Palmetto GBA E-mail Update: Monday, July 17, 2017

Claims Payment/Processing Issues Log Webcast: July 26
Palmetto GBA will host a Part B Claims Payment/Processing Issues Log (CPIL) webcast on July 26, 2017 at 10 am, ET. This 60-minute Webcast is designed to provide an overview of the CPIL available on the Part B Palmetto GBA website and will include a question and answer period for questions related to accessing and using the CPIL. This webcast will include: how to access the CPIL, types of issues included on the log, and how to sign up for email notification of an individual CPIL updates. Please plan to attend.

Applies to:

  • JM Part B//General

North Carolina Part B Providers: Quality Payment Program (QPP) Webcast: July 25
North Carolina Part B providers, do you need help in being successful under the Quality Payment Program? Please join Alliant as we partner with Palmetto GBA on Tuesday, July 25th at 1:00 pm ET, for information concerning the Quality Payment Program. This webcast is intended for North Carolina Part B providers. The Quality Payment Program improves Medicare by helping practices focus on care quality and the one thing that matters most – making patients healthier. If you participate in Medicare Part B, the Quality Payment Program will provide new tools and resources to help you give your patients the best possible care. Please plan to attend.

Applies to:

  • JM Part B//General

Part B Top 10 Medical Review Denials Webcast: July 31
Please join Palmetto GBA on July 31, 2017, at 10:30 a.m. ET as we share the Top 10 Medical Review Denials and provide a better understanding of medical review denial reasons. During this 45 minute webcast, providers can expect to learn about: top medical review denials; edit effectiveness letter; denial documentation examples; medical necessity; and documentation tips. Please plan to attend.

Applies to:

  • JM Part B//General

Signature Log Can Be the Key
Do you have questions regarding the signature log? A signature log is a typed listing of the provider(s) identifying their name with a corresponding handwritten signature. This may be an individual log or a group log. A signature log may be used to establish signature identity as needed throughout the medical record documentation.

Applies to:

  • JM Part B//General
  • JM Part A//General
  • JM Home Health and Hospice//General
  • Railroad Medicare (RRB)//General – Railroad Medicare

Did you know you can view your latest electronic Comparative Billing Report (eCBR) in eServices?
Did you know you can view your latest electronic Comparative Billing Report (eCBR) in eServices? Be sure to check them out today!

Applies to:

  • JM Part B//General
  • JM Part B//Chiropractic
  • JM Part B//Physician
  • JM Part B//Primary Care

eServices makes it easy to monitor the use of your NPI!
eUtilization reports provide rendering providers and ordering and referring providers access to their personal data. Check them out today.

Applies to:

  • JM Part B//General
  • JM Part B//Physician
  • JM Part B//Primary Care

E/M Weekly Tip

E/M Weekly Tip: History Component ‘Unable to Obtain’
If you are unable to obtain the review of systems (ROS) and past, family and social history from the patient/source, the documentation must clearly describe the patient’s condition or other circumstance. Please share with appropriate staff.

Applies to:

  • JM Part B//General
  • Railroad Medicare (RRB)//General – Railroad Medicare

Palmetto GBA Update – Proposed 2018 Policy and Payment Rate Changes

Hospital Outpatient, ASC: CMS Proposes 2018 Policy and Rate Changes

Proposed rule and Request for Information promote improvements to quality, accessibility, and affordability of care

On July 13, CMS issued a proposed rule that updates payment rates and policy changes in the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System. The proposed rule is one of several for 2018 that reflect a broader strategy to relieve regulatory burdens for providers; support the patient-doctor relationship in healthcare; and promote transparency, flexibility and innovation in the delivery of care.

The OPPS and ASC payment system are updated annually to include changes to payment policies, payment rates, and quality provisions for those Medicare patients who receive care at hospital outpatient departments or receive care at surgical centers. Among the provisions in this rule, CMS is proposing to change the payment rate for certain Medicare Part B drugs purchased by hospitals through the 340B program. The proposed rule also includes a provision that would alleviate some of the burdens rural hospitals experience in recruiting physicians by placing a two-year moratorium on the direct supervision requirement currently in place at rural hospitals and critical access hospitals. In addition, CMS is releasing within the proposed rule a Request for Information to welcome continued feedback on flexibilities and efficiencies in the Medicare program.

For More Information:

Physician Fee Schedule: CMS Proposes 2018 Payment and Policy Updates

Proposed rule & Request for Information provide flexibility, support strong patient-doctor relationships

On July 13, CMS issued a proposed rule that would update Medicare payment and policies for doctors and other clinicians who treat Medicare patients in CY 2018. The proposed rule is one of several Medicare payment rules for CY 2018 that reflect a broader strategy to relieve regulatory burdens for providers; support the patient-doctor relationship in healthcare; and promote transparency, flexibility, and innovation in the delivery of care.

The Physician Fee Schedule is updated annually to include changes to payment policies, payment rates, and quality provisions for services furnished to Medicare beneficiaries. This proposed rule would provide greater potential for payment system modernization and seeks public comment on reducing administrative burdens for providing patient care, including visits, care management, and telehealth services. The rule takes steps to better align incentives and provide clinicians with a smoother transition to the new Merit-based Incentive Payment System under the Quality Payment Program. The rule encourages fairer competition between hospitals and physician practices by promoting greater payment alignment, and it would improve the payment for office-based behavioral health services that are often the therapy and counseling services used to treat opioid addiction and other substance use disorders. In addition, the proposed rule makes additional proposals to implement the Center for Medicare and Medicaid Innovation’s Medicare Diabetes Prevention Program expanded model starting in 2018.

For More Information:

OCR FAQs on Section 1557 clarify member questions on language assistance requirements

Originally published in the July 12, 2017 issue of MGMA’s Washington Connection
Reprinted with permission from MGMA

The Office for Civil Rights (OCR) released FAQs on its final rule implementing Section 1557 of the Affordable Care Act that offer much needed clarification for covered medical group practices on language access requirements for individuals with limited English proficiency (LEP) stemming from a final rule implementing Section 1557 of the Affordable Care Act. Section 1557 builds on longstanding civil rights laws and provides additional nondiscrimination requirements for covered group practices, including posting taglines alerting LEP individuals to the availability of language assistance services. Notably, the FAQs clarify that the phone number displayed on each tagline should be your group practice’s phone number.

For more information about how to comply with Section 1557, download MGMA’s member resource entitled, “Section 1557: What Your Practice Needs to Know.”

MLN Connects for Thursday, July 13, 2017

News & Announcements

  • New Medicare Cards with New Numbers: 3 Changes You May Need to Make
  • QRDA III Implementation Guide Available
  • Quality Payment Program: View Recent Webinar Recordings
  • Hospital Discharge Notices
  • IPPS Hospitals: FY 2014 S-10 Revisions
  • Recognizing National HIV Testing Day

Provider Compliance

  • OIG Video: Reporting Fraud to the Office of the Inspector General

Claims, Pricers & Codes

  • ICD-10-CM Errata Available

Upcoming Events

  • Revised Interpretive Guidance for Nursing Homes and New Survey Process Call — July 25
  • ESRD QIP: Proposed Rule for Payment Year 2021 Listening Session — July 26
  • IRF Quality Reporting Program Refresher Training Webinar — August 15
  • Comparative Billing Report on Drugs of Abuse Testing Webinar — August 23

Medicare Learning Network Publications & Multimedia

  • CLIA Webcast: Audio Recording and Transcript — New
  • Appeals Call: Audio Recording and Transcript — New
  • Acute Care Hospital Inpatient Prospective Payment System Booklet — Reminder
  • Skilled Nursing Facility Prospective Payment System Booklet — Reminder
  • Ambulatory Surgical Center Fee Schedule Fact Sheet — Reminder
  • Ambulance Fee Schedule Fact Sheet — Reminder
  • Health Professional Shortage Area Physician Bonus Program Fact Sheet — Reminder
  • Suite of Products & Resources for Billers & Coders Educational Tool — Reminder

MLN Connects Newsletter: Thursday, July 6, 2017

News & Announcements

  • ESRD: Proposed 2018 Policy and Payment Rate Changes
  • ESRD QIP: Prepare for the PY 2018 Preview Period
  • QPP: New Resources to Help Clinicians Participate in MIPS
  • QPP: New Webpage for Clinicians in Small, Rural, or Underserved Areas
  • Open Payments Program Posts 2016 Financial Data

Provider Compliance

  • Chiropractic Services: High Improper Payment Rate within Medicare FFS Part B

Upcoming Events

  • ESRD QIP: Reviewing Your Facility’s PY 2018 Performance Data Call — July 10
  • Creating and Verifying Your National Provider Identifier Call — July 12
  • Assessing Your Ability to Support Patient Self-Management Webinar — July 19
  • ESRD QIP: Proposed Rule for Payment Year 2021 Listening Session — July 26

Medicare Learning Network Publications & Multimedia

  • Modernized National Plan and Provider Enumeration System MLN Matters Article — New
  • Infection Control: Hand Hygiene Video — New
  • PECOS for Provider and Supplier Organizations Booklet — Reminder
  • Medicare Vision Services Fact Sheet — Reminder
  • Mass Immunizers and Roster Billing Booklet — Reminder

MLN Connects for Thursday, June 22, 2017

News & Announcements

  • CMS Proposes Quality Payment Program Updates to Increase Flexibility and Reduce Burdens
  • Coming in April 2018: New Medicare Card – New Number
  • Quality Payment Program: New Resources Available
  • Quality Payment Program: View Recordings of Recent Webinars
  • Quality Measure Development Plan Annual Report
  • SNF QRP Review and Correct Reports Available
  • 2015 Physician and Other Supplier Utilization and Payment Data
  • 2015 Referring DMEPOS Utilization and Payment Data
  • Hospice QRP: Clarifying Coding Guidance for Hospice Item Set
  • IRFs & LTCHs: Reminder to Review QRP Provider Preview Reports by June 30
  • Hospices: Reminder to Review Provider Preview Reports by June 30
  • Minority Research Grant Program: Apply by July 10

Provider Compliance

  • Hospice Election Statements Lack Required Information or Have Other Vulnerabilities

Upcoming Events

  • CLIA Certificate of Provider-performed Microscopy Webcast – June 28
  • Improvements to the Medicare Claims Appeal Process and Statistical Sampling Call – June 29
  • Quality Payment Program Year 2 Proposed Rule Listening Session – July 5
  • Creating and Verifying Your National Provider Identifier Call – July 12

Medicare Learning Network Publications & Multimedia

  • Provider Enrollment Revalidation – Cycle 2 MLN Matters Article – Revised
  • Complying with Medical Record Documentation Requirements – Revised

CNBC Interview With Anthem CEO

Click here to view an interview with the Anthem Blue Cross CEO Joseph Swedish regarding their future participation in Obamacare. This is interesting perspective from the carrier’s position about the affordable care act.