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MLN Connects for June 28, 2018

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Thursday, June 28, 2018

News & Announcements

Provider Compliance

Claims, Pricers & Codes

Upcoming Events

Medicare Learning Network® Publications & Multimedia

   View this edition as a PDF (PDF)


News & Announcements


New Medicare Card: Use MBI Like HICN

Use the Medicare Beneficiary Identifier (MBI) the same way you use the Health Insurance Claim Number (HICN) today. Put the MBI in the same field where you have always put the HICN. This also applies to reporting informational only and no-pay claims. Do not use hyphens or spaces for hyphens with the MBI to avoid rejection of your claim.

For More Information:


CMS Data Element Library Supports Interoperability

CMS launched its first Data Element Library (DEL), a resource for providers, vendors, researchers, and other stakeholders that use CMS assessments. Search and obtain reports on CMS post-acute care assessment contents in one location, including:

  • Questions
  • Response codes
  • Attributes
  • Health information technology standards

The DEL supports interoperability and the exchange and reuse of data across post-acute care and other providers by using common assessment standards and definitions to facilitate coordinated care and improved health outcomes.

For More Information:


Physician Self-referral Law RFI: Submit Comments by August 24

On June 20, CMS issued a Request for Information - Opens in a new window (RFI) seeking public input on reducing the regulatory burdens of the Physician Self-referral Law (also known as the “Stark Law”). Submit comments by August 24.

For More Information:


Qualified Medicare Beneficiary Information on RAs and MSNs

Medicare providers may not bill beneficiaries enrolled in the Qualified Medicare Beneficiary (QMB) program for Medicare Parts A and B deductibles, coinsurance, or copays, but state Medicaid programs may pay for those costs. To make it easier to identify the QMB status of your patients, CMS will reintroduce QMB information in provider Remittance Advices (RAs) and Medicare Summary Notices (MSNs) for claims processed on or after July 2, 2018. You can also verify QMB enrollment by using Medicare eligibility information returned by the CMS Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS) 270/271 application.

For More Information:


Laboratory Date of Service Exception — Reminder

On July 2, CMS will implement the exception to the laboratory date of service policy for advanced diagnostic laboratory tests and molecular pathology tests excluded from the Medicare hospital outpatient prospective payment system packaging policy. 

For More Information:


Administrative Simplification Compliance Resources

CMS created tools and resources to help you understand and reach compliance:

For More Information:


2016 CMS Program Statistics

2016 CMS Program Statistics are available, including detailed summary statistics on Medicare populations, utilization, and expenditures, as well as counts for Medicare-certified institutional and non-institutional providers. Tables for calendar years 2013 to 2015 are updated to reflect changes to the source data for enrollment and utilization information. Visit the CMS Program Statistics website for more information.


Pride in Putting Patients First

While health care organizations have made great strides in collecting certain sociodemographic data, more work needs to be done, particularly when it comes to sexual and gender minorities. During Pride month, which recognizes sexual and gender minorities, CMS wants to highlight a number of resources that are available to assist organizations in collecting better data, including:

See the full text of this excerpted CMS blog (issued June 19).


Health Care System Response to Mass Shootings

A rapid, effective health response can save lives in the hours after a mass shooting or other unexpected events. In the Office of the Assistant Secretary for Preparedness and Response (ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE)  June newsletter - Opens in a new window , health professionals share lessons learned about pre-hospital care, trauma, and emergency response from mass shootings. Review resources - Opens in a new window on health care system preparedness, and  sign up - Opens in a new window  for the ASPR TRACIE listserv.


Provider Compliance


Comprehensive Error Rate Testing: Arthroscopic Rotator Cuff Repair

As reported in the Medicare Quarterly Compliance Newsletter (October 2017) (PDF), the Comprehensive Error Rate Testing (CERT) review contractor conducted a study of claims for arthroscopic rotator cuff repairs billed with HCPCS code 29827 submitted from January through March 2016. Most improper payments were due to insufficient documentation.

Avoid documentation errors and payment recoveries:


Claims, Pricers & Codes


New Part B Edit for Duplication of Diagnosis Codes on Hard Copy Claims

Medicare is implementing systems changes to ensure that all Part B 837 coordination of benefits/Medicare crossover claims do not include duplicate diagnosis codes. Part B providers: Effective July 2, 2018, CMS-1500 hard copy claims should not list the same diagnosis code twice within item 21, or your Medicare Administrative Contractor will return these claims as unprocessable with Claim Adjustment Reason Code 16, Remittance Advice Remark Code (RARC) M76, and alert RARC N211.


Upcoming Events


Provider Compliance Focus Group — July 13

Friday, July 13 from 8 am to 12:30 pm

CMS Central Office, Baltimore, MD or via phone/webinar

Register - Opens in a new window  for this event.

Join us for a focus group meeting on Medicare Fee-for-Service compliance topics. This is a chance for us to get together and talk about medical review, targeted probe and educate, the Recovery Audit Contractors and more. CMS is most interested in hearing from you about what we can do to better communicate, improve our processes, and eliminate unnecessary requirements. We want to ensure claims are paid appropriately and preserve the Medicare Trust Fund for future generations. We also want to make it easier for you to submit claims accurately and manage the audit process if you’re audited.

Target Audience: Physicians, non-physician practitioners, billing specialists, suppliers, and associations.


Medicare Learning Network® Publications & Multimedia


Medicare Billing for Cardiac Device Credits Fact Sheet — New

A new Medicare Billing for Cardiac Device Credits Fact Sheet is available. Learn about:

  • Basis for reducing payments
  • Hospital coding and billing requirements
  • Policy guidance


MBI: Get It, Use It MLN Matters Article — Revised

A revised MLN Matters Article on New Medicare Beneficiary Identifier (MBI) Get It, Use It (PDF) is available. Learn how to respond if your patient says they did not get their Medicare card.


Medicare Coverage for Chiropractic Services MLN Matters Article — Revised

A revised MLN Matters Article on Medicare Coverage for Chiropractic Services – Medical Record Documentation Requirements for Initial and Subsequent Visits (PDF) is available. Learn about coverage and documentation requirements.


ESRD PPS: Quarterly Update MLN Matters Article — Revised

A revised MLN Matters Article on Quarterly Update to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) (PDF) is available. Learn about new codes added for anemia management.


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

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


Hospital OPPS: July 2018 Update MLN Matters Article — Revised

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


Telehealth Billing Requirements for Distant Site Services MLN Matters Article — Revised

A revised 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.


MLN Learning Management System FAQs Booklet — Revised

A revised The Medicare Learning Network (MLN) Learning Management System (LMS) FAQs Booklet is available. Learn about:

  • Accessing the LMS
  • Finding products
  • Taking Web-Based Training



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