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. Important Notice Regarding Medicare Home Health Payments



3. Now Available ~ Report on Health Care Costing: Data, Methods, Future Directions



4. Five-Star Quality Rating System - July News



5. New Dedicated Website for 5010 Information Now Available



6. Release of the Draft Outcome and Assessment Information Set (OASIS-C) Data Specifications Version 2.00



7. Medicare Remit Easy Print (MREP) Software Codes Update – FYI



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.



# # # #

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. Important Notice Regarding Medicare Home Health Payments



Important Notice Regarding Medicare Home Health Payments



Some payments for home health providers received by the Centers for Medicare & Medicaid Services (CMS) Healthcare Integrated Ledger Accounting System (HIGLAS) for processing for cycle dates from July 7, 2009 through July 9, 2009, may have been paid incorrectly due to the installation of the July release. Home Health Request for Anticipated Payment (RAP) and Low Utilization Payment Adjustment (LUPA) claims and adjustments where the original or adjustment amount ended in zeroes were truncated, and the zeroes were dropped from the payment calculation. This has resulted in underpayments and some overpayments on claims processing for payment. The problem has been identified and was corrected on July 11, 2009 to prevent future occurrences.



Claims that were placed in the approved to pay location prior to the installation of the fix will pay at the incorrect amount. All future claims will be paid correctly. CMS is aggressively working to identify and calculate the payment differences on all impacted claims. A process to issue payments to providers is being developed by CMS with the highest priority, with an expected completion date on or about July 31, 2009. The corrected payments for the home health original claim underpayments will be issued on or about July 20, 2009, followed by corrected payments for the adjusted claim differences on or about July 31, 2009.



Impact to Providers



All amounts due will be issued as non-claim payments and appear with your normal remittance advice. Some claims on payments during the timeframe referenced above were underpaid and some adjustments were overpaid. The claim details related to these claim payments will be reported correctly within the remit, however, the payment difference will appear in the ‘Adjust to Balance’ field. There is no action required by providers regarding this issue, since CMS will be issuing corrected payments to all impacted providers.

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3. Now Available ~ 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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4. Five-Star Quality Rating System - July News



The Five-Star provider preview reports became available today, Wednesday, July 15, 2009. Providers can access the reports 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.

The Five Star helpline will be open from July 15, 2009 from 9 am to 5 pm EST through July 30, 2009

for questions and concerns about the July data. Alternatively, providers can write to

BetterCare@cms.hhs.gov.

Nursing Home Compare will update with July’s Five-Star data on Thursday, July 23, 2009.

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



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5. New Dedicated Website for 5010 Information Now Available



5010: Taking EDI to the Next Level

CMS has launched its website for agency-wide information and education on Versions 5010, D.0 and 3.0. As you may already know, Version 5010 is the new version of the X12 standards for HIPAA transactions; version D.0 is the new version of the National Council for Prescription Drug Program (NCPDP) standards for pharmacy and supplier transactions; and version 3.0 is a new NCPDP standard for Medicaid pharmacy subrogation.

On this website, you can view background information on the new standards, regulatory information, educational resources, resources specific to D.0 and 3.0, as well as implementation information for the Medicare Fee-For-Service systems. CMS plans to add additional information as it becomes available so bookmark the site today!

http://www.cms.hhs.gov/Versions5010andD0



You can also view the presentation, transcript and listen to the audio file from the June 9th national provider conference call on Versions 5010 and D.0 on the Educational Resources page or at http://www.cms.hhs.gov/Versions5010andD0/Downloads/6-9-2009_National_Provider_Call.pdf on the CMS website.

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6. Release of the Draft Outcome and Assessment Information Set (OASIS-C) Data Specifications Version 2.00



The Centers for Medicare & Medicaid Services (CMS) has requested the Office of Management and Budget’s approval to modify the Outcome and Assessment Information Set (OASIS) data set that Home Health Agencies (HHAs) are required to collect in order to participate in the Medicare program.



CMS has developed a new version of the OASIS data specifications which will be called version 2.00. These data specifications should be considered provisional or draft and are subject to change until the final data specifications are published.



A draft of the OASIS-C version 2.00 data specifications, the associated OASIS-C data set version 12.4, and an explanatory document is posted at http://www.cms.hhs.gov/OASIS/04_DataSpecifications.asp on the CMS website.



The final OASIS-C data specifications will be posted at a future date on the CMS website at http://www.cms.hhs.gov/OASIS/04_DataSpecifications.asp . The final OASIS-C instrument will be posted at a future date on the OASIS-C web page http://www.cms.hhs.gov/HomeHealthQualityInits/06_OASISC.asp on the CMS website.

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7. Medicare Remit Easy Print (MREP) Software Codes Update – FYI



The Centers for Medicare & Medicaid Services (CMS) is not providing an updated Codes.ini file with the implementation of the July 2009 release (CR6453). Due to the timing of when the Codes Committee meets, the list of updated Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs) will not be available until after the implementation of the July 2009 release. Therefore, CMS will provide an updated list of CARCs and RARCs via the Codes.ini file with the implementation of the October 2009 release.

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8. New from the Medicare Learning Network



Medicare Learning Network (MLN) Video Now Available for Download



A new video explaining the MLN and its benefits to Fee-For-Service healthcare providers, is now available for download on the CMS website. This video, approximately seven minutes in length, is suitable for self instruction or for use during provider education events. National associations and organizations may want to consider posting this video to their websites to educate their membership on the products and services of the MLN.



You can access the video here MLN Video - Quick and Basic Information about the MLN and its Benefits to Providers [ZIP, 44.1MB] , please note the large file size, download speeds will vary based on your internet connection.

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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