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Date
2017-09-21
Subject
MLN Connects for September 21,2017

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Thursday, September 21, 2017

News & Announcements

Provider Compliance

Upcoming Events

Medicare Learning Network Publications & Multimedia

View this edition as a PDF [PDF, 198KB]   

 

News & Announcements 

 

Transition to New Medicare Numbers and Cards

CMS, through the Medicare Administrative Contractors (MACs), recently mailed letters to all Medicare Fee-For-Service providers about our work to assign new numbers (known as Medicare Beneficiary Identifiers or MBIs) and issue new Medicare cards to all people with Medicare beginning in April 2018.

Our top priorities are to make sure:

  • Your Medicare patients have continuous access to care.
  • You have the tools and information you need for a smooth transition. Starting in June 2018, you can look up your patients’ new Medicare numbers through your MAC’s secure web portal.

Carefully review the letter and accompanying fact sheet and find out how to prepare to accept the new number beginning in April 2018. Your letter will contain specific information for your MAC. You can also view a sample letter and print-friendly fact sheet.

We also recently unveiled the new Medicare card design and issued a press release with more information about the project.

 

2016 PQRS Feedback Reports and Annual QRURs Available

The 2016 Physician Quality Reporting System (PQRS) Feedback Reports and 2016 Annual Quality and Resource Use Reports (QRURs) are now available:

  • PQRS Feedback Reports provide program results for 2016, including if you are subject to the 2018 PQRS downward payment adjustment
  • The 2016 Annual QRURs show how physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists in groups and solo practitioners performed in 2016 on the quality and cost measures used to calculate the 2018 Value Modifier, as well as their practice’s 2018 Value Modifier payment adjustment

If you perceive that your payment adjustment status was made in error, you may request an informal review of your 2016 PQRS results and/or 2018 Value Modifier calculation during the informal review period that will close on December 1, 2017, at 8 p.m. ET:

An Enterprise Identify Management (EIDM) account with the appropriate role is required for participants to obtain their 2016 PQRS Feedback Reports and 2016 Annual QRURs. Both reports can be accessed on the CMS Enterprise Portal using the same EIDM account. Visit the How to Obtain a QRUR webpage for instructions on accessing both reports.

For More Information on Your PQRS Feedback Report:

For More Information on Your Annual QRUR:

Payment adjustments under the PQRS and Value Modifier programs end in 2018. The Merit-based Incentive Payment System under the new Quality Payment Program combines the PQRS, the Value Modifier program, and the Medicare Electronic Health Records Incentive Program for eligible professionals. To prepare for success in the Quality Payment Program, review your PQRS feedback report and annual QRUR. Visit the Quality Payment Program website to learn more.

Questions:

  • For assistance with Enterprise Identity Management or PQRS Feedback Reports, contact the QualityNet Help Desk at 866-288-8912 (TTY 877-715- 6222) or qnetsupport@hcqis.org
  • For assistance with the QRURs or Value Modifier, contact the Physician Value Help Desk at pvhelpdesk@cms.hhs.gov or 888-734-6433 (select option 3)
  • Both helpdesks are available from 7 am to 7 pm CT, Monday through Friday.

 

Hospice Provider Preview Reports Available through September 28

Hospice Provider Preview Reports are now available through September 28. Preview your quality measure results, based on first to fourth quarter 2016 data, prior to the November 2017 Hospice Compare refresh.

For More Information:

Incorrect Footnote “E” on Provider Preview Report:

If you receive footnote E, “Results are based on a shorter time period than required” in error, please note that your data will display correctly on Hospice Compare in November, and the issue will be corrected for your next quarterly report in December.

For questions, contact the QTSO Help Desk at help@qtso.com or 877-201-4721.

 

IRF and LTCH Provider Preview Reports: Review by September 30

Inpatient Rehabilitation Facility (IRF) and Long-term Care Hospital (LTCH) Quality Reporting Program Provider Preview Reports are now available through September 30. Review your performance data on each quality measure, based on first to fourth quarter 2016 data, prior to public display on IRF Compare and LTCH Compare in December. Corrections to the underlying data will not be permitted during this preview period; however, you can request a CMS review if you believe your data is inaccurate. 

For more information:

 

CMS Innovation Center New Direction RFI: Submit Comments by November 20

On September 20, the CMS Innovation Center (Innovation Center) issued an informal Request for Information (RFI) seeking feedback on a new direction to promote patient-centered care and test market-driven reforms that empower beneficiaries as consumers, provide price transparency, increase choices and competition to drive quality, reduce costs, and improve outcomes.

The Innovation Center welcomes stakeholder input. Submit comments online or to CMMI_NewDirection@cms.hhs.gov through November 20 at 11:59 pm ET. Visit the New Direction webpage for more information.

 

DME Appeals Demonstration: Respond to Reopening Document Request Letters

The Qualified Independent Contractor (QIC), C2C Innovative Solutions, Inc., conducts reopenings under the Medicare Appeals Demonstration in Jurisdictions C and D. C2C is sending Reopening Document Request Letters for appeals that are selected for potential reopening as part of the Durable Medical Equipment (DME) formal telephone discussion demonstration. If you receive a letter and C2C does not receive a response in the timeframe requested, they will be unable to further consider the appeal(s) for reopening under this Demonstration, and your appeal will maintain its current placement with the Office of Medicare Hearings and Appeals (OMHA).

Respond to Reopening Document Requests:

  • Fax to 904-224-2711, include the appeal number(s), or
  • Mail to C2C Innovative Solutions, Inc., Appeal # --, QIC DME - Formal Telephone Discussion Reopening Process, P.O. Box 44050 Jacksonville, FL  32231-4050

Make Sure You Receive Your Reopening Document Request Letter:

C2C is mailing letters to the address on the previously adjudicated reconsideration. If you use a separate billing agency for processing your reconsiderations or relocated after submission and completion of the QIC reconsideration, notify C2C of the correct address at DMEPDFeedback@c2cinc.com or 904-224-7349. 

If you decide not to proceed with your appeal at the OMHA, fax your request to withdrawal the appeal on your company letter head to 904-224-2711, specifying the appeal number.

For additional information see the Demonstration webpage.

 

Chronic Care Management: Connected Care Videos

The CMS Connected Care campaign has videos:

  • Physician Testimonial: A rural physician shares her experience offering Chronic Care Management (CCM) services (2 minutes)
  • Connecting the Dots (English and Spanish): This animated video provides CCM services information for Medicare beneficiaries living with multiple chronic conditions (30 seconds)

You can also download posters and postcards about CCM from the Connected Care website or request printed copies at no cost from the CMS Product Ordering website:

  • Postcard for Health Care Professionals (Pub # 909444): An overview of CCM, the four billing codes for payment, and how to learn more about implementation
  • Postcard for Consumers (English and Spanish, Pub #909443): Helps you explain CCM and its benefits
  • Poster (English and Spanish, Pub #909445): Display in office or waiting room to get your patient’s attention and help start the conversation

For More Information:

 

Quality Payment Program: Hardship Exception Application for 2017 Transition Year Available

The Quality Payment Program Hardship Exception Application for the 2017 transition year is available. Visit the Hardship Exceptions webpage for more information.

 

Hospital Quality Reporting Programs: eCQM Value Set Addendum Available

CMS issued an addendum to the electronic Clinical Quality Measure (eCQM) annual update specifications published in April 2016. The addendum updates the eCQM value sets, technical release notes, and the binding parameter specification for the 4th Quarter 2017 reporting period. These changes affect electronic reporting of eCQMs for the hospital inpatient quality reporting and Medicare and Medicaid Electronic Health Record Incentive Programs for eligible hospitals and critical access hospitals. Changes to the eCQM value sets are available through the National Library of Medicine’s Value Set Authority Center.

For More Information:

Provider Compliance

 

Medicare Hospital Claims: Avoid Coding Errors

In two recent reports, the Office of Inspector General (OIG) cited significant issues leading to coding errors on Medicare hospital claims:

Use the following resources to bill correctly and avoid overpayment recoveries:

 

 

Upcoming Events

 

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.

 

IMPACT Act and Improving Care Coordination: Special Open Door Forum — September 28

Thursday, September 28 from 2 to 3 pm ET

This Special Open Door Forum provides information and solicits feedback on the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act), including goals, item development, and opportunities to become involved over the next year. See the announcement for more information.

 

SNF QRP: Claims-Based Measures Confidential Feedback Report Webinar — September 28

Thursday September 28 from 1 to 2 pm ET

Register for the event. For more information, visit the SNF Quality Reporting Program Training webpage.

CMS provides information on the Confidential Feedback Reports for the claims-based measures adopted for the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP). These reports will be available in your Certification and Survey Provider Enhanced Reporting (CASPER) folder in early October 2017. A question and answer session follows the presentation.

Topics:

  • Claims-based Post-Acute Care Transformation Act of 2014 (IMPACT Act) measures and specifications
  • Confidential feedback report layout
  • Additional resources
  • Next steps

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

 

Home Health Agencies: Quality of Patient Care Star Rating Algorithm Call — October 10

Tuesday, October 10 from 2-3 pm ET

Register for Medicare Learning Network events.

During this call, learn about modifications and proposed changes to the way the Quality of Patient Care star rating is calculated, including the removal of the influenza measure. CMS presents the rationale, proposed timing, and impact of the changes. A question and answer session follows the presentation.

Target Audience: Medicare-certified Home Health Agencies.

 

2016 Annual QRURs Webcast — October 19

Thursday, October 19 from 1:30 to 3 pm ET

Register for Medicare Learning Network events.

2016 Annual Quality and Resource Use Reports (QRURs) are available for all group practices and solo practitioners nationwide. This event provides an overview of the report and explains how to interpret and use the information.

2016 Annual QRURs show how groups and solo practitioners performed in 2016 on the quality and cost measures used to calculate the 2018 Value-Based Payment Modifier (Value Modifier) and how the Value Modifier will be applied to payments for physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists. Learn more on the 2016 QRUR and 2018 Value Modifier webpage. This event will be more meaningful if you have your report in front of you to follow along. Visit How to Obtain a QRUR to access your report prior to the event.

Topics:

  • Overview of the 2018 Value Modifier and 2016 Annual QRUR
  • Information in the 2016 Annual QRUR and accompanying tables
  • How to access the 2016 Annual QRUR
  • How to request an informal review of your 2018 Value Modifier

CMS will use webcast technology for this event with audio streamed through your computer. Please note: if you are unable to stream audio through your computer, phone lines are available.

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, Medicare eligible professionals, medical group practices, practice managers, medical and specialty societies.

 

Medicare Learning Network Publications & Multimedia

 

IMPACT Act Call: Audio Recording and Transcript — New

An audio recording and transcript are available for the September 6 call on the Improving Medicare Post-Acute Care Transformation of 2014 (IMPACT Act). During this call, CMS and measure developers present information on the Medicare Spending per Beneficiary Post-Acute Care resource use measures, focusing on the components of each measure, as well as public reporting.

 

Hurricane Harvey and Medicare Disaster Related Texas Claims MLN Matters Article — Updated

The MLN Matters Special Edition Article on Hurricane Harvey and Medicare Disaster Related Texas Claims has been updated.  This article was revised to include information about replacement prescription fills of covered Part B drugs.  All other information remains the same.

 

Tropical Storm Harvey and Medicare Disaster Related Louisiana Claims MLN Matters Article — Updated

The MLN Matters Special Edition Article on Tropical Storm Harvey and Medicare Disaster Related Louisiana Claims has been updated. This article was revised to include information about replacement prescription fills of covered Part B drugs. All other information remains the same.

 

Hurricane Irma and Medicare Disaster Related United States Virgin Islands, Commonwealth of Puerto Rico and State of Florida Claims MLN Matters Article — Updated

The MLN Matters Special Edition Article on Hurricane Irma and Medicare Disaster Related United States Virgin Islands, Commonwealth of Puerto Rico and State of Florida Claims has been updated. This article was revised to include information about new waivers regarding care for excluded inpatient psychiatric unit patients in the acute care unit of a hospital and care for excluded inpatient rehabilitation unit patients in the acute care unit of a hospital. Information regarding replacement prescription fills of covered Part B drugs and Facilities Quality Reporting was also added.  All other information remains the same.

 

Hurricane Irma and Medicare Disaster Related South Carolina and Georgia Claims MLN Matters Article — Updated

The MLN Matters Special Edition Article on Hurricane Irma and Medicare Disaster Related South Carolina and Georgia Claims has been updated. This article was revised to include information about new waivers regarding care for excluded inpatient psychiatric unit patients in the acute care unit of a hospital and care for excluded inpatient rehabilitation unit patients in the acute care unit of a hospital. Information regarding replacement prescription fills of covered Part B drugs was also added. All other information remains the same.

 

Prohibition on Billing Dually Eligible Individuals Enrolled in the QMB Program MLN Matters Article — Revised

An MLN Matters Special Edition Article on Prohibition on Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) Program is available, including these revisions:

  • Upcoming system changes that identify the QMB status of beneficiaries and exemption from Medicare cost-sharing
  • Key ways to promote compliance with QMB billing rules
  • Types of providers that may seek reimbursement for unpaid deductible and coinsurance amounts as a Medicare bad debt

 

Global Surgery Fact Sheet — Revised

A revised Global Surgery Fact Sheet is available. Learn about:

  • Components of a global surgery package
  • Coding and billing guidelines
  • Payment rules

 

 


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