Updates from the Medicare Learning Network for Jan. 2012

“Medicare Claim Review Programs” • 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. “Advanced Payment Accountable Care Organization Model” • The new “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, recoupment of advance payments, eligibility, and the application process. “Summary of Final Rule Provisions for Accountable Care Organizations Under the Medicare Shared Savings Program” • The new “Summary of Final Rule Provisions for Accountable Care Organizations Under the Medicare Shared Savings Program” fact sheet (ICN 907404) is designed to provide 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. New “Medicare Coverage of Radiology and Other Diagnostic Services” • A new “Medicare Coverage of Radiology and Other Diagnostic Services” fact sheet (ICN 907164) has been released in downloadable format. This fact sheet is designed to provide education on Medicare coverage and billing information for radiology and other diagnostic services, and includes specific information concerning billing and coding requirements and an overview of coverage guidelines.