How to Read MLN Dates

Summary

In this video, Victoria explains a common confusion about Medicare Learning Network (MLN) matters, particularly the difference between release date, effective date, and implementation date. Using an example about a guideline update regarding teaching physicians and residents, she clarifies that while rules can be implemented early, system updates by Medicare may take longer. Victoria emphasizes the importance of understanding these dates for proper implementation and potential appeals if Medicare reviews claims prematurely. She encourages viewers to stay updated on coding changes and offers further resources.

Takeaways

• 😀 Medicare Learning Network (MLN) Matters are official documents published by CMS to update healthcare providers about new rules and guidelines.
• 😀 MLN Matters documents are identified by a unique number and are cited with change request numbers for reference.
• 😀 The three key dates in MLN Matters are the release date, effective date, and implementation date, with confusion often surrounding the effective and implementation dates.
• 😀 The effective date marks when the rule or guideline can begin to be applied, but the implementation date is when CMS systems and documentation are officially updated.
• 😀 For example, Medicare updated guidelines allowing residents to attest to their own notes starting January 1st, 2019, but CMS would officially update their system on July 29th, 2019.
• 😀 Providers can begin applying the new rules from the effective date even if CMS systems are not yet updated.
• 😀 If a claim submitted with a date of service on or after the effective date doesn't comply with new rules, providers can use the update as a basis for appeal to Medicare.
• 😀 Medicare sometimes releases updates ahead of time, allowing providers to implement new rules while CMS systems are catching up.
• 😀 It's important for healthcare organizations to plan how they will roll out updates in response to new MLN Matters releases.
• 😀 The video encourages viewers to subscribe for more updates on coding guidelines and to visit the associated website for more resources.

Q & A

What are MLN Matters in the context of Medicare?

MLN Matters are publications from the Medicare Learning Network (MLN) that provide guidance on Medicare policies and updates. These are published by CMS and are listed by MLN Matters number and the corresponding change request number.

What is the difference between the release date, effective date, and implementation date in Medicare updates?

The release date refers to when an update is officially announced, the effective date is when the rules or guidelines can be applied, and the implementation date is when the updated documentation and systems are fully in place to support those changes.

Why is the implementation date often different from the effective date?

The implementation date is typically later than the effective date because it takes time for Medicare's documentation systems to be updated and for providers to receive the necessary information and training.

Can a resident attest to their own note in Medicare as of January 1, 2019?

Yes, as of January 1, 2019, residents can attest to their own notes, stating that the teaching physician was present and involved in the patient's care. However, Medicare will not update its documentation and systems until July 29, 2019.

What should a provider do if they submit a claim based on updated guidelines before the implementation date?

If a provider submits a claim before the implementation date and it is denied due to not reflecting the updated guidelines, they can appeal the decision, citing that the guidelines were effective as of the stated effective date (e.g., January 1, 2019).

What is the significance of the effective date for healthcare providers and residents?

The effective date allows healthcare providers, including residents, to begin applying the new rules and guidelines for patient care and documentation, even though Medicare's system may not fully support these changes until the implementation date.

Why do Medicare updates take a while to be implemented?

Medicare updates take time to implement because the organization needs to update a large number of documentation, systems, and online resources to ensure that all stakeholders are informed and the guidelines are properly integrated into the system.

What is the role of a teaching physician in the updated Medicare guidelines?

The updated guidelines allow a resident to attest to their own note, confirming that the teaching physician was present and involved in the patient's care. This change aims to streamline documentation processes in teaching hospitals.

How should healthcare organizations handle large updates like the one described in the script?

Healthcare organizations should plan and decide on how to roll out significant updates, ensuring that all relevant staff members are informed and prepared to implement the new guidelines when they are effective.

What can healthcare providers do if they encounter confusion or errors when submitting claims after an update?

Healthcare providers can contact Medicare with the updated guidelines, appeal decisions based on outdated information, or use the relevant MLN Matters document to clarify the rules and support their claims.