Thursday, March 18, 2021
- Clinical Laboratory Data Reporting Delayed Until 2022: Reminder
- Comprehensive Eye Examinations: Comparative Billing Report in March
- Long-Term Care: Dementia-related Psychosis Call — March 23
- Open Payments & You Call — March 25
- SNF Quality Reporting Program: Achieving a Full APU Webinar- March 30
- April 2021 Update to the Fiscal Year (FY) 2021 Inpatient Prospective Payment System (IPPS)
- April Quarterly Update for 2021 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule
- Clinical Laboratory Fee Schedule – Medicare Travel Allowance Fees for Collection of Specimens
- Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment
- Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2021 Update
- Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) & PC Print Update
View this edition as PDF (PDF)
News
Clinical Laboratory Data Reporting Delayed Until 2022: Reminder
For Clinical Diagnostic Laboratory Tests that are not Advanced Diagnostic Laboratory Tests, the requirement for you to report private payor data between January 1 and March 31, 2020, was delayed 2 years. You must report data from the original collection period. Reporting will resume on a 3-year cycle beginning in 2025. (Section 3718 of the Coronavirus Aid, Relief, and Economic Security Act). Current timeline:
- Collect Data for January 1 through June 30, 2019
- Report data between January 1 and March 31, 2022
For more information, see the PAMA Regulations webpage.
Comprehensive Eye Examinations: Comparative Billing Report in March
In late March, CMS will issue a Comparative Billing Report on Part B claims for comprehensive eye examinations. Use the data-driven tables to compare your billing and payment patterns with peers in your state and across the nation.
The public can’t view CBRs. Look for an email from cbrpepper.noreply@religroupinc.com to access your report. Update your email address in the Provider Enrollment, Chain, and Ownership System to ensure delivery.
More Information:
- View a webinar recording
- Visit the CBR website
- Register for a live webinar on April 7 from 3 to 4 pm ET
Compliance
Polysomnography Services: Bill Correctly
An Office of Inspector General (OIG) report found that Medicare improperly paid claims for polysomnography services that didn’t meet our requirements. Review the Provider Compliance Tips for Polysomnography (Sleep Studies) (PDF) fact sheet to help you bill correctly. Additional resources:
- Medicare Claims Processing Manual, Chapter 15 (PDF), Section 70
- Questionable Billing for Polysomnography Services OIG Report
Events
Long-Term Care: Dementia-related Psychosis Call — March 23
National Partnership to Improve Dementia Care and Quality Assurance Performance Improvement
Tuesday, March 23 from 1:30 to 3 pm ET
Register for our Medicare Learning Network call.
During this call, learn about the appropriate assessment, accurate diagnosis, and approaches to care for dementia-related psychosis in the long-term care setting. Hear about customized care strategies for nursing home residents. A question and answer session follows the presentations.
Speakers: Dr. George Grossberg, Dr. Alexis Eastman, Susan Scanland, and Dr. Chad Worz from the Gerontological Society of America’s Workgroup on Dementia-Related Psychosis
Target Audience:
- Consumer and advocacy groups
- Nursing home providers
- Surveyor community
- Prescribers
- Professional associations
- Other interested stakeholders
Open Payments & You Call — March 25
Thursday, March 25 from 2 to 3 pm ET
Register for our Medicare Learning Network call.
Reporting entities submit data to the Open Payments system about payments or transfers of value made to physicians and teaching hospitals. Beginning in April, you have 45 days to review and dispute 2020 payment data before it’s published on the CMS website by June 30.
Topics:
- Overview of the Open Payments program and what it means to you
- Program timeline
- Registration process
- Accessing the system
- Critical deadlines for physicians and teaching hospitals to review and dispute data
A question and answer session follows the presentation. See the Open Payments webpage for program information and resources.
Target Audience:
- Physicians
- Physician office staff
- Teaching hospitals
SNF Quality Reporting Program: Achieving a Full APU Webinar- March 30
Tuesday, March 30, from 1 to 2:30 pm ET
Register for the Webinar. Space is limited.
Learn about the relationship between the Annual Payment Update (APU) and the Skilled Nursing Facility (SNF) Quality Reporting Program, including:
- Submitting data
- Achieving the full APU
- Requesting a reconsideration if you’re noncompliant
For more Information, email PACTraining@econometricainc.com.
MLN Matters® Articles
April 2021 Update to the Fiscal Year (FY) 2021 Inpatient Prospective Payment System (IPPS)
CMS issued a new MLN Matters Article MM12062 on April 2021 Update to the Fiscal Year (FY) 2021 Inpatient Prospective Payment System (IPPS) (PDF). Learn about reprocessing for certain claims.
April Quarterly Update for 2021 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule
CMS issued a new MLN Matters Article MM12193 on April Quarterly Update for 2021 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule (PDF). Learn about changes to codes and payment policy.
Clinical Laboratory Fee Schedule – Medicare Travel Allowance Fees for Collection of Specimens
CMS issued a new MLN Matters Article MM12140 on Clinical Laboratory Fee Schedule – Medicare Travel Allowance Fees for Collection of Specimens (PDF). Learn about changes to travel allowances on a per mileage basis or a flat rate.
Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment
CMS issued a new MLN Matters Article MM12178 on Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment (PDF). Learn about advanced diagnostic laboratory tests, reporting period delay, and changes to codes.
Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2021 Update
CMS issued a new MLN Matters Article MM12155 on Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2021 Update (PDF). Learn about changes to codes.
Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) & PC Print Update
CMS issued a new MLN Matters Article MM12102 on Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) & PC Print Update (PDF). Learn about updates effective July 1.
Publications
Medicare Quarterly Provider Compliance Newsletter
CMS issued a new Medicare Learning Network educational tool, Medicare Quarterly Provider Compliance Newsletter [Volume 11, Issue 2] (PDF). Learn about:
- Prefabricated and custom-fabricated knee orthoses: medical necessity and documentation requirements
- Ankle-foot orthoses and knee-ankle foot orthoses within the reasonable useful lifetime: excessive units
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