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. The Latest on the Medicare DMEPOS Competitive Bidding Program



2. Physician Quality Reporting Initiative (PQRI) Updates



3. Information for Eligible Professionals Who Participated in the 2007 Physician Quality Reporting Initiative (PQRI)



4. ICD-10 Update



5. Healthcare Common Procedure Coding System (HCPCS) Coding Decision and Preliminary Medicare Payment Decision for Negative Pressure Wound Therapy (NPWT) Devices



6. New from the Medicare Learning Network



7. June 15th-21st is National Men’s Health Week and June 21st is Father’s Day!



8. Extra Help for Beneficiaries Paying for Prescription Drugs









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



1. The Latest on the Medicare DMEPOS Competitive Bidding Program



The Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)

Competitive Bidding Program Round 1 Rebid is Coming Soon!!



Summer 2009

Ø CMS announces bidding schedule/schedule of education events

Ø CMS begins bidder education campaign

Ø Bidder registration period to obtain user ID 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 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. DMEPOS suppliers should contact a CMS deemed accreditation organization to obtain information about the accreditation process and the application process. 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 website at http://www.cms.hhs.gov/DMEPOSCompetitiveBid/ for the latest information on the DMEPOS competitive bidding program.

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



2. Physician Quality Reporting Initiative (PQRI) Updates



2009 Physician Quality Reporting Initiative

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). This toll-free call will take place from 2:30 p.m. – 4:30 p.m., EDT, on Wednesday, June 17, 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.



The topics covered on this national provider call will include:



· How to access the PQRI help desk;

· Review of the incentive payments and feedback reports timeline; and

· An update on the upcoming decisions registries for 2009.



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. Feel free to download the resources prior to the call so that you may ask questions of the CMS presenters.



Conference call details:



Date: June 17, 2009



Conference Title: 2009 Physician Quality Reporting Initiative-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 June 16, 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/061709



2. Fill in all required data.



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



4. Click "Register".



5. 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 transcript of the call will be available at least one week after the call at http://www.cms.hhs.gov/pqri on the CMS website.



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





# # # # #





2007 Physician Quality Report Initiative Program Re-Run Frequently Asked Questions



The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the posting of five frequently asked questions (FAQs) related to the re-run of 2007 Physician Quality Reporting Initiative (PQRI) data. The FAQs below, as well as, all PQRI FAQs can be accessed under “Related Links Inside CMS” section at http://www.cms.hhs.gov/PQRI on the CMS website.



We will be updating the FAQ section, so please continue to check it often.

FAQ # 9537

Q. What is the reason for the re-run of 2007 Physician Quality Reporting Initiative (PQRI) feedback reports and incentive payments?

A. CMS investigated reported issues following delivery of the 2007 Physician Quality Reporting Initiative (PQRI) feedback reports and incentive payments and determined that several unanticipated technical issues could be corrected by conducting back-end system analytics and re-running the data. Reports are anticipated to be available in the fall of 2009.

Reference: http://www.cms.hhs.gov/pqri

FAQ # 9540

Q. When will the re-run of the 2007 Physician Quality Reporting Initiative (PQRI) feedback report and incentive payment be available? How will my practice receive this information?

A. 2007 Physician Quality Reporting Initiative (PQRI) reports are anticipated to be available in the fall of 2009 and will be available to the Tax Identification Number (TIN). These reports will be available only for those eligible professionals (EPs) who have qualified due to the back-end system analysis and re-running the data. For those EPs who already received an incentive, the re-run will not apply, thus those EPs will not receive an additional feedback report. Feedback reports will be available via the PQRI Reports Delivery System (RDS). An Individuals Authorized Access to the CMS Computer Services (IACS) user name and password will be required to access the report.

Reference: http://www.cms.hhs.gov/pqri

FAQ #9541

Q. Will eligible professionals (EPs), using their individual national provider identifier (NPI), receive an additional incentive when the 2007 Physician Quality Reporting Initiative (PQRI) data is re-run in the fall of 2009?

A. No. Only those eligible professionals (EPs) who previously did not receive a bonus but are bonus eligible following the back-end system analysis and re-run of the 2007 Physician Quality Reporting Initiative (PQRI) data will potentially receive the 2007 re-run incentive.

Reference: http://www.cms.hhs.gov/pqri

FAQ# 9542

Q. Will there be a 2007 Physician Quality Reporting Initiative (PQRI) re-run for the Medicare Care Management Performance (MCMP) and Physician Group Practice (PGP) demonstration projects?

A. No. Incentive payments to eligible Medicare Care Management Performance (MCMP) and Physician Group Practice (PGP) demonstration project participants have been issued and are a separate incentive program from the Physician Quality Reporting Initiative.

Reference: http://www.cms.hhs.gov/pqri

FAQ #9543

Q. Will there be a 2007 Physician Quality Reporting Initiative (PQRI) re-run for Medicare Advantage participants?

A. Yes. Those Medicare Advantage eligible professionals (EPs) who previously did not receive a bonus but are bonus eligible following the back-end system analysis and re-run of the 2007 Physician Quality Reporting Initiative (PQRI) data will potentially receive the 2007 re-run incentive.

Reference: http://www.cms.hhs.gov/pqri

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.

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



3. Information for Eligible Professionals Who Participated in the 2007 Physician Quality Reporting Initiative (PQRI)



The Centers for Medicare & Medicaid Services (CMS) announces that the 2007 Physician Quality Reporting Initiative (PQRI) feedback reports that have been posted since July 2008 on www.qualitynet.org/pqri will be archived effective June 30, 2009 and will no longer be available to eligible professionals (EPs) who participated in the 2007 PQRI.



Archiving is required to create server space for new feedback reports related to the 2008 PQRI and the 2007 PQRI re-run participation. Only those EPs who previously did not qualify by submitting at least one quality data code successfully, but are newly qualified following the back-end system analysis and re-run of 2007 PQRI data, will receive a 2007 PQRI re-run feedback report.



All eligible professionals who successfully submitted at least one quality data code for the 2008 PQRI will receive a feedback report. These reports should be available in October 2009.



The 2008 PQRI incentive payment will be distributed by the Carrier and/or A/B MAC in October 2009. The 2007 PQRI re-run incentive payments will be distributed by the Carrier and/or A/BMAC in November 2009.



Additional information about the 2007 PQRI feedback reports can be found in the “2007 PQRI Program” section page at http://www.cms.hhs.gov/pqri on the CMS website.

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



4. ICD-10 Update



The written and audio transcripts of the ICD-10-CM/PCS Implementation and General Equivalence Mappings (Crosswalks) National Provider Conference Call, which was conducted by the Centers for Medicare & Medicaid Services on May 19, 2009, are now available in the Downloads Section at http://www.cms.hhs.gov/ICD10/06a_2009_CMS_Sponsored_Calls.asp .

# # # # #

Reminder: The Centers for Medicare & Medicaid Services will conduct the Introduction to ICD-10-CM/PCS for Physician Specialty Group Representatives Conference Call on June 23, 2009 from 12:30 – 2:30 Eastern Daylight Time. This informative conference call has been organized with your specific needs in mind as you make plans to conduct ICD-10 implementation training for your members. Feel free to invite specialty group committee members and others within your society as well as physician specialty group colleagues outside your organization who may benefit from this outreach conference call.



Note: The conference call announcement and PowerPoint slide presentation that will be discussed during the conference call have been revised and are attached.



Please contact Ann Palmer at ann.palmer@cms.hhs.gov if you have any questions about this conference call.

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



5. Healthcare Common Procedure Coding System (HCPCS) Coding Decision and Preliminary Medicare Payment Decision for Negative Pressure Wound Therapy (NPWT) Devices



· CMS’ preliminary Healthcare Common Procedure Coding System (HCPCS) coding decision and preliminary Medicare Payment decision for negative pressure wound therapy (NPWT) devices is now published in the July 9, 2009 NPWT Public Meeting Agenda. This public meeting affords stakeholders an opportunity to provide input concerning the preliminary decision.



· The Medicare Improvements for Patients and Providers Act of 2008 required the Secretary to evaluate existing HCPCS codes for NPWT devices to ensure accurate reporting and billing for the items and services under such codes; use an existing process for the consideration of coding changes; and consider all relevant studies and information furnished through the process.



· CMS partnered with Agency of Healthcare Research and Quality (AHRQ) to commission a review of NPWT devices to ensure all relevant studies and information on NPWT were captured. ECRI Institute solicited information from stakeholders and searched literature in conducting this review. A draft report of their findings was published for comment in April 2009. After analysis of comments received, ECRI concluded that the available evidence does not support significant therapeutic distinction of a NPWT system or component of a system. The report informed CMS’ HCPCS workgroup’s decision. The final report will be publicly available no later than June 10, 2009 on AHRQ’s homepage for the Technology Assessment Program at http://www.ahrq.gov/clinic/techix.htm .

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



6. New from the Medicare Learning Network



· The revised Medicare Disproportionate Share Hospital Fact Sheet (April 2009), which provides information about methods to qualify for the Medicare Disproportionate Share Hospital (DSH) adjustment; Medicare Prescription Drug, Improvement, and Modernization Act of 2003 and Deficit Reduction Act of 2005 provisions that impact Medicare DSHs; number of beds in hospital determination; and Medicare DSH payment adjustment formulas, can be accessed at http://www.cms.hhs.gov/MLNProducts/downloads/2009_mdsh.pdf .

· The revised Critical Access Hospital Fact Sheet (April 2009), which provides information about eligible Critical Access Hospital (CAH) providers; CAH designation; CAH payments; reasonable cost payment principles that do not apply to CAHs; election of Standard Payment Method or Optional (Elective) Payment Method; Medicare Rural Pass-Through funding for certain anesthesia services; Health Professional Shortage Area Incentive payments; Physician Scarcity Area Bonus payments; Medicare Prescription Drug, Improvement, and Modernization Act of 2003 provisions that impact Critical Access Hospitals; and grants to states under the Medicare Rural Hospital Flexibility Program, can be accessed at http://www.cms.hhs.gov/MLNProducts/downloads/CritAccessHospfctsht.pdf .

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



7. June 15th-21st is National Men’s Health Week and June 21st is Father’s Day!



The Centers for Medicare & Medicaid Services (CMS) is asking the provider community to keep men with Medicare healthy by ensuring that they take advantage of Medicare-covered preventive services. Medicare covers colorectal and prostate cancer screenings, among other preventive services.

What Can You Do?

As a health care professional who provides care to seniors and others with Medicare, you can help protect the health of your Medicare patients who may be at risk for cancer by educating them about their risk factors and reminding them of the importance of getting the preventive cancer screenings covered by Medicare. Early detection and treatment of cancer can help men with Medicare live longer, fuller, healthier lives.

For More Information

CMS has developed several educational products related to Medicare-covered preventive services, including screenings for various forms of cancer. Please visit the Medicare Learning Network for more information, including the following cancer-screening pages:



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 Cancer Screenings Brochure ~ This tri-fold brochure provides health care professionals with an overview of Medicare's coverage of cancer screening tests, including colorectal and prostate cancer screenings. http://www.cms.hhs.gov/MLNProducts/downloads/cancer_screening.pdf

o Quick Reference Information: Medicare Preventive Services ~ This double-sided chart provides coverage and coding information on Medicare-covered cancer screenings. http://www.cms.hhs.gov/MLNProducts/downloads/MPS_QuickReferenceChart_1.pdf



Thank you for helping CMS improve the health of men with Medicare who are at risk for cancer by joining in the effort to educate beneficiaries about cancer, and the importance of early detection by taking advantage of the cancer screenings covered by Medicare.

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



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











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