Category: Medicare

Implementation of Changes in the ESRD PPS and Payment for Dialysis Furnished for AKI in ESRD Facilities for CY 2021

Centers for Medicare & Medicaid Services (CMS) issued a Medical Learning Network (MLN) Matters article #MM12188 on Implementation of Changes in the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Payment for Dialysis Furnished for Acute Kidney Injury (AKI) in ESRD Facilities for Calendar Year (CY) 2021.  The MLN Matters article is for ESRD facilities that bill Medicare Administrative Contractors (MACs) for services they provide to Medicare patients.  The article tells about the Calendar Year (CY) 2021 rate updates and policies for the ESRD PPS and implements payment for renal dialysis services furnished to Medicare patients with Acute Kidney Injury (AKI) in ESRD facilities. Learn about rate and policy updates, and make sure billing staff are aware of these changes.

CMS Releases Recommendations on Adult Elective Surgeries, Non-Essential Medical, Surgical, and Dental Procedures During COVID-19 Response

Earlier today at the White House Task Force Press Briefing, the Centers for Medicare & Medicaid Services (CMS) announced that all elective surgeries, non-essential medical, surgical, and dental procedures be delayed during the 2019 Novel Coronavirus (COVID-19) outbreak.

As more healthcare providers are increasingly being asked to assist with the COVID-19 response, it is critical that they consider whether non-essential surgeries and procedures can be delayed so they can preserve personal protective equipment (PPE), beds, and ventilators.

“The reality is clear and the stakes are high: we need to preserve personal protective equipment for those on the front lines of this fight,” said CMS Administrator Seema Verma.

This will not only preserve equipment but also free up our healthcare workforce to care for the patients who are most in need. Additionally, as states and the nation as a whole work towards limiting the spread of COVID-19, healthcare providers should encourage patients to remain home, unless there is an emergency, to protect others while also limiting their exposure to the virus. They should also urge patients to follow the President’s recently issued guidelines to help slow the spread of the virus.

The recommendations provide a framework for hospitals and clinicians to implement immediately during the COVID-19 response. The recommendations outline factors that should be considered for postponing elective surgeries, and non-essential medical, surgical, and dental procedures. Those factors include patient risk factors, availability of beds, staff and PPE, and the urgency of the procedure. This will help providers to focus on addressing more urgent cases and preserve resources needed for the COVID-19 response. The decision about proceeding with non-essential surgeries and procedures will be made at the local level by the clinician, patient, hospital, and state and local health departments.

The recommendations can be found here:  https://www.cms.gov/files/document/31820-cms-adult-elective-surgery-and-procedures-recommendations.pdf

These recommendations, and earlier CMS guidance and actions in response to the COVID-19 virus, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19 click here www.coronavirus.gov for further information. For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Website.

President Trump Expands Telehealth Benefits for Medicare Beneficiaries During COVID-19 Outbreak

The Trump Administration today announced expanded Medicare telehealth coverage that will enable beneficiaries to receive a wider range of healthcare services from their doctors without having to travel to a healthcare facility. Beginning on March 6, 2020, Medicare—administered by the Centers for Medicare & Medicaid Services (CMS)—will temporarily pay clinicians to provide telehealth services for beneficiaries residing across the entire country.

“The Trump Administration is taking swift and bold action to give patients greater access to care through telehealth during the COVID-19 outbreak,” said Administrator Seema Verma. “These changes allow seniors to communicate with their doctors without having to travel to a healthcare facility so that they can limit risk of exposure and spread of this virus. Clinicians on the frontlines will now have greater flexibility to safely treat our beneficiaries.”

On March 13, 2020, President Trump announced an emergency declaration under the Stafford Act and the National Emergencies Act. Consistent with President Trump’s emergency declaration, CMS is expanding Medicare’s telehealth benefits under the 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act. This guidance and other recent actions by CMS provide regulatory flexibility to ensure that all Americans—particularly high-risk individuals—are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the spread of coronavirus disease 2019 (COVID-19).

Prior to this announcement, Medicare was only allowed to pay clinicians for telehealth services such as routine visits in certain circumstances. For example, the beneficiary receiving the services must live in a rural area and travel to a local medical facility to get telehealth services from a doctor in a remote location. In addition, the beneficiary would generally not be allowed to receive telehealth services in their home.

Click here to read more.

CMS Announces Actions to Address Spread of Coronavirus

CMS calls on all health care providers to activate infection control practices and issues guidance to inspectors as they inspect facilities affected by Coronavirus

Today, the Centers for Medicare & Medicaid Services (CMS) is announcing several actions aimed at limiting the spread of the Novel Coronavirus 2019 (COVID-19). Specifically, CMS is issuing a call to action to health care providers across the country to ensure they are implementing their infection control procedures, which they are required to maintain at all times. Additionally, CMS is announcing that, effective immediately and, until further notice, State Survey Agencies and Accrediting Organizations will focus their facility inspections exclusively on issues related to infection control and other serious health and safety threats, like allegations of abuse – beginning with nursing homes and hospitals. Critically, this shift in approach, first announced yesterday by Vice President Pence, will allow inspectors to focus their energies on addressing the spread of COVID-19.

As the agency responsible for Medicare and Medicaid, CMS requires facilities to maintain infection control and prevention policies as a condition for participation in the programs. CMS is also issuing three memoranda to State Survey Agencies, State Survey Agency directors and Accrediting Organizations – to inspect thousands of Medicare-participating health care providers across the country, including nursing homes and hospitals.

Click here to read more.

ESRD Proposal May Inadequately Reimburse Medicare Advantage Plans

Medicare Advantage proponents are concerned that the new CMS proposal may result in underpayment to Medicare Advantage plans for end-stage renal disease care.  While payers and Medicare Advantage proponents applauded elements of the Medicare Advantage rule that CMS proposed yesterday which will increase plans’ revenues by nearly one percent, many expressed concerns about the proposed rule’s approach to chronic disease management costs for patients with end-stage renal disease (ESRD).

Click here to read more.

ACO Care Coordination Toolkit and Beneficiary Engagement Toolkit Available

The Centers for Medicare & Medicaid Services worked with 21 Medicare Accountable Care Organizations (ACOs) and End-Stage Renal Disease Seamless Care Organizations (ESCOs) participating in the Shared Savings Program, Next Generation ACO Model, and the Comprehensive ESRD Care Model to identify promising practices and innovative strategies for coordinating care for Medicare beneficiaries.

Specifically, the ACO Care Coordination Toolkit focuses on care coordination for Medicare beneficiaries who:

  • Recently received care in an emergency department,
  • Require treatment in a skilled nursing facility,
  • Have recently been discharged home after a hospital or emergency department visit,
  • Have been diagnosed with a chronic condition or have a complex medication regimen, or
  • Have conditions affected by the social determinants of health.

Working with the same methodology, CMS also has released the ACO Beneficiary Engagement Toolkit which highlights strategies used by ACOs and ESRD Seamless Care Organizations (ESCOs) to engage beneficiaries. Specifically, the toolkit explores how ACOs and ESCOs:

  • Engage beneficiaries in ACO governance,
  • Elicit beneficiary and family feedback,
  • Support beneficiaries in self-care management,
  • Enhance beneficiary communication in the clinical setting, and
  • Communicate with beneficiaries about the ACO as a value-based care organization.

These toolkits are part of a broader series of toolkits designed to educate the public about the strategies ACOs use to provide value-based care while also providing actionable ideas to current and prospective ACOs to help them improve or begin operations.

For more information on the toolkits and case studies please visit the ACO General Information webpage.

ESRD QIP Call: Audio Recording and Transcript

An audio recording and transcript are available for the August 20 Medicare Learning Network call on the End Stage Renal Disease (ESRD) Quality Incentive Program (QIP): CY 2020 ESRD PPS (Prospective Payment System) Proposed Rule Call. Learn about the legislative framework, the proposed rule, and methods for reviewing and commenting on the rule.

“Welcome to Medicare” Preventive Visit and Yearly “Wellness” Visits

Individuals new to Medicare should schedule a “Welcome to Medicare” preventive visit. Medicare Part B covers a FREE comprehensive screening within the first 12 months of having Part B.

Individuals who have had Medicare Part B for longer than 12 months can get a FREE yearly “Wellness” visit once every year to develop or update a personalized prevention plan.

Patients pay nothing if their doctor or other qualified health care provider accepts assignment. The Part B deductible doesn’t apply. However, patients may have to pay coinsurance, and the Part B deductible may apply, if doctors or other health care providers perform additional tests or services during the same visit that are not covered under the preventive benefits.

When making the appointment, patients should let the doctor’s office know a “Welcome to Medicare” preventive visit would like to be scheduled. It is also important to know what to bring to the “Welcome to Medicare” preventive visit.

The preventive visit includes a review of medical and social history related to the patient’s health, along with education and counseling about preventive services. It can also include:

  • Certain screenings, flu and pneumococcal shots, and referrals for other care, if needed.
  • Height, weight, and blood pressure measurements.
  • A calculation of your body mass index.
  • A simple vision test.
  • A review of your potential risk for depression and your level of safety.
  • An offer to talk with you about creating advance directives.
  • A written plan letting you know which screenings, shots, and other preventive services you need. Get details about coverage for screenings, shots, and other preventive services.

The yearly “Wellness” visit is designed to help prevent disease and disability based on current health and risk factors. Providers will ask patients to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit. It can also include:

  • A review of your medical and family history.
  • Developing or updating a list of current providers and prescriptions.
  • Height, weight, blood pressure, and other routine measurements.
  • Detection of any cognitive impairment.
  • Personalized health advice.
  • A list of risk factors and treatment options for you.
  • A screening schedule (like a checklist) for appropriate preventive services.
  • Advance care planning

By collaborating with physicians/practices that performs a comprehensive review of health status, the medical team at the dialysis clinic can be assured that patients have an established resource for healthcare issues that are not specifically related to ESRD. This is a great opportunity to coordinate care for essential services like immunizations, diabetes management and cardiac related issues, just to name a few.

Join CMS for a Public Webinar on Quality Measurement

CMS is pleased to invite the public to attend its upcoming webinar titled Measuring Quality to Improve Quality: Strengths and Challenges of Clinical Quality Measurement. The webinar will provide an engaging and informative overview of key concepts that go into its quality measures. Additionally, the presentation will review current CMS quality measures, explain how they are used, and how they fit into CMS’s quality goals, including the Meaningful Measures initiative.

The webinar will be offered twice in June, on Tuesday, June 25th, from 2:00-3:00pm EST (Register here) and Thursday, June 27th, from 2:00-3:00pm EST (Register here). Please register in advance if you can attend as space will be limited. CMS requests that interested individuals only register for the event they’re able to attend.  CMS looks forward to participant questions!

For questions, please contact MMSSupport@battelle.org.

Talk to Your Patients about Mental Health

May is Mental Health Month. Raise awareness by talking about mental health conditions. Recommend appropriate preventive services, including the Initial Preventive Physical Examination, Annual Wellness Visit, and Depression Screening.

For More Information:

Visit the Preventive Services website to learn more about Medicare-covered services.

“Welcome to Medicare” a Chance to Coordinate Care

If you have patients who are new to Medicare, encourage them to schedule their “Welcome to Medicare” physical exam. This is a FREE comprehensive screening that will ensure

  • A record and evaluation of their medical and family history, current health conditions, and prescriptions.
  • Baseline measures of blood pressure, vision, weight, and height.
  • Review of preventive screenings and services, like cancer screenings and immunizations.
  • Ordering of additional tests, if needed, depending on their general health and medical history.

After the visit, the doctor will give them a plan or checklist outlining free screenings and preventive services that they need. By collaborating with the physician/practice that performs the comprehensive review of the patient’s health status, the medical team at the dialysis clinic can be assured that the patient has an established resource for healthcare issues that are not specifically related to ESRD. This is a great opportunity to coordinate care for essential services like immunizations, diabetes management and cardiac related issues, just to name a few.

For more information, see: https://www.medicare.gov/people-like-me/new-to-medicare/welcome-to-medicare-visit.html