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. Only 10 Days Left To Bid For The Round 1 Rebid Of The DMEPOS Competitive Bidding Program!



2. DMEPOS Update



3. Delay in Implementing Phase 2 of CRs 6417 and 6421



4. Providers Must Wait for Medicare Claim Crossover Process to Work



5. CMS To Conduct Fifth Annual Medicare Contractor Provider Satisfaction Survey



6. Fiscal Year (FY) 2010 Inpatient Prospective Payment System (PPS) Personal Computer (PC) Pricer Updated



7. Medicare Fee-For-Service (FFS) Provider Listservs



8. New from the Medicare Learning Network®



9. Your December Flu Message



10. Extra Help for Medicare Beneficiaries Paying for Prescription Drugs













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1. Only 10 Days Left To Bid For The Round 1 Rebid Of The DMEPOS Competitive Bidding Program!



The Centers for Medicare & Medicaid Services (CMS) is currently accepting bids for the Round 1 Rebid of the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program. All bids must be submitted in DBidS, the on-line bidding system, by 9 p.m. prevailing Eastern Time on December 21, 2009; all required hardcopy documents that must be included as part of the bid package must be postmarked by 11:59 p.m. on December 21, 2009.



Here are some important things to remember when submitting your bid:

· You must submit your bid in DBidS using the user ID you received during registration. By now you should have already logged into DBidS and have started completing your bid application online. Please note that you must answer at least 2 and up to 10 authentication questions the first time you log in.

· All bidders must submit certain required hardcopy documents as specified in the Request for Bids (RFB) instructions. It is very important that you review Appendix B of the RFB instructions and the sample financial statements to ensure your documents include the required information. If you have already submitted your financial documents, you may still amend those documents until bidding closes on December 21, 2009. You are required to indicate your bidder number on each page of your hardcopy documents.

· If you submitted financial documents by the Covered Document Review Date (CDRD), November 21, 2009, you will receive an e-mail about your financial documents from the Competitive Bidding Implementation Contractor (CBIC) by December 29, 2009. If you submitted all financial documents, the e-mail will confirm that the CBIC received all financial documents and that no further action from you is required. If you did not submit all financial documents, the e-mail will alert you to expect a letter notifying you of the missing financial documents. The letter notifying you of missing financial documents will be mailed to your authorized official by January 4, 2010. The letter will identify the missing document(s) as of the CDRD. You will be required to submit only the indicated missing financial document(s) within 10 business days of the notification. If you did not submit any financial documents by the CDRD, you will not receive an e-mail or a letter about your financial documents.

· If you did not submit any hardcopy financial documents by the CDRD, you are still required to submit all required hardcopy documents specified in the Request for Bids (RFB) instructions by 11:59 p.m. on December 21, 2009.

· 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. You should review this information prior to submitting your bid(s).

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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2. DMEPOS Update



· The following message regarding the upcoming pharmacy accreditation deadline will be issued by CMM/Provider Communications this week and should now be distributed by ROs to your pharmacy organizations:



“Since HR 3663 postponed the accreditation timeframe for pharmacies until January 1, 2010, we are reminding pharmacies who have not been accredited to do so by January 1, 2010.

We encourage all pharmacies going through the accreditation process to resolve any outstanding issues on your accreditation report so that the Accrediting Organization can make an accreditation determination in advance of the January 1, 2010 deadline.

The DMEPOS Accrediting Organization will notify the National Supplier Clearinghouse (NSC) when your organization is accredited.

Pharmacies who do not plan to remain enrolled in the DMEPOS Medicare program are strongly encouraged to notify their customers as soon as possible. This will give your customers an opportunity to find another DMEPOS supplier.”



· A second beneficiary letter regarding the accreditation/surety bond requirements for DMEPOS suppliers is now in clearance and is projected to be mailed later this month. This letter will be sent to beneficiaries whose supplier did not receive accreditation or post a surety bond.

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3. Delay in Implementing Phase 2 of CRs 6417 and 6421



The Centers for Medicare & Medicaid Services (CMS) will delay, until April 5, 2010, the implementation of Phase 2 of Change Request (CR) 6417 (Expansion of the Current Scope of Editing for Ordering/Referring Providers for Claims Processed by Medicare Carriers and Part B Medicare Administrative Contractors (MACs)) and CR 6421 (Expansion of the Current Scope of Editing for Ordering/Referring Providers for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Supplier Claims Processed by Durable Medical Equipment Medicare Administrative Contractors (DME MACs)). CRs 6417 and 6421 are applicable to Part B claims only.



The delay in implementing Phase 2 of these CRs will give physicians and non-physician practitioners who order items or services for Medicare beneficiaries or who refer Medicare beneficiaries to other Medicare providers or suppliers sufficient time to enroll in Medicare or take the action necessary to establish a current enrollment record in Medicare prior to Phase 2 implementation.



Although enrolled in Medicare, many physicians and non-physician practitioners who are eligible to order items or services or refer Medicare beneficiaries to other Medicare providers or suppliers for services do not have current enrollment records in Medicare. A current enrollment record is one that is in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) and also contains the physician/non-physician practitioner’s National Provider Identifier (NPI). Under Phase 2 of the above referenced CRs, a physician or non-physician practitioner who orders or refers and who does not have a current enrollment record that contains the NPI will cause the claim submitted by the Part B provider/supplier who furnished the ordered or referred item or service to be rejected.



CMS continues to urge physicians and non-physician practitioners who are enrolled in Medicare but who have not updated their Medicare enrollment record since November 2003 to update their enrollment record now. If these physicians and non-physician practitioners have no changes to their enrollment data, they need to submit an initial enrollment application which will establish a current enrollment record in PECOS.



For physicians and non-physician practitioners who order or refer—



 If you are not enrolled in the Medicare program, or if you enrolled more than 6 years ago and have not submitted any updates or changes to your enrollment information in more than 6 years, you do not have an enrollment record in PECOS. In order to continue to order or refer items or services for Medicare beneficiaries, you will have to submit an initial enrollment application. You may do so either by (1) using Internet-based PECOS (which transmits your enrollment application to the Medicare carrier or A/B MAC via the Internet—be sure to mail the signed and dated Certification Statement to the carrier or A/B MAC immediately after submitting the application), or (2) filling out the appropriate paper Medicare provider enrollment application(s) (CMS-855I and CMS-855R, if appropriate) and mailing the application, along with any required additional supplemental documentation, to the local Medicare carrier or A/B MAC, who will enter your information into PECOS and process your enrollment application. Information on how to enroll in Medicare is found on the Medicare provider/supplier enrollment web site at www.cms.hhs.gov/MedicareProviderSupEnroll.

 If you are already enrolled in Medicare, make sure you have a current enrollment record. You can find out if you have an enrollment record in PECOS by calling your designated carrier or A/B MAC or by going on-line, using Internet-based PECOS, to view your enrollment record. We will be posting information to the Medicare provider/supplier enrollment web site that will guide you through this process. Information about Internet-based PECOS and a link to Internet-based PECOS can be found on the Medicare provider/supplier enrollment web site. Before using Internet-based PECOS, we recommend that you read the information that is posted there and that is available in the downloadable documents section.

 If you are a dentist or a physician with a specialty such as a pediatrics who is eligible to order or refer items or services for Medicare beneficiaries but have not enrolled in Medicare because the services you provide are not covered by Medicare or you treat few Medicare beneficiaries, you need to enroll in Medicare in order to continue to order or refer items or services for Medicare beneficiaries.

 If you are a physician who is employed by the Department of Veterans Affairs, the Public Health Service, or the Department of Defense Tricare program but have not enrolled in Medicare because you would not be paid by Medicare for your services, you need to enroll in Medicare in order to continue to order or refer items or services for Medicare beneficiaries.



If you are a resident who has a medical license but have not enrolled in Medicare because you would not be paid by Medicare for your services, you do not need to enroll in Medicare in order to continue to order or refer items or services for Medicare beneficiaries. The teaching physician—not the resident—should be identified in claims as the ordering/referring provider when a resident orders or refers items or services for Medicare beneficiaries.



CMS actions to mitigate the number of informational messages:



Since many Part B providers and suppliers are receiving a high volume of informational messages in their Remittances, CMS is taking the following actions to reduce the number of informational messages being generated:



1. Prior to the implementation of Phase 2, CMS will systematically add the NPIs to the PECOS enrollment records of all physicians and non-physician practitioners whose enrollment records are in PECOS but do not contain their NPIs. Because the NPI is one of the matching criteria used in implementing the two new edits on the Ordering/Referring Provider, it is essential that the NPI be in the PECOS enrollment record. Because the data file used to implement the two edits contains only the eligible physicians and non-physician practitioners who are in PECOS with NPIs in their enrollment records, this action will add many more physicians and non-physician practitioners to that data file.

2. Prior to the implementation of Phase 2, CMS will make publicly available on the Internet the names and NPIs of the Medicare physicians and non-physician practitioners who are eligible to order or refer in the Medicare program. The name displayed will be that of the physician or non-physician practitioner as it appears in his or her PECOS enrollment record. This will allow Part B providers and suppliers who furnish and bill for items or services based on orders or referrals to determine if the Ordering/Referring Provider being identified in their claims will pass the two new edits prior to submitting the claims to Medicare.

3. Prior to the implementation of Phase 2, CMS will issue instructions to carriers and A/B MACs that will assist them in processing enrollment applications from physicians who are employed by the Department of Veterans Affairs, the Public Health Service, and the Department of Defense Tricare program. The instructions will also state that the teaching physician should be reported as the Ordering/Referring Physician in situations where a resident orders or refers items or services for Medicare beneficiaries. The instructions will also note that dentists and pediatricians, who sometimes order or refer items or services for Medicare beneficiaries, may be enrolling in Medicare in order to continue to order and refer.

4. CMS will be preparing a Special Edition Medicare Learning Network (MLN) Matters Article on the implementation of these two new edits. This MLN Matters Article will expand upon the information currently available in MLN Matters Articles MM 6417 and MM 6421.



Note: If you have problems accessing any hyperlink in this message, please copy and paste the URL into your Internet browser.

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4. Providers Must Wait for Medicare Claim Crossover Process to Work



The Centers for Medicare & Medicaid Services (CMS) reminds all providers, physicians, and suppliers to allow sufficient time for the Medicare crossover process to work—approximately 15 work days after Medicare’s reimbursement is made, as stated in MLN Matters Article SE0909 (http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0909.pdf) — before attempting to balance bill their patients’ supplemental insurers. That is, do not balance bill until you have received written confirmation from Medicare that your patients’ claims will not be crossed over, or you have received a special notification letter explaining why specified claims cannot be crossed over. Remittance Advice Remark Codes MA18 or N89 on your Medicare Remittance Advice (MRA) represent Medicare’s intention to cross your patients’ claims over. Medicare will continue to issue supplemental notifications to all participating providers, physicians, and suppliers informing them if claims targeted for crossover, as evidenced by MA18 or N89 on the MRA, do not actually result in successful crossover transmissions.



Members of the supplemental payer/Medigap market are noting higher than average receipts of Medicare Part A paper claims that are preceding the arrival of Medicare’s 837 institutional COB crossover claims. The arrival of paper claims in advance of Medicare crossover claims is resulting in supplemental payer receipt of duplicate claims. This trend is particularly pronounced among hospital providers within the states of Iowa, Missouri, and Wisconsin.



Current trending suggests that approximately 99 percent of all claims that Medicare identifies for crossover, as cited on your Medicare Remittance Advice, actually are crossed over by CMS’ Coordination of Benefits Contractor (COBC). The remaining percentage error out at the COBC due to HIPAA compliance issues or related data errors, resulting in the provider, physician, or supplier’s receipt of a Medicare-generated special notification letter specifying the reason for the claim’s failure to cross over. This trending demonstrates that the crossover process is becoming more reliable all the time. The CMS requests that providers, physicians, and suppliers ensure that the trend continue.



Note: If you have problems accessing any hyperlink in this message, please copy and paste the URL into your Internet browser.

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5. CMS To Conduct Fifth Annual Medicare Contractor Provider Satisfaction Survey



The Centers for Medicare & Medicaid Services (CMS) is listening and wants to hear from you about the services provided by your Medicare Fee-for-Service (FFS) contractor that processes and pays your Medicare claims. CMS is preparing to conduct the fifth annual Medicare Contractor Provider Satisfaction Survey (MCPSS). This survey offers Medicare FFS providers and suppliers an opportunity to give CMS feedback on their interactions with Medicare FFS contractors related to seven key business functions: Provider Inquiries, Provider Outreach & Education, Claims Processing, Appeals, Provider Enrollment, Medical Review, and Provider Audit & Reimbursement.



The survey will be sent to a random sample of approximately 30,000 Medicare FFS providers and suppliers. Those who are selected to participate in the 2010 MCPSS will be notified starting in January. If you are selected to participate, please take a few minutes to complete this important survey. Providers and suppliers can complete the survey on the Internet via a secure website or by mail, fax, or telephone. To learn more about the MCPSS, please visit http://www.cms.hhs.gov/MCPSS on the CMS website.

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6. Fiscal Year (FY) 2010 Inpatient Prospective Payment System (PPS) Personal Computer (PC) Pricer Updated



The FY 2010 Inpatient PPS PC Pricer has been updated on the web for FY 2010 claims. Go to the Inpatient PPS PC Pricer page, http://www.cms.hhs.gov/PCPricer/03_inpatient.asp, under the Downloads section. The Inpatient PPS PC Pricer User Manual for FY 2010 has also been updated with new information for processing FY 2010 claims. If you use the FY 2010 Inpatient PPS PC Pricer, please go to the page above and download the latest versions of the PC Pricer and User Manual.

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7. Medicare Fee-For-Service (FFS) Provider Listservs



For the latest information on joining the Medicare FFS provider listservs, the MLN Matters Articles or MLN Educational Products listservs, and other listservs available through CMS, please click on the following link: http://www.cms.hhs.gov/prospmedicarefeesvcpmtgen/downloads/Provider_Listservs.pdf

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8. New from the Medicare Learning Network®



REVISED Guided Pathways (NOV2009) booklets now available at http://www.cms.hhs.gov/MLNEdWebGuide/30_Guided_Pathways.asp



Are you wondering how to find the latest and greatest resources by subject? The REVISED Guided Pathways (NOV2009) booklets incorporate existing Medicare Learning Network (MLN) products and other centers resources into well organized sections that can help Medicare Fee-for-Service (FFS) providers and suppliers find information to understand and navigate the Medicare Program. These booklets guide learners to Medicare program resources, FFS policies and requirements. You can access the REVISED Guided Pathways (NOV2009) booklets at http://www.cms.hhs.gov/MLNEdWebGuide/30_Guided_Pathways.asp on the Medicare Learning Network.





The Diabetes-Related Services brochure, which provides an overview of Medicare's coverage of diabetes screening tests, diabetes self-management training, medical nutrition therapy, and supplies and other services for Medicare beneficiaries with diabetes, 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/DiabetesSvcs.pdf



The Glaucoma Screening brochure, which brochure provides a basic overview of Medicare's glaucoma screening benefit, 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/glaucoma.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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9. Your December Flu Message



Flu Season is Here!



Annual outbreaks of the seasonal flu usually occur from late fall to early spring. Typically, 5 to 20 percent of Americans get the seasonal flu, resulting in approximately 36,000 flu-related deaths.[1]



If you have Medicare patients who haven’t yet received their flu shot, you can help them reduce their risk of contracting the seasonal flu by recommending an annual seasonal influenza vaccination. Medicare provides coverage of the seasonal flu vaccine and its administration. And don’t forget to immunize yourself and your staff. Protect yourself, your staff, your patients, and your family and friends.



Remember - Influenza vaccine plus 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.

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[1] Flu.gov. 2009. About the Flu [online]. Washington DC: The U.S. Department of Health and Human Services, 2009 [cited 30 November 2009]. Available from the World Wide Web:
(http://www.flu.gov/individualfamily/about/index.htm )

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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







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[1] Flu.gov. 2009. About the Flu [online]. Washington DC: The U.S. Department of Health and Human Services, 2009 [cited 30 November 2009]. Available from the World Wide Web:
(http://www.flu.gov/individualfamily/about/index.htm )