New and Revised Articles Posted to MLN Matters

New Articles

SE17031 – Updates to Medicare’s Cost Report Worksheet S-10 to Capture Uncompensated Care Data
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE17031.pdf

Revised Articles

MM9904 – Guidance on Implementing System Edits for Certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9904.pdf

MM10198 – New Waived Tests
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10198.pdf

CMS Reveals New Medicare Card Design

Removing Social Security numbers strengthens fraud protections
for about 58 million Americans

Thursday, September 14th — Today, the Centers for Medicare & Medicaid Services (CMS) gave the public its first look at the newly designed Medicare card. The new Medicare card contains a unique, randomly-assigned number that replaces the current Social Security-based number.

CMS will begin mailing the new cards to people with Medicare benefits in April 2018 to meet the statutory deadline for replacing all existing Medicare cards by April 2019. In addition to today’s announcement, people with Medicare will also be able to see the design of the new Medicare card in the 2018 Medicare & You Handbook. The handbooks are being mailed and will arrive throughout September.

“The goal of the initiative to remove Social Security numbers from Medicare cards is to help prevent fraud, combat identify theft, and safeguard taxpayer dollars,” said CMS Administrator Seema Verma. “We’re very excited to share the new design.”

CMS has assigned all people with Medicare benefits a new, unique Medicare number, which contains a combination of numbers and uppercase letters. People with Medicare will receive a new Medicare card in the mail, and will be instructed to safely and securely destroy their current Medicare card and keep their new Medicare number confidential. Issuance of the new number will not change benefits that people with Medicare receive.

Healthcare providers and people with Medicare will be able to use secure look-up tools that will allow quick access to the new Medicare numbers when needed. There will also be a 21-month transition period where doctors, healthcare providers, and suppliers will be able to use either their current SSN-based Medicare Number or their new, unique Medicare number, to ease the transition.

This initiative takes important steps towards protecting the identities of people with Medicare. CMS is also working with healthcare providers to answer their questions and ensure that they have the information they need to make a successful transition to the new Medicare number. For more information, please visit: www.cms.gov/newcard

Palmetto GBA E-mail Update: Tuesday, September 12, 2017

October 2017 Release ‘Dark Days’ for the Common Working File (CWF) Hosts
In anticipation of the October 2017 Release, the CWF Hosts will not process claims beginning Friday, September 29, 2017 through Sunday, October 1, 2017. During this period, which is commonly referred to as ‘dark days,’ the CWF Hosts will install the October 2017 Release, complete weekly/monthly/quarterly processing activities, and perform scheduled data center maintenance. This means Medicare Administrative Contractors (MACs) will not have access to the Health Insurance Master Record (HIMR) and Beneficiary Data Streamlining (BDS) transactions. Eligibility information in HIQA and HIQH will also not be available to providers.

Applies to:

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

Influenza And Pneumococcal Vaccines And Administration Reimbursement
These immunizations are paid at 100 percent of the established fee schedule amount. Coinsurance and the annual deductible do not apply. Please share with appropriate staff.

Applies to:

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

Palmetto GBA E-mail Update: Monday, September 11, 2017

Email and Faxed Inquiries
CMS requires all providers to utilize the Provider Contact Center (PCC) (855-696-0705) as their point of contact with their Medicare Administrative Contractors. If you submit an unsolicited fax or email inquiry directly to a specific department or individual your inquiry will be routed to the written correspondence area within the PCC for proper logging, tracking, research and response. An escalation process is used for complex issues. Submitting inquires directly to the PCC will assure CMS compliance and allow for the most timely response.

Applies to:

  • JM Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//General

Provider Contact Center (PCC) To Close For Training On September 15
The Provider Contact Center (PCC) will be closed for training on September 15, 2017, from 8 a.m. to 12 p.m. ET. The PCC will reopen at 12 p.m. ET.

Applies to:

  • JM Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//General

2018 Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Update
CR10262 provides the 2018 annual update of HCPCS Codes for SNF Consolidated Billing (SNF CB) and explains how the updates affect edits in Medicare claims processing systems. By the first week in December 2017, new code files will be posted at http://www.cms.gov/SNFConsolidatedBilling/. Make sure your staff is aware.

Applies to:

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

Medicare Secondary Payer Inquiry Form
As a reminder, A Medicare Secondary Payer Inquiry Form is available in the Medicare Secondary Payer forms section of our website. To ensure timely processing of your request, this form should be used for any Medicare Secondary Payer (MSP) request pertaining to Primary or Secondary payment of claims. Please share with appropriate staff.

Applies to:

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

A/B MACs Team Up with DME MACs for External Breast Prostheses and Related Mastectomy Supplies Webinar: October 18
Local A/B MACs and the DME MACs are excited to announce two collaboration webinars coming October 18, 2017. The event will be offered twice in the same day to accommodate national attendees. This webinar will focus on Medicare’s coverage of External Breast Prostheses and related supplies following surgical intervention. The educational representatives hosting the webinar will also spend time reviewing documentation requirements (such as detailed written orders and medical records). There will be plenty of time for questions after the presentation portion of the webinar. Please plan to attend.

Applies to:

  • JM Part A//General
  • JM Part B//General

MACtoberfest Workshop Conference: Innovation Today for Success Tomorrow
Palmetto GBA, the JM A/B MAC, is presenting an informative workshop in Columbia, South Carolina that will provide information related to the most common errors identified through a variety of data analysis and tips to avoid them. This workshop is intended to keep providers apprised of Medicare guidelines as well as using technology for better results. The recommended participants are administrators, billers, nurses and other healthcare professionals that submit claims to Medicare. Topics include: Electronic Data Interchange (EDI), Medicare Updates, Appeals, Medical Affairs, Medical Review, eServices portal, and Provider Enrollment and Revalidations. This is a free event! Please plan to attend.

Applies to:

  • JM Part B//General

September 2017 Medicare Part B Updates, Changes and Reminders: September 20
Palmetto GBA will host the Medicare Administrative Contract Part B September 2017 Quarterly Updates, Changes and Reminders Webcast on September 20, 2017, at 10 am. ET. These updates, changes and reminders include any new billing regulations, hot topics that impact provider billing, and a Q & A segment for questions on covered material. Note: An NPI and PTAN are required to register. You should only enter ‘n/a’ if you do not have an NPI or PTAN. Please share with your staff, and register today.

Applies to:

  • JM Part B//General

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

MLN Connects: Thursday, September 7, 2017

News & Announcements

  • Hospice Provider Preview Reports Available through September 28
  • IRF and LTCH Provider Preview Reports: Review by September 30
  • IRF and LTCH Compare Quarterly Refresh
  • Mapping Medicare Disparities Tool: 2017 Enhancements Released
  • 2015 Inpatient and Outpatient Hospital Utilization and Payment Data Available
  • Healthy Aging® Month: Discuss Preventive Services with your Patients

Provider Compliance

  • Lumbar Spinal Fusion CMS Provider Minute Video — Reminder

Claims, Pricers & Codes

  • October 2017 Average Sales Price Files Available

Upcoming Events

  • Overview of MIPS for Small, Rural, and Underserved Practices Webinar — September 8
  • New Medicare Card Project: Clearinghouses and Vendors Special Open Door Forum — September 12
  • Qualified Medicare Beneficiary Program Billing Requirements Call — September 19
  • Reporting Hospice Quality Data: Tips for Compliance Call — September 20
  • PQRS: Feedback Reports and Informal Review Process for PY 2016 Results Call — September 26
  • Physician Compare Call — September 28

Medicare Learning Network Publications & Multimedia

  • Medicare Diabetes Prevention Program: Audio Recording and Transcript — New

MLN Connects: Thursday, August 31, 2017

News & Announcements

  • New PEPPER Available for Short-term Acute Care Hospitals
  • Hospice Compare Update Document Available
  • Participate in Quality Payment Program Website Testing
  • Departmental Appeals Board: Submit Feedback
  • Correction to QRDA III Implementation Guide for Eligible Clinicians and Eligible Professionals

Provider Compliance

  • Billing For Stem Cell Transplants

Upcoming Events

  • IMPACT Act: Medicare Spending Per Beneficiary Measures Call – September 6
  • Nursing Home Facility Assessment Tool and State Operations Manual Revisions Call – September 7
  • Qualified Medicare Beneficiary Program Billing Requirements Call – September 19
  • Reporting Hospice Quality Data: Tips for Compliance Call – September 20
  • PQRS: Feedback Reports and Informal Review Process for PY 2016 Results Call – September 26
  • Physician Compare Call – September 28

Medicare Learning Network Publications & Multimedia

  • IMPACT Act Call: Audio Recording and Transcript – New
  • A Physician’s Guide to Medicare Part D Medication Therapy Management Programs MLN Matters Article – Revised
  • Preventive Services Poster Educational Tool – Revised
  • Medicare Costs at a Glance: 2017 Educational Tool – Reminder
  • Suite of Products & Resources for Rural Health Providers Educational Tool – Reminder
  • Inpatient Rehabilitation Facility Prospective Payment System Fact Sheet – Reminder
  • Physician Fee Schedule Fact Sheet – Reminder
  • Telehealth Services Fact Sheet – Reminder
  • Transitional Care Management Services Fact Sheet – Reminder
  • Federally Qualified Health Center Fact Sheet – Reminder
  • Rural Health Clinic Fact Sheet – Reminder
  • Medicare Home Health Benefit Booklet – Reminder
  • Critical Access Hospital Booklet – Reminder

Palmetto GBA E-mail Update: Friday, August 25, 2017

Email and Faxed Inquiries
CMS requires all providers to utilize the Provider Contact Center (PCC) (855-696-0705) as their point of contact with their Medicare Administrative Contractors. If you submit an unsolicited fax or email inquiry directly to a specific department or individual your inquiry will be routed to the written correspondence area within the PCC for proper logging, tracking, research and response. An escalation process is used for complex issues. Submitting inquires directly to the PCC will assure CMS compliance and allow for the most timely response.

Applies to:

  • JM Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//General

September 2017 Medicare Advisory
The September 2017 Medicare Advisory is now available. Please review this issue for Medicare policy and coverage updates as well as announcements for upcoming provider education opportunities. Please remember to share this information with your staff.

Applies to:

  • JM Part B//General

When using the Clock Draw test (CDT) to assess the patient’s cognitive function as part of the Annual Wellness Visit, do we need to scan the actual paper CDT into the patient’s medical record?
The provider may scan the patient’s Clock Draw test (CDT) but it is not required. At a minimum the interpretation and scoring of the drawing must be documented. Please share with appropriate staff.

Applies to:

  • JM Part B//General

A Physician’s Guide to Medicare Part D Medication Therapy Management (MTM) Programs
Medication Therapy Management providers work with physicians to deliver the best medication therapy to patients and to coordinate their medication therapy across multiple practitioners. The latest clinical information is used by MTM providers when reviewing patients’ medication therapy, such as updates to the Beers criteria for high-risk medications and revised monographs for old and new medications. MTM providers also listen to patients’ concerns about their medications and may offer recommendations to physicians and patients to help achieve their goals of therapy. As always, physicians make the final decisions about changes in drug therapy.

Applies to:

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