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Date
2016-11-17
Subject
MLN Connects Provider eNews for November 17, 2016
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Thursday, November 17, 2016

News & Announcements

Provider Compliance

Claims, Pricers & Codes

Upcoming Events

Medicare Learning Network® Publications & Multimedia

  View this edition as a PDF [PDF, 145KB]  

 

News & Announcements

 

CMS and Indian Health Service Expand Collaboration to Improve Health Care in Hospitals 

CMS now includes Indian Health Service hospitals in the nationwide Hospital Improvement and Innovation Networks (HIINs) contract for public and private sector hospitals to reduce adverse events by 20 percent and hospital readmissions by 12 percent. CMS recently awarded $347 million to 16 national, regional, or state hospital associations and health system organizations to serve as HIINs. Through 2019, HIINs will work to achieve a 20 percent decrease in overall patient harm and a 12 percent reduction in 30-day hospital readmissions as a population-based measure from the 2014 baseline.

See the full text of this excerpted CMS press release (issued November 10).

 

CMS to Release a Comparative Billing Report on Knee Orthoses in January

CMS will issue a national supplier Comparative Billing Report (CBR) on Knee Orthoses in January 2017. The CBR, produced by CMS contractor eGlobalTech, will educate suppliers about their billing patterns for knee orthoses. CBRs contain data driven tables with an explanation of findings that compare suppliers’ 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.

 

Recognizing Lung Cancer Awareness Month and the Great American Smokeout

November is Lung Cancer Awareness Month and November 19 is the Great American Smokeout. Many smokers want to quit but have difficulty succeeding, and tobacco use is the leading cause of preventable illness and death in the United States. Talk to your patients about quitting and recommend appropriate Medicare-covered preventive services, including counseling to prevent tobacco use and lung cancer screening.

For More Information:

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

 

Provider Compliance

 

False Claims Act

Watch a brief video on the False Claims Act to help you understand and comply with this law. False claims are not claims with innocent billing mistakes. Providers know these claims are false, and they include services that are:

  • Not rendered
  • Upcoded
  • Not supported by the patient’s medical record
  • Part of a previously submitted claim

This video is part of the Office of Inspector General (OIG) Health Care Fraud Prevention and Enforcement Action Team (HEAT) Provider Compliance Training initiative to prevent fraud, waste, and abuse. The video originally aired in 2011, but the information is still current.

 

Claims, Pricers & Codes

 

Sunsetting of Section 1011: Emergency Health Services Furnished to Undocumented Aliens

CMS completed the sunsetting of the Section 1011 program for federal reimbursement of emergency health services furnished to undocumented aliens as of September 29, 2016:

  • The final payment to providers was made on August 24, 2016, for dates of service from October 1, 2015, through December 31, 2015
  • No additional funding is available in any state
  • Do not submit requests for payments, new enrollment applications, or dispute resolutions
  • The Undocumented Alien Reimbursement System has been decommissioned

See the fact sheet for more information.

 

LTCH: Clarification of Immediately Preceding Hospitals for Exclusion from Site Neutral Payment Rate

The description of a qualifying immediately preceding hospital as Inpatient Prospective Payment System (IPPS) hospital in MLN Matters® Article MM9015 has been changed to "subsection (d) hospital” to be consistent with the Code of Federal Regulations. Discharges in cost reporting periods beginning on or after October 1, 2015, may have been incorrectly paid at the site neutral rate if:

  • The immediately preceding hospital claim was not present in Medicare claims processing claims history, or
  • The patient came from a “subsection (d)” immediately preceding hospital other than an IPPS hospital.

Long-Term Care Hospitals (LTCHs) should contact their Medicare Administrative Contractors (MACs) about these claims. MACs will work with LTCHs to obtain additional documentation for affected claims and make any appropriate adjustments to payment.

 

Upcoming Events

 

Medicare Diabetes Prevention Program Model Expansion Call — November 30

Wednesday, November 30 from 1:30 to 3 pm ET

To register or for more information, visit MLN Connects® Event Registration. Space may be limited, register early.

The CY 2017 Medicare Physician Fee Schedule (PFS) final rule includes the expansion of the Medicare Diabetes Prevention Program (MDPP) Model beginning January 1, 2018. During this call, CMS experts provide a high-level overview of the finalized policies. Participants should review the rule prior to the call. 

The goal of the model expansion is to prevent the onset of type 2 diabetes among Medicare beneficiaries diagnosed with pre-diabetes through a structured behavioral change intervention. MDPP services will be furnished in community and health care settings by coaches that are trained community health workers or health professionals. The rule finalizes aspects of the expansion that will enable organizations new to Medicare to prepare their organizations for enrollment into Medicare as MDPP suppliers. Subsequent rulemaking in 2017 will propose additional policies. Visit the MDPP webpage for more information about the model.

Agenda:

  • Overview of MDPP policies finalized in CY 2017 Medicare PFS
  • What you need to know now to prepare your organization for enrollment into Medicare as an MDPP supplier
  • Question and answer session

Target Audience: Current Centers for Disease Control and Prevention (CDC) recognized Diabetes Prevention Program organizations; organizations interested in becoming MDPP suppliers, including existing Medicare providers/suppliers, community organizations, non-for-profits; associations and advocacy groups focused on seniors or diabetes; and other interested stakeholders, including health plans, primary care/internal medicine specialties.

 

IRF and LTCH Quality Measure Report Call — December 1

Thursday, December 1 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 present on the soon to be released Certification and Survey Provider Enhanced Reports (CASPER) Quality Measure (QM) reports for the Inpatient Rehabilitation Facility (IRF) and Long-Term Care Hospital (LTCH) Quality Reporting Programs. Find out how to get aggregate performance for the current quarter or past three quarters, find reporting errors that may affect your performance, and interpret the information.

Agenda:

  • Quality measures for public reporting in 2016
  • Reports associated with public reporting
  • Content of the CASPER QM reports by data source
  • How to interpret facility and patient level results
  • Accessing reports in CASPER
  • Resources for providers

Target Audience: IRF and LTCH providers, healthcare industry professionals, clinicians, researchers, health IT vendors, and other interested stakeholders.

 

National Partnership to Improve Dementia Care and QAPI Call — December 6

Thursday, December 6 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, learn about the reform of requirements for long-term care facilities, highlighting the Behavioral Health Services & Pharmacy Services sections. A Tennessee nursing home will also discuss innovative approaches that they implemented to dramatically reduce the use of antipsychotic medications. 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.

Speakers:

  • Diane Corning, CMS
  • Douglas Ford, National HealthCare Corporation, Fort Sanders
  • Michele Laughman and Debbie Lyons, CMS

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

 

2016 Hospital Appeals Settlement Update Call — December 12

Monday, December 12 from 1:30 to 3 pm ET

To register or for more information, visit MLN Connects Event Registration. Space may be limited, register early.

On November 3, 2016, CMS provided details on the process to allow eligible providers to settle their inpatient status claims currently under appeal using the Hospital Appeals Settlement process. This national provider call is a follow-up to the November 16 call and gives an overview of this process, which is available beginning December 1. A question and answer session will follow the presentation.

Details on the settlement process are posted on the Hospital Appeals Settlement Process 2016 webpage.

Target Audience: Acute care hospitals, including those paid via the prospective payment system, periodic interim payments, and the Maryland waiver; and critical access hospitals.

 

Comparative Billing Report on Viscosupplementation of the Knee Webinar — December 14

Wednesday, December 14 from 3 to 4 pm ET

Join us for a discussion of the comparative billing report on Viscosupplementation of the Knee (CBR201616), an educational tool for Medicare providers who submit claims for viscosupplementation treatments for knee osteoarthritis. During the webinar, providers will interact directly with content specialists and submit questions about the report. See the announcement for more information and find out how to participate.

 

Medicare Learning Network® Publications & Multimedia

 

Hard Copy Claims Not Crossing Over Due to Duplicate Diagnosis Codes MLN Matters Article — New

An MLN Matters Special Edition Article on Guidance to Physician/Practitioner and Supplier Billing Offices that Submit Hard Copy Claims to Medicare to Help Reduce Incidence of Claims Not Crossing Over Due to Duplicate Diagnosis Codes and Diagnosis Code Pointers is available. Learn how to correctly submit CMS-1500 claim forms to reduce the number of claims that are not “crossed over,” or transferred electronically to the destination supplemental payer.

 

Medicare Basics: Parts A and B Claims Overview Video — New

A new Medicare Basics: Parts A and B Claims Overview Video is available. Learn about:

  • What you need to know before filing a claim
  • How to submit a claim

 

Medicare Quality Programs Call: Audio Recording and Transcript — New

An audio recording and transcript are available for the November 1 call on How to Report Across 2016 Medicare Quality Programs. Learn how to report quality measures during the 2016 program year to maximize your participation in Medicare quality programs, including the Physician Quality Reporting System, Medicare Electronic Health Record Incentive Program, Value-Based Payment Modifier, and the Medicare Shared Savings Program.

 

Clinical Labs Call: Audio Recording and Transcript — New

An audio recording and transcript are available for the November 2 call on the Clinical Diagnostic Laboratory Test Payment System: Data Reporting. Learn how to report data required by the final rule. CMS will use this data to set Medicare payment rates effective January 1, 2018.

 

Medicare Fraud & Abuse: Prevention, Detection, and Reporting Booklet — Revised

A revised Medicare Fraud & Abuse: Prevention, Detection, and Reporting Booklet is available. Learn about:

  • Fraud and abuse definitions
  • Laws used to fight fraud and abuse
  • Government partnerships engaged in fighting fraud and abuse
  • Where to report suspected fraud and abuse

 


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