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  • MedPAC Updates its Medicare 'Payment Basics' Series

    Need a quick, big-picture take on how Medicare payment works in various settings? The Medicare Payment Advisory Commission (MedPAC) offers an updated resource that can help.

    Now available for free download: MedPAC's latest version of "Payment Basics," a series of informational sheets that describe the need-to-know elements of 20 different Medicare payment systems. Areas covered include outpatient therapy, skilled nursing facilities, home health services, hospital acute inpatient services, and more. The newest version of the resource updates the 2018 edition.

    Most information sheets provide background on how the system is organized and flowcharts for a visual representation of how that particular payment system works.

    Quick facts from MedPAC Payment Basics: According to the MedPAC report on outpatient therapy, in 2017 Medicare spent $8 billion on outpatient therapy services, a 6% increase from 2015. Physical therapist services accounted for 72% of all spending in this area. In terms of settings, nursing facilities and physical therapy private practice clinics accounted for 71% of the spending, at 37% and 33%, respectively. Hospitals were next, at 16%.

    New Medicare ID System Goes Fully Operational on January 1, 2020

    Time's (nearly) up: if you haven't transitioned to Medicare's new patient identifier system, you need to make the switch by December 31.

    Recently, the US Centers for Medicare and Medicaid Services (CMS) announced that the 21-month period for transition to the Medicare Beneficiary Identifier (MBI) is nearly complete, meaning that beginning January 1, 2020, claims submitted with Health Insurance Claims Numbers (HICNs) will be rejected.

    The MBI cards feature a unique Medicare identification number that helps CMS move away from identifications that contain the beneficiary's Social Security number. The change, intended to thwart fraud, was required by provisions in the Affordable Care Act and the Small Business Jobs Act.

    According to CMS, participation is already high: it estimates that as recently as the week of October 4, 80% of all fee-for-service claims were submitted with MBIs

    Providers can learn more about the MBI system by way of a Medicare Learning Network MLN Matters article as well as CMS guide to understanding the MBI format. CMS also offers beneficiary-focused flyers on the new system in English and Spanish.