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Medicare offers materials on ACOs, billing error prevention

April 4, 2012

The Medicare Learning Network (MLN) has released the latest in a series of podcasts designed to provide education on avoiding common billing errors and complying with requirements of the Medicare program.

The “Medicare Overpayment Collection Process” (www.cms.gov/MLNProducts/MLM/itemdetail.asp?itemID=CMS1254707) podcast (ICN 907563), posted Dec. 8, 2011, is designed to provide education on the “Medicare Overpayment Collection Process.” It includes information from the MLN fact sheet titled “The Medicare Overpayment Collection Process,” which describes the collection of Medicare physician and supplier overpayments. Visit the MLN Multimedia Web page (www.cms.gov/MLNProducts/MLM/list.asp) to download this and other podcasts from the MLN.

The MLN also encourages practitioners to visit the MLN Provider Compliance Web page (www.cms.gov/MLN Products/45_ProviderCompliance.asp) for the latest educational products designed to help Medicare fee for service (FFS) providers understand – and avoid – common billing errors and other improper activities identified through claim review programs. New MLN podcasts are due for release in the coming months.

The “MLN Advanced Payment Accountable Care Organization Model” fact sheet (ICN 907403) is designed to provide education on the advance payment model for Accountable Care Organizations (ACOs). It includes a summary of the Advance Payment ACO Model, background, and information on the structure of payments, recouping of advance payments, eligibility, and the application process. The fact sheet can be accessed at www.cms.gov/MLNProducts/downloads/ACO_Advance_Payment_Factsheet_ICN907403.pdf.

The new “MLN Summary of Final Rule Provisions for Accountable Care Organizations Under the Medicare Shared Savings Program” fact sheet (ICN 907404) provides education on the provisions of the final rule that implements the Medicare Shared Savings Program with ACOs. It includes background, information on how ACOs impact beneficiaries, eligibility requirements to form an ACO, and information on monitoring and tying payment to improved care at lower costs. The fact sheet can be accessed at www.cms.gov/MLNProducts/downloads/ACO_Summary_Factsheet_ICN907404.pdf.

The new “Improving Quality of Care for Medicare Patients: Accountable Care Organizations” fact sheet (ICN 907407) is designed to provide education on improving quality of care under ACOs. It includes a table of quality measures under the program. The fact sheet can be accessed at www.cms.gov/MLNProducts/downloads/ACO_Quality_Factsheet_ICN907407.pdf.

The new “Medicare Shared Savings Program and Rural Providers” fact sheet (ICN 907408) is designed to provide education on how the Medicare Shared Savings Program impacts rural providers. It includes information on federally qualified health centers, rural health clinics, critical access hospitals, and how this program impacts them. The fact sheet can be downloaded at www.cms.gov/MLNProducts/downloads/ACO_Rural_Factsheet_ICN907408.pdf.

The new “Medicare Quarterly Provider Compliance Newsletter” [Volume 2, Issue 2] (ICN 907703) has been released in downloadable format. This educational tool is designed to help practices avoid common billing errors and other erroneous activities when dealing with the Medicare program, and highlights the top issues of the particular quarter. Visit www.CMS.gov/MLNProducts/downloads/MedQtrlyCompNL_Archive.pdf to download and print the latest newsletter or search an archive of previously-issued newsletters.

Recently revised MLN products

The revised “Medicare Claim Review Programs: MR, NCCI Edits, MUEs, CERT, and RAC” booklet (ICN 006973) is designed to provide education on the different CMS claim review programs and assist providers in reducing payment errors, including, in particular, coverage and coding errors. It includes frequently asked questions, resources, and an overview of the various programs, including Medical Review, Recovery Audit Contractor, and the Comprehensive Error Rate Testing Program. The booklet can be downloaded at www.cms.gov/MLNProducts/downloads/MCRP_Booklet.pdf.

The “Medicare Physician Fee Schedule” fact sheet (ICN 006814) has been revised and is now available in downloadable format. It includes information on physician services, therapy services, Medicare Physician Fee Schedule (PFS) payment rates, and the Medicare PFS rates formula. The fact sheet can be downloaded at www.cms.gov/MLNProducts/downloads/MedcrePhysFeeSchedfctsht.pdf.

The “Guide to Medicare Preventive Services: Errata Sheet to the Fourth Edition” fact sheet (ICN 907802) has been released and is available in downloadable format. This errata sheet reflects the changes to “The Guide to Medicare Preventive Services” and includes updates such as information on newly covered benefits, updated codes, and resources. Medicare’s preventive services program includes glaucoma screening. The fact sheet can be downloaded at www.cms.gov/MLNProducts/downloads/MPS_Guide_errata_factsheet_ICN907802.pdf.

The “Guidelines for Teaching Physicians, Interns, and Residents” fact sheet (ICN 006347) has been revised and is now available in downloadable format. It includes information about payment for physician services in teaching settings, general documentation guidelines, and evaluation and management documentation guidelines. The fact sheet can be downloaded at www.cms.gov/MLNProducts/downloads/gdelinesteachgresfctsht.pdf.

The new “Preventive Services Educational Resources for Health Care Professionals MLN Matters® Special Edition Article” (#SE1142) is designed to provide education on available educational resources related to Medicare-covered preventive services. 

It includes a list of MLN products that can help Medicare FFS providers understand coverage, coding, reimbursement, and billing requirements related to these services. The special edition article can be downloaded at www.cms.gov/MLNMattersArticles/Downloads/SE1142.pdf.

A new MLN Matters® Special Edition Article #SE1202, “Health Professional Shortage Area (HPSA) Bonus Payment Policy Reminders,” has been released in downloadable format. This article is designed to provide education on the HPSA Bonus Payment Program, and provides information about the program and resources that providers can use to determine whether they are eligible to receive the bonus payment. It can be downloaded at www.cms.gov/LNMattersArticles/Downloads/SE1202.pdf.

MLN Matters Special Edition Article #SE1201, “Important Reminder for Providers and Suppliers Who Provide Services and Items Ordered or Referred by Other Providers and Suppliers,” has been released in downloadable format. This article is designed to provide education on policy that says Medicare will only pay for specific items or services that are ordered or referred by providers or suppliers who are enrolled in Medicare and authorized to do so. It includes information about what providers should know before submitting a claim and limitations to the policy. The special edition article can be downloaded at www.cms.gov/MLNMattersArticles/Downloads/SE1201.pdf.

The Medicare Learning Network offers official U.S. Centers for Medicare & Medicaid Services information for Medicare fee-for-service providers, designed to help increase understanding of the Medicare program and stay current on program policy changes, and to provide the information needed to bill correctly. An overview of MLN resource can be on the program’s Web site (www.cms.gov/MLNgeninfo).

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