NCMS Morning Rounds 1-7-20

Happy Tuesday! Enjoy your

NCMS Morning Rounds.

Jan. 7, 2020

Medicare Enrollment Extended for Those Affected by Hurricane Dorian

Medicare Open Enrollment closed on Dec. 7, 2019, but those Medicare beneficiaries affected by Hurricane Dorian have until Jan. 31, 2020 to enroll in a Medicare health or prescription drug plan for coverage starting Feb. 1, 2020.

The special enrollment period is in effect for the 26 North Carolina counties declared major disaster areas as a result of last September’s storm.Those counties are: Beaufort, Brunswick, Camden, Carteret, Columbus, Craven, Currituck, Dare, Duplin, Greene, Hoke, Hyde, Jones, Lenoir, New Hanover, Onslow, Pamlico, Pasquotank, Pender, Perquimans, Pitt, Robeson, Sampson, Tyrrell, Washington and Wayne.

The extension applies to two sets of residents: Those who live in the disaster zones as well as others living outside the 26 counties who rely on help from people living in the affected areas.

For more information or if you or your patients have questions, contact the state’s Seniors’ Health Insurance Information Program (SHIIP) at 855-408-1212 or on through the SHIIP website. This is a free NC Department of Insurance health benefits counseling service for Medicare beneficiaries and their families or caregivers. SHIIP counselors are not licensed insurance agents, and they do not sell or endorse any product, plan or company.

Times Up: New Medicare Beneficiary Identifier Now Required

As of Jan. 1, all Medicare claims need to use the new Medicare Beneficiary Identifier (MBI) or they will be rejected, with a few exceptions. The new numbers, which no longer use patients’ social security numbers, have been phased in over the last few years, but some of your patients may still not have their updated cards.

Here are a few tips and resources so you’ll be sure to get paid.

  • If your patients do not bring their Medicare cards with them, give them the Get Your New Medicare Card flyer in English (PDF) or Spanish (PDF).
    • Use your Medicare Administrative Contractor’s look-up tool. Sign up for the Portal to use the tool.
    • Check the remittance advice. Until the end of December, the Centers for Medicare and Medicaid Services (CMS) will return the MBI on the remittance advice for every claim with a valid and active Health Insurance Claim Number.

Review this Medicare Learning Network Article to learn how to get and use MBIs.

Merit-based Incentive Payment System (MIPS) Updates

Those practices participating in the Merit-based Incentive Payment System (MIPS) as part of the Centers for Medicare and Medicaid Services (CMS) Quality Payment Program may start submitting data for 2019. Data may be submitted and updated until March 31, 2020.

Clinicians will follow the following steps to submit their data:
1. Go to the Quality Payment Program website
2. Sign in using your QPP access credentials
3. Submit your MIPS data for the 2019 performance period or review the data reported on your behalf by a third party.

Note: Clinicians who are not sure if they are eligible to participate in the Quality Payment Program can check their final eligibility status using the QPP Participation Status Lookup Tool.

To be eligible to participate in MIPS in 2020, you must:
• Bill more than $90,000 a year in allowed charges for covered professional services under the Medicare Physician Fee Schedule (PFS), AND
• Furnish covered professional services to more than 200 Medicare Part B beneficiaries, AND
• Provide more than 200 covered professional services under the PFS.

If you do not exceed all three of the above criteria for the 2020 performance period, you are excluded from MIPS. However, you have the opportunity to opt-in to MIPS and receive a payment adjustment if you meet or exceed one or two, but not all, of the low-volume threshold criteria. Alternatively, you may choose to voluntarily report to MIPS and not receive a payment adjustment if you do not meet any of the low-volume threshold criteria or if you meet some, but not all, of the criteria. Find out whether you’re eligible for MIPS today and prepare now to earn a positive payment adjustment in 2022 for your 2020 performance.

Clinicians in small practices (including those in rural locations), health professional shortage areas, and medically underserved areas may request technical assistance from organizations that can provide no-cost support. To learn more about this support, or to connect with your local technical assistance organization, visit the Small, Underserved, and Rural Practices page on the Quality Payment Program (QPP) website.

To learn more about how to submit data, please review the resources available in the QPP Resource Library.

You may also watch these quick (2-3 minute) data submission demo videos:
Introduction and Overview of 2019 Data Submission
File Upload and Quality Scoring
Manual Attestation of Improvement Activities

For help, please contact the Quality Payment Program at 1-866-288-8292, Monday through Friday, 8 am to 8 pm or by e-mail at:

In the News

Is It Time to Ditch the Name ‘Physician Assistant?’ The Advisory Board Forum, 1-3-20

Learning Opportunity

Shatterproof, the non-profit working to implement Atlas, an addiction treatment locator, analysis and standards tool, is offering a virtual ‘provider roundtable’ on Jan. 13 at noon to update practices on this initiative. Learn more about this pilot project. Register for the virtual roundtable here.


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