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 Competitive Acquisition Program (CAP) Updates
2. Physician Quality Reporting Initiative (PQRI) Updates
3. CMS Hosts Listening Session on Hospital-Acquired Conditions in Inpatient and Outpatient Settings
4. Electronic Prescribing (E-Prescribing) Incentive Program Update
5. Pricer Updates
6. News for Medicare Physicians and Non-Physician Practitioners Regarding Medicare Enrollment!
7. New Electronic Mailbox for Submitting Requests to Add or Delete Telehealth Services
8. New From the Medicare Learning Network
9. December 8 – 14, 2008 is National Influenza Vaccination Week
10. Extra Help for Beneficiaries Paying for Prescription Drugs
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1. Medicare Part B Competitive Acquisition Program (CAP) Updates
CAP Claims Submission Deadlines and Unused CAP Drugs
In preparation for the 2009 CAP postponement, the following is a reminder about upcoming CAP deadlines. It is very important that participating CAP physicians understand and comply with these deadlines because failure to do so will affect physicians’ ability to be reimbursed.
CAP Drugs Administered during 2008
§ All CAP drug claims must have a date of service on or before December 31, 2008, and physicians’ corresponding CAP drug administration claims must be submitted on or before January 30, 2009.
§ CAP drug claims for dates of service after December 31, 2008 will be denied.
§ CAP drugs that have not been administered by December 31, 2008 are the property of the Approved CAP Vendor.
CAP Drugs NOT Administered by December 31, 2008
§ CAP physicians must return any unused CAP drugs to the Approved CAP Vendor by February 28, 2009.
§ CAP drugs are the property of the Approved CAP Vendor. Therefore, physicians who have not returned these drugs to the Approved CAP vendor on or before February 28, 2009 will be liable for the cost of drugs.
§ Please note that CAP physicians may contact the Approved CAP Vendor to discuss the option of purchasing unused CAP drugs.
Emergency Restocking of CAP Drugs for Dates of Services on or before December 31, 2008
§ When permitted under the emergency restocking provisions, physicians may submit a prescription order for a CAP drug to replace what they used from their own stock (the emergency restocking provision). Physicians may request replacement drugs ONLY if the date of service is on or before December 31, 2008, AND the corresponding drug administration claim has been submitted on or before January 30, 2009.
§ Physicians must request replacement drugs by January 30, 2009.
§ The Approved CAP Vendor will not send replacement products under the CAP emergency restocking provision (J2 modifier claims) after February 28, 2009.
§ CAP physicians who have not submitted a prescription order and a request for replacement drugs under the emergency restocking provision as described above will not be able to bill Medicare under the ASP system for the CAP drugs that they administered on or before December 31, 2008 from their private stock.
What should you do to prepare?
Physicians who are participating in the CAP during 2008 are encouraged to contact the Approved CAP Vendor and reconcile their inventories as soon as possible. Contact information for the Approved CAP Vendor, BioScrip, is available on their website at www.bioscrip.com.
Additional information on the 2009 CAP Postponement is available on the Centers for Medicare and Medicaid Services website at: http://www.cms.hhs.gov/CompetitiveAcquisforBios/01_overview.asp
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CAP Post Payment Review in 2009
After January 1, 2009, the CAP post payment review process will continue for 2008 claims. The post payment review process for the CAP is conducted to verify drug administration for Medicare claims submitted by an Approved CAP Vendor. For this process, a small sample of physician and Vendor claims and other documentation is examined in order to establish that drugs billed by an Approved CAP Vendor were administered and were medically necessary.
To support this review, participating CAP physicians may receive a request for copies of medical records from the CAP designated carrier, Noridian Administrative Services (NAS). Medicare requirements require participating CAP physicians to submit all information necessary to support the services billed on claims.
Participating CAP physicians must submit medical records to NAS within the requested timeframe. This submission should include the patient's drug administration record and all other records supporting medical necessity for the drug. If CAP post payment review activity cannot establish that a drug was administered, then the vendor's drug claim will be denied. The associated physician drug administration claim will also be referred to the physician's local carrier for review and recoupment as necessary.
For additional information on the post payment review process, please visit NAS's CAP website at: https://www.noridianmedicare.com/cap_drug/index.html.
Also, please remember that CAP drugs will not be available from an Approved CAP Vendor for dates of service after December 31, 2008. Additional information about the 2009 CAP postponement claims submission deadlines, and instructions about what to do with unused CAP drug is available on the CMS CAP website at: http://www.cms.hhs.gov/CompetitiveAcquisforBios/01_overview.asp.
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2. Physician Quality Reporting Initiative (PQRI) Updates
2008 Physician Quality Reporting Initiative
National Provider Question & Answer Session
The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host the ninth in a series of national provider conference calls that began in November of 2007 on the 2008 Physician Quality Reporting Initiative (PQRI). This toll-free call will take place from 3:30 p.m. – 5:00 p.m., EST, on Tuesday, December 16, 2008.
Following a short presentation on the final PQRI 2007 reporting experience and a discussion of results from 2007, the lines will be opened to allow participants to ask questions of CMS PQRI subject matter experts.
Educational products are available on the PQRI dedicated web page located at, http://www.cms.hhs.gov/PQRI on the CMS website, in the Educational Resources section.
Feel free to download the resources prior to the call so that you may ask questions of the presenters, Dr. Michael Rapp and Dr. Daniel Green.
Conference call details:
Date: December 16, 2008
Conference Title: 2008 Physician Quality Reporting Initiative National Provider Call
Time: 3:30-5:00 p.m. EST
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. If you cannot attend the call, replay information is available below.
Registration will close at 3:30 p.m. EST on December 15, 2008, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
1. To register for the call participants need to go to: http://www2.eventsvc.com/palmettogba/121608
2. Fill in all required data.
3. Verify your time zone is displayed correctly the drop down box.
4. Click "Register".
5. You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and 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.
For those of you who will be unable to attend, a replay option will be available shortly following the end of the call. This replay will be accessible from 4:00 p.m. EST 12/16/2008 until 11:59 p.m. EST 12/23/2008. The call in data for the replay is (800) 642-1687 and the passcode is 76618434.
If you require services for the hearing impaired please send an email to Medicare.TTT@PalmettoGBA.com.
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Reporting Experience for the
2007 Physician Quality Reporting Initiative
New Report Posted Today Outlines CMS’ Response to Program Issues
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the release of a new report entitled, “Physician Quality Reporting Initiative (PQRI): 2007 Reporting Experience.” The report provides a detailed analysis of the 2007 PQRI reporting experience and outlines some of the challenges and successes of the 2007 program, as well as some of the business reasons that may explain why these challenges occurred.
Specifically, the report describes several issues identified for 2007 and CMS’ plans for modifications to the analytics for the 2008 PQRI. In addition, CMS will apply these modifications to the 2007 PQRI data and re-run the data. CMS expects that additional eligible professionals will qualify for an incentive payment for both 2007 and 2008 based on these efforts. It is anticipated that these activities will be completed by the fall of 2009.
The report is available online at http://www.cms.hhs.gov/PQRI/Downloads/PQRI2007ReportExperience.pdf on the CMS website.
This report will be also discussed on the upcoming PQRI National Provider Call to be held on Tuesday, December 16, 2008, from 3:30 PM EST to 5 PM EST. To register for the call, visit http://www2.eventsvc.com/palmettogba/121608 on the Internet.
To learn more about PQRI, visit http://www.cms.hhs.gov/pqri on the CMS website.
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2009 Physician Quality Reporting Initiative Program
New Educational Resources Now Available
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that two (2) new educational resources on the 2009 Physician Quality Reporting Initiative (PQRI) have been posted to the PQRI webpage on the CMS website.
2009 PQRI Quality Measure List- This reference list outlines the 153 quality measures which were published in the in the Medicare Physician Fee Schedule (MPFS) 2009 final rule on November 19, 2008. To access the 2009 PQRI Quality Measure list, visit http://www.cms.hhs.gov/PQRI/15_MeasuresCodes.asp#TopOfPage on the CMS website. Once on the Measure/Codes page, scroll down to the “Downloads” section and click on the “2009 PQRI Quality Measures List” link.
The detailed measure specifications will be available on this webpage on or before December 31, 2008.
Registry Requirements for Submission of 2009 PQRI Data on Behalf of Eligible Professionals- This document describes the high-level requirements for a registry to qualify to submit under the registry-based reporting alternatives for 2009. This document also outlines how a registry can become qualified for 2009 data submission. To access the Registry Requirements for Submission of 2009 PQRI Data on Behalf of Eligible Professionals document, visit http://www.cms.hhs.gov/PQRI/20_Reporting.asp#TopOfPage on the CMS website. Once on the Reporting page, scroll down to the “Downloads” section and click on the “Registry Requirements for Submission of 2009 PQRI Data on Behalf of Eligible Professionals” link.
To qualify to submit data on behalf of eligible professionals seeking incentive payments for 2009, registries are required to go through a self-nomination and vetting process if they are new to PQRI registry reporting or to notify CMS of their desire to continue PQRI data submission in 2009 if they were qualified in 2008. Selected registries must meet certain technical and other requirements specified by CMS.
Detailed information on the 2009 PQRI, including the 2009 Registry Requirements, may be found in the final 2009 Medicare Physician Fee Schedule rule with comment period (73 FR 69817 through 69847) that was published in the Federal Register on November 19, 2008. The final rule with comment period can be found in the “Related Links Outside of CMS” section of the Physician Quality Reporting Initiative website at: http://edocket.access.gpo.gov/2008/pdf/E8-26213.pdf on the CMS website.
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3. CMS Hosts Listening Session on Hospital-Acquired Conditions in Inpatient and Outpatient Settings
On October 30, 2008, the Centers for Medicare & Medicaid Services posted a notice in the Federal Register regarding a Listening Session on Hospital-Acquired Conditions in Inpatient and Outpatient Settings. The Listening Session will be held on December 18, 2008. Additional information on the Listening Session, as well as registration instructions, is available at: http://www.cms.hhs.gov/HospitalAcqCond/07_EducationalResources.asp#TopOfPage
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CMS has recently updated the Hospital-Acquired Conditions website to include the agenda for the Listening Session.
On October 30, 2008, the Centers for Medicare & Medicaid Services posted a notice in the Federal Register regarding a Listening Session on Hospital-Acquired Conditions in Inpatient and Outpatient Settings. The Listening Session will be held on December 18, 2008. Participants can register for the Listening Session through December 11, 2008, at:
https://registration.intercall.com/menu.php?short_name=cms2
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4. Electronic Prescribing (E-Prescribing) Incentive Program Update
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that the specifications for the E-Prescribing measure, which will be used to determine whether an eligible professional is a successful E-Prescriber and may qualify for a 2% incentive payment for the 2009 reporting period, has been posted to the CMS website. The measure specifications may be found in the “Downloads” section of the E-Prescribing Incentive Program webpage at http://www.cms.hhs.gov/PQRI/03_EPrescribingIncentiveProgram.asp#TopOfPage on the CMS website.
An eligible professional does not have to enroll in order to participate in the E-Prescribing Incentive Program. Furthermore, an eligible professional does not need to participate in PQRI in order to participate in this incentive program.
Beginning January 1, 2009, eligible professionals may participate in the E-Prescribing Incentive Program by submitting information required by the E-Prescribing measure on their Medicare Part B claims.
Detailed information on the implementation of the E-Prescribing Incentive Program for 2009 may be found in the final 2009 Medicare Physician Fee Schedule rule with comment period that was published in the Federal Register on November 19, 2008. A copy of the final rule with comment period is on display at the Federal Register and can be viewed at http://www.cms.hhs.gov/center/physician.asp on the CMS website.
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5. Pricer Updates
The Centers for Medicare & Medicaid Services (CMS) has updated the Skilled Nursing Facility (SNF) PPS PC Pricer for FY 2009 with the latest Provider Specific File data. If you use SNF PC Pricer software, please go to the web page at http://www.cms.hhs.gov/PCPricer/04_SNF.asp#TopOfPage and down load the latest FY 2009.0 version of the PC Pricer posted 12/01/2008.
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The Centers for Medicare & Medicaid Services (CMS) has updated the FY 2009 Inpatient Rehabilitation Facility (IRF) PC Pricer. If you use the IRF PC Pricer, please go to the web page at http://www.cms.hhs.gov/PCPricer/06_IRF.asp#TopOfPage and down load the most recent version of the FY 2009 IRF PC Pricer posted on 11/26/2008.
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The Centers for Medicare & Medicaid Services (CMS) has updated the FY09 Inpatient PPS PC Pricer (INP PPS) with the October ’08 Provider data. If you use the INP PPS PC Pricer, visit the CMS web page at http://www.cms.hhs.gov/PCPricer/03_inpatient.asp#TopOfPage and download the FY 2009 version of the PC Pricer posted on 11/26/2008.
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6. News for Medicare Physicians and Non-Physician Practitioners Regarding Medicare Enrollment!
MEDICARE PHYSICIANS AND NON-PHYSICIAN PRACTITIONERS
INTERNET-BASED MEDICARE ENROLLMENT IS AVAILABLE
in 15 STATES and the DISTRICT OF COLUMBIA
IT’S FAST, SECURE, and EASY
December 1, 2008
Now there’s a better way for physicians and non-physician practitioners to enroll or make a change in their Medicare enrollment information. The Internet-based Provider Enrollment, Chain and Ownership System (PECOS) will allow physicians and non-physician practitioners to enroll, make a change in their Medicare enrollment, view their Medicare enrollment information on file with Medicare, and check on the status of a Medicare enrollment application via the Internet.
Today, the Centers for Medicare & Medicaid Services (CMS) announced that Internet-based PECOS is available to physicians and non-physician practitioners in District of Columbia and the following States:
Delaware Minnesota New Jersey
Idaho Missouri North Carolina
Illinois Nebraska Pennsylvania
Iowa Maryland Tennessee
Kansas Michigan Wisconsin
Physicians and non-physician practitioners in the District of Columbia and the States shown above who wish to access Internet-based PECOS may go to https://pecos.cms.hhs.gov.
CMS will expand the availability of Internet-based PECOS for physicians and non-physician practitioners to all States over the next 2 months. In addition, CMS will make Internet-based PECOS available next year to all providers and suppliers (except durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers).
Fast
By submitting the initial Medicare enrollment application through Internet-based PECOS, a physician or non-physician practitioner’s enrollment application can be processed as much as 50 percent faster than by paper. This means that it will take less time to enroll.
Physicians and non-physician practitioners are required by regulation to report certain changes in their enrollment information within specified timeframes. Internet-based PECOS will allow them to update, make corrections, and check on the status of their Medicare enrollment applications —again, as much as 50 percent faster than by paper. Changes include a change in practice location, ownership, or final adverse action (e.g., medical license suspension or revocation.) For additional information about the types of changes that must be reported, go to the download section of www.cms.hhs.gov/MedicareProviderSupEnroll.
Secure
Internet-based PECOS meets all required Government security standards in terms of data entry, data transmission, and the electronic storage of Medicare enrollment information. Only authorized individuals can enter enrollment information into PECOS or view PECOS data from the Internet. Authorized individuals include physicians and non-physician practitioners. Their User IDs and passwords protect the access to their enrollment information. After physicians or non-physician practitioners create User IDs and passwords or change their passwords, they should keep this information secure and not share it with anyone. By safeguarding their User IDs and passwords, they are taking an important step in protecting their enrollment information. CMS does not disclose Medicare enrollment information to anyone except when we are authorized or required to do so by law.
Easy
Internet-based PECOS is a scenario-driven application process with front-end editing capabilities and built-in help screens. The scenario-driven application process will ensure that physicians and non-physician practitioners complete and submit only the information necessary to enroll or make a change in their Medicare enrollment record. In contrast to the information collected on the CMS-855I, physicians and non-physician practitioners will no longer see questions that are not applicable to their enrollment scenarios when using Internet-based PECOS.
Additional Information
For information about Internet-based PECOS, including important information that physicians and non-physician practitioners should know before submitting a Medicare enrollment application via Internet-based PECOS, go to www.cms.hhs.gov/MedicareProviderSupEnroll.
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7. New Electronic Mailbox for Submitting Requests to Add or Delete Telehealth Services
The Centers for Medicare & Medicaid Services (CMS) makes any additions or deletions to the services defined as Medicare telehealth services effective on a January 1st basis. Any interested parties from either the public or private sectors may submit requests for adding services to the list of Medicare telehealth services.
Requests for adding services to the list of Medicare telehealth services may be submitted on an ongoing basis. Requests must be submitted and received no later than December 31 of each calendar year to be considered for the following year's proposed rule (i.e. requests must be received by December 31, 2008, to be considered during the 2009 rulemaking cycle that establishes physician fee schedule rates for 2010).
Requests to add or delete services can be mailed to:
Division of Practitioner Services
Mail Stop: C4-03-06
Centers for Medicare and Medicaid Services
7500 Security Boulevard Baltimore, Maryland 21244-1850
Attention: Telehealth Review Process
As an alternative to regular mail, requests may be submitted electronically to the Telehealth Requests resource mailbox:
CMS Telehealth_Review_Process@cms.hhs.gov
For information on submitting a request to add or delete telehealth services, visit the CMS Web site at:
http://www.cms.hhs.gov/telehealth/
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8. New From the Medicare Learning Network
The ICD-10-Clinical Modification/Procedure Coding System Fact Sheet, which provides general information about the International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) including benefits of adopting the new coding system, structural differences between ICD-9CM and ICD-10-CM/PCS, and implementation planning recommendations, is now available in print format from the 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.”
The revised Facilitator's Guide - Companion to Medicare Physician Guide: A Resource for Residents, Practicing Physicians, and Other Health Care Professionals (October 2008) is now available in downloadable format from the Medicare Learning Network. This publication, which includes all the information and instructions necessary to prepare for and present a Medicare Resident, Practicing Physician, and Other Health Care Professional Training Program including instructions for facilitators, customization guide, a PowerPoint presentation with speaker notes, pre- and post-assessments, master assessment answer keys, and evaluation tools, may be accessed at http://www.cms.hhs.gov/MLNProducts/MPUB/list.asp.
Now available from the Medicare Learning Network! The Medicare Learning Network (MLN) Resources for Indian Health Care Professionals CD Rom. This CD provides descriptions of and links to various MLN products that can help Indian health care professionals and their staff gain a better understanding of the Medicare fee-for-service program. To view a PDF file of the content found on the CD, click on the following link http://www.cms.hhs.gov/MLNProducts/downloads/wIndianHealthFS102908f.pdf. Copies of this CD may be ordered free of charge from the CMS MLN Product Ordering Page, located at http://cms.meridianksi.com/kc/pfs/pfs_lnkfrm_fl.asp?lgnfrm=reqprod&function=pfs.
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9. December 8 – 14, 2008 is National Influenza Vaccination Week
The Centers for Disease Control and Prevention (CDC) has announced the week of December 8-14, 2008, as National Influenza Vaccination Week. This week-long event is designed to raise awareness of the importance of continuing influenza (flu) vaccination, as well as foster greater use of flu vaccine in December, January, and beyond. Since flu activity typically does not peak until February or later, December and January still provide good opportunities to offer flu shots. This year, Thursday, December 11th, is designated as Seniors' Vaccination Day. The Centers for Medicare & Medicaid Services (CMS) needs your help to ensure that people with Medicare get their flu shots. Please use this week long event as an opportunity to place greater emphasis on flu prevention. If you have Medicare patients who have not yet received their annual flu shots, we ask that you encourage these patients to protect themselves from the seasonal flu and serious complications arising from the flu virus by recommending that they take advantage of the flu shot benefit covered by Medicare. And remember, health care professionals and their staff are also at risk for contracting and spreading the flu virus, so 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!
NOTE: - Influenza vaccine plus its administration are covered Part B benefits. Influenza vaccine is NOT a Part D covered drug.
For More Information
Health care professionals and their staff can learn more about Medicare’s coverage of the flu vaccine and other Medicare Part B covered vaccines and related provider education resources created by CMS, by reviewing Special Edition MLN Matters article SE0838 located at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0838.pdf on the CMS website.
For more information about National Influenza Vaccination Week, please visit the Centers for Disease Control and Prevention’s website, http://www.cdc.gov/flu/nivw/, on the Web.
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10. 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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