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. Reminder: National Provider Conference Call on ICD-10-CM/PCS – May 19, 2009



2. Program Advisory & Oversight Committee (PAOC) Meeting Scheduled for June 4, 2009



3. CMS to Host First National Provider Education Call on HIPAA Version 5010 – June 9, 2009



4. PQRI and E-Prescribing Updates



5. New from the Medicare Learning Network



6. Pricer Updates



7. Posting of Draft Minimum Data Set (MDS) 3.0 Data Specifications and Data Item Set



8. May 19th is World Hepatitis Day



9. Extra Help for Beneficiaries Paying for Prescription Drugs









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1. Reminder: National Provider Conference Call on ICD-10-CM/PCS – May 19, 2009



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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2. Program Advisory & Oversight Committee (PAOC) Meeting Scheduled for June 4, 2009



PROGRAM ADVISORY and OVERSIGHT COMMITTEE (PAOC) MEETING ON THE IMPLEMENTATION OF THE MEDICARE

DURABLE MEDICAL EQUIPMENT, PROSTHETICS, ORTHOTICS, and SUPPLIES (DMEPOS) COMPETITIVE BIDDING PROGRAM



June 4, 2009

8:30 A.M. - 5:00 P.M. (Eastern Daylight Time)





The Centers for Medicare & Medicaid Services (CMS) will be hosting a meeting with the Program Advisory and Oversight Committee (PAOC) on June 4, 2009 to discuss the Round 1 Rebid of the Medicare DMEPOS Competitive Bidding Program. The agenda will focus on legislative changes mandated by the Medicare Improvements for Patients and Providers Act of 2008 as well as additional process improvements. CMS expects that the feedback received from the PAOC committee members and the public will assist the Agency as it moves forward with the Round 1 Rebid.



We look forward to your input and participation.



To register for the meeting, please visit: http://www2.blsdev.com/blsmeetings/h1565/



For additional information about the Medicare DMEPOS Competitive Bidding, please visit the CMS web site at: http://www.cms.hhs.gov/DMEPOSCompetitiveBid/01_overview.asp#TopOfPage

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3. CMS to Host First National Provider Education Call on HIPAA Version 5010 – June 9, 2009



The Centers for Medicare & Medicaid Services (CMS) will host a national education conference call to address the implementation of HIPAA Version 5010. This call is being conducted for all Medicare fee-for-service providers. The call will give a general overview of the transition to HIPAA Version 5010 and address some of the exceptions and situations you may encounter as the new version is implemented. A presentation will be given and CMS Subject Matter Experts will be available to answer questions. A PowerPoint presentation will be posted on the CMS 5010 Webpage prior to the call. The 5010 webpage is located at http://www.cms.hhs.gov/ElectronicBillingEDITrans/18_5010D0.asp





Conference call details:



Date: June 9, 2009



Conference Title: CMS audio conference call: HIPAA Version 5010 – What you need to know!



Time: 2:30 – 4:00 p.m. ET



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. ET on June 8, 2009, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.



1. To register for the call participants need to go to: http://www2.eventsvc.com/palmettogba/060909



2. Fill in all required data.



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



4. 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.

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4. PQRI and E-Prescribing Updates



Centers for Medicare & Medicaid Services

Special Open Door Forum:

2009 Physician Quality Reporting Initiative (PQRI) &

Electronic Prescribing (E-Prescribing) Incentive Programs

with the American Academy of Orthopaedic Surgeons and the American Association of Orthopaedic Executives



Tuesday, May 19, 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 PQRI and E-Prescribing Incentive Programs with the American Academy of Orthopaedic Surgeons (AAOS) and the American Association of Orthopaedic Executives (AAOE).



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 the Medicare Improvements for Patients and Providers Act of 2008 (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 the quality reporting incentive program authorized by Division B of the Tax Relief and Health Care Act of 2006 - Medicare Improvements and Extension Act of 2006 (MIEA-TRHCA) and known as the Physician Quality Reporting Initiative (PQRI).



This Special Open Door Forum will be geared towards orthopaedic-specific topics related to participation in the PQRI and E-Prescribing Incentive Programs. Following the presentation, the telephone lines will be opened to allow participants to ask questions of the AAOS/AAOE presenters, including Robert H. Haralson, III, MD, MBA; Toya M. Sledd, MPH, MBA; Barbara Sack, MHSA, CMPE; 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. E-Prescribing information and educational products are available on the E-Prescribing dedicated web page located at, http://www.cms.hhs.gov/ERXIncentive , on the CMS website.



We look forward to your participation.



Special Open Door Forum Participation Instructions:

Dial: 1-800-837-1935 Conference ID 94236628



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 28, 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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A reminder that CMS 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 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.

5. To register for the call participants need to go to: http://www2.eventsvc.com/palmettogba/052009



6. Fill in all required data.



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



8. Click "Register".



9. 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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And on a final note… CMS wants to assure physician practices that it isn’t too late to participate in PQRI. Mike Rapp, MD, JD, Director of the Quality Measurement and Health Assessment Group at CMS, has developed a quick and easy “how to participate successfully in PQRI” document that is available by going to www.medicarepatientmanagement.com and looking for the section entitled “From the Desk of CMS.” We thought that this “how to” piece would be especially useful for any physician or other provider practice that was interested in either the PQRI or the E-Prescribing incentives.

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5. New from the Medicare Learning Network



Newly Released MLN Matters Articles of Particular Interest!



SE0908 – Mandatory Claims Submission and Its Enforcement

http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0908.pdf



SE0905 – Training Medicare Patients on Use of Home Glucose Monitors and Related Billing Information http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0905.pdf



And don’t forget that if you have not already done so, sign up for MLN Matters listserv—it’s the best way to ensure that you have ready access to the latest information on Medicare coverage and reimbursement rules in a brief, accurate, and easy-to-understand format. To receive up-to-the-minute alerts regarding the release of new and/or revised MLN Matters articles, go to

https://list.nih.gov/cgi-bin/show_list_archives , click on "M" at "index" and then scroll down to MLN Matters - L and then click on "Join the list". You’ll be glad you did!

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The Swing Bed Fact Sheet (revised April 2009), which provides information about the requirements hospitals and Critical Access Hospitals must meet in order to enter into a swing bed agreement under which they can use beds, as needed, to provide either acute or Skilled Nursing Facility care, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/SwingBedFactsheet.pdf .

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6. Pricer Updates



Fiscal Year (FY) 2009 Inpatient Prospective Payment System (IPPS) Personal Computer (PC) Pricer Updated

The IPPS PC Pricer for FY 2009 has been updated with the April 2009 Provider data. If you use the IPPS PC Pricer, please go to, http://www.cms.hhs.gov/PCPricer/03_inpatient.asp, and download the FY 2009.5 version of the PC Pricer updated 05/08/2009.



Fiscal Year (FY) 2009 Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) Personal Computer (PC) Pricer Release -- 02/05/2009

The April 2009 Provider Specific data for the FY 2009 IRF PPS PC Pricer has been updated and is ready to be downloaded from the page, http://www.cms.hhs.gov/PCPricer/06_IRF.asp, under the Downloads section. If you use the IRF PPS PC Pricer, please go to the page above and download the latest version of the IRF PC Pricer, posted 05/14/2009.

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7. Posting of Draft Minimum Data Set (MDS) 3.0 Data Specifications and Data Item Set



A draft version of the MDS 3.0 item set has been posted. It can be accessed at http://www.cms.hhs.gov/NursingHomeQualityInits/25_NHQIMDS30.asp. The final version is still scheduled for publication in October 2009.

Please Note: This is a draft version of the item set and should not be used for training purposes. The final version of the item set, data specifications, and Resident Assessment Instrument (RAI) manual are scheduled for publication on the MDS 3.0 web page (http://www.cms.hhs.gov/NursingHomeQualityInits/25_NHQIMDS30.asp) in October 2009. As additional information becomes available, it will be posted on the MDS 3.0 section of the CMS website (see link above) and announced during calls, such as the Skilled Nursing Facilities (SNF)/Long-Term Care (LTC) Open Door Forum. For more information about the SNF/LTC Open Door Forum, go to http://www.cms.hhs.gov/OpenDoorForums/25_ODF_SNFLTC.asp. Questions regarding the draft item set should be directed to mailto:MDS30Comments@cms.hhs.gov.

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8. May 19th is World Hepatitis Day



Hepatitis B is a highly infectious disease caused by the Hepatitis B virus (HBV). Chronic HBV infection can lead to cirrhosis of the liver, liver cancer, liver failure, and death.

Medicare covers the Hepatitis B vaccine and its administration for Medicare beneficiaries with an intermediate to high risk of contracting the disease. CMS has created several educational products to help Medicare providers understand this benefit, including:

o The Adult Immunizations Brochure ~ provides coverage information for the Hepatitis B vaccine http://www.cms.hhs.gov/MLNProducts/downloads/adult_immunization.pdf

o The Medicare Preventive Services Quick Reference Information: Medicare Part B Immunization Billing Chart ~ provides billing and coding information for the Hepatitis B vaccine http://www.cms.hhs.gov/MLNProducts/downloads/qr_immun_bill.pdf



For more information about Medicare-covered preventive services, including the Hepatitis B vaccine, please visit our Preventive Services page on the Medicare Learning Network at: http://www.cms.hhs.gov/MLNProducts/35_PreventiveServices.asp

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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

Division for Medicare Health Plans Operations
Centers for Medicare & Medicaid Services
Region VIII
1600 Broadway, Suite 700
Denver, CO 80202
(303) 844-1568
lucretia.james@cms.hhs.gov