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. Medicare Part B Drug Competitive Acquisition Program: Feedback about the CAP – A Special Open Door Forum Teleconference on the 2009 CAP Postponement and How to Submit E-mail Comments
2. Medicare Part B Drug Competitive Acquisition Program (CAP) Updates
3. Reminder – ICD-10-CM/PCS National Provider Conference Call for Physicians and
Providers Who Missed Previous Calls
4. Agent Compensation Requirements for Medicare Advantage & Prescription Drug Programs
5. Call for Public Comment to CMS on Preliminary Imaging Efficiency Measures
6. Hospital Quality Alliance/Reporting Hospital Quality Data for Annual Payment Update Patient-Level Submission Deadline Postponed Until November 21st
7. CMS Identifies 15 Chronic Conditions for Medicare Special Needs Plans
8. Updates to Inpatient Psychiatric Facility PPS PC Pricer
9. Posting of Modifications to the HCPCS Code Set
10. New From the Medicare Learning Network
11. November Flu Shot Reminder
12. Extra Help for Beneficiaries Paying for Prescription Drugs
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1. Medicare Part B Drug Competitive Acquisition Program: Feedback about the CAP – A Special Open Door Forum Teleconference on the 2009 CAP Postponement and How to Submit E-mail Comments
The Centers for Medicare & Medicaid Services (CMS) is soliciting public feedback about the CAP. CMS is interested in hearing about a range of issues, including, but not limited to:
§ the categories of drugs provided under the CAP
§ the distribution of areas that are served by the CAP
§ procedural changes that may increase the program's flexibility and appeal to potential vendors and physicians.
On December 3, 2008, CMS will host a Special ODF Teleconference to obtain feedback about the program. This teleconference will be a listening session and is intended for current and former participating CAP physicians, potential Approved CAP Vendors, and any other interested parties. CMS will assess the information that it receives as it considers implementing changes to the CAP.
Call Details:
Date and Time: December 3, 2008 from 2:00-3:30PM EST
Toll Free Call Number: (800) 837-1935
Conference ID: 66307647
Interested parties can also submit comments to the CAP e-mailbox at MMA303DDrugBid@cms.hhs.gov
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2. Medicare Part B Drug Competitive Acquisition Program (CAP) Updates
Upcoming Training for the Medicare Part B Drugs Competitive Acquisition Program (CAP)
Noridian Administrative Services, the designated carrier for the CAP, offers interactive, online workshops about the CAP for Part B Drugs and Biologicals. These workshops train CAP vendors and elected physicians on a variety of CAP topics, including how to transition out of the CAP at the end of 2008 due to the postponement of the program for 2009. NAS staff will also be available to answer questions. Interested parties may view additional information about and register for these workshops on the Noridian website at:
https://www.noridianmedicare.com/cap_drug/train/schedule.html
A workshop will be held on the following date:
11/24/08 at 2:00 pm CST
Additional information about the CAP and the 2009 postponement is available at: http://www.cms.hhs.gov/CompetitiveAcquisforBios/01_overview.asp
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September 18, 2008 Ask the Contractor Teleconference PowerPoint Presentation
On September 18, 2008, the Centers for Medicare & Medicaid Services (CMS) hosted an ‘Ask the Contractor’ teleconference for Medicare Part B Drug Competitive Acquisition Program (CAP) physicians to discuss the postponement of the CAP for 2009 and to assist participating CAP physicians in planning for the transition out of the program. This event was moderated by Noridian Administrative Services (NAS), the CAP Designated Carrier.
The PowerPoint slide presentation for this teleconference is available in the ‘Training and Events’ section on the NAS website at: https://www.noridianmedicare.com/cap_drug/train/act.html
Additional information about the CAP and the 2009 CAP Postponement is available on the following CMS website at: http://www.cms.hhs.gov/CompetitiveAcquisforBios/.
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3. Reminder – ICD-10-CM/PCS National Provider Conference Call for Physicians and Providers Who Missed Previous Calls
Physicians and providers who were unable to attend the previous two ICD-10-CM/PCS conference calls may now register for the Centers for Medicare & Medicaid Services ICD-10-CM/PCS National Provider Conference Call that will be conducted on November 17, 2008 from 12:30 p.m. – 2:30 p.m. EST. Registration will close at 12:30 p.m. EST on November 16, 2008 or when available space has been filled. To register for this call, go to http://www.cms.hhs.gov/icd10/Downloads/Physicians_ICD10_CM_PCS_Conference_Call.pdf. To find additional information about this conference call and to access the ICD-10 Overview Presentation that will be discussed during the call, go to http://www.cms.hhs.gov/ICD10/07_Sponsored_Calls.asp
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4. Agent Compensation Requirements for Medicare Advantage & Prescription Drug Programs
The Centers for Medicare & Medicaid Services (CMS) recently issued revised compensation requirements for sales agents and brokers who sell Medicare Advantage and prescription drug benefit plan options to people with Medicare.
This CMS interim final rule with comment period modifies regulations issued on Sept. 18, 2008. Those regulations established how health and drug plans should structure the compensation for agents and brokers by reducing existing financial incentives to enroll a beneficiary in a new plan based on the agent’s or broker’s financial interests rather than the beneficiary’s health care needs. The Sept. 18 regulations required that compensation be paid on a six-year cycle, comprised of an initial enrollment year and five renewal years, and that the renewal rate be paid for a beneficiary changing plans during the renewal years. Compensation includes commissions and bonuses as well as other incentives, such as sales awards.
To read more about how this rule revises the Sept. 18 regulations, click here to read the entire CMS press release: http://www.cms.hhs.gov/apps/media/press_releases.asp
Comments to the must be submitted by 5:00 p.m. Eastern Standard Time on December 15, 2008.
The interim final rule with comment and guidance document will be available at: http://www.cms.hhs.gov/HealthPlansGenInfo/
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5. Call for Public Comment to CMS on Preliminary Imaging Efficiency Measures
The Centers for Medicare & Medicaid Services (CMS) through The Lewin Group and its subcontractors, the National Imaging Associates, Inc., (NIA) and Dobson | DaVanzo & Associates, LLC, is developing a preliminary set of outpatient imaging efficiency measures.
We would like to invite you to review and comment on these measures during the 30-day public comment period that begins on November 15, 2008, and will run through December 14, 2008. Please note that while the team will make every effort to consider and incorporate all comments, CMS will be making any and all determinations on the final measure set, including if or how they will be used in CMS program activities.
To review the measures and submit comments, please go to:
http://www.imagingmeasures.com
We would also like to encourage you to forward this message and link to any colleagues or organizations you believe would be interested in reviewing and commenting on the measures.
Thank you in advance for your interest and contributions as we work to improve this preliminary measure set. We are looking forward to hearing from you.
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6. Hospital Quality Alliance/Reporting Hospital Quality Data for Annual Payment Update Patient-Level Submission Deadline Postponed Until November 21st
The Centers for Medicare & Medicaid Services (CMS) has extended the patient-level data transmission deadline for hospitals participating in the Hospital Quality Alliance (HQA): Improving Care through Information and/or the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) initiative(s). This extension allows sufficient time for hospitals to submit both OPPS and IPPS clinical patient-level data to the warehouse.
Inpatient clinical patient-level data can be transmitted via My QualityNet to the QIO Clinical Data Warehouse (CDW) for 2nd quarter 2008 (April 1 through June 30, 2008) discharges through 11:59 P.M. Central Standard Time, Friday, November 21, 2008.
Please refer to the QualityNet website (http://www.qualitynet.org/ for more information about the HOP QDRP program.
Please notify your internal point of contact if you have any questions. He or she may contact the QualityNet Help Desk if additional information and/or assistance are needed.
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7. CMS Identifies 15 Chronic Conditions for Medicare Special Needs Plans
Beginning in 2010, Medicare Advantage Special Needs Plans (SNPs) that serve Medicare beneficiaries with chronic conditions must meet new guidelines recently issued by the Centers for Medicare & Medicaid Services (CMS).
Special needs plans are a type of Medicare Advantage plan that serve only beneficiaries living in institutions, eligible for both Medicare and Medicaid, or living with severe or disabling chronic conditions. The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) directed CMS to convene a panel of clinical advisors to determine the specific chronic conditions that met the MIPAA statutory definition of a severe or disabling chronic condition in regard to SNPs.
The panel’s recommendations were based on public input and panelists’ clinical experience, as well as the prevalence of these conditions among people with Medicare. The report can be found at www.cms.hhs.gov/SpecialNeedsPlans/.
To read the CMS press release issued 11/13 click here: http://www.cms.hhs.gov/apps/media/press_releases.asp
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8. Updates to Inpatient Psychiatric Facility PPS PC Pricer
The Centers for Medicare & Medicaid Services (CMS) has updated the Inpatient Psychiatric Facility (IPF) PPS PC Pricer for FY 2009. If you use the IPF PC Pricer, please go to the web page at http://www.cms.hhs.gov/PCPricer/09_inppsy.asp#TopOfPage and down load the FY 2009 version posted on 11/05/2008.
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9. Posting of Modifications to the HCPCS Code Set
The Centers for Medicare and Medicaid Services has reposted the recent scheduled release of modifications to the Healthcare Common Procedure Coding System (HCPCS) code set to incorporate new changes. The revised update has been posted to the HCPCS website at: http://www.cms.hhs.gov/HCPCSReleaseCodeSets/ANHCPCS/list.asp#TopOfPage .
The re-posted version includes changes to Current Dental Terminology (CDT) codes contributed by the American Dental Association (ADA) with their scheduled 2008 Update.
In addition, the following changes have been made:
E0764 - Language revised
E0770 - Coverage Indicator changed
Q4114 - Language revised
Please refer to the re-posted Annual Update for specific details.
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10. New From the Medicare Learning Network
The revised publication, 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 print format from the Centers for Medicare & Medicaid Services Medicare Learning Network. To place your order, visit http://www.cms.hhs.gov/MLNProducts/01_Overview.asp, scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page.”
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What to Expect In the New Medicare Administrative Contractor (MAC) World! A new MLN Matters provider education article entitled “Preparing for a Transition from an FI/Carrier to a Medicare Administrative Contractor (MAC)” is now available on the MLN website @ http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0837.pdf . This Special Edition article assists all providers who will be affected by Medicare Administrative Contractor (MAC) implementations. This article alerts providers as to what to expect as your FI or carrier transitions its work to a MAC and how to prepare for the MAC implementations. We hope that this article will help to minimize any disruption in your Medicare business as you go through these implementations.
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The Centers for Medicare & Medicaid Services has released the following Special Edition MLN Matters article, SE0838, 2008 - 2009 Influenza (Flu) Season Resources for Health Care Professionals, located at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0838.pdf, on the CMS website. This article provides fee-for-service Medicare providers and their staff with access to a variety of seasonal flu related educational resources that they can use during the 2008 - 2009 flu season.
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Would you like to stay informed of the educational products from the Medicare Learning Network (MLN)? If so, you can join the MLN Education Products mailing list, which will deliver the latest information about new and revised MLN products, right to your inbox. Here’s how to join:
Visit https://list.nih.gov/cgi-bin/wa?SUBED1=mln_education_products-l&A=1
Enter your email address and full name.
Click “Join the List”.
Follow the instructions in the confirmation email you will receive to confirm your subscription to the list. (Note, the sender of this email will appear as “NIH LISTSERV SERVER”)
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11. November Flu Shot Reminder
“Flu season is here! Medicare patients give many reasons for not getting their annual flu shot, including—“It causes the flu"; "I don’t need it"; "It has side effects"; "It’s not effective"; "I didn’t think about it"; "I don’t like needles!” The fact is that every year in the United States, on average, about 36,000 people die from influenza. Greater than 90 percent of these deaths occur in individuals 65 years of age and older. You can help your Medicare patients overcome these odds and their personal barriers through patient education. Talk with your Medicare patients about the importance of getting an annual flu shot--and don’t forget to immunize yourself and your staff. Protect yourself, your patients, and your family and friends. Get Your Flu Shot – 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 virus vaccine and its administration as well as related educational resources for health care professionals and their staff, please go to http://www.cms.hhs.gov/MLNProducts/Downloads/flu_products.pdf on the CMS website. To download the Medicare Part B Immunization Billing quick reference chart, go to http://www.cms.hhs.gov/MLNProducts/downloads/qr_immun_bill.pdf on the CMS website. A copy of this quick reference chart can be ordered, free of charge, by going to the MLN Products web page and clicking on “MLN Product Ordering Page” in the Related Links Inside CMS section of the web page.
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12. 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
Professor Emeritus -- Dr. Tom Seymour from West Fargo, North Dakota -- Professor, Minot State University, MSU Faculty Regents Award (2015) -- PAST Peer Reviewer (Higher Learning Commission - Chicago); - Author and Presenter Board of Directors, SRT Communications, Inc and Minot City Alderman - Ward 5 (2010-June, 2016) PAST - Editor-in-Chief (North Dakota State Senator (2002-2010) 2017-Cass County Electric Cooperative- Board of Directors
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