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Date
2018-03-15
Subject
MLN Connects for March 15, 2018

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Thursday, March 15, 2018

News & Announcements

Provider Compliance

Claims, Pricers & Codes

Upcoming Events

Medicare Learning Network® Publications & Multimedia

  View this edition as a PDF [PDF, 285KB]  

 

News & Announcements

 

MIPS Reporting Deadlines Approaching

Deadlines are approaching if you plan to submit data for the 2017 Merit-based Incentive Payment System (MIPS) performance period:

  • March 16 at 8 pm ET: Deadline for 2017 data submission for groups reporting via the CMS web interface.
  • March 31: Deadline for 2017 data submission for all other MIPS reporting, including via the Quality Payment Program website

Questions about your participation status or MIPS data submission? Contact the Quality Payment Program Service Center at qpp@cms.hhs.gov or 866-288-8292 (TTY: 877-715-6222).

 

EHR Incentive Program: Hospital Attestation Deadline Changed to March 16

The Electronic Health Record (EHR) Incentive Program Medicare eligible hospital and critical access hospital attestation deadline is changed to March 16 at 11:59 pm PT. Submit data through the QualityNet Secure Portal (QNet).

For More Information:

 

Hospice Provider Preview Reports: Review Your Data by March 30

Two reports are available in your Certification and Survey Provider Enhanced Reports (CASPER) folder: Hospice provider preview report and Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey provider preview report. Review your Hospice Item Set (HIS) quality measure results and your facility-level CAHPS survey results from the third quarter of 2016 to the second quarter of 2017 by March 30.

If you believe that the denominator or other HIS quality metric is inaccurate or if there are errors in the results from the CAHPS survey data, request CMS review:

Access Instructions:

 

IRF and LTCH Provider Preview Reports: Review Your Data by April 5

Inpatient Rehabilitation Facility (IRF) and Long-Term Care Hospital (LTCH) Provider Preview Reports are now available on quality measures based on third quarter 2016 through second quarter 2017 data. Review your performance data by April 5, prior to public display on IRF Compare and LTCH Compare in June 2018. Corrections to the underlying data will not be permitted during this time; request a CMS review if you believe that your data is inaccurate. 

IRF Provider Preview Report:

LTCH Provider Preview Report:

 

Medicare Pharmaceutical and Technology Ombudsman

James Bailey is serving as the Medicare Pharmaceutical and Technology Ombudsman. He will receive and review questions and concerns from pharmaceutical, biotechnology, medical device, diagnostic product manufacturers, and other stakeholders regarding Medicare coverage, coding, and payment. Visit the Medicare Pharmaceutical and Technology Ombudsman webpage for more information.

 

Updated QRDA III Implementation Guide with Advancing Care Information Identifier

CMS published an updated 2018 Quality Reporting Document Architecture (QRDA) Category III Implementation Guide for eligible clinician and eligible professional programs. The updated version includes an additional identifier (ACI_IACEHRT_1) for the Advancing Care Information Improvement Activities Bonus for the Quality Payment Program.

For More Information:

 

Hospice QRP Timeliness Compliance Threshold Report: Footnote Update

The footnote on the Hospice Quality Reporting Program (QRP) Timeliness Compliance Threshold Report is updated for the FY 2019 and FY 2020 reports. The submission requirements have not changed, but the wording of the footnote is enhanced to clarify that the score shown on the report is considered preliminary. For questions, contact the QTSO Help Desk at help@qtso.com or 877-201-4721.

 

Influenza Activity Continues: Are Your Patients Protected?

People 65 years and older are at a greater risk of serious complications from seasonal influenza. The Centers for Disease Control and Prevention (CDC) recommends that everyone 6 months of age and older receive an influenza vaccine every year. It is not too late to get vaccinated – to protect your patients, your staff, and yourself.

Medicare Part B covers one influenza vaccination and its administration each influenza season for Medicare beneficiaries. Medicare may cover additional seasonal influenza vaccinations if medically necessary.

You may also want to recommend pneumococcal vaccination during the same visit. Medicare covers an initial pneumococcal vaccine to Medicare beneficiaries who never received the vaccine under Medicare Part B and a different, second pneumococcal vaccine one year after the first vaccine was administered.

For More Information:

 

Provider Compliance

 

Provider Compliance Tips for Hospital Beds and Accessories

In 2017, the Medicare Fee-For-Service (FFS) improper payment rate for hospital beds and accessories was 78.5 percent, with projected inaccurate payments of $66.2 million. Improper payments resulted from insufficient documentation.

Prevent denials by reviewing the Provider Compliance Tips for Hospital Beds and Accessories Fact Sheet, which details general requirements, coverage, and documentation requirements for:

  • Physician’s prescription
  • Variable height feature
  • Electric powered adjustments
  • Side rails

Additional Resources:

 

Claims, Pricers & Codes

 

Integrated OCE Files for April 2018

The Outpatient Code Editor (OCE) Quarterly Release Files webpage is updated with files for April 2018.

 

Upcoming Events

 

New Medicare Card Project Special Open Door Forum — March 20

Tuesday, March 20 from 2 to 3 pm ET

CMS will host a Special Open Door Forum to give providers an opportunity to ask questions about the New Medicare Card Project. Use this call to get answers to your questions, so you are ready to accept the new Medicare Beneficiary Identifier starting April 1, 2018.

For more information, visit the New Medicare Card website. Send feedback and questions to NewMedicareCardSSNRemoval@cms.hhs.gov.

Participation Instructions:

  • Participant Dial-In Number: 800-837-1935; Conference ID #: 4588156
  • TTY Communications Relay Services are available for the Hearing Impaired; dial 7-1-1 or 800-855-2880

A transcript and audio recording will be posted to the Podcasts and Transcripts webpage.

 

Dementia Care: Person-Centered Care Planning and Practice Recommendations Call — March 20

National Partnership to Improve Dementia Care and Quality Assurance Performance Improvement

Tuesday, March 20 from 1:30 to 3 pm ET

Register for Medicare Learning Network events.

During this call, gain insight on the phase two changes for person-centered care planning and discharge planning. Also, learn about the new Alzheimer’s Association Dementia Care Practice Recommendations. Additionally, CMS shares updates on the progress of the National Partnership to Improve Dementia Care in Nursing Homes. A question and answer session follows the presentations.

Speakers:

  • Debra Lyons, CMS
  • Douglas Pace, Alzheimer’s Association
  • Michele Laughman, CMS

Target Audience: Consumer and advocacy groups; nursing home providers; surveyor community; prescribers; professional associations; and other interested stakeholders.

 

E/M Services: Documentation Guidelines and Burden Reduction Listening Session — March 21

Wednesday, March 21 from 1:30 to 3 pm ET

Register for Medicare Learning Network events.

CMS is looking for physicians and non-physician practitioners to provide feedback on Evaluation and Management (E/M) services. CMS seeks comments from stakeholders on potential updates to the E/M guidelines to reduce burden and better align coding and documentation with the current practice of medicine. This listening session follows CY 2018 Medicare Physician Fee Schedule rulemaking and is part of an ongoing effort to seek input from stakeholders on these topics.

Target Audience: Individual physicians and non-physician practitioners who perform and bill E/M services; state and national associations that represent health care providers; and other interested stakeholders.

 

Interdisciplinary Team Building, Management, and Communication Webinar — March 21

Wednesday, March 21 from 2 to 3 pm ET

Register for this webinar.

Part of the Disability Competent Care series, this webinar explores the value of the interdisciplinary team in supporting and empowering participants with disabilities. Continuing Medical Education (CME) and Continuing Education (CE) credits may be available.

 

Hospice Quality Reporting Program Webinar — March 27

Tuesday, March 27 from 1:30 to 3 pm ET

Register for this webinar.

During this webinar, learn about updated coding guidance for the Hospice Item Set and how to navigate the Hospice Quality Reporting Program websites. Subject matter experts also provide an update on Hospice CAHPS®. For more information, visit the Hospice Quality Reporting Training: Announcements and Registration webpage.

 

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

Wednesday, March 28 from 2 to 3 pm ET

This Special Open Door Forum provides information and solicits feedback on development and testing of standardized patient assessment data elements mandated by the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). Learn about the national field test, ongoing stakeholder engagement activities, and ways to remain engaged and informed during the upcoming year. See the announcement for more information.

 

Managing Transitions with Adults with Disabilities Webinar — March 28

Wednesday, March 28 from 2 to 3 pm ET

Register for this webinar.

Part of the Disability Competent Care series, this webinar describes the challenges participants with disabilities experience as they face care settings transitions and steps that providers can take to help empower participants to make informed decisions and improve care outcomes during these transitions. Continuing Medical Education (CME) and Continuing Education (CE) credits may be available.

 

Building Partnerships: Health Plans and Community-based Organizations Webinar — April 4

Wednesday, April 4 from 2 to 3 pm ET

Register for this webinar.

Part of the Disability Competent Care series, this webinar explores the benefits of partnerships between health plans and community-based organizations to establish a network with local leadership and support community integration for persons with disabilities. Continuing Medical Education (CME) and Continuing Education (CE) credits may be available.

 

Medicare Learning Network® Publications & Multimedia

 

Appropriate Use Criteria for Advanced Diagnostic Imaging: HCPCS Modifier QQ MLN Matters Article — New

A new MLN Matters Article on Appropriate Use Criteria for Advanced Diagnostic Imaging – Voluntary Participation and Reporting Period - Claims Processing Requirements – HCPCS Modifier QQ is available. Learn about the appropriate HCPCS modifier QQ that may be reported on the same claim line as the CPT code for an advanced diagnostic imaging service that is furnished in an applicable setting and paid for under an applicable payment system.

 

April 2018 I/OCE Specifications Version 19.1 MLN Matters Article — New

A new MLN Matters Article on April 2018 Integrated Outpatient Code Editor (I/OCE) Specifications Version 19.1 is available. Learn about the modifications of the I/OCE.

 

April 2018 Update of the Hospital OPPS MLN Matters Article — New

A new MLN Matters Article on April 2018 Update of the Hospital Outpatient Prospective Payment System (OPPS)  is available. Learn about changes to the OPPS.

 

Provider Compliance Tips for Enteral Nutrition Fact Sheet — New

A new Provider Compliance Tips for Enteral Nutrition Fact Sheet is available. Learn about:

  • Reasons for denials
  • How to prevent claim denials
  • Coverage requirements

 

Provider Compliance Tips for Walkers Fact Sheet — New

A new Provider Compliance Tips for Walkers Fact Sheet is available. Learn about:

  • Reasons for denials
  • How to prevent claim denials
  • Clinical criteria for mobile assistive equipment coverage

 

Provider Compliance Tips for Home Health Services Fact Sheet — New

A new Provider Compliance Tips for Home Health Services (Part A non DRG) Fact Sheet is available. Learn about:

  • Reasons for denials
  • How to prevent claim denials
  • Documentation requirements
  • Required elements of the plan of care

 

Provider Compliance Tips for Respiratory Assistive Devices Fact Sheet— New

A new Provider Compliance Tips for Respiratory Assistive Devices Fact Sheet is available. Learn about:

  • Reasons for denials
  • How to prevent claim denials
  • Documentation requirements
  • Acceptable formats for orders

 

ICD-10 and Other Coding Revisions to NCDs MLN Matters Article — Revised

A revised MLN Matters Article on ICD-10 and Other Coding Revisions to National Coverage Determinations (NCDs)  is available. Learn about the maintenance update of the ICD-10 conversions and other coding updates.

 

Diagnosis Code Update for Add-on Payments for Blood Clotting Factor Administered to Hemophilia Inpatients MLN Matters Article — Revised

A revised MLN Matters Article on Diagnosis Code Update for Add-on Payments for Blood Clotting Factor Administered to Hemophilia Inpatients is available. Learn about the updates to diagnosis codes required in order to allow add-on payments under the Inpatient Prospective Payment System.

 

Supervised Exercise Therapy for Symptomatic PAD MLN Matters Article — Revised

A revised MLN Matters Article on Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) is available. Learn about the National Coverage Determination issued to cover SET for beneficiaries with intermittent claudication for the treatment of PAD.

 

Quarterly HCPCS Drug/Biological Code Changes MLN Matters Article — Revised

A revised MLN Matters Article on Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - April 2018 Update is available. Learn about updates of biosimilar biological product HCPCS codes, modifiers, and autologous cellular immunotherapy treatment.

 

Provider Compliance Tips for Laboratory Tests: Other Fact Sheet – Revised

A revised Provider Compliance Tips for Laboratory Tests – Other (Non-Medicare Fee Schedule) Fact Sheet is available. Learn about:

  • Reasons for denial
  • How to prevent claim denials
  • Acceptable forms for submitting orders

 

Provider Compliance Tips for Ordering Hospital Outpatient Services Fact Sheet — Revised

A revised Provider Compliance Tips for Ordering Hospital Outpatient Services Fact Sheet is available. 

Learn about:

  • Reasons for claim denials
  • How to prevent claim denials
  • Required documentation

 

Provider Compliance Tips for Skilled Nursing Facility Services Fact Sheet — Revised

A revised Provider Compliance Tips for Skilled Nursing Facility Services Fact Sheet is available. Learn about:

  • Reasons for denials
  • How to prevent claim denials
  • Documentation requirements

 

Provider Compliance Tips for Enteral Nutrition Therapy Pumps Fact Sheet — Revised

A revised Provider Compliance Tips for Enteral Nutrition Therapy Fact Sheet is available. Learn about:

  • Reasons for claim denials
  • How to prevent denials
  • Medical necessity criteria

 

Provider Compliance Tips for IRF Fact Sheet — Revised

A revised Provider Compliance Tips for Inpatient Rehabilitation Facility (IRF)—Inpatient Rehabilitation Hospitals and Inpatient Rehabilitation Units Fact Sheet is available. Learn about:

  • Improper payments rates
  • Reasons for claim denials
  • Required documentation requirements for an IRF claim

 

Ambulatory Surgical Center Payment System Fact Sheet — Revised

A revised Ambulatory Surgical Center Payment System Fact Sheet is available. Learn about:

  • Payment and payment rates
  • Updates to the payment system
  • Quality Reporting Program

 

Beneficiaries in Custody under a Penal Authority Fact Sheet—Revised

A revised Beneficiaries in Custody under a Penal Authority Fact Sheet is available. Learn about:

  • How Medicare receives data for incarcerated beneficiaries
  • Medicare claims processing and appeals
  • Exception to Medicare policy

 

Medicare Ambulance Transports Booklet — Revised

A revised Medicare Ambulance Transports Booklet is available. Learn about:

  • Ground and air ambulance providers, vehicles, and personnel requirements
  • Documentation requirements
  • Coverage, billing, and payments
  • Advance Beneficiary Notice of Noncoverage

 

Medicare Provider-Supplier Enrollment National Educational Products Listing — Revised

A revised Medicare Provider-Supplier Enrollment National Educational Products Listing is available. Learn about:

  • Requirements
  • Resources

 

Global Surgery Booklet — Reminder

The Global Surgery Booklet is available. Learn about:

  • Coding and billing guidelines
  • Special billing situations
  • Payment rules

 

 


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