Medicare Information - 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. CMS Announces Series of Nationwide RAC 101 Calls



3. New from the Medicare Learning Network



4. Update to Guidance on Standardized Medigap Policy (Plan N)



5. Press Release -- Four States (MO, NM, OR, WA) & PR to Receive Federal Matching Funds for Electronic Health Record Incentives Program



6. Healthcare Common Procedural Coding System (HCPCS) Public Meeting Agendas for Supply and Other and Orthotics and Prosthetics



7. Inpatient Psychiatric Facilities Prospective Payment System Payment - Update for Rate Year Beginning July 1, 2010 (RY 2011)



8. Pricer Updates for Inpatient PPS Personal Computer, Skilled Nursing Facility, and Inpatient Rehabilitation Facility PPS



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.



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. New from the Medicare Learning Network



The April 2010 Edition of the Medicare Learning Network (MLN) Catalog of Products is now available and may be accessed at http://www.cms.gov/MLNproducts on the CMS website. The MLN Products Catalog is an interactive downloadable document that lists all Medicare Learning Network products by media format. The catalog has been revised to provide new customer-friendly links that are embedded within the document. All product titles and the word "download" when selected, will link you to the online version of the product. The word "hard copy" when selected, will automatically link you to the MLN Product Ordering page. To access the catalog, click on the link called MLN Product Catalog.

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The revised Rehabilitation Therapy Information Resource for Medicare Fact Sheet (April 2010) is now available in downloadable format from the Centers for Medicare & Medicaid Services’ Medicare Learning Network at http://www.cms.gov/MLNProducts/downloads/Rehab_Therapy_Fact_Sheet.pdf on the CMS website. This fact sheet provides guidance and resources related to rehabilitation therapy services, coverage requirements, and payment systems.

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The revised “Clinical Laboratory Fee Schedule Fact Sheet” (January 2010), which provides general information about the Clinical Laboratory Fee Schedule, coverage of clinical laboratory services, and how payment rates are set, is now available in print format from the Centers for Medicare & Medicaid Services Medicare Learning Network. To place your order, visit http://www.cms.gov/MLNGenInfo , scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page.”

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4. Update to Guidance on Standardized Medigap Policy (Plan N)



CMS recently issued guidance on a new standardized Medigap policy (Plan N) that will become effective June 1, 2010. Based on inquiries received from the provider community since the guidance was released, we have made several clarifying changes which have resulted in the original guidance being replaced with the attached.



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5. Press Release -- Four States (MO, NM, OR, WA) & PR to Receive Federal Matching Funds for Electronic Health Record Incentives Program



MEDICAID NEWS

FOR IMMEDIATE RELEASE Contact: CMS Office of Media Affairs

April 26, 2010 (202) 690-6145





Four States (MO, NM, OR, WA) and Puerto Rico 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).



EHRs will improve the quality of health care for the citizens of the recipient states and Puerto Rico 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 we began in November 2009. To date, including these latest matching funds, we will have awarded a total of $58.38 million to 35 states, Puerto Rico, and the U.S. Virgin Islands.



Missouri: $1.53 million

New Mexico: $405,000

Oregon: $3.53 million

Puerto Rico: $1.80 million

Washington: $967,000



Subtotal: $8.23 million



Total awards to date: $58.38 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 releases issued today (4/26) are available at: https://www.cms.hhs.gov/apps/media/press_releases.asp.

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6. Healthcare Common Procedural Coding System (HCPCS) Public Meeting Agendas for Supply and Other and Orthotics and Prosthetics



The Centers for Medicare & Medicaid Services is pleased to announce the scheduled release of the May 25, 26, 27, 2010 HCPCS Public Meeting Agendas for Supply and Other and Orthotics and Prosthetics. These documents and the links 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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7. Inpatient Psychiatric Facilities Prospective Payment System Payment - Update for Rate Year Beginning July 1, 2010 (RY 2011)



CMS-1424-N published at the Office of the Federal Register on April 30, 2010. This notice updates the payment rates for the Medicare prospective payment system (PPS) for inpatient psychiatric hospital services provided by inpatient psychiatric facilities (IPFs). These changes are applicable to IPF discharges occurring during the rate year beginning July 1, 2010 through June 30, 2011. We are also responding to comments on the IPF PPS teaching adjustment and the market basket, which we received in response to our May 2009 IPF PPS notice with request for comments. To view this notice, go to (http://www.cms.gov/InpatientPsychFacilPPS/IPFPPSRN/itemdetail.asp?itemID=CMS1235018).

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8. Pricer Updates for Inpatient PPS Personal Computer, Skilled Nursing Facility, and Inpatient Rehabilitation Facility 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 corrected 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 corrected 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 with the revised Provider data.



Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) Personal Computer (PC) Pricer Updates



The FY 2010 Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) PC Pricer has been updated with April provider data and calculation logic for the Health Care Reform Act. The PC Pricer is 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 Pricer, please go to the page above and download the latest version of the 2010 Pricer, posted 4/28/10, in the Downloads section.



Rate Year (RY) 2010 Inpatient Psychiatric Facility Prospective Payment System (PPS) Personal Computer (PC) Pricers Updated



The Inpatient Psychiatric Facility (IPF) PPS PC Pricer for RY 2010 has been updated with April 2010 provider data. The version for RY 2010 has been made available on the CMS website. If you use the IPF PPS PC Pricer for RY 2010, please go to the page, http://www.cms.hhs.gov/PCPricer/09_inppsy.asp, and download the latest versions of the IPF PPS 2010 PC Pricer, posted 04/28/2010.

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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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