Appropriate Use Criteria (AUC) for Advanced Diagnostic Imaging – Educational and Operations Testing Period - Claims Processing Requirements
The Centers for Medicare & Medicaid Services (CMS) is hosting a webinar on Wednesday, February 12 at 2:30 p.m. ET to provide an overview of the MIPS Value Pathways (also referred to as MVPs) participation framework, which was outlined in the 2020 Quality Payment Program Final Rule. CMS is committed to co-developing the MIPS Value Pathways with stakeholders and the public, and will be using this webinar to answer questions from organizations interested in providing input on MVPs.
During the webinar, CMS subject matter experts will:
Please note that this webinar will only cover existing information about the MIPS Value Pathways, as found within the 2020 Final Rule, MVPs webpage, and accompanying materials such as the MVPs fact sheet and illustrative diagrams. No new information about the MVPs will be presented during this time.
Title: MIPS Value Pathways Webinar
Date: Wednesday, February 12, 2020
Time: 2:30 – 3:30 p.m. ET
Registration Link: https://register.gotowebinar.com/register/7531766105167712011
Please note: The audio portion of this webinar will be broadcast through the web. You can listen to the presentation through your computer speakers. CMS will open the phone line for the feedback portion. If you cannot hear audio through your computer speakers, please contact CMSQualityTeam@ketchum.com.
CMS has posted the following new Quality Payment Program (QPP) resources to the QPP Resource Library to help eligible clinicians submit their 2019 Merit-based Incentive Payment System (MIPS) data until the submission period closes at 8:00 p.m. EDT on March 31, 2020.
For More Information
Today, January 17, 2020, the Centers for Medicare & Medicaid Services (CMS) updated the Open Payments dataset to reflect changes to the data that took place since the last publication in June 2019. The updated dataset is now available for viewing at https://openpaymentsdata.cms.gov/.
CMS updates the Open Payments data at least once annually to include updates from disputes and other data corrections made since the initial publication of the data. The refreshed Open Payments Data Set includes:
The following is not included in the data refresh:
Note: Updates not included in the refresh are due to the requirement that covered recipients must be provided an opportunity to review data attributed to them for accuracy. For more information about the Open Payments Program timeline, visit www.cms.gov/openpayments
This financial data was submitted by applicable manufacturers and group purchasing organizations (GPOs).
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CMS is pleased to announce that the Open Payments search tool (https://openpaymentsdata.cms.gov/) was updated with the following features:
Entity Profile Updates
Query Builder Renamed “Advanced Search”
Submit questions to the Help Desk via email at firstname.lastname@example.org or by calling 1-855-326-8366 (TTY Line: 1-844-649-2766), Monday through Friday, from 9:00 a.m. to 5:00 p.m. (ET), excluding Federal holidays.
The Help Desk refers media inquiries to CMS’ Press Office for response.
Visit the Resources page on the Open Payments website for many of the above resources.
Centers for Medicare & Medicaid Services (CMS) has sent this update.
To contact CMS go to our Contact Us page.
Due to the opening of the 2019 MIPS data submission period, the Quality Payment Program (QPP) Service Center is projecting an increase in volume of calls and emails between January and March 2020, resulting in longer wait times.
CMS recommends the following to minimize wait times and ensure successful 2019 submission:
Self-Service Pulse: What You Need To Know This Week
As your Medicare Administrative Contractor, National Government Services wants to provide you with a comprehensive source containing the most current information available for our self-service tools.
The New Medicare Beneficiary Identifier (MBI)
Effective 1/1/2020, the new Medicare Number, commonly referred to as the MBI, will be required for all Medicare inquiries and transactions. If you would like to learn more about the MBI, we have a section of our website with all the information you need to comply with the CMS initiative.
1. Select “Claims & Appeals” then select “Medicare Beneficiary Identifier (MBI).”
2. Click on the MBI scrolling banner on our home page.
3. Select “Learn About MBI” on our home page.
Avoid your claims being rejected. Use the MBI today.
Final Countdown for the Medicare Beneficiary Identifier Transition Period
There are less than 30 days left until the Medicare Beneficiary Identifier (MBI) transition period comes to an end. Effective, 1/1/2020 Medicare transactions can no longer contain Health Insurance Claim Numbers (HICNs). This includes transactions within the NGSConnex portal.
Don't wait; MBIs can be used now. We encourage NGSConnex users to start using the MBI in all your portal transactions, including eligibility and claim status inquiries.
Every person with Medicare has been assigned an MBI and beneficiaries can find this number on their new Medicare Card. If you are unable to obtain a copy of the beneficiary's new Medicare card, you can search for their MBI using the MBI Lookup Tool available in NGSConnex.
Instructions for using the MBI Lookup Tool can be found in the NGSConnex User Guide:
Printing Your Transcript
Do you need to show your manager the education you received for your end-of-year review? You can generate and print your Medicare University transcript. On the “My Courses” tab, click the “Transcript” tab, then click the “Print Report” button. Show your manager the quality education you have received from National Government Services.
Interactive Voice Response
When you utilize the interactive voice response (IVR) system, you have the ability to access a Medicare beneficiary's eligibility information via submenus. These submenus allow you to choose the specific eligibility elements you want to hear.
After the provider and beneficiary information is authenticated, you will hear the following upfront eligibility elements as applicable:
• Entitlement dates
• Qualified Medicare Beneficiary (QMB) status
• Inactive dates
• Corrected Medicare number
• Date of death
You can say "Repeat that" to hear the upfront eligibility elements again. You may then choose one of the submenu options to continue through the other eligibility elements as applicable.
Part A Eligibility Submenu Options
• Full Eligibility (Touchtone 1)
• Basic Eligibility (Touchtone 2)
• Hospital and SNF Billing (Touchtone 3)
• Other Insurance (Touchtone 4)
• ESRD (Touchtone 5)
• Home Health and Hospice (Touchtone 6)
• Special Services (Touchtone 7)
Part B Eligibility Submenu Options
• Full Eligibility (Touchtone 1)
• Basic Eligibility (Touchtone 2)
• Other Insurance (Touchtone 3)
• ESRD (Touchtone 4)
• Home Health and Hospice (Touchtone 5)
• Special Services (Touchtone 6)
After you select a submenu and listen to the elements available, you can say "Repeat that" to hear the specific submenu elements again. Or, you can say simply say another submenu option to listen to other elements.
Refer to the IVR User Guide for all available features in the IVR:
• Part A Provider Interactive Voice Response User Guide
• Part B Provider Interactive Voice Response User Guide
MBI Lookup Tool in NGSConnex
If you are currently registered with NGSConnex, our free, secure internet portal you will be able to login and use the MBI Lookup Tool to obtain your patient's MBI, if CMS has mailed them their new Medicare card. Watch this three-minute video to learn how to use the MBI LookUp Tool in our secure self-service portal, NGSConnex.
National Cocoa Day
A cold winter day is the perfect time to make yourself a cup of hot cocoa and enjoy National Cocoa Day. Each year on December 13, people across the country celebrate their favorite cold weather comfort drink.
Hot cocoa is a warm beverage made with cocoa powder, heated milk or water and sugar. The terms hot chocolate and hot cocoa are often used interchangeably by Americans. To make hot chocolate, we use ground chocolate which contains cocoa butter. It’s mixed with hot milk and is also called drinking chocolate.
Did You Know?
Did you know you can search for a participating physician on our website by using the Medicare Participating Physicians Directory?
The 21 month transition period will end on December 31; use Medicare Beneficiary identifiers (MBIs) now.
Starting January 1, if you do not use the MBI (regardless of the date of service) for Medicare transactions
See the MLN Matters Article for more information on getting and using MBIs.
Copyright 2019 - National Government Services
The Quality Payment Program website (qpp.cms.gov) has been updated to include 2019 Alternative Payment Model (APM) Incentive Payment details. Clinicians and surrogates can log in to the QPP website using their HARP credentials to see their APM Incentive Payment details.
In November, CMS announced that the second round of payments are being disbursed to eligible clinicians who were Qualifying APM Participants (QPs) based on their 2017 performance for their 2019 5% APM Incentive Payments. For additional information on the APM Incentive Payment, please review the 2019 APM Incentive Payment Fact Sheet to explain:
APM Incentive Payment Details Available on QPP Website
CMS has taken time to ensure correct payments and information are available during the 2019 payment year. CMS’ process includes verifying eligible clinicians’ Advanced APM participation and the calculation of the APM Incentive Payment.
You can now log in to the QPP website and see the amount and the organization paid.
· Contact the Quality Payment Program at 1-866-288-8292 (TTY 1-877-715-6222), Monday through Friday, 8:00 AM-8:00 PM ET or by e-mail at QPP@cms.hhs.gov.
If you are interested in applying for a Promoting Interoperability Hardship Exception or Extreme and Uncontrollable Circumstances Exception for the 2019 Performance Year of MIPS, you must submit your application to CMS by Tuesday, December 31, 2019.
Who is Eligible for a Promoting Interoperability Hardship Exception?
MIPS eligible clinicians, groups, and virtual groups may qualify for a re-weighting of the Promoting Interoperability performance category to 0% if they:
Note: If you’re already exempt from reporting Promoting Interoperability data, you don’t need to apply.
Who is Eligible for an Extreme and Uncontrollable Circumstances Exception?
MIPS eligible clinicians, groups, and virtual groups may qualify for a re-weighting of any or all MIPS performance categories to 0% if they are affected by extreme and uncontrollable circumstances extending beyond the Promoting Interoperability performance category. These circumstances must render them unable to:
Note: Individual MIPS eligible clinicians (not groups or virtual groups) will receive the exception automatically if they are located in a CMS-designated region that has been affected by an extreme and uncontrollable event during the 2019 MIPS Performance Year. These clinicians will not need to apply for the exception.
How do I Know if I’m Approved?
If you submit an application for either of the exceptions, you will be notified by email if your request was approved or denied. If approved, this will also be added to your eligibility profile on the QPP Participation Status Tool, but may not appear in the tool until the submission window is open in 2020.
CMS has contracted with Acumen, LLC to develop episode based-cost measures to meet the requirements of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). As part of the measure development process, CMS asks contractors to convene groups of stakeholders and experts who contribute direction and thoughtful input to the measure developer during cost measure development and maintenance.
Acumen, LLC is seeking nominations to a Technical Expert Panel (TEP) that will provide guidance for activities under the “Physician Cost Measures and Patient Relationship Codes (PCMP)” contract. This contract continues the measure development activities performed under the previous “MACRA Episode Groups and Resource Use Measures” contract, and adds the maintenance of the MSPB Hospital measure. This TEP nomination is separate from the nomination to Clinical Subcommittees, which Acumen convenes to gather detailed clinical input on measures in specific clinical areas.
The first meeting is a two-day, in-person meeting in Washington, D.C. on February 6-7, 2020. Subsequent meetings may be held in-person or via webinar.
Nominations can be submitted through this web-based nomination form and the nomination period will close on December 20, 2019 at 11:59PM ET. For more information, please visit the CMS Technical Expert Panel webpage.
Select this link to view email as a web page, go here.
The CY 2020 MPFS Is Now Available
The CY 2020 Medicare Physician Fee Schedule (MPFS) is now available. You can view the new fees using the Fee Schedule Lookup tool page on the NGSMedicare.com website.
Marc D. Brown, M.D., professor of Dermatology and Oncology at the University of Rochester Medical Center, was elected president of the American Society for Dermatologic Surgery (ADSD) at the organization’s annual meeting in October. Brown is director of the department’s Division of Mohs Surgery and Cutaneous Oncology.
An active ASDS member since residency, Brown previously served on its Board of Directors and on numerous work groups, and has chaired its Audit Committee and Educational Exchange Work Group.
“I’m passionate about making sure that ADSD members can continue to provide appropriate quality care for their patients by working with policy makers and insurance payers at the local, state, and national levels,” Brown said. “I also believe educating the public through the media is imperative to continue the message of the safe and effective surgical treatments that dermatologic surgeons provide.”
ASDS is the second largest professional medical specialty society for dermatology in North America.