The Centers for Medicare and Medicaid Services (CMS) is reporting these events, updates and deadlines for providers and hospitals on payment issues concerning Medicare and Medicaid. Read the latest MLN Connects Weekly Provider eNews.
Provider Compliance
CMS Proposes Quality Payment Program Updates to Increase Flexibility and Reduce Burdens
On June 20, CMS issued a proposed rule that would make changes in the second year of the Quality Payment Program as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). CMS’s goal is to simplify the program, especially for small, independent, and rural practices, while ensuring fiscal sustainability and high-quality care within Medicare. Proposed rule aims to simplify reporting requirements and offer support for doctors and clinicians in 2018
Evaluation and Management: Correct Coding
In a study report, the Office of the Inspector General (OIG) noted that 42 percent of claims for Evaluation and Management (E/M) services in 2010 were incorrectly coded, which included both upcoding and downcoding (i.e., billing at levels higher and lower than warranted, respectively), and 19 percent were lacking documentation. A number of physicians increased their billing of higher level, more complex and expensive E/M codes. Many providers submitted claims coded at a higher or lower level than the medical record documentation supports. Use the following resources to bill correctly for E/M services:
- OIG Report: Improper Payments For Evaluation and Management Services
- Claims Processing Manual: Chapter 12, Section 30.6
- E/M Services Guide
- 1995 Documentation Guidelines for E/M Services
- 1997 Documentation Guidelines for E/M Services
- Frequently Asked Question on Use of 1995 and 1997 Guidelines
- Provider Compliance Tips for Evaluation and Management (E/M) Services
- Evaluation and Management Services Web-Based Training course available through the MLN LMS
Coming in April 2018: New Medicare Card – New Number
Medicare is taking steps to remove Social Security numbers from Medicare cards. In April 2018, people with Medicare will begin receiving new Medicare cards, replacing all cards by April 2019. These cards will have a Medicare Beneficiary Identifier (MBI) number that is randomly generated with “non-intelligent” characters that do not have any hidden or special meaning.
Upcoming Events
Quality Payment Program Year 2 Proposed Rule Listening Session
When: Wednesday July 5 from 2 to 3:30 pm ET
Register for Medicare Learning Network events.
Creating and Verifying Your National Provider Identifier Call
When: Wednesday, July 12 from 2 to 3:30 pm ET
Register for Medicare Learning Network events.