Hello Everyone,
Please enjoy the information contained in this edition of Frontier Focus. Please be sure to share it with your members, colleagues, providers and office billing staff. Thank you for your continued efforts to broadcast Medicare information to the providers in Region VIII.
Table of Contents
1. CMS Announces DMEPOS Round 1 Rebid Contract Suppliers
2. Registration for ONC Personal Health Records Roundtable Now Open [Fri Dec 3]
3. Registration Deadline EXTENDED: National Education Call for Non-Contract Suppliers in the DMEPOS Competitive Bidding Program
4. Online registration now open for December 3rd roundtable on “Personal Health Records – Understanding the Evolving Landscape.”
5. Skilled Nursing Facility Prospective Payment System Resource Utilization Group-Version 4 (RUG-IV) National Provider Call with Q&A [Tue Nov 9]
6. 2010 Physician Quality Reporting Initiative & Electronic Prescribing Incentive Program National Provider Call with Question & Answer Session [Wed Nov 10]
7. Twelfth National Education Call on Medicare Fee-For-Service Implementation of HIPAA Version 5010 and D.0 Transactions: Taking EDI to the Next Level [Wed Nov 17]
8. Register now for National Education Call for Referral Agents for the DMEPOS Competitive Bidding Program
9. Updates from the Medicare Learning Network
– CMS Revised MLN Matters Article #SE1028 – RAC Demonstartion High-Risk DRG Coding Vulnerabilities for Inpatient Hospitals
– The “DMEPOS Competitive Bidding Program Grandfathering Requirements for Non-contract Suppliers” Fact Sheet
– “5010: Taking Electronic Billing and Electronic Data Interchange (EDI) to the Next Level”
– “Caregiving Education” Publication
– “Medicare Information for Advanced Practice Nurses and Physician Assistants” Booklet
– “Understanding the Remittance Advice for Institutional Providers” Web-Based Training
– Reminder about Important Timely Filing Requirement Information
– November is Lung Cancer Awareness Month and Thu Nov 18 is the Great American Smokeout
10. Medicare Improves Access to Preventive Services for 2011; New Physician Payment Policies Emphasize Role of Primary Care
11. 2011 Payment Changes for Medicare Home Health Services; Final Rule Reflects Improvements to Quality and Efficiency of Care
12. Medicare DMEPOS Rules to Take Effect in 2011
13. Medicare DSH Eligibility Data
14. October 2010 Quarterly Provider Specific Data Updates
15. Healthcare Common Procedure Coding System (HCPCS) Code Set Update
16. Inpatient Psychiatric Facility PPS RY2011 PC Pricer Update
17. Medicare Remit Easy Print Software Codes Update
18. 2009 Physician Quality Reporting Initiative Incentive Payment Update
19. November Flu Shot Reminder
20. A new “twist” in the law makes it easier to save on your prescription drug costs.
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1. CMS Announces DMEPOS Round 1 Rebid Contract Suppliers
DMEPOS Round 1 Rebid Contract Suppliers Announced!
The Centers for Medicare & Medicaid Services (CMS) has announced the contract suppliers for the Round 1 Rebid of the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program.
The list of contract suppliers is now available at http://www.cms.gov/DMEPOSCompetitiveBid/01A2_Contract_Supplier_Lists.asp.
Visit the CMS web site at http://www.cms.gov/DMEPOSCompetitiveBid for additional information.
View the Press Release at http://www.cms.gov/apps/media/press_releases.asp.
View the Fact Sheet at http://www.cms.gov/apps/media/fact_sheets.asp.
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2. Registration for ONC Personal Health Records Roundtable Now Open [Fri Dec 3]
Online registration is now open for the roundtable on “Personal Health Records – Understanding the Evolving Landscape.” This free day-long public roundtable, hosted by the Office of the National Coordinator for Health Information Technology (ONC), will be held on Fri Dec 3 at the FTC Conference Center in Washington DC (601 New Jersey Avenue NW, Washington, DC 20001).
Register to attend in person or via webcast by visiting http://healthit.hhs.gov/PHRroundtable. The webcast will be hosted at http://healthit.hhs.gov/blog/phr-roundtable.
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3. Registration Deadline EXTENDED: National Education Call for Non-Contract Suppliers in the DMEPOS Competitive Bidding Program
Mon Nov 8, 2-3:30pm EST
Registration for this previously-announced call will close at 2pm EST on Mon Nov 8 (the beginning of the call), or when available space has been filled.
The Centers for Medicare & Medicaid Services (CMS) will host a national education call on the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program for DMEPOS suppliers that will not be contract suppliers in the program.
If you are planning to participate in the call, please review the presentation that will be given, which is available in the “Downloads” section at http://www.cms.gov/DMEPOSCompetitiveBid/04_Educational_Resources.asp. In addition, this webpage includes educational resources (including fact sheets) about the Competitive Bidding Program.
In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation. Registration will close at 2pm EST on Mon Nov 8 (the beginning of the call), or when available space has been filled.
To register for the call:
Visit http://www.eventsvc.com/palmettogba/110810.
Fill in all required data.
Verify that your time zone is displayed correctly in the drop down box.
Click “Register.”
You will be taken to the “Thank you for registering” page and will receive a confirmation e-mail shortly thereafter. Note: Please save this page, in the event that your server blocks the confirmation e-mails. If you do not receive the confirmation e-mail, please check your spam/junk mail filter as it may have been directed there.
If assistance for hearing impaired services is needed the request must be sent to medicare.ttt@palmettogba.com no later than 3 business days before the event.
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4. Online registration now open for December 3rd roundtable on “Personal Health Records – Understanding the Evolving Landscape.”
· Online registration is now open for the December 3rd roundtable on “Personal Health Records – Understanding the Evolving Landscape.” This free day-long (8:30 a.m. – 4:30 p.m.) public roundtable, hosted by ONC, will be held at the FTC Conference Center, 601 New Jersey Avenue, NW, Washington, DC. You can register to attend in person or via webcast by visiting http://healthit.hhs.gov/blog/phr-roundtable/.
· The Governance Workgroup is developing recommendations on governance mechanisms for the nationwide health information network (NHIN). The Workgroup identified overarching objectives, key principles, and core functions for governance in its Preliminary Report and Recommendations on the Scope of Governance presented to the HIT Policy Committee on October 20. The Workgroup is now preparing final recommendations on how governance functions should be implemented and by whom. As a first step, the Workgroup would like to identify existing mechanisms that might be appropriate, with or without modifications, and with or without some added coordination; and whether new mechanisms are needed, and if so, which. The Workgroup would like public input on these issues and has created a table listing the core functions and questions to frame the input. To make comments, please visit:
http://healthit.hhs.gov/blog/faca/index.php/2010/10/25/governance-workgroup-seeks-comments-on-roles-and-responsibilities-for-governance/
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5. Skilled Nursing Facility Prospective Payment System Resource Utilization Group-Version 4 (RUG-IV) National Provider Call with Q&A [Tue Nov 9]
This call is one in a series of calls designed to provide information on key aspects of the RUG-IV SNF PPS case mix system, which was put into place on an interim basis effective October 1, 2010. CMS held three previous calls, which provided details of significant changes related to the RUG-IV payment system.
In June, CMS discussed coding procedures, with emphasis on the appropriate Look-back Period to be used when coding the Minimum Data Set (MDS) 3.0 and how facility staff should separately report individual, concurrent and group therapy for accurate payment, along with changes to the ADL coding requirements and their impact on the assignment of MDS 3.0 records to a RUG-IV group. In August, CMS held a second call, where subject matter experts discussed the transition from RUG-III to RUG-IV. The third call, in September, discussed several SNF PPS policies, including Start of Therapy and End of Therapy Other Medicare Required Assessments and the SNF short stay policy.
For this call, CMS subject matter experts will review some of the significant changes associated with the RUG-IV payment system. Information on the previous calls and future information for this call will be available on the SNF PPS webpage at http://www.cms.gov/SNFPPS/03_RUGIVEdu.asp. Following the formal presentation, callers will have an opportunity to ask questions of CMS subject matter experts.
In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation. Registration will close at 2pm EST on Mon Nov 8, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time. To register for the call:
Visit http://www.eventsvc.com/palmettogba/110910.
Fill in all required data.
Verify that your time zone is displayed correctly in the drop down box.
Click “Register.”
You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please save this page in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.
If assistance for hearing impaired services is needed, the request must be sent to medicare.ttt@palmettogba.com no later than 3 business day before the event.
For those who will be unable to attend, a transcript and MP3 audio file of the call will be available at http://www.cms.gov/SNFPPS/03_RUGIVEdu.asp on the CMS website shortly after the call.
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6. 2010 Physician Quality Reporting Initiative & Electronic Prescribing Incentive Program National Provider Call with Question & Answer Session [Wed Nov 10]
The PQRI is voluntary quality reporting program that provides an incentive payment to identified individual eligible professionals (EPs), and beginning with the 2010 PQRI, group practices who satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-For-Service (FFS) beneficiaries. The PQRI was first implemented in 2007 as a result of section 101 of the Tax Relief and Health Care Act of 2006 (TRHCA), and further expanded as a result of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), and the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).
The eRx Incentive Program is an incentive program for eligible professionals initially implemented in 2009 as a result of section 132(b) of the MIPPA. The eRx Incentive Program promotes the adoption and use of eRx systems by individual eligible professionals and beginning with the 2010 eRx Incentive Program, group practices.
The formal presentation will cover the following:
Overview of the 2011 rule and comments;
2009 PQRI and eRx Incentive Program payment distribution and instructions for understanding these payments;
An overview for the use of the 2009 Feedback Report User Guides for PQRI and the eRx Incentive Program;
Discussion on the changes to the electronic remittance advice for eligible professionals receiving PQRI and eRx incentive payments in 2010; and
Participation in the 2010 eRX Incentive Program.
The lines will be opened to allow participants to ask questions of CMS PQRI and eRx subject matter experts. A PowerPoint slide presentation will be posted to the PQRI webpage (at http://www.cms.gov/PQRI/04_CMSSponsoredCalls.asp) on the CMS website for you to download prior to the call so that you can follow along with the presenter.
Educational products are available on the PQRI-dedicated webpage (http://www.cms.hhs.gov/PQRI) in the Educational Resources section and on the eRx-dedicated webpage (http://www.cms.hhs.gov/ERxIncentive) on the CMS website. Feel free to download the resources prior to the call so that you may ask questions of the CMS presenters.
In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation. Registration will close at 1:30pm EST on Tue Nov 9 or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time. To register for the call:
Visit http://www.eventsvc.com/palmettogba/111010.
Fill in all required data.
Verify that your time zone is displayed correctly in the drop down box.
Click “Register.”
You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.
If assistance for hearing impaired services is needed the request must be sent to medicare.ttt@palmettogba.com no later than 3 business day before the event. For those of who will be unable to attend, a transcript and MP3 file of the call will be available at least one week after the call at http://www.cms.hhs.gov/PQRI on the CMS website.
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7. Twelfth National Education Call on Medicare Fee-For-Service Implementation of HIPAA Version 5010 and D.0 Transactions: Taking EDI to the Next Level [Wed Nov 17]
The Centers for Medicare & Medicaid Services (CMS) will host its twelfth national education call regarding Medicare FFS’s implementation of HIPAA Version 5010 and D.0 transaction standards on Wed Nov 17, focusing on the Coordination of Benefits (COB). Subject matter experts will review Medicare FFS specific changes, including those arising from the adoption of the HIPAA 5010 Errata, as well as general information to help the audience prepare for the transition; the presentation will be followed by a Q&A session. Target Audience includes vendors, clearinghouses, and providers who will need to make Medicare FFS specific changes in compliance with HIPAA version 5010 requirements. The presentation will be available on the CMS website at http://www.cms.gov/Versions5010andD0/V50/list.asp.
Agenda:
§ General Overview
§ Medicare Specific COB Changes
§ Timelines and Deadlines
§ What you need to do to prepare
§ Q & A
In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation. Registration will close at 2:00 p.m. ET on November 16, 2010, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time. To register for the call:
Visit http://www.eventsvc.com/palmettogba/111710.
Fill in all required data.
Verify that your time zone is displayed correctly in the drop down box.
Click “Register.”
You will be taken to the “Thank you for registering” page and will receive a confirmation e-mail shortly thereafter. Note: Please save this page, in the event that your server blocks the confirmation e-mails. If you do not receive the confirmation e-mail, please check your spam/junk mail filter as it may have been directed there.
If assistance for hearing impaired services is needed the request must be sent to medicare.ttt@palmettogba.com no later than 3 business day before the event.
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8. Register now for National Education Call for Referral Agents for the DMEPOS Competitive Bidding Program
The Centers for Medicare & Medicaid Services (CMS) will host a national education call on the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program for referral agents for the program. (Referral agents generally include Medicare-enrolled providers, physicians, treating practitioners, discharge planners, social workers, and pharmacists who refer beneficiaries for DMEPOS items and services in a competitive bidding area).
In advance of the call, participants are encouraged to visit the educational resources web page where they can review the latest educational tools including fact sheets. The presentation for the call will also be available at http://www.cms.gov/DMEPOSCompetitiveBid/04_Educational_Resources.asp.
In order to receive the call-in information for this call, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation. Registration will close at 2pm EST on Mon Nov 15, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
To register for the call:
§ Visit http://www.eventsvc.com/palmettogba/111610.
§ Fill in all required data.
§ Verify that your time zone is displayed correctly in the drop down box.
§ Click “Register.”
§ You will be taken to the “Thank you for registering” page and will receive a confirmation e-mail shortly thereafter. Note: Please save this page, in the event that your server blocks the confirmation e-mails. If you do not receive the confirmation e-mail, please check your spam/junk mail filter as it may have been directed there.
§ If assistance for hearing impaired services is needed the request must be sent to medicare.ttt@palmettogba.com no later than 3 business days before the event.
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9. Updates from the Medicare Learning Network
CMS Revised MLN Matters Article #SE1028 – RAC Demonstartion High-Risk DRG Coding Vulnerabilities for Inpatient Hospitals
The Medicare Learning Network® (MLN) has revised MLN Matters Article #SE1028 to clarify requirements for coding diagnosis codes by attending physicians. The article provides information related to four RAC demonstration-identified inpatient coding vulnerabilities in an effort to prevent similar problems from occurring in the future. The revised version is now available at http://www.cms.gov/MLNMattersArticles/downloads/SE1028.pdf on the CMS website.
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The “DMEPOS Competitive Bidding Program Grandfathering Requirements for Non-contract Suppliers” Fact Sheet
The Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program Grandfathering Requirements for Non-Contract Suppliers Fact Sheet is now available, free of charge, from the Medicare Learning Network®.
Once the DMEPOS competitive bidding program becomes effective on January 1, 2011, beneficiaries with Original Medicare who obtain competitively bid items in competitive bidding areas (CBAs) must obtain these items from a contract supplier for Medicare to pay, unless an exception applies.
All non-contract suppliers that furnish competitively bid rented durable medical equipment (DME) or oxygen and oxygen equipment to beneficiaries in CBAs must decide if they will elect to become grandfathered suppliers, notify beneficiaries of their grandfathering decisions, and fulfill other requirements. A non-contract supplier that elects to become a grandfathered supplier must provide written notification to the Centers for Medicare & Medicaid Services (CMS) of this decision by Wed Nov 17, 2010.
This fact sheet contains helpful information on competitive bidding program rules and requirements related to grandfathering. To learn more, please visit the DMEPOS Competitive Bidding Educational Resources page at http://www.cms.gov/DMEPOSCompetitiveBid/04_Educational_Resources.asp on the CMS website and scroll to the “Downloads” section.
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“5010: Taking Electronic Billing and Electronic Data Interchange (EDI) to the Next Level”
New! The Medicare Learning Network® has released a new educational tool titled “5010: Taking Electronic Billing and Electronic Data Interchange (EDI) to the Next Level.” This educational tool is designed to provide education on the upcoming implementation of Versions 5010 and D.0, which will replace the current version that covered entities must use when conducting electronic HIPPA transactions. It includes a timeline and list of resources related to the implementation. This product is suggested for all Medicare Fee-For-Service Providers and is available in downloadable format at http://www.cms.hhs.gov/MLNProducts/downloads/5010EDI_RefCard_ICN904284.pdf.
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“Caregiving Education” Publication
New! A new publication titled “Caregiving Education” (September 2010) is now available in downloadable format from the Medicare Learning Network® at http://www.cms.gov/MLNProducts/downloads/MLN_CaregivingEducation.pdf. Medicare will pay for certain types of caregiver education when it is provided as part of a patient’s medically-necessary face-to-face visit. This publication provides information on how to bill for Caregiver Education under Medicare Parts A and B.
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“Medicare Information for Advanced Practice Nurses and Physician Assistants” Booklet
New! A new Medicare Learning Network® booklet titled “Medicare Information for Advanced Practice Nurses and Physician Assistants” (September 2010), which is designed to provide education on Medicare requirements for advanced practice nurses (APN) and physician assistants (PA), is now available in downloadable format at
http://www.cms.gov/MLNProducts/downloads/Medicare_Information_for_APNs_and_PAs_Booklet_ICN901623.pdf. This publication provides information about required qualifications, coverage criteria, billing, and payment for Medicare services furnished by APNs and PAs.
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“Understanding the Remittance Advice for Institutional Providers” Web-Based Training
Revised! The Medicare Learning Network® is now offering the “Understanding the Remittance Advice for Institutional Providers” Web-Based Training. This WBT is designed to educate all institutional providers who bill Medicare with general RA information. It includes instructions to help you interpret the RA received from Medicare and reconcile it against submitted claims. It also provides guidance on how to read Electronic Remittance Advices (ERAs) and Standard Paper Remittance Advices (SPRs), as well as information on balancing an RA. This activity offers continuing education and is available from the MLN at http://www.cms.gov/MLNproducts by scrolling to the bottom of the page and selecting Web-Based Training Modules from the Related Links Inside CMS section.
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Reminder about Important Timely Filing Requirement Information
If you are a Medicare Fee-For-Service physician, provider, or supplier submitting claims to Medicare for payment, this is very important information you need to know. Effective immediately, any Medicare Fee-For-Service claim with a date of service on or after Jan 1, 2010, must be received by your Medicare contractor no later than one calendar year (12 months) from the claim’s date of service – or Medicare will deny the claim.
If you have Medicare Fee-For-Service claims with a service dates from Oct 1, 2009, through Dec 31, 2009, those claims MUST be received by Dec 31, 2010, or Medicare will deny them. Claims with services dates from Jan 1, 2009, to Oct 1, 2009, keep their original Dec 31, 2010, deadline for filing.
When claims for services require reporting a line item date of service, the line item date will be used to determine the date of service. CR 7080, issued on July 30, 2010, clarified that for institutional claims containing claim level span dates of service (ie. a “From” and “Through” date span on the claim), the “Through” date on the claim shall be used to determine the date of service for claims filing timeliness. Conversely, professional claims containing claim level span dates of service (ie. a “From” and “Through” date span on the claim), the “From” date on the claim shall be used to determine the date of service for claims filing timeliness.
For additional information about the new maximum period for claims submission filing dates, contact your Medicare contractor, or review the MLN Matters articles listed below related to this subject:
§ MM6960 – “Systems Changes Necessary to Implement the Patient Protection and Affordable Care Act (PPACA) Section 6404 – Maximum Period for Submission of Medicare Claims Reduced to Not More Than 12 Months” – http://www.cms.gov/MLNMattersArticles/downloads/MM6960.pdf
§ MM7080 – “Timely Claims Filing: Additional Instructions” – http://www.cms.gov/MLNMattersArticles/downloads/MM7080.pdf
You can also listen to a podcast on this subject by visiting http://www.cms.gov/CMSFeeds/02_listofpodcasts.asp.
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November is Lung Cancer Awareness Month and Thu Nov 18 is the Great American Smokeout
The Centers for Medicare & Medicaid Services asks the provider community to keep their patients with Medicare healthy by encouraging eligible patients to take advantage of Medicare-covered smoking and tobacco-use cessation and counseling to prevent tobacco use services.
Tobacco continues to be the leading cause of preventable death in the United States. Smoking can attribute to and exacerbate lung disease, including lung cancer, as well as other diseases, such as heart disease, stroke, hypertension and diabetes. Medicare provides coverage for smoking and tobacco-use cessation counseling services for certain symptomatic beneficiaries. In addition, effective Wed Aug 25, 2010, Medicare began covering counseling to prevent tobacco use for certain asymptomatic beneficiaries.
What Can You Do? As a health care professional who provides care to patients with Medicare, you can help protect the health of your patients by encouraging them to take advantage of Medicare-covered preventive services, including tobacco counseling services, that are appropriate for them.
For More Information: CMS has developed several educational products related to Medicare-covered tobacco-counseling services. They are all available, free of charge, from the Medicare Learning Network®:
§ The MLN Preventive Services Educational Products Web Page – provides descriptions and ordering information for Medicare Learning Network® educational products for health care professionals related to Medicare-covered preventive services. Visit http://www.cms.hhs.gov/MLNProducts/35_PreventiveServices.asp.
§ MLN Matters Article MM7133 Counseling to Prevent Tobacco Use – this educational article provides coverage, coding and payment information on counseling to prevent tobacco use for asymptomatic beneficiaries. Available as a downloadable PDF only at http://www.cms.gov/MLNMattersArticles/downloads/MM7133.pdf.
§ The Smoking and Tobacco-Use Cessation Counseling Services brochure – this brochure provides information on coverage for smoking and tobacco-use cessation counseling services for symptomatic beneficiaries. This product is available in hardcopy or as a downloadable PDF at http://www.cms.gov/MLNProducts/downloads/smoking.pdf.
§ The Guide to Medicare Preventive Services for Physicians, Providers, Suppliers, and Other Health Care Professionals – provides coverage and coding information on Medicare-covered preventive services and screenings. Available as a downloadable PDF only at http://www.cms.hhs.gov/MLNProducts/downloads/mps_guide_web-061305.pdf.
§ Quick Reference Information: Medicare Preventive Services – this chart provides coverage and coding information on Medicare-covered preventive services. Visit http://www.cms.hhs.gov/MLNProducts/downloads/MPS_QuickReferenceChart_1.pdf.
§ The Medicare Preventive Services Series: Part 2 Web-Based-Training course – includes lessons on coverage, coding, and billing for Medicare-covered preventive services, including smoking and tobacco-use cessation counseling services for symptomatic beneficiaries. To access the course, please visit the MLN home page at http://www.cms.gov/MLNGenInfo, scroll down to “Related Links Inside CMS,” and click on “Web-Based Training (WBT) Modules.”
Please visit the Medicare Learning Network for more information on these and other Medicare fee-for-service educational products. For more information on Lung Cancer Awareness Month, please visit the Lung Cancer Alliance’s official page at http://www.lungcanceralliance.org/involved/lcam_month.html. For additional information on the Great American Smokeout, please visit the American Cancer Society’s official page at http://www.cancer.org/Healthy/StayAwayfromTobacco/GreatAmericanSmokeout/index.
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10. Medicare Improves Access to Preventive Services for 2011; New Physician Payment Policies Emphasize Role of Primary Care
The Centers for Medicare & Medicaid Services (CMS) issued a final rule with comment period that will implement key provisions in the Affordable Care Act of 2010 that expand preventive services for Medicare beneficiaries, improve payments for primary care services, and promote access to health care services in rural areas. The new policies will apply to payments under the Medicare Physician Fee Schedule (MPFS) for services furnished on or after Jan 1, 2011.
The final rule with comment period implements provisions in the Affordable Care Act that expand beneficiary access to preventive services and, for the first time, provide coverage under the traditional fee-for-service program for an annual wellness visit beginning Jan 1, 2011. This visit augments the benefits of the Initial Preventive Physical Examination (IPPE or “Welcome to Medicare Visit”) with an annual visit that allows the physician and patient to develop a personalized prevention plan that considers not only the age-appropriate preventive services generally available to Medicare beneficiaries, but additional services that may be appropriate because of the patient’s individual health status. CMS will accept comments on certain aspects of the final rule with comment period until Jan 3, 2011.
To view the rule and supporting documentation, visit http://www.cms.gov/PhysicianFeeSched/PFSFRN/itemdetail.asp?itemID=CMS1240932. To read the entire CMS press release issued on Wed Nov 3, visit http://www.cms.gov/apps/media/press_releases.asp. CMS also issued fact sheets with additional details, available at http://www.cms.gov/apps/media/fact_sheets.asp.
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11. 2011 Payment Changes for Medicare Home Health Services; Final Rule Reflects Improvements to Quality and Efficiency of Care
The Centers for Medicare & Medicaid Services (CMS) issued a final rule to update the Home Health Prospective Payment System (HH PPS) rates for calendar year 2011. This final rule reflects CMS’s ongoing efforts to improve quality of care provided by home health agencies to Medicare beneficiaries. The rule promotes efficiency in payments, implements various Affordable Care Act (ACA) provisions and enhances Medicare’s program integrity. The rule will be published in the Federal Register on Wed Nov 17, 2010; the effective date is Jan 1, 2011.
Home health agency (HHA) payments are estimated to decrease by approximately 4.89 percent – or $960 million – in 2011. This impact accounts for ACA provisions, wage index and market basket updates, and case-mix coding adjustments. Under the new law, the existing home health agency outlier cap becomes permanent and HH PPS rates are reduced by an additional 2.5 percent. The rule mandates that CMS apply a one percentage point reduction to the CY2011 home health market basket amount; this results in a 1.1 percent market basket update for HHAs in CY2011.
To view the rule, visit http://www.cms.gov/HomeHealthPPS/HHPPSRN/itemdetail.asp?itemID=CMS1240989. To read the entire CMS press release issued on Wed Nov 3, visit http://www.cms.gov/apps/media/press_releases.asp. More information is also available at www.healthcare.gov, a new web portal from the US Department of Health and Human Services
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12. Medicare DMEPOS Rules to Take Effect in 2011
The Centers for Medicare & Medicaid Services (CMS) has announced that the following final rule is on display at the Federal Register: “Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2011.” The rule (CMS-1503-FC) can be viewed at http://www.cms.gov/PhysicianFeeSched/PFSFRN/list.asp.
This final rule includes provisions regarding the following DMEPOS subjects that impact the Medicare DMEPOS Competitive Bidding Program:
§ The establishment of an appeals process for competitive bidding contract suppliers that are notified that they are in breach of contract.
§ The subdivision of metropolitan statistical areas (MSAs) with populations over 8,000,000 into smaller competitive bidding areas (CBAs), in particular Chicago, New York and Los Angeles.
§ The addition of 21 MSAs to the 70 MSAs already included in the Round 2 Competitive Bidding program, for a total of 91 MSAs.
§ The addition of the following policies affecting future competitions for diabetic testing supplies following Round 1:
o Revision of the definition of a “mail order” item to include any item shipped or delivered to a beneficiary’s home, regardless of the method of delivery;
o Requirement that bidding suppliers demonstrate that their bid covers types of diabetic testing strip products that, in the aggregate and taking into account volume for the different products, cover at least 50 percent of the types of test strips products on the market; and
o Prohibition of contract suppliers from influencing or incentivizing
beneficiaries to switch types of test strips or glucose monitors.
§ The exemption of off-the shelf orthotics from competitive bidding when provided by a physician to his or her own patients or a hospital to its own patients.
§ The elimination of the lump sum purchase option for standard power wheelchairs furnished on or after January 1, 2011, and adjustments to the amount of the capped rental payments for both standard and complex rehabilitative power wheelchairs.
Appeals Process: We finalized, in the final rule, an appeals process for suppliers who have been notified that they are in breach of their DMEPOS competitive bidding contract. Depending on the circumstances, suppliers initially will either be afforded a process for submitting a corrective action plan or request a hearing prior to termination of the contract. The appeals process will ensure that suppliers have appeal rights and that they receive an opportunity to be heard before their contract is terminated.
Subdivision of the Metropolitan Statistical Areas (MSA): Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) allows us to subdivide MSAs with populations over 8,000,000 into smaller CBAs. We will subdivide the three largest MSAs: Chicago-Naperville-Joliet, IL-IN-WI; Los Angeles-Long Beach-Santa Ana, CA; and New York-Northern New Jersey-Long Island, NY-NJ-PA. We finalized the regulation to subdivide MSAs along county lines as we believe county lines are well-defined and more static.
Addition of 21 MSAs to 70 MSAs: The Affordable Care Act requires that we expand Round 2 of the competitively bidding program by adding an additional 21 of the largest MSAs based on total population to the original 70 already selected for Round 2. We have included this requirement in the regulation.
Diabetic Testing Supplies: MIPPA specifies that a national competition for mail order items and services is to be phased in after 2010. The regulation includes provisions to implement a national mail order competition for diabetic supplies in 2011 that includes all home deliveries while maintaining the local pharmacy pickup choice for beneficiaries. We are also implementing the special “50 percent rule” mandated by MIPPA and implementing an anti-switching requirement as part of the terms of the competitive bidding contract.
Exemption of Off-the Shelf (OTS) Orthotics from CBP: This regulation implements the MIPPA requirement to extend the competitive bidding exception to OTS orthotics furnished by: (1) a physician or other practitioner (as defined by the Secretary) to the physician’s or practitioner’s own patients as part of the physician’s or practitioner’s professional service; or (2) a hospital to the hospital’s own patients during an admission or on the date of discharge from the hospital.
Elimination of Additional Rental Payments: The regulation also solicited comments on whether to maintain the additional rental payments made to contract suppliers when a beneficiary does not continue to get capped rental or oxygen equipment from his or her current supplier.
We received nine public comments on this rule and will take them under consideration for future proposed rulemaking.
In addition to the competitive bidding rules, this regulation addresses the following payment policies for power-driven wheelchairs and oxygen and oxygen equipment:
§ Lump Sum Purchase Option for Standard Power Wheelchairs: Sections 3136(a)(1) and (2) of the Affordable Care Act required revisions to the regulations to eliminate lump sum (up-front) purchase payment for standard power-driven wheelchairs and permit payment only on a monthly rental basis for standard power-driven wheelchairs. For complex rehabilitative power-driven wheelchairs, the regulations will continue to permit payment to be made on a lump sum purchase method or a monthly rental method. Also, payment adjustments required by the statute were made for power-driven wheelchairs under the Medicare Part B DMEPOS fee schedule to pay 15 percent (instead of 10 percent) of the purchase price for the first three months under the monthly rental method and 6 percent (instead of 7.5 percent) for remaining rental months. Payment is based on the lower of the supplier’s actual charge and the fee schedule amount. These changes do not apply to power-driven wheelchairs furnished pursuant to contracts entered into prior to January 1, 2011 as part of the Medicare DMEPOS Competitive Bidding Program.
§ Oxygen and Oxygen Equipment: We have decided not to finalize this proposed revision for situations where a beneficiary relocates on or after the 18th month rental payment and before the 36-month rental at this time due to evidence that beneficiaries who relocate before the 36th month find suppliers to furnish the oxygen and oxygen equipment. We will consider implementing this regulatory change in the future if we determine that beneficiaries are having difficulty locating suppliers when they relocate during the 36-month rental period
These provisions are found in Sections H, N, P, Q, and R of the 2011 Physician Fee Schedule final rule, which is now on display at the Office of the Federal Register. The final rule (CMS-1503-FC) is available at http://www.cms.gov/PhysicianFeeSched/PFSFRN/list.asp.
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13. Medicare DSH Eligibility Data
CMS has developed a limited view of the HIPAA Eligibility Transaction System (HETS) to allow hospitals that receive Medicare Disproportionate Share (DSH) payments to view Medicare enrollment information for their hospital inpatients.
The data available via HETS 270/271 DSH will allow hospitals to verify that patients eligible for Medicaid are not also entitled to Medicare Part A benefits. In addition, hospitals can verify Medicare enrollment for their hospital inpatients, including whether a patient is entitled to Medicare Part A benefits, enrolled in a Medicare managed care plan, or has Medicare as its secondary insurance. HETS 270/271 is an electronic data interchange (EDI) system that uses current ANSI X12 formatting standards. Submitters must connect to HETS 270/271 via the Medicare Data Communication Network (MDCN). Additional information about the HETS 270/271 system, including connectivity and file formatting requirements, is available online at http://www.cms.hhs.gov/hetshelp.
Applicants interested in receiving the HETS 270/271 DSH view may contact the MCARE Help Desk (Monday through Friday, 7am to 9pm EST) at 866-324-7315, or send an email to mcare@cms.hhs.gov for additional information. The MCARE Help Desk will work with you and provide you with all documentation necessary to obtain access to the Medicare DSH view.
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14. October 2010 Quarterly Provider Specific Data Updates
The October 2010 Quarterly Provider Specific Files (PSF) SAS data files and text data files are now available on the CMS website. The SAS data files are available at http://www.cms.hhs.gov/ProspMedicareFeeSvcPmtGen/04_psf_SAS.asp and the text data files are available at http://www.cms.hhs.gov/ProspMedicareFeeSvcPmtGen/03_psf_text.asp, both in the Downloads section.
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15. Healthcare Common Procedure Coding System (HCPCS) Code Set Update
The Centers for Medicare & Medicaid Services is pleased to announce the scheduled release of modifications to the Healthcare Common Procedure Coding System (HCPCS) code set. These changes have been posted to the HCPCS website at http://www.cms.gov/HCPCSReleaseCodeSets/ANHCPCS/list.asp; changes are effective as of the date indicated on the update.
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16. Inpatient Psychiatric Facility PPS RY2011 PC Pricer Update
The Inpatient Psychiatric Facility (IPF) PPS PC Pricer for RY2011 has been updated on the CMS Website to correct commorbidity logic and for claims dates from 2010-10-01 to 2011-06-30. If you use the IPF PPS PC Pricer for RY2011, please visit http://www.cms.hhs.gov/PCPricer/09_inppsy.asp and download the latest versions of the IPF PPS RY2011 PC Pricers, posted Tue Nov 2, for commorbidity logic and posted Wed Nov 3 for claims.
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17. Medicare Remit Easy Print Software Codes Update
Medicare Fee-for-Service Professional Providers and Suppliers: The latest Claim Adjustment Reason Codes and Remittance Advice Remark Codes are available in the Codes.ini file for the MREP software. You can access this file in the zipped folder for “Medicare Remit Easy Print – Version 2.7” at http://www.cms.gov/AccesstoDataApplication/02_MedicareRemitEasyPrint.asp.
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18. 2009 Physician Quality Reporting Initiative Incentive Payment Update
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that incentive payments for the 2009 Physician Quality Reporting Initiative (PQRI) will begin this fall for eligible professionals who met the criteria for successful reporting. Carriers and Medicare Administrative Contractors (MACs) began processing and distributing 2009 PQRI incentive payments on Mon Oct 25. Distribution of 2009 PQRI incentive payments is scheduled to be completed by Fri Nov 12, 2010. Remember that PQRI incentives earned by individual participating physicians and other eligible professionals are paid as a lump-sum to the Taxpayer Identification Number (TIN) under which the professional’s claims were submitted. It is then up to the TIN to decide how to distribute the incentive within the practice.
Effective January 2010, CMS revised the manner in which incentive payment information is communicated to eligible professionals receiving electronic remittance advices. CMS has instructed Medicare contractors to use a new indicator of ‘LE’ to indicate incentive payments instead of ‘LS.’ ‘LE’ will appear on the electronic remit. In an effort to further clarify the type of incentive payment issued (either PQRI or Electronic Prescribing Incentive Program), CMS created a 4-digit code to indicate the type of incentive and reporting year. For the 2009 PQRI incentive payments, the 4-digit code is ‘PQ09.’ This code will be displayed on the electronic remittance advice along with the ‘LE’ indicator. For example, eligible professionals will see ‘LE’ to indicate an incentive payment, along with ‘PQ09’ to identify that payment as the 2009 PQRI incentive payment. Additionally, the paper remittance advice will read, “This is a PQRI incentive payment.” The year will not be included in the paper remittance.
2009 PQRI feedback reports will be available on the Physician and Other Health Care Professionals Quality Reporting Portal at http://www.qualitynet.org/PQRI, starting the second week of November. TIN-level reports on the Portal require an Individuals Authorized Access to CMS Computer Services (IACS) account. Participants may also contact their Carrier/MAC to request individual NPI-level reports via an alternate feedback report fulfillment process. View the Medicare Learning Network (MLN) article at http://www.cms.gov/MLNMattersArticles/downloads/SE0922.pdf for additional details.
Who to Contact for Questions? If you have questions about the status of your PQRI incentive payment (during the distribution timeframe), please contact your Provider Contact Center. The Contact Center Directory is available at http://www.cms.gov/MLNProducts/Downloads/CallCenterTollNumDirectory.zip. Contact the QualityNet Help Desk (7am-7pm CST, at 866-288-8912 or qnetsupport@sdps.org) with any of the following issues:
§ PQRI Portal password issues
§ PQRI/eRx feedback report availability and access
§ PQRI-IACS registration questions
§ PQRI-IACS login issues
Program- and measure-specific questions
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19. November Flu Shot Reminder
Each Office Visit is an Opportunity. Medicare patients give many reasons for not getting their annual flu vaccination, but the fact is that there are an average of 36,000 flu-related deaths in the United States each year, and more than 90% of these deaths occur in people 65 years of age and older. Please talk with your Medicare patients about the importance of getting their annual flu vaccination. This Medicare-covered preventive service will protect them for the entire flu season. And remember, vaccination is important for health care workers too, who may spread the flu to high risk patients. Don’t forget to immunize yourself and your staff. Protect your patients. Protect your family. Protect yourself. Get Your Flu Vaccine – Not the Flu.
Remember – Influenza vaccine plus its administration are covered Part B benefits. Note that influenza vaccine is NOT a Part D covered drug. For information about Medicare’s coverage of the influenza vaccine and its administration, as well as related educational resources for health care professionals and their staff, please visit http://www.cms.gov/MLNProducts/Downloads/Flu_Products.pdf and http://www.cms.gov/AdultImmunizations.
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20. A new “twist” in the law makes it easier to save on your prescription drug costs.
http://www.ssa.gov/prescriptionhelp/
Under a new law, more Medicare beneficiaries could qualify for Extra Help with their Medicare prescription drug plan costs because some things no longer count as income and resources. The Extra Help is estimated to be worth an average of $3,900 per year. To qualify for the Extra Help, a person must be on Medicare, have limited income and resources, and reside in one of the 50 states or the District of Columbia.
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