First Healthcare Compliance CONNECT- December 2017

®
CONNECT
An Exclusive Monthly Publication for Clients
NEW
Medicare
Beneficiary
Identifier
Listen
and Learn
Podcasts!
December 2017
CMS Emergency
Program
Moving Ahead
with MACRA

Important Compliance Dates
January
1
January
1
July
1
October
2
November
15
December
1
December
February
15
2017 EHR Stage 2 Medicaid reporting period is a minimum of any
continuous 90 days between January 1 and December 31, 2017.
2017 EHR Stage 3 Medicaid (for all new and returning participants)
reporting period is a minimum of any continuous 90 days between
January 1 and December 31, 2017.
Beginning July 1, 2017, practitioners in 9 states are required to
report claims data on post-operative visits furnished during the
global period of specified procedures using CPT code 99024.
October 2, 2017 is the last possible day to begin collecting MACRA
performance data.
There are 17 Provider types that must comply with the CMS
Emergency Preparedness Rule by November 15, 2017.
Virtual Group submissions due to CMS via email to
MIPS_VirtualGroups@cms.hhs.gov by December 1, 2017.
December 15, 2017 is the new extended deadline for electronic
submission of OSHA 300/300A Illness and Injury forms for required
establishments.
In This Issue:
Important Compliance Dates
Happy Holidays!
Latest System Updates
Moving Ahead with MACRA
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Happy Holidays!
Our team at First Healthcare Compliance
wishes you the Happiest of Holidays!
Please enjoy one set of complimentary
compliance posters available from our store at
1sthcc.com/shop
Use coupon code:
TISTHESEASON
Are you a Compliance Ninja?
Our monthly Compliance Ninja Super User will be selected
by our client services team beginning in January 2018.
You’ll get the honor of the title and cool swag too!
Is your practice ready for the new Medicare Beneficiary Identifier?
Qualifying Events that Trigger COBRA Benefits
CMS Emergency Preparedness Program
Upcoming Webinar Calendar
Contact Toll Free: 888-54-FIRST 3

Latest System Updates
Training Zone
Employee /
Training Zones
OSHA / HIPAA
Zones
Employee /
Training Zones
User Setup
Vendor Zone
Changed Employee view so assignments are still available
past the expiration date if the training has not been
completed.
New option in annual training requirements allowing
employers to turn off the CMS requirement on a per
employee basis.
Added “In Progress” status to the dashboard and changed
the overall status to include “In Progress” items in the
determination.
Added ability for supervisors to specify which individual
managers can assign training to employees.
Implemented new password viewing policy for greater
account security.
Added the ability to enter notes about vendor contracts.
Employee Zone
Added Certification column to the Employee Zone grid and
summary information to the grid at the top of the zone.
In observance of the holidays, our offices will be closed:
Friday, December 22, 2017
Monday, December 25, 2017
Friday, December 29, 2017
Monday, January 1, 2018
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Get the eBook!
Are you ready for MACRA?
It’s important to understand how MACRA and the final rule published on November
2, 2017, will impact your bottom line when it goes into effect on January 1, 2018.
Get help and determine your best course of action!
®
Moving Ahead
with MACRA
Learn more about getting on
track with MACRA:
• Common Misconceptions
• MIPS Hurdles
• Creating a MIPS Action Plan
By Julie Sheppard, BSN, JD, CHC
Download your copy today!
Contact Toll Free: 888-54-FIRST 5

By Jill Brooks, MD, CHCO
Preventing identity theft continues to be a major focus of the
Social Security Administration and the Center of Medicare and
Medicaid Services (CMS). Beginning April 2018, Medicare cards
will no longer contain Social Security Numbers (SSN) as part of
the Social Security Number Initiative (SSNI) and Medicare Access
and CHIP Reauthorization Act (MACRA). Instead, Medicare
beneficiaries will be assigned a new randomly generated individually
identifiable number— the Medicare Beneficiary Identifier
(MBI). Accordingly, your practice management systems must
be updated to accept and protect the confidentiality of these new
MBI numbers.
Educational materials are now available for providers to help educate
their Medicare patients on the new MBI: a poster, flyer and
a tear off. CMS emphasizes that beneficiaries must be assured
that benefits are not changing, only their identifier number. All
existing cards will be replaced and mailed to beneficiaries by
April 2019. Once the new MBI card is received, the beneficiary
should use it instead of the old card with the SSN-based Health
Insurance Claim Number (HICN), however either number should
be accepted by the provider until December 31, 2019. During the
transition period of April 1, 2018 to December 31, 2019, providers
may submit claims using the MBI or the Health Insurance Claim
Number (HICN). Following the transition period, only a few exceptions
will exist to allow for submissions containing any identifier
other than the MBI:
• MBI or HICN will be allowed for Medicare plan or fee-for-service
appeals
• HICN will continue to be used for Medicare adjustments and
reports
• For a fee- for-service claims status query, a date of service
prior to Jan 1, 2020 will allow use of MBI or HICN but after
that date only the MBI can be used
• MBI or HICN may be used on claims for services as an inpatient,
for home-health care or in a religious, non-medical
healthcare institution that begin before and end after the date
of transition.
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Regardless of the 2019 deadline, providers should be proactive
in compiling the MBIs assigned to their patients. An MBI
look-up tool is available to providers who sign up on their state
Medicare Administrative Contractor (MAC) provider portal.
Beginning October 2018, the new MBI number for the beneficiary
will also be included on each electronic remittance advice
(835) transaction. Another ardent step is to begin identifying
any Railroad Retirement Beneficiaries by their cards which will
continue to display the RRB logo and Railroad Retirement Board
(RRB) at the bottom. Due to the fact that the randomly generated
MBI number will not be unique for a RRB member, your
process must be able to determine RRB status simply based on
their card, in order to properly direct claims to the RRB Specialty
Medicare Administrative Contractor (SMAC).
What specific changes need to be implemented for the MBI to
be accepted by your practice management system?
• There will be 11 randomly generated characters
• Alphanumeric (0-9 and uppercase letters excluding S, L, O,
I, B, Z)
• 2nd, 5th, 8th, and 9th characters will always be a letter
• 1st, 4th, 7th, 10th, and 11th characters will always be a
number.
• 3rd and 6th characters will be a letter or a number
• The dashes are not part of the MBI
• Read and accept the MBI on electronic remittance advice
transaction (835)
Another consideration for providers is private insurance claims.
Private payers do not need to use the new MBI unless if it’s
secondary insurance for a Medicare transaction that would
currently use the HCIN. Only those private payer member IDs
based on whole or part of the SSN will need to be changed. The
ultimate goal is to prevent the continuation of healthcare fraud
by protecting the identity of all individuals.
New Card! New Number!
Mailing
in 2018
Current Medicare Card
NEW Medicare Card
CMS Product No. 12009-P
September 2017
Contact Toll Free: 888-54-FIRST 7

Spotlight
Sheba Vine, JD, CPCO talks about Qualifying Events that
Trigger COBRA Benefits.
COBRA is a federal law and is short for the Consolidated
Omnibus Budget Reconciliation Act of 1985. COBRA applies to
employers with 20 or more employees that offer group health
plans. COBRA provides the right to continue coverage in an
employer group plan in certain instances.
If an individual elects COBRA coverage, then he or she is
required to pay the full premium at the group plan rate. In
addition to the premium, the employer can charge a 2%
administration fee.
When determining if an employer has to comply with COBRA,
it must have at least 20 employees. To determine this, both
full-time and part-time employees are counted. A part-time
employee only counts as a fraction, equal to the number of
hours that the part-time employee worked divided by the
hours an employee must work to be considered full time. If
the employer doesn’t have 20 employees, then it is exempt
from COBRA. But many states have a continuing coverage
law that is similar to COBRA. These are referred to as the
mini-COBRA laws.
Under COBRA only qualified beneficiaries have the benefits of
COBRA. A qualified beneficiary is anyone that participates in
the employer sponsored group health plan. This includes all
employees that participate in the group plan, spouses and any
dependent children. It is important to note that the individual
must be covered by the plan on the day before an event that
causes loss of coverage.
There are instances where COBRA benefits would not apply
such as an employee who is not eligible to participate or an
employee who has declined to participate in the health plan.
There are notices that the employer is required to provide under
COBRA. A general notice of COBRA rights must be provided
to covered employees and spouses, within the first 90 days of
coverage under the plan. Employers usually include this notice
in the Summary Plan Description. There is also the election
notice, which describes the right to COBRA continuation coverage
and how to make an election when there is a qualifying
event that causes an employee and his or her family members
to lose health coverage. A qualifying event triggers the right
to COBRA coverage which includes: 1) an employee’s voluntary
or involuntary termination of employment, unless it is due
to the employee’s gross misconduct. Although COBRA does
not define what counts as gross misconduct, many states
refer to the definition provided under the respective state’s
unemployment laws; 2) reduction in hours of employment if
it effects their eligibility under the health plan; 3) divorce or
legal separation of the spouse from the covered employee;
4) an employee’s entitlement to Medicare; 5) the death of a
covered employee; and 6) the loss of dependent status, for
example, when a dependent reaches an age that no longer
qualifies them for coverage under the parent’s health plan.
An individual that elects coverage under COBRA can stay on
the employer’s group health plan for a maximum of 18 or 36
months, depending on the type of qualifying event.
Now that we know what events trigger COBRA, let’s talk
about COBRA and FMLA. FMLA applies to employers with 50
or more employees and it provides up to 12 weeks unpaid job
protected leave for an employee’s serious health condition, for
the birth, adoption, or foster of a child, or for the employee to
care for a family member’s serious health condition. It also
applies for qualifying military leaves which provides for 26
weeks of unpaid job protected leave. For an employee to be
Listen to the First Healthcare Compliance podcast!
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eligible for these FMLA benefits, the employee must have worked for the employer for 12 months and have worked at least 1250
hours.
During any FMLA leave, an employer must maintain the employee’s coverage under any group health plan. Employer contributions
must be the same as if the employee had continued to work his/her normal schedule. This means that if the health plan requires
an employee to work 30 hours a week to maintain coverage, and if that employee goes out on FMLA leave for 12 weeks, then
although the employee is not meeting his 30-hour requirement, the employer is legally required to continue the employee’s health
coverage. If the employee fails to pay any premium amount to keep up the health insurance then the employer may terminate
coverage provided that it gives advance written notice to the employee.
What if the employee in this example needs to extend his or her leave beyond the 12 weeks that FMLA provides, due to a disability
accommodation under the Americans with disability act? What happens to their health coverage? In this case, the employer is no
longer required to maintain health insurance as FMLA benefits have ended and if they have a 30 hour a week eligibility requirement
then this is not being met so health insurance cannot continue. At this juncture, there is a qualifying event because there is
a reduction in hours and the employer is required to provide a COBRA election notice informing the employee and other qualified
beneficiaries of their right to continue coverage through COBRA.
What if the employee suffers a job-related illness or injury and is placed on a worker’s compensation leave of absence? If the
employer has to comply with FMLA and the employee is eligible, the leave may come covered under FMLA and the employer
would be required to continue health insurance coverage. But what if the employer does not have 50 or more employees to come
under FMLA and there is no state law equivalent? First the employer should review the health plan requirements to determine if
coverage extends through a workers’ compensation leave. If the plan requires certain hours of work to be met each week, then
the employee would be ineligible for coverage. Due to the reduction in hours, this would be a qualifying event that triggers COBRA
and the employer would be required to provide the individual with an election notice.
Compliance with COBRA is as simple as providing the right notices and understanding when COBRA benefits are triggered. But if
the employer fails to notify individuals of their rights to continue coverage, then this single error can expose the employer to lawsuits
with huge penalties and attorney’s fees. It is critical to ensure employer obligations are followed. For more information visit the
Department of Labor’s website where you can find sample general and election COBRA notices.
Check out some of our other great resources to answer your FMLA and employee benefits questions!
Contact Toll Free: 888-54-FIRST 9

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Contact Toll Free: 888-54-FIRST 11

Join Us for These Upcoming
Learning Oportunities!
Complimentary CEU Webinars
January 9th @ 12pm ET
Strategic Planning To Action: Becoming
a Culturally Competent Organization
Dawn Cooper
The Arc of the United States
January 23rd @ 12pm ET
Red Flag Rule - HIPAA Compliance
Todd Sexton
Identillect Technologies
Listen and Learn Podcasts
Featured January 16th
Unauthorized Access
Ray Ribble
SPHER, Inc.
Featured January 30th
Security Management in
Healthcare Facilities
Steven S. Wilder, BA, CHSP, STS
Sorensen Wilder and Associates
Now available in our training zone!
CEUs from the following organizations:
AAPC
ADCA
AHCAE
AHIMA
APMBA
ARHCP
HBMA
MAB
NAMAS
NHCLA
PAHCOM
PAHCS
PHIA
PMI
PMRNC
POMAA
Contact our Client Services Team with any questions!
888.54.FIRST or clientservices@1sthcc.com
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