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. Final Reminder: ICD-10 Implementation in a 5010 Environment: Follow-Up National Provider Call



2. Special Open Door Forum: Medicare Provider & Supplier Enrollment



3. Special Open Door Forum: End Stage Renal Disease Quality Incentive Program Payment Year 2012: Proposed Rule Overview for Beneficiaries and Patient Advocates



4. CMS Announces Release of New DMEPOS Competitive Bidding Program Fact Sheet for Referral Agents in Hardcopy



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



6. CMS Makes Information about Physician Fee Schedule Payment Rates More Accessible



7. Updates from the Medicare Learning Network



8. Workshop on Issues Related to Accountable Care Organizations



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











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1. Final Reminder: ICD-10 Implementation in a 5010 Environment: Follow-Up National Provider Call



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: 12pm – 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 Friday, September 10, or when available space has been filled. No exceptions will be made. Please register today.

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2. Special Open Door Forum: Medicare Provider & Supplier Enrollment



Tuesday, September 28 / 2pm – 3:30pm ET / Conference Call Only



The Centers for Medicare & Medicaid Services (CMS) will hold a Special Open Door Forum (ODF) to discuss Medicare provider enrollment issues. During this call, CMS staff will discuss:

· Review how CMS plans to implement Section 3101 of the Affordable Care Act for pharmacies;

· Review 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.



Afterwards, there will be an opportunity for the public to ask questions. We look forward to your participation.



Open Door Forum Instructions: **Capacity is limited so dial in early. You may begin dialing into this Forum as early as 1:45 PM ET.**

Dial: 1-800-837-1935

Reference Conference ID# 98955726

Note: TTY Communications Relay Services are available for the hearing-impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.



An audio recording and transcript of this Special Forum will be posted to the Special ODF website at http://www.cms.gov/OpenDoorForums/05_ODF_SpecialODF.asp and will be accessible for downloading on or around Monday, October 4, 2010 and available for 30 days.

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3. Special Open Door Forum: End Stage Renal Disease Quality Incentive Program Payment Year 2012: Proposed Rule Overview for Beneficiaries and Patient Advocates



Tuesday, September 21 / 2pm – 3:30pm ET / Conference Call Only



The Centers for Medicare & Medicaid Services (CMS) will hold a Special Open Door Forum (ODF) to discuss the proposed rule for the End Stage Renal Disease (ESRD) Quality Incentive Program (QIP) that will go into effect January 1, 2012.



This Special ODF is designed specifically for ESRD beneficiaries, their families, and advocates in an effort to increase awareness and understanding of the proposed rule. In addition, the discussion will cover potential effects of the ESRD QIP. Most importantly, this Forum provides CMS with the opportunity to engage and listen to the needs and concerns of the beneficiary and advocate community.



The rule went on display at the Federal Register on July 26, 2010, and can be read online at http://edocket.access.gpo.gov/2010/pdf/2010-18465.pdf.



During this ODF, CMS will provide a comprehensive overview of the proposed rule and provide key insights to the ESRD QIP, including:

· Why the Quality Incentive Program was needed;

· How it will impact the care beneficiaries currently receive;

· What will change as a result of implementing the ESRD QIP and what will stay the same;

· An overview of the ESRD QIP;

· How the ESRD QIP was designed to improve quality of care; and

· How beneficiaries, their families, and patient advocates can submit comments and play a role in improving quality of dialysis care.



After CMS’ presentation, participants will have an opportunity to ask questions. Discussion materials for this Special ODF will be available to download at http://www.cms.gov/ESRDQualityImproveInit/ by September 17, 2010. We look forward to your participation and comments.



Special Open Door Forum Participation Instructions:

Dial: 1-800-837-1935 Reference Conference ID#: 98957601.

Note: TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.



An audio recording and transcript of this Special Open Door Forum will be posted to the Special Open Door Forum website: http://www.cms.gov/OpenDoorForums/05_ODF_SpecialODF.asp and will be accessible for downloading beginning on or around October 7, 2010 and will be available for 30 days.

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4. CMS Announces Release of New DMEPOS Competitive Bidding Program Fact Sheet for Referral Agents in Hardcopy



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) is now in the process of contracting with 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 will need to 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® (MLN) fact sheet “The DMEPOS Competitive Bidding Program: Fact Sheet for Referral Agents” located at http://www.cms.gov/DMEPOSCompetitiveBid/04_Educational_Resources.asp.



This fact sheet is also now available to order in hardcopy, free of charge, from the MLN. To order your copy, please visit the MLN homepage at http://www.cms.gov/mlngeninfo on the internet. Click on “MLN Product Ordering Page” in the “Related Links Inside CMS” section.



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



Friday, September 24 / 10am-4pm ET / 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, including registration information, visit http://edocket.access.gpo.gov/2010/pdf/2010-19128.pdf on the web.

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6. CMS Makes Information about Physician Fee Schedule Payment Rates More Accessible



The Physician Fee Schedule Lookup Tool (www.cms.gov/apps/physician-fee-schedule/overview.aspx) was designed to provide information on the payment rate for services by physicians and nonphysician practitioners under the Medicare Physician Fee Schedule (MPFS). The Fee Schedule Lookup includes more than 10,000 physician services, the associated relative value units, a fee schedule status indicator, and various payment policy indicators needed for payment adjustment. With the Fee Schedule Lookup, the user can find not only the national unadjusted payment rate for each service, determined by multiplying the total relative value units assigned to the service by the appropriate conversion factor, but also the geographically adjusted payment rates for each payment locality.



CMS has now updated and enhanced the Fee Schedule Lookup to allow the user to:

· Download search results into a CSV file;

· Modify search criteria without starting over;

· Search on all available types of information at the same time (Pricing Information, Payment Policy Indicators, Relative Value Units, and Geographical Practice Cost Index); and

Sort and view results table columns in ascending or descending order.

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7. Updates from the Medicare Learning Network



Medicare Learning Network: Now Available in Hardcopy: Advanced Beneficiary Notice of Noncoverage (ABN) booklet



The “Advanced Beneficiary Notice of Noncoverage (ABN)” booklet, which provides information on when providers should use an ABN, ABN policies, how to properly complete an ABN and ABN modifiers, is now available in hardcopy from the Medicare Learning Network®. To order your copy, free of charge, please visit the MLN Products page at http://www.cms.gov/MLNProducts/01_Overview.asp on the internet. Scroll down to the “Related Links Inside CMS” section and choose “MLN Product Ordering Page”. To view the online version, please visit http://www.cms.gov/MLNProducts/downloads/ABN_Booklet_ICN006266.pdf on the internet.



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Medicare Learning Network: Now Available in Hardcopy: DMEPOS Competitive Bidding Program: Fact Sheet for Referral Agents



Now available to order in hardcopy! The new Medicare Learning Network® (MLN) fact sheet “The DMEPOS Competitive Bidding Program: Fact Sheet for Referral Agents” is now available in both downloadable and hardcopy formats. The downloadable version is available at http://www.cms.gov/MLNProducts/downloads/DME_Ref_Agt_Factsheet_ICN900927.pdf . To order a hardcopy, free of charge, please visit the MLN homepage at http://www.cms.gov/mlngeninfo on the internet. Click on “MLN Product Ordering Page” in the “Related Links Inside CMS” section.



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Medicare Learning Network: Now Available for Download: The Medicare Overpayment Collection Process



The publication titled “The Medicare Overpayment Collection Process” (previously titled “What Physicians and Other Suppliers Should Know About Medicare Overpayments”), which provides the definition of an overpayment and information about the collection of Medicare physician and supplier overpayments, is now available in downloadable format from the Medicare Learning Network® at http://www.cms.gov/MLNProducts/downloads/OverpaymentBrochure508-09.pdf.

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8. Workshop on Issues Related to Accountable Care Organizations



FTC, HHS Office of Inspector General, and Centers for Medicare & Medicaid Services

Announce Workshop on

Issues Related to Accountable Care Organizations



Public Event to be Held at CMS Headquarters in Baltimore on October 5, 2010

On October 5, 2010, the Federal Trade Commission will co-host a workshop on several issues associated with Accountable Care Organizations (ACOs), organizations authorized by the new Affordable Care Act that seek to deliver high-quality and efficient health care services to consumers. Joining the FTC in hosting the event are the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services’ Office of Inspector General.

The workshop, which will be held at CMS Headquarters in Baltimore, Maryland, is free and open to the public. To facilitate providers’ efforts to develop ACOs that will provide high quality, lower-cost care to their patients, the workshop will address and solicit public comments on the legal issues raised by various ACO models being considered by health care providers. Physicians, physician associations, hospitals, health systems, payers, consumers, and other interested parties are invited to participate in the workshop.

The agencies will publish a Federal Register notice shortly that will include a more in-depth explanation of the topics to be covered during the day-long workshop, including the antitrust, physician self-referral, anti-kickback, and civil monetary penalty laws related to ACOs. The notice also will include information about how to register for the workshop.

Anyone interested in submitting comments for inclusion in workshop discussions must do so by September 27, 2010. Instructions on how to submit comments will be provided in the Federal Register notice.

The Federal Trade Commission works for consumers to prevent fraudulent, deceptive, and unfair business practices and to provide information to help spot, stop, and avoid them. To file a complaint in English or Spanish, visit the FTC’s online Complaint Assistant or call 1-877-FTC-HELP (1-877-382-4357). The FTC enters complaints into Consumer Sentinel, a secure, online database available to more than 1,800 civil and criminal law enforcement agencies in the U.S. and abroad. The FTC’s Web site provides free information on a variety of consumer topics.

http://www.ftc.gov/opa/2010/09/healthcare.shtm

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



http://www.ssa.gov/prescriptionhelp/



Under a new law, more Medicare beneficiaries could qualify for Extra Help with their Medicare prescription drug plan costs because some things no longer count as income and resources. The Extra Help is estimated to be worth an average of $3,900 per year. To qualify for the Extra Help, a person must be on Medicare, have limited income and resources, and reside in one of the 50 states or the District of Columbia.

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