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Date
2017-08-24
Subject
MLN Connects for August 24,2017

Thursday, August 24, 2017

News & Announcements

Provider Compliance

Upcoming Events

Medicare Learning Network Publications & Multimedia

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News & Announcements 

 

CMS Launches Jimmo Settlement Agreement Webpage

Looking for information about the Jimmo Settlement Agreement? Visit the new Jimmo Settlement Agreement webpage for:

  • Background on the settlement
  • Links to resources
  • Frequently Asked Questions (FAQs)

The Centers for Medicare & Medicaid Services (CMS) reminds the Medicare community of the Jimmo Settlement Agreement (January 2013), which clarified that the Medicare program covers skilled nursing care and skilled therapy services under Medicare’s skilled nursing facility, home health, and outpatient therapy benefits when a beneficiary needs skilled care in order to maintain function or to prevent or slow decline or deterioration (provided all other coverage criteria are met). Specifically, the Jimmo Settlement required manual revisions to restate a “maintenance coverage standard” for both skilled nursing and therapy services under these benefits:

  • Skilled nursing services would be covered where such skilled nursing services are necessary to maintain the patient's current condition or prevent or slow further deterioration so long as the beneficiary requires skilled care for the services to be safely and effectively provided.
  • Skilled therapy services are covered when an individualized assessment of the patient's clinical condition demonstrates that the specialized judgment, knowledge, and skills of a qualified therapist (“skilled care”) are necessary for the performance of a safe and effective maintenance program. Such a maintenance program to maintain the patient's current condition or to prevent or slow further deterioration is covered so long as the beneficiary requires skilled care for the safe and effective performance of the program.

The Jimmo Settlement may reflect a change in practice for those providers, adjudicators, and contractors who may have erroneously believed that the Medicare program covers nursing and therapy services under these benefits only when a beneficiary is expected to improve. The Settlement is consistent with the Medicare program’s regulations governing maintenance nursing and therapy in skilled nursing facilities, home health services, and outpatient therapy (physical, occupational, and speech) and nursing and therapy in inpatient rehabilitation hospitals for beneficiaries who need the level of care that such hospitals provide.

 

Provider Compliance

 

CMS Provider Minute: Preventive Services Video

Proper payment and sufficient documentation go hand in hand. The CMS Provider Minute: Preventive Services video includes pointers to help you avoid claim denials. Learn how to submit the correct documentation for:

  • Time spent providing a service
  • Record of billed service
  • Physician signature

This video is part of a series to help providers of all types improve in areas identified with a high degree of noncompliance.

 

Upcoming Events

 

IMPACT Act: Medicare Spending Per Beneficiary Measures Call — September 6

Wednesday, September 6 from 1:30 to 3 pm ET

Register for Medicare Learning Network events.

During this call, CMS and measure developers present information on the adopted Medicare Spending per Beneficiary Post-Acute Care (PAC) resource use measures, focusing on the components of each measure, as well as public reporting. A question and answer session follows the presentation.

The Improving Medicare Post-Acute Care Transformation of 2014 (IMPACT Act) requires the development of resource use measures for PAC providers, including skilled nursing facilities, home health agencies, inpatient rehabilitation facilities, and long-term care hospitals.

Target Audience: PAC providers, health care industry professionals, clinicians, researchers, health IT vendors, and other interested stakeholders.

 

Nursing Home Facility Assessment Tool and State Operations Manual Revisions Call — September 7

Thursday, September 7 from 1:30 to 3 pm ET

Register for Medicare Learning Network events.

During this call, learn about the new Facility Assessment Tool to help identify and develop the specific assessment of your facility. Also, find out about frequently asked questions related to revision of the State Operations Manual Appendix PP for Phase 2 of the Reform of Requirements for Long-Term Care Facilities final rule. A question and answer session follows the presentation.

Speakers:

  • Kelly O’Neill, Stratis Health
  • CMS Experts

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

 

Qualified Medicare Beneficiary Program Billing Rules Call — September 19

Tuesday, September 19 from 1:30 to 3 pm ET

Register for Medicare Learning Network events.

During this call, CMS experts discuss the Qualified Medicare Beneficiary (QMB) billing rules and their implications. Find out about upcoming changes to the HIPAA Eligibility Transaction System (HETS) and remittance advice to identify the QMB status of your patients and exemption from cost-sharing. Also, learn key steps to promote compliance.

Medicare providers may not bill people in the QMB program for Medicare deductibles, coinsurance, or copays. Visit the Medicare-Medicaid General Information webpage for more information.

Target Audience: Medicare Part A and B providers, medical billing specialists, practice administrators, IT vendors, health care industry professionals, and other interested stakeholders.

 

Reporting Hospice Quality Data: Tips for Compliance Call — September 20

Wednesday, September 20 from 1:30 to 3 pm ET

Register for Medicare Learning Network events.

During this call, learn more about Hospice Quality Reporting Program requirements. Find out how to be compliant and successfully submit Hospice Item Set (HIS) data and the Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey in the next reporting year. A question and answer session follows the presentation.

Topics:

  • HIS and CAHPS® submission requirements
  • Reasons for noncompliance and how to address them
  • Timelines for data submission and compliance determinations
  • Resources for success, including how to access important websites and helpdesks 

Target Audience: Hospice providers.

 

PQRS: Feedback Reports and Informal Review Process for PY 2016 Results Call — September 26

Tuesday, September 26 from 1:30 to 3 pm ET

Register for Medicare Learning Network events.

Learn about Physician Quality Reporting System (PQRS) downward payment adjustments, PQRS feedback reports, and the informal review process for Program Year (PY) 2016 results and 2018 payment adjustment determinations. 

Note: 2016 was the last program year for PQRS. PQRS transitioned to the Merit-based Incentive Payment System (MIPS) under the Quality Payment Program. The final data submission timeframe for reporting 2016 PQRS quality data to avoid the 2018 PQRS downward payment adjustment was January through March 2017. The first MIPS performance period is January through December 2017. For more information, visit the Quality Payment Program website.

This event is being evaluated by CMS for CME and CEU continuing education credit (CE). Check the event webpage for CE Activity Information & Instructions.

Physicians; individual eligible professionals; group practices; Comprehensive Primary Care practice sites; Accountable Care Organizations; therapists; practice managers; medical and specialty societies; payers; and insurers.

 

Physician Compare Call — September 28

Thursday, September 28 from 1:30 to 3 pm ET

Register for Medicare Learning Network events.

Are you interested in learning more about Physician Compare? Find out about the:

  • Upcoming 30-day preview period for the 2016 performance data targeted for release in December
  • Future of public reporting and what is coming in the next year

Learn how to review your performance information before it is published. A question and answer session follows the presentation.

This event is being evaluated by CMS for CME and CEU continuing education credit (CE). Check the event webpage for CE Activity Information & Instructions.

Target audience: Physicians and other clinicians; medical groups; practice managers; medical and specialty societies; and other interested stakeholders

 

Comparative Billing Report on Modifier 25 Dermatology Webinar — October 11

Wednesday, October 11 from 3 to 4 pm ET

Join us for a discussion of the comparative billing report on Modifier 25 Dermatology (CBR201708), an educational tool for providers who submit claims for established patient evaluation and management services appended with modifier 25. During the webinar, 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

 

Mass Immunizers and Roster Billing Booklet — Revised

A revised Mass Immunizers and Roster Billing Booklet is available. Learn about:

  • Requirements for mass immunizers
  • Roster billing
  • Centralized billing

 

Beneficiaries in Custody under a Penal Authority Fact Sheet — Revised

A revised Beneficiaries in Custody under a Penal Authority Fact Sheet is available. Learn about:

  • Medicare policy background
  • Determining whether a Medicare beneficiary is in custody under a penal statute or rule
  • Medicare claims processing
  • Exception to Medicare policy
  • Medicare appeals
  • Social Security Administration policy on beneficiaries in custody
  • How Medicare receives data for incarcerated beneficiaries

 

Chronic Care Management Services Changes for 2017 Fact Sheet — Reminder

A revised Chronic Care Management Services Changes for 2017 Fact Sheet is available. Learn about:

  • 2017 coding changes
  • Key improvements reducing requirements associated with initiating care

 

 


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