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MLN Connects for May 3, 2018

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Thursday, May 3, 2018

News & Announcements

Provider Compliance

Upcoming Events

Medicare Learning Network® Publications & Multimedia

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News & Announcements


New Medicare Cards: You Can Use MBIs Right Away

Your Medicare patients are getting their new Medicare cards with new numbers known as Medicare (PDF) Beneficiary Identifiers (MBIs) (PDF). MBIs will replace the existing Social Security Number (SSN) based Health Insurance Claim Number (HICN) on the new Medicare cards and in the systems Medicare uses now. Medicare will replace all current cards and SSN-based numbers by April 2019.

Medicare is telling your Medicare patients to show you and your office staff their new Medicare card when they come for care. It is important for you to protect the identity of your Medicare patients by getting and using their new MBIs as soon as you have them.

You and your office staff should:

  • Use the MBI to bill Medicare as soon as you get a Medicare patient’s new number
  • Use the transition period (PDF) to make sure your systems can accept and transmit MBIs

Here are three ways you and your office staff can get MBIs:

  • Ask your Medicare patients: Medicare is mailing the new Medicare cards in phases by geographic location (PDF) to people with Medicare. Ask your Medicare patients for their new Medicare card when they come for care. If they have received a new card but don’t have it with them at the time of service, remind them they can use MyMedicare.gov to get their new Medicare number.
  • Use the Medicare Administrative Contractors’ secure MBI look-up tool: Learn about (PDF) and sign up (PDF) for the Portal to use the tool when it is available no later than June 2018. You can look up MBIs for your Medicare patients who don’t have their new cards when they come for care.
  • Check the remittance advice: Starting in October 2018 through the end of the transition period, Medicare will return the MBI on every remittance advice when you submit claims with valid and active HICNs.

Medicare has resources to help you use the new Medicare cards:


New Strategy to Fuel Data-driven Patient Care, Transparency

On April 26, CMS Administrator Seema Verma announced the agency’s new Data Driven Patient Care Strategy as part of the MyHealthEData initiative. The strategy positions CMS to further support industry innovation in unleashing the power of data to inform patients’ healthcare decisions and transform the healthcare system by enhancing security and privacy, improving quality, increasing efficiency, and reducing costs. The latest effort is based on three critical cornerstones:

  • Putting patients first
  • Making more data available
  • Taking an “application programming interface-approach” to exchanging data in a secure and private manner

“We know we can’t achieve value-based care until we put the patient at the center of our healthcare system,” Administrator Verma said. “The Data Driven Patient Care Strategy will empower patients with the information they need as consumers of healthcare to enable them to make informed decisions about the care they need. Ultimately, the cornerstone of a patient-centered system is data—quality data, cost data, and a patient’s own data.”

For More Information:

See the full text of this excerpted CMS Press Release (issued April 26).


CMS Encourages Eligible Suppliers to Participate in Expanded Medicare Diabetes Prevention Program Model

In April, CMS expanded the Medicare Diabetes Prevention Program (MDPP), a national performance-based payment model offering a new approach to type 2 diabetes prevention in eligible Medicare beneficiaries with an indication of pre-diabetes. For the first time, both traditional health care providers and community-based organizations can enroll as Medicare suppliers of health behavior change services. This innovative model promotes patient-centered care and continues to test market-driven reforms to drive quality of care and improve outcomes for America’s seniors, more than a quarter of whom have type 2 diabetes. CMS recognizes that prevention is a critical part of creating an affordable healthcare system that puts patients first, and we encourage eligible suppliers to partner with us on this shared goal by participating in the national expansion of the MDPP.

Through the MDPP, trained community health workers and other health professionals empower beneficiaries at high risk of developing type 2 diabetes to take ownership of their health through curriculum-driven coaching and proven behavior change strategies for weight control. As a new preventive service for qualifying Medicare beneficiaries, MDPP services are available without a referral or co-payment.

One of the critical innovations in the MDPP is its approach to care delivery: For the first time, community-based organizations can enroll in Medicare to provide evidence-based diabetes prevention services after achieving preliminary or full recognition through the Centers for Disease Control and Prevention (CDC). These organizations can enroll in Medicare to become an MDPP Supplier today, and CMS will continue to accept supplier applications on a rolling basis.

For More Information:

See the full text of this excerpted CMS Blog (issued April 30).


Patients Over Paperwork April Newsletter

Read the CMS Patients Over Paperwork April newsletter (PDF), part of our ongoing effort to reduce administrative burden and improve the customer experience, while putting patients first. CMS solicited comments on burden reduction, transparency, and program simplification through nine proposed payment rules. Find out about the 14 themes that we identified and how we used your feedback to reduce burden for:

  • Medicare and Medicaid EHR Incentive Programs
  • Hospital quality and value-based purchasing programs
  • Part A certification statements
  • Clerical errors in documenting physician admission orders

This edition also clarifies billing for immunosuppressive drugs (PDF).

For More Information:


Hospital Quality Reporting Center Spring 2018 Newsletter

Read the Hospital Quality Reporting Center Spring 2018 newsletter with information for acute care hospitals, critical access hospitals, inpatient psychiatric facilities, and Prospective Payment System (PPS)-exempt cancer hospitals. Topics include:

  • FY 2019 inpatient PPS proposed rule
  • Enter your health care personnel influenza vaccination data
  • Keep your QualityNet security administrator account active
  • CY 2017 (FY 2019) Inpatient Quality Reporting structural measures and Data Accuracy and Completeness Acknowledgement
  • Download your Hospital Value-Based Purchasing Program Baseline Measures Report
  • New instructional guidance on the National Health Care Safety Network re-consent process
  • Extraordinary Circumstances Exception request form


Administrative Simplification: Transactions

Did you know that Administrative Simplification includes standards for common health care administrative transactions? The standards address the content and format for each transaction:


Can’t Find An Answer To Your Question?

Most key initiatives have Frequently Asked Questions (FAQs). If you search for a Medicare topic on cms.gov and do not find an answer, visit the fee-for-service FAQ webpage to search by topic or submit a question.


Hand Hygiene Day is May 5

“Clean Care is Safer Care.” Hand Hygiene Day is the World Health Organization’s annual call to action for health workers. Clean your hands at the right times and stop the spread of antibiotic resistance.

Medicare Learning Network resources:

  • Infection Control: Hand Hygiene Video — Learn when to wash your hands and techniques to wash visibly and non-visibly dirty hands — run time 1:58
  • Infection Control: Hand Hygiene Web-Based Training Course — Learn about hand hygiene in patient care zones and nearby administrative areas; appropriate methods for maintaining good hand hygiene; and how to recognize opportunities for hand hygiene in a health care setting — with continuing education credit


Provider Compliance


Provider Compliance Tips for Ordering Lower Limb Orthoses

The Medicare Fee-For-Service (FFS) improper payment rate for lower limb orthoses was 66.7 percent, representing a projected improper payment amount of $319.6 million. The 2017 reporting period indicates the following reasons for improper payments for lower limb orthoses:

  • Insufficient documentation errors - 92.2 percent
  • No documentation - 2.1 percent
  • Medical necessity - 1.5 percent

Prevent denials by reviewing the Provider Compliance Tips for Ordering Lower Limb Orthoses (PDF) Fact Sheet, which details Medicare’s coverage and documentation requirements.

Additional Resources:


Upcoming Events


Quality Payment Program: Participation Criteria for Year 2 Webinar — May 9

Wednesday, May 9 from 1 to 2:15 ET

Register for this webinar.

This webinar provides an overview of participation criteria used to determine inclusion in the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).Learn about:

  • How CMS determines a clinician’s participation status in MIPS at the individual and group level
  • Advanced APMs and criteria for how to become a Qualifying APM Participant
  • Advanced APMs All-Payer Combination Option
  • APM Scoring Standard benefits for participation in a MIPS APM
  • Checking your participation status for the 2018 Performance Year


eCQI Resource Center Demonstration and Annual Update Webinar — May 10

Thursday, May 10 from 12:30 to 1:30 pm ET

Register for this webinar.

Attend a live demonstration to tour the newly updated electronic Clinical Quality Improvement (eCQI) Resource Center. Learn about tools and resources related to the electronic Clinical Quality Measure (eCQM) annual update for the 2019 reporting and performance period. The website includes the most current eCQM specifications, as well as links to the tools, standards, education, and materials to support their development, testing, implementation, and reporting.


Quality Payment Program: Answering Your Frequently Asked Questions Call — May 16

Wednesday, May 16 from 1:30 to 3 pm ET

Register for Medicare Learning Network events.

During this call, CMS answers frequently asked questions about the Quality Payment Program from the 2018 Healthcare Information and Management Systems Society (HIMSS18) Annual Conference & Exhibition and inquiries received by the Quality Payment Program Service Center. Then, we open the phone lines to take your questions.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable Growth Rate formula, which would have resulted in a significant cut to payment rates for clinicians participating in Medicare. MACRA requires CMS by law to implement an incentive program, referred to as the Quality Payment Program, which provides two participation tracks for clinicians:

  • The Merit-based Incentive Payment System (MIPS)
  • Advanced Alternative Payment Models (Advanced APMs)

Target Audience: Medicare Part B fee-for-service clinicians; office managers and administrators; state and national associations that represent healthcare providers; and other stakeholders.


Settlement Conference Facilitation Expansion Call — May 22

An Alternative Dispute Resolution Initiative

Tuesday, May 22 from 1:30 to 3 pm ET

Register for Medicare Learning Network events.

As part of the broader commitment by HHS to improving the Medicare claims appeals process, the Office of Medicare Hearings and Appeals (OMHA) is expanding the current Settlement Conference Facilitation (SCF) program to reach additional providers and suppliers. SCF is an alternative dispute resolution process that gives certain providers and suppliers an opportunity to resolve their eligible Part A and Part B appeals pending at OMHA and the Medicare Appeals Council (Council).

During this call, learn about the newly expanded SCF Initiative, which appeals are eligible for SCF, and the SCF process. Visit the OMHA SCF website for more information.

A question and answer session follows the presentation; however, attendees may email questions in advance to OMHA.SCF@hhs.gov with “SCF May 22 Call” in the subject line. These questions may be addressed during the call or used for other materials following the call.

Target Audience: Medicare Part A and Part B providers and suppliers with a total of 500 or more appeals pending at OMHA and the Council combined; or Medicare Part A and Part B providers and suppliers with any number of appeals pending at OMHA and the Council that each have more than $9,000 in billed charges.


Comparative Billing Report on Critical Care Services Webinar — June 6

Wednesday, June 6 from 3 to 4 pm ET

Join us for a discussion of the comparative billing report on Critical Care Services (CBR201804), an educational tool for providers who submit claims for critical care evaluation and management services using current procedural terminology codes 99291 and 99292. During the webinar, providers interact directly with content specialists and submit questions about the report. See the announcement for more information and find out how to participate.


Medicare Learning Network® Publications & Multimedia


New Physician Specialty Code for Medical Genetics and Genomics MLN Matters® Article — New

A new MLN Matters Article on New Physician Specialty Code for Medical Genetics and Genomics (PDF) is available. Learn about the new physician specialty code D3.


Processing Instructions to Update the Identification Code Qualifier Being Used in the NM108 Data Element MLN Matters Article — New

A new MLN Matters Article on Processing Instructions to Update the Identification Code Qualifier Being Used in the NM108 Data Element at the 2100 Loop, NM1- Patient Name Segment in the 835 Guide (PDF) is available. Learn about modification of the Identification Code Qualifier in the 835 Electronic Remit from HN to MI.


Revisions to the Telehealth Billing Requirements for Distant Site Services MLN Matters Article — New

A new MLN Matters Article on Revisions to the Telehealth Billing Requirements for Distant Site Services (PDF) is available. Learn about use of the GT modifier on institutional claims billed under critical access hospital Method II.


Enhancements to Processing of Hospice Routine Home Care Payments MLN Matters Article — New

A new MLN Matters Article on Enhancements to Processing of Hospice Routine Home Care Payments (PDF) is available.  Learn about the addition of value codes to the claim that display the number of days paid at both the high and low payment rates.


Comprehensive ESRD Care Model Telehealth - Implementation MLN Matters Article — New

A new MLN Matters Article on Comprehensive ESRD Care (CEC) Model Telehealth - Implementation (PDF) is available. Learn about the telehealth waiver.


Removal of KH Modifier from Capped Rental Items MLN Matters Article — New

A new MLN Matters Article on Removal of KH Modifier from Capped Rental Items (PDF) is available. Learn about this change on purchased capped rental durable medical equipment or parenteral/enteral items and services


Acute Care Hospital IPPS Booklet — Revised

A revised Acute Care Hospital Inpatient Prospective Payment System (IPPS) Booklet is available. Learn about:

  • Payment: rates and updates
  • How payment rates are set
  • Quality Reporting and Electronic Health Record Meaningful User Incentive Programs



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