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Date
2017-06-22
Subject
MLN Connects for June 22, 2017

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Thursday, June 22, 2017

News & Announcements

Provider Compliance

Upcoming Events

Medicare Learning Network Publications & Multimedia

 

  View this edition as PDF [PDF, 326KB]  

 

News & Announcements

 

CMS Proposes Quality Payment Program Updates to Increase Flexibility and Reduce Burdens

Proposed rule aims to simplify reporting requirements and offer support for doctors and clinicians in 2018

On June 20, CMS issued a proposed rule that would make changes in the second year of the Quality Payment Program as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). CMS’s goal is to simplify the program, especially for small, independent, and rural practices, while ensuring fiscal sustainability and high-quality care within Medicare.

“We’ve heard the concerns that too many quality programs, technology requirements, and measures get between the doctor and the patient,” said CMS Administrator Seema Verma. “That’s why we’re taking a hard look at reducing burdens. By proposing this rule, we aim to improve Medicare by helping doctors and clinicians concentrate on caring for their patients rather than filling out paperwork. CMS will continue to listen and take actionable steps towards alleviating burdens and improving health outcomes for all Americans that we serve.”

The proposed rule would amend some existing requirements and also contains new policies for doctors and clinicians participating in the Quality Payment Program that would encourage participation in either Advanced Alternative Payment Models or the Merit-based Incentive Payment System. If finalized, the proposed rule would further advance the agency’s goals of regulatory relief, program simplification, and state and local flexibility in the creation of innovative approaches to healthcare delivery.

See full text of this excerpted Press Release (issued June 20).

For More Information:

 

Coming in April 2018: New Medicare Card – New Number

Medicare is taking steps to remove Social Security numbers from Medicare cards. In April 2018, people with Medicare will begin receiving new Medicare cards, replacing all cards by April 2019. These cards will have a Medicare Beneficiary Identifier (MBI) number that is randomly generated with “non-intelligent” characters that do not have any hidden or special meaning.

If you currently send Railroad Retirement Board (RRB) Medicare claims to the RRB Specialty Medicare Administrative Contractor, Palmetto GBA, you will notice a change with the new cards:

  • You will no longer be able to distinguish people with Railroad Medicare by the number on the card
  • The RRB will continue to send cards with the RRB logo to people with Railroad Medicare.
  • We will return a message on the eligibility transaction response for a Railroad Medicare patient. The message will say, “Railroad Retirement Medicare Beneficiary”  in  271 Loop 2110C, Segment MSG.
  • If you use eligibility service vendors to check patient Medicare eligibility, contact them to find out how to get this and other information.

Keep your colleagues up to date on the transition to the MBI by posting a widget to your webpage.  

 

Quality Payment Program: New Resources Available

CMS posted new resources on the Quality Payment Program Resource Library webpage to help clinicians successfully participate in the first year of the Merit-based Incentive Payment System (MIPS):

For More Information:

 

Quality Payment Program: View Recordings of Recent Webinars

View all Quality Payment Program webinar recordings, presentations, and transcripts on the Quality Payment Program Events webpage.

Two recent webinars:

 

Quality Measure Development Plan Annual Report

On June 15, CMS posted the Measure Development Plan (MDP) 2017 Annual Report, describing our progress developing clinician quality measures to support the Quality Payment Program. The first MDP Annual Report shows important gains in finding quality measurement that is:

  • Easier for clinicians
  • Means more to stakeholders
  • Able to make health care delivery better for patients, families, and caregivers

For more information, visit the MACRA website.

 

SNF QRP Review and Correct Reports Available

Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Review and Correct reports are available on demand in the CMS Certification and Survey Provider Enhanced Reporting (CASPER) application. Log into the CMS Network using your CMSNet user ID and password to access the “Welcome to the CMS QIES Systems for Providers” webpage, then select the CASPER Reporting link to locate your reports.

These reports:

  • Contain quality measure information at the facility level
  • Allow providers to obtain aggregate performance for the past four full quarters (when data is available)
  • Include data submitted prior to the applicable quarterly data submission deadlines
  • Display whether the data correction period for a given calendar year quarter is “open” or “closed”

Note: Quality measure data for Quarter 1, 2017 has been recalculated and providers are encouraged to request the corrected report to view updated measure results.

 

2015 Physician and Other Supplier Utilization and Payment Data

CMS released the Physician and Other Supplier Public Use File (PUF) with data for 2015. The PUF contains summarized information on Part B services and procedures provided to Medicare beneficiaries by physicians and other healthcare professionals. The data includes information on utilization; payment; and submitted charges organized by National Provider Identifier, Healthcare Common Procedure Coding System code, and place of service. The new 2015 dataset has information for over 1 million distinct health care providers who collectively received $94 billion in Medicare payments. Visit the Physician and Other Supplier Data webpage for more information.

 

2015 Referring DMEPOS Utilization and Payment Data

CMS released the Referring Provider Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Public Use File (PUF) with data for 2015. The PUF contains summarized information on physicians and other healthcare professionals who referred DMEPOS products and services for Medicare beneficiaries. The data includes information on utilization; payment; and submitted charges organized by National Provider Identifier, Healthcare Common Procedure Coding System code, and supplier rental indicator. The new 2015 dataset has information for over 370,000 distinct health care providers who collectively referred DMEPOS products and services in the amount of $8.2 billion in Medicare payments. Visit the Medicare Referring Provider DMEPOS Data webpage for more information.

 

Hospice QRP: Clarifying Coding Guidance for Hospice Item Set

CMS is clarifying coding guidance for Response option J, Self-pay for Item A1400 on V2.00.0 of the Hospice Item Set. For more instruction, review the updated guidance as well as the master guidance on A1400 located on the Hospice Item Set (HIS) webpage.

 

IRFs & LTCHs: Reminder to Review QRP Provider Preview Reports by June 30

Inpatient Rehabilitation Facility (IRF) and Long-Term Care Hospital (LTCH) Quality Reporting Program (QRP) Provider Preview Reports are available with October 1, 2015, to September 30, 2016, data. We will not correct underlying data; however, you can request a CMS review until June 30 if you believe your data is inaccurate. In September, CMS will publicly display refreshed IRF and LTCH Compare data.

Note: Central Line Associated Blood Stream Infections (CLABSI) data is not displayed on the Provider Preview Reports due to an error in the Centers for Disease Control and Prevention data. Footnote 4 will show “Not Available”, “Data suppressed by CMS for one or more quarters” on the Provider Preview Reports for this measure for LTCHs.  

For More Information:

 

Hospices: Reminder to Review Provider Preview Reports by June 30

Provider Preview Reports for the Hospice Item Set (HIS) are available with October 1, 2015, to September 30, 2016, data. If you believe your quality measure results are inaccurate, you can request a CMS review until June 30. This summer, CMS will release Hospice Compare data for the first time. You may continue to submit corrections to your HIS data for 36 months beyond the target date on a given assessment; corrections will be reflected in subsequent quarterly preview reports and Compare refreshes.

For More Information:

 

Minority Research Grant Program: Apply by July 10

For FY 2017, CMS announced two funding opportunities for systems level (e.g. health plans, hospitals, health systems) collaborative research that explores solutions to disparities that are prevalent in cardiovascular health, pre-diabetes, diabetes, and/or kidney disease among minority populations. The following may apply:

The funding period is for two years and the amount of each grant is $325,000. Applications are due by July 10, 2017. To qualify for the grant, academic institutions/organizations must meet the program requirements. See the Minority Research Grant Program webpage or contact HealthEquityTA@cms.hhs.gov for more information.

 

Provider Compliance

 

Hospice Election Statements Lack Required Information or Have Other Vulnerabilities

After a stratified random sample review of hospice election statements and certifications of terminal illness, the Office of the Inspector General (OIG) reports that more than one-third of hospice General Inpatient (GIP) stays lack required information or had other vulnerabilities.

  • Hospice election statements did not always mention – as required – that the beneficiary was waiving coverage of certain Medicare services by electing hospice care or that hospice care is palliative rather than curative
  • In 14 percent of GIP stays, the physician did not meet requirements when certifying that the beneficiary was terminally ill and appeared to have limited involvement in determining that the beneficiary’s condition was appropriate for hospice care

Hospices should improve their election statements and ensure that physicians meet requirements when certifying beneficiaries for hospice care. Resources:

 

Upcoming Events

 

CLIA Certificate of Provider-performed Microscopy Webcast — June 28

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

Register for Medicare Learning Network events.

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

Register for Medicare Learning Network events.

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.

 

Quality Payment Program Year 2 Proposed Rule Listening Session — July 5

Wednesday July 5 from 2 to 3:30 pm ET

Register for Medicare Learning Network events.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable Growth Rate formula and established the Quality Payment Program, improving Medicare by helping doctors and other clinicians focus on care quality and making patients healthier. If you participate in Medicare Part B, the Quality Payment Program provides new tools and resources to help you give your patients the best possible care.

This listening session is an opportunity for stakeholders to learn about proposed policy for the Quality Payment Program. Participants are encouraged to review the proposed rule prior to the listening session.

If time allows, we will open the lines for feedback. Note: feedback received during the listening session will not be considered formal comments on the rule. See the proposed rule for information on submitting these comments by the close of the 60-day comment period on August 21, 2017.

Target Audience: Part B Fee-For-Service clinicians and practice managers; state and national associations that represent healthcare providers; and other stakeholders.

 

Creating and Verifying Your National Provider Identifier Call — July 12

Wednesday, July 12 from 2 to 3:30 pm ET

Register for Medicare Learning Network events.

It is now easier to create, verify, or look up your National Provider identifier (NPI) using the National Plan and Provider Enumeration System (NPPES). During this call, CMS experts provide step–by-step details on the improved NPPES process. A question and answer session follows the presentation.

Target Audience: All providers/suppliers

 

Medicare Learning Network Publications & Multimedia

 

Provider Enrollment Revalidation – Cycle 2 MLN Matters Article — Revised

An MLN Matters Special Edition Article on Provider Enrollment Revalidation – Cycle 2 is available. The article was revised to change the effective date of deactivations due to non-billings from 5 days from the date of the deactivation letter to 10 days.

 

Complying with Medical Record Documentation Requirements — Revised

A revised Complying with Medical Record Documentation Requirements Fact Sheet is available.

Learn about:

  • Proper medical record documentation requirements
  • How to provide accurate and supportive medical record documentation


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