" >
Skip to Main Content
MLN Connects for October 18, 2018

 MLN Connects logo


Thursday, October 18, 2018

News & Announcements

Provider Compliance

Claims, Pricers & Codes

Upcoming Events

Medicare Learning Network® Publications & Multimedia

View this edition as a PDF [PDF, 295KB]  



News & Announcements


Hand in Hand: A Training Series for Nursing Homes

Do you need in-service training on dementia management and resident abuse prevention? Hand in Hand: A Training Series for Nursing Homes focuses on caring for residents with dementia and preventing abuse. This training is updated and available in two formats:

For help with registration and technical issues, contact the Helpdesk at cmstraininghelp@hendall.com.


MIPS Quality Data Submitted via Claims: 2018 Performance Feedback

CMS updated the Quality Payment Program website so individual eligible clinicians who choose to submit their Quality performance category data via claims can access performance feedback for the 2018 performance year on an ongoing basis.

For More Information:


Quality Payment Program: 2018 CME Modules, Infographics, and Scoring Guide

CMS posted three new Continuing Medical Education (CME) modules on the Medicare Learning Network Learning Management System - Opens in a new window  - External Link Policy - Opens in a new window    for the 2018 Merit-based Incentive Payment System (MIPS):

  • Improvement Activities Performance Category: Basics, including reporting requirements, scoring, and flexibilities for small and rural practices
  • Cost Performance Category: Overview and how CMS calculates scores
  • Alternative Payment Model (APM): Overview, scoring standard, and reporting requirements for participants

Additional 2018 Program Resources:

For More Information:


2019 QRDA III Implementation Guide, Schematron, and Sample Files

CMS published the 2019 Quality Reporting Document Architecture (QRDA) Category III Implementation Guide, Schematron, and Sample files.  The Implementation Guide helps eligible clinicians and eligible professionals report CY 2019 performance period electronic clinical quality measures, improvement activities, and/or promoting interoperability measures for the following programs:

  • Quality Payment Program: Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models
  • Comprehensive Primary Care Plus
  • Promoting Interoperability

For More Information:

  • For questions about the Implementation Guide and Schematrons, visit the ONC QRDA JIRA Issue Tracker
  • For questions about the Quality Payment Program/MIPS data submissions, call 866-288-8292 (TTY: 877-715-6222) or email QPP@cms.hhs.gov


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


Cardiac Device Credits: Medicare Billing — Reminder

A 2018 Office of the Inspector General (OIG) Report noted that payments reviewed for recalled cardiac medical devices did not comply with Medicare requirements for reporting manufacturer credits. Medicare incorrectly paid hospitals $7.7 million for cardiac device replacement claims, resulting in potential overpayments of $4.4 million. Manufacturers issued reportable credits to hospitals for recalled cardiac medical devices, but the hospitals did not adjust the claims with the proper condition codes, value codes, or modifiers to reduce payment as required.

CMS developed the Medicare Billing for Cardiac Device Credits Fact Sheet to ensure that hospitals properly report manufacturer credits for cardiac devices and avoid overpayment recoveries. Additional resources:


Claims, Pricers & Codes


2019 MS-DRG Definitions Manual and Software

The 2019 Medicare Severity Diagnosis Related Group (MS-DRG) definitions manual and software is available on the MS-DRG Classifications and Software webpage:


Upcoming Events


Hospital Reporting: Successful eCQM Submission for CY 2018 Webinar — October 24

Wednesday, October 24 from 2 to 3 pm ET

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

The demonstration will walk data submitters through the steps to electronically report clinical quality measure (CQM) data via the QualityNet Secure Portal.


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

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

Register - Opens in a new window  - External Link Policy - Opens in a new window   for Medicare Learning Network events.

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


Systematic Validation Edits for OPPS Providers MLN Matters® Article — New

A new MLN Matters Article SE18023 on Activation of Systematic Validation Edits for Outpatient Prospective Payment System (OPPS) Providers with Multiple Service Locations is available. Learn about requirements previously discussed in MLN Matter Articles 9613 and 9907.


IPPS and LTCH PPS: FY 2019 Changes MLN Matters Article — New

A new MLN Matters Article MM10869 on Fiscal Year (FY) 2019 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment Schedule (PPS) Changes is available. Learn about policy changes.


Home Health Star Ratings Call: Audio Recording and Transcript — New

An audio recording and transcript are available for the October 3 call on Final Modifications to the Quality of Patient Care Star Rating Algorithm. CMS presented the rationale, timing, and impact of planned modifications to the Home Health Quality of Patient Care star ratings.


Annual Wellness Visit Booklet — Revised

The revised Annual Wellness Visit Booklet is available. Learn about:

  • Health risk assessment
  • Initial and subsequent components
  • Coding, diagnosis, and billing


Initial Preventive Physical Examination Educational Tool — Revised

The revised Initial Preventive Physical Examination Educational Tool is available. Learn about:

  • Components
  • Coding, diagnosis, and billing



Like the newsletter? Have suggestions? Please let us know! - Opens in a new window  - External Link Policy - Opens in a new window  

Subscribe - Opens in a new window  - External Link Policy - Opens in a new window to MLN Connects. Previous issues are available in the archive.

This newsletter is current as of the issue date. View the complete disclaimer.

Follow the MLN on Twitter - Opens in a new window  - External Link Policy - Opens in a new window #CMSMLN, and visit us on YouTube - Opens in a new window  - External Link Policy - Opens in a new window .

The Medicare Learning Network®, MLN Connects®, and MLN Matters® are registered trademarks of the U.S. Department of Health and Human Services (HHS).

Medicare Learning Network logo