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. Medicare and Medicaid Programs; Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements; and Changes in Provider Agreements



2. 2010 Physician Quality Reporting Initiative & Electronic Prescribing Incentive Program National Provider Call with Question & Answer Session



3. Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Resource Utilization Group-Version 4 (RUG-IV) National Provider Call with Question & Answer Session



4. REMINDER-- ICD-10 Implementation in a 5010 Environment National Provider Conference Call



5. Your ICD-10 Updates



6. New from the Medicare Learning Network



7. June 6 is National Cancer Survivors Day



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











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1. Medicare and Medicaid Programs; Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements; and Changes in Provider Agreements



The Centers for Medicare & Medicaid Services (CMS), HHS published the interim final rule (IRF) with comment period titled Medicare and Medicaid Programs; Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements; and Changes in Provider Agreements. To view the IRF in its entirety, please click on the following link: http://edocket.access.gpo.gov/2010/2010-10505.htm.



This IRF with comment period implements several provisions set forth in the Patient Protection and Affordable Care Act (Affordable Care Act). It implements the provision which requires all providers of medical or other items or services and suppliers that

qualify for a National Provider Identifier (NPI) to include their NPI on all applications to enroll in the Medicare and Medicaid programs and on all claims for payment submitted under the Medicare and Medicaid programs. This interim final rule with comment period also requires physicians and eligible professionals to order and refer covered items

and services for Medicare beneficiaries to be enrolled in Medicare. In addition, it adds requirements for providers, physicians, and other suppliers participating in the Medicare program to provide documentation on referrals to programs at high risk of waste and abuse, to include durable medical equipment, prosthetics, orthotics and supplies (DMEPOS), home health services, and other items or services specified by the Secretary.



Instructions to submit your comments are included in the first page of the IRF. To be assured consideration, comments must be received at one of the addresses provided the IRF, no later than 5 p.m. on July 6,2010.

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2. 2010 Physician Quality Reporting Initiative & Electronic Prescribing Incentive Program National Provider Call with Question & Answer Session



The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host a national provider conference call on the 2010 Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (eRx). This toll-free call will take place from 1:30 p.m. – 3:00 p.m., EDT, on Tuesday, June 22, 2010.



The PQRI is voluntary quality reporting program that provides an incentive payment to identified individual eligible professionals (EPs), and beginning with the 2010 PQRI, group practices who satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-For-Service (FFS) beneficiaries.

The PQRI was first implemented in 2007 as a result of section 101 of the Tax Relief and Health Care Act of 2006 (TRHCA), and further expanded as a result of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), and the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).



The eRx Incentive Program is an incentive program for eligible professionals initially implemented in 2009 as a result of section 132(b) of the MIPPA. The eRx Incentive Program promotes the adoption and use of eRx systems by individual eligible professionals (and beginning with the 2010 eRx Incentive Program, group practices).



Following a few program announcements and updates, the lines will be opened to allow participants to ask questions of CMS PQRI and eRx subject matter experts.



Educational products are available on the PQRI dedicated web page located at, http://www.cms.hhs.gov/PQRI , on the CMS website, in the Educational Resources section, as well as educational products are available on the eRx dedicated web page located at http://www.cms.hhs.gov/ERxIncentive on the CMS website. Feel free to download the resources prior to the call so that you may ask questions of the CMS presenters.



Conference call details:



Date: June 22, 2010



Conference Title: Physician Quality Reporting Initiative (PQRI) - National Provider Call



Time: 1:30 p.m. EDT



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 1:30 p.m. ET on June 21, 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/062210



2. Fill in all required data.



3. Verify that your time zone is displayed correctly in 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.



6. 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.



For those of who will be unable to attend, a transcript and MP3 file of the call will be available at least one week after the call at http://www.cms.hhs.gov/pqri on the CMS website.

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3. Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Resource Utilization Group-Version 4 (RUG-IV) National Provider Call with Question & Answer Session



The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host a national provider conference call on the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Resource Utilization Group-Version 4 (RUG-IV). This toll-free call will take place from 1:30 p.m. – 3:00 p.m., EDT, on Wednesday, June 23, 2010.



This call will review key aspects of the SNF PPS case mix system, RUG-IV, which will be put into place ON AN INTERIM BASIS effective October 1, 2010. CMS subject matter experts will discuss coding procedures with emphasis on the appropriate “look-back” periods to be used when coding the Minimum Data Set (MDS) 3.0, and how facility staff should separately report individual, concurrent and group therapy for accurate payment. In addition, the call will discuss how changes to the ADL coding requirements impact the assignment of MDS 3.0 records to a RUG-IV group.



Two additional provider calls are being scheduled for August 2010 to explain other payment issues including the transition from RUG-III to RUG-IV and the additional changes needed to install a hybrid RUG-III grouper (HR-III) mandated by statute.



A PowerPoint slide presentation will be posted to the SNF PPS webpage at, http://www.cms.gov/SNFPPS/02_Spotlight.asp on the CMS website for you to download prior to the call so that you can follow along with the presenters. Following the formal presentation, callers will have an opportunity to ask questions of CMS subject matter experts.



Conference call details:



Date: June 23, 2010



Conference Title: Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Resource Utilization Group-Version 4 (RUG-IV)



Time: 1:30 p.m. EDT



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 1:30 p.m. EDT on June 22, 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/062310



2. Fill in all required data.



3. Verify that your time zone is displayed correctly in 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.



6. 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.



For those of who will be unable to attend, a transcript and MP3 audio file of the call will be available at least one week after the call at http://www.cms.gov/SNFPPS/02_Spotlight on the CMS website.

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4. REMINDER-- ICD-10 Implementation in a 5010 Environment National Provider Conference Call



The Centers for Medicare & Medicaid Services (CMS) will host a national provider conference call on "ICD-10 Implementation in a 5010 Environment". This toll-free teleconference will focus on ICD-10 implementation issues; proposals to partially freeze code updates; implementation of 5010 updates, including when 5010 will be implemented, who will be impacted by 5010 updates, and advice for providers in moving toward 5010 implementation. Subject matter experts will review basic information on both ICD-10 and 5010 and explain how they are interrelated. A question and answer session will follow the presentation.



When: Tuesday, June 15, 2010

Time: 12:00 p.m. – 2:00 p.m. ET

Target Audience: Medical coders, physician office staff, provider billing staff, health records staff, vendors, educators, system maintainers and all Medicare fee-for-service (FFS) providers

For more information and to register for this informative conference call, please go to http://www.cms.gov/ICD10/02c_CMS_Sponsored_Calls.asp#TopOfPage on the CMS website. Registration for this call will close at 12:00 p.m. ET on June 14, 2010, or when available space has been filled. Please register today.

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5. Your ICD-10 Updates



ICD-10 Implementation in a 5010 Environment

National Provider Conference Call

The Centers for Medicare & Medicaid Services (CMS) will host a national provider conference call on "ICD-10 Implementation in a 5010 Environment".

When: Tuesday, June 15, 2010

Time: 12:00 p.m. – 2:00 p.m. ET

Target Audience: Medical coders, physician office staff, provider billing staff, health records staff, vendors, educators, system maintainers and all Medicare fee-for-service (FFS) providers

The following topics will be discussed:

ICD-10

ICD-10 implementation for services provided on and after October 1, 2013
Benefits of ICD-10
Differences between ICD-10 and ICD-9-CM codes
Tools for converting codes – General Equivalence Mappings (GEMs)
Proposal to freeze ICD-9-CM and ICD-10 code updates except for new technologies and diseases
HIPAA Version 5010

General Overview HIPAA version 5010 and D.0 and who is impacted
Compliance dates
Benefits
5010 scope versus ICD-10 Scope
What you need to do to prepare
Timelines
Medicare FFS implementation of HIPAA version 5010 and D.0
Impact on paper claim forms
This toll-free teleconference will include a question and answer session. For more information and to register for this informative conference call, please go to http://www.cms.gov/ICD10/02c_CMS_Sponsored_Calls.asp#TopOfPage on the CMS website. Registration for this call will close at 12:00 p.m. ET on June 14, 2010, or when available space has been filled. No exceptions will be made. Please register as early as possible.





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New Frequently Asked Questions (FAQs) on ICD-10 Implementation



The Centers for Medicare & Medicaid Services (CMS) has posted on its website 11 new frequently asked questions (FAQ) about the ICD-10 Implementation.



To access these FAQs, please visit the CMS ICD-10 web page at, http://www.cms.gov/ICD10/, select the Medicare Fee-for-Service Provider Resources link on the left side of the page, scroll down the page to the “Related Links Inside CMS” section and select “ICD-10 FAQs”.



Please check the ICD-10 FAQ section regularly for newly posted or updated ICD-10 FAQs.

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6. New from the Medicare Learning Network



The Medicare Preventive Services Resources CD, which contains PDF files of our Medicare Preventive Services educational products on a single convenient CD Rom, is now available for order through the Medicare Learning Network—free of charge!

The CD includes the following products:

· The Guide to Medicare Preventive Services for Physicians, Providers, Suppliers, and Other Health Care Professionals,

· All 3 Quick Reference Billing Charts (Medicare Preventive Services, The ABCs of the IPPE, and Medicare Immunization Billing), and

· All 7 brochures (Adult Immunization, Bone Mass Measurements, Cancer Screenings, Diabetes-Related Services, Expanded Benefits, Glaucoma Screening, and Smoking and Tobacco-Use Cessation Counseling Services).

To order a free copy of the CD, please visit the Preventive Services Educational Products page at http://www.cms.gov/MLNProducts/35_PreventiveServices.asp on the CMS website. Scroll down to the “Related Links Inside CMS” section and click on “MLN Product Ordering”.



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JUST RELEASED: MLN Matters Article #SE1017 - Preparing for a Transition from an FI/Carrier to a Medicare Administrative Contractor (MAC) or From One Durable Medical Equipment (DME) MAC to Another DME MAC



The Centers for Medicare & Medicaid Services (CMS) has released MLN Matters Special Edition Article #SE1017 to assist all providers that will be affected by Medicare Administrative Contractor (MAC) implementations, or DME MAC transitions due to recompeting DME MAC Contracts. This article updates material contained in MLN Matters Article #SE0837, which was originally issued in November 2008, to reflect current experiences with transitions to a MAC. For more details, please read the article at http://www.cms.gov/MLNMattersArticles/downloads/SE1017.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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7. June 6 is National Cancer Survivors Day



In the spirit of National Cancer Survivors Day, the Centers for Medicare & Medicaid Services (CMS) reminds health care professionals that Medicare provides coverage for a variety of preventive services, including certain cancer screenings. By encouraging your patients with Medicare to take advantage of covered screenings, you can help them lead healthier lives.



Medicare Covered Cancer Screenings



Medicare provides coverage for the following cancer screenings for eligible Medicare beneficiaries:



· Screening mammographies,

· Screening pap tests,

· Screening pelvic exams,

· Colorectal cancer screening, and

· Prostate 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 the 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 The Cancer Screenings Brochure ~ This brochure provides coverage information on the Medicare-covered cancer screenings listed above.

http://www.cms.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 several Medicare-covered preventive services, including screening mammography, pap tests, and pelvic exams. To access the WBT, please visit the MLN homepage at: http://www.cms.gov/mlngeninfo Scroll down to “Related Links Inside CMS” and click on “WBT Modules”

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 Cancer Survivors Day, please visit the official website at http://www.ncsdf.org 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 cancer screenings covered by Medicare.

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8. 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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