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



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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.”

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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

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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/.

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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.

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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.

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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.

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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