A Medicare Update -- CMS

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. Reminder: Fifth National Medicare Fee-For-Service (FFS) Education Call on HIPAA Version 5010



3. CMS Announces Series of Nationwide RAC 101 Calls



4. Patient Protection and Affordable Care Act – Provisions Impacting Institutional Providers



5. New from the Medicare Learning Network



6. Transcripts for ICD-10-CM National Provider conference Call Now Available



7. Pricer Updates for Inpatient PPS and SNF PPS



8. CMS Proposes Policy And Payment Rate Changes For Inpatient Stays In Acute Care And Long-Term Care Hospitals In FY 2011



9. 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. Reminder: Fifth National Medicare Fee-For-Service (FFS) Education Call on HIPAA Version 5010



5010: Taking EDI to the Next Level





Fifth National Medicare Fee-For-Service (FFS) Education Call on HIPAA Version 5010 – April 28, 2010



The Centers for Medicare & Medicaid Services (CMS) will be hosting its fifth national provider call regarding the implementation of HIPAA Version 5010. There will be a brief presentation given by CMS followed by a Q&A session with CMS subject matter experts. The presentation is available by clicking on the following link to the CMS website: http://www.cms.gov/Versions5010andD0/Downloads/HIPAAProviderOutreach270_271.pdf.



Please note that this call is geared towards vendors, clearinghouses, and providers who are performing their own development of 5010.



Subject: Medicare Fee-For-Service Implementation of HIPAA version 5010 For Eligibility Inquiry and Response, 270/271 Transaction



Agenda:



· General Overview

· Medicare Specific Changes

o Service Type Codes

o Patient Matching Rules

o Error Handling

o Response Changes

· Timelines and Deadlines

· What you need to do to prepare

· 270/271 Errata

· Q & A



Conference call details:



Date: April 28, 2010

Conference Title: HIPAA Version 5010 national provider call: CMS’ discussion of Eligibility Inquiry and Response, 270/271 Transaction



Time: 2:00 p.m. – 3:30 p.m. ET



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 2:00 p.m. ET on April 27, 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/042810



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.

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



3. CMS Announces Series of Nationwide RAC 101 Calls



Please visit the CMS RAC website at http://www.cms.gov/rac/03_recentupdates.asp for more information.



April 28, 2010 1:00pm - 2:30pm EST: Nationwide RAC 101 Call, 1-877-251-0301



May 4, 2010 1:00pm - 2:30pm EST: Nationwide RAC 101 Call for Home Health and Hospice Providers, 1-877-251-0301



May 5, 2010 1:00pm - 2:30pm EST: Nationwide RAC 101 Call for DMEPOS, 1-877-251-0301



May 12, 2010 1:00pm - 2:30pm EST: Nationwide RAC 101 Call for Physicians, 1-877-251-0301

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



4. Patient Protection and Affordable Care Act – Provisions Impacting Institutional Providers



On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA). PPACA Sections 3401 and 3137 contain a number of provisions affecting institutional providers. The 3401 sections discussed below are effective April 1, 2010, while Section 3137(a) has October 1, 2009, and April 1, 2010 effective dates. The Centers for Medicare & Medicaid Services is working to expeditiously implement these important provisions of PPACA. Providers will begin seeing payments under these provision in the late April/early May time frame. Be on the alert for more information about these provisions and their impact on past and future claims. What follows are brief descriptions of each provision:



Inpatient Acute Hospitals (Section 3401(a))



Section 3401(a) of PPACA imposes a 0.25 percentage point reduction to the Inpatient Prospective Payment System (IPPS) hospital’s market basket for fiscal year (FY) 2010, effective for discharges on or after April 1, 2010. The reduction to the market basket will affect IPPS rates for discharges occurring on or after April 1, 2010, through September 30, 2010.



Long-Term Care Hospitals (Section 3401(c))



Section 3401(c) of PPACA imposes a 0.25 percentage point reduction to the Long Term Care Hospital’s (LTCH) market basket for FY 2010, effective for discharges on or after April 1, 2010. The reduction to the market basket will affect LTCH rates for discharges occurring on or after April 1, 2010, through September 30, 2010.



Inpatient Rehabilitation Facilities (Section 3401(d))



Section 3401(d) of PPACA imposes a 0.25 percentage point reduction to the Inpatient Rehabilitation Facility market basket for FY 2010, effective for discharges on or after April 1, 2010. The reduction is also resulting in changes to the standard payment conversion factor, payment rates, and the outlier threshold amount.



Extension of Section 508 Hospital Reclassifications (Sections 3137(a) and 10317)



Sections 3137(a) and 10317 extend section 508 and special exception hospital reclassifications from October 1, 2009, through September 30, 2010. Effective April 1, 2010, section 3137(a) and 10317 also require removing section 508 and special exception wage data from the calculation of the reclassified wage index if doing so raises the reclassified wage index. All hospitals affected by sections 3137(a) and 10317 will be assigned an individual special wage index effective April 1, 2010. If the section 508 or special exception hospital’s wage index applicable for the period beginning on October 1, 2009, and ending on March 31, 2010, is lower than for the period beginning on April 1, 2010, and ending on September 30, 2010, the hospital will be paid an additional amount that reflects the difference between the wage indices. The provision applies to both inpatient and outpatient hospital payments.



Be on the alert for more information pertaining to the PPACA.

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



5. New from the Medicare Learning Network



The Centers for Medicare & Medicaid Services (CMS) has released a Special Edition MLN Matters article to advise providers of what glucose self-testing equipment and supplies are covered for Medicare beneficiaries and what documentation is required for the beneficiary’s medical record. The article, SE1008, “Medicare Coverage of Blood Glucose Monitors and Testing Supplies,” is available at http://www.cms.gov/MLNMattersArticles/downloads/SE1008.pdf on the CMS website.

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



6. Transcripts for ICD-10-CM National Provider conference Call Now Available



The written and oral transcripts of the Basic Introduction to ICD-10-CM National Provider Conference Call, which was conducted by the Centers for Medicare & Medicaid Services on March 23, 2010, are now available in the Downloads Section at http://www.cms.gov/ICD10/02c_CMS_Sponsored_Calls.asp .

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



7. Pricer Updates for Inpatient PPS and SNF PPS



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



The Fiscal Year (FY) 2010 Inpatient PPS PC Pricer has been updated on the web for FY 2010 claims with provider data from April 2010. Go to the Inpatient PPS PC Pricer page at http://www.cms.hhs.gov/PCPricer/03_inpatient.asp, under the Downloads section, and download the latest version of the PC Pricer.



Skilled Nursing Facilities Prospective Payment System (SNF PPS) Personal Computer (PC) Pricer Files Updated for Fiscal Year (FY) 2010



Due to receiving quarterly provider data for April 2010, the FY 2010 SNF PPS PC Pricer has been updated on the page: http://www.cms.hhs.gov/PCPricer/04_SNF.asp, under the “Skilled Nursing Facilities (SNF PPS) PC Pricer.” Please go to the page above and download the latest version of the PC Pricer.

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



8. CMS Proposes Policy And Payment Rate Changes For Inpatient Stays In Acute Care And Long-Term Care Hospitals In FY 2011



The Centers for Medicare & Medicaid Services (CMS) recently proposed the fiscal year (FY) 2011 policies and payment rates for inpatient services furnished to people with Medicare by both acute care hospitals and long-term care hospitals. The proposals are intended to ensure that Medicare pays appropriately for high quality, efficient and safe inpatient care. The proposed rule does not address inpatient hospital related provisions of the recently enacted Patient Protection and Affordable Care Act, as amended by the Health Care and Education Affordability Reconciliation Act (collectively referred to as the “Affordable Care Act”). CMS expects to provide further information on the implementation of health care reform provisions in these laws that affect FY 2010 and FY 2011 IPPS payments in the near future.



CMS is similarly proposing to update long-term care hospital (LTCH) rates by 2.4 percent for inflation and apply an adjustment of -2.5 percentage points for the estimated increase in spending in FYs 2008 and 2009 due to documentation and coding that did not reflect increases in patients’ severity of illness. Based on these two proposed provisions and other proposed changes, CMS estimates that payments to LTCHs would increase by 0.8 percent or $41 million.



The proposed rule was placed on display at the Federal Register today, and can be found under Special Filings at:

http://www.federalregister.gov/inspection.aspx#special



CMS will accept comments on this proposed rule until June 18, and will respond to them in a final rule to be issued by August 1, 2010.



For more information, including supporting documentation, please see: http://www.cms.gov/AcuteInpatientPPS/IPPS2010/list.asp



Note: More information about the proposed rule, including the documentation and coding adjustment and the RHQDAPU changes and HACs discussion, can be found in Fact Sheets on our Web page at: www.cms.hhs.gov/apps/media/fact_sheets.asp.



To read the CMS Press release issued on 4/19/10 click here: http://www.cms.gov/apps/media/press_releases.asp

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



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.

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