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. Special ODF on Medicare Provider and Supplier Enrollment



2. Medicare Announces Sites for Pilot Program to Improve Quality as Patients Move Across Care Settings



3. Registration Now Open for Next National Conference Call for Providers Regarding ICD-10



4. Informational Sessions Scheduled May 4, 5 & 11, 2009 Regarding CMS’ Recovery Audit Contractor (RAC) Program



5. Five-Star Quality Rating System - April News



6. DMEPOS Supplier Accreditation Reminder



7. FY 2009 Inpatient Prospective Payment System (IPPS) Personal Computer (PC) Pricer Updated



8. New from the Medicare Learning Network



9. Extra Help for Beneficiaries Paying for Prescription Drugs



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1. Special ODF on Medicare Provider and Supplier Enrollment



Centers for Medicare & Medicaid Services

Special Open Door Forum:

Medicare Provider & Supplier Enrollment

April 30, 2009

2:00PM – 3:30PM ET



The Centers for Medicare & Medicaid Services (CMS) will hold a Special Open Door Forum (ODF) to discuss the availability of Internet-based Provider Enrollment, Chain and Ownership System (PECOS) and the implementation of regulatory provisions. During this call CMS staff will discuss the:

1. Internet-based PECOS for physicians, non-physician practitioners and provider and supplier organizations

2. Provider and supplier reporting responsibilities

· Final Adverse Actions

· Change of Practice Locations

· Change of Ownership

· Other Reportable Events

3. Effective date of Medicare billing privileges and retrospective billing for physicians, certain non-physician practitioners, and physician and non-physician practitioner organizations

4. Revalidation Efforts

Afterwards, there will be an opportunity for the public to ask questions.



We look forward to your participation.

Open Door Forum Instructions:

**Capacity is limited so dial in early. You may begin dialing into this forum as early as 1:45 PM ET.**

Dial: 1-800-837-1935

Reference Conference ID 94109369

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 ODF website at http://www.cms.hhs.gov/OpenDoorForums/05_ODF_SpecialODF.asp and will be accessible for downloading beginning Monday May 11, 2009 and available for 30 days.



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/

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2. Medicare Announces Sites for Pilot Program to Improve Quality as Patients Move Across Care Settings



MEDICARE ANNOUNCES SITES FOR PILOT PROGRAM TO IMPROVE QUALITY AS PATIENTS MOVE ACROSS CARE SETTINGS



14 Communities Funded to Reduce Rates of Hospital Re-admissions and

“Fragmentation of Care”



The Centers for Medicare & Medicaid Services (CMS) recently announced the 14 communities around the nation that have been chosen for the Agency’s Care Transitions Project, seeking to eliminate unnecessary hospital readmissions.



“Our data show that nearly one in five patients who leave the hospital today will be re-admitted within the next month, and that more than three-quarters of these re-admissions are potentially preventable,” said CMS Acting Administrator Charlene Frizzera. “This situation can be changed by approaching health care quality from a community-wide perspective, and focusing on how all of the members of an area’s health care team can better work together in the best interests of their shared patient population.”



The goal of the Care Transitions Project is to improve health care processes so that patients, their caregivers, and their entire team of providers have what they need to keep patients from returning to the hospital for ongoing care needs. By promoting seamless transitions from the hospital to home, skilled nursing care, or home health care, this community-wide approach seeks, not only to reduce hospital readmissions but to yield sustainable and replicable strategies that achieve high-value health care for Medicare beneficiaries



Communities in the following regions have been selected to participate in the Project: Providence, R.I.; Upper Capitol Region, N.Y.; Western Pennsylvania; Southwestern New Jersey; Metro Atlanta East, Ga.; Miami.; Tuscaloosa, Ala.; Evansville, Ind.; Greater Lansing Area, Mich.; Omaha, Neb.; Baton Rouge, La.; North West Denver, Colo.; Harlingen, Texas; and Whatcom County, Wash. The work of the Care Transitions Project will respond to the unique needs of each of the 14 communities.



Each of the Care Transitions communities is led by a state Quality Improvement Organization (QIO). QIOs work throughout the country as part of CMS’s quality program to help health care providers, consumers and stakeholder groups to refine care delivery systems to make sure all Medicare beneficiaries get the high-quality, high-value health care they deserve. Each QIO in the project is required to work with partners to implement the following:



a) hospital and community system-wide interventions;

b) interventions that target specific diseases or conditions; and

c) interventions that target specific reasons for admission.



The following QIOs serve as Care Transitions leaders throughout the country: Quality Partners of Rhode Island; IPRO Inc. (in New York); Quality Insights of Pennsylvania; Healthcare Quality Strategies Inc. (in New Jersey); Georgia Medical Care Foundation Inc.; FMQAI (in Florida); AQAF (in Alabama); Health Care Excel (in Indiana); MPRO (in Michigan); CIMRO of Nebraska; Louisiana Health Care Review; Colorado Foundation for Medical Care; TMF Health Quality Institute (in Texas); and Qualis Health (in Washington).



CMS will monitor the success of this project by watching the rates at which patients in these communities return to the hospital. Re-admission rates for hospitals have been tracked by CMS for some time, and will be available to consumers later this year through the Hospital Compare Web site at http://www.hospitalcompare.hhs.gov.



The Care Transitions Project will continue in all 14 communities through summer 2011. For more information about the Care Transitions Project, visit http://www.cfmc.org/caretransitions/. To learn more about the work that QIOs are doing across the country, visit http://www.cms.hhs.gov/qualityimprovementorgs.

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3. Registration Now Open for Next National Conference Call for Providers Regarding ICD-10



Providers may now register for the Centers for Medicare & Medicaid Services’ ICD-10-CM/PCS Implementation and General Equivalence Mappings (Crosswalks) National Provider Conference Call that will be conducted on May 19, 2009 from 1:00 p.m. – 2:30 p.m. Eastern Daylight Time.



This conference call will include a discussion of the following topics:

· An overview of the ICD-10 final rule, which requires the implementation of ICD-10-CM/PCS on October 1, 2013;

· The differences between ICD-9-CM and ICD-10-CM/PCS codes;

· The use of the General Equivalence Mappings that have been created to assist in converting policies, edits, and trend data from ICD-9-CM to ICD-10-CM/PCS; and

· The resources that are available to assist in planning for the transition from ICD-9-CM to ICD-10-CM/PCS.



Conference call discussion materials and registration information can be accessed at http://www.cms.hhs.gov/ICD10/07a_2009_CMS_Sponsored_Calls.asp .

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4. Informational Sessions Scheduled May 4, 5 & 11, 2009 Regarding CMS’ Recovery Audit Contractor (RAC) Program



The Centers for Medicare & Medicaid Services (CMS) will be offering several informational sessions on the Recovery Audit Contractor (RAC) Program. Presenting with CMS will be the RAC for California, HealthDataInsights, Inc. These sessions will take place at the CMS San Francisco Regional Office located at 90 7th Street in San Francisco, California.

On May 4, 2009, CMS will offer two sessions each with a capacity for 200 participants: one at 9:30 AM to 12:30 PM (PDT) and again at 2:00 PM to 5:00 PM (PDT).

On May 5, 2009, CMS will host an additional informational session from 9:30 AM to 12:30 PM (PDT) with a capacity of 90 participants.

The program will provide California hospitals, SNF’s, Rehabilitation Facilities, Home Health Agencies, DME Suppliers, and physicians with an opportunity to ask CMS officials and HealthDataInsights, Inc. questions regarding the RAC program. Space is limited to attend this program so register early for a session utilizing the following link:

http://www.cms.hhs.gov/apps/events/upcomingevents.asp?strOrderBy=1&type=3.



On May 11, 2009, the California Hospital Association (CHA) will host two additional informational sessions in the Los Angeles area. These sessions will be held at the Good Samaritan Hospital located at 1225 Wilshire Blvd., Los Angeles, CA 90017-1901. The first session is at 9:30 AM to 12:30 PM (PDT) and the second session is at 2:00 PM to 5:00 PM. (PDT). Registration will be handled by CHA. Further registration instructions will be sent by CHA to their members.



PLEASE NOTE THAT ALL OF THESE SESSIONS WILL CONTAIN THE SAME CONTENT; THEREFORE, YOU NEED ONLY REGISTER FOR ONE SESSION.



The permanent RAC Program was instituted as a result of Section 302 of the Tax Relief and Health Care Act of 2006 and requires the Secretary to expand the program to all 50 states by no later than January 1, 2010. The RACs are tasked with identifying improper payments paid on Medicare fee-for-service claims. Read the text of this legislation by going to Tax Relief and Health Care Act of 2006, Section 302 [pdf, 29kb].

If you have any questions please e-mail them to RAC@cms.hhs.gov

Please stay tuned for future Region D RAC Provider Outreach conferences in your area!

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5. Five-Star Quality Rating System - April News



1. The Five-Star provider preview reports will be available beginning Thursday, April 16, 2009. Providers can access the report from the Minimum Data Set (MDS) State Welcome pages available at the state servers for submission of MDS data.

Provider Preview access information:



· Visit the MDS State Welcome page available on the State servers where you submit Minimum Data Set (MDS) data to review your results.

· To access these reports select the Certification and Survey Provider Enhanced Reports (CASPER) Reporting link located at the bottom of the login page.

· Once in the CASPER Reporting system,

i. Click on the 'Folders' button and access the Five Star Report in your 'st LTC facid' folder,

ii. Where st is the 2-digit postal code of the state in which your facility is located and

iii. Facid is the state assigned facid of your facility.

2. The Five-Star Helpline will be open for providers from 9AM to 5PM ET beginning Thursday, April 16, 2009 - Friday, May 1, 2009 to address any April’s data concerns.

3. There will be no Five-Star helpline access for the months of May and June to coincide with the release of each month’s preview data. For Five-Star provider preview questions during these months, use the BetterCare@cms.hhs.gov email. The helpline will begin quarterly operation beginning in July.

4. Nursing Home Compare will update with April’s Five-Star data on Thursday, April 23, 2000.

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6. 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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7. FY 2009 Inpatient Prospective Payment System (IPPS) Personal Computer (PC) Pricer Updated



The American Recovery and Reinvestment Act (ARRA) of 2009 was signed into law on February 27, 2009. The ARRA removed the 50% reduction in capital Indirect Medical Education (IME) and hospitals will receive the full capital IME retroactive to October 1, 2008. To comply with the ARRA, the IPPS PC Pricer for FY 2009 has been updated. If you use the IPPS PC Pricers, please go to: http://www.cms.hhs.gov/PCPricer/03_inpatient.asp under the “Downloads” section, and download the FY 2009.5 version of the PC Pricer (updated 04/09/2009).

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8. New from the Medicare Learning Network



Newly Released MLN Matters Articles of Particular Interest!



MM6392 – Surety Bonds for Suppliers of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)

http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6392.pdf



SE0907 – Clarification on Provider Information Required on Medicare Claims for Routine Foot Care Services

http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0907.pdf



MM6404 – Payment for Maintenance and Servicing of Certain Oxygen Equipment as a Result of the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008

http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6404.pdf



MM6431 – Incorporation of Physician Fee Schedule Regulatory Changes into Chapter 10 of the Program Integrity Manual (PIM)

http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6431.pdf

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9. 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