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News & Announcements
News & Announcements
Medicare Diabetes Prevention Program: Supplier Enrollment OpenMedicare Diabetes Prevention Program (MDPP) supplier enrollment opened January 1:
Targeted Probe and Educate: New ResourcesFind out how the Targeted Probe and Educate (TPE) program helps providers and suppliers reduce claim denials and appeals through one-on-one education. The updated TPE webpage has new resources, including:
MIPS Clinicians: 2017 Extreme and Uncontrollable Circumstances PolicyCMS updated the Extreme and Uncontrollable Circumstances policy for the 2017 Merit-based Incentive Payment System (MIPS) transition year to include counties affected by Hurricane Nate and additional counties affected by the California wildfires. MIPS eligible clinicians in Federal Emergency Management Agency designated areas affected by Northern California wildfires and Hurricanes Harvey, Irma, Maria and Nate will be automatically identified. No action is required.
For More Information:
Quality Payment Program: Patient-facing Encounters ResourcesCMS posted these resources on the 2018 Resources webpage:
Eligible Hospitals and CAHs: Get Help with Attestation on QNetMedicare attestation for the Electronic Health Record (EHR) Incentive Program for eligible hospitals and Critical Access Hospitals (CAHs) transitioned to a new platform. Submit your CY 2017 attestations through the QualityNet Secure Portal (QNet).
Find Medicare FFS Payment RegulationsEach year, CMS issues proposed and final regulations with Medicare Fee-For-Service (FFS) payment and policy changes for each provider type. Find current and past regulations on the Medicare FFS Payment Regulations webpage.
February is American Heart MonthHeart disease can often be prevented by identifying risk factors and making healthy lifestyle choices. Help your Medicare patients reduce their risk. Recommend appropriate preventive services, including cardiovascular disease screening tests and intensive behavioral therapy for cardiovascular disease.
For More Information:
Cochlear Devices Replaced Without Cost: Bill Correctly — ReminderIn November 2016, the Office of the Inspector General (OIG) reported that hospitals did not always comply with Medicare requirements for reporting cochlear devices replaced without cost to the hospital or beneficiary. In 116 of 149 claims reviewed, hospitals did not report the appropriate modifiers and charges or a combination of the appropriate value code and condition codes. Medicare Administrative Contractors use this information to adjust payment; incorrect billing led to Medicare overpayments of $2.7 million.
eCQM Reporting for Hospital IQR-EHR Incentive Program Webinar — February 6Tuesday, February 6 from 2 to 3 pm ET
Register for CY 2017 electronic Clinical Quality Measure (eCQM) Reporting Tips and Tools for the Hospital Inpatient Quality Reporting (IQR) and Medicare Electronic Health Record (EHR) Incentive Programs.
This presentation provides an overview of helpful tips and available tools for successful electronic submission of clinical quality measure data, including Quality Reporting Document Architecture Category I file submissions, tips to troubleshoot error messages, and resources.
Low Volume Appeals Settlement Option Call — February 13Tuesday, February 13 from 1:30 to 3 pm ET
Register for Medicare Learning Network events.
As part of the broader HHS commitment to improving the Medicare appeals process, CMS is making available the Low Volume Appeals (LVA) settlement option on February 5, 2018. LVA is for providers and suppliers (appellants) with fewer than 500 appeals pending at the Office of Medicare Hearings and Appeals (OMHA) and the Medicare Appeals Council (the Council) at the Departmental Appeals Board.
During this call, learn more about LVA, the current status, and how the settlement process works. CMS speakers discuss how to identify whether you are eligible and which of your pending appeals may be settled. Visit the Low Volume Appeals Initiative webpage for more information.
A question and answer session follows the presentation; however attendees may email questions in advance to MedicareSettlementFAQs@cms.hhs.gov with “Low Volume Appeals Settlement February 13 Call” in the subject line. These questions may be addressed during the call or used for other materials following the call.
Target Audience: Medicare fee-for-service providers, physicians, and other suppliers with fewer than 500 appeals pending at OMHA and the Council.
Medicare Learning Network Publications & Multimedia
Next Generation Accountable Care Organization - Implementation MLN Matters® Article — RevisedA revised MLN Matters Special Edition Article on Next Generation Accountable Care Organization - Implementation
is available. Learn about the model’s waiver initiatives and supplemental claims processing direction.
DMEPOS Quality Standards Educational Tool — RevisedA revised DMEPOS Quality Standards Educational Tool is available. Learn about:
Home Oxygen Therapy Booklet — RevisedA revised Home Oxygen Therapy Booklet is available. Learn about:
Looking for Educational Materials?Visit the Medicare Learning Network and see how we can support your educational needs. Learn about publications; calls and webcasts; continuing education credits; Web-Based Training; newsletters; and other resources.
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I started in home healthcare in 2006 as an RN case manager. Some years passed and I began to get promoted to positions that requires more knowledge and responsibility. I found myself working as a review nurse looking over clinical charts recommending oasis and plan of care suggestions after an internal coder had coded the charts. It was a slow process as there was just the two of us. Our agency began to develop some financial concerns as growth began. Days to RAP (DTR) began to grow; days in AR along with it. Yearly audits were revealing that we were missing case mix and non-routine supplies (NRS) points on select oasis items which began to affect episode payments. Public outcome and process measures were struggling to keep up with industry averages and we would often have to face questions from our board members what the problems were but nobody appeared to have the answers. If the coder or reviewer were absent from work the flow would become stagnant. We finally had to make some changes. First it was decided that we had to educate ourselves to the process. Reviewers and Coders were sent to formal training classes to understand the coding and quality review process. This definitely broadened my knowledge as I realized an oasis assessment was just not something to get done in a hurry. We began to understand the depth these questions were related to quality and payment and the importance of maintaining a consistent flow of work. As the agency grew we began to realize the project was too big for just a few people to perform. We did some research on outsourcing, found a contractor that worked best for us and the agency never looked back. We ended turning a fiscal year loss to a six figure gain in a years time. Believe me it works!