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. Reminder: Registration System and Help Desk Closed Labor Day Weekend



2. 2009 Physician Quality Reporting Initiative (PQRI) National Provider Call with Question & Answer Session



3. Medicare Coverage and Reimbursement Rules for the H1N1 Vaccine and Seasonal Flu Coverage and Reimbursement



4. Reminder: 5010 - Taking EDI to the Next Level - Third National Medicare Fee-For-Service (FFS) Education Call on HIPAA Version 5010



5. New from the Medicare Learning Network



6. September is Prostate Cancer Awareness Month



7. Extra Help for Beneficiaries Paying for Prescription Drugs









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1. Reminder: Registration System and Help Desk Closed Labor Day Weekend



This is a reminder that the CMS registration system for the DMEPOS Competitive Bidding Program will be unavailable due to routine maintenance from Friday, September 4, at 9 p.m. Eastern Time until Tuesday, September 8, at 9 a.m. Eastern Time. The Competitive Bidding Implementation Contractor (CBIC) toll-free help desk will close for the Labor Day holiday on Friday, September 4, at 9 p.m. Eastern Time and will reopen on Tuesday, September 8, at 9 a.m. Eastern Time. The CBIC website, www.DMECompetitiveBid.com, and the Interactive Voice Response (IVR) unit will be available for registration and bidding information.

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2. 2009 Physician Quality Reporting Initiative (PQRI) National Provider Call with Question & Answer Session



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 Thursday, September 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:



· Status of the 2007 re-run and 2008 PQRI Incentive payments and feedback reports;

· How to access the 2007 re-run and 2008 PQRI feedback reports; Resources to assist eligible professionals; and

· PQRI and E-Prescribing Alternative Report Request Process

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, section, as well as educational products are available on the e-prescribing dedicated web page located at http://www.cms.hhs.gov/ERxIncentive. Feel free to download the resources prior to the call so that you may ask questions of the CMS presenters.



Conference call details:



Date: 9/17/2009

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. Registration will close at 2:30 p.m. EDT on 9/16/2009, 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/091709

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.

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3. Medicare Coverage and Reimbursement Rules for the H1N1 Vaccine and Seasonal Flu Coverage and Reimbursement



A new Special Edition MLN Matters article regarding Billing for the Administration of the Influenza A (H1N1) Vaccine is now available. This article explains Medicare coverage and reimbursement rules for the H1N1 vaccine and also addresses seasonal flu coverage and reimbursement.



Note that Medicare will pay for seasonal flu vaccinations even if the vaccinations are rendered earlier in the year than normal. We understand that such preparations are critical for the upcoming flu season, especially in planning for the influenza A (H1N1) vaccine.



Though Medicare typically pays for one vaccination per year, if more than one vaccination per year is medically necessary (i.e., the number of doses of a vaccine and/or type of influenza vaccine), then Medicare will pay for those additional vaccinations. Our Medicare claims processing contractors have been notified to expect and prepare for earlier-than-usual seasonal flu claims and there should not be a problem in getting those claims paid. Furthermore, in the event that it is necessary for Medicare beneficiaries to receive both a seasonal flu vaccination and an influenza A (H1N1) vaccination, then Medicare will pay for both.



Please be advised that if either vaccine is provided free of charge to the health care provider, then Medicare will only pay for the vaccine’s administration (not for the vaccine itself).



All providers administering flu vaccine should review this article and be sure that their billing staffs are aware of this information. For more information, please read the article located at:

http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0920.pdf

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4. Reminder: 5010 - Taking EDI to the Next Level - Third National Medicare Fee-For-Service (FFS) Education Call on HIPAA Version 5010



5010: Taking EDI to the Next Level



Third National Medicare Fee-For-Service (FFS) Education Call on HIPAA Version 5010



Conference call details:



Date: September 9, 2009

Conference Title: Third National Medicare FFS Education Call on HIPAA Version 5010

Time: 2:00 p.m. – 3:30 p.m. ET



The Centers for Medicare & Medicaid Services (CMS) will present the third in a series of National Education Conference Calls focused on Medicare’s Fee-for-Service (FFS) implementation of HIPAA Version 5010. The presentation will cover Medicare FFS error handling transactions (TA1, 999, and 277CA), planned use of each transaction and applicable rules and exceptions for the Medicare FFS program. The presentation is geared to billing software programmers or developers that reside within provider organizations. A Question & Answer (Q&A) session will follow the presentation that will give participants an opportunity to ask questions of CMS’ subject matter experts.



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.



Registration will close at 2:00 p.m. ET on September 8, 2009, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.



To register for the call participants need to go to:
http://www2.eventsvc.com/palmettogba/090909



Fill in all required data.


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


Click "Register".


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.


A few days prior to the call (not before September 6th), check the Educational Resources page on CMS’ 5010 web page at http://www.cms.hhs.gov/Versions5010andD0/40_Educational_Resources.asp to obtain a copy of the presentation that will be used during the call.


Learn more about 5010, visit CMS’ dedicated page at http://www.cms.hhs.gov/Versions5010andD0/ on the web.

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5. New from the Medicare Learning Network



Recently Released MLN Matters Articles of Particular Interest:



SE0916 – Medicare Parts A and B Coverage and Prior Authorization

http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0916.pdf



SE0920 – Billing for the Administration of the Influenza A (H1N1) Virus Vaccine

http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0920.pdf



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The Guide to Medicare Preventive Services for Physicians, Providers, Suppliers, and Other Health Care Professionals, which provides comprehensive information about the wide array of preventive benefits covered under Medicare, has been newly revised and updated! The third edition of this guide provides a variety of information on these vital benefits, including coverage, frequency, risk factors, billing, and reimbursement. It is now available on the Medicare Learning Network in a downloadable, printable format at the following address:

http://www.cms.hhs.gov/MLNProducts/downloads/mps_guide_web-061305.pdf

For more products related to Medicare-covered preventive services, please visit our preventive services educational products website at: http://www.cms.hhs.gov/MLNProducts/35_PreventiveServices.asp



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The Cancer Screenings Brochure, which provides information about the screening mammography, screening pap test, screening pelvic examination, colorectal cancer screening, and prostate cancer screening benefits covered under Medicare, has been newly revised and updated! It is now available on the Medicare Learning Network in a downloadable, printable format at the following address: http://www.cms.hhs.gov/MLNProducts/downloads/Cancer_Screening.pdf

A printed hardcopy version will be available at a later date.

For more products related to Medicare-covered preventive services, please visit our preventive services educational products website at: http://www.cms.hhs.gov/MLNProducts/35_PreventiveServices.asp

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6. September is Prostate Cancer Awareness Month



The Centers for Medicare & Medicaid Services (CMS) is asking the provider community to keep their patients with Medicare healthy by encouraging them to take advantage of Medicare-covered prostate cancer screenings.



Medicare provides annual coverage for digital rectal exams (DREs) and prostate specific antigen tests (PSAs) for qualified beneficiaries.

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 screenings that are appropriate for them.

For More Information

CMS has developed several educational products related to Medicare-covered prostate cancer screenings:



o The Guide to Medicare Preventive Services for Physicians, Providers, Suppliers, and Other Health Care Professionals ~ provides coverage and coding information on the array of preventive services and screenings that Medicare covers, including prostate cancer screening. http://www.cms.hhs.gov/MLNProducts/downloads/mps_guide_web-061305.pdf

o The MLN Preventive Services Educational Products Web Page ~ provides descriptions and ordering information for Medicare Learning Network (MLN) preventive services educational products, including Medicare-covered prostate cancer screenings, 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, including prostate cancer screenings. http://www.cms.hhs.gov/MLNProducts/downloads/MPS_QuickReferenceChart_1.pdf

o Cancer Screenings brochure~ this brochure provides information on coverage for Medicare-covered cancer screenings, including screenings for prostate cancer.

o http://www.cms.hhs.gov/MLNProducts/downloads/cancer_screening.pdf



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 taking advantage of cancer screenings and other preventive services covered by Medicare.

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7. 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 of 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 of 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