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. Reminder: Sixth National Education Call on Medicare Fee-For-Service (FFS) Implementation of HIPAA Version 5010 and D.0 Transactions



2. 2010 Physician Quality Reporting Initiative (PQRI) Program Update



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



4. Nursing Home Five-Star Quality Rating System - May News



5. New from the Medicare Learning Network



6. May 26 is National Senior Health and Fitness Day!



7. A new "twist" in the law makes it easier to save on your prescription drug costs.











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1. Reminder: Sixth National Education Call on Medicare Fee-For-Service (FFS) Implementation of HIPAA Version 5010 and D.0 Transactions



Medicare FFS 5010 Program: Taking EDI to the Next Level



May 26, 2010

2:00pm - 3:30pm EST



The Centers for Medicare & Medicaid Services (CMS) will host its sixth national education call regarding Medicare FFS’s implementation of HIPAA Version 5010 and D.0 transaction standards. This session will focus on the 837 Professional claim transaction. Subject matter experts will review Medicare FFS specific changes as well as general information to help the audience prepare for the transition, which will be followed by a Q&A session. The presentation will be available on the CMS website within 24 hours of the call. To access the presentation, click on the following link and scroll down to the Downloads section: http://www.cms.gov/Versions5010andD0/40_Educational_Resources.asp



Target Audience: Vendors, clearinghouses, and providers who will need to make Medicare FFS specific changes in compliance with HIPAA version 5010 requirements.



Registration will close at 2:00 p.m. EST on May 25, 2010 or when available space has been filled.



Subject: Medicare Fee-For-Service (FFS) Implementation of HIPAA Version 5010 837 Professional Claim Transaction



Agenda:

· General Overview

· Medicare Specific Changes

· Timelines and Deadlines

· What you need to do to prepare

· Transaction Specific Issues

· Q & A





Conference call details:



Date: May 26, 2010

Conference Title: Sixth National Education Call on Medicare Fee-For-Service (FFS) Implementation of HIPAA Version 5010 and D.0 Transactions



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 May 25, 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/052610



2. Fill in all required data.



3. Verify that 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.



If assistance for hearing impaired services is needed the request must be sent to medicare.ttt@palmettogba.com no later than 3 business day before the event.

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2. 2010 Physician Quality Reporting Initiative (PQRI) Program Update



2010 Physician Quality Reporting Initiative (PQRI) Program Update



It is not too late to start participating in the 2010 Physician Quality Reporting Initiative (PQRI) and potentially qualify to receive incentive payments. A new six month reporting period begins on July 1, 2010.



The 2010 Physician Quality Reporting Initiative (PQRI) has two reporting periods: 12-months (January 1-December 31, 2010) and 6-months (July 1-December 31, 2010). For 2010, eligible professionals (EPs) who satisfactorily report PQRI measures for the 6-month reporting period will become eligible to receive a PQRI incentive equal to 2.0% of their total Medicare Part B allowed charges for services performed during the reporting period.



If you have not participated in the PQRI program, you can begin by reporting PQRI data for July 1-December 31, 2010 using any of the following four options:



· Claims-based reporting of individual measures for 80% or more of applicable patients on at least 3 individual measures or on each measure if less than 3 measures apply

· Claims-based reporting of one measures group for 80% or more of applicable Medicare Part B FFS patients of each EP (with a minimum of 8 patients)

· Registry-based reporting of at least 3 individual PQRI measures for 80% or more of applicable Medicare Part B FFS patients of each EP

· Registry-based reporting of one measures group for 80% or more of applicable Medicare Part B FFS patients of each EP (with a minimum of 8 patients)



PQRI claims-based reporting involves the addition of quality-data codes (QDC) to claims submitted for services when billing Medicare Part B. EPs also have the option of using a qualified registry to assist in collecting PQRI measure data. The registry will submit this quality data directly to Medicare, eliminating the need for adding QDCs to the Medicare Part B claim.



Eligible professionals do not need to sign up or pre-register to participate in the 2010 PQRI. Submission of QDCs for individual PQRI measures to CMS through a qualified registry or for a measures group through claims or a qualified registry will indicate intent to participate.



Although there is no requirement to register prior to submitting the data, there are some preparatory steps that EPs should take prior to undertaking PQRI reporting. CMS has created many educational products that provide information about how to get started with PQRI reporting. To access all available educational resources on PQRI please visit, http://www.cms.hhs.gov/PQRI/ on the CMS website. Eligible professionals are encouraged to visit the PQRI webpage often for the latest information and downloads on PQRI.



Resources

2010 PQRI Implementation Guide at http://www.cms.gov/PQRI/Downloads/2010_PQRI_ImplementationGuide_02-10-2010_FINAL.pdf
· Qualified Registries for 2010 PQRI Reporting at

http://www.cms.gov/PQRI/20_AlternativeReportingMechanisms.asp#TopOfPage

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



There Is No ‘One-Size-Fits-All’ in Building a Nationwide Health Information Network

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

May 14, 2010

Private and secure health information exchange enables information to follow the patient when and where it is needed for better care. The Federal government is working to enable a wide range of innovative and complementary approaches that will allow secure and meaningful exchange within and across states, but all of our efforts must be grounded in a common foundation of standards, technical specifications, and policies. Our efforts must also encourage trust among participants and provide assurance to consumers about the security and privacy of their information. This foundation is the essence of the Nationwide Health Information Network (NHIN).

The NHIN is not a network per se, but rather a set of standards, services, and policies that enable the Internet to be used for the secure exchange of health information to improve health and health care. Different providers and consumers may use the Internet in different ways and at different levels of sophistication. To make meaningful use possible, including the necessary exchange of information, we need to meet providers where they are, and offer approaches that are both feasible for them and support the meaningful use requirements of the Centers for Medicare & Medicaid Services (CMS) Electronic Health Record Incentives Programs. As with the Internet, it is likely that what is today considered “highly sophisticated” will become common usage. Moreover, users may engage in simpler exchange for some purposes and more complex exchange for others.

Current NHIN exchange capabilities are the result of a broad and sustained collaboration among Federal agencies, large provider organizations, and a variety of state and regional health information organizations that all recognized a need for a high level of interoperable health information exchange that avoided “one-off” approaches. Based on this pioneering work, a subset of these organizations is now actively exchanging information. This smaller group currently includes the Department of Defense, Social Security Administration, Veterans Health Administration, Kaiser Permanente, and MedVirginia. They initially came together to show, on a pilot scale, that this type of highly evolved exchange was possible. Having succeeded, they continue to expand the level of exchange among their group and with their own respective partners in a carefully phased way to demonstrate and learn from these widening patterns of exchange. The robust exchange occurring at this level has several key attributes, including the:

1. Ability to find and access patient information among multiple providers;

2. Support for the exchange of information using common standards; and

3. Documented understanding of participants, enabling trust, such as the Data Use and Reciprocal Support Agreement (DURSA).

Not every organization and provider, however, needs or is ready for this kind of health information exchange today. Nor do the 2011 meaningful use requirements set forth by CMS in the recent proposed rule require it. Direct, securely routed information exchange may meet the current needs of some providers for their patients and their practices, such as receiving lab results or sending an electronic prescription.

To enable a wide variety of providers – from small practices to large hospitals – to become meaningful users of electronic health records in 2011, we need to ensure the availability of a reliable and secure “entry level” exchange option that aligns with the long-range information exchange vision we have for our nation. Such an option should balance the need for a consistent level of interoperability and security across the exchange spectrum with the reality that not all users are at the same point on the path to comprehensive interoperability. In an effort to provide the best customer service possible, the Office of the National Coordinator for Health IT (ONC) will consider what a complete toolkit would be for all providers who want to accomplish meaningful health information exchange.

Broadening the use of the NHIN to include a wider variety of providers and consumers who may have simpler needs for information exchange, or perhaps less technically sophisticated capabilities, is critical to bolstering health information exchange and meeting our initial meaningful use requirements. Building on the solid foundation established through the current exchange group mentioned above and the recommendations of the HIT Policy Committee (which originated with the Committee’s NHIN Workgroup), ONC is exploring this expansion of NHIN capabilities to find solutions that will work across different technologies and exchange models.

The newly launched NHIN Direct Project is designed to identify the standards and services needed to create a means for direct electronic communication between providers, in support of the 2011 meaningful use requirements. It is meant to enhance, not replace, the capabilities offered by other means of exchange. An example of this type of exchange would be a primary care physician sending a referral and patient care summary to a specialist electronically.

We are on an aggressive timeline to define these specifications and standards and to test them within real-world settings by the end of 2010. Timing is critical so that we may provide this resource to a broader array of participants in health information exchange as a wave of new, meaningful users prepare to qualify for incentives provided for in the HITECH Act and ultimately defined by CMS. This model for exchange will meet current provider needs within the broader health care community, complement existing NHIN exchange capabilities, and strengthen our efforts toward comprehensive interoperability across the nation.

A natural evolution in NHIN capabilities to support a variety of health information exchange needs is being reinforced by trends that are leading us toward widespread multi-point interoperability. The current movement toward consolidation in health care, coupled with health reform’s encouragement of bundled payments for coordinated care, will mean more providers need it. Quality improvement, public health, research, and a learning health care system all require it. Ultimately, simple exchange will be part of a package of broader functions that allows any provider, and ultimately consumers, to exchange information over the Internet, enabled by NHIN standards, services, and policies.

Your continued input will help guide us toward and maintain a direction that is in harmony with the rapid innovations in health IT today. The NHIN Direct Project will conduct an open, transparent, and collaborative process throughout its development by using a community wiki, blogs, and open source implementation already available on the project’s website (http://nhindirect.org). I encourage you to participate through the website, via public participation at the implementation group meetings, and by deploying and testing the resulting standards and specifications. For those of you who are participants in the current exchange group, I urge you to take every opportunity to share your experiences. Lessons learned from the NHIN Direct Project and the exchange group will inform the evolution of the NHIN as new uses and users come forward, and as continued innovation occurs to meet the growing needs of our community.

As we head into the next stage in the development of nationwide health information exchange, we should all take a moment to reflect on how far we have come and evaluate our plans for the future. ONC is committed to providing resources and guidance to stakeholders at all levels of exchange through HITECH programs, such as the Health IT Regional Extension Centers, the national Health IT Research Center, and the State Health Information Exchange Program. As you assess your own needs for exchange, please take advantage of the many Federal resources available to you on the ONC website and the online resources of the programs mentioned above, as well as through the “NHIN University” education program hosted by our public-private partner, the National eHealth Collaborative.

We have done a great deal of work in the short period of time since the passage of the HITECH Act. We at ONC appreciate your willingness to stay engaged and involved in every step of our journey, and we look forward to our continuing collaboration to improve the health and well-being of our nation.

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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4. Nursing Home Five-Star Quality Rating System - May News



1. The Five-Star provider preview reports will be available no later than Tuesday, May 18, 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. BetterCare@cms.hhs.gov is available to address your Five Star Quality Rating system questions.

3. Nursing Home Compare will update with May’s Five-Star data on Thursday, May 27, 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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5. New from the Medicare Learning Network



JUST RELEASED: MLN Matters Article #SE1016 - Re-Assignment of Certain Providers to Jurisdiction 1 and Jurisdiction 4 Medicare Administrative Contractors (MACs)



The Centers for Medicare & Medicaid Services (CMS) has released MLN Matters Special Edition Article #SE1016 to clarify CMS' approach for assigning providers to MACs and to discuss the process of moving providers to MACs, as described in Change Requests (CRs) 5979, 6569, and 6902. For more details, please read the article at http://www.cms.gov/MLNMattersArticles/downloads/SE1016.pdf on the CMS website.



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REMINDER: The Centers for Medicare & Medicaid Services (CMS) has 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

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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6. May 26 is National Senior Health and Fitness Day!



May 26 is National Senior Health and Fitness Day! In the spirit of National Senior Health and Fitness Day, the Centers for Medicare & Medicaid Services (CMS) reminds health care professionals that Medicare provides coverage for a variety of preventive services. By encouraging your senior patients with Medicare to take advantage of covered preventive services, you can help them lead healthier lives.



Medicare Covered Preventive Services



Medicare provides coverage for the following preventive services for eligible Medicare beneficiaries:



· Abdominal Aortic Aneurysm Screening,

· Adult Immunizations,

· Bone Mass Measurements,

· Cancer Screenings,

· Cardiovascular Screenings,

· Diabetes-Related Services and Screenings,

· Glaucoma Screenings,

· Smoking and Tobacco-Use Cessation Counseling, and

· Initial Preventive Physical Examination.



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 the many preventive services and 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 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. 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 in an easy-to-use quick-reference format. http://www.cms.hhs.gov/MLNProducts/downloads/MPS_QuickReferenceChart_1.pdf

o The Preventive Services Educational Products PDF ~ This PDF document contains links to downloadable versions of the many products the MLN has available related to Medicare-covered preventive services, including brochures, quick reference guides, and more. http://www.cms.hhs.gov/MLNProducts/Downloads/education_products_prevserv.pdf

o To order hard copies of certain MLN products, 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 Senior Health and Fitness Day, please visit the official website at http://www.fitnessday.com/senior/index.htm on the internet.





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 the many preventive services covered by Medicare.

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7. 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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