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. Important Information Regarding Availability of Internet-Based PECOS



2. Internet-Based Medicare Enrollment Now Available to Provider and Supplier Organizations!



3. PQRI National Provider Question & Answer Session



4. 2009 Physician Quality Reporting Initiative Program Update Regarding 2009 EHR Specifications



5. DMEPOS Supplier Accreditation Reminder



6. Medicare Announces Funding for State Health Insurance Counseling Programs for 2009



7. Medicare Expands Coverage of Positron Emission Tomography (PET) Scans as Cancer Diagnostic Tool



8. RAC Provider Outreach Schedule/ RAC Open Door Forums



9. Provider Communications Group PowerPoint Presentation



10. New Medicare Learning Network Publication and FAQs Now Available on ICD-10!



11. Extra Help for Beneficiaries Paying for Prescription Drugs



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1. Important Information Regarding Availability of Internet-Based PECOS



The Centers for Medicare & Medicaid Services (CMS) will be making changes at its Data Center that will affect the Provider Enrollment, Chain and Ownership System (PECOS). As a result, physicians, non-physician practitioners, and provider and supplier organizations will not be able to access Internet-based PECOS from 9:00 p.m. Eastern Time on Thursday, April 16, until 9:00 a.m. Eastern Time on Monday, April 20. We apologize for any inconvenience this may cause.

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2. Internet-Based Medicare Enrollment Now Available to Provider and Supplier Organizations!



MEDICARE PROVIDER AND SUPPLIER ORGANIZATIONS



Internet-based Medicare Enrollment is Available in

All States and the District of Columbia



IT’S FAST, SECURE, and EASY TO USE



Now there is a better way for provider and supplier organizations to enroll in Medicare or make a change to their Medicare enrollment information. The Centers for Medicare & Medicaid Services (CMS) announces the availability of Internet-based Provider Enrollment, Chain and Ownership System (PECOS) to provider and supplier organizations. They may use Internet-based PECOS to enroll in Medicare, make a change in their Medicare enrollment information, view their existing Medicare enrollment information, voluntarily withdraw from the Medicare program, or check on the status of an Internet-submitted Medicare enrollment application.



Internet-based PECOS is already available to physicians and non-physician practitioners in all 50 States and the District of Columbia. (CMS expects to make Internet-based PECOS available to suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) in the future.)



FAST



By submitting an initial Medicare enrollment application through Internet-based PECOS, a provider or supplier organization’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 information about the types of changes that enrolled Medicare provider and supplier organizations must report, go to the Downloads Section of the Medicare provider/supplier enrollment page: 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 individuals whose identities have been verified by CMS and who have been approved by a provider or supplier organization’s Authorized Official may use Internet-based PECOS on behalf of that provider or supplier organization. The PECOS User IDs and passwords that these individuals establish will protect the access to the given provider or supplier organization’s Medicare enrollment information. PECOS users should change their passwords frequently—at least once a year. By safeguarding their User IDs and passwords, PECOS users will be taking an important step in protecting the provider or supplier organization’s Medicare enrollment information. CMS does not disclose Medicare provider or supplier enrollment information to anyone except when authorized or required to do so by law.



EASY TO USE



Internet-based PECOS is a scenario-driven application process with front-end editing capabilities and built-in help screens. The scenario-driven application process ensures that provider and supplier organizations complete and submit only the information necessary to facilitate the action they wish to take. The CMS External User Services (EUS) Help Desk (1-866-484-8049) is available and staffed to respond to questions about using Internet-based PECOS, such as navigating through the screens, and to receive reports of systems problems as noted by users.



Obtaining Approval to Use Internet-based PECOS for a Provider or Supplier Organization



There are several steps that must be completed before a provider or supplier organization can use Internet-based PECOS. These steps are described in detail in the document entitled, “Getting Started with Internet-based Provider Enrollment, Chain and Ownership System (PECOS) – Information for Provider and Supplier Organizations,” which will soon be available in the Downloads Section on the Medicare provider/supplier enrollment page: www.cms.hhs.gov/MedicareProviderSupEnroll. Below is an overview of the process.



(1) The first step is taken by the Authorized Official (AO) of the provider or supplier organization. This is done only one time. He or she will register in the Internet-based PECOS Identification and Authentication System (PECOS I&A) by going to https://pecos.cms.hhs.gov. CMS will verify the information provided and the CMS EUS Help Desk will notify the AO of the verification.



(2) An individual who will use Internet-based PECOS to submit enrollment applications for the provider or supplier organization will also register in PECOS I&A. This individual may be an employee of the provider or supplier organization, or an employee of a separate organization. CMS will verify the information provided and the permission of the AO for that individual to use Internet-based PECOS on behalf of the provider or supplier organization. The individual will complete the Security Consent Form and have it signed by an official of his or her employer and by the AO of the provider or supplier organization. The individual will mail the signed and dated Security Consent Form to the CMS EUS Help Desk. The AO will need to periodically log on to Internet-based PECOS to see if there is a pending request for permission to access Internet-based PECOS on behalf of the provider or supplier organization. More than one person may be approved to use Internet-based PECOS on behalf of a given provider or supplier organization, but the Security Consent Form is completed only one time.





(3) Once the registration and verification processes are completed, the CMS EUS Help Desk will notify the AO of the establishment of the relationship between the provider or supplier organization and the organization that will be using Internet-based PECOS on its behalf.



It may take several weeks for the registration and verification processes to be completed. Therefore, we encourage the AO of a provider or supplier organization to begin the registration process now—before the provider or supplier organization has the need to use Internet-based PECOS to submit a Medicare enrollment application or enrollment update.


If a provider or supplier organization has an immediate need to submit a Medicare enrollment application to enroll or to report a change in enrollment information and the steps above have not been successfully completed, the provider or supplier organization should complete and submit the paper version of the Medicare enrollment application (CMS-855).
Submitting an Enrollment Application using Internet-based PECOS



After the steps above are successfully completed, the individual who will be using Internet-based PECOS is considered a PECOS user. If a PECOS user has not already done so, he or she should visit the Medicare provider enrollment web site (www.cms.hhs.gov/MedicareProviderSupEnroll) to download and read the documents relating to Internet-based PECOS. CMS advises PECOS users to avail themselves of this information before logging on to Internet-based PECOS.



After reading the informational documents referenced above, a PECOS user will log on to Internet-based PECOS at https://pecos.cms.hhs.gov. He or she will complete, review, and submit the Medicare enrollment application over the Internet to the designated Medicare contractor. Internet-based PECOS will guide the user through each of these processes. (Internet-based PECOS enables the user to print a copy of the enrollment application, if desired. We recommend this be done so the provider or supplier organization has a copy for its records.)



As part of the enrollment application submittal process, the AO of the provider or supplier organization must sign and date the 2-page Certification Statement that the user will print from Internet-based PECOS. The user must mail the signed and dated Certification Statement, along with any required supporting paper documentation, to the designated Medicare contractor. The Medicare contractor will not begin processing the application that was submitted over the Internet until it has received the signed and dated Certification Statement.



Limitations of Internet-based PECOS



At this time, Internet-based PECOS is unable to handle changes of ownership applications from provider and supplier organizations. Therefore, changes of ownership must be submitted using the paper Medicare enrollment application (CMS-855) process. Internet-based PECOS will be able to accommodate changes of ownership at a future date.



Additional Information



Several documents about Internet-based PECOS for provider and supplier organizations will soon be available in the Downloads Section of the Medicare provider/supplier enrollment web page: www.cms.hhs.gov/MedicareProviderSupEnroll.

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3. PQRI National Provider Question & Answer Session



2009 Physician Quality Reporting Initiative

National Provider Call with Question & Answer Session



The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host fourth in a series national provider conference calls on the 2009 Physician Quality Reporting Initiative (PQRI). This toll-free call will take place from 2:30 p.m. – 4:30 p.m., EDT, on Wednesday, April 22, 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.



The topics covered on this national provider call will include:

An update on the prostate cancer measures-2008: Measure #101; 2008-2009: Measure #102, #104, and #105;
An update on Medicare enrollment;
Tips for satisfactorily participating in the 2009 PQRI; and
Planning for the 2010 PQRI reporting options.


Following this presentation, 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 CMS presenters.



Conference call details:



Date: April 22, 2009

Conference Title: 2009 Physician Quality Reporting Initiative-National Provider Call

Time: 2:30 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 2:30 p.m. EDT on April 21, 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/042209


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 3:30 p.m. EDT 4/22/2009 until 11:59 p.m. EDT 4/29/2009. The call in data for the replay is (800) 642-1687 and the passcode is 90578004.



If you require services for the hearing impaired please send an email to: Medicare.TTT@PalmettoGBA.com.

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4. 2009 Physician Quality Reporting Initiative Program Update Regarding 2009 EHR Specifications



2009 Physician Quality Reporting Initiative (PQRI) Program Update –

2009 Electronic Health Record (EHR) Specifications Now Posted on the QualityNet Website

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the 2009 Data Submission Specifications for use in the 2009 PQRI Electronic Health Record (EHR) test are now posted on the QualityNet website.



As described in the Medicare Physician Fee Schedule (PFS) 2009 Final Rule, CMS is testing EHR data submission in cooperation with electronic health record vendors. These vendors were selected from those who self-nominated per a process described in the 2008 final PFS rule. The 2009 testing process will be similar to the testing process used for 2008. EHR vendors that are successful with the 2009 testing process will be "qualified" for possible PQRI data submission via EHRs if this means of data submission is used in a future PQRI reporting year. There is no incentive payment available through EHR-based data submission for 2009.



The Measure Specifications for the 2009 EHR test measures are also available on the QualityNet website by clicking on "PQRI" from the dropdown menu under the "Physician Offices" tab; then, click on the EHR Specifications link from the left navigation bar. The following link will take you to the QualityNet website on the internet: http://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier3&cid=1214232460333



A link to the QualityNet website is also available at http://www.cms.hhs.gov/PQRI on the CMS PQRI website under the “Related Links Outside CMS” tab. Additional information related to the EHR test is also available on the CMS PQRI website under the “Reporting” and “Measures/Codes” sections listed in the left navigation bar.



Detailed information on the 2009 PQRI program requirements may be found in the final 2009 Medicare PFS rule with comment period that was published in the Federal Register on November 19, 2008. A copy of the final rule with comment period is on display at the Federal Register and can be viewed at: http://edocket.access.gpo.gov/2008/pdf/E8-14949.pdf on the internet.



Additionally, the CMS PQRI web page http://www.cms.hhs.gov/PQRI on the CMS website is the primary resource for FAQs, helpful tools, and information on the PQRI program.

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5. DMEPOS Supplier Accreditation Reminder



DMEPOS Supplier Accreditation – Time is Running Out

Deadline is September 30, 2009



Time is running out for suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) who bill Medicare under Part B to obtain accreditation by the September 30, 2009 deadline or risk having their Medicare Part B billing privileges revoked on October 1, 2009. While the accreditation process takes on average 6-7 months to complete, the process could take as long as 9 months to complete. Accordingly, DMEPOS suppliers should contact an accreditation organization right away to obtain information about the accreditation process and submit an application.



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 the Medicare program’s supplier standards and quality standards to become accredited. 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, and 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 the CMS website:

http://www.cms.hhs.gov/MedicareProviderSupEnroll/03_DeemedAccreditationOrganizations.asp .

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6. Medicare Announces Funding for State Health Insurance Counseling Programs for 2009



Funding Designed to Help People With Medicare



Nearly $36 million in funding is being distributed to the 54 State Health Insurance Assistance Programs (SHIPs) to help people with Medicare get more information about their health care choices.



The $35.8 million in funding is the first installment of federal grant funds provided to SHIPs by the Centers for Medicare & Medicaid Services (CMS) for the grant year beginning April 1, 2009, and ending March 31, 2010. An additional $1.5 million in performance-based funding will be awarded in September 2009. SHIPs are state-based programs that use community-based networks to provide Medicare beneficiaries with local, personalized assistance on a wide variety of Medicare and health insurance topics.



“State Health Insurance Assistance Programs serve an important role in providing information and support to people with Medicare where they live,” said CMS Acting Administrator Charlene Frizzera. “These funds help ensure SHIPs continue their work with state and local governments, community-based organizations and others to meet the needs, beyond health care, of our Medicare beneficiaries.”



CMS expects the SHIPs to use the 2009 funding to conduct targeted community-based outreach to people with Medicare who may be unable to access other sources of information. SHIPs will also provide outreach and assistance to current and newly eligible Medicare beneficiaries and their caregivers, with a special emphasis on reaching people who will most likely be eligible for Medicare’s low-income subsidy if they enroll in Medicare prescription drug coverage.



CMS will continue to support the quality of services provided by SHIPs through training, technical assistance, the SHIP Resource Center, and the online tools at www.medicare.gov to help people with Medicare.

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7. Medicare Expands Coverage of Positron Emission Tomography (PET) Scans as Cancer Diagnostic Tool



MEDICARE EXPANDS COVERAGE OF PET SCANS

AS CANCER DIAGNOSTIC TOOL

CMS’ Coverage with Evidence Development Project Shows PET Scans as “Reasonable and Necessary” for Initial Treatment Decisions of Most Solid Tumor Cancers



The Centers for Medicare & Medicaid Services (CMS) issued a final national coverage determination (NCD) to expand coverage for initial testing with positron emission tomography (PET) for Medicare beneficiaries who are diagnosed with and treated for most solid tumor cancers. This NCD removes a clinical study requirement for PET scan use in these patients.

Since 2005, Medicare coverage of PET scans for diagnosing some forms of cancer and guiding treatment has been tied to a requirement that providers collect clinical information about how the scans have affected doctors’ treatment decisions. This information was gathered through the National Oncologic PET Registry (NOPR) observational study. Today’s decision removes the requirement to report data to the NOPR when the PET scan is used to support initial treatment (or diagnosis and “staging”) of most solid tumor cancers.



Medicare collects data from the NOPR under CMS’ Coverage with Evidence Development (CED) program. CED allows Medicare to develop evidence about how a medical technology is used in clinical practice so that Medicare can do the following:



(a) clarify the impact of these items and services on the health of Medicare beneficiaries;

(b) consider future changes in coverage for the technology; and

(c) generate clinical information that will improve the evidence base upon which providers base their recommendations to Medicare beneficiaries regarding the technology.



This decision is based, in part, on the information generated as a result of CMS’ 2005 decision to require NOPR reporting for many cancer PET scans. As a result of this evidence from NOPR, CMS reconsidered its 2005 coverage policy. This decision is the first time that CMS has reconsidered a coverage policy based on new evidence developed under the CED program.



It is important to note that this decision still requires clinicians to report data to the NOPR when using PET scans to monitor the progress of treatment or remission of cancer in some cases. Although the evidence generated by the NOPR study helped CMS determine that PET scans are useful in helping guide treatment when cancer is first diagnosed, scientific evidence is not as strong in showing that PET scans are as useful in making subsequent treatment decisions for some types of cancer. A minimally invasive diagnostic imaging procedure, PET uses a radioactive tracer to evaluate glucose metabolism in tumors and in normal tissue. The test may provide important clinical information to guide the initial treatment approach (e.g., diagnosis and “staging”) for many cancers.



More information about the types of cancer covered by this new policy is available in CMS’ final decision memorandum. Read the final decision on the CMS Web site at http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=218.

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8. RAC Provider Outreach Schedule/ RAC Open Door Forums



The CMS website has been updated to include the Recovery Audit Contractor (RAC) Provider Outreach schedule. This information can be viewed at the following website: http://www.cms.hhs.gov/RAC/Downloads/CMS%20Provider%20Outreach%20Schedule.pdf.



Two special RAC Open Door Forums have been scheduled. The Part A ODF will be held on April 8, 2009 and the Part B ODF will be held on April 14, 2009. For more information on these special Open Door Forums, please visit http://www.cms.hhs.gov/OpenDoorForums/05_ODF_SpecialODF.asp#TopOfPage.



For information regarding RACS, please visit the CMS website, http://www.cms.hhs.gov/RAC/.

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9. Provider Communications Group PowerPoint Presentation



Hello everyone. The latest version of the Provider Communications Group’s “Information and Education Resources for Medicare Providers” PowerPoint Presentation has been posted and is available for use. This revised edition includes updated information on:





A/B MAC Award Update
ICD-10-Clinical Modification/ (CM/PCS)




The PowerPoint Presentation is posted at:

http://cmsnett.cms.hhs.gov/hpages/cmm/pcg/pcg_outreach_support.asp as well as

http://www.cms.hhs.gov/ContractorLearningResources/ .



Please remember that the “Information and Education Resources for Medicare Providers” PowerPoint Presentation was developed to assist CMS staff and Medicare Contractors who are giving presentations to provider audiences regarding Medicare education and outreach information. The first and last slides should be edited to include the speaker’s name and title. The presentation also includes many website addresses that make it a useful tool when navigating through the CMS Website. Therefore, it may be helpful to print and distribute the slides to attendees. The presentation is updated regularly to ensure that it contains the most current and relevant provider-related information. If you have any questions, please contact me at robin.sutton@cms.hhs.gov .

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10. New Medicare Learning Network Publication and FAQs Now Available on ICD-10!



The General Equivalence Mappings – ICD-9-CM To and From ICD-10-CM and ICD-10-PCS Fact Sheet (March 2009), which provides information and resources regarding the General Equivalence Mappings that were developed as a tool to assist with the conversion of International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) codes to International Classification of Diseases, 10th Edition (ICD-10) and the conversion of ICD-10 codes back to ICD-9-CM, is now available in downloadable format from the Centers for Medicare & Medicaid Services (CMS) Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/ICD-10_GEM_factsheet.pdf . The General Equivalence Mappings information discussed in this fact sheet has also been posted in the CMS Frequently Asked Questions database at https://questions.cms.hhs.gov/cgi-bin/cmshhs.cfg/php/enduser/std_alp.php?p_sid=l2s5Zouj .



And remember that you can always find the latest ICD-10 information on the CMS Website at http://www.cms.hhs.gov/ICD10 !

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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