New and Revised Articles Posted to MLN Matters

Revised Articles

SE1128 – Prohibition on Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) Program

House Passes Repeal of IPAB; Tell Your Senators to do the Same!

Originally published in the November 8th issue of MGMA’s Washington Connection
Reprinted with permission from MGMA

Last week, the House of Representatives passed a bipartisan bill, the Protecting Seniors’ Access to Medicare Act (H.R. 849), to repeal the Independent Payment Advisory Board (IPAB) by a vote of 307–111. The IPAB is a cost containment tool created under the Affordable Care Act to convene if Medicare spending exceeds a particular limit. The board has draconian power to make changes to Medicare spending, leaving little-to-no room for recourse if IPAB-mandated payment cuts are triggered.

The fight to eliminate the IPAB is not yet over. The companion bill (S.260) to H.R. 849 now moves to the Senate; if it is successful there, it will advance to the President for his signature. Please join MGMA in urging the Senate to expeditiously pass this important legislation, before future actuary reports trigger the IPAB and activate payment reductions to Medicare providers. Contact your senators now via MGMA’s Advocacy Center to express support for IPAB repeal!

NCMGMA Survey: Medicare Advantage Organizations (MAOs) in NC

NCMGMA Member Survey
Medicare Advantage Organizations (MAOs) in NC

NCMGMA values your opinion. The NCMGMA leadership has a scheduled meeting with CMS leaders and this survey is intended to capture the extent and financial impact of improper sequestration by Medicare Advantage Organizations (MAOs) in North Carolina.

The results could be helpful to underscore MAO behavior and the responsibility of CMS to actively monitor – and respond to – complaints by providers about violations of CMS rules.

Please take a moment to complete our brief survey. If you have any questions, please email our offices at

Thank you and we appreciate your time!

Act Now on Independent Payment Advisory Board Repeal Legislation

Act Now on Independent Payment Advisory Board (IPAB) Repeal Legislation that was Enacted under the Affordable Care Act

Tomorrow, the House Energy and Commerce Committee and Ways and Means Committee, two committees with jurisdiction over Medicare Part B, are holding hearings on H.R. 849, the Protecting Seniors’ Access to Medicare Act of 2017, which would repeal the Independent Payment Advisory Board (IPAB) created under the Affordable Care Act. Under current law, the IPAB will be triggered when the growth rate in Medicare exceeds target growth rates (as reported by CMS’ Office of the Actuary), and will be responsible for recommending to Congress spending reductions in the Medicare program in order to reduce growth below the target growth rate. Although there have been no members appointed to the IPAB, if the IPAB is triggered, the Secretary of HHS is required to stand in place of the board and submit a proposal for reducing Medicare spending. Any proposal, whether from IPAB or HHS, is subject to a “fast track” legislative implementation process with virtually no oversight, leaving little-to-no room for recourse once IPAB-mandated payment cuts are implemented.

It is paramount that members of Congress act now, before future actuary reports trigger the IPAB and activate payment reductions to Medicare providers. Given the timeliness of the House Committee meetings this week, MGMA has created a template message supporting IPAB repeal that can be found by visiting the MGMA Advocacy Center, where you can contact lawmakers and urge them to support this important legislation.

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

Revised Articles

MM9904 – Guidance on Implementing System Edits for Certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)

MM10198 – New Waived Tests

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:

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