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Date
2018-10-11
Subject
MLN Connects for October 11, 2018

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Thursday, October 11, 2018

News & Announcements

Provider Compliance

Claims, Pricers & Codes

Upcoming Events

Medicare Learning Network® Publications & Multimedia

View this edition as a PDF [PDF, 213KB]   

 

News & Announcements

 

New Medicare Card: Destroy the Old Card

Remind your Medicare patients that when they get their new Medicare cards, they should destroy the old red, white, and blue Medicare cards but not their Social Security, Medicare Advantage plan, or drug plan cards. If they belong to a Medicare Advantage plan or a Medicare drug plan (Part D), they should continue to use these cards when they get health care services or fill a prescription.

 

CMS to Strengthen Oversight of Medicare’s Accreditation Organizations

On October 4, CMS acted to improve quality and safety in healthcare facilities and empower patients with information to make decisions about where to receive care.

“Today we are taking action to improve our oversight of Accrediting Organizations, including by increasing transparency for patients on the organizations’ performance,” said CMS Administrator Seema Verma. The public trusts CMS to ensure the quality and safety of patient care, and we take this responsibility very seriously. Today's changes will bolster the processes for overseeing how effective Accrediting Organizations, who work on CMS’ behalf, are in evaluating healthcare facilities.”

Currently, Medicare-participating health care providers and suppliers are surveyed either by state survey agencies or by Accrediting Organizations (AOs) to ensure that they meet our quality and safety standards. AOs receive deeming authority from us, which affirms that AOs’ health and safety standards meet or exceed those of Medicare. Only facilities and suppliers that have been deemed by state or AO surveyors to meet our standards may receive payments from Medicare. There are currently 10 CMS-approved AOs, each of which surveys one or more different types of facilities.

We will enhance and strengthen our oversight and quality transparency of AOs in three ways:

  • Public posting of AO performance data
  • Redesigned process for AO validation surveys
  • Release of the Annual Report to Congress

These efforts will provide important insights to the public and assist AOs, providers, and suppliers in ensuring patient health and safety. 

See the full text of this excerpted CMS Press Release (issued October 4).

 

Participants in New Value-Based Bundled Payment Model

On October 9, CMS announced that 1,299 entities have signed agreements with the agency to participate in the Administration’s Bundled Payments for Care Improvement (BPCI) – Advanced Model.  The participating entities will receive bundled payments for certain episodes of care as an alternative to fee-for-service payments that reward only the volume of care delivered. The Model participants include 832 Acute Care Hospitals and 715 Physician Group Practices – a total of 1,547 Medicare providers and suppliers, located in 49 states plus Washington, D.C. and Puerto Rico.

“To accelerate the value-based transformation of America’s healthcare system, we must offer a range of new payment models so providers can choose the approach that works best for them,” said CMS Administrator Seema Verma. “The Bundled Payments for Care Improvement – Advanced model was the Trump Administration’s first Advanced Alternative Payment Model, and today we are proud to announce robust participation.  We look forward to launching additional models that will provide an off-ramp to the inefficient fee-for-service system and improve quality and reduce costs for our beneficiaries.”

Under the traditional fee-for-service payment system, Medicare pays providers and suppliers for each individual service they perform.  However, under this new episode payment model, participants can earn an additional payment if all expenditures for a beneficiary’s episode of care are less than a spending target, which factors in measures of quality. Conversely, if the expenditures exceed the target price, the participant must repay money to Medicare.

The BPCI Advanced Model was publicly announced in January 2018, and runs from October 1, 2018, through December 31, 2023. It builds on the BPCI Initiative, which ended on September 30, 2018. BPCI Advanced will initially include 32 bundled clinical episodes - 29 inpatient and 3 outpatient. Currently, the top three clinical episodes selected by participants are: Major joint replacement of the lower extremity, congestive heart failure, and sepsis.

For More Information:

See the full text of this excerpted CMS Press Release (issued October 9).

 

Medicare Diabetes Prevention Program: New Covered Service

The 2019 Medicare & You Handbook includes information on the Medicare Diabetes Prevention Program (MDPP), a new Medicare-covered service. Help your patients prevent or delay Type 2 diabetes and understand their treatment options.

For More Information:

MDPP is a new program that is still ramping up. If you do not see an organization that offers services in your community, keep checking the list. New MDPP suppliers are added to the list on a regular basis.

 

Part A Providers: MCReF System Enhancement

On May 1, CMS implemented the new Medicare Cost Report e-Filing (MCReF) system; over 2,000 cost reports were submitted through the system in the first month. For FYs ending on or after December 31, 2017, you can electronically submit your cost report package to your Medicare Administrative Contractor through MCReF. You must use MCReF to submit your cost report electronically; you may also continue to mail or hand deliver them.

An enhancement on September 10 allows contractor users to submit MCReF role requests to multiple organizations at the same time without waiting for each request to be approved before submitting another. Users that represent multiple organizations can obtain timely approval.

For More Information:

 

Protect Your Patients from Influenza this Season

The Centers for Disease Control and Prevention (CDC) recommends annual influenza vaccination for everyone 6 months and older. Influenza is a serious health threat, especially to vulnerable populations like people 65 and older, who are at high risk for hospitalization and complications. Vaccinate before the end of October – to help protect your patients, your staff, and yourself.

Medicare Part B covers the influenza virus vaccine once per influenza season. Medicare covers additional influenza vaccines if medically necessary.

You may also want to recommend the pneumococcal vaccine during the same visit. Medicare covers:

  • An initial pneumococcal vaccine for Medicare beneficiaries who never received the vaccine under Medicare Part B
  • A different, second pneumococcal vaccine 1 year after the first vaccine was administered

For More Information:

 

Provider Compliance

 

Proper Use of the KX Modifier for Part B Immunosuppressive Drug Claims — Reminder

A 2017 Office of the Inspector General (OIG) report noted that, in some cases, pharmacies incorrectly billed Medicare Part B for claims using the KX modifier for immunosuppressive drugs. It is estimated that Medicare paid $4.6 million for these claims that did not comply with Medicare requirements.

In response to this report, CMS clarified manual instructions on the use of the KX modifier to help pharmacies document the medical necessity of organ transplant and eligibility for Medicare coverage. Resources for pharmacies:

 

Claims, Pricers & Codes

 

Reprocessing Claims for Diagnostic Services by Certain PTs

Some Part B Medicare Administrative Contractors (MACs) denied valid claims submitted by Physical Therapists (PTs) in private practice:

  • For professional component or global code for certain CMS-designated diagnostic services involving electromyography, nerve conduction velocity, and sensory evoked potentials with technical component physician supervision indicators of 21, 66, 6A, 77, or 7A
  • Furnished by PTs in private practice certified in clinical electrophysiology by the American Board of Physical Therapy Specialties and providing these services in accordance with state law

MACs will reprocess these claims brought to their attention by PTs in private practice. Visit the Physician Fee Schedule website for related CMS payment policy and the applicable code list.

 

Upcoming Events

 

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.

 

Patient Relationship Categories and Codes Webcast — October 17

Wednesday, October 17 from 1:30 to 3 pm ET

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Receive guidance for classifying patient relationships during the voluntary reporting period that CMS implemented on January 1, 2018. This webcast presents real world clinical scenarios to illustrate how Patient Relationship Categories and Codes work and reviews the statutory context and policy principles used in their development. A question and answer session follows the presentation.

For inquiries about the Patient Relationship Categories and Codes, contact the Quality Payment Program Service Center at QPP@cms.hhs.gov or 866-288-8292 (TTY: 877-715-6222).

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: Clinicians, clinical staff, organizations representing clinicians, and other interested stakeholders. Clinicians currently eligible to report patient relationships are physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists enrolled in Medicare.

 

Physician Compare: Preview Period and Public Reporting Webcast — October 30

Tuesday, October 30 from 1:30 to 3 pm ET

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Are you interested in learning more about Physician Compare? Find out about the:

  • 2017 Quality Payment Program performance information targeted for public reporting
  • Upcoming 30-day preview period

Learn how to review your performance information before it is publicly reported. A question and answer session follows the presentation.

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: Physicians and other clinicians; medical groups; practice managers; medical and specialty societies; and other interested stakeholders.

 

Medicare Learning Network® Publications & Multimedia

 

LCDs MLN Matters Article — New

A new MLN Matters Article MM10901 on Local Coverage Determinations (LCDs) is available. Learn about detailed changes to the LCD process.

 

Ensuring OC 22 is Billed Correctly on SNF Inpatient Claims MLN Matters Article — New

A new MLN Matters Article MM10922 on Ensuring Occurrence Code 22 (OC 22) is Billed Correctly on Skilled Nursing Facility (SNF) Inpatient Claims is available. Learn about necessary system changes to bill OC 22 correctly.

 

HCPCS Codes for SNF CB: 2019 Annual Update MLN Matters Article — New

A new MLN Matters Article MM10981 on 2019 Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Update is available. Learn about the new code files.

 

Medicare Diabetes Prevention Program Call: Audio Recording and Transcript — New

An audio recording and transcript are available for the September 26 call on the Medicare Diabetes Prevention Program: New Covered Service. Learn about the service, eligibility requirements, and how to refer your patients.

 

Medicare Preventive Services National Educational Products Listing — Revised 

The Medicare Preventive Services National Educational Products. Listing is available. Learn about:

  • Coverage
  • Coding
  • Billing

  


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