Archived Part A News - 2018
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
Have questions and not sure where to turn? Check out our FAQs for answers to your questions.
The September 2018 Calendar of Events is now available. Please visit the Education page of our website for additional information and registration opportunities.
MLN Connects® for Thursday, January 17, 2019
View this edition as a PDF
News & Announcements
Medicare Learning Network® Publications & Multimedia
Special Edition – Wednesday, January 16, 2019
New Medicare Card Mailing Complete, 58% of Claims Submitted with MBI
CMS finished mailing new Medicare cards to people with Medicare across all mailing waves, including Wave 7 states and territories and also to people with Medicare Parts A&B who live in Canada and Mexico.
Medicare patients are using their new cards in doctor’s offices and other health care facilities. For the week ending January 11, 2019, fee-for-service health care providers submitted 58% of claims with new Medicare Beneficiary Identifiers (MBIs), showing that many of you are already successfully submitting claims with MBIs. While you can continue using the former Social Security Number-based Health Insurance Claim Numbers during the transition period, we encourage you to use the new MBIs for all Medicare transactions.
To ensure that you have access to your patients’ new numbers, you can individually look up MBIs if you have access to your Medicare Administrative Contractor's secure provider portal. Likewise, your patients can access their new Medicare numbers or print official cards within their secure MyMedicare.gov accounts.
If your Medicare patients say they did not get a card, instruct them to:
Continue to use their current cards to get health care services. They can use their old cards until December 31, 2019.
The Part A Top Inquiries / FAQs, received by our Customer Contact Center, have been reviewed for December 2018. New questions / answers have been added to the Appeals and General Information categories. Please take time to review these and other FAQs for answers to your questions.
The December 2018 Part A Newsletter is now available. Please take a moment to review.
MLN Connects® for Thursday, January 10, 2019
View this edition as a PDF
News & Announcements
The following Proposed Local Coverage Determination (LCD) posted for comment on September 14, 2017, and presented at the October 2017 Contractor Advisory Committee (CAC) Meeting has been posted for notice. It will become effective February 28, 2019:
The following article contains a summary of the comments received and responses to the Frequency of Hemodialysis Proposed LCD (DL35014):
The following Local Coverage Article has been revised and will become effective February 28, 2019:
In response to Change Request (CR) 10901, effective January 8, 2019 the Local Coverage Determination (LCD) process has changed. The Medical Policy Center located on the Novitas Solutions Website has been updated to reflect the new process. Important updates include changes to the Local Coverage Determination Process, the LCD Reconsideration Process, the Contractor Advisory Committee (CAC) Meetings and Open Meetings. Please visit our Website for the most up to date information related to the new LCD process.
Novitas has posted new and updated information to our Medical Policy Center due to Change Request (CR) 10901 This CR alters Novitas Solutions’ Local Coverage Determination (LCD) process, Contractor Advisory Committee (CAC) Meetings, and Open Meetings. The new process will help to increase transparency, clarity, consistency, reduce provider burden and enhance public relations. Please visit our Medical Policy Center to review all of our updates.
The December 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, January 3, 2019
View this edition as a PDF
Claims, Pricers & Codes
The following JH Local Coverage Determination (LCD) is now effective after being posted for notice and has also been revised:
• Facet Joint Interventions for Pain Management (L34892)
The following JH LCD has been revised:
• Epidural Injections for Pain Management (L36920)
The following JH LCD has been retired for dates of service on and after January 2, 2019:
• Facet Joint Injections (L34974)
On Tuesday, January 8, 2019, Novitas will post changes to the content of our Medical Policy Center due to Change Request (CR) 10901. This CR alters Novitas Solutions’ current Local Coverage Determination (LCD) process as well as changes involving our Contractor Advisory Committee (CAC) Meetings, and Open Meetings. The new process will help to increase transparency, clarity, consistency, reduce provider burden and enhance public relations. Continue to watch our website for additional information on January 8th.
The Novitas Solutions medical policy team has evaluated all active Local Coverage Determinations (LCDs) and Local Coverage Articles for any impact in response to the 2019 Annual HCPCS/CPT Code Update. The following is a list of the impacted LCDs and Articles.
The revised LCDs and Articles will be published to the Medicare Coverage Database and on our Website in February. Please continue to watch our website for updates.
MLN Connects® for Thursday, December 20, 2018
View this edition as a PDF
The following JH Local Coverage Determination (LCD) has been revised:
The Center for Medicare and Medicaid Services (CMS) contracts with QIOs to perform core functions that include case review and quality improvement. The case review functions of a QIO include review of healthcare services and items for which payment is made under Medicare Parts A, B, C, or D to determine whether services or items are reasonable, medically necessary, and allowable, meet professionally recognized standards of care, or in the case of inpatient care, could be provided more economically on an outpatient basis or in an inpatient facility of a different type.
Currently the QIO is conducting reviews on the Two Midnight rule for acute care inpatient hospitals, long-term care hospitals and inpatient psychiatric facilities impacted by the FY 2016 Outpatient Prospective Payment System Final Rule.
After the review the QIO issues the provider a detailed results letter with claim-by-claim denial rationales. The letter you receive from the QIO is not an overpayment demand letter. The QIO sends a copy of the detailed results letter to your Medicare Area Contractor (Novitas), who will perform a claim adjustment in the Fiscal Intermediary Shared System (FISS) and issue the overpayment demand letter.
Upon receiving the overpayment demand letter you may appeal the QIO medical necessity decision to the MAC. Please see the Submit an Appeal - Forms & Tutorials section of the Appeals Center.
The November 2018 Part A Newsletter is now available. Please take a moment to review.
A new article has been added which contains valuable information regarding Medicare as the Tertiary Payer.
MLN Connects® for Thursday, December 13, 2018
Effective January 1, 2019, a new Invoice Number / Document Control Number (DCN) Translator screen has been added to the Direct Data Entry (DDE) Inquiry menu screen in the Fiscal Intermediary Shared System (FISS). This new feature allows you to use the Healthcare Integrated General Ledger Accounting System (HIGLAS) invoice number in DDE to look up the claims associated with a FISS DCN. A new DCN field was also added to the DDE Claim Summary screen to allow for DCN search. The FISS Manual / User Guide (Chapter 2, Sections 2.4 and 2.8) has been updated to add the new search feature to the DDE Inquiry Menu and DDE Claim Summary screen. For more information, please review Medicare Learning Network Matters Article, MM10542-User CR: FISS to Add Additional Search Features to Provider Direct Data Entry (DDE) Screen.
The Part A Top Inquiries / FAQs, received by our Customer Contact Center, have been reviewed for November 2018. New questions / answers have been added to the following categories:
Please take time to review these and other FAQs for answers to your questions.
In July 2018, the Centers for Medicare & Medicaid Services finalized a new case-mix classification model, the Patient Driven Payment Model (PDPM), effective October 1, 2019. This PDPM will replace the current Resource Utilization Groups, Version IV used under the SNF Prospective Payment System for classifying SNF patients in a covered Part A stay. Please read this article for details.
MLN Connects® for Thursday, December 6, 2018
Medicare FFS Response to the 2018 Alaska Earthquake MLN Matters Article — New
The President declared a state of emergency for the state of Alaska, and the HHS Secretary declared a Public Health Emergency, which allows for a CMS programmatic waivers based on Section 1135 of the Social Security Act. An MLN Matters Special Edition Article on Medicare Fee-for-Service (FFS) Response to the 2018 Alaska Earthquake 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 hold has been lifted from the following JH Local Coverage Determination and it will become effective for dates of service on and after January 3, 2019. No changes have been made to the content of this LCD since it was placed on hold. The LCD below reflects the effective date of January 3, 2019 and an updated revision history.
The following JH local Coverage Determinations have been revised:
Inpatient hospital claims, Type of Bill (TOB) 11x, related to the Demonstration 86 for the Bundled Payments for Care Improvement (BPCI) Advanced episode are incorrectly receiving reason code U5245. This issue has been reported to the Common Working File (CWF). Once the reason code is corrected, claims will be able to be resubmitted for processing. We will post additional information when the correction is installed.
Enhancements will be made to the IVR on December 5, 2018 after 6:00 pm. During the implementation, callers will not be permitted to use the IVR. We anticipate the IVR will be available for use beginning on December 6, 2018 at 6:00 am.
The November 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.
The Centers for Disease Control and Prevention has issued a reminder regarding the importance to continue flu vaccination through the holiday season and beyond. Please read this article for additional information.
The Centers for Medicare & Medicaid Services has announced the dollar amount that must remain in controversy to sustain appeal rights beginning January 1, 2019. Please read this article for details.
We are proud to announce the new and improved Novitas Learning Center. Effective January 1, 2019, the new Learning Center will have an improved look and feel, and offer more sophisticated capabilities while improving your experience. Please read the complete article for important steps you can take today to prepare for a seamless transition of your current account into our new system next month.
The FY 2019 Inpatient Prospective Payment System (IPPS) Pricer contained an incorrect maximum new technology add-on payment for Sentinel Cerebral Protection System™, ICD-10-PCS procedure code - X2A5312.
All revalidation applications and supporting documentation must now be sent to our Mechanicsburg, PA office. Please review our Revalidation Mailing Addresses article for additional information.