Thursday, May 18, 2017
- Clinical Laboratories: Lab Data Due May 30
- SNF Quality Reporting Program: Submission Deadline Extended to June 1
- National Mental Health Awareness Month 2017
- Quality Payment Program Participation Criteria Webinar — May 22
- National Partnership to Improve Dementia Care and QAPI Call — June 15
- Updated Manual Guidelines for Electronic Funds Transfer Payments and Change of Ownership MLN Matters Article — New
- Prohibition on Billing Dually Eligible Individuals Enrolled in the QMB Program MLN Matters Article — Revised
- Avoiding Medicare Fraud & Abuse: A Roadmap for Physicians Web-Based Training Course — Reminder
News & Announcements
If you are a reporting entity that has one or more applicable labs for which you are to report pricing data:
- Ensure data are certified to complete the data submission process; a separate individual must certify submitted data.
- Identify who will submit and certify your Clinical Lab Fee Schedule (CLFS) data. These two individuals must register in the Enterprise Identity Management (EIDM) system and request a CLFS submitter or certifier role in the Fee-For-Service Data Collection System.
- The CLFS submitter must be certified in the Provider Enrollment, Chain and Ownership System (PECOS) as a User or Authorized User on the PECOS Medicare Enrollment forms (CLFS submitters must have their name appear within one of the following 855 application forms: A,B,C,I,R).
A reporting entity that has multiple Taxpayer Identification Numbers (TINs) and multiple applicable lab National Provider Identifiers (NPIs) may register its TINs and NPIs under one user. For more information see the PAMA webpage
The reporting deadline for the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) FY 2018 payment determination is extended to June 1, including Minimum Data Set assessment data for the fourth quarter of CY 2016. Visit the SNF QRP Data Submission Deadlines webpage for a list of required measures.
National Mental Health Awareness Month raises awareness about mental health conditions and the importance of good mental health for everyone. Medicare covers several preventive services to help monitor your patients’ mental health, including the Initial Preventive Physical Examination (PDF), Annual Wellness Visit (PDF), and Depression Screening.
For More Information:
- Educational Tool
- President Donald J. Trump Proclaims May 2017 as National Mental Health Awareness Month
- Centers for Disease Control and Prevention Mental Health and Aging website
Visit the Preventive Services website to learn more about Medicare-covered services.
A 2016 Office of the Inspector General (OIG) report noted that providers may not be informing CMS of ownership changes. Providers must update their enrollment information to reflect changes in ownership within 30 days. Owners are individuals or corporations with a 5 percent or more ownership or controlling interest. Failure to comply could result in revocation of your Medicare billing privileges. Resources:
- Timely Reporting of Provider Enrollment Information Changes (PDF) MLN Matters® Article
- 42 CFR 424.516
- Medicare: Vulnerabilities Related to Provider Enrollment and Ownership Disclosure OIG Report
- PECOS Enrollment Tutorial - Change of Information for an Individual Provider
- PECOS Enrollment Tutorial - Change of Information for an Organization/Supplier
- Updated Manual Guidelines for Electronic Funds Transfer Payments and Change of Ownership (PDF) MLN Matters Article
Claims, Pricers & Codes
The 2018 ICD-10-PCS (procedure) code update files are available on the 2018 ICD-10 PCS and GEMs webpage. General Equivalence Mappings (GEMs) will be posted on this webpage in August 2017.
The 2018 ICD-10-CM (diagnosis) updates will be available in June 2017.
Monday, May 22 from 1 to 2 pm ET
Visit the event webpage to register.
Join CMS for an overview webinar on the participation criteria used to determine inclusion in the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs):
- An overview of MIPS participation requirements for individual clinicians and groups
- Participation requirements for Advanced APMs and MIPS APMs
- A new tool that allows clinicians to check if they are included in MIPS
- The recent participation letter sent to clinician offices
Thursday, June 15 from 1:30 to 3 pm ET
To register or for more information, visit MLN Connects® Event Registration.
During this call, learn about appropriate assessment and evaluation for the accurate diagnosis of schizophrenia and other mental disorders. Also, find out about the DICE Approach™ - Describe, Investigate, Create, and Evaluate, a simple but comprehensive method to understand and support individuals living with dementia. 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 follows the presentations.
- Dr. Susan Levy, Medical Director/Consultant
- Dr. Helen Kales, University of Michigan
- Michele Laughman and Debbie Lyons, CMS
Target Audience: Consumer and advocacy groups, nursing home providers, surveyor community, prescribers, professional associations, and other interested stakeholders.
Medicare Learning Network Publications & Multimedia
Updated Manual Guidelines for Electronic Funds Transfer Payments and Change of Ownership MLN Matters Article — New
An MLN Matters Special Edition Article on Updated Manual Guidelines for Electronic Funds Transfer Payments and Change of Ownership (PDF) is available. Learn about revisions to Chapter 15, Section 18.104.22.168.5 of the Medicare Program Integrity Manual.
Prohibition on Billing Dually Eligible Individuals Enrolled in the QMB Program MLN Matters Article — Revised
An MLN Matters Special Edition Article on Prohibition on Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) Program (PDF) is available. Learn about the prohibition on billing beneficiaries enrolled in the QMB program for Medicare cost-sharing.
With Continuing Education Credit
A revised Avoiding Medicare Fraud & Abuse: A Roadmap for Physicians Web-Based Training (WBT) course is available through the Learning Management System. Learn about:
- Laws governing health care fraud and abuse
- Real fraud and abuse cases
- Medicare fraud and abuse resources
This newsletter is current as of the issue date. View the complete disclaimer (PDF).
The Medicare Learning Network®, MLN Connects®, and MLN Matters® are registered trademarks of the U.S. Department of Health and Human Services (HHS).