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. May Is Older Americans Month!



2. Pricer Updates



3. Note to Integrated Outpatient Code Editors (IOCE) Users



4. Special ODF on Medicare Imaging Demonstration Project



5. Five-Star Quality Rating System - May News



6. Extra Help for Beneficiaries Paying for Prescription Drugs









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1. May Is Older Americans Month!



May is Older Americans Month ~ Please join with the Centers for Medicare & Medicaid Services (CMS) in promoting increased awareness of Medicare-covered preventive services that can help older Americans live longer, fuller, healthier lives.

Medicare provides coverage for a variety preventive screenings. These screenings can help older Americans with Medicare stay healthy and detect conditions like cancer, glaucoma, and cardiovascular disease early when treatment works best.

CMS recognizes the crucial role the Medicare provider community plays in promoting and providing their patients to about potentially life-saving preventive services. Therefore, we have created a number of products available free of charge to help you educate yourselves and your patients about Medicare-covered preventive services, including:

o The MLN Preventive Services Educational Products Web Page ~ provides descriptions and ordering information for Medicare Learning Network (MLN) preventive services educational products and resources for health care professionals and their staff. http://www.cms.hhs.gov/MLNProducts/35_PreventiveServices.asp

o Preventive Services Brochures ~ provide information on bone mass measurements, cancer and glaucoma screenings, diabetes-related services, and expanded benefits. http://www.cms.hhs.gov/MLNProducts/Downloads/education_products_prevserv.pdf (scroll down to “Brochures” and choose the link for the brochure you’re interested in)

o Quick Reference Guides ~ provide additional information about initial preventive physical exams, immunization billing, and other preventive services. http://www.cms.hhs.gov/MLNProducts/Downloads/education_products_prevserv.pdf (scroll down to “Quick Reference Information” and choose the link for the brochure you’re interested in)



Thank you for your support in helping CMS spread the word about the benefits of Medicare-covered preventive series that can help older Americans live longer, healthier lives.

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2. Pricer Updates



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



The IPPS PC Pricer for FY 2009 required a coding correction and 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 05/14/2009.



Skilled Nursing Facilities Prospective Payment System (SNF PPS) Personal Computer (PC) Pricer File Updated



The FY 2009.0 SNF PPS PC Pricer has been updated with the latest April 2009 provider specific file (PSF) data. To download the latest FY 2009.0 version of the PC Pricer file (updated 05/14/2009), go to the “Skilled Nursing Facilities (SNF PPS) PC Pricer” web page (http://www.cms.hhs.gov/PCPricer/04_SNF.asp), under the “Downloads” section.



Fiscal Year (FY) 2009 Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) Personal Computer (PC) Pricers Release -- 05/15/2009



The April provider data for the Inpatient Psychiatric Facility (IPF) PPS PC Pricers for FY 2009 has been updated. If you use the IPF PPS PC Pricer 2009.A and 2009.4, please go to the page, http://www.cms.hhs.gov/PCPricer/09_inppsy.asp, under the Downloads section, and download the latest versions of the IPF PPS PC Pricers, posted 05/15/2009.

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3. Note to Integrated Outpatient Code Editors (IOCE) Users



The October 2009 IOCE version 10.3 will contain several structural changes:

1) The software will be modified to retain 28 quarters (7 years) of programs and codes in each release. The earliest version date included in the October, 2009 release will be January 1, 2003. Going forward, the earliest start date will roll each quarter so that each release will conform to include only 28 quarters. If you need to access releases prior to 7 years, you will need to maintain a copy of the July 2009 IOCE in your system.

2) The tool set used to generate the Basic Assembler Language (BAL) for the Mainframe (MF) IOCE program will be updated. Though minor, the tool set change will slightly change the structure and source code of the mainframe IOCE, resulting in small changes in the procedure for installing the MF IOCE; complete instructions will be included in the MF Installation Manual.

More information on both of these changes is described in Change Requests 6401 (http://www.cms.hhs.gov/transmittals/downloads/R482OTN.pdf) and 6390 (http://www.cms.hhs.gov/Transmittals/Downloads/R484OTN.pdf).

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4. Special ODF on Medicare Imaging Demonstration Project



Centers for Medicare & Medicaid Services

Special Open Door Forum:

Medicare Imaging Demonstration Project

Wednesday, May 27, 2009

9:30 am – 11:30 am ET



The Centers for Medicare & Medicaid Services (CMS) is holding a Special Open Door Forum (ODF) in order to solicit stakeholder input for the design and development of the Appropriate Use of Imaging Services Demonstration. This Special ODF will be a “listening session” in which CMS hopes to gather information from stakeholders about issues that will affect Demonstration design and implementation.



This demonstration was authorized by Section 135(b) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) for the purpose of collecting data regarding physician use of advanced diagnostic imaging services. For purposes of this demonstration, advanced diagnostic imaging services are defined as diagnostic magnetic resonance imaging, computed tomography, and nuclear medicine (including positron emission tomography).



CMS is interested in holding this Special ODF to gather input related to the design and implementation of this provision. CMS will not be able to respond to comments at this Forum but intends to consider the information we obtain as input develop this demonstration.



CMS is especially interested in information and feedback in the following topic areas:

1. Demonstration Framework:

a. Given that prior authorization is excluded from the demonstration by legislative mandate, how can we best design the demonstration to test both point of order (POO) and point of service (POS) systems?



b. How could CMS assess the impact of POO and POS systems through randomized designs or other comparative models?



c. What will motivate physician participation in the demonstration? How should physicians be recruited? What is the role of economic and non-economic incentives in encouraging participation?



2. Point of Order (POO) and Point of Service Systems (POS):

a. What are the major characteristics of POO and POS? How are they similar and how are they different in their assessments of appropriateness? How are these systems currently used by providers and payers?



b. What data are captured by the systems and what is the comparability in data elements across systems? Are there distinctions in how appropriateness of individual procedures is assessed between these two systems?



c. Does use of POO versus POS systems vary systematically by type of service, service setting, type of physician, and/or geography? How common is the use of these systems by specialists, primary care physicians and performing physicians?



d. How do ordering and performing physicians interface with the POO or POS systems? Do individual physicians or group practices use of more than one system?



3. Imaging Procedures:

a. Specific procedures being considered for inclusion in the demonstration are likely to be high in volume, high in growth, exhibit geographic variation, and have consensus around clinical guidelines. Are there other criteria we should consider when selecting procedures for inclusion in the demonstration?



b. What procedures that have the characteristics described above have been incorporated into POO and POS?



c. Should the demonstration focus on applying a decision support system for only specific types of imaging procedure use (e.g., MRI for Lumbar Spine, rather than all MRIs)? Might a focus on only specific types of procedures cause confusion for physicians or increase burden on physicians?



For a more information, please see the demonstration website: http://www.cms.hhs.gov/DemoProjectsEvalRpts/MD/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=3&sortOrder=descending&itemID=CMS1222075&intNumPerPage=10



We ask that all interested parties who wish to present their positions or comments prepare to speak for no more than 2 minutes. Telephone participants will also be given an opportunity to speak and will be under the same time limitation.



CMS requests that interested parties prepare their comments or input in written form and submit this information to ImagingDemo135b@cms.hhs.gov . We also request that you bring a hard copy of your written material for collection at the Special ODF.



We look forward to your participation.

There are two ways to participate, by phone or "in-person".



1. To participate by phone:

Dial: 1-800-837-1935 & Reference Conference ID: 90111467

Persons participating by phone are not required to RSVP.

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 help.



2. To participate "in-person" at the CMS Baltimore Site, RSVP is required.

Please RSVP by 2pmET Thursday, May 21, 2009 to: SpecialODF@cms.hhs.gov . Please use “Medicare Imaging Demonstration” in the subject line, send your name along with the name of your organization, your contact information, and indicate whether or not you plan to speak.



Please plan to arrive no later than 9:00 AM to account for time required to pass through security. Visitors are subject to a vehicle search and an examination of all parcels (including purses) brought into the complex. Visitors all must have a valid Government-issued photo identification card or badge.



ADDRESS:

CMS Single Site Building

Auditorium

7500 Security Boulevard

Baltimore, MD 21244



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 June 8, 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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5. Five-Star Quality Rating System - May News



1. The Five-Star provider preview reports have begun as of Wednesday, May 20, 2009. Providers can access the report from the Minimum Data Set (MDS) State Welcome pages available at the state servers for submission of Minimum Data Set data.

Provider Preview access information:



· Visit the MDS State Welcome page available on the State servers where you submit 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. BetterCare@cms.hhs.gov is available to address May’s data concerns and/or issues. The helpline will reopen in July to coincide with quarterly Quality Measure (QM) data updates.

3. Nursing Home Compare will update with May’s Five-Star data on Thursday, May 28, 2009.

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6. 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