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Date
2017-11-09
Subject
MLN Connects for November 09, 2017
MLN Connects - Official CMS news from the Medicare Learning Network

Thursday, November 9, 2017

News & Announcements

Provider Compliance

Upcoming Events

Medicare Learning Network Publications & Multimedia

  View this edition as a PDF [PDF, 187KB]  

 

News & Announcements 

 

New Medicare Card: Help Notify Your Patients

CMS is starting to conduct a major education campaign about the new card for people with Medicare. Help alert your patients by displaying a poster in your office and giving your patients tear-off sheets or fliers.

Register then order these free color products:

  • Poster, 11”x17” (Product  #12009-P) limit-10
  • Pad of 50 tear-off sheets, 4”x 5.25” ( Product #12006) limit-25
  • Flyer English, 8.5”x11” (Product #12002) limit-100
  • Flyer Spanish, 8.5”x11” (Product #12002-S) limit-50

You can also print these products on 8.5”x11” paper. The poster and tear off sheets will be available in Spanish later this year.

 

Medicare Diabetes Prevention Program Expanded Model Implementation

On November 2, CMS issued the CY 2018 Physician Fee Schedule final rule, finalizing policies to implement the Medicare Diabetes Prevention Program (MDPP) expanded model starting in 2018:

  • Payment structure
  • Additional supplier enrollment requirements
  • Supplier compliance standards aimed to enhance program integrity

The MDPP expanded model is a structured intervention with the goal of preventing progression to type 2 diabetes in individuals with an indication of pre-diabetes.

For More Information:

 

Hospital Value-Based Purchasing Program Results for FY 2018

The Hospital Value-Based Purchasing (VBP) Program affects payment for inpatient stays in approximately 3,000 hospitals across the country. Hospitals’ payments depend on:

  • How well they performed – compared to their peers – on important healthcare quality and cost measures during a performance period
  • How much they have improved the quality of care provided to patients over time

For FY 2018, more hospitals will have an increase in their base operating Medicare Severity Diagnosis-Related Group (MS-DRG) payments than will have a decrease. In total, close to 1,600 hospitals will have a positive payment adjustment. About half of hospitals will see a small change in their base operating MS-DRG payments (between -0.5 and 0.5 percent). After taking into account the 2 percent withhold as required by law, the highest performing hospital in FY 2018 will receive a net increase in payments of slightly more than 3 percent, and the lowest performing hospital will incur a net reduction in payments of 1.65 percent. 

CMS posted Hospital VBP Program incentive payment adjustment factors for each participating hospital for FY 2018 in Table 16B on the FY 2018 Final Rule and Correction Notice Tables webpage.

For More Information:

See the full text of this excerpted CMS Fact Sheet (issued November 3).

 

Low Volume Appeals Settlements

As part of the broader HHS commitment to improving the Medicare appeals process, CMS will make available an additional settlement option for providers and suppliers (appellants) with appeals pending at the Office of Medicare Hearings and Appeals and the Medicare Appeals Council at the Departmental Appeals Board. See the Appeals Settlement Initiatives website for more information.

 

Hospice Item Set Data Freeze: November 15

The freeze date for Hospice Item Set (HIS) data that will be included in quality measure calculations for the February 2018 Hospice Compare refresh is November 15. The February refresh will include HIS data from the second quarter of 2016 to the first quarter of 2017. All HIS records, including modifications/corrections and inactivation’s, need to be accepted by the Quality Improvement and Evaluation System (QIES) Assessment Submission and Processing (ASAP) system by 11:59 pm ET on November 15 to be reflected in Hospice Provider Preview Reports available on December 1.

For more information about the freeze date, preview reports, and key public reporting dates, see the Hospice Quality Public Reporting webpage.

 

Draft 2018 CMS QRDA III Implementation Guide: Submit Comments by November 17

CMS published the draft Quality Reporting Document Architecture (QRDA) Category III Implementation Guide for eligible professionals and eligible clinicians for the 2018 performance period:

  • Based on the Health Level Seven QRDA Category III R1, Standard for Trial Use R2.1; no changes to the QRDA templates from the 2017 implementation guide
  • Includes updated electronic clinical quality measure specifications universally unique identifier list
  • Includes updates to the advancing care information measures and improvement activities

The draft Implementation Guide is posted in JIRA, ticket number QRDA-605. Submit comments by November 17; a JIRA account is required to comment.

For More Information:

For Questions:

 

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.

 

Therapeutic Shoe Inserts: Comment on DMEPOS Quality Standards through December 11

Proposed revisions to the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Quality Standards for therapeutic shoe inserts are posted to the Reducing Provider Burden webpage. Email comments on the proposed revised definitions to ReducingProviderBurden@cms.hhs.gov through December 11.  

 

Quality Payment Program Resources in New Location

To make it easier for you to find information on the Quality Payment Program, CMS moved the library of resources. Search the library by title, topic, or year.

CMS recently posted the Merit-based Incentive Payment System (MIPS) Claims Data Submission Fact Sheet and Eligible Measure Applicability Toolkit. New Resources:

Visit the Quality Payment Program website to check your participation status, explore measures, and review guidance. For questions, contact the Quality Payment Program Service Center at QPP@cms.hhs.gov or 866-288-8292 (TTY: 877-715-6222).

 

Post-Acute Care: Quality Reporting Program Quick Reference Guides Available

Quality Reporting Program Quick Reference Guides are available, including frequently asked questions, information on help desks, and links to additional resources:

 

Provider and Pharmacy Access during Public Health Emergencies

When public health emergencies are in effect, including those for recent hurricanes and California fires, the following apply in the affected areas:

  • You can treat Medicare beneficiaries enrolled in Medicare Advantage Organizations (MAOs) without prior authorization from the MAO
  • Medicare beneficiaries enrolled in Part D plans can have prescriptions filled at out-of-network pharmacies without the usual refill limits

 

Raising Awareness of Diabetes in November

American Diabetes Month®, Diabetic Eye Disease Month, and World Diabetes Day on November 14 promote diabetes awareness and the impact of diabetes on public health. Talk to your patients about their risk factors and recommend appropriate Medicare preventive services for detection and treatment.

For More Information:

Visit the Preventive Services website to learn more about Medicare-covered services.

 

Provider Compliance

 

Proper Use of the KX Modifier for Part B Immunosuppressive Drug Claims

A 2017 Office of the Inspector General (OIG) report noted that, in some cases, pharmacies incorrectly billed Medicare Part B for claims using the KX modifier for immunosuppressive drugs. It is estimated that Medicare paid $4.6 million for these claims that did not comply with Medicare requirements.

In response to this report, CMS clarified manual instructions on the use of the KX modifier to help pharmacies document the medical necessity of organ transplant and eligibility for Medicare coverage. Resources for pharmacies:

 

Upcoming Events

 

Quality Payment Program Year 2 Overview Webinar — November 14

Tuesday, November 14 from 1 to 2:30 pm ET

Register for this webinar.

Join the webinar to hear CMS policy experts provide an overview of the final requirements for the second year of the Quality Payment Program. 

 

SNF Value-Based Purchasing Program FY 2018 Final Rule Call — November 16

Thursday, November 16 from 1:30 to 3 pm ET

Register for Medicare Learning Network events.

Learn how the Skilled Nursing Facility (SNF) Value-Based Purchasing (VBP) Program will affect Medicare’s payments to your SNF beginning October 1, 2018, as well as details on how CMS will translate SNF performance scores into value-based incentive payments. CMS will also discuss policies finalized in the FY 2018 final rule.

A question and answer session follows the presentation; however attendees may email questions in advance to SNFVBPinquiries@cms.hhs.gov with “SNF VBP November NPC” in the subject line. These questions may be addressed during the call or used for other materials following the call.

Target audience: SNFs, administrators, and clinicians.

 

Quality Payment Program Virtual Groups Train-the-Trainer Webinar — November 17

Friday, November 17 from 2 to 3 pm ET

Register for this webinar.

Join CMS for a Train-the-Trainer session on the Virtual Groups provisions included in the Quality Payment Program Year 2 Final Rule. CMS provides an overview of Virtual Groups and the election process.

 

Quality Payment Program Year 2 Final Rule Call — November 30

Thursday, November 30 from 1:30 to 3 pm ET

Register for Medicare Learning Network events.

The Quality Payment Program, established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), is a quality payment incentive program for physicians and other eligible clinicians, which rewards value and outcomes in one of two ways:

  • The Merit-based Incentive Payment System
  • Alternative Payment Models

The Quality Payment Program allows clinicians to choose the best way to deliver quality care and participate based on their practice size, specialty, location, or patient population. During this call, learn about the Quality Payment Program Year 2 provisions in the final rule with comment and interim final rule with comment; participants should review the final rules prior to the call.  A question and answer session follows the presentation. 

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

 

Medicare Diabetes Prevention Program Model Expansion Call — December 5

Tuesday, December 5 from 1:30 TO 3 pm ET

Register for Medicare Learning Network events.

The CY 2018 Medicare Physician Fee Schedule final rule includes the expansion of the Medicare Diabetes Prevention Program (MDPP) Model starting in 2018. During this call, CMS experts provide a high-level overview of the finalized policies. A question and answer session follows the presentation.

The MDPP expanded model is a structured intervention with the goal of preventing progression to type 2 diabetes in individuals with an indication of pre-diabetes. Participants should review the final rule prior to the call.

Target Audience: Current Centers for Disease Control and Prevention recognized Diabetes Prevention Program organizations; organizations interested in becoming MDPP suppliers, including existing Medicare providers/suppliers, community organizations, non-for-profits; associations, and advocacy groups focused on seniors or diabetes; and other interested stakeholders, including health plans, primary care/internal medicine specialties.

 

LTCH Quality Reporting Program In-Person Training — December 6 and 7

Wednesday, December 6 through Thursday, December 7 in Dallas, TX

Register for this training.

CMS is hosting a 2-day Long Term Care Hospital (LTCH) Quality Reporting Program Train the Trainer event. See the LTCH Quality Reporting Training webpage for details.

 

Medicare Learning Network Publications & Multimedia

 

Quality Payment Program in 2017: Advanced Alternative Payment Models Web-Based Training Course — New

With Continuing Medical Education (CME) Credit

A new Quality Payment Program in 2017: Advanced Alternative Payment Models Web-Based Training course is available through the Learning Management System. Learn about:

  • Identifying Advanced Alternative Payment Models (APMs)
  • CMS Advanced APMs
  • How to participate in the Quality Payment Program via an Advanced APM

 

Medicare FFS Response to the 2017 California Wildfires MLN Matters Article — Updated

The MLN Matters Special Edition Article on Medicare Fee-for-Service (FFS) Response to the 2017 California Wildfires has been updated. This article was revised to add information regarding the exceptions granted for certain Medicare quality reporting and value-based purchasing programs.

 

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

A revised MLN Matters Special Edition Article on Prohibition on Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) Program is available. Learn about the HIPAA Eligibility Transaction System (HETS) QMB release in November 2017.

 

Transition to New Medicare Numbers and Cards Fact Sheet — Revised

A revised Transition to New Medicare Numbers and Cards Fact Sheet is available. Learn about updated information on:

  • New Medicare cards
  • New Medicare numbers, which will replace Health Insurance Claim Numbers on Medicare cards
  • What you need to do to get ready for the change
  • Where to find help

 

Hospital-Acquired Conditions and Present on Admission Indicator Reporting Provision Fact Sheet — Revised

A revised Hospital-Acquired Conditions and Present on Admission Indicator Reporting Provision Fact Sheet is available. Learn about:

  • General reporting requirements, coding, documentation, and billing
  • Exempt hospitals

 

Remittance Advice Information: An Overview Booklet — Reminder

A revised Remittance Advice Information: An Overview Booklet is available. Learn about:

  • What types of Remittance Advice (RA) are available
  • What information is included in an RA
  • How to view an RA

 

 


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