07/10/2018

CMS-Medicare

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CMS NEWS - FOR IMMEDIATE RELEASE - July 10, 2018

CMS Proposes Rule Change to Protect Medicaid Provider Payments

Today, the Centers for Medicare & Medicaid Services (CMS) proposed changes to the Medicaid Provider Reassignment regulation that would eliminate state’s ability to divert Medicaid payments away from providers, with the exception of payment arrangements explicitly authorized by statute. This proposed regulatory change is designed to ensure that taxpayer dollars dedicated to providing healthcare services for low-income vulnerable Americans are not siphoned away for other purposes.

“The law provides that Medicaid providers must be paid directly and cannot have part of their payments diverted to third parties outside of a few very specific exceptions,” said Tim Hill, Acting Director for the Center for Medicaid and CHIP Services. “This proposed rule is intended to ensure that providers receive their complete payment, and any circumstances in which a state does divert part of a provider’s payment must be clearly allowed under the law.”

Section 1902(a)(32) of the Social Security Act generally prohibits States from making payments for Medicaid services to anyone but the provider. The statute provides only a few specific exceptions to this requirement, such as withholding payment due to a court order for wage garnishments, child support orders, or judgments for monies that are owed to the state. 

In 2014, CMS revised the regulation to provide for a new exception to the direct payment requirement for certain providers, which primarily include independent in-home personal care workers. This new regulatory exception authorized a state to divert part of the Medicaid payment to third parties that could then be used to fund other costs on behalf of the provider. After further review, CMS has determined that the new exception created by the 2014 rule is not consistent with the statute, may have resulted in provider payments being diverted in ways that do not comport with the law, and, in some cases, may have occurred without the express knowledge of the provider.
We are seeking comments to inform the development of CMS guidance and help explain which payment arrangements would be considered acceptable assignments of Medicaid payments under the current law, especially those between the states and providers. 

To view the proposed rule, please visit: https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-14786.pdf. 

MIPS: Understanding and addressing topped-out measures

One aspect that practices may face as they conduct their quality reporting under CMS’s Merit-based Incentive Payment System (MIPS) in 2018 are “topped-out measures.”  READ MORE

MIPS Payment Adjustment Targeted Review: Request by September 30

If you participated in the Merit-based Incentive Payment System (MIPS) in 2017, your MIPS final score and performance feedback is available for review on the Quality Payment Program website. If you believe an error has been made in your 2019 MIPS payment adjustment calculation, you can request a targeted review until September 30.

For More Information:

• Performance Feedback Fact Sheet
• Targeted Review Fact Sheet
• Targeted Review User Guide
• If you have questions about your performance feedback or MIPS final score, contact the Quality Payment Program at 866-288-8292 (TTY: 877-715-6222) or QPP@cms.hhs.gov.

Qualified Medicare Beneficiary Information on RAs and MSNs

Medicare providers may not bill beneficiaries enrolled in the Qualified Medicare Beneficiary (QMB) program for Medicare Parts A and B deductibles, coinsurance, or copays, but state Medicaid programs may pay for those costs. To make it easier to identify the QMB status of your patients, CMS reintroduced QMB information in provider Remittance Advices (RAs) and Medicare Summary Notices (MSNs) for claims processed on or after July 2, 2018. You can also verify QMB enrollment by using Medicare eligibility information returned by the CMS Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS) 270/271 application.

For More Information:

• Reinstating the QMB Indicator MLN Matters Article
• Prohibition on Billing Dually Eligible Individuals Enrolled in the QMB Program MLN Matters Article
• QMB Program webpage
• Materials from June 6 Medicare Learning Network call, including presentation and FAQs

Public Reporting on Physician Compare Webinar — July 24 or 26

Tuesday, July 24 from 11 am to 12 pm ET
Thursday, July 26 from 3 to 4 pm ET

Register for July 24 or July 26; both webinars will present the same information.

For more information, visit the Physician Compare Initiative webpage.

IMPACT Act Call: Audio Recording and Transcript — New

An audio recording and transcript are available for the June 21 call on the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). CMS answers your frequently asked questions on quality measures, standardized data elements, the CMS data element library, and future directions of the IMPACT Act.

New Medicare Card: Use MBI Like HICN

Use the Medicare Beneficiary Identifier (MBI) the same way you use the Health Insurance Claim Number (HICN) today. Put the MBI in the same field where you have always put the HICN. This also applies to reporting informational only and no-pay claims. Do not use hyphens or spaces for hyphens with the MBI to avoid rejection of your claim.

For More Information:

• New MBI: Get It, Use It MLN Matters® Article
• Transition to New Medicare Numbers and Cards MLN Fact Sheet

Recent LearnResource & MedLearn Matters Articles

• Prohibition Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) Program (Revised SE 1128)
• Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - July 2018 Update (Revised MM 10624)
• Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 24.3, Effective October 1, 2018 (MM 10827)
• July 2018 Integrated Outpatient Code Editor (I/OCE) Specification Version 19.2 (Revised MM 10699)
• July 2018 Update of the Hospital Outpatient Prospective Payment System (OPPS) (Revised MM 10781)
• Revisions to the Telehealth Billing Requirements for Distant Site Services (Revised MM 10583)