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CMS Medicare FFS Provider e-News CMS Information for the Medicare Fee-For-Service Provider Community
February 22, 2013
Happy Friday! We have a couple of very important EHR deadlines and related announcements not to be missed...
• Medicare EP Attestation Reminder and Other Updates • February 28th Deadline: Get Paid for 2012: Medicare EPs Must Attest by February 28 for the EHR
Incentive Program • Centers for Medicare & Medicaid Services EHR Incentive Program - Stage 2 Tri-Regional Webinar
Invitation Also, you don’t want to miss the upcoming Healthcare Fraud Prevention and Awareness Symposium in Dallas for great information and continuing education credits. (See Region VI News below.) New DMEPOS CB Webinar Details Now Available… Don’t Forget to register! The Centers for Medicare & Medicaid Services will be hosting two more webinars for partners and providers on The Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. See below for further details.
• February 25, 2013 at 10:00 am CST Registration Link (URL): http://dmeposcbfeb25.eventbrite.com
• February 27, 2013 at 1:00 pm CST Registration Link (URL): http://dmeposcbfeb27.eventbrite.com Now for the news…
News for the Week of Friday, February 22, 2013
National Provider Calls
• End-Stage Renal Disease Quality Incentive Program - Payment Year 2015 Final Rule — Register Now
• Hospital Value-Based Purchasing Fiscal Year 2015 Overview — Register Now • Audio Recording and Written Transcript from January 16 Meaningful Use: Stage 1 and Stage 2
Call Now Available • Audio Recording and Written Transcript from January 31 CMS National Partnership to Improve
Dementia Care in Nursing Homes Call Now Available
Other Calls, Meetings, and Events
• Join the ICD-9-CM Coordination and Maintenance Committee Meeting for an ICD-10 Update
Announcements and Reminders
• Flu Season Isn’t Over—Continue to Recommend Vaccination • ICD-10 MS-DRG FY 2013 Software Now Available • Important Medicare Deadline Approaching Next Week… EHR Incentive Programs: Medicare EP
Attestation Reminder and Other Updates • Now Available: New and Updated FAQs about the EHR Incentive Programs • Health care law protects consumers against worst insurance practices • HHS providing states with additional flexibility, resources to enhance care • Health care law allows consumers to easily find and compare options starting in 2014
Claims, Pricer, and Code Updates
• New HCPCS G-code for Pharmacologic Management Service Furnished via Telehealth to Inpatients
MLN Educational Products Update
• New MLN Provider Compliance Fast Fact • New & Revised MLN Articles
CMS REGION VI NEWS
• FRAUD…Protect Your Practice & Your Patients Healthcare Fraud Prevention and Awareness Symposium in Dallas REGISTRATION REQIRED: http://www.eventbrite.com/event/5565496550
• Weekly S&C Letter Updates - S&C: None This Week!
• Centers for Medicare & Medicaid Services EHR Incentive Program - Stage 2 Tri-Regional Webinar Invitation
• The Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program Webinar Schedule
Medicare EP Attestation Reminder and Other Updates
CMS has several updates related to the Electronic Health Record (EHR) Incentive Programs.
February 28 Deadline Eligible professionals (EPs) who participated in the Medicare Electronic Health Record (EHR) Incentive Program in 2012 must complete attestation for the 2012 program year by February 28, 2013. CMS has several resources located on the Educational Resource page of the EHR Incentive Programs website to help you properly meet meaningful use and attest. Register and attest today. Medicaid EPs should check with their State for their attestation deadline.
Electronic Reporting Pilot Deadline If you selected the electronic reporting pilot option for your submission of clinical quality measures (CQMs) for the EHR Incentive Program (for the 2012 reporting year), you must submit 12 months of CQM data using a PQRS-qualified EHR system or data submission vendor. Failure to submit your CQMs electronically by 11:59 p.m. ET on February 28, 2013 will result in your attestation being rejected for the 2012 program year. If you are unable to continue or determine that you no longer wish to participate in the electronic reporting pilot, you may opt out by:
• Returning to your EHR Incentive Program registration • Changing your selection to "No" on the "e-Reporting" screen for CQMs • Entering your CQM data into the portal as part of your meaningful use attestation
System Outages There are two upcoming system outages scheduled:
1. Social Security Administration Outage – Saturday, February 16, 2013, 11:00 p.m. ET through Monday, February 18, 2013, 5:00 a.m. ET (PECOS and NPPES Applications will be unavailable)
2. CMS Systems Outage – Friday, February 22, 2013, 11:59 p.m. ET through Sunday, February 24, 2013, 11:59 p.m. ET (Providers will be unable to complete e-Reporting of electronic CQM data through the PQRS system)
Please plan attestation around these outages.
CMS anticipates a high volume of users on both the PQRS and EHR Incentive Program systems as the February 28 deadline for data submission approaches. Please keep this in mind when planning for your CQM data submission and completion of your 2012 attestation.
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.
Don’t Forget! Get Paid for 2012: Medicare EPs Must Attest by February 28 for the EHR Incentive Program [↑] Eligible professionals (EPs) who participated in the Medicare Electronic Health Record (EHR) Incentive Program in 2012 must complete attestation for the 2012 program year by February 28, 2013. In order to be eligible to attest you must have completed your 2012 reporting period by December 31, 2012. CMS encourages Medicare EPs to register and attest as soon as possible to resolve any potential issues that may delay their payment. Medicaid EPs should check with their State for their attestation deadline. Resources from CMS CMS has several resources located on the EHR Incentive Programs website to help EPs properly meet meaningful use and attest, including:
• A Registration & Attestation web page that includes information on registration and attestation, and links to additional resources.
• The Meaningful Use Attestation Calculator, which allows EPs and eligible hospitals to determine if they have met the Stage 1 meaningful use guidelines before they attest in the system.
• The Attestation User Guide for Medicare Eligible Professionals, providing step-by-step guidance for EPs participating in the Medicare EHR Incentive Program on navigating the attestation system.
• The Attestation Worksheet for Eligible Professionals, allowing users to enter their meaningful use measure values, creating a quick reference tool to use while attesting.
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.
Centers for Medicare & Medicaid Services EHR Incentive Program - Stage 2 Webinar
Wednesday, March 20th, 12:30 CDT/11:30 MDT
Register now by clicking: http://www.eventbrite.com/event/5083520948
CMS Regions VI, VII and VIII are pleased to announce a new EHR webinar focused on the EHR Incentive Payment Program – Stage 2.
For Eligible Professionals (EPs) and Eligible Hospitals (EHs) who have met meaningful use for a 90 day period plus at least one, one-year period, Stage 2 requirements will be effective in 2014.
The webinar will include:
• The Office of the National Coordinator (ONC) with information on new EHR certification requirements,
• CMS on Stage 2 – what’s new, what’s changed, and • An opportunity for you to ask CMS experts your Stage 2 questions.
National Provider Call: End-Stage Renal Disease Quality Incentive Program - Payment Year 2015 Final Rule — Register Now [Top of page]
Wednesday, March 13; 2-3:30pm ET
This National Provider Call will review the CMS final rule for implementing the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) in Payment Year (PY) 2015. This final rule was published in the Federal Register on November 9, 2012.
The performance period for PY 2015 began on January 1, 2013. To help dialysis facilities and other stakeholders understand the program and their responsibilities during the performance period, this call will review:
• The ESRD QIP legislative framework and how it fits into the National Quality Strategy; • Changes reflected in the final rule based on public comments; • The measures, standards, scoring methodology, and payment reduction scale that will be
applied to the PY 2015 program; and • Where to find additional information about the program.
Agenda:
• Introductions • Review of ESRD QIP and National Quality Strategy • Changes in PY 2015 Final Rule
o Measures o Standards o Scoring methodology o Payment reduction scale
• Sources for more information
Target Audience: Dialysis clinics and organizations, nephrologists, hospitals with dialysis units, billers/coders, and quality improvement experts.
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 prior to the call 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 Notification web page to learn more.
National Provider Call: Hospital Value-Based Purchasing Fiscal Year 2015 Overview — Register Now [Top of page]
Thursday, March 14; 1:30-3pm ET
This National Provider Call provides an overview of the FY 2015 Hospital Value-Based Purchasing (VBP) Program design and a preview of the FY 2015 Baseline Measures Report in order to help demonstrate how hospitals will be evaluated for each of the FY 2015 domains (measures/dimensions).
Agenda:
• Introduction to the Hospital VBP Program • FY 2015 Hospital VBP Program • How Hospitals Will Be Evaluated • Evaluation Example • FY 2015 Baseline Measures Report
Target Audience: Quality Improvement Organizations (QIOs) and Inpatient Hospital 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 prior to the call 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 Notification web page to learn more.
National Provider Call: Audio Recording and Written Transcript from January 16 Meaningful Use: Stage 1 and Stage 2 Call Now Available [Top of page]
The audio recording and written transcript from the January 16 Meaningful Use: Stage 1 and Stage 2 call are now available on the January 16 call web page in the “Call Materials” section.
National Provider Call: Audio Recording and Written Transcript from January 31 CMS National Partnership to Improve Dementia Care in Nursing Homes Call Now Available [Top of page]
The audio recording and written transcript from the January 31 CMS National Partnership to Improve Dementia Care in Nursing Homes call are now available on the January 31 call web page in the “Call Materials” section.
Join the ICD-9-CM Coordination and Maintenance Committee Meeting for an ICD-10 Update [Top of page]
Tuesday, March 5; 9am–5pm ET
Please join us on March 5 for the ICD-9-CM Coordination and Maintenance Committee Meeting. Pat Brooks, Senior Technical Advisor with the CMS Hospital and Ambulatory Policy Group will provide an update on ICD-10. The schedule for the March 5 meeting is as follows:
• 9am-12:30pm: ICD-10-PCS and ICD-9-CM procedure presentations with public comment • 12:30pm-1:30pm: Lunch break • 1:30pm-5pm: Diagnosis presentation with public comment
Webcast and Dial-In Information
• The meeting will begin promptly at 9am ET and will be webcast. • Toll-free dial-in access is available for participants who cannot join the webcast: Phone: 1-877-
267-1577; Meeting ID: 6601. We encourage you to join early, as the number of phone lines is limited.
New Name and Focus for ICD Coding Committee
The ICD-9-CM Coordination and Maintenance Committee will be re-named the ICD-10 Coordination and Maintenance Committee effective with the March 2014 Committee meeting. This committee is responsible for the development and maintenance of both ICD-9-CM and ICD-10 codes. In 2014, the committee will focus solely on the maintenance of ICD-10-CM and ICD-10-PCS codes.
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. For practical transition tips:
• Read recent ICD-10 email update messages
• Access the ICD-10 continuing medical education modules developed by CMS in partnership with Medscape
Flu Season Isn’t Over—Continue to Recommend Vaccination [Top of page]
While each flu season is different, flu activity typically peaks in February. Yet, even in February, the flu vaccine is still the best defense against the flu. The Centers for Disease Control and Prevention recommends yearly flu vaccination for everyone 6 months of age and older; and although anyone can get the flu, adults 65 years and older are at greater risk for serious flu-related complications that can lead to hospitalization and death. Each year in the United States, about 9 out of 10 flu-related deaths and more than 6 out of 10 flu-related hospital stays occur in people 65 years and older. Every office visit is an opportunity to check your patients’ vaccination status and encourage flu vaccination when appropriate.
Getting vaccinated is just as important for health care personnel, like you, for many reasons. You can get sick with the flu and spread it to your family, colleagues and patients without knowing or having symptoms. Be an example by getting your flu vaccine and know that you’re helping to reduce the spread of flu in your community.
Note: – influenza vaccines and their administration fees are covered Part B benefits. Influenza vaccines are NOT Part D-covered drugs.
For More Information:
• 2012-2013 Seasonal Influenza Vaccines Pricing list • MLN Matters® Article #MM8047, “Influenza Vaccine Payment Allowances - Annual Update for
2012-2013 Season” • Visit the CMS Medicare Learning Network® 2012-2013 Seasonal Influenza Virus Educational
Products and Resources and CMS Immunizations web pages for information on coverage and billing of the flu vaccines and their administration fees
• HealthMap Vaccine Finder is a free, online service where users can find nearby locations offering flu vaccines as well as other vaccines for adults
• CDC website offers a variety of provider resources for the 2012-2013 flu season
ICD-10 MS-DRG FY 2013 Software Now Available [Top of page]
ICD-10 Medicare Severity Diagnosis Related Grouper (MS-DRG), version 30.0 (FY 2013) mainframe and PC software is now available. This software is being provided to offer the public a better opportunity to review and comment on the ICD-10 MS-DRG conversion of the MS-DRGs.
This software can be ordered through the National Technical Information Service (NTIS) website. A link to NTIS is also available in the Related Links section of the ICD-10 MS-DRG Conversion Project website. The final version of the ICD-10 MS-DRGs will be subject to formal rulemaking and will be implemented on October 1, 2014.
EHR Incentive Programs: Medicare EP Attestation Reminder and Other Updates [Top of page]
CMS has several updates related to the Electronic Health Record (EHR) Incentive Programs.
February 28 Deadline
Eligible professionals (EPs) who participated in the Medicare Electronic Health Record (EHR) Incentive Program in 2012 must complete attestation for the 2012 program year by February 28, 2013. CMS has several resources located on the Educational Resources web page of the EHR Incentive Programs website to help you properly meet meaningful use and attest. Register and attest today.
Medicaid EPs should check with their State for their attestation deadline.
Electronic Reporting Pilot Deadline If you selected the electronic reporting pilot option for your submission of clinical quality measures (CQMs) for the EHR Incentive Program (for the 2012 reporting year), you must submit 12 months of CQM data using a PQRS-qualified EHR system or data submission vendor. Failure to submit your CQMs electronically by 11:59pm ET on February 28 will result in your attestation being rejected for the 2012 program year. If you are unable to continue or determine that you no longer wish to participate in the electronic reporting pilot, you may opt out by:
• Returning to your EHR Incentive Program registration
• Changing your selection to “No” on the “e-Reporting” screen for CQMs
• Entering your CQM data into the portal as part of your meaningful use attestation
System Outages There is an upcoming system outages scheduled. Please plan attestation around this outage.
• CMS Systems Outage – Friday, February 22, 11:59pm ET through Sunday, February 24, 11:59pm ET. Providers will be unable to complete e-Reporting of electronic CQM data through the PQRS system
CMS anticipates a high volume of users on both the PQRS and EHR Incentive Program systems as the February 28 deadline for data submission approaches. Please keep this in mind when
planning for your CQM data submission and completion of your 2012 attestation.
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.
Now Available: New and Updated FAQs about the EHR Incentive Programs [Top of page]
CMS has recently added one new and two updated FAQs related to the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. We encourage you to take a minute to review these changes below.
New FAQ:
1. What funding sources may States use to fund the 10 percent non-federal share of HITECH administrative expenditures? Read the answer here.
Updated FAQs:
1. What are the specific medical specialty codes associated with anesthesiology, radiology, and pathology for the specialty-based determination for the granting of a hardship exception... Read the answer here.
2. For the Medicare EHR Incentive Program, how are incentive payments determined for eligible professionals practicing in a Health Professional Shortage Area (HPSA)? Read the answer here.
To search and access more FAQs related to the EHR Incentive Programs, please use the CMS FAQ System.
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.
Health care law protects consumers against worst insurance practices
Key health insurance protections for all Americans moves forward The U.S. Department of Health and Human Services (HHS) today issued a final rule that implements five key consumer protections from the Affordable Care Act, and makes the health insurance market work better for individuals, families, and small businesses. “Because of the Affordable Care Act, being denied affordable health coverage due to medical conditions will be a thing of the past for every American,” said HHS Secretary Kathleen Sebelius. “Being sick will no longer keep you, your family, or your employees from being able to get
affordable health coverage.” Under these reforms, all individuals and employers have the right to purchase health insurance coverage regardless of health status. In addition, insurers are prevented from charging discriminatory rates to individuals and small employers based on factors such as health status or gender, and young adults have additional affordable coverage options under catastrophic plans. Today’s final rule implements five key provisions of the Affordable Care Act that are applicable to non-grandfathered health plans:
• Guaranteed Availability
Nearly all health insurance companies offering coverage to individuals and
employers will be required to sell health insurance policies to all consumers. No
one can be denied health insurance because they have or had an illness.
• Fair Health Insurance Premiums
Health insurance companies offering coverage to individuals and small employers
will only be allowed to vary premiums based on age, tobacco use, family size, and
geography. Basing premiums on other factors will be illegal. The factors that are
no longer permitted in 2014 include health status, past insurance claims, gender,
occupation, how long an individual has held a policy, or size of the small employer.
• Guaranteed Renewability
Health insurance companies will no longer refuse to renew coverage because an
individual or an employee has become sick. You may renew your coverage at your
option.
• Single Risk Pool
Health insurance companies will no longer be able to charge higher premiums to
higher cost enrollees by moving them into separate risk pools. Insurers are
required to maintain a single state-wide risk pool for the individual market and
single state-wide risk pool for the small group market.
• Catastrophic Plans
Young adults and people for whom coverage would otherwise be unaffordable will
have access to a catastrophic plan in the individual market. Catastrophic plans
generally will have lower premiums, protect against high out-of-pocket costs, and
cover recommended preventive services without cost sharing.
In preparation for the market changes in 2014 and to streamline data collection for insurers and states, the final rule amends certain provisions of the rate review program. And, HHS has
increased the transparency by directing insurance companies in every state to report on all rate increase requests. A new report has found that the law’s transparency provisions have already resulted in a decline in double-digit premium increases filed: from 75 percent in 2010 to, according to preliminary data, 14 percent in 2013. In addition, today the U.S. Department of Labor announced an interim final rule in the Federal Register that provides protection to employees against retaliation by an employer for reporting alleged violations of Title I of the Act or for receiving a tax credit or cost-sharing reduction as a result of participating in a Health Insurance Exchange, or Marketplace. Additional information is available at www.dol.gov/opa/media/press/osha/osha20130327.htm or www.osha.gov. For more information on how this final rule helps create a better health insurance market for consumers, please visit: http://cciio.cms.gov/resources/factsheets/marketreforms-2-22-2013.html For information on the rights and protections guaranteed by the health care law, please visit: http://www.healthcare.gov/law/features/rights/ For the full text of the proposed rule, please visit: http://www.ofr.gov/inspection.aspx
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HHS providing states with additional flexibility, resources to enhance care
HHS announces 25 states will receive funding to test new models of care that will improve health, lower costs
Health and Human Services (HHS) Secretary Kathleen Sebelius Thursday announced the first recipients of State Innovation Model awards made possible by the Affordable Care Act. Nearly $300 million in awards will provide flexibility and support to states to help them deliver high-quality health care, lower costs, and improve their health system performance. HHS is also releasing a new report titled Medicaid Moving Forward, which underscores the innovative efforts states and HHS have already undertaken to improve care and lower costs in their Medicaid programs. “As a former governor, I understand the real sense of urgency that states feel to improve the health of their populations while also reducing total health care costs, and it’s critical that the many elements of health care in each state -- including Medicaid, public health, and workforce training -- work together,” Secretary Sebelius said. “We are encouraged by the progress states have made and look forward to continuing to work with them as they move forward.” Model Testing awards will support Arkansas, Maine, Massachusetts, Minnesota, Oregon, and Vermont in implementing their plans for health care delivery system transformation. The six selected states will use funds to test multi-payer payment and service delivery models,
including approaches already under way at CMS, such as Accountable Care Organizations, on a broader scale within their state. Through the State Innovation Model Testing awards, CMS will learn whether these new models produce greater results when implemented broadly and combined with additional state-wide reforms. An additional 19 states will receive awards to further develop proposals for comprehensive health care transformation. “States have taken important steps in partnership with HHS, private payers, Medicaid, CHIP and their public health departments,” said CMS Acting Administrator Marilyn Tavenner. “The State Innovation Model awards are designed to bring additional flexibility to states on their path to improving their health care systems.” The Medicaid Moving Forward report highlights recent initiatives underway to support state efforts to achieve the goals of improving care and lowering costs in Medicaid and the Children’s Health Insurance Program (CHIP). It outlines specific examples of how states are using these tools to advance their own state initiatives. This report identifies current opportunities states can take advantage of now. For more information on the Medicaid Moving Forward report released later today, please go to: http://www.medicaid.gov/State-Resource-Center/Events-and-Announcements/Events-and-Announcements.html. For more information on the awards announced today, please go to: http://innovation.cms.gov/initiatives/State-Innovations/. To learn more about other innovative models being tested by the CMS Innovation Center, please visit: innovation.cms.gov.
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Health care law allows consumers to easily find and compare options starting in 2014
New rule will expand mental health and substance use disorder benefits to 62 million Americans
Department of Health and Human Services (HHS) Secretary Kathleen Sebelius Wednesday announced a final rule that will make purchasing health coverage easier for consumers. The policies outlined today will give consumers a consistent way to compare and enroll in health coverage in the individual and small group markets, while giving states and insurers more flexibility and freedom to implement the Affordable Care Act.
“The Affordable Care Act helps people get the health insurance they need,” said Secretary Sebelius. “People all across the country will soon find it easier to compare and enroll in health plans with better coverage, greater quality and new benefits.” Today’s rule outlines health insurance issuer standards for a core package of benefits, called essential health benefits, that health insurance issuers must cover both inside and outside the Health Insurance Marketplace. Through its standards for essential health benefits, the final rule released today also expands coverage of mental health and substance use disorder services, including behavioral health treatment, for millions of Americans. A new report by HHS, also released today, details how these provisions will expand mental health and substance use disorder benefits and federal parity protections for 62 million more Americans. In the past, nearly 20 percent of individuals purchasing insurance didn’t have access to mental health services, and nearly one third had no coverage for substance use disorder services. The rule seeks to fix that gap in coverage by expanding coverage of these benefits in three distinct ways:
(1) By including mental health and substance use disorder benefits as Essential Health Benefits
(2) By applying federal parity protections to mental health and substance use disorder benefits in the individual and small group markets
(3) By providing more Americans with access to quality health care that includes coverage for mental health and substance use disorder services
To give states the flexibility to define essential health benefits in a way that would best meet the needs of their residents, this rule also finalizes a benchmark-based approach. This approach allows states to select a benchmark plan from options offered in the market, which are equal in scope to a typical employer plan. Twenty-six states selected a benchmark plan for their state, and the largest small business plan in each state will be the benchmark for the rest.
The rule additionally outlines actuarial value levels in the individual and small group markets, which helps to distinguish health plans offering different levels of coverage. Beginning in 2014, plans that cover essential health benefits must cover a certain percentage of costs, known as actuarial value or “metal levels.” These levels are 60 percent for a bronze plan, 70 percent for a silver plan, 80 percent for a gold plan, and 90 percent for a platinum plan. Metal levels will allow consumers to compare insurance plans with similar levels of coverage and cost-sharing based on premiums, provider networks, and other factors. In addition, the health care law limits the annual amount of cost sharing that individuals will pay across all health plans – preventing insured Americans from facing catastrophic costs associated with an illness or injury.
Policies in today’s rule also provide more information on accreditation standards for qualified health plans (QHPs) that will be offered through the Health Insurance Marketplaces (also known as Exchanges), one-stop shops that will provide access to quality, affordable private health insurance choices.
Together, these provisions will help consumers compare and select health plans in the individual and small group markets based on what is important to them and their families. People can make these choices knowing these health plans will cover a core set of critical benefits and can more easily compare the level of coverage based on a uniform standard. Further, these provisions help expand choices and competition on the Marketplaces.
For more information on today’s rule, visit: http://cciio.cms.gov/resources/factsheets/ehb-2-20-2013.html To view the rule, visit: http://www.ofr.gov/inspection.aspx For more information on how today’s rule helps those in need of mental health and substance use disorder services, visit: http://aspe.hhs.gov/health/reports/2013/mental/rb_mental.cfm
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New HCPCS G-code for Pharmacologic Management Service Furnished via Telehealth to Inpatients [Top of page]
For 2013, the Current Procedural Terminology (CPT) Editorial Panel adopted a new structure for CPT codes used to report a set of psychiatric and psychotherapy services. Among other changes, the CPT code that was used by practitioners to report pharmacologic management services was deleted. CPT instructs that practitioners should now report the appropriate Evaluation/Management (E/M) code when furnishing pharmacologic management services. Existing Medicare telehealth payment policies will continue to apply for these services for 2013, and practitioners should be able to report the appropriate E/M code, as CPT suggests. However, when furnishing services to hospital inpatients and Skilled Nursing Facility (SNF) patients, physicians should use the new G-code to ensure that the telehealth frequency restrictions that apply to hospital and SNF E/M services do not also apply to pharmacologic management services furnished to hospital inpatients and SNF patients. The new G-code is:
• G0459 — Inpatient telehealth, pharmacologic management, including prescription use and review of medication with no more than minimal medical psychotherapy
Medicare Learning Network New MLN Provider Compliance Fast Fact [Top of page]
A new fast fact is now available on the MLN Provider Compliance web page. This web page provides the latest MLN Education Products and MLN Matters® Articles designed to help Medicare FFS providers understand common billing errors and avoid improper payments. Please bookmark this page and check back often as a new fast fact is added each month.
(Top of Page) New & Revised MLN Matters Articles [↑] New: MM8199 – Change of Address for Percutaneous Transluminal Angioplasty (PTA) of the Carotid Artery Concurrent with Stenting Facility Approval and Recertification Letter Submission http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8199.pdf MM8056 – Payment Related to Prior Authorization for Power Mobility Devices (PMD) http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8056.pdf Revised: MM7900 – Expansion of Medicare Telehealth Services for Calendar Year (CY) 2013 http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM7900.pdf MM8191 – Summary of Policies in the Calendar Year (CY) 2013 Medicare Physician Fee Schedule (MPFS) Final Rule and the Telehealth Originating Site Facility Fee Payment Amount http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8191.pdf (Top of Page) CMS REGION VI NEWS Healthcare Fraud Prevention and Awareness Symposium in Dallas REGISTRATION REQIRED: http://www.eventbrite.com/event/5565496550 REGISTRATION REQIRED: http://www.eventbrite.com/event/5565496550 S&C Letters [↑] (N/A)
# # # DMEPOS CB
Melissa Scarborough, MPH, CHES External Affairs Specialist/Provider Liaison Centers for Medicare & Medicaid Services Region VI Office of External Affairs 1301 Young Street, Room 766 Dallas, Texas 75202 PH: 214-767-4407 FX: 214-767-6400 [email protected]
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