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For May 2018, Published June, 2018

Table of Contents

General News

Comprehensive ESRD Care (CEC) Model Telehealth-Implementation

MLN Matters® Number: MM10314
Related Change Request (CR) #: 10314
Related CR Release Date: April 27, 2018
Effective Date: October 1, 2018
Related CR Transmittal #: R196DEMO
Implementation Date: October 1, 2018

Provider Types Affected
This MLN Matters Article is intended for physicians, providers, and suppliers billing Medicare Administrative Contractors (MACs) and participating in the Comprehensive ESRD Care (CEC) Model for telehealth services provided to Medicare End-Stage Renal Disease (ESRD) beneficiaries associated with the CEC Model.

Provider Action Needed

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

International Classification of Diseases, Tenth Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs)

MLN Matters® Number: MM10622
Related Change Request (CR) #: 10622
Related CR Release Date: May 4, 2018
Effective Date: October 1, 2018
Related CR Transmittal #: R2076OTN
Implementation Date: October 1, 2018

Provider Types Affected
This MLN Matters Article is intended for physicians and other providers billing Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.

Provider Action Needed
Change Request (CR) 10622 constitutes a maintenance update of International Classification of Diseases, 10th Revision (ICD-10) conversions and other coding updates specific to National Coverage Determinations (NCDs). These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received. Please follow the link below for the NCD spreadsheets included with this CR: https://www.cms.gov/Medicare/Coverage/DeterminationProcess/downloads/CR10622.zip.

Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD)

MLN Matters® Number: MM10295 Revised
Related Change Request (CR) #: 10295
Related CR Release Date: May 11, 2018
Effective Date: May 25, 2017
Related CR Transmittal #: R207NCD and R4049CP
Implementation Date: July 2, 2018

Note: The article was revised on May 15, 2018, to clarify that one of the requirements of the SET program is it must be conducted in a hospital outpatient setting or in a physician’s office. All other information remains the same.

Provider Types Affected
This MLN Matters Article is intended for physicians, providers, and suppliers billing Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.

Provider Action Needed
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.

New Medicare Beneficiary Identifier (MBI) Get It, Use It

MLN Matters® Number: SE18006
Related Change Request (CR) #: N/A
Related CR Release Date: May 25, 2018
Effective Date: N/A
Related CR Transmittal #: N/A
Implementation Date: N/A

Provider Type Affected
This Special Edition MLN Matters® Article is intended for physicians, providers, and suppliers submitting claims to Medicare Administrative Contractors (MACs), including Durable Medical Equipment MACs (DME MACs) and Home Health and Hospice MACs, for services provided to Medicare beneficiaries.

Provider Action Needed
The Centers for Medicare & Medicaid Services (CMS) is mailing the new Medicare cards with the MBI in phases by geographic location. Here are 3 ways you and your office staff can get MBIs:

1. Ask your Medicare patients

Ask your Medicare patients for their new Medicare card when they come for care. If they haven’t received a new card at the completion of their geographic wave, refer them to 1-800-Medicare (1-800-633-4227).

2. Use the MAC's secure MBI look-up tool

Once the new Medicare card with the MBI has been mailed to your patient, you can look up MBIs for your Medicare patients when they don’t or can’t give them. Sign up for the Portal to use the tool. You can use this tool even after the end of the transition period – it doesn’t end on December 31, 2019.

3. Check the remittance advice

Starting in October 2018 through the end of the transition period, Medicare will return the MBI on every remittance advice when you submit claims with valid and active Health Insurance Claim Numbers (HICNs).
You can start using the MBIs even if the other health care providers and hospitals who also treat your patients haven’t. When the transition period ends December 31, 2019, providers must use the MBI for most transactions.

Coding Guidelines/Claim Reporting

Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes – July 2018 Update

MLN Matters® Number: MM10624 Revised
Related Change Request (CR) #: 10624
Related CR Release Date: May 11, 2018
Effective Date: July 1, 2018
Related CR Transmittal #: R4048CP
Implementation Date: July 2, 2018

Note: This article was revised on May 14, 2018, to reflect a revised CR issued on May 11. In the article, a sentence is added to show that Part B payment for Q9995 includes the clotting factor furnishing fee. Also, the CR release date, transmittal number, and the Web address of the CR are revised. All other information is the same.

Provider Types Affected
This MLN Matters Article is intended for physicians, providers and suppliers billing Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.

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

Reimbursement

Medicare Cost Report E-Filing (MCReF)

MLN Matters® Number: MM10611
Related Change Request (CR) #: 10611
Related CR Release Date: April 30, 2018
Effective Date: June 12, 2018
Related CR Transmittal #: R2075OTN
Implementation Date: June 12, 2018

Provider Types Affected
This MLN Matters Article is intended for cost report staff submitting annual Medicare Cost Reports (MCRs) to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.

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

Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment

MLN Matters® Number: MM10642
Related Change Request (CR) #: 10642
Related CR Release Date: May 11, 2018
Effective Date: July 1, 2018
Related CR Transmittal #: R4045CP
Implementation Date: June 2, 2018

Provider Type Affected
This MLN Matters® Article is intended for clinical diagnostic laboratories submitting claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.

Provider Action Needed
Change Request (CR) 10642 informs MACs about the changes in the July 2018 quarterly update to the Clinical Laboratory Fee Schedule (CLFS). Make sure that your billing staffs are aware of these changes.

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

MLN Matters® Number: MM10644
Related Change Request (CR) #: 10644
Related CR Release Date: May 18, 2018
Effective Date: January 1, 2018
Related CR Transmittal #: R4053CP
Implementation Date: July 2, 2018

Prover Types Affected
This MLN Matters Article is intended for physicians, providers and suppliers submitting claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.

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

July 2018 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files

MLN Matters® Number: MM10667
Related Change Request (CR) #: 10667
Related CR Release Date: May 25, 2018
Effective Date: July 1, 2018
Related CR Transmittal #: R4061CP
Implementation Date: July 2, 2018

Provider Type Affected
This MLN Matters® Article is intended for physicians, providers, and suppliers submitting claims to Medicare Administrative Contractors (MACs) for Medicare Part B drugs provided to Medicare beneficiaries.

Provider Action Needed
Change Request (CR) 10667 instructs MACs to download and implement the July 2018 and, if released, the revised April, 2018, January 2018, October 2017, and July 2017 ASP drug pricing files for Medicare Part B drugs via the Centers for Medicare & Medicaid Services (CMS) Data Center (CDC). Medicare will use these files to determine the payment limit for claims for separately payable Medicare Part B drugs processed or reprocessed on or after July 2, 2018, with dates of service July 1, 2018, through September 30, 2018. Make sure that your billing staffs are aware of these changes.

Specialty

Skilled Nursing Facility Advance Beneficiary Notice of Non-Coverage (SNF ABN)

MLN Matters® Number: MM10567
Related Change Request (CR) #: 10567
Related CR Release Date: March 30, 2018
Effective Date: April 30, 2018
Related CR Transmittal #: R4011CP
Implementation Date: April 30, 2018

Provider Type Affected
This MLN Matters Article is intended for Skilled Nursing Facilities (SNFs) billing Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.

Provider Action Needed
This article informs you about Change Request (CR) 10567, which advises you that the Centers for Medicare & Medicaid Services (CMS) has revised the Skilled Nursing Facility Notice of Non-coverage (SNF ABN), Form CMS-10055. With this revision, CMS is discontinuing the five Skilled Nursing Facility (SNF) Denial Letters (namely, the Intermediary Determination of Noncoverage, the UR Committee Determination of Admission, the UR Committee Determination on Continued Stay, the SNF Determination on Admission and the SNF Determination on Continued Stay), and the Notice of Exclusion from Medicare Benefits (NEMB-SNF), Form CMS-20014. Please ensure that your billing staffs are aware of these changes.

Please note that the Notice of Medicare Non-Coverage (NOMNC), Form CMS-10123 is not being discontinued with this revised SNF ABN. More information on the NOMNC is available at https://www.cms.gov/Medicare/Medicare-General-Information/BNI/FFS-Expedited-Determination-Notices.html.

Coverage Issues

NA

Electronic Data Interchange News

Updates to Publication 100-04, Chapters 1 and 27, to Replace Remittance Advice Remark Code (RARC) MA61 with N382

MLN Matters® Number: MM10619
Related Change Request (CR) #: 10619
Related CR Release Date: May 11, 2018
Effective Date: August 13, 2018
Related CR Transmittal #: R4047CP
Implementation Date: August 13, 2018

Provider Type Affected
This MLN Matters Article is intended for physicians, providers, and suppliers billing Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.

Provider Action Needed
Change Request (CR) 10619 initiates both Medicare manual changes and operational changes related to the New Medicare Card. Medicare will replace the use of Remittance Advice Remark Code (RARC) MA61, referenced in the Medicare Claims Processing Manual, Chapters 1 and 27, with RARC N382 - missing/incomplete/invalid patient identifier (HICN or MBI). Effective for claims processed on or after the effective date of CR10619, MACs will use N382 in place of MA61 to communicate reject/denials for patient identifiers (HICN or MBI) in all remittance advices and 835 transactions. However, MACs will continue to use RARC MA61 only when/if communicating rejections/denials related to a missing/incomplete/invalid social security number. Make sure your billing staffs are aware of these updates.

Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update

MLN Matters® Number: MM10620
Related Change Request (CR) #: 10620
Related CR Release Date: May 18, 2018
Effective Date: October 1, 2018
Related CR Transmittal #: R4057CP
Implementation Date: October 1, 2018

Provider Types Affected
This MLN Matters Article is intended for physicians, providers and suppliers billing Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.

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

Reopenings and Redeterminations: Save time with Novitasphere

We highly encourage providers to preform reopenings or redeterminations on their claims through Novitasphere, our free web-based portal. These features are fast, and easy to use – saving your office valuable time.

One of the most utilized features in Novitasphere is the Claim Correction feature. Part B customers can use this to submit their clerical error reopenings to Novitas. It’s as simple as 1-2-3: login to Novitasphere, correct the claim, and submit!

One of our newest enhancements to Novitasphere is the Appeal Requests feature. The Appeal Requests feature is used to submit a Redetermination request for finalized claims. Once logged in to Novitasphere, users can quickly search for and locate the claim, complete the Appeal Request, upload documentation, and submit!

Coming soon, users will be able to correct paid claims that have been Billed in Error.  Users will be able to identify claims, or individual lines of a claim, that were billed in error, and submit those for correction. Additionally, the new Medicare Correspondence feature will provide users with the outcome of their Redeterminations by providing them with a copy of their Medicare Redetermination Notice. Please watch our website for more details as we near implementation of these features.

To find enrollment instructions, or view a copy of the User Manual, visit the Novitasphere Portal Center today! For questions, please contact the Novitasphere Help Desk at 1-855-880-8424.

JH Novitasphere Center

Medical Policy

JH Medical Policy

Novitas encourages you to stay current with policy changes by visiting our Medical Policy Center.  The Medical Policy Center offers a wealth of information including sections dedicated to the most current updates,  Local Coverage Determinations (LCDs) / Policies and Articles, LCDs in draft, and additional resources.

In the absence of a Local Coverage Determination (LCD), National Coverage Determination (NCD), or CMS Manual Instruction, Reasonable and Necessary guidelines still apply.  Section 1862(a)(1)(A) * of the Social Security Act (SSA) provides specific instructions.

For any service reported to Medicare, it is expected that the medical record documentation clearly demonstrates that the service was reasonable and necessary. All documentation must be maintained in the patient’s medical record and be available to the contractor upon request.

Educational Opportunities

Have you attended a Novitas educational event recently? Novitas offers several options for increasing your Medicare knowledge and keeping yourself up to date with the latest changes. Events include Teleconferences, Webinars, and Workshops. Choose the ones that work best for you.

Do you like to view the presentation first hand? Attend one of our educational Webinars. Listen through your computer and watch live as the presenters go through the slideshow. Several presentations offer live viewing of the website and other systems frequently used. Novitas offers webinars on hot topics, such as Advanced Evaluation and Management Scorecard, Signature Requirements, and Office New Patient Guidelines and Coding.

If you prefer to have personal contact with a Novitas Educational Specialist visit our Events calendar for opportunities to attend a Medicare workshop. Stay tuned to the Novitas Solutions website for this great opportunity.

Most events offer Continuing Education Units (CEUs). Attend today to receive your CEUs.

If you’re not available to attend our events, listen to the latest Medicare news and updates with our free podcast. The Medicare Insights Podcasts offer updates in a concise audio program that you can listen to at work, at home, or even in your car. Download this program to your MP3 player or computer today.

Are you an association? Novitas Solutions is committed to partnering with associations, and would be happy to speak at your next association meeting. It’s as simple as completing the online request form.

Please visit the Novitas Solutions website for a complete listing of all our exciting educational opportunities and events.

Join our Electronic Mailing Lists

In these hectic times, it is difficult to keep on top of all the changes taking place in the Medicare world. Subscribe to one of our Free Electronic Mailing Lists and receive messages from us relating to the Medicare program, directly to your inbox. You can join by visiting our website

Novitas’ providers Electronic Mailing Lists are managed through Mail Chimp, a 3rd party vendor. Corporate email servers, Internet Service Providers and email providers can be set to block or mark emails originating from Mail Chimp servers as “spam” or “suspected spam.” If you have subscribed to one of our Mailing Lists but have not received any messages check your "spam" or "junk-mail" folder. If you find messages there, or continue to not receive messages, check with your organization's Internet Technology (IT) staff for assistance with firewall or Internet security settings on your computer.

CMS Electronic Mailing Lists

Did you know that the CMS Electronic Mailing Lists can help you with your business?

There are a multitude of electronic mailing lists that you can subscribe to that can give you up-to-the-minute, accurate news regarding CMS activities.

To subscribe to any of the CMS mailing lists, visit the CMS.gov Email Updates web page.

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The Medicare Report is published monthly as an informational reference source by Novitas Solutions for health care professionals in Pennsylvania, Maryland, New Jersey, Delaware District of Columbia Metropolitan Area, Arkansas, Louisiana, Mississippi, Colorado, New Mexico, Oklahoma, and Texas. This material is intended to compliment and not replace Medicare program requirements as set forth in statue, regulations and manual instructions. It is the responsibility of each healthcare professional/supplier submitting claims to Novitas Solutions to familiarize themselves with Medicare coverage requirements. Novitas Solutions makes efforts to ensure the information contained in this publication is accurate and current. However, because the Medicare program is constantly changing, it is the responsibility of each provider/supplier to remain abreast of the Medicare program requirements. Questions concerning this publication or its contents may be directed in writing to:

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Last modified:  06/08/2018