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Date
2018-03-29
Subject
MLN Connects for March 29, 2018

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Thursday, March 29, 2018

News & Announcements

Provider Compliance

Upcoming Events

Medicare Learning Network® Publications & Multimedia

View this edition as a PDF [PDF, 255KB]

 

News & Announcements

 

Patients Over Paperwork: Empowering Patients Through Data

View our Patients Over Paperwork March newsletter to learn about the MyHealthEData initiative and how CMS is:

  • Helping patients get and share their electronic medical records
  • Working to improve Health Information Technology, which will lower burden on clinicians and patients
  • Helping patients use their healthcare data
  • Working across the government on health data

For More Information:

 

MIPS Data Submission Deadline: March 31

The data submission deadline for the Merit-based Incentive Payment System (MIPS) is March 31. Resources:

For More Information:

 

Transitions from Hospice Care, Followed by Death or Acute Care Draft Measure: Comment Period Ends April 25

CMS seeks to supplement the existing Hospice Quality Reporting Program measure set, which includes quality measures based on the Hospice Item Set and the Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS®) with measures that address additional identified gaps in hospice quality measurement without increasing burden to providers. Submit comments on the Transitions from Hospice Care, Followed by Death or Acute Care draft measure by April 25. Visit the public comment webpage for more information.

 

Open Payments Review and Dispute Period: April 1 through May 15

Industry is currently submitting Program Year 2017 data to the Open Payments System. From April 1 through May 15, physicians and teaching hospitals have the opportunity to review, affirm, and if necessary dispute newly submitted records. Review of the data is voluntary but strongly encouraged. Disputes must be initiated during the review and dispute period in order to be reflected in the June 2018 publication.

To review your data, register in the Open Payments system. Visit the Registration for Physicians & Teaching Hospitals webpage for instructions.

If you are already registered, log in to review your data:

  • If you have not accessed your account in 60 days or more you will need to unlock your account in the CMS Portal
  • If you have not accessed your account in 180 days or more, your account has been deactivated and you will need to contact the Open Payments Help Desk to reinstate your account

For More Information:

 

Qualified Medicare Beneficiary Claims: Replacement RAs

Medicare Administrative Contractors (MACs) will issue replacement Remittance Advices (RAs) through non-monetary mass adjustments for Qualified Medicare Beneficiary (QMB) claims paid after October 2 and up to December 31, 2017, that have not been voided or replaced. Use the replacement RAs to resubmit Medicaid QMB cost-sharing claims that states initially failed to pay due to the RA changes. To avoid duplicate claims, do not resubmit claims that were successfully processed by secondary payers through claims submission or the Coordination of Benefits Agreement process. Read MLN Matters® Article MM10494 for more information.

Timeline:

  • October 2, 2017 - RAs began identifying the QMB status of beneficiaries and reflecting their zero cost-sharing liability – MLN Matters Article MM9911
  • December 8, 2017 - CMS temporarily suspended the system changes due to unforeseen issues affecting the processing of QMB cost-sharing claims by states and other payers secondary to Medicare
  • March 2018 – MACs begin issuing replacement RAs for claims paid after October 2 and up to December 31, 2017, that have not been voided or replaced: By December 20, 2018, for Part B MAC claims and by September 20, 2018, for Part A/durable medical equipment MAC claims - MLN Matters Article MM10494
  • July 2018 - CMS will reintroduce QMB information in the RA without disrupting claims processing by secondary payers – MLN Matters Article MM10433

For More Information:

 

MACRA Patient Relationship Categories and Codes

Clinicians can now use Patient Relationship Categories and Codes to report patient relationships on Medicare claims. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires the development of these categories and codes to facilitate the attribution of patients and episodes to one or more clinicians for cost measurement.

Reporting codes is currently voluntary and will not affect Medicare reimbursement. CMS goals for the voluntary reporting period:

  • For clinicians to gain familiarity with the categories and experience submitting the codes
  • To collect data on the use and submission of the codes for analyses to inform the potential future use of these codes in cost measure attribution methodology in the Quality Payment Program

 

Advanced Diagnostic Laboratory Tests: Applications and Guidance

On March 23, CMS published:

  • Application for requesting Advanced Diagnostic Laboratory Test (ADLT) status under the Clinical Laboratory Fee Schedule (CLFS) and related guidance
  • Form for notifying CMS of a Food and Drug Administration (FDA) cleared or approved Clinical Diagnostic Laboratory Test (CDLT) under the Medicare CLFS
  • Application for requesting a Level II HCPCS code for ADLTs and FDA cleared or approved tests. 

For More Information:

Submit applications for ADLT status, notifications of FDA clearance/approval, and request for level II HCPCS codes for ADLTs and FDA cleared or approved CDLTs to CLFSFormSubmission@cms.hhs.gov.

 

HIMSS18 Presentations

CMS recently participated in the 2018 Healthcare Information and Management Systems Society (HIMSS18) Annual Conference & Exhibition. Presentations:

 

Hospice Quality Reporting Program Video Series: Navigating HQRP Websites

This series of videos presents information to help hospice providers navigate the three websites related to the Hospice Quality Reporting Program (HQRP). Five on-demand video modules:

  1. Introduction to the 3 HQRP Websites
  2. Learning How to use the CMS HQRP Website
  3. Learning how to use the CAHPS® Survey Website
  4. Learning how to use the QTSO Website
  5. Overview of the HQRP Help Desks

Visit the Training and Education Library webpage for more information, including slides and speaker notes.

 

Hospice Item Set Coding Video Series

This series of videos presents information on updated Hospice Item Set (HIS) coding guidance for selected HIS items. Eight on-demand video modules:

  1. General Information
  2. Section A, I, and Z
  3. Section F, Preferences
  4. Section J, Pain
  5. Section J, Respiratory Status
  6. Section N, Medications
  7. Section O, Service Utilization
  8. Chapter 3 Submission and Correction of HIS Records

Visit the Training and Education Library webpage for more information, including slides and speaker notes.

 

Physician Compare Quality Measure TEP Summary Report

A summary report from the December Physician Compare Technical Expert Panel (TEP) is available. This report includes an analysis of the 2016 measures selected for public reporting and ABC™ benchmark and star rating cut-offs. Visit the Informational Materials webpage to review summaries of past TEP meetings. For questions, contact PhysicianCompare@Westat.com.

 

Administrative Simplification: Reaching Compliance with ASETT Video

CMS posted a video on Reaching Compliance with the Administrative Simplification Enforcement and Testing Tool (ASETT). This animated short:

  • Explains the benefits of complying with Administrative Simplification standards
  • Describes how to test your transactions (and your business trading partners) with ASETT
  • Tells you how to use ASETT to file a complaint if you have any noncompliant business trading partners

 

Provider Compliance

 

Provider Compliance Tips for Diabetic Test Strips

The Office of Inspector General (OIG) found that Medicare fee-for-service improper payments for diabetic test strips resulted from three areas of insufficient documentation:

  • Claims without a documented diagnosis code for diabetes
  • Claims that overlapped with an inpatient hospital stay
  • Claims that overlapped with a skilled nursing facility stay

Prevent denials by reviewing the Provider Compliance Tips for Diabetic Test Strips  Fact Sheet for coverage and documentation requirements.

Additional Resources:

 

Upcoming Events

 

Comparative Billing Report on Spinal Orthoses Suppliers Webinar — May 2

Wednesday, May 2 from 3 to 4 pm ET

Join us for a discussion of the comparative billing report on Spinal Orthoses Suppliers (CBR201803), an educational tool for suppliers of off-the-shelf and custom-fitted prefabricated spinal orthoses, also known as braces. During the webinar, interact directly with content specialists and submit questions about the report. See the announcement for more information and find out how to participate.

 

LTCH Quality Reporting Program In-Person Training Event — May 8 and 9

Tuesday, May 8 and Wednesday, May 9 in Baltimore, MD

Register for this training.

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

 

IRF Quality Reporting Program In-Person Training Event — May 9 and 10

Wednesday, May 9 and Thursday, May 10 in Baltimore, MD

Register for this training.

CMS is hosting a 2-day Inpatient Rehabilitation Facility (IRF) Quality Reporting Program Train the Trainer event. Visit the IRF Quality Reporting Training webpage for details.

 

Medicare Learning Network® Publications & Multimedia

 

Claims Processing Actions to Implement Certain Provisions of the Bipartisan Budget Act of 2018 MLN Matters Article — New

A new MLN Matters Article on Claims Processing Actions to Implement Certain Provisions of the Bipartisan Budget Act of 2018 is available. Learn about Medicare fee-for-service claims reprocessing requirements and timeframes.

 

Adjustments to QMB Claims Processed under CR 9911 MLN Matters Article — New

A new MLN Matters Article on Adjustments to Qualified Medicare Beneficiary (QMB) Claims Processed under CR 9911  is available. Learn about Medicare Administrative Contractors issuing replacement remittance advice for claims paid after October 2 and up to December 31, 2017, that have not been voided or replaced.

 

April Quarterly Update for 2018 DMEPOS Fee Schedule MLN Matters Article — New

A new MLN Matters Article on April Quarterly Update for 2018 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule is available. Learn about instructions for implementing updated oxygen volume adjustments.

 

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

An audio recording and transcript are available for the March 13 call on the Low Volume Appeals Settlement Option Update. CMS speakers discuss how to identify whether you are eligible and which of your pending appeals may be settled.

 

Open Payments Call: Audio Recording and Transcript — New

An audio recording and transcript are available for the March 14 call on Open Payments: The Program and Your Role. Find out how to access the Open Payments system to review the accuracy of the data submitted about you before it is published on the CMS website.

 

E/M Services Listening Session: Audio Recording and Transcript — New

An audio recording and transcript are available for the March 21 listening session on Evaluation and Management (E/M) services. CMS seeks comments from stakeholders on potential updates to the guidelines to reduce burden and better align coding and documentation with the current practice of medicine.

 

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 Balance Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) Program is available. Learn about the prohibitions on billing beneficiaries enrolled in the QMB Program and steps to promote compliance. Revisions include:

  • Updated information on Remittance Advice and Medicare Summary Notice for QMB claims
  • New statistics on the number of beneficiaries enrolled in QMB

 

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

A revised MLN Matters Article on April 2018 Integrated Outpatient Code Editor (I/OCE) Specifications Version 19.1 is available. Learn about updated status indicator for drug code J0606 from SI=G to SI=K.

 

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

A revised MLN Matters Article on April 2018 Update of the Hospital Outpatient Prospective Payment System (OPPS)  is available. Learn about 11 drugs and biologicals granted OPPS pass-through status effective April 1, 2018, and removal of HCPCS code J0606.

 


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