Frontier Focus: A Medicare Update
James, Lucretia H. (CMS/CMHPO) [Lucretia.James@cms.hhs.gov]
Sent: Monday, November 09, 2009 10:39 AM
To:
CMS Contacts [Contacts@cms.hhs.gov]
Attachments:
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. Medicare DMEPOS Rules to Take Effect in 2010
3. Medicare Policy Regarding Replacement of Oxygen Equipment Lost as a Result of Supplier Bankruptcy
4. CMS Announces Payment, Policy Changes for Physicians' Services to Medicare Beneficiaries in 2010
5. Release of the 2010 Healthcare Common Procedure Coding System (HCPCS) Annual Update
6. ICD-10-CM/PCS Medicare Severity - Diagnosis Related Group Conversion Project National Provider Call
7. REMINDER: Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) National Provider Call with Question and Answer Session
8. 2009 Physician Quality Reporting Initiative (PQRI) National Provider Call with Question & Answer Session
9. Accessing Physician Quality Reporting Initiative (PQRI) Feedback Reports
10. Changes To The Physician Quality Reporting Initiative (PQRI) And The Electronic Prescribing Incentive Program (Included In The Calendar Year 2010 Medicare Physician Fee Schedule Final Rule With Comment)
11. Publishing Update for Minimum Data Set (MDS) 3.0 Data Item Set, Data Specifications, and Resident Assessment Instrument (RAI) Manual
12. CMS Announces Policy And Payment Updates For Medicare Home Health
13. CMS Adopts Policy, Payment Rate Changes For Services In Hospital Outpatient Departments and Ambulatory Surgical Centers For 2010
14. CMS Updates Medicare Hospice Statistics
15. Skilled Nursing Facilities Prospective Payment System (SNF PPS) Personal Computer (PC) Pricer File Updated
16. H1N1 - Requesting An 1135 Waiver
17. Information Discussion from the Department of Health and Human Services on H1N1
18. Your November Flu Message
19. Extra Help for Beneficiaries Paying for Prescription Drugs
~~~~~~~~~~~~~~~~~~~~
1. New from the Medicare Learning Network®
· “The Medicare Learning Network – A Good Place to Start” DVD Now Available for Order!
This DVD contains quick and basic information about the Medicare Learning Network (MLN) and its benefits to providers. This DVD is suitable for self instruction, as well as exhibits and training events. National and local provider associations are encouraged to post this product on websites and/or distribute via electronic newsletters or mailing lists. Run time is 7 minutes, 7 seconds.
Visit the MLN Product Ordering Page and scroll down to the “Educational Tool” topic category to find the DVD and place your order.
# # # # #
· The Medicare Preventive Services Series Part 3 web-based training course (WBT) has been updated. The WBT describes coverage, coding, billing and reimbursement policies for the following Medicare-covered preventive services:
· Screening mammography,
· Screening pap test and pelvic examinations,
· Colorectal cancer screening,
· Prostate cancer screening, bone mass measurements, and
· Glaucoma screening.
The course offers continuing education credits; please see the course description page for the details. To access the course, select the “Web Based Training (WBT) Modules” link in the "Related Links Inside CMS" section on the Medicare Learning Network homepage at www.cms.hhs.gov/MLNGenInfo/01_Overview.asp. Once on the web-based training module page, select the “Medicare Preventive Services Series Part 3” WBT from the list provided.
· The Expanded Benefits brochure, which provides information about the initial preventive physical examination (IPPE), ultrasound screening for abdominal aortic aneurysms (AAA), and cardiovascular screening blood test benefits covered under Medicare, is now available in print format. To place your order for the print version, select "MLN Product Ordering Page" in the "Related Links Inside CMS" Section on the Medicare Learning Network homepage at www.cms.hhs.gov/MLNGenInfo/01_Overview.asp. You can also view the downloadable version at the following address: http://www.cms.hhs.gov/MLNProducts/downloads/expanded_benefits.pdf
· The Bone Mass Measurements brochure, which provides information about the bone mass measurement benefit covered under Medicare, is now available in print format. To place your order for the print version, select "MLN Product Ordering Page" in the "Related Links Inside CMS" Section on the Medicare Learning Network homepage at www.cms.hhs.gov/MLNGenInfo/01_Overview.asp. You can also view the downloadable version at the following address: http://www.cms.hhs.gov/MLNProducts/downloads/bone_mass.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
# # # # #
· The Skilled Nursing Facility (SNF) Consolidated Billing (CB) web-based training course (WBT) has been updated. The WBT describes SNF CB and related coverage and payment policies, explains why Congress passed SNF CB, identifies services that are included and excluded from CB, and describes “under arrangement” agreements between SNFs and other providers or suppliers. To access the course, select the “Web Based Training (WBT) Modules” link in the "Related Links Inside CMS" section on the Medicare Learning Network homepage at www.cms.hhs.gov/MLNGenInfo/01_Overview.asp. Once on the web-based training module page, select the “Skilled Nursing Facility Consolidated Billing” WBT from the list provided.
· The following revised publications are now available in print format from the Centers for Medicare & Medicaid Services Medicare Learning Network:
· The 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; and
· The 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.
To place your order for these publications, visit http://www.cms.hhs.gov/MLNGenInfo/ , scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page.”
~~~~~~~~~~~~~~~~~~~~
2. Medicare DMEPOS Rules to Take Effect in 2010
The Centers for Medicare & Medicaid Services (CMS) has announced that the following final rule is on display at the Federal Register:
Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2010
The rule can be viewed at: http://federalregister.gov/page2.aspx
This final rule includes rules regarding the following Durable Medical Equipment Prosthetics/Orthotics and Supplies (DMEPOS) subjects:
(1) maintenance and servicing of oxygen equipment;
(2) the establishment of a notification process for suppliers choosing to become grandfathered suppliers under the DMEPOS Competitive Bidding Program; and
(3) payment for damages resulting from termination of contracts awarded in 2008 under Round 1 of the DMEPOS Competitive Bidding Program
Maintenance and Servicing of Oxygen Equipment
New rules regarding payment and supplier responsibilities for maintenance and servicing of oxygen equipment have been established in accordance with Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 requirements. The new maintenance and servicing rules permit payment every 6 months, beginning 6 months after the end of the 36 month rental payment cap, for maintenance and servicing of oxygen concentrators and transfilling equipment to ensure that the equipment is kept in good working order for the safety of the beneficiary. The new rules are effective for items furnished on or after July 1, 1010. The maintenance and servicing policy established for 2009 as part of an Interim Final Rule (73 FR 69726) will continue for items furnished through June 30, 2010.
Beginning July 1, 2010, a single maintenance and servicing payment of $66 may be made once every 6 months for maintenance and servicing of an oxygen concentrator (stationary or portable) and, if applicable, oxygen transfilling equipment. Separate payment is not made for each piece of equipment serviced. The maintenance and servicing payment does not apply to liquid or gaseous oxygen equipment (stationary or portable). The maintenance and servicing fee covers all maintenance and servicing needed during the 6 month period. The supplier is responsible for performing all necessary maintenance, servicing and repair of the equipment at the time it is needed and must also visit the beneficiary’s home during the first month of each 6 month period to inspect the equipment and perform any necessary maintenance and servicing needed at the time of each visit.
CMS will issue program guidance with specific information for claims processing and beneficiary education over the next few months.
Grandfathering Notification Process
A process has been established for suppliers that are not awarded contracts under the DMEPOS Competitive Bidding Program to provide notification of their decisions regarding whether they will continue furnishing rented durable medical equipment (DME) and/or oxygen and oxygen equipment as grandfathered suppliers under the program. This process requires noncontract suppliers to provide written notification of their grandfathering decisions to CMS and all Medicare beneficiaries who reside in a competitive bidding area to whom they are furnishing these items. The process also requires beneficiaries to notify grandfathered suppliers regarding whether they wish to continue receiving their items from a grandfathered supplier.
The regulation also establishes a requirement that there be coordination between contract and noncontract suppliers regarding the removal and delivery of medically necessary items to and from a beneficiary’s home. Noncontract and contract suppliers are required to work together to ensure that DMEPOS services are uninterrupted.
A grandfathered item is defined in the regulation to encompass all oxygen and oxygen equipment or all rented DME within a product category other than oxygen and oxygen equipment. Therefore, if a supplier chooses to become a grandfathered supplier for oxygen and oxygen equipment, it must continue to furnish all items of oxygen and oxygen equipment to all beneficiaries who choose to continue receiving the items from the grandfathered supplier. Likewise, if a supplier chooses to become a grandfathered supplier for an item of rented DME in a given product category, it must continue to furnish all rented DME in the product category to all beneficiaries who choose to continue receiving the items from the grandfathered supplier.
Process for Considering Claims for DAMAGES
MIPPA terminated contracts awarded under Round 1 of the Medicare DMEPOS Competitive Bidding Program and stipulated that, to the extent that any damages may be applicable as a result of the termination of contracts, such damages shall be payable from the Federal Supplementary Medical Insurance Trust Fund.
In accordance with the final regulation, claims for damages may only be filed by suppliers that submitted a bid and were awarded a contract in 2008 during Round 1 of the program. Any damages that are claimed must be substantiated and must be the direct result of termination of a contract under Round 1 of the program. The extent of the obligation for payment of damages is limited to damages realized by the contract supplier. Therefore, entities that entered into subcontracting relationships with a contract supplier for purposes related to the furnishing items and services under the program are not eligible to submit claims for damages.
The Competitive Bidding Implementation Contractor (CBIC) will be the intake point for claims for damages, which will be reviewed by the CBIC and CMS. Claims must comply with all requirements specified in the final regulations. The CBIC will accept claims that are submitted by April 1, 2010. The date of submission is the actual date of receipt of the completed claim by the CBIC. No claims for damages will be accepted if they are received by the CBIC after April 1, 2010. If a claim for damages is not submitted by the deadline, the CBIC will recommend to CMS not to process the claim any further.
Claims for damages must be submitted in writing to the following address (electronic submissions via e-mail or facsimile will not be accepted):
Competitive Bidding Implementation Contractor
2743 Perimeter Pkwy, Ste 200-400
Augusta, Georgia 30909-6499
Every effort will be made to make a determination within 120 days of initial receipt of a claim or the receipt of additional information, whichever is later. However, in the case of more complex cases, or in the event that a large volume of claims is submitted, it may take more than 120 days to process a claim.
~~~~~~~~~~~~~~~~~~~~
3. Medicare Policy Regarding Replacement of Oxygen Equipment Lost as a Result of Supplier Bankruptcy
The Centers for Medicare & Medicaid Services (CMS) has issued instructions to contractors regarding processing of claims for replacement oxygen equipment in situations in which the equipment is considered lost because a supplier files for Chapter 7 or 11 bankruptcy and is unable to continue furnishing oxygen and oxygen equipment.
The regulation at 42 CFR §414.210(f) provides that a patient may elect to obtain a new piece of equipment if the equipment has been in continuous use by the patient for the equipment’s reasonable useful lifetime or has been lost, stolen or irreparably damaged.
Oxygen equipment is considered lost if:
1. the supplier of the equipment has declared bankruptcy by filing a petition under Chapter 7 in a United States Bankruptcy Court; or
2. the supplier of the equipment has declared bankruptcy by filing a petition for Chapter 11 bankruptcy in a United States Bankruptcy Court and the oxygen equipment was sold or scheduled to be sold.
Billing for Replacement Oxygen Equipment
Claims for replacement oxygen equipment due to Chapter 7 and 11 bankruptcy will be processed similar to other situations where oxygen equipment is deemed lost. A new 36-month rental period and new reasonable useful lifetime begins on the date that the replacement equipment is furnished by the new oxygen supplier. Similar to other situations where equipment is lost and new replacement oxygen equipment is provided, repeat blood gas testing is not required, but the new supplier must provide a new, initial Oxygen Certificate of Medical Necessity (CMN) with the first claim. The most recent qualifying value and test date should be entered on the CMN. The initial date provided on the CMN should be the date of delivery for the replacement oxygen equipment.
On the claim for the first month of use, the new oxygen supplier must include the HCPCS code for the new oxygen equipment, the RA HCPCS modifier and a narrative describing why the equipment was replaced along with the specific type of bankruptcy (i.e. Chapter 7 or 11). When submitting claims electronically, suppliers may use loop 2400 (line note), segment NTE02 (NTE01+ADD) of the ASC X12, version 4010A1 electronic claim format. Suppliers billing using the Form CMS-1500 paper claim may report the narrative information in item 19 of the claim form. In addition, contractors shall instruct home health agencies billing using the UB-04 paper claim that they may report this information in Form Locator 80 (Remarks).
To document that the equipment was lost due to supplier bankruptcy, the new oxygen supplier must submit supporting documentation to the contractor for review.
For a Chapter 7 bankruptcy, the supplier must submit:
· Court records documenting that the previous supplier filed a petition for a Chapter 7 bankruptcy in a United States Bankruptcy Court,
For a Chapter 11 bankruptcy, the supplier must submit:
· Court records documenting that the previous supplier filed a petition for a Chapter 11 bankruptcy in a United States Bankruptcy Court; and
· Documents filed in the bankruptcy case confirming that the equipment was sold or is scheduled to be sold. These documents should include:
1. The Court order authorizing and/or approving the sale; or
2. Evidence that the sale is scheduled to occur or has occurred, e.g., a bill of sale, or an asset purchase agreement signed by the seller and the buyer; or
3. A Court order authorizing abandonment of the equipment.
Upon receipt of a claim for replacement of oxygen equipment lost due to bankruptcy, the contractor will request the supporting court documents from the supplier in order to evaluate whether the equipment can be considered lost. A new 36 month rental period and a new reasonable useful lifetime will not begin unless this documentation is made available to the contractor and, in the case of a Chapter 11 bankruptcy, the contractor is able to verify that the oxygen equipment that was being furnished to the beneficiary was one of the assets that was liquidated.
A Change Request (CR) and a MLN Matters Article will be forthcoming that will incorporate the information contained in this listserv message.
~~~~~~~~~~~~~~~~~~~~
4. CMS Announces Payment, Policy Changes for Physicians' Services to Medicare Beneficiaries in 2010
The Centers for Medicare & Medicaid Services (CMS) announced on Friday final changes to policies and payment rates for services to be furnished during calendar year (CY 2010) by over 1 million physicians and nonphysician 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. Today’s action complies with federal law, which requires these policies and payment rates to be announced by Nov. 1.
Current law requires CMS to adjust the MPFS payment rates annually based on an update formula which requires application of the Sustainable Growth Rate (SGR) that was adopted in the Balanced Budget Act of 1997. This formula has yielded negative updates every year beginning in CY 2002, although CMS was able to take administrative steps to avert a reduction in CY 2003, and Congress has taken a series of legislative actions to prevent reductions in CYs 2004-2009. In the absence of Congressional action for the CY 2010 physician update, the final rule with comment period will reduce the conversion factor for services on or after Jan. 1, 2010 by 21.2 percent rather than the -21.5 percent projected in the proposed rule. The difference is due to the use of the most recently available data on CMS spending for physicians’ services.
“The Administration tried to avert the pending fee schedule cut in the FY 2010 budget proposal that it submitted to Congress, and remains committed to repealing the SGR,” said Jonathan Blum, director of the CMS Center for Medicare Management. “In the meantime, CMS is finalizing its proposal to remove physician-administered drugs from the definition of ‘physicians’ services’ for purposes of computing the physician fee schedule update. While this decision will not affect payments for services during CY 2010, CMS projects it will have a positive effect on future payment updates.”
In the final rule with comment period, CMS is also adopting several refinements to Medicare payments to physicians which will improve payment rates for primary care services relative to other services. For 2010, for purposes of establishing the practice expense (PE) relative value units (RVUs), CMS had proposed 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 is finalizing the proposal, but will phase it in over a four year period. In addition, CMS will not use the PPIS data to determine the practice expenses for medical oncology, but instead will continue to use specialty supplemental survey data , as indicated by the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA).
CMS is also finalizing its proposal to stop making payment for consultation codes other than the G codes that are used to bill for telehealth consultations, and to redistribute the resulting savings to increase payments for the existing evaluation and management (E/M) services. CMS will adjust the payment for the surgical global period to reflect the higher value of the office visits furnished during the global period.
In the final rule with comment period, CMS is adopting two significant modifications to its proposal to increase the equipment utilization percentage that is assumed for purposes of setting PE RVUs. CMS will increase the equipment utilization rate assumption used to determine the practice expense for expensive equipment priced over one million dollars from 50 to 90 percent but will phase in this change over a four year period. CMS also will not apply this change to expensive therapeutic equipment.
CMS is increasing payment for the Initial Preventive Physical Exam (IPPE), also called the “Welcome to Medicare” visit to be more in line with payment rates for higher complexity services. Originally established in the MMA, the IPPE benefit now pays for an initial assessment of key elements of a beneficiary’s health within one year of the beneficiary’s enrollment in Medicare Part B.
Taking all changes in the final rule with comment period into account, CMS projects that payments to general practitioners, family physicians, internists, and geriatric specialists will increase by between 5 and 8 percent, prior to application of the negative update required by the SGR.
The final rule with comment period also implements a number of provisions in the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) including:
· Adding new Medicare benefit categories for cardiac and pulmonary rehabilitation services and for chronic kidney disease (CKD) education beginning Jan. 1, 2010. The final rule with comment period outlines what these programs will entail, how they will be
paid under the MPFS and the criteria for covering these services.
· Increasing the Medicare share of payments for outpatient mental health services to 55 percent from 50 percent, beginning a gradual transition to bring payment parity for mental health and medical services furnished to Medicare beneficiaries.
· Implementing a requirement that suppliers of the technical component of advanced imaging services be accredited beginning Jan. 1, 2012. The accreditation requirement will apply to mobile units, physicians’ offices, and independent diagnostic testing facilities that create the images, but will not apply to the physician who interprets them. CMS will address suppliers’ accountability, business integrity, physician and technician training, service quality, and performance management through additional guidance.
The final rule with comment period contains a number of provisions to promote improvement in quality of care and patient outcomes through revisions to the Electronic Prescribing Incentive Program (e-Prescribing Program) and the Physician Quality Reporting Initiative (PQRI). Specifically, the final rule simplifies the reporting requirements for the electronic prescribing measure, provides eligible professionals with more reporting options, and establishes a new process for group practices to be considered successful electronic prescribers. Eligible professionals or group practices that meet the requirements of each program in CY 2010 will be eligible for incentive payments for each program equal to 2.0 percent of their total estimated allowed charges for the reporting periods.
In addition, CMS is adding measures for eligible professionals to report under the PQRI, providing a mechanism for participants to submit quality measure data from a qualified electronic health record and creating a process for group practices to use for reporting the quality measures.
The final rule with comment will appear in the Nov. 25, 2009 Federal Register. CMS will accept comments on designated provisions of the final rule with comment period until Dec. 29, 2009, and will respond to all comments at a later date. Unless otherwise specified, the new payment rates and policies will apply to services furnished to Medicare beneficiaries on or after Jan. 1, 2010.
To view a copy of the final rule with comment period and supporting documentation, please see:
http://www.cms.hhs.gov/PhysicianFeeSched/PFSFRN/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=4&sortOrder=descending&itemID=CMS1230135&intNumPerPage=10 .
A fact sheet providing more information about the e-Prescribing Program and PQRI provisions can be found at:
www.cms.hhs.gov/apps/media/fact_sheets.asp
~~~~~~~~~~~~~~~~~~~~
5. Release of the 2010 Healthcare Common Procedure Coding System (HCPCS) Annual Update
The Centers for Medicare & Medicaid Services (CMS) 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 web page at http://www.cms.hhs.gov/HCPCSReleaseCodeSets/ANHCPCS/list.asp. Coding changes are effective on the date indicated in the update. The content of the 2010 HCPCS Annual Update reflects CMS' final coding decision for Negative Pressure Wound Therapy (NPWT) devices. The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), section 154(c)(3) requires the Secretary to evaluate the Health Care Common Procedure Codes (HCPCS) codes for NPWT using an existing process, and to consider all relevant studies and information in making the evaluation. CMS utilized its existing public process for evaluating HCPCS coding and determined that the current HCPCS codes for NPWT are appropriate and should not be changed. For more information about CMS' evaluation refer to: http://www.cms.hhs.gov/medHCPCSgeninfo/downloads/NPWTREV_FINAL.pdf.
~~~~~~~~~~~~~~~~~~~~
6. ICD-10-CM/PCS Medicare Severity - Diagnosis Related Group Conversion Project National Provider Call
When:
Thursday, November 19, 2009
12:30 p.m. – 2:00 p.m. Eastern Standard Time (EST)
Discussion Topics and Materials:
This outreach call describes the preliminary exercise the Centers for Medicare & Medicaid Services (CMS) undertook to convert data using the General Equivalence Mappings (GEM). The GEMs are a tool that was developed to assist CMS and other data users who need to convert ICD-9-CM data or payment systems to the relevant ICD-10-CM/PCS codes and
ICD-10-CM/PCS codes back to the relevant ICD-9-CM codes. The following topics will be discussed during the conference call:
· How ICD-9-CM based Medicare Severity - Diagnosis Related Group (MS-DRG), version 26.0, were converted to ICD-10-CM and ICD-10-PCS codes; and
· The best way to use the GEMs in converting data.
To access the ICD-10-CM/PCS Medicare Severity - Diagnosis Related Group Conversion Project Presentation that will be discussed during this conference call, visit http://www.cms.hhs.gov/ICD10/06a_2009_CMS_Sponsored_Calls.asp and select the title of the presentation in the Downloads Section.
Registration:
To receive call-in information, you must register for the conference call. Please note that if you are planning to sit 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 12:30 p.m. EST on November 18, 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 conference call:
· Visit http://www.eventsvc.com/palmettogba/111909 ;
· Fill in all required data;
· Verify that your time zone is displayed correctly in the drop down box; and
· Select "Register."
You will be taken to the “Thank You for Registering” Page and an e-mail confirmation will be sent to you shortly thereafter. Note: Please print and save the registration page in the event that your server blocks confirmation e-mails. If you do not receive the confirmation e-mail, please check your spam/junk mail filter as the confirmation may have been directed there.
For those who will be unable to attend, written and audio transcripts will be posted shortly after the conference call in the Downloads Section at http://www.cms.hhs.gov/ICD10/06a_2009_CMS_Sponsored_Calls.asp .
~~~~~~~~~~~~~~~~~~~~
7. REMINDER: Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) National Provider Call with Question and Answer Session
The Centers for Medicare & Medicaid Services (CMS) Provider Communications Group will host a national provider conference call on IRF PPS coverage requirements based on the fiscal year 2010 final rule. This toll-free call will take place from 2:00 p.m. – 4:00 p.m., ET, on Thursday November 12, 2009.
Following the presentation, the lines will be opened to allow participants to ask questions of CMS IRF PPS subject matter experts.
A PowerPoint slide presentation will be posted at least one day prior to the call on the IRF PPS Coverage web page at http://www.cms.hhs.gov/InpatientRehabFacPPS/04_Coverage.asp on the CMS website for you to download prior to the call so that you can follow along with the presenter.
Conference call details:
Date: November 12, 2009
Conference Title: Inpatient Rehabilitation Facility Coverage Requirements
Time: 2:00 p.m. ET
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 November 11, 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://www.eventsvc.com/palmettogba/111209
2. Fill in all required data.
3. Please provide any questions you may have in the space provided.
4. Verify that your time zone is displayed correctly in the drop down box.
5. Click "Register".
6. You will be taken to the “Thank you for registering” page and will receive a confirmation e-mail shortly thereafter. Note: Please print and save the “Thank you for registering” page, in the event that your server blocks the confirmation e-mails. If you do not receive the confirmation e-mail, please check your spam/junk mail filter as it may have been directed there.
CMS plans to post Q&As from this call, as appropriate, to the IRF Coverage Requirements website (http://www.cms.hhs.gov/InpatientRehabFacPPS/04_Coverage.asp) after the call.
If you require services for the hearing impaired, please send an e-mail to Medicare.TTT@PalmettoGBA.com.
~~~~~~~~~~~~~~~~~~~~
8. 2009 Physician Quality Reporting Initiative (PQRI) 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 1:00 p.m. – 3:00 p.m., EST, on Tuesday, November 10, 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:
· Updates on 2008 PQRI and 2007 PQRI re-run incentive payments & feedback reports;
· Results from the 2008 PQRI and 2007 PQRI re-run;
· An update on 2010 PQRI and E-prescribing programs; and
· What to expect on your feedback report.
Following the 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, as well as educational products are available on the e-prescribing dedicated web page located at http://www.cms.hhs.gov/ERxIncentive on the CMS website. Feel free to download the resources prior to the call so that you may ask questions of the CMS presenters.
Conference call details:
Date: November 10, 2009
Conference Title: Physician Quality Reporting Initiative (PQRI) - National Provider Call
Time: 1:00 p.m. EST
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 1:00 p.m. EST on November 9, 2009, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
7. To register for the call participants need to go to:
http://www.eventsvc.com/palmettogba/111009b
8. Fill in all required data.
9. Verify your time zone is displayed correctly the drop down box.
10. Click "Register".
11. 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 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.
~~~~~~~~~~~~~~~~~~~~
9. Accessing Physician Quality Reporting Initiative (PQRI) Feedback Reports
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that PQRI feedback reports are now available for the 2007 re-run and 2008 PQRI programs. Incentive payments for 2008 PQRI were distributed in October 2009. Incentive payments for the 2007 PQRI re-run will be distributed to eligible professionals (EPs) that are newly incentive-eligible in November 2009.
CMS has posted two educational guides on understanding the PQRI incentive payments for the 2007 re-run and for 2008. To access “A Guide for Understanding the 2007 Re-Run PQRI Incentive Payment” visit http://www.cms.hhs.gov/PQRI on the CMS website and click on the 2007 PQRI Program section page at the left. To access “A Guide for Understanding the 2008 PQRI Incentive Payment” visit http://www.cms.hhs.gov/PQRI on the CMS website and click on the 2008 PQRI Program section page at the left.
How to Access Feedback Reports based on Individual National Provider Identifiers (NPIs)
CMS has created an alternative feedback report request process for EPs requesting PQRI feedback reports based on their individual NPI. It is not necessary for EPs requesting a feedback report based on their individual NPI to register in the Individuals Authorized Access to CMS Computer Services (IACS) system to use the alternative feedback report request process.
Individual eligible professionals can simply call their respective Carrier or A/B MAC Provider Contact Center to request confidential 2007 PQRI re-run and 2008 PQRI feedback reports that will contain information based on their individual NPI. To get a list of Provider Contact Centers, visit http://www.cms.hhs.gov/MLNProducts/Downloads/CallCenterTollNumDirectory.zip on the CMS website. In addition to PQRI information, these reports will provide individual EPs with information on their Medicare Part B Physician Fee Schedule allowed charges for the 2007 or 2008 PQRI reporting period, upon which an incentive payment is based.
Additional information about the alternative feedback report request process can be found by accessing special edition Medicare Learning Network (MLN) article (SE0922) “Alternative Process for Individual Eligible Professionals to Access Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing (E-Prescribing) Feedback Reports” visit http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0922.pdf on the CMS website.
How to Access Feedback Reports based on Tax Identification Numbers (TINs)
EPs requesting feedback reports based on Tax Identification Numbers (TINs) or by groups will be required to access their PQRI feedback reports through the secure PQRI Portal on QualityNet at http://www.qualitynet.org/portal/server.pt on the internet. The “Verify TIN Report Portlet” on the Home Page of the PQRI Portal can be utilized to verify if a feedback report exists for your organization's TIN or individual NPI. A user login must be established before reports can be accessed. If you do not have an IACS account, you must apply for an account to gain access to the PQRI Portal and retrieve the feedback reports. Information on establishing an IACS Account is available in Section 3 of the PQRI Portal User Guide. To access the PQRI User Guide go to http://www.qualitynet.org/portal/server.pt on the internet.
If you have established an IACS account and have received a user name and password, but have forgotten your password, you can retrieve it through the Home Page of the PQRI Portal by clicking on “Forgot Your Password?” This will route you to the CMS Account Management page at https://applications.cms.hhs.gov/category.html?name=acctmngmt on the CMS website. Please contact the EUS Help Desk at 1-866-484-8049 or TTY: 1-866-523-4759 if you are having difficulty accessing your IACS account or to obtain a new one.
Once your user login is established, click on “Sign In” on the Home Page of the PQRI Portal, which will route you to the Sign In screen. (Note that the Sign In page requires your IACS credentials, not any Quality Net credentials you may possess.) Enter your User Name and Password in the fields provided and click on “Sign In”. You will then be asked to read and accept the Terms and Conditions.
After accepting the Terms and Conditions, you will be routed to the PQRI Report Delivery System (RDS) Reports Portlet where confidential feedback reports can be retrieved. Available reports will be listed in the main body of the page. Only reports that are relevant to your TIN organization or individual practice will display.
To view a report, click on the report name. The selected report will display on the screen. To keep a copy of the report, you will need to save the report to your computer. Detailed information on available reports can be found in “User Guide: 2007 Re-Run and 2008 PQRI Feedback Reports” available at http://www.cms.hhs.gov/PQRI/Downloads/UserGuide2007Re-Runand2008PQRIFeedbackReports.pdf on the CMS website.
To log off of the PQRI Portal, click on “Log Off” in the upper left hand corner of the page.
Help Desk Resources
For more information on the 2007 re-run and 2008 PQRI feedback reports or incentive payments, see the “PQRI and eRx Quick-Reference Support Guide for Eligible Professionals” at http://www.cms.hhs.gov/PQRI/Downloads/PQRI-eRxEPQuickRefGuideDiagram_100209.pdf on the CMS website.
Additional information about PQRI can be found at http://www.cms.hhs.gov/PQRI on the CMS website.
~~~~~~~~~~~~~~~~~~~~
10. Changes To The Physician Quality Reporting Initiative (PQRI) And The Electronic Prescribing Incentive Program (Included In The Calendar Year 2010 Medicare Physician Fee Schedule Final Rule With Comment)
Physician Quality Reporting Initiative (PQRI)
PQRI is a voluntary reporting program that provides an incentive payment to identified eligible professionals (EPs) who satisfactorily report data on specific quality measures for covered professional services furnished to Medicare Part B fee-for-service beneficiaries and paid under the Medicare Physician Fee Schedule (MPFS). The program was first implemented in 2007. For calendar year (CY) 2010, participants may earn an incentive payment of 2.0 percent of the EP’s estimated total allowed charges for Medicare Part B covered professional services under Medicare Part B provided during the reporting period. For the CY 2010 PQRI, the Centers for Medicare & Medicaid Services (CMS) is offering additional reporting options and reporting periods. Some options require data on quality measures to be submitted by Dec. 31, 2010. However, EPs who submit data through registries will not be required to submit data on quality measures until 2011.
Key changes in the MPFS final rule with comment period for CY 2010 will:
· Add 30 individual PQRI measures and six measures groups on which individual eligible professionals may report.
· Implement provisions of the Medicare Improvement for Patients and Providers Act of 2008 (MIPPA) that will enable group practices to qualify for a 2010 PQRI incentive payment based on a determination at the group practice level, rather than at the individual EP level.
· Add an electronic health record (EHR)-based reporting mechanism to promote the adoption and use of EHRs and to provide both eligible professionals and CMS with experience on EHR-based quality reporting. Under the rule, CMS will begin accepting data from qualified EHR products on ten individual PQRI measures. In 2010, CMS will, for the first time, allow EPs to count their submission of EHR-based measures toward their eligibility for a PQRI incentive payment. Specifically, the final rule provides that EPs who satisfactorily report data on at least three of the ten EHR-based individual PQRI measures are eligible for an incentive payment. In previous years, EHR-based measure submission has been on a voluntary or “pilot” basis and has not counted towards an EP’s eligibility for an incentive payment.
· Add a six-month reporting period, which begins Jul. 1, 2010, for claims-based reporting of individual measures. In prior years, the six-month reporting period was available only for measures group reporting or for registry-based reporting.
Following the distribution of 2010 incentive payments, CMS will, as required by MIPPA, post on its Web site the names of EPs and group practices that satisfactorily report quality measures.
E-Prescribing Incentive Program
MIPPA established a five-year program of incentive payments to EPs who are “successful electronic prescribers” (e-prescribers), as defined by the statute. Beginning in 2012, the program will impose penalties on EPs who are not successful e-prescribers. The reporting period for the E-Prescribing Incentive Program for 2010 will be the entire calendar year, and incentives will be paid based on the covered professional services furnished by an eligible professional during the reporting year.
Key changes for CY 2010 under the final rule will:
· Simplify the reporting requirements for the electronic prescribing measure by:
o Streamlining in what manner and how often an EP must report e-prescribing information to CMS. For 2010, the rule requires EPs to report an e-prescribing code only when a patient visit results in an electronic prescription being placed. The final rule also provides that EPs will need to report this code at least 25 times during the reporting period to be considered a successful electronic prescriber. In 2009, CMS required EPs to report one of several e-prescribing codes, based on different scenarios that characterized the presence or absence of an electronic prescription during a patient visit, and to report these codes at least 50 percent of the time.
o Providing more choices for reporting electronic prescribing measures. For 2010, in addition to the current claims-based reporting mechanism, EPs will be allowed to report the e-prescribing measure through qualified registries or through a qualified EHR product. Only registries and EHR products that qualify for the 2010 PQRI and have the capability to report the e-prescribing measure will be qualified for submitting data on the e-prescribing measure for 2010.
· Broaden eligibility for the e-prescribing incentive by including professional services furnished in skilled nursing facilities, domiciliary care, or the home care setting as part of the list of services for which the electronic prescribing measure is reportable; and
· Implement a MIPPA provision that enables group practices to qualify for a 2010 e-prescribing incentive payment based on a determination at the group practice level, rather than at the individual eligible professional level, that the group practice is a successful electronic prescriber.
Following the distribution of 2010 incentive payments, CMS will, as required by MIPPA, post on its Web site the names of individual EPs and group practices that are successful e-prescribers for the 2010 E-Prescribing Incentive Program.
To view a copy of the final rule with comment period, please see:
www.federalregister.gov/inspection.aspx#special
A fact sheet providing more information about the e-Prescribing Program and PQRI provisions can be found at:
www.cms.hhs.gov/apps/media/fact_sheets.asp
~~~~~~~~~~~~~~~~~~~~
11. Publishing Update for Minimum Data Set (MDS) 3.0 Data Item Set, Data Specifications, and Resident Assessment Instrument (RAI) Manual
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the publishing the MDS 3.0 Data Item Set and Data Specifications that will be implemented October 1, 2010. Information can be viewed on the MDS 3.0 page (http://www.cms.hhs.gov/NursingHomeQualityInits/25_NHQIMDS30.asp). The publishing of the MDS 3.0 RAI manual has been delayed. It is anticipated that chapters 1, 2, 3, 5, and 6 will be published in November. Chapter 4 (Care Area Assessments (CAAs)) & Appendix C (CAA resources) will be posted in December. When published the manual will include: Description and instructions for types of assessments and tracking documents, each MDS 3.0 item, the Care Area Assessment, submission and correction of MDS 3.0 records, Skilled Nursing Facility and Swing Bed Prospective Payment System (SNF PPS) policy for the MDS 3.0, and the RUG-IV classification system. You will be notified when the materials are published. Any questions can be directed to mds30comments@cms.hhs.gov.
~~~~~~~~~~~~~~~~~~~~
12. CMS Announces Policy And Payment Updates For Medicare Home Health
The Centers for Medicare & Medicaid Services (CMS) announced on Friday (10/30/2009) a 2.0 percent market basket update to Medicare’s calendar year (CY) 2010 home health prospective payment system (HH PPS) rates and modifications to the home health outlier policy. These improvements are evidence of CMS’ continued efforts to ensure appropriate payments, to prevent fraud and abuse, and to protect beneficiaries in the Medicare home health program. Home health agencies (HHAs) receive additional payments (outlier payments) for 60-day home health episodes of care that carry unusually high costs. For CY 2010, CMS will cap home health outlier payments at 10 percent per HHA and target total aggregate outlier payments at 2.5 percent of all HH PPS payments. The current (2009) target for aggregate outlier payments is 5 percent of total HH PPS expenditures. By lowering the total outlier payment target to 2.5 percent, this final rule increases home health base rates by 2.5 percent for CY 2010.
“This final regulation builds on Medicare’s efforts to refine its payment systems while working to reduce waste, fraud and abuse,” said Jonathan Blum, director of CMS’s Center for Medicare Management. “Through the use of up-to-date home health data, it also provides a clearer focus for oversight of the program while encouraging better coordination of Medicare’s home health benefits.”
In this final rule, CMS continues its current policy of a 2.75 percent reduction to national standardized 60-day episode payment rates and non-medical supply factors in CY 2010. Retention of this policy will help offset the increase in the home health case-mix that is not associated with any underlying change in the actual clinical conditions of home health patients. This CY 2010 reduction is the third year of a four-year phase-in of HH PPS rate adjustments, which were made final in the HH PPS Refinement and Rate Update for the CY 2008 final rule.
Historically, home health payment rates have been updated annually by either the full home health market basket index or by an adjustment to the home health market basket index by Congress. CMS uses the home health market basket index – an inflation measurement of the costs of the mix of goods and services offered by home health agencies. The Deficit Reduction Act of 2005 (DRA) provided for an adjustment to the home health market basket percentage update for CY 2007 and subsequent years depending on quality data submissions by HHAs.
Through implementation of new payment and enrollment safeguards, this final rule will reduce Medicare’s vulnerability to fraud, abuse and improper payments. HHAs currently submit Outcome and Assessment Information Set (OASIS) data as a condition of participation in Medicare. Beginning Jan. 1, 2010, the final rule will require HHAs to submit OASIS data as a condition of payment under HH PPS.
CMS is implementing an improved version of OASIS, called OASIS-C, to collect data on all episodes of care beginning Jan. 1, 2010. This data will document important aspects of the patient’s health status including clinical condition, functional abilities, and service needs. As a result, a clinician will be able to capture a clear and accurate picture of the patient which will assist in development of an appropriate plan of care. Documentation provided through OASIS-C also could be used to signal concerns about patient health, encourage preventive care, identify needs for additional patient treatment, and record patient immunizations and vaccinations.
In CY 2010, CMS will publicly report 12 nationally accepted and approved quality measures plus 13 new process measures on its CMS Home Health Compare Web site (http://www.Medicare.gov/HHCompare) HHAs that submit required quality data will receive payments based on the full home health market basket update of 2.0 percent for CY 2010. The home health market basket index percentage will be reduced by 2 percentage points to 0.0 percent for CY 2010 for those HHAs that do not submit the required quality data. For CY 2012, CMS will require HHAs to report, as part of the required home health quality measures, the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Home Health Care Survey for Medicare and/or Medicaid beneficiaries.
To qualify for the Medicare home health benefit, a Medicare beneficiary must be under the care of a physician and: have an intermittent need for skilled nursing care; need physical or speech therapy; or, have a continuing need for occupational therapy. The beneficiary also must be homebound and receive home health services from a Medicare approved HHA.
This final rule went on display at 4:15 pm Friday (10/30/2009), and will be published in the Federal Register on Nov. 10, 2009. The effective date is January 1, 2010.
The rule can be located at: http://www.cms.hhs.gov/HomeHealthPPS/HHPPSRN/itemdetail.asp?filterType=none&filterByDID=0&sortByDID=3&sortOrder=ascending&itemID=CMS1230142&intNumPerPage=10
~~~~~~~~~~~~~~~~~~~~
13. CMS Adopts Policy, Payment Rate Changes For Services In Hospital Outpatient Departments and Ambulatory Surgical Centers For 2010
The Centers for Medicare & Medicaid Services (CMS) announced Friday (10/30/2009) that most hospitals will receive an inflation update of 2.1 percent in their payment rates for services furnished to Medicare beneficiaries in outpatient departments. As required by Medicare law, CMS will reduce the update by 2.0 percentage points for hospitals that did not participate in quality data reporting for outpatient services or did not report the quality data successfully, resulting in a 0.1 percent update for those hospitals.
CMS also announced that ambulatory surgical centers (ASCs) will receive a 1.2 percent inflation update beginning Jan. 1, 2010. CMS projects that the aggregate Medicare payments to more than 4,000 hospitals and community mental health centers in CY 2010 will be approximately $32.2 billion, while aggregate Medicare payments to approximately 5,000 ASCs will total $3.4 billion.
The payment updates are included in a final rule with comment period that revises payment policies and updates the payment rates for services furnished to beneficiaries during calendar year (CY) 2010 in hospital outpatient departments under the Outpatient Prospective Payment System (OPPS) and in ASCs under a revised ratesetting methodology that was implemented Jan. 1, 2008.
“The payment rates we are announcing for 2010 are intended to ensure that Medicare beneficiaries continue to receive high quality and efficient care in the most appropriate setting,” said Jonathan Blum, director of the CMS Center for Medicare Management.
The final rule with comment period implements provisions of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) that extend Medicare coverage to important rehabilitative and educational services intended to improve the health of patients diagnosed with certain respiratory, cardiac, and renal diseases. Beginning Jan. 1, 2010, hospitals will be able to bill Medicare for new pulmonary and intensive cardiac rehabilitation services furnished in hospital outpatient departments to Medicare beneficiaries. The final rule with comment period also provides payments to rural hospitals for kidney disease education services furnished in outpatient departments to Medicare beneficiaries with Stage IV chronic kidney disease.
The final rule with comment period incorporates a payment adjustment for the hospital pharmacy overhead costs of separately payable drugs and biologicals. This adjustment better recognizes the overhead costs for these drugs and biologicals relative to those for drugs and biologicals that are packaged into Medicare’s payment for the associated ambulatory payment classification (APC). As a result, CMS will pay hospitals for most separately payable drugs and biologicals administered in hospital outpatient departments at the manufacturer’s average sales price (ASP) plus four percent. In order to maintain beneficiary access to safe, cost-effective health care, the final rule with comment period also modifies CMS’s requirements for physician supervision to ensure that hospital outpatient services are appropriately supervised by physicians or other qualified practitioners.
In addition to hospital outpatient departments, the final rule with comment period includes policy changes and payment rates for services in ASCs and continues to expand the list of surgical procedures that Medicare will cover when performed in ASCs. The final rule with comment period seeks to ensure that beneficiaries have access to outpatient services in all appropriate settings, while improving the quality and efficiency of service delivery.
Under the Hospital Outpatient Department Quality Data 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 inflation update factor minus 2.0 percentage points for a net update of 0.1 percent. CMS will 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. CMS also will phase in a new HOP QDRP validation requirement to ensure that hospitals are accurately reporting measures for chart-abstracted data. In addition, CMS established procedures to make quality data collected under the HOP QDRP publicly available beginning with the third quarter of CY 2008.
The CY 2010 OPPS/ASC final rule with comment period will appear in the Nov. 20 Federal Register. Comments on designated provisions are due by 5:00 p.m. EST on Dec. 29, 2009. CMS will respond to comments in the CY 2011 OPPS/ASC final rule.
For more information on the final CY 2010 policies for the OPPS and ASC payment system, please see the CMS Web site at:
OPPS: http://www.cms.hhs.gov/HospitalOutpatientPPS/HORD/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=3&sortOrder=descending&itemID=CMS1230047&intNumPerPage=10
ASC payment system: http://www.cms.hhs.gov/ASCPayment/ASCRN/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=3&sortOrder=descending&itemID=CMS1230100&intNumPerPage=10
~~~~~~~~~~~~~~~~~~~~
14. CMS Updates Medicare Hospice Statistics
Updated hospice statistics are now available for calendar years 1998 to 2008, and include the 20 most frequent diagnoses, the number of patients, average length of stay, and trends over time in length of stay, by diagnosis. Please see the hospice center page at http://www.cms.hhs.gov/center/hospice.asp.
~~~~~~~~~~~~~~~~~~~~
15. Skilled Nursing Facilities Prospective Payment System (SNF PPS) Personal Computer (PC) Pricer File Updated
The Fiscal Year (FY) 2010 SNF PPS PC Pricer has been updated for FY 2010 claims. Go to the SNF PPS PC Pricer page, http://www.cms.hhs.gov/PCPricer/04_SNF.asp, under the Downloads section. The FY 2009 SNF PPS PC Pricer has also been updated with the most recent provider data from October 2009. If you use the FY 2010.2 SNF PPS PC Pricer, please go to the page above and download the latest version of the PC Pricer.
~~~~~~~~~~~~~~~~~~~~
16. H1N1 - Requesting An 1135 Waiver
The Secretary of Health and Human Services has invoked her waiver authority under Section 1135 of the Social Security Act. This allows for the waiver or modification of certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements to ensure that sufficient health care items and services are available to meet the needs of individuals enrolled in Social Security Act programs in the emergency area and for the time periods covered by the 1135 authority.
Requests by providers to operate under the flexibilities afforded by the waiver should be sent to the state survey agency or CMS regional office. Please visit our website for a detailed paper outlining the 1135 waiver process (http://www.cms.hhs.gov/H1N1/Downloads/RequestingAWaiver101.pdf).
Further information on the 1135 Waiver process can be found at: http://www.cms.hhs.gov/H1N1/
~~~~~~~~~~~~~~~~~~~~
17. Information Discussion from the Department of Health and Human Services on H1N1
Call: 1-800-837-1935 Conference ID: 3H1N1;
Date: Tuesday, November 10, 2009;
Time: 2pm-3pm ET.
Opening Remarks:
Co-Chairs – Dr. Sally Phillips, Office of the Assistant Secretary for Preparedness and Response and
Jean Sheil, CMS Pandemic Coordinator;
Moderator – Susie Butler, CMS Office of External Affairs.
Purpose:
The purpose of this third H1N1 call is to discuss the Secretary of Health and Human Services invoking her waiver authority under Section 1135 of the Social Security Act. This allows for the waiver or modification of certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements to ensure that sufficient health care items and services are available to meet the needs of individuals enrolled in Social Security Act programs in the emergency area and for the time periods covered by the 1135 authority.
Requests by providers to operate under the flexibilities afforded by the waiver should be sent to the CMS regional office.
We will be talking live questions during this call. However, if you would like to submit a question prior to the call, please send your question to: Pandemic@cms.hhs.gov. Put “November 10, 2009 Call” in the subject line. We will have subject matter experts on hand to answer questions, and having your questions in advance ensure that we will have the right people available to respond.
We recognize that this call is being held during normal business hours; the Encore feature will be available for audio replay beginning 2hours after this call has ended. Please dial (800) 642-1687 and enter Conference ID 3H1N1. This access will expire May 10, 2010.
Helpful websites:
• www.flu.gov;
• www.cdc.gov/H1N1flu;
• http://www.cms.hhs.gov/H1N1/Downloads/RequestingAWaiver101.pdf -- Information outlining the 1135 Waiver process;
• http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm100228.htm -- Information on antivirals;
• http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6539.pdf -- CMS billing information;
• http://www.cms.hhs.gov/Emergency/Downloads/H1N1_Fact_Sheet_Medicare_FFS_Provider_Billing.pdf
--Information for Medicare Fee-for-Service Providers.
---------------------------------
All callers please dial: 1-800-837-1935 and use Conference ID 3H1N1.
Dial in at least 20minutes prior to start of the call. Inform the operator of the conference ID number. You will be in listen-only mode during the call. To make conferencing adjustments from your phone using a touchtone telephone keypad:
Press (*) & 0 to reach the Operator;
Press (*) & 4 to equalize your volume;
You can access the first H1N1 Information Exchange call from August 20, 2009 by using the Encore feature, by dialing (800) 642-1687, and entering Conference ID H1N1. This feature is available until February 20, 2010.
You can also still access the second H1N1 Information Sharing call from September 14, 2009 by using the Encore feature as well. Dial (800) 837-1935 Conference ID 2H1N1. Access will expire March 14, 2010.
~~~~~~~~~~~~~~~~~~~~
18. Your November Flu Message
Flu season is here! Every year in the United States, on average, about 36,000 people die from influenza and its complications[1]. You can help your Medicare patients overcome these odds through patient education. Please talk with your Medicare patients about the importance of getting an annual seasonal flu shot--and don’t forget to immunize yourself and your staff. Protect yourself, your patients, and your family and friends.
Remember – Seasonal influenza vaccine and its administration are covered Part B benefits. Note that influenza vaccine is NOT a Part D covered drug.
For information about Medicare’s coverage of the seasonal influenza virus vaccine and its administration as well as related educational resources for health care professionals and their staff, please go to http://www.cms.hhs.gov/MLNProducts/Downloads/flu_products.pdf on the CMS website. You will find a variety of resources that explain Medicare coverage and claims submission policies related to the seasonal influenza vaccine.
For information on Medicare policies related to H1N1 influenza, please go to http://www.cms.hhs.gov/H1N1 on the CMS website.
[1] The American Lung Association. 2009. Understanding Influenza [online]. New York, NY: The American Lung Association, 2009 [cited 3 November 2009]. Available from the World Wide Web:
(http://www.lungusa.org/lung-disease/influenza/understanding-influenza.html)
~~~~~~~~~~~~~~~~~~~~
19. 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.
~~~~~~~~~~~~~~~~~~~~
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
[1] The American Lung Association. 2009. Understanding Influenza [online]. New York, NY: The American Lung Association, 2009 [cited 3 November 2009]. Available from the World Wide Web:
(http://www.lungusa.org/lung-disease/influenza/understanding-influenza.html)
Paging and Bottom Toolbar Previous Item Next Item
Professor Emeritus -- Dr. Tom Seymour from West Fargo, North Dakota -- Professor, Minot State University, MSU Faculty Regents Award (2015) -- PAST Peer Reviewer (Higher Learning Commission - Chicago); - Author and Presenter Board of Directors, SRT Communications, Inc and Minot City Alderman - Ward 5 (2010-June, 2016) PAST - Editor-in-Chief (North Dakota State Senator (2002-2010) 2017-Cass County Electric Cooperative- Board of Directors
No comments:
Post a Comment