On April 9, CMS proposed to update its national coverage policy for Ambulatory Blood Pressure Monitoring (ABPM). ABPM is a non-invasive diagnostic test that uses a device to track blood pressure over 24-hour cycles. Ambulatory monitoring allows blood pressure to be measured over entire days rather than at a single moment in time. ABPM may measure blood pressure more accurately and lead to the diagnosis of high blood pressure (hypertension) in patients who would not otherwise have been identified as having the condition.

The current national coverage determination for ABPM, issued in 2001, covers the diagnostic test only for those patients with suspected “white coat hypertension” who are not currently being treated for high blood pressure under specific conditions. CMS received a request from stakeholders to reconsider this national coverage determination. Consistent with multi-society professional guidelines, CMS is proposing to update the current national coverage determination to expand access to ABPM to include coverage for cases of suspected “masked hypertension.”

CMS is seeking comments on the . A final decision will be issued no later than 60 days after the conclusion of the 30-day public comment period.

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

Vitamin D Testing: Comparative Billing Report in April

CMS will issue a Comparative Billing Report (CBR) on vitamin D testing in April, focusing on providers who submit Medicare Part B claims. These reports contain data-driven tables with an explanation of findings that compare your billing and payment patterns to those of your peers in your state and across the nation.

CBRs are not publicly available. Look for an email from with your report. Update your contact email address in the National Plan and Provider Enumeration System to ensure accurate delivery. Visit the CBR - Opens in a new window website for more information.

Air Ambulance Transports: Comparative Billing Report in April

CMS will issue a Comparative Billing Report (CBR) on air ambulance transports in April, focusing on providers who submit Medicare Part B claims. These reports contain data-driven tables with an explanation of findings that compare your billing and payment patterns to those of your peers in your state and across the nation.

Physician Compare: Supplemental Preview Period Open until April 27

A Physician Compare supplemental preview period is open through April 27 with the latest 2017 performance information. Eligible clinicians and groups: Check your information by logging into the Quality Payment Program website.

For More Information:

Preview Period User Guide (PDF)
from the October Medicare Learning Network webcast
website
Clinician Information: Performance Year 2017 Preview Period (PDF)
Group Information: Performance Year 2017 Preview Period (PDF)
For assistance accessing the Quality Payment Program website or obtaining your user role, contact
For questions about Physician Compare, public reporting, or the preview period, contact

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:

Obtain CDC preliminary or full recognition: Takes at least 12 months to obtain preliminary recognition and up to 24 additional months to achieve full recognition; see the Supplier Fact Sheet and CDC website for more information
Prepare for Medicare enrollment; see the Enrollment Fact Sheet and Checklist
Apply (PDF) to become a Medicare enrolled MDPP supplier (existing Medicare providers must re-enroll), See the Enrollment Webinar Recording
Furnish MDPP services; see the Session Journey Map
Submit claims to Medicare; see the Billing and Claims Fact Sheet and Billing and Payment Quick Reference Guide

Separate NPI for MDPP Enrollment:

We strongly encourage you to obtain a separate National Provider Identifier (NPI) for MDPP enrollment; claim rejections and denials may occur if multiple enrollments are associated with a single NPI. If you are a currently enrolled MDPP supplier that elects to obtain a separate NPI, update your enrollment in the Provider Enrollment, Chain and Ownership System (PECOS) with the new NPI. Contact your Medicare Administrative Contractor for assistance if:

Your organization is unable to obtain a separate NPI
You continue to encounter claims submission and processing issues after you update your enrollment with the new NPI

For More Information:

MDPP Expanded Model (PDF) Booklet
from Medicare Learning Network call on June 20
MDPP webpage
CDC - CMS Roles Fact Sheet
Contact the MDPP Help Desk at

STD Awareness Month: Talk, Test, Treat

Take three simple actions to protect your patients: Talk about sexual health, test for Sexually Transmitted Diseases (STDs) as recommended, and treat patients following approved guidelines. Recommend appropriate , including:

Screening for Sexually Transmitted Infections (STIs) and High Intensity Behavioral Counseling to Prevent STIs
Hepatitis B Virus (HBV) Screening
HBV Vaccine and Administration
Human Immunodeficiency Virus (HIV) Screening

For More Information:

Educational Tool
Medicare Part B Immunization Billing (PDF) Educational Tool
Centers for Disease Control and Prevention webpage
STD Awareness Month webpage

Visit the Preventive Services website to learn more about Medicare-covered services.

Compliance

Inpatient Rehabilitation Facility Services: Follow Medicare Billing Requirements

In a recent report, the Office of Inspector General (OIG) determined that payments for Inpatient Rehabilitation Facility (IRF) services did not comply with Medicare billing requirements. Medical record documentation did not support that IRF care was reasonable and necessary.

Use the following resources to bill correctly:

Booklet
Medicare Benefit Policy Manual Chapter 1 (PDF), Section 110
FY 2019 IRF PPS Final Rule
website
Many IRF Stays Did Not Meet Medicare Coverage and Documentation Requirements OIG Report, September 2018

Events

MIPS APMs Scoring Standard Webinar — April 24

Wednesday, April 24 from 2 to 3 pm ET

This webinar provides an overview of the Merit-based Incentive Payment System (MIPS) Alternative Payment Models (APMs) in the Quality Payment Program (QPP), including:

MIPS APMs in 2019
APM scoring standard and MIPS performance category requirements
APM information in the QPP Participation Status Tool
Additional resources and how to learn more

MLN Matters® Articles

Temporary Gap Period of the DMEPOS CBP: July 2019 Update

A new MLN Matters Article MM11233 on Quarterly Update for the Temporary Gap Period of the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP) - July 2019 (PDF) is available. Learn about coding updates.

Publications

Medicare Enrollment for Providers Who Solely Order or Certify — Revised

A revised Medicare Learning Network Booklet is available. Learn:

Who is an eligible or certifying provider
How to enroll in Medicare

Medicare Overpayments — Revised

A revised Medicare Learning Network Fact Sheet is available. Learn about:

Definition of an overpayment
Collection tools and processes
Payment options

PECOS for DMEPOS Suppliers — Revised

A revised Medicare Learning Network Booklet is available. Learn about:

Supplier standards, accreditation, and surety bond information
How to enroll in Medicare

PECOS for Physicians and NPPs — Revised

A revised The Medicare Learning Network Booklet is available. Learn how to:

Register in the system
Obtain a National Provider Identifier
Enter enrollment information
Respond to Medicare Administrative Contractor requests

PECOS for Provider and Supplier Organizations — Revised

A revised Medicare Learning Network Booklet is available. Learn how to:

Authenticate credentials
Register a surrogate
Respond to Medicare Administrative Contractor requests

Annual Wellness Visit — Reminder

The Medicare Learning Network Booklet is available. Learn about:

Health risk assessment
Initial and subsequent components
Advance care planning as an optional element

Initial Preventive Physical Examination — Reminder

The Medicare Learning Network Booklet is available. Learn about:

Components
Coding, diagnosis, and billing

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