Date

2019-01-31

Title

MLN Connects for January 31, 2019

Thursday, January 31, 2019

News & Announcements

New App Displays What Original Medicare Covers
Physicians and Non-Physician Practitioners: New Medicare Enrollment Application
QPP Videos: Create an Account in HARP
QPP Videos: MIPS Data Submission
eCQM Resources
Hospice Quality Reporting Program: FY 2021 Data Collection Began January 1
Hospice Training: Updates to Public Reporting in FY 2019
Prevent Legionnaires' Disease: Water Management Program Training

Provider Compliance

Cochlear Devices Replaced Without Cost: Bill Correctly — Reminder

Claims, Pricers & Codes

Physician Anesthesia Claims for SNF Patients

Upcoming Events

New Electronic System for Provider Reimbursement Review Board Appeals Call — February 5
New Medicare Card Open Door Forum — February 6
Home Health Patient-Driven Groupings Model Call — February 12
New Part D Opioid Overutilization Policies Call — February 14
MIPS Data Submission Office Hours Sessions — February 26 and March 19

Medicare Learning Network® Publications & Multimedia

RHCs/FQHCs: Communication Technology Based Services and Payment MLN Matters Article — New
Quality Payment Program in 2018: Transitioning to an Advanced APM Web-Based Training — New
Hospital Based Hospice Provider Compliance Tips Fact Sheet — New
Lab Tests: Urinalysis Provider Compliance Tips Fact Sheet — New
Lab Tests: Routine Venipuncture Provider Compliance Tips Fact Sheet — New
Lenses Provider Compliance Tips Fact Sheet — New
Parenteral Nutrition Provider Compliance Tips Fact Sheet — New
Patient Lifts Provider Compliance Tips Fact Sheet — New
Polysomnography Provider Compliance Tips Fact Sheet — New
Pressure Reducing Support Surfaces Provider Compliance Tips Fact Sheet — New
TENS Provider Compliance Tips Fact Sheet — New
ESRD Call: Audio Recording and Transcript — New
Clinical Labs Call: Audio Recording and Transcript — New
Typhoon Yutu and Medicare Disaster Related Commonwealth of the Northern Mariana Islands Claims MLN Matters Article — Revised
DMEPOS Fee Schedule: CY 2019 Update MLN Matters Article — Revised
Hospital OPPS: January 2019 Update MLN Matters Article — Revised
Diabetic Shoes Provider Compliance Tips Fact Sheet — Revised
Coding and Billing Date of Service on Professional Claims MLN Matters Article — Reissued
TKA Removal from IPO List and 2-Midnight Rule MLN Matters Article — Reissued

View this edition as a PDF (PDF)

News & Announcements

New App Displays What Original Medicare Covers

The new CMS “What’s Covered” app lets people with original Medicare, caregivers, providers, and others quickly see whether Medicare covers a specific medical item or service. You can now use your mobile device to more easily get accurate, consistent original Medicare coverage information in your office, the hospital, or anywhere. The free app is available in Google Play - Opens in a new window and the Apple App Store - Opens in a new window .

See the full text of this excerpted CMS Press Release (issued January 28), which discusses other eMedicare tools for people with Medicare.

Physicians and Non-Physician Practitioners: New Medicare Enrollment Application

CMS received approval for a new Medicare Enrollment Application for physicians and non-physician practitioners (CMS-855I (PDF) dated 12/2018). Many changes are minor; the major ones reduce provider burden:

Eliminated reporting for advanced diagnostic imaging, Clinical Laboratory Improvement Amendments number, and the Food and Drug Administration radiology certification number
Expanded instructions for individual and group affiliations to simplify reporting
Made it optional to list a contact person
Added electronic storage information for those who no longer keep paper records
Created a more logical data flow

You may begin using the new application immediately. Through April 30, Medicare Administrative Contractors will accept applications dated 7/2011, but after that, you have to use the new version.

QPP Videos: Create an Account in HARP

On December 19, 2018, CMS transitioned to a new system to create identity management accounts and request access to the Quality Payment Program (QPP) website: The Healthcare Quality Information System (HCQIS) Access Roles and Profile (HARP) system. If you previously created a QPP account in the Enterprise Identity Management (EIDM) system, continue to use your EIDM ID and password to sign-in, view, submit, and manage your data. If you need to make any changes to your ID/password or create a new account, you will do so in the HARP system.

View videos for step-by-step instructions on how to:

Create a QPP Account - Opens in a new window - Create a new HARP account
Connect to an Organization: Practice - Opens in a new window - View, submit, and manage data on behalf of the practice
Connect to an Organization: APM Entity - Opens in a new window - View, submit, and manage data on behalf of the APM
Connect to an Organization: Registry - Opens in a new window - Submit data on behalf of your customers
Connect to an Organization: Virtual Group - Opens in a new window - View, submit, and manage data on behalf of the virtual group
Security Officials: Approving Role Requests - Opens in a new window - Approve and deny requests from staff users

For More Information:

QPP User Access Guide - Opens in a new window
Questions: or 866-288-8292 (TTY: 877-715-6222)

QPP Videos: MIPS Data Submission

Learn how to manage and submit your 2018 Merit-based Incentive Payment System (MIPS) data through the Quality Payment Program (QPP) website by April 2 by viewing these brief videos:

For More Information:

Resource Library webpage

eCQM Resources

New Electronic Clinical Quality Measure (eCQM) resources:

Tools, Resources, & Collaboration: Interactive graphic that provides an in-depth overview of the tools, standards, and resources used in the various stages of the eCQM lifecycle
Annual Timeline: Interactive tool that improves awareness of eCQM resources and timeframes for measure developers, implementers, and end users to plan and provide feedback

For More Information:

eCQI Resource Center website
Contact

Hospice Quality Reporting Program: FY 2021 Data Collection Began January 1

The Hospice Item Set (HIS) and Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS®) data collection period for the FY 2021 reporting year is January 1 through December 31, 2019.

HIS data: The timeliness threshold requirement (PDF) for the FY 2021 reporting year and beyond is 90%. To be compliant with HIS requirements, you must submit at least 90% of your HIS records on time (within 30 days of the patient’s admission or discharge date). There are no size or newness exemptions.
CAHPS data: This data collection period impacts hospice payments for FY 2021. If you do not qualify for an exemption, make preparations to participate in the survey. For assistance, contact or 844-472-4621.

For more information, visit the Requirements and Best Practices webpage.

Hospice Training: Updates to Public Reporting in FY 2019

Information is available from the two-part webinar on Updates to Public Reporting in FY 2019: Hospice Comprehensive Assessment Measure and Data Correction Deadlines. Visit the Training and Education Library webpage for more information:

, including presentation, speaker notes, and transcript
Video - Opens in a new window

Prevent Legionnaires' Disease: Water Management Program Training

Did you know? The number of people with Legionnaires’ disease grew 5.5 times from 2000 to 2017 and is deadly for 25% of people who get it from a health care facility. Ninety percent of the problems that cause Legionnaires’ disease outbreaks could have been prevented with more effective water management. Help prevent outbreaks by taking the Centers for Disease Control and Prevention’s (CDC’s) new online training: Preventing Legionnaires' Disease: A Training on Legionella Water Management Programs:

Learn how to align with ASHRAE 188 - Opens in a new window risk management requirements for building water systems (e.g., potable water, cooling towers, hot tubs, decorative water features)
Earn continuing education units from the National Environmental Health Association - Opens in a new window

Target Audience:

Public health professionals, including infection preventionists
Building managers, maintenance/engineering staff, and safety officers
Equipment and water treatment suppliers, as well as consultants

Learn more about Legionnaires’ disease on the CDC Environmental Health Services webpage.

Provider Compliance

Cochlear Devices Replaced Without Cost: Bill Correctly — Reminder

In November 2016, the Office of the Inspector General (OIG) reported that hospitals did not always comply with Medicare requirements for reporting cochlear devices replaced without cost to the hospital or beneficiary. In 116 of 149 claims reviewed, hospitals did not report the appropriate modifiers and charges or a combination of the appropriate value code and condition codes. Medicare Administrative Contractors use this information to adjust payment; incorrect billing led to Medicare overpayments of $2.7 million.

Services furnished on or after January 1, 2014: outpatient hospitals should report value code “FD” along with condition code 49 or 50
Services furnished prior to January 1, 2014: outpatient hospitals should report the modifier “FB” on the same line as the procedure code (not the Cochlear Device code)

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

List of CMS resources (PDF)
Hospitals Did Not Always Comply With Medicare Requirements for Reporting Cochlear Devices Replaced Without Cost OIG Report, November 2016

Claims, Pricers & Codes

Physician Anesthesia Claims for SNF Patients

Some anesthesia claims for 2018 dates of service were incorrectly denied for Part B skilled nursing facility consolidated billing: HCPCS codes 00731, 00732, 00811, 00812, and 00813. Claims for these services will automatically be reprocessed by Medicare Administrative Contractors beginning January 28. You do not need to do anything.

Upcoming Events

New Electronic System for Provider Reimbursement Review Board Appeals Call — February 5

Tuesday, February 5 from 1:30 to 3 pm ET

Do you want to file or manage a Provider Reimbursement Review Board (PRRB) appeal? Learn how to use the new Office of Hearings Case and Document Management System (OH CDMS) to submit new appeals, transfer issues, file position papers, and manage all aspects of your PRRB appeals. For more information, visit the PRRB OH CDMS webpage.

During this call, PRRB staff discuss:

How to access the system
Detailed overview of the system and its capabilities
Frequently asked questions

A question and answer session follows the presentation; however, attendees may email questions in advance to with “Office of Hearings Case and Document Management System Conference Call” in the subject line. These questions may be addressed during the call or used for other materials following the call.

Target Audience: All PRRB appeal stakeholders.

New Medicare Card Open Door Forum — February 6

Wednesday, February 6 from 2 to 3 pm ET

Attend the next Open Door Forum on the new Medicare card. CMS shares the latest information, including the status of card mailing. You will have an opportunity to ask questions.

Participation Instructions:

Conference call only; you do not need to RSVP
Dial: 800-837-1935 and reference Conference ID: 9282568
TTY services: Dial 7-1-1 or 800-855-2880; a Relay Communications Assistant will help

Target Audience: Providers, plans, state Medicaid agencies, and other impacted stakeholders.

Home Health Patient-Driven Groupings Model Call — February 12

Tuesday, February 12 from 1:30 to 3 pm ET

During this call, learn about the Patient-Driven Groupings Model (PDGM) that will be implemented on January 1, 2020. CMS will use the PDGM to reimburse home health agencies for providing home health services under Medicare fee-for-service. Topics include:

Overview of PDGM model
Walkthrough of payment adjustments, including low utilization payment adjustments, partial payment adjustments, and outliers payments

A question and answer session follows the presentation. For more information, visit the Home Health Prospective Payment System webpage; review the CY 2019 final rule and Overview of the PDGM (PDF).

Target Audience: Home health agencies, administrators, clinicians, and other interested stakeholders.

New Part D Opioid Overutilization Policies Call — February 14

Thursday, February 14 from 1:30 to 3 pm ET

CMS implemented new opioid policies for Medicare drug plans effective 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

During this call, CMS experts discuss the new policies and answer questions.

Prior to the call, participants should review the following materials:

Training materials, including slide decks and tip sheets for prescribers (ZIP), pharmacists (ZIP), and patients (ZIP)
A Prescriber’s Guide to the New Medicare Part D Opioid Overutilization Policies for 2019 (PDF) MLN Matters® Article
Reducing Opioid Misuse webpage for more information on the CMS strategy

Target Audience: Physicians; physician assistants; nurses; nurse practitioners; dentists and other prescribers; case managers; and other interested stakeholders.

MIPS Data Submission Office Hours Sessions — February 26 and March 19

2018 Merit-based Incentive Payment System (MIPS) data submission office hours sessions:

Submit questions prior to the sessions to (Office Hours questions only).

For More Information:

Resource Library webpage

2018 Data Submission FAQs

QPP Access User Guide

Medicare Learning Network® Publications & Multimedia

RHCs/FQHCs: Communication Technology Based Services and Payment MLN Matters Article — New

A new MLN Matters Article MM10843 on Communication Technology Based Services and Payment for Rural Health Clinic (RHCs) and Federally Qualified Health Centers (FQHCs) (PDF) is available. Learn about the new Virtual Communications G Code.

Quality Payment Program in 2018: Transitioning to an Advanced APM Web-Based Training — New

With Continuing Medical Education Credit

A new Quality Payment Program in 2018: Transitioning to an Advanced APM Web-Based Training (WBT) course is available through the Learning Management System. Learn about:

Steps for joining an Advanced Alternative Payment Model (APM)
Benefits and risks of participation
Resources