The Medical Management Institute - MMI
The Medical Management Institute - MMI
The Medical Management Institute - MMI

MMI Updates & Announcements

  • Home Health Care: Proper Certification Required

    Posted: Jul 28 2016

    Originally Published on CMS.gov The Affordable Care Act requires a physician or a non-physician practitioner to have a face-to-face encounter with the beneficiary before a physician certifies the beneficiary’s eligibility for the home health benefit. One aspect of the certification is for the certifying physician to certify (attest) that the face-to-face encounter occurred and document the date of the encounter. For medical review purposes, Medicare requires documentation in the certifying physician’s medical records and/or the acute/post-acute care facility’s medical records to be used as the basis for certification of patient eligibility. This documentation must include the clinical note or discharge summary for the face-to-face encounter. Avoid home health claims payment denials or improper payment recoveries by understanding Medicare's requirements.   Resources: CY 2015 Home Health Prospective Payment System Final Rule Medicare Benefit Policy Manual, Chapter 7, Section 30.5.1 National Provider Call: Certifying Patients for the Medicare Home Health Benefit   MLN Matters® Articles: Certifying Patients...

  • New Payment Models and Rewards for Better Care at Lower Cost

    Posted: Jul 25 2016

    Originally Published by CMS.gov On July 25, 2016, the Department of Health & Human Services (HHS) proposed new models that continue to shift Medicare reimbursements from quantity to quality by creating strong incentives for hospitals to deliver better care at a lower cost. These models would reward hospitals that work together with physicians and other providers to avoid complications, prevent hospital readmissions, and speed recovery.BackgroundUnder the proposed episode payment models, the hospital in which a patient is admitted for care for a heart attack, bypass surgery, or surgical hip/femur fracture treatment  would be accountable for the cost and quality of care provided to Medicare fee-for-service beneficiaries during the inpatient stay and for 90 days after discharge. Participating hospitals will receive a separate target price for each MS-DRG under the model. All providers and suppliers would be paid under the usual payment system rules and procedures of the Medicare program for...

  • CMS Issues Guidance to States and Manufacturers Regarding Value Based Purchasing (VBP) Arrangements

    Posted: Jul 14 2016

    The Centers for Medicare & Medicaid Services (CMS) released guidance to states and manufacturers regarding participation in value based purchasing (VBP) arrangements.  The guidance also encourages states to participate in such arrangements as a means to address, as well as offset, higher cost drug treatments.  This guidance has been released through State Release #176 and Manufacturer Release #99, which are available for download by clicking here. If you have any questions regarding the states and/or drug manufacturer releases, email MDROperations@cms.hhs.gov.

  • Proposed Rules for Calendar Year 2017 Released by CMS

    Posted: Jul 07 2016

    On July 7, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that updates payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2017. This year, CMS is proposing a number of new physician fee schedule policies that will improve Medicare payment for those services provided by primary care physicians for patients with multiple chronic conditions, mental and behavioral health issues, and cognitive impairment or mobility-related disabilities. CMS is proposing to expand the Diabetes Prevention Program model starting January 1, 2018.  This is the second CMS Innovation Center – and first preventive services – model that has been certified for expansion.  Expansion of this model will enhance access to these important services for Medicare beneficiaries who are at risk for developing diabetes.  In addition CMS is also: • Proposing modifications to the Medicare...

  • [Announcement] Effective July 1st, 77295 and 77300 Can Be Reported Together

    Posted: Jul 01 2016

    In March 2016, CMS and the NCCI announced that they would remove the current edit prohibiting the reporting of CPT codes 77295 and 77300. The change will take effect today, July 1, 2016 (retroactive to January 1, 2016) and will be finalized in the July version of the NCCI Manual. Reporting requirements may vary by payer. Providers (hospitals, physicians and freestanding cancer centers) should continue to track and capture the supported work of code 77300 during the 3D planning process. When the transmittal is released, providers will be able to submit those charges, along with the retroactive charges, for payment and in accordance with documentation guidelines and published Medically Unlikely Edits (MUEs). Background: CMS originally implemented the prohibition of reporting these codes together (implemented January 1, 2016) because they believed the work of 77300 was integral to the work of 77295. Therefore, it should not be considered a separately reportable procedure. Opponents believed that this NCCI edit...