Medicare and Medicaid Information From Denver, CO

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. New From the Medicare Learning Network

2. News of Benefit to Medicare Beneficiaries

3. Guidelines for Teaching Physicians, Interns, and Residents

4. Open Door Forum Updates

5. Clarification of MIPPA Guidance for DME Accreditation

6. Medicare Premiums, Deductibles for 2009

7. CMS to Host ICD-10-CM/PCS National Provider Conference Calls

8. A New CMS Initiative That Helps to Assist and Identify Individuals Who Care for Medicare Beneficiaries as Caregivers

9. New Rules to Enforce Marketing Requirements During Upcoming Health and Drug Plan Enrollment Period

10. Your Medicare Payments Being Reduced If the IRS Needs to Collect Overdue Taxes That You Owe

11. Medicare Part B Drugs Average Sales Price Files – October 2008

12. Home Health PPS Grouper Update

13. Physician Payment Information for Value-Driven Health Care

14. Update of the Hospital-Acquired Conditions(HAC) & Present on Admission (POA) Indicator Reporting Website

15. CMS Selection of First Coast Service Options, Inc. to Administer Medicare Claims Payment in Florida, Puerto Rico, and U.S. Virgin Islands

16. Extra Help for Beneficiaries Paying for Prescription Drugs





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1. New From the Medicare Learning Network

The revised Guidelines for Teaching Physicians, Interns, and Residents (July 2008), which provides information about payment for physician services in teaching settings, general documentation guidelines, and evaluation and management documentation guidelines, is now available in downloadable format from the Medicare Learning Network at
http://www.cms.hhs.gov/MLNProducts/downloads/gdelinesteachgresfctsht.pdf.

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Just a reminder that the Medicare Learning Network web-based training courses and product ordering web page are currently unavailable on the CMS website while we perform system maintenance and upgrades. We expect the system will be available again around 10/1/2008. Thank you for your interest in the Medicare Learning Network. If you have any questions, please send them to MLN@cms.hhs.gov.
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2. News of Benefit to Medicare Beneficiaries

State Health Insurance Assistance Program Receives Performance Award

The Centers for Medicare & Medicaid Services (CMS) recently announced that State Health Insurance Assistance Program (SHIPs) will receive a $1.5 million in additional funding to be awarded based on their performance during the prior year. SHIP Performance Award based on the SHIPs’ outstanding achievements the prior year in serving Medicare beneficiaries, CMS is providing these additional funds to expand their services.

The SHIPs provide Medicare beneficiaries counseling and benefits information at the state and local level. SHIP counselors can help answer beneficiaries’ questions related to Medicare, Medicare Supplement Insurance, Medicare Advantage, prescription coverage, and low-income assistance. SHIPs can provide tools and information to help beneficiaries make decisions regarding their health care.

CMS works with a network of staff and volunteers to help SHIPs provide services to improve the health care of people with Medicare. For more information about SHIP local activities in your area, visit www.SHIPTalk.org.

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CMS EXPANDS PERSONAL HEALTH RECORD PILOT IN SOUTH CAROLINA TO INCLUDE DATA FROM TRICARE
The Centers for Medicare & Medicaid Services (CMS) recently announced an expansion of the South Carolina Personal Health Record pilot (MyPHRSC) to include TRICARE health data.
An interagency agreement between CMS and the Department of Defense (DoD) will enable beneficiaries who have original Medicare and also receive TRICARE benefits to be offered the option of adding TRICARE health data to their MyPHRSC personal health records (PHRs). This data has only been available to the beneficiary through the DoD Medical Information Technology systems until this point.
"This exciting pilot expansion will be a major step forward for Medicare and DoD. We believe that collaborations of this sort will provide more complete information and better tools to empower consumers to manage their health," CMS Acting Administrator Kerry Weems said. “We expect this pilot, which brings data together from multiple sources, can be combined successfully to provide the beneficiary with access to more complete personal health records.”
The PHR tool selected for the MyPHRSC was created by HealthTrio, which currently offers PHRs to thousands of individuals through employer contracts. The Medicare data is provided through Palmetto GBA, a Medicare contractor serving the region that includes South Carolina. The pilot is being managed by QSSI, a company that specializes in information technology solution development and headquartered in Gaithersburg, Md. The pilot is accepting enrollment online at www.MyPHRSC.com.
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3. Guidelines for Teaching Physicians, Interns, and Residents

The revised Guidelines for Teaching Physicians, Interns, and Residents (July 2008), which provides information about payment for physician services in teaching settings, general documentation guidelines, and evaluation and management documentation guidelines, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at
http://www.cms.hhs.gov/MLNProducts/downloads/gdelinesteachgresfctsht.pdf.
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4. Open Door Forum Updates

The next CMS Physicians, Nurses & Allied Health Professionals Open Door Forum is scheduled for:
Date: October 7, 2008
Start Time: 2:00 PM Eastern Daylight Time (EDT)
[Please dial in at least 15 minutes before call start time.]

Conference Leader(s): Jeffrey Rich, M.D./Bill Rogers, M.D./Mark Gilbert/Natalie Highsmith

Open Door Participation Instructions:

There are 2 ways to participate, by phone or onsite.

1. To participate by phone:

Dial: 1-800-837-1935 & Reference Conference ID 58370420
**Persons participating by phone do not need to RSVP. **

Note: TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880 and for Internet Relay services click here http://www.consumer.att.com/relay/which/index.html .
A Relay Communications Assistant will help.

2. To participate onsite:

Your RSVP is required.

Please send a reply to CMS PHYSICIANODF-L@cms.hhs.gov, by 2:00 PM EDT, October 3, 2008. Be sure to include the title of the forum "Physician ODF" in the subject line of your message, and send us the following information:
a) Your first & last name
b) Your organization or representation
c) Your telephone number

Please arrive no later than 1:30 p.m.

ADDRESS:
Hubert H. Humphrey Bldg.
200 Independence Avenue S.W.
Washington, D.C. 20201
Map & Directions: http://www.hhs.gov/about/hhhmap.html

ENCORE: 1-800-642-1687; Conf. ID# 58370420
Encore is a recording of this call that can be accessed by dialing 1-800-642-1687 and entering the Conf. ID., beginning 2 hours after the call had ended. The recording will be available for 3 business days.

For Forum updates, Mailing List subscription and Frequently Asked Questions please visit our website at www.cms.hhs.gov/opendoorforums.
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5. Clarification of MIPPA Guidance for DME Accreditation

On September 3, 2008, CMS announced those DMEPOS providers that are exempt from meeting the quality standards for DMEPOS accreditation. CMS, at that time, stated that Orthotists, Prosthetists, and Pedorthotists are included in that exemption. CMS will issue a notice of proposed rulemaking in 2009 that will define quality standards designed specifically for anyone furnishing or providing orthotics and prosthetics in order to be reimbursed for such supplies and services under Medicare Part B.
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6. Medicare Premiums, Deductibles for 2009

The standard Medicare Part B monthly premium will be $96.40 in 2009, the same as the Part B premium for 2008. This is the first year since 2000 that there was no increase in the standard premium over the prior year.

The 2009 Part B premium of $96.40 is the same as the amount projected in the 2008 Medicare Trustees Report issued in March. This monthly premium paid by beneficiaries enrolled in Medicare Part B covers a portion of the cost of physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and other items.

By law, the standard premium is set to cover approximately one-fourth of the average cost of Part B services incurred by beneficiaries aged 65 and over. The remaining Part B costs are financed by Federal general revenues. The income to the program from premiums and general revenues are paid into the Part B account of the Supplementary Medical Insurance trust fund, and Part B expenditures are drawn from this account.

To view this Fact Sheet in its entirety go to: http://www.cms.hhs.gov/apps/media/press/factsheet.asp?Counter=3272&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date
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7. CMS to Host ICD-10-CM/PCS National Provider Conference Calls

ICD-10-CM/PCS National Provider Conference Calls With Question & Answer Session

The Centers for Medicare & Medicaid Services (CMS) will host a series of national provider calls (see below) that will provide an overview of ICD-10 and how it differs from ICD-9-CM. The presentations will include the major impacts providers should consider when planning to update any systems with ICD-10 codes. Issues such as differences in code length, alpha-numeric characters, and increased details captured by the codes will be explained. For the provider, payer, vendor, and publishing community, this overview will help them think about future reporting, system updates, and training, considering that ICD-10 may be implemented in the future.

The presenters will include members of the Cooperating Parties for ICD-9-CM, a formal coalition that has been working together on ICD-10 issues. The role of each will be explained, along with a similar role they will play should ICD-10 be implemented. The Cooperating Parties include CMS, Centers for Disease Control and Prevention (CDC), American Health Information Management Association (AHIMA), and American Hospital Association (AHA).

A PowerPoint slide presentation has been posted on the ICD-10 Web Page at http://www.cms.hhs.gov/ICD10 for you to download prior to the conference call so that you can follow along with the presentation.

Conference Call Details:
Separate conference calls have been scheduled for each provider type. The same information will be presented at each conference call. Participants may select one of the times listed below to attend a conference call. Select the appropriate link below, according to your provider type, to register for a conference call.

Provider Type Date and Time of Conference Call

Hospital Staff October 14, 2008 12:30 p.m. – 2:30 p.m. EDT To register go to http://www.cms.hhs.gov/ICD10/downloads/ICD10_hospital.pdf.

Other Part A and November 12, 2008 12:30 p.m. – 2:30 p.m. EST Part B Providers
Registration information for this conference call will be forthcoming.

Physicians November 17, 2008 12:30 p.m. – 2:30 p.m. EST Registration information for this conference call will be forthcoming.

For those who are unable to attend, a transcript will be posted on the ICD-10 Web Page at http://www.cms.hhs.gov/ICD10 shortly after the conference call.
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8. A New CMS Initiative That Helps to Assist and Identify Individuals Who Care for Medicare Beneficiaries as Caregivers

Ask Medicare provides online information, tools, and materials for caregivers

The Centers for Medicare & Medicaid Services (CMS) recently launched Ask Medicare, a new initiative to help family caregivers--those who are family members or friends who help people with Medicare access and use valuable healthcare information, services and resources.

More than 44 million Americans, more than one in five adults, provide care to a loved one, friend or neighbor, valued in economic terms at $350 billion annually, according to a recent report by AARP. The new initiative will provide a one-stop Web page for caregivers www.medicare.gov/caregivers that provides easy access to useful information about Medicare and other essential resources to help with caregiving. Most caregivers do not think of or identify themselves as caregivers; yet so many of the resources available to them use that term.

The Ask Medicare Website will provide links to key partner organizations that assist caregivers and beneficiaries, and present personal stories from caregivers in the community. Support information and tools to help caregivers address common problems will also be available. As part of the initiative, CMS will launch an e-newsletter for caregivers that will deliver information into subscribers’ email boxes.

For more information about Medicare’s new caregiver initiative, please visit: www.medicare.gov/caregivers.

To read the CMS press release issued on September 18, 2008, click here: http://www.cms.hhs.gov/apps/media/press_releases.asp
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9. New Rules to Enforce Marketing Requirements During Upcoming Health and Drug Plan Enrollment Period

The two regulations issued today include prohibitions on telemarketing and other unsolicited sales contacts. The new rules also prohibit financial incentives that could encourage agents and brokers to maximize commissions by inappropriately moving, or churning, beneficiaries from one plan to another each year. Plans must be in compliance with these provisions when they begin their marketing activities on October 1.

The final rule implementing MIPPA marketing requirements may be viewed at http://www.cms.hhs.gov/HealthPlansGenInfo/.

The Interim Final Rule dealing with agent commissions and other MIPPA provisions may be viewed at http://www.cms.hhs.gov/HealthPlansGenInfo/.
Comments are due at 5:00 p.m. Eastern time on November 15, 2008.

Guidance for MA plans under Part C and PDPs under Part D plans may be viewed at http://www.cms.hhs.gov/HealthPlansGenInfo/Downloads/MIPPA_Imp_memo091208Final.pdf

Fact Sheets with more information on each rule may be viewed at http://www.cms.hhs.gov/apps/media/fact_sheets.asp.

To read more of the CMS press release issued 9/15/08 click here: http://www.cms.hhs.gov/apps/media/press_releases.asp
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10. Your Medicare Payments Being Reduced If the IRS Needs to Collect Overdue Taxes That You Owe

THIS IS A REMINDER: Beginning October 1, 2008 Your Medicare Payments Could Be Reduced If The Internal Revenue Service (IRS) Needs To Collect Overdue Taxes That You Owe

The Taxpayer Relief Act of 1997, Section 1024, authorizes the IRS to reduce certain federal payments, including Medicare payments, to allow collection of overdue taxes. Should you owe such taxes and your payments are reduced, your remittance advice will reflect a provider level adjustment code (PLB) of “WU” in the PLB03-1 data field. For more information, please see MLN Matters Article #MM6125 available at:
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6125.pdf
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11. Medicare Part B Drugs Average Sales Price Files – October 2008

The Centers for Medicare & Medicaid Services (CMS) has made available the Medicare Part B Drug and Biological Average Sales Price (ASP) Payment Amounts for October 1, 2008 to December 31, 2008 on the CMS website at http://www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/01a_2008aspfiles.asp#TopOfPage. The files are located in the "Downloads" section of this web page.
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12. Home Health PPS Grouper Update

The Centers for Medicare & Medicaid Services (CMS) has updated the Home Health (HH) PPS Grouper due to changes in ICD-9-CM coding (effective October 1, 2008). CMS is providing an updated HH PPS Grouper Software Package (Version 2.03). The package includes the updated GROUPER.DLL software module, an updated version of the grouper logic (pseudocode) and associated tables, and updated test cases to be used by those who are developing their own software to implement the grouper logic. The changes to the grouper are described in the README file (READM203.PDF) which is also included. This package is available at http://www.cms.hhs.gov/HomeHealthPPS/05_CaseMixGrouperSoftware.asp in the Downloads section.
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13. Physician Payment Information for Value-Driven Health Care

To support the delivery of high-quality, efficient health care and enable consumers to make more informed health care decisions, President Bush directed the U.S. Department of Health and Human Services to make cost and quality data available to all Americans. As a first step in this initiative, Medicare posted information in 2006 about the payments it made during the previous year for common and elective procedures and services provided by Hospitals, Ambulatory Surgery Centers (ASCs), Hospital Outpatient Departments, and Physicians. Medicare updated the information in 2007.

Earlier this year, Medicare updated the Hospital information and moved it to the Hospital Compare Website where it can be viewed along with hospital quality information. The Hospital compare website may be found at www.medicare.gov.
The ASC payment information was updated on August 22, 2008, and on September 23, 2008, Medicare posted an update to last year's physician services data. This information is being displayed in the same format as last year, updated with calendar year (CY) 2007 data. The posting update may be found at: www.cms.hhs.gov/HealthCareConInit/. Medicare will update the Hospital Outpatient Department payment information later this fall.

Medicare will continue to publicly report updates to this payment information as part of its commitment to enable consumers to compare the quality and price of health care services so that they can make informed choices about their providers, services, and treatments. Medicare also continues to expand the quality information it publicly reports for hospitals, nursing homes, dialysis facilities, home health agencies, Medicare Advantage and Part D plans and is considering options for reporting quality information for physicians. All of the quality information is available on the CMS Compare websites at www.medicare.gov.
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14. Update of the Hospital-Acquired Conditions(HAC) & Present on Admission (POA) Indicator Reporting Website

The Centers for Medicare & Medicaid Services (CMS) has recently updated all sections of the Hospital-Acquired Conditions (HAC) & Present on Admission (POA) Indicator Reporting website to describe the changes published in CMS’ Inpatient Prospective Payment System (IPPS) Fiscal Year (FY) 2009 Final Rule. The HAC & POA Indicator information is available at http://www.cms.hhs.gov/HospitalAcqCond/ on the CMS website.
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15. CMS Selection of First Coast Service Options, Inc. to Administer Medicare Claims Payment in Florida, Puerto Rico, and U.S. Virgin Islands

The Centers for Medicare & Medicaid Services (CMS) recently announced that First Coast Service Options, Inc. (FCSO) has been awarded a contract of up to five years for the combined administration of Part A and Part B Medicare claims payment in Florida, Puerto Rico, and U.S. Virgin Islands.

“With this award, CMS continues its progress in reengineering the way in which the government contracts for claims administration for the largest part of the Medicare program. CMS is seeking the best value, from a cost and technical perspective for this critical function,” said Acting CMS Administrator Kerry Weems. “This is another step toward improving services to beneficiaries and providers who are in the Medicare fee-for-service benefit plan.”

FCSO will serve as the first point of contact for the processing and payment of Medicare fee-for-service claims from hospitals, skilled nursing facilities, physicians and other health care practitioners in Florida, Puerto Rico and the U.S. Virgin Islands. The new Part A/Part B Medicare Administrative Contractor (A/B MAC) was selected using competitive procedures in accordance with federal procurement rules. The entire press release may be viewed at: http://www.cms.hhs.gov/apps/media/press_releases.asp
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16. 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: https://s044a90.ssa.gov/apps6z/i1020/main.html 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 http://www.medicare.gov/contacts/static/allStateContacts.asp or by calling
1-800-MEDICARE.
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Lucretia James
Centers for Medicare & Medicaid Services
Region VIII
1600 Broadway, Suite 700
Denver, CO 80202
(303) 844-1568
lucretia.james@cms.hhs.gov