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Medicare News and Web Updates for JH Part A (2018)

September 17, 2018

August 2018 Part A Newsletter

The August 2018 Part A Newsletter is now available. Please take a moment to review.


September 14, 2018

CMS Provider Education Message:

Special Edition – Friday, September 14, 2018

Hurricane Florence and Medicare Disaster Related North Carolina, South Carolina, and the Commonwealth of Virginia Claims MLN Matters Article — New

The President declared a state of emergency for the states of North Carolina, South Carolina, and the Commonwealth of Virginia, 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 Florence and Medicare Disaster Related North Carolina, South Carolina, and the Commonwealth of Virginia 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.


The following JH Local Coverage Determination (LCD) which was posted for notice on July 26, 2018 is now effective:


Medicare Learning Network® MLN Matters® Articles from CMS

New:

On September 10, 2018, pursuant to the Robert T. Stafford Disaster Relief and Emergency Assistance Act, President Trump declared that, as a result of the effects of Hurricane Florence, an emergency exists in North Carolina and South Carolina. On September 11, 2018, President Trump declared an emergency exists in the Commonwealth of Virginia as a result of Hurricane Florence. Also, on September 11, 2018, Secretary Azar of the Department of Health & Human Services declared that a public health emergency exists in North Carolina and South Carolina and authorized waivers and modifications under Section 1135 of the Social Security Act (the Act), retroactive to September 7, 2018, for the State of North Carolina and retroactive to September 8, 2018, for the State of South Carolina. On September 12, Secretary Azar declared a public health emergency exists in the Commonwealth of Virginia, retroactive to September 8, 2018.
On September 13, 2018, the Administrator of the Centers for Medicare & Medicaid Services (CMS) authorized waivers under Section 1812(f) of the Social Security Act for the States of North Carolina, South Carolina, and the Commonwealth of Virginia for those people who are evacuated, transferred, or otherwise dislocated as a result of the effect of Hurricane Florence in 2018.
Under Section 1135 or 1812(f) of the Social Security Act, the CMS has issued several blanket waivers in the impacted geographical areas of the States of North Carolina, South Carolina, and the Commonwealth of Virginia. These waivers will prevent gaps in access to care for beneficiaries impacted by the emergency. Providers do not need to apply for an individual waiver if a blanket waiver has been issued. Providers can request an individual Section 1135 MLN Matters SE18014, if there is no blanket waiver, by following the instructions available at https://www.cms.gov/About-CMS/Agency-Information/Emergency/Downloads/Requesting-an-1135-Waiver-Updated-11-16-2016.pdf.

Revised:

The HCPCS code set is updated on a quarterly basis. CR 10834 informs MACs of the October 2018 addition of new HCPCS codes, Q5108 and Q5110. The codes are payable by Medicare effective with dates of service on or after July 12, 2018, for Q5108 and effective with dates of service on or after October 1, 2018, for Q5110.
The short descriptor for Q5108 is Injection, fulphila, and the long descriptor is Injection, pegfilgrastim-jmdb, biosimilar, (fulphila), 0.5 mg. The Type of Service (TOS) Codes for Q5108 are 1, P.
The short descriptor for Q5110 is Nivestym, and the long descriptor is Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgram. The TOS Codes for Q5110 are 1, P.
The Medicare Physician Fee Schedule Database (MPFSDB) Status Indicator for both codes is E. Note that MACs should hold claims for Q5108 and Q5110 until CR10834 is implemented.

September 13, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, September 13, 2018

View this edition as a PDF

News & Announcements

Help Your Medicare Patients Avoid and Report Scams
Hospice Provider Preview Reports: Review Your Data by October 5
IRF Provider Preview Reports: Review Your Data by October 8
LTCH Provider Preview Reports: Review Your Data by October 8
Open Payments: Key Thresholds for Program Year 2019 Reporting
Open Payments: Program Year 2019 Teaching Hospital List
Hand in Hand: A Training Series for Nursing Homes
Quality Payment Program: Other Payer Advanced APM Resources
Mapping Medicare Disparities Tool: Hospital View
Physician Compare: Public Reporting Webinar Materials
Prostate Cancer Awareness Month

Provider Compliance

Bill Correctly for Device Replacement Procedures - Reminder

Upcoming Events

Dementia Care: Opioid Use & Impact for Persons Living with Dementia Call — September 18
Medicare Diabetes Prevention Program: New Covered Service Call — September 26
Final Modifications to the Quality of Patient Care Star Rating Algorithm Call — October 3
Comparative Billing Report on Psychologists Webinar — October 17

Medicare Learning Network® Publications & Multimedia

Billing Requirements Implemented for non-OPPS Providers MLN Matters® Article — New
Annual Clotting Factor Furnishing Fee: 2019 Update MLN Matters Article — New
ASC Payment System: October 2018 Update MLN Matters Article — New
Influenza Vaccine Payment Allowances: Annual Update MLN Matters Article — New
Influenza Virus Vaccine Code: January 2019 Update MLN Matters Article — Revised
Certification Statement Policies MLN Matters Article — Revised
Telehealth Billing Requirements for Distant Site Services MLN Matters Article — Revised
Complying with Documentation Requirements for Laboratory Services Fact Sheet — Revised
Global Surgery Booklet— Revised
Medicare Provider-Supplier Enrollment National Educational Products — Reminder

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

The following JH Local Coverage Article has been revised:


Medicare Learning Network® MLN Matters® Articles from CMS

Revised:

Change Request (CR) 10859 constitutes a maintenance update of International Classification of Diseases, Tenth Revision (ICD-10) conversions and other coding updates specific to national coverage determinations (NCDs). These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received.
Please follow the link below for the NCD spreadsheets included with this CR: https://www.cms.gov/Medicare/Coverage/DeterminationProcess/downloads/CR10859.zip. Make sure that your billing staffs are aware of these changes.
On September 18, 2017, pursuant to the Robert T. Stafford Disaster Relief and Emergency Assistance Act, President Trump declared that, as a result of the effects of Hurricane Maria, an emergency exists in the United States Virgin Islands and the Commonwealth of Puerto Rico. Also on September 19, 2017, Secretary Price of the Department of Health & Human Services declared that a public health emergency (PHE) exists in the United States Virgin Islands and the Commonwealth of Puerto Rico and authorized waivers and modifications under Section 1135 of the Social Security Act (the Act), retroactive to September 16, 2017, for the United States Virgin Islands and retroactive to September 17, 2017, for the Commonwealth of Puerto Rico.
The PHE declaration and Section 1135 waiver authority for the U.S. Virgin Islands were renewed on December 15, 2017, renewed again on March 15, 2018, June 13, 2018, and again on September 11, 2018. The PHE and Section 1135 waiver authority for Puerto Rico were extended to March 15, 2018, and were extended again on March 16, 2018, to June 13, 2018. The PHE and Section 1135 waiver authority for Puerto Rico expired on June 13, 2018.

September 12, 2018

Coming Soon: Registration for October 4, 2018, Open Meeting

Registration for the October 4, 2018, Open Meeting will be available after 11:00AM Eastern Time (ET) on Thursday, September 20, 2018, and will be closed at 3:00PM ET on Monday, October 1, 2018, or before October 1st if room capacity is filled. Novitas Solutions’ draft LCDs will be posted on September 20, 2018. 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 online registration being opened on September 20th. 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.


Medicare Learning Network® MLN Matters® Articles from CMS

New:

IMRT is a procedure that delivers radiation with adjusted intensity to preserve adjoining normal tissue. IMRT is provided in two treatment phases, planning and delivery. Medicare pays hospitals under the OPPS a bundled payment for the planning phase. The bundled payment covers a range of services that may be performed as part of developing an IMRT treatment plan. The bundled payment covers these services regardless of when they are billed.
This article provides a reminder to hospitals that bill for outpatient IMRT planning services to ensure that they bill correctly and avoid overpayments.

September 10, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

CR 10918 announces the clotting factor furnishing fee for 2019 is $0.220 per unit. Make sure that your billing staffs are aware of the update to the annual clotting factor furnishing fee for 2019.

Revised:

Change Request (CR) 10871 provides instructions for payment and edits for Medicare's Common Working File (CWF) and Fiscal Intermediary Shared System (FISS) to include and update new or existing influenza virus vaccine codes. This update includes one new influenza virus vaccine code: 90689. Please make certain your billing staffs are aware of this update.

September 7, 2018

Part A Open Issues Log Update

Reason Codes W7020, W7040, W7106, W7107, W7108 Update

The workaround for these reason codes will continue until October 1, 2018. With CR10900, the Integrated Outpatient Code Editor (I/OCE) Version 19.3, logic will be corrected within these reason codes to apply to CAH TOB 85x claims. Please make sure your billing staff is aware of the National Correct Coding Initiative (NCCI) Edits, reason codes W7020 and W7040, and NCCI billing. Also be aware of the add-on code NCCI editing with reason codes W7106-W7108. The CMS has published an educational article Special Edition Article SE18012 and Novitas has created a supplemental article, National Correct Coding Initiative (NCCI) Edits Apply to OPPS and Non-OPPS Claims, with additional references for your convenience. These articles will provide you with useful information about NCCI billing practices.

Reason Codes W7020, W7040, 32264 Update

The CMS has published an educational article Special Edition Article SE18012 and Novitas has created a supplemental article, National Correct Coding Initiative (NCCI) Edits Apply to OPPS and Non-OPPS Claims, with additional references for your convenience. These articles will provide you with useful information about NCCI billing practices.


Medicare Learning Network® MLN Matters® Articles from CMS

Revised:

Change Request (CR) implements requirements for billing modifier GT for Telehealth Distant Site Services. As of October 1, 2018, the GT modifier is only allowed on institutional claims billed by a Critical Access Hospital (CAH) Method II. Make sure your billing staffs are aware of this requirement.

September 6, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, September 6, 2018

View this edition as a PDF

News & Announcements

Physician Fee Schedule Year 3 Proposed Rule: Comments due September 10
QRDA III Implementation Guide: Submit Comments by September 21
PEPPERs for Short-term Acute Care Hospitals
Hospice Quality Reporting Program: Training Materials from August Webinar
Healthy Aging® Month: Discuss Preventive Services with your Patients

Provider Compliance

CMS Provider Minute Video: The Importance of Proper Documentation — Reminder

Claims, Pricers & Codes

Average Sales Price Files: October 2018

Upcoming Events

Quality Payment Program All-Payer Combination Option Overview Webinar — September 12
New Medicare Card Open Door Forum — September 13
Dementia Care: Opioid Use & Impact for Persons Living with Dementia Call — September 18
Medicare Diabetes Prevention Program: New Covered Service Call — September 26

Medicare Learning Network® Publications & Multimedia

Review of Opioid Use during the IPPE and AWV MLN Matters® Article — New
Update of the Hospital OPPS: October 2018 MLN Matters Article — New
Physician Fee Schedule Listening Session: Audio Recording and Transcript — New
Next Generation ACO Model 2019 Benefit Enhancement MLN Matters Article — Revised
Mass Immunizers and Roster Billing Booklet — Revised

Medicare Learning Network® MLN Matters® Articles from CMS

Revised:

Change Request (CR) 10845 makes modifications to certain provider enrollment certification statement policies. Specifically, you may upload provider enrollment certification statements using PECOS functionality.
CR10845 makes these modifications via changes to the Medicare Program Integrity Manual, Chapter 15, Section 15.5.14.4. The revised manual section is attached to CR10845. Make sure your billing staff is aware of these changes.

September 5, 2018

Part A Top Claims Submission / Reason Code Errors 

The August 2018 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:

Change Request (CR) 10914 informs MACs about payment allowances for influenza virus vaccines, which are updated on August 1 of each year. The Centers for Medicare & Medicaid Services (CMS) will post the payment allowances for influenza vaccines that are approved after the release of CR 10914. Make sure your billing staffs are aware that the payment allowances are being updated.
This article conveys enforcement editing requirements for the Medicare Claims Processing Manual, Chapter 12, Section 30 which describes Correct Coding Policy, Section D. Coding Services Supplemental to Principal Procedure (Add-On Codes) Code and Chapter 23, Section 20.9 which describes the Correct Coding Initiative. These requirements are not new requirements. Previously, these requirements were discussed in CRs 10504 and 10699, which were effective on April 1, 2018 and July 1, 2018. Make sure your billing staff is aware of these instructions.

September 4, 2018

September is Prostate Cancer Awareness Month 

September is Prostate Cancer Awareness Month. Did you know that the average age at the time of diagnosis is about 66? About one in every 41 men will die of prostate cancer. For more information, please review this article.


National Correct Coding Initiative (NCCI) Edits Apply to OPPS and Non-OPPS Claims

Based on the implementation of the Integrated Outpatient Code Editor (IOCE) specifications from Change Request (CR) 10699, for claims received on or after July 1, 2018, regardless of the date of service, provider types that previously were not subject to NCCI edits '20' (W7020) and '40' (W7040) are now subject to these edits. Review this article for details.


August 30, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, August 30, 2018

View this edition as a PDF

News & Announcements

ACOs Taking Risk in Innovative Payment Model Generate Savings for Patients and Taxpayers
Physician Fee Schedule Year 3 Proposed Rule: Comments due September 10
Call for Panel on 2018 MIPS IA Performance Category — Nominations due September 21
MIPS Targeted Review Request: Deadline October 1
Hospice Public Reporting: Key Dates
2019 eCQM Flows for EPs
Home Health Agencies: 2016 Utilization and Payment Data

Provider Compliance

Provider Minute: Laboratory and Diagnostic Services Billing Video

Claims, Pricers & Codes

Integrated OCE Files for October 2018
Claims for Biosimilar Drug Code Q5108

Upcoming Events

New Medicare Card Open Door Forum — September 13
Dementia Care: Opioid Use & Impact for Persons Living with Dementia Call — September 18
Medicare Diabetes Prevention Program: New Covered Service Call—September 26

Medicare Learning Network® Publications & Multimedia

Next Generation ACO Model 2019 Benefit Enhancement MLN Matters Article — New
Update to Chapter 15: Certification Statement Policies MLN Matters Article — New
HPTCs Code Set Update: October 2018 MLN Matters Article — New
I/OCE Specifications Version 19.3: October 2018 MLN Matters Article — New
Implement Operating Rules - Phase III ERA EFT MLN Matters Article — New
Claim Status Category and Codes Update MLN Matters Article — New
Medicare Billing for Outpatient Physical Therapy Fact Sheet — New
Diabetes Self-Management Training Accrediting Organizations Fact Sheet — New
ESRD Quality Incentive Program Call: Audio Recording and Transcript — New
Medical Privacy of Protected Health Information Fact Sheet — Revised
Diagnosis Coding: Using the ICD-10-CM Web-Based Training Course — Revised
Medicare Enrollment for Physicians, NPPs, and Other Part B Suppliers Booklet — Reminder
Screening Pap Tests and Pelvic Examinations Booklet — Reminder  

New Medicare Insights Podcast

In this Medicare Insights Podcast episode, we invite you to join us for our 2018 Medicare Symposiums.


New Medicare Card Open Door Forum 

The Centers for Medicare & Medicaid Services is hosting an Open Door Forum on the New Medicare Card on Thursday, September 13, 2018 from 2:00 p.m. - 3:00 p.m. Eastern Time. For participation instructions, please read this article.


Medicare Learning Network® MLN Matters® Articles from CMS

Revised:

Change Request (CR) 10824 provides instruction on implementing one new Benefit Enhancement for program year four of the NGACO Model.

August 29, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

CR10923 describes changes to and billing instructions for various payment policies implemented in the October 2018 Outpatient Prospective Payment System (OPPS) update. The October 2018 Integrated Outpatient Code Editor (I/OCE) will reflect the Healthcare Common Procedure Coding System (HCPCS), Ambulatory Payment Classification (APC), HCPCS Modifier, and Revenue Code additions, changes, and deletions identified in CR10923. Make sure your billing staffs are aware of these updates.

August 27, 2018

The September 2018 Calendar of Events is Currently Available

The September 2018 Calendar of Events is now available for your immediate review. Visit the Education page of our website for additional information and registration opportunities.


August 24, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10900 informs MACs about the changes to the Integrated Outpatient Code Editor (I/OCE) instructions and specifications for the Integrated OCE that will be utilized under the Outpatient Prospective Payment System (OPPS) and non-OPPS for hospital outpatient departments, community mental health centers, all non-OPPS providers, and for limited services when provided in a home health agency not under the Home Health Prospective Payment System or to a hospice patient for the treatment of a non-terminal illness. Make sure your billing staffs are aware of these changes.
Change Request (CR) 10845 makes modifications to certain provider enrollment certification statement policies. Specifically, you may upload provider enrollment certification statements using PECOS functionality.
CR10845 makes these modifications via changes to the Medicare Program Integrity Manual, Chapter 15, Section 15.5.14.4. The revised manual section is attached to CR10845. Make sure your billing staff are aware of these changes.
Change Request (CR) 10857 directs MACs to obtain the most recent Healthcare Provider Taxonomy Codes (HPTCs) code set and use it to update their internal HPTC tables and/or reference files. Make sure your billing staffs are aware of these updates.
CR 10904 instructs the MACs and Medicare’s Shared System Maintainers to update their systems based on the CORE 360 Uniform Use of CARC, RARC, and CAGC Rule publication. These system updates are based on the CORE Code Combination List to be published on or about October 1, 2018. Make sure that your billing staff is aware of these changes.
Change Request (CR) 10925 updates, as needed, the Claim Status and Claim Status Category Codes used for the Accredited Standards Committee (ASC) X12 276/277 Health Care Claim Status Request and Response and ASC X12 277 Health Care Claim Acknowledgment transactions. Make sure your billing staffs are aware of these updates.

Part A Open Issues Log Update

Various MSP Reason Codes

Additional issues have been identified related specifically to reason codes U681E and U681L. The correction for U681D did not resolve the issue. Claims receiving these reason codes will be held in status location SM681X until the correction is installed on October 1, 2018.


Fiscal Intermediary Standard System (FISS) Manual

Updates were made to Chapter 3, Claims and Attachments Entry, of the FISS Manual to add a new claim page to report your Provider Practice Location Address. This new claim page must include your practice location address when services billed are rendered in an off-campus, outpatient, or provider-based department of a hospital facility. Please review these updates with your staff and vendors. For more information on Billing Requirements for OPPS Providers with Multiple Service Locations, please review SE18002.


August 23, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, August 23, 2018

View this edition as a PDF

News & Announcements

New Medicare Card: 0 not O
Medicare Diabetes Prevention Program: Become a Medicare Enrolled Supplier
2016 PQRS and 2018 Value Modifier Experience Reports
Patients Over Paperwork: Medicare Physician Fee Schedule Proposed Rule Presentation
2019 MIPS Performance Year Virtual Groups Toolkit
Hospice Compare Quarterly Refresh
2016 Inpatient Hospital Utilization and Payment Data
Hospices: Second Quarter HQRP Update

Provider Compliance

Medicare Hospital Claims: Avoid Coding Errors — Reminder

Claims, Pricers & Codes

2019 MS-DRG Definitions Manual and Software
Hospice: NOE information in the HETS Transaction

Upcoming Events

Quality Payment Program Virtual Groups Webinar — August 27
Person-Centered Approaches to Support Dual Eligibles for Medicare & Medicaid- September 6
Dementia Care: Opioid Use & Impact for Persons Living with Dementia Call — September 18

Medicare Learning Network® Publications & Multimedia

Additional Search Features on FISS Provider DDE Screen MLN Matters Article — New
ICD-10 and Other Coding Revisions to NCDs MLN Matters Article — New
Clarifying Language for Chapters 3 and 5 of the MSP Manual MLN Matters Article — New
Medicare Coverage of Diabetes Supplies MLN Matters Article — New
Improvements in Hospice Billing and Claims Processing MLN Matters Article — Revised

August 22, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10824 provides instruction on implementing one new Benefit Enhancement for program year three of the NGACO Model.

Part A Open Issues Log Update

Prepay Review- Additional Development Requests (ADR)

Starting on August 4, 2018, a system error caused incorrect Additional Development Request (ADR) letters to be created for completed/closed prepay probes. As of August 17, 2018, this issue has been resolved. Providers should no longer receive incorrect ADR letters.


August 21, 2018

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 July 2018. New questions / answers have been added to the Claim Status and General Information categories. Please take time to review these and other FAQs for answers to your questions.


Medicare Learning Network® MLN Matters® Articles from CMS

Revised:

Hospice billing staff should review this article to understand the recent and upcoming Medicare improvements to hospice billing and claims processing.

August 20, 2018

CMS Provider Education Message:
Special Edition – Monday, August 20, 2018

New Medicare Card Mailing Update – Wave 5 Begins, Wave 3 Ends

We started mailing new Medicare cards to people with Medicare who live in Wave 5 states: Alabama, Florida, Georgia, North Carolina, and South Carolina.  We continue to mail new cards to people who live in Wave 4 states, as well as nationwide to people who are new to Medicare.

We finished mailing cards to people with Medicare who live in Wave 1, 2 and 3 states and territories. If your Medicare patients say they did not get a card, instruct them to:

Sign into MyMedicare.gov to see if we mailed their card.  If so, they can print an official card. They must create an account if they do not already have one. 
Call 1-800-MEDICARE (1-800-633-4227).  There might be something that needs to be corrected, such as updating their mailing address.

You can also print out and give them a copy of “Still Waiting for Your New Card?” or you can order copies to hand out. 

To ensure your Medicare patients continue to get care, you can use either the former Social Security number-based Health Insurance Claim Number or the new alpha-numeric Medicare Beneficiary Identifier (MBI) for all Medicare transactions through December 31, 2019.   

Check this website as the mailings progress. Continue to direct your Medicare patients to Medicare.gov/NewCard for information about the mailings and to sign up to get email about the status of card mailings in their state. 

Information on the transition to the new MBI:

New MBI Get It, Use It MLN Matters® Article

Enrollment Form Signature

Don't forget to sign your Medicare enrollment application!

Signatures are a very important step in the Provider Enrollment process. Your signature validates that the information provided on the application is current and correct.

If you are submitting a paper application, please make sure to sign the Certification Statement.

If you are submitting a PECOS web application, we encourage you to electronically sign the application. Using the electronic signature option allows a faster turnaround time since we will not have to wait for signatures.


Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10863 furnishes providers and hospitals with additional clarification regarding when and where to obtain information from Medicare beneficiaries, or authorized representatives, for inpatient admissions or outpatient encounters. Make your staff aware of this clarification.

August 17, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

This special edition article presents a current overview of the diabetes supplies covered by Medicare (Part B and Part D) to assist physicians, providers, suppliers, and other health care professionals who provide diabetic supplies to Medicare beneficiaries.

August 16, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, August 16, 2018

View this edition as a PDF

News & Announcements

New Medicare Card: Order Handouts for Patients That Did Not Get Their New Cards
Proposed Pathways to Success for the Medicare Shared Savings Program
Quality Payment Program: Design Examples for CY 2019 Proposed Rule
Quality Payment Program: Participation Status Tool Includes 2018 Data Snapshot

Provider Compliance

Cochlear Devices Replaced Without Cost: Bill Correctly — Reminder

Upcoming Events

Physician Fee Schedule Proposed Rule: Understanding 3 Key Topics Listening Session — August 22

Medicare Learning Network® Publications & Multimedia

Inclusion of PMD Codes in DMEPOS Prior Authorization Program MLN Matters® Article — New
Medicare Physician Fee Schedule Database: October 2018 Update MLN Matters Article — New
Hospice Payment Rates, Cap, Wage Index, and Pricer: FY 2019 Update MLN Matters Article — New
HCPCS Drug/Biological Code Changes: October 2018 Update MLN Matters Article — New
2018 DMEPOS Fee Schedule: October Update MLN Matters Article — New
Advance Care Planning Fact Sheet — Revised
PECOS for Physicians and NPPs Booklet — Reminder
Medicare Enrollment for Institutional Providers Booklet — Reminder
Medicare Part D Vaccines and Vaccine Administration Fact Sheet — Reminder

The following JH Local Coverage Determination (LCD) has been placed on hold and will not become effective on August 16, 2018.  Please watch our website for updates regarding this LCD and its effective date.

The following LCD will remain in effect until further notice:

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


August 15, 2018

Electrocardiographic services

A system edit has been turned off that rejected claims for certain electrocardiographic services. Novitas will reprocess all affected claims. If you have any questions, please call customer service at:

JH: 1-855-252-8782
JL:  1-877-235-8073

New Issue: Part A Open Issues Log

Starting on August 4, 2018, a system error caused incorrect Additional Development Request (ADR) letters to be created for completed/closed prepay probes. The issue has been reported to the Fiscal Intermediary Shared System (FISS) and they are currently working on a resolution. We will post additional information as it becomes available. In the meantime, we are manually releasing claims daily that have incorrectly suspended to Status Location SB6001.

Providers should reference the Medical Review Targeted Probe and Educate page to determine active probe reviews. Respond to ADR letters for the reason codes included on this page. If the reason code on the letter is not on the web page, you do not need to respond.


July 2018 Part A Newsletter

The July 2018 Part A Newsletter is now available. Please take a moment to review.


Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10542 allows providers who use DDE to look up the claims associated with an Accounts Receivable (AR) by using the invoice number on the AR to find the Document Control Number (DCN), and then using the DCN to look up the claims. This update will improve provider customer service, allowing providers to find the claim associated with the AR and reconcile it back to their patient accounts. Please make certain your billing staff is aware of this enhancement. Detailed instructions on how to use the new feature will be provided closer to implementation.
Change Request (CR) 10859 constitutes a maintenance update of International Classification of Diseases, Tenth Revision (ICD-10) conversions and other coding updates specific to national coverage determinations (NCDs). These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received. Please follow the link below for the NCD spreadsheets included with this CR: https://www.cms.gov/Medicare/Coverage/DeterminationProcess/downloads/CR10859.zip. Make sure that your billing staffs are aware of these changes.

August 13, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10898 amends payment files issued to MACs based upon the 2018 Medicare Physician Fee Schedule (MPFS) Final Rule. Make sure your billings staffs are aware of these changes.

August 10, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

The HCPCS code set is updated on a quarterly basis. Change Request (CR) 10834 informs MACs of the October 2018 addition of one new HCPCS code. Effective with dates of service on or after July 12, 2018, the Q5108 is payable by Medicare. The short descriptor for Q5108 is Injection, fulphila and the long descriptor is Injection, pegfilgrastim-jmdb, biosimilar, (fulphila), 0.5 mg. The Type of Service (TOS) Codes for Q5108 are 1, P and the Medicare Physician Fee Schedule Database (MPFSDB) Status Indicator is E. Note that MACs should hold claims for Q5108 until CR10834 is implemented.
Change Request (CR) 10881 informs DME MACs about the changes to the DMEPOS fee schedule which is updated on a quarterly basis, when necessary, to implement fee schedule amounts for new codes and correct any fee schedule amounts for existing codes. Make sure that your billing staffs are aware of these changes.

August 9, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, August 9, 2018

View this edition as a PDF

News & Announcements

Help Your Medicare Patients Avoid and Report Scams
SNF VBP FY 2019 Annual Performance Score Report: Submit Correction Requests by August 31
Quality Payment Program Exception Applications Due by December 31
Quality Payment Program: 2017 MIPS Performance Feedback and Payment Adjustment
Quality Payment Program Performance Feedback and Targeted Review Videos
Medicare Diabetes Prevention Program Suppliers: Separate Medicare Enrollment
Vaccines are Not Just for Kids

Provider Compliance

Reporting Changes in Ownership — Reminder

Upcoming Events

ESRD Quality Incentive Program: CY 2019 ESRD PPS Proposed Rule Call — August 14
Physician Fee Schedule Proposed Rule: Understanding 3 Key Topics Listening Session — August 22
Comparative Billing Report on Licensed Clinical Social Workers Webinar — September 12

Medicare Learning Network® Publications & Multimedia

Quarterly Influenza Virus Vaccine Code Update: January 2019 MLN Matters Article — New
Update to Medicare Claims Processing Manual, Chapter 24 MLN Matters Article — New
IRF Annual Update: PPS Pricer Changes for FY 2019 MLN Matters Article — New
Implementing Epoetin Alfa Biosimilar, Retacrit for ESRD/AKI Claims MLN Matters Article — New
Medicare Claims Processing Manual, Chapter 24 Update: Form Letters — New
IPF PPS Updates for FY 2019 MLN Matters Article — New
ASP Medicare Part B Drug Pricing Files and Revisions: October 2018 MLN Matters Article — New
August 2018 Catalog — Revised
Medicare Preventive Services Educational Tool — Revised
Medicare Enrollment for Providers Who Solely Order, Certify, or Prescribe Booklet — Revised
Quality Payment Program Year 2 Overview Web-Based Training Course — Revised
Quality Payment Program: MIPS Promoting Interoperability Performance Category Year 2 Web-Based Training Course — Revised
Quality Payment Program MIPS Quality Performance Category Year 2 Web-Based Training Course — Revised
Safeguard Your Identity and Privacy Using PECOS Booklet — Reminder
PECOS FAQs Booklet — Reminder
PECOS for Provider and Supplier Organizations Booklet — Reminder

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


Part A Open Issues Log

Reason codes U5600 and U6006-Update

The claims suspended to status location SMDUPS with reason code U5600 or SM9001 with reason code U6006 have been released for processing.

Various MSP Reason Codes-Update

All claims impacted by this issue have been released for processing, except for claims receiving reason code U681D. The correction for these claims is tentatively scheduled for August 20, 2018.


August 7, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10871 provides instructions for payment and edits for Medicare's Common Working File (CWF) and Fiscal Intermediary Shared System (FISS) to include and update new or existing influenza virus vaccine codes. This update includes one new influenza virus vaccine code: 90689. Please make certain your billing staffs are aware of this update.

August 6, 2018

Rescinded:

This article was rescinded on August 2, 2018.

August 3, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

This article is based on Change Request (CR) 10559 which reduces confusion and clarifies the Administrative Simplification Compliance Act (ASCA) waiver process guideline in the Medicare Claims Processing Manual, Chapter 24, Section 90. CR10559 combines two sections (90.3.2 and 90.3.3) into one new Section 90.3.2 with a new title and description.
Change Request (CR) 10826 notifies MACs that a new IRF PRICER software package will be released prior to October 1, 2018, that will contain the updated rates that are effective for claims with discharges that fall within October 1, 2018, through September 30, 2019. MACs will install and pay IRF claims with the FY 2019 IRF Prospective Payment System (PPS) PRICER for discharges on or after October 1, 2018. Be sure your billing staffs are aware of these changes.
Change Request (CR) 10839 updates the list of supplies, drugs, and labs included in the End Stage Renal Disease (ESRD) consolidated billing list and therefore included in the base rate payment for Acute Kidney Injury (AKI). This includes erythropoietin stimulating agents billed with the ESRD-specific Healthcare Common Procedure Coding System (HCPCS) or the non-ESRD specific HCPCS.
CR10839 adds Q5106 (Injection, epoetin alfa, biosimilar, (Retacrit) (for non-esrd use), 1000 units) to the list established in CR9987. Claims that include Q5106 with dates of service between July 1, 2018, and December 31, 2018 will need to be reprocessed. Make sure your billing staffs are aware of these changes.
Change Request (CR) 10858 provides an update to the language contained in the Form Letters the MACs use to inform certain providers of Administrative Simplification Compliance Act (ASCA) waiver reviews. The CR gives you clear directions for communicating with your MACs regarding ASCA waiver review-related questions when you receive a review Form Letter. Make sure your billing staffs are aware of these directions.
Change Request (CR) 10880 identifies required changes as part of the annual IPF PPS update established in the Medicare Program; FY 2019 Inpatient Psychiatric Facilities Prospective Payment System and Quality Reporting Updates for Fiscal Year Beginning October 1, 2018 (FY 2019) Final Rule. These changes are applicable to discharges occurring from October 1, 2018through September 30, 2019 (FY 2019), and they relate to Chapter 3, Section 190.49 of the Medicare Claims Processing Manual. This update includes technical corrections and updates to various parts of Section 190 from prior rulemaking. Please make sure your billing staffs are aware of these updates.
Change Request (CR) 10899 provides the quarterly update for Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to the prior quarterly pricing files. CR 10899 instructs MACs to download and implement the October 2018 and, if released, the revised July 2018, April 2018, January 2018, and October 2017 ASP drug pricing files for Medicare Part B drugs. Medicare shall use the October 2018 ASP and Not Otherwise Classified (NOC) drug pricing files to determine the payment limit for claims for separately payable Medicare Part B drugs processed or reprocessed on or after October 1, 2018 with dates of service October 1, 2018, through December 31, 2018. Make sure your billing staffs are aware of these updates.

Part A Open Issues log

Inpatient Prospective Payment System (IPPS) claims

Certain acute care IPPS claims billed with patient status codes 02 or 82 were paying with an incorrect Diagnosis Related Grouping from April 23, 2018 until July 23, 2018. A correction was installed on July 23, 2018, and all impacted claims will be automatically reprocessed. No provider action is needed.

Claims suspended to status location SMCWFX

A large volume of claims suspended to status location SMCWFX with reason code 3715X. This issue only impacted claims that processed during the first week of July. All impacted claims have been released for processing.

Bipartisan Budget Act of 2018 provisions

On February 9, 2018, Congress passed the Bipartisan Budget Act of 2018 which contains a number of provisions that extend certain Medicare FFS policies, including Ambulance add-on payment provisions and Work Geographic Practice Cost Index (GPCI) Floor including anesthesia services. In addition, the Act permanently repeals the outpatient therapy caps beginning on January 1, 2018, while retaining the requirement to submit the KX modifier for services in excess of the prior cap amounts. Due to the retroactive effective dates of these provisions, MACs were instructed to reprocess these claims. All claims identified to be adjusted have been processed.


August 2, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, August 2, 2018

View this edition as a PDF

News & Announcements

SNF FY 2019 Payment and Policy Changes
IRF FY 2019 Prospective Payment System Final Rule
IPF FY 2019 Final Medicare Payment and Quality Reporting Updates
Qualified Medicare Beneficiary Program Billing Requirements FAQs
Data Element Library Webinar: Video Recording
CMS Administrator Address on Strengthening Medicare
2018 QRDA III Implementation Guide for Eligible Professionals — Updated
LTCH Provider Preview Reports Reissued

Provider Compliance

Ophthalmology Services: Questionable Billing and Improper Payments — Reminder

Upcoming Events

MIPS Quality Performance Category for Year 2 (2018) Overview Webinar — August 6
ESRD Quality Incentive Program: CY 2019 ESRD PPS Proposed Rule Call — August 14
Sharing Federal Strategies to Address the Opioid Epidemic Open Door Forum — August 15
Physician Fee Schedule Proposed Rule: Understanding 3 Key Topics Listening Session – August 22

Medicare Learning Network® Publications & Multimedia

Provider Minute Video: Physician Orders/Intent to Order Laboratory Services and Other Diagnostic Services - New
PECOS Technical Assistance Contact Information Fact Sheet — Reminder
Medicare Enrollment Resources Educational Tool — Reminder
PECOS for DMEPOS Suppliers Booklet — Reminder

Part A Top Claims Submission / Reason Code Errors 

The July 2018 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.


Part A Open Issues log- UPDATE

The Centers for Medicare and Medicaid Services (CMS) has advised for claims processed on and after July 1, 2018, the MD Waiver claims WILL be included in NCCI editing. The claims are receiving reason code W7020 and W7040 appropriately.

Complete information about the NCCI Editing is available on the CMS website.


July 26, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, July 26, 2018

View this edition as a PDF

News & Announcements

New Medicare Card: Using Your MAC’s MBI Look-Up Tool
E/M Coding Reform: Recording of Panel Discussion
Patients Over Paperwork July Newsletter
Hospice Quality Reporting Program Quick Reference Guide
HQRP Non-Compliance Letters: Request for Reconsideration by August 7
IRF QRP Non-Compliance Letters: Request for Reconsideration by August 7
LTCH QRP Non-Compliance Letters: Request for Reconsideration by August 7
SNF QRP Non-Compliance Letters: Request for Reconsideration by August 7
Emergency Preparedness: Information on Radiological Incidents, DME, and Blood
World Hepatitis Day: Medicare Coverage for Viral Hepatitis

Provider Compliance

Proper Coding for Specimen Validity Testing Billed in Combination with Urine Drug Testing

Upcoming Events

MIPS Improvement Activities Performance Category Year 2 Overview Webinar — August 1
MIPS Quality Performance Category Year 2 Overview Webinar — August 6
ESRD Quality Incentive Program: CY 2019 ESRD PPS Proposed Rule Call — August 14

Medicare Learning Network® Publications & Multimedia

IOM Update to Publication 100-02, Chapter 11 – ESRD MLN Matters Article — New
New Waived Tests MLN Matters Article — New
HCPCS Codes Used for SNF CB Enforcement: Annual Update MLN Matters Article — New
Changes to the Laboratory NCD Edit Software: October 2018 MLN Matters Article — New
CLFS and Laboratory Services Payment: Quarterly Update MLN Matters Article — New

The following JH Draft Local Coverage Determination (LCD) posted for comment on January 18, 2018 and presented at the February 2018 Contractor Advisory Committee (CAC) Meeting has been posted for notice. It will become effective September 14, 2018:

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

The following JH Local Coverage Articles have been revised:


Medicare Learning Network® MLN Matters® Articles from CMS

Revised:

The most current waiver information can be found on the CMS website. See this article for more details.

July 25, 2018

CMS Provider Education Message:
Special Edition – Tuesday, July 25, 2018

CMS Empowers Patients and Ensures Site-Neutral Payment in Proposed Rule

Outpatient Prospective Payment System (OPPS) & Ambulatory Surgical Center (ASC) proposed rule advances CMS commitment to increasing transparency and lowering drug prices

On July 25, CMS took steps to strengthen the Medicare program with proposed changes to ensure that seniors can access the care they need at the site of care that they choose. In addition, as part of the agency’s ongoing efforts to lower drug prices as outlined in the President’s Blueprint, CMS included a Request for Information on how best to develop a model leveraging authority provided to the agency under the Competitive Acquisition Program (CAP) to strengthen negotiations for prescription drugs.

“Our healthcare system should always put patients first, and CMS today is taking important steps to empower patients and provide more affordable choices and options,” said CMS Administrator Seema Verma. “In line with President Trump and Secretary Azar’s priority to lower drug prices, today’s proposed rule is also an important step towards expanding competition for drug payment in Medicare, in order to get the best deal for patients.”

The proposed policies in the CY 2019 Medicare Hospital OPPS and ASC Payment System proposed rule would help lay the foundation for a patient-driven healthcare system. To increase the sustainability of the Medicare program and improve quality of care for seniors, CMS is moving toward site neutral payments for clinic visits (which are essentially check-ups with a clinician). Clinic visits are the most common service billed under the OPPS. Currently, CMS often pays more for the same type of clinic visit in the hospital outpatient setting than in the physician office setting.

If finalized, this proposal is projected to save patients about $150 million in lower copayments for clinic visits provided at an off-campus hospital outpatient department. CMS is also proposing to close a potential loophole through which providers are billing patients more for visits in hospital outpatient departments when they create new service lines.

Additionally, CMS is giving patients more options on where to obtain care, in order to improve access and convenience and ensure that CMS policies are not favoring any particular provider type from the start. The proposed rule aims to address other payment differences between sites of service, so that patients can choose the setting that best meets their needs among safe and clinically appropriate options. For 2019, CMS is proposing to:

Expand the number of procedures payable at ASCs to include additional procedures that can safely be performed in that setting
Ensure ASC payment for procedures involving certain high-cost devices parallels the payment amount provided to hospital outpatient departments for these devices
Help ensure that ASCs remain competitive by stabilizing the differential between ASC payment rates and hospital outpatient department payment rates

As part of active efforts to reduce the cost of prescription drugs, CMS is issuing a Request for Information to solicit public comment on how best to leverage the authority provided under the CAP to get a better deal for beneficiaries as part of a CMS Innovation Center model. We believe a CAP-based model would allow CMS to introduce competition to Medicare Part B, the part of Medicare that pays for medicines that patients receive in a doctor’s office. Currently, CMS pays the average sales price for these therapies plus an extra add-on payment. A CAP-based model would allow CMS to bring on vendors to negotiate payment amounts for Part B drugs, so that Medicare is no longer merely a price taker for these medicines. We are seeking public comment on how the vendors that CMS brings on could help the agency structure value-based payment arrangements with manufacturers, especially for high-cost products, so that seniors and taxpayers will know that medicines are working before they have to pay.

In 2018, CMS implemented a payment policy to help beneficiaries save on coinsurance on drugs that were administered at hospital outpatient departments and that were acquired through the 340B program—a program that allows hospitals to buy certain outpatient drugs at a lower cost. Due to CMS’s policy change, Medicare beneficiaries are now benefiting from the discounts that 340B hospitals enjoy when they receive 340B-acquired drugs. In 2018 alone, beneficiaries are saving an estimated $320 million on out-of-pocket payments for these drugs. For 2019, CMS is expanding this policy by proposing to extend the 340B payment change to non-excepted off-campus departments of hospitals that are paid under the Physician Fee Schedule.

In response to recommendations from the President’s Commission on Combatting Drug Addiction and the Opioid Crisis, CMS also is proposing to pay separately for certain non-opioid pain management drugs in ASCs; is seeking feedback on evidence to support that other non-opioid alternative treatments for acute or chronic pain warrant separate payment under the OPPS or ASC payment systems; and is proposing to eliminate questions regarding pain communication from the hospital patient experience survey.

As part of its commitment to price transparency, CMS is seeking comment through a Request for Information asking whether providers and suppliers can and should be required to inform patients about charge and payment information for healthcare services and out-of-pocket costs, what data elements would be most useful to promote price shopping, and what other changes are needed to empower healthcare consumers.

In the proposed rule, CMS is releasing a Request for Information to welcome continued feedback on the Medicare program and interoperability. CMS is gathering public feedback on revising the CMS patient health and safety standards that are required for providers and suppliers participating in the Medicare and Medicaid programs to further advance electronic exchange of information that supports safe, effective transitions of care between hospitals and community providers.

Across all the Fiscal Year and CY proposed Medicare payment rules, we have proposed the elimination of reporting requirements for over 100 measures across the health care delivery system, saving providers more than $175 million over the next two years.

See the full text of this excerpted CMS Press Release (issued July 25).

For More Information:


July 24, 2018

Part A Open Issues log- UPDATE

Medicare claims related to various MSP reason codes are still not able to be processed appropriately at this time. The correction that was to be installed on July 23, 2018, did not resolve the processing issues. Claims could not be released. FISS has developed a new correction that is tentatively scheduled for August 20, 2018.


Part A Open Issues Log- 2 New Issues

A large volume of claims have suspended to status location SMCWFX with reason code 3715X. This issue has been reported to the Fiscal Intermediary Shared System (FISS) and they are currently researching. This is only impacting claims that were in process during the first week of July. This is not an ongoing issue. We are not able to process these claims at this time and no provider action is needed. We will post additional information as it becomes available.

Critical Access Hospital (CAH) outpatient claims are incorrectly processing with Integrated Outpatient Code Editor (I/OCE) reason codes W7020, W7040, W7106, W7107 or W7108. A correction has been developed and is tentatively scheduled for October 1, 2018. Until then, a workaround is being implemented to allow the claims to be processed. Claims with lines that have been rejected in error can be adjusted by the provider.


July 23, 2018

Resolution Tips for Overlapping Claims

This article is intended to assist providers that experience claim rejections for overlapping dates of service. The information contained in this article is designed to give providers tips that can be used to resolve an overlapping billing situation and avoid future overlapping situations. 

Overlapping situations can occur for any number of reasons. This article contains information on the most common reasons for which an overlapping situation can occur. 


Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10809 informs MACs about an update to the Medicare Benefit Policy Manual, Chapter 11, Section 100, extending renal dialysis services paid under Section 1881(b)(14) of the Social Security Act to beneficiaries with Acute Kidney Injury (AKI), effective January 1, 2017. This revision does not represent a policy change.
Specifically, the manual has been updated to state that Erythropoietin Stimulating Agents (ESAs) are included in the bundled payment amount for treatments administered to patients with AKI. The Non-ESRD HCPCS codes should be used (J0881, J0883, J0885, J0888, and Q0138). The revenue codes for reporting Epoetin Alfa are 0634 and 0635. All other ESAs are reported using revenue code 0636. Make sure your billing staffs area aware of these changes.
Change Request (CR) 10852 provides updates to the lists of Healthcare Common Procedure Coding System (HCPCS) codes that are subject to the Consolidated Billing (CB) provision of the SNF Prospective Payment System (PPS). Changes to Current Procedural Terminology (CPT)/HCPCS codes and Medicare Physician Fee Schedule designations are to revise Common Working File (CWF) edits to allow MACs to make appropriate payments in accordance with policy for SNF CB in the “Medicare Claims Processing Manual”, Chapter 6, Section 20.6. Make sure your billing staffs are aware of these changes.
This article is based on Change Request (CR) 10873 which informs MACs about the changes that will be included in the October 2018 quarterly release of the edit module for clinical diagnostic laboratory services. Make sure that your billing staffs are aware of these changes.
Change Request (CR) 10875 provides instructions for the quarterly update to the Clinical Laboratory Fee Schedule (CLFS). These updates apply to Chapter 16, Section 20 of the Medicare Claims Processing Manual. Please make sure your billing staffs are aware of these updates.

July 20, 2018

August 2018 Calendar of Events Is Available

The August 2018 Calendar of Events is currently available for your immediate review. Please visit the Education Center of our website for additional information and registration opportunities. 


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 June 2018. New questions / answers have been added to the following categories:

Claim Denials
General Information
Return to Provider

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


Part A Open Issues- Large Volume of Suspended Claims with Reason Codes U5600 or U6006

A high volume of claims have suspended to status location SMDUPS with reason code U5600 or SM9001 with reason code U6006. This issue has been reported to the Fiscal Intermediary Shared System (FISS) and they are currently researching. We are actively working through the suspended claims.

We will post additional information as it becomes available.


July 19, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, July 19, 2018

View this edition as a PDF

News & Announcements

MIPS 2017 Performance Feedback User Guide
MIPS Payment Adjustment Targeted Review: Request by October 1
PEPPERs for Home Health Agencies, Partial Hospitalization Programs
July Quarterly Provider Update

Provider Compliance

Cardiac Device Credits: Medicare Billing

Upcoming Events

CY 2018 eCQM Self-Directed Tools and Resources Webinar — July 24
IMPACT Act and SPADE Special Open Door Forum — July 25
Meeting the Behavioral Health Needs of the Dually Eligible Webinar — August 2
ESRD Quality Incentive Program: CY 2019 ESRD PPS Proposed Rule Call — August 14
CBR on Independent Diagnostic Testing Facilities Referring Providers Webinar — August 22

Medicare Learning Network® Publications & Multimedia

New MBI: Get It, Use It MLN Matters® Article — Revised
Medical Review of E/M Documentation MLN Matters Article — New
New Physician Specialty Code for Undersea and Hyperbaric Medicine MLN Matters Article — New
Medicare Part A SNF PPS Pricer Update MLN Matters Article — New
Automating First Claim Review in Serial Claims for DMEPOS MLN Matters Article — Revised
Medicare Preventive Services Educational Tool — Revised
Behavioral Health Integration Services Fact Sheet — Reminder
Chronic Care Management Services: Changes for 2017 Fact Sheet — Reminder
Chronic Care Management Services Fact Sheet — Reminder
Avoiding Medicare Fraud & Abuse: A Roadmap for Physicians Web-based Training — Reminder

July 17, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10627 establishes a new Section (6.8) in Chapter 6 of the “Medicare Program Integrity Manual” (Pub. 100-08), titled, “Medical Review of Evaluation and Management (E/M) Documentation.” Please make sure your billing staffs are aware of this new content.
Change Request (CR) 10666 informs you that the Centers for Medicare & Medicaid Services (CMS) has established a new Physician Specialty code for Undersea and Hyperbaric Medicine. This new code is D4. Make sure your billing staffs are aware of these changes.

July 16, 2018

The comment period is now closed for the following JH Draft Local Coverage Determinations (LCDs). Comments received will be reviewed by our Contractor Medical Directors and Response to Comments Articles will be posted to our website and related to the LCDs when they are posted for notice.


July 12, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, July 12, 2018

View this edition as a PDF


News & Announcements

New Medicare Card Reminder: Wave 1 Mailing Complete
Qualified Medicare Beneficiary: Learn about State Medicaid Agency Requirements
MIPS 2019 Payment Adjustment Fact Sheet
Quality Payment Program: Obtaining Your EIDM Credentials
IRF QRP Non-Compliance Letters: Request for Reconsideration by August 7
LTCH QRP Non-Compliance Letters: Request for Reconsideration by August 7
SNF QRP Non-Compliance Letters: Request for Reconsideration by August 7
HQRP Non-Compliance Letters: Request for Reconsideration by August 7

Provider Compliance

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

Medicare Learning Network® Publications & Multimedia

HHA Star Ratings Call: Audio Recording and Transcript — New
Ambulance Services Listening Session: Audio Recording and Transcript — New
HCPCS Drug/Biological Code Changes: July 2018 Quarterly Update MLN Matters Article — Revised
Dual Eligible Beneficiaries under Medicare and Medicaid Booklet — Revised
Medicare Vision Services Fact Sheet — Revised
SNF Consolidated Billing Web-Based Training Course — Revised
Looking for Educational Materials?

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


Part A Open Issues Log- New Issue

Maryland (MD) Waiver claims received on and after July 1, 2018, are receiving National Correct Coding Initiative (NCCI) line level reason code W7020 or W7040 incorrectly. Certain claims that are receiving line level reason code W7040, are resulting in the entire claim Returning to Provider (RTP) with reason code 32264.

This issue has been reported to the Fiscal Intermediary Shared System (FISS) and they are currently researching.


Medicare Learning Network® MLN Matters® Articles from CMS

Revised:

The Centers for Medicare & Medicaid Services (CMS) is mailing the new Medicare cards with the MBI in phases by geographic location.
There are 3 ways you and your office staff can get MBIs:
1. Ask your Medicare patients
Ask your Medicare patients for their new Medicare card when they come for care. If they haven’t received a new card at the completion of their geographic mailing wave, give them the “Still Waiting for Your New Card?” handout (in English or Spanish) or refer them to 1-800-Medicare (1-800-633-4227).
2. Use the MAC's secure MBI look-up tool
Once we mail the new Medicare card with the MBI to your patient, you can look up MBIs for your Medicare patients when they don’t or can’t give them. If the tool indicates the card hasn’t been mailed for your Medicare patient who lives in a geographic location where the card mailing is finished, tell your patient to call 1-800-Medicare (1-800-633-4227). Sign up for the Portal to use the tool. You can use this tool even after the end of the transition period – it doesn’t end on December 31, 2019. MLN Matters SE18006 Related CR N/A
3. Check the remittance advice
Starting in October 2018 through the end of the transition period, we’ll also return the MBI on every remittance advice when you submit claims with valid and active Health Insurance Claim Numbers (HICNs).
You can start using the MBIs even if the other health care providers and hospitals who also treat your patients haven’t. When the transition period ends on December 31, 2019, you must use the MBI for most transactions.

July 11, 2018

DDE CWF and HIQA Eligibility Screens Issue - Resolved

System Alert - Issued 7/5/2018 at 10:45 AM

The DDE CWF and HIQA eligibility issue originally posted on July 5, 2018, has been resolved much sooner than originally anticipated. Please resume using DDE and HIQA for your eligibility inquiries. We apologize for the inconvenience.


Proper Billing for Intensity-Modulated Radiation Therapy (IMRT) Planning Services

IMRT is a procedure that uses advanced computer programs to plan and deliver radiation to treat difficult to reach tumors.  The intensity of the radiation can be adjusted to deliver higher doses to a treatment area while reducing exposure to surrounding healthy tissue.  Review this article for proper billing of IMRT planning reported with CPT code 77301.


Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10118 informs MACs about updates to the payment rates under the PPS for SNFs, for Fiscal Year (FY) 2019, as required by statute. Make sure your billing staffs are aware of these changes. Also, be sure your billing staff are aware of the annual updates.

July 10, 2018

June 2018 Part A Newsletter

The June 2018 Part A Newsletter is now available. Please take a moment to review


July 9, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

Revised:

Change Request (CR) 10624 is revised to show the Type of Service Code for CPT code 90739 remains as V. Also, the CR release date, transmittal number, and the Web address of the CR are revised. All other information is the same. Please make sure your billing staffs are aware of these updates.

July 6, 2018

Attention: Please Resubmit Your Recent Draft LCD Comment Forms

Due to a technical issue, some of the Draft LCD comments that you have submitted, in the past 7 days, through our online form may not have reached us. If you have submitted comments for either of the following draft LCDs,

please resubmit your comments either directly by e-mail to draftlcdcomments@novitas-solutions.com or by fax at (717) 728-8767.

To allow time for resubmissions and to ensure that adequate time has been provided for comments, the comment period has been extended to July 13, 2018.

We apologize for any inconvenience this may have caused.


July 5, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, July 5, 2018

View this edition as a PDF


News & Announcements

New Medicare Card: MBI Changes
MIPS Payment Adjustment Targeted Review: Request by September 30
Open Payments Program 2017 Financial Data
Laboratory Date of Service Exception
Qualified Medicare Beneficiary Information on RAs and MSNs

Provider Compliance

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

Claims, Pricers & Codes

Rejected Claims for Medicare Diabetes Prevention Program Services
ESRD Claims Error: Transitional Drug Adjustment Add-On Payment Adjustment

Upcoming Events

CMS Data Element Library Webinar — July 11
Public Reporting on Physician Compare Webinar — July 24 or 26

Medicare Learning Network® Publications & Multimedia

NCCI PTP Edits, Version 24.3: Quarterly Update MLN Matters Article — New
Medicare Diabetes Prevention Program Call: Audio Recording and Transcript — New
IMPACT Act Call: Audio Recording and Transcript — New
Prohibition Billing Dually Eligible Individuals Enrolled in the QMB Program MLN Matters Article — Revised
Global Surgical Days for CAH Method II MLN Matters Article — Revised
HCPCS Drug/Biological Code Changes: July 2018 Quarterly Update MLN Matters Article — Revised
Comprehensive ESRD Care Model Telehealth: Implementation MLN Matters Article — Revised
ASC Payment System: July 2018 Update MLN Matters Article — Revised

Frequently Asked Questions (FAQs)

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


System Alert - Issued 10:45 AM

DDE CWF and HIQA Eligibility Screens

FISS has identified a problem for direct data entry (DDE) providers using option 10-eligibility lookup and HIQA/ELGA, which occurred with the July 2018 release. The fix is tentatively scheduled for August 6, 2018. We apologize for the inconvenience. During this time please use the IVR for eligibility inquiries.


Targeted Probe and Educate on E43 - Severe Protein Calorie Malnutrition Webinar

Register for the webinar on Targeted Probe and Educate E43 - Severe Protein Calorie Malnutrition on July 16, 2018. We will discuss the review and education process on the appropriateness of billing for malnutrition, tips for documentation, and round one probe results.


July 3, 2018

CMS Provider Education Message:
Special Edition – Tuesday, July 3, 2018

CMS Takes Action to Modernize Medicare Home Health

On July 2, CMS proposed significant changes to the Home Health Prospective Payment System (PPS) to strengthen and modernize Medicare, drive value, and focus on individual patient needs rather than volume of care. Specifically, CMS is proposing changes to improve access to solutions via remote patient monitoring technology, and to update the payment model for home health care.

For More Information:

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


Part A Top Claims Submission / Reason Code Errors 

The June 2018 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.


July 2, 2018

Part A Open Issues Log- New Issue Reason Code 32440

Positron Emission Tomography (PET) claims containing certain radiopharmaceutical Healthcare Common Procedure Coding System (HCPCS) codes are returning to provider (RTP'ing) in error for reason code 32440 with dates of service on or after January 1, 2018. Those HCPCS codes are: A9515, A9586, A9587, and A9588.

A correction has been developed and is tentatively scheduled to be installed on October 1, 2018, with CR10622. 

A workaround is in place and providers are able to resubmit or  F9 claims that have incorrectly returned for reason code 32440.


June 29, 2018

System Alert - Issued 10:30 AM

Limited Systems Availability

There will be Common Working File (CWF) "Dark" days on Friday, June 29, 2018, through Sunday, July 1, 2018. Due to this systems upgrade, Novitasphere Portal, our Interactive Voice Response (IVR) Unit, and Health Insurance Query Access (HIQA) will have limited availability.


Part A Claims Open Issues Log Update

On February 9, 2018, Congress passed the Bipartisan Budget Act of 2018 which contains a number of provisions that extend certain Medicare FFS policies, including Ambulance add-on payment provisions, the Work Geographic Practice Cost Index (GPCI) Floor including anesthesia services and the Act permanently repeals the outpatient therapy caps beginning on January 1, 2018, while retaining the requirement to submit the KX modifier for services in excess of the prior cap amounts.

The adjustment process continues. Please be aware that claims were selected based on general criteria outlined within the Change Request (CR10531). There may be claims selected for mass adjustment related to the general criteria, where there are no payment changes that appear on the remittance (such as some anesthesia services). These adjustments will continue into early July. Thank you for your patience as we complete this process.


Medicare Learning Network® MLN Matters® Articles from CMS

Revised:

Change Request (CR) 10314 details the CEC Model telehealth program and how it will be implemented. Make sure your billing staffs are aware of this initiative.

June 28, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, June 28, 2018  

View this edition as a PDF

News & Announcements

New Medicare Card: Use MBI Like HICN
CMS Data Element Library Supports Interoperability
Physician Self-referral Law RFI: Submit Comments by August 24
Qualified Medicare Beneficiary Information on RAs and MSNs
Laboratory Date of Service Exception — Reminder
Administrative Simplification Compliance Resources
2016 CMS Program Statistics
Pride in Putting Patients First
Health Care System Response to Mass Shootings

Provider Compliance

Comprehensive Error Rate Testing: Arthroscopic Rotator Cuff Repair

Claims, Pricers & Codes

New Part B Edit for Duplication of Diagnosis Codes on Hard Copy Claims

Upcoming Events

Provider Compliance Focus Group — July 13

Medicare Learning Network® Publications & Multimedia

Medicare Billing for Cardiac Device Credits Fact Sheet — New
MBI: Get It, Use It MLN Matters Article — Revised
Medicare Coverage for Chiropractic Services MLN Matters Article — Revised
ESRD PPS: Quarterly Update MLN Matters Article — Revised
I/OCE Specification Version 19.2: July 2018 MLN Matters Article — Revised
Hospital OPPS: July 2018 Update MLN Matters Article — Revised
Telehealth Billing Requirements for Distant Site Services MLN Matters Article — Revised
MLN Learning Management System FAQs Booklet — Revised

The following JH Draft Local Coverage Determination (LCD) posted for comment on January 18, 2018 and presented at the February 2018 Contractor Advisory Committee (CAC) Meeting has been posted for notice. It will become effective August 16, 2018:

Comments Received and Contractor Responses

The comment period will close on July 5, 2018 for the following JH Draft Local Coverage Determinations (LCDs):

Submit Comments


July 2018 Calendar of Events Is Available

The July 2018 Calendar of Events is currently available for your immediate review. Please visit the Education Center of our website for additional information and registration opportunities. 


June 27, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

Revised:

Change Request (CR) 10624 informs MACs of updated drug/biological HCPCS codes. The HCPCS code set is updated on a quarterly basis. The July 2018 HCPCS file includes six new HCPCS codes: Q9991, Q9992, Q9993, Q9995, Q5105, and Q5106. Please make sure your billing staffs are aware of these updates
This Special Edition MLN Matters® Article from the Centers for Medicare & Medicaid Services (CMS) reminds all Medicare providers and suppliers, including pharmacies, that they may not bill beneficiaries enrolled in the QMB program for Medicare cost-sharing. Medicare beneficiaries enrolled in the QMB program have no legal obligation to pay Medicare Part A or Part B deductibles, coinsurance, or copays for any Medicare-covered items and services.
Implement key measures to ensure compliance with QMB billing requirements. Use the Medicare 270/271 HIPAA Eligibility Transaction System (HETS) (effective November 2017), CMS’ eligibility-verification system, and the provider Remittance Advice (RA) (July 2018) to identify beneficiaries’ QMB status and exemption from cost-sharing prior to billing. Starting July 2018, look for QMB alerts messages in the RA for FFS claims to verify QMB after claims processing. Work with your office staff and vendors to make sure your insurance verification and billing systems are ready to incorporate these QMB updates. Refer to the Background and Additional Information Sections below for further details and important steps to promote compliance.

June 26, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

Revised:

This article is based on Change Request (CR) 10425 which discusses the global surgical days for Method II Critical Access Hospital (CAH) providers. CR 10425 contains no new policy. It improves the implementation of existing Medicare payment policies. Make sure that your billing staffs are aware of these changes.

June 25, 2018

CMS Provider Education Message:
Special Edition – Monday, June 25, 2018

New Medicare Card Mailing Update – Wave 3 Begins, Wave 1 Ends

We started mailing new Medicare cards to people with Medicare who live in Wave 3 states: Arkansas, Illinois, Indiana, Iowa, Kansas, Minnesota, Nebraska, North Dakota, Oklahoma, South Dakota and Wisconsin.  We continue to mail new cards to people who live in Wave 2 states and territories (Alaska, American Samoa, California, Guam, Hawaii, Northern Mariana Islands, Oregon), as well as nationwide to people who are new to Medicare.

We finished mailing most cards to people with Medicare who live in Wave 1 states: Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia.  If someone with Medicare says they did not get a card:

Print and give them the “Still Waiting for Your New Card?” handout (in English or Spanish).
Or tell them to call 1-800-Medicare (1-800-633-4227). There might be something that needs to be corrected, such as updating their mailing address.

All Medicare Administrative Contractor (MAC) secure portal Medicare Beneficiary Identifier (MBI) look-up tools are ready for use. If you do not already have access, sign up for your MAC’s portal to use the tool. Once we mail the new Medicare card with the MBI to your patient, you can look up MBIs for your Medicare patients when they do not or cannot give them. If the tool indicates the card has not been mailed for your Medicare patient who lives in a geographic location where the card mailing is finished, tell your patient to call 1-800-Medicare (1-800-633-4227).

To ensure people with Medicare continue to get health care services, continue to use the Health Insurance Claim Number (HICN) through December 31, 2019 or until your patient brings in their new card with the new number.

Check this website as the mailings progress. Continue to direct people with Medicare to Medicare.gov/NewCard for information about the mailings and to sign up to get email about the status of card mailings in their state. 

We’re committed to mailing new cards to all people with Medicare by April 2019.

Information on the transition to the new Medicare Beneficiary identifier:

New MBI Get It, Use It MLN Matters® Article (Updated 6/25/18)

Fiscal Intermediary Shared System (FISS) Manual/User Guide Updates 

Updates were made to the Beneficiary/Common Working File and Health Insurance Query Access (HIQA) sections of the FISS Manual/User Guide to include Supervised Exercise Therapy Sessions (SETS) data as part of the July 2018 quarterly release. Please review these updates with your staff and vendors.


New Medicare Insights Podcast

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


Medicare Learning Network® MLN Matters® Articles from CMS

Revised:

This Change Request (CR) implements requirements for billing modifier GT for Telehealth Distant Site Services. As of January 1, 2018, the GT modifier is only allowed on institutional claims billed by a Critical Access Hospital (CAH) Method II. Make sure your billing staffs are aware of this requirement.
The Centers for Medicare & Medicaid Services (CMS) is mailing the new Medicare cards with the MBI in phases by geographic location. There are 3 ways you and your office staff can get MBIs:
1. Ask your Medicare patients
Ask your Medicare patients for their new Medicare card when they come for care. If they haven’t received a new card at the completion of their geographic wave, refer them to 1-800-Medicare (1-800-633-4227).
2. Use the MAC's secure MBI look-up tool
Once we mail the new Medicare card with the MBI to your patient, you can look up MBIs for your Medicare patients when they don’t or can’t give them. Sign up for the Portal to use the tool. You can use this tool even after the end of the transition period – it doesn’t end on December 31, 2019.
3. Check the remittance advice
Starting in October 2018 through the end of the transition period, we’ll also return the MBI on every remittance advice when you submit claims with valid and active Health Insurance Claim Numbers (HICNs).
You can start using the MBIs even if the other health care providers and hospitals that also treat your patients haven’t. When the transition period ends on December 31, 2019, you must use the MBI for most transactions.

June 22, 2018

340B Acquired Drugs and Appeals

Novitas Solutions has been receiving redetermination requests from our providers requesting a review of reimbursement of 340B acquired drugs. However, appeal requests for reimbursement of drugs purchased through the 340B program will be dismissed as the amount reimbursed for drugs through the 340B program is not acceptable for administrative review.


Part A Open Issues Log

Medicare claims related to various Medicare Secondary Payer (MSP) reason codes are not able to be processed appropriately at this time. The issue was reported to the Fiscal Intermediary Shared System (FISS) and a correction has been developed. The correction is tentatively scheduled for July 23, 2018.

Claims are being held in status location S M681X and will be released when the correction is successfully installed. No provider action is needed.


June 21, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, June 21, 2018  

View this edition as a PDF

News & Announcements

New Medicare Cards May Have QR Codes
Continuous Glucose Monitors: Changes Impacting Medicare Coverage
Quality Payment Program Look-Up Tool Updated
Quality Payment Program Website Includes 2018 MIPS Measures and Activities
Hospice Provider Preview Reports: Review Your Data by June 30
IRF and LTCH Provider Preview Reports: Review Your Data by July 1
SNF Provider Preview Report: Review Your Data by July 1
CMS Leverages Medicaid Program to Combat the Opioid Crisis

Provider Compliance

Payment for Outpatient Services Provided to Beneficiaries Who Are Inpatients of Other Facilities — Reminder

Upcoming Events

Home Health Agencies: Quality of Patient Care Star Ratings Algorithm Call — June 27
Ground Ambulance Providers and Suppliers: Data Collection System Listening Session — June 28

Medicare Learning Network® Publications & Multimedia

July Quarterly Update for 2018 DMEPOS Fee Schedule MLN Matters Article — New
Qualified Medicare Beneficiary Call: Audio Recording and Transcript — New

June 20, 2018

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 May 2018. New questions / answers have been added to the following categories:

Claim Denials
General Information
Return to Provider

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


July 26 is World Hepatitis Day 

Hospital stays involving hepatitis C is on the rise. Hepatitis C is spread through the hepatitis C virus, reported to be the leading cause of chronic hepatitis, cirrhosis, as well as liver cancer, and a primary indication for liver transplant in the United States. For more information, please review this article.


Medicare Learning Network® MLN Matters® Articles from CMS

Revised:

CR10781 describes changes to and billing instructions for various payment policies implemented in the July 2018 OPPS update. Make sure your billing staffs are aware of these changes.
Change Request (CR) 10818 provides instructions for new codes added to the Healthcare Common Procedure Coding System (HCPCS) file for anemia management that will be included in the list of items and services subject to the ESRD PPS Consolidated Billing (CB) requirements. Make sure your billing staff is aware of the changes.

June 19, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10818 provides instructions for new codes added to the Healthcare Common Procedure Coding System (HCPCS) file for anemia management that will be included in the list of items and services subject to the ESRD PPS Consolidated Billing (CB) requirements. Make sure your billing staff is aware of the changes.

Revised:

CR 10699 provides the I/OCE instructions and specifications for the I/OCE that will be utilized under the Outpatient Prospective Payment System (OPPS) and non-OPPS for hospital outpatient departments, community mental health centers, all non-OPPS providers, and for limited services when provided in a home health agency not under the Home Health PPS (HH PPS) or to a hospice payment for the treatment of a non-terminal illness. Please make sure your billing staffs are aware of these updates.

June 18, 2018

New Targeted Education for June 2018 Calendar of Events

Join us Wednesday, June 27, 2018, for Part A Targeted Probe and Educate E43 Severe Protein Calorie Malnutrition. This session is open to both JH and JL Part A Providers.

This new targeted education course provides guidelines for the Targeted Probe and Educate on E43 - Severe Protein Calorie Malnutrition. We will discuss the review and education process on the appropriateness of billing for malnutrition, tips for documentation, and round one probe results.

Visit the Education Center of our webpage for additional information and registration opportunities! Don't miss it!


June 15, 2018

Date of Service Reporting and Split Billing

Visit our new and revised articles for reminders of the correct date of service to submit on your claims.


June 14, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, June 14, 2018  

View this edition as a PDF

News & Announcements

CMS Opioids Roadmap
LTCH and IRF Compare Refresh
Antipsychotic Drug Use in Nursing Homes: Trend Update
Men’s Health Week Ends on Father’s Day

Provider Compliance

Billing for Stem Cell Transplants — Reminder

Claims, Pricers & Codes

FY 2019 ICD-10-CM Diagnosis Codes

Upcoming Events

Medicare Diabetes Prevention Program: Supplier Enrollment Call — June 20
IMPACT Act: Frequently Asked Questions Call — June 21
Home Health Agencies: Quality of Patient Care Star Ratings Algorithm Call — June 27
Ground Ambulance Providers and Suppliers: Data Collection System Listening Session — June 28

Medicare Learning Network® Publications & Multimedia

Improvements in Hospice Billing and Claims Processing MLN Matters Article — New
Provider Enrollment: Unlicensed Residents MLN Matters Article — New
Update of the Hospital OPPS: July 2018 MLN Matters Article — New
I/OCE Specification Version 19.2: July 2018 MLN Matters Article — New
Quarterly Update for the DMEPOS CBP: October 2018 MLN Matters Article — New
Medicare Claims Processing Manual Update, Chapters 18 and 35: IDTF MLN Matters Article — New
Provider/Supplier Reporting of Adverse Legal Actions MLN Matters Article — New
Transition to New Medicare Numbers and Cards Fact Sheet — Revised
CMS Web Wheel Educational Tool — Revised
Avoiding Medicare Fraud & Abuse: A Roadmap for Physicians Web-based Training — Reminder
Remittance Advice Resources and FAQs Booklet — Reminder

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

The following JH Local Coverage Articles have been revised:


June 13, 2018

Physicians: Are You Treating Men?

June is Men’s Health Month and recognized around the country with screenings, health fairs, and other health education and outreach activities. Men’s Health Month can heighten awareness for preventable health problems and encourage early detection and treatment of disease among men. For more information, please review this article. 

Don't forget about Preventive Testing for Human Immunodeficiency Virus (HIV). The Centers for Disease Control and Prevention (CDC) recognizes June 27 as National HIV Screening Day (NHTD). For more information, please review this article.  


June 12, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10707 provides the July 2018 Medicare DMEPOS fee schedule quarterly update listing fee schedule amounts for non-rural and rural areas. Additionally, the Parenteral and Enteral Nutrition (PEN) fee schedule file includes state fee schedule amounts for enteral nutrition items and national fee schedule amounts for parental nutrition items. Also, the files for this update include the July 2018 DMEPOS Rural ZIP code file containing the Third Quarter 2018 Rural ZIP code changes.

June 11, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10735 updates Medicare Claims Processing Manual, Chapter 18 - Preventive and Screening Services and Chapter 35 - Independent Diagnostic Testing Facility (IDTF) to include requirements and payment policies for screening mammography services furnished by IDTFs. CR10735 does not convey any policy changes. Instead, it just documents current policy in the Medicare Claims Processing Manual.
This MLN Matters Article is intended to update the Medicare provider and supplier community on what Final Adverse Action(s) need to be timely reported to the Centers for Medicare & Medicaid Services (CMS).
Hospice billing staff should review this article to understand the recent and upcoming Medicare improvements to hospice billing and claims processing.

June 8, 2018

May 2018 Part A Newsletter

The May 2018 Part A Newsletter is now available. Please take a moment to review.


June 7, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, June 7, 2018  

View this edition as a PDF

News & Announcements

New Medicare Card: MBI Look-up Tool Available through your MAC
Declines in Hospital-Acquired Conditions Save 8,000 Lives and $2.9 Billion
2017 Quality Payment Program Year 1 Submission Results
DMEPOS Prior Authorization List Additions
Draft QRDA III Implementation Guide: Submit Comments by June 20
IRF and LTCH Provider Preview Reports: Review Your Data by June 30
SNF Provider Preview Report: Review Your Data by June 30
Hospice Provider Preview Reports: Review Your Data by June 30
Eligible Hospitals: Submit a Hardship Exception Application by July 1
PEPPER for Short-term Acute Care Hospitals
View Your MIPS Preliminary Performance Feedback Data
Physician Compare Downloadable Database: 2016 Performance Scores

Provider Compliance

Bill Correctly for Device Replacement Procedures — Reminder

Claims, Pricers & Codes

July 2018 Average Sales Price Files

Upcoming Events

MIPS Promoting Interoperability Performance Category Webinar — June 12
CMS Quality Measures: Development, Implementation, and You Webinar — June 13 or 14
Medicare Diabetes Prevention Program: Supplier Enrollment Call — June 20
IMPACT Act: Frequently Asked Questions Call — June 21
Home Health Agencies: Quality of Patient Care Star Ratings Algorithm Call — June 27
Ground Ambulance Providers and Suppliers: Data Collection System Listening Session — June 28
Comparative Billing Report on Knee Orthoses Referring Providers Webinar — July 11

Medicare Learning Network® Publications & Multimedia

New Q Code for In-Line Cartridge Containing Digestive Enzyme(s) MLN Matters Article — New
July 2018 Update of the Ambulatory Surgical Center Payment System MLN Matters Article — New
Claim Status Category and Claim Status Codes Update MLN Matters Article — New
Settlement Conference Facilitation Call: Audio Recording and Transcript — New
E/M Service Documentation Provided by Students MLN Matters Article — Revised

Part A Open Issues Log

Inpatient hospital (11X) claims reporting Value Code D4 for Investigational Device Exemption (IDE) studies or Clinical Studies Approved Under Coverage with Evidence Development (CED), and condition codes 04 and 69 for Beneficiaries enrolled in Managed Care claims, are incorrectly receiving payment. Claims that were incorrectly paid are being reprocessed. Please refer to our new article, Informational Only Bills Related to IDE Studies and Clinical Studies Approved Under CED, for supplemental information related to MM10238.


Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10699 provides the I/OCE instructions and specifications for the I/OCE that will be utilized under the Outpatient Prospective Payment System (OPPS) and non-OPPS for hospital outpatient departments, community mental health centers, all non-OPPS providers, and for limited services when provided in a home health agency not under the Home Health PPS (HH PPS) or to a hospice payment for the treatment of a non-terminal illness. Please make sure your billing staffs are aware of these updates.

June 6, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10781 describes changes to and billing instructions for various payment policies implemented in the July 2018 OPPS update. Make sure your billing staffs are aware of these changes.

Part A Top Claims Submission / Reason Code Errors 

The May 2018 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.


June 5, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10777 updates, as needed, the Claim Status and Claim Status Category Codes used for the Accredited Standards Committee (ASC) X12 276/277 Health Care Claim Status Request and Response and ASC X12 277 Health Care Claim Acknowledgment transactions. Make sure your billing staffs are aware of these updates.

June 4, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

Revised:

CR 10412 revises the Medicare Claims Processing Manual to allow the teaching physician to verify in the medical record any student documentation of components of E/M services, rather than re-documenting the work. Make sure your billing staffs are aware of the changes.

May 31, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, May 31, 2018  

View this edition as a PDF

News & Announcements

New Medicare Card Project — Card Mailing Update
MIPS: Submit Quality Measures for Consideration by June 1
2016 Physician and Other Supplier PUF
2016 Referring Provider DMEPOS PUF

Provider Compliance

Provider Minute Video: The Importance of Proper Documentation

Upcoming Events

Qualified Medicare Beneficiary Program Billing Requirements Call — June 6
Medicare Diabetes Prevention Program: Supplier Enrollment Call — June 20
IMPACT Act: Frequently Asked Questions Call — June 21

Medicare Learning Network® Publications & Multimedia

New Medicare Beneficiary Identifier: Get It, Use It MLN Matters Article — New
Quarterly Update to the Medicare Physician Fee Schedule Database MLN Matters Article — New
Quarterly Update for the DMEPOS CBP MLN Matters Article — New
Quarterly ASP Part B Drug Pricing Files and Revisions to Prior Files MLN Matters Article — New
MCReF System Webcast: Video Presentation — New
Quality Payment Program Call: Audio Recording and Transcript — New
Diagnosis Code Update for Add-on Payments for Blood Clotting Factor Administered to Hemophilia Inpatients MLN Matters Article — Revised

Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - July 2018 Update

Our downloadable data files have been updated to reflect the July MPFSDB update.  The left column of our fee schedule search tool allows you to search for individual codes.  Download complete fee schedules using the right column.


May 29, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10667 instructs MACs to download and implement the July 2018 and, if released, the revised April, 2018, January 2018, October 2017, and July 2017 ASP drug pricing files for Medicare Part B drugs via the Centers for Medicare & Medicaid Services (CMS) Data Center (CDC). Medicare will use these files to determine the payment limit for claims for separately payable Medicare Part B drugs processed or reprocessed on or after July 2, 2018, with dates of service July 1, 2018, through September 30, 2018. Make sure that your billing staffs are aware of these changes.
The Centers for Medicare & Medicaid Services (CMS) is mailing the new Medicare cards with the MBI in phases by geographic location. Here are 3 ways you and your office staff can get MBIs:
1. Ask your Medicare patients
Ask your Medicare patients for their new Medicare card when they come for care. If they haven’t received a new card at the completion of their geographic wave, refer them to 1-800-Medicare (1-800-633-4227).
2. Use the MAC's secure MBI look-up tool
Once the new Medicare card with the MBI has been mailed to your patient, you can look up MBIs for your Medicare patients when they don’t or can’t give them. Sign up for the Portal to use the tool. You can use this tool even after the end of the transition period – it doesn’t end on December 31, 2019.
3. Check the remittance advice
Starting in October 2018 through the end of the transition period, Medicare will return the MBI on every remittance advice when you submit claims with valid and active Health Insurance Claim Numbers (HICNs).
You can start using the MBIs even if the other health care providers and hospitals who also treat your patients haven’t. When the transition period ends December 31, 2019, providers must use the MBI for most transactions.

Revised:

Change Request (CR) 10474 provides updates to diagnosis codes required in order to allow add-on payments under the Inpatient Prospective Payment System (IPPS) for blood clotting factor administered to hemophilia inpatients. The add-on payment criteria for blood clotting factors administered to hemophilia inpatients will be updated July 1, 2018, by terminating International Classification of Diseases, Clinical Modification (ICD-CM) code D68.32, effective with that date. The list of ICD-CM codes that will continue to receive the add-on payment can be found in Section 20.7.3, of Chapter 3 of the “Medicare Claims Processing Manual”. Make sure your billing staffs are aware of this update.

May 25, 2018

2018 June Calendar of Events is Currently Available

The 2018 June Calendar of Events is now available for your reading pleasure! Please visit the Education and Training page of our website for additional information and registration opportunities.


Part A Open Issue Log

Some SNF claims are incorrectly Returning to Provider (RTP) with reason code 38119 when a Medicare Beneficiary Identifier (MBI) is submitted.

The issue was reported to the Fiscal Intermediary Shared System (FISS) and a correction has been developed. The correction is tentatively scheduled for July 2, 2018. 
The SNF claims submitted with an MBI that received reason code 38119 will be held in status location S M0340 until the correction is successfully installed. 

Claims submitted for processing with an MBI that were RTP’d for valid reasons currently cannot be corrected through the FISS DDE system. 

To avoid delays in payment, submit a new claim either through DDE or electronically if an MBI claim was returned to you. A correction is tentatively scheduled for July 3, 2018.


May 24, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, May 24, 2018  

View this edition as a PDF

News & Announcements

MIPS Promoting Interoperability Performance Category
Provider Documentation Manual on Home Use of Oxygen: Submit Comments on Draft by May 31
Proposals for New Measures for Promoting Interoperability Program: Deadline June 29
Targeted Probe and Educate Video
Hospice Compare Quarterly Refresh
CQM Annual Update
Break Free from Osteoporosis

Provider Compliance

Medicare Hospital Claims: Avoid Coding Errors — Reminder

Claims, Pricers & Codes

FY 2019 ICD-10-PCS Procedure Codes

Upcoming Events

Hospice Quality Reporting Program Data Submission and Reporting Webinar — May 30
DMEPOS Dietary Related Items, Templates and CDEs Special Open Door Forum — May 31
Qualified Medicare Beneficiary Program Billing Requirements Call — June 6
MIPS Promoting Interoperability Performance Category Webinar — June 12

Medicare Learning Network® Publications & Multimedia

RARC, CARC, MREP, and PC Print Update MLN Matters Article — New
Implement Operating Rules - Phase III ERA EFT: CORE 360 Uniform Use of CARC, RARC and CAGC Rule - Update from CAQH CORE MLN Matters Article — New
Removal of KH Modifier from Capped Rental Items MLN Matters Article — Revised
Changes to the ESRD Claim to Accommodate Dialysis Furnished to Beneficiaries with AKI MLN Matters Article — Revised
World of Medicare Web-Based Training Course — Revised
Your Office in the World of Medicare Web-Based Training Course — Revised
Your Institution in the World of Medicare Web-Based Training Course — Revised

New Medicare Insights Podcast

In this Medicare Insights Podcast episode, we remind you about the New Medicare Card and provide updates. 


May 23, 2018

Reason Code 37098 – Medicare Advantage (MA) Supplemental Wrap Around Payments 

Federally Qualified Health Centers (FQHCs) that have a written contract with a MA organization are paid by the MA plan at the rate specified within their contract. If the MA contract rate is less than the Medicare PPS rate, Medicare will pay the difference. This is called a supplemental wrap around payment.


May 22, 2018

Observer Online Registration for May 31, 2018 Open Meeting Now Closed

Observer online registration for the May 31, 2018 Open Meeting is now closed. Due to limited room capacity, registered presenters will be given priority for seating and registered observers are accepted until remaining seats are filled. Since the maximum seating capacity for observers has been reached, online registrations for observers are no longer being accepted. For those who have already registered, you will receive an e-mail notice by end of day on May 29th regarding your status.


Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10644 amends payment files issued to MACs based upon 2018 Medicare Physician Fee Schedule (MPFS) Final Rule. Make sure your billings staffs are aware of these changes.

May 21, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10620 updates the Remittance Advice Remark Code (RARC) and Claims Adjustment Reason Code (CARC) lists and instructs Medicare Shared System Maintainers (SSMs) to update Medicare Remit Easy Print (MREP) and PC Print. Be sure your staff are aware of these changes and obtain the updated MREP and PC Print software if they use that software.

May 18, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10622 constitutes a maintenance update of International Classification of Diseases, 10th Revision (ICD-10) conversions and other coding updates specific to National Coverage Determinations (NCDs). These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received.
Change Request (CR) 10566 informs MACs to update their systems based on the CORE 360 Uniform use of Claims Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC) and Claim Adjustment Group Code (CAGC) rule publication. These system updates are based on the Committee on Operating Rules for Information Exchange (CORE) Code Combination List to be published on or about June 4, 2018. CR10566 applies to the Medicare Claims Processing Manual, Chapter 22, Section 80.2. Make sure that your billing staffs are aware of these changes.

Revised:

Change Request (CR) 9598 implements changes to the ESRD Facility claim (Type of Bill 72x) to accommodate dialysis furnished to beneficiaries with Acute Kidney Injury (AKI). This MLN Matters Article summarizes these changes. Make sure that your billing staffs are aware of these changes.

Part A Open Issues Log Update

The adjustment process has started for claims identified from MM10531. Due to the volumes identified, claims to be adjusted will be entered each day until approximately July 2018. We will post information when all adjustments have been initiated.


May 17, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, May 17, 2018  

View this edition as a PDF

News & Announcements

New Medicare Card: MBI Look-up Tool Clarification and RRB Mailing
Enhanced “Drug Dashboards” to Increase Transparency on Drug Prices
CMS Safeguards Patient Access to Certain Medical Equipment and Services in Rural and Other Non-contiguous Communities
Quality Payment Program: Check 2018 MIPS Clinician Eligibility at the Group Level
Medicare Diabetes Prevention Program Resources
Hospital Outpatient Quality Reporting Spring 2018 Newsletter
Talk to Your Patients about Mental Health

Provider Compliance

Cochlear Devices Replaced Without Cost: Bill Correctly — Reminder

Upcoming Events

Settlement Conference Facilitation Expansion Call — May 22
Qualified Medicare Beneficiary Program Billing Requirements Call — June 6

Medicare Learning Network® Publications & Multimedia

ICD-10 and Other Coding Revisions to National Coverage Determinations MLN Matters Article — New
Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment MLN Matters Article — New
Updates to Publication 100-04 to Replace RARC MA61 with N382 MLN Matters Article — New
IPPS and LTCH PPS Extensions per the ACCESS Act MLN Matters Article — New
Supervised Exercise Therapy for Symptomatic PAD MLN Matters Article — Revised
Quarterly HCPCS Drug/Biological Code Changes – July 2018 Update MLN Matters Article — Revised
Medicare Preventive Services National Educational Products — Revised
Power Mobility Devices Booklet — Reminder
Advance Beneficiary Notice of Noncoverage Interactive Tutorial Educational Tool — Reminder
Medicare Advance Written Notices of Noncoverage Booklet — Reminder
Long-Term Care Hospital Prospective Payment System Booklet — Reminder
Medicare Disproportionate Share Hospital Fact Sheet — Reminder
Hospital-Acquired Conditions and Present on Admission Indicator Reporting Provision Fact Sheet — Reminder

April 2018 Part A Newsletter

The April 2018 Part A Newsletter is now available. Please take a moment to review


The following JH Draft Local Coverage Determinations (LCDs) have been posted for comment. The comment period will end on July 5, 2018:

Submit Comments


Online Registration Available for May 31, 2018, Open Meeting and Draft LCDs Now Posted

Online registration for the May 31, 2018, Open Meeting is now available and will close at 12:00 PM (Noon) Eastern Time (ET) on Tuesday, May 29, 2018, or before May 29th if room capacity is filled. The 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 10:00 AM 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 LCDs. Anyone is welcome to present information related to the draft LCDs that are 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 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 April 2018. 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.


May 16, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

Revised:

Change Request (CR) 10295 informs MACs that effective May 25, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a National Coverage Determination (NCD) to cover Supervised Exercise Therapy (SET) for beneficiaries with Intermittent Claudication (IC) for the treatment of symptomatic Peripheral Artery Disease (PAD). Make sure your billing staffs are aware of these changes.

May 15, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10642 informs MACs about the changes in the July 2018 quarterly update to the Clinical Laboratory Fee Schedule (CLFS). Make sure that your billing staffs are aware of these changes.
Change Request (CR) 10619 initiates both Medicare manual changes and operational changes related to the New Medicare Card. Medicare will replace the use of Remittance Advice Remark Code (RARC) MA61, referenced in the Medicare Claims Processing Manual, Chapters 1 and 27, with RARC N382 - missing/incomplete/invalid patient identifier (HICN or MBI). Effective for claims processed on or after the effective date of CR10619, MACs will use N382 in place of MA61 to communicate reject/denials for patient identifiers (HICN or MBI) in all remittance advices and 835 transactions. However, MACs will continue to use RARC MA61 only when/if communicating rejections/denials related to a missing/incomplete/invalid social security number. Make sure your billing staffs are aware of these updates.
Change Request (CR) 10547 provides information and implementation instructions for Sections 50204, 50205, and 51005 of the Advancing Chronic Care, Extenders, and Social Services (ACCESS) Act of 2018. Make sure that your billing staffs are aware of these changes.

Revised:

Change Request (CR) 10295 informs MACs that effective May 25, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a National Coverage Determination (NCD) to cover Supervised Exercise Therapy (SET) for beneficiaries with Intermittent Claudication (IC) for the treatment of symptomatic Peripheral Artery Disease (PAD). Make sure your billing staffs are aware of these changes.
Change Request (CR) 10624 informs MACs of updated drug/biological HCPCS codes. The HCPCS code set is updated on a quarterly basis. The July 2018 HCPCS file includes 4 new HCPCS codes: Q9991, Q9992, Q9993 and Q9995. Please make sure your billing staffs are aware of these updates.

May 14, 2018

Coming Soon: Registration for May 31, 2018, Open Meeting

Registration for the May 31, 2018, Open Meeting will be available starting on Thursday, May 17, 2018, and will be closed at 12:00PM (Noon) Eastern Time (ET) on Tuesday, May 29, 2018, or before May 29th if room capacity is filled. Novitas Solutions’ draft LCDs will be posted on May 17, 2018. 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 May 17th. 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.


May 10, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, May 10, 2018  

View this edition as a PDF

News & Announcements

First CMS Rural Health Strategy
Direct Provider Contracting RFI — Submit Comments by May 25
Provider Documentation Manual: Home Use of Oxygen — Submit Comments on Draft by May 31
Hospital Compare Preview Reports Available through June 2
eCQM Annual Update
Hospital Quality Reporting: 2019 QRDA I Implementation Guide, Schematron, and Sample Files
2018 Measure Development Plan Annual Report
National Women’s Health Week Kicks off on Mother’s Day

Provider Compliance

Reporting Changes in Ownership — Reminder

Upcoming Events

Quality Payment Program: Answering Your Frequently Asked Questions Call — May 16
Managing Older Adults with Substance Use Disorders Webinar — May 16
FY 2019 IPPS Proposed Rule: eCQM Reporting Webinar — May 16
Settlement Conference Facilitation Expansion Call — May 22
Qualified Medicare Beneficiary Program Billing Requirements Call — June 6

Medicare Learning Network® Publications & Multimedia

Inexpensive or Routinely Purchased DME Payment Classification for SGD and Accessories MLN Matters Article — New
Medicare Cost Report E-Filing MLN Matters Article — New
MCReF System Webcast: Audio Recording and Transcript — New

Part A Open Issues Log Updates

Rural Health Clinic and Federally Qualified Health Center claims for Chronic Care Management HCPCS G0511 and G0512 that processed at an incorrect rate have all be entered for reprocessing and should pay appropriately.

The correction for the Travel Allowance HCPCS P9603 and P9604 was successfully installed on May 7, 2018. Claims processed after that date will pay appropriately. Any claims that processed incorrectly prior to May 7, 2018, will be identified and automatically reprocessed. No provider action will be needed.


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


Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10622 constitutes a maintenance update of International Classification of Diseases, 10th Revision (ICD-10) conversions and other coding updates specific to National Coverage Determinations (NCDs). These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received.

May 8, 2018

Direct Data Entry Claims Display Error

Claims that were originally submitted for processing with a Health Insurance Claim Number (HICN) as the beneficiary identifier are being incorrectly displayed in Direct Data Entry (DDE) with the Medicare Beneficiary Identifier (MBI). Claims should be displaying in DDE with the original identifier submitted on the claim (either the HICN or MBI). We will resolve this issue no later than May 29, 2018.

If you use the MBI returned through this display error on claims, the beneficiary will receive a Medicare Summary Notice with the MBI on it, possibly before they receive their new Medicare card containing their MBI.

To avoid confusion, please do not use a beneficiary’s MBI until one of these occur:

They present their new Medicare card (which will contain their MBI)
The MBI is available through your Medicare Administrative Contractor’s secure portal
Their MBI is shared through the remittance advice starting in October 2018

For More Information


Automation of the Request for Reopening Claims Process

This article informs you and your vendors about changes that will allow you to request reopening of claims electronically. To request a reopening, you will report a new Type of Bill (TOB), XXQ, along with condition codes to indicate that the claim is a Request for Reopening. 

Effective on or after January 1, 2016, all providers must use the new reopening process, TOB XXQ, when a correction is to be made beyond the timely filing limit (one year from the through date of the service). An adjustment TOB XX7 is not allowed and the claim will return to provider.

The Centers for Medicare & Medicaid Services issued MLN Matters article, MM8581 and Special Edition Article, SE1426 to assist with billing the TOB XXQ and the reopening adjustment reason code.


May 4, 2018

May is National Osteoporosis Awareness Month 

May is National Osteoporosis Awareness Month. Osteoporosis is a preventable and treatable disease, yet approximately 10 million Americans have the disease and about 34 million more are at risk. For more information please review this article.


Have you submitted your Credit Balance Report?

The 03/31/2018 quarterly Credit Balance report was due 4/30/2018. Delinquency letters will be mailed on 5/15/18; withholding will begin on 6/3/18. Use our Online Status Tool to verify receipt. This is your only true confirmation. Allow 24-hours for reports indicating no credits to report and up to 10-days for those reporting credits. Fax reports to 410-891-5230. If you have questions or concerns, e-mail us at creditbalanceinquiries@novitas-solutions.com.


May 3, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, May 3, 2018

View this edition as a PDF

News & Announcements

New Medicare Cards: You Can Use MBIs Right Away
New Strategy to Fuel Data-driven Patient Care, Transparency
CMS Encourages Eligible Suppliers to Participate in Expanded Medicare Diabetes Prevention Program Model
Patients Over Paperwork April Newsletter
Hospital Quality Reporting Center Spring 2018 Newsletter
Administrative Simplification: Transactions
Can’t Find An Answer To Your Question?
Hand Hygiene Day is May 5

Provider Compliance

Provider Compliance Tips for Ordering Lower Limb Orthoses

Upcoming Events

Quality Payment Program: Participation Criteria for Year 2 Webinar — May 9
eCQI Resource Center Demonstration and Annual Update Webinar — May 10
Quality Payment Program: Answering Your Frequently Asked Questions Call — May 16
Settlement Conference Facilitation Expansion Call — May 22
Comparative Billing Report on Critical Care Services Webinar — June 6

Medicare Learning Network® Publications & Multimedia

New Physician Specialty Code for Medical Genetics and Genomics MLN Matters® Article — New
Processing Instructions to Update the Identification Code Qualifier Being Used in the NM108 Data Element MLN Matters Article — New
Revisions to the Telehealth Billing Requirements for Distant Site Services MLN Matters Article — New
Enhancements to Processing of Hospice Routine Home Care Payments MLN Matters Article — New
Comprehensive ESRD Care Model Telehealth - Implementation MLN Matters Article — New
Removal of KH Modifier from Capped Rental Items MLN Matters Article — New
Acute Care Hospital IPPS Booklet — Revised

2018 Medicare Symposiums

The Novitas 2018 Medicare Symposiums are here!  We invite you to join us in Albuquerque, NM on May 10 through May 11, 2018, for the first of our symposiums.   Whether you are new to the Medicare program or an experienced provider, the Novitas Symposiums have a variety of free courses to highlight the tools and resources you need to remain compliant with the Medicare program.

This in-person educational conference provides you with the opportunity to engage with our Provider Outreach and Education team and network with your colleagues, while gaining access to the most up-to-date Medicare information available. This year’s symposium has been redesigned to a two-day event offering unlimited scheduling combinations for Part A and Part B providers.  To access the Novitas 2018 Medicare Symposium schedule, click here.

Come explore Medicare with us and sign up today!


Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10611 informs MACs and providers of the new MCR e-filing (MCReF) system available for electronic transmission of cost reports. Medicare Part A providers file an annual MCR with the Centers for Medicare & Medicaid Services (CMS). The reports are filed with a MAC assigned to each provider. The MCR is used to determine the providers’ Medicare reimbursable costs. MACs may suspend payments to providers that fail to file their MCR on the due date. Make sure your cost report staffs are aware of the new MCReF System.

May 2, 2018

Part A Top Claims Submission / Reason Code Errors 

The April 2018 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.


May 1, 2018

Reason Code U5061 Rejections

Effective April 1, 2018, claims submitted with an invalid or old HIC number will reject with reason code U5061.  This reason code indicates the submitted Medicare number is not found in the CWF crosswalk. Providers will need to check with the beneficiary for their valid Medicare number.  Providers are also encouraged to verify the patient’s appropriate Medicare number using the self-service tools. Providers should attempt to cancel the rejected claim billed under the incorrectly submitted Medicare number, and resubmit using the valid Medicare number.


Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10314 details the CEC Model telehealth program and how it will be implemented. Make sure your billing staffs are aware of this initiative.

April 30, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10457 informs MACs that CMS has established a new physician specialty code for Medical Genetics and Genomics (D3). Make sure that your billing staffs are aware of these changes.
Change Request (CR) 10565 provides instructions to the MACs to update the Identification Code Qualifier in Data Element NM108 currently being used in the 2100 Loop, NM1- Patient Name Segment of the 835 guide. This will synchronize the usage of the same qualifier as used/submitted on the claim. Make sure your billing staffs are aware of these instructions.
Change Request (CR) implements requirements for billing modifier GT for Telehealth Distant Site Services. As of January 1, 2018, the GT modifier is only allowed on institutional claims billed by a Critical Access Hospital (CAH) Method II. Make sure your billing staffs are aware of this requirement.

April 27, 2018

Special Edition – Friday, April 27, 2018

Skilled Nursing Facility: Proposed FY 2019 Payment and Policy Changes
Inpatient Rehabilitation Facility: Prospective Payment System FY 2019 Proposed Rule
Inpatient Psychiatric Facility: FY 2019 Payment and Quality Reporting Updates
Hospice: Proposed Updates to the Wage Index and Payment Rates for FY 2019

Skilled Nursing Facility: Proposed FY 2019 Payment and Policy Changes

CMS issued a proposed rule outlining proposed FY 2019 Medicare payment updates and proposed quality program changes for Skilled Nursing Facilities (SNFs).
Proposed Rule Details:

Advancing My HealthEData: Request for Information from stakeholders
Modernizing the SNF Prospective Payment System (PPS) Case-mix Classification System
SNF Quality Reporting Program (QRP)
SNF Value-Based Purchasing Program (VBP)
Payment rate changes under SNF PPS

For More Information:

Proposed Rule: CMS will accept comments until June 26
SNF PPS website
SNF QRP website
SNF VBP Program website

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

Inpatient Rehabilitation Facility: Prospective Payment System FY 2019 Proposed Rule

On April 27, CMS proposed changes on how Medicare pays Inpatient Rehabilitation Facilities (IRFs) to make it easier for providers to spend more time with their patients and improve the use of electronic health records.
Proposed Rule Details:

Advancing My HealthEData: Request for Information from stakeholders
Burden reduction / Patients over Paperwork
Meaningful Measures
Proposed updates to IRF payment rates
Solicitation of comments regarding additional changes to the physician supervision requirement

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).

Inpatient Psychiatric Facility: FY 2019 Payment and Quality Reporting Updates

On April 27, CMS issued a rule proposing updates for FY 2019 to Medicare payment policies and rates for the Inpatient Psychiatric Facility (IPF) Prospective Payment System (PPS) and the IPF Quality Reporting Program.

Proposed Rule Details:

Advancing My HealthEData: Request for Information from stakeholders

Meaningful Measures
Proposed payment updates
Proposed technical corrections to IPF regulations
IPF PPS refinements comment solicitation

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).

Hospice: Proposed Updates to the Wage Index and Payment Rates for FY 2019

On April 27, CMS issued a proposed rule that would update FY 2019 Medicare payment rates and the wage index for hospices serving Medicare beneficiaries. This rule also proposes changes to the Hospice Quality Reporting Program. Proposed Rule Details:

Advancing My HealthEData: Request for Information from stakeholders
Burden reduction
Meaningful Measures
Routine annual rate setting changes
Hospice regulations text changes due to the Bipartisan Budget Act of 2018
Improving transparency for patients

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).


2018 May Calendar of Events is now Available

The May 2018 Calendar of Events is now available. Visit the Education and Training page of our website for additional information and registration opportunities. 


April 26, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, April 26, 2018

View this edition as a PDF

News & Announcements

New Medicare Card: Help Your Patients
CMS Changes Name of the EHR Incentive Programs and Advancing Care Information to “Promoting Interoperability”
Protect Medicare and Medicaid: Report Fraud, Waste, and Abuse
Hospital Inpatient Quality Reporting Program: Submission Deadline May 15
IRF, LTCH, and SNF Quality Reporting Programs: Submission Deadline May 15
Open Payments Review and Dispute Data by May 15
MACRA Funding Opportunity: Deadline Extended to May 30
STD Awareness Month: Talk, Test, Treat

Provider Compliance

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

Upcoming Events

Medicare Cost Report e-Filing System Webcast — May 1
CMS Quality Measures: How They Are Used and How You Can Be Involved Webinar — May 2
Quality Payment Program: Answering Your Frequently Asked Questions Call — May 16
Settlement Conference Facilitation Expansion Call — May 22

Medicare Learning Network® Publications & Multimedia

Quarterly HCPCS Drug/Biological Code Changes: July 2018 Update MLN Matters Article — New

Part A Open Issues- Update to existing reason code 32412 and new issue

Reason Code 32412 update: The correction installed on April 23, 2018, has resolved the issue with reason code 32412 editing on observation services.

The Centers for Medicare & Medicaid Services (CMS) created two new Healthcare Common Procedure Coding Systems (HCPCS) codes, G0511 and G0512, for RHCs and FQHCs only for dates of service on or after January 1, 2018.

It has been brought to the attention of CMS that the claims processing system is reading the incorrect rate for care management services.

The HCPCS files for G0511 and G0512 were corrected on April 20, 2018. Claims processed with dates of service January 1, 2018, through April 19, 2018, will be identified and automatically reprocessed. No provider action is needed. 


Part A Open Issues Update - New item

On February 9, 2018, Congress passed the Bipartisan Budget Act of 2018 which contains a number of provisions that extend certain Medicare FFS policies, including Ambulance add-on payment provisions, the Work Geographic Practice Cost Index (GPCI) Floor including anesthesia services, and the Act permanently repeals the outpatient therapy caps beginning on January 1, 2018, while retaining the requirement to submit the KX modifier for services in excess of the prior cap amounts. Please review MM10531 for complete details.

Change Request (CR) 10531 provides direction to MACs to reprocess claims related to several provisions of the Bipartisan Budget Act of 2018, referred to as Medicare Extenders. Specifically, the CR provides guidance to MACs regarding Medicare Fee For Service (FFS) claims reprocessing requirements and timeframes. Novitas will initiate adjustments on claims identified for this CR in the near future. We will provide specific dates and information as it becomes available.


April 25, 2018

Special Edition – Wednesday, April 25, 2018

CMS Proposes Changes to Empower Patients and Reduce Administrative Burden

Changes in IPPS and LTCH PPS would advance price transparency and interoperability

On April 24, CMS proposed changes to empower patients through better access to hospital price information, improve patients’ access to their electronic health records, and make it easier for providers to spend time with their patients. The proposed rule proposes updates to Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS).

“We seek to ensure the health care system puts patients first,” said Administrator Seema Verma. “Today’s proposed rule demonstrates our commitment to patient access to high quality care while removing outdated and redundant regulations on providers. We envision a system that rewards value over volume and where patients reap the benefits through more choices and better health outcomes. Secretary Azar has made such a value-based transformation in our health care system a top priority for HHS, and CMS is taking important, concrete steps toward achieving it.”

The policies in the IPPS and LTCH PPS proposed rule would further advance the agency’s priority of creating a patient-driven health care system by achieving greater price transparency and interoperability – essential components of value-based care – while also significantly reducing the burden for hospitals so they can operate with better flexibility and patients have the information they need to become active health care consumers.

While hospitals are already required under guidelines developed by CMS to either make publicly available a list of their standard charges, or their policies for allowing the public to view a list of those charges upon request, CMS is updating its guidelines to specifically require that hospitals post this information. The agency is also seeking comment on what price transparency information stakeholders would find most useful and how best to help hospitals create patient-friendly interfaces to make it easier for consumers to access relevant health care data so they can more readily compare providers.

The proposed policies begin implementing core pieces of the government-wide MyHealthEData initiative through steps to strengthen interoperability or the sharing of health care data between providers. Specifically, CMS is proposing to overhaul the Medicare and Medicaid Electronic Health Record Incentive Programs (also known as the “Meaningful Use” program) to:

Make the program more flexible and less burdensome
Emphasize measures that require the exchange of health information between providers and patients
Incentivize providers to make it easier for patients to obtain their medical records electronically

To better reflect this new focus, we are renaming the Meaningful Use program “Promoting Interoperability.” In addition, the proposed rule reiterates the requirement for providers to use the 2015 Edition of certified electronic health record technology in 2019 as part of demonstrating meaningful use to qualify for incentive payments and avoid reductions to Medicare payments. This updated technology includes the use of application programming interfaces, which have the potential to improve the flow of information between providers and patients. In the proposed rule, CMS is requesting stakeholder feedback through a Request for Information on the possibility of revising Conditions of Participation to revive interoperability as a way to increase electronic sharing of data by hospitals.

As part of its commitment to burden reduction, CMS is proposing in the FY 2019 IPPS/LTCH PPS proposed rule to remove unnecessary, redundant, and process-driven quality measures from a number of quality reporting and pay-for-performance programs. The proposed rule would eliminate a significant number of measures acute care hospitals are currently required to report and remove duplicative measures across the 5 hospital quality and value-based purchasing programs. This would remove 19 measures from the programs and de-duplicate another 21 measures while still maintaining meaningful measures of hospital quality and patient safety. Additionally, CMS is proposing a variety of other changes to reduce the number of hours providers spend on paperwork. CMS is proposing this new flexibility so that hospitals can spend more time providing care to their patients thereby improving the quality of care their patients receive.

In sum, this results in the elimination of 25 measures across the 5 programs with well over 2 million burden hours reduced for hospital providers impacted by the IPPS proposed rule, saving them $75 million.

For More Information:

See the full text of this excerpted CMS Press Release (issued April 24).


April 23, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10624 informs MACs of updated drug/biological HCPCS codes. The HCPCS code set is updated on a quarterly basis. The July 2018 HCPCS file includes 4 new HCPCS codes: Q9991, Q9992, Q9993 and Q9995. Please make sure your billing staffs are aware of these updates.

April 19, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, April 19, 2018

View this edition as a PDF

News & Announcements

New Medicare Card: New Numbers Are Confidential
Market Saturation and Utilization Data Tool
MIPS Study on Burdens Associated with Reporting Quality Measures: Apply by April 30
IMPACT Act Transfer of Health Measures: Public Comment Period Ends May 3
PEPPERs Available for Hospices, SNFs, IRFs, IPFs, CAHs, LTCHs
National Minority Health Month: Partnering for Health Equity

Provider Compliance

Ophthalmology Services: Questionable Billing and Improper Payments

Claims, Pricers & Codes

April 2018 OPPS Pricer File

Upcoming Events

Medicare Cost Report e-Filing System Webcast — May 1
LTCH Quality Reporting Program In-Person Training Event — May 8 and 9
IRF Quality Reporting Program In-Person Training Event — May 9 and 10

Medicare Learning Network® Publications & Multimedia

Quarterly Update to the NCCI PTP Edits, Version 24.2 MLN Matters Article — New
Change in Type of Service for CPT Code 77067 MLN Matters Article — New
Ambulance Transportation for SNF Resident in Stay Not Covered by Part A MLN Matters Article — New
Supervised Exercise Therapy for Symptomatic PAD MLN Matters Article — Revised
Guidelines for Teaching Physicians, Interns, and Residents Booklet — Revised
Billing Information for Rural Providers and Suppliers Booklet — Revised
ICD-10-CM/PCS: The Next Generation of Coding Booklet — Reminder
General Equivalence Mappings FAQs Booklet — Reminder
Critical Access Hospital Booklet — Reminder
Learn About Medicare Policy

Update Part A Open Issues Log

Claims that contained line items that were incorrectly denied for reason codes 59172/59173 and 59049-59052, prior to the temporary correction, have been identified. The claims will be automatically reprocessed and no provider action is necessary. For providers with access to view claims in the Fiscal Intermediary Shared System, the adjustments will include remarks on Page 4 (MAP1714) that will indicate which NCD denial is being corrected. 
 

Reason codes 59172/59173 are used for NCD 220.4

Reason codes 59049-59052 are used for NCD 220.13


April 18, 2018

Your Chance to Complete the 2018 MSI Survey Ends on Friday, April 20th

Friday, April 20th, will be the last day for this year's MAC Satisfaction Indicator (MSI) Survey.

We'd like to thank all of our customers who took the time to complete a survey this year.  If you have yet to do so, we would love to hear from you before the end of the day on Friday, April 20th.  The MSI shares your opinions about the services we provide to you with the Centers for Medicare and Medicaid Services and helps us gain valuable insights to determine process improvements.


Group Suffixes on Provider Transaction Access Numbers (PTANs)

Due to internal system changes, we will be ending the practice of appending suffixes to PTANs of group members.  Effective April 16, 2018, group suffixes will no longer be issued to newly enrolling group practices, and individuals reassigning benefits to a group will no longer be assigned a suffix. 

Note: Existing suffixes will not be deleted from enrollment records.  


April 16, 2018

New Medicare Insights Podcast

In this Medicare Insights Podcast episode, we repeat the discussion about the 2018 Medicare Satisfaction Indicator (MSI) Survey, due to its importance. If you who have already participated, we thank you. If you have not yet participated, we look forward to hearing from you.


Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10550 provides clarification on coverage of an ambulance transport for a SNF resident in a stay not covered by Part A, who has Part B benefits, to the nearest supplier of medically necessary services not available at the SNF, including the return trip. These clarifications relate to Chapter 10 of the Medicare Benefit Policy Manual, and Chapter 15, of the Medicare Claims Processing Manual. The revised manual sections are attachments to CR10550. Make sure your billing staffs are aware of these clarifications.

April 12, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, April 12, 2018

View this edition as a PDF

News & Announcements

Help Your Medicare Patients Avoid and Report Scams
2018 MIPS Eligibility Tool
Draft 2019 QRDA Category I Schematron: Submit Comments by April 20
Home Health Utilization and Payment Data
National Health Care Decisions Day is April 16

Provider Compliance

Provider Compliance Tips for Oral Anticancer Drugs and Antiemetic Drugs Used in Conjunction

Upcoming Events

Opioids Forum: Strategies and Solutions for Minority Communities — April 25
Medicare Cost Report e-Filing System Webcast — May 1

Medicare Learning Network® Publications & Multimedia

Increased Ambulance Payment Reduction for Non-Emergency BLS Transports to and from Renal Dialysis Facilities MLN Matters Article — New
New Waived Tests MLN Matters Article — New
Supervised Exercise Therapy for Symptomatic PAD MLN Matters Article — Revised
Modifications to the Implementation of the PWK Segment of the esMD System MLN Matters Article — Revised
Claims Processing Actions to Implement Certain Provisions of the Bipartisan Budget Act of 2018 MLN Matters Article — Revised
Revised and New Modifiers for Oxygen Flow Rate MLN Matters Article — Revised
April 2018 MLN Catalog – Revised
Medicare Home Health Benefit Booklet - Revised

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

The following JH Local Coverage Articles have been revised:


Low Volume Appeals (LVA) Initiative is being extended to June 8, 2018

The deadline to submit an expression of interest (EOI) for the Low Volume Appeals (LVA) Initiative is being extended to June 8, 2018. Appellants with either an odd or an even NPI, that meet the eligibility criteria, should submit an EOI between April 12, 2018 and June 8, 2018. Details about the process, including a fillable EOI, are available at http://go.cms.gov/LVA.


Medicare Learning Network® MLN Matters® Articles from CMS

Revised:

Change Request (CR) 10295 informs MACs that effective May 25, 2017; the Centers for Medicare & Medicaid Services (CMS) issued a National Coverage Determination (NCD) to cover Supervised Exercise Therapy (SET) for beneficiaries with Intermittent Claudication (IC) for the treatment of symptomatic Peripheral Artery Disease (PAD). Make sure your billing staffs are aware of these changes.

Issue: Claims billed with the Travel Allowance Healthcare Common Procedure Coding System (HCPCS) P9603 and/or P9604

Claims billed with the Travel Allowance Healthcare Common Procedure Coding System (HCPCS) P9603 and/or P9604 are not processing correctly. There may be coinsurance applied to the service line inappropriately and no actual payment is being made.

This issue was reported to the Fiscal Intermediary Shared System (FISS) maintainer. A correction has been developed that is tentatively scheduled for May 7, 2018. We will provide additional information for the reprocessing of impacted claims when it is available.


Clinical Laboratory Fee Schedule (CLFS) Billing for Dates of Service January 1, 2018 and After

Laboratory services receiving reason code 32402 for dates of service in 2018? Review this article for details.


Alcohol Misuse Screening and Counseling

About 38 million adults in the United States drink too much. Only one in six adults have talked to a health professional. Alcohol screening and brief counseling has been proven to work and talking to your patient is the first step! For more information please review this article.


April 11, 2018

March 2018 Part A Newsletter

The March 2018 Part A Newsletter is now available. Please take a moment to review.


Frequently Asked Questions (FAQs)

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


April 9, 2018

MSI Survey 2018 - There's Still Time!

There is still time to share your experiences with the Centers for Medicare and Medicaid Services (CMS) about the services we provide to you.  If you have a few moments to spare, your completion of the annual MAC Satisfaction Indicator (MSI) survey and help us gain valuable insights to determine process improvements.  Thanks in advance.  We look forward to your comments.


Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10549 provides instructions regarding Section 53108 of the Bipartisan Budget Act of 2018. This section reduces the ambulance payment by 23 percent for non-emergency Basic Life Support (BLS) transports of individuals with End-Stage Renal Disease (ESRD), to and from renal dialysis treatment (at both hospital-based and freestanding renal dialysis treatment facilities). Please make sure your billing staffs are aware of these changes.

Revised:

Change Request (CR) 10295 informs MACs that effective May 25, 2017; the Centers for Medicare & Medicaid Services (CMS) issued a National Coverage Determination (NCD) to cover Supervised Exercise Therapy (SET) for beneficiaries with Intermittent Claudication (IC) for the treatment of symptomatic Peripheral Artery Disease (PAD). Make sure your billing staffs are aware of these changes.
Change Request (CR) 10397updates the business requirements to enable MACs to receive unsolicited documentation (also known as paperwork (PWK)) via the Electronic Submission of Medical Documentation (esMD) system. CR10397 is for esMD purposes only. Please make sure your billing staffs are aware of these updates.
Change Request (CR) 10531 provides direction to MACs to reprocess claims related to several provisions of the Bipartisan Budget Act of 2018, referred to as Medicare Extenders. Specifically, the CR provides guidance to MACs regarding Medicare Fee For Service (FFS) claims reprocessing requirements and timeframes. Make sure your billing staffs are aware of these changes.

April 5, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, April 5, 2018

View this edition as a PDF

News & Announcements

New Medicare Card Project – Important Updates
Bipartisan Budget Act: CMS Reprocessing Impacted Claims
Reducing Provider Burden: Send us Your Feedback
MIPS Group Web Interface and CAHPS Survey: Register by June 30
MIPS APM: Resources for Performance Year 2018
Medicare Diabetes Prevention Program: New Resources
Administrative Simplification: Electronic Transactions
Opioids: CDC Online Training Series
Opioid Overdoses Treated in Emergency Departments: CDC Vital Signs Report
Help Prevent Alcohol Misuse or Abuse
Reduce the Risk of Falls in Elderly Patients

Provider Compliance

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

Claims, Pricers & Codes

HCPCS Code Set Modifications

Upcoming Events

Cultural Competence: Meeting LTSS Needs of Beneficiaries Webinar — April 12
Safe and Effective Use of Medications in Older Adults Webinar — April 18
Managing Older Adults with Substance Use Disorders Webinar — May 16

Medicare Learning Network® Publications & Multimedia

Institutional Billing for No Cost Items MLN Matters Article — New
Proper Coding for Specimen Validity Testing Billed in Combination with Drug Testing MLN Matters Article — New
SNF ABN MLN Matters Article — New
SNF Value-Based Purchasing Program Updated MLN Matters Article — New
Dementia Care Call: Audio Recording and Transcript — New
Medicare FFS Response to the 2017 California Wildfires MLN Matters Article — Updated
Medicare FFS Response to the 2017 Southern California Wildfires MLN Matters Article — Updated
Inpatient Psychiatric Facility PPS Booklet — Revised
Medicare Enrollment for Providers Who Solely Order, Certify, or Prescribe Booklet — Revised
2018 Medicare Part C and Part D Reporting Requirements and Data Validation Web-Based Training Course — Revised
Medicare Parts A & B Appeals Process Booklet — Reminder

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 March 2018. New questions / answers have been added to the General Information and Return to Provider categories. Please take time to review these and other FAQs for answers to your questions.


Part A Top Claims Submission / Reason Code Errors 

The March 2018 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.


April 3, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

Revised:

Pursuant to the Robert T. Stafford Disaster Relief and Emergency Assistance Act, President Trump declared that, as a result of the effects of the 2017 Wildfires, a major disaster exists in the State of California.
On October 15, 2017, Acting Secretary Hargan of the Department of Health & Human Services declared that a public health emergency exists in the State of California retroactive to October 8, 2017, and authorized waivers and modifications under §1135 of the Social Security Act.
On October 17, 2017, the Administrator of the Centers for Medicare & Medicaid Services (CMS) authorized waivers under §1812(f) of the Social Security Act for the State of California retroactive to October 8, 2017 for those people who are evacuated, transferred, or otherwise dislocated as a result of the effect of wildfires. Providers can request an individual Section 1135 waiver by following the instructions available at https://www.cms.gov/About-CMS/Agency- Information/Emergency/Downloads/Requesting-an-1135-Waiver-Updated-11-16-2016.pdf. The Public Health Emergency declaration and Social Security Act waivers including the Section 1135 waiver authority expired on January 5, 2018.
Pursuant to the Robert T. Stafford Disaster Relief and Emergency Assistance Act, President Trump declared that, as a result of the effects of the December 2017 Wildfires, an emergency exists in the State of California.
On December 11, 2017, Acting Secretary Hargan of the Department of Health & Human Services declared that a public health emergency (PHE) exists in the State of California retroactive to December 4, 2017, and authorized waivers and modifications under §1135 of the Social Security Act.
On December 13, 2017, the Administrator of the Centers for Medicare & Medicaid Services (CMS) authorized waivers under §1812(f) of the Social Security Act for the State of California retroactive to December 4, 2017 for those people who are evacuated, transferred, or otherwise dislocated as a result of the effect of wildfires. Providers can request an individual Section 1135 waiver by following the instructions available at https://www.cms.gov/About-CMS/Agency- Information/Emergency/Downloads/Requesting-an-1135-Waiver-Updated-11-16-2016.pdf. The Public Health Emergency declaration and Social Security Act waivers including the Section 1135 waiver authority expired on March 3, 2018.

April 2, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

This article provides clarification of the billing instructions specific to drugs provided at no cost when claims processing edits prevent drug administration charges from being billed when the claim does not contain a covered/billable drug charge. This is not a new policy but a reminder of the policy in place. Please make sure your billing staffs are aware of this clarification.
This article advises that the Centers for Medicare & Medicaid Services (CMS) has revised the Skilled Nursing Facility Notice of Non-coverage, Form CMS-10055. With this revision, CMS is discontinuing the five Skilled Nursing Facility Denial Letters (namely, the Intermediary Determination of Noncoverage, the UR Committee Determination of Admission, the UR Committee Determination on Continued Stay, the SNF Determination on Admission and the SNF Determination on Continued Stay), and the Notice of Exclusion from Medicare Benefits (NEMB-SNF), Form CMS-20014. Please ensure that your billing staffs are aware of these changes.
This MLN Matters Special Edition article reminds laboratories and other providers about how to properly bill for specimen validity testing done in conjunction with drug testing. Please make sure your billing staffs are aware of these instructions.

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Special Edition article SE18003 informs providers about the SNF Value-Based Purchasing (VBP) Program. The VBP Program is one of many VBP programs that aim to reward quality and improve health care. Beginning October 1, 2018, SNFs will have an opportunity to receive incentive payments based on their performance in the program.

March 29, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, March 29, 2018

View this edition as a PDF

News & Announcements

Patients Over Paperwork: Empowering Patients Through Data
MIPS Data Submission Deadline: March 31
Transitions from Hospice Care, Followed by Death or Acute Care Draft Measure: Comment Period Ends April 25
Open Payments Review and Dispute Period: April 1 through May 15
Qualified Medicare Beneficiary Claims: Replacement RAs
MACRA Patient Relationship Categories and Codes
Advanced Diagnostic Laboratory Tests: Applications and Guidance
HIMSS18 Presentations
Hospice Quality Reporting Program Video Series: Navigating HQRP Websites
Hospice Item Set Coding Video Series
Physician Compare Quality Measure TEP Summary Report
Administrative Simplification: Reaching Compliance with ASETT Video

Provider Compliance

Provider Compliance Tips for Diabetic Test Strips

Upcoming Events

Comparative Billing Report on Spinal Orthoses Suppliers Webinar — May 2
LTCH Quality Reporting Program In-Person Training Event — May 8 and 9
IRF Quality Reporting Program In-Person Training Event — May 9 and 10

Medicare Learning Network® Publications & Multimedia

Claims Processing Actions to Implement Certain Provisions of the Bipartisan Budget Act of 2018 MLN Matters Article — New
Adjustments to QMB Claims Processed under CR 9911 MLN Matters Article — New
April Quarterly Update for 2018 DMEPOS Fee Schedule MLN Matters Article — New
Low Volume Appeals Settlement Call: Audio Recording and Transcript — New
Open Payments Call: Audio Recording and Transcript — New
E/M Services Listening Session: Audio Recording and Transcript — New
Prohibition on Billing Dually Eligible Individuals Enrolled in the QMB Program MLN Matters Article — Revised
April 2018 I/OCE Specifications Version 19.1 MLN Matters Article — Revised
April 2018 Update of the Hospital OPPS MLN Matters Article — Revised

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


March 28, 2018

New Addition to the April 2018 Calendar of Events

We have added a new event to the April 2018 Calendar, Ability/PCACE, scheduled for Monday, April 23. Visit the Education and Training page of our website for additional information and registration opportunities.


March 27, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10531 provides direction to MACs to reprocess claims related to several provisions of the Bipartisan Budget Act of 2018, referred to as Medicare Extenders. Specifically, the CR provides guidance to MACs regarding Medicare Fee For Service (FFS) claims reprocessing requirements and timeframes. Make sure your billing staffs are aware of these changes.

Part A Open Issues update

For claims processed on or after July 2, 2018, CMS will reintroduce QMB information on the Medicare remittance with revised coding from what was implemented with CR9911. Refer to MM10433 for more information.

Claims that processed with the QMB information prior to December 8, 2017, will be identified and automatically reprocessed. No provider action will be necessary. Refer to MM10494 issued by CMS for additional details.


March 23, 2018

New Medicare Card

Beginning in April 2018, the Centers for Medicare & Medicaid Services (CMS) will mail new Medicare cards to all people with Medicare on a flow basis by geographic location and other factors. Additional details on timing will be available as the mailings progress.

Mailing Schedule 

April - June 2018
Jurisdiction L - Pennsylvania, Maryland, Delaware and the Washington D.C. Metro Area (Arlington and Fairfax counties in Virginia, the city of Alexandria, VA, the District of Columbia, and Montgomery and Prince George’s counties in Maryland)
After June 2018
Jurisdiction L - New Jersey, and
Jurisdiction H - Colorado, Oklahoma, New Mexico, Texas, Arkansas, Louisiana, Mississippi, Indian Health Service and Veterans Affairs

Additional details on timing will be available as mailings progress.

Starting in April 2018, beneficiaries can check the status of card mailings in their area on Medicare.gov.

For more information, please reference this article.


Medicare Learning Network® MLN Matters® Articles from CMS

New:

This article is based on Change Request (CR) 10494 which directs MACs to mass adjust QMB claims impacted by CR9911. Make sure that your billing staff is aware of these upcoming claims adjustments.
Change Request (CR) 10503 provides the April 2018 Medicare DMEPOS fee schedule quarterly update. It provides specific instructions to your DME MAC for implementing updated Oxygen Volume Adjustments. When necessary, the DMEPOS fee schedule is updated quarterly, to implement fee schedule amounts for new codes, to correct any fee schedule amounts for existing codes (as applicable) and to apply changes in payment policies. It contains fee schedule amounts for both non-rural and rural areas. Additionally, the parenteral and enteral nutrition (PEN) fee schedule file includes state fee schedule amounts for enteral nutrition items and national fee schedule amounts for parental nutrition items.

Revised

CR 10514 provides the Integrated Outpatient Code Editor (I/OCE) instructions and specifications for the I/OCE that will be used in the Outpatient Prospective Payment System (OPPS) and non-OPPS for hospital inpatient departments, Community Mental Health Centers (CMHCs), all non-OPPS providers, and for limited services when provided in a home health agency not under the Home Health Prospective Payment System (HH PPS) or to a hospice patient for the treatment of a non-terminal illness. Make sure your billing staffs are aware of these updates
CR 10515 describes changes to the OPPS to be implemented in the April 2018 update. Make sure your billing staffs are aware of these changes.
This Special Edition MLN Matters® Article from the Centers for Medicare & Medicaid Services (CMS) reminds all Medicare providers and suppliers, including pharmacies, that they may not bill beneficiaries enrolled in the QMB program for Medicare cost-sharing. Medicare beneficiaries enrolled in the QMB program have no legal obligation to pay Medicare Part A or Part B deductibles, coinsurance, or copays for any Medicare-covered items and services.
Implement key measures to ensure compliance with QMB billing requirements. Use HIPAA Eligibility Transaction System (HETS) (effective November 2017), CMS’ eligibility-verification system, and the provider RA (July 2018) to identify beneficiaries’ QMB status and exemption from cost-sharing prior to billing. Starting July 2018, look for QMB alerts messages in the Remittance Advice for FFS claims to verify QMB after claims processing.

March 22, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, March 22, 2018

View this edition as a PDF

News & Announcements

Coverage of Next Generation Sequencing Tests Ensures Enhanced Access for Cancer Patients
IMPACT Act Transfer of Health Measures: Public Comment Period Ends May 3
Hospice Quality Reporting Program: HART v1.4.0
Hospital VBP Program FY 2020 Baseline Measures Report

Provider Compliance

Billing for Stem Cell Transplants — Reminder

Upcoming Events

IMPACT Act and Improving Care Coordination Special Open Door Forum — March 28
Spinal Orthoses Referring Providers Comparative Billing Report Webinar — April 11
CMS National Provider Enrollment Conference — April 24 and 25

Medicare Learning Network® Publications & Multimedia

April 2018 Update: ASC Payment System MLN Matters Article — New
Internet Only Manual Update to Correct Errors and Omissions: SNF 2018 MLN Matters Article — New
SSI/Medicare Beneficiary Data for FY 2016: IPPS Hospitals, IRFs, LTCHs MLN Matters Article — New
Billing Requirements for OPPS Providers with Multiple Service Locations MLN Matters Article — New
Reinstating the QMB Indicator in the Medicare FFS Claims Processing System MLN Matters Article — Revised
Quarterly Update for CLFS and Laboratory Services Subject to Reasonable Charge Payment MLN Matters Article — Revised
Home Health Prospective Payment System Booklet — Revised
Federally Qualified Health Center Booklet — Revised
Medicare Parts A and B Appeals Process Booklet — Reminder
The Medicare Secondary Payer Provisions Web-Based Training Course — Reminder
CLIA Program and Medicare Laboratory Services — Reminder

March 21, 2018

Inclement Weather Update: Winter Storm Toby

Winter Storm Toby continues to bring hazardous weather conditions to our Mechanicsburg, PA offices. For the safety or our employees, our Contact Center will be closed for the remainder of the day on Wednesday, March 21, 2018.  

Normal business hours are expected to resume Thursday, March 22, 2018.  During the Contact Center closure, our IVR and Portal will remain available to address your self-service needs. We appreciate your patience as we address impacts caused by Winter Storm Toby.


March 20, 2018

Revision of Paperwork (PWK) Fax / Mail Cover Sheet

The PWK Fax / Mail cover sheet is being revised to remove the health insurance claim number (HICN) and replace it with "Medicare ID" as part of the Medicare Access and CHIP Re-authorization Act of 2015, requiring removal of the Social Security number-based HICN from Medicare cards.

As a result of this change, Medicare contractors will accept only the new PWK Fax / Mail cover sheets that contain "Medicare ID" beginning April 2, 2018. 


New Medicare Insights Podcast

In this Medicare Insights Podcast episode, we discuss the Medicare Satisfaction Indicator (MSI) Survey.


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 February 2018. New questions / answers have been added to the Eligibility/Entitlement category. Please take time to review these and other FAQs for answers to your questions.


March 19, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

This article conveys enforcement editing requirements for the Medicare Claims Processing Manual, Chapter 1, and Section 170 which describes Payment Bases for Institutional Claims. These requirements are not new requirements. Make sure your billing staff is aware of these instructions.
This article is based on Change Request (CR) 10512 which informs MACs about an update to the Medicare manuals to correct various minor technical errors and omissions. Those changes are intended only to clarify the existing content and no policy, processing, or system changes are anticipated. Make sure your billing staff is aware of these instructions.
Change Request (CR) 10527 informs MACs about updated data for determining the disproportionate share adjustment for IPPS hospitals and the low-income patient adjustment for IRFs, as well as payments, as applicable, for LTCH discharges (for example, discharges paid the IPPS comparable amount under the short-stay outlier payment adjustment). Make sure that your billing staffs are aware of these changes.

Revised:

CR 10445 informs the MACs about the changes in the April 2018 quarterly update to the Clinical Laboratory Fee Schedule (CLFS). Make sure that your billing staffs are aware of these changes.

March 16, 2018

The April 2018 Calendar of Events is Now Available

The April 2018 Calendar of Events is currently available for your review. Visit the Education and Training page of our website for additional information and registration opportunities. Do not miss your chance to remain current and update on the latest Medicare news.


March 15, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, March 15, 2018

View this edition as a PDF

News & Announcements

MIPS Reporting Deadlines Approaching
EHR Incentive Program: Hospital Attestation Deadline Changed to March 16
Hospice Provider Preview Reports: Review Your Data by March 30
IRF and LTCH Provider Preview Reports: Review Your Data by April 5
Medicare Pharmaceutical and Technology Ombudsman
Updated QRDA III Implementation Guide with Advancing Care Information Identifier
Hospice QRP Timeliness Compliance Threshold Report: Footnote Update
Influenza Activity Continues: Are Your Patients Protected?

Provider Compliance

Provider Compliance Tips for Hospital Beds and Accessories

Claims, Pricers & Codes

Integrated OCE Files for April 2018

Upcoming Events

New Medicare Card Project Special Open Door Forum — March 20
Dementia Care: Person-Centered Care Planning and Practice Recommendations Call — March 20
E/M Services: Documentation Guidelines and Burden Reduction Listening Session — March 21
Interdisciplinary Team Building, Management, and Communication Webinar — March 21
Hospice Quality Reporting Program Webinar — March 27
IMPACT Act and Improving Care Coordination Special Open Door Forum — March 28
Managing Transitions with Adults with Disabilities Webinar — March 28
Building Partnerships: Health Plans and Community-based Organizations Webinar — April 4

Medicare Learning Network® Publications & Multimedia

Appropriate Use Criteria for Advanced Diagnostic Imaging: HCPCS Modifier QQ MLN Matters Article — New
April 2018 I/OCE Specifications Version 19.1 MLN Matters Article — New
April 2018 Update of the Hospital OPPS MLN Matters Article — New
Provider Compliance Tips for Enteral Nutrition Fact Sheet — New
Provider Compliance Tips for Walkers Fact Sheet — New
Provider Compliance Tips for Home Health Services Fact Sheet — New
Provider Compliance Tips for Respiratory Assistive Devices Fact Sheet— New
ICD-10 and Other Coding Revisions to NCDs MLN Matters Article — Revised
Diagnosis Code Update for Add-on Payments for Blood Clotting Factor Administered to Hemophilia Inpatients MLN Matters Article — Revised
Supervised Exercise Therapy for Symptomatic PAD MLN Matters Article — Revised
Quarterly HCPCS Drug/Biological Code Changes MLN Matters Article — Revised
Provider Compliance Tips for Laboratory Tests: Other Fact Sheet – Revised
Provider Compliance Tips for Ordering Hospital Outpatient Services Fact Sheet — Revised
Provider Compliance Tips for Skilled Nursing Facility Services Fact Sheet — Revised
Provider Compliance Tips for Enteral Nutrition Therapy Pumps Fact Sheet — Revised
Provider Compliance Tips for IRF Fact Sheet — Revised
Ambulatory Surgical Center Payment System Fact Sheet — Revised
Beneficiaries in Custody under a Penal Authority Fact Sheet—Revised
Medicare Ambulance Transports Booklet — Revised
Medicare Provider-Supplier Enrollment National Educational Products Listing — Revised
Global Surgery Booklet — Reminder

The following JH Local Coverage Article which was posted for notice on January 25, 2018 is now effective:


March 14, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

Revised:

Effective with Change Request (CR) 10433, the Centers for Medicare & Medicaid Services (CMS) will reintroduce Qualified Medicare Beneficiary (QMB) information in the Medicare Remittance Advice (RA) and Medicare Summary Notice (MSN). CR 9911 modified the Fee-For-Service (FFS) systems to indicate the QMB status and zero cost-sharing liability of beneficiaries on RAs and MSNs for claims processed on or after October 2, 2017. CR 10433 reinstates all changes to the MSNs under CR 9911. Please make sure your billing staff is aware of these changes.

March 12, 2018

The 2018 MAC Satisfaction Indicator (MSI) Survey is Here!

The MSI is the best way to share your opinions directly with the Centers for Medicare & Medicaid Services (CMS) about your experience with us. These survey results will help us gain valuable insights and determine process improvements.  The survey will be available for a limited time and can be completed by clicking here.  Thank you in advance for your participation.


Medicare Learning Network® MLN Matters® Articles from CMS

Revised:

Change Request (CR) 10454 informs MACs of the April 2018 updates of specific biosimilar biological product HCPCS code, modifiers used with these biosimilar biologic products and an autologous cellular immunotherapy treatment. The HCPCS code set is updated on a quarterly basis. Be sure your staffs are aware of these updates.

March 9, 2018

The comment period is now closed for the following JH Draft Local Coverage Determinations (LCDs). Comments received will be reviewed by our Contractor Medical Directors and Response to Comments Articles will be posted to our website and related to the LCDs when they are posted for notice.


March 8, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, March 8, 2018

View this edition as a PDF

News & Announcements

MyHealthEData Initiative Puts Patients at the Center of the US Health Care System
New Medicare Card Transition Begins In Less Than a Month
MACRA Funding Opportunity: Measure Development for the Quality Payment Program
IRF and LTCH Compare Refresh
Quality Payment Program: Submit 2017 Participation Data through March 31
EHR Incentive Program: Hospitals Submit Proposals for New Measures until June 29
PEPPER for Short-term Acute Care Hospitals
DME Supplier Feedback on Telephone Discussion and Reopening Process Demonstration
EHR Incentive Programs FAQs
Antipsychotic Drug Use in Nursing Homes: Trend Update
Help Your Patients Go Further With Food

Provider Compliance

Bill Correctly for Device Replacement Procedures — Reminder

Claims, Pricers & Codes

April 2018 Average Sales Price Files

Upcoming Events

Low Volume Appeals Settlement Option Update Call — March 13
National Patient Safety Week Panel Discussion — March 13
Open Payments: The Program and Your Role Call — March 14
QRDA Category I Implementation Guide for CY 2018 Hospital Quality Reporting Webinar — March 19
Dementia Care: Person-Centered Care Planning and Practice Recommendations Call — March 20
E/M Services: Documentation Guidelines and Burden Reduction Listening Session — March 21

Medicare Learning Network® Publications & Multimedia

Provider Compliance Tips for Glucose Monitors Fact Sheet — New
Provider Compliance Tips for Manual Wheelchairs Fact Sheet — New
Provider Compliance Tips for Ordering Lower Limb Prostheses Fact Sheet — New
Provider Compliance Tips for Laboratory Tests – Bacterial Cultures Fact Sheet — New
Provider Compliance Tips for Wheelchair Options/Accessories Fact Sheet — New
Provider Compliance Tips for Ostomy Supplies Fact Sheet — New
Provider Compliance Tips for Ordering Oxygen Supplies and Equipment Fact Sheet — New
Provider Compliance Tips for Negative Pressure Wound Therapy Fact Sheet — New
Provider Compliance Tips for Surgical Dressings Fact Sheet — New
Provider Compliance Tips for Urological Supplies Fact Sheet — New
Low Volume Appeals Settlement Call: Video Presentation — New
ESRD QIP Call: Audio Recording and Transcript — New
Rural Health Clinic Fact Sheet — Revised

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

The following JH Local Coverage Articles have been revised:


Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10515 describes changes to the OPPS to be implemented in the April 2018 update. Make sure your billing staffs are aware of these changes.

March 7, 2018

February 2018 Part A Newsletter

The February 2018 Part A Newsletter is now available. Please take a moment to review


March 6, 2018

Clarification on the implementation of change request (CR) 10318, transmittal 2005 titled, “ICD-10 and Other Coding Revisions to National Coverage Determinations (NCDs)”

The Centers for Medicare & Medicaid Services (CMS) has received multiple inquiries related to instructions in CR10318 for NCDs 110.21 and 80.11, and provides clarification. Please read this article for details.


Update to Opt Out Page

Novitas has recently updated our Opt Out page to link users to the CMS Opt Out Listing. The CMS listing is the most efficient means to search for providers who have opted out of the Medicare program. For a list of all physicians and practitioners that are currently opted out of Medicare, please review the CMS Opt-Out Affidavit listing. The Opt-Out Listing is updated on a quarterly basis. Please make sure that your enrollment staff is aware of this change.

Note: There will no longer be downloadable spreadsheets from this page.


Medicare Learning Network® MLN Matters® Articles from CMS

Revised:

Change Request (CR) 10295 effective May 25, 2017, a National Coverage Determination (NCD) covers Supervised Exercise Therapy (SET) for beneficiaries with Intermittent Claudication (IC) for the treatment of symptomatic Peripheral Artery Disease (PAD). Make sure your billing staffs are aware of these changes.

March 5, 2018

Part A Top Claims Submission / Reason Code Errors 

The February 2018 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:

Change Request (CR) 10481 informs the MACs of the appropriate Healthcare Common Procedure Coding System (HCPCS) modifier (QQ) that may be reported on the same claim line as the Current Procedural Terminology (CPT) code for an advanced diagnostic imaging service that is furnished in an applicable setting and paid for under an applicable payment system.
Change Request (CR) 10514 provides the Integrated Outpatient Code Editor (I/OCE) instructions and specifications for the I/OCE that will be used in the Outpatient Prospective Payment System (OPPS) and non-OPPS for hospital inpatient departments, Community Mental Health Centers (CMHCs), all non-OPPS providers, and for limited services when provided in a home health agency not under the Home Health Prospective Payment System (HH PPS) or to a hospice patient for the treatment of a non-terminal illness. Make sure your billing staffs are aware of these updates.

Revised:

Change Request (CR) 10474 provides updates to diagnosis codes required in order to allow add-on payments under the Inpatient Prospective Payment System (IPPS) for blood clotting factor administered to hemophilia inpatients. The add-on payment criteria for blood clotting factors administered to hemophilia inpatients will be updated July 1, 2018, by terminating International Classification of Diseases, Clinical Modification (ICD-CM) code D68.32, effective with that date. The list of ICD-CM codes that will continue to receive the add-on payment can be found in Section 20.7.3, of Chapter 3 of the “Medicare Claims Processing Manual”. Make sure your billing staffs are aware of this update.

March 2, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

Revised:

CR 10473 constitutes a maintenance update of the International Classification of Diseases, Tenth Revision (ICD-10) conversions and other coding updates specific to National Coverage Determinations (NCDs). These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received.

March 1, 2018

Medicare Expired Legislative Provisions Extended and Other Bipartisan Budget Act of 2018 Provisions

On February 9, 2018, President Trump signed into law the Bipartisan Budget Act of 2018. This new law includes several provisions related to Medicare payment.

With regard to payment for outpatient therapy services, the law repeals application of the Medicare outpatient therapy caps but retains the former cap amounts as a threshold above which claims must include the KX modifier as a confirmation that services are medically necessary as justified by appropriate documentation in the medical record; and retains the targeted medical review process, but at a lower threshold amount. It also extends several recently expired Medicare legislative provisions affecting health care providers and beneficiaries, including the Medicare physician fee schedule work geographic adjustment floor, add-on payments for ambulance services and home health rural services, changes to the payment adjustment for low volume hospitals, and the Medicare dependent hospital program.

In addition, with regard to Section 53111 – Medicare Payment Update for Skilled Nursing Facilities, the Centers for Medicare & Medicaid Services has received questions from stakeholders about the impact of the FY 2019 Skilled Nursing Facility (SNF) update due to section 53111 of the BBA of 2018. To help answer these questions, we are providing information about the estimated market basket update for FY 2019 based on currently available data. This estimate may be updated in the Notice of Proposed Rulemaking for the FY 2019 SNF Prospective Payment System (PPS).

Read the full summary.


CMS Provider Education Message:

MLN Connects® for Thursday, March 1, 2018

View this edition as a PDF

News & Announcements

New Medicare Card: Video for Your Waiting Room
Patients over Paperwork Newsletter
CMS Launches Public Reporting of CAHPS® Hospice Survey Results
Hospice Compare Quarterly Refresh
Medicare Diabetes Prevention Program: Supplier Enrollment
Medicare EHR Incentive Program Hospital Attestation: Deadline Extended to March 16
Draft 2019 QRDA Category I Implementation Guide: Submit Comments by March 21
MIPS: Apply to Participate in Quality Measures Study by March 23
MIPS Reporting Deadlines
MIPS 2018 QCDR Measure Specifications
MIPS Claims Based Quality Measures Projections and Results Video
eCQM Annual Update Pre-Publication Document
What’s New with Physician Compare Webinar Materials
Are You Prepared for a Health Care Emergency?
March is National Colorectal Cancer Awareness Month

Provider Compliance

Provider Compliance Tips for Laboratory Blood Counts Fact Sheet — New

Upcoming Events

Low Volume Appeals Settlement Option Update Call — March 13
Open Payments: The Program and Your Role Call — March 14
Dementia Care: Person-Centered Care Planning and Practice Recommendations Call — March 20
E/M Services: Documentation Guidelines and Burden Reduction Listening Session — March 21

Medicare Learning Network Publications & Multimedia

Provider Compliance Tips for PAP Devices and Accessories Including CPAP Fact Sheet — New
Provider Compliance Tips for Oral Anticancer Drugs and Antiemetic Drugs Used in Conjunction Fact Sheet — New
Provider Compliance Tips for Bariatric Surgery Fact Sheet — New
Provider Compliance Tips for Diabetic Shoes Fact Sheet — New
Provider Compliance Tips for Lower Limb Orthoses Fact Sheet — New
Provider Compliance Tips for Enteral Nutrition Fact Sheet — New
Provider Compliance Tips for Immunosuppressive Drugs Fact Sheet — New
Provider Compliance Tips for Ambulance Services Fact Sheet — Revised
Provider Compliance Tips for Clinic ESRD Services (Part A Non-DRG) Fact Sheet — Revised
Provider Compliance Tips for CT Scans Fact Sheet — Revised
Medicare Part D Vaccines and Vaccine Administration Fact Sheet — Revised
Medicare Part B Immunization Billing Educational Tool — Revised
Screening Pap Tests and Pelvic Examinations Booklet — Revised
Medicare Enrollment for Physicians, NPPs, and Other Part B Suppliers Booklet — Revised
Hospital Outpatient Prospective Payment System Booklet — Revised

Part A Open Issues update

Update regarding claims for certain non-OPPS providers billed with observation services (revenue code 0762) that are incorrectly receiving reason code 32412. The correction installed on 2/19/18 did not resolve the issue. A new correction has been created and is tentatively scheduled for April 23, 2018.


Medicare Learning Network® MLN Matters® Articles from CMS

Revised:

Effective with Change Request (CR) 10433, the Centers for Medicare & Medicaid Services (CMS) will reintroduce Qualified Medicare Beneficiary (QMB) information in the Medicare Remittance Advice (RA) and Medicare Summary Notice (MSN). CR 9911 modified the Fee-For-Service (FFS) systems to indicate the QMB status and zero cost-sharing liability of beneficiaries on RAs and MSNs for claims processed on or after October 2, 2017. CR 10433 reinstates all changes to the MSNs under CR 9911. Please make sure your billing staff is aware of these changes.

February 28, 2017

Expressions of interest for low volume appeals settlement (LVA) process

On February 5, 2018, CMS started accepting Expressions of Interest for its low volume appeals settlement (LVA) process. The LVA settlement option is for providers, physicians, and suppliers (appellants) with fewer than 500 appeals pending at the Office of Medicare Hearing and Appeals (OMHA) and the Medicare Appeals Council (Council) at the Departmental Appeals Board, combined, as of November 3, 2017, with a total billed amount of $9,000 or less per appeal. If you are interested in participating in LVA to address your pending appeals, visit CMS’ website at go.cms.gov/LVA.


The comment period will close on March 8, 2018 for the following JH Draft Local Coverage Determinations (LCDs):

Submit Comments


February 27, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

Revised:

Change Request (CR) 10480 updates the Federally Qualified Health Center Prospective Payment System (FQHC PPS) grandfathered tribal FQHC base payment rate and the Geographic Adjustment Factors (GAFs) for the FQHC Pricer. Make sure your billing staffs are aware of these changes.

February 26, 2018

The Medicare Satisfaction Indicator (MSI) Survey - Coming in March 2018!

MSI Coming in March 2018!  The 2018 MAC Satisfaction Indicator (MSI), a survey administered by the Centers for Medicare & Medicaid Services (CMS), is coming in March. The MSI measures your satisfaction with our processes and service delivery so we can gain valuable insights and determine process improvements.

Thanks for your feedback in 2017. We used your feedback to make improvements to our services.

Here are some highlights of changes and enhancements we made to our website as a result of your feedback in 2017:

Added a "Was this page helpful?" interaction to all content pages
Designed and debuted new information centers for Enrollment, Appeals and Claims
Enhanced and expanded data provided by many of our self-service lookup tools 

Watch our website and eNews listserv for more details on how you can participate in the MSI survey next month.


February 23, 2018

The March 2018 Calendar of Events is Currently Available

The March 2018 Part A Calendar of Events is available for your immediate review. Visit the Education and Training page of our website for additional information and registration opportunities.


February 22, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, February 22, 2018

View this edition as a PDF

News & Announcements

Low Volume Appeals Settlement Process

Provider Compliance

Payment for Outpatient Services Provided to Beneficiaries Who Are Inpatients of Other Facilities — Reminder

Upcoming Events

Low Volume Appeals Settlement Option Update Call — March 13
Open Payments: The Program and Your Role Call — March 14
Dementia Care: Person-Centered Care Planning and Practice Recommendations Call — March 20
CMS National Provider Enrollment Conference — April 24 and 25

Medicare Learning Network Publications & Multimedia

CMS Provider Minute Video: Utilizing Your MAC to Prepare for CERT Review — New
Low Volume Appeals Settlement Call: Audio Recording and Transcript — New
Provider Compliance Tips for Hospital Beds and Accessories Fact Sheet — New
Provider Compliance Tips for Infusion Pumps and Related Drugs Fact Sheet — New
Provider Compliance Tips for Nebulizers and Related Drugs Fact Sheet — New
Provider Compliance Tips for Laboratory Tests – Blood Counts Fact Sheet — New
Provider Compliance Tips for Diabetic Test Strips Fact Sheet — Revised
Overview of the Repetitive Scheduled Non-emergent Ambulance Prior Authorization Model MLN Matters Article — Revised
Telehealth Services Booklet — Revised
Medicare Enrollment for Institutional Providers Booklet — Revised
PECOS for Physicians and NPPs Booklet — Revised
DMEPOS Information for Pharmacies Fact Sheet — Reminder
DMEPOS Accreditation Fact Sheet — Reminder
Mass Immunizers and Roster Billing Booklet — Reminder

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10473 constitutes a maintenance update of the International Classification of Diseases, Tenth Revision (ICD-10) conversions and other coding updates specific to National Coverage Determinations (NCDs). These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received.

February 21, 2018

CMS National Provider Enrollment Conference: April 24 - 25, 2018

Register for the CMS National Provider Enrollment Conference at the San Diego Convention Center, San Diego, California, on Tuesday, April 24 and Wednesday, April 25 from 8:00 a.m. to 5:00 p.m. PT. Take advantage of this opportunity to interact directly with CMS and Medicare Administrative Contractor provider enrollment experts.


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 January 2018. 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.


February 20, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10402 directs MACs to obtain the most recent Healthcare Provider Taxonomy Codes (HPTCs) code set and use it to update their internal HPTC tables and/or reference files. Make sure your billing staffs are aware of these changes.
Change Request (CR) 10489 updates the Remittance Advice Remark Codes (RARC) and Claims Adjustment Reason Code (CARC) lists and instructs Medicare Shared System Maintainers (SSMs) to update Medicare Remit Easy Print (MREP) and PC Print. Be sure your staffs are aware of these changes.
Change Request (CR) 10397updates the business requirements to enable MACs to receive unsolicited documentation (also known as paperwork (PWK)) via the Electronic Submission of Medical Documentation (esMD) system. CR10397 is for esMD purposes only. Please make sure your billing staffs are aware of these updates.
Change Request (CR) 10488 amends payment files issued to MACs based upon the calendar year 2018 Medicare Physician Fee Schedule (MPFS) Final Rule. Make sure your billings staffs are aware of these changes.

February 16, 2018

Revalidation and Application Development Tips

Provider Enrollment Services want to make 2018 a success with your enrollment needs. We would also like to remind you about the importance of complying with Revalidation and application development requests. Please take time to review the article we developed to share information on revalidation, keeping development down and fulfilling development requests. For more information, please visit our website.


February 15, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, February 15, 2018

View this edition as a PDF

News & Announcements

MIPS Reporting Deadlines Fast Approaching: 10 Things to Do and Know
Quality Payment Program: Performance Scores for 2017 Claims Data
Diabetic Self-Management Training Accreditation Program: New Webpage and Helpdesk
Measures of Hospital Harm: Comment by February 16
EHR Incentive Program: Accepting Proposals for New Measures by June 29
New Option for Submission of Medicare Cost Reports

Provider Compliance

Home Health Care: Proper Certification Required — Reminder

Claims, Pricers & Codes

January 2018 OPPS Pricer File

Upcoming Events

Improving Accessibility of Provider Settings Webinar — February 21
ESRD QIP: Final Rule for CY 2018 Call — February 22
2018 QCDR Measures Workgroup Webinar — February 27
Serving Adults with Disabilities on the Autism Spectrum Webinar — February 28
MIPS Quality Data Submission Webinar — February 28
Palliative and Hospice Care for Adults with Disabilities Webinar — March 7
Low Volume Appeals Settlement Option Update Call — March 13
Open Payments: The Program and Your Role Call — March 14
MIPS Attestation for Advancing Care Information and Improvement Activities Webinar — March 14

Medicare Learning Network Publications & Multimedia

Medicare Enrollment Resources Educational Tool — Revised
PECOS FAQs Booklet — Revised
PECOS for DMEPOS Suppliers Booklet — Revised
Safeguard Your Identity and Privacy Using PECOS Booklet —Revised
PECOS for Provider and Supplier Organizations Booklet — Revised
PECOS Technical Assistance Contact Information Fact Sheet — Revised
Health Professional Shortage Area Physician Bonus Program Fact Sheet — Revised
Medicare Secondary Payer Booklet – Reminder
Beneficiaries in Custody under a Penal Authority Fact Sheet — Reminder

New Medicare Insights Podcast

In this Medicare Insights Podcast episode, we discuss the new Medicare card.


Part A Open Issues Log updates

Outpatient claims billed with laboratory services on revenue code 030x or 031x are incorrectly receiving reason code 32404.

Update 2/15/18: The correction has been created and is tentatively scheduled to be installed on March 5, 2018. Claims will continue to be held in status location SMQ199.


February 14, 2018

Transcatheter Aortic Valve Replacement (TAVR) Coverage Reminder

TAVR became nationally covered in 2012 under Coverage with Evidence Development outlined in NCD 20.32. Therefore, the billing and processing of TAVR claims is different from Investigational Device Exemptions (IDEs) that require Novitas or the Centers for Medicare & Medicaid Services approval prior to billing for associated routine costs. Our claims department has seen an increase in claims being submitted by facilities that are not approved. It is important that prior to claim submission you verify your participation in an approved TAVR study location. Please review our article for more information.


February 13, 2018

Part A Open Issues Log Update- Q197 location and cosmetic SMQ update

Certain claims suspend for manual intervention. After the claims are reviewed, the reason codes are bypassed and the claim is allowed to continue processing. The bypass of several reason codes is no longer functioning and the claims are remaining suspended.

 

Update 2/13/18: The correction to the bypass was installed earlier than expected. Claims that were being held in this location have been processed.


Medicare Learning Network® MLN Matters® Articles from CMS

Revised:

Change Request (CR) 10181 provides for the replacement of HCPCS codes G0202, G0204, and G0206 with Current Procedural Terminology (CPT) codes 77067, 77066, and 77065, effective January 1, 2018. CR 10181 also applies the waiver of deductible and coinsurance to 76706, 77067, prolonged preventive services, and anesthesia services furnished in conjunction with and in support of colorectal cancer services. Make sure your billing staffs are aware of these changes.

February 12, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10474 provides updates to diagnosis codes required in order to allow add-on payments under the Inpatient Prospective Payment System (IPPS) for blood clotting factor administered to hemophilia inpatients. Make sure your billing staffs are aware of this update.
Change Request (CR) 10445 informs the MACs about the changes in the April 2018 quarterly update to the Clinical Laboratory Fee Schedule (CLFS). Make sure that your billing staffs are aware of these changes.
Change Request (CR) 10480 updates the Federally Qualified Health Center Prospective Payment System (FQHC PPS) grandfathered tribal FQHC base payment rate in the FQHC Pricer. Make sure your billing staffs are aware of these changes.

February 9, 2018

January 2018 Part A Newsletter

The January 2018 Part A Newsletter is now available. Please take a moment to review.


February 8, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, February 8, 2018

View this edition as a PDF

News & Announcements

Patients over Paperwork: January Newsletter
Open Payments Registration
MIPS: Call for Advancing Care Information Measures and Improvement Activities
Quality Payment Program: Advanced APM Table
Hospice Quality Reporting Program Resources
LTCH Quality Reporting Program: Materials from December Training
SNF QRP Quality Measure and Review and Correct Report: Calculation Error
Home Health Review and Correct Report: Correction
Influenza Activity Continues: Are Your Patients Protected?

Provider Compliance

Medicare Hospital Claims: Avoid Coding Errors — Reminder

Upcoming Events

Low Volume Appeals Settlement Option Call — February 13
What’s New with Physician Compare Webinar — February 21 or 22
Comparative Billing Report on Opioid Prescribers Webinar — February 21 or March 7
ESRD QIP: Final Rule for CY 2018 Call — February 22

Medicare Learning Network Publications & Multimedia

E/M Service Documentation Provided by Students MLN Matters Article — New
Medicare Enrollment Resources Educational Tool — Revised
Medicare Part B Immunization Billing Educational Tool — Reminder

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


Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10295 informs MACs that effective May 25, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a National Coverage Determination (NCD) to cover Supervised Exercise Therapy (SET) for beneficiaries with Intermittent Claudication (IC) for the treatment of symptomatic Peripheral Artery Disease (PAD). Make sure your billing staffs are aware of these changes.

February 6, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

The HCPCS code set is updated on a quarterly basis. Change Request (CR) 10454 informs MACs of the April 2018 updates of specific biosimilar biological product HCPCS code, modifiers used with these biosimilar biologic products and an autologous cellular immunotherapy treatment. Be sure your staffs are aware of these updates.
Change Request (CR) 10412 revises the Medicare Claims Processing Manual to allow the teaching physician to verify in the medical record any student documentation of components of E/M services, rather than re-documenting the work. Make sure your billing staffs are aware of the changes.
Effective with Change Request (CR) 10433, the Centers for Medicare & Medicaid Services (CMS) will reintroduce Qualified Medicare Beneficiary (QMB) information in the Medicare Remittance Advice (RA) and Medicare Summary Notice (MSN).
CR 9911 modified the Fee-For-Service (FFS) systems to indicate the QMB status and zero cost-sharing liability of beneficiaries on RAs and MSNs for claims processed on or after October 2, 2017. On December 8, 2018, CMS suspended CR 9911 to address unforeseen issues preventing the processing of QMB cost-sharing claims by States and other secondary payers outside of the Coordination of Benefits Agreement (COBA) process.
CR 10433 remediates these issues by including revised “Alert” Remittance Advice Remark Codes (RARC) in RAs for QMB claims without adopting other RA changes that impeded claims processing by secondary payers. CR 10433 reinstates all changes to the MSNs under CR 9911. Please make sure your billing staff is aware of these changes.

February 5, 2018

Part A Top Claims Submission / Reason Code Errors

The January 2018 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.


Attention Home Health Agencies (HHAs)

Novitas is aware that the enrollment contractor ID was systematically changed for 61 of our HHAs in PECOS causing the records to show another contractor in PECOS. Affected HHAs may experience claims and payment issues because their enrollment records are showing as deactivated in the Fiscal Intermediary Shared System due to this accidental contractor ID change. CMS is working on the issue with a resolution expected on February 12, 2018. Stay tuned to our website (JH) (JL) for updates.


February 1, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, February 1, 2018

View this edition as a PDF

News & Announcements

Medicare Diabetes Prevention Program: Supplier Enrollment Open
Targeted Probe and Educate: New Resources
MIPS Clinicians: 2017 Extreme and Uncontrollable Circumstances Policy
Quality Payment Program: Patient-facing Encounters Resources
Eligible Hospitals and CAHs: Get Help with Attestation on QNet
Find Medicare FFS Payment Regulations
February is American Heart Month

Provider Compliance

Cochlear Devices Replaced Without Cost: Bill Correctly — Reminder

Upcoming Events

eCQM Reporting for Hospital IQR-EHR Incentive Program Webinar — February 6
Low Volume Appeals Settlement Option Call — February 13

Medicare Learning Network Publications & Multimedia

Next Generation Accountable Care Organization - Implementation MLN Matters® Article — Revised
DMEPOS Quality Standards Educational Tool — Revised
Home Oxygen Therapy Booklet — Revised
Looking for Educational Materials?

Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) Specialty Page

We are pleased to announce the addition of Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) to the Part A Provider Specialties/Services page of our website.


January 30, 2018

2018 Medicare Participation Physicians/Suppliers Directory (MEDPARD) Now Available

The 2018 MEDPARD (Medicare Participation Physicians / Suppliers Directory) is now available. As in the past, there will be no hardcopy distributions. Beneficiaries can use the Internet or contact 1-800-MEDICARE for assistance in locating a participating supplier near their home. Also, the beneficiary's local Social Security Office(s), the Area Administration on Aging office(s), and other beneficiary advocacy organizations may be able to assist as well.


The February 2018 Calendar of Events is Currently Available

The February 2018 Part A Calendar of Events is available for your immediate review. Visit the Education and Training page of our website for additional information and registration opportunities.


January 29, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:


January 26, 2018

Special Edition – Friday, January 26, 2018

In this Edition:

Therapy Cap Claims Rolling Hold
New Medicare Card: Web Updates
New Medicare Card: When Will My Medicare Patients Receive Their Cards?

Therapy Cap Claims Rolling Hold

CMS is immediately releasing for processing held therapy claims with the KX modifier with dates of receipt beginning January 1-10; CMS will also implement a “rolling hold” to minimize impact if legislation to extend the outpatient therapy caps exceptions process is enacted.

New Medicare Card: Web Updates

To help you prepare for the transition to the Medicare Beneficiary Identifier (MBI) on Medicare cards beginning April 1, 2018, review the new information about remittance advices.

Beginning in October 2018, through the transition period, when providers submit a claim using a patient’s valid and active Health Insurance Claim Number (HICN), CMS will return both the HICN and the MBI on every remittance advice. Here are examples of different remittance advices:

Medicare Remit Easy Print (Medicare Part B providers and suppliers) 

Find more new information on the New Medicare Card provider webpage.

New Medicare Card: When Will My Medicare Patients Receive Their Cards?

Starting April 2018, CMS will begin mailing new Medicare cards to all people with Medicare on a flow basis, based on geographic location and other factors. Learn more about the Mailing Strategy.  Also starting April 2018, your patients will be able to check the status of card mailings in their area on Medicare.gov.

For More Information:

Questions from Patients? Guidelines
New Medicare Card  overview and provider webpages

January 25, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, January 25, 2018

View this edition as a PDF

News & Announcements

VA, HHS Announce Partnership to Strengthen Prevention of Fraud, Waste and Abuse Efforts
CMS Updates Open Payments Data
Improved Open Payments Data Website
IRF and LTCH Quality Reporting Programs: Submission Deadline February 15
Panel on Development of Potentially Preventable Hospitalization Measures for HHAs: Nominations due February 22
SNF Quality Reporting Program: Submission Deadline Extended to May 15
Hospice Quality Reporting Program: Quality Measure User’s Manual Version 2
Continue Seasonal Influenza Vaccination through January and Beyond

Provider Compliance

Reporting Changes in Ownership — Reminder

Upcoming Events

Low Volume Appeals Settlement Option Call — February 13
Home Health Review and Correct Reports Webinar — March 6

Medicare Learning Network Publications & Multimedia

Low Volume Appeals Settlement Call: Video Presentation — New
Hurricane Nate and Medicare Disaster Related Alabama, Florida, Louisiana and Mississippi Claims MLN Matters Article — Updated
Swing Bed Services 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, 2018:

The following JH Local Coverage Determinations (LCDs) which were posted for notice on December 7, 2017 are now effective:

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, 2018:

The following JH Local Coverage Article has been posted for notice and will become effective March 15, 2018:


Part A Open Issues Log Update

Certain claims suspend for manual intervention. After the claims are reviewed, the reason codes are bypassed and the claim is allowed to continue processing.

The bypass of the following reason codes is no longer functioning and the claims are remaining suspended.32411, 32412, 31616, 31617, 32296, 31817, 32413, 31740, 32148
A correction is tentatively scheduled for February 19, 2018. No provider action will be needed. The claims will be suspended in status location SMQ197 until the correction is installed.
Claims for certain non-OPPS providers billed with observation services (revenue code 0762) are incorrectly receiving reason code 32412.
A correction is tentatively scheduled for February 19, 2018. No provider action will be needed. The claims will be suspended in status location SMQ198 until the correction is installed.
Outpatient claims billed with laboratory services on revenue code 030x or 031x are incorrectly receiving reason code 32404.
This has been reported to the Fiscal Intermediary Shared System maintainer. They have identified the problem and are working on a resolution. The claims will remain suspended in status location SMQ199. No provider action will be needed.

Medicare Learning Network® MLN Matters® Articles from CMS

Revised:


January 24, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

Revised:


January 23, 2018

Observer Online Registration for February 1, 2018 Open Meeting Now Closed

Observer online registration for the February 1, 2018 Open Meeting is now closed. Due to limited room capacity, registered presenters will be given priority for seating and registered observers are accepted until remaining seats are filled. Since the maximum seating capacity for observers has been reached, online registrations for observers are no longer being accepted.


January 22, 2018

Special Edition – Monday, January 22, 2018

MAC Operations Continue During Shutdown

During the time that the partial government shutdown is in effect, Medicare Administrative Contractors will continue to perform all functions related to Medicare fee-for-service claims processing and payment.


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 December 2017. New questions / answers have been added to the General Information 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:

Revised:


January 19, 2018

Medicare Symposium: Houston, Texas - Friday, January 26, 2018

Don't forget to join us on Friday, January 26, 2018, at the Crowne Plaza Houston Reliant/Medical Center in Houston, Texas for our 2017 Medicare Symposium rescheduled from September 14, 2017 due to Hurricane Harvey.

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 compliant with the Medicare program. Spend the day with us or attend as many classes that interest you. Seats are still available, so register today.


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.


January 18, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, January 18, 2018
View this edition as a PDF

News & Announcements

2018 Value Modifier Results and Payment Adjustment Factor
Final DMEPOS Quality Standards for Therapeutic Shoe Inserts
Glaucoma Awareness Month: Make a Resolution for Healthy Vision

Provider Compliance

CMS Provider Minute Video: CT Scans — Reminder

Upcoming Events

New Medicare Card Project Special Open Door Forum — January 23
ESRD QIP: Final Rule for CY 2018 Call — January 23
MIPS Annual Call for Measures and Activities Webinar — February 5
Comparative Billing Report on Opioid Prescribers Webinar — February 21

Medicare Learning Network Publications & Multimedia

QRUR Video Presentation — New
Low Volume Appeals Settlement Call: Audio Recording and Transcript — New
Avoiding Medicare Fraud & Abuse: A Roadmap for Physicians Web-based Training — Revised
How to Use the Medicare Coverage Database Booklet — Revised
Behavioral Health Integration Services Fact Sheet — Revised

The following JH Draft Local Coverage Determinations (LCDs) have been posted for comment. The comment period will end on March 8, 2018:

Submit Comments


Medicare Learning Network® MLN Matters® Articles from CMS

Revised:


Online Registration Available for February 1, 2018 Open Meeting and Draft LCDs Now Posted

Online registration for the February 1, 2018 Open Meeting is now available and will close at 3:00PM Eastern Time (ET) on Monday, January 29, 2018. The 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.

Open Meetings are for the specific purpose of discussing the draft LCDs. Anyone is welcome to present information related to the draft LCDs that are 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.


January 16, 2018

Part A Open Issues Log- Update to rc 59172/59173 and 59049-59052

The reason code logic for 59172-59173 and 59049-59052 will be updated with CR10318 to accept the replacement diagnosis codes for N63. National Coverage Determinations 220.4 - Mammograms and 220.13 - Percutaneous Image-Guided Breast Biopsy will be updated on April 2, 2018. Until the logic is updated, a temporary correction has been implemented that will allow the new ICD-10 diagnosis codes to be submitted for these services until the permanent correction is implemented.


January 12, 2018

Medicare does not pay acute-care hospitals for outpatient services they provide to beneficiaries in a covered Part A inpatient stay at other facilities

Generally, Medicare should not pay an acute-care hospital for services (outpatient surgery or lab work) furnished to a beneficiary that is still an inpatient of another facility. Acute-care hospitals, under arrangements with the Long-Term Care Hospital (LTCH), Inpatient Rehabilitation Facility (IRF), Inpatient Psychiatric Facility (IPF), and/or Critical Access Hospital (CAH), should look to the LTCH, IRF, IPF, and/or CAH for payment of outpatient services it provides to inpatients of those facilities. Additionally, acute-care hospitals should not charge beneficiaries for outpatient deductibles and coinsurance payments as a result of such services.


Medicare Learning Network® MLN Matters® Articles from CMS

Revised:


Registration for February 1, 2018 Open Meeting

Registration for the February 1, 2018 Open Meeting will be available starting on Thursday, January 18, 2018 and will be closed at 3:00PM Eastern Time (ET) on Monday, January 29, 2018. Novitas Solutions’ draft LCDs will be posted on January 18, 2018. 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 January 18th. 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.


January 11, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, January 11, 2018

View this edition as a PDF

News & Announcements

New Payment Model to Improve Quality, Coordination, and Cost-effectiveness for Both Inpatient and Outpatient Care
SNF Quality Reporting Program Confidential Feedback Reports
Hospital Quality Reporting: Updated CY 2018 QRDA I Schematron
January is Cervical Health Awareness Month

Provider Compliance

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

Upcoming Events

New Medicare Card Project Special Open Door Forum — January 23
ESRD QIP: Final Rule for CY 2018 Call — January 23

Medicare Learning Network Publications & Multimedia

Major Joint Replacement (Hip or Knee) Booklet — New
Medicare-Required SNF PPS Assessments Educational Tool — Revised

Medicare Learning Network® MLN Matters® Articles from CMS

Revised:


New Format for Novitas’ Local Coverage Determinations (LCDs)

There are three new sections included in our LCDs that provide insight into the rationale for indications and limitations of coverage:

1. Summary of Evidence - Contains a summary of the pertinent literature and/or guidelines that were used to determine covered indications and limitations.
2. Analysis of Evidence (Rationale for Determination) - A high level overview and conclusion based on all of the literature and guidelines reviewed. This section provides the reasoning or basis for the indications and limitations of coverage.
3. Bibliography - A new subsection under the “Sources of Information” that includes all sources used to write the LCD.

For details, please review this article in its entirety.


January 10, 2018

Frequently Asked Questions (FAQs)

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


January 8, 2018

December 2017 Part A Newsletter

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


Medicare Learning Network® MLN Matters® Articles from CMS

New:


January 4, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, January 4, 2018

View this edition as a PDF

News & Announcements

CMS Launches Data Submission System for Clinicians in the Quality Payment Program
CMS Updates Website to Compare Hospital Quality
Patients over Paperwork: Get Updates on Burden Reduction
Quality Payment Program: Qualified Registries and QCDRs
Quality Payment Program Resources
EHR Incentive Program Hospitals: Use QNet to Attest
Medicare Diabetes Prevention Program Resources
Post-Acute Care Quality Reporting Program Section GG Web-based Training
Hospice Compare Update
Are You Prepared for a Health Care Emergency?
Get Your Patients Off to a Healthy Start in 2018

Provider Compliance

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

Upcoming Events

Low Volume Appeals Settlement Option Call — January 9
ESRD QIP: Final Rule for CY 2018 Call — January 23

Medicare Learning Network Publications & Multimedia

Dementia Care Call: Audio Recording and Transcript — New
Avoiding Medicare Fraud & Abuse: A Roadmap for Physicians Booklet — Revised

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Revised:


January 3, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Revised:


Looking for news archives?

Archived Part A News - 2017

Archived Part A News - 2016

Archived Part A News - 2015

Archived Part A News - 2014

Archived Part A News - 2013


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Last modified:  09/17/2018