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. Special ODF on the 2009 Physician Quality Reporting Initiative (PQRI) With the American College of Cardiology



2. 2009 Physician Quality Reporting Initiative National Provider Question & Answer Session



3. “Ask the Contractor” Call for Section 1011 Providers to Examine the Provider Payment Determination (PPD) Form



4. National Patient Safety Awareness Week



5. New CMS Web Page for the Electronic Prescribing Incentive Program (E-Prescribing)



6. Update on Final Rules Regarding ICD-10 Code Sets and Standards Governing Electronic Transactions



7. DMEPOS Supplier Accreditation Reminder



8. Update to Inpatient PPS (IPPS) PC Pricer for Fiscal Year (FY) 2007



9. New From the Medicare Learning Network



10. March Flu Shot Reminder



11. Extra Help for Beneficiaries Paying for Prescription Drugs



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1. Special ODF on the 2009 Physician Quality Reporting Initiative (PQRI) With the American College of Cardiology



Centers for Medicare & Medicaid Services

Special Open Door Forum:

2009 Physician Quality Reporting Initiative

With the American College of Cardiology

Wednesday, March 18, 2009

3:30pm-5pm ET

Conference Call Only



The Centers for Medicare & Medicaid Services (CMS) will co-host a Special Open Door Forum on the 2009 Physician Quality Reporting Initiative (PQRI) Program with the American College of Cardiology (ACC).



The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) made the PQRI program permanent, but only authorized incentive payments through 2010. Eligible professionals who meet the criteria for satisfactory submission of quality measures data for services furnished during the reporting period, January 1, 2009 - December 31, 2009, will earn an incentive payment of 2.0 percent of their total allowed charges for Physician Fee Schedule (PFS) covered professional services furnished during that same period. The 2009 PQRI consists of 153 quality measures and 7 measures groups.



This Special ODF will be geared towards cardiology-specific topics related to participation in PQRI. Following the presentation, the lines will be opened to allow participants to ask questions of the ACC presenters as well as CMS PQRI subject matter expert, Sylvia Publ.



PQRI information and educational products are available on the PQRI dedicated web page located at, http://www.cms.hhs.gov/PQRI , on the CMS website.



We look forward to your participation.

Special Open Door Forum Participation Instructions:

Dial: 1-800-837-1935 Conference ID 89036042

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 A Relay Communications Assistant will help.

An audio recording and transcript 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 March 26, 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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2. 2009 Physician Quality Reporting Initiative National Provider Question & Answer Session



The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host the first in a series of national provider conference calls on the 2009 Physician Quality Reporting Initiative (PQRI). This toll-free call will take place from 1:30 p.m. – 3:30 p.m., EDT, on Thursday, March 19, 2009.



The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) made the PQRI program permanent, but only authorized incentive payments through 2010. Eligible professionals who meet the criteria for satisfactory submission of quality measures data for services furnished during the reporting period, January 1, 2009 - December 31, 2009, will earn an incentive payment of 2.0 percent of their total allowed charges for Physician Fee Schedule (PFS) covered professional services furnished during that same period. The 2009 PQRI consists of 153 quality measures and 7 measures groups.



Following a short presentation on what’s new for the 2009 PQRI, the lines will be opened to allow participants to ask questions of CMS PQRI subject matter experts.



Educational products are available on the PQRI dedicated web page located at, http://www.cms.hhs.gov/PQRI , on the CMS website, in the Educational Resources section. Feel free to download the resources prior to the call so that you may ask questions of the presenters, Dr. Michael Rapp and Dr. Daniel Green.



Conference call details:

Date: March 19, 2009

Conference Title: 2009 PQRI- National Provider Call

Time: 1:30 p.m. EDT



In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation. If you cannot attend the call, replay information is available below.



Registration will close at 1:30 p.m. EDT on March 18, 2009, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.



To register for the call participants need to go to: http://www2.eventsvc.com/palmettogba/031909


Fill in all required data.


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


Click "Register".


You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.


For those of you who will be unable to attend, a replay option will be available shortly following the end of the call. This replay will be accessible from 4:30 p.m. EDT 3/19/2009 until 11:59 p.m. EDT 3/26/2009. The call in data for the replay is (800) 642-1687 and the passcode is 84546375.

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3. “Ask the Contractor” Call for Section 1011 Providers to Examine the Provider Payment Determination (PPD) Form



The National Contractor for the Section 1011 program, TrailBlazer Health Enterprises®, is hosting the first of two “Ask the Contractor” Teleconferences (ACT) for 2009 on Thursday, March 26, 2009 from 1-2:30 p.m. (CT).



This ACT is designed for Section 1011 providers and will examine the Provider Payment Determination (PPD) form.



Ask the Contractor Teleconference – Section 1011 Providers

Thursday, March 26, 2009

1-2:30 p.m. (CT)



You may register for the event on the calendar of events page of the Section 1011 Web site, http://www.trailblazerhealth.com/Calendar/Default.aspx



A confirmation e-mail with the dial-in information will be sent to the e-mail address provided when your registration is approved.



A question-and-answer session concludes the teleconference and you may e-mail your questions in advance through the close of business Thursday, March 19, 2009 to section.1011@trailblazerhealth.com with Ask the Contractor in the subject line.

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4. National Patient Safety Awareness Week



This week is National Patient Safety Awareness Week! As part of National Patient Safety Week, the Centers for Medicare & Medicaid Services (CMS) reminds beneficiaries and health care professionals what patients and their local healthcare providers can do to improve the safety of care. CMS is also working to make health care safer through its Quality Improvement Organization (QIO) Program.



What can patients/consumers do to make health care safer?

According to the National Patient Safety Foundation, consumers can help bring patient safety to the forefront of healthcare providers’ agendas:

· Ask your hospital or health care professional about patient safety, and how communication and partnership between you and your providers can be improved.

· Ask your hospital or health care organization what they are doing for Patient Safety Awareness Week, and attend events to learn more about patient safety.

· Communicate with your provider about your health care safety concerns.

· Let your health care provider know who they should talk with in the case that you are unable to speak for yourself.



Consumers can also work with the Quality Improvement Organization (QIO) in their state to raise concerns about the quality or safety of care they or a loved one have received under the Medicare program. QIOs will work to find the reason why things happened to cause the concern and to determine the likelihood that it will happen again. The purpose of a quality of care review is not to punish the doctor, but to help improve care delivery for future patients. In cases where chances are high that the scenario will happen again, the QIO will help health care providers make changes in procedures to prevent future problems.



CMS has published two guides for consumers about working with QIOs about quality/safety of care problems.

· Quality of Care Concerns: What Can Your Quality Improvement Organization Address? (Publication CMS-11362), available online at http://www.medicare.gov/Publications/Pubs/pdf/11362.pdf; and

· Frequently Asked Questions: What to Do If You Have a Quality of Care Concern (Publication CMS-11348), available online at http://www.medicare.gov/Publications/Pubs/pdf/11348.pdf.



Consumers can learn more about how the QIO works with them in their state by visiting the directory of QIOs online at http://www.medicare.gov/Contacts.



What is CMS doing to make health care safer?

In addition to working with consumers on quality of care problems, QIOs are working nationwide with select hospitals and nursing homes to improve patient safety by:

• Improving surgical safety/infection rates.

• Reducing rates of certain infections in hospitals.

• Intensively working with “nursing homes in need.”

• Improving care for patients with heart failure.

• Preventing pressure ulcers (or “bed sores”) in patients from nursing homes and hospitals.

• Eliminating physical restraints in nursing homes.

• Combating drug-drug interactions and potentially inappropriate medication errors.



Health care professionals can learn more about how QIOs are making care safer at http://www.qualitynet.org/medqic. Our website contains more information about each of these tasks, as well as tools designed to help providers improve quality in each of these areas. Professionals can also contact the Patient Safety QIO Support Center at psqiosc@okqio.sdps.org.

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5. New CMS Web Page for the Electronic Prescribing Incentive Program (E-Prescribing)



Centers for Medicare & Medicaid Services Announces New Web Page on the Electronic

Prescribing Incentive Program (E-Prescribing)



The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the new Electronic Prescribing Incentive Program (E-Prescribing) web page at http://www.cms.hhs.gov/ERXIncentive on the CMS website. All information about the E-Prescribing Incentive Program has been moved from the CMS PQRI web page at http://www.cms.hhs.gov/PQRI to http://www.cms.hhs.gov/ERXIncentive. This new web page provides information about the new E-Prescribing incentive program that was authorized by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).



Please note that many new resources have also been added to the E-Prescribing Incentive web page as part of the migration to the new URL. Included on this page in the Downloads section is:



• A 2009 Electronic Prescribing (E-Prescribing) Incentive Program Made Simple Fact Sheet;
• A Spanish version of the Introduction to E-Prescribing Incentive Fact Sheet;
• A Sample Electronic Prescribing Claim; and
• Information on how to access the audiotapes and slides from the National E-Prescribing Conference that was held in October 2008 for continuing education credit.



New and updated information will continually be added, so please visit the Electronic Incentive Program web page at http://www.cms.hhs.gov/ERXIncentive on the CMS website on a frequent basis.

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6. Update on Final Rules Regarding ICD-10 Code Sets and Standards Governing Electronic Transactions



On January 15, the U.S. Department of Health and Human Services released two final rules that will facilitate the United States’ ongoing transition to an electronic health care environment through adoption of an updated set of diagnosis and procedure codes and updated standards for electronic health care and pharmacy transactions.



In accordance with the White House Chief of Staff’s memorandum of January 20, 2009 entitled “Regulatory Review,” a determination has been made that the effective date will not be extended and the comment period will not be reopened for either of these rules.



The first rule finalizes new code sets to be used for reporting diagnoses and procedures on health care transactions. This final rule replaces the ICD-9-CM code sets, developed nearly 30 years ago, with greatly expanded ICD-10 code sets. The second final rule adopts updated versions of the standards governing electronic transactions under the authority of the Health Insurance Portability and Accountability Act of 1996. The updated versions replace the current standards and will promote greater use of electronic transactions. In response to public comments suggesting that more time would be needed for effective industry implementation, the final rules include later compliance dates. More specifically, the final rules provide compliance dates of Jan. 1, 2012, for the transaction standards and Oct. 1, 2013, for the ICD-10 code set.

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7. DMEPOS Supplier Accreditation Reminder



Deadline is September 30, 2009



CMS wants to remind suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) who bill Medicare under Part B that they must obtain accreditation by September 30, 2009. In order to retain or obtain a Medicare Part B billing number, all DMEPOS suppliers (except for exempted professionals and other persons as specified by the Secretary) must comply with Medicare’s supplier and quality standards and become accredited. DMEPOS suppliers should contact an accreditation organization right away to obtain information about the accreditation process and submit an application.



DMEPOS suppliers who submitted a completed application to an accrediting organization, on or before January 31, 2009, will have an accreditation decision (either full accreditation or denied accreditation) on or before the September 30, 2009 deadline.



DMEPOS suppliers submitting applications to an accrediting organization, on or after February 1, 2009, may or may not have their accreditation decision by the September 30, 2009 deadline.



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.



Certain eligible professionals and other persons as specified by the Secretary are exempt from the accreditation requirement.



Further information on the DMEPOS accreditation requirements along with a list of the accreditation organizations and those professionals and other persons exempted from accreditation may be found at www.cms.hhs.gov/medicareprovidersupenroll.

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8. Update to Inpatient PPS (IPPS) PC Pricer for Fiscal Year (FY) 2007



To correct pricing issues, the Inpatient PPS (IPPS) PC Pricer for Fiscal Year (FY) 2007 has been updated with the January 2008 Provider data. If you use the IPPS PC Pricers, please go to the “Inpatient PPS PC Pricer” web page (http://www.cms.hhs.gov/PCPricer/03_inpatient.asp), under the “Downloads” section and download the FY 2007 version of the PC Pricer (posted 03/05/2009).

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9. New From the Medicare Learning Network



A revised MLN Matters Special Edition Article (SE0837) is now available @ http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0837.pdf on the CMS website. This revised article entitled: “Preparing for a Transition from an FI/Carrier to a Medicare Administrative Contractor (MAC)” is intended to assist all providers that will be affected by Medicare Administrative Contractor (MAC) implementations. The Centers for Medicare & Medicaid Services (CMS) is providing this information to make you aware of what to expect as your FI or carrier transitions its work to a MAC. Knowing what to expect and preparing, as outlined in this article, will minimize disruption in your Medicare business.

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10. March Flu Shot Reminder



It’s Not Too Late to Give and Get the Flu Shot!

In the US, the peak of flu season typically occurs anywhere from late December through March; however, flu season can last as late as May. Each office visit presents an opportunity for you to talk with your patients about the importance of getting an annual flu shot and a one time pneumococcal vaccination. Protect yourself, your patients, and your family and friends by getting and giving the flu shot. Don’t Get the Flu. Don’t Give the Flu.



Remember - Influenza and pneumococcal vaccinations plus their administration are covered Part B benefits. Note that influenza and pneumococcal vaccines are NOT Part D covered drugs.



Health care professionals and their staff can learn more about Medicare’s Part B coverage of adult immunizations and related provider education resources, 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