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News Updates | January 24, 2014
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ICD-10 Coding Basics MLN Connects™ VideoAre you ready to transition to ICD-10 on October 1, 2014? To help make sure you’re prepared, CMS has released a new MLN Connects™ video on ICD-10 Coding Basics. Sue Bowman from the American Health Information Management Association (AHIMA) provides a basic introduction to ICD-10 coding, including:
Keep Up to Date on ICD-10 Visit the CMS ICD-10 website for the latest news and resources to help you prepare for the October 1, 2014, deadline. Sign up for CMS ICD-10 Industry Email Updatesand follow us on Twitter. |
Monday, January 27, 2014
ICD-10 News: Training Webinar Video
Thursday, January 23, 2014
Manual Updates to Clarify Skilled Nursing Facility, Inpatient Rehabilitation Facility, Home Health, and Outpatient Coverage Pursuant to Jimmo vs. Sebelius” MLN Matters® Article — Released
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| “Manual Updates to Clarify Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF), Home Health (HH), and Outpatient (OPT) Coverage Pursuant to Jimmo vs. Sebelius” MLN Matters® Article — Released MLN Matters® Article #MM8458, “Manual Updates to Clarify Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF), Home Health (HH), and Outpatient (OPT) Coverage Pursuant to Jimmo vs. Sebelius” has been released and is now available in downloadable format. The article was prepared and is being distributed as a result of the settlement agreement in the case of Jimmo v. Sebelius. This article is designed to provide education on the updated portions of the “Medicare Benefit Policy Manual” (MBPM). It includes clarification on the coverage requirements of skilled nursing and skilled therapy services to Medicare beneficiaries. |
| Centers for Medicare & Medicaid Services (CMS) has sent this update. To contact Centers for Medicare & Medicaid Services (CMS) go to our contact us page. |
MLN Connects Provider eNews for Thursday January 23, 2014
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Thursday January 23, 2014
MLN Connects™ National Provider Calls
CMS Events
Announcements
Claims, Pricers, and Codes
MLN Educational Products
MLN Connects™ National Provider CallsNational Partnership to Improve Dementia Care in Nursing Homes — Register Now
Wednesday, February 26; 2-3:30pm ET
The CMS National Partnership to Improve Dementia Care in Nursing homes was developed to improve dementia care through the use of individualized, comprehensive care approaches. The partnership promotes a systematic process to evaluate each person and identify approaches that are most likely to benefit that individual. The goal of the partnership is to continue to reduce the use of unnecessary antipsychotic medications, as well as other potentially harmful medications in nursing homes and eventually other care settings as well.
During this MLN Connects Call, a CMS subject matter expert will discuss the critical role of both state and federal surveyors in the implementation of the partnership. Additional speakers will be presenting on the importance of leadership, as well as the strong correlation that exists between proper pain assessment and antipsychotic medication use. A question and answer session will follow the presentation.
Agenda:
Target Audience: Consumer and advocacy groups, nursing home providers, surveyor community, prescribers, professional associations, and other interested stakeholders.
Continuing education credit may be awarded for participation in certain MLN Connects Calls. Visit the Continuing Education Credit Information web page to learn more.
Need to Learn More About ICD-10? The MLN Connects™ Collection of Resources Can Help
The CMS MLN Connects™ Call Program has a variety of online resources to get you started down the road to ICD-10 proficiency. Check out our Calls and Events web page for slide presentations, audio recordings, and written transcripts, from previous ICD-10 educational conference calls, or view one of our popular ICD-10 educational video programs. Read, listen, or view these information packed programs at your convenience to learn more about implementing ICD-10 in your workplace.
For the latest information on ICD-10, visit the CMS ICD-10 dedicated website, including the Medicare Fee-For-Service Provider Resources web page for a list of resources developed under the Medicare Learning Network ® (MLN).
CMS EventsComparative Billing Report Teleconference
Wednesday, January 29; 3-4pm ET
Join us for an informative discussion of the Comparative Billing Report (CBR201401) to be held by eGlobalTech. CBR201401 was developed as an educational tool to assist suppliers of Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) billing positive airway pressure (PAP) devices and accessories. This is your opportunity to interact directly with the subject matter experts and ask questions about the report.
Agenda:
Presenter Information:
How to Register:
Register online at or via telephone at 877-692-5217 using Conference ID # 23939759. Space is limited, so please register early. Registration will close at 1:30pm ET on Monday, January 27 or when available space has been filled.
You may access a recording of the teleconference approximately one week following the event 5217 using Conference ID # 23939759.
AnnouncementsContinue Seasonal Flu Vaccination through January and Beyond
Seasonal influenza activity is increasing in parts of the United States and is expected to continue to increase across the country in the coming weeks. As long as flu viruses are circulating, flu vaccine can still offer protection. The Centers for Disease Control and Prevention (CDC) urges individuals not yet vaccinated to get their flu vaccine now. With each office visit, health care professionals should continue to assess patient vaccination status. For patients who haven’t received the seasonal flu vaccine, encourage vaccine usage by discussing the benefits and importance of flu vaccination, offer to vaccinate, or refer to a vaccine provider when appropriate.
As a reminder, generally, Medicare Part B covers one influenza vaccination and its administration each influenza season for Medicare beneficiaries without co-pay or deductible. Note: The influenza vaccine is not a Part D-covered drug.
For more information on coverage and billing of the influenza vaccine and its administration, please visit:
Submit Quality Data for 2013 PQRS-Medicare EHR Incentive Pilot by February 28
The Physician Quality Reporting System (PQRS) Medicare Electronic Health Record (EHR) Incentive Pilot allows eligible professionals to meet the clinical quality measure (CQM) reporting requirement for the Medicare EHR Incentive Program through electronic submission while also reporting for the PQRS program. Are you an eligible professional who is participating or wishes to participate in the 2013 PQRS-Medicare EHR Incentive Pilot? You can now submit your 2013 quality data. If you would like to participate in the pilot you must submit 12 months of CQM data by February 28, 2014 at 11:59pm ET.
Steps to Successfully ParticipateTo successfully participate in the pilot, you must do the following by February 28, 2014:
If you cannot submit your CQM data for 12 months electronically through PQRS, you must return to the EHR Attestation System and deselect the electronic reporting option. Please note: if you do not submit your 2013 quality data or deselect the electronic reporting option in the EHR Attestation System, you will not receive an EHR incentive payment.
For More InformationFor further guidance on the 2013 PQRS-Medicare EHR Incentive Pilot, please read the Participation Guide and Quick-Reference Guide.If you have additional questions, please contact QualityNet Help Desk at 866-288-8912 (TTY 1-877-715-6222) or via qnetsupport@sdps.org. The Held Desk is available Monday through Friday from 7am through 7pm CT.
Claims, Pricers, and CodesRevised CMS 1500 Paper Claim Form: Version 02/12
CMS began receiving claims on the revised CMS 1500 claim form (02/12) on January 6, 2014. The CMS 1500 claim form is the required format for submitting professional and supplier claims to Medicare on paper, when submitting paper claims is permissible.
Features of the Revised Form
The revised form, among other changes, notably adds the following functionality:
Note: although the revised CMS 1500 claim form has functionality for accepting ICD-10 codes, do not submit ICD-10 codes on claims for dates of service prior to October 1, 2014.
Instructions for Completing the Revised Form
Instructions for completing the revised CMS 1500 claim form (02/12) are provided in the Medicare Claims Processing Manual (Pub. 100-04).
d CMS 1500 claim form (08/05) will not be accepted.
Note: The Administrative Simplification Compliance Act (ASCA) requires that Medicare claims be sent electronically unless certain exceptions are met. Some Medicare providers qualify for these exceptions and send their claims to Medicare on paper. For more information about ASCA exceptions, please contact the Medicare Administrative Contractor (MAC) who processes your claims. Claims sent electronically must abide by the standards adopted under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The current standard adopted under HIPAA for electronically submitting professional health care claims is the 5010 version of the ASC X12 837 Professional Health Care Claim standard and its implementation specification, Technical Report 3 (TR3). More information about the ASC X12 and TR3 is available on the ASC X12 website.
MLN Educational Products“Inpatient Rehabilitation Facility Prospective Payment System” Fact Sheet — Revised
The “Inpatient Rehabilitation Facility Prospective Payment System” Fact Sheet (ICN 006847) was revised and is now available in downloadable format. This fact sheet is designed to provide education on the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS). It includes the following information: background, elements of the IRF PPS, and quality reporting.
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Thursday, January 16, 2014
MLN Connects Provider eNews for Thursday January 16, 2014
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Thursday January 16, 2014
Thanks again to all those who responded to our request for feedback about the eNews. Unfortunately it’s not possible for us to answer questions submitted as part of anonymous feedback. Please direct your questions to the Medicare Administrative Contractor (MAC) that serves your state. You can find their toll free number in the Provider Compliance Interactive Map .
MLN Connects™ National Provider Calls
MLN Connects™ Videos
CMS Events
Announcements
Claims, Pricers, and Codes
MLN Educational Products
MLN Connects™ National Provider CallsNational Partnership to Improve Dementia Care in Nursing Homes — Register Now
Wednesday, February 26; 2-3:30pm ET
The CMS National Partnership to Improve Dementia Care in Nursing homes was developed to improve dementia care through the use of individualized, comprehensive care approaches. The partnership promotes a systematic process to evaluate each person and identify approaches that are most likely to benefit that individual. The goal of the partnership is to continue to reduce the use of unnecessary antipsychotic medications, as well as other potentially harmful medications in nursing homes and eventually other care settings as well.
During this MLN Connects Call, a CMS subject matter expert will discuss the critical role of both state and federal surveyors in the implementation of the partnership. Additional speakers will be presenting on the importance of leadership, as well as the strong correlation that exists between proper pain assessment and antipsychotic medication use. A question and answer session will follow the presentation.
Agenda:
Target Audience: Consumer and advocacy groups, nursing home providers, surveyor community, prescribers, professional associations, and other interested stakeholders.
Continuing education credit may be awarded for participation in certain MLN Connects Calls. Visit the Continuing Education Credit Information web page to learn more.
Providers and Suppliers — Browse the MLN Connects™ Call Program Collection of Resources
In 2013, CMS hosted MLN Connects™ Calls on a variety of topics, including enrollment, EHR, ICD-10, PQRS, value-based payment modifier, and dementia — just to name a few. Check our Calls and Events web page for slide presentations, audio recordings, written transcripts, and a list of upcoming calls, or search our videos by topic. Become more informed about the Medicare Program by reading, listening, or viewing these information packed programs at your convenience. Visit www.cms.gov/npc for more information on the MLN Connects Call Program.
MLN Connects™ VideosICD-10 Coding Basics
Are you ready to transition to ICD-10 on October 1, 2014? In this MLN Connects™ video on ICD-10 Coding Basics, Sue Bowman from the American Health Information Management Association (AHIMA) provides a basic introduction to ICD-10 coding, including:
CMS EventsHospice Open Door Forum
Wednesday, January 22; 2-3pm ET
On January 22, there will be an Open Door Forum (ODF) focused on the Hospice Quality Reporting Program (HQRP). During this call, both the FY 2015 and FY 2016 reporting cycles will be discussed. In addition, the call will provide information about the upcoming patient/family survey requirements for hospices that will begin on January 1, 2015.
The FY 2015 cycle consists of reporting on two measures: the structural measure and the National Quality Forum (NQF) #0209 pain measure. The HQRP Data Entry and Submission Site is now available for data submission. Data for each measure must be submitted to CMS by 11:59pm ET on April 1, 2014 for FY 2015 payment determination. The Technical User’s Guide, posted on the Data Submission web page is the primary reference for the HQRP Data Entry and Submission Site for the FY2015 reporting cycle.
As part of the FY 2016 cycle, the Hospice Item Set (HIS) will be implemented on July 1, 2014. The HIS is a set of patient-level data items that can be used to calculate 6 NQF-endorsed measures and one modified NQF measure. Training on data collection for the HIS will be offered on February 4 and 5 in Baltimore.Registration for the training is now open. Hospices may also live- stream the event if they are unable to attend in person. Instructions for live video-streaming access will be provided on the HIS web page; no registration is required. This training will also be recorded and posted on the HIS web page for on-demand viewing.
A question and answer session will follow the presentations. Additional information about the ODF, including the agenda, call-in information and conference ID, will be posted on the Home Health, Hospice & Durable Medical Equipment ODF web page.
AnnouncementsConnections in the I&A System
In response to concerns about access to provider information in PECOS and HITECH, CMS is providing clarification on the recommended number of connections in the Identity & Access Management (I&A) system. Group Practices or any other Organization who act on behalf of Providers as Surrogates, and have 1,000 or more Connections to Eligible Professionals (EPs) in the Identity & Access Management (I&A) system may experience an issue when attempting to access records for these providers in PECOS or in HITECH (R&A). A long-term fix for this issue is targeted for later this year. Until the long-term fix can be implemented, you can avoid any issues by reducing the number of EPs that any one Staff End User within your Organization has connections to within I&A. If a user acts on behalf of 1,000 or less EPs they should not have any issues accessing records within PECOS or HITECH(R&A).
CMS to Release a Comparative Billing Report on PAP Devices and Accessories in January
CMS has contracted with eGlobalTech to provide the Comparative Billing Reports (CBRs) to the provider community. In mid-January 2014, CMS will release a national provider CBR addressing Positive Airway Pressure (PAP) Devices and Accessories. CBRs contain actual data-driven tables and graphs with an explanation of findings that compare providers’ billing and payment patterns to those of their peers located in the state and across the nation.
These reports are not available to anyone, except the providers who receive them. To ensure privacy, CMS presents only summary billing information. No patient or case-specific data is included. These reports are an example of a tool that helps providers better understand applicable Medicare billing rules and improve the level of care they furnish to their Medicare patients.
For more information, please call the CBR Support Help Desk at 1-800-771-4430.
CMS Quality Strategy — Response Period Extended to January 24
CMS has extended the comment period for the CMS Quality Strategy to January 24, 2014. Driving quality improvement is a core function of CMS. This commitment is particularly evident as CMS enhances its partnerships with a delivery system in which providers are supported in achieving better outcomes in health and healthcare, at lower cost, for the beneficiaries and communities they serve.
The vision for the CMS Quality Strategy is to optimize health outcomes by leading clinical quality improvement and health system transformation. The CMS Quality Strategy is built on the foundation of the CMS Strategy and the HHS National Quality Strategy (NQS). Like the NQS, the CMS Quality Strategy was developed through a participatory, transparent, and collaborative process that included the input of a wide array of stakeholders. For more than a year, a group of leaders from across CMS met and developed the strategy. This group also sought out advice and input from other HHS agencies, the community, and CMS beneficiaries to inform their efforts.
The CMS Quality Strategy pursues and aligns with the three broad aims of the National Quality Strategy and its six priorities. Each of these priorities has become a goal in the CMS Quality Strategy. Four foundational principles guide the Agency’s action toward each of these goals. This document identifies quality-focused objectives that CMS can drive or enable to further these goals. Quality interventions are inherently interrelated, thus many goals include concepts that could be articulated under more than one goal. As we organized and structured objectives, we sought to put them in the place that captures where the primary driver of change occurs.
Review the 2014 PQRS Measures Codes Resources for Claims and Registry-Based Reporting
2014 is the last year eligible professionals can earn an incentive for satisfactorily reporting Physician Quality Reporting System (PQRS) quality data to CMS, and 2014 reporting will be used to determine the 2016 PQRS payment adjustment. Are you planning to participate in PQRS using claims or registry-based reporting? Get ready by reviewing the 2014 quality measures for these methods.
2014 Measures Now AvailableThe 2014 measures codes resources with information about PQRS quality measures for claims and registry-based reporting are now available. These new zip files on the PQRS website include the following 2014 resources:
Selecting Measures for 2014 PQRS
Consider the following when selecting measures for 2014 reporting:
For More InformationAdditional resources on 2014 measures for claims and registry-based reporting can be found on the PQRS Measures Codes web page. Visit the PQRSwebsite for more information about the program.
Medicare EPs Must Attest by February 28 to Receive 2013 Incentive for EHR Incentive Program
If you are an eligible professional (EP), the last day you can register and attest to demonstrating meaningful use for the 2013 Medicare EHR Incentive Program is February 28, 2014. You must successfully attest by 11:59pm ET on February 28 to receive an incentive payment for your 2013 participation. You must attest to demonstrating meaningful use every year to receive an incentive and avoid a payment adjustment.
Medicaid Eligible ProfessionalsEPs participating in the Medicaid EHR Incentive Program need to refer to their state deadlines for attestation information.
Payment AdjustmentsPayment adjustments for EPs will be applied beginning January 1, 2015 to Medicare participants that have not successfully demonstrated meaningful use. The adjustment is determined by your reporting period in a prior year. For more information, visit the payment adjustment tipsheet for EPs. If you are only eligible to participate in the Medicaid EHR Incentive Program, you are not subject to these payment adjustments.
Resources
Claims, Pricers, and CodesProcessing Repair Claims for Capped Rental DME Furnished by the Scooter Store Related Suppliers
Effective October 24, 2013, The Scooter Store (TSS) transferred titles to capped durable medical equipment (DME) rented to Medicare beneficiaries. Medicare beneficiaries now own this equipment. Medicare can pay for repairs to this equipment performed on or after October 24, 2013 if the contractor determines that the repairs are reasonable and necessary in accordance with Medicare regulations and program instructions.
Temporary Hold of Home Health LUPA Claims
Medicare contractors have identified an incorrect payment calculation affecting home health claims that would be paid low utilization payment adjustments (LUPAs). To prevent these claims from paying incorrectly, Medicare contractors will hold all home health LUPA claims with "Through" dates on or after January 1, 2014 until Medicare systems are corrected. This correction should occur in early February, 2014.
Home health agencies do not need to take any action. Medicare contractors will release the claims as soon as the correction is complete.
Quarterly Provider Specific Files for the Prospective Payment System Now Available
The January 2014 Provider Specific Files (PSF) are now available for download from the CMS website in SAS and Text format. The files contain information about the facts specific to the provider that affect computations for the Prospective Payment System. The SAS data files are available on the Provider Specific Data for Public Use In SAS Format web page, and the Text data files are available on the Provider Specific Data for Public Use in Text Format web page. The Text data files are available in two versions. One version contains the provider records that were submitted to CMS. The other version also includes name and address information for providers at the end of the records.
January 2014 Outpatient Prospective Payment System Pricer File Update
The Outpatient Prospective Payment System (OPPS) Pricer web page has been updated with Pricer file and outpatient provider data for January 2014. The January provider data is available for use and may be downloaded from the OPPS Pricer web page under “1st Quarter 2014 Files.”
MLN Educational Products“Documentation Requirements for Home Health Prospective Payment System (HH PPS) Face-to-Face Encounter” MLN Matters® Article — Released
MLN Matters® Special Edition Article #SE1405, “Documentation Requirements for Home Health Prospective Payment System (HH PPS) Face-to-Face Encounter” was released and is now available in a downloadable format. This article is designed to provide education on elements of the required brief narrative for documenting the Home Health face-to-face encounter. It includes information and examples to help health care professionals avoid insufficient documentation errors and HH PPS improper payments.
MLN Products Now Available in Hard Copy Format
To access a new or revised product available for order in a hard copy format, go to MLN Products , scroll down to the bottom of the web page to the “Related Links” section, and click on the “MLN Product Ordering Page.”
Medicare Learning Network® Pilot Testers and Product Reviewers Needed
Are you interested in pilot testing MLN web-based trainings and/or reviewing MLN products? We are looking for pilot testers/product reviewers from all areas of health care professionals. Please email CMSCE@cms.hhs.gov with your full name and email address if you would like to participate.
Subscribe to the MLN Educational Products and MLN Matters® Electronic Mailing Lists
The Medicare Learning Network® (MLN) is the home for education, information, and resources for health care professionals. Sign up for both of the electronic mailing lists below to stay informed about the latest MLN Educational Products and MLN Matters® Articles. You will receive an email when new and revised products and articles are released.
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