Medicare News

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) – Reminder about CAP Claims Submission Deadlines and Unused CAP Drugs



2. DMEPOS Accreditation Deadline--Act Now!!!



3. Special ODF on Medicare Classification Criteria for Inpatient Rehabilitation Facilities



4. Physician Quality Reporting Initiative (PQRI) Updates



5. New Educational Product Available on E-Prescribing



6. Medicare Billing Requirements and Policies for Replacement of Oxygen Equipment and Oxygen Contents



7. New From the Medicare Learning Network



8. Notification of Error in Attachment D to Chapter 8 of the “OASIS Implementation Manual”



9. CMS Updates End Stage Renal Disease (ESRD) PC Pricer



10. January Flu Shot Reminder



11. Extra Help for Beneficiaries Paying for Prescription Drugs



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1. Medicare Part B Competitive Acquisition Program (CAP) – Reminder about CAP Claims Submission Deadlines and Unused CAP Drugs



The following is a reminder about upcoming CAP deadlines. It is very important that physicians who participated in the CAP during 2008 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 be submitted on or before January 30, 2009. CAP drug claims and corresponding physicians’ drug administration claims must have a date of service on or before December 31, 2008.

§ CAP drugs that have not been administered by December 31, 2008 are the property of the Approved CAP Vendor.

§ Do not submit CAP claims for dates of service after December 31, 2008 because they will be denied.

§ CAP claims submitted by the Approved CAP Vendor for dates of service after December 31, 2008 will also be denied.



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 provision, physicians may submit a prescription order for a CAP drug to replace what they used from their own stock. 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.



For more information

Physicians who participated 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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2. DMEPOS Accreditation Deadline--Act Now!!!



DMEPOS Accreditation Deadline is September 30, 2009

CMS Encourages Suppliers to Submit Applications by January 31, 2009



The Centers for Medicare & Medicaid Services (CMS) wants to ensure that suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) who bill Medicare for Part B services have ample time to complete the accreditation process and thus receive an accreditation decision by the September 30, 2009 deadline. In order to meet this deadline, CMS is encouraging all enrolled DMEPOS suppliers, except those eligible professionals and other persons exempted by law, to submit a complete accreditation application to an accreditation organization by January 31, 2009.



The accreditation requirement applies to suppliers of durable medical equipment, medical supplies, home dialysis supplies and equipment, therapeutic shoes, parenteral/enteral nutrition, transfusion medicine and prosthetic devices, prosthetics and orthotics. Pharmacies, pedorthists, mastectomy fitters, orthopedic fitters/technicians and athletic trainers must also meet the September 30, 2009 deadline for DMEPOS accreditation. A DMEPOS supplier that wishes to become accredited should contact an Accreditation Organization and obtain information about the accreditation process.



Section 302 (b) (1) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), required the Secretary of the Department of Health and Human Services (HHS) to establish and implement quality standards for DMEPOS suppliers, except those eligible professionals and other persons exempted by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). In order to retain or obtain a Medicare Part B DMEPOS number, all DMEPOS suppliers must comply with these standards and become accredited.



Certain eligible professionals and other persons are exempted from the accreditation requirement including physicians, physical and occupational therapists, qualified speech-language pathologists, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, certified nurse-midwives, clinical social workers, clinical psychologists, registered dietitians/nutrition professionals, orthotists, prosthetists, opticians and audiologists.



Further information on the DMEPOS accreditation requirements along with a list of the accreditation organizations may be found at www.cms.hhs.gov/medicareprovidersupenroll.

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3. Special ODF on Medicare Classification Criteria for Inpatient Rehabilitation Facilities



Centers for Medicare & Medicaid Services

Special Open Door Forum:

Medicare Classification Criteria for Inpatient Rehabilitation Facilities



Monday, February 9, 2009

2:00 pm-4:00 pm Eastern Time



The purpose of this Special Open Door Forum (ODF) is to gather public input on the classification criteria commonly applicable to Inpatient Rehabilitation Facilities, commonly known as the “75 percent rule.” The compliance percentage threshold is currently set at 60 percent. Public input from this meeting will be considered in the preparation of the Report to Congress required by the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA).



Background



CMS has contracted with RTI International to assist CMS in preparing the Report to Congress required by the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA). Specifically, RTI will examine and report on:



(1) Whether Medicare beneficiaries have access to medically necessary rehabilitation services and any potential effect of the “75% rule” on their access to appropriate care?

(2) Whether alternative criteria or refinements to the 75% rule could be used to determine IRF classification, including patients’ functional status, diagnosis, comorbidities, or other attributes?

(3) Whether IRF care is appropriate for certain other types of conditions which are commonly treated in IRFs, but are outside of the 13 conditions specified in the 75% rule? Are there differences in patient outcomes and costs when these cases are treated in different settings?



RTI’s 24 month contract includes two phases. The first phase consists primarily of reviewing the relevant literature and policy materials and compiling stakeholder input. The second phase involves conducting analyses utilizing administrative and clinical assessment data. CMS will be reporting on the first phase in a Report to Congress which is due June 2009. The RTI analysis will continue through 2009 with a final report to CMS by late 2010.



Comments should be limited. Longer written comments may be submitted via e-mail to IRFReporttoCongress@cms.hhs.gov. If possible, comments should be submitted to CMS in writing in advance of the Special ODF. If you have any questions please feel free to contact Julie Stankivic at (410) 786-5725.



We look forward to your participation



Special ODF participation Instructions:

Dial: 1-800-837-1935 & Reference Conference ID: 80702717

Note: TTY Communications Relay Services are available for the Hearing Impaired. For

TTY services dial 7-1-1 or 1-800-855-2880 and for Internet Relay services click here

http://www.consumer.att.com/relay/which/index.html. A Relay Communications

Assistant will help.



An audio recording of this Special Forum will be posted to the Special Open Door Forum website at http://www.cms.hhs.gov/OpenDoorForums/05_ODF_SpecialODF.asp and will be accessible for downloading beginning February 18, 2009.



For automatic emails of Open Door Forum schedule updates (E-Mailing list subscriptions) and to view Frequently Asked Questions please visit our website at http://www.cms.hhs.gov/opendoorforums/



Thank you for your interest in CMS Open Door Forums.

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4. Physician Quality Reporting Initiative (PQRI) Updates



Frequently Asked Questions

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that updates to many of the Frequently Asked Questions (FAQS) on the Physician Quality Reporting Initiative (PQRI) are now available on the PQRI webpage. A number of FAQs have been revised, while many new FAQS have been added to the system. The purpose of the FAQs is to provide detailed answers to common questions regarding the PQRI program. Among the various FAQs included in this update are several related to the 2007 PQRI data re-run. The FAQs may be found in the “Related Links Inside CMS” section of the PQRI webpage at http://www.cms.hhs.gov/pqri/ on the CMS website.



New Educational Products for 2009 PQRI Now Available

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that two new educational resources have been posted to the PQRI webpage on the CMS website.



2009 PQRI Fact Sheet: What's New for the 2009 PQRI- This Fact Sheet provides an overview of the 2009 PQRI and highlights the changes from the 2008 PQRI program.



2009 PQRI Made Simple – Reporting the Preventive Care Measures Group- This Tip Sheet provides quick, easy to understand instructions on how to satisfactorily participate in the 2009 PQRI for those who wish to report quality data using claims for the Preventive Care Measures Group.



To access these new, and all, available educational resources, visit http://www.cms.hhs.gov/PQRI on the CMS website and click on the Educational Resources tab. Once on the Educational Resources page, scroll down to the “Downloads” section and click on the “2009 PQRI Fact Sheet: What’s New for the 2009 PQRI” and the “2009 PQRI Made Simple- Reporting the Preventive Care Measures Group” links.

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5. New Educational Product Available on E-Prescribing



The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that a new Medicare Learning Network educational resource has been posted to the Electronic Prescribing (E-Prescribing) Incentive Program section page on the PQRI webpage:



2009 Electronic Prescribing Incentive Program Made Simple- This Fact Sheet provides detailed information on how to participate in the 2009 Electronic Prescribing (E-Prescribing) Incentive Program by reporting the E-Prescribing measure.



To access this new educational product, as well as all available E-Prescribing educational resources, visit http://www.cms.hhs.gov/PQRI on the CMS website and click on the Electronic Prescribing Incentive Program tab. Once on the E-Prescribing page, scroll down to the “Downloads” section and click on the “2009 Electronic Prescribing Incentive Program Made Simple” link.

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6. Medicare Billing Requirements and Policies for Replacement of Oxygen Equipment and Oxygen Contents



This message is for suppliers and home health agencies that furnish oxygen and oxygen equipment to Medicare beneficiaries



Suppliers of oxygen and oxygen equipment need to be aware of the procedures for submitting claims for oxygen and oxygen equipment following the enactment of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) on July 15, 2008.



Section 144(b) of MIPPA took effect on January 1, 2009, and repeals the requirement for you to transfer title to oxygen equipment to the beneficiary after the 36 month payment cap mandated by the Deficit Reduction Act of 2005. Section 144(b) of MIPPA also establishes new payment rules and supplier responsibilities following the 36 month payment period. See MLN Matters number SE0840 for additional information about these new rules. This listserv message provides specific instructions for submitting claims for oxygen contents and replacement of oxygen equipment.





REPLACEMENT OF OXYGEN EQUIPMENT



New HCPCS Modifier for Replacement of DME

Effective January 1, 2009, the following modifiers was added to the Healthcare Common Procedure Coding System (HCPCS):



RA – Replacement of a DME item;



This modifier is to be used on claims for replacement of oxygen equipment with dates of service on or after January 1, 2009. HCPCS modifier RP, which was discontinued effective December 31 2008, remains in effect for claims with dates of service prior to January 1, 2009.



If oxygen equipment is replaced because the equipment has been in continuous use by the patient for the equipment’s reasonable useful lifetime or is lost, stolen, or irreparably damaged, the patient may elect to obtain a new piece of equipment. Irreparable damage refers to a specific incident of damage to equipment such as equipment falling down a flight of stairs as opposed to equipment that is worn out over time. In these situations, a new 36-month rental period and new reasonable useful lifetime is started on the date that the new, replacement item is furnished. Claims for the replacement of oxygen equipment for the first month of use only are billed using the HCPCS code for the new equipment and either the RA or RP HCPCS modifier depending on the date that the equipment is furnished.


You must include on the claim for the first month of use a narrative explanation of the reason why the equipment was replaced and supporting documentation must be maintained in your files. For example, if equipment is stolen, you should keep a copy of the police report in your files. For lost or irreparably damaged equipment, you should maintain any documentation that supports the narrative account of the incident. For reasonable useful lifetime replacements, the narrative explanation should include the date that the beneficiary received the equipment being replaced.


When submitting claims electronically for replacement of oxygen equipment, you may use, for the narrative explanation, loop 2400 (line note), segment NTE02 (NTE01=ADD) of the ASC X12, version 4010A1 professional electronic claim format. If you are billing using the Form CMS-1500 paper claim, you may report this information in item 19 of the claim form.


If you are a home health agency submitting claims electronically for replacement of oxygen equipment, you may use, for the narrative explanation, loop 2300, segment NTE (billing note) of the ASC X12, version 4010A1 institutional electronic claim format. If you are a home health agency billing using the UB-04 paper claim, you may report this information in Form Locator 80 (Remarks).


A new certificate of medical necessity (CMN) is required in situations where oxygen equipment is replaced because the equipment has been in continuous use by the patient for the equipment’s reasonable useful lifetime or is lost, stolen, or irreparably damaged. New testing, however, is not required unless it is necessary in order to meet existing medical review guidelines for oxygen and oxygen equipment. You should continue to follow the existing guidelines requiring recertification CMNs for all situations in which oxygen equipment is being replaced. The most recent qualifying value and testing date should be entered on the CMN.


As is the case for all DME items, you must maintain proof-of-delivery documentation in your files for replacement oxygen equipment. In addition, for equipment that is being replaced because it has been in continuous use by the beneficiary for the reasonable useful lifetime and the beneficiary has elected to obtain new equipment, you must also have proof-of-delivery documentation in your files for the item being replaced that documents that the oxygen equipment has been in use for at least 5 years.


Change in Oxygen Equipment during the Reasonable Useful Lifetime Period

The reasonable useful lifetime for stationary or portable oxygen equipment begins when the oxygen equipment is first delivered to the beneficiary and continues until the point at which the stationary or portable oxygen equipment has been used by the beneficiary on a continuous basis for 5 years. Computation of the reasonable useful lifetime is not based on the age of the equipment.


If there is a change in oxygen equipment modalities (e.g., from a concentrator to a stationary liquid oxygen system) prior to the end of the reasonable useful lifetime period, this does not result in the start of a new reasonable useful lifetime period or a new 36 month payment period. In addition, if you have to replace oxygen equipment that is not functioning properly prior to the end of the reasonable useful lifetime period, this does not result in the start of a new reasonable useful lifetime period or a new 36 month payment period. Finally, if the beneficiary switches to a new supplier and new equipment prior to the end of the reasonable useful lifetime period, this does not result in the start of a new reasonable useful lifetime period or a new 36 month payment period.


A beneficiary may elect to obtain new oxygen equipment at the end of the 5 year reasonable useful lifetime period in these situations.


Clarification of Policy Regarding Continuous Use of Oxygen and Oxygen Equipment

The instructions pertaining to payments for capped rental items during a period of continuous use now apply to the monthly payment amounts for oxygen and oxygen equipment and the portable oxygen equipment add-on payments.


A period of continuous use allows for temporary interruptions in the use of the equipment. For breaks in need (beneficiary no longer needs or uses the equipment) of less than 60 days plus the days remaining in the last paid rental month, the period of continuous use does not start over and so the count of continuous months picks up where it left off before the break. For example, if the last paid rental month is month #31 and there is a 50 day break in need, the next paid rental month would be month #32.


If, however, there is a break in need more than 60 days plus the days remaining in the last paid rental month, and the need for the equipment resumes at a later date, a new period of continuous use, a new 36-month payment period, and a new reasonable useful lifetime period would begin provided that you have submitted the following:


o New medical necessity documentation (i.e., a new CMN and retesting) for oxygen and oxygen equipment and/or portable oxygen equipment;



AND



o A narrative explanation describing the reason for the interruption which shows that medical necessity in the prior episode ended. When submitting claims electronically for replacement of oxygen equipment, you may use, for the narrative explanation, loop 2400 (line note), segment NTE02 (NTE01=ADD) of the ASC X12, version 4010A1 professional electronic format. If you are billing using the Form CMS-1500 paper claim, you may report this information in item 19 of the claim form. If you are a home health agency submitting claims electronically for replacement of oxygen equipment, you may use, for the narrative explanation, loop 2300, segment NTE (billing note) of the ASC X12, version 4010A1 institutional electronic claim format. If you are a home health agency and are billing using the UB-04 paper claim, you may report this information in Form Locator 80 (Remarks). Suppliers and home health agencies are not to use modifier RA on these claims.



PLEASE NOTE: If medical necessity for the equipment continues during a break in billing/Part B payment (e.g., the beneficiary is hospitalized for 70 days but continues to use oxygen equipment during the hospital stay), this DOES NOT constitute a break in need, and therefore, a new period of continuous use DOES NOT begin. In these situations, the count of continuous months picks up where it left off before the break.





OXYGEN CONTENTS



Payment for Oxygen Contents (General Policy)

If you furnished liquid or gaseous oxygen equipment during the 36-month rental period, you are responsible for furnishing the oxygen contents used with the oxygen equipment for any period of medical need following the 36-month rental cap for the remainder of the reasonable useful lifetime of the equipment.


In these situations, you can bill for and receive a monthly payment for furnishing oxygen contents (see chart below).


Payment for Oxygen Contents (When Monthly Payments May Begin)

Payment for both oxygen contents used with stationary oxygen equipment and oxygen contents used with portable oxygen equipment is included in the 36 monthly payments for oxygen and oxygen equipment (stationary oxygen equipment payment) made for codes E0424, E0439, E1390, or E1391. Beginning with dates of service on or after the end date of service for the month representing the 36th payment for code E0424, E0439, E1390, or E1391, you may bill on a monthly basis for furnishing oxygen contents (stationary and/or portable), but only in accordance with the following chart:


Equipment Furnished in Month 36
Monthly Contents Payment after Stationary Cap

Oxygen Concentrator (E1390, E1391, or E1392)


None

Portable Gaseous Transfilling Equipment (K0738)


None

Portable Liquid Transfilling Equipment (E1399)


None

Stationary Gaseous Oxygen System (E0424)
Stationary Gaseous Contents (E0441)

Stationary Liquid Oxygen System (E0439)
Stationary Liquid Contents (E0442)

Portable Gaseous Oxygen System (E0431)
Portable Gaseous Contents (E0443)

Portable Liquid Oxygen System (E0434)
Portable Liquid Contents (E0444)




You may not bill for stationary oxygen contents if the beneficiary uses a stationary concentrator and you may not bill for portable oxygen contents if the beneficiary uses a portable concentrator or transfilling equipment.


PLEASE NOTE: The descriptors for HCPCS codes E0441 through E0444 reflect older policies and regulations and need to be revised to reflect current policies and regulations. For now, each of these four codes represents monthly delivery of either stationary or portable oxygen contents. The language in parentheses in the descriptors for each of these codes should be disregarded.



If the beneficiary began using portable gaseous or liquid oxygen equipment (E0431 or E0434) more than one month after they began using stationary oxygen equipment, monthly payments for portable gaseous or liquid oxygen contents (E0443 or E0444) may begin following the stationary oxygen equipment payment cap AND prior to the end of the portable equipment payment cap (code E0431 or E0434). As long as the beneficiary is using covered gaseous or liquid portable oxygen equipment, payments for portable oxygen contents may begin following the stationary oxygen equipment payment cap. This will result in a period during which monthly payments for E0431 and E0443, in the case of a beneficiary using portable gaseous oxygen equipment, or E0434 and E0444, in the case of a beneficiary using portable liquid oxygen equipment, overlap. In these situations, after the 36-month portable oxygen equipment payment cap for E0431 or E0434 is reached, monthly payments for portable oxygen contents (E0443 or E0444) would continue.


If the beneficiary began using portable gaseous or liquid oxygen equipment (E0431 or E0434) following the 36-month stationary oxygen equipment payment period, payments may be made for both the portable equipment (E0431 or E0434) and portable contents (E0443 or E0444).


In all cases, separate payment for oxygen contents (stationary or portable) would end in the event that a beneficiary receives new stationary oxygen equipment and a new 36-month stationary oxygen equipment payment period begins (i.e., in situations where stationary oxygen equipment is replaced because the equipment has been in continuous use by the patient for the equipment’s reasonable useful lifetime or is lost, stolen, or irreparably damaged). Again, the monthly payment for stationary oxygen equipment includes payment for both stationary and portable oxygen contents. Therefore, under no circumstances can you receive both the monthly stationary oxygen equipment payment and payment for either stationary or portable oxygen contents.


Proof-of-Delivery Requirements for Oxygen Contents

Following the stationary oxygen equipment payment cap, you may bill for oxygen contents (stationary and/or portable in accordance with the chart above) on the anniversary date of the oxygen equipment billing.


For example, if the 36th month of continuous use of the stationary oxygen equipment begins on March 11th and ends on April 10th, you may begin billing for monthly oxygen contents that the beneficiary will use after the cap on April 11th.



For subsequent months, you do not need to deliver the oxygen contents every month in order to continue billing for the contents on a monthly basis. A maximum of 3 months of oxygen contents can be delivered at one time. In these situations, the delivery date of the oxygen contents does not have to be the DOS (anniversary date) on the claim. However, in order to bill for contents for a specific month, you must have previously delivered quantities of oxygen that are sufficient to last for one month following the date of service on the claim. You are required to have proof-of-delivery for each actual delivery of oxygen, but as discussed above, this may be less often than monthly.


For example, if you deliver 30 oxygen tanks on April 11th and the beneficiary only uses 15 tanks from April 11th through May 10th and 15 tanks from May 11th through June 10th, you may bill for contents on April 11th and again on May 11th for contents delivered on April 11th that were used for two months.





A Change Request (CR) and a MLN Matters Article will be forthcoming that will incorporate the information contained in this listserv message.

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7. New From the Medicare Learning Network



Now Available to Order! The Expanded Benefits Brochure (January 2009). This tri-fold brochure provides health care professionals with an overview of Medicare's coverage of three preventive services: the initial preventive physical examination (IPPE), also known as the Welcome to "Medicare Physical" Exam or the "Welcome to Medicare" visit, ultrasound screening for abdominal aortic aneurysms, and cardiovascular screening blood tests. To view, download and print this brochure, please go to the CMS Medicare Learning Network (MLN) at http://www.cms.hhs.gov/MLNProducts/downloads/Expanded_Benefits.pdf. To order free of charge, visit http://www.cms.hhs.gov/MLNProducts/, scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page.”



The ABC’s of Providing the Initial Preventive Physical Examination Quick Reference Information (January 2009 Resource). This resource tool is now available in either a two-sided laminated chart or in a tear off pad. It can be used by Medicare fee-for-service physicians and qualified non-physician practitioners as a guide when providing the initial preventive physical examination (IPPE) (also known as the "Welcome to Medicare" Physical Exam or the "Welcome to Medicare" Visit). The two-sided reference identifies the components and elements of the IPPE; provides eligibility requirements, procedure codes to use when filing claims, FAQs, and suggestions for preparing patients for the IPPE; and lists references for additional information. To view, download and print this resource, please go to the CMS Medicare Learning Network (MLN) at http://www.cms.hhs.gov/MLNProducts/downloads/MPS_QRI_IPPE001a.pdf. To order free of charge the laminated chart or tear off pad, visit http://www.cms.hhs.gov/MLNProducts/, scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page.”





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 print format from the Centers for Medicare & Medicaid Services Medicare Learning Network. To place your order, visit http://www.cms.hhs.gov/MLNGenInfo/ , scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page.”

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8. Notification of Error in Attachment D to Chapter 8 of the “OASIS Implementation Manual”



Section D (4) (c) (3) of Attachment D in the “OASIS Implementation Manual” contains an error. Currently, this section of the document incorrectly lists the Neuro 3-Stroke diagnosis group. The correct diagnosis group is Neuro 1-Brain Disorders and Paralysis. Case Scenario #4 also incorrectly assigns a diagnosis from the Neuro 3-Stroke diagnosis group. The correct diagnosis assignment in Scenario #4 should be from the Neuro 1- Brain Disorders and Paralysis diagnosis group. Revisions to the above section of Attachment D, to include revisions to the associated Case Scenario #4, will be posted in the near future. Questions related to Attachment D should be sent to: AskOasisAttachD@cms.hhs.gov.



“Attachment D” to Chapter 8 of the "OASIS Implementation Manual" is currently posted in the "Downloads" section of the "OASIS B1 User Manual website: http://www.cms.hhs.gov/HomeHealthQualityInits/14_HHQIOASISUserManual.asp.

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9. CMS Updates End Stage Renal Disease (ESRD) PC Pricer



The Centers for Medicare & Medicaid Services (CMS) has updated the PC Pricer web page at http://www.cms.hhs.gov/PCPricer/02e_ESRD_Pricer.asp#TopOfPage to include the updated ESRD PC Pricer with the rates for 2009. The PC Pricer is located in the Downloads section of the web page.

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10. January 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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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

North Dakota Legislative Budget Status

The following links provide information regarding the current status of the legislative action affecting the 2009-11 state budget:

http://www.legis.nd.gov/fiscal/

Budget Status - Executive Summary. This is an executive summary of the current status of the 2009-11 general fund state budget.

Budget Status - Detail Reports. These reports provide detail regarding the current status of the 2009-11 state budget including revenue and appropriation comparisons to the executive recommendation and the 2007-09 state budget and statements of purpose of amendments.

Analysis of Fiscal Impact. This report provides information regarding bills under consideration which contain an appropriation, state fiscal impact, or state revenue impact. Paper copies of the report are available in the Legislative Council office.

North Dakota Human Services

NEWS from the North Dakota Department of Human Services

600 E Boulevard Ave, Bismarck ND 58505-0250


FOR IMMEDIATE RELEASE

January 28, 2009



Contacts: Nancy McKenzie, Vocational Rehabilitation Division Director, 701-328-8926; Cheryl Wescott Wetsch, Program Administrator, Vocational Rehabilitation Division, 701-328-8959; or Heather Steffl, Public Information Officer, N.D. Department of Human Services, 701-328-4933



State seeks information about employment needs of people with disabilities



BISMARCK, N.D. – The North Dakota Department of Human Services and the State Rehabilitation Council are working together to gather information about the employment needs of people with disabilities, as well as issues encountered by providers delivering services to these individuals. The agency’s Vocational Rehabilitation Division is distributing surveys statewide and hosting focus groups in tribal areas, and invites interested individuals, service providers, advocates, and others to participate. Findings will help identify priorities and shape services for the next three years.



“This process helps us understand consumer and provider needs, so that we can deliver effective training and employment services,” said Nancy McKenzie, director of the department’s Vocational Rehabilitation Division.



McKenzie said the department has mailed paper surveys to individual consumers and providers. Individuals can also complete the survey by phone by calling 328-8950 in Bismarck, 1-800-755-2745 toll free for long distance calls, or by contacting ND Relay 711, a telecommunication service for people with hearing impairments.



In addition, people can complete the survey about consumer needs online at https://eforms.nd.gov/lfserver/ConsumerFocus. The survey about organizations that provide employment-related services to North Dakotans with disabilities can be completed at https://eforms.nd.gov/lfserver/ProviderFocus.



In recent years, North Dakota’s vocational rehabilitation program has earned national recognition for its outreach efforts to businesses and rural residents. Last year, the program provided training and employment services to 6,472 North Dakotans. For information about services see http://www.nd.gov/dhs/rcs/.

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Teacher Education News

AACTE Weekly News Briefs | January 27, 2009_____________

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Click here for more information on the 61st Annual Meeting & Exhibits as well as direct links for registration, hotel reservations, and answers to frequently asked questions.



You Spoke…and AACTE Listened!

In a recent AACTE membership survey, an overwhelming majority of survey respondents indicated they prefer to receive AACTE news updates online. We will continue to bring you the latest news in our popular monthly Briefs newsletter, but beginning with the March 2009 issue, it will be available online only at www.aacte.org. Representatives will be notified by e-mail when each issue is posted. If you currently receive AACTE’s weekly NewsBriefs e-mails, you will receive Briefs information at the same address. To confirm or update your e-mail address, please contact membership@aacte.org. To view the current or archived issues of Briefs on the web, click here (member login required).



AACTE Announces Member News

Has your institution recently received a grant? Is a former student now recognized as a teacher of the year? Have you recently received a prestigious award? Well here is your chance to showcase your accomplishments! AACTE has developed a “Member News” section on our website where members are encouraged to submit news stories including the recognition of awards, grants, and other notable achievements. All submissions postings are subject to the discretion of AACTE staff. Please email your accomplishments to Alyssa Mangino at amangino@aacte.org.



AACTE Announces 2009 Annual Meeting Planner

Did you know that you can search an online database for ALL confirmed sessions as well as create your own customized itinerary for AACTE’s 61st Annual Meeting & Exhibits? You can do all that and more by using AACTE's exclusive Online Itinerary Planner!



Voting to Commence Soon on Proposed Changes to AACTE’s Bylaws and Resolutions

AACTE's Institutional Representatives will have one week, from February 9 through 16, 2009, to vote on changes to the Association's bylaws and resolutions for 2009 already approved by the Board. AACTE members will convene at the Chicago conference on Saturday, February 7, from 7:45 to 9:00 a.m. at the annual hearing of AACTE's Issues and Resolutions Committee to discuss the issues approved by the Board of Directors for this year's vote by the membership. Voting will be conducted online via electronic balloting.





NATIONAL NEWS



House to vote on stimulus package this week

From the Committee on Appropriations

Education for the 21st Century: To enable more children to learn in 21st century classrooms, labs, and libraries to help our kids compete with any worker in the world, this package provides:

· $41 billion to local school districts through Title I ($13 billion), IDEA ($13 billion), a new School Modernization and Repair Program ($14 billion), and the Education Technology program ($1 billion).

· $79 billion in state fiscal relief to prevent cutbacks to key services, including $39 billion to local school districts and public colleges and universities distributed through existing state and federal formulas, $15 billion to states as bonus grants as a reward for meeting key performance measures, and $25 billion to states for other high priority needs such as public safety and other critical services, which may include education.

· $15.6 billion to increase the Pell grant by $500.

· $6 billion for higher education modernization.



Gates Gives $22 Million in Grants

From Education Week

As part of its recently revamped education agenda, the Bill & Melinda Gates Foundation today rolled out $22 million in grants to build and strengthen student-data systems at the high school and postsecondary levels and to support new research on teacher effectiveness.



Stimulus school money could be hard to cut later

From the Associated Press

If the government spends billions on education to help jump-start the staggering economy, what happens when things improve and schools have grown used to the largesse? That is what Republicans are asking about President Barack Obama's recovery plan, the largest increase in federal money for schools.



A New Era for Teacher Policy?

From Education Week

Maybe it's a little early to read the tea leaves, but we here at Teacher Beat we think there might be a lot more attention at the federal level to teacher quality. Why? Well, the confirmation hearing for Arne Duncan focused nearly exclusively on teaching, while the economic-stimulus package has oodles of new funding for teachers.





NEWS FROM AROUND THE COUNTRY



U of M program recruits professionals for career switch to education

From commercialappeal.com

For three years, the University of Memphis has recruited several dozen teachers through a $1.2 million federal grant aimed at getting math and science experts into middle-school classrooms. Many have completed master's degrees in education through a loan forgiveness option that refunds their tuition if they teach in a high-need school for two years.



Economy has many applying to be teachers

From AZStarnet.com

Teaching is looking pretty good to a lot of people right now. The Tucson Unified School District for the first time in a decade has had to impose a hiring freeze on substitutes because there are so many applicants. Amphitheater Public Schools, too, has more substitutes than it knows what to do with. And it's getting easier to hire for the certified teaching pool, too, school officials say.



Zero to teacher in five weeks

From Medill Reports Chicago

Teach for America prepares young men and women nationwide for the urban classroom. Its ranks are filled with those who are willing to leave educational comfort zones to teach students in historically neglected schools. Its training consists of five weeks focused on breeding an aggressive team of reformers eager to close America’s educational achievement gap. Dr. Sharon Damore, a department assistant chair for teacher education at the DePaul University School of Education, acknowledged she was skeptical about the institute’s brevity. Teach for America core members spend five weeks training; graduate students at DePaul spend two years.



UNT College of Education Receives $1 Million Endowment to Fund Scholarships for Students Pursuing Su

From PRCanada.com

The University of North Texas College of Education has signed a memorandum of understanding with Dallas-based Southwest Securities, Inc., establishing a $1 million scholarship endowment to benefit students in the college's superintendent certification program. The Southwest Securities Superintendent Certification Scholarship will allow students to have approximately half of their tuition restored upon the successful completion of their coursework.





Other Announcements



AERA Undergraduate Student Education Research Training Workshop

From AERA

Call for Applications

Deadline: February 20, 2009

The American Educational Research Association invites fellowship applications for an Undergraduate Student Education Research Training Workshop to be held at the 2009 Annual Meeting in San Diego. This workshop is designed to build the talent pool of undergraduate students who plan to pursue doctorate degrees in education research or in disciplines and fields that examine education issues. Applicants are sought who have potential and interest in pursuing careers as education researchers, faculty members, or other professionals who contribute to the research field.



Free Live Webinar on Environmental Building in the Educational Sector

From Xtalks.com

Xtalks, a web-based news and information network, has produced a complimentary, live webinar on the topic, "Environmental Building in the Educational Sector," scheduled for March 5, 2009, 2:00pm – 3:00pm EST. Listeners will learn about the LEED (Leadership in Energy and Environmental Design) "green" building rating system for schools. LEED is the U.S. Green Building Council's voluntary, consensus-based national rating system for developing high-performance, sustainable buildings.

Click here for more information and to register for the webinar.





Alyssa J. Mangino

Communications Manager

AACTE

1307 New York Ave., NW Suite 300

Washington, DC 20005

(202) 478-4596 -Direct

(202) 457-8095 -Fax

amangino@aacte.org

Every Child Matters

Dear Tom,

The U.S. Senate will soon vote on expanding health coverage for children, but amendments may be offered to deny coverage to legal immigrant children and pregnant women for 5 years.

Please contact your Senators toll-free: 1-800-828-0498* and tell them: Support expanding SCHIP so millions of uninsured children can get health coverage, and remove restrictions delaying coverage for children in need.

Background: The House has passed its bill to expand the State Children's Health Insurance Program (SCHIP), including an end to the current 5-year waiting period for legal immigrant and new citizen children to receive SCHIP coverage. The Senate Finance Committee also approved SCHIP legislation and also ended the 5-year denial of benefits. The Senate may start debate on SCHIP Monday night, and the final vote is expected some time this week. It is very important that Senators hear that you want all children to be covered.

For more information, read the talking points from our friends at the National Council of La Raza, available for download here (pdf).

Thank you for your help to make children a political priority.



To unsubscribe from receiving these e-mails, click here

North Dakota State College of Science

NEWS
FOR IMMEDIATE RELEASE
January 23, 2009

Contact: Don Canton or Brandi Pelham
701.328.2200

HOEVEN PRESENTS HALF MILLION DOLLAR CHECK
TO NDSCS FOR DIESEL TECHNOLOGY AND MACHINE TOOLING PROGRAMS
Total private, public funds exceed $1 million

BISMARCK, ND - Gov. Hoeven today presented North Dakota State College of Science with two Workforce Enhancement Grants totaling $520,000. The grants will help expand the college’s diesel technology curriculum and the machine tooling program and will be leveraged with $636,000 in private sector matching funds for a total of more than $1.1 million.

“These two programs help educate and train people for occupations that are in high demand in our state,” Gov. John Hoeven said. “By expanding the diesel technology and machine tooling programs, we are increasing the capacity of our higher ed institutions like NDSCS to provide a consistent pipeline of well-trained workers educated right here in North Dakota.”

This Workforce Enhancement Grant program was established by the 2007 Legislature as an adjunct to the Centers of Excellence program to fund workforce training initiatives.

A $260,000 grant will prepare new workers for the transportation and construction industry by enhancing the diesel technology curriculum to meet the latest emissions and electronic control technologies. The grant covers the cost of software, equipment, instructor certification and student recruitment. The project was industry-driven and guided by recommendations from the transportation and construction industry.

Another $260,000 grant will cover the cost of equipment and student recruitment for automating the precision machining project. The machine tooling program will be expanded by imbedding automation into the machining curriculum to provide training to entry-level workers and incumbent workers. The project was industry driven and guided by recommendations form the NDSCS partners Productivity, Inc. and Haas Technical Center Education Council. Equipment and in-kind match will be provided by Manufacturing Industry Employers.

“This is the culmination of a collaborative effort at its best,” said John Richman, Ph.D., NDSCS president. “These funds will benefit NDSCS students, our business partners and ultimately our local and state economies.”

Workforce Enhancement Grants are a tool for two-year institutions of higher education to apply for funds to help create or enhance training programs that address workforce needs of private sector employers in North Dakota. Projects require private sector participation and a dollar-for-dollar match of all state money with private funds. The North Dakota Department of Commerce Workforce Development Division oversees the grants.

Grant funding may be used for curriculum development, equipment, recruitment of participants and training and certification of instructors. Funds may not be used to supplant funding for current operations.

A Workforce Enhancement Council, consisting of the private sector membership of the North Dakota Workforce Development Council, the state director of the Department of Career & Technical Education and the Division Director of the workforce development division of the ND Department of Commerce who serves as the Chair, reviews all proposals and provides funding recommendations to the Commissioner, ND Department of Commerce.

###

The North Dakota Legislature

Key Hearings Held Jan. 19-23



SB 2019 – Support

SB 2019 was heard before the Senate Appropriations Committee on Jan. 22. This bill is the Department of Career and Technical Education appropriation. It provides a $1.2 million increase (of which the Governor recommended $800,000) for the virtual area career and technical education centers. These centers offer IT courses to students who previously did not have access to them, and each center is required to offer at least two credits of IT coursework to all students in member schools. The bill also provides $3 million (of which the Governor recommended $1.8 million) to increase funding for schools for career and technical education (CTE) programs. This is important due to the high cost of equipment for CTE courses and increased staffing needs due to smaller class requirements for lab settings. This provides an incentive for additional schools to add CTE courses, including IT, to their curriculum. Lastly, it includes $1.6 million (of which the Governor recommended $400,000) to increase the number of career resource coordinators and career advisors. These individuals would assist in providing information to students and educators on the IT cluster. ITCND supported this bill. Attached is the testimony of Gary Inman, ITCND president.



Status of Key Bills



SB 2110 – Support

SB 2110 was given a 6-0 “do pass” recommendation from the Senate Industry, Business and Labor Committee on Jan. 21. This bill expands the Operation Intern program to include apprenticeships and participation from 11th and 12th graders. Operation Intern is important to ITCND because, of the 87 companies taking advantage of the program, 20 are technology-related. The $1.2 million in funding for the expanded program is in both SB 2018 and HB 1065. It is assumed the funding will be taken out of one of the bills. ITCND supported this bill at its hearing on Jan.13.



Hearing Schedule and Status Report (Jan. 26-30)



The hearing schedule and status of bills being tracked by ITCND are attached. We will not be offering testimony on all of these bills, but are tracking them because they have a direct or indirect impact on information technology issues, either at the state agency level, political subdivision level or in private business.



For More Information



If at any time you need additional information or know of others who are interested in receiving this report, contact Annika Nelson, ITCND assistant executive director, at office@itcnd.org or 701-355-4458.



Copies of bill drafts and information about the 61st Legislative Session can be found at the Bills and Resolutions link on the North Dakota Legislative Council website at www.legis.nd.gov/.



How to Contact Your Legislators



During a legislative session, a legislator can be reached at the State Capitol through e-mail or by leaving a message with the legislative telephone message center at 888-NDLEGIS (635-3447) or 701-328-3373 (local). These numbers can also be used to obtain information on bills under consideration. Otherwise, a legislator can be reached by mail or e-mail at the address listed in the legislator's bio online under the 61st Legislative Assembly link at www.legis.nd.gov/assembly/61-2009.





Addressing Mail Correspondence

To a Senator:

Honorable (full name)

State Senator

600 E. Boulevard Ave.

Bismarck, ND 58505



Dear Senator (last name)


To a Representative:

Honorable (full name)

State Representative

600 E. Boulevard Ave.

Bismarck, ND 58505



Dear Representative (last name)




2009 Legislative Deadlines




Date

January 26

February 20

February 20, 23-24

March 5

April 10

April 30
Topic

Deadline for senators to introduce bills

Crossover for bills

Recess

Crossover for resolutions

Good Friday

Session is limited to 80 legislative days




Legislative Bills Tracked (to date)






Appropriation Bills

SB 2003 – North Dakota University System – Support

SB 2016 – Job Service North Dakota – Support

SB 2018 – ND Department of Commerce – Support

SB 2019 – North Dakota Department of Career and Technical Education – Support

SB 2021 – Information Technology Department – Support



Other Bills

HB 1065 – Expansion of Operation Intern – Support

HB 1066 – Tax credits for automation and innovation – Track

HB 1085 – Income tax credits for employment of apprentices and for workforce recruitment – Track

HB 1144 – Relating to confidentiality of information contained in records – Track

HB 1208 – Relating to the use of a wireless communications device and demerit points – Track

SB 2040 – Sales and use tax exemption for telecommunications infrastructure equipment – Support

SB 2062 – Opportunity grant for North Dakota high school graduates and new graduate earned income deduction – Track

SB 2110 – Expands Operation Intern to include apprenticeships and participation from 11th and 12th graders – Support

SB 2131 – Relating to service charges for recycling and disposal for surplus property – Track

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. New From the Medicare Learning Network



2. Upcoming Training for the Medicare Part B Drugs Competitive Acquisition Program (CAP): Transitioning Out of the CAP



3. CMS Selects Final Five Medicare Contractors to Administer Medicare Claims Payments in 14 States



4. Medicare Solicits Nominees for the Advisory Panel on Ambulatory Payment Classification Groups



5. DMEPOS Accreditation Deadline



6. Medicare DMEPOS Competitive Bidding Program Announcements



7. HHS Issues Final ICD-10 Code Sets and Updated Electronic Transaction Standards Rules



8. E-Prescribing Incentive Program Update



9. Enrollment Reporting Responsibilities for Physicians, Non-Physician Practitioners and Group Practices



10. Update on the Availability of Internet-Based Enrollment for Physicians & Non-Physician Practitioners



11. Five-Star Quality Rating Data



12. CMS Updates Five-Star Quality Rating Technical Users’ Guide



13. CMS Issues Three National Coverage Determinations to Protect Patients from Preventable Surgical Errors



14. Physician Fee Schedule Pricing Files Update



15. Audio File and Transcript Posted from Hospital-Acquired Conditions and Hospital Outpatient Healthcare-Associated Conditions Listening Session



16. CMS Announces Implementation of Renal CROWNWeb System



17. Revised Quarterly Provider Specific Files (PSF) Available in SAS and Text Formats



18. January Flu Shot Reminder



19. Extra Help for Beneficiaries Paying for Prescription Drugs



~~~~~~~~~~~~~~~~~~~~



1. New From the Medicare Learning Network



Now Available to Order Free of Charge from the CMS Medicare Learning Network (CMS)!

The ABC’s of Providing the Initial Preventive Physical Examination Quick Reference Information Chart (January 2009). This handy two-sided laminated chart can be used by Medicare fee-for-service physicians and qualified non-physician practitioners as a guide when providing the initial preventive physical examination (IPPE) (also known as the "Welcome to Medicare" Physical Exam or the "Welcome to Medicare" Visit). The two-sided reference identifies the components and elements of the IPPE; provides eligibility requirements, procedure codes to use when filing claims, FAQs, and suggestions for preparing patients for the IPPE; and lists references for additional information. To view, download and print this resource, please go to the CMS Medicare Learning Network (MLN) at http://www.cms.hhs.gov/MLNProducts/downloads/MPS_QRI_IPPE001a.pdf. To order free of charge, visit http://www.cms.hhs.gov/MLNProducts/01_Overview.asp, scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page.”

The Medicare Preventive Services Quick Reference Information Chart (January 2009). This two-sided laminated chart gives Medicare fee-for-service physicians, providers, suppliers, and other health care professionals a quick reference to Medicare's preventive services. To view, download and print this resource, please go to the CMS Medicare Learning Network (MLN) at http://www.cms.hhs.gov/MLNProducts/downloads/MPS_QuickReferenceChart_1.pdf . To order free of charge, visit http://www.cms.hhs.gov/MLNProducts/01_Overview.asp, scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page.”

~~~~~~~~~~~~~~~~~~~~



2. Upcoming Training for the Medicare Part B Drugs Competitive Acquisition Program (CAP): Transitioning Out of the CAP



Noridian Administrative Services (NAS), the designated carrier for the CAP, offers interactive, online workshops about the CAP for Part B Drugs and Biologicals. During the 2009 CAP postponement, a limited number of workshops are being held to assist 2008 CAP physicians with transitioning out of the CAP. Specific topics will include billing for CAP claims and reconciling CAP drug inventory. NAS staff will be available to answer questions during the session. Interested parties may view additional information about and register for these workshops on the Noridian website at:

https://www.noridianmedicare.com/cap_drug/train/schedule.html

Workshops will be held on the following dates:

01/29/09 at 2:00 pm CST
02/12/09 at 2:00 pm CST
Additional information about the CAP and the 2009 postponement is available at: http://www.cms.hhs.gov/CompetitiveAcquisforBios/01_overview.asp

~~~~~~~~~~~~~~~~~~~~



3. CMS Selects Final Five Medicare Contractors to Administer Medicare Claims Payments in 14 States



The Centers for Medicare & Medicaid Services (CMS) recently announced the final five contractors that will process and pay Medicare claims for health care services under the Medicare Fee-for-Service program. The new contracts that will be administered for up to five years will process and pay 36 percent of the national volume of Medicare Part A (hospital insurance) and Part B (medical insurance) claims payments in 14 states, mostly in the South and Midwest. These are services furnished by hospitals, physicians and other health care providers to people with Medicare. CMS now has met its goal of awarding all 15 Medicare Administrative Contractor (MAC) contracts.



“With these last awards, CMS completes a major step in its effort to improve the way in which the government contracts for claims administration for the largest part of Medicare across the United States,” Acting CMS Administrator Kerry Weems said. “CMS will receive the best value for the critical function of processing and paying Medicare claims. This is another step toward ensuring that we have a highly functioning processing and payment system that helps to improve services to beneficiaries and health care providers in the Medicare fee-for-service benefit plan.”



The competitive selection of the new Part A and Part B MACs was made on a “best value” basis. Primary consideration was given to the technical quality of the offerors’ proposals. CMS conducted a technical and past performance evaluation, performed a cost realism analysis and assessed overall cost reasonableness for each award.



The final five Part A and Part B MAC contractors will immediately begin their implementation activities and will assume full responsibility for the claims processing work in their respective jurisdictions no later than March 2010. During the implementation period, the Part A and Part B MAC contractors will be conducting extensive outreach to health care providers, state medical associations and beneficiaries in their jurisdictions to provide education and information about the implementation. The five new MACs are:

· Noridian Administrative Services, LLC (NAS) has been awarded a contract for the combined administration of Part A/Part B Medicare claims payment in Jurisdiction 6 comprised of Illinois, Minnesota and Wisconsin. NAS is headquartered in Fargo, N.D. NAS’ can reached at http://www.noridianmedicare.com/.



· National Government Services (NGS) has been awarded a contract for the combined administration of Part A/Part B Medicare claims payment in Jurisdiction 8 comprised of Indiana and Michigan. NGS is headquartered in Indianapolis, Ind. The NGS website is http://www.ngsmedicare.com/HomePage.aspx.



· Cahaba Government Benefit Administrators, LLC (Cahaba GBA) has been awarded a contract for the combined administration of Part A/Part B Medicare claims payment in Jurisdiction 10 comprised of Alabama, Georgia and Tennessee. Cahaba GBS is headquartered in Birmingham, Ala. The Cahaba GBA’s website is http://cahabagba.com/.



· Palmetto Government Benefits Administrators, LLC (Palmetto GBA) has been awarded a contract for the combined administration of Part A/Part B Medicare claims payment in Jurisdiction 11 comprised of North Carolina, South Carolina, Virginia and West Virginia. Palmetto GBA has its operational headquarters in Columbia, S.C., with some operations performed in Columbus, Ohio. Palmetto GBA’s website is http://www.palmettogba.com/palmetto/palmetto.nsf/SiteHome?ReadForm.



· Highmark Medicare Services (HMS) has been awarded a contract for the combined administration of Part A/Part B Medicare claims payment in Jurisdiction 15 comprised of Kentucky and Ohio. HMS is headquartered in Camp Hill, Pa. HMS’s website is http://www.highmarkmedicareservices.com/.



Under the current system, fiscal intermediaries process claims for Medicare Part A providers, such as hospitals, skilled nursing facilities and other institutional providers. Carriers process claims for physicians, laboratories and other practitioners under Medicare Part B. The new system consolidates those contractors, making it simpler for practitioners to have a single point of contact with Medicare. The Part A and B MACs will be the contact for all Medicare providers and physicians, while beneficiaries will pose their claims-related questions to a Beneficiary Contact Center that can be reached at 1-800-MEDICARE (800-633-4227).



As a result of a full and open competitive procurement, the new contractors will take over the claims payment work now performed by numerous fiscal intermediaries and carriers. The MAC contracts, which have an approximate value of $1.4 billion over five years, will fulfill the requirements of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) contracting reform provisions.



The awards announced close procurement activities under the MMA that began in April 2005 with the issuance of a request for proposal. This action represented the first time full and open competition had been used to select Medicare fee-for-service contractors to perform claims administration services. A total of 19 new contracts have been awarded under MMA provisions. When fully operational the Part A and Part B MACs will completely replace the fiscal intermediaries and carriers that have administered Medicare since its inception. All contracts include a base period and four one-year options and will provide the contractors with the opportunity to earn award fees based on their ability to meet or exceed performance requirements set by CMS. These requirements are rooted in CMS’ key objectives for MACs, including enhanced provider customer service, increased payment accuracy, improved provider education and training leading to correct claims submissions, and realized cost savings resulting from efficiencies and innovation. In accordance with the MMA, MAC contracts will be recompeted at least every five years.



CMS awarded the first Part A and Part B MAC contracts in July 2006. A complete list of contractors and the states they cover, along with other information, can be found at www.cms.hhs.gov/MedicareContractingReform/.

~~~~~~~~~~~~~~~~~~~~



4. Medicare Solicits Nominees for the Advisory Panel on Ambulatory Payment Classification Groups



MEMBERS TO ADVISE CMS ON THE CLINICAL INTEGRITY OF THE

APC GROUPS AND THEIR PAYMENT WEIGHTS



The Centers for Medicare & Medicaid Services (CMS) is soliciting nominations for individuals to serve on the Advisory Panel on Ambulatory Payment Classification (APC) Groups (the Panel) that advises the Secretary, Department of Health and Human Services, and the Administrator, CMS, about the clinical integrity of the APC groups and their associated weights, which are major elements of the Medicare hospital Outpatient Prospective Payment System (OPPS). Nominations are due to CMS no later than Friday, March 13, 2009 – 5 p.m. EST. There will be five vacancies on the Panel as of August 16, 2009.

On November 21, 2000, the Secretary signed the initial Charter establishing the APC Panel. Since its initial chartering, the Secretary has renewed the APC Panel’s Charter four times: on November 1, 2002; on November 1, 2004; effective November 21, 2006; and on November 2, 2008.



The APC Panel may be composed of up to 15 members and a Chair. The following requirements apply to all members of the Panel:



· Must be representatives of providers subject to payment under the hospital OPPS: hospitals, hospital systems, or other Medicare providers

· Cannot be consultants or independent contractors

· May be self-nominations or nominations submitted by Medicare providers and other interested organizations

· Must have technical expertise to enable them to participate fully in the Panel’s work—such expertise encompasses the following:

o hospital payment systems

o hospital medical care delivery systems

o provider billing systems

o APC groups, Current Procedural Terminology codes, and alpha-numeric Health Care Common Procedure Coding System codes

o use of, and payment for, drugs, medical devices, and other services in the outpatient setting, as well as other forms of relevant expertise

· Must have a minimum of 5 years experience in their area(s) of expertise

· Must serve on a voluntary basis, without compensation, pursuant to advance written agreement

· Shall be entitled to receive reimbursement for travel expenses and per diem in lieu of subsistence, in accordance with Standard Government Travel Regulations



The Panel is technical in nature, and it shall deal with the following issues:

Addressing whether procedures within an APC group are similar both clinically and in terms of resource use
· Evaluating APC group weights

· Reviewing the packaging of OPPS services and costs, including the methodology and the impact on APC groups and payment

· Removing procedures from the inpatient list for payment under the OPPS

· Using single and multiple procedure claims data for CMS’ determination of APC group weights

· Addressing other technical issues concerning APC group structure



The current APC Panel membership and other information pertaining to the APC Panel, including its Charter, Federal Register notices, membership, meeting dates, agenda topics, and meeting reports can be viewed on the CMS Web site at: http://www.cms.hhs.gov/FACA/05_AdvisoryPanelonAmbulatoryPaymentClassificationGroups.asp.



Persons wishing to nominate individuals to serve on the Panel may contact Shirl Ackerman-Ross, the Designated Federal Official (DFO), at the following e-mail addresses: shirl.ackermanross@cms.hhs.gov or CMS APCPanel@cms.hhs.gov. (NOTE: There is NO underscore in the APC Panel e-mail address; there is a SPACE between CMS and APCPanel.) Ms. Ackerman-Ross may also be reached at 410-786-4474.

Please mail or hand deliver nominations to the following address:

Centers for Medicare & Medicaid Services

Attn: Shirl Ackerman-Ross, DFO

Advisory Panel on APC Groups

Center for Medicare Management

Hospital & Ambulatory Policy Group

Division of Outpatient Care

7500 Security Boulevard, Mail Stop C4-05-17

Baltimore, MD 21244-1850.

~~~~~~~~~~~~~~~~~~~~



5. DMEPOS Accreditation Deadline



DMEPOS Accreditation Deadline is September 30, 2009

CMS Encourages Suppliers to Submit Applications by January 31, 2009





The Centers for Medicare & Medicaid Services (CMS) wants to ensure that suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) who bill Medicare for Part B services have ample time to complete the accreditation process and thus receive an accreditation decision by the September 30, 2009 deadline. In order to meet this deadline, CMS is encouraging all enrolled DMEPOS suppliers, except those eligible professionals and other persons exempted by law, to submit a complete accreditation application to an accreditation organization by January 31, 2009.



The accreditation requirement applies to suppliers of durable medical equipment, medical supplies, home dialysis supplies and equipment, therapeutic shoes, parenteral/enteral nutrition, transfusion medicine and prosthetic devices, prosthetics and orthotics. Pharmacies, pedorthists, mastectomy fitters, orthopedic fitters/technicians and athletic trainers must also meet the September 30, 2009 deadline for DMEPOS accreditation. A DMEPOS supplier that wishes to become accredited should contact an Accreditation Organization and obtain information about the accreditation process.



Section 302 (b) (1) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), required the Secretary of the Department of Health and Human Services (HHS) to establish and implement quality standards for DMEPOS suppliers, except those eligible professionals and other persons exempted by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). In order to retain or obtain a Medicare Part B DMEPOS number, all DMEPOS suppliers must comply with these standards and become accredited.



Certain eligible professionals and other persons are exempted from the accreditation requirement including physicians, physical and occupational therapists, qualified speech-language pathologists, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, certified nurse-midwives, clinical social workers, clinical psychologists, registered dietitians/nutrition professionals, orthotists, prosthetists, opticians and audiologists.



Further information on the DMEPOS accreditation requirements along with a list of the accreditation organizations may be found at www.cms.hhs.gov/medicareprovidersupenroll.

~~~~~~~~~~~~~~~~~~~~



6. Medicare DMEPOS Competitive Bidding Program Announcements



The Centers for Medicare & Medicaid Services (CMS) has announced that an Interim Final Rule with Comment Period, which implements certain provisions of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) for the Round 1 Rebid of the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Acquisition Program, is on display at the Federal Register.



CMS has also announced the appointment of new members to serve on the Program Advisory and Oversight Committee (PAOC) for the DMEPOS competitive bidding program.



Visit the CMS web site at www.cms.hhs.gov/CompetitiveAcqforDMEPOS/ to view the list of PAOC members and for the latest information on the DMEPOS competitive bidding program.



To view the Press Release, please click: http://www.cms.hhs.gov/apps/media/press_releases.asp.

~~~~~~~~~~~~~~~~~~~~



7. HHS Issues Final ICD-10 Code Sets and Updated Electronic Transaction Standards Rules



The U.S. Department of Health and Human Services (HHS) recently released two final rules that will facilitate the United States’ ongoing transition to an electronic health care environment through adoption of a new generation of diagnosis and procedure codes and updated standards for electronic health care and pharmacy transactions.



The first final rule replaces the ICD-9-CM code sets now used to report health care diagnoses and procedures with greatly expanded ICD-10 code sets, with a compliance date of Oct. 1, 2013. The second final rule adopts an updated X12 standard, Version 5010, for certain electronic health care transactions, an updated version of the National Council for Prescription Drug Programs (NCPDP) standard, Version D.0, for electronic pharmacy-related transactions, and a standard for Medicaid pharmacy subrogation transactions. Version 5010 includes updated standards for claims, remittance advice, eligibility inquiries, referral authorization, and other administrative transactions. Version 5010 also accommodates the use of the ICD-10 code sets, which are not supported by Version 4010/4010A1, the current X12 standard.



“These regulations will move the nation toward a more efficient, quality-focused health care system by helping accelerate the widespread adoption of health information technology,” HHS Secretary Mike Leavitt said. “The greatly expanded ICD-10 code sets will fully support quality reporting, pay-for-performance, bio-surveillance, and other critical activities. The updated X12 transaction standards, Version 5010, provide the framework needed to support the ICD-10 codes.”



Both regulations are on display today at the Federal Register and may be viewed at http://www.archives.gov/federal-register/public-inspection/index.html.

Click on View the Regular Filing Documents.



Both regulations will be published on Jan. 16, 2009, and may be viewed that day and thereafter at http://www.gpoaccess.gov/fr/browse.html. Click “Go” next to where 2009 appears in the year selection box for “Back Issues (HTML Only).”



A fact sheet describing both rules may be viewed at: http://www.cms.hhs.gov/apps/media/fact_sheets.asp.

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8. E-Prescribing Incentive Program Update



Beginning January 1, 2009, eligible professionals can participate in the E-Prescribing Incentive Program by reporting on their adoption and use of an e-prescribing system by submitting information on one e-prescribing measure on their Medicare Part B claims. For the 2009 e-prescribing reporting year, to be a successful e-prescriber and to qualify to receive an incentive payment, an eligible professional must report one e-prescribing measure in at least 50% of the cases in which the measure is reportable by the eligible professional during 2009. There is no sign-up or pre-registration to participate in the E-Prescribing Incentive Program. For more information, visit http://www.cms.hhs.gov/PQRI and select “E-Prescribing Incentive Program” in the left-hand column.



In October 2008, CMS and 34 partner organizations hosted a meeting about the mechanics of implementing an e-prescribing program in a practice. Audiotapes and slides are now archived online for continuing education credit. The Massachusetts Medical Society and the American Pharmacist Association are pleased to provide Continuing Medical Education (a maximum of 22.5 AMA PRA Category 1 Credits™, (risk management study for MA Physicians) and Continuing Education for pharmacists (up to 13.25 hours of continuing education credit (1.325 CEUs)). Simply go to www.massmed.org/cme/CMS_eprescribing to view the presentations and hear the audiotapes of the program. There are no registration or certificate fees.

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9. Enrollment Reporting Responsibilities for Physicians, Non-Physician Practitioners and Group Practices



Attention Physicians, Non-Physician Practitioners and Group Practices:

Reporting Responsibilities



The Centers for Medicare & Medicaid Services has revised the physician, non-physician practitioner and group practice reporting responsibility Fact Sheets and the physicians, non-physician practitioner and other health care supplier brochure found on the Medicare Provider Enrollment web page.



These Fact Sheets list the types of changes that enrolled physicians, non-physician practitioners, and group practices are required to report to Medicare. By reporting changes as soon as possible, physicians, non-physician practitioners, and group practices will help to ensure that their claims are claims are processed correctly.



Links to the following educational materials are provided below:



Reporting Responsibilities for Individual Physicians Enrolled in the Medicare Program

http://www.cms.hhs.gov/MedicareProviderSupEnroll/Downloads/PhysicianReportingResponsibilities.pdf



Reporting Responsibilities for Individual Non-Physician Practitioners Enrolled in the Medicare Program

http://www.cms.hhs.gov/MedicareProviderSupEnroll/Downloads/Non-PhysicianReportingResponsibilities.pdf



Reporting Responsibilities for Physician Group Practices Enrolled in the Medicare Program

http://www.cms.hhs.gov/MedicareProviderSupEnroll/Downloads/GroupPracticeReportingResponsibilities.pdf



Physicians, Non-Physician Practitioners, and Other Health Care Suppliers Brochure

http://www.cms.hhs.gov/MedicareProviderSupEnroll/downloads/suppliers.pdf

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10. Update on the Availability of Internet-Based Enrollment for Physicians & Non-Physician Practitioners



MEDICARE PHYSICIANS AND NON-PHYSICIAN PRACTITIONERS

INTERNET-BASED MEDICARE ENROLLMENT IS AVAILABLE

ALL STATES and the DISTRICT OF COLUMBIA



IT’S FAST, SECURE, and EASY



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.



The Centers for Medicare & Medicaid Services (CMS) will make Internet-based PECOS to all organizational providers and suppliers (except durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers) later this year.



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 or make a change in an existing enrollment record. 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.



There are three basic steps to completing an enrollment action using Internet-based PECOS. Physicians and non-physician practitioners must:



Have an NPPES User ID and password to use Internet-based PECOS.


For security reasons, physicians and non-physician practitioners should change passwords periodically, at least once a year. For information on how to change a password, go to the NPPES Application Help page available at https://nppes.cms.hhs.gov/NPPES/Welcome.do and select the “Reset Password Page” under the NPPES Application help page.


Go to Internet-based PECOS at https://pecos.cms.hhs.gov and complete, review, and submit the electronic enrollment application via Internet-based PECOS.


Print, sign and date the Certification Statement (blue ink recommended) and mail the Certification Statement and all supporting paper documentation to the Medicare contractor.


Note: A Medicare contractor will not process an Internet enrollment application without the signed and dated Certification Statement and the required supporting documentation. In addition, the effective date of filing an enrollment application is the date the Medicare contractor receives the signed Certification Statement that is associated with the Internet submission.



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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11. Five-Star Quality Rating Data



The Centers for Medicare & Medicaid Services (CMS) is giving nursing home providers another preview of the Five-Star Quality Rating data as this is a relatively new program. Please visit your Quality Improvement Evaluation System (QIES) mailbox now (available through your electronic connection to the State servers for submission of Minimum Data Set [MDS] data) to review your results. To access these reports, select the Certification and Survey Provider Enhanced Reporting (CASPER) link located at the bottom of the Home page. Once in the CASPER Reporting system, click on the 'Folders' button and access the Five Star Report in your 'st LTC facid' folder, where st is the 2-digit postal code of the state in which your facility is located, and facid is the state assigned identifier of your facility.



Although Nursing Home Compare is generally updated on the 3rd Thursday of the month, we have built in a one-week delay to allow you time to review your rating prior to the Website’s update. We have also reinstituted the help desk at 1-800-839-9290 which will be open from 9 to 5 EST through January 30, 2009 to address any concerns.

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12. CMS Updates Five-Star Quality Rating Technical Users’ Guide



A new version of the Five-Star Quality Rating Technical Users' Guide and an accompanying Summary of Updates to the Technical Users' Guide document are available on the Five-Star Quality Rating System Web page. See http://www.cms.hhs.gov/CertificationandComplianc/13_FSQRS.asp#TopOfPage for the latest version of the manual.

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13. CMS Issues Three National Coverage Determinations to Protect Patients from Preventable Surgical Errors



The Centers for Medicare & Medicaid Services (CMS) recently announced three national coverage determinations (NCDs) to establish uniform national policies that will prevent Medicare from paying for certain serious, preventable errors in medical care. The following errors, called “never events,” covered in these NCDs are identified in the National Quality Forum’s (NQF) list of Serious Reportable Events:



· Wrong surgical or other invasive procedures performed on a patient;

· Surgical or other invasive procedures performed on the wrong body part; and

· Surgical or other invasive procedures performed on the wrong patient.



In addition, consistent with current policy for non-covered services, Medicare does not cover any services related to these non-covered services.



In 2002, prompted in part by the release of the 1999 Institute of Medicine report titled, “To Err is Human: Building a Safer Health System,” the NQF created a list of 27 never events, which was expanded to 28 events in 2006. As part of the ongoing implementation of Section 5001(c) of the Deficit Reduction Act (DRA) of 2005, CMS has addressed some of the NQF never events through the Hospital-Acquired Conditions (HACs) provisions in the Inpatient Prospective Payment System (IPPS) final rule for fiscal years (FY) 2008 and 2009.



For discharges occurring on or after Oct. 1, 2008, Medicare will no longer pay a hospital at a higher rate for an inpatient hospital stay if the sole reason for the enhanced payment is one of the selected HACs, and the condition was acquired during the hospital stay. CMS is exploring the feasibility of adapting this policy to its other payment systems.



In the IPPS FY 2008 final rule, CMS selected eight categories of conditions for the HAC list, a number of which were among the 28 never events listed by the NQF and include retained foreign object after surgery, air embolism, blood incompatibility, stage III & IV pressure ulcers, and injuries related to falls and traumatic events such as electric shock and burns.



In the IPPS FY 2009 final rule, CMS added manifestations of poor glycemic control, including hypoglycemic coma, to the list. Hypoglycemic coma is closely related to NQF’s listing of death or serious disability associated with hypoglycemia.



CMS determined that not all conditions included on the NQF list of Never Events should be addressed by the HAC payment provision and therefore determined that the NCD process was appropriate to address coverage for the three types of surgical errors cited above. Unlike the HAC provisions, which affect only payments to hospitals for inpatient stays, these NCDs may affect payment to hospitals, physicians, and any other health care providers and suppliers involved in the erroneous surgeries.



These NCDs are effective immediately, however; implementation instructions for processing such claims will occur at a later date. To view the NCDs, visit:



Wrong body part: www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=222



Wrong patient: www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=221



Wrong surgery performed on a patient: www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=223

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14. Physician Fee Schedule Pricing Files Update



New for Calendar Year (CY) 2009! The Centers for Medicare & Medicaid Services (CMS) has condensed all 56 Physician Fee Schedule (PFS) carrier specific pricing files into one zip file. This file is found in the list on the CMS web page at http://www.cms.hhs.gov/PhysicianFeeSched/PFSCSF/list.asp. It is labeled as “All States” in the State field, and “2009” in the Calendar Year field. Because the list is ordered by State name, “All States” appears after the Alaska files. If you sort by most recent Calendar Year, the file will appear at the top of the list.

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15. Audio File and Transcript Posted from Hospital-Acquired Conditions and Hospital Outpatient Healthcare-Associated Conditions Listening Session



The Centers for Medicare & Medicaid Services (CMS) has recently updated the Educational Resources section (http://www.cms.hhs.gov/HospitalAcqCond/07_EducationalResources.asp) of the Hospital-Acquired Conditions (HAC) & Present on Admission (POA) Indicator Reporting web site to include the audio file and transcript from the Hospital-Acquired Conditions and Hospital Outpatient Healthcare-Associated Conditions Listening Session held on Thursday, December 18, 2008.

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16. CMS Announces Implementation of Renal CROWNWeb System



The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that the renal CROWNWeb system will move from its testing environment to a production/implementation environment on February 1, 2009. At that time, CMS will launch CROWNWeb to a small, select group of providers across the country-representing both large- and small-dialysis organizations, as well as independent dialysis facilities across the country. CMS will expand implementation as it learns more about how the system functions within individual facilities.

Until facilities are phased in to CROWNWeb implementation, they should continue with their normal business operations and reporting requirements, including using the SIMS, VISION, and paper-based data submissions. Facilities that are not part of the first phase of implementation may continue to meet their requirements under the ESRD conditions for coverage by continuing to use these submission methods.

CROWNWeb is a secure, web-based system that will capture clinical and administrative data from dialysis facilities across the country, supplanting the paper-based data collection methods that CMS currently uses.

CROWNWeb is CMS' first step in leveraging the benefits of health information technology for the dialysis population, and will help us improve the quality of data we receive about dialysis treatments; help providers focus on providing optimal patient care; drive innovations and quality improvement of care practices; and equip CMS with more data in order to develop a more refined and responsive ESRD bundled payment system and ESRD value-based purchasing framework.

More support will be available to dialysis facilities from their local ESRD Network Organizations. A list of Networks is online at http://www.medicare.gov/Dialysis/Static/ContactList.asp?dest=NAV|Home|Resources|ESRDContacts|Contacts&ContactType=ESRD. Facilities can also call the CROWN Help Desk at 888-ESRD-HD1 or email ESRDHD1@esrd.net.

Consumers who wish to learn more about dialysis facilities in their communities can visit the Dialysis Facility Compare website at www.medicare.gov/dialysis for information.

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17. Revised Quarterly Provider Specific Files (PSF) Available in SAS and Text Formats



The January 2009 quarterly Provider Specific Files (PSF) SAS data files have been revised and are now available on the CMS website at: http://www.cms.hhs.gov/ProspMedicareFeeSvcPmtGen/04_psf_SAS.asp in the Downloads section. If you use the Provider Specific SAS File data, please go to the page above and download the latest version of the PSF Files. Note: These are the quarterly data sets for the Provider Specific Data for Public Use in SAS Format.



The January 2009 quarterly Provider Specific Files (PSF) Text data files have been revised and are now available on the CMS website at: http://www.cms.hhs.gov/ProspMedicareFeeSvcPmtGen/03_psf_text.asp in the Downloads section. If you use the Provider Specific Text File data, please go to the page above and download the latest versions of the PSF Files. Note: These are the quarterly data sets for the Provider Specific Data for Public Use in text format.

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18. January Flu Shot Reminder



It’s Not Too Late to Get the Flu Shot. We are in the midst of flu season and a flu vaccine is still the best way to prevent infection and the complications associated with the flu. Re-vaccination is necessary each year because flu viruses change each year. So please encourage your Medicare patients who haven’t already done so to get their annual flu shot--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 the CMS Medicare Learning Network (MLN), 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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19. 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