Medicare Information

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. Physician and non-physician practitioners who order or refer must be enrolled in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) and must be of the types/specialties that are eligible to order/refer services for Medicare beneficiaries Effective April 5, 2010.



2. CMS Launches Fifth Annual Medicare Contractor Provider Satisfaction Survey



3. CMS and ONC Issue Regulations Proposing a Definition of Meaningful Use and Setting Standards for Electronic Health Record Incentive Program



4. 2010 Physician Quality Reporting Initiative (PQRI) & Electronic Prescribing Incentive Program (eRx) Updates



5. Your Latest Health Information Technology Updates, Including Information About Regulations Proposing a Definition of Meaningful Use and Setting Standards for the Electronic Health Record Incentive Program



6. Scheduled Release of Modifications to the Healthcare Common Procedure Coding System (HCPCS) Code Set



7. Transcript Summaries of ICD-10 Call Now Available



8. New from the Medicare Learning Network®



9. Next Week is National Influenza Vaccination Week!



10. Your January Flu Message



11. Help Keep Your Medicare Patients Healthy In the New Year!



12. January is National Glaucoma Awareness Month



13. Extra Help for Medicare Beneficiaries Paying for Prescription Drugs













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1. Physician and non-physician practitioners who order or refer must be enrolled in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) and must be of the types/specialties that are eligible to order/refer services for Medicare beneficiaries Effective April 5, 2010.





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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2. CMS Launches Fifth Annual Medicare Contractor Provider Satisfaction Survey



The Centers for Medicare & Medicaid Services (CMS) is listening and wants to hear from you about your satisfaction with the services provided by Medicare fee-for-service (FFS) contractors that process and pay Medicare claims. CMS has launched 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. Approximately 30,000 randomly selected providers will be notified in January that they have been selected to participate in the survey. CMS urges all health care providers selected to participate in the 2010 survey to take a few minutes to complete and return this important survey. To read the CMS press release announcing the launch of the 2010 MCPSS, please go to (http://www.cms.hhs.gov/MCPSS/Downloads/2010_MCPSS_contractor_survey.pdf). CMS is listening and wants to hear from you.

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3. CMS and ONC Issue Regulations Proposing a Definition of Meaningful Use and Setting Standards for Electronic Health Record Incentive Program



The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) encourage public comment on two regulations issued today that lay a foundation for improving quality, efficiency and safety through meaningful use of certified electronic health record (EHR) technology.



The CMS proposed rule and fact sheets may be viewed at http://www.cms.hhs.gov/Recovery/11_HealthIT.asp





The full press release is included below for your convenience:







FOR IMMEDIATE RELEASE Contact: HHS Press Office



Wednesday, December 30, 2009 (202) 690-6343





CMS and ONC Issue Regulations Proposing a Definition of ‘Meaningful Use’ and Setting Standards for Electronic Health Record Incentive Program



Public Encouraged to Comment on New Regulations



The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) encourage public comment on two regulations issued today that lay a foundation for improving quality, efficiency and safety through meaningful use of certified electronic health record (EHR) technology. The regulations will help implement the EHR incentive programs enacted under the American Recovery and Reinvestment Act of 2009 (Recovery Act).



A proposed rule issued by CMS outlines proposed provisions governing the EHR incentive programs, including defining the central concept of “meaningful use” of EHR technology. An interim final regulation (IFR) issued by ONC sets initial standards, implementation specifications, and certification criteria for EHR technology. Both regulations are open to public comment.



“Widespread adoption of electronic health records holds great promise for improving health care quality, efficiency, and patient safety,” said, National Coordinator for Health Information Technology David Blumenthal, M.D., M.P.P. “The Recovery Act’s financial incentives demonstrate Congress’ and the Administration’s commitment to help providers adopt and make meaningful use of EHR technology so they can give better care and their patients’ experience of care will improve. Over time, we believe the EHR incentive program under Medicare and Medicaid will accelerate and facilitate health information technology adoption by more individual providers and organizations throughout the health care system.”



“These regulations are closely linked,” said Charlene Frizzera, CMS Acting Administrator. “CMS’s proposed regulation would define and specify how to demonstrate ‘meaningful use’ of EHR technology, which is a prerequisite for receiving the Medicare incentive payments. Our rule also outlines the proposed payment methodologies for the Medicare and Medicaid EHR incentive programs. ONC’s regulation sets forth the standards and specifications that will enhance the interoperability, functionality, utility and security of health information technology.”



CMS and ONC worked closely to develop the two rules and received input from hundreds of technical subject matters experts, health care providers, and other key stakeholders. Numerous public meetings to solicit public comment were held by three Federal advisory committees: the National Committee on Vital and Health Statistics (NCVHS), the Health IT Policy Committee (HITPC), and the Health IT Standards Committee (HITSC). HITSC presented its final recommendations to the National Coordinator in August 2009. These recommendations, along with all other input were considered to help inform the development of the regulations announced today.



The IFR issued by ONC describes the standards that must be met by certified EHR technology to exchange healthcare information among providers and between providers and patients. This initial set of standards begins to define a common language to ensure accurate and secure health information exchange across different EHR systems. The IFR describes standard formats for clinical summaries and prescriptions; standard terms to describe clinical problems, procedures, laboratory tests, medications and allergies; and standards for the secure transportation of this information using the Internet.



The IFR calls for the industry to standardize the way in which EHR information is exchanged between organizations, and sets forth criteria required for an EHR technology to be certified. These standards will support meaningful use and data exchange among providers who must use certified EHR technology to qualify for the Medicare and Medicaid incentives.



Under the statute, HHS is required to adopt an initial set of standards for EHR technology by Dec. 31, 2009. The IFR will go into effect 30 days after publication, with an opportunity for public comment and refinement over the next 60 days. A final rule will be issued in 2010. “We strongly encourage stakeholders to provide comments on these standards and specifications,” Dr. Blumenthal said.



The Recovery Act established programs to provide incentive payments to eligible professionals and eligible hospitals participating in Medicare and Medicaid that adopt and make “meaningful use” of certified EHR technology. Incentive payments may begin as soon as October 2010 to eligible hospitals. Incentive payments to other eligible providers may begin in January 2011.



The proposed rule would define the term "meaningful EHR user" as an eligible professional or eligible hospital that, during the specified reporting period, demonstrates meaningful use of certified EHR technology in a form and manner consistent with certain objectives and measures presented in the regulation. These objectives and measures would include use of certified EHR technology in a manner that improves quality, safety, and efficiency of health care delivery, reduces health care disparities, engages patients and families, improves care coordination, improves population and public health, and ensures adequate privacy and security protections for personal health information.



The proposed rule would define meaningful use for the Medicare EHR incentive programs. It proposes one definition that would apply to eligible professionals participating in the Medicare fee-for-service and the Medicare Advantage EHR incentive programs as well as a proposed definition that would apply to eligible hospitals and critical access hospitals. These definitions also would serve as the minimum standard for eligible professionals and eligible hospitals participating in the Medicaid EHR incentive program. The rule proposes that states could request CMS approval to implement additional meaningful use measures, as appropriate, but could not request approval of fewer or less rigorous meaningful use measures than required by the rule.



This rule proposes a phased approach to implement the proposed requirements for demonstrating meaningful use. This approach would initially establish reasonable criteria for meaningful use based on currently available technological capabilities and providers’ practice experience. CMS will establish stricter and more extensive criteria for demonstrating meaningful use over time, as anticipated developments in technology and providers’ capabilities occur.



CMS provides a 60-day comment period on the proposed rule. “The definition and requirements for demonstrating meaningful use of EHR technology are proposals. CMS welcomes and will give serious consideration to comments that improve our proposal while achieving the goals Congress established for the EHR incentive programs,” Frizzera said.



The CMS proposed rule and fact sheets may be viewed at http://www.cms.hhs.gov/Recovery/11_HealthIT.asp



ONC’s interim final rule may be viewed at http://healthit.hhs.gov/standardsandcertification. In early 2010 ONC intends to issue a notice of proposed rulemaking related to the certification of health information technology





Additional Website resources:



The Recovery Act Health IT Page is: http://www.cms.hhs.gov/Recovery/11_HealthIT.asp.



DIRECT Link to CMS Reg: http://www.federalregister.gov/OFRUpload/OFRData/2009-31217_PI.pdf.



A copy of the ONC Reg is available at: http://healthit.hhs.gov/standardsandcertification.



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



The CMS Fact Sheets are available at: https://www.cms.hhs.gov/apps/media/fact_sheets.asp.

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4. 2010 Physician Quality Reporting Initiative (PQRI) & Electronic Prescribing Incentive Program (eRx) Updates



The Centers for Medicare & Medicaid Services (CMS) is pleased to announce updates to several 2010 PQRI and eRx measures-related documents. The updated documents are now available on the CMS PQRI webpage at http://www.cms.hhs.gov/PQRI and the CMS eRx webpage at http://www.cms.hhs.gov/ERxincentive respectively on the CMS website.



2010 Measures Groups Specification Update



Version 3.0 of the Measures Groups Specifications Manual released in November 2009 for 2010 PQRI has been revised. Version 3.1 of the 2010 PQRI Measures Groups Specifications Manual and Release Notes reflects a change to the denial remark code note for several Measures Groups. Correct G-codes specific to each Measures Group have been replaced within this document. For further details, the updated “2010 PQRI Measures Groups Specifications Manual and Release Notes” is now available on the CMS PQRI webpage at http://www.cms.hhs.gov/pqri, on the CMS website. Click on the “Measures Codes” section page on the left.



2010 Measure Specifications Update



Version 4.0 of the Measure Specifications Manual and Release Notes, which was released in November 2009 for PQRI 2010, has been updated.

· Two updates were made to Version 4.1 of the Measure Specifications Manual

o Measure #193: Additional information was added to the note for Numerator Coding option CPT II 4256F

o Measure #94: CPT 92567 was added to the Denominator Coding

· Version 4.1 of the Release Notes was updated in several areas:

o Two temporary measure numbers have been replaced with final measure numbers

o Measure #21 and Measure #22: A CPT code that was listed as being deleted from the Denominator Coding was revised to reflect the correct code

o Measure #48: CPT codes listed as being added and deleted from the Denominator Coding have been updated to reflect they were only added to the measure.



The updated version of the “2010 PQRI Measure Specifications Manual for Claims and Registry Reporting of Individual Measures and Release Notes” is now available on the CMS PQRI webpage at http://www.cms.hhs.gov/pqri, on the CMS website. Click on the “Measures Codes” section page on the left.



Final 2010 EHR Measures Specifications



The final “2010 EHR Measures Specifications” and “2010 EHR Measures Specifications - Release Notes” have been modified and are now available on the CMS PQRI website. Please note, changes were made to this document, as some encounter codes were identified as non-covered services under the Medicare Physician Fee Schedule and will not be counted in the denominator population for PQRI reporting calculations. To access these final documents, please visit the CMS PQRI webpage at http://www.cms.hhs.gov/pqri, on the CMS website. Click on the “Alternative Reporting Mechanisms” section page on the left.



2010 PQRI Single Source Code Master Update



The “2010 PQRI Single Source Code Master” document released in November 2009 for PQRI 2010 has been revised to add CPT 92567 to the Denominator Coding for Measure #94. The updated document is now available on the CMS PQRI webpage at http://www.cms.hhs.gov/pqri, on the CMS website. Click on the “Measures Codes” section page on the left.



2010 eRx Measure Specifications Update



Version 1.0 of the 2010 eRx Release Notes released in November for 2010 eRx has also been revised. The updated Version 1.1 of the eRx Release Notes now correctly reflects a change in the Denominator Updates section of the document. To access this updated document, please see the “2010 eRx Measures Specifications and Release Notes”, which available on the CMS Electronic Prescribing Incentive Program (eRx) webpage at http://www.cms.hhs.gov/ERxincentive, on the CMS website. Click on the “E-Prescribing Measure” section page on the left.

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5. Your Latest Health Information Technology Updates, Including Information About Regulations Proposing a Definition of Meaningful Use and Setting Standards for the Electronic Health Record Incentive Program



Standards and Certification Criteria to Support Meaningful Use of Electronic Health Records

December 30, 2009

A Message from Dr. David Blumenthal, National Coordinator for Health Information Technology

As we look toward 2010, we can envision a transformation of our health system to improve health care quality, efficiency, equity, and safety through the use of health information technology (HIT), while providing the foundation for continued, measurable improvement in our nation’s health. The adoption and meaningful use of information technology in health care is central to a necessary and overdue modernization of our health system.

As required by the HITECH Act, the Secretary of the Department of Health and Human Services (HHS) has published an initial set of standards, implementation specifications, and certification criteria to enhance the interoperability, functionality, utility, and security of health information technology. These criteria are outlined in the interim final rule (IFR) on Standards & Certification Criteria issued today by the Office of the National Coordinator for Health Information Technology (ONC).

The IFR provides details on requirements for “certified” electronic health record (EHR) systems, and the technical specifications needed to support secure, interoperable, nationwide electronic exchange and meaningful use of health information.

In a related announcement, the Centers for Medicare & Medicaid Services (CMS) issued a notice of proposed rulemaking (NPRM) that outlines provisions governing the Medicare and Medicaid EHR incentive programs, including a proposed definition for the central concept of “meaningful use” of EHR technology. In order for professionals and hospitals to be eligible to receive payments under the incentive programs, provided through the Recovery Act, they must be able to demonstrate meaningful use of a certified EHR system. The proposed standards and certification criteria in the IFR are fundamentally linked to and specifically designed to support the 2011 meaningful use criteria.

Great care was taken in the development of these criteria, with input from the public and federal advisory committees every step of the way. The resulting standards and certification criteria in the IFR are organized into four categories as recommended by the HIT Policy Committee and HIT Standards Committee:

· Content Exchange Standards (i.e., standards used to share clinical information such as clinical summaries, prescriptions, and structured electronic documents);

· Vocabulary Standards (i.e., standard nomenclature used to describe clinical problems and procedures, medications, and allergies);

· Transport Standards (i.e., standards used to establish the communication protocol between systems); and

· Privacy and Security Standards (e.g., authentication, access control, transmission security/encryption) which relate to and span across all of the other types of standards.


While well-defined data and technical standards are the foundation for interoperability between systems – allowing for reliable, consistent, secure, and accurate information exchange – we recognize that a high-level of nationwide interoperability will take time and will occur at varying rates. Therefore, our approach to the adoption of standards and certification criteria is pragmatic, yet forward looking. The criteria are designed to be supportive of the staged meaningful use requirements, but at the same time lay the foundation for future growth in information exchange and technological innovation.

An incremental approach to standards adoption requires harmonization with current and future standards to come. We will continue to be guided by recommendations from our federal advisory committees, public comment, industry readiness, and future meaningful use goals and objectives established for the Medicare and Medicaid EHR incentive programs. We anticipate this ongoing evolution in standards and certification criteria development as meaningful use requirements become more demanding over time and as industry continues to spur adoption through its innovative offerings.

Now, we ask for your continued input to inform the final regulations due in 2010.

Additional information on both of these regulations and how you can contribute to the open public comment periods can be found through the HHS news release issued today and at the http://HealthIT.HHS.Gov website.

At ONC, we look forward to your continued and active participation in HITECH programming and ongoing rulemaking processes in the new year.

Sincerely,

David Blumenthal, M.D., M.P.P.
National Coordinator for Health Information Technology
U.S. Department of Health & Human Services

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Also, please find attached an article authored by Dr. Blumenthal and published in the New England Journal of Medicine regarding the proposed rules.

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Help Wanted: Skilled Health IT Workforce to Modernize Health Care

December 24, 2009

A Message from Dr. David Blumenthal, National Coordinator for Health Information Technology

As health care providers and hospitals across the nation incorporate electronic health records into routine patient care, the demand for highly skilled health IT professionals will rapidly grow. We will need a workforce that not only understands the technology and how it functions, but also its implications for patient care and workflow in clinical settings. When my practice implemented electronic records a decade ago, we were fortunate to have our hospital’s highly skilled IT support staff working shoulder-to-shoulder with us. These staff got us over the considerable hurdle of learning to use EHRs. Unfortunately, not every hospital or practice has the benefit of this kind of help, and the necessary personnel are in short supply. Various studies have shown that we need at least 50,000 additional qualified health IT workers to assist hospitals and physicians as they move to adopt and meaningfully use electronic health records. Clearly, we must “grow” a corps of talented individuals with different backgrounds to fill a wide range of important roles, to support rising demand sparked by the Medicare and Medicaid incentives authorized by HITECH.

Last month I announced the availability of $80 million to fund community college training programs and curriculum development to help strengthen the health IT workforce. These grants were the first in a series of programs, authorized by the HITECH Act, to address the need for the skilled workforce to help providers put in place and maintain secure, interoperable EHR systems.

The first, the Community College Consortia Program, totaling $70 million, will help create programs of study in health IT that trainees with some background in health care or IT will be able to complete in six months or less. Graduates will be equipped to work at the frontlines of adoption and meaningful use, helping doctors, nurses, and hospitals set up and use health IT systems in their practices and workplaces.

The second, the Curriculum Development Centers Program, totaling $10 million, will fund the development of educational materials to support the community college training programs. The availability of these resources will allow these programs to ramp up quickly so graduates can begin meeting workforce demands.

Today’s announcement of two new workforce development grant programs includes an additional $38 million to establish a competency testing program and university-based training programs.

The Competency Examination Program will provide $6 million to an institution of higher education to create an objective mechanism to assess basic competency for individuals completing programs like those developed through the Community College Consortia Program.

The University-Based Training Program is expected to generate graduates in vital highly specialized health IT roles over the course of three years. The program will provide $32 million to support academic program development that will lead to a university-issued certificate of advanced training (e.g., post-baccalaureate or graduate certificate) or a master’s degree.

As these workforce programs are rolled out, you can find grants information and corresponding application deadlines at http://HealthIT.HHS.Gov/HITECHgrants.

Modernizing our health care system requires the mobilization of an educated and talented workforce. By supporting such training we will accelerate the meaningful use of health IT and create tens of thousands of secure jobs when and where they are desperately needed.

Sincerely,

David Blumenthal, M.D., M.P.P.
National Coordinator for Health Information Technology
U.S. Department of Health & Human Services

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6. Scheduled Release of Modifications to the Healthcare Common Procedure Coding System (HCPCS) Code Set



The Centers for Medicare & Medicaid Services 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 website at http://www.cms.hhs.gov/HCPCSReleaseCodeSets/02_HCPCS_Quarterly_Update.asp . Changes are effective on the date indicated on the update.

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7. Transcript Summaries of ICD-10 Call Now Available



The written and audio transcript summaries of the ICD-10-CM/PCS Medicare Severity - Diagnosis Related Group Conversion Project National Provider Conference Call, which was conducted by the Centers for Medicare & Medicaid Services on November 19, 2009, are now available in the Downloads Section at http://www.cms.hhs.gov/ICD10/06a_2009_CMS_Sponsored_Calls.asp .

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8. New from the Medicare Learning Network®



The revised Understanding the Remittance Advice (RA) for Professional Providers Web-Based Training (WBT), has been made available by the Centers for Medicare & Medicaid Services (CMS) Medicare Learning Network (MLN). Available for Continuing Education credit, this course provides instructions to help fee-for-service Medicare providers and their billing staffs interpret the RA received from Medicare and reconcile it against submitted claims. It additionally provides guidance on how to read Electronic Remittance Advices (ERAs) and Standard Paper Remittance Advices (SPRs), as well as information for balancing an RA. This course also presents an overview of software that Medicare provides free to providers in order to view ERAs. This training can be accessed by visiting http://www.cms.hhs.gov/MLNgeninfo/ and scrolling to the “Related Links Inside CMS” page section. Within these links, select Web Based Training (WBT) Modules and then Understanding the Remittance Advice for Professional Providers from the list of training courses provided.



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The Adult Immunizations brochure, which provides an overview of Medicare's coverage of seasonal influenza, Pneumococcal, and Hepatitis B vaccines and their administration, 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/adult_immunization.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. Next Week is National Influenza Vaccination Week!



January 10 – 16, 2010 is National Influenza Vaccination Week. The Centers for Disease Control and Prevention (CDC) has announced the week of January 10-16, 2010, as National Influenza Vaccination Week. This week-long event is designed to raise awareness of the importance of continuing influenza (flu) vaccinations, as well as foster greater use of flu vaccine in January, February, and beyond. Since flu activity typically does not peak until February or later, January and February still provide good opportunities to offer flu shots.



This year, Thursday, January 15th, is designated as Seniors' Vaccination Day. The Centers for Medicare & Medicaid Services (CMS) needs your help to ensure that people with Medicare get their flu shots. Please use this week long event as an opportunity to place greater emphasis on flu prevention.



If you have Medicare patients who have not yet received their annual flu shots, we ask that you encourage these patients to protect themselves from the seasonal flu and serious complications arising from the flu virus by recommending that they take advantage of the flu shot benefit covered by Medicare. And remember, health care professionals and their staff are also at risk for contracting and spreading the flu virus, so don’t forget to immunize yourself and your staff.



NOTE: - Influenza vaccine plus its administration are covered Part B benefits. 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.



For more information about National Influenza Vaccination Week, please visit the Centers for Disease Control and Prevention’s website, http://www.cdc.gov/flu/nivw/index.htm, on the Web.



We hope you find the attached information useful:



1. A letter from Secretary Sebelius to partner organizations about National Influenza Vaccination Week

2. A one-pager on National Influenza Vaccination Week.





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10. Your January Flu Message



It’s Not Too Late to Get the Seasonal Flu Shot. While seasonal influenza outbreaks can happen as early as October, influenza activity usually peaks in January.[1] The seasonal flu vaccine is the best way to prevent infection and the complications associated with the flu. Re-vaccination is necessary each flu season because flu viruses change each year.



CMS is asking our health care provider community to please encourage your Medicare patients who haven’t already done so to get their annual flu shot. It is also important to be sure that you immunize yourself and your staff.



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] Seasonal Influenza, 2009-2010. Key Facts About Seasonal Flu Vaccine [online]. Atlanta, GA: The Centers for Disease Control and Prevention, 2009 [cited 23 December 2009]. Available from the World Wide Web:
(http://www.cdc.gov/flu/protect/keyfacts.htm)

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11. Help Keep Your Medicare Patients Healthy In the New Year!



Help Keep Your Medicare Patients Healthy In the New Year! The Centers for Medicare & Medicaid Services (CMS) is asking the provider community to keep their patients with Medicare healthy this year by ensuring that they take advantage of Medicare-covered preventive services. Medicare covers a wide array of preventive services for eligible beneficiaries, including cancer screenings, glaucoma screenings, an initial preventive physical examination, and certain immunizations, among others.

What Can You Do?

As a health care professional who provides care to seniors and others with Medicare, you can help protect the health of your Medicare patients by educating them about their risk factors and reminding them of the importance of getting the preventive screenings covered by Medicare.

For More Information

CMS has developed several educational products related to Medicare-covered preventive services, including:



o The MLN Preventive Services Educational Products Web Page ~ provides descriptions and ordering information for Medicare Learning Network (MLN) preventive services educational products and resources for health care professionals and their staff. 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. http://www.cms.hhs.gov/MLNProducts/downloads/MPS_QuickReferenceChart_1.pdf

o Quick Reference Information: The ABCs of Providing the Initial Preventive Physical Examination (IPPE) ~ This double-sided chart provides a checklist of services included in the IPPE, as well as additional information on the IPPE benefit.

http://www.cms.hhs.gov/MLNProducts/downloads/MPS_QRI_IPPE001a.pdf

o Quick Reference Information: Medicare Part B Immunization Billing ~This double-sided chart provides coverage and coding information on Medicare-covered immunizations. http://www.cms.hhs.gov/MLNProducts/downloads/qr_immun_bill.pdf



Please visit the Medicare Learning Network for more information on these and other Medicare fee-for-service educational products.



Thank you for helping CMS improve the health of patients with Medicare by joining in the effort to educate beneficiaries about the importance of early detection of various diseases by taking advantage of the screenings and other preventive services covered by Medicare.

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12. January is National Glaucoma Awareness Month



January is National Glaucoma Awareness Month ~ The Centers for Medicare & Medicaid Services (CMS) reminds health care professionals that Medicare provides coverage of a comprehensive annual glaucoma screening exam for Medicare beneficiaries at high risk for developing glaucoma.



Medicare Coverage

Medicare provides coverage of an annual glaucoma screening for beneficiaries in at least one of the following high risk groups:



· Individuals with diabetes mellitus;

· Individuals with a family history of glaucoma;

· African-Americans age 50 and older; and

· Hispanic-Americans age 65 and older.



A covered glaucoma screening includes:



· A dilated eye examination with an intraocular pressure (IOP) measurement; and

· A direct ophthalmoscopy examination or a slit-lamp biomicroscopic examination.



What Can You Do?



As a health care professional who provides care to seniors and others with Medicare, you can help protect the vision of your Medicare patients who may be at high risk for glaucoma by educating them about their risk factors and reminding them of the importance of getting an annual glaucoma screening exam.



For More Information



CMS has developed several educational products related to Medicare-covered preventive services, including glaucoma screenings:



o The Glaucoma Screening brochure ~ provides information on risk factors, coverage, and documentation for Medicare-covered Glaucoma screenings. http://www.cms.hhs.gov/MLNProducts/downloads/glaucoma.pdf

o The MLN Preventive Services Educational Products Web Page ~ provides descriptions and ordering information for Medicare Learning Network (MLN) preventive services educational products and resources for health care professionals and their staff, including products related to Medicare-covered glaucoma screening. 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 Medicare-covered glaucoma screenings. http://www.cms.hhs.gov/MLNProducts/downloads/MPS_QuickReferenceChart_1.pdf

o The Guide to Medicare Preventive Services for Physicians, Providers, Suppliers, and Other Health Care Professionals ~ This comprehensive resource provides in-depth information about the many preventive services Medicare covers, including glaucoma screenings. http://www.cms.hhs.gov/MLNProducts/downloads/mps_guide_web-061305.pdf



Please visit the Medicare Learning Network for more information on these and other Medicare fee-for-service educational products.



Thank you for helping CMS improve the health of patients with Medicare by joining in the effort to educate beneficiaries at high risk for developing glaucoma about the importance of getting a Medicare-covered glaucoma screening.

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13. 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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[1] Seasonal Influenza, 2009-2010. Key Facts About Seasonal Flu Vaccine [online]. Atlanta, GA: The Centers for Disease Control and Prevention, 2009 [cited 23 December 2009]. Available from the World Wide Web:
(http://www.cdc.gov/flu/protect/keyfacts.htm)