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MLN Connects for September 14,2017

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Thursday, September 14, 2017

News & Announcements

Provider Compliance

Upcoming Events

Medicare Learning Network Publications & Multimedia

View this edition as a PDF [PDF, 83KB]  


News & Announcements 


Quality Payment Program: New Resources Available

CMS posted new and updated resources on the Quality Payment Program website:

Additional resources are available on the Resource Library webpage.


September is Prostate Cancer Awareness Month

Prostate cancer is the most common non-skin cancer among American men. Talk to your Medicare patients about the nature and risk of prostate cancer and help them make an informed decision about screening.

For More Information:

Prostate cancer screening is promoted on your patients’ Medicare Summary Notices. Visit the Preventive Services website to learn more about Medicare-covered services.


Provider Compliance


Billing for Ambulance Transports — Reminder

In a September 2015 report, the Office of the Inspector General (OIG) released results of a study of Medicare Part B ambulance claims. According to the report, almost 20 percent of ambulance suppliers had inappropriate and questionable billing for ambulance transport, creating vulnerabilities to Medicare program integrity. The OIG identified a number of key problems, including:

  • Ambulance transports for beneficiaries who did not receive any Medicare services at the point of origin or destination
  • Transports to noncovered destinations
  • Excessive mileage reported on claims for urban transports
  • Medically unnecessary transports to partial hospitalization programs
  • Inappropriate transport service levels

Review the following resources to bill correctly for this service:


Upcoming Events


Qualified Medicare Beneficiary Program Billing Requirements 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 requirements 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 QMB Program 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.


  • 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.

Target Audience: 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.

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


Medicare Learning Network Publications & Multimedia


Office of Inspector General Reports Highlight Hospital Billing Issues MLN Matters® Article — New

An MLN Matters Special Edition Article on Office of Inspector General Reports Highlight Hospital Billing Issues is available. In recent reports, the Office of Inspector General cites two significant issues leading to coding errors on hospital Medicare claims. Learn about:

  • Improper use of modifier -59 for 96 or more continuous hours of mechanical ventilation
  • Incorrect procedure codes when billing for mechanical ventilation


PECOS for DMEPOS Suppliers Booklet — Reminder

A revised PECOS for DMEPOS Suppliers Booklet is available. Learn about:

  • Medicare enrollment application submission options in the Provider Enrollment, Chain and Ownership System (PECOS)
  • Individual and organizational Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers


Medicare Enrollment Resources Educational Tool — Reminder

The Medicare Enrollment Resources Educational Tool is available. Learn about:

  • How to enroll in the Medicare Program
  • What to do if you run into problems
  • Where to locate enrollment forms



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