The Record

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September 2017
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CMS begins transition to new fraud-protected Medicare cards
The Centers for Medicare & Medicaid Services is taking steps to remove Social Security numbers from Medicare cards. This initiative will help CMS prevent fraud, fight identity theft and protect essential program funding, as well as the private health care and financial information of Medicare beneficiaries. Read more.

Inside this issue for you

See all the articles in this issue, grouped by category, below.

All Providers

CMS begins transition to new fraud-protected Medicare cards
Prefix on member ID cards will expand to include alpha-numeric combinations next year
Here’s what you need to know about authorization requirements for different types of members
We’re updating reimbursement language for certain provider agreements
Correction: Go to the September billing chart for corrected version of ‘Therapeutic massage’ article
New payment model for knee arthroplasty includes prehabilitative services
Payment policy for evaluation and management services
Cultural sensitivity training available
Here are some tips for navigating PARS
Providers acknowledge improvements in BlueCard^® process but want continued improvement, survey shows
BlueCard^® connection: How do I report an outpatient BlueCard claim for screening and diagnostic services on same claim?
Searching for drug prior authorization criteria just got easier
Custom drug lists transitioning to monthly updates
FY 2018 ICD-10-CM and ICD-10-PCS code updates now available
Coding corner: Morbid obesity
Billing chart: Blues highlight medical, benefit policy changes

Professional

We’re continuing to streamline preauthorization process for MA PPO physical therapy
Audits of Medicare Plus Blue^SM PPO durable medical equipment claims began Aug. 1
Reminder: CLIA numbers must be submitted for most lab tests
Comprehensive diabetes care: Improve patient health, while reducing need for medical record reviews
Remind your eligible Medicare Advantage members to get mammograms every two years
Clinical Quality Corner tip sheets now available on web-DENIS
We need you to update information for practitioners and locations that don’t accept appointments
Our updated process for making group changes starts Jan. 1, 2018
Include key information in opioid requests to avoid processing delays
Help prevent denials on prior authorizations for weight loss, diabetes and testosterone drugs
2 drugs will have higher copays starting in September
RC Claim Assist tool ensures correct billing units on medical drug codes

Pharmacy

2 drugs will have higher copays starting in September

Facility

We’re continuing to streamline preauthorization process for Medicare Plus Blue^SM PPO physical therapy
We’re enhancing our process for MA PPO, PFFS high-cost claims
Inpatient rehabilitation facility audits for Medicare Plus Blue^SM PPO claims start Oct. 1
Audits of Medicare Plus Blue^SM PPO outpatient, observation, ambulatory claims have begun
Audits of Medicare Plus Blue^SM PPO automatic implantable cardiac defibrillator claims have begun
Audits of Medicare Plus Blue^SM PPO durable medical equipment claims began Aug. 1
Here’s our reimbursement policy for medication from multiple-use vials
Reminder: Use correct home health care services billing units

DME

Audits of Medicare Plus Blue^SM PPO durable medical equipment claims began Aug. 1

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