how to submit a comment. Comments are due by 11:59 pm ET on August 23, 2016.
Thursday, August 25
- In-person session 10:30 am to Noon ET (at CMS Headquarters)
- Virtual session 1 pm to 2:30 pm ET (by webinar)
See the announcement to register or for more information.
CMS is holding a town hall meeting to give stakeholders the opportunity to provide feedback on the CMS proposal for collecting data on global services from the CY 2017 Physician Fee Schedule Proposed Rule (CMS-1654-P). Feedback received at this meeting is not part of our notice and comment rulemaking process. See the proposed rule for information on how to submit a comment. To be assured consideration, comments on the proposed rule must be received by 5 pm on September 6, 2016.
The town hall will be divided into two sessions. From 10:30 am to Noon, those attending in person will have the opportunity to present. From 1 to 2:30 pm, virtual participants will be able to present. During registration for both sessions, you should indicate if you wish to speak. Those attending virtually will be able to hear the morning session but will not be able to present until the afternoon.
Target Audience: Practitioners who furnish surgical services to Medicare beneficiaries; state and national associations that represent these practitioners; integrated delivery systems representatives; coding professionals; and practice managers.
Wednesday, August 31 from 1:30 to 3 pm ET
To register or for more information, visit MLN Connects Event Registration. Space may be limited, register early.
During this call, CMS experts discuss how data elements are used in measure development. Find out how information from assessment instruments is used to calculate quality measures. The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) requires the reporting of standardized patient assessment data on quality measures, resource use, and other measures by Post-Acute Care (PAC) providers, including skilled nursing facilities, home health agencies, inpatient rehabilitation facilities, and long-term care hospitals.
- Overview of National Quality Strategy and CMS Quality Strategy
- Why do we have quality measures?
- How do data elements fit within measure development?
- How is provider data used in the development process?
- Example: pressure ulcer measure
- Question and answer/discussion session
Target Audience: PAC providers, healthcare industry professionals, clinicians, researchers, health IT vendors, and other interested stakeholders.
Thursday, September 15 from 1:30 to 3 pm ET
To register or for more information, visit MLN Connects Event Registration. Space may be limited, register early.
This call focuses on effective care transitions between long-term and acute care settings, highlighting transitions that involve residents with dementia. This is critical for residents with dementia, as care transitions can cause heightened anxiety and aggression. Communication should be optimized, as care transitions are high-risk periods for nursing home residents. Additionally, CMS experts share updates on the progress of the National Partnership to Improve Dementia Care in Nursing Homes and Quality Assurance and Performance Improvement (QAPI). A question and answer session will follow the presentations.
- Dr. Kevin Biese, University of North Carolina (UNC), Department of Emergency Medicine
- Tammie Stanton, UNC Health Care System
- Kathryn Weigel, Rex Rehabilitation & Nursing Care Center of Apex
- Scott Bartlett, Pikes Peak Area Council of Governments – Area Agency on Aging
- Michele Laughman and Debbie Lyons, CMS
Target Audience: Consumer and advocacy groups, nursing home providers, surveyor community, prescribers, professional associations, and other interested stakeholders.
An MLN Matters Special Edition Article on Timely Reporting of Provider Enrollment Information Changes is available. Learn about the requirements to report changes in your Medicare enrollment information.
With Continuing Education Credit
A new Inpatient Rehabilitation Facilities (IRFs): Improving Documentation Positively Impacts CERT Web-Based Training (WBT) Course is available through the Learning Management and Product Ordering System. Learn about:
- Basic elements of the Comprehensive Error Rate Testing (CERT) Program
- IRF services
- Documentation requirements for IRF services
An addendum is available from the June 16 call on the Physician Compare Initiative, providing clarification and additional information on the Achievable Benchmark of Care (ABC™). Visit the June 16 call webpage for other materials from this call, including the audio recording and transcript.
An MLN Matters Special Edition Article on Rural Health Clinics (RHCs) Healthcare Common Procedure Coding System (HCPCS) Reporting Requirement and Billing Updates is available. Learn about the requirements to report the HCPCS code for each service furnished, along with the revenue code on Medicare claims.
The revised MLN Guided Pathways Provider Specific Medicare Resources booklet is available. Learn about:
- Resources for various specialties of physicians and other enrolled health care professionals
- Resources for providers, suppliers, and hospitals specific to their provider/billing type
- Internet-Only Manuals, Medicare Learning Network publications, CMS webpages, and more
- Specialty-specific pathways, including audiologists, skilled nursing facilities, home health agencies, laboratories, physician assistants, critical access hospitals, ambulatory surgical centers, and inpatient rehabilitation facilities
A revised PECOS Technical Assistance Contact InformationFact Sheet is available. Learn about:
- Common problems and who to contact
- Provider Enrollment, Chain and Ownership System (PECOS) resources