Thursday, September 3, 2020
- CMS Acts to Spur Innovation for America’s Seniors
- Hospital Opioid Toolkit
- CMS Offers Comprehensive Support for California due to Wildfires
- PEPPERs for Short-term Acute Care Hospitals
- Office Visits by Nurse Practitioners: Comparative Billing Report
- 2021 Annual Update for the Health Professional Shortage Area (HPSA) Bonus Payments
- Annual Clotting Factor Furnishing Fee Update 2021
- Claim Status Category and Claim Status Codes Update
- Implement Operating Rules - Phase III Electronic Remittance Advice (ERA) Electronic Funds Transfer (EFT): Committee on Operating Rules for Information Exchange (CORE) 360 Uniform Use of Claim Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC) and Claim Adjustment Group Code (CAGC) Rule - Update from Council for Affordable Quality Healthcare (CAQH) CORE
- Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) Updates for Fiscal Year (FY) 2021
- The Intravenous Immune Globulin (IVIG) Demonstration: Demonstration is ending on December 31, 2020
- October 2020 Integrated Outpatient Code Editor (I/OCE) Specifications Version 21.3
- October Quarterly Update for 2020 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule
- Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment — Revised
- Update to the International Classification of Diseases, Tenth Revision (ICD-10) Diagnosis Codes for Vaping Related Disorder and Diagnosis and Procedure Codes for the 2019 Novel Coronavirus (COVID-19) — Revised
View this edition as PDF (PDF)
News
CMS Acts to Spur Innovation for America’s Seniors
On August 31, under President Trump’s leadership, CMS issued a proposed rule that unleashes innovative technology so Medicare beneficiaries have access to the latest, most cutting-edge devices. See the press release for more information.
Hospital Opioid Toolkit
CMS works closely with the Centers for Disease Control and Prevention and other federal agencies to develop policies, procedures, and resources that promote appropriate opioid prescribing and person-centered pain management for hospitals and health systems. We assembled resources (PDF) to help you develop strategies for pain management and opioid use disorder prevention and treatment. For more information, visit the Reducing Opioid Misuse webpage.
CMS Offers Comprehensive Support for California due to Wildfires
On August 28, CMS announced efforts to support California in response to wildfires across the state. On August 26, HHS Secretary Alex Azar declared a Public Health Emergency (PHE) in California, retroactive to August 14. CMS is working to ensure hospitals and other facilities can continue operations and provide access to care despite the effects of the wildfires. CMS provided numerous waivers to health care providers during the current Coronavirus Disease 2019 (COVID-19) pandemic to meet the needs of beneficiaries and providers. These waivers will be available to health care providers to use during the duration of the COVID-19 PHE determination timeframe and for the wildfires PHE. CMS will be waiving certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements; creating special enrollment opportunities for individuals to access health care quickly; and taking steps to ensure dialysis patients obtain critical life-saving services.
For More Information:
See the full text of this excerpted CMS Press Release (issued August 28).
PEPPERs for Short-term Acute Care Hospitals
Second quarter FY 2020 Program for Evaluating Payment Patterns Electronic Reports (PEPPERs) are available for short-term acute care hospitals. These reports summarize provider-specific data statistics for Medicare services that may be at risk for improper payments. Use your data to support internal auditing and monitoring activities. The PEPPER files were recently distributed through a QualityNet secure file exchange to hospital QualityNet Administrators and user accounts with the PEPPER recipient role.
For More Information:
- Visit the PEPPER Resources website for the user's guide, recorded training sessions, QualityNet account information, FAQs, and examples of how other hospitals are using the report
- Visit the Help Desk if you have questions or need help obtaining your report
- Send us your feedback or suggestions
Office Visits by Nurse Practitioners: Comparative Billing Report
CMS issued a Comparative Billing Report (CBR) on Office Visits, New and Established Patients by Nurse Practitioners, 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 cbrpepper.noreply@religroupinc.com to access your report. Update your contact email address in the Provider Enrollment, Chain, and Ownership System to ensure accurate delivery.
For More Information:
- View a webinar recording
- Visit the CBR website
Events
Dementia Care Call — September 22
National Partnership to Improve Dementia Care and Quality Assurance Performance Improvement
Tuesday, September 22 from 1:30 to 3 pm ET
Register for Medicare Learning Network events.
During this call, learn about the unique challenges facing nursing home residents living with dementia during the COVID-19 pandemic and best practices to support them. A question and answer session follows the presentations.
Speakers:
- Cathleen Lawrence and Dara Graham, CMS
- Kara Jacobs Slifka, MD, MPH, Centers for Disease Control and Prevention
- Douglas Pace, Alzheimer’s Association
Target Audience: Consumer and advocacy groups; nursing home providers; surveyor community; prescribers; professional associations; and other interested stakeholders.
MLN Matters® Articles
2021 Annual Update for the Health Professional Shortage Area (HPSA) Bonus Payments
CMS issued a new MLN Matters Article MM11852 on 2021 Annual Update for the Health Professional Shortage Area (HPSA) Bonus Payments (PDF). Learn about automated bonus payments.
Annual Clotting Factor Furnishing Fee Update 2021
CMS issued a new MLN Matters Article MM11932 on Annual Clotting Factor Furnishing Fee Update 2021 (PDF). Learn about the $0.238 per unit fee for 2021.
Claim Status Category and Claim Status Codes Update
CMS issued a new MLN Matters Article MM11796 on Claim Status Category and Claim Status Codes Update (PDF). Learn about changes approved by the National Code Maintenance Committee.
Implement Operating Rules - Phase III Electronic Remittance Advice (ERA) Electronic Funds Transfer (EFT): Committee on Operating Rules for Information Exchange (CORE) 360 Uniform Use of Claim Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC) and Claim Adjustment Group Code (CAGC) Rule - Update from Council for Affordable Quality Healthcare (CAQH) CORE
CMS issued a new MLN Matters Article MM11881 on Implement Operating Rules - Phase III Electronic Remittance Advice (ERA) Electronic Funds Transfer (EFT): Committee on Operating Rules for Information Exchange (CORE) 360 Uniform Use of Claim Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC) and Claim Adjustment Group Code (CAGC) Rule - Update from Council for Affordable Quality Healthcare (CAQH) CORE (PDF). Learn the next version of the Code Combination List.
Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) Updates for Fiscal Year (FY) 2021
CMS issued a new MLN Matters Article MM11949 on Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) Updates for Fiscal Year (FY) 2021 (PDF). Learn about payment rates, coding, adjustments, and the quality reporting program.
The Intravenous Immune Globulin (IVIG) Demonstration: Demonstration is ending on December 31, 2020
CMS issued a new MLN Matters Article MM11877 on The Intravenous Immune Globulin (IVIG) Demonstration: Demonstration is ending on December 31, 2020 (PDF). Learn about the end of this three-year demonstration for durable medical equipment suppliers.
October 2020 Integrated Outpatient Code Editor (I/OCE) Specifications Version 21.3
CMS issued a new MLN Matters Article MM11944 on October 2020 Integrated Outpatient Code Editor (I/OCE) Specifications Version 21.3 (PDF). Learn about modifications for the October 2020 release.
October Quarterly Update for 2020 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule
CMS issued a new MLN Matters Article MM11956 on October Quarterly Update for 2020 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule (PDF). Learn about fee schedule amounts for new and existing codes and changes to payment policy.
Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment — Revised
CMS revised MLN Matters Article MM11937 on Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment (PDF) to include additional COVID-19 codes effective August 10.
Update to the International Classification of Diseases, Tenth Revision (ICD-10) Diagnosis Codes for Vaping Related Disorder and Diagnosis and Procedure Codes for the 2019 Novel Coronavirus (COVID-19) — Revised
CMS revised MLN Matters Article MM11623 on Update to the International Classification of Diseases, Tenth Revision (ICD-10) Diagnosis Codes for Vaping Related Disorder and Diagnosis and Procedure Codes for the 2019 Novel Coronavirus (COVID-19) (PDF) to include 12 new procedure codes for therapeutics.
Publications
Medicare Preventive Services — Revised
A revised Medicare Preventive Services Medicare Learning Network Educational Tool is available. Learn about:
- Coding
- Coverage
- Copayment/coinsurance and deductible
Medicare Preventive Services Poster — Revised
A revised Medicare Preventive Services Poster Medicare Learning Network Educational Tool is available. Get quick-reference information for your billing office.
Like the newsletter? Have suggestions? Please let us know!
Subscribe 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 #CMSMLN, and visit us on YouTube.
The Medicare Learning Network®, MLN Connects®, and MLN Matters® are registered trademarks of the U.S. Department of Health and Human Services (HHS).
