- MLN Connects for April 12, 2018
- Help Your Medicare Patients Avoid and Report Scams
- 2018 MIPS Eligibility Tool
- Draft 2019 QRDA Category I Schematron: Submit Comments by April 20
- Home Health Utilization and Payment Data
- National Health Care Decisions Day is April 16
- Opioids Forum: Strategies and Solutions for Minority Communities — April 25
- Medicare Cost Report e-Filing System Webcast — May 1
- Increased Ambulance Payment Reduction for Non-Emergency BLS Transports to and from Renal Dialysis Facilities MLN Matters Article — New
- New Waived Tests MLN Matters Article — New
- Supervised Exercise Therapy for Symptomatic PAD MLN Matters Article — Revised
- Modifications to the Implementation of the PWK Segment of the esMD System MLN Matters Article — Revised
- Claims Processing Actions to Implement Certain Provisions of the Bipartisan Budget Act of 2018 MLN Matters Article — Revised
- Revised and New Modifiers for Oxygen Flow Rate MLN Matters Article — Revised
- April 2018 MLN Catalog – Revised
- Medicare Home Health Benefit Booklet — Revised
Medicare will never call beneficiaries uninvited and ask for personal or private information to get their new Medicare Number and card. Scam artists may try to get personal information (like their current Medicare Number) by contacting them about their new card. If your Medicare patient is asked for their information, for money, or someone threatens to cancel their health benefits if they don't share their personal information, have them call 1-800-MEDICARE (1-800-633-4227).
The new Medicare Number is also called the Medicare Beneficiary Identifier (MBI) and is replacing the current Social Security-based Health Insurance Claim Number (HICN) on Medicare health insurance cards. We will continue to accept the HICN through the transition period.
Find identity theft resources for people with Medicare.
Use the updated MIPS Participation Lookup Tool to check on your 2018 eligibility for the Merit-based Incentive Payment System (MIPS). Just enter your National Provider Identifier to find out whether you need to participate during the 2018 performance year.
To reduce the burden on small practices, CMS changed the eligibility threshold for 2018. Clinicians and groups are now excluded from MIPS if they:
- Billed $90,000 or less in Medicare Part B allowed charges for covered professional services under the Physician Fee Schedule (PFS)
- Furnished covered professional services under the PFS to 200 or fewer Medicare Part B -enrolled beneficiaries
CMS published the draft 2019 Quality Reporting Document Architecture (QRDA) Category I Schematron for hospital quality reporting. This Schematron is a companion to the 2019 QRDA I Implementation Guide (IG) and allows for computerized validation of QRDA documents against the IG requirements. Submit comments until April 20 at 5 pm through JIRA ticket number QRDA-681; a JIRA account is required to comment.
The final Schematron and sample file will be published May 4 on the eCQI Resource Center QRDA webpage.
CMS posted the home health agency Public Use File (PUF) with data for 2015, including utilization, payment, submitted charges, and condition indicators. The PUF has information for 10,526 home health agencies, over 6 million claims, and $18 billion in Medicare payments.
Visit the Provider Utilization and Payment Data webpage for more information, including updated PUFs for 2013 and 2014.
National Health Care Decisions Day educates the public and providers about the importance of Advance Care Planning (ACP). Did you know that ACP services can be billed to the Medicare Physician Fee Schedule?
For More Information:
- ACP Fact Sheet
- Billing the Physician Fee Schedule for ACP Services Frequently Asked Questions
- ACP as an Optional Element of an Annual Wellness Visit MLN Matters® Article
- National Health Care Decisions Day website
Provider Compliance Tips for Oral Anticancer Drugs and Antiemetic Drugs Used in Conjunction
For the 2017 reporting period, the Medicare Fee-For-Service (FFS) improper payment rate for oral anticancer drugs was 43.2 percent, representing a projected improper payment amount of $66.09 million. According to 2016 reporting data, improper payments resulted from:
- Insufficient documentation - 74 percent
- No documentation - 1.8 percent
- Other reasons such as duplicate payment error, non-covered or unallowable service, or ineligible Medicare beneficiary - 24.1 percent
Prevent denials by reviewing the Provider Compliance Tips for Oral Anticancer Drugs and Antiemetic Drugs used in Conjunction Fact Sheet for coverage and documentation requirements.
- 2017 Medicare FFS Supplemental Improper Payment Data
- Supplementary Appendices for the Medicare FFS 2016 Improper Payments Report
- Local Coverage Determination: Oral Anticancer Drugs
- Local Coverage Article: Oral Anticancer Drugs
Wednesday, April 25 from 10 am to noon ET
Register to stream online.
CMS and the Substance Abuse and Mental Health Administration will host a forum on combating the opioid epidemic and addressing behavioral health in minority populations. The panel of public health leaders, health care professionals, and community members provide updates on prevention, diagnosis, intervention, treatment/recovery, and access to behavioral health services. Attendees are encouraged to join the discussion.
Tuesday, May 1 from 1 to 2:30 pm ET
Register for Medicare Learning Network events.
During this webcast, learn how to use the Medicare Cost Report e-Filing (MCReF) system. Beginning May 1, Medicare Part A providers can use MCReF to submit cost reports with fiscal years ending on or after December 31, 2017. You will have the option to electronically transmit your cost report through MCReF or mail or hand deliver it to your Medicare Administrative Contractor. Starting July 2, you must use MCReF if you choose electronic submission of your cost report. Access to MCReF will be controlled by the CMS Enterprise Identity Management (EIDM) system. Security Officials (SOs) and Backup SOs registered in EIDM for access to the Provider Statistical and Reimbursement (PS&R) system will have access to MCReF through their existing account. Providers that are not registered in EIDM as PS&R users must register and assign an SO for their organization.
A question and answer session follows the presentation; however, attendees may email questions in advance to OFMDPAOQuestions@cms.hhs.gov with “Medicare Cost Report e-Filing System Webcast” in the subject line. These questions may be addressed during the webcast or used for other materials following the webcast.
CMS will use webcast technology for this event with audio streamed through your computer. If you are unable to stream audio through your computer, phone lines are available.
Target Audience: Medicare Part A providers and entities that file cost reports for providers.
Increased Ambulance Payment Reduction for Non-Emergency BLS Transports to and from Renal Dialysis Facilities MLN Matters Article — New
A new MLN Matters Article on Increased Ambulance Payment Reduction for Non-Emergency Basic Life Support (BLS) Transports to and from Renal Dialysis Facilities is available. Learn about payment reductions applied to both the base rate and the mileage reimbursement.
A new MLN Matters Article on New Waived Tests is available. Learn about the latest tests approved by the Food and Drug Administration under Clinical Laboratory Improvement Amendments.
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.
Modifications to the Implementation of the PWK Segment of the esMD System MLN Matters Article — Revised
A revised MLN Matters Article on Modifications to the Implementation of the Paperwork (PWK) Segment of the Electronic Submission of Medical Documentation (esMD) System is available. Learn about cover sheets that must be used for electronic, fax, or mail submissions of unsolicited documentation.
Claims Processing Actions to Implement Certain Provisions of the Bipartisan Budget Act of 2018 MLN Matters Article — Revised
A revised 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.
A revised MLN Matters Article on Revised and New Modifiers for Oxygen Flow Rate is available. Learn about adjustments to the monthly payment amounts for oxygen and oxygen equipment based on the patient’s prescribed oxygen flow rate.
A revised April 2018 MLN Catalog is available. Learn about:
- Products and services that can be downloaded for free
- Web-based training courses; some offer continuing education credits
- Helpful links, tools, and tips
A revised Medicare Home Health Benefit Booklet is available. Learn about:
- Qualifying for services
- Consolidated billing
- Therapy services
- Physician billing and payment
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