A Medicare Update

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. Reminder Notice: 2008 Physician Quality Reporting Initiative (PQRI) National Provider Call



2. Written Clarification on Medicare for Patients and Providers Act of 2008 (MIPPA) Regarding Accreditation Deadlines



3. Transcript Now Available for ICD-10-CM/PCS National Provider Conference Call



4. Fee-for-Service Provider Web Pages Update



5. Internet-Based Medicare Enrollment for Physicians and Non-Physician Practitioners Expanded to 24 States and the District of Columbia



6. New From the Medicare Learning Network



7. December Flu Shot Reminder



8. Extra Help for Beneficiaries Paying for Prescription Drugs









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1. Reminder Notice: 2008 Physician Quality Reporting Initiative (PQRI) National Provider Call



Registration will close at 3:30 p.m. EST, 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.



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.



To register for the call participants need to go to: http://www2.eventsvc.com/palmettogba/121608


Fill in all required data.


Verify your time zone is displayed correctly the drop down box.


Click "Register".


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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2. Written Clarification on Medicare for Patients and Providers Act of 2008 (MIPPA) Regarding Accreditation Deadlines



MIPPA section 154(b) added a new subparagraph (F) to section 1834(a)(20) of the Social Security Act. This subparagraph states that eligible professionals and other persons are exempt from meeting the September 30, 2009 accreditation deadline that generally applies to other DMEPOS suppliers unless CMS determines that the quality standards are specifically designed to apply to such professionals and persons.



The eligible professionals to whom this exemption applies are set out at sections 1848(k)(3)(B) and 1861(r) of the Act, and include Physicians, Physical Therapists, Occupational Therapists, Qualified Speech-Language Pathologists, Physician Assistants, and Nurse Practitioners.



Additionally, section 154(b) of MIPPA allows the Secretary to specify “other persons” that, like the eligible professionals described above, are exempt from meeting the accreditation requirements unless CMS determines that the quality standards are specifically designed to apply to such other persons. At this time, we are defining “such other persons” as Orthotists, Prosthetists, Opticians, and Audiologists.



CMS will define how the quality standards apply to these eligible professionals and other persons by rulemaking in 2009.



Individuals not included in this exemption list, such as pedorthotists, mastectomy fitters, orthopaedic fitters/ technicians or athletic trainers applying for Medicare enrollment in order to bill for Medicare part B services are not exempt from meeting the September 30, 2009 deadline for DMEPOS accreditation.

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3. Transcript Now Available for ICD-10-CM/PCS National Provider Conference Call



The transcript of the Centers for Medicare & Medicaid Services’ ICD-10-CM/PCS National Provider Conference Call for Other Part A and Part B Providers that was held on November 12, 2008 is now available at http://www.cms.hhs.gov/ICD10/Downloads/November12calltranscript.pdf . If you are unable to access the hyperlink in this message, please copy and paste the URL into your Internet browser.

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4. Fee-for-Service Provider Web Pages Update



The Centers for Medicare & Medicaid Services (CMS) is continually updating and improving the fee-for-service (FFS) provider web pages to make it easier for FFS providers to find important information on the CMS website. We will notify you periodically when those revisions are made. Most of the Medicare FFS provider web pages can be found on the Medicare page (http://www.cms.hhs.gov/home/medicare.asp). The following Medicare FFS provider web pages are a sample of what's been updated:



These sections have been improved by adding dynamic lists for provider specific regulations & notices and transmittals for Inpatient Psychiatric Facilities (http://www.cms.hhs.gov/InpatientPsychFacilPPS/) and Hospice (http://www.cms.hhs.gov/Hospice/) providers.
The Educational Resources section of the Hospital-Acquired Conditions (HAC) & Present on Admission (POA) Indicator Reporting web page (http://www.cms.hhs.gov/HospitalAcqCond/) has recently been updated to include the agenda for the Hospital-Acquired Conditions and Hospital Outpatient Healthcare-Associated Conditions Listening Session scheduled for Thursday, December 18, 2008.


Effective for dates of service on or after 01/01/09, the National Correct Coding Initiative (NCCI) edits will not categorically exclude any types of services. For more information, go to the Hospital Outpatient PPS and Therapy NCCI Web Page at (http://www.cms.hhs.gov/NationalCorrectCodInitEd/02_hoppscciedits.asp). These institutional NCCI edits will be available on or about 01/01/09 at: (http://www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEHOPPS/list.asp). To review the types of NCCI edits that were previously excluded from the institutional version but are currently included in the physician version for these categories, refer to the NCCI files on the following page: (http://www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/list.asp).


See the updates to the Competitive Acquisition for Part B Drugs & Biologicals (http://www.cms.hhs.gov/CompetitiveAcquisforBios/) web pages which reflect the major changes to this program.
Check out what’s new for you!

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5. Internet-Based Medicare Enrollment for Physicians and Non-Physician Practitioners Expanded to 24 States and the District of Columbia



MEDICARE PHYSICIANS AND NON-PHYSICIAN PRACTITIONERS

INTERNET-BASED MEDICARE ENROLLMENT IS AVAILABLE

in 24 STATES and the DISTRICT OF COLUMBIA



IT’S FAST, SECURE, and EASY



December 10, 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, or check on the status of a Medicare enrollment application via the Internet.



Last week, 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



Today, CMS is announcing the expansion of Internet-based PECOS for physicians and non-physician practitioners in the following States:



Connecticut Kentucky Ohio

Hawaii Nevada South Carolina

Indiana New York West Virginia



Physicians and non-physician practitioners in the States shown and the District of Columbia 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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6. New From the Medicare Learning Network



Advanced Practice Nursing & Physician Assistants Web Page

The Medicare Learning Network (MLN) is pleased to announce the availability of the Advanced Practice Nursing & Physician Assistants (APN/PA) web page. This dedicated web page is for Medicare fee-for-service (FFS) advanced practice nurses and physician assistants who provide services to Medicare beneficiaries.

From this web page, you will be able to access and peruse the Medicare FFS program topics in order to keep abreast of policy and operational updates specific to Advanced Practice Nurses and Physician Assistants.

One of the educational resources featured on this webpage is the "Advanced Practice Nurse/Physician Assistant Web-Based Training Program" – this interactive web-based training program provides definitions of the Advanced Practice Nursing/Physician Assistant provider types; outlines the qualifications of the Advanced Practice Nursing/Physician Assistant provider types; describes collaboration/supervision requirements for Advanced Practice Nursing/Physician Assistant Medicare reimbursements; lists the Medicare billing requirements for Advanced Practice Nursing and Physician Assistants; and identification of links to Medicare manuals and other resources.

This web page is updated on a regular basis, so check it often for timely and reliable information from MLN.

For more information about the Advanced Practice Nursing and Physician Assistants visit, http://www.cms.hhs.gov/MLNProducts/70_APNPA.asp#TopOfPage on the CMS website.

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7. December Flu Shot Reminder



It's seasonal flu time again! If you have Medicare patients who haven’t yet received their flu shot, you can help them reduce their risk of contracting the seasonal flu and potential complications by recommending an annual influenza and a one-time pneumococcal vaccination. Medicare provides coverage of flu and pneumococcal vaccines and their administration. – 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.



Health care professionals and their staff can learn more about Medicare’s coverage of the influenza vaccine and other Medicare Part B covered vaccines and related provider education resources created by CMS, by reviewing Special Edition MLN Matters article SE0838 http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0838.pdf on the CMS website.

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8. 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