Medicare

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 Needs Your Feedback



3. CMS Releases 12 Medicaid HITECH Grants for VT, AL, AR, AZ, FL, IL, KS, ME, MI, NE, OK, and VA



4. Registration Now Open for Program Advisory and Oversight Committee (PAOC) Meeting on Competitive Acquisition for DMEPOS



5. 2010 Physician Quality Reporting Initiative & Electronic Prescribing Incentive Program National Provider Call with Question & Answer Session



6. New from the Medicare Learning Network



7. March Is National Nutrition Month



8. Your February Flu Message



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











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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.

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2. CMS Needs Your Feedback



The Centers for Medicare & Medicaid Services (CMS) is conducting the fifth national administration of the Medicare Contractor Provider Satisfaction Survey (MCPSS). This survey is designed to collect quantifiable data on providers’ satisfaction with the performance of the Medicare fee-for-service (FFS) contractors that process and pay their Medicare claims. CMS conducts the MCPSS on an annual basis and uses the results for Medicare contractor oversight and process improvement initiatives.

In January, CMS notified approximately 30,000 Medicare FFS providers and suppliers that they had been randomly selected to participate in the 2010 MCPSS study. As representatives of the more than 1.5 million providers nationwide who serve Medicare beneficiaries across the country, these providers and suppliers have an opportunity to give CMS valuable feedback on their satisfaction, attitudes, perceptions, and opinions about the services provided by their respective contractor.

If you have been notified that you were selected to participate in this study and have not yet done so, CMS is listening and wants to hear from you. Please take a few minutes to go online and complete your survey via a secure online Internet survey tool. Responding online is a convenient, easy, and quick way to provide CMS with your feedback. Survey questionnaires can also be submitted by mail, secure fax, and over the telephone. The survey takes approximately 20 minutes to complete.



CMS has contracted with SciMetrika, a public health consulting firm, to administer this important survey and report statistical data to CMS. If you received notification that you were selected to participate in the MCPSS study and you no longer have your online survey tool access information or need help accessing the survey tool, please call the MCPSS Provider Helpline at 1-800-835-7012 or send an email to MCPSS@scimetrika.com.



Please Note: Only providers and suppliers notified that they have been randomly selected to take part in the 2010 MCPSS may participate in this study. A new random sample of providers and suppliers is selected annually to participate in the MCPSS study.

For more information about the MCPSS, please visit the CMS MCPSS website at http://www.cms.hhs.gov/mcpss, or read the CMS MLN Matters Special Edition article at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE1005.pdf featuring the survey.

CMS urges you to please take a few moments to complete your survey today. Thank you.

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3. CMS Releases 12 Medicaid HITECH Grants for VT, AL, AR, AZ, FL, IL, KS, ME, MI, NE, OK, and VA



MEDICAID NEWS

FOR IMMEDIATE RELEASE Contact: CMS Office of Media Affairs

February 26, 2010 (202) 690-6145





Twelve States (VT, AL, AR, AZ, FL, IL, KS, ME, MI, NE, OK, and VA) to Receive Federal Matching Funds for Electronic Health Record Incentives Program



In another key step to further states’ role in developing a robust U.S. health information technology (HIT) infrastructure, the Centers for Medicare & Medicaid Services (CMS) announced today additional federal matching funds for certain state planning activities necessary to implement the electronic health record (EHR) incentive program established by the American Recovery and Reinvestment Act of 2009 (Recovery Act).



The Recovery Act provides a 90 percent federal match for state planning activities to administer the incentive payments to Medicaid providers, to ensure their proper payments through audits and to participate in statewide efforts to promote interoperability and meaningful use of EHR technology statewide and, eventually, across the nation.



EHRs will improve the quality of health care for the citizens of the recipient states and make their care more efficient. The records make it easier for the many providers who may be treating a Medicaid patient to coordinate care. Additionally, EHRs make it easier for patients to access the information they need to make decisions about their health care.



This batch is part of a rolling announcement CMS began in November 2009. To date, including the new states, we will have awarded a total of $43.56 million.



Alabama - $269,000

Arkansas - $815,000

Arizona - $2.89 million

Florida - $1.69 million

Illinois - $2.18 million

Kansas - $1.70 million

Maine - $1.40 million

Michigan - $1.52 million

Nebraska - $894,000

Oklahoma - $587,000

Vermont - $294,000

Virginia - $1.66 million



Additional information on implementation of the Medicaid-related provisions of the Recovery Act’s EHR incentive payment program may be found at: http://www.cms.hhs.gov/Recovery/11_HealthIT.asp#TopOfPage



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

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4. Registration Now Open for Program Advisory and Oversight Committee (PAOC) Meeting on Competitive Acquisition for DMEPOS



PROGRAM ADVISORY and OVERSIGHT COMMITTEE (PAOC) MEETING ON DURABLE MEDICAL EQUIPMENT, PROSTHETICS, ORTHOTICS, and SUPPLIES (DMEPOS) COMPETITIVE BIDDING PROGRAM



March 17, 2010

8:00 A.M. - 4:30 P.M. (Eastern Daylight Time)

Centers for Medicare & Medicaid Services

7500 Security Boulevard

Baltimore, Maryland 21244





The Centers for Medicare & Medicaid Services (CMS) will be hosting a meeting with the Program Advisory and Oversight Committee (PAOC) on March 17, 2010 to discuss the Round 1 Rebid and upcoming Rounds of the Medicare DMEPOS Competitive Bidding Program. The agenda for the meeting is available on the CMS website at: http://www.cms.hhs.gov/DMEPOSCompetitiveBid/downloads/AGENDA_FOR_031710_PAOC_MEETING.pdf .



Registration for the meeting is now open. To register for the meeting, please visit: http://www.blsmeetings.net/paoc2010/. Registrations must be received no later than 5:00 p.m. Eastern Standard Time on March 12, 2010.



Meeting attendees should allow plenty of time to ensure access to the CMS facility. CMS security procedures require that all visitors are subject to a vehicular search and can only gain access through the Central Building Main Lobby. All visitors must also be in possession of a valid, government-issued form of photo identification, such as a driver's license, age of majority card, passport or visa.



For more information about the DMEPOS competitive bidding program, including information about the PAOC, please visit: http://www.cms.hhs.gov/DMEPOSCompetitiveBid/.

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5. 2010 Physician Quality Reporting Initiative & Electronic Prescribing Incentive Program National Provider Call with Question & Answer Session



2010 Physician Quality Reporting Initiative & Electronic Prescribing Incentive Program

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 2010 Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (eRx). This toll-free call will take place from 1:30 p.m. – 3:30 p.m., EST, on Wednesday, March 10, 2010.



The PQRI is voluntary quality reporting program that provides an incentive payment to identified individual eligible professionals (EPs), and beginning with the 2010 PQRI, group practices who satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-For-Service (FFS) beneficiaries.



The PQRI was first implemented in 2007 as a result of section 101 of the Tax Relief and Health Care Act of 2006 (TRHCA), and further expanded as a result of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), and the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). The eRx Incentive Program is an incentive program for eligible professionals initially implemented in 2009 as a result of section 132(b) of the MIPPA. The eRx Incentive Program promotes the adoption and use of eRx systems by individual eligible professionals (and beginning with the 2010 eRx Incentive Program, group practices).



Following a few program announcements and updates, the lines will be opened to allow participants to ask questions of CMS PQRI and eRx 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 eRx 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: March 10, 2010



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 March 9, 2010, 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/031010



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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6. New from the Medicare Learning Network



New MLN Matters Article Regarding "Questions and Answers on Reporting Physician Consultation Services"


The MLN Matters Special Edition Article #SE1010 entitled, “Questions and Answers on Reporting Physician Consultation Services,” has just been released and is available at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE1010.pdf on the CMS website. This article is intended for physicians and non-physician practitioners (NPPs) who perform initial evaluation and management (E/M) services previously reported by Current Procedural Terminology (CPT) consultation codes for Medicare beneficiaries and submit claims to Medicare Carriers and/or Medicare Administrative Contractors (MACs) for those services. The article pertains to change request (CR) 6740, which alerts providers that effective January 1, 2010, the CPT consultation codes (ranges 99241-99245 and 99251-99255) are no longer recognized for Medicare Part B payment.



Consequently, MLN Matters Article #MM6740 entitled, “Revisions to Consultation Services Payment Policy,” is being revised to clarify language contained in the original CR and to add a reference to MLN Matters Article #SE1010. All other information remains the same. The revised article is available at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6740.pdf on the CMS website.

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7. March Is National Nutrition Month



Please join with the Centers for Medicare & Medicaid Services (CMS) in promoting increased awareness of nutrition, healthful eating and the medical nutrition therapy (MNT) benefit covered by Medicare. More than 13.7 million Americans at least 60 years or older are diagnosed with diabetes or chronic kidney disease[1]. MNT provided by a registered dietitian or nutrition professional may result in improved diabetes and renal disease management and other health outcomes and may help delay disease progression.

Medicare Coverage

Medicare provides coverage of medical nutrition therapy (MNT) for beneficiaries diagnosed with diabetes and/or renal disease (except for those receiving dialysis) and post renal transplant when provided by a registered dietitian or nutrition professional who meets the provider qualifications requirement. A referral by the beneficiary’s treating physician indicating a diagnosis of diabetes or renal disease is required. Medicare provides coverage for 3 hours of MNT in the first year and 2 hours in subsequent years, and additional hours in certain situations.



NOTE: For the purpose of this benefit, renal disease means chronic renal insufficiency or the medical condition of a beneficiary who has been discharged from the hospital after a successful renal transplant for up to 36 months post transplant. Chronic renal insufficiency means a reduction in renal function not severe enough to require dialysis or transplantation [Glomerular Filtration Rate (GFR) 13-50 ml/min/1.73m2].



What Can You Do?

As a trusted source of health care information, your patients rely on their physician’s or other health care professional’s recommendations. CMS requests your help to ensure that all eligible people with Medicare take full advantage of the medical nutrition therapy benefit. Talk with your eligible Medicare patients about the benefits of managing diabetes and renal disease through MNT and encourage them to make an appointment with a registered dietitian or nutrition professional qualified to provide MNT services covered by Medicare.



For More Information

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

o The Guide to Medicare Preventive Services for Physicians, Providers, Suppliers, and Other Health Care Professionals ~ this newly revised comprehensive resource provides coverage and coding information on the array of preventive services and screenings that Medicare covers, including medical nutrition therapy and other services for Medicare beneficiaries with diabetes. www.cms.hhs.gov/MLNProducts/downloads/mps_guide_web-061305.pdf

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

o Diabetes-Related Services Brochure ~ This tri-fold brochure provides health care professionals with 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. www.cms.hhs.gov/MLNProducts/downloads/DiabetesSvcs.pdf

o The CMS website provides additional information about the MNT benefit at www.cms.hhs.gov/MedicalNutritionTherapy

o To order copies of Medicare Preventive Services products, select the link for “MLN Product Ordering Page” on the MLN Products page at: http://www.cms.hhs.gov/MLNProducts/01_Overview.asp



· For information to share with your Medicare patients, visit www.medicare.gov

· For more information about National Nutrition Month®, or to “Find a Registered Dietitian” consumers and health care professionals can visit the American Dietetic Association’s website www.eatright.org to locate downloadable nutrition information for handouts and presentations.

· For more information on diabetes, including additional publications to help educate your patients about diabetes prevention and treatment, please visit the National Diabetes Education Program website at: http://www.ndep.nih.gov



Thank you for your support in helping CMS spread the word about the benefits of good nutrition, healthful eating and the medical nutrition therapy benefit covered by Medicare that may help people with Medicare learn to control and manage their medical conditions.



[1] Department of Health and Human Services. Centers for Disease Control and Prevention, “2007 National Diabetes Fact Sheet,” accessed at: http://apps.nccd.cdc.gov/ddtstrs/FactSheet.aspx. The United States Renal Data System, “2008 USRDS Annual Data Report (ADR) Atlas,” accessed at: www.usrds.org/2008/pdf/V1_Precis_2008.pdf.

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8. 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. The Centers for Disease Control continues to recommend that patients and health care providers and caregivers be vaccinated against seasonal influenza[1].



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.

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[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)

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9. 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.

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[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)