CMS Update – 6/21/13


CMS Medicare FFS Provider e-News for Thursday, June 20, 2013
06/20/2013

 

The CMS Medicare FFS Provider e-News contains important news, announcements, and updates for Medicare FFS providers. Please share it with anyone who would benefit from this information.

 

Table of Contents for Thursday, June 20, 2013


National Provider Calls

 

Previous National Provider Calls: New Materials Available 

 

Announcements and Reminders

 

Claims, Pricer and Code Updates

 

MLN Educational Products Update

 

National Provider Call: Medicare and Medicaid EHR Incentive Programs and Certified EHR Technology — Register Now

Thursday, June 27; 2:30-3:45pm ET

CMS and the Office of the National Coordinator for Health Information Technology (ONC) will provide an overview of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, including the use of certified EHR technology to meet meaningful use. Learn about the different types of certification and what certification actually tests.

Agenda:

  • Overview of the EHR Incentive Programs
  • ONC Health Information Technology (HIT) Certification Program
  • 2014 Edition Testing and Certification
  • Resources
  • Question and answer with CMS and ONC experts

Target Audience:Eligible Professionals and Eligible Hospitals as defined by the Medicare and Medicaid EHR Incentive Programs. 

Registration Information:  In order to receive call-in information, you must register for the call on the CMS Upcoming National Provider Calls registration website. Registration will close at 12pm on the day of the call or when available space has been filled; no exceptions will be made, so please register early.

 Presentation:  The presentation for this call will be posted on the FFS National Provider Calls web page. In addition, a link to the slide presentation will be emailed to all registrants on the day of the call.

Continuing education credit may be awarded for participation in certain CMS National Provider Calls. Visit the Continuing Education Credit Information web page to learn more.

 

National Provider Call: CMS National Partnership to Improve Dementia Care in Nursing Homes — Register Now

Wednesday, July 10; 1:30-3pm ET

CMS has developed a national partnership to improve the quality of care provided to individuals with dementia living in nursing homes. This partnership is focused on delivering health care that is person-centered, comprehensive, and interdisciplinary. By improving dementia care through the use of individualized, person-centered care approaches, CMS hopes to continue to reduce the use of unnecessary antipsychotic medications in nursing homes and eventually other care settings as well. The partnership promotes a systematic process to evaluate each person and identify approaches that are most likely to benefit that individual. While antipsychotic medications are the initial focus of the partnership, CMS recognizes that attention to other potentially harmful medications is also an important part of this initiative.

During this National Provider Call, CMS subject matter experts will discuss the progress that has been made during the implementation of this national partnership, its successes, and next steps. Additional speakers will share some personal success stories from the field. A question and answer session will follow the presentation.

Agenda:

  • National partnership overview: Success through data
  • Stories from the field: State coalitions, providers, clinicians
  • Next Steps
    • Provider feedback
    • What outreach strategies have been successfully implemented and have led to meaningful change in nursing homes?
  • Question and answer session

Target Audience: Consumer and advocacy groups, nursing home providers, surveyor community, prescribers, professional associations, and other interested stakeholders

Registration Information:  In order to receive call-in information, you must register for the call on the CMS Upcoming National Provider Calls registration website. Registration will close at 12pm on the day of the call or when available space has been filled; no exceptions will be made, so please register early.

Presentation:  The presentation for this call will be posted on the FFS National Provider Calls web page. In addition, a link to the slide presentation will be emailed to all registrants on the day of the call.

Continuing education credit may be awarded for participation in certain CMS National Provider Calls. Visit the Continuing Education Credit Information web page to learn more.

 

National Provider Call: Medicare Shared Savings Program Application Process Question and Answer Session — Register Now

Thursday, July 18; 1-2:30pm ET

On October 20, 2011, CMS issued a final rule under the Affordable Care Act to establish the Medicare Shared Savings Program (Shared Savings Program). This initiative will help providers participate in Accountable Care Organizations (ACOs) to improve quality of care for Medicare patients. During this National Provider Call, CMS subject matter experts will be available to answer questions about the Shared Savings Program and application process for the January 1, 2014 start date.

The Shared Savings Program Application web page has important information, dates, and materials on the application process. Call participants are encouraged to review the application and materials prior to the call.

Target Audience: Medicare FFS providers

Registration Information:  In order to receive call-in information, you must register for the call on the CMS Upcoming National Provider Calls registration website. Registration will close at 12pm on the day of the call or when available space has been filled; no exceptions will be made, so please register early.

 Presentation:  The presentation for this call will be posted on the FFS National Provider Calls web page. In addition, a link to the slide presentation will be emailed to all registrants on the day of the call.

 Continuing education credit may be awarded for participation in certain CMS National Provider Calls. Visit the Continuing Education Credit Information web page to learn more.

 

National Provider Call: Choosing Your PQRS Group Reporting Mechanism and Implications for the Value-based Payment Modifier — Register Now

Wednesday, July 31; 2:30-3:30pm ET

This National Provider Call will walk through the Physician Value (PV) – Physician Quality Reporting System (PQRS) Registration System. The PV-PQRS Registration System is a new application to serve the Physician Value Modifier and PQRS programs. The PV-PQRS Registration system will allow: (1) physician group practices to select their CY 2013 PQRS Group Reporting Mechanism, and if the group has 100 or more eligible professionals, elect quality tiering to calculate their CY 2015 Value-based Payment Modifier; and (2) individual eligible professionals to select the CMS-calculated Administrative Claims reporting mechanism for CY 2013 in order to avoid the PQRS negative payment adjustment in CY 2015. A question and answer session will follow the presentation. The PV-PQRS Registration System will be open from July 15, 2013 to October 15, 2013.

Please note that while this call is scheduled for 60 minutes. CMS experts will be available to stay on the line for an additional 30 minutes to take outstanding questions, should they exist, at the end of the scheduled call time. Participants can remain on the line until the conclusion of the call or refer to the call transcript and audio recording (to be posted 7-10 business days after the call) if they are unable to participate beyond the 60 minute scheduled duration.

Agenda:

  • Introduction/opening remarks
  • PV-PQRS registration walkthrough     
  • Question and answer session  

Target Audience: Physicians, physician group practices, practice managers, medical and specialty societies, payers, insurers.

Registration Information:  In order to receive call-in information, you must register for the call on the CMS Upcoming National Provider Calls registration website. Registration will close at 12pm on the day of the call or when available space has been filled; no exceptions will be made, so please register early.

Presentation:  The presentation for this call will be posted on the FFS National Provider Calls web page. In addition, a link to the slide presentation will be emailed to all registrants on the day of the call.

Continuing education credit may be awarded for participation in certain CMS National Provider Calls. Visit the Continuing Education Credit Information web page to learn more.

 

National Provider Call:  Medicare and Medicaid EHR Incentive Programs National Provider Call Series — Save the Dates

The Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs paid out over $13.7 billion in incentives through March of this year. Don’t be left out. CMS will be holding a series of National Provider Calls (NPCs) about different aspects of the EHR incentive programs. Don’t miss these opportunities to learn from the experts.

Register now for the June 27 Certification call for Medicare and Medicaid eligible professionals.

Mark your calendars for these upcoming NPCs. Registration will be announced soon:

Medicare and Medicaid Eligible Professionals, Eligible Hospitals, and Critical Access Hospitals:

  • July 23; 1:30-3 —Clinical Quality Measures  
  • July 24; 1:30-3 —Stage 2

Medicare Eligible Professionals, Eligible Hospitals, and Critical Access Hospitals

  • August 13; 1:30-3 —Hardship Exceptions
  • August 15; 1:30-3 —Payment Adjustments

 

National Provider Call: Video Slideshow Presentation from April 18 “Begin Transitioning to ICD-10 in 2013” Call Now Available

 

Are you ready to transition to ICD-10? Now is the time to prepare. CMS has released a video slideshow presentation from the April 18 call on “Begin Transitioning to ICD-10 in 2013.” The presentation is now available on the CMS YouTube Channel as a video slideshow that includes the call audio. Visit the April 18 call detail web page for access to all of the related call materials, including the slide presentation, audio recording, and written transcript.

 

 

National Provider Call: Audio Recording and Written Transcript from May 22 “National Physician Payment Transparency Program (Open Payments) – What You Need To Know” Call Now Available

 

The audio recording and written transcript from the May 22 “National Physician Payment Transparency Program (Open Payments)” call are now available on the May 22 call detail web page under the “Call Materials” section.

 

 

National Provider Call: Audio Recording and Written Transcript from May 30 “Stage 1 of the Medicare & Medicaid EHR Incentive Programs for Eligible Professionals” Call Now Available  

 

The audio recording and written transcript from the May 30 “Stage 1 of the Medicare & Medicaid EHR Incentive Programs for Eligible Professionals”call are now available on the May 30  call detail web page under the “Call Materials” section. Learn if you are eligible, and if so, what you need to do to earn an incentive.

 

 

National Provider Call: Audio Recording and Written Transcript from June 5 “Getting Started with PQRS Reporting: Implications for the Value-based Payment Modifier” Call Now Available

 

The audio recording and written transcript from the June 5 “Getting Started with PQRS Reporting: Implications for the Value-based Payment Modifier” call are now available on the June 5 call detail web page under the “Call Materials” section.

 

 

National HIV Testing Day – an Annual Observance to Promote HIV Testing

 

June 27is National HIV Testing Day. Healthcare professionals, this is a great time to encourage Medicare beneficiaries to get tested. Did you know? In 2011, according to the Centers for Disease Control and Prevention there were over 2,000 newly reported cases of HIV among individuals aged 60 and over. There may even be more cases unreported. One reason may be that doctors do not always test older people for HIV/AIDS and so may miss some cases during routine check-ups. However, under the Affordable Care Act, Medicare now covers preventative services such as screenings for HIV and sexually transmitted infections (STIs), and high intensity behavioral counseling to prevent STIs. Talk with your patients to ensure they understand risk does not diminish with age and encourage utilization of these important preventive benefits as appropriate.

 

For More Information:

 

PV-PQRS: IACS Modified to Accept PTANs Less Than Ten Characters Long

During the June 5 National Provider Call “Getting Started with PQRS Reporting: Implications for the Value-based Payment Modifier and the PQRS Payment Adjustment”, CMS indicated that physicians in group practices and individual eligible professionals (EPs) whose Provider Transaction Access Numbers (PTANs) are not 10 characters long should wait to request an Individuals Authorized Access to the CMS Computer Services (IACS) account with a Physician Value-Physician Quality Reporting System (PV-PQRS) Registration System role or modify an existing account to add a PV-PQRS Registration System role until further notice from CMS. 

The purpose of this message is to notify all physician group practices and EPs that IACS has been modified to accept PTANs that are less than 10 characters long. We urge representatives of group practices and EPs to request a new IACS account or modify an existing account on the CMS Applications Portal as soon as possible.

For additional information about getting an IACS account with a PV-PQRS Registration System role, please visit the Physician Feedback Program/Value-Based Payment Modifier Self Nomination/Registration web page.

For More Information:
Visit the Physician Feedback Program website for more information on the Value-based Payment Modifier.

 

CMS Posts 2014 Eligible Professional Clinical Quality Measure Update

 

The updated 2014 clinical quality measures (CQMs) for eligible professionals (EPs) are now available, as well as corresponding specifications for electronic reporting. CMS updates the specifications annually in order to ensure that specifications maintain alignment with current clinical guidelines, and remain relevant and actionable within the clinical care setting.Beginning in 2014, the CQM specifications will be used for multiple programs, such as the Physician Quality Reporting System, to align the EHR Incentive Programs and reduce the burden on providers to report quality measures. 

 

CMS strongly encourages the implementation and use of the updated 2014 CQMs for EPs since they include new codes, logic corrections, and clarifications. However, CMS will accept all versions of the CQMs for meaningful use, beginning with those finalized in the December 4, 2012 CMS-ONC Interim Final Rule, until the next phase of the EHR Incentive Programs.

 

Updated 2014 CQM Resources
To help EPs navigate the updated CQMs, several resources are available on the eCQM Library page:

In addition, CMS also posted a Guide to the Quality Reporting Data Architecture, QRDA, for 2014 eCQMs. Note: The annual update for eligible hospital specifications was released in April 2013. Related resources are also available on the eCQM Library page.

 

Want more information about the EHR Incentive Programs?
Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

 

 

New FAQs for ICD-10 Billing

 

CMS has released three new FAQs about submitting ICD-10 claims around the October 1, 2014, deadline. These FAQs update previous information about submitting claims and explain how to split claims for services that span the October 1, 2014, transition date. The three new FAQs on ICD-10 billing discuss these topics:

You can find these questions and many other FAQs about ICD-10 at https://questions.cms.gov/.

 

Keep Up to Date on ICD-10
Visit the CMS ICD-10 website for the latest news and resources to help you prepare for the October 1, 2014, deadline. Sign up for CMS ICD-10 Industry Email Updates and follow us on Twitter.

 

Recovery Auditor Adjustments for Periodic Interim Payment Providers

Periodic Interim Payment (PIP) providers may have been previously notified by a Recovery Auditor that their claim was reviewed and an improper payment identified. Providers may also be aware that a claim adjustment issue delayed recoupments. This issue has been addressed, and Recovery Auditor adjustments will begin to occur on a controlled basis. Recovery Auditors will work with Medicare Administrative Contractors (MACs) and Fiscal Intermediaries (FIs) to adjust previously identified improper payments in the upcoming months.

 

From the MLN: “Acute Care Hospital Inpatient Prospective Payment System” Fact Sheet — Revised

 The “Acute Care Hospital Inpatient Prospective Payment System” Fact Sheet (ICN 006815) was revised and is now available in downloadable format. This fact sheet is designed to provide education on the Acute Care Hospital Inpatient Prospective Payment System (IPPS). It includes the following information: background, basis for IPPS payment, payment rates, how payment rates are set, and payment updates.

 

From the MLN: “Ambulance Fee Schedule” Fact Sheet — Revised

 The “Ambulance Fee Schedule” Fact Sheet (ICN 006835) was revised and is now available in downloadable format. This fact sheet is designed to provide education on the Ambulance Fee Schedule. It includes the following information: background, ambulance providers and suppliers, payments, and how payment rates are set.

 

From the MLN: “Clinical Laboratory Fee Schedule” Fact Sheet — Revised

 The “Clinical Laboratory Fee Schedule” Fact Sheet (ICN 006818) was revised and is now available in downloadable format. This fact sheet is designed to provide education on the Clinical Laboratory Fee Schedule. It includes the following information: background, coverage of clinical laboratory services, and how payment rates are set.

 

New MLN Educational Web Guides Fast Fact

 A new fast fact is now available on the MLN Educational Web Guides web page. This web page provides information on Evaluation and Management services; Guided Pathways that contain resources and topics of interest; lists of health care management products; and easy-to-understand billing and coding educational products. It is designed to provide educational and informational resources related to certain Medicare FFS initiatives. Please bookmark this page and check back often as a new fast fact is added each month.

 

Updated MLN Matters® Search Indices

The MLN Matters® Articles Search indices were updated and are now available. Each index is organized by year and provides the ability to search by specific keywords and topics. Most indices link directly to the related article(s).  For more information and a list of available indices, visit the MLN Matters® Articles website and scroll down to the “Downloads” section. 

The Medicare Learning Network® offers other ways to search and quickly find articles of interest to you:

  • MLN Matters® Dynamic Lists: an archive of previous and current articles organized by year with the ability to search by keyword, transmittal number, subject, article number, and release date. To view and search articles, select the desired year from the left column on the MLN Matters® Articles website.
  • MLN Matters® Electronic Mailing List: a free electronic notification service that sends an email message when new and revised MLN Matters® articles are released.  For more information, including how to subscribe to the service, download How to Sign Up for MLN Matters®.  You can also view and search an archive of previous messages.

 

Subscribe to the MLN Educational Products and MLN Matters® Electronic Mailing Lists

The Medicare Learning Network® (MLN) is the home for education, information, and resources for health care professionals. Sign up for both of the electronic mailing lists to stay informed about the latest MLN Educational Products and MLN Matters® Articles. You will receive an e-mail when new and revised products and articles are released.

  • MLN Educational Products Electronic Mailing List – MLN Products are designed to provide education on a variety of CMS programs, including provider supplier enrollment, preventive services, provider compliance, and Medicare payment policies. All products are free of charge and offered in a variety of formats to meet your educational needs.
  • MLN Matters® Articles Electronic Mailing List – MLN Matters® are national articles that educate health care professionals about important changes to CMS programs. Articles explain complex policy information in plain language to help health care professionals reduce the time it takes to incorporate these changes into their CMS-related activities. 

 

Submit Feedback on MLN Educational Products

 The Medicare Learning Network® (MLN) is interested in what you have to say. Visit the MLN Opinion web page to submit an anonymous evaluation about specific MLN educational products. Your feedback is important and helps us develop quality MLN products that meet your educational needs.


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    Please share this important information with your colleagues and encourage them to subscribe to the
 e-News.
  

Previous issues are available in the archive.

Robin Fritter, Director
Division of Provider Relations & Outreach
Provider Communications Group
Centers for Medicare & Medicaid Services
Center for Medicare
[email protected]
 / 410-786-7485  

ICD-10 News: Documentation and ICD-10
06/20/2013

 
News Updates | June 20, 2013
 

How Will ICD-10 Affect Clinical Documentation?

As practices prepare for the October 1, 2014, transition to ICD-10, there’s been a good deal of discussion about the many new codes ICD-10 offers and how clinical documentation will be affected.  Just as with ICD-9, complete documentation is essential for patient care and accurate selection of ICD-10 codes. 

ICD-10 Captures Familiar Clinical Concepts
Concepts that are new to ICD-10 are not new to clinicians, who are already documenting a patient’s chart with more clinical information than an ICD-9 code can capture about:

  • Initial Encounter, Subsequent Encounter, or Sequelae
  • Acute or Chronic
  • Right or Left
  • Normal Healing, Delayed Healing,  Nonunion, or Malunion

Many ICD-10 codes—more than one-third—are identical except for indicating laterality, or whether the right or left side of the body is affected. The advantage of ICD-10 codes is that they enable clinicians to capture laterality and other concepts in a standardized way that supports data exchange and interoperability for a more efficient health care system.

Verifying Your Documentation Is ICD-10-Ready
While ICD-10 should not require providers to change documentation practices, reviewing documentation will help you understand how ICD-10 will affect your practice. Understanding the scope of the ICD-10 transition will reduce the likelihood that you will overlook areas that need updates for ICD-10. Testing ICD-10, from documentation all the way through communication with billing services, is vital to making sure you have worked out any snags in the process before the October 1, 2014, transition date.

Take a look at documentation for the most often-used ICD-9 codes in your practice and work with coding staff to select the appropriate corresponding ICD-10 codes. Identifying these codes will help reinforce the information to highlight when documenting patient diagnoses for ICD-10.

Keep Up to Date on ICD-10
Visit the CMS ICD-10 website for the latest news and resources to help you prepare for the October 1, 2014, deadline.

 

 
       
 
 
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Less than 2 Weeks until EHR Hospital Deadline
06/20/2013

 
  News Updates | June 20, 2013
 
  July 3rd is an Important EHR Deadline for Medicare Eligible Hospitals and CAHs

July 3, 2013 is last day that eligible hospitals and critical access hospitals (CAHs) in their first year of participation of the Medicare EHR Incentive Program can begin their 90-day reporting period to demonstrate meaningful use for Fiscal Year (FY) 2013. Hospitals in their second and third years of participation must demonstrate meaningful use for the full FY. 

Looking Ahead
Three other important dates for eligible hospitals and CAHs include:

  • September 30, 2013—Last day of the FY 2013, and the end of the reporting year.
  • October 1, 2013—First day of FY 2014, and the start of Stage 2 for hospitals in their third or fourth years of participation.
  • November 30, 2013—Last day to register and attest to receive an incentive payment for FY 2013.

See other 2013 important dates in the 2012-2014 Health Information Technology timeline.

Want more information about the EHR Incentive Programs?
Make sure to visit the CMS EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

 

 
 
         
 
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Less than 2 Weeks until June 30 eRx Deadline
06/20/2013

 

Learn about the June 30 eRx Deadline and Available CMS Resources

A major Electronic Prescribing (eRx) Incentive Program deadline is approaching for both individual eligible professionals (EPs) and group practices participating in the Group Practice Reporting Option (GPRO).  If you are an EP or an eRx GPRO participant, you must successfully report as an electronic prescriber before June 30, 2013 or you will experience a payment adjustment in 2014 for professional services covered under Medicare Part B’s Physician Fee Schedule (PFS.)

The 2013 eRx Incentive Program 6-month reporting period (January 1, 2013 to June 30, 2013) is the final reporting period available to you if you wish to avoid the 2014 eRx payment adjustment.

If you do not successfully report, a payment adjustment of 2.0% will be applied, and you will receive only 98.0% of your Medicare Part B PFS amount for covered professional services in 2014.

Avoiding the 2014 eRx Payment Adjustment
Individual EPs and eRx GPRO participants who were not successful electronic prescribers in 2012 can avoid 2014 eRx payment adjustment by meeting specified reporting requirements between January 1, 2013 and June 30, 2013. Below are the 6-month reporting requirements:

  • Individual EPs – 10 eRx events via claims
  • eRx GPRO of 2-24 EPs – 75 eRx events via claims
  • eRx GPRO of 25-99 EPs – 625 eRx events via claims
  • eRx GPRO of 100+ EPs – 2,500 eRx events via claims

Exclusions and Hardships Exemptions
Exclusions from the 2014 eRx payment adjustment only apply to certain individual EPs and group practices, and CMS will automatically exclude those individual EPs and group practices who meet the criteria. CMS may exempt individual eligible professionals and group practices participating in eRx GPRO from the 2014 eRx payment adjustment if it is determined that compliance with the requirements for becoming a successful electronic prescriber would result in a significant hardship. Requests for hardship exemptions must be submitted through the Communication Support Page by 11:59pm ET on June 30, 2013. More information on exclusion criteria and hardship exemption categories can be found on the Electronic Prescribing (eRx) Incentive Program: 2014 Payment Adjustment Fact Sheet.

Resources from CMS
Additional resources on the 2014 payment adjustment are available on the eRx Incentive Program Payment Adjustment Information webpage, including the resource Electronic Prescribing (eRx) Incentive Program: Updates for 2013.

Questions about eRx?
If you have questions regarding the eRx Incentive Program, eRx payment adjustments, or need assistance submitting a hardship exemption request, please contact the QualityNet Help Desk at 866-288-8912 (TTY 1-877-715-6222) or via [email protected]. The Help Desk is available Monday through Friday from 7am-7pm CT.

To learn more about the eRx Incentive Program and program alignment under the CMS eHealth initiative, please visit www.CMS.gov/eHealth.

 

 
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