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. 2009 Physician Quality Reporting Initiative and Electronic Prescribing Incentive Program National Provider Call to be held~ May 20, 2009



2. Reminder: National Provider Conference Call on ICD-10-CM/PCS



3. Special ODF on Outpatient Imaging Efficiency Measures



4. Special Edition MLN Matters Article



5. New from the Medicare Learning Network



6. Help Us Keep Women Healthy



7. CMS Proposes More Accurate Payment Rates for Medicare SNFs in FY 2010



8. CMS Proposes Policy and Payment Rate Changes for Inpatient Stays in Acute Care and Long-Term Care Hospitals in FY 2010



9. April 2009 Quarterly Provider Specific File Updates



10. Medicare Wage Index Report



11. Extra Help for Beneficiaries Paying for Prescription Drugs









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1. 2009 Physician Quality Reporting Initiative and Electronic Prescribing Incentive Program National Provider Call to be held~ May 20, 2009



2009 Physician Quality Reporting Initiative & Electronic Prescribing Incentive Program (e-Prescribing)

National Provider Call with Question & Answer Session



The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host a national provider conference call on the 2009 Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (e-Prescribing). This toll-free call will take place from 2:30 p.m. – 4:30 p.m., EDT, on Wednesday, May 20, 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.

Section 132 of MIPPA authorizes a new and separate incentive program for individual eligible professionals who are successful electronic prescribers (e-Prescribers) as defined by MIPPA. This new incentive is separate from and is in addition to PQRI.

The topics covered on this national provider call will include:

An update on the Quality Data Code (QDC) Error Report;
Tips for satisfactorily reporting a Measures Group in the 2009 PQRI; and
Frequently Asked Questions on e-Prescribing.


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, section, as well as educational products are available on the e-prescribing dedicated web page located at http://www.cms.hhs.gov/ERxIncentive. Feel free to download the resources prior to the call so that you may ask questions of the CMS presenters.



Conference call details:



Date: May 20, 2009



Conference Title: 2009 Physician Quality Reporting Initiative and Electronic Prescribing Incentive Program-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 May 19, 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/052009


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 5:30 p.m. EDT 5/20/2009 until 11:59 p.m. EDT 5/27/2009. The call in data for the replay is (800) 642-1687 and the passcode is 90613260.



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

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2. Reminder: National Provider Conference Call on ICD-10-CM/PCS



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.



Note:

Discussion materials for this call, including a newly-developed fact sheet that provides additional information about the ICD-10 General Equivalence Mappings and a revised PowerPoint slide presentation have been posted in the Downloads Section at http://www.cms.hhs.gov/ICD10/07a_2009_CMS_Sponsored_Calls.asp . If you are unable to access the hyperlink in this message, please copy and paste the URL into your Internet browser.

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3. Special ODF on Outpatient Imaging Efficiency Measures



Centers for Medicare & Medicaid Services

Special Open Door Forum:

Outpatient Imaging Efficiency Measures

Wednesday, May 20, 2009

2:00PM – 4:00PM Eastern Time (ET)

Conference Call Only



Featuring:

John Cooper, M.D. (CMS),

Mark Zezza, Ph.D. (The Lewin Group),

Thomas G. Dehn, M.D., FACR (National Imaging Associates, Inc.),

Joan DaVanzo, Ph.D. (Dobson | DaVanzo & Associates, LLC).



The Centers for Medicare & Medicaid Services (CMS) will hold a Special Open Door Forum (ODF) to discuss the development and implementation of facility-level hospital Outpatient Imaging Efficiency measures. The CMS has contracted with The Lewin Group, to develop a set of imaging efficiency measures. National Imaging Associates, and Dobson & DaVanzo are subcontracted by Lewin to support this effort.

During this Special ODF, CMS staff will discuss:



· Each of the four outpatient imaging efficiency measures currently required under the Hospital Outpatient Quality Data Reporting Program (HOP

QDRP) for CY2010 payment determination;

· Highlight some frequently asked questions;

· New Outpatient Imaging Efficiency measures under development.



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



To make the call as informative as possible, we recommend that participants:

· Visit the QualityNet (http://www.QualityNet.org) and Choose “Imaging Efficiency Measures” under “Hospital – Outpatient” and also http://www.ImagingMeasures.com ;



· Pre-submit any questions you wish to have addressed on the call to Imaging.Measures@lewin.com. Please type “Question for National Open Door Forum” in your Subject line. The most frequently asked questions received by 5 pm ET on Thursday, May 14, 2009, will be addressed on the call. Submitted questions not selected for the call will be answered individually via e-mail reply.



We look forward to your participation.



Special Open Door Forum Participation Instructions:



Dial: 1-800-837-1935 Conference ID 94281978

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



For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will A Relay Communications Assistant will help.

An audio recording of this Special Forum will be posted to the Special Open Door Forum website at http://www.cms.hhs.gov/OpenDoorForums/05_ODF_SpecialODF.asp and will be accessible for downloading beginning May 29, 2009.

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

Thank you for your interest in CMS Open Door Forums.

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4. Special Edition MLN Matters Article



Newly Released MLN Matters Article of Particular Interest!



SE0904 – An Introductory Overview of the HIPAA 5010

http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0904.pdf



The implementation of HIPAA 5010 presents substantial changes in the content of the data that providers submit with their claims as well as the data available to them in response to their electronic inquiries. This Special Edition MLN Matters article alerts providers of these HIPAA changes and how they need to plan for their implementation.

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5. New from the Medicare Learning Network



A new Medicare Secondary Payer Fact Sheet (April 2009), which provides a general overview of the MSP provisions for individuals involved in the admission and billing procedures at provider, physician, and other supplier settings is now available in downloadable format from the Medicare Learning Network at: http://www.cms.hhs.gov/MLNProducts/downloads/MSP_Fact_Sheet.pdf





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



The Medicare Preventive Services Quick Reference Information – Medicare Part B Immunization Billing Chart (revised March 2009), which provides billing and coding information related to Medicare-covered adult immunizations, is now available in print format from the Centers for Medicare & Medicaid Services Medicare Learning Network. To place your order, visit http://www.cms.hhs.gov/MLNGenInfo/, scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page.”



The revised Rural Health Clinic Fact Sheet (April 2009), which provides information about Rural Health Clinic (RHC) services, Medicare certification as a RHC, RHC visits, RHC payments, cost reports, and annual reconciliation, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/RuralHlthClinfctsht.pdf . If you are unable to access the hyperlink in this message, please copy and paste the URL into your Internet browser.

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6. Help Us Keep Women Healthy



May 10th is Mother’s Day! The Centers for Medicare & Medicaid Services is asking the provider community to help keep women with Medicare healthy by ensuring that they take advantage of Medicare-covered preventive services. Medicare covers mammograms, bone mass measurements, screening pap tests, and screening pelvic exams, among other services, that can help women live longer, healthier lives.



The Medicare Learning Network (MLN) offers a variety of educational products related to Medicare-covered preventive services geared towards women. They include:



· The Bone Mass Measurements brochure, which provides information on Medicare coverage of bone-mass measurements: http://www.cms.hhs.gov/MLNProducts/downloads/bone_mass.pdf .

· The Cancer Screenings brochure, which provides information on Medicare coverage of cancer screenings, including screening mammography, screening pelvic exams, and screening pap tests: http://www.cms.hhs.gov/MLNProducts/downloads/cancer_screening.pdf.

For additional educational products, including quick reference guides and web-based training courses, please visit the Medicare Preventive Services MLN products website at: http://www.cms.hhs.gov/MLNProducts/35_PreventiveServices.asp.

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7. CMS Proposes More Accurate Payment Rates for Medicare SNFs in FY 2010



CASE-MIX ADJUSTMENT RECALIBRATION PROPOSED

The Centers for Medicare & Medicaid Services (CMS) recently proposed adjustments to fiscal year (FY) 2010 payment rates to better reflect the cost of caring for Medicare beneficiaries in nursing homes.

The rule calls for payments to Medicare skilled nursing facilities to be reduced by $390 million, or 1.2 percent lower than payments for FY 2009. This adjustment to nursing facility payments is an effort to rebalance an earlier adjustment to the case-mix indexes (CMIs).

The proposed FY 2010 recalibration of the CMIs would result in a reduction in payments to nursing homes of $1.050 billion, or 3.3 percent. However, this decrease would be largely offset by this fiscal year’s proposed update to Medicare payments to skilled nursing facilities. The update—a proposed increase of 2.1 percent or $660 million for FY 2010—is based on the change in prices of a “market basket” of goods and services included in covered skilled nursing facility stays. The percentage increase in the market basket is used to compute the update factor annually. The combination of the market basket increase and the recalibration of the CMIs yields the 1.2 percent reduction.

To view the entire Press Release, please visit the CMS website at http://www.cms.hhs.gov/apps/media/press_releases.asp

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8. CMS Proposes Policy and Payment Rate Changes for Inpatient Stays in Acute Care and Long-Term Care Hospitals in FY 2010



The Centers for Medicare & Medicaid Services (CMS) recently proposed the fiscal year (FY) 2010 policies and payment rates for inpatient services furnished to people with Medicare by both acute care hospitals and long-term care hospitals.

CMS is proposing to update acute care hospital rates by 2.1 percent for inflation less an adjustment of 1.9 percentage points to remove the effect of increases in aggregate payments due to changes in hospital coding practices that do not reflect increases in patient’s severity of illness. CMS is similarly proposing to update long-term care hospital rates by 2.4 percent for inflation less an adjustment of 1.8 percentage points to account for changes in documentation and coding practices that do not reflect increases in patient’s severity of illness. Beginning October 1, 2008, Medicare adopted a new classification system for general acute and long term care hospitals to better recognize severity of illness and the cost of treating Medicare patients.

However, hospitals changed their documentation and coding of patient diagnoses under the new system in a manner that leads to an increase in aggregate payments without corresponding growth in actual patient severity. The proposed documentation and coding adjustments help ensure that estimated aggregate payments to these hospitals under the new classification systems would not increase solely as a result of the changes to the classification system and hospital coding practices. Although CMS has the authority to make a much greater downward adjustment to payment rates to address these changes in hospital coding practices, CMS believes it would be prudent to phase-in the adjustment carefully over time.

The proposed rule would apply to approximately 3,500 acute care hospitals paid under the Inpatient Prospective Payment System (IPPS), and 400 long-term care hospitals paid under the Long-Term Care Hospital Prospective Payment System (LTCH PPS), beginning with discharges occurring on or after October 1, 2009. The proposed payment rates are based on the most recently available data and are subject to revision in the final rule to reflect more current data.

The proposed rule (CMS-1406-P) was placed on display at the Federal Register and can be found under Special Filings at:

(http://www.federalregister.gov/inspection.aspx#spec_C).

CMS will accept comments on the proposed rule until June 30, 2009, and will respond to comments in a final rule to be made publicly available no later August 1, 2009.

For more information, including supporting files, please see: (www.cms.hhs.gov/AcuteInpatientPPS/01_overview.asp).

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9. April 2009 Quarterly Provider Specific File Updates



The April 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.



The April 2009 quarterly Provider Specific Files (PSF) Statistical Analysis Software (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.

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10. Medicare Wage Index Report



In the Fiscal Year (FY) 2010 Hospital Inpatient Prospective Payment System Proposed Rule, we discuss that Acumen, LLC's final report addressing wage index issues in section 106(b)(2) of the Medicare division of the Tax Relief and Health Care Act of 2006 is divided into two parts. The first part, now available on Acumen's Web site, analyzes the strengths and weaknesses of the data sources used to construct the MedPAC and CMS indexes. The second part, which is expected to be released after the publication of the FY 2010 final rule, will focus on the methodology for computing the wage index and covers issues including the definition of wage areas and methods of adjusting for differences among neighboring wage areas. Acumen's Web address is: http://www.acumenllc.com/reports/cms .

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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