Under Section 106 of the Further Consolidated Appropriations Act, 2020, Medicare fee schedule amounts for complex rehabilitative and certain manual wheelchair accessories and cushions cannot be adjusted based on information from the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) competitive bidding programs between January 1, 2020, and June 30, 2021. Visit the Durable Medical Equipment Center webpage for a list of affected codes.

CMS welcomes public input on this list. Submit your comments to by March 12.

Medicare Promoting Interoperability Program: CAH Reconsideration Forms due March 6

Critical Access Hospitals (CAHs): If you received notification that you are subject to a Medicare Promoting Interoperability payment adjustment and believe there is an error, you can apply for reconsideration.

The deadline to submit a reconsideration form for your 2018 payment adjustment is March 6.

For More Information:

Medicare Promoting Interoperability Program: Submit Proposals for New Measures by July 1

The CMS Annual Call for Measures for eligible hospitals and critical access hospitals participating in the Medicare Promoting Interoperability Program is open. Submit a measure proposal by July 1. For more information see the Annual Call for Measures webpage, fact sheet (PDF) and submission form (PDF).

PEPPERs for Short-term Acute Care Hospitals

Fourth quarter FY 2019 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. Providers can use the 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

2018 Geographic Variation Public Use File

CMS posted the Geographic Variation Public Use File (PUF) and dashboards with data for 2018 on the PUF webpage. The PUF is a series of downloadable tables and reports with demographic, spending, utilization, and quality indicators for the Medicare fee-for-service population. It presents data at the state, hospital referral region, and county-level. For 2018, the PUF includes data for 33.5 million Medicare beneficiaries and $357.8 billion in Medicare costs.

Help Your Patients Make Informed Food Choices

March is National Nutrition Month® - “Eat Right Bite by Bite”. Good nutrition does not have to be restrictive or overwhelming. Help your patients make informed food choices and develop sound eating habits by setting small, attainable goals. These changes will help prevent or reduce nutrition-related health conditions, including diabetes, chronic kidney disease, and obesity. Encourage your patients to take advantage of appropriate Medicare-covered preventive services:

Medical Nutrition Therapy
Diabetes Screening
Diabetes Self-Management Training
Intensive Behavioral Therapy for Obesity
Intensive Behavioral Therapy for Cardiovascular Disease
Annual Wellness Visit

For More Information:

Educational Tool
National Nutrition Month website
National Institute of Diabetes and Digestive and Kidney Diseases website
Million Hearts® website
Find a Registered Dietitian/Nutritional Professional
Visit the Preventive Services website to learn more about Medicare-covered services.

Compliance

Ambulance Fee Schedule and Medicare Transports

In a recent report, the Office of Inspector General (OIG) determined that Medicare made Part B payments to ambulance suppliers for transportation services that were also included in Medicare Part A payments to Skilled Nursing Facilities, as part of consolidated billing requirements. CMS developed the Ambulance Fee Schedule and Medicare Transports Booklet to help you bill correctly. Additional resources:

Claims, Pricers & Codes

Average Sales Price Files: April 2020

CMS posted the April 2020 Average Sales Price (ASP) and Not Otherwise Classified (NOC) pricing files and crosswalks on the 2020 ASP Drug Pricing Files webpage.

Events

Ground Ambulance Organizations: Data Collection for Public Safety-Based Organizations Call — March 12

Thursday, March 12 from 1 to 2 pm ET

During this call, ground ambulance organizations that also provide fire, police, and other public safety services learn how to collect information for reporting to the new Ground Ambulance Data Collection System.

A question and answer session follows the presentation; however, you may email questions in advance to with “March 12 Call” in the subject line. These questions may be addressed during the call or used for other materials following the call. For more information, including ground ambulance organizations selected for the first round of reporting, see the Ambulances Services Center webpage, CY 2020 Physician Fee Schedule final rule, and Bipartisan Budget Act of 2018.

Target Audience: Ground ambulance organizations that also provide fire, police, or other public safety services.

Open Payments: Your Role in Health Care Transparency Call — March 19

Thursday, March 19 from 2 to 3 pm ET

Did you know that reporting entities annually submit records to CMS of payments or transfers of value they made to physicians and teaching hospitals? Beginning in April, you have 45 days to review and dispute Program Year 2019 records. CMS will publish this data and updates to previous program years’ data by June 30. Topics:

Overview of the Open Payments national transparency program
Program timeline
Registration process
Critical deadlines for physicians and teaching hospitals to review and dispute data

A question and answer session follows the presentation.

Target Audience: Physicians, teaching hospitals, and physician office staff.

Anesthesia Modifiers: Comparative Billing Report Webinar — March 19

Thursday March 19 from 3 to 4 pm ET

Join us for a discussion of the Comparative Billing Report (CBR) on Anesthesia Modifiers, an educational tool for providers who submit Medicare Part B claims. Visit the CBR website for more information.

Ground Ambulance Organizations: Data Collection for Medicare Providers Call — April 2

Thursday, April 2 from 2 to 3 pm ET

During this call, learn how to allocate costs, collect data, and report data for the new Ground Ambulance Data Collection System.

A question and answer session follows the presentation; however, you may email questions in advance to with “April 2 Call” in the subject line. These questions may be addressed during the call or used for other materials following the call. For more information, including ground ambulance organizations selected for the first round of reporting, see the Ambulances Services Center webpage, CY 2020 Physician Fee Schedule final rule, and Bipartisan Budget Act of 2018.

Target Audience: Ground ambulance organizations that are Medicare providers, including hospitals, critical access hospitals, skilled nursing facilities, home health agencies, comprehensive outpatient rehabilitation facilities, and hospices.

LTCH and IRF Quality Reporting Programs: SPADEs In-Depth Training Event — June 9-10

Tuesday, June 9 through Wednesday, June 10

Baltimore, MD

CMS is hosting a 2-day “Train the Trainer” event for Inpatient Rehabilitation Facility (IRF) and Long-Term Care Hospital (LTCH) providers. Topics:

Implementation of the Standardized Patient Assessment Data Elements (SPADEs)
Revisions to the IRF-Patient Assessment Instrument and the Long-Term CARE Data Set

For More Information:

LTCH Quality Reporting Training webpage
IRF Quality Reporting Training webpage

MLN Matters® Articles

Standard Elements for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Order, and Master List of DMEPOS Items Potentially Subject to a Face-to-Face Encounter and Written Orders Prior to Delivery and, or Prior Authorization Requirements

A new MLN Matters Special Edition Article SE20007 on Standard Elements for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Order, and Master List of DMEPOS Items Potentially Subject to a Face-to-Face Encounter and Written Orders Prior to Delivery and, or Prior Authorization Requirements (PDF) is available. Learn about requirements from the CY 2020 final rule.

Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update

A new MLN Matters Article MM11638 on Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update (PDF) is available. Learn about updated RARC and CARC lists and MREP and PC Print software.

Quarterly Update for the Temporary Gap Period of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP) - April 2020

A new MLN Matters Article MM11652 on Quarterly Update for the Temporary Gap Period of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP) - April 2020 (PDF) is available. Learn about changes to the HCPCS, ZIP code, and supplier files.

International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs) -- July 2020 Update

A new MLN Matters Article MM11655 on International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs) -- July 2020 Update (PDF) is available. Learn about ICD-10 conversions and coding updates.

Publications

Administrative Simplification: Claim Status Basics

The Claim Status Basics (PDF) fact sheet covers claim status inquiry and response and provides information on the adopted standards and operating rules for these transactions. This fact sheet is part of a series of fact sheets on Administrative Simplification.

Hospice Quality Reporting Program: Timeliness Compliance Threshold for HIS Submissions

CMS posted an updated fact sheet (PDF) on the timeliness compliance threshold for Hospice Item Set (HIS) submissions, including policies finalized in the FY 2016 final rule and a preliminary algorithm for the calculation. Visit the HIS webpage for more information.

Guide to Reducing Chronic Kidney Disease Disparities in the Primary Care Setting

During National Kidney Month, learn more about chronic kidney disease from our new kidney disease resource, Guide to Reducing Chronic Kidney Disease Disparities in the Primary Care Setting (PDF). The guide includes resources for primary care teams that treat vulnerable populations.

Multimedia

Ambulance Services Call: Audio Recording and Transcript

An audio recording (ZIP) and transcript (PDF) are available for the February 20 Medicare Learning Network call on Ground Ambulance Organizations: Reporting Volunteer Labor. Learn how to report in the new Ground Ambulance Data Collection system.

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).