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. Registration for ONC Personal Health Records Roundtable Now Open [Fri Dec 3]



2. Graduate Medical Education (GME) Provisions from the Affordable Care Act



3. Physicians Billing for Technical Component of Advanced Diagnostic Imaging Must be Accredited



4. CMS Is Here to Help in the Transitions to Version 5010 and ICD-10



5. 2009 Physician Quality Reporting Initiative (PQRI) & Electronic Prescribing (eRx) Incentive Program Feedback Reports



6. Electronic Prescribing (eRx) Incentive Program Update



7. 2010 E-Prescribing Incentive Program Measurement Code Reporting Update


8. CORRECTED: Inpatient Psychiatric Facility PPS RY2011 PC Pricer Updated



9. Inpatient PPS FY2011 PC Pricer Updated to Correct Error



10. Skilled Nursing Facilities FY2011 PC Pricer Update



11. Inpatient Rehabilitation Facility PPS FY2011 PC Pricer Update



12. Outpatient Prospective Payment System CY2010 Pricer Update



13. Updates from the Medicare Learning Network

- “Glucose Testing Supplies - Complying with Documentation & Coverage - Requirements” Fact Sheet

- MLN Matters Article #SE1033: “Partial Code Freeze Prior to ICD-10 Implementation”

- Revised: MLN Matters Article #SE1027: Recovery Audit Contractor Demonstration High-Risk Medical Necessity Vulnerabilities for Inpatient Hospitals

- “The Medicare Overpayment Collection Process” Publication Now Available in Print

- “Sole Community Hospital” Fact Sheet Revised

- “Medicare Outpatient Therapy Billing” Publication Now Available in Print

- A Message to Our Provider Partners



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











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1. Registration for ONC Personal Health Records Roundtable Now Open [Fri Dec 3]



Online registration is now open for the roundtable on “Personal Health Records – Understanding the Evolving Landscape.” This free day-long public roundtable, hosted by the Office of the National Coordinator for Health Information Technology (ONC), will be held on Fri Dec 3 at the FTC Conference Center in Washington DC (601 New Jersey Avenue NW, Washington, DC 20001).



Register to attend in person or via webcast by visiting http://healthit.hhs.gov/PHRroundtable. The webcast will be hosted at http://healthit.hhs.gov/blog/phr-roundtable.

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2. Graduate Medical Education (GME) Provisions from the Affordable Care Act



On Tue Nov 2, 2010, the Centers for Medicare & Medicaid Services issued final regulations regarding the graduate medical education (GME) provisions included in the Affordable Care Act (ACA). The final regulations are a part of the CY2011 Hospital Outpatient Prospective Payment System final rule (available at http://www.ofr.gov/OFRUpload/OFRData/2010-27926_PI.pdf). Two of these GME provisions, section 5503 and section 5506, establish processes for redistribution of full-time equivalent (FTE) resident cap slots, and are time-sensitive in nature.



Section 5503 of the ACA provides for reductions in the direct GME and indirect medical education (IME) FTE resident caps for certain hospitals, and authorizes a “redistribution” to certain hospitals of the estimated number of FTE resident slots that result from the reductions. The provision is effective for portions of cost reporting periods occurring on or after July 1, 2011, for direct GME and IME. Applications for hospitals requesting slots under section 5503 must be received (not just postmarked) by the CMS Regional Office and CMS Central Office by Fri Jan 21, 2011.



Section 5506 of the ACA instructs the Secretary to establish a process by regulation that would redistribute FTE resident cap slots from teaching hospitals that close to hospitals that meet certain criteria, with priority given to hospitals located in the same Core Based Statistical Area (CBSA) or in a contiguous CBSA as the closed hospital. Section 5506 applies to teaching hospitals that closed on or after March 23, 2008, and to future teaching hospital closures. For teaching hospital closures that occurred on or after March 23, 2008, through August 3, 2010, applications for receipt of slots must be received (not just postmarked) by the CMS Regional Office and CMS Central Office by Fri Apr 1, 2011. All teaching hospital closures occurring after August 3, 2010 will be handled as part of a separate notification and application process.



Hospitals should refer to the direct GME website (http://www.cms.gov/AcuteInpatientPPS/06_dgme.asp) for more information on Section 5503 and Section 5506, and for a link to download the relevant application forms for these two provisions.

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3. Physicians Billing for Technical Component of Advanced Diagnostic Imaging Must be Accredited



Beginning Jan 1, 2012, suppliers furnishing the technical component of advanced diagnostic imaging services for which payment is made under the physician fee schedule must be accredited by a CMS-designated accreditation organization. In the case where a physician chooses to contract out those services to an accredited mobile unit, the physician must be accredited in order to bill Medicare for such services.



For more information regarding advanced diagnostic imaging, please visit http://www.CMS.gov/MedicareProviderSupEnroll/03_AdvancedDiagnosticImagingAccreditation.asp.

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4. CMS Is Here to Help in the Transitions to Version 5010 and ICD-10



Have questions about the Version 5010 and ICD-10 transition? CMS is here to help! We have resources for providers, vendors, and payers to prepare for the transition. Fact sheets available for educating staff and others about the transition include:

§ The ICD-10 Transition: An Introduction

§ ICD-10 Basics for Medical Practices

§ Talking to Your Vendors About ICD-10 and Version 5010: Tips for Medical Practices

§ Talking to Your Customers About ICD-10 and Version 5010: Tips for Software Vendors



Compliance timelines, materials from CMS-sponsored calls and conferences, links to resources, and the latest news are all available at http://www.cms.gov/ICD10. Check back often for the latest information and updates, and to sign up for Version 5010 and ICD-10 e-mail updates!

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5. 2009 Physician Quality Reporting Initiative (PQRI) & Electronic Prescribing (eRx) Incentive Program Feedback Reports



The Centers for Medicare & Medicaid Services (CMS) would like to share this important information with participants in the 2009 Physician Quality Reporting Initiative (PQRI) or Electronic Prescribing (eRx) Incentive Program.



After beginning the release of the 2009 PQRI Feedback Reports, CMS temporarily halted production of the files to investigate some conflicting field information in the reports. The 2009 PQRI and eRx Incentive Program feedback reports will soon be made available on the PQRI portal. CMS anticipates that the Taxpayer Identification Number (Tax ID Number or TIN) level reports, which include the National Provider Identifier or NPI level reports, will be available the week of Mon Nov 22 on the PQRI Portal. Individual NPI reports will be made available shortly afterward, and may be requested via your Carrier or Medicare Administrative Contractor.



Feedback reports are compiled at the TIN level, with individual-level reporting NPI information for each eligible professional who reported at least one valid PQRI and/or eRx quality-data code (QDC) on a claim submitted under that TIN for services furnished during the reporting period. The TIN or NPI must be the one used by the eligible professional to submit Medicare claims and valid PQRI and/or eRx QDCs.

Bottom of Form

If a 2009 PQRI and/or eRx Incentive Program feedback report is available for your organization’s TIN or NPI, there are two ways to access your report:



1. Individuals Authorized Access to the CMS Computer Services (IACS): Eligible professionals can log on to the secure “Physician and Other Health Care Professionals Quality Reporting Portal” on QualityNet at http://www.qualitynet.org/PRQI to access their feedback report(s) based on their TIN or for a group. Access to the Portal requires registration in the IACS system to obtain a user ID and password. Information on creating and/or updating an IACS account is included later in this message.



2. Alternative Feedback Report Method: An individual eligible professional can simply call his or her respective Carrier or Medicare Administrative Contractor (MAC) provider contact center to request confidential 2009 PQRI or eRx feedback reports that will contain information based on the eligible professional’s individual NPI. If an eligible professional is part of a group practice, each eligible professional in the group practice must individually call their respective Carrier/MAC provider contact center to request a feedback report based on the individual NPI. For a list of Provider Contact Centers, visit http://www.cms.gov/MLNProducts/Downloads/CallCenterTollNumDirectory.zip. In addition to reporting information, these reports will provide individual eligible professionals with information on their Medicare Part B Physician Fee Schedule-allowed charges for the 2009 reporting period, upon which an incentive payment is based.



Additional information about this alternative feedback report request process can be found in the Medicare Learning Network Special Edition article #SE0922, “Alternative Process for Individual Eligible Professionals to Access Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing (E-Prescribing) Feedback Reports,” available at http://www.cms.gov/MLNMattersArticles/downloads/SE0922.pdf.



Additional Resources: The IACS home page for the Provider/Supplier user community, which includes eRx and PQRI, is http://www.cms.gov/IACS/04_Provider_Community.asp; the IACS account management page is https://applications.cms.hhs.gov/category.html?name=acctmngmt. The “Physician and Other Health Care Professionals Quality Reporting Portal” is available at http://www.qualitynet.org/PQRI. (Although the “Forgot Password” link on the Portal sends users to the IACS website, IACS and the Portal are two separate websites.)



Who to Call for Help: Provider Community users should direct questions or concerns to the QualityNet Help Desk at 866-288-8912 (Mon–Fri, 7am-7pm CST) or via email at qnetsupport@sdps.org.

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6. Electronic Prescribing (eRx) Incentive Program Update



In November, the Centers for Medicare & Medicaid Services announced that beginning in 2012, eligible professionals who are not successful electronic prescribers may be subject to a payment adjustment or penalty. Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorizes CMS to apply this payment adjustment whether or not the eligible professional is planning to participate in the eRx Incentive Program.



The payment adjustment in 2012, with regard to all of the eligible professionals’ Part B-covered professional services, will result in the eligible professional or group practice receiving 99% of the Physician Fee Schedule (PFS) amount that would otherwise apply to such services. In 2013, the eligible professional will receive 98.5% of their covered Part B-eligible charges if they aren’t a successful electronic prescriber. In 2014, the penalty for not being a successful electronic prescriber is 2%, resulting in eligible professionals receiving 98% of their covered Part B charges.



For purposes of determining which eligible professionals or group practices are subject to the payment adjustment in 2012, CMS will analyze claims data from January 1, 2011, through June 30, 2011, to determine if the eligible professional has submitted at least 10 electronic prescriptions during the first six months of calendar year 2011. Group practices reporting as a GPRO-I or GPRO-II in 2011 must report all of their required electronic prescribing events in the first six months of 2011 to avoid the payment adjustment in 2012.



Please see the “Getting Started” webpage at http://www.cms.gov/ERXincentive for more information, specifically paying attention to the “Medicare’s Practical Guide to the Electronic Prescribing (eRx) Incentive Program” product in the “Educational Resources” section.



If an eligible professional or selected group practice wishes to request an exemption to the eRx Incentive Program and the payment adjustment, there are two “hardship codes” that can be reported via claims:

§ G8642 – The eligible professional practices in a rural area without sufficient high-speed internet access and requests a hardship exemption from the application of the payment adjustment under section 1848(a)(5)(A) of the Social Security Act.

§ G8643 – The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing and requests a hardship exemption from the application of the payment adjustment under section 1848(a)(5)(A) of the Social Security Act.



Additionally, there will be a G-code which can be used by eligible professionals to indicate that they do not have prescribing privileges. Reporting this G-code will prevent the eligible professional from being subjected to a payment adjustment in 2012.

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7. 2010 E-Prescribing Incentive Program Measurement Code Reporting Update


All Eligible Professionals (EPs) are encouraged to follow the current 2010 E-Prescribing (eRx) incentive program requirements. EPs should check the measure specifications at the beginning of each year because they may change. The correct measurement code to bill in 2010 for calculations of the 2010 eRx incentive payment is G8553.



The 2009 eRx measurement codes have been accepted for processing by the Medicare claims systems. However, in October, a temporary change occurred that led to the rejection of 2009 eRx codes. EPs cannot resubmit claims that may have been rejected with the 2009 eRx measurement codes. Submissions reported using a qualified registry or a qualified Electronic Health Record will not be affected by this situation.



All EPs should work with their vendors and clearinghouses to make sure they are aware of any measure specification changes. Current information, as well as the requirements, can be found at www.cms.gov/ERXincentive. To access the requirements, click on “E-Prescribing Measure” on the left hand side of the page; scroll down to the downloads section of the page and click to view “2010 eRx Measure Specification & Release Notes,” and “Claims Based Reporting Principles for 2010 eRx.”



EPs with any additional questions may contact the Quality Net Help Desk at 866-288-8912 (or the TTY line 877-715-6222), 7am-7pm CST.

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8. CORRECTED: Inpatient Psychiatric Facility PPS RY2011 PC Pricer Updated



The message sent last week about the updated Inpatient Psychiatric Facility PPS RY2011 PC Pricer included a typo in the dates listed in the message. The corrected message should have read: “The Inpatient Psychiatric Facility (IPF) PPS PC Pricer needed corrected provider data for RY2011 and has been updated on the CMS Website for claims dates from 2010-07-01 to 2010-09-30 and 2010-10-01 to 2011-06-30. If you use the IPF PPS PC Pricer for RY2011, please visit http://www.cms.hhs.gov/PCPricer/09_inppsy.asp, under the Downloads section, and download the latest versions of the IPF PPS RY2011 PC Pricers, posted 2010-11-08.

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9. Inpatient PPS FY2011 PC Pricer Updated to Correct Error



A typo was discovered in the FY 2011 Inpatient (INP) PPS PC Pricer, so a corrected version has been updated on the CMS website. If you use the FY2011 INP PPS PC Pricer, please visit http://www.cms.hhs.gov/PCPricer/03_inpatient.asp and download the latest version, dated 2010-11-10. This PC Pricer is for claims dated from 2010-10-01 to 2011-09-30.

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10. Skilled Nursing Facilities FY2011 PC Pricer Update



The FY2011 Skilled Nursing Facilities (SNF) PC Pricer has been updated at http://www.cms.hhs.gov/PCPricer/04_SNF.asp, under the “Skilled Nursing Facilities (SNF PPS) PC Pricer.” If you use the FY2011 SNF PC Pricer please visit the page above and download the SNF PC Pricer with the revised provider data.

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11. Inpatient Rehabilitation Facility PPS FY2011 PC Pricer Update



The FY2011 Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) PC Pricer is ready for download from the Centers for Medicare & Medicaid Services at http://www.cms.hhs.gov/PCPricer/06_IRF.asp. If you use the IRF PPS PC Pricers, please visit the page above and download the latest version, posted 2010-11-16.

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12. Outpatient Prospective Payment System CY2010 Pricer Update



The CY2010 Outpatient Prospective Payment System (OPPS) Pricer web page has been updated to include the October 2010 update for outpatient provider data. Users may access the October provider data update at http://www.cms.gov/PCPricer/OutPPS/list.asp. Download the “4th Quarter 2010 Files” and select the file titled “OPSF October Update file.”

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13. Updates from the Medicare Learning Network



“Glucose Testing Supplies - Complying with Documentation & Coverage - Requirements” Fact Sheet



New! The Medicare Learning Network® has released a new educational product titled “Glucose Testing Supplies - Complying with Documentation & Coverage Requirements.” This fact sheet is designed to provide education on common Comprehensive Error Rate Testing (CERT) Program errors related to glucose testing supplies, and includes a checklist of the documentation needed to support claims submitted to Medicare for glucose testing supplies. This product is currently available at http://www.cms.gov/MLNProducts/downloads/GlucSup_DocCvge_FactSheet_ICN905104.pdf and is suggested for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) providers.



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MLN Matters Article #SE1033: “Partial Code Freeze Prior to ICD-10 Implementation”



Just released! The Medicare Learning Network® has released MLN Matters Special Edition Article #SE1033 to inform affected Fee-For-Service (FFS) providers about the implementation of a partial freeze for both ICD-9-CM, ICD-10-CM, and ICD-10-PCS codes prior to implementation of ICD-10 on October 1, 2013. This decision was announced at the ICD-9-CM Coordination & Maintenance Meeting, held on Wed Sep 15, 2010. For more details, the article can be found at http://www.cms.gov/MLNMattersArticles/downloads/SE1033.pdf.



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Revised: MLN Matters Article #SE1027: Recovery Audit Contractor Demonstration High-Risk Medical Necessity Vulnerabilities for Inpatient Hospitals



The Medicare Learning Network® has revised MLN Matters Special Edition Article #SE1027 to update the list of vulnerabilities found on page two. This article advises inpatient hospitals about 17 RAC demonstration-identified medical necessity vulnerabilities. For more details, please read the updated version of the article at http://www.cms.gov/MLNMattersArticles/downloads/SE1027.pdf.



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“The Medicare Overpayment Collection Process” Publication Now Available in Print



The revised 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 print format from the Medicare Learning Network®. To place your order, visit http://www.cms.gov/MLNGenInfo, scroll down to “Related Links Inside CMS,” and select “MLN Product Ordering Page.”



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“Sole Community Hospital” Fact Sheet Revised



The revised fact sheet titled “Sole Community Hospital” (October 2010), which provides information about Sole Community Hospital (SCH) classification criteria and SCH payments, is now available in downloadable format from the Medicare Learning Network® at http://www.cms.gov/MLNProducts/downloads/SoleCommHospfctsht508-09.pdf.



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“Medicare Outpatient Therapy Billing” Publication Now Available in Print



A new publication titled “Medicare Outpatient Therapy Billing” (August 2010) is now available in print format from the Medicare Learning Network®. This publication provides information about Medicare outpatient physical therapy, occupational therapy, and speech-language pathology (therapy services) coverage requirements; calendar years 2010 and 2011 therapy codes and dispositions; and billing measures for therapy services. To place your order, visit http://www.cms.gov/MLNGenInfo, scroll down to “Related Links Inside CMS,” and select “MLN Product Ordering Page.”



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A Message to Our Provider Partners



Earlier this year when we introduced the “Medicare Learning Network® (MLN) Suite of Products and Resources for Billing and Coding Professionals,” we recommended you forward an email to your members and any staff that may have the responsibility for developing and submitting claims (ie. billers, coders, reimbursement specialists, and office practice managers). As part of our ongoing efforts to keep our providers aware of new and improved products, and to remind you that important MLN information is continuously available, we would like you to again recommend this comprehensive range of products to your existing and new reimbursement specialists. The timely and accurate information they need to submit Medicare claims correctly the first time is just a download away!



Like all MLN products and resources, the Suite is available at no cost. It contains easy-to-understand and current Medicare information, all prepared by subject-specific experts. We recommend you copy and paste the message below into the body of an email, then forward to your members. The email contains a link to a complete detailed listing of all of the products in the “Medicare Learning Network® Suite of Products and Resources for Billing and Coding Professionals.”



We very much appreciate your help in spreading the word about this and all other MLN products and hope you find the products beneficial as well. Please contact Valerie Haugen directly (at Valerie.haugen@cms.hhs.gov) if you have received any feedback about the Suite or have questions or concerns. Thanks!



Please copy and paste the message below into the body of e-mail, then forward to your members:



Get Accurate Solutions Now to Your Medicare Claim Questions



You can find plenty of answers to your Medicare questions. Find the accurate ones from the Medicare Learning Network® (MLN).



As a billing or coding professional, you need Medicare information at your fingertips. That is why CMS experts developed the “Medicare Learning Network® Suite of Products and Resources for Billing and Coding Professionals” just for you. The Suite contains easy-to-understand, accessible, and free Medicare Program information.



To access a detailed listing of all of the products you need to correctly submit claims the first time, visit the MLN Educational Web Guides web page at http://www.cms.gov/MLNEdWebGuide and, on the left hand side of the page, click on the “Medicare Learning Network Suite of Products and Resources for Billing and Coding Professionals.”



Equip yourself today with critical reimbursement solutions from the official source for Medicare Fee-For-Service Provider information.

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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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