Skip to Main Content
Date
2016-11-23
Subject
MLN Connects Provider eNews for November 23,2016

 

Wednesday, November 23, 2016

News & Announcements

Provider Compliance

Claims, Pricers & Codes

Upcoming Events

Medicare Learning Network® Publications & Multimedia

View This Edition As A PDF [PDF, 121KB]  

 

 

News & Announcements

 

CMS Launches New Online Tool to Make Quality Payment Program Easier for Clinicians

On November 17, CMS released a tool to automatically share electronic data for the Medicare Quality Payment Program. The Application Program Interface (API) builds on the Quality Payment Program website by making it easier for other organizations to retrieve and maintain the Quality Payment Program’s measures and enable them to build applications for clinicians and their practices. The API will allow developers to write software using the information described on the Explore Measures section of the Quality Payment Program website.

See the full text of this excerpted CMS Press Release (issued November 17).

 

2017 PQRS Results: Submit an Informal Review by November 30

In 2017, CMS will apply a downward payment adjustment to those who did not satisfactorily report for the Physician Quality Reporting System (PQRS) in 2015 including:

  • Individual eligible professionals
  • Comprehensive Primary Care practice sites
  • PQRS group practices
  • Accountable Care Organizations

If you believe you have been incorrectly assessed the 2017 PQRS payment adjustment, submit an informal review through November 30:

2015 PQRS feedback reports are available:

For more information, visit the Analysis and Payment webpage. For questions about the informal review process, contact the QualityNet Help Desk at 866-288-8912 (TTY 877-715-6222) or Qnetsupport@hcqis.org.

 

Value Modifier: Informal Review Request Period Open through November 30

The 2015 Annual Quality and Resource Use Reports (QRURs) were released on September 26. These reports show how physician groups and physician solo practitioners performed in 2015 on the quality and cost measures used to calculate the 2017 Value Modifier. Access and review your 2015 Annual QRUR now to determine whether you are subject to the 2017 Value Modifier payment adjustment. See the How to Obtain a QRUR webpage and Quick Access Guide for the 2015 Annual QRURs and Tables for more information.

You may request an informal review of perceived errors in your 2017 Value Modifier calculation during the informal review period open through November 30. See the 2015 QRUR and 2017 Value Modifier webpage for additional information.

Help Desk Information:

  • For the Enterprise Identity Management System (EIDM), contact the QualityNet Help Desk at qnetsupport@hcqis.org or 866-288-8912 (TTY 877-715- 6222)
  • For QRURs or the Value Modifier, contact the Physician Value Help Desk at pvhelpdesk@cms.hhs.gov or 888-734-6433 (select option 3)

 

IMPACT Act Cross-Setting Quality Measures: Comments Due

Public comments are due on cross-setting post-acute care measures under the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act):

  • December 9 - Transfer of Health Information and Care Preferences; visit the Public Comment webpage for more information
  • December 11 - Percent of Home Health Episodes with an Admission and Discharge Functional Assessment and a Care Plan; visit the Public Comment webpage for more information

 

Post-Acute Care QRP Data Submission Exceptions for Hurricane Matthew

CMS is granting quality reporting data submission exceptions to post-acute care Quality Reporting Program (QRP) providers adversely affected by Hurricane Matthew; this impacts providers in Federal Emergency Management Agency (FEMA) - designated “major disaster” counties in Georgia, Florida, North Carolina, and South Carolina. For more information and a list of FEMA-designated counties, visit your Exception and Extension Quality Reporting webpage:

 

New Quality Payment Program Resources Available

New Quality Payment Program resources are available on the Education & Tools webpage:

 

Each Office Visit is an Opportunity to Recommend Influenza Vaccination

People’s immune systems can become weaker with age, which can place some people 65 years and older at greater risk of serious influenza-related complications. As a trusted health care professional, research shows that your recommendation for yearly influenza vaccination and taking action to get yourself vaccinated is vital – to protect your patients, your staff, and yourself.

  • Medicare Part B covers one influenza vaccination and its administration each influenza season for Medicare beneficiaries. Medicare may cover additional seasonal influenza vaccinations if medically necessary.
  • For the 2016-2017 season, the CDC recommends use of the Inactivated Influenza Vaccine (IIV) or the Recombinant Influenza Vaccine (RIV). The nasal spray influenza vaccine (Live Attenuated Influenza Vaccine (LAIV)) should not be used during 2016-2017.

For More Information:

 

Provider Compliance

 

Enteral Infusion Pumps

Proper payment and sufficient documentation go hand in hand. The CMS Provider Minute: Enteral Infusion Pumps video includes pointers on how to bill correctly the first time for this product. Learn about:

  • Medicare coverage criteria for enteral infusion pumps
  • Four pieces of information necessary for proper documentation

This video is part of a series to help providers of all types improve in areas identified with a high degree of noncompliance.

 

Claims, Pricers & Codes

 

Reprocessing of Some IPPS Claims

Some Inpatient Prospective Payment System (IPPS) hospital and Long Term Care Hospital (LTCH) claims with discharge dates on or after October 1, 2016, may be grouped to an incorrect Medicare Severity - Diagnosis Related Group (MS-DRG). A revision to the ICD-10 MS-DRG version 34 software file was made and affected claims will be reprocessed by your Medicare Administrative Contractor by February 1, 2017. No action is required by IPPS and LTCH hospitals.

 

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.

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.

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

Tuesday, December 6 from 1:30 to 3 pm ET

To register or for more information, visit MLN Connects Event Registration.

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.

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.

 

IRF-PAI Therapy Information Data Collection Call — January 12

Thursday, January 12 from 1:30 to 3 pm ET

To register or for more information, visit MLN Connects Event Registration.

In the fiscal year 2015 Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) final rule, CMS finalized a new Therapy Information section on the IRF-Patient Assessment Instrument (PAI).  During this call, CMS will focus on reviewing the types and methods of therapy collected on the IRF-PAI, examples of each type of therapy, and how to accurately code and complete the therapy information section on the IRF-PAI.  Prior to the call, participants are encouraged to review the IRF-PAI Training Manual.  Participants can also review materials from our 2015 MLN Connects Call  on how to code and complete the new IRF-PAI item for Therapy Data Collection.  A question and answer session will follow the presentation.

Target Audience: IRF providers

 

Medicare Learning Network® Publications & Multimedia

 

Emergency Preparedness Video Presentation — New

A video presentation is available for the October 5 call on Emergency Preparedness Requirements. During this call, CMS discussed the new requirements and revisions in the final rule, as well as how to plan for both natural and man-made disasters, while coordinating with other emergency preparedness systems.

 

Inappropriate Billing of Qualified Medicare Beneficiaries for Medicare Cost-Sharing MLN Matters Article — Revised

An MLN Matters Article on Issuing Compliance Letters to Specific Providers and Suppliers Regarding Inappropriate Billing of Qualified Medicare Beneficiaries for Medicare Cost-Sharing is available. Learn about compliance letters to refund any erroneous charges and recall any past or existing billing.

 

Provider Enrollment Requirements for Writing Prescriptions for Medicare Part D Drugs MLN Matters Article — Revised

An MLN Matters Special Edition Article on Provider Enrollment Requirements for Writing Prescriptions for Medicare Part D Drugs is available. Learn about the phased approach of the Part D prescriber enrollment requirements.

 

Hospital-Acquired Conditions and POA Indicator Reporting Provision Fact Sheet — Reminder

The Hospital-Acquired Conditions and Present on Admission Indicator Reporting Provision Fact Sheet is available. Learn about:

  • List of Hospital-Acquired Conditions
  • Present on Admission (POA) indicator payment information
  • Exempt hospitals

 

PAP Devices: Complying with Documentation & Coverage Requirements Fact Sheet — Revised

A revised Positive Airway Pressure (PAP) Devices: Complying with Documentation & Coverage Requirements Fact Sheet is available. Learn about:

  • Comprehensive Error Rate Testing Program billing errors  
  • Checklist of documentation requirements
  • Coding information needed to support a Medicare claim

 

Evaluation and Management Services Guide — Reminder

The Evaluation and Management Services Guide is available. Learn about:

  • Medical record documentation
  • Billing and coding considerations
  • 1995 and 1997 documentation guidelines

 

DMEPOS Quality Standards Booklet—Revised

A revised DMEPOS Quality Standards Booklet is available. Learn about:

  • Durable Medical Equipment, Prosthetics, Orthotics, and Supplies(DMEPOS) quality standards for suppliers
  • Accreditation organizations
  • Business service requirements
  • Product-specific service requirements

 

Medicare Claim Review Programs Booklet — Revised

A revised Medicare Claim Review Programs Booklet is available. Learn about:

  • Different CMS claim review programs
  • Coverage and coding errors
  • How to assist providers in reducing payment errors

 

Drug Diversion: Do You Know Where the Drugs Are Going? Web-Based Training Course—Revised

With Continuing Education Credit

A revised Drug Diversion: Do You Know Where the Drugs Are Going? Web-Based Training (WBT) course is available through the MLN Learning Management and Product Ordering System. Learn about:

  • Common types of drug diversion activities
  • Drug classes that are targets of drug diversion
  • Common drug diversion behaviors to look for in pharmacy practices
  • Actions that can be taken to prevent drug diversion activity

 

Hospice Payment System Booklet – Reminder

The Hospice Payment System Booklet is available. Learn about:

  • Benefit and payments
  • Option for Medicare Advantage enrollees
  • Hospice Quality Reporting Program

 

 


Like the eNews? Have suggestions? Please let us know!

Subscribe to the eNews. Previous issues are available in the archive. This newsletter is current as of the issue date. View the complete disclaimer.

Follow the MLN on Twitter #CMSMLN, and visit us on YouTube.

The Medicare Learning Network®, MLN Connects®, and MLN Matters® are registered trademarks of the U.S. Department of Health and Human Services (HHS).