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: CMS to Host First National Medicare Fee-For-Service (FFS) Provider Education Call on HIPAA Version 5010 - June 9, 2009



2. Noridian Administrative Services DME Update: May 2009 NSC News Now Available



3. Ask the Contractor Teleconference on Section 1011



4. DMEPOS Supplier Accreditation Reminder



5. New from the Medicare Learning Network



6. Supplemental Proposed Rule CMS-1406-P2



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



8. Extra Help for Beneficiaries Paying for Prescription Drugs









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



1. REMINDER: CMS to Host First National Medicare Fee-For-Service (FFS) 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 Medicare’s FFS 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 Medicare’s 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 Subject Matter Experts will be available to answer questions specific to Medicare. A PowerPoint presentation will be posted on the CMS 5010 Web page prior to the call. The CMS 5010 Web address is http://www.cms.hhs.gov/ElectronicBillingEDITrans/18_5010D0.asp





Conference call details:



Date: June 9, 2009



Conference Title:



Medicare 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, there will be an audio version available for downloading on the 5010 Web page.



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.

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



2. Noridian Administrative Services DME Update: May 2009 NSC News Now Available



The May 2009 National Supplier Clearinghouse (NSC) supplier newsletter has been published. Included in this issue is accreditation and surety bond information as well as a review of the appeals process and the requirements for completing the revised CMS-855S enrollment application for initial enrollment, reenrollments and changes of information. Suppliers are also provided with tips for successful site inspections. View the May 2009 NSC News here. Read the complete update

No 'General Announcements' articles are available for this scheduled distribution.

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



3. Ask the Contractor Teleconference on Section 1011



The National Contractor for the Section 1011 program, TrailBlazer Health Enterprises®, is hosting the second of two Ask the Contractor Teleconferences for 2009 on Thursday, June 18, 2009 from 1-2:30 p.m. (CT).



This teleconference is designed for physicians, hospitals and ambulance suppliers and it will examine a variety of program issues that are specific to Section 1011 providers.

Ask the Contractor Teleconference – Section 1011 Providers

Thursday, June 18, 2009

1-2:30 p.m. (CT)



You may register for the event on the calendar of events page of the Section 1011 Web site, http://www.trailblazerhealth.com/Calendar/Default.aspx



A confirmation e-mail will be sent to the e-mail address provided when your registration is approved. The dial-in information will be e-mailed separately.



A question-and-answer session concludes the teleconference and you may e-mail your questions in advance through the close of business Thursday, June 11, 2009 to section.1011@trailblazerhealth.com with Ask the Contractor in the subject line.

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



4. DMEPOS Supplier Accreditation Reminder



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. New from the Medicare Learning Network



The Second in Series: General Equivalence Mappings – ICD-9-CM to and from ICD-10-CM and ICD-10-PCS Fact Sheet (May 2009), which provides basic information about the General Equivalence Mappings (GEM) including possible users of the GEMs, why the GEMs are needed, and how the GEMs files are formatted as well as Reimbursement Mappings information, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/ICD-10Mappingfctsht.pdf .



For Your Information: MLN Matters Special Edition Article SE0433 titled "Skilled Nursing Facility Consolidated Billing As It Relates to Ambulance Services" is available at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0433.pdf .



Reminder of Special Edition MLN Matters Article SE0904 titled “An Introductory Overview of the HIPAA 5010.” The implementation of HIPAA 5010 presents substantial changes in the content of the data that you submit with your claims as well as the data available to you in response to your electronic inquiries. The implementation will require changes to the software, systems, and perhaps procedures that you use for billing Medicare and other payers. So it is extremely important that you are aware of these HIPAA changes and plan for their implementation. This Special Edition article can help! View it at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0904.pdf

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



6. Supplemental Proposed Rule CMS-1406-P2



Title: Medicare Program; Proposed Rate Year (RY) 2010 Medicare Severity Long-Term Care Diagnosis‑Related Group (MS‑LTC‑DRG) Relative Weights and High‑Cost Outlier Fixed‑Loss Amount

Description: This supplemental proposed rule presents both proposed rate year (RY) 2010 Medicare severity-long-term care diagnosis related groups (MS‑LTC‑DRG) weights and a proposed RY 2010 high cost outlier (HCO) fixed-loss amount based on the revised fiscal year (FY) 2009 MS‑LTC‑DRG relative weights presented in an interim final rule with comment period (CMS-1337-IFC) published elsewhere in the same Federal Register.

CMS-1406-P2 can be found at:

http://www.cms.hhs.gov/LongTermCareHospitalPPS/LTCHPPSRN/itemdetail.asp?itemID=CMS1222248.

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



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



The IPPS PC Pricer for FY 2009 required a coding correction for special pay transfer. The diagnosis-related group (DRG) - 956 was removed from the special pay transfer list and moved to a regular post-acute care (PAC) transfer DRG. If you use the IPPS PC Pricer, please go to, http://www.cms.hhs.gov/PCPricer/03_inpatient.asp, and download the FY 2009.6 version of the PC Pricer, updated 05/28/2009.

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



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