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Providers in AR, CO, LA, MS, NM, OK, TX, Indian Health & Veteran Affairs

Medicare News and Web Updates for JH Part A (2017)

November 22, 2017

CMS Provider Education Message:

MLN Connects® for Wednesday, November 22, 2017

View this edition as a PDF

News & Announcements

Medicare Clinical Laboratory Fee Schedule: Final CY 2018 Payment Rates
National Rural Health Day
2017 Medicare FFS Improper Payment Rate Below 10 Percent for First Time Since 2013
CMS Measures Inventory Tool
2016 PQRS Feedback Reports and Annual QRURs: Informal Review Period Ends December 1
Hospice Compare: Guidance on Updating Demographic Data
Hospice Compare Refresh Delayed
Submit Suggestions for Precedential Medicare Appeals Council Decisions
IPPS Hospitals: Review FY 2014 and FY 2015 Worksheet S-10 Cost Report Data
Recommend Influenza Vaccination: Each Office Visit is an Opportunity

Provider Compliance

OIG Video: Reporting Fraud to the Office of the Inspector General — Reminder

Upcoming Events

Revisions to DMEPOS Quality Standards for Therapeutic Shoe Inserts Special Open Door Forum — November 28
Quality Payment Program Year 2 Final Rule Call — November 30
Medicare Diabetes Prevention Program Model Expansion Call — December 5
SNF QRP: Assessment-Based Measures Confidential Feedback Report Webinar — December 6
LTCH Quality Reporting Program In-Person Training — December 6 and 7
IMPACT Act Special Open Door Forum — December 12
National Partnership to Improve Dementia Care and QAPI Call — December 14

Medicare Learning Network Publications & Multimedia

Medicare Fraud & Abuse Poster — New
Medicare Fraud & Abuse: Prevention, Detection, and Reporting Booklet — Revised
Medicare Disproportionate Share Hospital Fact Sheet — Revised
ABCs of the Initial Preventive Physical Examination Educational Tool — Reminder

November 21, 2017

IPPS Hospitals: Review FY 2014 and FY 2015 Worksheet S-10 Cost Report Data

Form CMS-2552-10 modified the application of the cost to charge ratio for hospital uncompensated and indigent care amounts reported on Worksheet S-10. The modification is applied to all FY 2014 and 2015 cost reports, both amended and not amended, for Inpatient Prospective Payment System (IPPS) hospitals eligible for a Disproportionate Share (DSH) payment adjustment. To benefit from the modified calculations, review Worksheet S-10 data to ensure your cost reports pass all edits. Amend your cost report if an edit is flagged; amendments must be received on or before January 2, 2018. Approximately 300 DSH eligible IPPS providers will need to amend their cost reports to correct these edits. We will be sending an amended cost report request letter to providers we were able to identify but please review your affected cost reports to benefit from the modified calculations.
Worksheet S-10 edits ensure:

Medicare allowable bad debts do not exceed total facility bad debts
Charity care charges do not exceed total facility charges
Charges for patient days beyond the indigent care program's length of stay limit (line 20, column 2) are greater than or equal to charges for patient days beyond the indigent care program's length of stay limit (line 25)

For more information:


Medicare Learning Network® MLN Matters® Articles from CMS

New:


November 20, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:


November 17, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Revised:


November 16, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, November 16, 2017

View this edition as a PDF

News & Announcements

New Medicare Card: New Webpage Information
CAHs: Deadline to Apply for a Hardship Exception is November 30
Virtual Group for MIPS in 2018: Apply by December 31
QMB Remittance Advice Issue
IRF/LTCH Quality Measure Reports: Measures Added
Hospice Quality Reporting Program: Quarterly Update
Physician Compare: How to Update Your Listing
Recognizing Lung Cancer Awareness Month and the Great American Smokeout

Provider Compliance

Evaluation and Management: Correct Coding — Reminder

Upcoming Events

Quality Payment Program Year 2 Final Rule Call — November 30
Medicare Diabetes Prevention Program Model Expansion Call — December 5
National Partnership to Improve Dementia Care and QAPI Call — December 14

Medicare Learning Network Publications & Multimedia

Hospital Call: Audio Recording and Transcript — New
Medicare and Medicaid Basics Booklet — Revised
Looking for Educational Materials?

QMB Remittance Advice Issue

On October 2, 2017 Change Request 9911 modified the Medicare Remittance Advice (RA) for Qualified Medicare Beneficiary (QMB) claims to identify QMB patients and reflect zero cost-sharing liability. This change resulted in unanticipated issues for providers, states, and other secondary payers who are used to seeing Medicare deductible and coinsurance amounts in specific fields on the RA. Beginning December 8, 2017 CMS systems will revert back to the previous display of patient responsibility for QMBs on RAs. Providers may want to hold QMB claims and submit them after December 8.


Part A Top Inquiries / Frequently Asked Questions (FAQs) for AR, CO, LA, MS, NM, OK, & TX

The Part A Top Inquiries / FAQs, received by our Customer Contact Center, have been reviewed for October 2017. New questions / answers have been added to the Appeals and General Information categories. Please take time to review these and other FAQs for answers to your questions.


Appropriate Use of Not Otherwise Classified Codes

Correct coding requires services to be reported with the most specific code available that appropriately describes the service.

Not Otherwise Classified (NOC) Healthcare Common Procedure Coding System (HCPCS) codes must only be used when a more specific HCPCS or Current Procedural Terminology (CPT) code is not available. Please take time to review this article.


November 14, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Revised:


November 13, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Reissued:


November 9, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, November 9, 2017

View this edition as a PDF

News & Announcements

New Medicare Card: Help Notify Your Patients
Medicare Diabetes Prevention Program Expanded Model Implementation
Hospital Value-Based Purchasing Program Results for FY 2018
Low Volume Appeals Settlements
Hospice Item Set Data Freeze: November 15
Draft 2018 CMS QRDA III Implementation Guide: Submit Comments by November 17
CMS Innovation Center New Direction RFI: Submit Comments by November 20
Therapeutic Shoe Inserts: Comment on DMEPOS Quality Standards through December 11
Quality Payment Program Resources in New Location
Post-Acute Care: Quality Reporting Program Quick Reference Guides Available
Provider and Pharmacy Access during Public Health Emergencies
Raising Awareness of Diabetes in November

Provider Compliance

Proper Use of the KX Modifier for Part B Immunosuppressive Drug Claims

Upcoming Events

Quality Payment Program Year 2 Overview Webinar — November 14
SNF Value-Based Purchasing Program FY 2018 Final Rule Call — November 16
Quality Payment Program Virtual Groups Train-the-Trainer Webinar — November 17
Quality Payment Program Year 2 Final Rule Call — November 30
Medicare Diabetes Prevention Program Model Expansion Call — December 5
LTCH Quality Reporting Program In-Person Training — December 6 and 7

Medicare Learning Network Publications & Multimedia

Quality Payment Program in 2017: Advanced Alternative Payment Models Web-Based Training Course — New
Medicare FFS Response to the 2017 California Wildfires MLN Matters Article — Updated
Prohibition on Billing Dually Eligible Individuals Enrolled in the QMB Program MLN Matters Article— Revised
Transition to New Medicare Numbers and Cards Fact Sheet — Revised
Hospital-Acquired Conditions and Present on Admission Indicator Reporting Provision Fact Sheet — Revised
Remittance Advice Information: An Overview Booklet — Reminder

The following JH Local Coverage Determinations (LCDs) have been revised:

The following JH Local Coverage Article has been revised:

The following JH Article has been added:

The following JH Local Coverage Determination (LCD) which was posted for notice on September 21, 2017 is now effective:

The following JH Local Coverage Determination (LCD) which was posted for notice on September 21, 2017 has been revised and is now effective:


October 2017 Part A Newsletter

The October 2017 Part A Newsletter is now available. Please take a moment to review.


November 7, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Revised


November 6, 2017

Medicare Overpayments

Have you discovered an overpayment that you need to report to Medicare and aren't sure what to do? Help is just a click or two away. Please take a moment to review our overpayment page located under the quick links section of our website.


November 3, 2017

Part A Top Claims Submission / Reason Code Errors

The October 2017 Top Claim Submission / Reason Code Errors and resolutions for Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas are now available. Please take time to review these errors and avoid them on future claims.


The comment period is now closed for the JH Draft Local Coverage Determination (LCD) listed below. Comments received will be reviewed by our Contractor Medical Directors and a summary comment and response document will be posted to our website when the final LCD is posted for notice.


November 2, 2017

Special Edition – Thursday, November 2, 2017

Physician Fee Schedule Final Policy, Payment, and Quality Provisions for CY 2018
Hospital OPPS and ASC Payment System and Quality Reporting Programs Changes for 2018
HHAs: Payment Changes for 2018
Quality Payment Program Rule for Year 2

Physician Fee Schedule Final Policy, Payment, and Quality Provisions for CY 2018

On November 2, CMS issued a final rule that includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2018. 

The overall update to payments under the PFS based on the finalized CY 2018 rates will be +0.41 percent. This update reflects the +0.50 percent update established under the Medicare Access and CHIP Reauthorization Act of 2015, reduced by 0.09 percent, due to the misvalued code target recapture amount, required under the Achieving a Better Life Experience Act of 2014. After applying these adjustments, and the budget neutrality adjustment to account for changes in Relative Value Units, all required by law, the final 2018 PFS conversion factor is $35.99, an increase to the 2017 PFS conversion factor of $35.89. 

The Final Rule Includes:

Patients over Paperwork Initiative
Changes in valuation for specific services
Payment rates for nonexcepted off-campus provider-based hospital departments
Medicare telehealth services
Malpractice relative value units
Care management services
Improvement of payment rates for office-based behavioral health services
Evaluation and management comment solicitation
Emergency department visits comment solicitation
Solicitation of public comments on initial data collection and reporting periods for Clinical Laboratory Fee Schedule
Part B drugs: Payment for biosimilar biological products
Part B drug payment: Infusion drugs furnished through an item of durable medical equipment
New care coordination services and payment for rural health clinics and federally-qualified health centers
Appropriate use criteria for advanced diagnostic imaging
Medicare Diabetes Prevention Program expanded model
Physician Quality Reporting System
Patient relationship codes
Medicare Shared Savings Program
2018 Value Modifier

For More Information:

Press Release: CMS Finalizes Policies that Reduce Provider Burden, Lower Drug Prices

See the full text of this excerpted CMS Fact Sheet (issued November 2).

Hospital OPPS and ASC Payment System and Quality Reporting Programs Changes for 2018

On November 1, CMS issued the CY 2018 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule with comment period, which includes updates to the 2018 rates and quality provisions and other policy changes. CMS adopted a number of policies that will support care delivery; reduce burdens for health care providers, especially in rural areas; lower beneficiary out of pocket drug costs for certain drugs; enhance the patient-doctor relationship; and promote flexibility in healthcare.

CMS is increasing the OPPS payment rates by 1.35 percent for 2018. The change is based on the hospital market basket increase of 2.7 percent minus both a 0.6 percentage point adjustment for multi-factor productivity and a 0.75 percentage point adjustment required by law. After considering all other policy changes under the final rule, including estimated spending for pass-through payments, CMS estimates an overall impact of 1.4 percent payment increase for providers paid under the OPPS in CY 2018.

CMS updates ASC payments annually by the percentage increase in the Consumer Price Index for all urban consumers (CPI-U). The Medicare statute specifies a Multi-Factor Productivity (MFP) adjustment to the ASC annual update. For CY 2018, the CPI-U update is 1.7 percent. The MFP adjustment is 0.5 percent, resulting in a CY 2018 MFP-adjusted CPI-U update factor of 1.2 percent. Including enrollment, case-mix, and utilization changes, total ASC payments are projected to increase approximately 3 percent in 2018.

The Final Rule Includes:

Patients over Paperwork Initiative
Payment for drugs and biologicals purchased through the 340B drug pricing program
Supervision of hospital outpatient therapeutic services
Packaging of low-cost drug administration services
Inpatient only list
High cost/low cost threshold for packaged skin substitutes
Revisions to the laboratory date of service policy
Partial Hospitalization Program rate setting
Comment solicitation on ASC payment reform
ASC covered procedures list
Hospital Outpatient Quality Reporting Program
Ambulatory Surgical Center Quality Reporting Program

For More Information:

Press Release: CMS Finalizes Policies that Lower Out-of-Pocket Drug Costs and Increase Access to High-Quality Care

See the full text of this excerpted CMS Fact Sheet (issued November 1).

HHAs: Payment Changes for 2018

On November 1, CMS issued a final rule that updates the CY 2018 Medicare payment rates and the wage index for Home Health Agencies (HHAs) serving Medicare beneficiaries. The rule also finalizes proposals for the Home Health Value-Based Purchasing Model and the Home Health Quality Reporting Program.

CMS projects that Medicare payments to HHAs in CY 2018 will be reduced by 0.4 percent, or $80 million, based on the finalized policies. This decrease reflects the effects of a one percent home health payment update percentage ($190 million increase); a -0.97 percent adjustment to the national, standardized 60-day episode payment rate to account for nominal case-mix growth for an impact of -0.9 percent ($170 million decrease); and the sunset of the rural add-on provision ($100 million decrease).

The Final Rule Includes:

Patients over Paperwork Initiative
Annual home health payment update percentage
Adjustment to reflect nominal case-mix growth
Sunset of the rural add-on provision

For More Information:

Press Release: CMS Finalizes Policies that Lower Out-of-Pocket Drug Costs and Increase Access to High-Quality Care

See the full text of this excerpted CMS Fact Sheet (issued November 1).

Quality Payment Program Rule for Year 2

On November 2, CMS issued the final rule with comment for the second year of the Quality Payment Program (CY 2018), as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), as well as an interim final rule with comment. We finalized policies for Year 2 of the Quality Payment Program to further reduce your burden and give you more ways to participate successfully. We are keeping many of our transition year policies and making some minor changes.

The Final Rule Includes:

Weighting the Merit-based Incentive Payment System (MIPS) Cost performance category to 10% of your total MIPS final score, and the Quality performance category to 50%
Raising the MIPS performance threshold to 15 points in Year 2
Allowing the use of 2014 Edition and/or 2015 Certified Electronic Health Record Technology (CEHRT) in Year 2 for the Advancing Care Information performance category, and giving a bonus for using only 2015 CEHRT
Awarding up to 5 bonus points on your MIPS final score for treatment of complex patients
Automatically weighting the Quality, Advancing Care Information, and Improvement Activities performance categories at 0% of the MIPS final score for clinicians impacted by Hurricanes Irma, Harvey and Maria and other natural disasters
Adding 5 bonus points to the MIPS final scores of small practices
Adding Virtual Groups as a participation option for MIPS
Issuing an interim final rule with comment for extreme and uncontrollable circumstances where clinicians can be automatically exempt from these categories in the transition year without submitting a hardship exception application
Decreasing the number of doctors and clinicians required to participate as a way to provide further flexibility by excluding individual MIPS eligible clinicians or groups with ≤$90,000 in Part B allowed charges or ≤200 Medicare Part B beneficiaries
Providing more detail on how eligible clinicians participating in selected Advanced Alternative Payment Models (APMs) will be assessed under the APM scoring standard
Creating additional flexibilities and pathways to allow clinicians to be successful under the All Payer Combination Option

For More Information:

Press Release: CMS Finalizes Policies that Reduce Provider Burden, Lower Drug Prices
Register for a webinar on November 14

CMS Provider Education Message:

MLN Connects® for Thursday, November 2, 2017

View this edition as a PDF

News & Announcements

ESRD PPS: Updates to Policies and Payment Rates
New Medicare Card: Provider Ombudsman Announced
IRF and LTCH Quality Reporting Programs Submission Deadline: November 15
Physician Compare Preview Period Extended to December 1
Hospitals: Take Action before Meaningful Use Attestation Beginning January 2
SNF Quality Reporting Program Submission Deadline Extended to May 15
eCQM Value Set Addendum: Updated Technical Release Notes
Administrative Simplification Enforcement and Testing Tool
Antipsychotic Drug use in Nursing Homes: Trend Update
CMS Offers Medicare Enrollment Relief for Americans Affected by Recent Disasters
November is Home Care and Hospice Month

Provider Compliance

Advanced Life Support Ambulance Services: Insufficient Documentation — Reminder

Claims, Pricers & Codes

Outpatient Claims: Correcting Deductible and Coinsurance for Code G0473

Upcoming Events

SNF Value-Based Purchasing Program FY 2018 Final Rule Call — November 16

Medicare Learning Network Publications & Multimedia

QRUR Webcast: Audio Recording and Transcript — New
ICD-10-CM/PCS the Next Generation of Coding Booklet — Revised
Diagnosis Coding: Using the ICD-10-CM Web-Based Training Course — Reminder
Medicare Home Health Benefit Web-Based Training Course — Reminder
Dual Eligible Beneficiaries under Medicare and Medicaid Booklet — Reminder
Resources for Medicare Beneficiaries Booklet — Reminder
Medicare Ambulance Transports Booklet — Reminder
SNF Billing Reference Booklet — Reminder
Items and Services Not Covered under Medicare Booklet — Reminder
Guidelines for Teaching Physicians, Interns, and Residents Fact Sheet — Reminder

Medicare Learning Network® MLN Matters® Articles from CMS

Revised:


Medicare Learning Network® MLN Matters® Articles from CMS

New:


Know the Advantages of Billing Electronically

Novitas would like to decrease the number of paper claims being submitted. Many paper claims are being returned or rejected, which requires the claim to be resubmitted. Billing electronically will help reduce these issues, saving you time and money, along with many other advantages. For more information review our article Paper Billers - Know the Advantages of Billing Electronically.  In addition, visit our Events Calendar to sign up for the upcoming webinar on Advantages of Electronic Billing.


October 31, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Revised:

Rescinded:


Fiscal Year (FY) 2014 and 2015 S-10 Revisions: Extensions for All Inpatient Prospective Payment System (IPPS) Hospitals

For Inpatient Prospective Payment System (IPPS) hospitals, CMS issued an extension from October 31, 2017 until January 2, 2018 for all IPPS hospitals to resubmit certain Worksheet S-10 data. As described in the FY 2018 IPPS/Long-Term Care Hospital Prospective Payment System (LTCH PPS) final rule (82 FR 38208, August 14, 2017), the initial deadline had been September 30, 2017. For revisions to be considered, CMS modified the deadline such that amended FY 2014 and FY 2015 cost reports due to revised or initial submissions of Worksheet S-10 must be received by on or before January 2, 2018.


October 30, 2017

Part A Event Calendar

Join us for one of our powerful educational events. Learn more about the Medicare program and discover ways to improve the accuracy and efficiency of your Medicare billing process by participating in the free educational events hosted by Novitas Solutions.


October 27, 2017

Part A Open Issues Log - New Issue

Please review the Part A Open Issues Log for new updates.


New Medicare Insights Podcast

In this Medicare Insights Podcast episode, we provide guidance on subscribing to our email list and staying up-to-date on Medicare news.


October 26, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, October 26, 2017

View this edition as a PDF

News & Announcements

New Medicare Numbers/Cards: Coordination of Benefits
Hospice QRP: Register for HEART Pilot Study by October 31
MIPS: Participate in Field Testing of Episode-Based Cost Measures by November 15
Physician Compare Preview Period Closes November 17

Provider Compliance

Reporting Changes in Ownership — Reminder

Upcoming Events

Definition of a Hospital: Primarily Engaged Requirement Call — November 2
Preventive Care and Health Screenings for Persons with Disabilities Webinar — November 2
SNF Value-Based Purchasing Program FY 2018 Final Rule Call — November 16
Comparative Billing Report on Emergency Department Services Webinar — December 13

Medicare Learning Network Publications & Multimedia

Quality Payment Program in 2017: MIPS APMs Web-Based Training Course —New
HHA Star Rating Call: Audio Recording and Transcript — New
Prohibition on Billing Dually Eligible Individuals Enrolled in the QMB Program MLN Matters Article — Revised
General Equivalence Mappings FAQs Booklet — Revised
Medicare Fraud & Abuse: Prevention, Detection, and Reporting Web-Based Training Course — Reminder

The comment period will close on November 2, 2017 for the following JH Draft Local Coverage Determination (LCD):

Submit Comments


2017 Novitas Solutions Medicare Symposium - Houston, TX

The Houston, TX 2017 Novitas Solutions Medicare Symposium has been rescheduled to January 26, 2018.  This year’s conference offers fifteen (15) classes during multiple sessions dedicated to providing you with the knowledge necessary to be a successful Medicare provider. You have the option of attending a class within each session, or customizing your participation to your own personal schedule and area of interest.


October 23, 2017

Part A Open Issues Log - New Issue

An issue has been identified with the transmission of IRF-PAI (Patient Assessment Instrument) data from CMS's National Assessment Collection Database (the Database) to the Fiscal Intermediary Shared System (FISS) system for Inpatient Rehab Facility (IRF) and Rehabilitation Units of an acute hospital submitted for Type of Bill(TOB) 11x. Claims may have been incorrectly Returned to Provider (RTP) with reason code 37096.

A temporary workaround has been put in place. Any claims that have incorrectly RTP may be resubmitted.


October 20, 2017

The November 2017 Calendar of Events is now available

Join us for one of our powerful educational events. Learn more about the Medicare program and discover ways to improve the accuracy and efficiency of your Medicare billing process by participating in the free educational events hosted by Novitas Solutions.


Medicare Learning Network® MLN Matters® Articles from CMS

Revised:


October 19, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, October 19 ,2017

View this edition as a PDF

News & Announcements

Preview Draft eCQM Specifications through November 13
MIPS Virtual Group Election Period Ends December 1
Quality Payment Program: New Resources
SNF Quality Reporting Program Confidential Feedback Reports for Claims-Based Measures
SNF Review and Correct Report Update
Post-Acute Care Quality Reporting Programs FY 2018 APU: Successful Facilities
New CMS Legionella Requirement for Hospitals, Critical Access Hospitals, and Nursing Homes

Provider Compliance

Coudé Tip Catheters CMS Provider Minute Video — Reminder

Claims, Pricers & Codes

October 2017 OPPS Pricer File
Outpatient Claims: Correcting Deductible and Coinsurance for Code G0473

Upcoming Events

Definition of a Hospital: Primarily Engaged Requirement Call — November 2
New Medicare Card Project Special Open Door Forum — November 9
SNF Value-Based Purchasing Program FY 2018 Final Rule Call — November 16

Medicare Learning Network Publications & Multimedia

Medicare FFS Response to the 2017 California Wildfires MLN Matters Article — New
Hurricane Nate and Medicare Disaster Related Alabama, Florida, Louisiana and Mississippi Claims MLN Matters Article — New
Medicare Quarterly Provider Compliance Newsletter Educational Tool — New
Physician Compare Call: Audio Recording and Transcript — New
Prohibition on Billing Dually Eligible Individuals Enrolled in the QMB Program MLN Matters Article — Revised
Critical Access Hospital Booklet — Revised

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Revised:


October 17, 2017

Part A Frequently Asked Questions (FAQs)

Have a question and not sure where to turn? Check out our FAQs for answers to your questions.


October 13, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:


October 12, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, October 12, 2017

View this edition as a PDF

News & Announcements

New Medicare Card Web Updates
2018 Medicare EHR Incentive Program Payment Adjustment Fact Sheet for Hospitals
Qualifying APM Participant Look-Up Tool
Hospice Quality Reporting Program: New and Updated Resources
SNF Quality Reporting Program: Quick Reference Guide
Protect Your Patients from Influenza this Season

Provider Compliance

Cochlear Devices Replaced Without Cost: Bill Correctly — Reminder

Claims, Pricers & Codes

Home Health Claims Will Be Returned When No OASIS Is Found

Upcoming Events

2016 Annual QRURs Webcast — October 19
Definition of a Hospital: Primarily Engaged Requirement Call — November 2

Medicare Learning Network Publications & Multimedia

PQRS Call: Audio Recording and Transcript — New

The following JH Article has been added:


Attention Critical Access Hospitals

A system edit has been retired that was rejecting some “new patient” claims from Critical Access Hospitals (CAHs), when a patient was established with the hospital or hospital system within a three year period. The CAHs were then resubmitting the claims and receiving payment at the “established” patient rate. If impacted; the CAH will need to cancel the established patient claims, and resubmit the claims with the “new patient” codes. For details on the reason code and procedure codes involved, please refer to our Claims Issues Log. If you have questions, please call our customer contact center at 1-855-252-8782.


October 11, 2017

Part A Top Claims Submission / Reason Code Errors

The September 2017 Top Claim Submission / Reason Code Errors and resolutions for Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas are now available. Please take time to review these errors and avoid them on future claims.


Medicare Learning Network® MLN Matters® Articles from CMS

New:


October 10, 2017

2018 CRNA Exception Status Requests

Rural hospitals and Critical Access Hospitals (CAHs) or hospitals/CAHs reclassified to a rural area can qualify for reasonable cost reimbursement of anesthesia services performed by a qualified non-physician anesthetist if they meet certain criteria and obtain approval for the CRNA/AA cost reimbursement. Pease read our article regarding Election of Cost Reimbursement for CRNA Services for details.


October 9, 2017

September 2017 Part A Newsletter

The September 2017 Part A Newsletter is now available. Please take a moment to review.


October 6, 2017

Part A Top Inquiries / Frequently Asked Questions (FAQs) for AR, CO, LA, MS, NM, OK, & TX

The Part A Top Inquiries / FAQs, received by our Customer Contact Center, have been reviewed for September 2017. New questions / answers have been added to the following categories:

Claim Status
Eligibility/Entitlement
General Information

Please take time to review these and other FAQs for answers to your questions.


October 5, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, October 5, 2017

View this edition as a PDF

News & Announcements

National Partnership to Improve Dementia Care Achieves Goals to Reduce Unnecessary Antipsychotic Medications in Nursing Homes
2018 eCQM Value Set Addendum Available
2018 eCQM Logic Flows Available
Health Services Research Health Equity Issue: Submit Abstracts by November 1
Extension of Medicare IVIG Demonstration through December 31, 2020
October is National Breast Cancer Awareness Month

Provider Compliance

Hospice Election Statements Lack Required Information or Have Other Vulnerabilities — Reminder

Claims, Pricers & Codes

FY 2018 IPPS and LTCH PPS Claims Hold

Upcoming Events

2016 Annual QRURs Webcast — October 19
Definition of a Hospital: Primarily Engaged Requirement Call — November 2

Medicare Learning Network Publications & Multimedia

Medicare Basics: Parts A and B Appeals Overview Video — New
Updates to Medicare’s Cost Report Worksheet S-10 to Capture Uncompensated Care Data MLN Matters Article — New
Qualified Medicare Beneficiary Program Call: Audio Recording and Transcript — New
Hospice Quality Reporting Program Call: Audio Recording and Transcript — New
Hurricane Maria and Medicare Disaster Related United States Virgin Islands and Commonwealth of Puerto Rico Claims MLN Matters Article — Updated
Reading a Professional Remittance Advice Booklet — Reminder
Reading an Institutional Remittance Advice Booklet — Reminder

Medicare Learning Network® MLN Matters® Articles from CMS

Reissued:

Rescinded:


The following JH Local Coverage Determinations (LCDs) have been revised to reflect the Annual ICD-10-CM Code Updates effective for dates of service on and after October 1, 2017:

The following JH Local Coverage Articles have been revised to reflect the Annual ICD-10-CM Code Updates effective for dates of service on and after October 1, 2017:

The following JH Local Coverage Determination (LCD) has been revised:

The following JH Local Coverage Article has been revised:


Part A Issues Log Update

The PRV field is not being considered when processing claims related to NCD policies. This has been reported to FISS and CMS. Claim lines are denied with reason codes in the 59XXX range even when an appropriate diagnosis code is reported in the PRV field.

The correction was installed with the October 2, 2017, release. Claims should process correctly against NCD policies if an appropriate diagnosis code is reported in the PRV field.


October 3, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Revised:


October 2, 2017

Local Coverage Determinations (LCDs) and Local Coverage Articles affected by the Annual ICD-10 Code Update will be revised and posted on the Novitas Website and the Medicare Coverage Database (MCD) on Thursday October 5, 2017.


Medicare Learning Network® MLN Matters® Articles from CMS

New:


September 28, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, September 28, 2017

View this edition as a PDF

News & Announcements

Medicare Clinical Laboratory Fee Schedule: Preliminary CY 2018 Payment Rates
2016 PQRS Feedback Reports and Annual QRURs Updates
Quality Payment Program: New Resources Available
Quality Payment Program: View Recordings of Recent Webinars
MIPS Eligible Measure Applicability: New Resources Available
National Cholesterol Education Month and World Heart Day

Provider Compliance

Psychiatry and Psychotherapy CMS Provider Minute Video — Reminder

Claims, Pricers & Codes

Clinicians: Medicare Part B Crossover Claims Issue Tied to Error Code H51082

Upcoming Events

Home Health Agencies: Quality of Patient Care Star Rating Algorithm Call — October 10
2016 Annual QRURs Webcast — October 19

Medicare Learning Network Publications & Multimedia

2017-2018 Influenza Resources for Health Care Professionals MLN Matters® Article — New
Billing in Medicare Secondary Payer Liability Insurance Situations MLN Matters Article — New
Accepting Payment from Patients with Set-Aside Arrangements MLN Matters Article — New
Clarification of Billing and Payment Policies for Negative Pressure Wound Therapy Using a Disposable Device MLN Matters Article — New
Transition to New Medicare Numbers and Cards Fact Sheet — New
Nursing Home Call: Audio Recording and Transcript — New
SNF Consolidated Billing Web-Based Training Course — Reminder
Remittance Advice Resources and FAQs Fact Sheet — Reminder
Medicare Enrollment Guidelines for Ordering/Referring Providers Booklet — Reminder

Medicare Learning Network® MLN Matters® Articles from CMS

New:


September 27, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:


September 26, 2017

Fiscal Year (FY) 2014 and 2015 S-10 Revisions: Extensions for All Inpatient Prospective Payment System (IPPS) Hospitals

For Inpatient Prospective Payment System (IPPS) hospitals, CMS issued an extension from September 30, 2017 until October 31, 2017 for all IPPS hospitals to resubmit certain Worksheet S-10 data. As described in the FY 2018 IPPS/Long-Term Care Hospital Prospective Payment System (LTCH PPS) final rule (82 FR 38208, August 14, 2017), the initial deadline had been September 30, 2017. For revisions to be considered, CMS modified the deadline such that amended FY 2014 and FY 2015 cost reports due to revised or initial submissions of Worksheet S-10 must be received by on or before October 31, 2017.


Open Meeting Scheduled for September 28, 2017 Is Canceled

The Open Meeting scheduled for September 28, 2017 is canceled. This decision was made since we did not receive registrations for presenters to speak on the posted draft LCD. Although Novitas will not hold the Open Meeting, all interested parties are welcome to submit comments on the draft LCD. The public comment period on the posted draft LCD will end on November 2, 2017.

We apologize for any inconvenience caused by this change.


Limited Systems Availability

There will be Common Working File (CWF) "Dark" days on Friday, September 29, 2017, through Sunday, October 1, 2017. CWF Hosts will implement the Out of Service Area (OSA) drop from Monday, September 25, 2017, through Friday, September 29, 2017.
Due to this systems upgrade, Novitasphere Portal, our Interactive Voice Response (IVR) Unit, and Customer Service will have limited availability.
Customer Service Representatives will not be able to assist providers with the following:

• Eligibility Inquiries
• Claim Status Inquiries Relating to Eligibility
• Claim Denial Inquiries Relating to Eligibility


September 25, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:


September 22, 2017

Special Edition – Thursday, September 21, 2017

Hurricane Maria and Medicare Disaster Related United States Virgin Islands and Commonwealth of Puerto Rico Claims MLN Matters Article — New

The President declared a state of emergency for the United States Virgin Islands and the Commonwealth of Puerto Rico and the HHS Secretary declared a Public Health Emergency which allows for CMS programmatic waivers based on Section 1135 of the Social Security Act. An MLN Matters Special Edition Article on Hurricane Maria and Medicare Disaster Related United States Virgin Islands and Commonwealth of Puerto Rico Claims is available.  Learn about blanket waivers CMS issued for the impacted geographical areas. These waivers will prevent gaps in access to care for beneficiaries impacted by the emergency.

Check the Hurricanes webpage for current information on temporary emergency policies and waivers


Medicare Learning Network® MLN Matters® Articles from CMS

New:


September 21, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, September 21, 2017

View this edition as a PDF

News & Announcements

Transition to New Medicare Numbers and Cards
2016 PQRS Feedback Reports and Annual QRURs Available
Hospice Provider Preview Reports Available through September 28
IRF and LTCH Provider Preview Reports: Review by September 30
CMS Innovation Center New Direction RFI: Submit Comments by November 20
DME Appeals Demonstration: Respond to Reopening Document Request Letters
Chronic Care Management: Connected Care Videos
Quality Payment Program: Hardship Exception Application for 2017 Transition Year Available
Hospital Quality Reporting Programs: eCQM Value Set Addendum Available

Provider Compliance

Medicare Hospital Claims: Avoid Coding Errors

Upcoming Events

PQRS: Feedback Reports and Informal Review Process for PY 2016 Results Call — September 26
Physician Compare Call — September 28
IMPACT Act and Improving Care Coordination: Special Open Door Forum — September 28
SNF QRP: Claims-Based Measures Confidential Feedback Report Webinar — September 28
Home Health Agencies: Quality of Patient Care Star Rating Algorithm Call — October 10
2016 Annual QRURs Webcast — October 19

Medicare Learning Network Publications & Multimedia

IMPACT Act Call: Audio Recording and Transcript — New
Hurricane Harvey and Medicare Disaster Related Texas Claims MLN Matters Article — Updated
Tropical Storm Harvey and Medicare Disaster Related Louisiana Claims MLN Matters Article — Updated
Hurricane Irma and Medicare Disaster Related United States Virgin Islands, Commonwealth of Puerto Rico and State of Florida Claims MLN Matters Article — Updated
Hurricane Irma and Medicare Disaster Related South Carolina and Georgia Claims MLN Matters Article — Updated
Prohibition on Billing Dually Eligible Individuals Enrolled in the QMB Program MLN Matters Article — Revised
Global Surgery Fact Sheet — Revised

Medicare Learning Network® MLN Matters® Articles from CMS

Revised:


The following JH Draft Local Coverage Determinations (LCDs) posted for comment on January 19, 2017 and presented at the February 2017 Contractor Advisory Committee (CAC) Meeting have been posted for notice. They will become effective November 9, 2017:

Comments Received and Contractor Responses

The following JH LCD is still being finalized and will become effective at a later date. Please continue to watch our website for updates:

The following JH LCD is not being finalized. Continue to watch our website for further updates.


September 20, 2017

Part A Open Claims Issues log- update to existing issue for DDE

Some Direct Data Entry (DDE) providers are experiencing issues when attempting to suppress claims in DDE in the Claims Correction option. When a ‘Y’ is entered in the SV field on Claim Page 01 (MAP1711) and F9 is pressed, the claim is being resubmitted instead of being suppressed. A new correction has been developed and is tentatively scheduled for October 23, 2017.


Medicare Learning Network® MLN Matters® Articles from CMS

New:


September 19, 2017

Fiscal Year (FY) 2014 and 2015 S-10 Revisions: Extensions for Hospitals Affected by Hurricanes Harvey and Irma

The Centers for Medicare & Medicaid Services (CMS) is granting an extension from September 30, 2017 until October 31, 2017 for Inpatient Prospective Payment System (IPPS) hospitals, in the States of Texas, Louisiana, Florida, Georgia, and South Carolina, and in the Commonwealth of Puerto Rico, to resubmit certain Worksheet S-10 data.

As described in the FY 2018 IPPS/Long-Term Care Hospital Prospective Payment System (LTCH PPS) final rule (82 FR 38208, August 14, 2017), our initial deadline had been September 30, 2017. For revisions to be considered, we are modifying the deadline in accordance with Waivers or Modifications of Requirements under Section 1135(b)(5) of the Social Security Act, such that amended FY 2014 and FY 2015 cost reports due to revised or initial submissions of Worksheet S-10 must be received by Novitas on or before October 31, 2017.

If hospitals encounter difficulty meeting this extended deadline, they should communicate their concerns to CMS via Novitas, and CMS may consider an additional extension if warranted.


Medicare Learning Network® MLN Matters® Articles from CMS

New:

Revised:


September 15, 2017

The following JH Local Coverage Determination (LCD) has been revised:

The following JH Draft Local Coverage Determination (LCD) has been posted for comment. The comment period will end on November 2, 2017.

Submit Comments

The following JH Local Coverage Article has been added as a companion Article for DL35014, Frequency of Hemodialysis. The Article will become effective at the same time the Final policy becomes effective.

The following JH Local Coverage Article has been revised:


Medicare Learning Network® MLN Matters® Articles from CMS

New:

Revised:


September 14, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, September 14, 2017

View this edition as a PDF

News & Announcements

Quality Payment Program: New Resources Available
September is Prostate Cancer Awareness Month

Provider Compliance

Billing for Ambulance Transports — Reminder

Upcoming Events

Qualified Medicare Beneficiary Program Billing Requirements Call — September 19
Reporting Hospice Quality Data: Tips for Compliance Call — September 20
PQRS: Feedback Reports and Informal Review Process for PY 2016 Results Call — September 26
Physician Compare Call — September 28

Medicare Learning Network Publications & Multimedia

Office of Inspector General Reports Highlight Hospital Billing Issues MLN Matters® Article — New
PECOS for DMEPOS Suppliers Booklet — Reminder
Medicare Enrollment Resources Educational Tool — Reminder

Online Registration Available for September 28, 2017 Open Meeting and Draft LCD Now Posted

Online registration for the September 28, 2017 Open Meeting is now available and will close at 3:00PM Eastern Time (ET) on Monday, September 25, 2017. The Novitas Solutions’ draft LCD is also now posted. IMPORTANT: The Open Meeting will be held at Novitas Solutions, 2020 Technology Parkway, Mechanicsburg, PA 17050 at 10:00AM ET. Due to limited room capacity, registered presenters will be given priority for seating and registered observers will be accepted until remaining seats are filled.

Open Meetings are for the specific purpose of discussing the draft LCD. Anyone is welcome to present information related to the draft LCD that is in the 45-day draft comment period. Interested parties may also request to attend as an observer. If you are interested in attending as a presenter or observer, please view our Draft Local Coverage Determination Open Meetings page for specific guidelines and other helpful information.


Part A Open Issues Log update

Some Direct Data Entry (DDE) providers are experiencing issues when attempting to suppress claims in DDE in the Claims Correction option. When a ‘Y’ is entered in the SV field on Claim Page 01 (MAP1711) and F9 is pressed, the claim is being resubmitted instead of being suppressed.  The correction installed on 9/4/17 did not resolve the issue. We have reported this to FISS, we will post additional information when it is available.


September 13, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:


September 12, 2017

Provider Specialties/Services

We are pleased to announce the addition of Blood and Blood Products to the Part A Provider Specialties/Services page of our website.


August 2017 Part A Newsletter

The August 2017 Part A Newsletter is now available. Please take a moment to review.


Medicare Learning Network® MLN Matters® Articles from CMS

New:


September 11, 2017

Registration for September 28, 2017 Open Meeting

Registration for the September 28, 2017 Open Meeting will be available starting on Thursday, September 14, 2017 and will be closed at 3:00 PM Eastern Time (ET) on Monday, September 25, 2017. Novitas Solutions’ draft LCDs will be posted on September 14, 2017.  IMPORTANT: The Open Meeting will be held at Novitas Solutions, 2020 Technology Parkway, Mechanicsburg, PA 17050 at 10:00AM ET. Once available, all registrations must be submitted via the provided online form and no registrations will be accepted prior to September 14, 2017.  Due to limited room capacity, registered presenters will be given priority for seating and registered observers will be accepted until remaining seats are filled.

If you are interested in attending as a presenter or observer, please view our Draft Local Coverage Determination Open Meetings page for specific guidelines and other helpful information.


Hurricane Irma and Medicare Disaster Related United States Virgin Islands, Commonwealth of Puerto Rico and State of Florida Claims MLN Matters Article

The President declared a state of emergency for the United States Virgin Islands, Commonwealth of Puerto Rico and State of Florida and the HHS Secretary declared a Public Health Emergency which allows for CMS programmatic waivers based on Section 1135 of the Social Security Act. An MLN Matters Special Edition Article on Hurricane Irma and Medicare Disaster Related United States Virgin Islands, Commonwealth of Puerto Rico and State of Florida Claims is available.  Learn about blanket waivers CMS issued for the impacted counties and geographical areas. These waivers will prevent gaps in access to care for beneficiaries impacted by the emergency.

Check the Hurricanes webpage for current information on temporary emergency policies and waivers. Additional waiver requests are being reviewed, and the webpage will be updated as decisions are made.


Hurricane Irma and Medicare Disaster Related South Carolina and Georgia Claims MLN Matters Article

The President declared a state of emergency for the States of South Carolina and Georgia and the HHS Secretary declared a Public Health Emergency which allows for CMS programmatic waivers based on Section 1135 of the Social Security Act. An MLN Matters Special Edition Article on Hurricane Irma and Medicare Disaster Related South Carolina and Georgia Claims is available.  Learn about blanket waivers CMS issued for the impacted counties and geographical areas. These waivers will prevent gaps in access to care for beneficiaries impacted by the emergency.

Check the Hurricanes webpage for current information on temporary emergency policies and waivers.


Medicare Learning Network® MLN Matters® Articles from CMS

New:


September 8, 2017

Part A Top Inquiries / Frequently Asked Questions (FAQs) for AR, CO, LA, MS, NM, OK, & TX

The Part A Top Inquiries / FAQs, received by our Customer Contact Center, have been reviewed for August 2017. New questions / answers have been added to the following categories:

Appeals
Claim Denials
Claim Status

Please take time to review these and other FAQs for answers to your questions.


Medicare Secondary Payer (MSP) Ongoing Responsibility for Medicals (ORM)

This article provides Medicare claims processing guidance specific to Ongoing Responsibility for Medicals (ORM) for liability insurance  no-fault insurance, and workers' compensation in Medicare Secondary Payer (MSP) situations.


Medicare Learning Network® MLN Matters® Articles from CMS

New:


September 7, 2017

Special Edition – Thursday, September 7, 2017

Hurricane Harvey and Medicare Disaster Related Texas Claims MLN Matters Article — Updated
Tropical Storm Harvey and Medicare Disaster Related Louisiana Claims MLN Matters Article — Updated

Hurricane Harvey and Medicare Disaster Related Texas Claims MLN Matters Article — Updated

The MLN Matters Special Edition Article on Hurricane Harvey and Medicare Disaster Related Texas Claims has been updated.  This article was revised to include additional waiver information about emergency durable medical equipment, prosthetics, orthotics, and supplies for Medicare beneficiaries impacted by Hurricane Harvey. All other information remains the same.

Tropical Storm Harvey and Medicare Disaster Related Louisiana Claims MLN Matters Article — Updated

The MLN Matters Special Edition Article on Tropical Storm Harvey and Medicare Disaster Related Louisiana Claims has been updated. This article was revised to include additional waiver information about emergency durable medical equipment, prosthetics, orthotics, and supplies for Medicare beneficiaries impacted by Hurricane Harvey. All other information remains the same.


September 7, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, September 7, 2017

View this edition as a PDF

News & Announcements

Hospice Provider Preview Reports Available through September 28
IRF and LTCH Provider Preview Reports: Review by September 30
IRF and LTCH Compare Quarterly Refresh
Mapping Medicare Disparities Tool: 2017 Enhancements Released
2015 Inpatient and Outpatient Hospital Utilization and Payment Data Available
Healthy Aging® Month: Discuss Preventive Services with your Patients

Provider Compliance

Lumbar Spinal Fusion CMS Provider Minute Video — Reminder

Claims, Pricers & Codes

October 2017 Average Sales Price Files Available

Upcoming Events

Overview of MIPS for Small, Rural, and Underserved Practices Webinar — September 8
New Medicare Card Project: Clearinghouses and Vendors Special Open Door Forum — September 12
Qualified Medicare Beneficiary Program Billing Requirements Call — September 19
Reporting Hospice Quality Data: Tips for Compliance Call — September 20
PQRS: Feedback Reports and Informal Review Process for PY 2016 Results Call — September 26
Physician Compare Call — September 28

Medicare Learning Network Publications & Multimedia

Medicare Diabetes Prevention Program: Audio Recording and Transcript — New

September 6, 2017

Part A Top Claims Submission / Reason Code Errors

The Top Claim Submission / Reason Code Errors and resolutions for August 2017 in Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas are now available. Please take time to review these errors and avoid them on future claims.


Medicare Symposiums – Texas Update

Our thoughts are with those impacted by Hurricane Harvey, and we understand the tremendous challenges our customers are facing in the Texas and Louisiana areas.  We are sensitive to the ongoing recovery efforts as a result of Hurricane Harvey and fully support the need to provide aid and service to those in that area.  We realize attention will quickly turn toward repair and recovery and as such, we have decided to cancel our September 14, 2017, Medicare Symposium in Houston, and reschedule it for Friday, January 26, 2018. 

All class registrations for the September event in Houston will be automatically canceled.  Customers who would like to attend the rescheduled event in January will need to re-register to attend.  We will notify you when registration for this event is available.

We will continue with the plans previously established for San Antonio on September 12, 2017.  We appreciate your flexibility as we navigate through these unforeseen challenges.


Extensions for Hospitals Affected by Hurricane Harvey- MDH and LVH

For Medicare-dependent small, rural hospitals (MDHs) an extension has been granted from September 1, 2017 until October 2, 2017 for hospitals in the States of Texas and Louisiana to apply for sole community hospital (SCH) status in advance of the expiration of the MDH program with an effective date of an approval of SCH status that is the day following the expiration date of the MDH program (that is, September 30, 2017 under current law). CMS is currently granting a 31-day extension to the deadline at § 412.92(b)(2)(v) for the States of Texas and Louisiana. If a hospital located in these areas that is classified as an MDH applies for classification as an SCH under the provisions of § 412.92(b)(2)(v), and that hospital's SCH status is approved, the effective date of approval of SCH status will be the day following the expiration date of the MDH program if such hospital applies for classification as a SCH not later than October 2, 2017. Medicare Administrative Contractors (MACs) must receive the applications and supporting documentation by October 2, 2017. If hospitals encounter difficulty meeting this extended deadline of October 2, 2017, hospitals should communicate their concerns to the Centers for Medicare & Medicaid Services (CMS) via their Medicare Administrative Contractor (MAC), and CMS may consider an additional extension if CMS determines it is warranted.

This extension is also granted from September 1, 2017 until October 2, 2017 for hospitals in the States of Texas and Louisiana to make a written request for low-volume hospital status that is received by its MAC in order for the 25-percent low-volume hospital payment adjustment to be applied to payments for its discharges beginning on or after the start of the Federal fiscal year (FY) 2018. CMS is currently granting a 31-day extension to the deadline established in the FY 2018 Inpatient Prospective Payment System (IPPS)/LTCH PPS Long-Term Care Hospital Prospective Payment System (LTCH PPS) final rule (82 FR 38186) for the States of Texas and Louisiana. Requests for low-volume hospital status for FY 2018 from a hospital located in these areas must be received by the MAC no later than October 2, 2017 in order for the low-volume hospital payment adjustment to be applied beginning with the start of the FY 2018 (that is, for discharges occurring on or after October 1, 2017). MACs must receive the requests and supporting documentation by October 2, 2017. If hospitals encounter difficulty meeting this extended deadline of October 2, 2017, hospitals should communicate their concerns to CMS via their MAC, and CMS may consider an additional extension if CMS determines it is warranted.


Medicare Learning Network® MLN Matters® Articles from CMS

Revised:


September 5, 2017

Special Edition – Tuesday, September 5, 2017

Hurricane Harvey and Medicare Disaster Related Texas Claims MLN Matters Article — Updated
Tropical Storm Harvey and Medicare Disaster Related Louisiana Claims MLN Matters Article — Updated

Hurricane Harvey and Medicare Disaster Related Texas Claims MLN Matters Article — Updated

The MLN Matters Special Edition Article on Hurricane Harvey and Medicare Disaster Related Texas Claims has been updated.  The article was revised to include additional waiver information about housing acute care patients in excluded distinct part units and lifting the temporary enrollment moratoria on Part B non-emergency ambulance suppliers in Texas.  Information regarding the Facilities Quality Reporting was also added.  All other information remains the same.

Tropical Storm Harvey and Medicare Disaster Related Louisiana Claims MLN Matters Article — Updated

The MLN Matters Special Edition Article on Tropical Storm Harvey and Medicare Disaster Related Louisiana Claims has been updated. The article was revised to include additional waiver information about housing acute care patients in excluded distinct part units. Information regarding the Facilities Quality Reporting was also added. All other information remains the same.


Medicare Learning Network® MLN Matters® Articles from CMS

New:

Revised:


September 1, 2017

Special Edition – Friday, September 1, 2017

Hurricane Harvey and Medicare Disaster Related Texas Claims MLN Matters Article — Updated
Tropical Storm Harvey and Medicare Disaster Related Louisiana Claims MLN Matters Article — Updated

 
Hurricane Harvey and Medicare Disaster Related Texas Claims MLN Matters Article — Updated


The MLN Matters Special Edition Article on Hurricane Harvey and Medicare Disaster Related Texas Claims has been updated.  The article was revised to include additional waiver information for Medicare-dependent small, rural hospitals and for low-volume hospitals.  Information regarding administrative relief related to timely filing of appeals was also added. All other information remained the same.


Tropical Storm Harvey and Medicare Disaster Related Louisiana Claims MLN Matters Article — Updated


The MLN Matters Special Edition Article on Tropical Storm Harvey and Medicare Disaster Related Louisiana Claims has been updated. The article was revised to include additional waiver information for Medicare-dependent small, rural hospitals and for low-volume hospitals.  Information regarding administrative relief related to timely filing of appeals was also added. All other information remained the same.


August 31, 2017

Special Edition – Thursday, August 31, 2017

CMS Helping Texas and Louisiana with Hurricane Harvey Recovery
Hurricane Harvey and Medicare Disaster Related Texas Claims MLN Matters Article — New
Tropical Storm Harvey and Medicare Disaster Related Louisiana Claims MLN Matters Article — New

CMS Helping Texas and Louisiana with Hurricane Harvey Recovery

On August 30, 2017, the Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma announced the efforts that are underway to support Texas and Louisiana in response to Hurricane Harvey. Earlier this week, Health and Human Services Secretary Tom Price, M.D., declared public health emergencies in both States. Actions include temporarily waiving or modifying certain Medicare, Medicaid and Children’s Health Insurance Program (CHIP) requirements to provide immediate relief to those affected by the hurricane and resulting floods.

“In light of the natural disaster still unfolding in Texas and Louisiana, CMS is committed to acting as quickly and effectively as possible so the States can continue to ensure the vital health care needs of our most vulnerable beneficiaries are not interrupted,” said CMS Administrator Seema Verma. “CMS is in constant communication with officials in Texas and Louisiana to be sure we are doing all we can to support those in the path of this historic and devastating storm.”

CMS and the U.S. Department of Health and Human Services (HHS) are working in close coordination with the Kidney Community Emergency Response (KCER) Network and the States of Texas and Louisiana to ensure that beneficiaries have access to facilities to provide their treatments. As the CMS response continues, other efforts include, supporting Texas and Louisiana in arranging Special Purpose Renal Dialysis Facilities, transporting patients to facilities and arranging for new facilities to open in order to serve beneficiaries without interruption. In Texas, CMS is coordinating with the workforce on the ground that cares for renal patients to ensure there are enough facilities to serve beneficiaries in need of dialysis. The agency is accepting requests from end stage renal disease suppliers to become a temporary Special Purpose Renal Dialysis Facility (SPRDF).

Since the public health emergencies were declared, CMS has offered immediate administrative relief actions to Texas and Louisiana including issuing several general waivers of certain requirements for specific types of providers in impacted counties and geographical areas. These waivers work to prevent gaps in access to care for beneficiaries.

Skilled Nursing Facilities (SNF): CMS waives requirements for a 3-day prior hospitalization before admission in order to receive Medicare SNF services and provides temporary emergency coverage of services in SNFs without a qualifying hospital stay for people who are evacuated, transferred, or otherwise dislocated due to Hurricane Harvey. Certain people with Medicare benefits who recently exhausted their SNF benefits are authorized for renewed coverage without first having to start a new benefit period.
Home Health Agencies: This CMS waiver provides relief to Home Health Agencies on the timeframes related to completion of OASIS (assessment data) Transmission.
Critical Access Hospitals (CAH): CMS waives the requirements limiting the number of patient beds to 25, and allows for length of stays beyond the capped 96-hour time period.

With the public health emergency in effect, CMS can also waive or modify certain Medicare provisions for providers, including certain deadlines, conditions of participation and certification requirements. Providers can now submit waiver requests to the state survey agency or the CMS regional office and they will be evaluated to ensure that they meet the requirements set out under the law. To help clarify billing instructions, CMS has issued technical direction to the Medicare Administrative Contractors regarding the waivers and has reminded area Medicare Advantage plans regarding their responsibilities to relax certain requirements during a disaster or emergency.

CMS will continue to work with the States of Texas and Louisiana. The agency continues to update our emergency page (www.cms.gov/emergency) with important information for state and local officials, providers, healthcare facilities and the public.

To read previous updates regarding HHS activities related to Hurricane Harvey, please visit https://www.hhs.gov/about/news.

To learn more about HHS resources related to Hurricane Harvey, please visit https://www.hhs.gov/hurricane-harvey

Hurricane Harvey and Medicare Disaster Related Texas Claims MLN Matters Article — New


The President declared a state of emergency for Texas and the HHS Secretary declared a Public Health Emergency for Texas which allows for CMS programmatic waivers based on Section 1135 of the Social Security Act.  An MLN Matters Special Edition Article on Hurricane Harvey and Medicare Disaster Related Texas Claims is available.  Learn about blanket waivers CMS issued in the impacted counties and geographical areas in Texas. These waivers will prevent gaps in coverage for beneficiaries impacted by the emergency.

Check the Hurricanes webpage for current information on temporary emergency policies and waivers. Additional waiver requests are being reviewed, and the webpage will be updated as decisions are made.

Tropical Storm Harvey and Medicare Disaster Related Louisiana Claims MLN Matters Article — New


The President declared a state of emergency for Louisiana and the HHS Secretary declared a Public Health Emergency for Louisiana which allows for CMS programmatic waivers based on Section 1135 of the Social Security Act.  An MLN Matters Special Edition Article on Tropical Storm Harvey and Medicare Disaster Related Louisiana Claims is available.  Learn about blanket waivers CMS issued in the impacted counties and geographical areas in Louisiana. These waivers will prevent gaps in coverage for beneficiaries impacted by the emergency.

Check the Hurricanes webpage for current information on temporary emergency policies and waivers. Additional waiver requests are being reviewed, and the webpage will be updated as decisions are made.


CMS Provider Education Message:

MLN Connects® for Thursday, August 31, 2017

View this edition as a PDF

News & Announcements

New PEPPER Available for Short-term Acute Care Hospitals
Hospice Compare Update Document Available
Participate in Quality Payment Program Website Testing
Departmental Appeals Board: Submit Feedback
Correction to QRDA III Implementation Guide for Eligible Clinicians and Eligible Professionals

Provider Compliance

Billing For Stem Cell Transplants

Upcoming Events

IMPACT Act: Medicare Spending Per Beneficiary Measures Call — September 6
Nursing Home Facility Assessment Tool and State Operations Manual Revisions Call — September 7
Qualified Medicare Beneficiary Program Billing Requirements Call — September 19
Reporting Hospice Quality Data: Tips for Compliance Call — September 20
PQRS: Feedback Reports and Informal Review Process for PY 2016 Results Call — September 26
Physician Compare Call — September 28

Medicare Learning Network Publications & Multimedia

IMPACT Act Call: Audio Recording and Transcript — New
A Physician’s Guide to Medicare Part D Medication Therapy Management Programs MLN Matters Article — Revised
Preventive Services Poster Educational Tool — Revised
Medicare Costs at a Glance: 2017 Educational Tool — Reminder
Suite of Products & Resources for Rural Health Providers Educational Tool — Reminder
Inpatient Rehabilitation Facility Prospective Payment System Fact Sheet — Reminder
Physician Fee Schedule Fact Sheet — Reminder
Telehealth Services Fact Sheet — Reminder
Transitional Care Management Services Fact Sheet — Reminder
Federally Qualified Health Center Fact Sheet — Reminder
Rural Health Clinic Fact Sheet — Reminder
Medicare Home Health Benefit Booklet — Reminder
Critical Access Hospital Booklet — Reminder

August 30, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Revised:


August 28, 2017

The following JH Local Coverage Article which was posted for notice on July 13, 2017 is now effective:


August 25, 2017

Potential Medicare billing and payment impacts due to Hurricane Harvey

While Hurricane Harvey will not affect Novitas Solutions operations, many of Novitas Solutions Medicare customers may experience storm-related impacts. In response to potential damage, Novitas is working to determine how to best help impacted health care providers as they recover. We will be providing you with helpful tips related to communication, benefit payments, and operational processes that may warrant special consideration.

Listed below are additional areas you can contact with regards to natural disasters, extreme weather, and emergencies.

This section of the Centers for Medicare & Medicaid Services (CMS) website will provide up-to-date information for people with Medicare and Medicaid and providers with regards to natural disasters, extreme weather, and emergencies.
This is a link to the official website of the Federal Emergency Management Agency.
Follow this link to the National Oceanic and Atmospheric Administration's (NOAA) Hurricane Center.
Emergency preparedness information for businesses and individuals from Homeland Security

Medicare Learning Network® MLN Matters® Articles from CMS

Revised:


The 2017 September and October Calendar of Events is Currently Available

The 2017 September and October calendar of events is available.  Visit our Education and Training page on our website to review and register.  You do not want to miss any of our education opportunities.  Remain current and compliant with the Medicare program, register today!


August 24, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, August 24, 2017

View this edition as a PDF

News & Announcements

CMS Launches Jimmo Settlement Agreement Webpage

Provider Compliance

CMS Provider Minute: Preventive Services Video

Upcoming Events

IMPACT Act: Medicare Spending Per Beneficiary Measures Call — September 6
Nursing Home Facility Assessment Tool and State Operations Manual Revisions Call — September 7
Qualified Medicare Beneficiary Program Billing Rules Call — September 19
Reporting Hospice Quality Data: Tips for Compliance Call — September 20
PQRS: Feedback Reports and Informal Review Process for PY 2016 Results Call — September 26
Physician Compare Call — September 28
Comparative Billing Report on Modifier 25 Dermatology Webinar — October 11

Medicare Learning Network Publications & Multimedia

Mass Immunizers and Roster Billing Booklet — Revised
Beneficiaries in Custody under a Penal Authority Fact Sheet — Revised
Chronic Care Management Services Changes for 2017 Fact Sheet — Reminder

The following JH Local Coverage Determination (LCD) has been revised:


Medicare Learning Network® MLN Matters® Articles from CMS

Revised:


August 22, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Revised:


August 21, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

Rescinded:


August 18, 2017

Update to July 2017 Non-935 Demand Letters

In July 2017, Novitas issued Non-935 Demand Letters to certain providers that contained incorrect appeal language. On August 7, 2017, we issued correct appeal language with reference to the original demand letters. However, it has come to our attention that the demand amounts referenced in the notification letters may be incorrect. If you believe the demand amounts in your notification letter is incorrect, please refer to your original Non-935 Demand Letter. If you have any questions, feel free to call us at: 1-855-252-8782.

We apologize for any inconvenience this matter may have caused.


August 17, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, August 17, 2017

View this edition as a PDF

News & Announcements

CMS Releases Hospice Compare Website to Improve Consumer Experiences, Empower Patients
Proposed Changes to Comprehensive Care for Joint Replacement Model, Cancellation of Other Models
CMS Releases Updated Data on Medicare Hospice Utilization and Payment
SNF Quality Reporting Program Web-based Training Module Available
Beneficiary Notices: Large Print Forms Available

Provider Compliance

Inpatient Skilled Nursing Facility Denials

Claims, Pricers & Codes

2018 ICD-10-CM Coding Guidelines and Conversion Table Available

Upcoming Events

IMPACT Act: Medicare Spending Per Beneficiary Measures Call — September 6
Nursing Home Facility Assessment Tool and State Operations Manual Revisions Call — September 7

Medicare Learning Network Publications & Multimedia

Care Management Listening Session: Audio Recording and Transcript — New
Medicare Parts A & B Appeals Process Booklet— Revised
DMEPOS Information for Pharmacies Fact Sheet – Revised
DMEPOS Accreditation Fact Sheet – Revised

August 15, 2017

Part A Top Inquiries Frequently Asked Questions (FAQs)

The Part A Top Inquiries FAQs have been reviewed for July 2017. New questions / answers have been added to the Appeals and Return to Provider categories. Please take time to review these and other FAQs for answers to your questions.


Medicare Learning Network® MLN Matters® Articles from CMS

New:


August 14, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

Revised:


August 11, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:


August 10, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, August 10, 2017

View this edition as a PDF

News & Announcements

New Medicare Card: Webpage Updates
IRF Quality Reporting Program: Reconsideration Period Ends August 17
LTCH Quality Reporting Program: Reconsideration Period Ends August 17
Hospice Quality Reporting Program: Reconsideration Period Ends August 17
EHR Incentive Program Hardship Exception Application Due by October 1
Hospitals: Submit Meaningful Use Data to the HQR via the QualityNet Secure Portal in 2018
Chronic Care Management: New Connected Care Videos
Medicare Fee-For-Service Beneficiary Selection of a Primary Clinician
Home Health Quality Reporting Program: OASIS-C2 2018 Guidance Manual Available
Quality Payment Program Hardship Exception Application for 2017 Transition Year Open
Quality Payment Program: Explanation of Special Status Calculation — Correction

Provider Compliance

Home Health Care: Proper Certification Required

Claims, Pricers & Codes

July 2017 OPPS Pricer File
Part B Billing for Certain New Biosimilar Biological Products before the Modifier is Implemented

Upcoming Events

IRF Quality Reporting Program Refresher Training Webinar — August 15
Medicare Diabetes Prevention Program Model Expansion Listening Session — August 16
Quality Payment Program Year 2 NPRM Virtual Office Hours Session — August 16
IMPACT Act: Drug Regimen Review Measure Overview for the Home Health QRP Call — August 17
LTCH Quality Reporting Program Refresher Training Webinar — August 22
Nursing Home Facility Assessment Tool and State Operations Manual Revisions Call — September 7

Medicare Learning Network Publications & Multimedia

August 2017 Catalog Available
Quality Payment Program 2017: MIPS Quality Performance Category Web-Based Training Course — New
Long-Term Care Call: Audio Recording and Transcript — New
ESRD Listening Session: Audio Recording and Transcript — New
Medicare Secondary Payer Web-Based Training Course — Revised
Medicare Secondary Payer Booklet — Revised

The following JH Local Coverage Determinations (LCDs) have been revised:

The following JH Local Coverage Article has been revised:


July 2017 Part A Newsletter

The July 2017 Part A Newsletter is now available. Please take a moment to review.


Medicare Learning Network® MLN Matters® Articles from CMS

Revised:


August 9, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:


August 8, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:


August 7, 2017

Part A Top Claims Submission/Reason Code Errors

The Top Claim Submission/Reason Code Errors and resolutions for July 2017 are now available. Please take time to review these errors and avoid them on future claims.


August 4, 2017

The following JH Local Coverage Article has been revised:

The following JH Local Coverage Article has been retired:


August 3, 2017

CMS Provider Education Message:

MLN Connects® for Day, August 03, 2017

View this edition as a PDF

News & Announcements

CMS Updates Medicare Payment Rates, Quality Reporting Requirements
Hospice Benefit: FY 2018 Updates to the Wage Index and Payment Rates
IRFs: Final FY 2018 Payment and Policy Changes
SNFs: Final FY 2018 Payment and Policy Changes
SNF Quality Reporting Program: Reconsideration Period Ends August 13
Antipsychotic Drug use in Nursing Homes: Trend Update
Vaccines are Not Just for Kids

Provider Compliance

Reporting Changes in Ownership

Claims, Pricers & Codes

ICD-10 GEMS for 2018 Available

Upcoming Events

SNF Quality Reporting Program: Review and Correct Reports Refresher Training Webinar — August 7
Medicare Diabetes Prevention Program Model Expansion Listening Session — August 16
IMPACT Act: Drug Regimen Review Measure Overview for the Home Health QRP Call — August 17
CMS National Provider Enrollment Conference — September 6 and 7
Nursing Home Facility Assessment Tool and State Operations Manual Revisions Call — September 7
Comparative Billing Report on IPPE/AWV Webinar — September 13

Medicare Learning Network Publications & Multimedia

Medicare Part B Immunization Billing Educational Tool — Revised
The ABCs of the Annual Wellness Visit Educational Tool — Reminder

Medicare Learning Network® MLN Matters® Articles from CMS

New:


Part A Open Issues Log update

Some Direct Data Entry (DDE) providers are experiencing issues when attempting to suppress claims in DDE in the Claims Correction option. When a ‘Y’ is entered in the SV field on Claim Page 01 (MAP1711) and F9 is pressed, the claim is being resubmitted instead of being suppressed. The Fiscal Intermediary Shared System (FISS) was made aware of this issue and has developed a correction. It is tentatively scheduled to be installed on September 4, 2017.


August 2, 2017

Special Edition – Wednesday, August 02, 2017

CMS Finalizes 2018 Payment and Policy Updates for Medicare Hospital Admissions
Inpatient Psychiatric Facilities: FY 2018 Medicare Payment and Policy Updates
CMS Updates Medicare Payment Rates, Quality Reporting Requirements

CMS Finalizes 2018 Payment and Policy Updates for Medicare Hospital Admissions

On August 2, CMS issued the FY 2018 Medicare Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System final rule, which updates 2018 Medicare payment and policies when patients are discharged from hospitals. The final rule relieves regulatory burdens for providers, supports the patient-doctor relationship in healthcare, and promotes transparency, flexibility, and innovation in the delivery of care for Medicare patients.

“This final rule will help provide flexibility for acute and long-term care hospitals as they care for Medicare’s sickest patients,” said CMS Administrator Seema Verma. “Burden reduction and payment rate increases for acute care hospitals and long-term care hospitals will help ensure those suffering from severe injuries and illnesses have access to the care they need.”

Due to the combination of payment rate increases and other policies and payment adjustments, particularly in changes in uncompensated care payments, acute care hospitals will see a total increase in Medicare spending on inpatient hospital payments of $2.4 billion in FY 2018. Based in part on the changes included in the final rule, overall payments to long-term care hospitals will decrease by $110 million in FY 2018.

In addition to the payment and policy updates for Medicare hospital admissions, the final rule addresses changes to how the public is notified of Medicare terminations of certain providers and implements the statutory extension of the Rural Community Hospital Demonstration. 

For More Information:

See the full text of this excerpted Press Release (issued August 2).

Inpatient Psychiatric Facilities: FY 2018 Medicare Payment and Policy Updates

On August 2, CMS issued a notice with comment period updating FY 2018 Medicare payment policies and rates for the Inpatient Psychiatric Facilities (IPF) Prospective Payment System. CMS estimates IPF payments to increase by 0.99 percent or $45 million in FY 2018. This amount reflects a 2.6 percent IPF market basket update less the productivity adjustment of 0.6 percentage point and less the 0.75 percentage point reduction required by law, for a net market basket update of 1.25 percent. Additionally, estimated payments to IPFs are reduced by 0.26 percentage point due to updating the outlier fixed-dollar loss threshold amount. CMS is also updating the IPF wage index for FY 2018.

CMS is soliciting comments on improvements that can be made to the healthcare delivery system that would reduce unnecessary burden for clinicians, providers such as IPFs, and patients and their families.

For more information, view the notice with comment period. See the full text of this excerpted Fact Sheet (issued August 2).

MS Updates Medicare Payment Rates, Quality Reporting Requirements

CMS issued three final rules outlining 2018 Medicare payment rates for skilled nursing facilities, hospice, and inpatient rehabilitation facilities. The final rules are effective for FY 2018 and reflect a broader Administration strategy to streamline administrative requirements for providers; support the patient-doctor relationship in healthcare; and promote transparency, flexibility, and innovation in the delivery of care.

“These announcements take important steps to support innovation in the delivery of care in order to promote a Medicare program that is responsive to patients’ unique needs and ensure that patients have access to high-quality skilled nursing, hospice, and inpatient rehabilitative care,” said CMS Administrator Seema Verma.  “These rules update quality reporting requirements and allow providers to spend less time and fewer resources on cumbersome paperwork, so they can increase their focus on the needs of Medicare patients.”

Final Rules:

Hospice: Fact Sheet and Final Rule
IRF: Fact Sheet and Final Rule
SNF: Fact Sheet and Final Rule

See the full text of this excerpted Press Release (issued August 1).


Indian Health Service (IHS) 2017 Workshop Brochure

Please take a moment to review our 2017 IHS Medicare Workshop brochure for details about the workshops and then register for an upcoming event near you. In order to register for this year’s workshops, you will need a Novitas Medicare Learning Center account. If you do not have a Novitas Medicare Learning Center account, you can create one by visiting the Novitas Medicare Learning Center and select 'Request a new account.' You will receive an email confirmation within three business days with your login information. Accounts are free for Medicare providers.


July 31, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:


July 28, 2017

Diabetic Shoes - Novitas and DME MAC Webinar

Join Novitas and CGS Administrators, the DME MAC for Jurisdiction C, in a collaborative webinar focusing on Diabetic Shoes, on Wednesday, August 16, 2017. This webinar on Diabetic Shoes, including physician’s roles and coverage criteria, will be hosted by the CGS Provider Outreach and Education representatives. If you order diabetic shoes for your patients, this webinar is for you!  The Provider Outreach and Education instructors will leave time for questions at the conclusion of the presentation.  Don't delay, register today for this educational opportunity.


Medicare Learning Network® MLN Matters® Articles from CMS

Revised:


July 27, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, July 27, 2017

View this edition as a PDF

News & Announcements

Home Health Agencies: CMS Proposes 2018 and 2019 Payment Changes
New Medicare Card (formerly called SSNRI)
Quality Payment Program: Explanation of Special Status Calculation
Updated CMS Measures Inventory Posted
World Hepatitis Day: Medicare Coverage for Viral Hepatitis
Anniversary of the American Disabilities Act

Provider Compliance

Hospital Discharge Day Management Services CMS Provider Minute Video

Claims, Pricers & Codes

2018 ICD-10-CM POA Exempt Codes Available

Upcoming Events

New Proposals for RHCs and FQHCs on Care Management Services and ACO Assignments Listening Session — August 1
Medicare Diabetes Prevention Program Model Expansion Listening Session — August 16
IMPACT Act: Drug Regimen Review Measure Overview for the Home Health QRP Call — August 17
LTCH Quality Reporting Program Refresher Training Webinar — August 22
CMS National Provider Enrollment Conference — September 6 and 7

Medicare Learning Network Publications & Multimedia

Quality Payment Program 2017 MIPS: Improvement Activities Performance Category Web-Based Training Course — New
Provider/Supplier Enrollment Call: Audio Recording and Transcript — New
Medicare Part B Immunization Billing Educational Tool — Reminder

Revised CMS-588: Electronic Funds Transfer Authorization Agreement

Providers and suppliers must use the revised CMS-588 form (Electronic Funds Transfer Authorization Agreement) beginning January 1, 2018. The revised form will be posted on the CMS Forms List (https://go.usa.gov/xX3Sa ) by early summer. Medicare Administrative Contractors will accept both the current and revised versions of the CMS-588 through December 31, 2017. Visit the Medicare Provider-Supplier Enrollment webpage for more information about Medicare enrollment and the Electronic Funds Transfer (EFT) requirements.

Changes to the form include:

New indicator shows if the EFT is for an individual or a group/organization/corporation in Parts 1 and 2 (Reason for Submission and Account Holder Information)
Now optional to list the financial institution's contact person
Four digits added to the "Provider's/Supplier's/Indirect Payment Procedure Entity's Account Number with Financial Institution," making it consistent with the industry standard

July 26, 2017

New Version of Advance Beneficiary Notice of Noncoverage (ABN) Form CMS-R-131

Are you aware there is a renewed version of the Advance Beneficiary Notice of Noncoverage (ABN) Form (CMS-R-131)? The new form was effective for use on or after June 21, 2017, and has an expiration date of March 2020. If you have not already done so, please begin using the new form.


New Medicare Insights Podcast

In this Medicare Insights Podcast episode, we invite you to join us for one of our 2017 Medicare Fall Symposiums.


July 25, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:


July 21, 2017

Diabetic Shoes Collaboration Webinar

Join Novitas and CGS Administrators, the DME MAC for Jurisdiction C, in a collaborative webinar focusing on Diabetic Shoes, August 16, 2017. This webinar on Diabetic Shoes, including physician’s roles and coverage criteria, will be hosted by CGS Provider Outreach and Education representatives. If you order diabetic shoes for your patients, this webinar is for you!  The Provider Outreach and Education instructors will leave time for questions at the conclusion of the presentation.

The webinar is scheduled for 12:30 PM Eastern (11:30 AM Central) to minimize the impact on your work schedule.  Don't delay, go online and register today.


Part A Top Inquiries Frequently Asked Questions (FAQs)

The Part A Top Inquiries FAQs have been reviewed for June 2017. New questions/answers have been added to the General Information category. Please take time to review these and other FAQs for answers to your questions.


July 20, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, July 20, 2017

View this edition as a PDF

News & Announcements

Home Health Agency CoP Final Rule: Effective Date Extended to January 13, 2018
Hospice Quality Reporting Program: Non-Compliance Letters
IRF Quality Reporting Program: Non-Compliance Letters
LTCH Quality Reporting Program: Non-Compliance Letters
SNF Quality Reporting Program: Non-Compliance Letters
IRF, LTCH, and SNF Quality Reporting Program Data due August 15
New PEPPER Available for Home Health Agencies and Partial Hospitalization Programs
Hospitals: 2018 QRDA Category I Implementation Guide
Health Care Fraud Takedown: Charges Against Individuals Responsible for $1.3 Billion in Fraud

Provider Compliance

Billing For Stem Cell Transplants

Claims, Pricers & Codes

Clinicians: Medicare Part B Crossover Claims Issue Tied to Error Code H31312

Upcoming Events

Revised Interpretive Guidance for Nursing Homes and New Survey Process Call — July 25
ESRD QIP: Proposed Rule for Payment Year 2021 Listening Session — July 26
New Proposals for RHCs and FQHCs on Care Management Services and ACO Assignments - Listening Session — August 1
Medicare Diabetes Prevention Program Model Expansion Listening Session — August 16
IMPACT Act: Drug Regimen Review Measure Overview for the Home Health Quality Reporting Program Call — August 17
LTCH Quality Reporting Program Refresher Training Webinar — August 22

Medicare Learning Network Publications & Multimedia

Quality Payment Program Listening Session: Audio Recording and Transcript — New
Medicare Quarterly Provider Compliance Newsletter [Volume 7, Issue 4] Educational Tool — New
Medicare Basics: Parts A and B Claims Overview Video — Reminder
Chronic Care Management Services Fact Sheet — Reminder

Comprehensive Error Rate Testing (CERT) Program New Processes

The CERT Documentation Office wants to make you aware of new address processes.

Documentation requests letters are sent to addresses on file with Novitas
Providers who have at least ten (10) PTAN numbers can designate a single point of contact
The CERT contractor groups calls so that a single contact can be made with the provider

If you receive CERT requests, please review the complete article for details. Questions about your CERT cases can be emailed to QuestCERT@novitas.solutions.com.


July 19, 2017

Qualified Medicare Beneficiary Indicator in the Claims Processing System

The Centers for Medicare & Medicaid Services added a QMB status indicator to Medicare’s claims processing systems for claims processed on or after October 2, 2017. This system enhancement will trigger notification to providers (through the Provider Remittance Advice) and beneficiaries (through the Medicare Summary Notice) reflecting that the beneficiary is enrolled in the QMB program and has no Medicare cost-sharing liability. Please review our article for further information.


New Addition to the August 2017 Education Event Calendars

Join us on Monday, August 24, 2017, as we discuss Local Coverage Determination revisions. Visit the Education and Training page of the website for additional details and registration opportunities.  

 You do not want to miss this! Register today!


Medicare Learning Network® MLN Matters® Articles from CMS

New:


July 18, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:


Fiscal Year 2014 S-10 Revisions

Amended cost reports must be received by September 30, 2017.

Some IPPS hospitals have requested CMS provide them with an additional opportunity to revise the Worksheet S-10 submitted with their FY 2014 cost reports (starting on or after October 1, 2013 and prior to October 1, 2014). Amended FY 2014 cost reports due to revised or initial submissions of Worksheet S-10 received by MACs on or before September 30, 2017 will be uploaded to HCRIS by December, 2017. Providers must follow the current requirements for electronic submission of cost reports found at 42 CFR §413.24(f)(4), which includes submitting:

hard copy of a settlement summary
statement of certain worksheet totals found within the electronic file statement signed by its administrator or chief financial officer certifying the accuracy of
the electronic file or the manually prepared cost report

Requests to amend or submit FY 2014 worksheet S-10 received after September 30, 2017, will still be accepted under normal timelines and procedures. Revisions to Worksheet S-10 from other fiscal years, revisions to other worksheets of the FY 2014 cost reports, or revisions to Worksheet S-10 by non-IPPS hospitals are not subject to this instruction.


July 17, 2017

Part A Frequently Asked Questions (FAQs)

Have a question and not sure where to turn? Check out our FAQs for answers to your questions.


July 14, 2017

Special Edition – Thursday, July 13, 2017

In This Edition:

Hospital Outpatient, ASC: CMS Proposes 2018 Policy and Rate Changes

Proposed rule and Request for Information promote improvements to quality, accessibility, and affordability of care

On July 13, CMS issued a proposed rule that updates payment rates and policy changes in the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System. The proposed rule is one of several for 2018 that reflect a broader strategy to relieve regulatory burdens for providers; support the patient-doctor relationship in healthcare; and promote transparency, flexibility and innovation in the delivery of care. 

The OPPS and ASC payment system are updated annually to include changes to payment policies, payment rates, and quality provisions for those Medicare patients who receive care at hospital outpatient departments or receive care at surgical centers. Among the provisions in this rule, CMS is proposing to change the payment rate for certain Medicare Part B drugs purchased by hospitals through the 340B program. The proposed rule also includes a provision that would alleviate some of the burdens rural hospitals experience in recruiting physicians by placing a two-year moratorium on the direct supervision requirement currently in place at rural hospitals and critical access hospitals. In addition, CMS is releasing within the proposed rule a Request for Information to welcome continued feedback on flexibilities and efficiencies in the Medicare program.

For More Information:

See the full text of this excerpted Press Release (issued July 13).

Physician Fee Schedule: CMS Proposes 2018 Payment and Policy Updates

Proposed rule & Request for Information provide flexibility, support strong patient-doctor relationships

On July 13, CMS issued a proposed rule that would update Medicare payment and policies for doctors and other clinicians who treat Medicare patients in CY 2018. The proposed rule is one of several Medicare payment rules for CY 2018 that reflect a broader strategy to relieve regulatory burdens for providers; support the patient-doctor relationship in healthcare; and promote transparency, flexibility, and innovation in the delivery of care. 

The Physician Fee Schedule is updated annually to include changes to payment policies, payment rates, and quality provisions for services furnished to Medicare beneficiaries. This proposed rule would provide greater potential for payment system modernization and seeks public comment on reducing administrative burdens for providing patient care, including visits, care management, and telehealth services. The rule takes steps to better align incentives and provide clinicians with a smoother transition to the new Merit-based Incentive Payment System under the Quality Payment Program. The rule encourages fairer competition between hospitals and physician practices by promoting greater payment alignment, and it would improve the payment for office-based behavioral health services that are often the therapy and counseling services used to treat opioid addiction and other substance use disorders. In addition, the proposed rule makes additional proposals to implement the Center for Medicare and Medicaid Innovation’s Medicare Diabetes Prevention Program expanded model starting in 2018.

For More Information:

See the full text of this excerpted Press Release (issued July 13).


July 13, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, July 13, 2017

View this edition as a PDF

News & Announcements

New Medicare Cards with New Numbers: 3 Changes You May Need to Make
QRDA III Implementation Guide Available
Quality Payment Program: View Recent Webinar Recordings
Hospital Discharge Notices
IPPS Hospitals: FY 2014 S-10 Revisions
Recognizing National HIV Testing Day

Provider Compliance

OIG Video: Reporting Fraud to the Office of the Inspector General
Claims, Pricers & Codes
ICD-10-CM Errata Available

Upcoming Events

Revised Interpretive Guidance for Nursing Homes and New Survey Process Call — July 25
ESRD QIP: Proposed Rule for Payment Year 2021 Listening Session — July 26
IRF Quality Reporting Program Refresher Training Webinar — August 15
Comparative Billing Report on Drugs of Abuse Testing Webinar — August 23

Medicare Learning Network Publications & Multimedia

CLIA Webcast: Audio Recording and Transcript — New
Appeals Call: Audio Recording and Transcript — New
Acute Care Hospital Inpatient Prospective Payment System Booklet — Reminder
Skilled Nursing Facility Prospective Payment System Booklet — Reminder
Ambulatory Surgical Center Fee Schedule Fact Sheet — Reminder
Ambulance Fee Schedule Fact Sheet — Reminder
Health Professional Shortage Area Physician Bonus Program Fact Sheet — Reminder
Suite of Products & Resources for Billers & Coders Educational Tool — Reminder

The following JH Local Coverage Determinations (LCDs) have been revised:

The following JH Local Coverage Determination (LCD) has been retired effective July 13, 2017:

The following JH Local Coverage Article has been revised:

The following JH Local Coverage Article has been posted for notice and will become effective August 28, 2017:


July 2017 Addition

We've added a new session. Join us Thursday, July 20, 2017 for the Preventive Service Guidelines and Billing webinar. Visit the Education and Training page of our website for additional information and registration opportunities. 


July 11, 2017

Important information about CERT Documentation Request Letters

All initial Additional Documentation Request (ADR) letters for CERT are sent to the billing provider address on file with the National Supplier Clearinghouse for Durable Medical Equipment Prosthetics, Orthotics and Supplies suppliers, or the Medicare Administrative Contractor.  

For information on how to update your address, please visit the Novitas Enrollment Center.

If you have a specific CERT correspondence address, you can provide it once you are contacted by the CERT Customer Service Representative after the first documentation request letter is sent. The address will be used only for subsequent ADR letters for that sampled claim.


Part A Top Claims Submission/Reason Code Errors

The Top Claim Submission/Reason Code Errors and resolutions for June 2017 are now available. Please take time to review these errors and avoid them on future claims.


June 2017 Part A Newsletter

The June 2017 Part A Newsletter is now available. Please take a moment to review!


July 10, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:


July 7, 2017

The comment period is now closed for the JH Draft Local Coverage Determinations (LCDs) listed below. Comments received will be reviewed by our Contractor Medical Directors and a summary comment and response document will be posted to our website when the final LCDs are posted for notice.


July 6, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, July 6, 2017

View this edition as a PDF

News & Announcements

ESRD: Proposed 2018 Policy and Payment Rate Changes
ESRD QIP: Prepare for the PY 2018 Preview Period
QPP: New Resources to Help Clinicians Participate in MIPS
QPP: New Webpage for Clinicians in Small, Rural, or Underserved Areas
Open Payments Program Posts 2016 Financial Data

Provider Compliance

Chiropractic Services: High Improper Payment Rate within Medicare FFS Part B

Upcoming Events

ESRD QIP: Reviewing Your Facility's PY 2018 Performance Data Call — July 10
Creating and Verifying Your National Provider Identifier Call — July 12
Assessing Your Ability to Support Patient Self-Management Webinar — July 19
ESRD QIP: Proposed Rule for Payment Year 2021 Listening Session — July 26

Medicare Learning Network Publications & Multimedia

Modernized National Plan and Provider Enumeration System MLN Matters Article — New
Infection Control: Hand Hygiene Video — New
PECOS for Provider and Supplier Organizations Booklet — Reminder
Medicare Vision Services Fact Sheet — Reminder
Mass Immunizers and Roster Billing Booklet — Reminder

The following JH Local Coverage Determination (LCD) has been revised and is now displaying properly:


DMEPOS: Payment for Accessories used with Group 3 Complex Rehabilitative Power Wheelchairs Effective July 1

CMS is adopting a new interpretation of the statute that impacts how adjustments to the fee schedule based on information from competitive bidding programs apply to wheelchair accessories used with group 3 complex rehabilitative power wheelchairs. Effective July 1, fee schedule amounts for wheelchair accessories and back and seat cushions used with group 3 complex rehabilitative power wheelchairs will not be adjusted using information from the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program. The fee schedule amounts will be based on the unadjusted fee schedule amounts updated by the annual fee schedule covered item update. Suppliers should continue to use the KU modifier when billing for wheelchair accessories and seat and back cushions furnished in connection with Group 3 complex rehabilitative power wheelchairs with dates of service beginning July 1, 2017.

For more information, view the posting and FAQ on the DME Center web page.


July 5, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:


July 3, 2017

If it is not Signed, then it is not Complete

Prior to submitting records to Medicare, you must ensure that the documentation is signed. For medical review purposes, we require that services provided and/or ordered are authenticated by the author. For more information please take a moment to review the article.


Medicare Learning Network® MLN Matters® Articles from CMS

Revised:


June 30, 2017

It Pays to Have the Correct Address with Medicare

Did you recently move? Are you missing important notices from Medicare? We can help. Please take a moment to review the article.


June 29, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, June 29, 2017

View this edition as a PDF

News & Announcements

New Medicare Number: Prepare Your Systems for April 2018
DMEPOS: Payment for Group 3 Complex Rehabilitative Power Wheelchair Accessories Effective July 1
Quarterly Provider Update

Provider Compliance

Evaluation and Management: Correct Coding

Upcoming Events

Quality Payment Program Year 2 Proposed Rule Listening Session — July 5
DMEPOS Prior Authorization Special Open Door Forum – July 6
ESRD QIP: Reviewing Your Facility's PY 2018 Performance Data — July 10
Creating and Verifying Your National Provider Identifier Call — July 12

Medicare Learning Network Publications & Multimedia

Behavioral Health Integration Services Fact Sheet — New
Evaluation and Management Services Web-Based Training Course — New
Dementia Care Call: Audio Recording and Transcript — New
Medical Privacy of Protected Health Information Fact Sheet — Revised
Medicare Basics: Commonly Used Acronyms Educational Tool — Revised

The following JH Local Coverage Determination (LCD) has been revised:

The comment period will close on July 6, 2017 for the following JH Draft Local Coverage Determinations (LCDs):

Submit Comments


June 28, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:


June 27, 2017

Epidural Injections for Pain Management (L36920)

It has been brought to our attention that LCD L36920, Epidural Injections for Pain Management is displaying incorrectly indicating that the policy is on hold. Please be advised that as communicated on June 8, 2017, L36920, Epidural Injections for Pain Management is effective and became effective June 8, 2017.

We apologize for any confusion that this may have caused and we are diligently working to have the notification on the LCD corrected as soon as possible. Please continue to watch our website for updates.


Limited Systems Availability

There will be Common Working File (CWF) "Dark" days on Friday, June 30, 2017, through Sunday, July 2, 2017. CWF Hosts will implement the Out of Service Area (OSA) drop from Monday, June 26, 2017, through Friday, June 30, 2017.

Due to this systems upgrade, Novitasphere Portal, our Interactive Voice Response (IVR) Unit, and Customer Service will have limited availability.

Customer Service Representatives will not be able to assist providers with the following:

Eligibility Inquiries
Claim Status Inquiries Relating to Eligibility
Claim Denial Inquiries Relating to Eligibility

June 26, 2017

Fall 2017 Novitas Solutions Medicare Symposiums

Novitas Solutions invites you to join us at one of our 2017 Novitas Solutions Medicare Symposium.  The symposium is for Part A and Part B Medicare providers, and their billing and compliance representatives.  Classes will highlight the tools and information you need to avoid billing pitfalls and remain complaint with the Medicare program.  We look forward to seeing you at this FREE event.


June 22, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, June 22, 2017

View this edition as a PDF

News & Announcements

CMS Proposes Quality Payment Program Updates to Increase Flexibility and Reduce Burdens
Coming in April 2018: New Medicare Card – New Number
Quality Payment Program: New Resources Available
Quality Payment Program: View Recordings of Recent Webinars
Quality Measure Development Plan Annual Report
SNF QRP Review and Correct Reports Available
2015 Physician and Other Supplier Utilization and Payment Data
2015 Referring DMEPOS Utilization and Payment Data
Hospice QRP: Clarifying Coding Guidance for Hospice Item Set
IRFs & LTCHs: Reminder to Review QRP Provider Preview Reports by June 30
Hospices: Reminder to Review Provider Preview Reports by June 30
Minority Research Grant Program: Apply by July 10

Provider Compliance

Hospice Election Statements Lack Required Information or Have Other Vulnerabilities

Upcoming Events

CLIA Certificate of Provider-performed Microscopy Webcast — June 28
Improvements to the Medicare Claims Appeal Process and Statistical Sampling Call — June 29
Quality Payment Program Year 2 Proposed Rule Listening Session — July 5
Creating and Verifying Your National Provider Identifier Call — July 12

Medicare Learning Network Publications & Multimedia

Provider Enrollment Revalidation – Cycle 2 MLN Matters Article — Revised
Complying with Medical Record Documentation Requirements — Revised

Medicare Learning Network® MLN Matters® Articles from CMS

New:


Modifier 25 Checklist

Having problems deciding on when to use modifier 25?  Help is here! Take a look at our Modifier 25 checklist.


Find status of your Comprehensive Error Rate Testing (CERT) review FAST!

Novitas enhanced the CERT Claim Identifier (CID) look up tool to provide current, detailed information about your CERT review. The tool now shows you the dates the medical records were requested and received by CERT. In addition, it shows you the date additional documentation was requested and received.  Error codes and status descriptions now have detailed information that you can view by hovering your mouse over the question mark next to the code or status. We now update the CERT data every two weeks so you have the most current information available about your claim. Try out these new features today.

If you have any questions about your CERT review, please email QuestCERT@novitas-solutions.com. Please include the CID number in your email.


June 20, 2017

LCD L36711 – Intensity Modulated Radiation Therapy (IMRT)

Following review and discussion of L36711 Novitas will be making revisions to the policy. Please continue to watch our website.

As a reminder, the LCD Reconsideration Process is the appropriate mechanism for interested parties to request a revision to a LCD. The process is available only for final LCDs. The whole LCD or any provision of the LCD may be reconsidered. Any requests for revisions to LCD L36711 must be submitted via this process.

LCD Reconsideration Process Instructions


5 Ways for Healthcare Providers to Get Ready for New Medicare Cards

The Centers for Medicare & Medicaid Services created a new drop-in article: “5 Ways for Healthcare Providers to Get Ready for New Medicare Cards.” Please take a moment to review the article.


Medicare Learning Network® MLN Matters® Articles from CMS

New:

Revised:


June 19, 2017

New Medicare Insights Podcast

In this Medicare Insights Podcast episode, we encourage you to subscribe to our email lists and stay up-to-date on Medicare news.


June 16, 2017

Revised HIGLAS Transition Notice

Novitas Solutions will be undergoing a HIGLAS transition involving Part B workloads. There is a possibility that these systems will be delayed on Tuesday June 20, 2017. Please review this notice, which explains the impact this will have on your organization’s Medicare payments.


Medicare Learning Network® MLN Matters® Articles from CMS

Revised:


June 15, 2017

CMS Provider Education Message:


MLN Connects® for Thursday, June 15, 2017

View this edition as a PDF

News & Announcements

MIPS Group Reporting: Registration Period Ends June 30
MIPS Performance Categories: Accepting Future Measures and Activities until June 30
Chronic Care Management Services: New Connected Care Materials
National Men’s Health Week 2017
County by County Analysis of Current Projected Insurer Participation in Health Insurance Exchanges

Provider Compliance

CMS Provider Minute: CT Scans Video

Claims, Pricers & Codes

2018 ICD-10-CM Code Files Available

Upcoming Events

IMPACT Act Special Open Door Forum — June 20
CLIA Certificate of Provider-performed Microscopy Webcast — June 28
Diagnosis and Treatment of Parkinson’s Disease Webinar — June 28
Improvements to the Medicare Claims Appeal Process and Statistical Sampling Call — June 29

Medicare Learning Network Publications & Multimedia

Guidance to Providers that Submit Outpatient Facility Claims and Those That Enter Claims Data via DDE Screens to Reduce Incidence of Claims Not Crossing Over MLN Matters® Article — New

Part A Top Inquiries Frequently Asked Questions (FAQs)

The Part A Top Inquiries FAQs have been reviewed for May 2017. New questions/answers have been added to the Claim Denials and General Information categories. Please take time to review these and other FAQs for answers to your questions.


June 14, 2017

Draft Local Coverage Determination Comment Submission Issue

It has come to our attention that the Draft Local Coverage Determinations (LCDs) Submit Comments form has not been functioning properly. Your comments are important to us; therefore, if you submitted comments for the following draft LCDs using the form and did not receive an email acknowledging receipt of your comments, we encourage you to re-submit your comments. We apologize for any inconvenience.

Submit Comments


Medicare Learning Network® MLN Matters® Articles from CMS

New:


June 13, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

Revised:


June 12, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

Revised:


June 9, 2017

HIGLAS Transition Notice

Novitas Solutions will be undergoing a HIGLAS transition involving Part A workloads. Please review this notice, which explains the impact this will have on your organization’s Medicare payments.

June 8, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, June 8, 2017

View this edition as a PDF

News & Announcements

Hospitals and SNFS: Reduce Legionella Risk in Water Systems
Predictive Qualifying APM Participant Status Announced
Hospices: Review First Provider Preview Reports by June 30
IRFs & LTCHs: Review QRP Provider Preview Reports by June 30
IRF and LTCH Compare Quarterly Refresh
PEPPER for Short-term Acute Care Hospitals Available
Quality Payment Program Resources Available
ONC eMeasurement and Quality Improvement Webinar: Recording Available
Proposed Revisions to Long-Term Care Facilities’ Arbitration Agreements
World No Tobacco Day

Provider Compliance

Duplicate Claims Will Not be Paid

Claims, Pricers & Codes

July 2017 Average Sales Price Files Available

Upcoming Events

National Partnership to Improve Dementia Care and QAPI Call — June 15
CLIA Certificate of Provider-performed Microscopy Webcast — June 28
Improvements to the Medicare Claims Appeal Process and Statistical Sampling Call — June 29

Medicare Learning Network Publications & Multimedia

Quality Payment Program Overview Web-Based Training Course — New
Scheduled End of the Intravenous Immune Globulin Demonstration MLN Matters® Article — New
Avoiding Medicare Fraud and Abuse: A Roadmap for Physicians Booklet — Reminder
Medicare Secondary Payer Booklet — Reminder

The following JH Local Coverage Determinations (LCDs) have been revised:

The following JH Draft LCD which was posted for comment on December 8, 2016 is retired and will not be finalized at this time. 

The following JH Local Coverage Article has been revised:

The hold that was placed on the following LCD on April 27, 2017 has been lifted and the LCD is effective as of June 8, 2017:


Medicare Learning Network® MLN Matters® Articles from CMS

New:


June 7, 2017

May 2017 Part A Newsletter

The May 2017 Part A Newsletter is now available. Please take a moment to review.


Medicare Learning Network® MLN Matters® Articles from CMS

New:


June 6, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:


Part A Top Claims Submission/Reason Code Errors

The Top Claim Submission/Reason Code Errors and resolutions for May 2017 are now available. Please take time to review these errors and avoid them on future claims.


June 2, 2017

HIGLAS Notice

Effective June 16, 2017, Novitas Solutions will be undergoing a HIGLAS transition involving the JL MAC Part A and Part B workloads. Please review the HIGLAS Notice on our website for further details.


June 1, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, June 1, 2017

View this edition as a PDF

News & Announcements

New Medicare Cards Offer Greater Protection to More Than 57.7 Million Americans
EHR Incentive Programs: Submit Comments on Proposed Changes by June 13
New Quality Payment Program Resources Available
Review 2017 EHR Incentive Program Requirements
CY 2017 eCQM Resources and Tools

Provider Compliance

Automatic External Defibrillators: Inadequate Medical Record Documentation

Claims, Pricers & Codes

Hospices: Submit Adjustments to Correct Payment Errors

Upcoming Events

National Partnership to Improve Dementia Care and QAPI Call — June 15
CLIA Certificate of Provider-performed Microscopy Webcast — June 28
Improvements to the Medicare Claims Appeal Process and Statistical Sampling Call — June 29

Medicare Learning Network Publications & Multimedia

Required Workaround for Hospices Submitting RHC and SIA Payments at the End of Life MLN Matters Article — New
SBIRT Services Booklet — Revised
Medicare Basics: Parts A and B Claims Overview Video — Reminder
Medicare Fraud & Abuse: Prevention, Detection, and Reporting Booklet — Reminder

May 31, 2017

Partial Hospitalization Program (PHP) Specialty Page

We are pleased to announce the addition of Partial Hospitalization Program to the Part A Provider Specialties/Services page of our website.


Telehealth Services Specialty Page

We are pleased to announce the addition of Telehealth Services to the Part A Provider Specialties/Services page of our website.


Medicare Learning Network® MLN Matters® Articles from CMS

New:


May 30, 2017

LCD L36711 Update

This is an update regarding bulletin Provider Type Restriction for LCD L36711 – Intensity Modulated Radiation Therapy (IMRT) posted on January 23, 2017.  Provider type restrictions for IMRT is still under discussion; therefore, please continue to watch our website for future news related to LCD L36711.


Medicare Learning Network® MLN Matters® Articles from CMS

New:

Revised:


May 25, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, May 25, 2017

View this edition as a PDF

News & Announcements

Social Security Number Removal Initiative Reminder: Get Your Systems Ready
2018 Medicare Shared Savings Program: Submit Notice of Intent to Apply by May 31
Quality Payment Program: Technical Assistance Resource Guide Available
SNF QRP Quality Measure User’s Manual
Administrative Simplification: Get the Basics
May is National Osteoporosis Month

Provider Compliance

Advanced Life Support Ambulance Services: Insufficient Documentation

Upcoming Events

National Partnership to Improve Dementia Care and QAPI Call — June 15
CLIA Certificate of Provider-performed Microscopy Webcast — June 28
CBR on Anesthesia Services for Lower Endoscopic Procedures Webinar — July 12

Medicare Learning Network Publications & Multimedia

ABCs of the Initial Preventive Physical Examination Educational Tool — Revised

Open Comment Period for Draft Policies

Novitas Solutions recently posted the following draft Local Coverage Determinations (LCDs) for public comment. This is an important opportunity to provide feedback on any aspect of the draft policies.

Under each draft LCD, the specialties listed may have a particular interest in the policies. Please take the time to read the drafts and comment before July 6, 2017.

For more information, please visit our Medical Policy Update page for Jurisdiction H.


Part A Open Issues Log Updates

Claims that were being held in status location SM9818 for reason code 31442 have been released for processing. The correction was successfully installed on May 22, 2017.
The correction to be implemented with CR9672 for the PRV field has been moved to October 1, 2017. Please see MM9672.

May 24, 2017

Comprehensive Error Rate Testing (CERT) Educational Posters are Online

You've seen them at our educational events. You may have picked up a few for your facility or practice. Now, our Comprehensive Error Rate Testing (CERT) educational posters are online. Download and print as many posters as you need for your organization. The posters are in PDF format that can be shared. Jump start your CERT education today with these materials.


May 19, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

Revised:


May 18, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, May 18, 2017

View this edition as a PDF

News & Announcements

Clinical Laboratories: Lab Data Due May 30
SNF Quality Reporting Program: Submission Deadline Extended to June 1
National Mental Health Awareness Month 2017

Provider Compliance

Reporting Changes in Ownership

Claims, Pricers & Codes

2018 ICD-10-PCS Files Available

Upcoming Events

Quality Payment Program Participation Criteria Webinar — May 22
National Partnership to Improve Dementia Care and QAPI Call — June 15

Medicare Learning Network Publications & Multimedia

Updated Manual Guidelines for Electronic Funds Transfer Payments and Change of Ownership MLN Matters Article — New
Prohibition on Billing Dually Eligible Individuals Enrolled in the QMB Program MLN Matters Article — Revised
Avoiding Medicare Fraud & Abuse: A Roadmap for Physicians Web-Based Training Course — Reminder

The following JH Draft Local Coverage Determinations (LCDs) have been posted for comment. The comment period will end on July 6, 2017.

Submit Comments


Registration Available for June 1, 2017 Open Meeting and Draft LCDs Now Posted

Registration for the Thursday, June 1, 2017 Open Meeting is now available. Registration will be closed at 3:00PM Eastern Time (ET) on Tuesday, May 30, 2017. Novitas Solutions’ draft LCDs are also now posted. IMPORTANT: The Open Meeting will be held at Novitas Solutions, 2020 Technology Parkway, Mechanicsburg, PA 17050 at 10:00AM ET. Due to limited room capacity, registered presenters will be given priority for seating and registered observers will be accepted until remaining seats are filled.

The Novitas Solutions Open Meeting is a combined meeting for both Medicare Administrative Contractor (MAC) Jurisdiction H (JH) and MAC Jurisdiction L (JL) contract areas.

Open Meetings are for the purpose of discussing draft Local Coverage Determinations (LCDs). Anyone is welcome to present information related to the draft policies that are in the 45-day draft comment period. Interested participants may request to present scientific, evidence-based information; professional consensus opinions; or any other information that is relevant to any of the LCDs that are in draft. These in-person presentations are made to the Novitas Solutions’ Contractor Medical Directors. Interested parties may also request to attend as an observer.

NOTE: The Open Meeting is not a forum for discussing specific claims; or for the submission of new drugs, indications, or marketing of forthcoming drugs or medical devices. Information regarding new drugs, indications, or marketing information should be submitted according to Novitas guidelines. Specific claim questions, including billing, pricing and coding, should be directed to our Customer Service Center at 1-855-252-8782.


Part A Open Issues Log Update

The error that occurred within the NPI Crosswalk file has been identified and corrected. Any claims currently being held will be released for processing.

PROVIDER ACTION NEEDED: Impacted claims on the Returned to Provider (RTP) file with reason codes 32103 or 32104, will need to be resubmitted (F9). Claims submitted via Direct Data Entry (DDE) on May 16, 2017, or May 17, 2017, may not be available to view in the Claims Corrections option RTP file, if they are not present, please rebill as a new submission for processing.


Part A Top Inquiries Frequently Asked Questions (FAQs)

The Part A Top Inquiries FAQs have been reviewed for April 2017. New questions/answers have been added to the Claim Denials and General Information categories. Please take time to review these and other FAQs for answers to your questions.


New Medicare Insights Podcast

In this Medicare Insights Podcast episode, we invite you to join us for one of our 2017 Medicare Symposiums.


Medicare Learning Network® MLN Matters® Articles from CMS

Revised:


May 17, 2017

Part A Open Issues Log

An error has occurred with the National Provider Identifier (NPI) Crosswalk file in the Fiscal Intermediary Shared System (FISS) on May 16, 2017. Claims are on the Return to Provider (RTP) file with reason code 32103 or 32104. The reason codes 32103 and 32104 will be set to suspend to status location SMNPIC until the issue is resolved. Any claims that may incorrectly RTP due to this issue will be identified and corrected. We will provide additional information as it becomes available.


Medicare Learning Network® MLN Matters® Articles from CMS

New:


May 16, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:


Part A Open Issues Log Update

The claims for the seasonal Influenza Virus Vaccine and Pneumococcal Vaccine Healthcare Common Procedure Coding System (HCPCS) that were not receiving reimbursement or coinsurance may have been incorrectly applied have been identified and adjusted.


May 15, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Revised:


Registration for June 1, 2017 Open Meeting

Registration for the June 1, 2017 Open Meeting will be available starting on Thursday, May 18, 2017 and will be closed at 3:00PM Eastern Time (ET) on Tuesday, May 30, 2017. Novitas Solutions’ draft LCDs will be posted on May 18, 2017. IMPORTANT: The Open Meeting will be held at Novitas Solutions, 2020 Technology Parkway, Mechanicsburg, PA 17050 at 10:00AM ET. Due to limited room capacity, registered presenters will be given priority for seating and registered observers will be accepted until remaining seats are filled.

If you are interested in becoming a participant as a presenter or observer, please view our Draft Local Coverage Determination Open Meetings page for specific guidelines and other helpful information.


May 11, 2017

CMS Provider Education Message:

MLN Connects® for Thursday May 11, 2017

View this edition as a PDF

News & Announcements

Open Payments Program Year 2016 Review and Dispute Period Ends May 15
2018 Medicare Shared Savings Program: Submit Notice of Intent to Apply by May 31
Lookup Tool to Help Determine MIPS Participation Status
Updated CY 2018 eCQM Specifications Available
New PEPPERs Available for Hospices, SNFs, IRFs, IPFs, CAHs, LTCHs
Requesting Appeal Redeterminations
National Women’s Health Week Kicks off on Mother’s Day

Provider Compliance

CMS Provider Minute Video: Coudé Tip Catheters

Medicare Learning Network Publications & Multimedia

Global Surgery Call: Audio Recording and Transcript — New
Emergency Preparedness Call: Audio Recording and Transcript — New
Resources for Medicare Beneficiaries Booklet — Revised
SNF Billing Reference Booklet — Revised
Dual Eligible Beneficiaries under Medicare and Medicaid Booklet — Revised

The following JH Local Coverage Determinations (LCDs) have been revised:

The following JH Local Coverage Articles have been revised:


Update Part A Open Issues Log

The claims that were held for reason codes 31728 and 31729 in status location SM9698 have been released for processing.


May 9, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

Revised:


May 8, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:


May 5, 2017

April 2017 Part A Newsletter

The April 2017 Part A Newsletter is now available. Please take a moment to review.


May 4, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, May 4, 2017

View this edition as a PDF

News & Announcements

DMEPOS Revised Blended Fee Schedule Amounts
TEP on SNF QRP Development and Maintenance of Quality Measures: Nominations due May 12
2018 Medicare Shared Savings Program: Submit Notice of Intent to Apply by May 31
MIPS: Submit Measures for the Advancing Care Information Performance Category by June 30
Hospice Item Set V2.00.0 Receives OMB Approval
EHR Incentive Programs: Review 2017 Program Requirements
Hand Hygiene Day is May 5

Provider Compliance

Cochlear Devices Replaced Without Cost: Bill Correctly

Upcoming Events

MIPS Group Reporting 101 Webinar — May 11

Medicare Learning Network Publications & Multimedia

Medicare Shared Savings Program Call: Audio Recording and Transcript — New
Medicare Fraud & Abuse: Prevention, Detection, and Reporting Web-Based Training Course — Revised
Medicare Ambulance Transports Booklet — Revised
Looking for the Latest National Medicare Policy Information?

The following JH Local Coverage Determinations (LCDs) have been revised:

The following JH Local Coverage Determination (LCD) which was posted for notice on March 16, 2017 is now effective:


Part A Top Claims Submission/Reason Code Errors

The Top Claim Submission/Reason Code Errors and resolutions for April 2017 are now available. Please take time to review these errors and avoid them on future claims.


Medicare Learning Network® MLN Matters® Articles from CMS

New:


May 3, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

Revised:


May 2, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Revised:

Rescinded:


May 1, 2017

Present on Admission Indicators

The Present on Admission Indicators article has been added to the Claims page of our website. Please take a moment to review.


April 28, 2017

Special Edition – Friday, April 28, 2017

In This Edition:

1. Skilled Nursing Facilities: Proposed FY 2018 Payment and Policy Changes
2. Inpatient Rehabilitation Facilities: Proposed FY 2018 Payment and Policy Changes
3. Medicare Hospice Benefit: Proposed FY 2018 Updates to the Wage Index and Payment Rates

Skilled Nursing Facilities: Proposed FY 2018 Payment and Policy Changes

CMS issued a proposed rule (CMS-1679-P) outlining proposed FY 2018 Medicare payment rates and quality programs for Skilled Nursing Facilities (SNFs). Additionally, CMS released an Advance Notice of Proposed Rulemaking (CMS-1686-ANPRM), which solicits comment on potential revisions to the SNF payment system, based on research conducted under the SNF Payment Models Research project.

Proposed Rule Details:

Changes to payment rates under the SNF Prospective Payment System (PPS)
SNF Quality Reporting Program
SNF Value-Based Purchasing (VBP) Program  
End-Stage Renal Disease Quality Incentive Program
Request for Information
Survey team composition

For More Information:

Proposed Rule: CMS will accept comments until June 26
Advanced Notice of Proposed Rulemaking: CMS will accept comments until June 26
SNF PPS website
SNF QRP website

See the full text of this excerpted CMS Fact Sheet (issued April 27).

 Inpatient Rehabilitation Facilities: Proposed FY 2018 Payment and Policy Changes 

CMS issued a proposed rule (CMS-1671-P) outlining proposed FY 2018 Medicare payment policies and rates for the Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) and the IRF Quality Reporting Program (QRP). In addition to the proposed rule, CMS is releasing a Request for Information to welcome continued feedback on the Medicare Program.  

Proposed Rule Details:

Proposed updates to IRF payment rates
Proposed removal of 25 percent payment penalty for late transmissions of the IRF- Patient Assessment Instrument
Proposed refinements to the 60 percent rule presumptive methodology
Solicitation of comments regarding the criteria used to classify facilities for payment under the IRF PPS
Proposed technical IRF process revisions
Proposed changes to the IRF QRP

For More Information:

Proposed Rule: CMS will accept comments until June 26

See the full text of this excerpted CMS Fact Sheet (issued April 27).

 Medicare Hospice Benefit: Proposed FY 2018 Updates to the Wage Index and Payment Rates

CMS issued a proposed rule (CMS-1675-P) that would update FY 2018 Medicare payment rates and the wage index for hospices serving Medicare beneficiaries and releases Request for Information within the proposed rule. This proposed rule would update the hospice wage index, payment rates, and cap amount for FY 2018.

Proposed Rule Details:

Routine annual rate setting changes
Discussion and solicitation of comments regarding sources of clinical information for certifying terminal illness
Hospice CAHPS® Experience of Care Survey
Quality measure concepts under consideration for future years
New data collection mechanisms under consideration: Hospice Evaluation & Assessment Reporting Tool (HEART) 
Public reporting

For More Information:

Proposed rule: CMS will accept comments until June 26

See the full text of this excerpted CMS Fact Sheet (issued April 27).


April 27, 2017

CMS Provider Education Message:

News & Announcements

Clinicians: MIPS Participation Status Letter
Open Payments Program Year 2016 Review and Dispute Period Ends May 15
EHR Incentive Programs: Submit Comments on Proposed Changes by June 13
IMPACT Act Data Elements Public Comments Due June 26
IRF Quality Reporting Program Review and Correct Reports Available
Quality Payment Program: New Videos for Small, Rural, and Underserved Practices
EHR Incentive Programs: Public Health Agency and Clinical Data Registry Reporting
Updated Advance Beneficiary Notice
Antipsychotic Drug use in Nursing Homes: Trend Update
April is STD Awareness Month: Talk, Test, Treat

Provider Compliance

Hospice Election Statements Lack Required Information or Have Other Vulnerabilities

Upcoming Events

IRF, LTCH, SNF QRP Review and Correct Reports Provider Training Webcast — May 2
Comparative Billing Report on Transitional Care Management Webinar — June 21

Claims, Pricers & Codes

Hospitals and SNFs: Claims Hold Related to VA Claims
Medicare Learning Network Publications & Multimedia
Next Generation ACO – All Inclusive Population Based Payment Implementation MLN Matters Article — New
Open Payments Call: Audio Recording and Transcript — New
Medicare Home Health Benefit Web-Based Training Course — Revised
Diagnosis Coding: Using the ICD-10-CM Web-Based Training Course — Revised
Guidelines for Teaching Physicians, Interns, and Residents Fact Sheet — Revised
PECOS FAQs Booklet — Reminder

The following JH LCD has been revised and placed on hold and will not become effective May 4, 2017. Please continue to watch our website for updates:


Part A Open Issues Log

With CR9818, April 1, 2017, reason code 31442 was updated to ensure that the Condition Code 26 and Value Code 42 are billed on the same claim. The reason code is only supposed to apply on inpatient claims, Type of Bill (TOB) 11x, 18x or 21x. The reason code is assigning in error on outpatient claims and Returning to Provider (RTP).

This reason code is now set to suspend to status location SM9818 until the correction is installed. Any outpatient claims that were incorrectly RTP may be resubmitted (or F9) by the provider so the claims can be held until the correction is installed.

Inpatient claims should RTP when not billed correctly. Any inpatient claims that are held in SM9818 will be RTP when released per MM9818.


Medicare Learning Network® MLN Matters® Articles from CMS

Revised:


April 25, 2017

Part A Open Issues Log  - Update to Issue for RC 31728-31729

Update for the claims receiving 31728 or 31729: These reason codes are now set to suspend to status location SM9698 until the correction is installed on May 8, 2017. If any claims were incorrectly processed with these reason codes, providers can submit adjustments to have the claims suspended until the fix or wait until after the fix is installed to adjust claims.

As a reminder, when submitting an adjustment via Direct Data Entry (DDE) for this type of line item denial, you must delete and rekey the line item. Please refer to our instruction for Deleting a Claim Line.


April 24, 2017

Adjusting Claims for Integrated Outpatient Code Editor Logic and File Content Errors on Outpatient Prospective Payment System Claims  

Reported logic and file content errors with Outpatient PPS services updates contained in the January 2017 Integrated Outpatient Code Editor (I/OCE) Specifications, Version 18.0. For more details, please review our article.


Part A Top Inquiries Frequently Asked Questions (FAQs)

Our Part A Top Inquiries FAQs have been reviewed for March 2017. New questions/answers have been added to the categories below. Please take time to review these and other FAQs for answers to your questions.

Appeals
Claim Denials
General Information
Return to Provider 

April 21, 2017

Open Issues Log

Update to the issue for certain seasonal Influenza Virus Vaccine and Pneumococcal Vaccine Healthcare Common Procedure Coding System (HCPCS) that were not receiving reimbursement or coinsurance was incorrectly being applied. All research has been completed and we are now ready to initiate the adjustments. We will post additional information when the adjustments are all initiated.  


Medicare Learning Network® MLN Matters® Articles from CMS

New:


April 20, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, April 20, 2017
View this edition as a PDF

News & Announcements

2018 Medicare Shared Savings Program: Submit Notice of Intent to Apply May 1 through 31
IRF/LTCH/SNF QRP Data Due May 15
Rural Community Hospital Demonstration: Submit Applications by May 17
New Quality Payment Program Resources Available
Revised CMS-588: Electronic Funds Transfer Authorization Agreement
SNF QRP Quick Reference Guide Now Available
Beneficiary Notice Initiative: New Email Address for Questions
April is National Minority Health Month

Provider Compliance

Psychiatry and Psychotherapy CMS Provider Minute Video

Upcoming Events

Global Surgery: Required Data Reporting for Post-Operative Care Call — April 25
Emergency Preparedness Requirements Final Rule Training Call — April 27
IRF, LTCH, SNF QRP Review and Correct Reports Provider Training Webcast — May 2

Medicare Learning Network Publications & Multimedia

Medicare Shared Savings Program Call: Audio Recording and Transcript — New
Provider Compliance Products Fact Sheet — Revised
Provider Compliance Tips for Spinal Orthoses Fact Sheet — Revised
SNF Billing Reference Booklet — Revised

April 18, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:


Frequently Asked Questions (FAQs)

Have questions and not sure where to turn? Check out our FAQs for answers to your questions.


Are You Ready for the Social Security Number Removal Initiative? 

We have created an article to help you prepare for the upcoming changes to the Medicare beneficiary's Health Insurance Claim Number.


April 13, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, April 13, 2017

View this edition as a PDF

News & Announcements

Accountable Health Communities Model: CMS Selects 32 Participants
Mapping Medicare Disparities Tool: Identify Disparities in Chronic Disease
Questions about Medicare Enrollment Revalidation?
Administrative Simplification: New Fact Sheet and Infographic
National Healthcare Decisions Day is April 16

Provider Compliance

Billing for Ambulance Transports

Claims, Pricers & Codes

April 2017 OPPS Pricer File

Upcoming Events

Medicare Shared Savings Program ACO: Completing the 2018 Application Process Call — April 19
Global Surgery: Required Data Reporting for Post-Operative Care Call — April 25
Emergency Preparedness Requirements Final Rule Training Call — April 27
IRF, LTCH, SNF QRP Review and Correct Reports Provider Training Webcast — May 2

 Medicare Learning Network Publications & Multimedia

April 2017 Catalog Available
Quality Payment Program in 2017: Pick Your Pace Web-Based Training Course — New
2017 Medicare Part C and Part D Reporting Requirements and Data Validation Web-Based Training Course — New
Medicare Quarterly Provider Compliance Newsletter [Volume 7, Issue 3] Educational Tool — New
IMPACT Act Call: Audio Recording and Transcript — New
Educational Resources to Assist Chiropractors with Medicare Billing MLN Matters Article — Revised
Home Health Prospective Payment System Booklet — Revised

The following JH Local Coverage Determinations have been revised:

The following JH Local Coverage Articles have been revised:


Open Issues Log

CR9698

April 1, 2017, reason codes 31728 and 31729 were updated to include the new Current Procedural Terminology (CPT) codes 97161-97168 for therapy evaluation and reevaluations. These reason codes are assigning in error when two or more evaluation codes are billed for the same date of service for different disciplines. The reason codes assign as denials on the line level. 

A correction has been created and is tentatively scheduled to be installed on May 8, 2017. When the correction is installed, claims will be able to be corrected. We will post additional information when it is available.

CR9818

April 1, 2017, reason code 31442 was updated to ensure that the Condition Code 26 and Value Code 42 are billed on the same claim. The reason code is only supposed to apply on inpatient claims, Type of Bill (TOB) 11x, 18x or 21x. The reason code is assigning in error on outpatient claims and Returning to Provider (RTP).

A correction has been created and is tentatively scheduled to be installed on May 22, 2017. When the correction is installed, claims will be able to be corrected. We will post additional information when it is available.


New Medicare Insights Podcast now available

In this Medicare Insights Weekly Podcast, we review our mailing list and all it has to offer.


April 11, 2017

Supporting Documentation for Federally Qualified Health Centers - Form CMS-855A

We have recently seen an increase in development on supporting documentation for Federally Qualified Health Centers (FQHCs) when enrolling.

Including copies of the proper supporting documents with your CMS-855A application will ensure accurate and timely processing of your enrollment applications by allowing us to verify and process crucial information required to determine your eligibility to enroll in the Medicare program.

To avoid processing delays please refer to the complete article in our Enrollment Center.


Medicare Learning Network® MLN Matters® Articles from CMS

New:

Revised:


April 10, 2017

Part A Top Claims Submission/Reason Code Errors

The Top Claim Submission/Reason Code Errors and resolutions for March 2017 are now available. Please take time to review these errors and avoid them on future claims.


April 7, 2017

March 2017 Part A Newsletter

The March 2017 Part A Newsletter is now available. Please take a moment to review.


April 6, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, April 6, 2017

View this edition as a PDF

News & Announcements

Clinical Laboratory Data Reporting: Enforcement Discretion
Open Payments Program Year 2016 Review and Dispute Period Ends May 15
MIPS Group Web Interface and CAHPS Reporting: Registration Period Open through June 30
Home Health and LTCH Quality Reporting Program Review and Correct Reports Available
2018 Medicare Shared Savings Program: Notice of Intent to Apply Guidance Document Available
April Quarterly Provider Update Available
Help Prevent Alcohol Misuse or Abuse

Provider Compliance

Lumbar Spinal Fusion CMS Provider Minute Video

Claims, Pricers & Codes

Home Health Services Pre-Claim Review Demonstration Pause

Upcoming Events

Open Payments: Prepare to Review Reported Data Call — April 13
Medicare Shared Savings Program ACO: Completing the 2018 Application Process Call — April 19
Global Surgery: Required Data Reporting for Post-Operative Care Call — April 25
Emergency Preparedness Requirements Final Rule Training Call — April 27
Hospice Quality Reporting Program: Public Reporting Webinar — April 27

Medicare Learning Network Publications & Multimedia

Denial of Home Health Payments When Required Patient Assessment Is Not Received: Additional Information MLN Matters® Article — New
SNF Value-Based Purchasing Call: Audio Recording and Transcript — New
Dementia Care Call: Audio Recording and Transcript — New
Reading an Institutional RA Booklet — Revised
PECOS for Physicians and Non-Physician Practitioners Booklet — Reminder

April 5, 2017

CMS Provider Education Message:

Home Health Services Pre-Claim Review Demonstration Pause

As of April 1, 2017, the Pre-Claim Review demonstration for home health services is paused in Illinois and didn’t expand to Florida.  We will process claims under normal processing rules. The Centers for Medicare & Medicaid Services will notify providers at least 30 days in advance of further developments related to the demonstration. For more information, see the Pre-Claim Review Demonstration webpage and FAQs


Film Mammography Services

Due to existing logic in the Fiscal Intermediary Standard System, claims for G0202, G0204, or G0206, with dates of service on or after January 1, 2017, submitted by providers certified to perform film mammography services, were incorrectly returned with reason code 36428. For details, please review our article.


March 31, 2017

2017 Novitas Solutions Medicare Symposium

Novitas Solutions invites you to join us at our annual Medicare educational in-person event, 2017 Novitas Solutions Medicare Symposium.  This event is for Part A and Part B Medicare providers, and their billing and compliance representatives.  Classes will highlight the tools and information you need to avoid billing pitfalls and remain complaint with the Medicare program.   Spend the day with us or attend as many classes that interest you.  We look forward to seeing you at this FREE event.


March 30, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, March 30, 2017

View this edition as a PDF

News & Announcements

MIPS Annual Call for Measures and Activities through June 30
CMS Voluntary Self-Referral Disclosure Protocol: New Form

Provider Compliance

Billing For Stem Cell Transplants

Upcoming Events

MIPS Cost Measure Development Listening Session — April 5
Medicare Shared Savings Program ACO: Preparing to Apply for the 2018 Program Year Call — April 6
Open Payments: Prepare to Review Reported Data Call — April 13
Medicare Shared Savings Program ACO: Completing the 2018 Application Process Call — April 19
Global Surgery: Required Data Reporting for Post-Operative Care Call — April 25
Emergency Preparedness Requirements Final Rule Training Call — April 27

Medicare Learning Network Publications & Multimedia

NPI: What You Need to Know Booklet — New
IRF-PAI Call: Video Presentation — New
ESRD QIP Call: Follow-up Questions and Answers — New
SNF Consolidated Billing Web-Based Training Course — Revised
Remittance Advice Resources and FAQs Fact Sheet — Revised
Reading a Professional Remittance Advice Booklet— Revised
Medicare Home Health Benefit Booklet — Revised
MLN Learning Management System FAQs Booklet — Revised
Medicare Enrollment for Physicians and Other Part B Suppliers Booklet — Reminder
Medicare Enrollment for Institutional Providers Booklet — Reminder
Safeguard Your Identity and Privacy Using PECOS Booklet — Reminder

Part A Open Issues Log

Effective for claims with a receipt date on/after April 1, 2017, new Fiscal Intermediary Shared System (FISS) editing was implemented with CR9681 to make Modifications to the National Coordination of Benefits Agreement Crossover Process.

Reason code 36190 was established to prevent duplicate hospital day counts (e.g. more than one value code 80, 81, 82 or 83). If duplicate value codes are submitted, the claim will Return to Provider (RTP).

Reason code 34961 was established to prevent reporting of Present of Admission (POA) indicators on outpatient claims. The POA indicators should only be included on Type of Bill (TOB) 11x, 18x, 21x or 41x. If POA is submitted on any other TOB, the claim will Return to Provider (RTP).

Provider billing staff and billing vendors should be aware of MM9681. Any contractor initiated adjustment claims will be corrected by Novitas. Provider initiated adjustments, TOB xx7, xx8 or xxQ, must be corrected by the provider, before the adjustments are submitted. Any provider initiated adjustments submitted with invalid information will RTP. Any newly submitted claims with receipt dates on/after April 1, 2017, must be submitted according to the guidance provided in MM9681.


March 29, 2017

Cardiac and Pulmonary Rehabilitation Programs 

Medicare pays for Cardiac Rehabilitation (CR), Intensive Cardiac Rehabilitation (ICR), and Pulmonary Rehabilitation (PR) programs if specific criteria are met. This criterion includes coverage provisions for CR, ICR, and PR items and services, physician standards, required components, and limitations to the sessions that may be covered. Please review the Cardiac and Pulmonary Rehabilitation Programs article on our website for further details.


March 28, 2017

Provider Specialties/Services

We are pleased to announce the addition of Preventive Services to the Part A Provider Specialties/Services page of our website.


March 27, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

Revised:


March 23, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, March 23, 2017

View this edition as a PDF

News & Announcements

Connected Care: New Educational Initiative to Raise Awareness of Chronic Care Management
Quality Payment Program: New Materials
IRF and LTCH Compare Quarterly Refresh

Provider Compliance

Preventive Services CMS Provider Minute Video

Upcoming Events

IMPACT Act: Standardized Patient Assessment Data Activities Call — March 29
Medicare Shared Savings Program ACO: Preparing to Apply for the 2018 Program Year Call — April 6
Open Payments: Prepare to Review Reported Data Call — April 13
Medicare Shared Savings Program ACO: Completing the 2018 Application Process Call — April 19

Medicare Learning Network Publications & Multimedia

Provider Enrollment Revalidation: Cycle 2 MLN Matters® Article — Revised
Medicare-Required SNF PPS Assessments Educational Tool — Revised
Items and Services Not Covered under Medicare Booklet — Revised

March 22, 2017

Part A Top Inquiries Frequently Asked Questions (FAQs)

Our Part A Top Inquiries FAQs have been reviewed for February 2017. Please take time to review these and other FAQs for answers to your questions.


March 21, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:


March 20, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

Rescinded:


March 16, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, March 16, 2017

View this edition as a PDF

News & Announcements

Revised CMS-855O Application: Enrollment Solely to Order, Certify, or Prescribe
Comparative Billing Report on Sudomotor Function Testing in April
IRF and LTCH QRP Preview Reports Available: Review by March 30
Improve Health during National Nutrition Month®

Provider Compliance

Inpatient Skilled Nursing Facility Denials

Claims, Pricers & Codes

Chronic Care Management Payment Correction for RHCs and FQHCs

Upcoming Events

National Partnership to Improve Dementia Care and QAPI Call — March 21
Medicare ACO Track 1+ Model Webinar — March 22
DMEPOS Adjusted Fee Methodology for Non-Bid Areas: Stakeholder Input on Section 16008 of the 21st Century Cures Act Call — March 23
IMPACT Act: Standardized Patient Assessment Data Activities Call — March 29
Medicare Shared Savings Program ACO: Preparing to Apply for the 2018 Program Year Call — April 6
Open Payments: Prepare to Review Reported Data Call — April 13
Medicare Shared Savings Program ACO: Completing the 2018 Application Process Call — April 19
Comparative Billing Report Webinar on Sudomotor-Function Testing — May 10

Medicare Learning Network Publications & Multimedia

Rural Health Clinic Fact Sheet — Revised

The following JH Local Coverage Determinations have been revised:

The following JH Local Coverage Article has been revised:

The following JH Local Coverage Determination (LCD) posted for notice on December 8, 2016 became effective February 1, 2017:

The following JH LCD has been retired effective January 31, 2017:

The following JH LCD has been retired effective February 1, 2017:

The following JH Draft Local Coverage Determinations (LCDs) posted for comment on September 15, 2016 and presented at the October 2016 Contractor Advisory Committee (CAC) Meeting have been posted for notice. They will become effective May 4, 2017:


Part A Open Issues Log Update

Update to the issue for Certain seasonal Influenza Virus Vaccine and Pneumococcal Vaccine Healthcare Common Procedure Coding System (HCPCS) are not receiving reimbursement or coinsurance is incorrectly being applied. Update 3/16/17: We are still working on resolving issues with the administration codes, specifically HCPCS 90471, which in some cases is still applying coinsurance or deductible. We have resolved the issues with the vaccine codes and those should be processing appropriately. We still plan on reprocessing impacted claims when the issues with the HCPCS 90471 are resolved. In the meantime, providers are able to submit adjustment claims where reimbursement was not received if they choose not to wait for the mass adjustment.


2017 April Calendar of Events Is Now Available For Review

The 2017 April Calendar of Events is currently available for your viewing pleasure. Visit the Education and Training page of our website for additional information and registration opportunities


Medicare Learning Network® MLN Matters® Articles from CMS

New:

Revised:


Instructions to Hospitals on the Election of a Medicare SSI Component of the DSH Payment Adjustment for Cost Reports that Involve SSI Ratios for FY 2004 and Earlier

On February 1, 2017 Novitas updated novitas-solutions.com to include Instructions to Hospitals on the Election of a Medicare-Supplemental Security Income (SSI) Component of the Disproportionate Share (DSH) Payment Adjustment for Cost Reports that Involve SSI Ratios for Fiscal Year (FY) 2004 and Earlier, or SSI Ratios for Hospital Cost-Reporting Periods for Patient Discharges Occurring Before October 1, 2004. This news update is to identify the easiest way for hospitals to submit their elections. 

Electronic submission:


Hard copy submission
:


Christopher Smith
Novitas Solutions
Union Trust Building
501 Grant Street
Suite 600
Pittsburgh, PA  15219

March 14, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:


March 13, 2017

Rural Health Clinic Claims Missing Modifier CG

Novitas has identified an increased number of Rural Health Clinic (RHC) claims being returned with reason code 39910 because they do not include modifier CG appended to the clinic visits. Please review our article New RHC Reporting Requirement – Modifier CG, verify your billing and correct/resubmit your claims as appropriate.


Medicare Learning Network® MLN Matters® Articles from CMS

New:


March 10, 2017

The comment period is now closed for the JH Draft Local Coverage Determinations (LCDs) listed below. Comments received will be reviewed by our Contractor Medical Directors and a summary comment and response document will be posted to our website when the final LCDs are posted for notice.


March 9, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, March 9, 2017

View this edition as a PDF

News & Announcements

Social Security Number Removal Initiative: New Details
Clinical Laboratories: Report Lab Data through March 31
New Release of PEPPER for Short-term Acute Care Hospitals
Hospice Quality Reporting Program: Rerun Your Quality Measure Reports
LTCHs: Exceptions to Moratorium on Increasing Beds
Therapeutic Continuous Glucose Monitors Classified as Durable Medical Equipment
Influenza Activity Continues: Are Your Patients Protected?

Provider Compliance

Chiropractic Services: High Improper Payment Rate within Medicare FFS Part B

Claims, Pricers & Codes

April 2017 Average Sales Price Files Available

Upcoming Events

SNF VBP: Understanding Your Facility's Confidential Feedback Report Call — March 15
National Partnership to Improve Dementia Care and QAPI Call — March 21
Medicare Diabetes Prevention Program Expanded Model Webinar — March 22
Medicare ACO Track 1+ Model Webinar — March 22
DMEPOS Adjusted Fee Methodology for Non-Bid Areas: Stakeholder Input on Section 16008 of the 21st Century Cures Act Call — March 23
IMPACT Act: Standardized Patient Assessment Data Activities Call — March 29
Open Payments: Prepare to Review Reported Data Call — April 13

Medicare Learning Network Publications & Multimedia

Medicare Enrollment Resources Educational Tool — New
Chronic Care Management Services Call: Audio Recording and Transcript — New
IMPACT Act Call: Audio Recording and Transcript — New
Suite of Products & Resources Educational Tools — Revised
Federally Qualified Health Center Fact Sheet — Revised
PECOS for DMEPOS Suppliers Fact Sheet — Revised
PECOS Technical Assistance Contact Information Fact Sheet — Reminder
Advance Care Planning Fact Sheet — Reminder

Medicare Learning Network® MLN Matters® Articles from CMS

Revised:


Knowing How and When to Cancel a Claim 

There may be times when you need to cancel a claim. Please make sure you follow the steps to successfully cancel your claim.  For more information please review the article at the link above.


March 8, 2017

February 2017 Part A Newsletter

The February 2017 Part A Newsletter is now available. Please take a moment to review.


Part A Top Claims Submission/Reason Code Errors

The Top Claim Submission/Reason Code Errors and resolutions for February 2017 are now available. Please take time to review these errors and avoid them on future claims.


March 7, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:


March 3, 2017

The comment period will close on March 9, 2017 for the following JH Draft Local Coverage Determinations (LCDs):

Submit Comments


March 2, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, March 2, 2017

View this edition as a PDF

News & Announcements

IRF and LTCH QRP Preview Reports Available: Review by March 30
March is National Colorectal Cancer Awareness Month

Provider Compliance

Home Health Care: Proper Certification Required

Upcoming Events

SNF VBP: Understanding Your Facility’s Confidential Feedback Report Call — March 15
National Partnership to Improve Dementia Care and QAPI Call — March 21
Home Health Quality Reporting Program Provider Training — May 3 and 4

Medicare Learning Network Publications & Multimedia

Critical Access Hospital Booklet — Revised
Transitional Care Management Services Fact Sheet — Revised
MREP Software Fact Sheet — Reminder
HIPAA Basics for Providers: Privacy, Security, and Breach Notification Rules Fact Sheet — Reminder
PECOS Technical Assistance Contact Information Fact Sheet — Reminder

March 1, 2017

Medicare Satisfaction Indicator 2016

The 2016 Medicare Satisfaction Indicator (MSI) survey was distributed by the Centers for Medicare and Medicaid Services in May 2016.  Data was collected between May 16, 2016 and June 24, 2016.  Your feedback is valuable to us and Novitas Solutions reviewed all comments received.

Based on your feedback, Novitas Solutions implemented improvements to better service you.  View the Medicare Satisfaction Indicator 2016 article on our website to see a list of our improvements!


The comment period is now closed for the JH Draft Local Coverage Determination (LCD) listed below. Comments received will be reviewed by our Contractor Medical Directors and a summary comment and response document will be posted to our website when the final LCD is posted for notice.


February 28, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:


February 27, 2017

Nebulizer and Inhalation Medication Collaborative Webinar Scheduled for March 8

Join Novitas and CGS Administrators, the DME MAC for Jurisdictions C, in a collaborative webinar focusing on nebulizers and inhalation medication. This webinar is scheduled for March 8, 2017, at 11:30 AM CT. The webinar will be hosted by CGS Provider Outreach and Education representatives and will detail Medicare’s coverage criteria for nebulizers and related inhalation medication. The presentation also includes a section on documentation requirements including medical records, detailed written orders and medication/prescription refills. Staff will be available to answer your questions at the conclusion of the presentation portion of the webinar.

Part A and Part B Providers are encouraged to attend. Register today online.


Medicare Learning Network® MLN Matters® Articles from CMS

New:

Revised:


February 23, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, February 23, 2017

View this edition as a PDF

News & Announcements

CMS Awards Approximately $100 Million to Help Small Practices Succeed in the Quality Payment Program
NHSN Data Submission Deadline for IRF and LTCH QRP: Extended to May 15

Provider Compliance

Reporting Changes in Ownership

Upcoming Events

SNF VBP: Understanding Your Facility’s Confidential Feedback Report Call — March 15
National Partnership to Improve Dementia Care and QAPI Call — March 21
Comparative Billing Report on Physical Therapy Webinar — March 29

Medicare Learning Network Publications & Multimedia

Collecting Data on Sexual Orientation and Gender Identity in Health Care Settings Web-Based Training Course — New
Audio Recordings and Transcripts from Recent Calls — New
Medicare Outpatient Observation Notice Instructions MLN Matters Article — Revised
Acute Care and the IPPS Web-Based Training Course — Revised

Claim Reopening Decision Letters

Effective February 27, 2017, Novitas Solutions will consider a corrected claim reopening notification satisfied with a corrected Remittance Advice.


February 22, 2017

New Medicare Insights Podcast now available

In this Medicare Insights Podcast episode, we discuss modifier JW for discarded drugs.


Medicare Learning Network® MLN Matters® Articles from CMS

New:


February 21, 2017

The comment period will close on February 28, 2017 for the following JH Draft Local Coverage Determination (LCD):

Submit comments


Part A Top Inquiries Frequently Asked Questions (FAQs)

Our Part A Top Inquiries FAQs have been reviewed for January 2017 with new questions added to the Appeals and General Information categories. Please take time to review these and other FAQs for answers to your questions.


February 17, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

Revised:


February 16, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, February 16, 2017

View this edition as a PDF

News & Announcements

Influenza Activity Continues: Are Your Patients Protected?

Upcoming Events

Understanding and Promoting the Value of Chronic Care Management Services Call — February 21
What’s New with Physician Compare Webinar — February 21 and 23
Looking Ahead: The IMPACT Act in 2017 Call — February 23

Medicare Learning Network Publications & Multimedia

Medicare Home Health Benefit Booklet — Revised
Medicare Costs at a Glance: 2017 Educational Tool — Revised
CMS Provider Minute Video: Nasal Endoscopy — Reminder

February 15, 2017

2017 March Calendar of Events is Available

The 2017 March Calendar of Events is now available for your viewing pleasure. Take the time to review the Education and Training page of our website for additional information and registration opportunities.


Medicare Learning Network® MLN Matters® Articles from CMS

New:


February 14, 2017

February 2017 Calendar of Events Update

Join us for February 24, 2017 for the rescheduled webinar session, "Medicare Provider Enrollment Revalidation – Cycle 2." You do not want to miss this session. Visit the Education and Training page of our website for additional information and registration opportunities.


February 13, 2017

CERT Identification Online Tool Updated

The CERT Identification Online Tool has been updated with the most recent claim sampling. You can find this tool on the CERT Center under "interactive Tools". Simply enter the CID number and click the "search CID" button to obtain a status of your CERT sampled claims. Providers can find the CID number assigned to the claim under review on the letter from the CERT Documentation Contractor.


Qualified Independent Contractor Change

Effective February 14, 2017 the Part A Qualified Independent Contractor (QIC) contractor will change to C2C Solutions. This will impact providers in Colorado, New Mexico, Texas, Oklahoma, Arkansas, Louisiana, Mississippi, New Jersey, Delaware, Maryland, Pennsylvania, and Washington DC.

Reconsiderations sent on or after February 14, 2017 should be sent to:

C2C Innovative Solutions, Inc.
QIC Part A East Appeals
P.O. Box 45305
Jacksonville, FL 32232-5305

Any reconsideration requested on or before February 13, 2017, will continue to be processed by the existing Part A East QIC, Maximus Federal Services, Inc. Due to the change there will be a short transition period during which both Maximus and C2C will be issuing decisions.


February 9, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, February 9, 2017

View this edition as a PDF

News & Announcements

Clinical Laboratories: Easier to Report Lab Data

Claims, Pricers & Codes

January 2017 OPPS Pricer File

Upcoming Events

Understanding and Promoting the Value of Chronic Care Management Services Call — February 21
Looking Ahead: The IMPACT Act in 2017 Call — February 23

New Educational Events

Join us February 27, 2017 for the Jurisdiction H Cotiviti – Recovery Auditor for CMS webinar session. For additional information and registration opportunities, visit the Education and Training page of our website.


January 2017 Part A Newsletter

The January 2017 Part A Newsletter is now available! Please take a moment to review.


February 8, 2017

Paper Billers - Know the Advantages of Billing Electronically 

We are seeing an increase in paper claims being submitted. In addition, many of these claims are being returned or rejected, which requires the claim to be resubmitted. Billing electronically will help reduce these issues, saving you time and money, along with many other advantages.


February 7, 2017

Claim Submission for Beneficiaries Enrolled in Medicare Advantage Plans

Medicare has specific guidelines for claims submission for beneficiaries who are enrolled in a Medicare Advantage plan.  For more information read the entire article.


February 6, 2017

Part A Top Claims Submission/Reason Code Errors

The Top Claim Submission/Reason Code Errors and resolutions for January 2017 are now available. Please take time to review these errors and avoid them on future claims.


February 3, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, February  2, 2017
View this edition as a PDF


News & Announcements

Clinical Laboratories: Prepare Now to Report Lab Data through March 31
Updated Clinical Laboratory Fee Schedule Website
Teaching Hospitals Receiving FTE Resident Caps Due to Hospital Closures
February is American Heart Month

Provider Compliance

Hospital Discharge Day Management Services

Upcoming Events

Understanding and Promoting the Value of Chronic Care Management Services Call — February 21
Looking Ahead: The IMPACT Act in 2017 Call — February 23

Medicare Learning Network Publications & Multimedia

Telehealth Services Fact Sheet — Revised
Inpatient Rehabilitation Facility Prospective Payment System Fact Sheet — Revised
Home Oxygen Therapy Booklet — Revised
MLN Suite of Products & Resources for Rural Health Providers Educational Tool — Revised

February 1, 2017

Instructions to Hospitals on the Election of a Medicare-Supplemental Security Income (SSI) Component of the Disproportionate Share (DSH) Payment Adjustment for Cost Reports that Involve SSI Ratios for Fiscal Year (FY) 2004 and Earlier, or SSI Ratios for Hospital Cost-Reporting Periods for Patient Discharges Occurring Before October 1, 2004 - Revised

Change Request (CR) 9896 was revised to correct one of the items required to be reported by the provider in its election request; i.e., FFY Based on CY Begin Date (YYYY) should be FFY Based on CR Begin Date. In addition, a clarifying phrase was added to the third paragraph under the "Realignment" section of the CR. Also, this CR has been changed from a Pub. 100-06 to a Pub. 100-20. All other information remains the same.


January 31, 2017

Fiscal Intermediary Standard System (FISS) Manual 

Due to changes effective January 1, 2017, updates were made to Chapter 2 of the FISS Manual. We added section 2.4d2 'Provider Practice Location Address', and updated section 2.4g to show a new field for 'PIP Pay As Cash'. 


January 25, 2017

New Medicare Insights Podcast now available

In this Medicare Insights Podcast episode, we bring you an informative interview on the Comprehensive Error Rate Testing program.


January 24, 2017

Same Day Transfers

A same day transfer occurs if the beneficiary is admitted to your facility and is expected to stay overnight, but transfers to a different facility. We have provided additional information about Same Day Transfers on our website.


Provider Enrollment Application Fee Amount for Calendar Year (CY) 2017

On November 7, 2016, the Centers for Medicare & Medicaid Services (CMS) issued Provider Enrollment Application Fee Amount for Calendar Year 2017. Effective January 1, 2017, the CY 2017 application Fee is $560 for institutional providers that are:

Initially Enrolling in the Medicare or Medicaid Program or the Children's Health Insurance Program (CHIP);
Revalidating their Medicare, Medicaid, or CHIP enrollment; or
Adding a new Medicare practice location.

This fee is required with any enrollment application submitted from January 1, 2017 through December 31, 2017.


Medicare Learning Network® MLN Matters® Articles from CMS

New:


Novitas has decided to extend the comment period for the following JH Draft Local Coverage Determination (LCD) which was posted for a second comment period on December 8, 2016. The comment period will now end on February 28, 2017.


January 20, 2017

February 2017 Part A Calendar of Events is Now Available!

The February 2017 Part A Calendar of Events is now available for your reviewing pleasure. We have a wide selection of educational topics to choose from this month so visit the Education and Training page of our website for additional information and registration opportunities.  


Changes to the Laboratory National Coverage Determination (NCD) Edit Software

Change Request (CR) 9934 announces changes to NCDs outlined in Publication 100-03, Sections 190.12 – 190.34 for Laboratory Services involving ICD-10 diagnosis editing. These changes will be implemented on April 3, 2017, for dates of service on and after October 1, 2016.

Claims that denied with reason codes in the 5xNCD series with diagnosis codes updated with CR9934 will be adjusted when brought to our attention after April 3, 2017.

Reference: Medicare Learning Network (MLN) Matters Article, MM9934


Part A Top Inquiries Frequently Asked Questions (FAQs)

Our Part A Top Inquiries FAQs have been reviewed for December 2016 with new questions added to the categories listed below. Please take time to review these and other FAQs for answers to your questions.

Appeals
Claim Denials
General Information

January 19, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, January 19, 2017

View this edition as a PDF


News & Announcements

Over 40 Million Medicare Beneficiaries Utilized Free Preventive Services in 2016
Prosthetics and Custom-Fabricated Orthotics Practitioners and Suppliers: Establishment of Special Payment Provisions and Requirements
eCQM Data: Extension of 2016 Reporting Deadline to March 13
EHR Incentive Program: Attest to 2016 Program Requirements by February 28
EHR Incentive Programs: Calculations for Objectives and Measures Requiring Patient Action
CMS Releases ESRD QIP Performance Score Reports for PY 2017
New Care Management Webpage
Provider Enrollment Application Fee Amount for CY 2017
2017 Annual Stationary Oxygen Budget Neutrality Calculations
Glaucoma Awareness Month: Make a Resolution for Healthy Vision

Provider Compliance

Hospice Election Statements Lack Required Information or Have Other Vulnerabilities

Claims, Pricers & Codes

OPPS Hospital Claim Issues

Upcoming Events

Medicare Quality Programs: Transitioning from PQRS to MIPS Call — January 24

Medicare Learning Network Publications & Multimedia

Medicare Quarterly Provider Compliance Newsletter [Volume 7, Issue 2] — New
Medicare Parts C and D General Compliance Web-Based Training Course — Revised
Combating Medicare Parts C and D Fraud, Waste, and Abuse Web-Based Training Course — Revised
Health Care Professional Frequently Used Web Pages Educational Tool — Revised
ICD-9-CM, ICD-10-CM, ICD-10-PCS, CPT, and HCPCS Code Sets Educational Tool — Reminder

The following JH Draft Local Coverage Determinations (LCDs) are posted for comment. The comment period will end on March 9, 2017.

Submit Comments


Ask-the-Contractor 2017 Meeting Dates

The 2017 Ask-the-Contractor meeting dates are now available.  Mark your calendar to join us at the next Ask-the-Contractor meeting.


January 18, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:


December Medicare Part A Newsletter

The December 2016 Medicare Part A Newsletter has been updated to include Change Request (CR) 9896 - Instructions to Hospitals on the Election of a Medicare-Supplemental Security Income (SSI) Component of the Disproportionate Share (DSH) Payment Adjustment for Cost Reports that Involve SSI Ratios for Fiscal Year (FY) 2004 and Earlier, or SSI Ratios for Hospital Cost-Reporting Periods for Patient Discharges Occurring Before October 1, 2004. The revised Newsletter is now available for your review.


Registration for January 26, 2017 Open Meeting

Registration for the January 26, 2017 Open Meeting will be available starting on Thursday, January 19, 2017 and will be closed at 3:00PM Eastern Time (ET) on Tuesday, January 24, 2017. Novitas Solutions’ draft LCDs will be posted on January 19, 2017. IMPORTANT: The Open Meeting will be held at Novitas Solutions, 2020 Technology Parkway, Mechanicsburg, PA 17050 at 2:00PM ET. Due to limited room capacity, registered presenters will be given priority for seating and registered observers will be accepted until remaining seats are filled.

The Novitas Solutions Open Meeting is a combined meeting for both Medicare Administrative Contractor (MAC) Jurisdiction H (JH) and MAC Jurisdiction L (JL) contract areas.

Open Meetings are for the purpose of discussing draft Local Coverage Determinations (LCDs). Anyone is welcome to present information related to the draft policies that are in the 45-day draft comment period. Interested participants may request to present scientific, evidence-based information; professional consensus opinions; or any other information that is relevant to any of the LCDs that are in draft. These in-person presentations are made to the Novitas Solutions’ Contractor Medical Directors. Interested parties may also request to attend as an observer.

NOTE: The Open Meeting is not a forum for discussing specific claims; or for the submission of new drugs, indications, or marketing of forthcoming drugs or medical devices. Information regarding new drugs, indications, or marketing information should be submitted according to Novitas guidelines. Specific claim questions, including billing, pricing and coding, should be directed to our Customer Service Center at 1-855-252-8782.


Medicare Learning Network® MLN Matters® Articles from CMS

New:

Revised:


January 13, 2017

Part A Open Issues Log Update 

Reason code W7099 was corrected with the January 2017 IOCE update. Refer to MM9754 for billing guidance related to this editing. All claims have been released for processing.


January 12, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, January 12, 2017

View this edition as a PDF

News & Announcements

Addressing the Opioid Epidemic: Keeping Medicare and Medicaid Beneficiaries Healthy
Post-Acute Care TOH Quality Measures Pilot Study: Respond by January 17
Clinical Laboratories: Prepare Now to Report Lab Data through March 31
Chronic Care Management Services Changes for 2017
eCQI Resource Center Integrated with USHIK
eCQM Value Sets for 2017 Performance Period: Addendum Available
Medicare Quality Programs: ICD-10 Code Updates and Impact to 4th Quarter 2016
January is Cervical Health Awareness Month

Provider Compliance

CMS Provider Minute: CT Scans Video

Upcoming Events

ESRD QIP: Payment Year 2020 Final Rule Call — January 17
Home Health Groupings Model Technical Report Call — January 18
Home Health Quality of Patient Care Star Rating Call — January 19
Medicare Quality Programs: Transitioning from PQRS to MIPS Call — January 24

Medicare Learning Network Publications & Multimedia

Additional Guidance for Clinical Laboratories as Data Reporting Begins MLN Matters Article — New
Revised CMS 855S Application: DMEPOS Suppliers MLN Matters Article — New
Chronic Care Management Services Changes for 2017 Fact Sheet — New
How to Use the Medicare Coverage Database Booklet — Revised
SNF Prospective Payment System Booklet — Revised
Acute Care Hospital Inpatient Prospective Payment System Booklet — Revised
HH Prospective Payment System Booklet — Revised
IRF Prospective Payment System Fact Sheet — Revised
Chronic Care Management Services Fact Sheet — Revised
Medicare Vision Services Fact Sheet — Revised
Swing Bed Services Fact Sheet — Revised
Mass Immunizers and Roster Billing Fact Sheet — Revised

The following JH Local Coverage Determinations (LCDs) have been revised to reflect the Annual CPT/HCPCS Code updates effective for dates of service on and after January 1, 2017:

The following JH LCDs have been revised:

The following JH Local Coverage Determination has been retired effective December 31, 2016:

The following LCD is currently being reviewed. Revisions will be forthcoming. Please continue to watch our website.

The following JH Local Coverage Articles have been revised to reflect the Annual CPT/HCPCS code updates effective for dates of service on and after January 1, 2017:

The Following JH Local Coverage Articles have been revised:


Frequently Asked Questions (FAQs)

Have questions and not sure where to turn? Check out our FAQs for answers to your questions.


January 2016 Calendar of Events Updates

We've added additional Part A webinar sessions for the month of January. Visit the Education and Training page of the website for additional information and registration opportunities.


January 10, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

Revised:


December 2016 Part A Newsletter

The December 2016 Part A Newsletter is now available! Please take a moment to review.


Part A Top Claims Submission/Reason Code Errors 

The Top Claim Submission/Reason Code Errors and resolutions for December 2016 are now available. Please take time to review these errors and avoid them on future claims.


January 9, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Revised:


January 5, 2017

CMS Provider Education Message:

Editor's Note:

Best wishes for a happy and healthy 2017. Your MLN Connects® Provider eNews has a new name and design for the new year. Let us know what you think. MLN Connects still delivers the weekly Medicare news you expect but with a fresh new style from the Medicare Learning Network® (MLN). 

MLN Connects® for Thursday, January 5, 2017

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News & Announcements

Apply for Clinical Practice Improvement Activities and Measurement Study by January 31
Updated ESRD PPS Website
Comparative Billing Report on Physical Therapy in February
EHR Incentive Programs: New Attestation Resources
Implementation Guide for QRDA-III Eligible Clinician Programs Available
January Quarterly Provider Update Available
Get Your Patients Off to a Healthy Start in 2017

Provider Compliance

Duplicate Claims Will Not be Paid

Claims, Pricers & Codes

Fee Schedule Amounts for Group 3 Power Wheelchair Accessories and Cushions

Upcoming Events

ESRD QIP: Payment Year 2020 Final Rule Call — January 17
Home Health Groupings Model Technical Report Call — January 18
Hospice Quality Reporting Program Provider Training — January 18
Home Health Quality of Patient Care Star Rating Call — January 19
Medicare Quality Programs: Transitioning from PQRS to MIPS Call — January 24

Medicare Learning Network Publications & Multimedia

Quality Payment Program Video Presentation — New
Hospital Settlement Call: Audio Recording and Transcript — New
Medicare Overpayments Fact Sheet — Revised
PECOS for Provider and Supplier Organizations Fact Sheet — Revised
Long-Term Care Hospital Prospective Payment System Booklet — Reminder
Advanced Practice Registered Nurses, Anesthesiologist Assistants, and Physician Assistants Booklet — Reminder

Medicare Learning Network® MLN Matters® Articles from CMS

New:


Section 16001 and 16002 of the 21st Century Cures Act

On December 13, 2016, the 21st Century Cures Act was enacted into law. Sections 16001 and 16002 amended section 1833(t)(21) of the Social Security Act (as added by section 603 of the Bipartisan Budget Act of 2015) and provided additional criteria about which off-campus departments of a provider will be “excepted” from payment under the section 1833(t)(21)(C ) of the Social Security Act.

The mid- build requirement specifies that, before November 2, 2015, the provider had a binding written agreement with an outside unrelated party for the actual construction of the department.

For more information view the full Section 16001 and 16002 of the 21st Century Cures Act bulletin posted to our website.


January 4, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:


January 3, 2017

New Policy on JW Modifier

Effective January 1, 2017, the use of the JW modifier is required for claims with unused drugs or biologicals from single use vials or single use packages that are appropriately discarded. Providers are required to document the discarded drug or biological in the patient's medical record. The JW modifier is only applied to the amount of drug or biological that is discarded. The JW modifier is not required for drugs that are not separately payable, such as packaged Outpatient Prospective Payment System (OPPS) drugs or drugs administered in the Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) setting, or drugs paid under the Part B drug Competitive Acquisition Program (CAP). The JW modifier is not intended for use on claims for hospital inpatient admissions that are billed under the Inpatient Prospective Payment System.

For more information read the entire JW Modifier article.


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Last modified:  11/21/2017