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MLN Connects for May 28, 2020

Thursday, May 28, 2020


Claims, Pricers & Codes


MLN Matters® Articles


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COVID-19: Adjusting Operations to Manage Patient Surge

The Office of the Assistant Secretary for Preparedness and Response (ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE) collaborated with the COVID-19 Healthcare Resilience Task Force on resources:

For More Information:


PECOS/NPPES/EHR Identity & Access Management System: Role Renamed

Starting June 8, the role Delegated Official is renamed Access Manager throughout the Identity & Access Management System (I&A) used to manage access to the Provider Enrollment, Chain, and Ownership System (PECOS), National Plan and Provider Enumeration System (NPPES), and the Electronic Health Record (EHR) incentive program:

  • No change to requirements, functions, access, or privileges for this role
  • No impact on I&A users; no action required
  • No change to PECOS, NPPES, or EHR systems

This change will avoid confusion between the Delegated Official in PECOS and the Delegated Official in the I&A System supporting PECOS, NPPES, and EHR. This change has no impact on Delegated Officials listed in PECOS or their titles.


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 eligible 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:


Claims, Pricers & Codes


Medicare Diabetes Prevention Program: Valid Claims

For a claim to be valid under the Medicare Diabetes Prevention Program (MDPP), you must have both:


If you do not have a separate Medicare enrollment as an MDPP supplier and you submit a claim for MDPP services, your claim will be rejected.

Medicare enrolled MDPP suppliers: See the Quick Reference Guide to Payment and Billing and Billing and Claims Fact Sheet for information on valid claims:

  • MDPP Medicare beneficiary eligibility data is returned via the HIPAA Eligibility Transaction System (HETS) on the 271 response; use this data to determine if a beneficiary meets the criteria to receive MDPP services
  • Submit claims when a performance goal is met, and report codes only once per eligible beneficiary (except G9890 and G9891)
  • List each HCPCS code with the corresponding session date of service and the coach’s National Provider Identifier
  • List all HCPCS codes associated with a performance payment (including non-payable codes) on the same claim
  • Include Demo code 82 in block 19 (Loop 2300 segment REF01 (P4) and segment REF02 (82)) to identify MDPP services
  • Do not include codes for other, non-MDPP services on the same claim

For More Information:




COVID-19: Lessons from the Front Lines Call — May 29

Fridays from 12:30 to 2 pm ET

These weekly calls are a joint effort between CMS Administrator Seema Verma, Food and Drug Administration (FDA) Commissioner Stephen Hahn, MD, and the White House Coronavirus Task Force. Physicians and other clinicians: Share your experience, ideas, strategies, and insights related to your COVID-19 response. There is an opportunity to ask questions.

To Participate:

  • Conference lines are limited; we encourage you to join via audio webcast
  • Or, call 877-251-0301; Access Code: 6350189

For More Information:

Target Audience: Physicians and other clinicians.


MLN Matters® Articles


Medicare Continues to Modernize Payment Software

A new MLN Matters Special Edition Article SE20019 on Medicare Continues to Modernize Payment Software (PDF) is available. Learn about efforts to modernize payment grouping and code editing software for inpatient rehabilitation facilities and skilled nursing facilities




Acute Care Hospital Inpatient Prospective Payment System — Revised

A revised Acute Care Hospital Inpatient Prospective Payment System Medicare Learning Network Booklet is available. Learn about:

  • Payment rates
  • Payment adjustments


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