Thursday, March 28, 2019
- New Medicare Card and MBI Adoption: How Do You Compare?
- SNF PPS Patient Driven Payment Model: Get Ready for Implementation on October 1
- Billing for Hospital Part B Inpatient Services
- Grandfathered Tribal FQHCs: Payment for CY 2019
- Home Health Certification and Recertification Policy Changes
- ASC Payment System: April 2019 Update
- Hospital OPPS: April 2019 Update
- Medicare Physician Fee Schedule Database: April 2019 Update — Revised
- CY 2019 eCQM
- Medicare Promoting Interoperability Program: Scoring Methodology
- Medicare Enrollment for Physicians and Other Part B Suppliers — Revised
- Medicare Preventive Services Poster — Revised
- Medicare Secondary Payer — Revised
- Safeguard Your Identity and Privacy Using PECOS — Revised
- Dementia Care Call: Audio Recording and Transcript
- Open Payments Call: Audio Recording and Transcript
- Medicare Secondary Payer Provisions Web-Based Training Course — Revised
View this edition as a PDF (PDF)
News
New Medicare Card and MBI Adoption: How Do You Compare?
Use Medicare Beneficiary Identifiers (MBIs) for all Medicare transactions – the transition period ends December 31, 2019. For the week ending March 22, here is how you are using the MBI on claims:
- National: 68%
- Institutional: 68%
- Professional:69%
- Durable Medical Equipment: 52%
- Ask your patients for the card. If your Medicare patients say they did not get a card, instruct them to call 1-800-MEDICARE (1-800-633-4227), so we can help them get their new cards.
- Use your Medicare Administrative Contractor’s look up tool. Sign up (PDF) for the Portal to use the tool.
- Check the remittance advice. Until the end of the transition period, we return the MBI on the remittance advice for claims with a valid and active Health Insurance Claim Number. Contact your vendor if you do not see the MBI.
SNF PPS Patient Driven Payment Model: Get Ready for Implementation on October 1
On October 1, the new Patient Driven Payment Model (PDPM) is replacing Resource Utilization Group, Version IV for the Skilled Nursing Facility (SNF) Prospective Payment System (PPS). CMS has resources to help you prepare.
For More Information:
- PDPM webpage, including fact sheets, , presentation (PDF), and coding crosswalks/classification logic
- from the Medicare Learning Network call in December
- New Medicare Webpage on PDPM (PDF) MLN Matters Article
- Implementation of the SNF PDPM (PDF) MLN Matters Article
Compliance
DME Proof of Delivery Documentation Requirements
CMS simplified and clarified documentation requirements for proof of delivery of Durable Medical Equipment (DME) and related services. If you are a physician, provider, or supplier who bills a DME Medicare Administrative Contractor, read the MLN Matters Article on Proof of Delivery Documentation Requirements (PDF) for details. Learn about updates to support compliance and the impact on your payment.
More resources to help you bill correctly and avoid overpayment recoveries:
- , Section 26
- 42 CFR Section 424.57(c)(12) - Opens in a new window
MLN Matters® Articles
Billing for Hospital Part B Inpatient Services
A new MLN Matters Article MM11181 on Billing for Hospital Part B Inpatient Services (PDF) is available. Learn about billing instructions.
Grandfathered Tribal FQHCs: Payment for CY 2019
A new MLN Matters Article MM11203 on Update to the Payment for Grandfathered Tribal Federally Qualified Health Centers (FQHCs) for Calendar Year (CY) 2019 (PDF) is available. Learn about updates to the base payment rate.
Home Health Certification and Recertification Policy Changes
A new MLN Matters Article MM11104 on Manual Updates Related to Home Health Certification and Recertification Policy Changes (PDF) is available. Learn about policy updates.
ASC Payment System: April 2019 Update
A new MLN Matters Article MM11232 on April 2019 Update of the Ambulatory Surgical Center (ASC) Payment System (PDF) is available. Learn about changes to billing instructions and HCPCS updates.
Hospital OPPS: April 2019 Update
A new MLN Matters Article MM11216 on April 2019 Update of the Hospital Outpatient Prospective Payment System (OPPS) (PDF) is available. Learn about four new CPT codes.
Medicare Physician Fee Schedule Database: April 2019 Update — Revised
A revised MLN Matters Article MM11163 on Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) – April 2019 Update (PDF) is available. Learn about the new HCPCS codes.
Publications
CY 2019 eCQM
Eligible hospitals and critical access hospitals: CMS posted updated resources for CY 2019 Electronic Clinical Quality Measure (eCQM) data reporting for the Hospital Inpatient Quality Reporting (IQR) and the Promoting Interoperability Programs:
- eCQM Submission Overview - Opens in a new window
- Preparation Checklist - Test - Opens in a new window
- Preparation Checklist - Production - Opens in a new window
- Electronic Health Record Report Overview - Opens in a new window
For More Information
- QualityNet eCQM Overview - Opens in a new window webpage
- QualityNet eCQM Reporting Resources - Opens in a new window webpage
- Quality Reporting Center - Opens in a new window website
- eCQI Resource Center website
- For questions about the Hospital IQR Program, visit the Questions and Answers - Opens in a new window webpage or call 844-472-4477
- For questions about the Promoting Interoperability Program, QualityNet Secure Portal, Pre-Submission Validation Application tool, and file error messages, contact the QualityNet Help Desk at or 866-288-2912
- For questions about eCQM specifications, value sets, and mapping, visit the ONC eCQM Issue Tracker webpage
Medicare Promoting Interoperability Program: Scoring Methodology
In the FY 2019 Inpatient Prospective Payment Systems final rule - Opens in a new window , CMS finalized a new performance-based scoring methodology for eligible hospitals and critical access hospitals that attest under the Medicare Promoting Interoperability Program. See the Scoring Methodology (PDF) Fact Sheet for information on scoring and reporting requirements.
For More Information:
- Overview (PDF) Fact Sheet
- website
Medicare Enrollment for Physicians and Other Part B Suppliers — Revised
A revised Medicare Learning Network Booklet is available. Learn:
- Who are part B suppliers
- What it means to be a participating provider
Medicare Preventive Services Poster — Revised
A revised Medicare Learning Network Educational Tool is available. Learn about:
- Coding
- Coverage requirements
- Patient cost-sharing for each service
Medicare Secondary Payer — Revised
A revised Medicare Learning Network Booklet is available. Learn:
- When Medicare pays first
- How to gather accurate data from the beneficiary
- What happens if you fail to file correct and accurate claims
Safeguard Your Identity and Privacy Using PECOS — Revised
A revised Medicare Learning Network Booklet is available. Learn:
- How to use the Provider Enrollment, Chain, and Ownership System (PECOS)
- Privacy tips
- How to keep, review, and protect enrollment information
Multimedia
Dementia Care Call: Audio Recording and Transcript
An audio recording (ZIP) and transcript (PDF) are available for the Medicare Learning Network call on the Dementia Care & Psychotropic Medication Tracking Tool. Learn about the tool, updates on the Phase 3 Requirements for Participation, and the progress of the National Partnership to Improve Dementia Care in Nursing Homes.
Open Payments Call: Audio Recording and Transcript
An audio recording (ZIP) and transcript (PDF) are available for the Medicare Learning Network call on Open Payments: Transparency and You. Find out how to access the Open Payments system to review the accuracy of the data submitted about you before it is published on the CMS website.
Medicare Secondary Payer Provisions Web-Based Training Course — Revised
With Continuing Education Credit
A revised Medicare Secondary Payer Provisions Web-Based Training (WBT) course is available through the Medicare Learning Network Learning Management System - Opens in a new window . Learn about:
- Identifying provisions
- Recognizing when Medicare is primary and secondary
- Responsibilities to comply
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