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. The Continuing Extension Act of 2010 Extends Zero Percent Medicare Physician Fee Schedule (MPFS) Update



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



5. April 21, 2010 Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) Webinar Available



6. April 2010 Quarterly Provider Specific File Update



7. Nursing Home Five-Star Quality Rating System – April News



8. New from the Medicare Learning Network



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 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. The Continuing Extension Act of 2010 Extends Zero Percent Medicare Physician Fee Schedule (MPFS) Update



On April 15, 2010, President Obama signed into law the “Continuing Extension Act of 2010.” This law extends through May 31, 2010, the zero percent update to the MPFS that was in effect for claims with dates of service January 1, 2010 through March 31, 2010. The law is retroactive to April 1, 2010. Consequently, effective immediately, claims with dates of service April 1 and later, which were being held by Medicare contractors, are being released for processing and payment. Please keep in mind that the statutory payment floors still apply and, therefore, clean electronic claims cannot be paid before 14 calendar days after the date they are received by Medicare contractors (29 calendar days for clean paper claims).



Given the uncertainty regarding MPFS claims with dates of service June 1, 2010, and later, please watch your listservs and your contractor’s website for more information.

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



5010: Taking EDI to the Next Level





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. 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

If you have trouble accessing this link, copy and paste it into your web browser.



2. Fill in all required data.



3. Verify your time zone is displayed correctly the drop down box.



4. Click "Register".



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.

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5. April 21, 2010 Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) Webinar Available



The Centers for Medicare & Medicaid Services (CMS) has called a public meeting of the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) on Wednesday, April 21, 2010. The Committee generally provides advice and recommendations concerning the adequacy of scientific evidence needed to determine whether certain medical items and services can be covered under the Medicare statute. This meeting will examine currently available evidence on the use of Radiation Therapy for Localized Prostate Cancer. This meeting is open to the public in accordance with the Federal Advisory Committee Act (5 U.S.C. App. 2, section 10(a)).

CMS is hosting a webinar for this meeting. Webinar participants will be able to view presentations and will be connected to live audio. However, live video will not be streamed. Attendance is limited and requires registration. Registration will be closed at 5pm eastern time on April 19, 2010. Participants should be advised that the webinar is a listening only session; that is, no questions or interactions will be permitted and all lines will be muted.

Date: Wednesday, April 21, 2010
Time: 7:50am -8:00am, Eastern (Webinar Login)
8:00am-4:30pm, Eastern (Live MEDCAC Meeting)

Please register by going to this link (there is no cost to register):

https://webinar.cms.hhs.gov/_a7/medcacprostate421/event/registration.html

You will be required to develop a password. Passwords must be 8-32 characters, and contain at least one capital letter and one number.

Thank you,
The MEDCAC Team

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6. April 2010 Quarterly Provider Specific File Update



The April 2010 quarterly Provider Specific Files (PSF) SAS data files are now available on the CMS website at: http://www.cms.gov/ProspMedicareFeeSvcPmtGen/04_psf_SAS.asp in the Downloads section. If you use the Provider Specific SAS File data, please go to the page above and download the latest version of the PSF Files. Note: These are the quarterly data sets for the Provider Specific Data for Public Use in SAS Format.



The April 2010 quarterly Provider Specific Files (PSF) Text data files are now available on the CMS website at: http://www.cms.gov/ProspMedicareFeeSvcPmtGen/03_psf_text.asp in the Downloads section. If you use the Provider Specific Text File data, please go to the page above and download the latest versions of the PSF Files. Note: These are the quarterly data sets for the Provider Specific Data for Public Use in text format.

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7. Nursing Home Five-Star Quality Rating System – April News



1. The Five-Star provider preview reports will be available no later than Friday, April 16, 2010. 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. The helpline will be available from April 14 - 29, 2010 for questions and concerns about the April data. Alternatively, providers can write to BetterCare@cms.hhs.gov.

3. Nursing Home Compare will update with April’s Five-Star data on Thursday, April 22, 2010.

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

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8. New from the Medicare Learning Network



The Medicare Fraud and Abuse Web-based Training Course has been revised and is now available - The course provides information helpful for Medicare providers and suppliers involved in providing and billing for services to people with Medicare. This activity provides information that will increase awareness of Medicare fraud and abuse; provide information regarding correct billing practices, and help Medicare providers, suppliers and staff to file claims correctly. The course offers continuing education credits; please see the course description page for details. To access the course, go to the MLN Products page at http://www.cms.gov/MLNProducts/ , and select the web-based training modules link in the "Related Links Inside CMS" section. Once the web-based training courses page is displayed, select the Medicare Fraud and Abuse WBT from the list provided.

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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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