US Department of Health - Center for Medicare Services

“reServing C“A quarterly rServing
gionare oloradkota, egionre professionals” Coloradkota, Utah and Wyoming. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Denver Regional Office
l Daal publication for health cao, Montana, North Dakota, South DaThe The Pulse of CMS
successfully reports undePQRI initiatives could receiveboost for 2009.
e-prescribing and a 5.1 percent pay mprovem
the PQRI, which allows eligibreport quality measures relatipractice
e
ssionals to their clinical ully report on their arn an incentive ribing incentive Medicare allowed rates will become pear in the
cases during 2009 will bpayment, in addition to the e-payment of 2 percent of theircharges.
The revised policies and paeffective January 1, 2009.
m
ments on :00 P.M. EST on e responding to a later date. ision
he comments ill be p
For more details on the generule, CMS’ implementation of thprescribing initiative, and MIPPMedicare Fact Sheets post
ov
QRI and e-hanges, see the
e
2009 PQwith CCMS Implementsew Incentives to Encurage E-Prescribing
physicians to trade in their prescription improve efficiency and safety when ordfor patients with Medicare. The initiativeincluded in the Medicare Physician Fefinal rule for calendar year 2009. ds and ing drugs s chedule
Widespread adoption of electronic preliminate medication errors that result fromisreading of handwritten prescriptionbeneficiaries may also have reduced out-costs as e-prescribing facilitates combetween prescribers and pharmacies ocost generic alternatives. Physicians and other eligible professioadopt and use qualified electronprescribing) systems to transmit prescri
ibing can m the edicare of-pocket ication
lower-s who
percent of their tota
during 2009. This incentive is in addi
percent incentive payment for 2009 for
who successfully report measures under the RI), and the 1.1 the
Physician Quality Reporting Initiative
both incentive payments are in additi
percent fee schedule update require
Medicare Improvements for PatientsProviders Act of 2008. Thus, a physiThe Physician Q2008 will end on Dparticipated in 20received by Febru To submit many registry on ththey will be sreporting period,measures or measreport. The Medicare ImProviders Act (Mauthorities and2009 andaddition of “qualeligible provider. Fprofessionals shaltotal allowablemonths after the the reporeporting
The Pulse of CMS Page 2
CMS Clarifies M
CMS Phy
s
icin
Changes for Oxygen Required by M
IPPA The Medicare Improvements for Patients aAct of 2008 implements new payment rulsuppliers effeCMS issued a final rule forFee Schedule for 2009 on final rule implements a nuMedicare ImprovementsProviders Act of 2008 (MIon July 15, 2008. Most oimplementing and require ochanges
the Medicare Physician October 30, 2008. The mber of provisions of the for Patients and PPA), which became law f these changes are self-nly conforming o CMS regulations. Some e interpretation for
oviders xygen ges r 2009 n d
were made under the physician fee schedwhich went on display in the Federal RegisOctober 30, 2008. It is important to note that Medicare hascoverage of oxygen for benefic
nge
change of supplier responsibilities and equipment after 36 months of use mand
p of recent ing e
atechanges in the Medicare law. Medicare is chow it pays oxygen suppliers as follows: • For the first 36 mon
t
hs, the supplier rental payments for oxygen and equipme• After 36 months, the supplier is required tto furnish an
nt
t
a
dditional charge, but Medicare will contifor oxygen contents furnished for use wi
to pay uid or o
•
Also, after 36 months, the suppliercontinue to furnish replacement accessosupplies (e.g., masks, regulators, tubingadditional charge. • When the equipment is no longer needback to the supplier; title is not transbeneficiary after 36 months as was done pr
tn
d
oe
s ly.
This new payment method enprovision of oxygen, prevents supto receive payment for equipmenpayments hav
ng e
ning
ded. nd rental
beneficiaries both during and after the 36-period.
provisions require ad
tivimplementation. For thoseaccept comments on the in a subsequent final rule Initial Preventive PhysicIn an effort to increase besection 101 of MIPPA wai
rovisions, CMS will and res
Examination: ficiary access to care, the deductible for l examination (IPPE), expands the types of
s incIPPE to include discussion and body mass index assethe timeframe for IPPEfrom Part B enrollme
end-of-life planning sments, and extends e to 12 months
rag
changes are effective ary 1, 2009. nal Preventive horizes the Secretary for services on or after J Authority to Cover AddiMIPPA, for the first time, autof Health and Human Serto additional preventive
es to extend coverage ices through the tion process if: nes them to be ary for the prevention • The Secretary determior early detection of
illn • They are recommendB by the United StatesTask Force, a taHealthcare Research
th a grade of A or
Prev AmbulanceSection 146groundthe period J2009, by 3 perural areaoriginating inestablishesfor air amarea that wasunder neweffect Januar MiscellaMIPPA: Technicafor Hospital Pallows indedirectly fohospital inpatiDecemberbe bundled Exceptions tMIPPA extetherapy cap Telehealth Sadds the sites: a hoscommuservices
The Pulse of CMS Page 3
Medicare Providers Con
e to
Be Satisfied with Contra
rs New MPlans ReleaseCMS has released final reMedicare beneficiaries fropressure marketing tactics bycompanies and their agents2009 Medicare Advantag
g
ulations that will protect present
m
deceptive or high- private insurance prohibite• Reviewing
during the upcoming e and prescription drug e regulations also include ed Medicare Advanadvertise• Reensur
open enrollment perioother non-marketing relatand prescription drug plan (P The two regulations includetelemarketing and other unsoliccontacts. The new rules also
D
) p
rovisions. hibitions on ted sales ohibit financial agents and brokers ppropriately moving, ne plan to another mpliance with these • Ensuring threpomarketiissues. Another key provagents and brokbeneficiary in a plage
to maximize commissions bor churning, beneficiaries froeach year. Plans were to be iprovisions
o
r marketing activities will build upon the ance prto plan. Thesbeneficiaries frohave been acrather than
CMS will emphasize efforts thsuccess of past marketplace s
rveillns’Medicare healthcare providers contisatisfied with services provided by Medfor-service contractors, showing a relsmooth transition to the new MedicaAdministrative Contrace fee-
ore
contractors was 4.51 on a scale of 1 to 6.year’s average score was comparable tyear’s average score of 4.56. The Medicare Contractor Provider SatisSurvey (MCPSS), conducted by CMS fyear, is designed to gather and repoquantifiable dathis t on e third
tivth the nd pay llion ately
fe
e-for-service contractors which procesMedicare claims. In 2007, more than oclaims were processed and paid one million health care providers who provmedically necessary items and servicemillion beneficiaries. As in 2007, the top indicator of satisproviders in 2008 was how Medicare chandled provider inquiries. T
marketing practices reflect the new requirements. Surveillance will include: ctors one of
consecutive year this function was citethe key indicators of provider satisfacall contractor types, claims procesremained a strong indicator in 200ross der arts of ith and omly- h • Tripling the numberactivities in which a Meprospective enrol
ret shopper” are official poses as a onitors sales agents’ Part C andviewed on the hwebsite.
satisfaction, as in the past two yearthe claims function particularly assoprovider satisfaction included c
The 2008 survey queried
selected providerscare practitioners
Medicare beneficiaries across the c
s S CMS has announcedbetween the quality of cMedicare in hospital outpatien(HOPDs) and the payments hosthose services. In a final rul
trengthen the tie ished to people with departments pitals receive for blishing MedicThe final rule emrationale existsa policy that worelated to illnessCMS FocuseServices in 20spital Quality on O
during a hospitapolicy would make adjustments to O
The Pulse of CMS Page 4
Ne
Caregiver
Chances are, you know a L
. Linda takes care of he a widow, who lives e of her recently Now Medicare offers s services netothers can g
1,200 miles away, and tadisabled husband at hom45 minutes to and from a Family caregivers like Lindmore than one full-time job.demands of the workplac
r
a also commutes e office job. tually hold down ey respond to the then come h
to meet the nones. In fact, fa
di
sabled loved provide almost 80 U.S. They’re me estimates place ear, for free.
percent of long term-cproviding this service, whiat a staggering $350
.
CMS has launched a new servialled Ask Medicare, to support Linda and the more th
ce c
million Americ
adults—who ation on a wide igating social
provide care to a lo Ask Medicare provides inforrange of issues and hCMS wMedhelp with hcommunity sehousing op Ask countrydoctor. It ctelephone nuand help thassistance. Caregiverscaregivers Chances are, ycase we hCMS website. In July 2000, the Treasury Department’sManagement Service and the IRS starteFederal Payment Levy Program (FPLP),authorized by Internal Revenue Code Se(h), as prescribed by Section 1024 of theRelief Act of 1997. Through this prograof overdue taxcial is
h 6331 ayer ection cludes ndors, ith certain federal payments is authorizfederal payments made to contractors aincluding Medicare providers, doing the government. Beginning in October 2008, Medicare provpayments will be levied to pay delinquentowed by Medicare providers. Payments wsubject to a maximum 15 percent lecontinuous until overdue taxes are paid other arrangements are made to satisfy the deEach time a federal payment is levie
wdebts
yor bt. ll send that is out a remittance advice to include twithheld and a Department of the Treasurynumber to be used by the payee to discureduction in payment. If the amount of the withholding through FPLP exceeds the toowed by the payee
ephone e ebt nsible , only h you. ation to for refunding the overpayment to the Medicare contractors will not have share with you.calling 1-800-82
ctly by A Medicare LearnIRS FedProgram published that discus
tail. The changes in the finaoutpatient services furnis
will apply to more than 4,000 based on a formudesigned to procoinsurance
by
hospitals, inpatient nt psychiatric e hospitals, 25 percent of all tyHOPDs, reflectingrehabilitation facilities, inpfacilities, long-term acute chospithospitals will receive $30.1 billion in CY 2009 for outpatient services furnished to Medicare The final rule
beneficiarpayments of almost $3.9 billion in CY 2009 to more than 5,100 ASCs that participate in Medicare. December 29, 2the comments wil Hospital OutpStory continuedtient Quality (cont’d from pre