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MLN Connects for June 1, 2017

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Thursday, June 1, 2017

News & Announcements

Provider Compliance

Claims, Pricers & Codes

Upcoming Events

Medicare Learning Network Publications & Multimedia

  View this edition as a PDF [PDF, 96KB]  


News & Announcements


New Medicare Cards Offer Greater Protection to More Than 57.7 Million Americans

New cards will no longer contain Social Security numbers, to combat fraud and illegal use

CMS is readying a fraud prevention initiative that removes Social Security numbers from Medicare cards to help combat identity theft and safeguard taxpayer dollars. The new cards will use a unique, randomly-assigned number called a Medicare Beneficiary Identifier (MBI), to replace the Social Security-based Health Insurance Claim Number currently used on the Medicare card. CMS will begin mailing new cards in April 2018 and will meet the congressional deadline for replacing all Medicare cards by April 2019. On May 30, CMS kicked-off a multi-faceted outreach campaign to help providers get ready for the new MBI.

“We’re taking this step to protect our seniors from fraudulent use of Social Security numbers which can lead to identity theft and illegal use of Medicare benefits,” said CMS Administrator Seema Verma. “We want to be sure that Medicare beneficiaries and healthcare providers know about these changes well in advance and have the information they need to make a seamless transition.”

Providers and beneficiaries will both be able to use secure look up tools that will support quick access to MBIs when they need them. There will also be a 21-month transition period where providers will be able to use either the MBI or the HICN further easing the transition

CMS is committed to a successful transition to the MBI for people with Medicare and for the health care provider community. CMS has a website dedicated to the Social Security Removal Initiative (SSNRI) where providers can find the latest information and sign-up for newsletters. CMS is also planning regular calls as a way to share updates and answer provider questions before and after new cards are mailed beginning in April 2018.

See the full text of this excerpted CMS Press Release (issued May 30).


EHR Incentive Programs: Submit Comments on Proposed Changes by June 13

Submit a formal comment on the FY 2018 Inpatient Prospective Payment System and Long Term Acute Care Hospital Proposed Rule by June 13, 2017. The proposed rule includes potential changes to the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, including:

  • For CY 2018, modifying the EHR reporting period from the full calendar year to a minimum of any continuous 90-day period for new and returning participants in the Medicare and Medicaid EHR Incentive programs
  • Adding a new exception from the Medicare payment adjustments for Eligible Professionals (EPs), eligible hospitals, and critical access hospitals that demonstrate through an application process that complying with the requirement for being a meaningful EHR user is not possible if ONC’s Health IT Certification Program has decertified their certified EHR technology
  • Implementing a policy in which no payment adjustments will be made for EPs who furnish “substantially all” of their covered professional services in an Ambulatory Surgical Center (ASC); applicable for the 2017 and 2018 Medicare payment adjustments
  • Using Place of Service (POS) code 24 to identify services furnished in an ASC, as well as requesting public comment on whether other POS codes or mechanisms should be used to identify sites of service in addition to or in lieu of POS code 24

For More Information:


New Quality Payment Program Resources Available

CMS recently revamped the look of the Quality Payment Program website and posted new resources to help clinicians successfully participate in the first year of the Quality Payment Program:

  • MIPS Quick Start Guide: Outlines the steps Merit-based Incentive Payment System (MIPS) clinicians need to take between now and March 2018 to prepare for and participate in MIPS
  • 2017 CAHPS for MIPS Conditionally-Approved Survey Vendor List: Includes contact information for the list of conditionally-approved survey vendors to administer the Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS Survey in 2017
  • Medicare Shared Savings Program and Quality Payment Program Fact Sheet: Explains how the Shared Savings Program and the Quality Payment Program align reporting requirements for participating Accountable Care Organizations (ACOs) and MIPS clinicians and how certain tracks in Shared Savings Program ACOs meet Advanced Alternative Payment Model (APM) criteria under the Quality Payment Program
  • MIPS APM Fact Sheet: Provides an overview of this specific type of APM and the special APM scoring standard

For More Information:


Review 2017 EHR Incentive Program Requirements

Review the 2017 program requirements for the Medicare Electronic Health Record (EHR) Incentive Program:

  • Eligible professionals (EPs) who demonstrated meaningful use successfully in a prior year can determine participation status through the Quality Payment Program look up tool. Find out if you should participate in the Merit-based Incentive Payment System (MIPS) this year and where to find resources. 
  • If you are new to Medicare in 2017, you do not participate in MIPS. You may also be exempt if you qualify for one of the special rules for certain types of clinicians or are participating in an Advanced Alternative Payment Model. To learn more, review the MIPS Participation Fact Sheet
  • If you are not in the Quality Payment Program in 2017, you can participate voluntarily, and you will not be subject to payment adjustments. 
  • CMS recently mailed letters notifying clinicians of their MIPS participation status. See sample on the Educational Resources webpage.
  • For EPs who are participating in the Medicare EHR Incentive Program for the first time in 2017, you must take one of the following actions by October 1, 2017, to avoid the 2018 payment adjustment: Attest to the Modified Stage 2 2017 EHR Incentive Program requirements or submit a one-time hardship exception application if you are transitioning to the MIPS path of the Quality Payment Program and plan to report on measures specified for the Advancing Care Information performance category


CY 2017 eCQM Resources and Tools 

CMS posted updated resources on the QualityNet and Quality Reporting Center websites to assist with the reporting of CY 2017 electronic Clinical Quality Measure (eCQM) data for the hospital Inpatient Quality Reporting Program and the Medicare Electronic Health Record Incentive Program, including:

  • Available eCQMs
  • eCQM Overview
  • Preparation Checklists for Test and Production Files
  • EHR Report Overview


Provider Compliance


Automatic External Defibrillators: Inadequate Medical Record Documentation

Automatic External Defibrillator (AED) providers often submit claims that lack sufficient medical record documentation. Physicians and non-physician practitioners must follow Medicare requirements:

  • Before delivery of the AED, examine the beneficiary in-person within six months prior to the date of the written order.
  • Document that the beneficiary was evaluated and/or treated for a condition that supports the need for the AED.
  • Sign and date the order. As of November 10, 2015, physicians are not required to co-sign face-to-face encounters performed by non-physician practitioners.

Document and bill correctly for AEDs:


Claims, Pricers & Codes


Hospices: Submit Adjustments to Correct Payment Errors

Medicare has corrected most of the system errors associated with 2016 hospice service intensity add-on and routine home care payments; however, Medicare cannot accurately re-process claims for two issues. Hospices should submit claims adjustments as specified in MLN Matters® Special Edition Article SE17014.


Upcoming Events


National Partnership to Improve Dementia Care and QAPI Call — June 15

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 work of the Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) and how their efforts align with the National Partnership to Improve Dementia Care in Nursing Homes and Quality Assurance and Performance Improvement (QAPI). Additionally, CMS experts share updates on the progress of the National Partnership and QAPI. A question and answer session follows the presentations.


  • Dr. Susan Levy, Medical Director/Consultant
  • Kaylie Doyle, Telligen
  • Kelly O’Neill, Stratis Health
  • Michele Laughman and Debbie Lyons, CMS

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


CLIA Certificate of Provider-performed Microscopy Webcast — June 28

Wednesday, June 28 from 1:30 to 3 pm ET

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

During this webcast, learn about the Clinical Laboratory Improvement Amendments (CLIA) requirements for Provider-performed Microscopy (PPM) testing. Participants should review PPM Procedures: A Focus on Quality prior to the webcast.

CLIA established quality standards to ensure accuracy and reliability of patients’ test results regardless of where the test is performed. The CLIA Certificate for PPM procedures is issued to laboratories where physicians, mid-level practitioners or dentists perform specific microscopic examinations during the course of the patients’ visit.  

Target Audience: Physicians, mid-level practitioners, dentists, pathologists, laboratory directors, laboratories managers, point-of care testing coordinators, clinical laboratory scientists, and medical laboratories technicians.


Improvements to the Medicare Claims Appeal Process and Statistical Sampling Call — June 29

Thursday, June 29 from 1 to 3 pm ET

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

Are you aware of recent regulatory changes to the Medicare claims appeal process? During this call, CMS and the Office of Medicare Hearings and Appeals (OMHA) discuss the HHS Medicare Appeals Final Rule, published on January 17, 2017. Learn about changes intended to streamline the administrative appeal processes, reduce the backlog of pending appeals, and increase consistency in decision making across appeal levels. For an overview of the Final Rule, see the HHS fact sheet.

Did you know that certain appeals pending at OMHA may be eligible for more efficient adjudication through statistical sampling? Learn about the expansion of this program based on feedback from the pilot phase and how your participation may advance the adjudication of your appeals.

A question and answer session follows the presentation.

Target Audience: All Medicare Fee-For-Service providers.


Medicare Learning Network Publications & Multimedia


Required Workaround for Hospices Submitting RHC and SIA Payments at the End of Life MLN Matters Article — New

An MLN Matters Special Edition Article on Required Workaround for Hospices Submitting Routine Home Care (RHC) and Service Intensity Add-On (SIA) Payments at the End of Life is available. Learn about corrections to two errors for hospice payments that could result in overpayments.


SBIRT Services Booklet — Revised

A revised Screening, Brief Intervention, and Referral to Treatment (SBIRT) Services Booklet is available. Learn about:

  • SBIRT under Medicare and Medicaid
  • How to bill for dual eligibles


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

The Medicare Basics: Parts A and B Claims Overview video is available. Learn about Medicare claims, what you need to know before filing a claim, and how to submit a claim.


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

The 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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