Loading...
Skip to content
Medicare Part [Change]
CMS Link
CMS Link
Providers in AR, CO, LA, MS, NM, OK, TX, Indian Health & Veteran Affairs

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

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. We have provided a bulletin to share information on revalidation, keeping development down and fulfilling development requests. Please view our website for more information.


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 (CMS) 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 that you verify your participation an approved TAVR study location. Please visit 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 (FISS) 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 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 (FISS) 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. The National Coverage Determination (NCD)220.4, Mammograms and NCD 220.13 for 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 (for example, outpatient surgery or lab work) furnished to a beneficiary at that facility when the beneficiary is still an inpatient of another facility. Acute-care hospitals, under arrangements with the LTCH, IRF, IPF, and/or CAH, should look to the LTCH, IRF, IPF, and/or CAH for payment for the outpatient services it provides to the beneficiary while an inpatient of that other facility. 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)

Novitas’ Local Coverage Determinations (LCDs) have a new format. There are three new sections that provide insight into the rationale for the indications and limitations of coverage in Novitas’ LCDs:  

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.

The new sections have been added to accommodate the 21st Century Cures Act and will be included in all draft LCDs requiring a comment and notice period. Additionally, when draft LCDs are finalized, Novitas will include a hyperlink at the bottom of the LCD to a “Response to Comments (RTC)” Local Coverage Article that will provide a summary of all the comments received during the draft comment period along with Novitas’ responses. LCDs will continue to be developed and revised in accordance with the CMS Internet-Only Manual (IOM) Publication 100-08, Medicare Program Integrity Manual, Chapter 13.

The new LCD format and RTC Article provide increased clarity and transparency for a better understanding of the development of Local Coverage Determinations.


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:


December 29, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Revised:


December 28, 2017

January 2018 Calendar of Educational Events

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


December 27, 2017

Update to Part A Open Issues Log- 59172/59173

Reason codes 59172/59173 are editing on mammography service lines and reason codes 59049-59052 are editing on Percutaneous Image-Guided Breast Biopsy service lines when billed with the following diagnosis codes:
N63.11-N63.14, N63.21- N63.24, N63.31, N63.32, N63.41, N63.42
These codes are replacing the truncated ICD-10 diagnosis N63.

The reason code logic will be updated with CR10318. The National Coverage Determination (NCD)220.4, Mammograms and NCD 220.13 for Percutaneous Image-Guided Breast Biopsy, which includes the logic for reason code 59172, will be updated on April 2, 2018.
Once this has been implemented, any incorrectly processed claims will be identified and reprocessed by Novitas. No provider action will be needed.


December 21, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, December 21, 2017
View this edition as a PDF

News & Announcements

2018 Medicare EHR Incentive Program Payment Adjustment for Eligible Clinicians
Physician Compare: 2016 Performance Information Available

Provider Compliance

Medicare Hospital Claims: Avoid Coding Errors — Reminder

Upcoming Events

Low Volume Appeals Settlement Option Call — January 9

Medicare Learning Network Publications & Multimedia

Medicare FFS Response to the 2017 Southern California Wildfires MLN Matters Article — New
Medicare Diabetes Prevention Program Model Call: Audio Recording and Transcript — New
Hospice Payment System Booklet — Revised
Ambulance Fee Schedule Fact Sheet — Revised
Medicare Overpayments Fact Sheet — Revised

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 November 2017. New questions / answers have been added to the following categories:

Appeals
Claim Denials
Claim Status
General Information

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


December 19, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:


December 18, 2017

2018 Annual CPT / HCPCS Code Update

Novitas is currently reviewing all Local Coverage Determinations (LCDs) and Local Coverage Articles to identify any impact to the documents as a result of the 2018 Annual CPT/HCPCS Code Update. We anticipate posting the revised LCDs and Articles on January 25, 2018.


Medicare Learning Network® MLN Matters® Articles from CMS

New:


December 14, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, December 14, 2017

View this edition as a PDF

News & Announcements

New Medicare Card: Less Than Four Months until Transition Begins
IRF and LTCH Compare Quarterly Refresh: New Measures Added
Hospice Compare Quarterly Refresh
MACRA Measure Development Plan Technical Expert Panel: Submit Nominations by December 20
Medicare Advisory Panel on Clinical Diagnostic Laboratory Tests: Request for Nominations
QRDA I Conformance Statement Resource
Provider Enrollment Application Fee Amount for CY 2018

Provider Compliance

Payment for Outpatient Services Provided to Beneficiaries Who Are Inpatients of Other Facilities
Bill Correctly for Device Replacement Procedures

Claims, Pricers & Codes

If You Submit Paper Claims: Avoid Crossover Issues

Medicare Learning Network Publications & Multimedia

IRF Medical Review Changes MLN Matters Article — New
IRF Reference Booklet — New
Quality Payment Program Call: Audio Recording and Transcript — New
Hurricane Irma and Medicare Disaster Related United States Virgin Islands, Commonwealth of Puerto Rico and State of Florida Claims MLN Matters Article — Updated
Hurricane Irma and Medicare Disaster Related South Carolina and Georgia Claims MLN Matters Article — Updated
December 2017 Catalog — Revised
IRF Prospective Payment System Booklet — Revised
DMEPOS Competitive Bidding Program Grandfathering Requirements for Non-Contract Suppliers Fact Sheet — Revised
DMEPOS Competitive Bidding Program Traveling Beneficiary Fact Sheet — Revised
Medical Privacy of Protected Health Information Fact Sheet — Reminder
Behavioral Health Integration Services Fact Sheet — Reminder
Medicare Basics: Commonly Used Acronyms Educational Tool — Reminder
Evaluation and Management Services Web-Based Training Course — Reminder

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

The following JH Local Coverage Determination has been retired effective December 1, 2017:


Medicare Learning Network® MLN Matters® Articles from CMS

Revised:


December 13, 2017

Provider Enrollment Application Fee Amount Calendar Year 2018

On December 4, 2017 the Centers for Medicare & Medicaid Services (CMS) issued a notice for the Provider Enrollment Application Fee Amount for Calendar Year 2018. Effective January 1, 2018, the CY 2018 application fee is $569 for institutional providers that are:

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

This fee applies to any provider or supplier that submits a Medicare Enrollment application using the forms CMS-855A or CMS-855B applications, not including physician and non-physician practitioner organizations. Please refer to the CMS Application Fee Quick Reference Chart.


Clarification Regarding Biomarkers

Novitas considers any biomarker that is not addressed as specifically covered in any of our Local Coverage Determinations (LCDs) or any national policy to be not reasonable and necessary. Although this instruction is included in our Biomarkers for Oncology LCD (L35396), it has been determined that further clarification would be helpful. Therefore, the following statement from the Biomarkers for Oncology LCD is being added to the Novitas’ Biomarkers Overview LCD (L35062): “Biomarkers not addressed in this LCD or any other Novitas LCD will be considered not reasonable and necessary unless specifically covered by national policy.”

The above statement will display in the Biomarkers Overview LCD (L35062) on Novitas’ website and the Medicare Coverage Database (MCD) on December 14, 2017.


December 12, 2017

Part A Open Issues

Inpatient hospital (11X) claims with Value Code D4 for Investigational Device Exemption (IDE) studies or Clinical Studies Approved Under Coverage with Evidence Development (CED) billed for Beneficiaries enrolled in Managed Care claims, billed with Condition Code 04 and Condition Code 30, are incorrectly receiving payment.

A correction to prevent payment on these claims is tentatively scheduled for April 2, 2018, with Change Request (CR)10238. Once the correction is installed, Novitas will identify and reprocess claims that were inappropriately paid within 90 days of April 2, 2018.

Reason codes 59172/59173 are editing incorrectly on some mammography service lines for certain diagnosis codes. The reason code logic will be updated with CR10318 on April 2, 2018. Once this has been implemented, any incorrectly denied claims that are brought to our attention will be adjusted.


Medicare Learning Network® MLN Matters® Articles from CMS

New:


December 11, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:


Long Term Care Facility Prospective Payment System Standard versus Site Neutral Payment

The Long Term Care Facility Prospective Payment System Standard versus Site Neutral Payment article has been updated. Please take a moment to review.


December 8, 2017

November 2017 Part A Newsletter

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


Appropriate Use of Not Otherwise Classified Codes

Correct coding requires services to be reported with the most specific code available which appropriately describes the service. Not Otherwise Classified Healthcare Common Procedure Coding System (HCPCS) codes must only be used when a more specific HCPCS or Current Procedural Terminology (CPT) code is not available.

Any claims received on or after January 15, 2018, containing a description in the remarks field of a claim describing a procedure/service where a valid HCPCS/CPT code exists, the claim will be rejected.

Please take time to review this article.


December 7, 2017

The following JH Draft Local Coverage Determination (LCD) posted for comment on January 19, 2017 and presented at the February 2017 Contractor Advisory Committee (CAC) Meeting has been posted for notice. It will become effective January 25, 2018:

The following JH Draft Local Coverage Determinations (LCDs) posted for comment on May 18, 2017 and presented at the June 2017 Contractor Advisory Committee (CAC) Meeting have been posted for notice. They will become effective January 25, 2018:

Comments Received and Contractor Responses


CMS Provider Education Message:

MLN Connects® for Thursday, December 7, 2017

View this edition as a PDF

News & Announcements

First Breakthrough-Designated Test to Detect Extensive Number of Cancer Biomarkers
CMS Finalizes Comprehensive Care for Joint Replacement Model Changes, Cancels Episode Payment Models & Cardiac Rehabilitation Incentive Payment Model
Updated Medicare Part D Opioid Drug Mapping Tool
Quality and Cost Measures under Consideration: CMS Releases List for 2018 Pre-rulemaking
Hospice Provider Preview Reports: Review by December 30
Quality Payment Program Hardship Exception Application Deadline: December 31
IRF and LTCH Provider Preview Reports: Review by January 3
New PEPPER Available for Short-term Acute Care Hospitals
Quality Payment Program Resources
Extreme and Uncontrollable Circumstances Policy for MIPS Clinicians in 2017
Targeted Probe and Educate Limits MAC Medical Record Reviews
Medical Record Documentation: Helpful Clinical Templates and Data Elements
Qualified Medicare Beneficiary: HETS and Remittance Advice
National Influenza Vaccination Week: December 3 through 9
National Handwashing Awareness Week: December 3 through 9

Provider Compliance

Hospital Discharge Day Management Services CMS Provider Minute Video — Reminder

Claims, Pricers & Codes

January 2018 Average Sales Price Files Available

Upcoming Events

Medicare Diabetes Prevention Program Model Expansion Orientation Webinar — December 13
National Partnership to Improve Dementia Care and QAPI Call — December 14
Home Health QRP: Proposed Removal of Influenza Vaccination Measure from Home Health Quality of Patient Care Star Rating Webinar — December 14

Medicare Learning Network Publications & Multimedia

DMEPOS Quality Standards Educational Tool – Revised
Advance Beneficiary Notice of Noncoverage Interactive Tutorial Educational Tool — Revised
Medicare Advance Written Notices of Noncoverage Booklet — Revised
How to Use the Searchable Medicare Physician Fee Schedule Booklet — Revised
Long-Term Care Hospital Prospective Payment System Booklet — Revised
Power Mobility Devices Booklet — Revised

Medicare Learning Network® MLN Matters® Articles from CMS

New:


December 5, 2017

Part A Top Claims Submission / Reason Code Errors

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


Additional December Webinars

Additional webinars have been added to the December 2017 calendar.  Join us for one of our powerful educational events.   Register today.


Medicare Learning Network® MLN Matters® Articles from CMS

New:

Revised:


December 4, 2017

Common Working File (CWF) Modifying Health Insurance Query Access (HIQA) Queries

Effective January 1, 2018, queries made to the CWF for checking eligibility and entitlement status for Medicare beneficiaries will be modified to only accept the National Provider Identifier (NPI) as a valid Provider Number. The Provider Transaction Access Number (PTAN) will no longer be accepted when accessing HIQA. For more information, review the Medicare Learning Network Matters Article MM10098.


November 30, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, November 30, 2017

View this edition as a PDF

News & Announcements

QRDA III Implementation Guide for CY 2018 Performance Period
DMEPOS: Traveling Beneficiary Clarification
Hospice Compare Search Function
World AIDS Day is December 1

Provider Compliance

Billing for Stem Cell Transplants — Reminder

Upcoming Events

Medicare Diabetes Prevention Program Model Expansion Call — December 5
Interdisciplinary Care Teams for Older Adults Webinar — December 7
National Partnership to Improve Dementia Care and QAPI Call — December 14

Medicare Learning Network Publications & Multimedia

Quality Payment Program 2017: MIPS ACI Performance Category Web-Based Training Course — New
SNF Value-Based Purchasing Program Call: Audio Recording and Transcript — New
Hurricane Harvey and Medicare Disaster Related Texas Claims MLN Matters Article — Updated
Tropical Storm Harvey and Medicare Disaster Related Louisiana Claims MLN Matters Article — Updated
SBIRT Services Booklet — Reminder

November 29, 2017

Modifier 50 Fact Sheet

Updates have been made to the modifier 50 fact sheet.  Please review the information at your leisure. 


Medicare Learning Network® MLN Matters® Articles from CMS

Revised:


November 28, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:


November 27, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Revised:


November 22, 2017

CMS Provider Education Message:

MLN Connects® for Wednesday, November 22, 2017

View this edition as a PDF

News & Announcements

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

Provider Compliance

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

Upcoming Events

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

Medicare Learning Network Publications & Multimedia

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

November 21, 2017

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

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

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

For more information:


Medicare Learning Network® MLN Matters® Articles from CMS

New:


November 20, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:


November 17, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Revised:


November 16, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, November 16, 2017

View this edition as a PDF

News & Announcements

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

Provider Compliance

Evaluation and Management: Correct Coding — Reminder

Upcoming Events

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

Medicare Learning Network Publications & Multimedia

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

QMB Remittance Advice Issue

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


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

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


Appropriate Use of Not Otherwise Classified Codes

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

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


November 14, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Revised:


November 13, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Reissued:


November 9, 2017

CMS Provider Education Message:

MLN Connects® for Thursday, November 9, 2017

View this edition as a PDF

News & Announcements

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

Provider Compliance

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

Upcoming Events

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

Medicare Learning Network Publications & Multimedia

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

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

The following JH Local Coverage Article has been revised:

The following JH Article has been added:

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

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


October 2017 Part A Newsletter

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


November 7, 2017

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Revised


November 6, 2017

Medicare Overpayments

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


November 3, 2017

Part A Top Claims Submission / Reason Code Errors

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


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


November 2, 2017

Special Edition – Thursday, November 2, 2017

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

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

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

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

The Final Rule Includes:

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

For More Information:

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

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

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

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

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

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

The Final Rule Includes:

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

For More Information:

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

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

HHAs: Payment Changes for 2018

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

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

The Final Rule Includes:

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

For More Information:

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

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

Quality Payment Program Rule for Year 2

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

The Final Rule Includes:

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

For More Information:

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

CMS Provider Education Message:

MLN Connects® for Thursday, November 2, 2017

View this edition as a PDF

News & Announcements

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

Provider Compliance

Advanced Life Support Ambulance Services: Insufficient Documentation — Reminder

Claims, Pricers & Codes

Outpatient Claims: Correcting Deductible and Coinsurance for Code G0473

Upcoming Events

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

Medicare Learning Network Publications & Multimedia

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

Medicare Learning Network® MLN Matters® Articles from CMS

Revised:


Medicare Learning Network® MLN Matters® Articles from CMS

New:


Know the Advantages of Billing Electronically

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


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


Was this page helpful?
Last modified:  02/20/2018