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Date
2018-06-14
Subject
MLN Connects for June 14, 2018
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Thursday, June 14, 2018

News & Announcements

Provider Compliance

Claims, Pricers & Codes

Upcoming Events

Medicare Learning Network® Publications & Multimedia

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News & Announcements

 

CMS Opioids Roadmap

Although some progress has been made in efforts to combat the opioid epidemic, the latest data from the Centers for Disease Control and Prevention indicate the crisis is not slowing down. CMS published a roadmap outlining our efforts to address this issue of national concern. In this roadmap, we detail our three-pronged approach to combating the opioid epidemic, focusing on:

  • Prevention of new cases of opioid use disorder (OUD)
  • Treatment of patients who have already become dependent on or addicted to opioids
  • Utilization of data from across the country to target prevention and treatment activities

Current estimates show that over two million people suffer from opioid use disorder, with a prevalence in Medicare of 6 out of every 1,000 beneficiaries. In order to decrease that number, it is crucial that Medicare beneficiaries and providers are aware that there are options available for both prevention of developing new cases of OUD and the treatment of existing cases. CMS is working to ensure that beneficiaries are not inadvertently put at risk of misuse by closely monitoring prescription opioid trends, strengthening controls at the time of opioid prescriptions, and encouraging health care providers to promote a range of safe and effective pain treatments, including alternatives to opioids. We are also working on communications with beneficiaries to explain the risks of prescription opioids and how to safely dispose of them, so they are not misused by others.

This roadmap is only a start, and as we begin to implement many of our plans and programs, it will continue to evolve. See the full text of this excerpted CMS blog (issued June 11).

 

LTCH and IRF Compare Refresh

The June 2018 quarterly Long-term Care Hospital (LTCH) and Inpatient Rehabilitation Facility (IRF) Compare refresh is available, including quality measure results based on data from the third quarter of 2016 to the second quarter of 2017. Visit LTCH Compare and IRF Compare to view the data. For more information, visit the LTCH Quality Public Reporting and IRF Quality Public Reporting webpages.

 

Antipsychotic Drug Use in Nursing Homes: Trend Update

CMS is tracking the progress - Opens in a new window  - External Link Policy - Opens in a new window of the National Partnership to Improve Dementia Care in Nursing Homes by reviewing publicly reported measures. The official measure of the Partnership is the percentage of long-stay nursing home residents who receive antipsychotic medication, excluding residents diagnosed with schizophrenia, Huntington's disease or Tourette’s syndrome. In the fourth quarter of 2011, 23.9 percent residents received an antipsychotic medication; since then there has been a decrease of 36.6 percent to a national prevalence of 15.1 percent in the fourth quarter of 2017. Success varies by state and CMS region; some states and regions have a reduction greater than 40 percent. A four-quarter average of this measure is posted on the Nursing Home Compare website.

For More Information:

 

Men’s Health Week Ends on Father’s Day

June is Men’s Health Month, and June 11 through 17 is Men’s Health Week, which ends on Father’s Day. These observances heighten awareness of preventable health problems and encourage early detection and treatment of disease. Help your Medicare patients understand the steps they can take to improve their health and recommend appropriate preventive services.

For More Information:

Visit the Preventive Services website to learn more about Medicare-covered services.

 

Provider Compliance

 

Billing for Stem Cell Transplants — Reminder

In a February 2016 report, the Office of the Inspector General (OIG) determined that Medicare paid for many stem cell transplants incorrectly. The main finding was that providers billed these procedures as inpatient when they should have been submitted as outpatient services.

Use the following resources to bill correctly and avoid overpayment recoveries:

 

Claims, Pricers & Codes

 

FY 2019 ICD-10-CM Diagnosis Codes

Final FY 2019 ICD-10-CM diagnosis code updates are available on the 2019 ICD-10-CM webpage.

 

Upcoming Events

 

Medicare Diabetes Prevention Program: Supplier Enrollment Call — June 20

Wednesday, June 20 from 1:30 to 3 pm ET

Register - Opens in a new window  - External Link Policy - Opens in a new window  for Medicare Learning Network events.

During this call, find out about the Medicare Diabetes Prevention Program (MDPP), the processes organizations and health care providers must go through to enroll as MDPP suppliers, and how to bill for services. A question and answer session follows the presentation.

Target Audience: Current Centers for Disease Control and Prevention recognized Diabetes Prevention Program organizations; organizations interested in becoming MDPP suppliers, including existing Medicare providers/suppliers, community organizations, non-for-profits; associations, and advocacy groups focused on seniors or diabetes; and other interested stakeholders, including health plans, primary care/internal medicine specialties.

 

IMPACT Act: Frequently Asked Questions Call — June 21

Thursday, June 21 from 2 to 3 pm ET

Register - Opens in a new window  - External Link Policy - Opens in a new window  for Medicare Learning Network events.

During this call, learn more about the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). CMS answers your frequently asked questions on quality measures, standardized data elements, the CMS data element library, and future directions of the IMPACT Act. A question and answer session follows the presentation.

Target Audience: Post-acute care providers, including skilled nursing facilities, home health agencies, inpatient rehabilitation facilities, and long-term care hospitals; researchers; administrators; and other industry stakeholders and interested parties.

 

Home Health Agencies: Quality of Patient Care Star Ratings Algorithm Call — June 27

Wednesday, June 27 from 2 to 3 pm ET

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During this call, learn about proposed modifications to the way CMS calculates Home Health Quality of Patient Care star ratings, including:

  • Removal of the Drug Education on All Medications Provided to Patient/Caregiver during All Episodes of Care measure
  • Addition of the Improvement in Oral Medications measure

CMS presents the rationale, proposed timing, and impact of these changes. A question and answer session follows the presentation.

Target Audience: Home health agencies and other industry stakeholders.

 

Ground Ambulance Providers and Suppliers: Data Collection System Listening Session — June 28

Thursday, June 28 from 1:30 to 3 pm ET

Register - Opens in a new window  - External Link Policy - Opens in a new window for Medicare Learning Network events.

Section 50203(b) of the Bipartisan Budget Act of 2018 requires the development of a data collection system (which may include use of a cost survey) to collect cost, revenue, utilization, and other information on providers and suppliers of ground ambulance services. The system must collect information:

  • Needed to evaluate the extent to which reported costs relate to payment rates
  • On the utilization of capital equipment and ambulance capacity
  • On different types of ground ambulance services furnished in different geographic locations, including rural and super rural areas

This listening session is an opportunity to provide input on the development of this system, including:

  • Recommendations on the data elements that CMS should collect
  • Identifying costs that would be difficult to define and report and why
  • Addressing the potential that there is a variation of costs among organizations that provide ambulance services
  • Other comments on the provision that CMS should consider

Target Audience: Ground ambulance providers and suppliers, as well as ambulance stakeholders.

 

Medicare Learning Network® Publications & Multimedia

 

Improvements in Hospice Billing and Claims Processing MLN Matters Article — New

A new MLN Matters Special Edition Article on Recent and Upcoming Improvements in Hospice Billing and Claims Processing is available. Learn about submitting Notices of Election via Electronic Data Interchange, correcting election or revocation dates using Occurrence Code 56, and upcoming improvements.

 

Provider Enrollment: Unlicensed Residents MLN Matters Article — New

A new MLN Matters Special Edition Article on Provider Enrollment – Unlicensed Residents is available. Learn about the enrollment policies and procedures related to unlicensed residents.

 

Update of the Hospital OPPS: July 2018 MLN Matters Article — New

A new MLN Matters Article on July 2018 Update of the Hospital Outpatient Prospective Payment System (OPPS) is available. Learn about changes to and billing instructions for various payment policies.

 

I/OCE Specification Version 19.2: July 2018 MLN Matters Article — New

A new MLN Matters Article on July 2018 Integrated Outpatient Code Editor (I/OCE) Specification Version 19.2 is available. Learn about instructions and specifications.

 

Quarterly Update for the DMEPOS CBP: October 2018 MLN Matters Article — New

A new MLN Matters Article on Quarterly Update for the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP) - October 2018 is available. Learn when to implement fee schedule amounts for new codes and correct amounts for existing codes.

 

Medicare Claims Processing Manual Update, Chapters 18 and 35: IDTF MLN Matters Article — New

A new MLN Matters Article on Update of Internet Only Manual (IOM), Medicare Claims Processing Manual, Publication 100-04, Chapter 18 - Preventive and Screening Services, and Chapter 35 - Independent Diagnostic Testing Facility (IDTF) is available. Learn about requirements and payment policies for screening mammography services furnished by IDTFs.

 

Provider/Supplier Reporting of Adverse Legal Actions MLN Matters Article — New

A new MLN Matters Article on Provider/Supplier Reporting of Adverse Legal Actions is available. Learn about the updated list of reportable Final Adverse Actions.

 

Transition to New Medicare Numbers and Cards Fact Sheet — Revised

A revised Transition to New Medicare Numbers and Cards Fact Sheet is available. Learn about:

  • New Medicare numbers, which will replace Health Insurance Claim Numbers on new Medicare cards
  • What you need to do to get ready for the change
  • Where to find help

 

CMS Web Wheel Educational Tool — Revised

A revised CMS Web Wheel Educational Tool is available. Find webpages to learn about:

  • Educational resources
  • CMS initiatives
  • Medicare Administrative Contractor resources

 

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

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 - Opens in a new window  - External Link Policy - Opens in a new window . Learn about:

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

 

Remittance Advice Resources and FAQs Booklet — Reminder

A revised Remittance Advice Resources and FAQs Booklet is available. Learn about:

  • How to read institutional or professional Remittance Advice (RA)
  • Assigned and unassigned claims
  • Balancing an RA

 

 


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