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. Covered Document Review Date for the Round 1 Rebid of the DMEPOS Competitive Bidding Program is Coming Soon!
3. Medicare Paid Over $92 Million in Incentives for 2008 Under the Physician Quality Reporting Initiative
4. A Message from Dr. David Blumenthal, National Coordinator for Health Information Technology
5. Notice Regarding Proposed Rule for New Prospective Payment System for Renal Dialysis Facilities
6. Message Regarding Medicare Home Health Prospective Payment System (HH PPS) Rate Update for CY 2010 Final Rule (CMS-1560-F)
7. November 19th is the Great American Smokeout!
8. Your November Flu Message
9. Extra Help for Medicare Beneficiaries Paying for Prescription Drugs
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1. New from the Medicare Learning Network®
Recently Released MLN Matters articles of particular interest:
Ø MM6677 – Round One Rebid of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program - Phase 8A: Hospital Exception
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6677.pdf
Ø MM6678 – Round One Rebid of the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program—Phase 8C of Implementation: Repairs and Replacements
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6678.pdf
Ø MM6692 – Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program Round One Rebid Implementation--Phase 8B: Oxygen Modality
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6692.pdf
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2. Covered Document Review Date for the Round 1 Rebid of the DMEPOS Competitive Bidding Program is Coming Soon!
Reminder: If you are a supplier bidding in the Round 1 Rebid of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program, you must submit your hardcopy financial documentation by November 21, 2009 in order to be eligible to be notified if you have any missing documents.
The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) established the covered document review process to give suppliers the opportunity to be notified of missing required financial documents. The Centers for Medicare & Medicaid Services (CMS) urges all bidders to take advantage of this new process. Under the covered document review process, we will notify suppliers that submit their hardcopy financial documents by the Covered Document Review Date (CDRD) of any missing financial documents. The CDRD for the Round 1 Rebid is November 21, 2009 - financial documents must be postmarked by 11:59 p.m. on November 21, 2009 to qualify for the covered document review process.
The new covered document review process only determines if there are any missing financial documents. It does not indicate if the documents are acceptable, accurate or meet applicable requirements. Suppliers that submit financial documents by the CDRD will be notified of any missing financial documents within 45 days of the CDRD. Suppliers will be required to submit only the indicated missing financial document(s) within 10 business days of the notification. Only those suppliers that submit financial documents by the CDRD will receive notice from CMS of any missing documents. Bidders that submit their hardcopy financial documents after the CDRD will not be notified of any missing documents. Bidders may not change bid amounts or submit revised versions of previously submitted documents after the bid window closes. We encourage bidders to review the CDRD fact sheet available on the Competitive Bidding Implementation Contractor (CBIC) website.
Here are some important things to remember when submitting your hardcopy documents:
· Review the RFB instructions carefully to be sure that your documents comply with all requirements. The RFB instructions contain complete instructions for compiling and submitting your documents.
· Put your bidder number on every page of every document. We need your bidder number to match your hardcopy documents with your electronic bid. You will get your bidder number when you complete Form A in DBidS, the on-line bidding system.
· Submit all required hardcopy documents in one package.
· Submit financial documents for the most recent year end prior to the date on which the bid is submitted. The financial statements must be for the same accounting period as the tax returns. For example, if your tax return extract is for a fiscal year, then your financial statements must be for the same fiscal year. Please note that CMS is in the process of updating its instructional materials to emphasize that all financial documents must be for the same accounting period (calendar or fiscal).
The Round 1 Rebid competitive bidding areas (CBAs), product categories, DBidS information, bidder charts, educational materials, and complete RFB instructions can be found on the CBIC web site, www.dmecompetitivebid.com. Suppliers should review this information prior to submitting their bid(s). CMS will send important bidding updates via e-mail, so 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 bidding process, please contact the CBIC Customer Service Center at 1-877-577-5331.
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3. Medicare Paid Over $92 Million in Incentives for 2008 Under the Physician Quality Reporting Initiative
MEDICARE NEWS - FOR IMMEDIATE RELEASE
Friday, November 13, 2009
Medicare Paid Over $92 Million in Incentives for 2008
Under the Physician Quality Reporting Initiative
More than 85,000 physicians and other eligible professionals who successfully reported quality-related data to Medicare under the 2008 Physician Quality Reporting Initiative (PQRI) received incentive payments totaling more than $92 million, the Centers for Medicare & Medicaid Services (CMS) announced today, well above the $36 million paid in 2007.
The number of eligible professionals who earned an incentive payment increased by one-third from 2007, when 56,700 eligible professionals earned an incentive payment. In 2007, eligible professionals could only participate in the program during a 6-month reporting period. In 2008, the program expanded to allow reporting for either a 6-month or a 12-month period.
“We are very pleased with the results for 2008,” said Charlene Frizerra, Acting CMS Administrator. “More health professionals have successfully reported data, and the substantial growth in the national total for PQRI incentive payments demonstrates that Medicare can align payment with quality incentives.
To read the entire CMS Press release issued today (11/13) click here: http://www.cms.hhs.gov/apps/media/press_releases.asp
To read the entire CMS Fact Sheet issued today (11/13) click here: http://www.cms.hhs.gov/apps/media/fact_sheets.asp
CMS recently announced its plan for the 2010 PQRI Program as part of the Medicare Physician Fee Schedule final rule. A fact sheet on the 2010 PQRI Program is available online at http://www.cms.hhs.gov/apps/media/press/factsheet.asp?Counter=3541&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date.
More information about the PQRI program, including participation guidance and the criteria to qualify for an incentive payment is available at www.cms.hhs.gov/PQRI.
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4. A Message from Dr. David Blumenthal, National Coordinator for Health Information Technology
The HITECH Foundation for Information Exchange
November 12, 2009
A Message from Dr. David Blumenthal, National Coordinator for Health Information Technology
As the many activities mandated by the HITECH Act move forward, I want to take a moment to share my vision of the overarching goal and some of its implications. Our goal, above all else, is to make care better for patients, and to make it patient-centered. Information policy and health IT policy should serve that goal.
A key premise: information should follow the patient, and artificial obstacles – technical, business related, bureaucratic – should not get in the way. As a doctor, I have many times wanted access to data that I knew were buried in the computers or paper records of another health system across town. Neither my care nor my patients were well served in those instances. That is what we must get beyond. That is the goal we will pursue, and it will inform all our policy choices now and going forward. This means that information exchange must cross institutional and business boundaries. Because that is what patients need. Exchange within business groups will not be sufficient – the goal is to have information flow seamlessly and effortlessly to every nook and cranny of our health system, when and where it is needed, just like the blood within our arteries and veins meets our bodies’ vital needs.
If we are to reap the benefit of information exchange, Americans must also be assured that the most advanced technology and proven business practices will be employed to secure the privacy and security of their personal health information, both within and across electronic systems, and that persons and organizations who hold personal health data are trustworthy custodians of the information. We must have comprehensive, clear, and sustainable policies that strengthen existing protections, fill gaps as they emerge, fortify new opportunities for patients’ access to and control of their information, and align with evolving technologies. I will devote a separate letter to this critical issue and the many activities mandated by the HITECH Act that we are developing.
On the question of exchange, however, the HITECH Act is pretty specific about eliminating inappropriate barriers.
It squarely tackles the commercial barriers. The HITECH Act calls for the “development of a nationwide health information technology infrastructure that allows for the electronic use and exchange of information and that…promotes a more effective marketplace, greater competition...[and] increased consumer choice” among other goals. (Section 3001(b)) This means we cannot support arrangements that restrict the secure, private exchange of information required for patient care across provider or network boundaries. Some of these arrangements may improve care for those inside their walls. But ultimately, they have the potential to carve the nation up into disconnected silos of information, and thus, to undermine the vision of a secure, interoperable, nationwide health information infrastructure, which the law requires us to establish. Consumers, patients and their caretakers should never feel locked into a single health system or exchange arrangement because it does not permit or encourage the sharing of information.
It tackles the economic barriers. The HITECH Act incentives for providers and hospitals are powerful tools. While the official definition of “Meaningful Use” won’t be finalized until next year, the HITECH Act specifically highlights “information exchange” as one requirement for the incentives.
It tackles the technical barriers. The HITECH Act focuses on “interoperability” or “interoperable products.” In plain English, this means that our policies, programs, and incentives must aim for electronic health record (EHR) software and systems that can share information with different EHRs and networks so that information can follow patients wherever they go. And to build the pipelines to carry this information, HHS is directed to invest in the infrastructure to “support the nationwide electronic exchange and use of health information …including connecting health information exchanges…” (Section 3011) This means we will work with all our partners in the health and IT industries and with organizations that are committed to information sharing to develop the technologies and policies that can help us deliver information securely, privately, and accurately to whomever needs to see it on behalf of the patient’s health. We must ensure interoperability for the future.
It provides building blocks for information exchange across jurisdictions. The grants for states and state-designated entities in Section 3013 – which will total $564 million – target information exchange across boundaries, not only within each state but explicitly as part of a nationwide framework. We will start announcing the awards this winter. These grantees’ activities must support interoperability that lets patient data follow the patient across political and geographic boundaries. The grantees will be our partners in building the nationwide infrastructure mentioned previously.
In short, the HITECH Act not only authorizes but requires us to mobilize all our policies, programs, and incentives to give the American people the patient-centric care they deserve and expect.
I look forward to engaging all our partners in this unique opportunity.
Regards,
David Blumenthal, M.D., M.P.P.
National Coordinator for Health Information Technology
U.S. Department of Health & Human Services
This letter is part of a series of ongoing updates from the National Coordinator for Health Information Technology. The Office of the National Coordinator for Health Information Technology (ONC) encourages you to share this information as we work together to enhance the quality, safety and value of care and the health of all Americans through the use of electronic health records and health information technology.
For more information and to receive regular updates from the Office of the National Coordinator for Health Information Technology, please subscribe to our Health IT News list.
If you have difficulty viewing this message, please view it online.
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5. Notice Regarding Proposed Rule for New Prospective Payment System for Renal Dialysis Facilities
The Centers for Medicare & Medicaid Services (CMS) has published a Notice in the Federal Register (CMS-1418-N) extending the comment period for a proposed rule published in the Federal Register on September 29, 2009 (74 FR 49922). The proposed rule would implement a case-mix adjusted bundled prospective payment system (PPS) for Medicare outpatient end-stage renal disease (ESRD) dialysis facilities. The proposed ESRD PPS would also replace the current basic case-mix adjusted composite payment system and the methodologies for the reimbursement of separately billable outpatient ESRD services. The comment period for the proposed rule, which would have ended on November 16, 2009, is extended to 5 p.m. on December 16, 2009.
CMS is also extending the availability of the audio recording of the October 23, 2009 ESRD PPS Town Hall Meeting. The audio recording will be available through December 16, 2009. To access the recording, dial 1-800-642-1687 and, when prompted, enter conference ID: 33239635.
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6. Message Regarding Medicare Home Health Prospective Payment System (HH PPS) Rate Update for CY 2010 Final Rule (CMS-1560-F)
The Medicare Home Health Prospective Payment System (HH PPS) Rate Update for CY 2010 Final Rule (CMS-1560-F) contained some important revisions to the level of outlier payments available 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. Final instructions (Change Request/Transmittal) describing the changes that will be made by Medicare contractors to implement this new outlier policy are currently being developed and are expected to be released sometime in early December. HHAs should note that HH PPS billing instructions are not changing as a result of this policy. CMS will provide an update as to the status of those instructions at our next Open Door Forum (ODF) on Wednesday, December 2nd.
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7. November 19th is the Great American Smokeout!
The Centers for Medicare & Medicaid Services (CMS) is asking the provider community to keep their patients with Medicare healthy by encouraging them to take advantage of Medicare-covered smoking and tobacco-use cessation counseling benefits.
Tobacco use contributed to more than 438,000 premature deaths in the United States annually between 1997 and 2001[1]. Additionally, tobacco continues to be the leading cause of preventable disease and death in the United States. Smoking can attribute to and exacerbate heart disease, stroke, lung disease, cancer, diabetes, hypertension, osteoporosis, macular degeneration, abdominal aortic aneurysm, and cataracts.
Medicare provides coverage of smoking and tobacco-use cessation counseling for beneficiaries who use tobacco and have a disease or adverse health effect linked to tobacco use, or who take certain therapeutic agents whose metabolism or dosage is affected by tobacco use.
What Can You Do?
As a health care professional who provides care to patients with Medicare, you can help protect the health of your patients by educating them about their risk factors and encourage them to take advantage of Medicare-covered smoking and tobacco-use cessation counseling benefits.
For More Information
CMS has developed several educational products related to Medicare-covered smoking and tobacco-use cessation counseling:
o The Guide to Medicare Preventive Services for Physicians, Providers, Suppliers, and Other Health Care Professionals ~ provides coverage and coding information on the array of preventive services and screenings that Medicare covers, including smoking and tobacco-use cessation counseling. http://www.cms.hhs.gov/MLNProducts/downloads/mps_guide_web-061305.pdf
o The MLN Preventive Services Educational Products Web Page ~ provides descriptions and ordering information for Medicare Learning Network (MLN) preventive services educational products, including products related to Medicare-covered smoking and tobacco-use cessation counseling. http://www.cms.hhs.gov/MLNProducts/35_PreventiveServices.asp
o Quick Reference Information: Medicare Preventive Services ~ this double-sided chart provides coverage and coding information on Medicare-covered preventive services, including smoking and tobacco-use cessation counseling. http://www.cms.hhs.gov/MLNProducts/downloads/MPS_QuickReferenceChart_1.pdf
o Smoking and Tobacco-Use Cessation Counseling brochure~ this brochure provides information on coverage for Medicare-covered smoking and tobacco-use cessation counseling.
http://www.cms.hhs.gov/MLNProducts/downloads/smoking.pdf
Please visit the Medicare Learning Network for more information on these and other Medicare fee-for-service educational products. For more information about The Great American Smokeout, please visit the American Cancer Society’s website at: http://acsf2f.com/gaso/index.html.
Thank you for helping CMS improve the health of patients with Medicare by joining in the effort to educate eligible beneficiaries about the importance of taking advantage of smoking and tobacco-use cessation counseling services and other preventive services covered by Medicare.
[1] The American Cancer Society. 2009. Great American Smokeout: Tobacco-Related Cancer Statistics 2007 [online]. [cited 5 November 2009]. Available from the World Wide Web: (http://acsf2f.com/gaso/statistics.html)
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8. 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)
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9. Extra Help for Medicare 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. This can mean big savings on prescription drug costs.
· Encourage people with Medicare to file for Extra Help online: https://secure.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/staticpages/ships.aspx 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
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[1] The American Cancer Society. 2009. Great American Smokeout: Tobacco-Related Cancer Statistics 2007 [online]. [cited 5 November 2009]. Available from the World Wide Web: (http://acsf2f.com/gaso/statistics.html)
[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
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
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