Medicare Update

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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. ESRD News

2. Holding of Certain Screening Pap Smear Claims Billed by OPPS Providers

3. Extra Help for Beneficiaries Paying for Prescription Drugs


1. ESRD News

Updated ESRD PC Pricer Now Available

The Centers for Medicare & Medicaid Services (CMS) has updated the PC Pricer web page at ( to include an ESRD PC Pricer that uses the same pricing logic as the Medicare claims processing system. This version of the software will replace the current version (referred to as the ESRD Calculator) in January 2009. Both pricing tools will continue to be available through the end of this calendar year. The CMS is encouraging renal dialysis facilities to download the updated version of the ESRD PC Pricer and begin familiarizing themselves with it as soon as possible. Feedback on the latest version of this PC Pricer should be directed to

Sunset of ESRD Final Rule Rollout Mailbox
Thank you to all of our colleagues in the renal care community who submitted questions to the Centers for Medicare & Medicaid Services (CMS) about our recently released ESRD Conditions for Coverage final rule. We received a good number of interesting and important questions from you to our ESRD Final Rule Rollout mailbox. In response to these inquiries, we have already provided many of you with individual responses to your questions; however, to share the benefit of these questions with the entire community, CMS is working on a “Frequently Asked Questions” document that will condense many of the questions we received through the mailbox. That document will be posted online in the coming weeks—we will let you know once it is available for public download.

With the imminent publication of our “Frequently Asked Questions” document, we have decided to sunset the ESRD Final Rule Rollout mailbox. As of September 1, we will no longer monitor the mailbox for new questions.

For more information about the new rule, please visit us online at If you have an immediate inquiry, please contact Lauren Oviatt at

2. Holding of Certain Screening Pap Smear Claims Billed by OPPS Providers

Due to systems issues related to an incorrect deductible and coinsurance assignment of Screening Pap Smears claims containing Healthcare Common Procedure Coding (HCPCS) code Q0091, (Screening Papanicolaou (Pap) smear, obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) on OPPS claims, effective immediately, CMS will be instructing their contractors to hold all claims containing HCPCS code Q0091 submitted by OPPS facilities. These claims will be held by contractors until the successful implementation of the Outpatient Code Editor (OCE), scheduled for January 5, 2009. In the interim, OPPS facilities may choose not to submit HCPCS code Q0091 until the successful implementation of the OCE, in order to avoid a delay in reimbursement for other services submitted on the claim. Interest will be paid on clean claims held longer than 30 days after the date of receipt.

3. Extra Help for Beneficiaries Paying for Prescription Drugs

Do You Know Someone Who Is Having Trouble Paying For Prescription Drugs?
Medicare Can Help!

If an individual has limited income and resources, they may qualify for extra help from Medicare. It could be worth over $3,300 in savings on prescription drug costs per year.
Encourage people with Medicare to file for Extra Help online: or by calling Social Security at 1-800-772-1213 to apply over the phone.
State Health Insurance Information Program (SHIP) offices can assist with the application. Find contact information for a local SHIP Counselor at or by calling

Lucretia James
Centers for Medicare & Medicaid Services
Region VIII
1600 Broadway, Suite 700
Denver, CO 80202
(303) 844-1568

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