Thursday, April 30, 2020
- Infection Control Guidance to Home Health Agencies on COVID-19
- Now Available: Nursing Home Five Star Quality Rating System Updates, Nursing Home Staff Counts, and Frequently Asked Questions
- CMS Adds New COVID-19 Clinical Trials Improvement Activity to the Quality Payment Program
- Medicare Diabetes Prevention Program: Become a Medicare Enrolled Supplier
- COVID-19: Lessons from the Front Lines Calls — May 1 and 8
- COVID-19: Home Health and Hospice Call — May 5
- COVID-19: Office Hours Call — May 5
- COVID-19: Nursing Homes Call — May 6
- July 2020 Quarterly Update to the Inpatient Prospective Payment System (IPPS) Fiscal Year (FY) 2020 Pricer
- Quarterly Update to the Long Term Care Hospital (LTCH) Prospective Payment System (PPS) Fiscal Year (FY) 2020 Pricer
- Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendment (CLIA) Edits — Revised
- 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 — Revised
- April 2020 Medicare Quarterly Provider Compliance Newsletter
- Advanced Practice Registered Nurses, Anesthesiologist Assistants, and Physician Assistants — Revised
- Ambulatory Surgical Center Payment System — Revised
- Dual Eligible Beneficiaries Under Medicare and Medicaid — Revised
- Hospital Outpatient Prospective Payment System — Revised
- How to Use the Searchable Medicare Physician Fee Schedule — Revised
- Long-Term Care Hospital Prospective Payment System — Revised
- Combating Medicare Parts C and D Fraud, Waste, and Abuse Web-Based Training Course — Revised
- Medicare Parts C and D General Compliance Training Web-Based Training Course — Revised
View this edition as PDF (PDF)
News
Infection Control Guidance to Home Health Agencies on COVID-19
CMS issued guidance to respond to questions from Medicare & Medicaid Home Health Agencies and Religious Nonmedical Healthcare Institutions. The guidance addresses the COVID-19 outbreak and minimizing transmission to other individuals.
Guidance
Now Available: Nursing Home Five Star Quality Rating System Updates, Nursing Home Staff Counts, and Frequently Asked Questions
In a recent memo to State Survey Agencies, CMS announced that the inspection domain of the Nursing Home Compare website will be held constant temporarily due to the prioritization and suspension of certain surveys, to ensure the rating system reflects fair information for consumers. In addition, CMS is releasing information that shows the average number of staff each nursing home has onsite, each day (nursing staff and total staff), and aggregated by state and nationally. Along with these announcements CMS released a list of Frequently Asked Questions to clarify certain actions the agency has taken related to visitation, surveys, waivers, and other guidance.
Memo
Five-Star Quality Rating Information
CMS Adds New COVID-19 Clinical Trials Improvement Activity to the Quality Payment Program
CMS issued a letter thanking clinicians for their ongoing efforts to treat patients and combat COVID-19 and shared additional details on the new Merit-Based Incentive Payment System (MIPS) improvement activity. As announced earlier this month, clinicians who participate in a COVID-19 clinical trial and report their findings to a clinical data repository or registry many now earn credit in MIPS under the Improvement Activities performance category for the 2020 performance period by attesting to this new activity.
Letter (PDF)
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:
- Participants in the MDPP: CMS Flexibilities to Fight COVID-19 (PDF)
- 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
Home Health Claims: Correcting Recoding Errors
Medicare home health claims are being paid based on incorrect HIPPS codes when:
- Dates spanning January 1, 2020, are recoded by Medicare systems
- From dates after January 1, 2020, are submitted with institutional occurrence codes and are recoded due to period timing
These errors will be corrected by May 4, 2020. Medicare Administrative Contractors will adjust the claims to correct payments. Home health agencies do not need to take any action.
Events
COVID-19: Lessons from the Front Lines Calls — May 1 and 8
Fridays from 12:30 to 2 pm ET
These weekly calls are a joint effort between CMS Administrator Seema Verma, Food and Drug Administration Commissioner Stephen Hahn, MD, and the White House Coronavirus Task Force. Physicians and other clinicians: Share your experience, ideas, strategies, and insights related to your COVID-19 response. There is an opportunity to ask questions.
To Participate on May 1:
- Conference lines are limited, so we encourage you to join via audio webcast, either on your computer or smartphone web browser
- Or, call 877-251-0301; Access Code: 9545128
To Participate on May 8:
- Conference lines are limited, so we encourage you to join via audio webcast, either on your computer or smartphone web browser
- Or, call 877-251-0301; Access Code: 9146779
For More Information:
- Coronavirus.gov
- CMS Current Emergencies website
- Podcast and Transcripts webpage: Audio recordings and transcripts
Target Audience: Physicians and other clinicians.
COVID-19: Home Health and Hospice Call — May 5
Tuesday, May 5 from 3 to 3:30 pm ET
These calls provide targeted updates on the agency’s latest COVID-19 guidance. Leaders in the field also share best practices. There is an opportunity to ask questions if time allows.
To Participate:
- Conference lines are limited, so we encourage you to join via audio webcast, either on your computer or smartphone web browser
- Or, call 833-614-0820; Access Passcode: 7844154
For More Information:
- Coronavirus.gov
- CMS Current Emergencies website
- Podcast and Transcripts webpage: Audio recordings and transcripts
Target Audience: Home health and hospice providers.
COVID-19: Office Hours Call — May 5
Tuesday, May 5 from 5 to 6 pm ET
Hospitals, health systems, and providers: Ask CMS questions about our temporary actions that empower you to:
- Increase hospital capacity – CMS Hospitals Without Walls
- Rapidly expand the health care workforce
- Put patients over paperwork
- Promote telehealth
To Participate:
- Conference lines are limited, so we encourage you to join via audio webcast, either on your computer or smartphone web browser
- Or, call 833-614-0820; Access Passcode: 3996146
For More Information:
- Coronavirus.gov
- CMS Current Emergencies website
- Podcast and Transcripts webpage: Audio recordings and transcripts
Target Audience: Hospitals, health systems, and providers.
COVID-19: Nursing Homes Call — May 6
Wednesday, May 6 from 4:30 to 5 pm ET
These calls provide targeted updates on the agency’s latest COVID-19 guidance. Leaders in the field also share best practices. There is an opportunity to ask questions if time allows.
To Participate:
- Conference lines are limited, so we encourage you to join via audio webcast, either on your computer or smartphone web browser
- Or, call 833-614-0820; Access Passcode: 8899983
For More Information:
- Coronavirus.gov
- CMS Current Emergencies website
- Podcast and Transcripts webpage: Audio recordings and transcripts
Target Audience: Nursing home providers.
MLN Matters® Articles
July 2020 Quarterly Update to the Inpatient Prospective Payment System (IPPS) Fiscal Year (FY) 2020 Pricer
A new MLN Matters Article MM11764 on July 2020 Quarterly Update to the Inpatient Prospective Payment System (IPPS) Fiscal Year (FY) 2020 Pricer (PDF) is available. Learn about new payment policy for COVID-19.
Quarterly Update to the Long Term Care Hospital (LTCH) Prospective Payment System (PPS) Fiscal Year (FY) 2020 Pricer
A new MLN Matters Article MM11742 on Quarterly Update to the Long Term Care Hospital (LTCH) Prospective Payment System (PPS) Fiscal Year (FY) 2020 Pricer (PDF) is available. Learn about the discharge payment percentage payment adjustment and new payment policy for COVID-19.
Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendment (CLIA) Edits — Revised
A revised MLN Matters Article MM11640 on Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendment (CLIA) Edits (PDF) is available. This Article was revised to update the change request information.
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 — Revised
A revised MLN Matters Article MM11490 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) is available. This Article was revised to update the Washington Publishing Company website.
Publications
April 2020 Medicare Quarterly Provider Compliance Newsletter
A new Medicare Learning Network April 2020 Medicare Quarterly Provider Compliance Newsletter - [Volume 10, Issue 3] is available. Learn about:
- Lower limb orthosis-knee orthosis: Insufficient documentation
- Visits to patients in swing beds: Incorrect coding
Advanced Practice Registered Nurses, Anesthesiologist Assistants, and Physician Assistants — Revised
A revised Advanced Practice Registered Nurses, Anesthesiologist Assistants, and Physician Assistants Medicare Learning Network Booklet is available. Learn about:
- Qualifications
- Billing and payment guidelines
Ambulatory Surgical Center Payment System — Revised
A revised Ambulatory Surgical Center Payment System Medicare Learning Network Booklet is available. Learn about:
- Payment
- Quality Reporting Program
Dual Eligible Beneficiaries Under Medicare and Medicaid — Revised
A revised Dual Eligible Beneficiaries Under Medicare and Medicaid Medicare Learning Network Booklet is available. Learn about:
- Medicare Savings Programs, including benefits and qualifications
- Billing requirements
Hospital Outpatient Prospective Payment System — Revised
A revised Hospital Outpatient Prospective Payment System Medicare Learning Network Booklet is available. Learn about:
- Payment classification
- Payment rates
- Quality Reporting Program
How to Use the Searchable Medicare Physician Fee Schedule — Revised
A revised How to Use The Searchable Medicare Physician Fee Schedule Medicare Learning Network Booklet is available. Learn to navigate and search for:
- Pricing information
- Payment policy indicators
- Relative value units and geographic practice cost index
Long-Term Care Hospital Prospective Payment System — Revised
A revised Long-Term Care Hospital Prospective Payment System Medicare Learning Network Booklet is available. Learn about:
- Certification
- Patient classification
- Payment adjustments
Multimedia
Combating Medicare Parts C and D Fraud, Waste, and Abuse Web-Based Training Course — Revised
A revised Combating Medicare Parts C and D Fraud, Waste, and Abuse Web-Based Training (WBT) course is available through the Medicare Learning Network Learning Management System. Learn about:
- Laws and regulations
- Consequences and penalties for violations
- How to recognize and prevent
Medicare Parts C and D General Compliance Training Web-Based Training Course — Revised
A revised Medicare Parts C and D General Compliance Training Web-Based Training (WBT) course is available through the Medicare Learning Network Learning Management System. Learn:
- How compliance programs operate
- How to report violations
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