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. The 2010 Medicare Contractor Provider Satisfaction Survey -- Time Is Running Out!!



3. Affordable Care Act – Provisions Impacting Outpatient Prospective Payment Systems (OPPS) Hospitals



4. Important message regarding Medicare's implementation of the Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act of 2010



5. Healthcare Common Procedural Coding System (HCPCS) Public Meeting Agenda for Durable Medical Equipment



6. Medicare’s Home Health Pay for Performance Demonstration Year 1 Incentive Payments Issued



7. Newly-Released MLN Matters Article Regarding Changes to Medicare Claims Submission Requirements



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. The 2010 Medicare Contractor Provider Satisfaction Survey -- Time Is Running Out!!



Time Is Running Out – Have You Responded?



Your opportunity to participate in the 2010 Medicare Contractor Provider Satisfaction Survey (MCPSS) is quickly coming to an end and the Centers for Medicare & Medicaid Services (CMS) still needs your feedback. If you or your office received notification from CMS that you were randomly selected to participate in the 2010 MCPSS, this is your last chance to respond before the survey closes. Your feedback is very important. The MCPSS is your opportunity to tell us about your satisfaction with the services you receive from the Medicare contractor that processes and pays your fee-for-service Medicare claims.



Completion of the survey is quick and easy. It only takes a few minutes of your time. To respond to the survey or to designate a proxy respondent to complete it on your behalf, please call the MCPSS Provider Helpline today at 1-800-835-7012, or send an email to mcpss@scimetrika.com. A representative from the MCPSS team will be happy to assist you.



We assure you we will not provide information that identifies you or your practice or facility to anyone outside the study team, except as required by law.



If you have already responded to the 2010 MCPSS, thank you. If you have not, don’t pass up this golden opportunity to let your voice be heard. Time is running out… please respond today!

Please Note: Only providers and suppliers who have been randomly selected and notified can participate in the 2010 MCPSS. 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, SE1005, at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE1005.pdf featuring the survey.

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3. Affordable Care Act – Provisions Impacting Outpatient Prospective Payment Systems (OPPS) Hospitals



On March 23, 2010, President Obama signed into law the Affordable Care Act (ACA). Section 3401(i) of the ACA imposes a 0.25 percentage point reduction to the OPPS market basket for Calendar Year (CY) 2010, effective for services furnished on or after January 1, 2010.



The Centers for Medicare & Medicaid Services is working to expeditiously implement Section 3401(i) of ACA. Providers will begin seeing payments under this provision in the late May/early June time frame. Be on the alert for more information about this provision and its impact on past and future claims.

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4. Important message regarding Medicare's implementation of the Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act of 2010



“On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act. One week later, on March 30, the President also signed into law the Health Care and Education Reconciliation Act of 2010. These two new laws have a significant impact on the Medicare program and many of the provisions have effective dates prior to this point in time. Over the past several weeks, the Centers for Medicare & Medicaid Services (CMS) has begun implementing various provisions of the new laws, including those with past effective dates. In addition to implementing these legislative changes, the Medicare Physician Fee Schedule is being updated to include certain corrections, retroactive to January 1, 2010, as prescribed in recently published notices in the Federal Register.



Once Medicare contractors have the new payment files in place, per the above, all claims going forward will be processed at the revised rates. However, we continue to work on the best way to address the many claims that are paid at the rates that were in place before the current corrections and updates are made. Please be on the alert for further information about how CMS will address past claims. Until then, providers should NOT resubmit previously-processed claims affected by the payment changes, as it is likely that these resubmissions may be denied as duplicate claims.”

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5. Healthcare Common Procedural Coding System (HCPCS) Public Meeting Agenda for Durable Medical Equipment



The Centers for Medicare & Medicaid Services is pleased to announce the scheduled release of the June 8, 2010 HCPCS Public Meeting Agenda for Durable Medical Equipment. This document and the link for the corresponding public meeting registration are located on the HCPCS website at http://www.cms.gov/MedHCPCSGenInfo/08_HCPCSPublicMeetings.asp.

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6. Medicare’s Home Health Pay for Performance Demonstration Year 1 Incentive Payments Issued



The Centers for Medicare & Medicaid Services (CMS) announced today that it is sharing more than $15 million in savings with 166 home health agencies (HHAs) based on their performance during the first year of the Medicare Home Health Pay for Performance (HHP4P) demonstration. The 2-year demonstration, which began in January 2008 and ended in December 2009, was undertaken to show the impact of financial incentives on the quality of care provided to home health patients in traditional fee-for-service Medicare and their overall Medicare costs. Savings in the program are being shared with agencies that either maintained high levels of quality or made significant improvements in quality of care. This demonstration is part of CMS' value-based purchasing initiative to improve the quality and efficiency of care furnished to Medicare beneficiaries.



All Medicare-certified home health agencies in seven states representing four U.S. census regions were invited to participate in the demonstration. The Northeast region included HHAs in Connecticut and Massachusetts, the South included HHAs in Alabama, Georgia, and Tennessee, and the Midwest and West regions included HHAs in Illinois and California, respectively. HHAs that volunteered were randomly assigned to either an intervention or control group. Performance was measured using seven home health quality measures that are computed from the Outcome-Based Quality Improvement (OBQI) data set and are currently publicly reported on the Home Health Compare Web site. Each measure evaluated the performance of the HHA’s for the quality and efficiency of care provided to traditional Medicare patients. Each HHA in the intervention group was compared only to other intervention agencies within the same state. For each measure, HHAs that ranked by performance in the top 20 percent in their state, as well as those demonstrating the greatest degree of quality improvement, were eligible to share in Medicare savings generated in their region.



Medicare savings for the demonstration were determined by comparing total Medicare costs for beneficiaries receiving care from the intervention group’s HHAs with the costs for beneficiaries served by the control groups HHAs in the same region. These costs include Medicare payments for home health care, inpatient hospital care, nursing home and rehabilitation facility care, outpatient care, physician care, durable medical equipment (DME), and hospice care. If no savings were generated in a region, no incentive payments were made in that region. Results for calendar year 2008, the first year of the demonstration, indicated an aggregate Medicare savings of $15.4 million for three of the four regions; the Midwest region did not achieve any savings.



Year 1 incentive payments are being made to 59 percent of the HHAs in the intervention group based on their performance and improvement on the seven various quality measures. In addition to the number of quality measures for which they qualify for an incentive payment, the amount of the incentive paid to an individual HHA is also based on the total number of Medicare patient days associated with that HHA. CMS will calculate savings and determine which HHAs are eligible for incentive payments for the second year of the demonstration, calendar year 2009, later this year. In addition, the demonstration is still being evaluated, with results expected later in 2010.



Additional background about this demonstration can be found at: http://www.cms.hhs.gov/DemoProjectsEvalRpts/MD/itemdetail.asp?itemID=CMS1189406 .



Questions may be submitted to CMS at: hhp4p@cms.hhs.gov .

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7. Newly-Released MLN Matters Article Regarding Changes to Medicare Claims Submission Requirements



JUST RELEASED: MLN Matters Article #MM6960 - Systems Changes Necessary to Implement the Patient Protection and Affordable Care Act (PPACA) Section 6404 – Maximum Period for Submission of Medicare Claims Reduced to Not More Than 12 Months



The Centers for Medicare & Medicaid Services (CMS) has released MLN Matters Article #MM6960 to advise providers who submit claims to Medicare contractors that, as a result of the Affordable Care Act (ACA), claims with dates of service on or after January 1, 2010, received later than one calendar year beyond the date of service will be denied by Medicare. For more details, please read the article at http://www.cms.gov/MLNMattersArticles/downloads/MM6960.pdf on the CMS website.

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8. New from the Medicare Learning Network



JUST RELEASED: MLN Matters Article #MM6960 - Systems Changes Necessary to Implement the Patient Protection and Affordable Care Act (PPACA) Section 6404 – Maximum Period for Submission of Medicare Claims Reduced to Not More Than 12 Months



The Centers for Medicare & Medicaid Services (CMS) has released MLN Matters Article #MM6960 to advise providers who submit claims to Medicare contractors that, as a result of the Affordable Care Act (ACA), claims with dates of service on or after January 1, 2010, received later than one calendar year beyond the date of service will be denied by Medicare. For more details, please read the article at http://www.cms.gov/MLNMattersArticles/downloads/MM6960.pdf on the CMS website.

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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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