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Date
2018-09-20
Subject
MLN Connects for September 20, 2018
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Thursday, September 20, 2018

News & Announcements

Provider Compliance

Claims, Pricers & Codes

Upcoming Events

Medicare Learning Network® Publications & Multimedia

  View this edition as a PDF [PDF, 337KB]  

 

News & Announcements

 

CMS Proposes to Lift Unnecessary Regulations and Ease Burden on Providers

On September 17, CMS announced a proposed rule to relieve burden on health care providers by removing unnecessary, obsolete, or excessively burdensome Medicare compliance requirements for health care facilities. Collectively, these updates would save health care providers an estimated $1.12 billion annually. Taking into account policies across rules finalized in 2017 and 2018, as well as this and other proposed rules, savings are estimated at $5.2 billion.

CMS developed the proposed rule in response to President Trump’s charge to federal agencies to “cut the red tape” and reduce burdensome regulations. In addition, feedback from Requests for Information the agency issued seeking stakeholder input on regulatory burdens helped inform this proposed rule.

“We are committed to putting patients over paperwork, while at the same time increasing the quality of care and ensuring patient safety and bolstering program integrity,” said CMS Administrator Seema Verma. “With this proposed rule, CMS takes a major step forward in its efforts to modernize the Medicare program by removing regulations that are outdated and burdensome. The changes we’re proposing will dramatically reduce the amount of time and resources that health care facilities have to spend on CMS-mandated compliance activities that do not improve the quality of care, so that hospitals and health care professionals can focus on their primary mission: treating patients.”

Includes proposed changes for:

  • Conditions of participation and conditions for coverage
  • Emergency Preparedness policies
  • Hospitals
  • Critical access hospital, rural health centers, and federally qualified health centers
  • Ambulatory surgical centers
  • Transplant centers
  • Hospices
  • Comprehensive outpatient rehabilitation facilities
  • Community mental health centers
  • Portable x-ray services
  • Religious nonmedical health care institutions

See the full text of this excerpted CMS Press Release and Fact Sheet (issued September 17).

 

Hospital Quality Reporting System Open for CY 2018 eCQM Data

The Hospital Quality Reporting system is available to accept electronic Clinical Quality Measure (eCQM) data for the CY 2018 reporting period. The system, accessible via the QualityNet Secure Portal, is updated to accept Quality Reporting Document Architecture (QRDA) Category I test and production files using CY 2018 requirements.

CY 2018 Resources:

For Questions:

 

eCQM Value Sets: Updates for 2019 Reporting and Performance Periods

CMS and the National Library of Medicine (NLM) published updates to the electronic Clinical Quality Measure (eCQM) value sets to align with recent releases to terminologies, including, ICD-10-CM/PCS, SNOMED CT, LOINC, and RxNorm. This addendum affects the electronic reporting of eCQMs for the following programs:

  • Quality Payment Program: Merit-based Incentive Payment System and Advanced Alternative Payment Models
  • Comprehensive Primary Care Plus
  • Hospital Inpatient Quality Reporting
  • Medicare and Medicaid Promoting Interoperability Programs

Where is the addendum posted?

All changes to the eCQM value sets are available through the NLM Value Set Authority Center website in the download tab. The value sets are available as a complete set, as well as value sets per measure. 

For More Information:

 

MIPS Targeted Review Request: Deadline Extended to October 15

If you participated in the Merit-based Incentive Payment System (MIPS) in 2017, your MIPS final score and performance feedback are available on the Quality Payment Program website. The payment adjustment you receive in 2019 is based on this final score. If you believe there is an error in your 2019 MIPS payment adjustment calculation, request a targeted review until October 15 at 8 pm ET.

For More Information:

 

Quality Payment Program: MIPS Resources

CMS posted new Merit-based Incentive Payment System (MIPS) resources:

For More Information:

 

Medicare Diabetes Prevention Program: Become a Medicare Enrolled Supplier

Medicare pays Medicare Diabetes Prevention Program (MDPP) suppliers to furnish group-based intervention to at-risk Medicare beneficiaries:

  • Centers for Disease Control and Prevention (CDC)-approved National Diabetes Prevention Program curriculum
  • Up to 2 years of sessions delivered to groups of eligible beneficiaries

Find out how to become a Medicare enrolled MDPP supplier:

For More Information:

 

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

 

ASP Pricing Files and Coverage for Drugs  

The Average Sales Price (ASP) files include payment amounts for Medicare Part B drugs. These files are not intended indicate whether a drug or biological is covered under Part B:

  • The absence or presence of a HCPCS code and payment allowance limit does not indicate whether Medicare covers the drug
  • The inclusion of a payment allowance limit within a specific column (for example clotting factor) does not indicate whether Medicare covers the drug in that specific category

Remember: Medicare Part B drug coverage determinations are made by your Medicare Administrative Contractor.

 

Upcoming Events

 

Medicare Diabetes Prevention Program: New Covered Service Call — September 26

Wednesday, September 26 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.

The 2019 Medicare & You Handbook includes information on the Medicare Diabetes Prevention Program, a new Medicare-covered service. Help your patients prevent or delay Type 2 diabetes and understand their treatment options. During this call, learn about the service, eligibility requirements, and how to refer your patients. A question and answer session follows the presentation.

Target Audience: Medicare fee-for-service providers.

 

FY 2019 IPPS/LTCH PPS Final Rule Webinar—September 26

Overview of eCQM Reporting and Promoting Interoperability Programs

Wednesday, September 26 from 2 to 3 pm ET

Register - Opens in a new window  - External Link Policy - Opens in a new window for this webinar.

Learn about the FY 2019 Inpatient Prospective Payment System (IPPS)/Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) final rule, focusing on finalized electronic Clinical Quality Measure (eCQM) reporting requirements for the Hospital Inpatient Quality Reporting Program and finalized requirements for the Medicare and Medicaid Promoting Interoperability Programs for hospitals.

 

Final Modifications to the Quality of Patient Care Star Rating Algorithm Call — October 3

Wednesday, October 3 from 2 to 3 pm ET

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During this call, learn about planned modifications to the 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 Management of Oral Medications measure

CMS presents the rationale, timing, and impact of this change. A question and answer session follows the presentation.

Target Audience: Home health agencies and other industry stakeholders.

 

Provider Compliance Focus Group Meeting — October 5

Friday, October 5 from 10 am to 2 pm ET

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

Register - Opens in a new window  - External Link Policy - Opens in a new window for this meeting.

Join us for a focus group meeting on Medicare fee-for-service compliance topics, including targeted probe and educate, Electronic Submission of Medical Documentation System (esMD), and more. CMS is interested in hearing from you about what we can do to better communicate, improve our processes, and eliminate unnecessary requirements. 

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

 

Submitting Your Medicare Part A Cost Report Electronically Webcast — October 15

Monday, October 15 from 1:30 to 3 pm ET

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Medicare Part A providers: Learn how to use the new Medicare Cost Report e-Filing (MCReF) system. Use MCReF to submit cost reports with fiscal years ending on or after December 31, 2017. You have the option to electronically transmit your cost report through MCReF or mail or hand deliver it to your Medicare Administrative Contractor. You must use MCReF if you choose electronic submission of your cost report. For more information, see the MCReF MLN Matters Article and MCReF webpage.

During this webinar, CMS discusses:

  • Changes based on user feedback
  • How to access the system
  • Detailed overview
  • Frequently asked questions

A question and answer session follows the presentation; however, attendees may email questions in advance to OFMDPAOQuestions@cms.hhs.gov with “Medicare Cost Report e-Filing System Webcast” in the subject line. These questions may be addressed during the webcast or used for other materials following the webcast.

CMS will use webcast technology for this event with audio streamed through your computer. If you are unable to stream audio, phone lines are available.

Target Audience: Medicare Part A providers and entities that file cost reports for providers.

 

Home Health Quality Reporting Program In-Person Training Event — November 6 and 7

Baltimore, MD

Join CMS for this 2-day, in-person, “Train the Trainer” event for the Home Health Quality Reporting Program. See the Home Health Quality Reporting Training webpage for details.

 

Medicare Learning Network® Publications & Multimedia

 

IMRT Planning Services Editing MLN Matters Article — New

A new MLN Matters Article SE18013 on Intensity-Modulated Radiation Therapy (IMRT) Planning Services Editing is available. Learn about billing correctly and avoiding overpayments.

 

Payment Policy Changes Affecting Hospice Aggregate Cap Calculation and Designation of Hospice Attending Physicians MLN Matters Article — New

A new MLN Matters Article MM10517 on Manual Updates Related to Payment Policy Changes Affecting the Hospice Aggregate Cap Calculation and the Designation of Hospice Attending Physicians is available. Learn about policies finalized in the FY 2016 Hospice Final Rule.

 

Medicare Claims Processing Manual, Chapter 23: Update MLN Matters Article — New

A new MLN Matters Article MM10924 on Update to the Medicare Claims Processing Manual, Chapter 23, Section 60.3 is available. Learn about potential sources for gap-filling.

 

Procedure Coding: Using the ICD-10-PCS Web-Based Training — New

With Continuing Education Credit

A new Procedure Coding: Using the ICD-10-PCS 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:

  • Coding tips, information, and resources
  • Format and features
  • How to find correct codes

 

ICD-10 and Other Coding Revisions to NCDs MLN Matters Article — Revised

A revised MLN Matters Article MM10859 on International Classification of Diseases, Tenth Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs) is available. Learn about coding updates.

 

HCPCS Drug/Biological Code Changes: October 2018 Update MLN Matters Article — Revised

A revised MLN Matters Article MM10834 on Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes – October 2018 Update is available. Learn about the addition of new HCPCS codes.

 

Hurricane Maria and Medicare Disaster Related U.S Virgin Islands and Commonwealth of Puerto Rico Claims MLN Matters Article — Revised

The MLN Matters Special Edition Article SE17028 on Hurricane Maria and Medicare Disaster Related United States Virgin Islands and Commonwealth of Puerto Rico Claims is updated. This article was revised to advise providers that the public health emergency declaration and Section 1135 waiver authority for the U.S. Virgin Islands were renewed again on September 11.

 

Preventive Services Poster Educational Tool — Revised

A revised Preventive Services Poster Educational Tool is available. Learn about:

  • Coding
  • Coverage requirements
  • Patient cost-sharing for each Medicare preventive service

 

Medicare Fraud & Abuse Poster — Revised

A revised Medicare Fraud & Abuse Poster is available. Learn about:

  • Web-based trainings
  • Publications
  • Frequently asked questions

 

 


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