- MLN Connects for December 21, 2017
Thursday, December 21, 2017
- 2018 Medicare EHR Incentive Program Payment Adjustment for Eligible Clinicians
- Physician Compare: 2016 Performance Information Available
- Medicare FFS Response to the 2017 Southern California Wildfires MLN Matters Article — New
- Medicare Diabetes Prevention Program Model Call: Audio Recording and Transcript — New
- Hospice Payment System Booklet — Revised
- Ambulance Fee Schedule Fact Sheet — Revised
- Medicare Overpayments Fact Sheet — Revised
The payment adjustment amount for the Electronic Health Record (EHR) Incentive Program is established by statute for specific calendar years and continues through the end of CY 2018. A new fact sheet for eligible clinicians includes:
- Payment adjustments
- Exceptions process
- Applicable hardship exceptions categories
For more information, visit the EHR Incentive Programs website.
CMS recently added PY 2016 performance information to Physician Compare. For the first time, CMS publicly reported a small subset of 2016 Physician Quality Reporting System (PQRS) group-level measures on Physician Compare profile pages as star ratings.
The updated 2016 measures CMS released on the Physician Compare public-facing profile pages include:
- Fifteen 2016 PQRS measures for groups as star ratings
- 2016 Consumer Assessment of Healthcare Providers and Systems for PQRS patient experience measures for groups as top-box scores
- 2016 non-PQRS Qualified Clinical Data Registry measures with performance rates expressed as percentages for clinicians and groups
- 2016 Accountable Care Organization measures
Data are also available via the Physician Compare Downloadable Database on data.medicare.gov. The 2016 performance information is anticipated to be made publicly available for download in late spring/early summer 2018. While the profile pages are intended for patients and caregivers, the Downloadable Database is a resource for clinicians and group representatives as well as third-party data users.
For More Information:
In two recent reports, the Office of Inspector General (OIG) cited significant issues leading to coding errors on Medicare hospital claims:
- Hospitals Nationwide Generally Did Not Comply with Medicare Requirements for Billing Outpatient Right Heart Catheterizations with Heart Biopsies: The OIG found that hospitals often use modifier -59 incorrectly when billing for outpatient right heart catheterizations with heart biopsies, which leads to significant overpayments and overpayment recoveries on claims for these services
- Medicare Improperly Paid Hospitals for Beneficiaries Who Had Not Received 96 or More Consecutive Hours of Mechanical Ventilation: The OIG found that hospitals often use incorrect procedure codes when billing for mechanical ventilation
Use the following resources to bill correctly and avoid overpayment recoveries:
- OIG Reports Highlight Hospital Billing Issues MLN Matters® Special Edition Article
- Proper Use of Modifier 59 MLN Matters Special Edition Article
- Specific Modifiers for Distinct Procedural Services MLN Matters Article
- Medicare Claims Processing Manual, Chapter 3, Inpatient Hospital Billing: Section 10, General Inpatient Requirements
- Medicare Quarterly Provider Compliance Newsletter, Volume 2, Issue 1
- Medicare Quarterly Provider Compliance Newsletter, Volume 7, Issue 4
Tuesday, January 9 from 1:30 to 2:30 pm ET
Register for Medicare Learning Network events.
As part of the broader HHS commitment to improving the Medicare appeals process, CMS will make available a settlement option for providers and suppliers (appellants) with fewer than 500 appeals pending at the Office of Medicare Hearings and Appeals (OMHA) and the Medicare Appeals Council (the Council) at the Departmental Appeals Board.
During this call, learn about the low volume appeals settlement option and how the settlement process will work. CMS speakers discuss how to identify whether you are eligible and which of your pending appeals may be settled. Visit the Low Volume Appeals Initiative webpage for more information.
This call will not include a question and answer session. Submit questions in advance to MedicareSettlementFAQs@cms.hhs.gov. Questions may be addressed during the call or used for materials following the call.
Target Audience: Medicare fee-for-service providers, physicians, and other suppliers with fewer than 500 appeals pending at OMHA and the Council.
The President declared that an emergency exists in the state of California, and the Acting HHS Secretary declared a Public Health Emergency, which allows for a CMS programmatic waiver based on Section 1135 of the Social Security Act. An MLN Matters Special Edition Article on Medicare Fee-For-Service (FFS) Response to the 2017 Southern California Wildfires is available. Learn about the waiver CMS issued for the impacted geographical areas.
An audio recording, transcript, and clarification are available for the December 5 call on the Medicare Diabetes Prevention Program Model. The CY 2018 Medicare Physician Fee Schedule final rule includes the expansion of the model starting in 2018.
A revised Hospice Payment System Booklet is available. Learn about:
- Certification requirements
- Election periods and statements
- Option for Medicare Advantage enrollees
- Hospice Quality Reporting Program
A revised Ambulance Fee Schedule Fact Sheet is available. Learn about:
- Ambulance transport benefit
- Providers and suppliers
- Advance Beneficiary Notice of Noncoverage
- Payments and payment rates
- Updates to the Ambulance Fee Schedule
A revised Medicare Overpayments Fact Sheet is available. Learn about:
- Collection process, tools, and payment options
- Timeframes for the debt collection process
This newsletter is current as of the issue date. View the complete disclaimer.
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