Submitted by Matthew.Gregor… on Mon, 11/04/2019 - 02:44
MLN Connects for January 18, 2018

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Thursday, January 18, 2018

News & Announcements

Provider Compliance

Upcoming Events

Medicare Learning Network Publications & Multimedia


View this edition as PDF (PDF)  


News & Announcements


2018 Value Modifier Results and Payment Adjustment Factor

CMS announced the results of the 2018 Value Modifier and the adjustment factor that will be applied to clinicians receiving an upward payment adjustment. In 2018, over 20,000 clinicians will receive an increase of 6.6% to 19.9% on their Medicare physician fee schedule payments as a result of their high performance on quality and cost measures in 2016. The 2018 Value Modifier results (PDF) and the payment adjustment factor (PDF) are available on the 2016 QRUR and 2018 Value Modifier webpage.

The Value Modifier payment adjustment ends in 2018. The Merit-based Incentive Payment System under the new Quality Payment Program is replacing the Value Modifier.

For More Information:


Final DMEPOS Quality Standards for Therapeutic Shoe Inserts

CMS revised the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Quality Standards (PDF). We updated the definitions (PDF) for custom fabricated and therapeutic inserts, so orthotists/prosthetists can bill Medicare for inserts made with current technology. See the Reducing Provider Burden webpage for more information.


Glaucoma Awareness Month: Make a Resolution for Healthy Vision

Encourage people with a higher risk for glaucoma to make a resolution for healthy vision this New Year. Medicare provides glaucoma screening coverage for beneficiaries in at least one high risk group; recommend an annual screening if appropriate.

For More Information:

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


Provider Compliance


CMS Provider Minute Video: CT Scans — Reminder 

Insufficient documentation continues to be a leading cause of Medicare noncompliance for providers who bill for CT Scans. The CMS Provider Minute: CT Scans video includes pointers to help you properly submit claims with sufficient documentation. 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


New Medicare Card Project Special Open Door Forum — January 23

Tuesday, January 23 from 2 to 3 pm ET

This call will educate State Medicaid Agencies, Medicaid providers, Managed Care Organizations, Medicaid partners, and other Medicaid stakeholders about the change from Social Security Number-based Health Insurance Claim Numbers to new Medicare Beneficiary Identifiers (MBIs). A question and answer session follows the presentation. This is the same presentation given on November 9 (ZIP)

CMS discusses:

  • Background and implementation
  • MBI format
  • Timeline and milestones, including the transition period
  • Beneficiary outreach and education
  • How to get ready for the new number

Dial in at least 15 minutes prior to the start of the call.

  • Dial-In Number: 800-837-1935; conference ID #: 8259057
  • TTY services dial 7-1-1 or 800-855-2880

For More Information


ESRD QIP: Final Rule for CY 2018 Call — January 23

Tuesday, January 23 from 1:30 to 3 pm ET

Register for Medicare Learning Network events.

During this call, learn about provisions in the CY 2018 End-Stage Renal Disease (ESRD) Prospective Payment System final rule, including plans for the ESRD Quality Incentive Program (QIP) in Payment Year (PY) 2019, 2020, and 2021. Topics include:

  • ESRD QIP legislative framework
  • Measures, standards, scoring method, and payment reduction scale for PY 2021
  • Modifications to PY 2019 and PY 2020 policies

A question and answer session follows the presentation.

Target Audience: Dialysis clinics and organizations, nephrologists, hospitals with dialysis units, billers/coders, and quality improvement experts.


MIPS Annual Call for Measures and Activities Webinar — February 5

Monday February 5 from 2:30 to 3:30 pm ET

Register for this Merit-based Incentive Payment System (MIPS) webinar.

The Annual Call for Measures and Activities process allows clinicians and organizations to identify and submit for consideration:

  • Quality measures for the quality performance category
  • Electronic Health Record measures for the advancing care information performance category
  • Activities for the improvement activities performance category


Comparative Billing Report on Opioid Prescribers Webinar — February 21

Wednesday, February 21 from 3 to 4:30 pm ET

Join us for a discussion of the Comparative Billing Report on Opioid Prescribers (CBR201801), an educational tool for providers of all specialties who prescribe opioids for Medicare Part D beneficiaries. During the webinar, interact directly with content specialists, including guest speakers from the Food and Drug Administration and the Centers for Disease Control and Prevention, and submit questions about the report. See the announcement for more information, and find out how to participate.


Medicare Learning Network Publications & Multimedia


QRUR Video Presentation — New

A video presentation is available for the October 19 webcast on the 2016 Annual Quality and Resource Use Reports (QRURs). This event provides an overview of the report and explains how to interpret and use the information.


Low Volume Appeals Settlement Call: Audio Recording and Transcript — New

A revised presentation (PDF), audio recording (ZIP), transcript (PDF), and clarification (PDF) are available for the January 9 call on the Low Volume Appeals Settlement Option. Learn how the settlement process will work, how to identify whether you are eligible and which of your pending appeals may be settled.


Avoiding Medicare Fraud & Abuse: A Roadmap for Physicians Web-based Training — Revised

With Continuing Education Credit

A revised Avoiding Medicare Fraud & Abuse: A Roadmap for Physicians Web-Based Training course is available through the Learning Management System. Learn about:

  • Federal laws
  • The "red flags" that could lead to potential liability in law enforcement and administrative actions
  • Three types of physician business relationships that may raise concerns
  • Where to find help with fraud and abuse concerns


How to Use the Medicare Coverage Database Booklet — Revised

A revised How to Use the Medicare Coverage Database Booklet is available. Learn about:

  • Navigating the database
  • Searching indexes and reports
  • Download features


Behavioral Health Integration Services Fact Sheet — Revised

A revised Behavioral Health Integration Services Fact Sheet is available. Learn about:

  • Who can bill for services
  • New CPT codes
  • Primary care services
  • Psychiatric Collaborative Care Model



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