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Date
2018-07-26
Subject
MLN Connects for July 26, 2018
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Thursday, July 26, 2018

News & Announcements

Provider Compliance

Upcoming Events

Medicare Learning Network® Publications & Multimedia

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News & Announcements

 

New Medicare Card: Using Your MAC’s MBI Look-Up Tool

When you use the Medicare Administrative Contractor (MAC) secure portal Medicare Beneficiary Identifier (MBI) look-up tool, you must use your patient’s own Social Security Number (SSN) along with your patient’s first name, last name, and date of birth. Your patient’s SSN may differ from the number part of the Health Insurance Claim Number (HICN), which uses the SSN of the primary wage earner on whom benefits are based. The original Medicare card, with a HICN, of a spouse, widow, or other dependent will have the SSN of the wage earner; ask for your patient’s SSN to use in the look up tool. If you do not have access to the tool, sign up.

If you use your patient’s SSN and the look-up tool does not return an MBI, be sure you are using the full last name exactly as it appears on the Medicare card. You may want to include any suffix, such as Jr, Sr, or III.

Remember:

To ensure people with Medicare continue to get health care services, you can use the HICN through December 31, 2019, or until your patient brings in a new card with the new number.

Reminder:

We finished mailing most cards to people with Medicare who live in Wave 1 and 2 states: Alaska, American Samoa, California, Delaware, District of Columbia, Guam, Hawaii, Maryland, Northern Mariana Islands, Pennsylvania, Oregon, Virginia, and West Virginia. If your Medicare patients did not get a card:

  • Print and give them the “Still Waiting for Your New Card?” handout (in English or Spanish).
  • Or, tell them to call 1-800-Medicare (1-800-633-4227). There might be something that needs to be corrected, such as updating their mailing address.

 

E/M Coding Reform: Recording of Panel Discussion

CMS proposed historic changes that would increase the amount of time that doctors and other clinicians can spend with their patients by reducing the burden of paperwork that clinicians face when billing Medicare. We held listening sessions all over the country and heard from thousands of providers and one thing they consistently brought up was how documentation was needlessly burdensome, was not improving patient care, and was actually having a negative impact on patient care. We listened, and in response, we proposed streamlining the documentation requirements for Evaluation and Management (E/M) visits, as well as moving to single payment rates.

Watch CMS Administrator Seema Verma, CMS Chief Medical Officer and Director of CCSQ Kate Goodrich, Dr. Donald Rucker, National Coordinator for Health Information Technology, Dr. Anand Shah, CMMI Chief Medical Office and Dr. Thomas A. Mason, ONC Chief Medical Officer discuss proposed E/M coding changes.

Watch videos on E/M:

Patients Over Paperwork July Newsletter

Read the CMS Patients Over Paperwork July newsletter about our ongoing effort to reduce administrative burden and improve the customer experience, while putting patients first. In this edition, we:

  • Provide updates on how we are reducing burden for skilled nursing facilities/nursing homes, including regulatory actions, documentation review, Meaningful Measurement framework, and health IT
  • Describe how we are simplifying documentation requirements, including a change in procedures for therapeutic shoe inserts
  • Provide updates on where we are meeting with stakeholders to talk about reducing burden
  • Remind stakeholders of opportunities to give feedback through Requests for Information and proposed rules

More Information:

 

Hospice Quality Reporting Program Quick Reference Guide

An FY 2020 Hospice Quality Reporting Program Quick Reference Guide is available, including frequently asked questions, information on help desks, and links to additional resources. Visit the Reconsideration Requests webpage for more information.

 

HQRP Non-Compliance Letters: Request for Reconsideration by August 7

CMS provided notifications to hospices that were determined to be out of compliance with Hospice Quality Reporting Program (HQRP) requirements for CY 2017. This will affect your FY 2019 Annual Payment Update. Non-compliance notifications were mailed by Medicare Administrative Contractors and placed into QIES CASPER folders on July 9.

If you receive a letter of non-compliance, you may submit a request for reconsideration to CMS via email no later than 11:59 pm PT on August 7. See the instructions in your notification and on the Reconsideration Requests webpage.

 

IRF QRP Non-Compliance Letters: Request for Reconsideration by August 7

CMS provided notifications to facilities that are determined to be out of compliance with Inpatient Rehabilitation Facility (IRF) Quality Reporting Program (QRP) requirements for CY 2017. This will affect your FY 2019 Annual Increase Factor. Non-compliance notifications were mailed by Medicare Administrative Contractors and placed into QIES CASPER folders on July 9.

If you received a letter of non-compliance, you may submit a request for reconsideration to CMS via email no later than 11:59 pm PT on August 7. See the instructions in your notification letter and on the IRF Quality Reporting Reconsideration and Exception & Extension webpage.

 

LTCH QRP Non-Compliance Letters: Request for Reconsideration by August 7

CMS provided notifications to facilities that were determined to be out of compliance with Long-Term Care Hospital (LTCH) Quality Reporting Program (QRP) requirements for CY 2017. This will affect your FY 2019 Annual Payment Update. Non-compliance notifications were mailed by Medicare Administrative Contractors and placed into QIES CASPER folders on July 9.

 

If you receive a letter of non-compliance, you may submit a request for reconsideration to CMS via email no later than 11:59 pm PT on August 7. See the instructions in your notification letter and on the LTCH Quality Reporting Reconsideration and Exception & Extension webpage.

 

SNF QRP Non-Compliance Letters: Request for Reconsideration by August 7

CMS provided notifications to facilities that were determined to be out of compliance with Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) requirements for CY 2017. This will affect your FY 2019 Annual Payment Update. Non-compliance notifications were mailed by Medicare Administrative Contractors and placed into QIES CASPER folders on July 9.

If you receive a letter of non-compliance, you may submit a request for reconsideration to CMS via email no later than 11:59 pm PT on August 7. See the instructions in your notification letter and on the SNF Quality Reporting Reconsideration and Exception & Extension webpage.

 

Emergency Preparedness: Information on Radiological Incidents, DME, and Blood

The most recent  Express - Opens in a new window  - External Link Policy - Opens in a new window from the Office of the Assistant Secretary for Preparedness and Response (ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE) highlights:

  • Webinar on Healthcare Challenges after Radiological Incidents
  • New resources on Durable Medical Equipment (DME), blood, and blood products
  • Upcoming events

HHS offers a comprehensive national knowledge center about emergency preparedness for health care, public health, and disaster clinical practitioners. Sign up to receive the monthly Express and quarterly Exchange that highlight new and trending emergency preparedness resources.

For More Information:

 

World Hepatitis Day: Medicare Coverage for Viral Hepatitis

For World Hepatitis Day on July 28, learn more about the different types of viral hepatitis and how to take action. Most people with chronic hepatitis virus do not have symptoms until the later stages of the infection, putting them at risk for serious liver disease. Medicare covers viral hepatitis immunization and screening services, including:

  • Hepatitis B virus vaccine and administration
  • Hepatitis C virus screening
  • Screening for Sexually Transmitted Infections (STIs) and high-intensity behavioral counseling to prevent STIs

For More Information:

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

 

Provider Compliance

 

Proper Coding for Specimen Validity Testing Billed in Combination with Urine Drug Testing

In a February 2018 report, the Office of the Inspector General (OIG) determined that Medicare payments to clinical laboratories and providers for specimen validity tests did not comply with Medicare billing requirements. A recent MLN Matters® Special Edition Article reminds laboratories and other providers about proper billing for specimen validity testing done in conjunction with drug testing; this article contains no policy changes.

Current coding for testing for drugs of abuse relies on a structure of presumptive and definitive testing that identifies the specific drug and quantity in the patient. This article includes descriptors for:

  • Presumptive drug testing codes
  • Definitive drug testing codes

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

 

Upcoming Events

 

MIPS Improvement Activities Performance Category Year 2 Overview Webinar — August 1

Wednesday, August 1 from 1 to 2 pm ET

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Learn about the Merit-based Incentive Payment System (MIPS) Improvement Activities Performance Category for Year 2 (2018). Topics include category requirements, scoring details, and data submission mechanisms.

 

MIPS Quality Performance Category Year 2 Overview Webinar — August 6

Monday, August 6 from 1 to 2 pm ET

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Learn about the Merit-based Incentive Payment System (MIPS) Quality Performance Category for Year 2 (2018). Topics include category requirements, scoring details, and data submission mechanisms.

 

ESRD Quality Incentive Program: CY 2019 ESRD PPS Proposed Rule Call — August 14

Tuesday, August 14 from 2 to 3 pm ET

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During this call, learn about proposals for the End Stage Renal Disease Quality Incentive Program (ESRD QIP) in the CY 2019 ESRD Prospective Payment System (PPS) proposed rule. Topics include:

  • ESRD QIP legislative framework
  • Proposed updates to ESRD QIP measures, domain structure, and weights
  • Proposed modifications to data submission requirements and the National Healthcare Safety Network Validation Study
  • Methods for reviewing and commenting on the proposed rule

Please note: This call will not include a question and answer session.

Target Audience: Dialysis clinics and organizations, nephrologists, hospitals with dialysis units, billers/coders, quality improvement experts, and other stakeholders.

 

Medicare Learning Network® Publications & Multimedia

 

IOM Update to Publication 100-02, Chapter 11 – ESRD MLN Matters Article — New

A new MLN Matters Article MM10809 on Internet Only Manual (IOM) Update to Publication 100-02, Chapter 11 - End Stage Renal Disease (ESRD), Section 100 is available. Learn about extending renal dialysis services paid under Section 1881(b) (14) of the Social Security Act.

 

New Waived Tests MLN Matters Article — New

A new MLN Matters Article MM10819 on New Waived Tests is available. Learn about 17 newly added waived complexity tests.

 

HCPCS Codes Used for SNF CB Enforcement: Annual Update MLN Matters Article — New

A new MLN Matters Article MM10852 on Quarterly Update to 2018 Annual Update of HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement is available. Learn about updates to the lists for billing.

 

Changes to the Laboratory NCD Edit Software: October 2018 MLN Matters Article — New

A new MLN Matters Article MM10873 on Changes to the Laboratory National Coverage Determination (NCD) Edit Software for October 2018 is available. Learn about the changes to the edit module for clinical diagnostic laboratory services.

 

CLFS and Laboratory Services Payment: Quarterly Update MLN Matters Article — New

A new MLN Matters Article MM10875 on Quarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment is available. Learn about updates to Chapter 16, Section 20 of the Medicare Claims Processing Manual.

  

  


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