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Date
2017-04-13
Subject
MLN Connects for April 13, 2017

 

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Thursday, April 13, 2017

News & Announcements

Provider Compliance

Claims, Pricers & Codes

Upcoming Events

 Medicare Learning Network Publications & Multimedia 

  View this edition as a PDF [PDF, 185KB]  

 

News & Announcements

 

Accountable Health Communities Model: CMS Selects 32 Participants

On April 6, CMS announced the participants for the Assistance and Alignment Tracks of the Accountable Health Communities (AHC) Model. These tracks will begin on May 1, 2017 with a five-year performance period. By addressing critical drivers of poor health and high health care costs, the model aims to reduce avoidable health care utilization, impact the cost of health care, and improve health and quality of care for Medicare and Medicaid beneficiaries.

Visit the AHC Model webpage for more information and a list of participants. See the full text of this excerpted CMS Press Release (issued April 6).

 

Mapping Medicare Disparities Tool: Identify Disparities in Chronic Disease

The Mapping Medicare Disparities Tool is an interactive website that can help you identify and visualize disparities among Medicare Fee-For-Service beneficiaries. The Tool displays health-related measures from Medicare claims by sex, age, dual eligibility for Medicare and Medicaid, race, ethnicity, state, and county. Use the Mapping Medicare Disparities Tool to target interventions for populations with special health needs:

  • Visualize prevention quality indicators, disease prevalence, readmissions, and cost at the state or county level
  • Compare measures by race, ethnicity, dual-eligibility, age, and sex
  • Analyze geographic needs, including rural and urban counties and the U.S. territories

 

Questions about Medicare Enrollment Revalidation?

What's ahead for your next Medicare enrollment revalidation? View CMS resources to help you stay on top of the process every step of the way:

 

Administrative Simplification: New Fact Sheet and Infographic

Administrative Simplification standards apply to entities who exchange health care information electronically, including health plans, health care providers, and clearinghouses. New CMS resources:

  • Fact sheet explains how these standards streamline day-to-day tasks like billing; verifying patient eligibility; and sending and receiving payment
  • Infographic explains how health care providers can streamline paperwork

 

National Healthcare Decisions Day is April 16

“It Always Seems Too Early, until It’s Too Late." National Healthcare Decisions Day raises awareness about the importance of Advance Care Planning (ACP). Did you know that ACP services can be billed to the Medicare Physician Fee Schedule?

For More Information:

 

Provider Compliance

 

Billing for Ambulance Transports

In a September 2015 report, the Office of the Inspector General (OIG) released results of a study of Medicare Part B ambulance claims. According to the report, almost 20 percent of ambulance suppliers had inappropriate and questionable billing for ambulance transport, creating vulnerabilities to Medicare program integrity. The OIG identified a number of key problems, including:

  • Ambulance transports for beneficiaries who did not receive any Medicare services at the point of origin or destination
  • Transports to noncovered destinations
  • Excessive mileage reported on claims for urban transports
  • Medically unnecessary transports to partial hospitalization programs
  • Inappropriate transport service levels

Review the following resources to bill correctly for this service:

 

Claims, Pricers & Codes

 

April 2017 OPPS Pricer File

The Outpatient Prospective Payment System (OPPS) Pricer webpage is updated with outpatient provider data for April 2017 under “2nd Quarter 2017 Files.” There is no Pricer file logic update this quarter.

 

Upcoming Events

 

Medicare Shared Savings Program ACO: Completing the 2018 Application Process Call — April 19

Wednesday, April 19 from 1:30 to 3 pm ET

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

During this call, learn helpful tips to complete a successful application for the 2018 Medicare Shared Savings Program, the Medicare Accountable Care Organization (ACO) Track 1+ Model, and/or Skilled Nursing Facility (SNF) 3-Day Rule Waiver. Topics:

  • Completing an application
  • ACO participant lists and agreements
  • SNF affiliate lists and agreements (Applicable to the SNF 3-Day Rule Waiver)
  • Beneficiary assignment

Visit the How to Apply webpage to review important information, dates, and materials prior to the call. And, review materials from our April 6 call on Preparing to Apply.

Target Audience: Potential 2018 Shared Savings Program initial, renewal, SNF 3-Day Rule Waiver, and Medicare ACO Track 1+ Model applicants.

 

Global Surgery: Required Data Reporting for Post-Operative Care Call — April 25

Tuesday, April 25 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 adopted a data reporting requirement for practitioners furnishing specified global procedures in Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon, and Rhode Island. CMS will use reported data, along with other data to establish payment rates under the PFS.

During this call, learn about the new requirements that go into effect July 1, 2017, and resources you can use for reporting. A question and answer session follows the presentation.

Target Audience: Physicians, physician assistants, nurse practitioners and other clinicians who furnish global services; coders; billers; and practice managers in Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon, and Rhode Island. Practitioners who only work in practices with fewer than 10 practitioners and those furnishing services in other states are not required to report but may report voluntarily.

 

Emergency Preparedness Requirements Final Rule Training Call — April 27

Thursday, April 27 from 2:30 to 3:30 pm ET

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

Is your facility prepared to meet the new emergency preparedness requirements by the November 15, 2017, compliance date? During this call, learn about implementation of the final rule, including an overview of the regulation and training and testing requirements. A question and answer session follows the presentation.

Target Audience: Facilities, providers, and suppliers affected by the final rule; state survey agencies; health care coalitions; and state emergency preparedness officials.

 

IRF, LTCH, SNF QRP Review and Correct Reports Provider Training Webcast — May 2

Tuesday, May 2 from 2 to 3 pm ET

During this webcast, find out how Review and Correct Reports fit within the Quality Reporting Programs (QRPs) for Inpatient Rehabilitation Facilities (IRFs), Long-Term Care Hospitals (LTCHs), and Skilled Nursing Facilities (SNFs). Additionally, learn about re-submitting data to correct errors prior to the quarterly submission deadlines to ensure that accurate data is publicly displayed.

For more information and to register, visit:

 

Medicare Learning Network Publications & Multimedia

 

April 2017 Catalog Available

The April 2017 Catalog is available. Learn about:

  • Products and services that can be downloaded for free
  • Web-based training courses; some offer continuing education credits
  • Helpful links, tools, and tips

 

Quality Payment Program in 2017: Pick Your Pace Web-Based Training Course — New

With Continuing Education Credit

A new Quality Payment Program in 2017: Pick Your Pace Web-Based Training course is available through the Learning Management System. Learn:

  • If your medical practice needs to participate
  • How to participate
  • How to pick a pace in the program

 

2017 Medicare Part C and Part D Reporting Requirements and Data Validation Web-Based Training Course — New

With Continuing Education Credit

A new 2017 Medicare Part C and Part D Reporting Requirements and Data Validation Web-Based Training course is available through the Learning Management System. Learn how to plan, perform and complete validation activities.

 

Medicare Quarterly Provider Compliance Newsletter [Volume 7, Issue 3] Educational Tool — New

A new Medicare Quarterly Provider Compliance Newsletter [Volume 7, Issue 3] Educational Tool is available. Learn about:

  • How to avoid common billing errors and other erroneous activities
  • How to address and avoid the top issues of this quarter

 

IMPACT Act Call: Audio Recording and Transcript — New

An audio recording, transcript, updated presentation, and post-call presentation clarification are available for the March 29 call on the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act): Standardized Patient Assessment Data Activities. During this call, find out about efforts to develop, implement, and maintain standardized post-acute care patient assessment data, including pilot testing results and plans for the upcoming national field test.

 

Educational Resources to Assist Chiropractors with Medicare Billing MLN Matters Article — Revised

An MLN Matters Special Edition Article on Educational Resources to Assist Chiropractors with Medicare Billing is available. Learn about:

  • Enrollment
  • Coverage, documentation, and billing
  • Advance Beneficiary Notice

 

Home Health Prospective Payment System Booklet — Revised

A revised Home Health Prospective Payment System Booklet is available. Learn about:

  • Consolidated billing requirements
  • Criteria to qualify for home health services
  • Therapy services
  • Physician billing and payment
  • Home Health Quality Reporting Program 

 


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