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. New from the Medicare Learning Network



2. Recovery Audit Contractor Update



3. CMS Website on Recovery Act and Health Information Technology Now Available!



4. Provider Communications Group’s PowerPoint Presentation



5. 2009 Physician Quality Reporting Initiative (PQRI) Program Reminder



6. Get Ready for DMEPOS Competitive Bidding!



7. Reminder of DMEPOS Supplier Accreditation and Surety Bond Requirement Deadlines Coming in October



8. Proposed DMEPOS Regulatory Updates



9. CMS Proposes Payment, Policy Changes for Physicians’ Services to Medicare Beneficiaries in 2010



10. CMS Proposes Policy, Payment Rate Changes for Services In Hospital Outpatient Departments And Ambulatory Surgical Centers In 2010



11. HHS Rescinds Medicaid Regulations



12. Extra Help for Beneficiaries Paying for Prescription Drugs









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1. New from the Medicare Learning Network



The Medicare Dependent Hospital Fact Sheet (April 2009), which provides the criteria that rural hospitals must meet in order to be classified as a Medicare Dependent Hospital, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/MedDependHospfctsht508.pdf . If you are unable to access the hyperlink in this message, please copy and paste the URL into your Internet browser.



Release of MLN Matters Article SE0912 – Expiration of Medicare Processing of Certain Indian Health Service (IHS) Part B Claims - Sunset of Section 630 of the Medicare Modernization Act (MMA) of 2003 for Payment of Indian Health Services (IHS). View it at:

http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0912.pdf

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2. Recovery Audit Contractor Update



CMS Recovery Audit Contractor Program

Section 302 of the Tax Relief and Health Care Act of 2006 (TRHCA) required the Department of Health and Human Services (DHHS) to make the Recovery Audit Contractor (RAC) program permanent and nationwide by no later than January 1, 2010. CMS is conducting outreach and education about the RAC in each of the 50 states. On 06/24/09 CMS Released a RAC Review Phase-in Strategy. It can be viewed at:

http://www.cms.hhs.gov/RAC/Downloads/CMS%20RAC%20review%20strategy.pdf



To sign up for email updates from CMS about the RAC program, please visit our website at: https://subscriptions.cms.hhs.gov/service/subscribe.html?code=USCMS_542



The CMS Denver Regional Office is currently planning future Medicare Chat toll free conference calls to provide Region VIII providers with additional opportunities to learn more this program. Stay tuned for more information about these upcoming calls.

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3. CMS Website on Recovery Act and Health Information Technology Now Available!



A new website is now available from the Centers for Medicare & Medicaid Services (CMS) concerning Health Information Technology as provided for in the American Recovery and Reinvestment Act of 2009. On this website, you can find information pertaining to the Medicare and Medicaid incentives for electronic health records adoption and important links to related websites at the Department of Health and Human Services.



Posted now are:

· A CMS fact sheet and questions/answers pertaining to the incentive programs

· Link to press release pertaining to the process of defining meaningful use (Comments are due June 26, 2009.)

· Resources on Health IT and privacy & security (HIPAA)



Bookmark http://www.cms.hhs.gov/Recovery/11_HealthIT.asp#TopOfPage today to find the latest on Health Information Technology.

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4. Provider Communications Group’s PowerPoint Presentation



Hello everyone. The latest version of the Provider Communications Group’s “Information and Education Resources for Medicare Providers” PowerPoint Presentation has been posted and is available for use. This revised edition includes updated information on:





Competitive Acquisition for DMEPOS
Physician Quality Reporting Initiative




The PowerPoint Presentation is posted at:

http://cmsnett.cms.hhs.gov/hpages/cmm/pcg/pcg_outreach_support.asp as well as

http://www.cms.hhs.gov/ContractorLearningResources/

.



Please remember that the “Information and Education Resources for Medicare Providers” PowerPoint Presentation was developed to assist CMS staff and Medicare Contractors who are giving presentations to provider audiences regarding Medicare education and outreach information. The first and last slides should be edited to include the speaker’s name and title. The presentation also includes many website addresses that make it a useful tool when navigating through the CMS Website. Therefore, it may be helpful to print and distribute the slides to attendees. The presentation is updated regularly to ensure that it contains the most current and relevant provider-related information. If you have any questions, please e-mail robin.sutton@cms.hhs.gov .

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5. 2009 Physician Quality Reporting Initiative (PQRI) Program Reminder



It is not too late to start participating in the 2009 Physician Quality Reporting Initiative (PQRI) and potentially qualify to receive incentive payments. A new half-year reporting period began on July 1. If you have not yet started, you can begin by reporting either:



· Three individual 2009 PQRI measures for at least 80% of applicable Medicare Part B FFS patients seen between July 1, 2009 and December 31, 2009 through a qualified 2009 PQRI registry. To qualify for a half-year incentive (some registries may allow an eligible professional to submit data to them from the start of 2009 thus being able to report for the entire year); or



· A measures group through claims or a qualified 2009 PQRI registry.; depending on the sample method selected for a measures group, you could qualify for:

o A half-year incentive by reporting the measures group on 80% of applicable Medicare Part B FFS patients seen between July 1, 2009 and December 31, 2009 or

o A full-year incentive by reporting the measures group on 30-consecutive patients.



A list of qualified registries for the 2009 PQRI can be found on the CMS PQRI “Reporting” section page at http://www.cms.hhs.gov/PQRI on the CMS website.



Eligible professionals do not need to sign-up or pre-register to participate in the 2009 PQRI. Submission of quality data codes for individual PQRI measures to CMS through a qualified registry or for a measures group through claims or a qualified registry will indicate intent to participate.



Although there is no requirement to register prior to submitting the data, there are some preparatory steps that professionals should take prior to undertaking PQRI reporting. CMS has created a tip sheet titled, “Satisfactorily Reporting 2009 PQRI Measures,” that provides information about how to get started with PQRI reporting. To access this tip sheet and all available educational resources on the 2009 PQRI please visit, http://www.cms.hhs.gov/PQRI/ on the CMS website. Eligible professionals are encouraged to visit the PQRI webpage often for the latest information and downloads on PQRI.

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6. 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

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.

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7. Reminder of DMEPOS Supplier Accreditation and Surety Bond Requirement Deadlines Coming in October



Suppliers May Choose to Voluntarily Terminate Enrollment If They Do Not Plan To Comply



Medicare suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS), unless exempt, must be accredited and obtain a surety bond by October 1, 2009 and October 2, 2009, respectively.



If you have made the decision not to obtain accreditation or a surety bond when required, you may want to voluntarily terminate your enrollment in the Medicare program before the implementation dates above. You can voluntary terminate your enrollment with the Medicare program by completing the sections associated with voluntary termination on page 4 of the Medicare enrollment application (CMS-855S). Once complete, you should sign, date and send the completed application to the National Supplier Clearinghouse (NSC). By voluntarily terminating your Medicare enrollment, you will preserve your right to re-enroll in Medicare once you meet the requirements to participate in the Medicare program.



If you do not comply with the accreditation and surety bond requirements and do not submit a voluntary termination, your Medicare billing privileges will be revoked. A revocation will bar you from re-enrolling in Medicare for at least one year after the date of revocation.



Suppliers who do not plan to stay enrolled in Medicare are strongly encouraged to notify their beneficiaries as soon as possible so the beneficiary can find another supplier.



For additional information regarding DMEPOS accreditation or the provisions associated with a surety bond, go to www.cms.hhs.gov/MedicareProviderSupEnroll. Frequently Asked Questions (FAQs) on the surety bond requirement can be found on the NSC’s FAQ page at www.palmettogba.com/nsc.

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8. Proposed DMEPOS Regulatory Updates



The Centers for Medicare & Medicaid Services (CMS) has announced limited proposed regulatory provisions for the Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) competitive bidding program. These proposals include a proposed administrative process for contract suppliers whose contracts were terminated by the Medicare Improvements for Patients and Providers Act of 2008 to submit claims for any applicable damages and proposed grandfathering provision updates. These proposed provisions are found in Section O of the Physician Fee Schedule and Other Revisions to Part B regulation (CMS-1413-P), which is now on display at the Office of the Federal Register.

Visit the CMS website at www.cms.hhs.gov/center/dme.asp to view the rule and obtain additional information.

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9. CMS Proposes Payment, Policy Changes for Physicians’ Services to Medicare Beneficiaries in 2010



The Centers for Medicare & Medicaid Services (CMS) announced yesterday proposed changes to policies and payment rates for services to be furnished during calendar year (CY 2010) by over 1 million physicians and non-physician practitioners who are paid under the Medicare Physician Fee Schedule (MPFS). The MPFS sets payment rates for more than 7,000 types of services in physician offices, hospitals, and other settings.



CMS is making several proposals to refine Medicare payments to physicians, which are expected to increase payment rates for primary care services. The proposals include an update to the practice expense component of physician fees. For 2010, CMS is proposing to include data about physicians’ practice costs from a new survey, the Physician Practice Information Survey (PPIS), designed and conducted by the American Medical Association.



CMS will accept comments on the proposed rule until August 31, and will respond to all comments in a final rule to be issued by November 1, 2009. Unless otherwise specified, the new payment rates and policies will apply to services furnished to Medicare beneficiaries on or after January 1, 2010.



To read the entire CMS Press Release issued today (6/30), please click here:

http://www.cms.hhs.gov/apps/media/press_releases.asp



To read the CMS Fact Sheet on the Physician Fee Proposed rule also issued today (6/30), click here:

http://www.cms.hhs.gov/apps/media/fact_sheets.asp



For more information on the proposed rule, which went on display at 11:15 a.m. (approx.) today (7/1) and be published on Monday, July 13. The 60-day comment period will close on Monday, August 31. Click here:

http://www.federalregister.gov/OFRUpload/OFRData/2009-15835_PI.pdf . More information will be posted shortly at: http://www.cms.hhs.gov/PhysicianFeeSched/PFSFRN/list.asp .



Other helpful CMS web pages include:

Information on the PQRI program visit: www.cms.hhs.gov/pqri.

Information on the e-prescribing incentive program, visit: www.cms.hhs.gov/erxincentive.

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10. CMS Proposes Policy, Payment Rate Changes For Services In Hospital Outpatient Departments And Ambulatory Surgical Centers In 2010





Hospitals would be able to bill Medicare for pulmonary and intensive cardiac rehabilitation services furnished in outpatient departments beginning January 1, 2010 under a proposed rule issued yesterday by the Centers for Medicare & Medicaid Services (CMS ). The proposed rule would also provide for payments to rural hospitals for kidney disease education services furnished in their outpatient departments for Medicare beneficiaries with Stage IV chronic kidney disease.



The proposals, which would implement provisions of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), were contained in a notice of proposed rulemaking (NPRM) that would revise payment policies and update the payment rates for services furnished to beneficiaries during calendar year (CY) 2010 in hospital outpatient departments under the Outpatient Prospective Payment System (OPPS). Additional proposals to incorporate an adjustment for hospital pharmacy costs that would result in OPPS payment at the Average Sale Price (ASP) plus four percent for most separately payable drugs and biologicals and to adapt current requirements for physician supervision of hospital outpatient services to the changing health care environment would help ensure beneficiary access to safe, cost-effective health care at all hospital outpatient sites.



The NPRM also includes proposals for policy changes and payment rates for services in ambulatory surgical centers (ASCs), which would continue the expansion of surgical procedures Medicare would cover when performed in ASCs. The proposed rule seeks to ensure that beneficiaries have access to outpatient services in all appropriate settings, while improving the quality and efficiency of service delivery.



“In this proposed rule, CMS is continuing to strengthen the connection between Medicare payment and efficient, high quality care,” said CMS Acting Administrator Charlene Frizzera. “The payment proposals are also designed to ensure that when services can be performed in a variety of settings, such as a physician’s office, a hospital outpatient department, or an ambulatory surgical center, the choice of setting is based on the patient’s needs, rather than payment incentives.”



Medicare currently pays more than 4,000 hospitals ‑ including general acute care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, long-term acute care hospitals, children’s hospitals, and cancer hospitals ‑ for outpatient services under the OPPS, which also sets payment policies and payment rates for partial hospitalization services furnished by community mental health centers. CMS is projecting a market basket update for CY 2010 of 2.1 percent for outpatient departments, and estimates total payments of $31.5 billion under the OPPS in CY 2010.



There are approximately 5,000 Medicare-participating ASCs. Since January 1, 2008 , ASCs have been paid under a revised payment system that not only aligns ASC payment rates with the rates paid for similar services when furnished in hospital outpatient departments, but also greatly expands the number and types of surgical services that are covered by Medicare when performed in ASCs. CY 2010 is the third year of a four-year phase-in of the ASC payment rates calculated under the standard ratesetting methodology and the first year for which CMS is authorized to apply an update to the conversion factor. CMS is projecting the percentage increase in the Consumer Price Index for All Urban Consumers that would update the ASC conversion factor to be 0.6 percent. Total CY 2010 payments to ASCs are estimated to be $3.4 billion.



The proposed rule affects Medicare payments to hospitals and ASCs for the resources ‑ such as equipment, supplies, and hospital or ASC staff ‑ they use to furnish ambulatory health care services to beneficiaries. CMS pays separately for the services of physicians and non-physician practitioners under the Medicare Physician Fee Schedule (MPFS).



Under the Hospital Outpatient Department Quality Reporting Program (HOP QDRP), hospitals that did not participate in the program or did not successfully report the quality measures will receive an update in CY 2010 equal to the annual payment update factor minus 2.0 percentage points, or 0.1 percent. Hospitals that are exempt from the Inpatient Prospective Payment System – such as long-term care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, cancer hospitals, and children’s hospitals – as well as hospitals in Puerto Rico are not subject to the HOP QDRP payment reduction.



CMS is proposing to continue to require HOP QDRP participating hospitals to report the existing seven emergency department and perioperative care measures, as well as the four existing claims-based imaging efficiency measures for the CY 2011 payment determination. Although it is not proposing to adopt any new measures for the CY 2011 update, CMS is seeking public comment on potential additional quality measures for consideration for future OPPS updates. The potential measures relate to a number of areas including cancer care, emergency department throughput, diabetes, stroke and rehabilitation, osteoporosis, medication reconciliation, respiratory, immunization, health information technology, cataract surgery, overuse/appropriate use, imaging efficiency, and surgical care.



CMS is also proposing to phase in a new HOP QDRP validation requirement to ensure that hospitals are accurately reporting measures for chart-abstracted data, but the validation results will not have any impact on outpatient department payments in CY 2011. In addition, CMS is proposing to establish procedures to make quality data collected under the HOP QDRP for quarters beginning with the third quarter of CY 2008 publicly available.



CMS will accept comments on the proposed rule until August 31, 2009, and will respond to comments in a final rule to be issued by November 1, 2009 .



The proposed rule is available at: http://www.federalregister.gov/OFRUpload/OFRData/2009-15882_PI.pdf .



The supporting information on the CY 2010 proposals for the OPPS and ASC payment system will be posted on the CMS Website at:

OPPS: http://www.cms.hhs.gov/HospitalOutpatientPPS/

ASC payment system: http://www.cms.hhs.gov/ASCPayment/

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11. HHS Rescinds Medicaid Regulations



Department of Health and Human Services (HHS) Secretary Kathleen Sebelius recently announced that the administration will rescind all or part of three Medicaid regulations that were previously issued and delay the enforcement of a fourth regulation. Each of these rules, in whole or in part, had been subject to Congressional moratoria set to expire on July 1, 2009.



“These regulations, if left in place would have potentially adverse consequences for Medicaid beneficiaries, some of our nation’s most vulnerable people,” said Secretary Sebelius. “By rescinding these rules, we can expect that children will continue receiving services through their schools, beneficiaries will be able to access all available case management resources to help them better manage their health care, and outpatient hospital and clinic services can continue to be covered in the most efficient manner.”



“The actions we are taking are necessary to ensure that the states have the flexibility they need to fully serve Medicaid-eligible individuals,” said Secretary Sebelius.



The Centers for Medicare & Medicaid Services (CMS) and HHS are:



· Rescinding a final rule, published December 28, 2007, that would have eliminated reimbursement for school-based administrative costs and costs of transportation to and from schools. The rescission reflects concern that the rule could limit the Medicaid administrative outreach activities of schools, and that the overall budgetary impact on schools could potentially impact their ability to offer Medicaid services to students.



· Rescinding a rule, published November 7, 2008, that would have limited the outpatient hospital and clinic service benefit for Medicaid beneficiaries to the scope of services recognized as an outpatient hospital service under Medicare. This rule was rescinded because CMS became aware that coverage beyond that scope could not be easily moved to other benefit categories, resulting in great impact than previously anticipated.



· Rescinding provisions of an interim final rule published December 4, 2007, which would have restricted beneficiary access to case management services. These provisions appeared to, in practice, restrict beneficiary access to needed covered case management services, and limit state flexibility in determining efficient and effective delivery systems for case management services.



Delaying until June 30, 2010, the enforcement of portions of a regulation that clarified limitations on health care related tax programs so that CMS could determine whether states need additional clarification or guidance. CMS may also further review the potential impact of the regulation, and give additional consideration to alternative approaches.

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12. 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