Updates from the Medicare Learning Network… [cid:[email protected]]
§ “Swing Bed” Fact Sheet Revised § MLN Matters Article “Edits on the Ordering/Referring Providers in Medicare Part B Claims” Revised § “Medicare Claim Review Programs: MUE, CCI, CERT, RAC” Booklet Revised § MLN Matters Article “Recovery Audit Contractor Demonstration High-Risk Vulnerabilities for Physicians” Released § December Flu Shot >From the Medicare Learning Network: “Swing Bed” Fact Sheet Revised [↑] The revised fact sheet titled “Swing Bed” (November 2010), which provides information about the requirements hospitals and Critical Access Hospitals must meet in order to be granted approval to furnish either Acute- or Skilled Nursing Facility-level care via a swing bed agreement, is now available in downloadable format from the Medicare Learning Network(r) at http://www.cms.gov/MLNProducts/downloads/SwingBedFactsheet.pdf. >From the Medicare Learning Network: MLN Matters Article “Edits on the >Ordering/Referring Providers in Medicare Part B Claims” Revised [↑] The Medicare Learning Network(r) has revised MLN Matters Special Edition Article #SE1011 to inform providers that, beginning January 3, 2011, if certain Part B-billed items and services require an ordering/referring provider and the ordering/referring provider is not on the claim, is not of a profession that is permitted to order/refer, or does not have an enrollment record in the Medicare Provider Enrollment, Chain and Ownership System (PECOS), the claim will not be paid. For more information, please read the revised article at http://www.cms.gov/MLNMattersArticles/downloads/SE1011.pdf. >From the Medicare Learning Network: “Medicare Claim Review Programs: MUE, >CCI, CERT, RAC” Booklet Revised [↑] The Medicare Learning Network(r) has revised the “Medicare Claim Review Programs: MUE, CCI, CERT, RAC” booklet, which is designed to provide education on the different CMS claim-review programs and assist providers in reducing payment errors - in particular, coverage and coding errors. It includes FAQs, resources , and an overview of the various programs, including Medical Review (MR), Recovery Audit Contractor (RAC), and the Comprehensive Error Rate Testing (CERT) Program. This product is suggested for all Medicare Fee-For-Service providers and is available in downloadable format at http://www.cms.gov/MLNProducts/downloads/MCRP_Booklet.pdf. Additionally, please visit the MLN Provider Compliance web page at http://www.cms.gov/MLNProducts/45_ProviderCompliance.asp for additional resources designed to educate FFS providers about the common billing errors and other improper activities identified through these programs. >From the Medicare Learning Network: MLN Matters Article “Recovery Audit >Contractor Demonstration High-Risk Vulnerabilities for Physicians” Released [↑] The Medicare Learning Network(r) (MLN) has released MLN Matters Special Edition Article #SE1036 as the next in a series of articles designed to educate providers about Recovery Audit Contractor (RAC) demonstration high-dollar improper payment vulnerabilities. This article is designed to educate physicians about two vulnerabilities concerning services with excessive units billed and duplicate claims in an effort to prevent similar problems from occurring in the future, and is available online at http://www.cms.gov/MLNMattersArticles/downloads/SE1036.pdf. Please visit the MLN Provider Compliance web page at http://www.cms.gov/MLNProducts/45_ProviderCompliance.asp for additional articles and other resources designed to help Fee-For-Service providers avoid improper activities when dealing with the Medicare Program. --------------------------------------------------------------------------------------------------------------------------------------------- December It’s a Busy Time of Year. Make each office visit an opportunity to talk with your patients about the importance of getting the seasonal flu vaccination and a one-time pneumococcal vaccination. Remember, Medicare pays for these vaccinations for all beneficiaries with no co-pay or deductible. The seasonal flu and invasive pneumococcal disease kill thousands of people in the United States each year, most of them 65 years of age or older. The Centers for Disease Control and Prevention (CDC) also recommends that health care workers and caregivers be vaccinated against the seasonal flu. Protect your patients. Protect your family. Protect yourself. Get Your Flu Vaccine - Not the Flu. Remember - Influenza vaccine plus its administration are covered Part B benefits. Note that influenza vaccine is NOT a Part D covered drug. For information about Medicare’s coverage of the influenza vaccine and its administration, as well as related educational resources for health care professionals and their staff, please visit the following CMS websites: http://www.cms.gov/MLNProducts/Downloads/Flu_Products.pdf and http://www.cms.gov/AdultImmunizations. --------------------------------------------------------------------------------------------------------------------------------------------- Note: If you have problems accessing any hyperlink in this message, please copy and paste the URL into your Internet browser. Please DO NOT respond to this email. This email is a service of CMS and routed through an electronic mail server to communicate Medicare policy and operational changes and/or updates. Responses to this email are not routed to CMS personnel. Inquiries may be sent by going to (http://www.cms.hhs.gov/ContactCMS). Thank you. If you received this message as part of the All FFS Providers listserv, you are currently subscribed to one of eighteen Medicare Fee-For-Service (FFS) provider listservs. If you would like to be removed from all NIH listservs, please go to (https://list.nih.gov/LISTSERV_WEB/signoff.htm) to unsubscribe. If you would like to unsubscribe from a specific provider listserv, please go to (https://list.nih.gov/cgi-bin/show_list_archives) to unsubscribe or to leave the appropriate listserv. If you know someone who would like to subscribe to a FFS provider listserv, go to (http://www.cms.hhs.gov/prospmedicarefeesvcpmtgen/downloads/Provider_Listservs.pdf) .
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