A 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 Announces Series of Nationwide RAC 101 Calls



3. CMS Needs Your Help With the Medicare Contractor Provider Satisfaction Survey



4. CMS Issues final 2011 Payment Policies For Medicare Advantage and Prescription
Drug Plans



5. 2010 Part D Symposium



6. HITECH Update: Preparing Professionals for a Nationwide Health Care Transformation



7. Extension of Ambulance Add-Ons for Ambulance Services



8. HCPCS Public Meeting Agendas for Drugs, Biologicals and Radiopharmaceuticals



9. April is National Cancer Control Month



10. 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 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

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3. CMS Needs Your Help With the Medicare Contractor Provider Satisfaction Survey



Attention: All Physicians, Hospitals, Rural Health Clinics (RHCs), and Federally Qualified Health Centers (FQHCs) (and their designated Proxy Billing Agents) Selected to Participate in the 2010 Medicare Contractor Provider Satisfaction Survey (MCPSS)



CMS needs to hear from you!



· To date, the response rate for physicians, hospitals, RHCs, and FQHCs, randomly selected to participate in the 2010 MCPSS, and billing agents designated by providers as proxy respondents, is lower than expected.

· If you or your office received a letter inviting you to participate in this survey, or you have been designated by a provider as a proxy respondent, now is the time to give CMS your feedback on your satisfaction with the performance of the Medicare contractor that processes and pays your fee-for-service (FFS) Medicare claims.

· Your feedback is very important to the success of this survey, as you represent many other organizations similar in size, practice type, and geographical location.

· Completion of the survey is quick and easy – it only takes a few minutes of your time.

· To complete the survey or to designate a proxy respondent to complete the survey on your behalf, please call the MCPSS Provider Helpline at 1-800-835-7012 or send an email to mcpss@scimetrika.com. Someone on the MCPSS team will be happy to assist you.

· Approximately 30,000 Medicare FFS health care providers were randomly selected to participate in the 2010 survey; only those selected may participate. A new random sample is selected each year.

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

CMS urges you to take a few minutes today to complete and submit this important survey. Your feedback is needed now. Don’t delay. Please respond today!

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4. CMS Issues final 2011 Payment Policies For Medicare Advantage and Prescription
Drug Plans



Background: On April 5, 2010, the Centers for Medicare & Medicaid Services (CMS) announced the capitation rates for Medicare Advantage plans for 2011. The 2011 Rate Announcement was accompanied by the final 2011 Call Letter for Medicare Advantage (Part C) and Medicare prescription drug (Part D) plans.



CMS stated in the 2011 Advance Notice that, if new legislation was enacted after the Advance Notice was released, but before the Rate Announcement was published, changes would be incorporated into the Announcement. As required by Section 1102 of the Health Care and Education Reconciliation Act of 2010, the capitation rates for 2011 are the same as the capitation rates for 2010.



In previous years’ Rate Announcements, CMS included final estimates of the National Per Capita Growth Percentages (MA Growth Percentages) as well as tables summarizing the key assumptions that were used to develop the MA Growth Percentages. The final estimates of the MA Growth Percentages were used to trend the previous years’ capitation rates to the payment year. Given that the capitation rates for 2011 are the same as the capitation rates for 2010, the MA Growth Percentages have no relevance for the 2011 capitation rates. Therefore, this Rate Announcement does not include final estimates of the MA growth percentages or the associated key assumptions tables.



The Rate Announcement also contains the following key changes in response to this new legislation:



· CMS will not implement the new CMS-HCC and CMS-HCC ESRD dialysis and risk adjustment models or the recalibrated frailty factors in 2011.

· CMS will maintain the 2011 State ESRD rates at the 2010 amounts.

· As required by the Patient Protection and Affordable Care Act of 2010, CMS will calculate the government Part D premium subsidy amounts for low-income beneficiaries using plans’ basic part D premiums before the premiums are reduced by Part C rebates. This will help ensure that the premium subsidy in each Part D region provides low-income beneficiaries with a sufficient choice of plans for which they would incur no premium liability.



The Rate Announcement also contains a discussion of the provisions in the health reform legislation that begin to close the Part D coverage gap in 2011 and the effect of these provisions on plans’ Part D bids.



In addition to changes resulting from new legislation, the following key changes or updates have been made to the Advance Notice and draft Call Letter in response to public comments received from beneficiary advocacy groups, associations, Congressional agencies, members of the public, and health plans:



· CMS describes the methodology that will be used to adjust the ‘default’ risk scores for new enrollees to reflect the predicted costs of full risk enrollees in chronic care SNPs.

· CMS notes that for beneficiaries to receive reimbursement for clinical trial services, beneficiaries (or providers acting on their behalf) must notify their plan that they have received clinical trial services and provide documentation of the cost sharing incurred, such as a Medicare Summary Notice (MSN). CMS will explore ways that this information can be provided to plans in the future to alleviate the potential burden on beneficiaries.

· CMS states that, at this time, low-income beneficiaries who originally chose to enroll in their current plan will not be reassigned, but several methods to make beneficiaries more aware of their options are being considered. CMS will also continue to evaluate the merits of reassigning beneficiaries based on beneficiary drug utilization.

· CMS announces that we intend to issue a regulation proposing to authorize the release of Part C and Part D payment data.

Annual parameter updates to Medicare Part D benefits are unchanged (with the exception of a $10 increase in the Initial Coverage Limit).

Part D Benefit Parameters
2010
2011

Defined Standard Benefit



Deductible
$310
$310

Initial Coverage Limit
$2,830
$2,840

Out-of-Pocket Threshold
$4,550
$4,550

Minimum Cost-sharing for Generic/Preferred

Multi-Source Drugs in the Catastrophic Phase
$2.50
$2.50

Minimum Cost-sharing for Other Drugs in the

Catastrophic Phase
$6.30
$6.30

Retiree Drug Subsidy



Cost Threshold
$310
$310

Cost Limit
$6,300
$6,300


(Note: The changes from 2010 to 2011 are rounded to the closest appropriate unit)

The Final Rate Announcement and Call Letter can be viewed at: http://www.cms.hhs.gov/MedicareAdvtgSpecRateStats/ .

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5. 2010 Part D Symposium



The Centers for Medicare & Medicaid Services (CMS) would like to cordially thank you for attending the 2010 Part D Symposium on March 18, 2010. We received very positive feedback from participants and presenters. The Part D Symposium presentations are now available online under the download section at http://www.cms.hhs.gov/PrescriptionDrugCovGenIn/09_ProgramReports.asp#TopOfPage. We hope you found the symposium a valuable opportunity to discuss Medicare Part D trends and experiences with the community.

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6. HITECH Update: Preparing Professionals for a Nationwide Health Care Transformation



Preparing Professionals for a Nationwide Health Care Transformation

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

April 7, 2010

I know that health care providers are concerned about implementing new health information technology and finding professionals who can operate and maintain such systems. I know many clinicians are unsure how they will develop or strengthen their skill set to incorporate using health IT efficiently and effectively without jeopardizing their communication with patients during a clinical visit. It seems like a daunting transformation to clinicians themselves and, indeed, for our health care system overall. The HITECH Act recognized that the success of this health IT journey depends on people: people who are passionate about improving patient care, and who are supported in making those improvements.

To this end, the Department of Health and Human Services awarded $84 million to 16 institutions of higher education to fund the Health IT Workforce Development Program, which focuses on several key resources required to rapidly expand the availability of health IT professionals who will support broad adoption and use of health IT in the provider community. Those resources include:

· A community college training program to create a workforce that can facilitate the implementation and support of an electronic health care system

· Quality educational materials that institutions of higher education can use to construct core instructional programs

· A competency examination program to evaluate trainee knowledge and skills acquired through non-degree training programs

· Additional university programs to support certificate and advanced degree training


The Workforce Development Program is one of the best examples of the depth of thought behind the HITECH Act. We could spend many billions of dollars developing, incentivizing, and implementing health IT solutions, but without an effectively trained workforce, our efforts would fall short of their ultimate goal of improving patient care. These efforts, designed in collaboration with the National Science Foundation, Department of Education, and the Department of Labor, are estimated to reduce the shortfall of qualified health IT professionals by 85 percent.

I congratulate the Workforce Development Program awardees and look forward to working with them on this important initiative. Those who take advantage of professional training in health IT provided through award recipients will find opportunities for interesting, challenging, and important work. Not only do these opportunities represent new jobs, they represent promising careers in a growing sector of our economy.


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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7. Extension of Ambulance Add-Ons for Ambulance Services



On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA). PPACA Sections 3105 and 10311 impact certain ambulance payment provisions. It should be noted that PPACA Section 3105 establishes the implementation date as April 1, 2010. PPACA Section 10311 revises Section 3105 and changes the implementation date retroactive to January 1, 2010.



The PPACA extends increases in the ambulance fee schedule amounts for covered ground ambulance transports which originated in rural areas by 3 percent and for covered ground ambulance transports which originated in urban areas by 2 percent retroactive to January 1, 2010, through December 31, 2010. The new law similarly extends the provision for air ambulance services provided in any area that was designated as a rural area for purposes of making payments under the ambulance fee schedule for services furnished on December 31, 2006. Finally, the PPACA extends retroactive to January 1, 2010, and through December 31, 2010, Section 414 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 which established the super rural bonus.



The Centers for Medicare & Medicaid Services is working to expeditiously implement these three ambulance provisions of the PPACA. Be on the alert for more information about these ambulance provisions and their impact on your past and future claims. Further, be on the alert for more information pertaining to the Patient Protection and Affordable Care Act.

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8. HCPCS Public Meeting Agendas for Drugs, Biologicals and Radiopharmaceuticals



The Centers for Medicare & Medicaid Services is pleased to announce the scheduled release of the May 4 & 5, 2010 HCPCS Public Meeting Agendas for Drugs, Biologicals and Radiopharmaceuticals. These documents and the link for the corresponding public meeting registrations are located on the HCPCS website at http://www.cms.gov/MedHCPCSGenInfo/08_HCPCSPublicMeetings.asp .

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9. April is National Cancer Control Month



April is National Cancer Control Month. The Centers for Medicare & Medicaid Services (CMS) reminds health care professionals that Medicare provides coverage for certain cancer screenings. These screenings can help detect cancer in its earliest stages when outcomes are most favorable.



Medicare Covered Cancer Screenings



· Screening mammographies,

· Screening pap tests,

· Screening pelvic examination,

· Colorectal cancer screening, and

· Prostate cancer screening



For More Information



· CMS has developed a variety of educational products and resources to help health care professionals and their staff become familiar with coverage, coding, billing, and reimbursement for cancer screenings covered by Medicare.



o The Medicare Learning Network (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 Cancer Screenings Brochure ~ This brochure provides health care professionals with an overview of cancer screenings covered by Medicare. http://www.cms.hhs.gov/MLNProducts/downloads/Cancer_Screening.pdf.

o The Guide to Medicare Preventive Services for Physicians, Providers, Suppliers and Other Health Care Professionals ~ This comprehensive resource contains coverage, coding, and payment information for the many preventive services covered by Medicare, including cancer screenings. http://www.cms.hhs.gov/MLNProducts/downloads/mps_guide_web-061305.pdf

o Quick Reference Information: Medicare Preventive Services ~ This chart contains coverage, coding, and payment information for the many preventive services covered by Medicare, including cancer screenings, in an easy-to-use quick-reference format. http://www.cms.hhs.gov/MLNProducts/downloads/MPS_QuickReferenceChart_1.pdf

o The Medicare Preventive Services Series: Part 3 Web-Based Training Course (WBT) ~ This WBT includes lessons on coverage, coding, and billing for Medicare-covered cancer screenings. To access the WBT, please visit the MLN homepage at: http://www.cms.hhs.gov/mlngeninfo Scroll down to “Related Links Inside CMS” and click on “WBT Modules”

o To order hard copies of certain MLN products, including the Cancer Screenings brochure and the Quick Reference Information chart, please visit the MLN homepage at: http://www.cms.hhs.gov/mlngeninfo Scroll down to “Related Links Inside CMS” and click on “MLN Product Ordering Page”



· For more information about National Cancer Control Month, please visit the American Cancer Society’s homepage at www.cancer.org





Thank you for helping CMS improve the health of patients with Medicare by joining in the effort to educate eligible beneficiaries about the importance of taking advantage of cancer screening services and other preventive services covered by Medicare.

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10. 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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