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MLN Connects for July 13, 2017

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 Thursday, July 13, 2017

News & Announcements

Provider Compliance

Claims, Pricers & Codes

Upcoming Events

Medicare Learning Network Publications & Multimedia

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News & Announcements 


New Medicare Cards with New Numbers: 3 Changes You May Need to Make

The Medicare Access and CHIP Reauthorization Act of 2015 requires CMS to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. CMS will begin mailing new Medicare cards with a new Medicare number (currently called the Medicare Claim Number on cards) to your patients in April 2018. You may need to change your systems to:

  • Accept the new Medicare number (Medicare Beneficiary Identifier or MBI).  Use the MBI format specifications if you currently have edits on the current Health Insurance Claim Number (HICN).
  • Identify your patients who qualify for Medicare under the Railroad Retirement Board (RRB). You will no longer be able to distinguish RRB patients by the number on the new Medicare card. You will be able to identify them by the RRB logo on their card, and we will return a message on the eligibility transaction response for a RRB patient. The message will say, “Railroad Retirement Medicare Beneficiary” in 271 Loop 2110C, Segment MSG. If you use the number only to identify your RRB patients beginning in April 2018, you must identify them differently to send Medicare claims to the RRB Specialty Medicare Administrative Contractor, Palmetto GBA.
  • Update your practice management system’s patient numbers to automatically accept the new Medicare number or MBI from the remittance advice (835) transaction. Beginning in October 2018, through the transition period, CMS will return your patient’s MBI on every electronic remittance advice for claims you submit with a valid and active HICN. It will be in the same place you currently get the “changed HICN”:  835 Loop 2100, Segment NM1 (Corrected Patient/Insured Name), Field NM109 (Identification Code).

If you use vendors to bill Medicare, contact them if they haven’t already shared their new Medicare card system changes with you; they can also tell you how they will pass the new Medicare number to you.  Visit the New Medicare Card Provider webpage for the latest information.


QRDA III Implementation Guide Available

CMS published the 2017 CMS Quality Reporting Document Architecture Category III (QRDA III) Implementation Guide Version 1.0 (7/07/2017) for eligible clinician and eligible professional programs with Schematron and sample files, replacing Version 0.1 (12/29/2016). The guide provides technical instructions for QRDA III reporting for the following programs:

  • Merit-based Incentive Payment System (MIPS)
  • Comprehensive Primary Care Plus

For More Information:


Quality Payment Program: View Recent Webinar Recordings

Unable to participate in a recent Quality Payment Program webinar? View webinar recordings, presentations, and transcripts on the Events webpage:


Hospital Discharge Notices

The following updated notices have been approved by the Office of Management and Budget. Hospitals and Critical Access Hospitals must use these notices no later than Monday, August 28.

Find issuance guidelines at Section 200 in Chapter 30 of the Medicare Claims Processing Manual.


IPPS Hospitals: FY 2014 S-10 Revisions

Amended cost reports must be received by September 30, 2017

Some Inpatient Prospective Payment System (IPPS) hospitals have requested CMS provide them with an additional opportunity to revise the Worksheet S-10 submitted with their FY 2014 cost reports (starting on or after October 1, 2013, and prior to October 1, 2014). Amended FY 2014 cost reports due to revised or initial submissions of Worksheet S-10 received by Medicare Administrative Contractors on or before September 30, 2017, will be uploaded to the Healthcare Cost Report Information System by December 2017. Providers must follow the current requirements for electronic submission of cost reports found at 42 CFR §413.24(f)(4), which includes submitting:

  • Hard copy of a settlement summary
  • Statement of certain worksheet totals found within the electronic file
  • Statement signed by its administrator or chief financial officer certifying the accuracy of the electronic file or the manually prepared cost report

Requests to amend or submit FY 2014 worksheet S-10 received after September 30, 2017, will still be accepted under normal timelines and procedures. Revisions to Worksheet S-10 from other fiscal years, revisions to other worksheets of the FY 2014 cost reports, or revisions to Worksheet S-10 by non-IPPS hospitals are not subject to this instruction.


Recognizing National HIV Testing Day

On June 27, the Centers for Disease Control and Prevention hosted the annual National HIV Testing Day (NHTD), including employee education; testing day events; and digital and partner engagement. NHTD encourages Americans to seek HIV testing; healthcare providers to offer HIV testing in clinical and non-clinical settings; and clinicians to complete free training on how to incorporate routine HIV screening into their practices.

Estimated annual HIV infections have declined 18% between 2008 and 2014, but there are still 1.1 million people living with HIV—15% of whom do not know they have it. Most new HIV infections (92%) are transmitted by persons who don’t know they’re infected or who are not receiving treatment. HIV testing saves lives.

For More Information:


Provider Compliance


OIG Video: Reporting Fraud to the Office of the Inspector General

Do you suspect someone is submitting fraudulent claims to Medicare? Watch a brief video on How to Report Fraud to the OIG and learn how you can report these activities anonymously to The Office of the Inspector General (OIG). Help protect the Medicare Program and your patients.

This video is part of the OIG Health Care Fraud Prevention and Enforcement Action Team (HEAT) Provider Compliance Training initiative to prevent fraud, waste, and abuse. The video originally aired in 2011, but the information is current.


Claims, Pricers & Codes


ICD-10-CM Errata Available

The Centers for Disease Control and Prevention issued an errata, which makes a minor change to the ICD-10-CM diagnosis code title of new diagnosis code O00.212 (Left ovarian pregnancy with intrauterine pregnancy). Visit the ICD-10-CM and GEMs website for more information.


Upcoming Events


Revised Interpretive Guidance for Nursing Homes and New Survey Process Call — July 25

Tuesday, July 25 from 1:30 to 3 pm ET

Register for Medicare Learning Network events.

CMS experts discuss the revised Interpretive Guidance for Nursing Homes and the new Survey Process effective November 28, 2017. Learn about the major components of Phase 2 implementation, changes to the survey process, and training resources available to the public. A question and answer session follows the presentation.

You may email questions in advance of the call to NHSurveyDevelopment@cms.hhs.gov. Questions received in advance of the call may be addressed during the call or used for other materials following the call.

Target Audience: Nursing home providers; surveyor community; prescribers, professional associations; consumer and advocacy groups; and other interested stakeholders.


ESRD QIP: Proposed Rule for Payment Year 2021 Listening Session — July 26

Wednesday, July 26 from 2 to 3 pm ET

Register for Medicare Learning Network events.

During this call, learn about provisions in the CY 2018 End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) proposed rule, including plans for the program in Payment Years (PY) 2019, 2020, and 2021. Topics include:

  • ESRD QIP legislative framework
  • Proposed measures, standards, scoring method, and payment reduction scale for PY 2021
  • Proposed modifications to PY 2019 and PY 2020 activities
  • Methods for reviewing and commenting on the proposed rule

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 28.

Target Audience: Dialysis clinics and organizations, nephrologists, hospitals with dialysis units, billers/coders, and quality improvement experts.


IRF Quality Reporting Program Refresher Training Webinar — August 15

Tuesday, August 15 from 2 to 4 pm ET

CMS is hosting a webinar for Inpatient Rehabilitation Facility (IRF) providers. Visit the IRF Quality Reporting Training webpage for more information and to register.


Comparative Billing Report on Drugs of Abuse Testing Webinar — August 23

Wednesday, August 23 from 3 to 4 pm ET

Join us for a discussion of the comparative billing report on Drugs of Abuse Testing (CBR201706), an educational tool for Medicare part B providers who referred or ordered these procedures with presumptive and/or definitive testing. During the webinar, providers interact directly with content specialists and submit questions about the report. See the announcement for more information and find out how to participate.


Medicare Learning Network Publications & Multimedia


CLIA Webcast: Audio Recording and Transcript — New

An audio recording and transcript are available for the June 28 webcast on the Clinical Laboratory Improvement Amendments (CLIA) Certificate of Provider-performed Microscopy (PPM). 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.


Appeals Call: Audio Recording and Transcript — New

An audio recording and transcript are available for the June 29 call on Improvements to the Medicare Claims Appeal Process and Statistical Sampling. During this call, CMS and the Office of Medicare Hearings and Appeals discuss the HHS Medicare Appeals Final Rule.


Acute Care Hospital Inpatient Prospective Payment System Booklet — Reminder

A revised Acute Care Hospital Inpatient Prospective Payment System Booklet is available. Learn about:

  • Basis for IPPS payment, payment rates, how payment rates are set, and payment updates
  • Hospital Inpatient Quality Reporting and Electronic Health Record Meaningful User Incentive Programs


Skilled Nursing Facility Prospective Payment System Booklet — Reminder

A revised Skilled Nursing Facility Prospective Payment System Booklet is available. Learn about:

  • Elements of the Skilled Nursing Facility (SNF) Prospective Payment System
  • SNF Quality Reporting Program
  • SNF Value-Based Purchasing Program


Ambulatory Surgical Center Fee Schedule Fact Sheet — Reminder

A revised Ambulatory Surgical Center Fee Schedule Fact Sheet is available. Learn about:

  • Definition of an Ambulatory Surgical Center (ASC)
  • ASC payment and payment rates
  • Updates to the ASC Fee Schedule
  • ASC Quality Reporting Program


Ambulance Fee Schedule Fact Sheet — Reminder

A revised Ambulance Fee Schedule Fact Sheet is available. Learn about:

  • Medicare Part B ambulance transport benefit
  • Ambulance providers and suppliers
  • Advance Beneficiary Notice of Noncoverage
  • Payments, how payment rates are set, and updates to the Ambulance Fee Schedule


Health Professional Shortage Area Physician Bonus Program Fact Sheet — Reminder

A revised Health Professional Shortage Area Physician Bonus Program Fact Sheet is available. Learn about the definition of a Health Professional Shortage Area (HPSA) and the HPSA bonus payment.


Suite of Products & Resources for Billers & Coders Educational Tool — Reminder

A revised Medicare Learning Network Suite of Products & Resources for Billers & Coders Educational Tool is available. Learn about:

  • Claims submission
  • Federal initiatives and incentive programs


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