Medicare Report

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. Physicians May Earn Pay Boost of Up to 5.1 Percent from MIPPA Update Plus E-Prescribing and PQRI Incentives



3. Update Notice for HH PPS



4. Announcement of New Oxygen Payment Rules and Supplier Responsibilities



5. Announcement of Plans to Bolster Quality of Care in Hospital Outpatient Departments



6. ICD-10-CM/PCS National Provider Conference Calls



7. Medicare Value-Based Purchasing Program for Physician and Other Professional Services Listening Session



8. Medicare Summary Notice (MSN) Update



9. Medicare Prescription Drug Event Data Overview



10. October Flu Shot Reminder



11. Extra Help for Beneficiaries Paying for Prescription Drugs









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1. New From the Medicare Learning Network



The revised Medicare Physician Guide: A Resource for Residents, Practicing Physicians, and Other Health Care Professionals (October 2008), which offers general information about the Medicare Program, becoming a Medicare provider or supplier, Medicare reimbursement, Medicare payment policies, evaluation and management services, protecting the Medicare Trust Fund, inquiries, overpayments, and appeals, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/physicianguide.pdf .

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2. Physicians May Earn Pay Boost of Up to 5.1 Percent from MIPPA Update Plus E-Prescribing and PQRI Incentives



The Centers for Medicare & Medicaid Services (CMS) yesterday announced a new initiative for physicians to trade in their prescription pads and improve efficiency and safety when ordering drugs for patients with Medicare. The initiative is included in the Medicare Physician Fee Schedule (MPFS) final rule for calendar year 2009. To view the Press Release, go to the web page at http://www.cms.hhs.gov/apps/media/press_releases.asp.



A copy of the final rule (CMS-1403-FC) is available at: http://www.cms.hhs.gov/PhysicianFeeSched/PFSFRN/itemdetail.asp?filterType=none&filterByDID=0&sortByDID=4&sortOrder=descending&itemID=CMS1216674&intNumPerPage=10

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3. Update Notice for HH PPS



The Centers for Medicare & Medicaid Services (CMS) issued a notice to update the Home Health Prospective Payment System (HH PPS) for calendar year (CY) 2009. Medicare payments to home health agencies will increase by an estimated additional $30 million next year as a result of a 2.9 percent increase in the annual market basket calculation of the cost of goods and services included in providing services under the HH PPS. The update also accounts for a 2.75 percent reduction to the HH PPS rates (the 2nd year of a 4-year phased in reduction) to account for the changes in case-mix that are unrelated to patient’s health status, and an updated 2009 wage index.



A copy of the notice (CMS-1555-N) is available on the CMS website at: http://www.cms.hhs.gov/center/hha.asp .

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4. Announcement of New Oxygen Payment Rules and Supplier Responsibilities



The Centers for Medicare & Medicaid Services (CMS) has announced new oxygen payment rules and supplier responsibilities required by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). These final rules are found in the regulation titled “Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B (CMS-1403-FC),” which is now on display at the Office of the Federal Register.

Visit the CMS website at www.cms.hhs.gov/center/dme.asp to view the rule and obtain additional information.

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5. Announcement of Plans to Bolster Quality of Care in Hospital Outpatient Departments



The Centers for Medicare & Medicaid Services (CMS) recently announced plans to strengthen the tie between the quality of care furnished to people with Medicare in hospital outpatient departments (HOPDs) and the payments hospitals receive for those services. In a final rule establishing Medicare payment and policy changes for services in HOPDs and ambulatory surgical centers (ASCs) for calendar year (CY) 2009, CMS reiterates its commitment to implementing Value Based Purchasing (VBP) initiatives across the continuum of beneficiaries’ care and transforming Medicare from a passive payer to a prudent purchaser of health care.



The final Outpatient Prospective Payment System/Ambulatory Surgical Center Payment System (OPPS/ASC) rule also includes a 3.6 percent annual inflation update for HOPDs; and adopts changes to payment policies for HOPDs and Ambulatory Surgical Centers (ASCs) beginning on January 1, 2009. The law sets the ASC update for CY 2009 at 0 percent.



To view the entire Press Release, go to http://www.cms.hhs.gov/apps/media/press_releases.asp .



A copy of the final rule (CMS-1404-FC) is available at

http://www.cms.hhs.gov/HospitalOutpatientPPS/HORD/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=3&sortOrder=descending&itemID=CMS1216689&intNumPerPage=10 .

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6. ICD-10-CM/PCS National Provider Conference Calls



ICD-10-CM/PCS National Provider Conference Call for Physicians

Physicians may now register for the Centers for Medicare & Medicaid Services (CMS) 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. To register for this call, go to http://www2.eventsvc.com/palmettogba/111708. 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.





ICD-10-CM/PCS National Provider Conference Call for Hospital Staff Transcript

The transcript of the CMS ICD-10-CM/PCS National Provider Conference Call for Hospital Staff that was held on October 14, 2008 is now available at http://www.cms.hhs.gov/ContractorLearningResources/Downloads/ICD-10_October14calltranscript.pdf.



If you are unable to access any of the hyperlinks in this message, please copy and paste the URL into your Internet browser.

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7. Medicare Value-Based Purchasing Program for Physician and Other Professional Services Listening Session



December 9, 2008



10:00 AM ET – 4:00 PM EST



The Center for Medicare and Medicaid Services (CMS) announces a listening session being conducted as part of the development of a plan for the transition to a value-based purchasing program for physician and other professional services as required by section 131(d) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). This notice was published in the Federal Register on October 24, 2008.



The purpose of the listening session is to solicit comments on an issues paper that will present the range of issues being considered for plan development. Physicians, physician associations, and all others interested in the pursuit of new payment approaches to enhance the quality and efficiency of physician and other professional services are invited to participate, in person or by calling in to the teleconference. The Issues Paper will be posted on the CMS Website Physician Center Spotlights at http://www.cms.hhs.gov/center/physician.asp no later than November 28, 2008. The issues identified and discussed during this meeting will assist us in developing options for the plan. The meeting is open to the public, but attendance is limited to space and teleconference lines available.



For further details, you can view the notice at:

http://edocket.access.gpo.gov/2008/pdf/E8-24900.

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8. Medicare Summary Notice (MSN) Update



I wanted to make you aware that the Centers for Medicare & Medicaid Services (CMS) has directed its Medicare contractors to begin including messages regarding electronic prescribing and new services for caregivers on all Medicare Summary Notices (MSNs) generated and sent to Medicare beneficiaries on or after October 14, 2008, through February 28, 2009. Specifically, the MSN messages include the following statements:



o “Electronic prescribing can save you time at the pharmacy, reduce the chance of getting the wrong medication or dose, and save money. When you go to the doctor, ask “Do you e-prescribe?”

o “Caring for someone with Medicare? We know it’s not easy. Visit “Ask Medicare” at medicare.gov/caregivers for up-to-the-minute information, resources, and tips on making the most of Medicare.”



You can find additional information on CMS’ e-prescribing initiative at http://www.cms.hhs.gov/EPrescribing/ and http://www.cms.hhs.gov/PQRI/03_EPrescribingIncentiveProgram.asp on the CMS Website.”

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9. Medicare Prescription Drug Event Data Overview



MEDICARE RELEASES PART D DATA FOR 2006 AND 2007 AT

MEDICARE PRESCRIPTION DRUG BENEFIT SYMPOSIUM



CMS is presenting information, which has never before been made public, on Medicare drug claims for the 25 million Medicare beneficiaries in the Part D program. Pursuant to the Medicare Part D Data Final Rule, published in May 2008, CMS now has an unprecedented tool for evaluation of the Medicare Prescription Drug Benefit and the entire Medicare program. The Part D Data Final Rule permits Part D claims data to be analyzed and used for program monitoring, research, quality improvement, and other purposes.



Highlights from the six presentations from the Medicare Prescription Drug Benefit (Part D) Symposium conducted by CMS on October 30, 2008, are attached.

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10. October Flu Shot Reminder



Flu Season Is Upon Us! Begin now to take advantage of each office visit as an opportunity to encourage your patients to get a flu shot. It’s still their best defense against combating the flu this season. (Medicare provides coverage of the flu vaccine without any out-of-pocket costs to the Medicare patient. No deductible or copayment/coinsurance applies.) And don’t forget, health care personnel can spread the highly contagious flu virus to patients. Protect Yourself. Don’t Get the Flu. Don’t Give the Flu. Get Your Flu Shot.

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, please go to http://www.cms.hhs.gov/MLNProducts/Downloads/flu_products.pdf on the CMS website.

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11. 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