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Date
2018-12-13
Subject
MLN Connects for December 13, 2018

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Thursday, December 13, 2018

News & Announcements

Provider Compliance

Claims, Pricers & Codes

Upcoming Events

Medicare Learning Network® Publications & Multimedia

  View this edition as a PDF [PDF, 220KB]  

 

News & Announcements

 

New Medicare Card: MAC Look-Up Tool Updated

Your Medicare Administrative Contractor’s (MAC’s) secure portal Medicare Beneficiary Identifier (MBI) look-up tool now returns the MBI even if the new Medicare card has not been mailed. If you do not already have access, sign up for your MAC’s portal to use the tool. For more information on the transition to the MBI:

You can also ask your patients to call 1-800-MEDICARE to get a new card if they need one. 

To ensure your Medicare patients continue to get care, you can use either the Health Insurance Claim Number or the MBI for all Medicare transactions through December 31, 2019.

 

2019 Medicare Part D Opioid Policies: Training Materials

CMS will implement new opioid policies for Medicare drug plans on January 1. The new policies include:

  • Improved safety alerts when patients fill opioid prescriptions at the pharmacy
  • Drug management programs for patients at-risk for misuse or abuse of opioids or other drugs 

CMS posted new training materials, including slide decks and tip sheets for:

CMS also recently released an MLN Matters® Article: A Prescriber’s Guide to the New Medicare Part D Opioid Overutilization Policies for 2019. Visit the Reducing Opioid Misuse webpage for more information on CMS’ overall strategy.

 

Open Payments: Review Program Year 2017 Data through December 31

On June 29, CMS published Program Year 2017 Open Payments data, along with updated and newly submitted data from previous program years (2013-2016). Physicians and teaching hospitals: This data is available for review and dispute through December 31. Review of the data is voluntary, but strongly encouraged.

For More Information:

 

LTCH Provider Preview Reports: Review Your Data by January 2

Long-Term Care Hospital (LTCH) Provider Preview Reports are now available with second quarter 2017 to first quarter 2018 data. Review your performance data on quality measures by January 2, prior to public display on LTCH Compare in March 2019. Corrections to the underlying data are not permitted during this time; request a CMS review if you believe that your data is inaccurate. 

For More Information:

 

IRF Provider Preview Reports: Review Your Data by January 2

Inpatient Rehabilitation Facility (IRF) Provider Preview Reports are now available with second quarter 2017 to first quarter 2018 data. Review your performance data on quality measures by January 2, prior to public display on IRF Compare in March 2019. Corrections to the underlying data are not permitted during this time; request a CMS review if you believe that your data is inaccurate. 

For More Information:

 

Hospice Provider Preview Reports: Review Your Data by January 9

Two reports are available in your Certification and Survey Provider Enhanced Reports (CASPER) non-validation reports folder:

  • Hospice provider preview report: Review Hospice Item Set (HIS) quality measure results from the second quarter of 2017 to the first quarter of 2018
  • Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey provider preview report: Review facility-level CAHPS survey results from the second quarter of 2016 to the first quarter of 2018

Review your HIS and CAHPS results by January 9. If you believe the denominator or other HIS quality metric is inaccurate or if there are errors in the results from the CAHPS survey data, request a CMS review:

Access Instructions:

 

Hospice Compare Quarterly Refresh

The December 2018 quarterly refresh is available; visit Hospice Compare to view the data. This update reflects Hospice Item Set quality measure results based on data collected for the first through fourth quarters of 2017 and on Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey results reported for the first quarter of 2016 through the fourth quarter of 2017.

For More Information:

 

Quality Payment Program: Webinar Library

CMS moved Quality Payment Program (QPP) webinar resources to the newly redesigned QPP Webinar Library webpage. Search for the webinars and accompanying recordings, transcripts, and presentation slides by performance year, reporting track, performance category, and webinar type. For questions, contact QPP@cms.hhs.gov or 866-288-8292 (TTY: 877-715-6222).

 

Quality Payment Program: Updated List of APMs

CMS posted an  updated list of Alternative Payment Models (APMs) - Opens in a new window  - External Link Policy - Opens in a new window in the Quality Payment Program.  The list displays the APMs that we currently operate or announced since November 2018, including those considered Advanced APMs and Merit-based Incentive Payment System APMs. 

For More Information:

 

2018 QRDA Category I Implementation Guide Addendum

CMS published an addendum to the 2018 Quality Reporting Document Architecture (QRDA) Category I Implementation Guide. This addendum includes six new conformance statements and updates the description of one other conformance number. The Implementation Guide provides technical instructions for eligible hospitals and critical access hospitals reporting electronic clinical quality measures for the following programs:

  • Hospital Inpatient Quality Reporting Program
  • Medicare and Medicaid Promoting Interoperability Programs

For More Information:

 

QRDA I File: Sample Hybrid Hospital-Wide Readmission Measure

CMS released a sample Quality Reporting Document Architecture (QRDA) I file for reporting the voluntary Hybrid Hospital-Wide Readmission (HWR) Measure under the Hospital Inpatient Quality Reporting Program. The Hybrid HWR measure was developed to address complex and critical aspects of care that cannot be derived through claims data alone. Hospitals can voluntarily submit data for this measure and participation will not impact payments to hospitals.

For More Information:

 

Provider Compliance

 

Bill Correctly for Device Replacement Procedures — Reminder

In a September 2017 report, the Office of the Inspector General (OIG) determined that Medicare paid for many device replacement procedures incorrectly. Hospitals are required to use condition codes 49 or 50 on claims for device replacement procedures resulting from a recall or premature failure (whether the device is provided at no cost or with a credit).

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

 

Claims, Pricers & Codes

 

HETS Includes Medicare Diabetes Prevention Program Information

Starting December 8, the Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS) returns Medicare Diabetes Prevention Program (MDPP) usage information. The HETS Medicare beneficiary eligibility response (271) includes HCPCS codes for MDPP services if the National Provider Identifier (NPI) on the eligibility inquiry (270) belongs to a Medicare enrolled MDPP supplier or if it includes the Service Type Code “CQ.” In many cases, vendors or clearinghouses submit HETS inquiries on behalf of health care providers. Contact your eligibility transaction service provider for information on how and when you will get MDPP usage information about your patients.

Use this information to determine the next available MDPP service for your patients. If a Medicare Beneficiary is ineligible for MDPP, HETS will not return MDPP usage information. Check your 271 response for the following HCPCS codes:

  • No prior MDPP usage: G9873.
  • MDPP Usage: G9873, G9874, G9875, G9876, G9877, G9878, G9879, G9880, G9881, G9882, G9883, G9884, G9885, G9890 and G9891, including the NPI and date of service.
  • Note: G9890 and G9891 can be returned multiple times. All other MDPP HCPCS codes are once-in-a-lifetime services and will only return once.

You must enroll as an MDPP supplier to give MDPP service to patients and bill Medicare for MDPP services. Review the current list of MDPP suppliers or find them on the MDPP supplier map.

 

Upcoming Events

 

Medicare Diabetes Prevention Program Enrollment Tutorial Webinar — January 9

Wednesday, January 9 from 11 am to 12 pm ET

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

Join CMS for a step-by-step tutorial on how to submit your application to enroll in Medicare as a Medicare Diabetes Prevention Program (MDPP) supplier. This webinar guides you through each section of the Provider Enrollment Chain and Ownership System (PECOS) application and gives you information to successfully complete and submit an MDPP supplier application. Prior to the webinar, review guidance on supplier enrollment on the MDPP webpage.

Target Audience: Organizations interested in becoming MDPP suppliers, especially those with no or little familiarity with PECOS. 

 

Medicare Learning Network® Publications & Multimedia

 

Per-Beneficiary Therapy Amounts: Annual Update MLN Matters Article — New

A new MLN Matters Article MM11055 on Annual Update to the Per-Beneficiary Therapy Amounts is available. Learn about KX modifier thresholds.

 

CY 2019 MPFS Final Rule: Summary of Policies MLN Matters Article — New

A new MLN Matters Article MM11063 on Summary of Policies in the Calendar Year (CY) 2019 Medicare Physician Fee Schedule (MPFS) Final Rule, Telehealth Originating Site Facility Fee Payment Amount and Telehealth Services List, CT Modifier Reduction List, and Preventive Services List is available. Learn about policy changes.

 

Quality Payment Program: MIPS Participation in 2018 Web-Based Training Course — New

With Continuing Medical Education

A new Quality Payment Program: Merit-based Incentive Payment System (MIPS) Participation in 2018 Web-Based Training is available through the Learning Management System - Opens in a new window  - External Link Policy - Opens in a new window  . Learn about:

  • Eligible and exempt clinicians
  • Difference between individual, group and virtual group reporting
  • Data submission mechanisms for 2018

 

NCD 20.4 Implantable Defibrillators MLN Matters Article — Revised

A revised MLN Matters Article MM10865 on NCD 20.4 Implantable Defibrillators (ICDs) is available. Learn about the final decision.

 

MLN Catalog: December 2018 – Revised

A revised MLN Catalog – December 2018 is available. Learn about free:

  • Products and services that can be downloaded
  • Web-based training courses; some offer continuing education credits
  • Helpful links, tools, and tips

 


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