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 “Today’s proposed rule demonstrates our commitment to patient access to high quality care while removing outdated and redundant regulations on providers.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:
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).
MLN Connects® for Thursday, April 19, 2018
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News & Announcements
Claims, Pricers & Codes
Medicare Learning Network® Publications & Multimedia
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
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.
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.
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.
CMS Provider Education Message:
MLN Connects® for Thursday, April 12, 2018
The following JH Local Coverage Determinations (LCDs) have been revised:
The following JH Local Coverage Articles have been revised:
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.
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.
Laboratory services receiving reason code 32402 for dates of service in 2018? Review this article for details.
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.
The March 2018 Part A Newsletter is now available. Please take a moment to review.
Have questions and not sure where to turn? Check out our FAQs for answers to your questions.
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.
MLN Connects® for Thursday, April 5, 2018
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.
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.
MLN Connects® for Thursday, March 29, 2018
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.
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.
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.
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.
MLN Connects® for Thursday, March 22, 2018
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.
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.
In this Medicare Insights Podcast episode, we discuss the Medicare Satisfaction Indicator (MSI) Survey.
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.
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.
MLN Connects® for Thursday, March 15, 2018
The following JH Local Coverage Article which was posted for notice on January 25, 2018 is now effective:
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.
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.
MLN Connects® for Thursday, March 8, 2018
The February 2018 Part A Newsletter is now available. Please take a moment to review
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.
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.
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.
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.
MLN Connects® for Thursday, March 1, 2018
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News & Announcements
Medicare Learning Network Publications & Multimedia
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.
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):
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:
Watch our website and eNews listserv for more details on how you can participate in the MSI survey next month.
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.
MLN Connects® for Thursday, February 22, 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.
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.
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.
MLN Connects® for Thursday, February 15, 2018
In this Medicare Insights Podcast episode, we discuss the new Medicare card.
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.
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.
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.
The January 2018 Part A Newsletter is now available. Please take a moment to review.
MLN Connects® for Thursday, February 8, 2018
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News & Announcements
Medicare Learning Network Publications & Multimedia
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.
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.
MLN Connects® for Thursday, February 1, 2018
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.
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 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.
In this Edition:
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:
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.
MLN Connects® for Thursday, January 25, 2018
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:
Certain claims suspend for manual intervention. After the claims are reviewed, the reason codes are bypassed and the claim is allowed to continue processing.
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.
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.
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.
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.
In this Medicare Insights Podcast episode, we provide guidance on subscribing to our email list and staying up-to-date on Medicare news.
MLN Connects® for Thursday, January 18, 2018
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The following JH Draft Local Coverage Determinations (LCDs) have been posted for comment. The comment period will end on March 8, 2018:
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.
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.
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.
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.
MLN Connects® for Thursday, January 11, 2018
There are three new sections included in our LCDs that provide insight into the rationale for indications and limitations of coverage:
For details, please review this article in its entirety.
The December 2017 Part A Newsletter is now available. Please take a moment to review.
MLN Connects® for Thursday, January 4, 2018
Archived Part A News - 2017
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Archived Part A News - 2015
Archived Part A News - 2014
Archived Part A News - 2013