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. Scam Alert: CMS has become aware of a scam targeting physician offices



2. FDA Consumer Alert: Warning Consumers of a Tainted Skin Sanitizer



3. The Availability of Qualified Registries for 2009 Physician Quality Reporting Initiative (PQRI) Reporting



4. Get Ready for DMEPOS Competitive Bidding!



5. Nursing Home Five-Star Quality Rating System – June News



6. July 2009 Average Sales Price (ASP) Files Are Now Available



7. New from the Medicare Learning Network



8. Extra Help for Beneficiaries Paying for Prescription Drugs









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1. Scam Alert: CMS has become aware of a scam targeting physician offices



CMS has become aware of a scam where perpetrators are sending faxes to physician offices posing as the Medicare carrier or Medicare Administrative Contractor (MAC). The fax instructs physician staff to respond to a questionnaire to provide an account information update within 48 hours in order to prevent a gap in Medicare payments. The fax may have the CMS logo and/or the contractor logo to enhance the appearance of authenticity.



Medicare FFS providers, including physicians, non-physician practitioners, should be wary of this type of request. If you receive a request for information in the manner described above, please check with your contractor before submitting any information. Medicare providers should only send information to a Medicare contractor using the address found in the download section of the CMS.gov website found at http://www.cms.hhs.gov/MLNGenInfo/ or http://www.cms.hhs.gov/MedicareProviderSupEnroll .

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2. FDA Consumer Alert: Warning Consumers of a Tainted Skin Sanitizer



Following an announcement by the U. S. Food and Drug Administration (FDA) warning consumers of a tainted skin sanitizer, the Centers for Medicare & Medicaid Services (CMS) is advising health care providers and consumers not to use skin products made by Clarcon Biological Chemistry Laboratory. Clarcon is voluntarily recalling some skin sanitizers and skin protectants marketed under several different brand names because of high levels of disease-causing bacteria found in the product during a recent inspection.



Consumers and providers are being warned to not use any Clarcon products and to throw these products away in household refuse.



FDA analyses of several samples of Clarcon products revealed high levels of various bacteria, including some associated with unsanitary conditions. Some of these bacteria can cause opportunistic infections of the skin and underlying tissues. Such infections may need medical or surgical attention, and may result in permanent damage. Examples of products that should be discarded include:

Citrushield Lotion

Dermasentials DermaBarrier

Dermassentials by Clarcon Antimicrobial Hand Sanitizer

Iron Fist Barrier Hand Treatment

Skin Shield Restaurant

Skin Shield Industrial

Skin Shield Beauty Salon Lotion

Total Skin Care Beauty

Total Skin Care Work



Health care professionals and consumers may report serious adverse events (side effects) or product quality problems with the use of this product to the FDA's MedWatch Adverse Event Reporting program either online, by regular mail, fax or phone.

--Online
--Regular Mail: use postage-paid FDA form 3500 and mail to MedWatch, 5600 Fishers Lane, Rockville, MD 20852-9787
--Fax: 800-FDA-0178
--Phone: 800-FDA-1088

For more information:
http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm164845.htm

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3. The Availability of Qualified Registries for 2009 Physician Quality Reporting Initiative (PQRI) Reporting



The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the availability of Qualified Registries for 2009 Physician Quality Reporting Initiative (PQRI) Reporting.



A list of qualified registries can be accessed under the “Reporting” section page on the CMS website at http://www.cms.hhs.gov/PQRI. Each of the registries listed has gone through a vetting process. CMS believes that it is highly likely each of these registries will be successful in their data submission for the PQRI program.



Eligible professionals who wish to participate in the 2009 PQRI using one of the registry-based options may contact the registries for additional details on participation options.



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

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4. Get Ready for DMEPOS Competitive Bidding!



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

1. 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.

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5. Nursing Home Five-Star Quality Rating System – June News



1. The Five-Star provider preview reports are beginning Wednesday, June 17, 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 June’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 June’s Five-Star data on Thursday, June 25, 2009.

4. Please visit http://www.cms.hhs.gov/CertificationandComplianc/13_FSQRS.asp for the latest Five-Star Quality Rating system information.

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6. July 2009 Average Sales Price (ASP) Files Are Now Available



The Centers for Medicare & Medicaid Services (CMS) has posted the July 2009 ASP pricing files and crosswalks, which are available for download at: http://www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/01a1_2009aspfiles.asp

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7. New from the Medicare Learning Network



The revised Sole Community Hospital Fact Sheet ( April 2009), which provides information about Sole Community Hospital classification and payments, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/SoleCommHospfctsht508-09.pdf .



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The revised Rural Referral Center Fact Sheet (April 2009), which provides information about Rural Referral Center program requirements, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/RuralRefCtrfctsht2008.pdf .



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Revised in June 2009 -- The Certificate of Medical Necessity (CMN) Web-Based Training (WBT), which is made available by the Centers for Medicare & Medicaid Services (CMS) Medicare Learning Network (MLN), contains information about the Certificate of Medical Necessity, commonly known as a CMN.



This course will be helpful to physicians, health care professional, and medical administrative staff in the completion, submission and maintenance of the documentation required to verify the CMN. It can be accessed by going to http://www.cms.hhs.gov/MLNGenInfo. Scroll to the "Related Links Inside CMS" section at the bottom of the page, and select Web Based Training (WBT) Modules. You will find the "Certificate of Medical Necessity WBT " from the list provided.



Upon completion of this course you should be able to:



· List the items that require a Certificate of Medical Necessity (CMN)

· Identify the responsibilities of Physicians, Physician Assistants, Nurse Practitioners, or Clinical Nurse Specialists as they relate to the CMN

· Define medical record documentation

· Identify the sections of a CMN

· List CMN common Errors

· Identify CMN completion resources



Successful completion of this course requires completion of all course lessons, pre-test, course evaluation and a score of 70 percent of higher on the post-test.



The Centers for Medicare & Medicaid Services (CMS) is authorized by IACET to offer 0.1 continuing education units (CEUs) for this program.



The Centers for Medicare & Medicaid Services designates this educational Activity for a maximum of 1 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.



Credit for this course expires May 4, 2012.



This course and its post test score of 70% or higher, is approved for 1 CEU by the American Academy of Professional Coders (AAPC). Index # CMS06140728A



When submitting a CMS completed web-based training course to AAPC as part of your recertification, please retain a copy of your CMS certificate and a copy of the course description that contains the AAPC index number and number of AAPC CEUs. The AAPC will request copies of these if you are selected for verification of the CEUs listed on your renewal form.



The author has no conflicts of interest to disclose.



This course was developed without any commercial support.



Click here to view the biographical information of the course developers. http://www.cms.hhs.gov/MLNEdWebGuide/Downloads/2009_May_Biographical_Data_CMN_WBT.pdf

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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.

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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