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. Final Agenda for the Next Meeting of the Program Advisory and Oversight Committee (PAOC)



2. A Reminder for You to Send to Your Members About Medicare Contractor Listservs



3. GET READY FOR COMPETITIVE BIDDING!



4. DMEPOS Supplier Accreditation Reminder



5. What’s New with the 2009 PQRI and E-Prescribing Incentive Programs



6. New from the Medicare Learning Network



7. Fiscal Year (FY) 2009 Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) Personal Computer (PC) Pricers Release -- 05/21/2009



8. Extra Help for Beneficiaries Paying for Prescription Drugs









~~~~~~~~~~~~~~~~~~~~



1. Final Agenda for the Next Meeting of the Program Advisory and Oversight Committee (PAOC)



CMS has finalized the agenda (below) for the next meeting of the Program Advisory and Oversight Committee (PAOC) which advises the agency on implementation of the DMEPOS competitive bidding program and DMEPOS supplier quality standards. Jon Blum, CMS, and Tom Jeffers, Hill Rom Inc., are co-chairs for the committee.



Program Advisory and Oversight Committee (PAOC)

Meeting Agenda, Thursday, June 04, 2009, Marriott Hotel BWI



8:00 – 8:30 a.m. Public Registration



8:30 – 8:45 a.m. Opening Remarks



8:45 – 9:00 a.m. Introduction of New PAOC Committee



9:00 – 10:00 a.m. Background on the Program



· Standard Payment Rules

· Competitive Bidding Demonstrations

· Medicare Modernization Act of 2003

· 2008 Legislative Refinements



10:00 – 10:30 a.m. On-Line Bidding System



10:30 – 10:45 a.m. Mid-Morning Break



10:45 – 11:30 a.m. Education on Program Requirements and Bidder Responsibilities



11:30 – 12:00 p.m. Financial Documentation



12:00 – 1:30 p.m. LUNCH (On your own)



1:30 – 2:30 p.m. Licensure, Accreditation, and Subcontracting Requirements



2:30 – 3:15 p.m. New Supplier Issues



3:15 – 3:30 p.m. Mid-Afternoon Break



3:30 – 4:00 p.m. Mail Order - Diabetic Testing Supplies



4:00 – 4:15 p.m. Tentative Timeline



4:15 – 5:00 p.m. Public Comments

~~~~~~~~~~~~~~~~~~~~



2. A Reminder for You to Send to Your Members About Medicare Contractor Listservs



Help your association members stay up-to-date on the latest Medicare-related information! Below is a brief news item that we encourage you to put in your next newsletter, bulletin, or whatever vehicle you use to provide your members with news they need to know. Through their electronic mailing lists, Medicare contractors serve as a valuable source of news and information regarding Medicare business in specific provider practice locations, including local coverage determinations and local provider education events. So do your members a favor and help us spread the word!



“Did you know that your local Medicare contractor is a valuable source of news and information regarding Medicare business in your specific practice location? Through their electronic mailing lists, your local contractor can quickly provide you with information pertinent to your geographic area, such as local coverage determinations, local provider education activities, etc. If you have not done so already, you should go to your local contractor website and sign up for their listserv or e-mailing list. Many contractors have links on their home page to take you to their registration page to subscribe to their listserv. If you do not see a link on the homepage, just search their site for “listserv” or “e-mail list” to find the registration page. If you do not know the Web address of your contractor’s homepage, it is available at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip on the CMS website.”

~~~~~~~~~~~~~~~~~~~~



3. GET READY FOR COMPETITIVE BIDDING!



The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), enacted on July 15, 2008, made limited changes to the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program, including a requirement that competition to re-bid Round 1 occur in 2009. On January 16, 2009, the Centers for Medicare & Medicaid Services (CMS) issued an interim final rule with comment period that incorporates into regulations only those provisions of MIPPA related to the DMEPOS competitive bidding program that are self-implementing and necessary to conduct the Round 1 rebid competition in 2009. That rule became effective on April 18, 2009. To ensure that suppliers have ample time to prepare for the competition, CMS has announced the following next steps for the program:



SPRING 2009

Ø CMS BEGINS PRE-BIDDING SUPPLIER AWARENESS CAMPAIGN

Ø PROGRAM ADVISORY AND OVERSIGHT COMMITTEE (PAOC) MEETING (JUNE 4, 2009)



SUMMER 2009

Ø CMS ANNOUNCES BIDDING SCHEDULE/SCHEDULE OF EDUCATION EVENTS

Ø CMS BEGINS BIDDER EDUCATION CAMPAIGN

Ø BIDDER REGISTRATION PERIOD TO OBTAIN USER IDS AND PASSWORDS BEGINS



FALL 2009

Ø BIDDING BEGINS



If you are a supplier interested in bidding, prepare now – don’t wait!



Ø UPDATE YOUR NSC FILES: DMEPOS supplier standard # 2 requires ALL suppliers to notify the National Supplier Clearinghouse (NSC) of any change to the information provided on the Medicare enrollment application (CMS-855S) within 30 days of the change. DMEPOS suppliers should use the 3/09 version of the CMS-855S and should review and update:

• The list of products and services found in section 2.D;

• The Authorized Official(s) information in sections 6A and 15; and

• The correspondence address in section 2A2 of the CMS-855S.

This is especially important for suppliers who will be involved in the Medicare DMEPOS Competitive Bidding Program. These suppliers must ensure the information listed on their supplier files is accurate to enable participation in this program. Information and instructions on how to submit a change of information may be found on the NSC Web site (http://www.palmettogba.com/nsc) and by following this path: Supplier Enrollment/Change of Information/Change of Information Guide.



Ø GET LICENSED: Suppliers submitting a bid for a product category in a competitive bidding area (CBA) must meet all DMEPOS state licensure requirements and other applicable state licensure requirements, if any, for that product category for every state in that CBA. Prior to submitting a bid for a CBA and product category, the supplier must have a copy of the applicable state licenses on file with the NSC. As part of the bid evaluation we will verify with the NSC that the supplier has on file a copy of all applicable required state license(s).



Ø GET ACCREDITED: CMS would like to remind DMEPOS suppliers again that time is running out to obtain accreditation by the September 30, 2009 deadline or risk having their Medicare Part B billing privileges revoked on October 1, 2009. Accreditation takes an average of 6 months to complete. It is very important for DMEPOS suppliers to contact an accreditation organization right away to obtain information about the accreditation process and submit an application. Suppliers must be accredited for a product category in order to submit a bid for that product category. CMS cannot contract with suppliers that are not accredited by a CMS-approved accreditation organization.



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/01_Overview.asp .



Ø GET BONDED: CMS would like to remind DMEPOS suppliers that certain suppliers will need to obtain and submit a surety bond by the October 2, 2009 deadline or risk having their Medicare Part B billing privileges revoked. Suppliers subject to the bonding requirement must be bonded in order to bid in the DMEPOS competitive bidding program. A list of sureties from which a bond can be secured is found at the Department of the Treasury’s “List of Certified (Surety Bond) Companies;” the web site is located at:

www.fms.treas.gov/c570/c570_a-z.html.



Visit the CMS web site at www.cms.hhs.gov/CompetitiveAcqforDMEPOS/ for the latest information on the DMEPOS competitive bidding program.



To view the Press Release, please click: http://www.cms.hhs.gov/apps/media/press_releases.asp.

~~~~~~~~~~~~~~~~~~~~



4. 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. A new MLN Matters Special Edition articles on this subject is now available. This article outlines what you need to do if you have not yet complied with the Medicare Program’s supplier and quality standards to be come accredited. To view the article, go to: http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0903.pdf on the CMS website.



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 .

~~~~~~~~~~~~~~~~~~~~



5. What’s New with the 2009 PQRI and E-Prescribing Incentive Programs



1. Article Regarding Implementation Advice for 2009 PQRI and E-Prescribing Incentive Programs Now Available

2. Three Physician Quality Reporting Initiative Help Desk Resources Now Available for Eligible Professionals



CMS Announces Availability of a New Educational Resource Article on the 2009 PQRI and E-Prescribing Program



The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that a new educational resource has been posted to the PQRI webpage on the CMS website. An article titled: Physician Quality

Reporting Initiative (PQRI) & E-Prescribing: Implementation Advice for the Office Manager outlines step-by-step how to get started in reporting 2009 PQRI measures.



The article is available at http://www.cms.hhs.gov/PQRI/31_PQRIToolKit.asp on the CMS website as a downloadable document and is accessible by scrolling down to the Downloads section and selecting the “2009 PQRI and E-Prescribing Implementation Advice” link.





Three Physician Quality Reporting Initiative Help Desk Resources are Now Available for Eligible Professionals



The Centers for Medicare & Medicaid Services (CMS) is pleased to announce three PQRI Help Desk Resources to assist eligible professionals with their questions on the Physician Quality Reporting Initiative.

1. Provider Call Center Directory

· Remittance Advice Notices

· Incentive payment distribution status

· Adjustments made to incentive payment due to sanctions/overpayments

For contact information, see the “Provider Center Toll-free Numbers Directory” by clicking the link under the “Related Links Inside CMS” section below and scrolling down to the “Downloads” section.

2. External User Services (EUS) – 7:00 AM – 7:00 PM EST

· Registering/creating an IACS account

· Accessing an IACS account

· Changing an IACS account

· Approving users into an organization

Phone: 1-866-484-8049

TTY: 1-866-523-4759

3. QualityNet Help Desk – 7:00 AM – 7:00 PM CST

· General CMS PQRI & ERX Information

· PQRI Portal Password Issues

· PQRI feedback report availability and access

Phone: 1-866-288-8912

All publicly available information on the CMS Physician Quality Reporting Initiative can be found at http://www.cms.hhs.gov/PQRI, on the CMS website.



All publicly available information on the CMS Electronic Prescribing Incentive Program can be found at http://www.cms.hhs.gov/ERxIncentive on the CMS website.

~~~~~~~~~~~~~~~~~~~~



6. New from the Medicare Learning Network



The Inpatient Psychiatric Facility Prospective Payment System Fact Sheet (revised May 2009), which provides general information about the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS), how payment rates are set, and the Rate Year 2010 update to the IPF PPS, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/InpatientPsychFac.pdf .



Recently Revised MLN Matters Articles of Particular Interest:



Revised:

SE0903 – Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Supplier Accreditation Requirements

http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0903.pdf



Revised:

SE0832 – The ICD-10 Clinical Modification/Procedure Coding System (CM/PCS)—The Next Generation of Coding

http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0832.pdf

~~~~~~~~~~~~~~~~~~~~



7. Fiscal Year (FY) 2009 Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) Personal Computer (PC) Pricers Release -- 05/21/2009



Corrections were made to the Inpatient Psychiatric Facility (IPF) PPS PC Pricers for FY 2009 and 2008. If you use the IPF PPS PC Pricer 2008 or 2009, 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 and 5/21/2009.

~~~~~~~~~~~~~~~~~~~~



8. 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.

~~~~~~~~~~~~~~~~~~~~









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