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. Physicians and Non-Physician Practitioners: Have you tried Internet-based PECOS for your Medicare enrollment actions?



2. Provider and Supplier Organizations: Have you tried Internet-based PECOS for your Medicare enrollment actions?



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



4. Follow-Up National Provider Call regarding ICD-10 Implementation in a 5010 Environment



5. Updates from the Medicare Learning Network



6. “How to Get Started” Section Added to Electronic Prescribing Incentive Program Webpage



7. New PQRI Information



8. Medicare Imposes Stronger Protections on Medical Equipment Suppliers: New Rule Strengthens Supplier Enrollment Standards to Help Prevent Fraud



9. Upcoming Home Health, DME, and Hospice Open Door Forums (ODF) regarding Pharmacies



10. CMS to Host Listening Session Regarding Confidential Feedback Reports and the Implementation of a Value-Based Payment Modifier for Physicians



11. Closing in on 120 Days and Counting Until January 2011 Target Testing for Version 5010



12. Minimum Data Set (MDS) 3.0 Training Materials Updates



13. Clinician Outreach and Communication Activities (COCA) from the CDC



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











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1. Physicians and Non-Physician Practitioners: Have you tried Internet-based PECOS for your Medicare enrollment actions?



It’s easy to use and offers a host of advantages over the paper-based enrollment process.



Want more control over your enrollment information? The Internet-based Provider Enrollment, Chain and Ownership System (PECOS) does that!



Want more control when adding or changing a reassignment of benefits? Internet-based PECOS does that, too!



Using Internet-based PECOS Is Easy! Learn how to use the system by reading the Medicare Physician and Non-Physician Practitioner Getting Started Guide. And if you encounter problems or have questions as you navigate the system, there is help available!



Don’t wait – Set your practice free from paper – Start using Internet-based PECOS today!

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2. Provider and Supplier Organizations: Have you tried Internet-based PECOS for your Medicare enrollment actions?



It’s easy to use and offers a host of advantages over the paper-based enrollment process.



[Note that Internet-based PECOS is not yet available for suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). The system will be available for use by DMEPOS suppliers later this year.]



Want more control over your enrollment information? The Internet-based Provider Enrollment, Chain and Ownership System (PECOS) does that!



Want more control when adding or changing a location or changing ownership information? Internet-based PECOS does that, too!



Using Internet-based PECOS Is Easy! Learn how to use the system by reading the Getting Started Guide for Provider and Supplier Organizations. Remember, the process by which an organization provider can use Internet-based PECOS may take several weeks. It is recommended that you begin this process (if you have not already) well in advance of any upcoming enrollment actions. For more information on this setup process, read the Provider and Supplier Organization Overview.



Don’t wait – Set your organization free from paper – Start using Internet-based PECOS today!

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



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 1:00 p.m. – 2:30 p.m., EDT, on Wednesday, September 1, 2010.



This call is one in a series of calls designed to provide information on key aspects of the RUG-IV SNF PPS case mix system which will be put into place on an interim basis effective October 1, 2010. In June CMS discussed coding procedures with emphasis on the appropriate Look-back Period 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, along with changes to the ADL coding requirements and their impact on the assignment of MDS 3.0 records to a RUG-IV group.



As a continuation of the series, CMS subject matter experts will discuss topics such as: the transition from RUG-III to RUG-IV, Start of Therapy and End of Therapy Other Medicare Required Assessments, and the SNF short stay policy. 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: September 1, 2010

Time: 1:00 p.m. EDT

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



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 1:00 p.m. EDT on August 31, 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/090110
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 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.


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

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4. Follow-Up National Provider Call regarding ICD-10 Implementation in a 5010 Environment



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



When: Monday, September 13, 2010

Time: 1pm – 1:30pm 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
Differences between ICD-10 and ICD-9-CM codes
ICD-10-CM basic information for all users
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

Compliance dates and timelines (No contingencies)
5010 before and after ICD-10 Implementation
Readiness review for implementing HIPAA version 5010 and D.0
What you need to be doing to prepare
Medicare fee-for-service activities update
Other issues and considerations


For more information and to register for this informative session, please go to http://www.cms.gov/ICD10/02c_CMS_Sponsored_Calls.asp on the CMS website. Registration will close at 12pm ET on September 10, 2010, or when available space has been filled. No exceptions will be made. Please register early.

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5. Updates from the Medicare Learning Network



JUST RELEASED -- Special Edition MLN Matters Article #SE1025 - Consumer Assessment of Health Providers and Systems (CAHPS) Update for Home Health Agencies (HHA)



The Centers for Medicare & Medicaid Services (CMS) has released Special Edition MLN Matters Article #SE1025 to remind Home Health Agencies (HHAs) about the steps they must take to meet the upcoming Home Health Care CAHPS Survey (HHCAHPS) requirements. To fulfill the HHCAHPS requirements for the CY 2012 APU, Medicare HHAs must begin participating in the HHCAHPS by September 2010. This article is informational and does not present new policy. For more details, please read the article at http://www.cms.gov/MLNMattersArticles/downloads/SE1025.pdf on the CMS website.





REVISED -- Special Edition MLN Matters Article #SE1014 - Medicare Policy Regarding Pressure Reducing Support Surfaces



The Centers for Medicare & Medicaid Services (CMS) has revised Special Edition MLN Matters Article #SE1014 to clarify existing support surface medical policies and coverage requirements. This article is informational in nature and reinforces existing policy. It does not present new policy. For more details, please read the article at http://www.cms.gov/MLNMattersArticles/downloads/SE1014.pdf on the CMS website.

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6. “How to Get Started” Section Added to Electronic Prescribing Incentive Program Webpage



The Centers for Medicare & Medicaid Services (CMS) is pleased to announce a new section on "How to Get Started" in participating with the Electronic Prescribing Incentive (eRx) program, is available on the eRx webpage. The new section page can be found on the eRx webpage at http://www.cms.gov/ERxIncentive/03_How_To_Get_Started on the CMS website.

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7. New PQRI Information



New Section Page added to the Physician Quality Reporting Initiative (PQRI) Webpage

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce a new section on "How to Get Started" in participating with the PQRI program, is available on the PQRI webpage. The new section page can be found on the PQRI webpage at http://www.cms.gov/PQRI/03_How_To_Get_Started on the CMS website.

2010 PQRI 1st Quarter Data Codes Submission Error Report by Specialty

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the 2010 PQRI 1st Quarter Data Codes Submission Error Report by Specialty for January 1, 2010 - March 31, 2010 is available on the PQRI webpage on the CMS website.

To access this downloadable report, visit http://www.cms.hhs.gov/PQRI on the CMS website and click on the Educational Resources tab. Once on the Analysis and Payment page, scroll down to the “Downloads” section and click on the “2010 PQRI 1st Quarter Data Codes Submission Error Report by Specialty for January 1, 2010 - March 31, 2010” link.

Payment Adjustment for Newly Incentive Eligible Professionals for the 2008 PQRI

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce information on payment adjustments for newly incentive eligible professionals for the 2008 Physician Quality Reporting Initiative (PQRI) program is posted on the Spotlight page of the PQRI webpage at www.cms.gov/PQRI on the CMS website.

Upcoming incentive payment distributions-payment adjustment for newly incentive eligible professionals for the 2008 PQRI after incorporation of the allowed charges requirement:

o Distribution of this additional 2008 incentive, for those newly incentive eligible, begins August 25, 2010 and ends September 17, 2010 (late August through mid September).

o There is a total of 889 TIN/NPIs who were not incentive eligible in the 2008 PQRI program but who are newly incentive eligible after incorporation of the allowed charges requirement.

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8. Medicare Imposes Stronger Protections on Medical Equipment Suppliers: New Rule Strengthens Supplier Enrollment Standards to Help Prevent Fraud



The Centers for Medicare & Medicaid Services (CMS) today issued a final rule representing another step to increase protections for Medicare and beneficiaries from potentially fraudulent suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).



The new regulation enhances Medicare enrollment standards for DMEPOS suppliers by adding several new standards and strengthening existing standards that suppliers must meet before being able to furnish equipment and supplies to Medicare beneficiaries. These new and stronger standards will help to reduce fraud in Medicare and provide beneficiaries with additional assurance that they are being served by legitimate suppliers who meet Medicare’s standards.



The final rule also clarifies and expands the existing enrollment requirements that DMEPOS suppliers must meet to establish and maintain billing privileges in the Medicare program.



To read the entire CMS press release issued today (8/26) click here: https://www.cms.gov/apps/media/press_releases.asp



To read the final rule today click here: http://www.ofr.gov/OFRUpload/OFRData/2010-21354_PI.pdf



And will be posted here:

http://www.cms.gov/MedicareProviderSupEnroll/09_ProviderEnrollmentRegulation.asp

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9. Upcoming Home Health, DME, and Hospice Open Door Forums (ODF) regarding Pharmacies



On March 23, 2010, with the passage of the Patient Protection and Affordable Care Act (known as Affordable Care Act – ACA), there was a provision for pharmacies to be exempt from meeting the January 1, 2011 accreditation deadline. We would like to announce that CMS is planning a Special Open Door Forum to answer any questions pertaining to the ACA provision for billing DME as a pharmacy.



On Tuesday, September 28, at 2:00 PM, CMS will be providing information relevant to all pharmacies that plan on furnishing and billing Medicare for DME. The purpose of this call is to review how CMS plans to implement Section 3101 of ACA. We will go through the recent instructions given to our contractor; answer questions related to those pharmacies who voluntarily disenrolled last year and next steps required by the pharmacy.



Please look for the announcement and agenda to be released on the ODF website sometime in the latter part of September.

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10. CMS to Host Listening Session Regarding Confidential Feedback Reports and the Implementation of a Value-Based Payment Modifier for Physicians



September 24, 2010 from 10am-4pm ET

at CMS Headquarters in Baltimore, MD



CMS will host a listening session on September 24th as part of the transition to a value-based purchasing program for services of physicians and certain other professionals, as well as other related provisions under the Patient Protection and Affordable Care Act (known as the Affordable Care Act (ACA)). The ACA contains provisions that continue and expand the Physician Feedback Program and also require implementation of a value-based payment modifier to the Fee-For-Service physician fee schedule. The purpose of the listening session is to solicit comments on approaches being considered as we implement these provisions.



Physicians, physician associations, and all others interested in the use of confidential feedback reports as one means of enhancing quality and efficiency are invited to participate, in person or by calling in to the teleconference. The meeting is open to the public, but attendance is limited to space and teleconference lines available. Persons interested in attending the meeting or participating by teleconference must register by completing the on-line registration via the CMS Web site at http://www.eventsvc.com/palmettogba/092410.



For the complete Federal Register notice, which includes registration information, visit http://edocket.access.gpo.gov/2010/pdf/2010-19128.pdf on the web.

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11. Closing in on 120 Days and Counting Until January 2011 Target Testing for Version 5010



Health care providers, health plans, clearinghouses and vendors should be finished with their internal testing of the Version 5010 HIPAA electronic health care transaction standards by the first recommended deadline for internal testing, December 31, 2010, and be ready to start testing with their external partners, beginning in January 2011, just about four months away.



Beginning January 2011, CMS’ Medicare Fee-for-Service program will be ready to test Version 5010 transaction standards with its external partners, and other industry segments should be poised to follow suit. This recommended external testing start date will give the industry adequate time to ensure that their Version 5010 transactions are being conducted correctly, in preparation for mandatory Version 5010 compliance by January 1, 2012.



Don’t fall behind on this important testing process. Make sure you communicate with your external partners about your Version 5010 testing plans. Incorporate your Version 5010 testing messages into your existing communication vehicles, including website links, customer service encounters, etc., to let everyone know when you will be ready to start testing Version 5010 transactions with them.



Keep Up to Date on Version 5010 and ICD-10.

Please visit www.cms.gov/icd10 for the latest news and sign up NOW for Version 5010 and ICD-10 e-mail updates!



Read the press release issued today (8/24) by CMS at: https://www.cms.gov/apps/media/press_releases.asp





Version 5010 and ICD-10 are coming. Will you be ready?

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12. Minimum Data Set (MDS) 3.0 Training Materials Updates



Under the Downloads section of the Nursing Home Quality Initiatives MDS 3.0 Training Materials page (http://www.cms.gov/NursingHomeQualityInits/45_NHQIMDS30TrainingMaterials.asp), the following revised training materials are now available:

• A new naming convention is now being used for the MDS 3.0 RAI Manual.

• Any sections or chapters that have had revisions will now have an updated version number along with the month and year that the information was revised (e.g. MDS 3.0 Chapter 4 V1.03 August 2010). Subsequent revisions of any section or chapter of the manual will have updated version numbers (e.g. V1.04, V1.05, etc…)

• Any sections or chapters that have NOT been revised will have the same version number, month, and year that that version was last published (e.g. MDS 3.0 RAI Manual Chapter 3 Section A V1.02 July 2010). However, you will notice that the "day" has been dropped from the file name now that we do not have frequent updates to the manual.

• Any changes from the previous version of all Chapter 3 Sections are now listed at the beginning of each respective section.



MDS 3.0 RAI Manual Chapter 4 has been reposted and is available for download in the file labeled "MDS 3.0 RAI Manual August 2010."

• MDS 3.0 RAI Manual Chapter 3 Updates: V1.03 of the following sections - A, C, D, E, F, G, K, M, O, P, X, and Z.

VIVE - Video on Interviewing Vulnerable Elders – Will be available for ordering from CMS beginning the week of August 16, 2010. Please visit http://productordering.cms.hhs.gov to order a copy of the DVD (CMS Product No. 11479-CD). This Video on Interviewing Vulnerable Elders (VIVE) was funded by the Picker Institute and produced by the UCLA/JH Borun Center.

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13. Clinician Outreach and Communication Activities (COCA) from the CDC



Upcoming COCA Call: HHS/CDC Influenza Update

Title: HHS/CDC Update: 2010-11 Flu Season and Universal Vaccine Recommendations

Date: Monday, August 30, 2010

Time: 3:00 PM – 400 PM (Eastern Time)

Call Number: 1-888-790-2034

Passcode: 4027970

The Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC) are co-hosting a COCA conference call to provide influenza updates for healthcare providers. During the 2010-2011 flu season, CDC expects the 2009 H1N1 virus to cause illness again along with other influenza viruses. The best way to prevent the flu is by getting vaccinated each year and by encouraging your patients to be vaccinated as well.

This COCA call is designed to highlight the importance of vaccination, discuss CDC’s new universal recommendations, address vaccination challenges with minority and at-risk populations, and discuss strategies and resources for encouraging influenza vaccination. Join Dr. Howard Koh, Assistant Secretary for Health (HHS); Dr. Garth Graham, Deputy Assistant Secretary for Minority Health (HHS); and Dr. Carolyn Bridges, Influenza Division Associate Director for Science (CDC), as they discuss influenza vaccination.

For more information on this call visit: http://emergency.cdc.gov/coca/callinfo.asp



Upcoming COCA Call: Alternate Care Systems/Crisis Scenarios

Title: Preparing for Large-Scale Surge Incidents: Alternate Care Systems and Crisis Standards of Care

Date: September 2, 2010

Time: 2:00 PM – 3:00 PM (Eastern Time)

Call Number: 888-790-6180

Passcode: 1281914

Public health emergencies can limit access to routine medical care and diminish resources. Healthcare systems may need to institute alternate care systems to manage the potential influx of patients during an emergency. Join subject matter experts as they discuss the concept of alternate care systems and crisis standards of care and why planning is critical for a community’s ability to respond to a large-scale disaster. CE Credits are being offered for this call!

For more information on this call visit: http://emergency.cdc.gov/coca/callinfo.asp

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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/



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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