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. Medicare Consumer Alert: New Rules for Beneficiaries Who Use Oxygen Equipment and Supplies



2. CMS Launches Fourth Annual Medicare Health Care Provider Satisfaction Survey



3. CMS Issues Historic Star Quality Rating System for Nursing Homes



4. Physician Quality Reporting Initiative (PQRI) Updates



5. Update to Internet-Based Medicare Enrollment for Physicians & Non-Physician Practitioners



6. ICD-10 Updates



7. Pricing File Updates



8. New From the Medicare Learning Network



9. December Flu Shot Reminder



10. Extra Help for Beneficiaries Paying for Prescription Drugs









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1. Medicare Consumer Alert: New Rules for Beneficiaries Who Use Oxygen Equipment and Supplies



A recent Medicare law changes how Medicare pays for oxygen equipment and supplies, but beneficiaries will still have continued Medicare coverage for oxygen equipment and related supplies. CMS posted a tip sheet on Medicare.gov for beneficiaries about new Medicare rules due to changes from the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). MIPPA repealed the requirement to transfer ownership of the equipment to the beneficiary after the 36-month rental period. Suppliers now retain ownership of the equipment.



The tip sheet provides information about the changes in the law, what Medicare pays after the 36 months of rental payments, if a beneficiary moves or travels, and if a supplier is not complying with the law.



If a supplier refuses to comply with these rules, please notify us immediately by calling:



1-800-Medicare (1-800-633-4227) or, for users of TTY, 1-877-486-2048



Your call will be referred to the appropriate place to be sure that you continue to receive your oxygen without interruption.



More information is available at: www.medicare.gov/Publications/pubs/pdf/11405.pdf





To read the consumer alert go to CMS Press releases (12/17) at: http://www.cms.hhs.gov/apps/media/press_releases.asp

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2. CMS Launches Fourth Annual Medicare Health Care Provider Satisfaction Survey



The Centers for Medicare & Medicaid Services (CMS) recently announced it has launched its fourth annual health care provider satisfaction survey of Medicare fee-for-service contractors who process and pay more than $280 billion in Medicare claims each year.



“I urge all 30,000 Medicare providers selected to participate in the survey to complete and return their surveys upon receipt,” Acting CMS Administrator Kerry Weems said.



The Medicare Contractor Provider Satisfaction Survey (MCPSS) offers health care providers the opportunity to contribute directly to CMS’ understanding of contractor performance, as well as aid future process improvement efforts at the contractor level. CMS is sending the 2009 survey, designed to be completed in about 20 minutes, to approximately 30,000 randomly selected providers, including physicians and other health care practitioners, suppliers and institutional facilities that serve Medicare beneficiaries across the country. Those health care providers selected to participate in the survey will be notified this month. Providers can submit their responses via a secure website, mail, fax or over the telephone. All Medicare Administrative Contractors (MACs) will be measured against performance targets on the 2009 MCPSS as part of their contract requirements. MACs are Medicare contractors that provide a number of services, including processing Medicare fee-for-service claims and fielding health care provider questions.



The MCPSS is required by the Medicare Prescription Drug, Improvement and Modernization Act of 2003. Specifically, the law calls for CMS to develop contract performance requirements, including measuring health care provider satisfaction with Medicare contractors. CMS will analyze the 2009 MCPSS data and release a summary report on the CMS website in July 2009.



Further information about the MCPSS is available at: www.cms.hhs.gov/MCPSS



To read the CMS Press release (12/16), please visit : http://www.cms.hhs.gov/apps/media/press_releases.asp

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3. CMS Issues Historic Star Quality Rating System for Nursing Homes



For the first time in history, the Centers for Medicare & Medicaid Services (CMS) released quality ratings for each of the nation’s 15,800 nursing homes that participate in Medicare or Medicaid. For more information, view the Press Release at

http://www.cms.hhs.gov/apps/media/press_releases.asp.

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4. Physician Quality Reporting Initiative (PQRI) Updates



2009 Physician Quality Reporting Initiative Measure Specifications Are Now Available!

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the release of the detailed specifications for the 2009 Physician Quality Reporting Initiative (PQRI) measures and the 2009 PQRI measures groups. The following resources have been posted to the PQRI webpage on the CMS website:

2009 PQRI Quality Measure Specifications Manual and Release Notes- Contains the detailed specifications (including codes and reporting instructions) for the 153 2009 PQRI quality measures for claims or registry-based reporting and a summary of the changes from the 2008 PQRI Measure Specifications (in the form of release notes delineated by measure number).

2009 PQRI Implementation Guide - Provides guidance about how to implement 2009 PQRI claims-based reporting of measures to facilitate satisfactory reporting of quality data codes by eligible professionals for the 2009 PQRI.

2009 PQRI Measures Group Specifications Manual and Release Notes- Contains the detailed specifications and instructions for the seven (7) 2009 PQRI measures groups and a summary of the changes from the 2008 PQRI Measures Groups Specifications (in the form of release notes).

Getting Started with 2009 PQRI Reporting of Measures Groups - Provides guidance about implementing the 2009 PQRI measures groups.

To access the 2009 PQRI Quality Measure Specifications Manual and Release Notes, the 2009 PQRI Implementation Guide, the 2009 PQRI Measures Group Specifications Manual and Release Notes, or the Getting Started with 2009 PQRI Reporting of Measures Groups, 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 appropriate link.

Please note that the 2009 PQRI quality measure specifications for any given quality measure may be different from specifications for the same quality measure used in 2008. Therefore, specifications for all 2009 PQRI quality measures, whether or not included in the 2008 PQRI program, must be obtained from the 2009 PQRI Quality Measure Specifications Manual.



In addition, measures groups specifications are different from the specifications for individually reported measures that form the group. Therefore, the specifications and reporting instructions for the 2009 PQRI measures groups must be obtained from the 2009 PQRI Measures Group Specifications Manual.



Reporting for the 2009 PQRI begins January 1, 2009. Please note there is no need to sign up or pre-register in order to participate.



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New Section Page on the Physician Quality Reporting Initiative Web Page

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce a new section page on the Physician Quality Reporting Initiative web page. The “Spotlight” section page can be accessed on PQRI web page at http://www.cms.hhs.gov/pqri/ on the CMS website and click on the Spotlight tab. The “Spotlight” page is updated frequently and was created to alert eligible professionals to the newest program information available on the PQRI web page.

Detailed information on the 2009 PQRI may be found in the 2009 Medicare Physician Fee Schedule final 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.

Reporting for the 2009 PQRI begins January 1, 2009. Please note there is no need to sign up or pre-register in order to participate.



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CMS Posts PQRI Reporting Information on CMS Website



Beginning December 19, 2008, the names of physicians and other health care professionals who reported quality information under the Physician Quality Reporting Initiative (PQRI) in 2007 will be available at www.medicare.gov\physician, the Physician and Other Healthcare Professional Directory located on www.medicare.gov. This information includes all eligible professionals identified by their National Provider Identifier (NPI) who submitted at least one quality data code on their Medicare claims for services furnished between July 1, 2007 and December 31, 2007.



The PQRI is a voluntary reporting program. A physician or other healthcare professional can choose whether to report quality information to Medicare under the PQRI program. Reporting quality information by professionals is an important means to promote improved quality of care to Medicare beneficiaries. There are, however, numerous reasons why physicians or other healthcare professionals, who are committed to providing high quality care to their patients, may have chosen not to report quality information under the PQRI Program which began in 2007.



For more information on the PQRI and the instructions for reporting and requirements for satisfactory reporting, go to http://www.cms.hhs.gov/pqri.

Detailed information on the 2009 PQRI may be found in the 2009 Medicare Physician Fee Schedule final 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.

Reporting for the 2009 PQRI begins January 1, 2009. Please note there is no need to sign up or pre-register in order to participate.

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5. Update to Internet-Based Medicare Enrollment for Physicians & Non-Physician Practitioners



MEDICARE PHYSICIANS AND NON-PHYSICIAN PRACTITIONERS

INTERNET-BASED MEDICARE ENROLLMENT IS AVAILABLE

in 34 STATES and the DISTRICT OF COLUMBIA



IT’S FAST, SECURE, and EASY



December 15, 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.



Previously, 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:



Connecticut Kansas Nevada Tennessee

Delaware Kentucky New Jersey West Virginia

Hawaii Maryland New York Wisconsin

Illinois Michigan North Carolina

Indiana Minnesota Ohio

Iowa Missouri Pennsylvania

Idaho Nebraska South Carolina



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



Alaska North Dakota Washington

Arizona Oregon Wyoming

Florida South Dakota

Montana Utah



Physicians and non-physician practitioners in the States shown above 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. ICD-10 Updates



Transcript Now Available – ICD-10-CM/PCS National Provider Conference Call for Physicians

The transcript of the Centers for Medicare & Medicaid Services (CMS) ICD-10-CM/PCS National Provider Conference Call for Physicians that was held on November 17, 2008 is now available at

http://www.cms.hhs.gov/ICD10/Downloads/November17calltranscript.pdf .



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ICD-10 2009 Files

CMS has updated the ICD-10 download files by posting the 2009 version of the following documents at http://www.cms.hhs.gov/ICD10/02_ICD-10-PCS.asp :

ICD-10 General Equivalence Mappings (these refer to procedure codes)
Reimbursement mappings and guides for the use of the Mappings
2009 version of ICD-10-Procedure Coding System (PCS)
ICD-10 version of the digestive Medicare Severity Diagnosis Related Groups (MS-DRG)


The 2009 ICD-10-CM (Diagnosis codes) General Equivalence Mappings have been posted at http://www.cms.hhs.gov/ICD10/03_ICD_10_CM.asp .



The 2009 version of ICD-10-Clinical Modifications (CM), Diagnoses, will be posted by the end of December 2008 on the following sites:

http://www.cdc.gov/nchs/icd9.htm
http://www.cms.hhs.gov/ICD10/03_ICD_10_CM.asp

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7. Pricing File Updates



RY 2009 Inpatient Psychiatric Facility Prospective Payment System (IPFPPS) PC Pricer Release -- 12/10/2008

The Centers for Medicare & Medicaid Services (CMS) has updated the Inpatient Psychiatric Facility (IPF) PPS PC Pricer for. RY2009 claims dates from 7/1/2008 to 9/30/2008. 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 RY 2009.A version of the Pricer posted on 12/10/2008.

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Medicare Part B Drugs Average Sales Price Files -- January 2009



The Centers for Medicare & Medicaid Services (CMS) has made available the Medicare Part B Drug and Biological Average Sales Price (ASP) Payment Amounts for January 1, 2009 to March 31, 2009 on the CMS website at http://www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/01a1_2009aspfiles.asp#TopOfPage. The files are located in the "Downloads" section of this web page.

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8. 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 CD-Rom format from the CMS 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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The revised publication titled Inpatient Rehabilitation Facility Prospective Payment System Fact Sheet (October 2008), which provides information about Inpatient Rehabilitation Facility Prospective Payment System rates and classification criterion, is now available in downloadable format from the CMS Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/InpatRehabPaymtfctsht09-508.pdf .



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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 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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The October 2008 version of the Adult Immunizations tri-fold brochure, which provides fee-for-service health care professionals with an overview of Medicare's coverage of influenza, pneumococcal, and hepatitis B vaccines and their administration, is now available to order from the Centers for Medicare & Medicaid Services (CMS) Medicare Learning Network (MLN). 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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9. 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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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