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 Enrollment Guidance for Physicians that Infrequently Receive Reimbursement from the Medicare Program
2. CMS Announces Release Of New DMEPOS Competitive Bidding Program Fact Sheet For Referral Agents
3. Electronic Health Record (EHR) Incentive Program “Meaningful Use” Final Rule (CMS-0033-F)
4. Eighth National Education Call on Medicare Fee-For-Service (FFS) Implementation of HIPAA Version 5010 and D.0: 276/277 Status Inquiry and Response Paired Transaction
5. CMS Seeks Public Comments on Physician Quality Reporting Initiative (PQRI) Medications Measure: Comments Accepted through July 30, 2010
6. Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Resource Utilization Group-Version 4 (RUG-IV) National Provider Call with Questions & Answer Session
7. MLN Matters Article #SE1024 - Recovery Audit Contractor (RAC) Demonstration High-Risk Vulnerabilities – No Documentation or Insufficient Documentation Submitted
8. Updates from the Medicare Learning Network
9. Minimum Data Set (MDS) 3.0 Training Materials Updates – July 12, 2010
10. Now Available from CMS - The Written Transcript of the June 15 ICD-10 Implementation in a 5010 Environment Teleconference
11. July 2010 Quarterly Provider Specific File Update
12. Release of the Positive 2.2 Percent Update for the 2010 Medicare Ambulatory Surgical Center Files
13. Fiscal Year (FY) 2010 Inpatient (INP) PPS PC Pricers – July 2010 Provider Data Updates
14. A new "twist" in the law makes it easier to save on your prescription drug costs.
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1. Medicare Enrollment Guidance for Physicians that Infrequently Receive Reimbursement from the Medicare Program
Traditionally, most physicians have enrolled in the Medicare program to furnish covered services to Medicare beneficiaries. However, with the implementation of Section 6405 of the Affordable Care Act, some physicians will need to enroll in the Medicare program for the sole purpose of certifying or ordering services for Medicare beneficiaries. These physicians do not send claims to a Medicare contractor for the services they furnish.
In the process of implementing the provisions contained in the Affordable Care Act, CMS has become aware of several unique enrollment issues for certain types of physicians or practitioners. Specifically, CMS modified the process of enrollment to accommodate the special circumstances of the following individual physicians and practitioners:
• Physicians employed by the Department of Veterans Affairs
• Physicians employed by the Public Health Service
• Physicians employed by the Department of Defense Tricare program
• Physicians employed by Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) or Critical Access Hospitals (CAHs)
• Physicians in a Fellowship
• Dentists, including oral surgeons
For details on the modifications to the enrollment process for these special circumstances, visit the Special Enrollment Fact Sheet for Physicians with Infrequent Reimbursements on the CMS website.
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2. CMS Announces Release Of New DMEPOS Competitive Bidding Program Fact Sheet For Referral Agents
The Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program is scheduled to begin in nine competitive bidding areas (CBAs) on January 1, 2011. The competitive bidding program will offer beneficiaries in the designated CBAs access to quality DMEPOS products and services with lower out-of-pocket costs.
When the program starts, beneficiaries located in the CBAs must obtain these items from a contract supplier unless an exception applies. The Centers for Medicare & Medicaid Services (CMS) has offered contracts to DMEPOS suppliers to become contract suppliers in the nine CBAs. All suppliers being offered contracts went through a thorough vetting process, are licensed and accredited, and meet financial standards. This means that Medicare beneficiaries will continue to receive quality items and services from DMEPOS suppliers they can trust.
CMS expects to complete the contracting process in time to announce the contract suppliers in September 2010. Referral agents located in CBAs who prescribe DMEPOS for beneficiaries or refer beneficiaries to specific suppliers should be aware of which suppliers in the area are contract suppliers as well as other important referring information. Referral agents include such entities as Medicare enrolled providers, physicians, treating practitioners, discharge planners, social workers, and pharmacists who refer beneficiaries for services in a CBA.
More information for referral agents can be found in the new Medicare Learning Network® fact sheet located at…. http://www.cms.gov/DMEPOSCompetitiveBid/04_Educational_Resources.asp
For more general information about the DMEPOS Competitive Bidding Program, please visit http://www.cms.hhs.gov/DMEPOSCompetitiveBid on the CMS dedicated website.
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3. Electronic Health Record (EHR) Incentive Program “Meaningful Use” Final Rule (CMS-0033-F)
Today, CMS and ONC jointly announce their final rules for both electronic health record standards for certification and the Medicare and Medicaid EHR incentive programs, including the definition of meaningful use.
Under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, eligible health care professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt certified EHR technology and use it to achieve specified objectives. One of the two regulations announced today defines the “meaningful use” objectives that providers must meet to qualify for the bonus payments, and the other regulation identifies the technical capabilities required for certified EHR technology.
Announcement of today’s regulations marks the completion of multiple steps laying the groundwork for the incentive payments program. With “meaningful use” definitions in place, EHR system vendors can ensure that their systems deliver the required capabilities, providers can be assured that the system they acquire will support achievement of “meaningful use” objectives, and a concentrated five-year national initiative to adopt and use electronic records in health care can begin.
To read the Press Release issued today (7/13) click here: http://www.cms.gov/apps/media/press_releases.asp or http://www.hhs.gov/news/press/2010pres/2010.html
Also CMS Issued Fact Sheets (7/13) with additional details at: http://www.cms.gov/apps/media/fact_sheets.asp
To learn more about the Medicare and Medicaid EHR incentive programs, visit the CMS-dedicated website to this program, http://www.cms.gov/EHRIncentivePrograms/ . Here you’ll find information about eligibility, requirements, upcoming events and more. To learn more about electronic health records and certification standards, visit the HHS/ONC-website at http://healthit.hhs.gov/portal/server.pt . This website is the premier place to learn about the benefits of using EHR technology in a meaningful way, local resources to assist in EHR adoption and more.
And, be sure to attend our upcoming joint CMS & ONC training on the EHR incentive programs and certification on July 22 at 2:oo pm EST. More information can be found on the CMS website: http://www.cms.gov/EHRIncentivePrograms/.
Links to Rules via Federal Register:
http://www.ofr.gov/OFRUpload/OFRData/2010-17207_PI.pdf
http://www.ofr.gov/OFRUpload/OFRData/2010-17210_PI.pdf
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4. Eighth National Education Call on Medicare Fee-For-Service (FFS) Implementation of HIPAA Version 5010 and D.0: 276/277 Status Inquiry and Response Paired Transaction
Medicare FFS 5010 Program: Taking EDI to the Next Level
July 28, 2010
2:00pm To 3:30pm EST
The Centers for Medicare & Medicaid Services (CMS) will host its eighth national education call regarding Medicare FFS’s implementation of HIPAA Version 5010 and D.0 transaction standards on July 28, 2010. This session will focus on the 276/277 Status Inquiry and Response paired transaction. Subject matter experts will review Medicare FFS specific changes as well as general information to help the audience prepare for the transition; the presentation will be followed by a Q&A session. The presentation is available on the CMS website by clicking on the following link: http://www.cms.gov/Versions5010andD0/V50/list.asp - Please bookmark this new “5010 National Calls” web page.
Registration will close at 2:00 p.m. EST on July 27, 2010, or when available space has been filled.
Target Audience: Vendors, clearinghouses, and providers who will need to make Medicare FFS specific changes in compliance with HIPAA version 5010 requirements.
Subject: Medicare Fee-For-Service (FFS) Implementation of HIPAA Version 5010 276/277 Status Inquiry and Response Paired 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: July 28, 2010
Conference Title: Eighth 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 July 27, 2010, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
To register for the call participants need to go to:
http://www.eventsvc.com/palmettogba/072810
Fill in all required data.
Verify your time zone is displayed correctly the drop down box.
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.
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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5. CMS Seeks Public Comments on Physician Quality Reporting Initiative (PQRI) Medications Measure: Comments Accepted through July 30, 2010
The Centers for Medicare & Medicaid Services (CMS) has contracted with Quality Insights of Pennsylvania to develop and maintain quality measures for the Physician Quality Reporting Initiative (PQRI). One of the PQRI measures, “Measure 130: Documentation & Verification of Current Medications in the Medical Record” has been referred for further action in an effort to remove National Quality Forum (NQF) time-limited endorsement status of the measure. To date, CMS and Quality Insights of Pennsylvania has convened a Technical Expert Panel (TEP) and revised the measure based on an environmental scan, measure beta testing, and TEP recommendations.
CMS now requests stakeholder review and public comment on the measure. Comments must be received by Friday, July 30, 2010. To be considered, comments must be forwarded to Quality Insights of Pennsylvania via email at measures@wvmi.org on the internet. Please include your name, credentials, and email address in your message, and indicate whether you are commenting as an individual or as a representative on behalf of an organization.
To review the measure in more detail, please visit CMS’ Measures Management System online at: https://www.cms.gov/MMS/17_CallforPublicComment.asp on the CMS website.
A summary of all the comments received will be posted on CMS’ Measures Management System website about four weeks after the public comment period closes.
Thank you for your support and participation.
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6. Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Resource Utilization Group-Version 4 (RUG-IV) National Provider Call with Questions & 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, August 4, 2010.
This call will review 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#TopOfPageS 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: August 4, 2010
Conference Title: Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Resource Utilization Group – Version 4 (RUG-IV) 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. EDT on August 3, 2010, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
To register for the call participants need to go to:
http://www.eventsvc.com/palmettogba/080410
Fill in all required data.
Verify that your time zone is displayed correctly in the drop down box.
Click "Register".
You will be taken to the “Thank you for registering” page and will receive a confirmation e-mail shortly thereafter. Note: Please print and save this page, in the event your server blocks the confirmation emails. If you do not receive the confirmation e-mail, 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.
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.asp#TopOfPage on the CMS website.
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7. MLN Matters Article #SE1024 - Recovery Audit Contractor (RAC) Demonstration High-Risk Vulnerabilities – No Documentation or Insufficient Documentation Submitted
The Centers for Medicare & Medicaid Services (CMS) has released MLN Matters Special Edition Article #SE1024 as the first in a series of articles concerning RAC high-dollar improper payment vulnerabilities. These articles are intended to provide education about RAC demonstration-identified vulnerabilities in an effort to prevent these same problems from occurring in the future. This article in particular focuses on Medicare’s documentation requirements and how to avoid unnecessary denial of claims. For more details, please read the article at http://www.cms.gov/MLNMattersArticles/downloads/SE1024.pdf on the CMS website.
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8. Updates from the Medicare Learning Network
Revised! The downloadable version of the “Medicare Physician Fee Schedule Fact Sheet” (July 2010) has been revised to include information about the 2.2 percent update to the 2010 Medicare Physician Fee Schedule (PFS) effective for dates of service from June 1, 2010, through November 30, 2010. This publication also provides PFS payment rate information, the PFS payment rates formula, and PFS resources. To access this Medicare Learning Network fact sheet, visit http://www.cms.gov/MLNProducts/downloads/MedcrePhysFeeSchedfctsht.pdf .
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JUST RELEASED: MLN Matters Article #SE1013 - Summary of Medicare Reporting and Payment of Services for Alcohol and/or Substance (Other than Tobacco) Abuse Structured Assessment and Brief Intervention (SBIRT) Services
The Centers for Medicare & Medicaid Services (CMS) has released MLN Matters Special Edition Article #SE1013 in conjunction with the Substance Abuse and Mental Health Services Administration (SAMHSA) to inform Medicare providers about reporting and payment for the appropriate delivery of alcohol and/or substance (other than tobacco) abuse structured assessment and brief intervention (SBIRT) services. For more details, please read the article at http://www.cms.gov/MLNMattersArticles/downloads/SE1013.pdf on the CMS website.
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JUST RELEASED: MLN Matters Article #SE1021 - Electronic Prescribing (eRx) Incentive Program 2010 Updates
The Centers for Medicare & Medicaid Services (CMS) has released MLN Matters Special Edition Article #SE1021 to alert providers that it is not too late to start participating in the eRx Incentive Program to potentially qualify to receive a full-year incentive payment. Eligible professionals may begin reporting eRx at any time throughout the 2010 program year of January 1, 2010, through December 31, 2010, to be incentive eligible. For more details, please read the article at http://www.cms.gov/MLNMattersArticles/downloads/SE1021.pdf on the CMS website.
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Need a quick and easy-to-use source of information to help you with your Medicare-covered preventive services billing? The Medicare Preventive Services Quick Reference Information Charts contain coverage, coding, and billing information in an easy-to use format, and includes the following charts:
Quick Reference Information: Medicare Preventive Services: This two-sided reference chart provides health care providers with coverage, coding, and payment information on the many preventive services covered by Medicare.
Quick Reference Information: Medicare Immunization Billing: This two-sided reference chart provides coverage, coding and payment information on seasonal influenza, pneumococcal, and Hepatitis B vaccinations covered by Medicare.
Quick Reference Information: The ABCs of Providing the Initial Preventive Physical Examination (IPPE): This two-sided reference chart provides a checklist of the elements of an IPPE, as well as coding information and frequently asked questions.
All three charts are available, free of charge, from the Medicare Learning Network®, in both downloadable PDF and hardcopy format.
To view the PDF charts, please visit the "Preventive Services Educational Products" page at: http://www.cms.gov/MLNProducts/35_PreventiveServices.asp and select the “Educational Products” link in the “Downloads” section.
To order hardcopies, please select the “MLN Product Ordering” link on the same web page.
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9. Minimum Data Set (MDS) 3.0 Training Materials Updates – July 12, 2010
New MDS 3.0 Postings: MDS 3.0 RAI Manual V1.02 July 12, 2010 – Note: This update includes the following revisions of the RAI Manual: Title Page, Chapter 3, Section M. This file now contains revised versions of the following sections of the RAI Manual: Title Page, Chapter 1, Chapter 2, Chapter 3 (Introduction, Sections: A, B, C, D, E, F, G, H, I, J, K, L, M, N, O, P, Q, S, V, X and Z), Appendices B, C, D, E, and G) Chapter 4, Chapter 5, and Chapter 6.
MDS 3.0 Training Slides V1.00 July 12, 2010 –This update includes the following: Chapter 3, Section A and M. This file now contains revised versions of the following sections of the MDS 3.0 Training Slides: Chapter 3, Sections: A, B, C (Staff), C (BIMs), D, E, F, G, H, I, J, K, L, M, N, O, P, Q, V, X and Z.
MDS 3.0 Instructor Guides V1.00 July 12, 2010 - This update includes the following: Chapter 3, Section A.
This file now contains MDS 3.0 Instructor Guides to facilitate MDS 3.0 training. Chapter 3, Sections: A, B, C, (Staff), C (BIMs), D, E, F, G, H, I, J, K, L, N, O, P, Q, V X, and Z.
For more information, please see the following URL: www.cms.gov/NursingHomeQualityInits/45_NHQIMDS30TrainingMaterials.asp
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10. Now Available from CMS - The Written Transcript of the June 15 ICD-10 Implementation in a 5010 Environment Teleconference
The written transcript of the Centers for Medicare & Medicaid Services’ (CMS) June 15, 2010 national provider conference call, “ICD-10 Implementation in a 5010 Environment”, is now available. To access the transcript, go to http://www.cms.gov/ICD10/02c_CMS_Sponsored_Calls.asp#TopOfPage on the CMS website. In the Downloads section select the “June 15, 2010 ICD-10 Conference Call” Zip file. This Zip file contains the written and audio transcripts as well as the slide presentation used during the teleconference. Note: The length of the audio transcript is 1 hour and 51 minutes.
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11. July 2010 Quarterly Provider Specific File Update
The July 2010 quarterly Provider Specific Files (PSF) SAS data files and Text data files are now available on the CMS website. The SAS data files are available at: http://www.cms.gov/ProspMedicareFeeSvcPmtGen/04_psf_SAS.asp in the Downloads section and the Text data files are 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 or SAS File data, please go to the respective page above and download the latest version of the PSF Files.
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12. Release of the Positive 2.2 Percent Update for the 2010 Medicare Ambulatory Surgical Center Files
The recent enactment of the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, §101, resulted in a positive 2.2 percent update in the 2010 Medicare Physician Fee Schedule (MPFS), effective June 1, 2010, through November 30, 2010.
Many payment rates under the Ambulatory Surgical Center (ASC) payment system are controlled by payment rate information in the MPFS. In order to fully comply with this legislation, it is necessary to implement revised MPFS payment rates in the ASC payment system. Therefore, the Centers for Medicare & Medicaid Services (CMS) has provided its contractors with two sets of positive 2.2 percent ASCFS and ASCPI update files to test, and implement. One set of files is for ASC services furnished on or after July 1, 2010, and the second set of files is for ASC services furnished June 1, 2010, through June 30, 2010. Once installed, Medicare contractors shall use these updated payment files to process new ASC claims and shall adjust previously processed ASC claims for dates of service on or after June 1, 2010, that are brought to their attention.
In accordance with the requirements in Change Request (CR) 7008, contractors shall make July 2010 ASCFS fee data for their ASC payment localities available on their websites. The payment rates in the July 2010 ASCFS fee data files mirror the 2.2 percent update payment rates for services June 1, 2010-June 30, 2010 and also contain payment rates for newly established services identified in CR7008 effective July 1, 2010.
An MLN Matters article which explains the requirements in CR 7008 may be found at:
http://www.cms.gov/MLNMattersArticles/downloads/MM7008.pdf on the CMS website.
CMS is aware that contractors were unable to implement the revised payment rates by the July 6, 2010 implementation date contained in CR7008 because these files have just become available to contractors for download and testing. Contractors have been directed to have all these ASC update files in production no later than July 28, 2010. This implementation date supersedes the implementation date specified in CR7008.
ASCs who may have received an incorrect payment determination for certain services furnished on or after June 1, 2010 through the implementation of the July 2010 ASCFS may request contractor adjustment of the previously processed claims.
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13. Fiscal Year (FY) 2010 Inpatient (INP) PPS PC Pricers – July 2010 Provider Data Updates
The Fiscal Year (FY) 2010 INP PPS PC Pricers have been updated with the July 2010 Provider Data. If you use the FY 2010 INP PPS PC Pricers, please go to the Centers for Medicare & Medicaid Services (CMS) web page at http://www.cms.gov/PCPricer/03_inpatient.asp#TopOfPage, and download the latest version of the PC Pricers. Note there are now two Pricers for FY 2010. One is for claims dated from 10/01/2009 to 03/31/2010, and the other is for claims dated from 04/01/2010 to 09/30/2010. Both download modules changed. The update is dated 07/16/2010.
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14. 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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Professor Emeritus -- Dr. Tom Seymour from West Fargo, North Dakota -- Professor, Minot State University, MSU Faculty Regents Award (2015) -- PAST Peer Reviewer (Higher Learning Commission - Chicago); - Author and Presenter Board of Directors, SRT Communications, Inc and Minot City Alderman - Ward 5 (2010-June, 2016) PAST - Editor-in-Chief (North Dakota State Senator (2002-2010) 2017-Cass County Electric Cooperative- Board of Directors
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