Thursday, March 26, 2020
- CMS Announces Findings at Kirkland Nursing Home and New Targeted Plan for Health Care Facility Inspections in light of COVID-19
- SNF Quality Reporting Program: MDS 3.0 v1.18.1 Release Delayed
- Home Health Quality Reporting Program: Draft OASIS-E Instrument
- Medicare Diabetes Prevention Program: Become a Medicare Enrolled Supplier
- The Supplemental Security Income (SSI)/Medicare Beneficiary Data for Fiscal Year 2018 for Inpatient Prospective Payment System (IPPS) Hospitals, Inpatient Rehabilitation Facilities (IRFs), and Long Term Care Hospitals (LTCHs)
- April 2020 Update of the Ambulatory Surgical Center (ASC) Payment System
- April 2020 Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
- April Quarterly Update for 2020 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule
- New Medicare Beneficiary Identifier (MBI) Get It, Use It — Revised
- Add Dates of Service (DOS) for Pneumococcal Pneumonia Vaccination (PPV) Health Care Procedure Code System (HCPCS) Codes (90670, 90732), and Remove Next Eligible Dates for PPV HCPCS — Revised
View this edition as a PDF (PDF)
News
CMS Announces Findings at Kirkland Nursing Home and New Targeted Plan for Health Care Facility Inspections in light of COVID-19
On March 23, the Centers for Medicare & Medicaid Services (CMS) announced the preliminary results of a recent inspection of the Life Care Center nursing home in Kirkland, Washington – the epicenter of the 2019 Novel Coronavirus (COVID-19) outbreak in that state. The inspection, which the Agency conducted with the Washington Department of Social & Health Services, has helped inform CMS’s national strategy for keeping patients safe in nursing homes and other health care facilities. In keeping with the Trump Administration’s aggressive moves to combat further spread of COVID-19, CMS is also utilizing flexibilities allowed by President Trump’s Emergency Declaration to announce an enhanced, focused inspection process, informed in part by the Agency’s experiences on the ground in Kirkland, and close coordination and input from the Centers for Disease Control and Prevention (CDC). This focused inspection process will be provided to all inspectors and facilities, and used on a national scale. Critically, this focused inspection process includes a self-assessment tool for providers to employ.
You can find a copy of the press release here: – https://www.cms.gov/newsroom/press-releases/cms-announces-findings-kirkland-nursing-home-and-new-targeted-plan-healthcare-facility-inspections. Please note that links to the guidance can be found in the press release.
You can find a copy of the fact sheet here: – https://www.cms.gov/newsroom/fact-sheets/kirkland-washington-update-and-survey-prioritization-fact-sheet.
And Talking Points- CMS Administrator Seema Verma’s Remarks as Prepared for Delivery: Updates on Health Care Facility Inspections in light of COVID-19 – https://www.cms.gov/newsroom/press-releases/cms-administrator-seema-vermas-remarks-prepared-delivery-updates-healthcare-facility-inspections.
This guidance, and earlier CMS actions in response to the COVID-19 virus, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, please visit the coronavirus.gov webpage. For information specific to CMS, please visit the Current Emergencies Website.
SNF Quality Reporting Program: MDS 3.0 v1.18.1 Release Delayed
CMS is delaying the Minimum Data Set (MDS) 3.0 v1.18.1 release, which had been scheduled for October 1, 2020, in response to stakeholder concerns. Visit the MDS webpage for more information.
Home Health Quality Reporting Program: Draft OASIS-E Instrument
The draft OASIS-E All Items Instrument (PDF) is available for the Home Health Quality Reporting Program. Note: The instrument is not final; Office of Management and Budget approval is expected later this year. OASIS-E is effective January 1, 2021. Visit the Outcome and Assessment Information Set (OASIS) Data Sets webpage for more information.
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 eligible 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
- 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 and Enrollment Tutorial Video
- Furnish MDPP service: See the Session Journey Map
- Submit claims to Medicare: See the Billing and Claims Webinar Recording, Billing and Claims Fact Sheet, and Billing and Payment Quick Reference Guide
For More Information:
- MDPP Expanded Model (PDF) Booklet
- from Medicare Learning Network call on June 20, 2018
- MDPP webpage
- CDC - CMS Roles Fact Sheet
- Contact
Claims, Pricers & Codes
Medicare Diabetes Prevention Program: Valid Claims
For a claim to be valid under the Medicare Diabetes Prevention Program (MDPP), you must have both:
- Centers for Disease Control and Prevention (CDC) preliminary or full recognition; see the Supplier Fact Sheet and CDC website for more information
- Separate Medicare enrollment as an MDPP supplier (Specialty D1); see the Enrollment Fact Sheet and Checklist
Important:
If you do not have a separate Medicare enrollment as an MDPP supplier and you submit a claim for MDPP services, your claim will be rejected.
Medicare enrolled MDPP suppliers: See the Quick Reference Guide to Payment and Billing and the Billing and Claims Fact Sheet for information on valid claims:
- MDPP Medicare beneficiary eligibility data is returned via the HIPAA Eligibility Transaction System (HETS) on the 271 response; use this data to determine if a beneficiary meets the criteria to receive MDPP services
- Submit claims when a performance goal is met, and report codes only once per eligible beneficiary (except G9890 and G9891)
- List each HCPCS code with the corresponding session date of service and the coach’s National Provider Identifier
- List all HCPCS codes associated with a performance payment (including non-payable codes) on the same claim
- Include Demo code 82 in block 19 (Loop 2300 segment REF01 (P4) and segment REF02 (82)) to identify MDPP services
- Do not include codes for other, non-MDPP services on the same claim
For More Information:
- MDPP Expanded Model (PDF) Booklet
- MDPP webpage
- For trouble with MDPP billing and claims, contact your Medicare Administrative Contractor
MLN Matters® Articles
The Supplemental Security Income (SSI)/Medicare Beneficiary Data for Fiscal Year 2018 for Inpatient Prospective Payment System (IPPS) Hospitals, Inpatient Rehabilitation Facilities (IRFs), and Long Term Care Hospitals (LTCHs)
A new MLN Matters Article MM11679 on The Supplemental Security Income (SSI)/Medicare Beneficiary Data for Fiscal Year 2018 for Inpatient Prospective Payment System (IPPS) Hospitals, Inpatient Rehabilitation Facilities (IRFs), and Long Term Care Hospitals (LTCHs) (PDF) is available. Learn about updated data to determine adjustments.
April 2020 Update of the Ambulatory Surgical Center (ASC) Payment System
A new MLN Matters Article MM11694 on April 2020 Update of the Ambulatory Surgical Center (ASC) Payment System (PDF) is available. Learn about billing instructions and updates to HCPCS codes.
April 2020 Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
A new MLN Matters Article MM11701 on April 2020 Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files (PDF) is available. Learn about new and revised files.
April Quarterly Update for 2020 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule
A new MLN Matters Article MM11702 on April Quarterly Update for 2020 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule (PDF) is available. Learn about fee schedule amounts for new codes and updates for existing codes and the rural ZIP code file.
New Medicare Beneficiary Identifier (MBI) Get It, Use It — Revised
A revised MLN Matters Special Edition Article SE18006 on New Medicare Beneficiary Identifier (MBI) Get It, Use It (PDF) is available. This revision clarifies that you need the beneficiary’s first name, last name, date of birth, and Social Security Number to use the MBI look-up tool.
Add Dates of Service (DOS) for Pneumococcal Pneumonia Vaccination (PPV) Health Care Procedure Code System (HCPCS) Codes (90670, 90732), and Remove Next Eligible Dates for PPV HCPCS — Revised
A revised MLN Matters Article MM11335 on Add Dates of Service (DOS) for Pneumococcal Pneumonia Vaccination (PPV) Health Care Procedure Code System (HCPCS) Codes (90670, 90732), and Remove Next Eligible Dates for PPV HCPCS (PDF) is available. Learn about changes to the eligibility data for these codes beginning April 13.
Multimedia
Ground Ambulance Data Collection System Call: Audio Recording and Transcript
An audio recording (ZIP) and transcript (PDF) are available for the March 12 Medicare Learning Network call on Ground Ambulance Organizations: Data Collection for Public Safety-Based Organizations. learn how to collect information for reporting to the new Ground Ambulance Data Collection System for organizations that also provide fire, police, and other public safety services.
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