Medicare

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. Time is Running Out for Authorized Officials to Register for DMEPOS Competitive Bidding



3. DMEPOS Competitive Bidding – Deadline and Important Reminders



4. DMEPOS Special Open Door Forum



5. What’s New with 2009 Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing (E-Prescribing) Incentive Programs



6. 2009 Medicare Contractor Provider Satisfaction Survey (MCPSS) Results Available



7. Nursing Home Five-Star Quality Rating System – September News



8. Minimum Data Set (MDS) Coding for the 2009-2010 Flu Season



9. CMS Proposes New Prospective Payment System for Renal Dialysis Facilities



10. October 2009 Average Sales Price (ASP) Files Are Now Available



11. Extra Help for Beneficiaries Paying for Prescription Drugs









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1. New from the Medicare Learning Network



A 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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The revised Acute Care Hospital Inpatient Prospective Payment System Fact Sheet (September 2009), which provides general information about the Acute Care Hospital Inpatient Prospective Payment System (IPPS) including information about the basis for IPPS payment, IPPS payment rates, and how IPPS payment rates are set, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/AcutePaymtSysfctsht.pdf .



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The revised quick reference chart, Steps to Accessing CMS Enterprise Applications for Provider Organizations (August 2009), is now available for download. This chart for provider organizations outlines how to access CMS Enterprise Applications. CMS enterprise applications are those hosted and managed by CMS and do not include Fiscal Intermediary (FI)/carrier/Medicare Administrative Contractor (MAC) internet applications. You can access this product at http://www.cms.hhs.gov/MLNProducts/downloads/IACSChart.pdf on the CMS website.



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The Medicare Learning Network is pleased to announce the availability of the 2009 PQRI and E-Prescribing Program Web-based Training Course! Please see the announcement under “What’s New with 2009 Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing (E-Prescribing) Incentive Programs” for additional details.



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The revised Skilled Nursing Facility Prospective Payment System Fact Sheet (August 2009), which provides the elements of the Skilled Nursing Facility Prospective Payment System, 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 Rehabilitation Facility Prospective Payment System Fact Sheet (August 2009), which provides information about Inpatient Rehabilitation Facility Prospective Payment System rates, classification criterion, and reasonable and necessary criteria, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/InpatRehabPaymtfctsht09-508.pdf . If you are unable to access the hyperlink in this message, please copy and paste the URL into your Internet browser.

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2. Time is Running Out for Authorized Officials to Register for DMEPOS Competitive Bidding



The target deadline for Authorized Officials (AOs) to register for the Round 1 Rebid of the Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) competitive bidding program was September 14, 2009. All suppliers interested in bidding must designate one AO from those listed on the CMS-855S enrollment form to act as their AO for registration purposes. If you are a supplier interested in bidding and your designated AO has not yet registered, he or she should register now. Suppliers whose AOs do not register will not be able to bid when bidding opens. AOs who do not register now may not have time to designate other employees to assist with bidding.



Remember, the AO must be listed on the CMS-855S enrollment form. Once the AO registers, then the AO’s user ID and password will be sent by mail and should be delivered within 10 days after successful registration. After an AO successfully registers, the AO may designate other employees to serve as Backup Authorized Officials (BAOs) and/or End Users (EUs). BAOs and EUs must also register in order to be able to use the on-line bidding system. The legal name, date of birth, and Social Security number (SSN) of the AO and BAOs must match exactly with what is on file with the National Supplier Clearinghouse in order to register successfully. Legal names, dates of birth, and SSNs of all users must match what is on file with the Social Security Administration.



We recommend that BAOs register no later than October 9, 2009 so that they will be able to assist AOs with approving EU registration. Registration will close on November 4, 2009 at 9:00 p.m. EST – no AOs, BAOs, or EUs can register after registration closes.



To register, go to the Competitive Bidding Implementation Contractor (CBIC) website at www.dmecompetitivebid.com. Please review the IACS Reference Guide for step-by-step instructions on registration. The CBIC web site also has the following useful tools: a registration checklist; Quick Step guides; and frequently asked questions. All suppliers interested in bidding are urged to sign up for E-mail Updates on the home page of the CBIC website. If you have any questions about the registration process, please contact the CBIC Customer Service Center at 1-877-577-5331.

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3. DMEPOS Competitive Bidding – Deadline and Important Reminders



We would like to remind all suppliers interested in participating in the Round 1 Rebid of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) competitive bidding program that registration for user IDs and passwords is open. If you are interested in bidding you must designate one Authorized Official (AO) from those listed on the CMS-855S enrollment form to act as your AO for registration purposes, and that AO must register. We strongly urge all AOs to register no later than September 14, 2009 to ensure that AOs have time to designate other supplier employees to use the on-line bidding system. Suppliers that do not register will not be able to bid when bidding opens.



AOs who successfully register should receive their user IDs and passwords in the mail within 10 days after successful registration. After an AO successfully registers and receives his or her user ID and password, the AO may designate other supplier employees to serve as Backup Authorized Officials (BAO) and/or End Users (EU). BAOs and EUs must also register in order to be able to use the on-line bidding system. The legal name, date of birth, and Social Security number (SSN) of the AO and BAOs must match what is on file with the National Supplier Clearinghouse (NSC) in order to register successfully.



Registering now allows the AO and/or BAO time to correct the supplier’s NSC records if their name, date of birth, and SSN does not match what is on file with NSC. We recommend that BAOs register no later than October 9, 2009, so that they will be able to assist AOs with approving EU registration. Registration will close on November 4, 2009, at 9:00 p.m. EST – no AOs, BAOs, or EUs can register after registration closes. To register, go to the Competitive Bidding Implementation Contractor (CBIC) web site: www.dmecompetitivebid.com.



We have three additional competitive bidding reminders for suppliers interested in participating in the Round 1 Rebid:



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: Medicare DMEPOS suppliers, unless exempt, must be accredited by October 1, 2009. Suppliers must be accredited for a product category in order to submit a bid for that product category. CMS will not accept bids from and will not contract with suppliers that are not accredited by a CMS-approved accreditation organization for the applicable product categories.



If you have already been notified by an approved accrediting organization that each of your practice locations has been accredited, the accreditation organization will notify the NSC that your DMEPOS supplier practice locations have been accredited. However, DMEPOS suppliers that obtain accreditation after September 1, 2009 but before October 1, 2009, should submit proof of accreditation to the NSC via submission of an amendment to their CMS-855S.



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 web site: http://www.cms.hhs.gov/MedicareProviderSupEnroll/01_Overview.asp .



GET BONDED: Medicare DMEPOS suppliers, unless exempt, must obtain and submit a surety bond by October 2, 2009. Suppliers subject to the bonding requirement must be bonded in order to bid in the DMEPOS competitive bidding program. A list of surety companies 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. When submitting your DMEPOS surety bond to the NSC, you are required to submit sections 1, 2A1, 12, and either 15 (if you are the AO) or 16 (if you are the delegated official) of the CMS-855S. By submitting the required sections of the CMS-855S, you will help to ensure that NSC is able to correctly associate your DMEPOS surety bond to your enrollment record.

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4. DMEPOS Special Open Door Forum



Centers for Medicare & Medicaid Services

Special Open Door Forum:

Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program Bidders’ Conference:

Financial Documentation Plus Small Supplier Considerations



Tuesday, September 22, 2009

2:00 pm – 3:00 pm Eastern Time

Conference Call Only



Please join us for the fourth in a series of eight Special Open Door Forum (ODF) bidders’ conferences for the Round 1 Rebid of the Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) competitive bidding program. At this Special ODF, we will provide an overview of the required financial documentation that must be submitted for each type of business structure and how bidders should report their capacity to serve beneficiaries. In addition, we will discuss special provisions for small suppliers and networks.



Reminder: Registration for user IDs and passwords is open. The target deadline for Authorized Officials interested in participating in the Round 1 Rebid to register was September 14, 2009. If you are an Authorized Official who has not yet registered – do it TODAY! Visit www.dmecompetitivebid.com to register.



Background:



On August 3, 2009, the Centers for Medicare & Medicaid Service (CMS) issued the bidding timeline for the Round 1 Rebid of the DMEPOS competitive bidding program and initiated a comprehensive bidder education campaign. CMS’ Competitive Bidding Implementation Contractor (CBIC) is the focal point for bidder education. Please visit the CBIC's dedicated website, www.dmecompetitivebid.com, for important information, including bidding rules, user guides, frequently asked questions, policy fact sheets, checklists, and bidding information charts. The CBIC toll-free help desk, 1‑877‑577‑5331, is open to help bidders with all of their questions and concerns. All suppliers interested in bidding are urged to sign up for e-mail updates on the home page of the CBIC website.



We look forward to your participation.

Special Open Door Participation Instructions:

Dial: 1-800-837-1935 & Reference Conference ID: 23045166

Note: TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.



An audio recording of this Special Forum will be posted to the Special Open Door Forum website at http://www.cms.hhs.gov/OpenDoorForums/05_ODF_SpecialODF.asp and will be accessible for downloading beginning Thursday, October 1, 2009.



For Open Door Forum schedule updates, E-Mailing list subscriptions, and to view Frequently Asked Questions please visit our website at http://www.cms.hhs.gov/opendoorforums/ .



Thank you for your interest in CMS Open Door Forums.

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5. What’s New with 2009 Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing (E-Prescribing) Incentive Programs



New Medicare Learning Network Education Product



The Centers for Medicare & Medicaid Services (CMS) Medicare Learning Network (MLN) is pleased to announce that the Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (E-Prescribing) Web-based Training Course is now available.



The course provides information to physicians, health care professionals, and medical administrative staff on the completion, submission and maintenance of the documentation required to successfully participate in Physician Quality Reporting Initiative (PQRI) and Electronic Prescription Incentive (E-Prescribing) programs. The course offers continuing education credits; please see the course description page for the details.



The course can be accessed by going to http://www.cms.hhs.gov/MLNGenInfo on the CMS website and scrolling down to the “Related Links Inside CMS” section and selecting Web Based Training (WBT) Modules. Once on the web-based training module page, select the Physician Quality Reporting Initiative and Electronic Prescribing Incentive Program WBT from the list provided.



New and Revised MLN Articles on the Physician Quality Reporting Initiative



~New-MM6514- Coding and Reporting Principles for the Physician Quality Reporting Initiative (PQRI) and the Electronic Prescribing (E-Prescribing) Incentive Programs

http://www.cms.hhs.gov/mlnmattersarticles/downloads/MM6514.pdf



~Revised-SE0830- Steps for Individual Eligible Professionals to Access Their 2007 Physician Quality Reporting Initiative (PQRI) Feedback Reports Personally

http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0830.pdf



~Revised-SE0831- Steps for Organizations to Access Their 2007 Physician Quality Reporting Initiative (PQRI) Feedback Reports

http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0831.pdf



These new and revised articles are intended to assist eligible professionals and group practices who report PQRI quality measures data to Medicare.



Three Physician Quality Reporting Initiative Help Desk Resources Now Available for Eligible Professionals



The Centers for Medicare & Medicaid Services (CMS) is pleased to announce three PQRI Help Desk Resources to assist eligible professionals with their questions on the Physician Quality Reporting Initiative.

Provider Call Center Directory

Remittance Advice Notices

Incentive payment distribution status

Adjustments made to incentive payment due to sanctions/overpayments

For contact information, see the “Provider Center Toll-free Numbers Directory” by clicking the link under the “Related Links Inside CMS” section below and scrolling down to the “Downloads” section.

External User Services (EUS) – 7:00 AM – 7:00 PM EST

Registering/creating an IACS account

Accessing an IACS account

Changing an IACS account

Approving users into an organization

Phone: 1-866-484-8049

TTY: 1-866-523-4759

QualityNet Help Desk – 7:00 AM – 7:00 PM CST

General CMS PQRI & ERX Information

PQRI Portal Password Issues

PQRI feedback report availability and access

Phone: 1-866-288-8912

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



All publicly available information on the CMS Electronic Prescribing Incentive Program can be found at http://www.cms.hhs.gov/ERxIncentive on the CMS website.

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6. 2009 Medicare Contractor Provider Satisfaction Survey (MCPSS) Results Available



The results of the 2009 Medicare Contractor Provider Satisfaction Survey (MCPSS) are now available.



The MCPSS enables CMS to gauge provider satisfaction with key services performed by the Medicare Fee-for-Service (FFS) contractors that process and pay the more than $300 billion in Medicare claims each year. Respondents rated their FFS contractors between 4 and 6 on a 6-point scale, with “1” representing “not at all satisfied” and “6” representing “completely satisfied.” The 2009 MCPSS marked the fourth annual administration of the survey.



The national average has remained relatively stable through each MCPSS administration. The 2009 national average was 4.54, compared to last year’s national average of 4.51. The MCPSS was sent early this year to more than 32,000 randomly selected providers, including physicians, suppliers, health care practitioners and institutional facilities that serve Medicare beneficiaries across the country.



As in 2008, Provider Inquiries was cited as the top indicator of satisfaction. For the fourth consecutive year this business function was cited as one of the key predictors of provider satisfaction. Claims Processing remained a strong predictor of provider satisfaction as in the past three years.



The public reporting of the results over the last four years has increased awareness about the MCPSS. CMS has used the MCPSS to establish a uniform measure of provider satisfaction with FFS contractor performance. Each FFS contractor receives an individual report of findings specific to their organization, which can be used to implement process improvement initiatives.



The results of the 2009 survey are available through the CMS and MCPSS web pages at:

http://www.cms.hhs.gov/MCPSS/ and https://www.mcpsstudy.org/ .

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7. Nursing Home Five-Star Quality Rating System – September News



1. The Five-Star provider preview reports are available beginning today, Friday September 11, 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. For questions and concerns about the September data, providers can write to BetterCare@cms.hhs.gov. The helpline will reopen in October.

3. Nursing Home Compare will update with September’s Five-Star data on Thursday, September 24, 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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8. Minimum Data Set (MDS) Coding for the 2009-2010 Flu Season



For the purposes of coding the MDS during the upcoming flu season, Nursing Facilities should only code for the "Seasonal Influenza Vaccine." You should not code the MDS for the "H1N1 Influenza Vaccine." Nursing Facilities should follow guidance from the Centers for Disease Control and Prevention (CDC) for specific guidance for H1N1 Influenza. For the most up to date and accurate information it is recommended that you frequently check the CDC Influenza Website (http://www.cdc.gov/flu/). Any additional questions can be directed to mds30comments@cms.hhs.gov.

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9. CMS Proposes New Prospective Payment System for Renal Dialysis Facilities



PROGRAM WOULD REWARD EFFICIENT, HIGH QUALITY CARE

FOR PEOPLE WITH END-STAGE RENAL DISEASE



The Centers for Medicare & Medicaid Services (CMS) proposed a new prospective payment system (PPS) for facilities that provide dialysis services to Medicare beneficiaries who have end-stage renal disease (ESRD).



The proposed PPS would provide a single bundled payment to dialysis facilities that would cover the items and services used in providing outpatient such services, including the dialysis treatment, prescription drugs, and clinical laboratory tests.



The new payment system, which was required by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), is designed to improve the efficiency of care, while promoting high quality services. Today’s notice proposes three quality measures that CMS plans to use for its quality incentive program (QIP) and lays out a conceptual model for public comment.



“Combining a fully bundled prospective payment system with required performance standards would encourage facilities to operate more efficiently and ensure that beneficiaries receive high quality care, while saving dollars for both beneficiaries and the Medicare program,” said Jonathan Blum, director of the CMS Center for Medicare Management.



ESRD is the only category for Medicare eligibility that is based on a specific diagnosis, without regard to the age of the patient. Patients diagnosed with ESRD must rely on dialysis or receive a kidney transplant for survival. In 2007, there were about 591 hospital-based and 4,330 freestanding ESRD facilities furnishing outpatient dialysis services to nearly 330,000 Medicare patients. This total cost of this service was $9.2 billion including the dialysis service and other ESRD-related items such as drugs.



ESRD services are furnished on an outpatient basis in independent or hospital-based dialysis facilities. Currently, Medicare pays for certain dialysis services under a partial bundled rate, referred to as the composite rate. Payments for these composite rate services represent about 60 percent of total Medicare payments to ESRD facilities. The remainder of Medicare spending for dialysis services is for separately billed items such as drugs, but may also include laboratory services, supplies and blood products.



Under the proposed rule, CMS would establish a base bundled payment rate of $198.64 for all of the services related to a dialysis session, including the services in the current composite rate as well as items, including oral drugs that are billed separately. The proposed base rate was derived from 2007 claims data for both composite rate and separately billable services and updated to reflect projected 2011 prices. It would also be adjusted for case mix factors such as the patient’s age, gender, body size, and time on dialysis. A special case-mix adjustment would apply to pediatric patients. Additional adjustments to the payment rate would be made for specific conditions, or co-morbidities that have a significant impact on a course of treatment. By accounting for more characteristics of patients, the new PPS would target payments more appropriately, paying higher rates to those facilities with the most costly patients.



The base rate would also be adjusted to reflect geographic differences in labor costs. In addition, CMS is proposing to provide an adjustment for low-volume facilities, as well as an outlier policy that would make an adjustment for particularly expensive cases.



CMS will accept comments on the proposed rule through November 16, 2009, and will respond to them in a final rule to be issued in 2010. The new payment system would apply to dialysis services furnished to Medicare beneficiaries on or after January 1, 2011.



For more information, please see: http://www.cms.hhs.gov/ESRDPayment/ .

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10. October 2009 Average Sales Price (ASP) Files Are Now Available



The Centers for Medicare & Medicaid Services (CMS) has posted the October 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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11. 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