A 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. DMEPOS Competitive Bidding Messages (3) With Important Information on What You Should Be Doing NOW to Get Ready



2. Healthcare Common Procedure Coding System (HCPCS) Quarterly Update



3. Revised National Correct Coding Initiative (NCCI) Edits for Physicians from July 1st



4. New Ratings for America’s Hospitals Now Available on Hospital Compare Website



5. And Now A Word About Medicare Preventive Services



6. The National Cancer Institute, the Agency for Healthcare Research and Quality (AHRQ), and the Department of Veterans Affairs (VA) Publish Report on Health Care Costing: Data, Methods, Future Directions



7. New Report By HHS' Agency for Healthcare Research and Quality on Genetic Testing Now Available



8. New from the Medicare Learning Network



9. Extra Help for Beneficiaries Paying for Prescription Drugs









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1. DMEPOS Competitive Bidding Messages (3) With Important Information on What You Should Be Doing NOW to Get Ready



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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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.



# # # #





Take Action Now to Prepare for the Medicare Durable Medical Equipment, Prosthetics, Orthotics,

and Supplies (DMEPOS) Competitive Bidding Program!



A Special Edition MLN Matters education article identifying steps suppliers should take in preparation for the DMEPOS Competitive Bidding Program to ensure successful bidder registration is available at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0915.pdf.



The article highlights specific sections of the CMS-855S, Medicare Enrollment Application, where the accuracy of the Authorized Official information and correspondence mailing address are critical for successful bidder registration. The Centers for Medicare & Medicaid Services (CMS) urges suppliers planning to bid in the 2009 bidding cycle to read this article and make sure their most recent CMS-855S submission is still current and accurate.

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2. Healthcare Common Procedure Coding System (HCPCS) Quarterly Update



The Centers for Medicare & Medicaid Services is pleased to announce the scheduled release of modifications to the Healthcare Common Procedure Coding System (HCPCS) code set. These changes have been posted to the HCPCS website at http://www.cms.hhs.gov/HCPCSReleaseCodeSets/02_HCPCS_Quarterly_Update.asp. Changes are effective on the date indicated on the update.

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3. Revised National Correct Coding Initiative (NCCI) Edits for Physicians from July 1st



IMPORTANT NOTICE: If you downloaded the National Correct Coding Initiative (NCCI) Edits for Physicians (version number 15.2, effective 7/1/09 – 9/30/09) yesterday or today, please download the files again. Incorrect files were posted for the NCCI Edits for Physicians. The files have been corrected, and can be found at http://www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/list.asp on the CMS website. Thank You.

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4. New Ratings for America’s Hospitals Now Available on Hospital Compare Website



Individual Rates Provided on More Than 4,000 Hospitals Nationwide,

New Mortality and Readmission Data Included



Important new information was recently added to the Centers for Medicare & Medicaid Services’ (CMS) Hospital Compare Website that reports how frequently patients return to a hospital after being discharged, a possible indicator of how well the facility did the first time around. The site is www.hospitalcompare.hhs.gov.



On average, 1 in 5 Medicare beneficiaries who are discharged from a hospital today will re-enter the hospital within a month. Reducing the rate of hospital readmissions to improve quality and achieve savings are key components of President Obama’s health care reform agenda.



“The President and Congress have both identified the reduction of readmissions as a target area for health reform,” said HHS Secretary Kathleen Sebelius. “When we reduce readmissions, we improve the quality of care patients receive and cut health care costs.”



For further details, the CMS Fact Sheet on this topic can be found at http://www.cms.hhs.gov/apps/media/press_releases.asp on the CMS Website.

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5. And Now A Word About Medicare Preventive Services



Help Keep Your Medicare Patients Healthy This Summer. The Centers for Medicare & Medicaid Services (CMS) is asking the provider community to keep their patients with Medicare healthy by ensuring that they take advantage of Medicare-covered preventive services. Medicare covers a wide array of preventive services for eligible beneficiaries, including cancer screenings, glaucoma screenings, an initial preventive physical examination, and certain immunizations, among others.

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 by educating them about their risk factors and reminding them of the importance of getting the preventive screenings covered by Medicare.

For More Information

CMS has developed several educational products related to Medicare-covered preventive services, including screenings for various forms of cancer:



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

o Quick Reference Information: The ABCs of Providing the Initial Preventive Physical Examination (IPPE) ~ This double-sided chart provides a checklist of services included in the IPPE, as well as additional information on the IPPE benefit.

http://www.cms.hhs.gov/MLNProducts/downloads/MPS_QRI_IPPE001a.pdf

o Quick Reference Information: Medicare Part B Immunization Billing This double-sided chart provides coverage and coding information on Medicare-covered immunizations.



Please visit the Medicare Learning Network for more information on these and other Medicare fee-for-service educational products.



Thank you for helping CMS improve the health of patients with Medicare by joining in the effort to educate beneficiaries about the importance of early detection of various diseases by taking advantage of the screenings and other preventive services covered by Medicare.

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6. The National Cancer Institute, the Agency for Healthcare Research and Quality (AHRQ), and the Department of Veterans Affairs (VA) Publish Report on Health Care Costing: Data, Methods, Future Directions



The National Cancer Institute (NCI), the Agency for Healthcare Research and Quality (AHRQ), and the Department of Veterans Affairs (VA) are pleased to announce the publication of Health Care Costing: Data, Methods, Future Directions, published July 2009, Volume 47, Issue 7, Supplement 1 in Medical Care. Accurate measurement of health care costs is critical for developing health care budgets, setting priorities for allocating funds, and making health care policy decisions. Estimates of these costs are key inputs to cost-effectiveness analyses and other economic evaluations. The supplement takes a careful look at diverse methodologic issues related to this timely and important topic.



Written by experts in health economics, epidemiology, health services research, and biostatistics, the papers discuss ways to improve and apply health care cost estimation methods and promote research in this area. The supplement was developed by scientists at the NCI, the AHRQ, the VA, and Emory University. It was based on a 2007 workshop sponsored by the NCI and the AHRQ. For more information about the supplement and the workshop, visit http://healthservices.cancer.gov/publications/costing.html.



Requests for one free copy of the supplement may be made to the AHRQ Publications Clearinghouse. Please order by specifying AHRQ publication number OM 09-0079: Medical Care supplement on health care costing. If more than one copy is needed, please describe the reason in your request.

* In the United States, call the toll-free number 800-358-9295, 24 hours a day, 7 days a week.

* Hearing impaired persons may call 888-586-6340 for the TDD service.

* Callers from outside of the United States only should use the telephone number (703) 437-2078.

* Written requests may be sent to: AHRQ Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907-8547.

Electronic requests may be made to: AHRQPubs@ahrq.hhs.gov.

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7. New Report By HHS' Agency for Healthcare Research and Quality on Genetic Testing Now Available



A new report by HHS' Agency for Healthcare Research and Quality, which found insufficient evidence to conclude that genetic testing for two gene mutations in adults with a history of deep-vein thrombosis (DVT) prevents reoccurrence or improves other outcomes, is now available. The report, a summary of which was published in the June 17, 2009 issue of JAMA, also failed to find any benefit from genetic testing of DVT patients' family members.

The report's authors, who were led by Jodi Segal, M.D., of the AHRQ-supported Johns Hopkins Evidence-based Practice Center in Baltimore, failed to find any studies that directly addressed the effect of genetic testing on patient outcomes, but they found research indicating that keeping patients who have a genetic tendency to develop blood clots on blood-thinning drugs such as warfarin reduces the chance of a future clot. This benefit appears to be similar to that seen in patients who do not have the genetic tendency to develop blood clots but who have a history of clots.

The authors also reviewed the evidence for the accuracy of the testing methods used to identify the FVL and prothrombin G20210A mutations, which can signal continued risk of blood clots. The evidence shows that tests for identifying the mutations have excellent analytic validity and that nearly all laboratories report accurate results.

AHRQ's report, Outcomes of Genetic Testing in Adults with a History of Venous Thromboembolism, is available at http://www.ahrq.gov/clinic/tp/fvltp.htm.

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8. New from the Medicare Learning Network



· The publication titled ICD-10-CM/PCS Myths & Facts (June 2009), which presents correct information in response to some myths regarding the ICD-10-Clinical Modification/Procedure Coding System, 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 .



· 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 print format from the Centers for Medicare & Medicaid Services Medicare Learning Network. To place your order, visit http://www.cms.hhs.gov/MLNGenInfo/ , scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page.”



· The revised Inpatient Psychiatric Facility Prospective Payment System Fact Sheet (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 print format from the Centers for Medicare & Medicaid Services Medicare Learning Network. To place your order, visit http://www.cms.hhs.gov/MLNGenInfo/ , scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page.”



· The revised Clinical Laboratory Improvement Amendment (CLIA) Brochure, which contains information and links to a variety of CLIA resources including: CLIA regulations, CLIA enrollment, CLIA certificates, CLIA fee schedules, CLIA-approved accrediting organizations and CLIA State and Regional offices, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at: http://www.cms.hhs.gov/MLNProducts/downloads/CLIABrochure.pdf .

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9. 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