- MLN Connects for June 21,2018
Thursday, June 21, 2018
- New Medicare Cards May Have QR Codes
- Continuous Glucose Monitors: Changes Impacting Medicare Coverage
- Quality Payment Program Look-Up Tool Updated
- Quality Payment Program Website Includes 2018 MIPS Measures and Activities
- Hospice Provider Preview Reports: Review Your Data by June 30
- IRF and LTCH Provider Preview Reports: Review Your Data by July 1
- SNF Provider Preview Report: Review Your Data by July 1
- CMS Leverages Medicaid Program to Combat the Opioid Crisis
- Payment for Outpatient Services Provided to Beneficiaries Who Are Inpatients of Other Facilities — Reminder
- Home Health Agencies: Quality of Patient Care Star Ratings Algorithm Call — June 27
- Ground Ambulance Providers and Suppliers: Data Collection System Listening Session — June 28
- July Quarterly Update for 2018 DMEPOS Fee Schedule MLN Matters Article — New
- Qualified Medicare Beneficiary Call: Audio Recording and Transcript — New
New Medicare cards may have a square code, also referred to as a QR code (a type of machine-readable code). The QR codes on Medicare cards allow the contractor who prints the cards to ensure the right card goes to the right person with Medicare or Railroad Retirement Board (RRB) benefits. Providers cannot use it for any other purpose. The RRB issued cards may have a QR code on the front of the card while all other Medicare patients may get a new card with a QR code on the back of the cards. These are legitimate (official) Medicare cards.
Information on the transition to the new Medicare Beneficiary identifier:
- New MBI Get It, Use It MLN Matters® Article
- Transition to New Medicare Numbers and Cards MLN Fact Sheet
- New Medicare Card information website
- New Medicare cards are in the mail website for people with Medicare
CMS announced that it will modify Medicare’s published coverage policy for Continuous Glucose Monitors (CGMs) to support the use of CGMs in conjunction with a smartphone, including the important data sharing function they provide for patients and their families. Durable Medical Equipment Medicare Administrative Contractors will issue a revised policy article in the near future, at which time the published change will be effective. Visit the Durable Medical Equipment Center webpage for more information.
CMS updated the Quality Payment Program Look-Up Tool with 2018 Merit-based Incentive Payment System (MIPS) eligibility and Qualifying Alternative Payment Model (APM) Participant (QP) data. Clinicians, enter your National Provider Identifier (NPI) to find out:
- Whether you need to participate in MIPS in 2018
- Your Predictive QP status
You can also check 2018 MIPS clinician eligibility at the group level and APM Predictive QP status at the APM entity level:
- Log into the Quality Payment Program website with your Enterprise Identity Data Management credentials
- Browse to the Taxpayer Identification Number (TIN) affiliated with your group
- Access the details screen to view the eligibility status of every clinician based on their NPI
- Download the list of all NPIs associated with your TIN, including eligibility information for each NPI
For More Information:
- Predictive QP Methodology Fact Sheet
- Contact the Quality Payment Program Service Center at QPP@cms.hhs.gov or 866-288-8292 (TTY: 877-715-6222)
CMS updated the Explore Measures section of the Quality Payment Program website for the 2018 performance period, including Merit-based Incentive Payment System (MIPS) measures and activities. Note: The Explore Measures tool is for informational purposes only; it cannot be used to submit or attest to measures and activities. For more information on MIPS measures and activities, visit the 2018 Resources webpage.
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 from the fourth quarter of 2016 to the third quarter of 2017 and your facility-level CAHPS survey results from the fourth quarter of 2015 to the third quarter of 2017 by June 30.
If you believe 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:
- HIS Preview Reports and Requests for CMS Review webpage
- CAHPS Preview Reports and Requests for CMS Review webpage
Inpatient Rehabilitation Facility (IRF) and Long-Term Care Hospital (LTCH) Provider Preview Reports are now available on quality measures based on fourth quarter 2016 through third quarter 2017 data. Review your performance data by July 1, prior to public display on IRF Compare and LTCH Compare in September 2018. Corrections to the underlying data are not permitted during this time; request a CMS review if you believe that your data is inaccurate.
IRF Provider Preview Report:
- IRF Quality Public Reporting webpage, including information on new measures
- IRF Compare website
- Preview Report Access Instructions
LTCH Provider Preview Report:
- LTCH Quality Public Reporting webpage, including information on new measures
- LTCH Compare website
- Preview Report Access Instructions
Skilled Nursing Facility (SNF) Provider Preview Reports are now available; visit the Spotlights and Announcements webpage for a list of quality measures based on quarterly data. Review your performance data by July 1, prior to public display on Nursing Home Compare. Corrections to the underlying data are not permitted during this time; request a CMS review if you believe that your data is inaccurate.
CMS released guidance aimed at building on our commitment to partner with states to ensure that they have flexibilities and the tools necessary to combat the opioid crisis. This new guidance provides information to states on the tools available to them, describes the types of approaches they can use to combat this crisis, ensures states know what resources are available, and articulates promising practices for addressing the needs of beneficiaries facing opioid addiction.
CMS released an Informational Bulletin that provides states with information they can use when designing approaches to covering critical treatment services for Medicaid eligible infants with Neonatal Abstinence Syndrome. Additionally, CMS issued a letter to states on how they may best use federal funding to enhance Medicaid technology to combat drug addiction and the opioid crisis.
See the full text of this excerpted CMS press release (issued June 11).
Payment for Outpatient Services Provided to Beneficiaries Who Are Inpatients of Other Facilities — Reminder
In a recent report, the Office of the Inspector General (OIG) determined that Medicare inappropriately paid acute-care hospitals for outpatient services provided to beneficiaries who were inpatients of other facilities, including long term care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, and critical access hospitals. As a result, beneficiaries were unnecessarily charged outpatient deductibles and coinsurance payments.
All items and non-physician services provided during a Medicare Part A inpatient stay must be provided directly by the inpatient hospital or under arrangements with the inpatient hospital and another provider. Use the following resources to bill correctly:
- Medicare Inappropriately Paid Acute-Care Hospitals for Outpatient Services They Provided To Beneficiaries Who Were Inpatients of Other Facilities. OIG Report, September 2017.
- MLN Matters Special Edition Article
- Provider Compliance Tips for Ordering Hospital Outpatient Services Fact Sheet
- Acute Care Hospital Inpatient Prospective Payment System Fact Sheet, see payment information on page 3
- Items and Services Not Covered Under Medicare Booklet, Page 12
- Medicare Claims Processing Manual, Chapter 3, Section 10.4
Wednesday, June 27 from 2 to 3 pm ET
Register - Opens in a new window for Medicare Learning Network events.
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.
Thursday, June 28 from 1:30 to 3 pm ET
Register - 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.
A new MLN Matters Article on July Quarterly Update for 2018 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule is available. Learn about quarterly update listing fee schedule amounts for non-rural and rural areas.
An audio recording and transcript are available for the June 6 call on Qualified Medicare Beneficiary (QMB) Program Billing Requirements. Find out about the July 2018 re-launch of changes to the remittance advice and November 2017 changes to the HIPAA Eligibility Transaction System (HETS) to identify the QMB status of your patients and exemption from cost-sharing. Also, learn key steps to promote compliance.
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