Thursday, July 9, 2020
- Open Payments: Program Year 2019 Data
- LTCH Provider Preview Reports: Review Your Data by July 18
- IRF Provider Preview Reports: Review Your Data by July 21
- Reduce Provider Burden: Participate in Medical Documentation Interoperability Pilot
- COVID-19: Alternate Care Site Toolkit, Third Edition
- ICD-10-CM Diagnosis Codes: FY 2021
- Teaching Physicians and Residents: Expansion of CPT Codes that May Be Billed with the GE Modifier
- Quarterly Update to the End-Stage Renal Disease Prospective Payment System (ESRD PPS)
- Revising Chapters 3 and 5 of Publication (Pub.) 100-08, to Reflect the Recent Final Rule CMS-1713-F
- New Point of Origin Code for Transfer from a Designated Disaster Alternate Care Site — Revised
View this edition as PDF (PDF)
News
Open Payments: Program Year 2019 Data
CMS published Open Payments Program Year 2019 data, along with newly submitted and updated payment records for previous program years. This accounts for payments or transfers of value made between January 1 and December 31, 2019. Applicable manufacturers and group purchasing organizations collectively reported:
- $10.03 billion publishable payments and ownership and investment interests to physicians and teaching hospitals
- 10.98 million total records
- Attributable to 614,910 physicians and 1,196 teaching hospitals
For more information, visit the Open Payments website. Visit our Frequently Asked Questions webpage to read announcements to reporting entities and covered recipients regarding the impact of COVID-19.
LTCH Provider Preview Reports: Review Your Data by July 18
Long-Term Care Hospital (LTCH) Provider Preview Reports are available with first to fourth quarter 2019 data. Review your performance data on quality measures by July 18, prior to public display on the LTCH Compare website in September. Corrections to the underlying data are not permitted during this time; request a CMS review if you believe your data is inaccurate.
Beginning with the September 2020 refresh, CMS will display three new measures. For more information, visit the LTCH Quality Public Reporting webpage.
IRF Provider Preview Reports: Review Your Data by July 21
Inpatient Rehabilitation Facility (IRF) Provider Preview Reports are available with first to fourth quarter 2019 data. Review your performance data on quality measures by July 21, prior to public display on the IRF Compare website in September. Corrections to the underlying data are not permitted during this time; request a CMS review if you believe your data is inaccurate.
Beginning with the September 2020 refresh, CMS will display six new measures.
On June 19, new reports that correctly display the Lower Limit Confidence Interval Risk-Standardized value, followed by the Upper Limit Confidence Interval Risk-Standardized values replaced the older versions of this report. For more information, visit the IRF Quality Public Reporting webpage.
Reduce Provider Burden: Participate in Medical Documentation Interoperability Pilot
In support of the health care industry’s Health IT movement towards interoperability, CMS encourages providers to participate in an interoperability pilot to test specific medical documentation use cases. The Electronic Medical Documentation Interoperability (EMDI) program is designed to reduce provider burden by assembling a robust network of stakeholders willing to:
- Pilot test use cases
- Participate in gap analysis
- Contribute to resource documentation for new adopters
Participants will have an opportunity to test interoperable solutions by piloting one or more of three use cases:
- Ordering
- Requesting additional medical documentation from another provider
- Requesting physician signatures
If you are interested in partnering with us or learning more about our program, email .
COVID-19: Alternate Care Site Toolkit, Third Edition
The Office of the Assistant Secretary for Preparedness and Response (ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE) released the Third Edition of the Federal Healthcare Resilience Task Force Alternate Care Site (ACS) Toolkit, providing enhanced guidance, including:
- Updated directions
- Funding sources
- Guidance on providing dialysis support
- New temperature screening protocol and updated glossary of terms
- Information on retaining a warm site, including funding strategies
- Updated supply lists
Find More Information:
- COVID-19 ACS Resource Collection
- Funding Sources for the Establishment and Operationalization of ACS webinar
- ACS Funding Summary tip sheet
- COVID-19 ACS webinar
- ASPR TRACIE Novel Coronavirus Resources webpage
- ASPR TRACIE Fact Sheet
- ASPR TRACIE website
Claims, Pricers & Codes
ICD-10-CM Diagnosis Codes: FY 2021
FY 2021 ICD-10-CM diagnosis codes are available on the 2021 ICD-10-CM webpage. Use these codes for discharges and patient encounters that occur from October 1, 2020, through September 30, 2021.
Teaching Physicians and Residents: Expansion of CPT Codes that May Be Billed with the GE Modifier
Teaching physicians and residents: Expansion of CPT codes that may be billed with the GE modifier under 42 CFR 415.174 on and after March 1, 2020, for the duration of the public health emergency:
- Residents furnishing services at primary care centers may provide an expanded set of services to beneficiaries, including levels 4-5 of an office/outpatient Evaluation and Management (E/M) visit, telephone E/M, care management, and some communication technology-based services
- This expanded set of services are CPT codes 99204-99205, 99214-99215, 99495-99496, 99421-99423, 99452, and 99441-99443 and HCPCS codes G2010 and G2012
- Teaching physicians may submit claims for these services furnished by residents in the absence of a teaching physician using the GE modifier
Medicare Administrative Contractors will automatically reprocess claims billed with the GE modifier on or after March 1, 2020, that were denied. You do not need to do anything.
Events
Nursing Home Training Series Webcasts — July 9 and 16
Thursdays from 4 to 5 pm ET
Register for these webcasts.
This series is brought to you by CMS and the Quality Improvement Organization Program, a national network of Quality Innovation Network-Quality Improvement Organizations serving every state and territory. Upcoming topics:
- July 9: Managing Staffing Challenges
- July 16: Reopening Considerations
Miss a training? View recordings, slides, and resources on QIOProgram.org.
MLN Matters® Articles
Quarterly Update to the End-Stage Renal Disease Prospective Payment System (ESRD PPS)
A new MLN Matters Article MM11835 on Quarterly Update to the End-Stage Renal Disease Prospective Payment System (ESRD PPS) (PDF) is available. Learn about new diagnosis codes eligible for the comorbidity payment adjustment on October 1.
Revising Chapters 3 and 5 of Publication (Pub.) 100-08, to Reflect the Recent Final Rule CMS-1713-F
A new MLN Matters Article MM11599 on Revising Chapters 3 and 5 of Publication (Pub.) 100-08, to Reflect the Recent Final Rule CMS-1713-F (PDF) is available. Learn about finalized regulatory updates for durable medical equipment suppliers, including face-to-face encounter and written order requirements.
New Point of Origin Code for Transfer from a Designated Disaster Alternate Care Site — Revised
A revised MLN Matters Article MM11836 on New Point of Origin Code for Transfer from a Designated Disaster Alternate Care Site (PDF) is available. Learn about the new August 3 implementation date.
Publications
Hospice Quality Reporting Program: COVID-19 PHE
A tip sheet (PDF) on the Hospice Quality Reporting Program (HQRP): COVID-19 Public Health Emergency (PHE) is available. This tip sheet provides guidance on quality data submissions starting on July 1, 2020, now that the temporary exemptions from the COVID-19 PHE ended. Visit the HQRP Requirements and Best Practices webpage for more information.
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