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. Update on Claims Processing for Ordering/Referring Providers



2. CMS Invites You to HITECH Teleconference on Medicare & Medicaid Incentives Program NPRM



3. A Message from Dr. David Blumenthal on Advancing Health Information Exchange



4. POSTPONED - Program Advisory and Oversight Committee (PAOC) Update Meeting on Competitive Acquisition for DMEPOS



5. 2010 Part D Data Symposium Invitation



6. The Medicare Learning Network--Quality You Can Trust!



7. New from the Medicare Learning Network



8. Medicare Claims Crossover to Supplemental Payer Problem



9. Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) PC Pricers Updates



10. Fiscal Year (FY) 2009 Inpatient Prospective Payment System (IPPS) Personal Computer (PC) Pricer Updated



11. Nursing home Five-Star Quality Rating System – February News



12. Your February Flu Message



13. A new "twist" in the law makes it easier to save on your prescription drug costs.











~~~~~~~~~~~~~~~~~~~~



1. Update on Claims Processing for Ordering/Referring Providers



The Centers for Medicare & Medicaid Services (CMS) will delay until January 3, 2011, 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)).



This delay 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 contains the 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.

~~~~~~~~~~~~~~~~~~~~



2. CMS Invites You to HITECH Teleconference on Medicare & Medicaid Incentives Program NPRM



Have you heard about HITECH and Meaningful Use?

Do you want to learn more about the upcoming Medicare and
Medicaid Electronic Health Record (EHR) incentive programs?



The Centers for Medicare & Medicaid Services (CMS) invites you to join us

For a teleconference on Medicare and Medicaid EHR Incentives NPRM--

Implementing the American Recovery and Reinvestment Act of 2009 (Recovery Act)



The Centers for Medicare & Medicaid Services (CMS) has issued a Notice of Proposed Rule Making (NPRM) for the Medicare and Medicaid EHR incentive programs established by the Recovery Act. The HITECH provisions are a subset of the Recovery Act. The rule, sometimes called the “meaningful use NPRM,” proposes a definition for the meaningful use of certified EHR technology as well as many other policy proposals. Join us to learn the basics of the rule from the CMS experts.





Learn about

· CMS’ proposed rule for the EHR incentive programs including:

o Who is eligible

o What constitutes meaningful use

o How to demonstrate meaningful use

o What incentives are available under Medicare and Medicaid

· How to make comments

· Where to find additional resources



Hear first hand from the CMS Experts



When: Tuesday, February 23rd

Time: 1:30-2:30 pm EST



We suggest you call in early as lines are limited.



To join the meeting, dial 1-866-501-5502

The conference ID is 58353012



Materials will be available on the morning of the call at



http://www.cms.hhs.gov/NationalMedicareTrainingProgram/10_Audio_Conference_Training.asp

~~~~~~~~~~~~~~~~~~~~



3. A Message from Dr. David Blumenthal on Advancing Health Information Exchange



Advancing Health Information Exchange



February 12, 2010



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



Today we announce the first cooperative agreement awards authorized by the Health Information Technology for Economic and Clinical Health (HITECH) Act. It marks a major milestone in our journey towards nationwide adoption and meaningful use of health information technology (health IT). One set of awards provides $386 million to 40 States and qualified State-Designated Entities to rapidly build capacity for exchanging health information across the health care system both within and between states through the State Health Information Exchange Cooperative Agreement Program. The other awards provide $375 million to create 32 Regional Extension Centers (RECs) that will support the efforts of health professionals, starting with priority primary care providers, to become meaningful users of electronic health records (EHRs). Additional awards will be made in both programs over the coming weeks. Together, these programs will help modernize the use of health information, improving the quality and efficiency of care for all Americans.

As part of the State Health Information Exchange Cooperative Agreement Program, states will play a leadership role in achieving HIE to meet health reform goals. The funds awarded will be used to establish and implement plans for statewide HIE by creating the appropriate governance, policies, and technical services required to support HIE. Developing this state-level capability will help us break down the current barriers to HIE and help providers to qualify for Medicare and Medicaid incentives under the HITECH Act. The awards will also strongly encourage states to consider participating in the Nationwide Health Information Network as an approach to HIE. This would create a pathway toward seamless, nationwide health information exchange.

While the State HIE awards will strengthen capacity for health information exchange, the Health Information Technology Extension Program awards will establish RECs to deliver direct outreach, education, and technical assistance services to health care providers in their regions. Each REC will focus most intensively on the physicians, physician assistants, and nurse practitioners who work as part of individual and small group primary care practices, as well as those who dedicate themselves to providing health care to the underserved. Primary care providers in small practices provide the great majority of such services in the U.S. but have limited resources to implement, meaningfully use, and maintain EHR systems. On-site technical assistance for these priority primary care providers will be a key service offered by the RECs. RECs will assist providers who have not adopted EHRs, as well as those who have but need help progressing to meaningful use. Regional extension centers will also help providers keep health information private and secure.

The Health Information Technology Extension Program and the State Health Information Exchange Cooperative Agreement Program are critical components to the end of a nation-wide interoperable, private and secure electronic health information system. I look forward to working in collaboration with each state and REC as they establish their programs, begin work within their communities, and promote the transformation of our health care system. I applaud each awarded entity for its dedication to the mission of improving the quality of health care and for the leadership and guidance it will provide.

Sincerely,

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


The Office of the National Coordinator for Health Information Technology (ONC) encourages you to share this information as we work together to enhance the quality, safety and value of care and the health of all Americans through the use of electronic health records and health information technology.

~~~~~~~~~~~~~~~~~~~~



4. POSTPONED - Program Advisory and Oversight Committee (PAOC) Update Meeting on Competitive Acquisition for DMEPOS



The Program Advisory and Oversight Committee (PAOC) meeting originally scheduled for February 23, 2010 has been postponed until March 17, 2010 due to logistical issues, including meeting registration delays, caused by the recent severe winter storms affecting the Baltimore area. The Centers for Medicare & Medicaid Services (CMS) regrets any inconvenience but believes this postponement is necessary to ensure all interested members of the public have sufficient time to register for the meeting.



CMS will send a more detailed listserv notification about the March 17, 2010 meeting along with registration information shortly. For more information about the DMEPOS competitive bidding program, including information about the PAOC, please visit: www.cms.hhs.gov/DMEPOSCompetitiveBid/ .

~~~~~~~~~~~~~~~~~~~~



5. 2010 Part D Data Symposium Invitation



The Centers for Medicare and Medicaid Services (CMS) is pleased to announce that the 2010 Part D Data Symposium will be held on March 18, 2010. Located at CMS in Baltimore, Maryland, the conference will offer educational sessions on Part D research and outcomes presented by both CMS and external industry experts.



Prior online registration is required for entry into the Symposium. You may register from February 5, 2010 through March 5, 2010 at: http://www.cms.hhs.gov/apps/events/upcomingevents.asp?strOrderBy=1&type=3



Please do not reply back to this listserv. For more information, please see the link to registration web site above.



We look forward to seeing you at the conference.

~~~~~~~~~~~~~~~~~~~~



6. The Medicare Learning Network--Quality You Can Trust!



There Is Information. And Then There Is Quality Information You Can Trust From The Medicare Learning Network.



All Medicare Learning Network products are thoroughly researched and cleared by the experts at CMS.



What does that mean to you?



It means there is official Medicare Fee-For-Service (FFS) Program information always available for your immediate use to assist you with your business needs. The Medicare Learning Network knows how to translate complex language into easier to understand language and in various formats, e.g., guides, booklets, web-based training courses, brochures, national articles and fact sheets.



Test the quality of our products for yourself and begin obtaining information regarding billing and Medicare coverage & payment – or even basic information such as office management. Visit the MLN Publications page on the CMS website to view downloadable publications or click on the Product Ordering Page to see what is available in hard copy.

Remember… there’s never a charge for Medicare Learning Network products!

~~~~~~~~~~~~~~~~~~~~



7. New from the Medicare Learning Network



The MLN Matters Article #MM6782 - Dialysis Adequacy, Infection and Vascular Access Reporting - has recently been released and is available at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6782.pdf . This article is of particular interest to Renal Dialysis Facilities (RDFs) who need to be aware of some new quality data reporting for dialysis adequacy, infection and vascular access on all End Stage Renal Disease (ESRD) claims and all ESRD Hemodialysis claims with dates of service on or after July 1, 2010. This new data reporting will allow the Centers for Medicare & Medicaid Services (CMS) to implement an accurate quality incentive payment for dialysis providers by January 1, 2012.



Read it now to find out more!



# # # # #



The revised Medicare Appeals Process brochure (January 2010), which provides an overview of the Medicare Part A and Part B administrative appeals process available to providers, physicians and other suppliers who provide services and supplies to Medicare beneficiaries, as well as details on where to obtain more information about this appeals process, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/MedicareAppealsProcess.pdf .

# # # # #



“We Heard the Bells: The Influenza of 1918”, a documentary that explores the experiences of Americans during the influenza pandemic of 1918, is now available to order, free of charge, on DVD.

The documentary features stories from survivors of the influenza pandemic that swept the United States in 1918. These stories serve to frame the key questions that apply to the current H1N1 pandemic. Award-winning actress S. Epatha Merkerson (Law & Order) narrates the documentary that includes information about seasonal vs. pandemic influenza, symptoms, immunizations, treatment, and research.



To order a copy of the DVD, please visit our product ordering website by first visiting our Medicare Learning Network page at: http://www.cms.hhs.gov/MLNGenInfo/01_Overview.asp, then click on “MLN Product Ordering Page” in the “Related Links Inside CMS” section.



This product will also be available in a Spanish language translation at a later date.

~~~~~~~~~~~~~~~~~~~~



8. Medicare Claims Crossover to Supplemental Payer Problem



The Centers for Medicare & Medicaid Services (CMS) has identified a problem where claims were not automatically crossing over to supplemental payers even though the provider remittance advice indicated otherwise. This problem began January 5, 2010. Part A institutional claims and Part B professional claims, with the exception of supplier claims processed by Durable Medical Equipment Medicare Administrative Contractors (DME MACs), were impacted by this problem. Claims processed by DME MACs were not impacted.



Part A Institutional Claims



No action is required by Part A institutional providers. As of February 2, 2010, CMS successfully implemented a systems fix to ensure that all Part A institutional claims are now crossing over to supplemental payers as indicated on the remittance advice received by providers. As part of the fix, CMS’ Medicare contractors were able to identify claims processed between January 5 and February 1, 2010, where the provider remittance advice indicated that the affected claims were crossed over to various supplemental payers but were not. On February 2, 2010, the affected Medicare contractors began to send the affected claims to the Coordination of Benefits Contractor (COBC) to be crossed over to supplemental payers. This effort is now largely completed. Please allow until March 1, 2010, for supplemental payers to receive and process these claims before attempting to balance bill them for any remaining balances after Medicare.



Part B Professional Claims



Action is required on behalf of Part B professional providers where a remittance advice with an issue date between January 5, 2010, and February 12, 2010, has two or more service lines for a beneficiary where both of the following apply:

· One service line is 100 percent reimbursable (i.e., the approved amount and amount to be paid are equal,) AND

· One service line where part of or the entire Medicare approved amount is applied to the Part B deductible and/or carries co-insurance amounts.



CMS is not able to forward these beneficiary claims to supplemental payers even though the remittance advice may indicate otherwise. Providers will need to identify these claims by reviewing their remittance advice with an issue date between January 5, 2010, and February 12, 2010, that contain the criteria noted above. Once identified, providers will need to take action to balance bill the beneficiary’s supplemental payer. As of February 12, 2010, this system problem was fixed and all claims are crossing over to supplemental payers as indicated on the provider remittance advice.



The CMS has already notified supplemental payers of these issues. We regret any inconvenience you may experience related to this Medicare claim supplemental payer crossover problem.

~~~~~~~~~~~~~~~~~~~~



9. Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) PC Pricers Updates



The FY 2010 and FY 2009 Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) PC Pricers have been updated with January 2010 Provider Specific data and are ready for download from the Centers for Medicare & Medicaid Services (CMS) web page at http://www.cms.hhs.gov/PCPricer/06_IRF.asp. If you use the IRF PPS PC Pricers, please go to the page above and download the latest versions of the Pricers, posted 02/05/10, in the Downloads section.

~~~~~~~~~~~~~~~~~~~~



10. Fiscal Year (FY) 2009 Inpatient Prospective Payment System (IPPS) Personal Computer (PC) Pricer Updated



The Fiscal Year (FY) 2009 IPPS PC Pricer has been updated for FY 2009 claims with corrected provider data from January 2010. If you use the FY 2009 IPPS PC Pricer, go to the IPPS PC Pricer page, http://www.cms.hhs.gov/PCPricer/03_inpatient.asp, and download the latest version of the FY 2009 PC Pricer.

~~~~~~~~~~~~~~~~~~~~



11. Nursing home Five-Star Quality Rating System – February News



1. The Five-Star provider preview reports will be available now for viewing. 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 Five Star rating questions and concerns.

3. Nursing Home Compare will update with February’s Five-Star data on Thursday, February 25, 2010.

4. Please visit http://www.cms.hhs.gov/CertificationandComplianc/13_FSQRS.asp for the latest Five-Star Quality Rating system information.

~~~~~~~~~~~~~~~~~~~~



12. Your February Flu Message



There’s still time to get the seasonal flu shot! Although influenza activity has declined recently, it still may continue for several months.[1] The Centers for Disease Control continues to recommend that patients and health care providers and caregivers be vaccinated against seasonal influenza.



CMS encourages health care providers to use each office visit as an opportunity to talk with Medicare your patients about the importance of getting a seasonal flu shot. And remember, it is also important to immunize yourself and your staff.



Remember – Seasonal influenza vaccinations and their administration are covered Part B benefits. Note that influenza and pneumococcal vaccines are NOT Part D covered drugs.



For information about Medicare’s coverage of the seasonal influenza virus vaccine and its administration, as well as related educational resources for health care professionals and their staff, please go to http://www.cms.hhs.gov/MLNProducts/Downloads/flu_products.pdf on the CMS website. You will find a variety of resources that explain Medicare coverage and claims submission policies related to the seasonal influenza vaccine.

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

[1] Seasonal Influenza (Flu). [online]. Atlanta, GA: The Centers for Disease Control and Prevention, January 19, 2010 [cited 21 January 2010]. Available from the World Wide Web: (http://www.cdc.gov/flu)

~~~~~~~~~~~~~~~~~~~~



13. A new "twist" in the law makes it easier to save on your prescription drug costs.



http://www.ssa.gov/prescriptionhelp/



Under a new law, more Medicare beneficiaries could qualify for Extra Help with their Medicare prescription drug plan costs because some things no longer count as income and resources. The Extra Help is estimated to be worth an average of $3,900 per year. To qualify for the Extra Help, a person must be on Medicare, have limited income and resources, and reside in one of the 50 states or the District of Columbia.

~~~~~~~~~~~~~~~~~~~~