Medicare Update

Hello Everyone,

Please enjoy the information contained in this edition of Frontier Focus. Please be sure to share it with your members, colleagues, providers and office billing staff. Thank you for your continued efforts to broadcast Medicare information to the providers in Region VIII.





Table of Contents



1. 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. Physician Quality Reporting Initiative (PQRI) Program Updates



4. Physician Fee Schedule - 2010 Annual Participation Enrollment Program Extension



5. Nursing Home Five-Star Quality Rating System – November News



6. HHS Employs New Tougher Standards In Calculation Of Improper Medicare Payment Rates For 2009



7. Mini-Poster about Flu Vaccines for Medicare Beneficiaries



8. H1N1 Outreach



9. Your November Flu Message



10. Extra Help for Medicare Beneficiaries Paying for Prescription Drugs









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1. New from the Medicare Learning Network®



The Cancer Screenings brochure, which provides information about Medicare coverage of screening mammographies, screening pap tests, screening pelvic exams, and colorectal and prostate cancer screenings, 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/cancer_screening.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 Smoking and Tobacco-Use Cessation Counseling Services brochure, which provides information about Medicare coverage of smoking and tobacco-use cessation services, 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/smoking.pdf

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



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Recently Released MLN Matters Articles of Particular Interest



MM6690 – Update to Medicare Deductible, Coinsurance, and Premium Rates for 2010

http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6690.pdf



SE0929 – 2010 Annual Participation Enrollment Program Extension

http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0929.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. Physician Quality Reporting Initiative (PQRI) Program Updates



Suggestions for Potential 2011 Physician Quality Reporting Initiative

Quality Measures and/or Measures Groups



The Centers for Medicare & Medicaid Services (CMS) is now accepting quality measure suggestions for consideration for possible inclusion in the proposed set of quality measures for use in the 2011 Physician Quality Reporting Initiative (PQRI).



Interested parties have an additional opportunity to submit measure suggestions for the 2011 PQRI program beyond the request for 2011 measure suggestions included in the Calendar Year (CY) 2010 Medicare Physician Fee Schedule (PFS) proposed rule published in the Federal Register (74 FR 33587) on July 13, 2009. Interested parties who have already submitted measure suggestions in response to the request for 2011 PQRI measures included in the CY 2010 PFS proposed rule do not need to re-submit their measure suggestions.



To learn more about the 2011 PQRI Call for Measures, visit the CMS Quality Measures Management Information System (QMIS) website at http://www.cms.hhs.gov/apps/QMIS/CallforMeasures.asp on the CMS website.



All suggestions must be received by CMS no later than 5:00 p.m. EST December 16, 2009.

Please note: Suggesting individual measures or measures for a new or existing measures group does not guarantee that the measure(s) will be included in the proposed or final sets of measures of any proposed or final rules that address the 2011 PQRI. CMS will determine what individual measures and measures group(s) to include in the proposed set of quality measures, and after a period of public comment, the agency will make the final determination with regard to the final set of quality measures for the 2011 PQRI.



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2009 Physician Quality Reporting Initiative

National Provider Call with Question & Answer Session



The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host a national provider conference call on the 2009 Physician Quality Reporting Initiative (PQRI). This toll-free call will take place from 1:30 p.m. – 3:30 p.m., EST, on Thursday, December 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:



· Alternate feedback report request process;

· Update on incentive payments and feedback reports;

· Results from the 2008 PQRI and 2007 PQRI re-run; and

· Measures issues identified in 2008 PQRI.



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: December 10, 2009



Conference Title: Physician Quality Reporting Initiative (PQRI) - National Provider Call



Time: 1:30 p.m. EST



In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation.

Registration will close at 1:30 p.m. EST on December 9, 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/121009

2. Fill in all required data.



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



4. Click "Register".



5. You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.



For those of who will be unable to attend, a transcript of the call will be available at least one week after the call at http://www.cms.hhs.gov/pqri on the CMS website.



If you require services for the hearing impaired please send an email to: Medicare.TTT@PalmettoGBA.com.

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4. Physician Fee Schedule - 2010 Annual Participation Enrollment Program Extension



2010 Annual Participation Enrollment Program Extension



Due to recent revisions that were made to the 2010 Medicare Physician Fee Schedule (MPFS), the Centers for Medicare & Medicaid Services (CMS) has extended the 2010 Annual Participation Enrollment Program end date from December 31, 2009, to January 31, 2010 – therefore, the enrollment period now runs from November 13, 2009, through January 31, 2010.



The effective date for any Participation status change during the extension, however, remains January 1, 2010; and will be in force for the entire year.



Contractors will accept and process any Participation elections or withdrawals, made during the extended enrollment period that are received or post-marked on or before January 31, 2010.



Note: This is an extension of the annual participation enrollment period dates in CR 6637 (Transmittal 1832 -- Calendar Year (CY) 2010 Participation Enrollment and Medicare Participating Physicians and Suppliers Directory (MEDPARD) Procedures), dated October 16, 2009.



The Participation Agreement (CMS-Form 460) is available on the CD-ROM that is sent out annually by your Medicare contractor during the Annual Participation Enrollment period. Your contractor will also make the Participation Agreement available to you by placing it on their Web sites with Participation enrollment (and termination) instructions.

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5. Nursing Home Five-Star Quality Rating System – November News



1. The Five-Star provider preview reports will be available no later than Thursday, November 19, 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. BetterCare@cms.hhs.gov is available to address any questions and concerns about the November data. The helpline will reopen in January 2010.

3. Nursing Home Compare will update with November’s Five-Star data on Wednesday, November 25, 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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6. HHS Employs New Tougher Standards In Calculation Of Improper Medicare Payment Rates For 2009



Part of Administration-Wide Strategy to Eliminate Errors and Prevent Waste and Fraud



As part of the Obama Administration’s goal of reducing waste, fraud and abuse in Medicare, the Department of Health and Human Services and the Centers for Medicare & Medicaid Services (CMS) significantly revised and improved its calculations of Medicare fee-for-service (FFS) error rates in 2009, reflecting a more complete accounting of Medicare’s improper payments than in past years. These improvements will provide CMS with more complete information about errors so that the Agency can better target improper payments.



“The Obama Administration is committed to strengthening and improving the Medicare and Medicaid systems and doing everything we can to be responsible and vigilant stewards of these programs that millions of Americans rely upon,” said HHS Secretary Kathleen Sebelius. “From the very start of the Administration, the President has directed all the agencies across government to use honest budgeting and to take the hardest, most detailed look possible at what was happening with taxpayer dollars inside our agencies and inside critical programs. This year, we made the call to stop calculating our error rate in fee-for-service Medicare the way that the previous Administration did and to start using a more rigorous method in calculating this rate in keeping with our mandate to root out errors and fraud. “



The Medicare, Medicaid and Children’s Health Insurance Program (CHIP) improper payment rates are issued annually as part of the U.S. Department of Health and Human Services (HHS) Agency Financial Report.



While improper payment rates are not necessarily an indicator of fraud in Medicare or any other federal health care program, they do provide HHS, CMS, and its partners who are responsible for the oversight of Medicare and Medicaid funds a more complete assessment of how many errors need to be fixed.



“If we aren’t honest about the problem, there is no way we can get to a solution. Through a more stringent review of Medicare claims, we’ve been able to establish a more complete accounting of errors, enabling CMS to take more actionable steps to further reduce the error rate and identify abusive or potentially fraudulent actions before they become problems,” said Sebelius. “This change in calculating the error rate is just one part of our larger Administration-wide effort to reduce waste, fraud and abuse in health care. In addition to the establishment of HEAT, the joint task force that was established earlier this year with the Department of Justice, we’ve taken aggressive steps at HHS and CMS to improve our oversight of the Medicare trust funds and the taxpayer dollars that pay for the health care of millions of older and vulnerable Americans.”



“As we move forward in our review of the Medicare and Medicaid error rate data, we expect to be able to determine if there are specific trends that can better help us identify weaknesses in our programs or systems,” said Acting CMS Administrator Charlene Frizzera. “We hope to be able to use data available through the use of new electronic health record reporting that can help in the design of new and innovative approaches to finding emerging trends and vulnerabilities in high risk areas such as durable medical equipment and home health.”



Sebelius and Frizzera also pointed out the HHS and the CMS would invest more time and resources into working with providers to eliminate errors through increased and improved training and education outreach.



“It’s important that we continue to work closely with doctors, hospitals and other health care providers to make sure they understand and follow the more comprehensive fee-for-service requirements,” said Frizzera. “We are committed to working closely with them to reduce the rate of improper payments.”



Press Release available at: https://www.cms.hhs.gov/apps/media/press_releases.asp

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7. Mini-Poster about Flu Vaccines for Medicare Beneficiaries



CMS would appreciate your help communicating with the public, especially seniors and vulnerable populations, that Medicare and Medicaid cover both the seasonal and H1N1 flu vaccines. Seniors are encouraged to get their seasonal flu vaccine as soon as possible. The vaccine that protects against the 2009 H1N1 influenza virus (sometimes called swine flu) is a separate vaccine and is available now. The first available doses of this vaccine should be given to those at highest risk of infection and complications such as children, pregnant women, health care workers and younger adults with certain medical conditions. There is some evidence that people 65 and older are less likely than younger people to be infected with the 2009 H1N1 influenza virus.

Please share this bilingual mini-poster http://www.cms.hhs.gov/AdultImmunizations/Downloads/FluPoster2009.pdf with your colleagues and encourage them to post it in places where Medicare patients will see and understand the need for their seasonal flu shot and that they can get the H1N1 vaccine once the high risk groups are vaccinated.


We encourage Medicare practitioners to refer patients to www.flu.gov if they need more information about the seasonal and H1N1 flu vaccines. Information for practitioners, mass immunizers and others who want to bill Medicare for the flu vaccines can be obtained at www.cms.hhs.gov/adultimmunizations. The Immunizers Q & A Guide in the download section also includes a list of regional CMS contacts on page 55 that would be helpful if you want to organize a large scale immunization clinic for seniors.

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8. H1N1 Outreach



Dear Provider Partners,



The Department of Health and Human Services thanks you for your work in communities across the country. As this year’s flu season continues, we want to provide you with up-to-date information about the new 2009 H1N1 virus, and also give you some easy-to-read information with the hope that it will reach people who need it the most.



Below is an email template that includes important resources to help protect families and communities from H1N1. Participation in this outreach effort is voluntary.



2009 H1N1 UPDATES

Flu activity is already higher than what is seen during the peak of many regular flu seasons. Almost all of the flu viruses identified this season so far are 2009 H1N1.
All states have placed orders for the 2009 H1N1 vaccine, and more orders are expected daily. Vaccine is arriving in thousands of places across the country. Because the vaccine distribution system varies by state, the vaccine situation on the ground may differ from community to community.
The 2009 H1N1 vaccine is taking longer to produce than manufacturers initially expected. Scientists, doctors, and manufacturers are working around the clock to produce this vaccine safely, effectively, and as quickly as the science allows. The U.S. Department of Health and Human Services, through state and local health departments, will continue to make the vaccine available as soon as it comes off the production line.
Clinical trials conducted by the National Institutes of Health and the vaccine manufacturers have shown that the new H1N1 vaccine is both safe and effective.
In the past, flu pandemics have been characterized by multiple waves. Scientists and doctors recommend H1N1 vaccination even if flu activity slows, as it could resume later in the season.


Please feel free to share any general feedback you receive for additional information and materials. Again, dissemination of this information is voluntary.



Thank you.

________________________________________________________________________





Dear Friend:



You’ve probably been hearing a lot this year about the H1N1 flu. And you may have questions. You may have even had the flu, or know a friend or neighbor who has been sick. This email features some tools suggested by the U.S. Department of Health and Human Services to help you prevent the flu, know what to do if you get sick, and find a place to get vaccinated.



People recommended by the Centers for Disease Control and Prevention (CDC) to receive the vaccine as soon possible include: health care workers; pregnant women; people ages 25 through 64 with chronic medical conditions, such as asthma, heart disease, or diabetes; anyone from 6 months through 24 years of age; and people living with or caring for infants under 6 months old.



FLU.gov is a one-stop resource with the latest updates on the H1N1 flu. On this site, you can find information on How to Prevent and Treat the Flu, Flu Essentials and Why the H1N1 Vaccine is Safe and Recommended by Health Experts. To look up where to get vaccinated in your state, visit the Vaccine Locator. This information is updated regularly as more doses are shipped each week.



An additional resource is the CDC hotline, 1-800-CDC-INFO (1-800-232-4636), which offers services in English and Spanish, 24 hours a day, 7 days a week.



Heard a rumor? Visit Myths & Facts to run a fact check.



Please forward this email to your family, friends, co-workers and networks today. Let’s work together to help keep our communities safe and healthy.

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9. Your November Flu Message



Flu Season is upon us! CMS encourages providers to begin taking advantage of each office visit to encourage your patients with Medicare to get seasonal flu shots. Flu shots are their best defense against combating flu this season. And don’t forget—health care workers also need to protect themselves.



Medicare provides coverage of the flu vaccine without any out-of-pocket costs to the Medicare patient as a part B benefit. No deductible or copayment/coinsurance applies. Note that influenza vaccine is NOT a Part D covered Drug.



For more information about Medicare’s coverage of the seasonal influenza vaccine and its administration, as well as related educational resources for health care professionals, please go to http://www.cms.hhs.gov/MLNProducts/35_PreventiveServices.asp on the CMS website.



For information on Medicare policies related to H1N1 influenza, please go to http://www.cms.hhs.gov/H1N1 on the CMS website.

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10. 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