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Medicare News and Web Updates for JL Part A (2019)

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February 15, 2019

Medicare Administrative Contractors (MACs) will host a multi-jurisdictional Contractor Advisory Committee (CAC) via Webex on March 20, 2019, 1-4 pm EST

The purpose of the meeting is to obtain advice from CAC members and subject matter experts (SMEs) regarding the strength of published evidence on Percutaneous Vertebral Augmentation (PVA) for osteoporotic Vertebral Compression Fracture (VCF). In addition to discussion, the CAC and SME panel will vote on pre-distributed questions. The public is invited to attend as observers.

Ever since two high profile, methodologically controversial, randomized controlled trials (RCTs) found no benefit of percutaneous vertebroplasty over sham in 2009, there has been a lack of consensus on the appropriate management of osteoporotic VCF, particularly the role of PVA. After several recent publications further question the value of PVA, Contractor Medical Directors (CMDs) thought it appropriate to reassess current Medicare coverage. CAC panels do not make coverage determinations, but MACs benefit from their advice.

A participant Disclosure Statement, background material, and tentative questions will be posted by 2/22; the agenda (including final questions and Webex details) will be posted 3/13/19.


Turn Phone Calls into Conversations with Novitasphere Live Chat

If you have general questions about Novitasphere, such as how to enroll or navigate the site, you can chat with a representative using Live Chat. Live Chat is a quick and easy way to get your questions answered without calling the Novitasphere Help Desk.

Live Chat can be found in the top banner when logged in to Novitasphere Portal, or on any Novitasphere-related page on our provider website at www.novitas-solutions.com.

Find out more about the features of Novitasphere Live Chat by viewing this helpful article, and other online Novitasphere resources.


Avoid Delays to your EDI and Novitasphere Enrollment

EDI Services regularly receives incorrect EDI and Novitasphere enrollment forms which must be returned for corrections. Avoid delays to your enrollment by carefully reviewing the tips and information in this article.


February 14, 2019

CMS Provider Education Message:

MLN Connects® for Thursday, February 14, 2019

View this edition as a PDF

News & Announcements

New Medicare Card: 0 not O
Home Health Compare Refresh
MIPS: Check Your Preliminary 2019 Eligibility
Comparative Billing Report on Family Practitioner Office Visits in February
2019 CMS Health Equity Award Winners
Medicare Diabetes Prevention Program: Become a Medicare Enrolled Supplier
Influenza Activity Continues: Are Your Patients Protected?

Provider Compliance

Medicare Hospital Claims: Avoid Coding Errors — Reminder

Upcoming Events

Comparative Billing Report: Family Practitioner Office Visits Webinar — February 28
Dementia Care & Psychotropic Medication Tracking Tool Call — March 12
Open Payments: Transparency and You Call — March 13

Medicare Learning Network® Publications & Multimedia

Home Health PDGM MLN Matters Article — New
ICD-10 and Other Coding Revisions to NCDs MLN Matters Article — New
Implementation of the SNF PDPM MLN Matters Article — New
Implementation to Exchange the List of eMDR for Registered Providers MLN Matters Article — New
Independent Laboratory Billing of Tests for ESRD Beneficiaries MLN Matters Article — New
Medicare Physician Fee Schedule Database: April 2019 Update MLN Matters Article — New
Processing Instructions to Update the SPR MLN Matters Article — New
Supervised Exercise Therapy for Symptomatic PAD MLN Matters Article — New
Update to ICR Programs MLN Matters Article — New
CWF Provider Queries NPI Verification MLN Matters Article — Revised
Medicare FFS Response to the 2018 California Wildfires MLN Matters Article — Revised
Advance Beneficiary Notice of Noncoverage Interactive Tutorial — Revised
CLIA Program and Medicare Laboratory Services Fact Sheet— Revised
Long-Term Care Hospital Prospective Payment System — Revised
Medicare Advance Written Notices of Noncoverage Booklet— Revised
Medicare Parts A & B Appeals Process Booklet— Revised

Consistent with the new LCD process outlined in the Medicare Program Integrity Manual, Chapter 13, Section 13.5.1, language from statute, regulations, rulings interpretive manuals, etc. has been removed from the coverage and indications section of the revised Local Coverage Determinations (LCDs) listed below and replaced with the applicable references.

The following JL 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, 2019:

The following JL Local Coverage Articles have been revised to reflect the Annual CPT/HCPCS Code updates effective for dates of service on and after January 1, 2019:


February 11, 2019

Physicians Ordering Oxygen and Oxygen Equipment - Quick Tips!

Please take a moment to read this quick reference guide for physicians and non-physician practitioners concerning Medicare’s coverage of Oxygen and Oxygen Equipment.


January 2019 Part A Newsletter

The January 2019 Part A Newsletter is now available. Please take a moment to review.


Medicare Learning Network® MLN Matters® Articles from CMS

New:

This article informs you that the Centers for Medicare & Medicaid Services (CMS) has issued payment files to the MACs based upon the 2019 Medicare Physician Fee Schedule (MPFS) Final Rule. CR 11163 amends those payment files. Please be sure your billing staffs are aware of these changes.

February 8, 2019

Medicare Learning Network® MLN Matters® Articles from CMS

New:

CR 11152 effectuates changes to the SNF Prospective Payment System (PPS) that are required for the PDPM. These changes were finalized in the FY 2019 SNF PPS Final Rule (83 FR 39162). SNFs billing on Type of Bill (TOB) 21X and hospital swing bed providers billing on TOB 18X, (subject to SNF PPS) will be subject to these requirements. Make sure your billing staff is aware of these changes.
CR 11022 informs providers that on May 25, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a National Coverage Determination (NCD) to cover SET for Medicare beneficiaries with Intermittent Claudication (IC) for the treatment of symptomatic PAD. See the Key Points section of this article and make sure your billing staff is aware of this update.

February 7, 2019

CMS Provider Education Message:

MLN Connects® for Thursday, February 7, 2019

View this edition as a PDF


News & Announcements

New Medicare Card: Are You Using the MBI?
Open Payments Registration
Promoting Interoperability Programs: IPPS Final Rule Fact Sheet
Promoting Interoperability Programs: Hospitals Submit Attestation Data by February 28
SNF Provider Preview Reports: Review Your Data by March 4
Nursing Home Compare Refresh
QRDA III Implementation Guide Addendum
DMEPOS: Strategies to Support Access for Dually Eligible Individuals
February is American Heart Month

Provider Compliance

DME Proof of Delivery Documentation Requirements

Claims, Pricers & Codes

MIPS: Error in 2019 Payment Adjustment
DMEPOS 2019 Fee Schedule File Revision for HCPCS Code L3761

Upcoming Events

Home Health Patient-Driven Groupings Model Call — February 12
Falls Prevention for Older Adults Webinar — February 13
New Part D Opioid Overutilization Policies Call — February 14
Quality Payment Program: Overview of APMs for Year 3 Webinar — February 21

Medicare Learning Network® Publications & Multimedia

Functional Reporting Requirements and Therapy Provisions Update MLN Matters Article — New
Organ Acquisition Charges Not Included in IPPS Payment MLN Matters Article — New
RA Messaging: 20-Hour Weekly Minimum for PHP Services MLN Matters Article — New
VA Inpatient Claims Exempt from POA Reporting MLN Matters Article — New
ASP Medicare Part B Drug Pricing Files: April 2019 MLN Matters Article — New
Coding and Billing Date of Service on Professional Claims MLN Matters Article — Revised
CWF Provider Queries NPI and Submitter ID Verification MLN Matters Article — Revised
LCDs MLN Matters Article — Revised
Inpatient Psychiatric Facility Prospective Payment System Booklet — Revised
Skilled Nursing Facility Prospective Payment System Booklet — Revised
Medicare Enrollment for Providers Who Solely Order, Certify, or Prescribe Booklet — Reminder

Part A Top Claims Submission / Reason Code Errors 

The January 2019 Top Claim Submission / Reason Code Errors and resolutions for Delaware, Washington D.C., Maryland, New Jersey, and Pennsylvania are now available. Please take time to review these errors and avoid them on future claims.


Medicare Learning Network® MLN Matters® Articles from CMS

New:

This article is based on Change Request (CR) 11117 which informs MACs about Section 51004 of the Bipartisan Budget Act (BBA) of 2018, Pub. L. No. 115-123 (2018), which amended Section 1861(eee)(4)(B) of the Social Security Act (the Act) to expand coverage of ICR to additional conditions that became effective February 9, 2018. Make sure that your billing staff is aware of these changes.
Change Request (CR) 11134 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.
Make sure that your billing staffs are aware of these changes.

Revised:

This article was revised on February 6, 2019, to advise providers that the public health emergency (PHE) declaration and Section 1135 waiver authority for the State of California were renewed, effective February 6, 2019. All other information remains the same.

February 6, 2019

Assist us in Developing Local Coverage Determinations – Volunteer as a CAC Member!

The Centers for Medicare & Medicaid Services (CMS) recently released Change Request 10901 and the companion MLN Matters article to expand the parameters of who may serve as a Medicare Contractor Advisory Committee (CAC)* member. Novitas Solutions invites you to volunteer as a CAC member or alternate to represent your organization during our CAC meetings.

If you would like to volunteer as a representative or alternate, please ask your affiliated National or State Society to provide you with a nomination letter. When you have the nomination letter, send it in an email to MedicalAffairs@novitas-solutions.com along with your:

Contact information (Name, email address, phone number, etc.)
Area of specialty

At that time, Conflict of Interest and Consent to Disclose and Publish forms will be sent to you for completion. These forms are necessary since the new regulations prohibit us from using your opinions without your consent.

Thank you for your interest in our Local Coverage Determination (LCD) development process. Novitas Solutions will reach out to you with details regarding the LCD process and upcoming meetings.

If you have questions about becoming a CAC member, learn more on our website or reach out to us at MedicalAffairs@novitas-solutions.com.

* The purpose of the CAC is to provide a formal mechanism for healthcare professionals to be informed of the evidence used in consideration of a proposed LCD and to promote communications between the Medicare Administrative Contractor (MAC) and the healthcare community. CAC members serve in an advisory capacity as representatives of their constituency to review the quality of the evidence regarding a topic under consideration for development of a proposed LCD.


Medicare Learning Network® MLN Matters® Articles from CMS

Revised:

This article is revised on February 5, 2019, to delete references to Submitter ID changes removed from CR 10983. All other information remains the same.

February 5, 2019

Coming Soon!

Consistent with Change Request (CR) 10901 language from National Coverage Determinations and/or CMS manuals must be removed from our Local Coverage Determinations (LCDs) and replaced with the applicable references. This change will begin with the LCD revisions in response to the 2019 Annual HCPCS/CPT code update which will be published on the Novitas Website and the Medicare Coverage Database on Thursday February 14, 2019.

In the near future HCPCS/CPT codes and ICD-10 codes will be removed from LCDs and placed in Local Coverage Articles.

The above changes will alter the look of our LCDs; however, the “Revision History Information” will continue to provide a clear explanation for any modifications. Continue to watch our website for additional information.


Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 11112 instructs MACs to update their systems to ensure that SPRs mailed after July 1, 2019, mask the Health Insurance Claim Number (HICN), so the Social Security Number (SSN) does not show. Make sure your billing staff is aware of these instructions.
Change Request (CR) 11061 sunsets the requirement for Independent Laboratories to use the CB modifier to bill separately for renal dialysis laboratory tests. Make sure your billing staff is aware of these changes.
Change Request (CR) 11003 makes the changes required to send Additional Documentation Request (ADR) letters to participating providers via the (esMD) system.
A CR to effectuate the exchange of ADR letters to registered providers via the esMD system will be released at a later date.
Make sure your billing staffs are aware of these changes.

February 4, 2019

Revised CMS-855I Application

CMS has revised the CMS-855I Physicians and Non-Physician Practitioners enrollment application. If you need to submit a CMS-855I, please begin using the revised CMS-855I (12/18) version, which can be obtained from either the CMS or Novitas' website. Please visit the article for more details.


New Medicare Card Open Door Forum

The Centers for Medicare & Medicaid Services (CMS) is hosting an Open Door Forum conference call on Wednesday, February 6, 2019, from 2:00 to 3:00 pm Eastern Time. During this open door forum, CMS will share the latest information on the new Medicare card, including status of card mailing. You will also have the opportunity to ask questions. For participation instructions, please read this article. 


February 1, 2019

Medicare Learning Network® MLN Matters® Articles from CMS

Revised:

We revised the article on February 1, 2019, to reflect the revised CR 10901 issued on January 30, 2019, to include the updates in Chapter 13 of the “Medicare Program Integrity Manual”, which were erroneously not updated in the most recent on-line manual change. The effective date in the article was also corrected. We also revised the CR release date, transmittal number, and the web address of the CR. All other information remains the same.

January 31, 2019

CMS Provider Education Message:


MLN Connects® for Thursday, January 31, 2019

View this edition as a PDF

News & Announcements

New App Displays What Original Medicare Covers
Physicians and Non-Physician Practitioners: New Medicare Enrollment Application
QPP Videos: Create an Account in HARP
QPP Videos: MIPS Data Submission
eCQM Resources
Hospice Quality Reporting Program: FY 2021 Data Collection Began January 1
Hospice Training: Updates to Public Reporting in FY 2019
Prevent Legionnaires' Disease: Water Management Program Training

Provider Compliance

Cochlear Devices Replaced Without Cost: Bill Correctly — Reminder

Claims, Pricers & Codes

Physician Anesthesia Claims for SNF Patients

Upcoming Events

New Electronic System for Provider Reimbursement Review Board Appeals Call — February 5
New Medicare Card Open Door Forum — February 6
Home Health Patient-Driven Groupings Model Call — February 12
New Part D Opioid Overutilization Policies Call — February 14
MIPS Data Submission Office Hours Sessions — February 26 and March 19

Medicare Learning Network® Publications & Multimedia

RHCs/FQHCs: Communication Technology Based Services and Payment MLN Matters Article — New
Quality Payment Program in 2018: Transitioning to an Advanced APM Web-Based Training — New
Hospital Based Hospice Provider Compliance Tips Fact Sheet — New
Lab Tests: Urinalysis Provider Compliance Tips Fact Sheet — New
Lab Tests: Routine Venipuncture Provider Compliance Tips Fact Sheet — New
Lenses Provider Compliance Tips Fact Sheet — New
Parenteral Nutrition Provider Compliance Tips Fact Sheet — New
Patient Lifts Provider Compliance Tips Fact Sheet — New
Polysomnography Provider Compliance Tips Fact Sheet — New
Pressure Reducing Support Surfaces Provider Compliance Tips Fact Sheet — New
TENS Provider Compliance Tips Fact Sheet — New
ESRD Call: Audio Recording and Transcript — New
Clinical Labs Call: Audio Recording and Transcript — New
Typhoon Yutu and Medicare Disaster Related Commonwealth of the Northern Mariana Islands Claims MLN Matters Article — Revised
DMEPOS Fee Schedule: CY 2019 Update MLN Matters Article — Revised
Hospital OPPS: January 2019 Update MLN Matters Article — Revised
Diabetic Shoes Provider Compliance Tips Fact Sheet — Revised
Coding and Billing Date of Service on Professional Claims MLN Matters Article — Reissued
TKA Removal from IPO List and 2-Midnight Rule MLN Matters Article — Reissued

Medicare Learning Network® MLN Matters® Articles from CMS

Revised:

This article was revised on January 29, 2019, to reflect an updated Change Request that removed the July 2019 verification effective and implementation dates. The transmittal number, CR release date and link to the transmittal was also changed. All other information is unchanged.

The following Proposed Local Coverage Determinations (LCDs) posted for comment on May 17, 2018 and presented at the June 2018 Contractor Advisory Committee (CAC) Meeting have been posted for notice. They will become effective March 21, 2019.

The following Local Coverage Articles will become effective March 21, 2019:

The following Articles contain summaries of comments received and Novitas’ responses:


January 29, 2019

Medicare Learning Network® MLN Matters® Articles from CMS

New:

CR 11053 ensures that Medicare Severity Diagnosis Related Group (MS-DRG) Grouper does not apply the Hospital Acquired Condition (HAC) – Present on Admission (POA) logic to VA inpatient claims exempt from reporting POA indicators. Make sure your billing staffs are aware of this update.
CR11151 instructs MACs to download and implement the April 2019 and, if released, the revised January 2019, October 2018, July 2018, and April 2018 ASP drug pricing files for Medicare Part B drugs via the CMS Virtual 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 April 1, 2019, with dates of service April 1, 2019, through June 30, 2019. Make sure your billing staffs are aware of these changes.
CR 11120 updates both the Medicare Benefit Policy Manual and Medicare Claims Processing Manual to reflect recent changes in outpatient therapy services billing instructions and payment policies related to the Bipartisan Budget Act of 2018 and the Calendar Year (CY) 2019 Medicare Physician Fee Schedule (MPFS) Final Rule. These policy revisions include: (a) the repeal of the application of the outpatient therapy caps and the retention of the therapy cap amounts as thresholds of incurred expenses above which claims must include a modifier to confirm services are medically necessary as shown by medical record documentation; and, (b) the discontinuation of the functional reporting requirements. Please make sure your billing staffs are aware of these changes.
CR11087 which informs MACs about system changes to ensure that organ acquisition costs are not included in the IPPS payment calculation for claims that group to a non-transplant Medicare Severity Diagnostic Related Group (MS-DRG). Make sure that your billing staffs are aware of these changes.
CR11066 revises remittance advice informational messaging, effective July 1, 2019, to give supplemental and educational information to the hospitals and CMHCs submitting PHP claims where the patient did not get the minimum 20 hours per week of therapeutic services required by a PHP plan of care. The CR applies to claims with a Line Item Date of Service (LIDOS) on or after July 1, 2019. Make sure your billing staffs are aware of these updates.

January 24, 2019

CMS Provider Education Message:

MLN Connects® for Thursday, January 24, 2019

View this edition as a PDF

News & Announcements

New Medicare Card: Web Updates
CDC Opioids Training Modules
Open Payments Data Update
Medicare Shared Savings Program and Quality Payment Program Interactions Guide
Continue Seasonal Influenza Vaccination through January and Beyond

Provider Compliance

Reporting Changes in Ownership — Reminder

Upcoming Events

New Electronic System for Provider Reimbursement Review Board Appeals Call — February 5
Home Health Patient-Driven Groupings Model Call — February 12
New Part D Opioid Overutilization Policies Call — February 14

Medicare Learning Network® Publications & Multimedia

Proof of Delivery Documentation Requirements MLN Matters Article — New
New System for PRRB Appeals MLN Matters Article — New
Appropriate Use Criteria for Advanced Diagnostic Imaging Fact Sheet — New
Canes and Crutches: Provider Compliance Tips Fact Sheet — New
Tracheostomy Supplies: Provider Compliance Tips Fact Sheet — New
Ventilators: Provider Compliance Tips Fact Sheet — New
Commodes, Bed Pans, and Urinals: Provider Compliance Tips Fact Sheet — New
Comprehensive Outpatient Rehabilitation Facilities: Provider Compliance Tips Fact Sheet—New
New MBI: Get It, Use It MLN Matters Article — Revised
CLFS and Laboratory Services: CY 2019 Update MLN Matters Article — Revised
ASC Payment System: January 2019 Update MLN Matters Article — Revised
DMEPOS Update MLN Matters Article — Revised
ESRD PPS: Payment for Dialysis Furnished for AKI: CY 2019 MLN Matters Article — Revised
Influenza Virus Vaccine Code Update: January 2019 MLN Matters Article — Revised
Next Generation ACO Model 2019 Benefit Enhancement MLN Matters Article — Revised
ICD-10-CM, ICD-10-PCS, CPT, and HCPCS Code Sets Educational Tool — Reminder

Medicare Learning Network® MLN Matters® Articles from CMS

New:

CR10843 provides instructions for payment to RHCs and FQHCs billing for communication technology-based services for dates of service on or after January 1, 2019. Make sure your billing staffs are aware of these instructions.

Reissued:

This article was reissued on January 24, 2019, to clarify information.

Revised:

This article was revised on January 24, 2019, to advise providers that the public health emergency (PHE) declaration and Section 1135 waiver authority for the United States Virgin Islands expired on December 9, 2018. All other information remains the same.
This article was revised on January 23, 2019, to advise providers that the public health emergency (PHE) declaration and Section 1135 waiver authority for the Commonwealth of the Northern Mariana Islands were renewed, effective January 22, 2019. All other information remains the same.

January 23, 2019

Medicare Learning Network® MLN Matters® Articles from CMS

Revised:

This article was revised on January 18, 2019, to reflect an updated Change Request (CR) that corrected the link to the list of drugs and biologicals with corrected payments rates in Section I.B.11.d of that CR. The transmittal number, CR release date and link to the transmittal also changed. All other information is unchanged.
In the article, we revised the CR release date, transmittal number, and the web address of the CR. All other information remains the same as the changes to the CR had no impact on the substance in the article.

January 22, 2019

Frequently Asked Questions (FAQs)

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


January 18, 2019

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Special Edition (SE) article 19004 informs Part A providers of the new electronic system for Provider Reimbursement Review Board (PRRB) appeals. The new system, the Office of Hearings Case and Document Management System (OH CDMS) went live on August 16, 2018.
CMS encourages Part A providers, Medicare contractors, and other PRRB stakeholders to learn more about the benefits of using OH CDMS by attending the upcoming MLN event. Register for the New Electronic System for Provider Reimbursement Review Board Appeals Call scheduled for Tuesday, February 5 from 1:30 to 3 pm ET.

Revised:

We revised the article on January 18, 2019, to reflect the revised CR issued on January 17. The revised CR deleted code 0008U from the list of revised codes effective January 1, 2019. We deleted that code from the article. Also, we revised the CR release date, transmittal number, and the web address of the CR. All other information remains the same.

January 2019 Calendar of Educational Events

The September 2018 Calendar of Events is now available. Please visit the Education page of our website for additional information and registration opportunities.


January 17, 2019

CMS Provider Education Message:

MLN Connects® for Thursday, January 17, 2019

View this edition as a PDF

News & Announcements

Medicare Shared Savings Program: Submit Notice of Intent to Apply by January 18
Hospice Quality Reporting Program: Quality Measure User’s Manual
Qualified Medicare Beneficiary Billing Requirements
Medicare Diabetes Prevention Program: Become a Medicare Enrolled Supplier
Glaucoma Awareness Month: Make a Resolution for Healthy Vision

Provider Compliance

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

Upcoming Events

Clinical Diagnostic Laboratories to Collect and Report Private Payor Rates Call — January 22
Comparative Billing Report Webinar on Intensity-Modulated Radiation Therapy Webinar — January 24
New Electronic System for Provider Reimbursement Review Board Appeals Call — February 5
Home Health Patient-Driven Groupings Model Call — February 12
New Part D Opioid Overutilization Policies Call — February 14

Medicare Learning Network® Publications & Multimedia

2019 DMEPOS HCPCS Code Jurisdiction List MLN Matters Article — New
DMEPOS CBP: Quarterly Update MLN Matters Article — New
NCCI PTP Edits: Quarterly Update MLN Matters Article — New
Medicare Claims Processing Manual MLN Matters Article — New
Clinical Lab Fee Schedule: Medicare Travel Allowance Fees MLN Matters Article — New
New Waived Tests MLN Matters Article — New
ICD-10 and Other Coding Revisions to NCDs MLN Matters Article — Revised
Local Coverage Determinations MLN Matters Article — Revised
Skilled Nursing Facility ABN MLN Matters Article — Revised
Medicare Preventive Services Educational Tool — Revised
Remittance Advice: An Overview Booklet — Revised

Medicare Learning Network® MLN Matters® Articles from CMS

New:

CR10324 simplified and clarified the Centers for Medicare & Medicaid Services’ (CMS) requirements for proof of delivery and documentation necessary to support compliance for payment purposes. These proof of delivery requirements (including equipment examination requirements for newly eligible beneficiaries) are in revised Medicare Program Integrity Manual, Chapter 4, Section 26.

January 16, 2019

CMS Provider Education Message:

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:

Look for unopened mail. We mailed new Medicare cards in a plain white envelope from the Department of Health and Human Services.
Sign into MyMedicare.gov to get their new numbers or print official cards. They need to create an account if they do not already have one.
Call 1-800-MEDICARE (1-800-633-4227), so we can help them get their new cards.  

Continue to use their current cards to get health care services. They can use their old cards until December 31, 2019.


January 15, 2018

Part A Top Inquiries / Frequently Asked Questions (FAQs) for DE, DC, MD, NJ, & PA

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.


Medicare Learning Network® MLN Matters® Articles from CMS

Rescinded:

The Centers for Medicare & Medicaid Services (CMS) is revising this article and will re-issue it in the near future.

January 11, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

CR10848 revises the Medicare Claims Processing Manual, Chapter 30. The current policy in Chapter 30 is not changing. The Centers for Medicare & Medicaid Services (CMS) is revising the chapter to provide improved formatting and readability. CMS also added a glossary to assist you with common terminology within the chapter. The revised chapter is attached to CR10848. Make sure your billing staffs are aware of these changes.
CR11146 revises travel allowances payment amounts when billed on a per mileage basis using HCPCS code P9603 and when billed on a flat rate basis using HCPCS code P9604 for Calendar Year (CY) 2019. Make sure your billing staffs are aware of these changes.

Revised:

CMS revised this article on January 11, 2019, to reflect the revised CR 10567. The CR revisions had no impact on the content of the article. In the article, we revised the CR release date, transmittal number, and the web address of the CR. All other information remains the same.
CMS revised the article on January 11, 2019, to reflect the revised CR 10901. In the article, we added language to show that MACs have the discretion to host multi-jurisdictional CACs. Also, we revised the CR release date, transmittal number, and the web address of the CR. All other information remains the same.

December 2018 Part A Newsletter

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


January 10, 2019

CMS Provider Education Message:

MLN Connects® for Thursday, January 10, 2019
View this edition as a PDF

News & Announcements

Medicare Shared Savings Program: Submit Notice of Intent to Apply by January 18
New Medicare Card: Transition Period Ends December 31
January is Cervical Health Awareness Month

Provider Compliance

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

Upcoming Events

ESRD Quality Incentive Program: CY 2019 ESRD PPS Final Rule Call — January 15
Clinical Diagnostic Laboratories to Collect and Report Private Payor Rates Call —January 22
New Electronic System for Provider Reimbursement Review Board Appeals Call — February 5
Home Health Patient-Driven Groupings Model Call — February 12
New Part D Opioid Overutilization Policies Call — February 14

Medicare Learning Network® Publications & Multimedia

Orders for DMEPOS Items: What Suppliers Need to Know MLN Matters Article — New
ASC Payment System: January 2019 Update MLN Matters Article — New
Hospital OPPS: January 2019 Update MLN Matters Article — New
CLFS and Laboratory Services: CY 2019 Update MLN Matters Article — New
Immunosuppressive Guidance: Updates MLN Matters Article — New
Home Health Rural Add-on Payment MLN Matters Article — Revised
Implantable Defibrillators: NCD 20.4 MLN Matters Article — Revised
Medicare Billing: Form CMS-1500 and the 837 Professional Web-Based Training Course — Revised

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:


January 9, 2019

Important Updates to the Medical Policy Center

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.


Medicare Learning Network® MLN Matters® Articles from CMS

New:

The Centers for Medicare & Medicaid Services (CMS) removed the Current Procedural Terminology (CPT) code describing TKA procedures from Medicare’s Inpatient-Only List (IPO) effective January 2018. This allows TKA procedures to be performed on an inpatient or outpatient basis. It allows Medicare payment to be made to the hospital for TKA procedures regardless of whether a beneficiary is admitted to the hospital as an inpatient or as an outpatient, assuming all other criteria are met. This does not have any impact on CMS’ 2-midnight policy.

January 8, 2019

Medicare Learning Network® MLN Matters® Articles from CMS

Revised:

This article was revised on January 4, 2019, to show the correct effective date of April 1, 2019. All other information remains the same.

Important Updates Available on the Medical Policy Center

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.


January 7, 2019

Part A Top Claims Submission / Reason Code Errors 

The December 2018 Top Claim Submission / Reason Code Errors and resolutions for Delaware, Washington D.C., Maryland, New Jersey, and Pennsylvania are now available. Please take time to review these errors and avoid them on future claims.


January 4, 2019

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

The Centers for Medicare and Medicaid Services (CMS) has implemented an additional six-month extension for Maryland (MD) Waiver providers. The moratorium for National Correct Coding Initiative (NCCI) line level reason codes W7020 and W7040 will now be in place until June 30, 2019. Please review the updates in this article.


Medicare Learning Network® MLN Matters® Articles from CMS

New:

CR 11099 describes changes to and billing instructions for various payment policies implemented in the January 2019 OPPS update. The January 2019 Integrated Outpatient Code Editor (I/OCE) will reflect the Healthcare Common Procedure Coding System (HCPCS), Ambulatory Payment Classification (APC), HCPCS Modifier, and Revenue Code additions, changes, and deletions identified in CR 11099. Be sure your billing staffs are aware of these changes.

January 3, 2019

CMS Provider Education Message:

MLN Connects® for Thursday, January 3, 2019
View this edition as a PDF

News & Announcements

Medicare Shared Savings Program: Final Rule Creates Pathways to Success
Physician Compare Preview Period Extended to January 7
Hospice Provider Preview Reports: Review Your Data by January 9
Medicare Shared Savings Program: Submit Notice of Intent to Apply by January 18
Laboratory Date of Service Exception Policy: Enforcement Discretion Exercised until July 1
Quality Payment Program: 2019 Resources
eCQM Resource: The Collaborative Measure Development Workspace
Medicare Enrollment Application Fee for CY 2019
Delivery of Initial Prescriptions of Immunosuppressive Drugs
Antipsychotic Drug Use in Nursing Homes: Trend Update
Get Your Patients Off to a Healthy Start in 2019

Provider Compliance

Coding for Specimen Validity Testing Billed in Combination with Urine Drug Testing — Reminder

Claims, Pricers & Codes

Medicare Diabetes Prevention Program: Valid Claims

Upcoming Events

ESRD Quality Incentive Program: CY 2019 ESRD PPS Final Rule Call — January 15
Clinical Diagnostic Laboratories to Collect and Report Private Payor Rates Call —January 22
Home Health Patient-Driven Groupings Model Call — February 12

Medicare Learning Network® Publications & Multimedia

Claim Status Category and Codes Update MLN Matters Article — New
Ensuring Only the Active Billing Hospice Can Submit a Revocation MLN Matters Article — New
Guidance for MACs Processing BFCC QIO 2MN SSR Determinations MLN Matters Article — New
I/OCE Version 20.0: January 2019 MLN Matters Article — New
FISS/DDE: New Search Features MLN Matters Article — New
Quality Payment Program in 2018: Group Participation Web-Based Training — New
SNF PPS Call: Audio Recording and Transcript — New
IRF Medical Review Changes MLN Matters Article — Revised
New Physician Specialty Code for Undersea and Hyperbaric Medicine MLN Matters Article — Revised
Repetitive, Scheduled Non-emergent Ambulance Prior Authorization Model MLN Matters Article — Revised
Looking for Educational Materials?

The following JL Local Coverage Determination (LCD) is now effective after being posted for notice and has also been revised

The following JL LCD has been revised:


Coming Soon! Important Updates to the Medical Policy Center

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.


Medicare Learning Network® MLN Matters® Articles from CMS

New:

CR 11072 updates guidance in the Medicare Claims Processing Manual regarding the provision of covered immunosuppressive drugs to inpatients for use upon after a transplant procedure. Make sure your billing staffs are aware of these updates.

Revised:

CR 10782 implements recent legislation that requires home health rural add-on payments to vary, based on the county in which the service was furnished. Make sure your billing staffs are aware of these changes.

December 28, 2018

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.

Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (L35041)
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (A54117)
Billing and Coding for Rezum® Procedure (A55352)
Biomarkers for Oncology (L35396)
Biomarkers for Oncology (A52986)
Biomarkers Overview (L35062)
BRCA1 and BRCA2 Genetic Testing (L36715)
Cardiac Rhythm Device Evaluation (L34833)
Electroretinography (ERG) (L37371)
Hemophilia Factor Products (L35111)
Hyaluronan Acid Therapies for Osteoarthritis of the Knee (L35427)
Hyaluronan Acid Therapies for Osteoarthritis of the Knee (A55036)
Independent Diagnostic Testing Facility (IDTF) (L35448)
Independent Diagnostic Testing Facility (IDTF) (A53252)
Outpatient Wireless Pulmonary Artery Pressure Monitoring for Heart Failure (L36419)
Psychiatric Codes (L35101)
Self-Administered Drug Exclusion List (A53127)
Services That Are Not Reasonable and Necessary (L35094)
Speech-Language Pathology (SLP) Services: Communication Disorders (L35070)
Speech-Language Pathology (SLP) Services: Communication Disorders (A54111)
Spinal Cord Stimulation (Dorsal Column Stimulation) (L35450)

December 27, 2018

Updated Part A Open Issues Log 

The Centers for Medicare and Medicaid Services (CMS) has implemented an additional six-month extension for Maryland (MD) Waiver providers. The moratorium for National Correct Coding Initiative (NCCI) line level reason codes W7020 and W7040 will now be in place until June 30, 2019.


December 26, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request (CR) 10600 clarifies MAC follow up actions when they receive the BFCC-QIO Short Stay Review Denial Determinations. Be aware that CR10600 provides clarification that:
MACs will adjust the BFCC-QIO SSR denial decisions as an overpayment (a full claim denial)
Clarifies how a MAC is notified of the BFCC SSR denial decisions
Clarifies that appeals rights for BFCC-QIO SSR denial determinations are provided through a MAC issuing a demand letter.
CR 11073 updates, as needed, the Claim Status and Claim Status Category Codes used for the Accredited Standards Committee (ASC) X12 276/277, Health Care Claim Status Request and Response and ASC X12 277 Health Care Claim Acknowledgment transactions. Make sure your billing staffs are aware of these updates.
CR 11068 provides the instructions and specifications for the I/OCE that Medicare uses under the Outpatient Prospective Payment System (OPPS) and non-OPPS for hospital outpatient departments, community mental health centers, all non-OPPS providers, and for limited services when provided in a home health agency not under the Home Health Prospective Payment System or to a hospice patient for the treatment of a non-terminal illness. Make sure your billing staffs are aware of these updates.
Two new features are being added to the FISS/DDE inquiries menu options in January 2019. These features include a translator tool and an option to search for a claim using the FISS Document Control Number (DCN). The new features are described below.

December 20, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, December 20, 2018

View this edition as a PDF

News & Announcements

Opioids Training Modules
Open Payments: Review Program Year 2017 Data through December 31
QRURs and PQRS Feedback Reports: Access Ends December 31
LTCH Provider Preview Reports: Review Your Data by January 2
IRF Provider Preview Reports: Review Your Data by January 2
Hybrid Hospital-Wide Readmission Measure: Voluntary Reporting Extended to January 4
LTCH Compare Refresh
IRF Compare Refresh
Medicare Diabetes Prevention Program: Become a Medicare Enrolled Supplier
CY 2018 eCQM Data Receiving System Edits Document

Provider Compliance

Billing for Stem Cell Transplants — Reminder

Upcoming Events

ESRD Quality Incentive Program: CY 2019 ESRD PPS Final Rule Call — January 15
Clinical Diagnostic Laboratories to Collect and Report Private Payor Rates Call —January 22

Medicare Learning Network® Publications & Multimedia

DMEPOS Fee Schedule: CY 2019 Update MLN Matters Article — New
Inpatient Psychiatric Facility Benefit Policy Manual Update MLN Matters Article — New
Next Generation Sequencing NCD MLN Matters Article — New
Physician Supervision of Diagnostic Procedures, Telehealth Services MLN Matters Article — New
RHC and FQHC Medicare Benefit Policy Manual Update MLN Matters Article — New
Hurricane Florence and Medicare Disaster Related North Carolina, South Carolina, and the Commonwealth of Virginia Claims MLN Matters Article — Updated
Hurricane Michael and Medicare Disaster Related Florida and Georgia Claims MLN Matters Article — Updated

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


Medicare Learning Network® MLN Matters® Articles from CMS

Revised:

Special Edition article SE17036 reiterates policy related to claims submitted with regard to services provided to Medicare beneficiaries in an IRF. Please make sure your billing and coding staffs review these policies associated with Medicare IRF benefit.
Change Request (CR) 10666 informs you that the Centers for Medicare & Medicaid Services (CMS) has established a new Physician Specialty code for Undersea and Hyperbaric Medicine. This new code is D4. Make sure your billing staffs are aware of these changes.

Beneficiary and Family Centered Care (BFCC) Quality Improvement Organizations (QIO) Two-Midnight Short Stay Reviews Demand and Appeal Process

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.


December 19, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

SE 18009 provides important information about orders for DMEPOS items, to include those from telemarketers and/or telemedicine companies. You and your staff should be aware of these requirements.

December 18, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

CR 11076 provides instructions for the Calendar Year (CY) 2019 Clinical Laboratory Fee Schedule (CLFS), mapping for new codes for clinical laboratory tests, and updates for laboratory costs subject to the reasonable charge payment. Make sure your billing staffs are aware of these updates.

Revised:

This article was revised on December 17, 2018, to reflect a revised CR10865 issued on December 13. In the article, two sentences are added at the end of the Provider Action Needed section to emphasize that this coverage policy no longer requires trial-related coding on claims for dates of service on or after February 15, 2018. Also, the CR release date, transmittal number, and the Web address of the CR are revised. All other information is unchanged.

December 17, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

CR 11064 provides the Calendar Year (CY) 2019 annual update for the Medicare DMEPOS fee schedule. The instructions include information on the data files, update factors and other information related to the update of the fee schedule. Make sure your billing staffs are aware of these updates.
CR 11062 updates the language in the Medicare Benefit Policy Manual, Chapter 2, to add language from existing IPF regulations, to make technical corrections, or to clarify existing manual language. This CR also reflects changes to IPF regulations that were made in the Fiscal Year (FY) 2019 IPF Prospective Payment System (PPS) and Quality Reporting Updates final rule.
The changes made in the FY 2019 IPF PPS and Quality Reporting Updates final rule include changes to regulatory text at 42 Code of Federal Regulations (CFR) 412.27 to update language from International Classification of Diseases, 9th version, Clinical Modification (ICD-9-CM) to ICD-10-CM, and to note that the ICD-10-CM is the source for the principal psychiatric diagnosis.

Revised:

This article was revised on December 14, 2018, to reflect a revised CR10824 issued on October 5. In the article, the CR release date, transmittal number, and the Web address of the CR are also revised. All other information remains the same.
This article was revised on December 14, 2018 to reflect the revised CR10871 issued on September 27. In the article, the CR release date, transmittal number, and the Web address for accessing CR10871 are revised. All other information remains the same.
This article was revised on December 14, 2018, to reflect a revised CR11021 issued on December 13, 2018. The CR was revised to correct typos. In the article, the CR release date, transmittal number, and the Web address of the CR are revised. Also, the legislative reference in the second paragraph of the Background section is changed to section 808(b) of the Trade Preferences Extension Act of 2015 (TPEA). All other information remains the same.

December 14, 2018

November 2018 Part A Newsletter

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


Medicare Secondary Payer (MSP) – Medicare as the Tertiary Payer

A new article has been added which contains valuable information regarding Medicare as the Tertiary Payer.   


December 13, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, December 13, 2018

View this edition as a PDF

News & Announcements

New Medicare Card: MAC Look-Up Tool Updated
2019 Medicare Part D Opioid Policies: Training Materials
Open Payments: Review Program Year 2017 Data through December 31
LTCH Provider Preview Reports: Review Your Data by January 2
IRF Provider Preview Reports: Review Your Data by January 2
Hospice Provider Preview Reports: Review Your Data by January 9
Hospice Compare Quarterly Refresh
Quality Payment Program: Webinar Library
Quality Payment Program: Updated List of APMs
2018 QRDA Category I Implementation Guide Addendum
QRDA I File: Sample Hybrid Hospital-Wide Readmission Measure

Provider Compliance

Bill Correctly for Device Replacement Procedures — Reminder

Claims, Pricers & Codes

HETS Includes Medicare Diabetes Prevention Program Information

Upcoming Events

Medicare Diabetes Prevention Program Enrollment Tutorial Webinar — January 9

Medicare Learning Network® Publications & Multimedia

Per-Beneficiary Therapy Amounts: Annual Update MLN Matters Article — New
CY 2019 MPFS Final Rule: Summary of Policies MLN Matters Article — New
Quality Payment Program: MIPS Participation in 2018 Web-Based Training Course — New
NCD 20.4 Implantable Defibrillators MLN Matters Article — Revised
MLN Catalog: December 2018 – Revised

Medicare Learning Network® MLN Matters® Articles from CMS

Revised:

This article was revised on December 12, 2018, to advise providers that the public health emergency (PHE) declaration and Section 1135 waiver authority for North Carolina expired on December 6, 2018. Also, the PHE and Section 1135 waiver authority for South Carolina and the Commonwealth of Virginia expired on December 7, 2018. All other information is unchanged.
This article was revised on December 12, 2018, to advise providers that the public health emergency (PHE) declaration and Section 1135 waiver authority for Florida expires on January 5, 2019. Also, the PHE and Section 1135 waiver authority for Georgia expires on January 7, 2019. All other information is unchanged.

New Search Feature added to FISS DDE

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.


December 12, 2018

Part A Top Inquiries / Frequently Asked Questions (FAQs) for DE, DC, MD, NJ, & PA 

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:

Appeals
Claim Denials
General Information

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


December 11, 2018

Medicare Learning Network® MLN Matters® Articles from CMS

New:

CR 11019 informs MACs about the updates to Chapter 13 of the Medicare Benefit Policy Manual to clarify RHC and FQHC payment and other policy information. Make sure that your billing staffs are aware of these changes.
This article is based on CR 11043, which:
Revises the definition of "Personal Supervision" of the Physician Supervision of Diagnostic Procedures indicator to specify that procedures performed by a Registered Radiologist Assistant (RRA) or a Radiology Practitioner Assistant (RPA) may be performed under direct supervision
Adds instructions to use modifier G0 (G zero) to identify Telehealth services furnished for purposes of diagnosis, evaluation, or treatment of symptoms of an acute stroke
Clarifies requirements for when Diabetes Self-Management Training (DSMT) services may be paid as a telehealth service
Please be sure your staffs are aware of these changes.
Change Request (CR) 10878 informs, effective March 16, 2018, the Centers for Medicare & Medicaid Services (CMS) covers diagnostic laboratory tests using next generation sequencing when performed in a Clinical Laboratory Improvement Amendments- certified laboratory when ordered by a treating physician and when specific requirements are met. Make sure your billing staffs are aware of this change.
This revision to the “Medicare National Coverage Determinations Manual” is a national coverage determination (NCD). NCDs are binding on MACs with the Federal government that review and/or adjudicate claims, determinations, and/or decisions, quality improvement organizations, qualified independent contractors, the Medicare appeals council, and administrative law judges (ALJs) (see 42 CFR Section 405.1060(a)(4) (2005)). An NCD that expands coverage is also binding on a Medicare advantage organization. In addition, an ALJ may not review an NCD. (See section 1869(f)(1)(A)(i) of the Social Security Act.)

Revised:

This article was revised on December 10, 2018, to update the language regarding when MACs can return an MBI through the MBI look up tool (page 1). All other information remains the same.

December 7, 2018

Skilled Nursing Facility (SNF) Patient Driven Payment Model

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.


December 6, 2018

CMS Provider Education Message:

MLN Connects® for Thursday, December 6, 2018

View this edition as a PDF

News & Announcements

CMS Strengthens Nursing Home Oversight and Safety to Ensure Adequate Staffing
Hospital Value-Based Purchasing Program Results for FY 2019
Physician Compare Preview Period Open through December 31
QRURs and PQRS Feedback Reports: Access Ends December 31
Quality Payment Program: Check Your Final 2018 MIPS Eligibility Status
Quality Payment Program: MIPS Resources
Nursing Home Staff Competency Assessment Toolkit
PEPPERs for Short-term Acute Care Hospitals
eCQM Resources for the 2019 Performance Period
Updated QRDA I Conformance Statement Resource for Hospital Submissions
National Influenza Vaccination Week: December 2 through 8
National Handwashing Awareness Week: December 2 through 8

Provider Compliance

Cardiac Device Credits: Medicare Billing — Reminder

Claims, Pricers & Codes

HETS to Release MSP Diagnosis Codes Starting December 8
January 2019 Average Sales Price Files

Upcoming Events

SNF PPS: New Patient Driven Payment Model Call — December 11
Hospice Public Reporting Webinar — December 13

Medicare Learning Network® Publications & Multimedia

New Medicare Webpage on Patient Driven Payment Model MLN Matters Article — New
Ambulance Inflation Factor for CY 2019 and Productivity Adjustment MLN Matters Article — New
ICD-10 and Other Coding Revisions to NCDs MLN Matters Article — New
Implementation of Bundled Payment for Multi-Component DME MLN Matters Article — New
NCD 20.4 Implantable Cardiac Defibrillators MLN Matters Article — New
New Telehealth Modifier for Individuals with Stroke MLN Matters Article — New
New Waived Tests MLN Matters Article — New
NCCI Procedure-to-Procedure Edits, Version 25.0: Quarterly Update MLN Matters Article — New
IRF PPS Call: Audio Recording and Transcript — New
Physician Fee Schedule Call: Audio Recording and Transcript — New
NGACO Model Post Discharge Home Visit HCPCS MLN Matters Article — Revised
HIPAA Basics for Providers: Privacy, Security, and Breach Notification Rules Fact Sheet — Revised

Special Edition – 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.


Medicare Learning Network® MLN Matters® Articles from CMS

New:

Pursuant to the Robert T. Stafford Disaster Relief and Emergency Assistance Act, President Trump declared that, as a result of the effects of the 2018 Alaska earthquake, a major disaster exists in the State of Alaska. On December 3, 2018, Secretary Azar of the Department of Health & Human Services declared that a public health emergency exists in the State of Alaska retroactive to November 30, 2018, and authorized waivers and modifications under §1135 of the Social Security Act.
Also, the Administrator of the Centers for Medicare & Medicaid Services (CMS) authorized waivers under §1812(f) of the Social Security Act for the State of Alaska retroactive to November 30, 2018, for those people who are evacuated, transferred, or otherwise dislocated as a result of the effect of the earthquake.
Under Section 1135 or 1812(f) of the Social Security Act, CMS has issued several blanket waivers in the impacted geographical areas of the State of Alaska. These waivers will prevent gaps in access to care for beneficiaries impacted by the emergency. Providers do not need to apply for an individual waiver if a blanket waiver has been issued. Providers can request an individual Section 1135 waiver by following the instructions available on the CMS website.

The hold has been lifted from the following JL 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 JL Local Coverage Determinations have been revised:


Part A Open Issues Log- Update

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.


December 5, 2018

Interactive Voice Response (IVR) 

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.  


Medicare Learning Network® MLN Matters® Articles from CMS

New:

Change Request 11055 describes the annual per-beneficiary incurred expense amounts now known as the KX modifier thresholds, and related policy updates for Calendar Year (CY) 2019. For CY 2019, the KX modifier threshold amount for physical therapy (PT) and speech-language pathology (SLP) services combined is $2,040. For occupational therapy (OT) services, the CY 2019 threshold amount is $2,040. Make sure that your billing staffs are aware of these updates.

Revised:

CR 10865 was revised on December 3, 2018, to correct the implementation date. That date should be February 26, 2019. All other information is unchanged.

December 4, 2018

Part A Top Claims Submission / Reason Code Errors 

The November 2018 Top Claim Submission / Reason Code Errors and resolutions for Delaware, Washington D.C., Maryland, New Jersey, and Pennsylvania are now available. Please take time to review these errors and avoid them on future claims.


Protect Your Patients from Influenza this Season

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.


Changes to Amount in Controversy (AIC) for Appeals in 2019

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.


Coming January 2019 - A Redesigned Novitas Learning Center

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.


Medicare Learning Network® MLN Matters® Articles from CMS

New:

CR 11063 provides a summary of policies in the Calendar Year (CY) 2019 MPFS Final Rule and announces the Telehealth Originating Site Facility Fee payment amount and makes other policy changes related to Medicare Part B payment. These changes are applicable to services furnished in CY 2019. Make sure your billing staffs are aware of these updates.

December 3, 2018

Part A Open Issues Log- New Issue

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.


Revalidation Mailing Addresses Have Changed

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.


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Last modified:  02/15/2019