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Announcements
January 5, 2008
Glaucoma Awareness Month
January is National Glaucoma Awareness Month ~ In recognition of National Glaucoma Awareness Month the Centers for Medicare & Medicaid Services (CMS) reminds health care professionals that Medicare provides coverage of a comprehensive annual glaucoma screening exam for seniors and others with Medicare at high risk for developing glaucoma.
Glaucoma is a leading cause of blindness in the United States and while anyone can develop glaucoma, the risk of glaucoma increases with age. Early detection and treatment of glaucoma, before it causes major vision loss, is the best way to control the disease.
Medicare Coverage
Medicare beneficiaries in one of the following high risk groups are eligible for an annual glaucoma screening covered by Medicare:
- Individuals with diabetes mellitus;
- Individuals with a family history of glaucoma;
- African-Americans age 50 and older; and
- Hispanic-Americans age 65 and older.
A covered glaucoma screening includes:
- A dilated eye examination with an intraocular pressure (IOP) measurement; and
- A direct ophthalmoscopy examination or a slit-lamp biomicroscopic examination.
What Can You Do?
As a health care professional who provides care to seniors and others with Medicare, you can help protect the vision of your Medicare patients who may be at high risk for glaucoma by educating them about their risk factors and reminding them of the importance of getting an annual glaucoma screening exam covered by Medicare. Your reminder and referral for a glaucoma screening exam can help provide eligible Medicare beneficiaries with peace of mind and safeguard their vision.
For More Information
· CMS has developed a variety of educational products and resources to help health care professionals and their staff learn more about coverage, coding, billing, and reimbursement for preventive services and screenings covered by Medicare.
- The MLN Preventive Services Educational Products Web Page ~ provides descriptions and ordering information for all provider specific educational products related to preventive services. The web page is located at http://www.cms.hhs.gov/MLNProducts/35_PreventiveServices.asp on the CMS website.
- Glaucoma Screening Brochure ~ this tri-fold brochure provides health care professionals with an overview of Medicare’s coverage of glaucoma screening services. To view online go to http://www.cms.hhs.gov/MLNProducts/downloads/glaucoma.pdf on the CMS website. To order copies of the brochure, go to the CMS Medicare Learning Network (MLN) Product Ordering System located at: http://cms.meridianksi.com/kc/main/kc_frame.asp?kc_ident=kc0001&loc=5
- The CMS Website ~ provides information for preventive service covered by Medicare. Go to http://www.cms.hhs.gov, select “Medicare”, scroll down to the “Prevention” section.
· For information to share with your Medicare patients, visit http://www.medicare.gov
· For more information about glaucoma, visit The National Eye Institute http://www.nei.nih.gov/index.asp
· For more information about National Glaucoma Awareness Month, please visit http://www.preventblindness.org/
The following articles have been published to the Centers for Medicare and Medicaid Services Web site:
Change Request 6245 - End Stage Renal Dialysis (ESRD) Medicare Claims Processing Manual Clarification
Change Request 6282 - Incorporation of Recent Regulatory Revisions Pertinent to Suppliers of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)
Change Request 6208 - Adjustment for Medicare Mental Health Services
Change Request 6299 - HIPAA Inbound 837 Institutional and Inbound 837 Professional Flat Files
Change Request 6320 - January 2009 Update of the Hospital Outpatient Prospective Payment System (OPPS)
Change Request 6328 - Claim Status Category Code and Claim State Code Update
Change Request 6261 Signature and Date Stamps for DME Supplies CMNs and DIFs
Change Request 6290 Quarterly Update to Correct Coding Initiative Edits, Version 15.0, Effective January 1, 2009
Change Request 6070 - Calendar Year 2009 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment
December 30, 2008
CMS has implemented changes to the FISS payments system that is affecting our ability to process payments for providers that do not have an NPI number. We have made CMS aware of the problem and they are working on a resolution; however, until this problem is resolved no payments can be issued for any provider type for which an NPI number does not exist.
We apologize for any inconvenience this may have caused. We will continually monitor the situation and promptly process your payments as soon as the problem is resolved.
December 26, 2008
The following articles have been published to the Centers for Medicare and Medicaid Services Web site:
Change Request 6349 - Summary of Policies in the 2009 Medicare Physician Fee Schedule and the Telehealth Originating Site Facility Fee Payment Amount
Change Request 6170 & 6171 - Zone Program Integrity Contractor Updates
Change Request 6097 - Additional Provider Enrollment Verfication and Program Integrity Activities
Change Request 6194 - Decesed Individual and the Provider Enrollment Process
Change Request 6068 - Implementation - Processing All Diagnosis Codes Reported on Claims Submitted to DME MACs
Change Request 6070 - Calendar Year 2009 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payments
Change Request 6288 - January 2009 Quarterly Average Sales Price Medicare Part B Drug Pricing Files
Change Request 6277 - Annual clotting Factor Furnishing Fee Update
Change Request 6287 - New Waived Tests
Change Request 6275 - CAS segments for MSP Part A Claims
Change Request 6172 - Moratorium on Classification of Long Term Care Hospitals
Change Request 6297 - Changes in Payment for Oxygen Equipment and Additional Instructions for DMEPOS
Change Request 6298 - HIGLAS Part A Changes for Limitation on Recoupment
Change Request 6130 - Expansion of Medicare Telehealth Services
Change Request 6285 - New Contractor Number for the J9 MAC Workloads
Change Request 6301 - Percutaneous Transluminal Angioplasty of the Carotid Artery Concurrent with Stenting
December 23, 2008
The following articles have been published to the Centers for Medicare and Medicaid Services Web site:
Change Request 6057 - Method of Payment under Frontier Extended Stay Clinic Demonstration
Change Request 6211 - Utilizing 837 Professional Claim Adjustment Segments for MSP Part B Claims
Change Request 6206 - Improved Access to Ambulance Services Payment Rates
Change Request 6216 - Implementation of Changtes in ESRD Payment for calendar year 2009
Change Request 6275 - Instructions on ANSI X12 837 Institutional claim segments for MSP Part A claims
Change Request 6172 - Moratorium on Classification of LTCH
December 13, 2008
The following articles have been published to the Centers for Medicare and Medicaid Services Web site:
Change Request 6304 - Changes to the Laboratory National Coverage Determination
Change Request 6291 - Theramal Intradiscal Procedures
Change Request 6062 - 2008 Jurisdiction List for DMEPOS HCPCS Codes
December 9, 2008
Change Request 6106 provides information for the Health Professional Shortage Area (HPSA) bonus payment policy changes. You may view this article in its entirety at www.cms.hhs.gov/MLNMattersArticles/downloads/MM6106.pdf
December 4, 2008
Due to scheduling conflicts, you may not have been able to participate in the December 2, 2008 Rural Health Open Door Forum (ODF). There were important rural health policy updates given during the ODF and we want to make sure you have the opportunity to hear them. We want to remind you about the Encore feature which allows you to replay the ODF at your convenience. To access the Encore feature for this ODF, dial 1-(800)-642-1687 and enter Conference ID 58377162. This service is currently available and will expire on Tuesday, December 9, 2008.Thank you for your continued interest in the Open Door Forums.
December 3, 2008
Transition to Value-Based Purchasing for Physicians and Other Professionals
The Centers for Medicare & Medicaid Services has extended the registration period for the Listening Session on a Plan to Transition to Value-Based Purchasing for Physicians and Other Professionals. Registration will now end on Thursday, December 4th at 5 PM EST. The Listening Session will be held at the CMS Central Facility on December 9, 2008, from 10 AM EST to 4 PM EST. The notice for this meeting was published in the Federal Register on October 24, 2008. Physicians and other professionals, their associations, health care purchasers, consumers, and all other interested parties are invited to participate, in person or by calling in to the teleconference. The issues identified and discussed during this meeting will assist CMS in developing options for the Plan. The meeting is open to the public, but attendance is limited to space and teleconference lines available.Interested parties are reminded that to participate, either in person or by teleconference, on‑line registration is required via the CMS website at: http://registration.intercall.com/go/cms2. Registration will close at 5 PM EST on Thursday, December 4, 2008.
. Registration will close at 5 PM EST on Thursday, December 4, 2008.
Facilitator's Guide
The revised Facilitator's Guide - Companion to Medicare Physician Guide: A Resource for Residents, Practicing Physicians, and Other Health Care Professionals (October 2008) is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network. This publication, which includes all the information and instructions necessary to prepare for and present a Medicare Resident, Practicing Physician, and Other Health Care Professional Training Program including instructions for facilitators, customization guide, a PowerPoint presentation with speaker notes, pre- and post-assessments, master assessment answer keys, and evaluation tools, may be accessed at http://www.cms.hhs.gov/MLNProducts/MPUB/list.asp.
The Centers for Medicare & Medicaid Services (CMS) has updated the FY 2009 Inpatient Rehabilitation Facility (IRF) PC Pricer. If you use the IRF PC Pricer, please go to the web page at http://www.cms.hhs.gov/PCPricer/06_IRF.asp#TopOfPage and down load the most recent version of the FY 2009 IRF PC Pricer posted on 11/26/2008.
December 2, 2008
The ICD-10-Clinical Modification/Procedure Coding System Fact Sheet, which provides general information about the International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) including benefits of adopting the new coding system, structural differences between ICD-9CM and ICD-10-CM/PCS, and implementation planning recommendations, is now available in print format from the Centers for Medicare & Medicaid Services Medicare Learning Network. To place your order, visithttp://www.cms.hhs.gov/MLNProducts/01_Overview.asp, scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page.”
November 26, 2008
Update to Medicare Deductible, Coinsurance and Premium Rates for 2009Transmittal 55 dated November 7, 2008 was rescinded and replaced with Transmittal 56, dated November 17, 2008. This transmittal adds information inadvertently left out in section 20.6 of the manual. The 2009 Income Parameters for Determining Part B Premium were not complete. All other information remains the same.
On October 30, 2008, the Centers for Medicare & Medicaid Services posted a notice in the Federal Register regarding a Listening Session on Hospital-Acquired Conditions in Inpatient and Outpatient Settings. The Listening Session will be held on December 18, 2008. Additional information on the Listening Session, as well as registration instructions, is available at: http://www.cms.hhs.gov/HospitalAcqCond/07_EducationalResources.asp#TopOfPage .CMS has recently updated the Hospital-Acquired Conditions website to include the agenda for the Listening Session.
November 14th 2008
CMS has issued Transmittal 16 to the Provider Reimbursement Manual 15-2, Chapter 35. This Transmittal communicates changes to the Form CMS 2540-96, the Skilled Nursing Facility Medicare cost reporting forms.November 12, 2008
The FISS online system will not be available on Thursday, November 27, 2008 or Thursday, December 25, 2008 in observance of the Thanksgiving and Christmas holidays. The November holiday payment schedule will be November 24, 2008 and November 26, 2008. The December holiday payment schedule will be December 22, 2008 and December 26, 2008.
Update to the Initial Preventive Physical Examination (IPPE) Benefit
Based on Change Request (CR) 6223, which announces that, effective January 1, 2009, the Centers for Medicare & Medicaid Services (CMS) is expanding coverage for the IPPE benefit.
This expanded coverage is subject to certain eligibility and other limitations that allow payment for an IPPE, no later than 12 months (rather than 6 months as previously required) after the date the individual’s first coverage period begins under Medicare Part B. However, this expanded coverage only applies if the IPPE is performed on or after January 1, 2009. To view the article in its entirety http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6223.pdf
November 10, 2008
Beginning in January of 2009, the Medicare Contractor Provider Satisfaction Survey (MCPSS)will query randomly selected providers (physicians, healthcare practitioners, and facilities) out of the 1.2 million who serve Medicare beneficiaries. Westat, a survey research firm, administers the MCPSS. Westat is responsible for all aspects of the survey administration including printing and mailing the survey materials, processing all completed surveys, analyzing the data and reporting the results.
CMS will use the results of the survey to improve its oversight and increase the efficiency of administration of the Medicare program. Contractors will use the results to improve the services they offer to providers. A scientifically-sound, objective measuring provider satisfaction enables CMS to make continuing improvements to services available to enrolled Medicare Fee for Service providers.
Information regarding the application of the Hosital Outpatient Quality Data Reporting Program to services paid under the Hospital OPPS, effective for services rendered on or after January 1, 2009 has been published. Effective for OPPS services furnished on or after January 1, 2009, subsection (d) hospitals that have failed to submit timely outpatient hospital quality data as required by the Social Security Act (Section 1833 (t)(17)(A)) will receive payment under the OPPS that reflects a two percent deduction from the annual OPPS update. More..
October 31, 2008
Riverbend will be issuing the remittance on Monday, November 24, 2008, Wednesday, November 26, 2008 and December 1, 2008 for the Thanksgiving holiday.
October 27, 2008
RGBA's Provider Call Center will be closed on Tuesday, November 11, 2008, in observance of Veterans Day. We will reopen on Wednesday, November 12, 2008. Please call back during normal business hours, which are, Monday thru Friday, 8:00 a.m. thru 6:00 p.m., Eastern Standard Time.
October 17, 2008
Other Part A and Part B providers may now register for the Centers for Medicare & Medicaid Services (CMS)
ICD-10-CM/PCS National Provider Conference Call that will be conducted on November 12, 2008, from
12:30 p.m. to 2:30 p.m. EST. To register for this call, go to http://www.cms.hhs.gov/icd10/Downloads/ICD10_otherproviders.pdf. For additional information about this conference call and to access the ICD-10 Overview Presentation that will be discussed during the call, go to http://www.cms.hhs.gov/ICD10/07_Sponsored_Calls.asp.
October 13, 2008
CMS has made available two preliminary Wage Index Public Use Files (PUFs) for the FY 2010 wage index: the Worksheet S-3 wage data PUF (which includes Worksheet S-3, Parts II and III wage data from cost reporting periods beginning on or after October l, 2005 through September 30, 2006; that is, FY 2006 wage data) and the occupational mix data PUF (which includes data from the 2007-2008 occupational mix survey, Form CMS-10079). These files are posted on the Internet at http://www.cms.hhs.gov/AcuteInpatientPPS/WIFN/list.asp#TopOfPage. The files include FY 2006 wage data for all hospitals in the CMS database as of June 30, 2008 and 2007-2008 occupational mix data submitted to CMS by September 30, 2008. The files exclude hospitals designated as CAHs as of July 8, 2008. The FY 2006 wage data and 2007-2008 occupational mix data will be used in the development of the proposed FY 2010 wage index, to be published in the Federal Register in Spring, 2009.
Attached is a letter ( 
) that will be sent to all hospitals that are serviced by Riverbend GBA that are required to submit wage index information. As stated in this letter, hospitals must review the PUFs to confirm the inclusion and accuracy of their wage index data. All requests from hospitals for changes to their FY 2010 wage index data or occupational mix data must be submitted to and received by their fiscal intermediaries on or before December 8, 2008. Please note that requests postmarked by December 8, but not received until after December 8, are unacceptable.
October 8, 2008
Riverbend will be performing a disaster recovery test Saturday, October 25, 2008. To complete this testing successfully Riverbend will have a dark day meaning there will not be Direct Data Entry (DDE) access or IVR access on Saturday, October 25, 2008.
October 6, 2008
October 6, 2008
October 6, 2008
October 6, 2008
October 6, 2008
October 6, 2008
The CDS is currently in process of making changes to Riverbends session ID selections when accessing FISS. Anyone currently in Direct Data Entry (DDE) will need to log out until notification is issued that DDE is available.
September 29, 2008
The Centers for Medicare and Medicaid Services (CMS) developed the Medically Unlikely Edit (MUE) program to reduce the paid claims error rate for Part B claims. The first edits were implemented January 1, 2007. Subsequently there have been quarterly updates increasing the number of edits. The edits were developed based on anatomic considerations, HCPCS/CPT code descriptors, CPT instructions, CMS policies, nature of service/procedure, nature of analyte, nature of equipment, and clinical judgment. Prior to implementation, all edits were reviewed by national healthcare organizations, and their alternative recommendations were taken into consideration. In 2008, CMS has been refining the edits based on 100% submitted claims data from a six month period in 2006.
CMS is pleased to announce that beginning October 1, 2008, coincident with implementation of MUE version 2.3, the majority of existing MUEs will be made public and posted on the CMS website accessed through the MUE webpage at http://www.cms.hhs.gov/NationalCorrectCodInitEd/08_MUE.asp#TopOfPage .
The published MUE will consist of most of the codes with MUE values of 1-3. At some future time, these edits will also be available from the National Technical Information Service.
CMS will not publish all MUE values that are 4 or higher because of CMS concerns about fraud and abuse. National healthcare organizations and contractors with information about MUE values that are not published on the CMS website should continue to maintain confidentiality of those values. In addition, a minimal number of MUEs with lower values believed by CMS to be particularly vulnerable to fraud and abuse may not be published.
CMS will update the MUE values on its website on a quarterly basis coincident with each quarterly version of MUE. Future postings of MUE values will also include some codes with MUE values of 4 or more.
CMS is concerned that providers will incorrectly interpret MUE values as utilization guidelines. MUE values do NOT represent units of service that may be reported without concern about medical review. Providers should continue to only report services that are medically reasonable and necessary.
National Healthcare Organizations may notice that some MUE values differ from the ones originally implemented based on their alternative recommendations. Some MUE values have been modified in 2008 based on the data refinement using the 100% submitted claims data from a six month period in 2006. The data refinement has resulted in some MUE values being increased and others decreased.
Further information about the MUE program and requests for reconsideration of MUE values may be viewed in the FAQ (Frequently Asked Questions) link from the CMS MUE webpage cited above.
September 26, 2008
Need More Information?
The NPI Registry option to search by ‘Doing Business As’ (DBA) name has been temporarily removed from the NPI Registry search page while we make enhancements to the system. The DBA search option is expected to be available by Friday, October 10, 2008.
Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203. Having trouble viewing any of the URLs in this message? If so, try to cut and paste any URL in this message into your web browser to view the intended information.
Note: All current and past CMS NPI communications are available by clicking "CMS Communications" in the left column of the www.cms.hhs.gov/NationalProvIdentStand CMS webpage.
September 23, 2008
The EC Gateway will have an upgrade to Sybase over the weekend. The Bulletin Board System (BBS) will be brought down at noon this Friday, September 26th, 2008 and be brought back up early Monday, September 29th, 2008. During that time clients will not be able to access their electronic mailbox to submit claims or retrieve files. A message is being placed on the ECG Welcome screen to advise of the outage.September, 22, 2008
Provider Call Center
RGBA's Provider Call Center will be closed on Friday, October 17, 2008 from 11:00 am to 6:00 pm Eastern Standard Time for an Employee Appreciation Celebration.
HAC and POA Indicator
The Centers for Medicare & Medicaid Services (CMS) has recently updated all sections of the Hospital-Acquired Conditions (HAC) & Present on Admission (POA) Indicator Reporting web site to describe the changes published in CMS’ Inpatient Prospective Payment System (IPPS) Fiscal Year (FY) 2009 Final Rule. The HAC & POA Indicator information is available at http://www.cms.hhs.gov/HospitalAcqCond/ on the CMS website.
Provider Call Center
RGBA's Provider Call Center will be closed on Monday, October 13, 2008 in observance of Columbus Day. We will reopen on Tuesday, October 14, 2008. Please call back during normal business hours, which are, Monday thru Friday, 8:00 am to 6:00 p.m., Eastern Standard Time.
Ask the Contractor Teleconference – AMBULANCE Suppliers
Thursday, October 30, 2008
1-3:00 p.m. (CT)
You may register for the event on the calendar of events page of the Section 1011 Web site, www.trailblazerhealth.com/Section1011/Default.aspx.
A confirmation e-mail with the dial-in information will be sent to the e-mail address provided when your registration is approved.
A question-and-answer session concludes the teleconference and you may e-mail your questions in advance through the close of business Thursday, October 23, 2008 to section.1011@trailblazerhealth.com with Ask the Contractor in the subject line.
CMS Announces Medicare Premiums, Deductibles for 2009 The standard Medicare Part B monthly premium will be $96.40 in 2009, the same as the Part B premium for 2008. This is the first year since 2000 that there was no increase in the standard premium over the prior year.
The 2009 Part B premium of $96.40 is the same as the amount projected in the 2008 Medicare Trustees Report issued in March. This monthly premium paid by beneficiaries enrolled in Medicare Part B covers a portion of the cost of physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and other items.By law, the standard premium is set to cover approximately one-fourth of the average cost of Part B services incurred by beneficiaries aged 65 and over. The remaining Part B costs are financed by Federal general revenues. The income to the program from premiums and general revenues are paid into the Part B account of the Supplementary Medical Insurance trust fund, and Part B expenditures are drawn from this account.
Normally, the Part B premium increases at the same rate as average Part B expenditures from year to year. A number of factors explain why the premium can be kept level for 2009.Growth is expected in 2009 for most areas of the Medicare Part B program, including growth in the cost and use of physician and outpatient hospital care, home health services, physician-administered drugs, ambulatory surgical center services, durable medical equipment, independent lab and physician’s office lab services, as well as growth in the Medicare Advantage program. In most years, this would result in the need for an increase in the Part B premium and general revenue financing.
To view this Fact Sheet in its entirety go to: http://www.cms.hhs.gov/apps/media/fact_sheets.asp The Deficit Reduction Act of 2005 capped the Medicare physician fee schedule (MPFS) payment for the technical component (TC) of most imaging services at the outpatient prospective payment system (OPPS) payment rate. The cap applies to both TC-only and the TC of global services. Where the payment is capped, the MPFS files may disclose only the capped payment amount. Several providers have requested disclosure of both the capped and uncapped amounts. Such information can be found at http://www.cms.hhs.gov/PFSlookup/02_PFSSearch.asp#TopOfPage.
September 19, 2008
ICD-10 Overview Presentation
The PowerPoint Presentation that will be discussed during the ICD-10 All Contractor Conference Call on September 30, 2008 is posted at a different website than that listed in the JSM/TDL 08489 issued September 15, 2008. The presentation is posted on the MLN Contractor Training & Education Web Page at: http://www.cms.hhs.gov/ContractorLearningResources Click on MLN Contractor Training & Education link and access by selecting ICD-10 Overview Presentation in the Downloads Section.
September 16, 2008
September 16, 2008
September 16, 2008
September 16, 2008
September 16, 2008
September 16, 2008
RGBA has identified a problem with ESRD Pricer that results in some claims paying at a higher rate than they should be paying, resulting at times in a significant overpayment. We have reported this problem to FISS with the highest priority. We have also alerted CMS that the problem exists. At this point we feel the issue involves HCPC 90999, but not all claims with 90999 are overpaying. As soon as we have more information we will share it with our ESRD provider community.
September 15, 2008
Correction for phone number information and title of conference
The Centers for Medicare & Medicaid Services (CMS) will host an “Ask-the-Contractor” teleconference on September 18, 2008 to discuss the postponement of the CAP for 2009 and to assist participating CAP physicians in planning for the transition out of the program. The call will be conducted by the CAP designated carrier, Noridian Administrative Services (NAS). NAS staff will be available to respond to inquiries during a question and answer session after the presentation. This call is intended for all interested providers and their staff. Call Details:Title: Competitive Acquisition Program (CAP) for Part B Drugs and Biologicals – Transitioning Physicians out of CAP
Date and Time: September 18, 2008 at 2:00PM CSTDomestic U.S. Call Number: (800) 398-9397
U.S. Territories Call Number: (612) 332-0226 A PowerPoint slide presentation to accompany the “Ask-the-Contractor” teleconference will be posted on the NAS website at least one day prior to the teleconference. The NAS website can be found at: https://www.noridianmedicare.com/cap_drug/index.html
Updates on the Medicare Part B Competitive Acquisition Program (CAP) for Drugs and Biologicals
Medicare Part B Drug Competitive Acquisition Program (CAP): “Ask-the-Contractor” Teleconference - CAP Postponement for 2009
On September 10, 2008, the Centers for Medicare & Medicaid Services (CMS) announced the postponement of the 2009 Medicare Part B Competitive Acquisition Program (CAP). As a result, CAP physician election for participation in the CAP in 2009 will not be held, and CAP drugs will not be available from an approved CAP vendor for dates of service after December 31, 2008.
To discuss this major change to the CAP for 2009 and assist participating CAP physicians in planning for the transition out of the CAP, an “Ask-The-Contractor” teleconference for participating CAP physicians will be hosted by the CAP designated carrier, Noridian Administrative Services (NAS). NAS staff will be available to respond to inquiries during a question and answer session after the presentation. This call is intended for all interested providers and their staff.
Use the following information to participate on the call:
Date: September 18, 2008 at 2:00PM CST
Domestic U.S. Dial In Number: 800-230-1085
U.S. Territories Dial In Number: 612-332-0923
A PowerPoint slide presentation to accompany the “Ask-the-Contractor” teleconference will be posted on the NAS website at: (https://www.noridianmedicare.com/cap_drug/train/act.html). The slides will be available at least one day prior to the teleconference.
Additional information about the postponement is available on the CMS CAP website (http://www.cms.hhs.gov/CompetitiveAcquisforBios/.)
Information for 2008 Medicare Part B Competitive Acquisition Program (CAP) for Drugs and Biologicals
October 2008 CAP Drug List Update
The list of drugs available under the CAP has been updated and is now available in the ‘Downloads’ section on the CMS CAP “Information for Physicians” page at: http://www.cms.hhs.gov/CompetitiveAcquisforBios/02_infophys.asp.
The following drug has been added to the CAP effective October 1, 2008: Vivitrol® naltrexone (J2315). CAP Physician Billing Tips” Handout for Submitting CAP Claims Now Available
An updated version of the “CAP Physician Billing Tips” handout is now available. This reference contains information on the claims submission requirements for the CAP such as the CAP modifiers and other necessary elements. A copy of this document is available on the ‘Information for Physicians’ page on the CMS CAP website at: http://www.cms.hhs.gov/CompetitiveAcquisforBios
On September 10, 2008, the Centers for Medicare & Medicaid Services (CMS) announced the postponement of the 2009 Medicare Part B Competitive Acquisition Program (CAP). As a result, CAP physician election for participation in the CAP in 2009 will not be held, and CAP drugs will not be available from an approved CAP vendor for dates of service after December 31, 2008.
To discuss this major change to the CAP for 2009 and assist participating CAP physicians in planning for the transition out of the CAP, an “Ask-The-Contractor” teleconference for participating CAP physicians will be hosted by the CAP designated carrier, Noridian Administrative Services (NAS). NAS staff will be available to respond to inquiries during a question and answer session after the presentation. This call is intended for all interested providers and their staff.
Use the following information to participate on the call:
Date: September 18, 2008 at 2:00PM CST
Domestic U.S. Dial In Number: 800-230-1085
U.S. Territories Dial In Number: 612-332-0923
A PowerPoint slide presentation to accompany the “Ask-the-Contractor” teleconference will be posted on the NAS website at: (https://www.noridianmedicare.com/cap_drug/train/act.html). The slides will be available at least one day prior to the teleconference.
Additional information about the postponement is available on the CMS CAP website (http://www.cms.hhs.gov/CompetitiveAcquisforBios/.)
On Saturday, October 18, 2008, the Common Working File (CWF) will be conducting activity with CWF. Due to the anticipated duration of this activity and to ensure the completion of weekly processing and scheduled data center maintenance, there will be a CWF dark day on that Saturday. This will mean there will be no access to CWF, which is usually available until noon on Saturdays.
September 12, 2008
2009 Competitive Acquisition Program Postponement Announcement
The Centers for Medicare & Medicaid Services (CMS) today announced the postponement of the 2009 Medicare Part B Competitive Acquisition Program (CAP). The program will continue through December 31, 2008.
Earlier this year, CMS accepted bids for vendor contracts for the 2009-11 CAP. While CMS received several qualified bids, contractual issues with the successful bidders resulted in CMS postponing the 2009 program. As a result, CAP physician election for participation in the CAP in 2009 will not be held, and CAP drugs will not be available from an approved CAP vendor for dates of service after December 31, 2008.
Later this fall, CMS will provide additional guidance for participating CAP physicians on how to transition out of the program. This information will be posted on the CMS CAP physician’s page at: http://www.cms.hhs.gov/CompetitiveAcquisforBios/02_infophys.asp .
CMS also plans to seek feedback on the CAP from participating physicians, potential vendors, and other interested parties. CMS will assess the information and consider implementing changes to the CAP before proceeding with another bid solicitation. As part of the process, CMS is interested in hearing from the public about a range of issues, including, but not limited to, the categories of drugs provided under the CAP, the distribution of areas that are served by the CAP, and procedural changes that may increase the program’s flexibility and appeal to potential vendors and physicians.
Information about how to submit comments will be available at: http://www.cms.hhs.gov/CompetitiveAcquisforBios/.
September 10, 2008
CMS has published the FY 2010 Hospital Wage Index Development Timetable.
September 5, 2008
The list of drugs available under the CAP has been updated and is now available in the ‘Downloads’ section on the CMS CAP “Information for Physicians” page at: http://www.cms.hhs.gov/CompetitiveAcquisforBios/02_infophys.asp.
The following drug has been added to the CAP effective October 1, 2008: Vivitrol® naltrexone (J2315).
Holding of Certain Screening Pap Smear Claims Billed by OPPS Providers
Holding of Certain Screening Pap Smear Claims Billed by OPPS ProvidersDue to systems issues related to an incorrect deductible and coinsurance assignment of Screening Pap Smears claims containing Healthcare Common Procedure Coding (HCPCS) code Q0091, (Screening Papanicolaou (Pap) smear, obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) on OPPS claims, effective immediately, CMS will be instructing their contractors to hold all claims containing HCPCS code Q0091 submitted by OPPS facilities. These claims will be held by contractors until the successful implementation of the Outpatient Code Editor (OCE), scheduled for January 5, 2009. In the interim, OPPS facilities may choose not to submit HCPCS code Q0091 until the successful implementation of the OCE, in order to avoid a delay in reimbursement for other services submitted on the claim. Interest will be paid on clean claims held longer than 30 days after the date of receipt.
September 4, 2008
7:45 AM EST - Riverbend has been notified that FISS is now available.
7:00 AM EST - Riverbend has been notified that the FISS system is unavailable at this time. The CDC is working to resolve the issue. We will continue to keep you updated.
September 3, 2008
Hurricane Gustav- State of Emergency Notice
A State of Emergency has been declared by the President and the Secretary of Health and Human Services as a result of Hurricane Gustav in Louisiana and Texas as of August 27th, August 28th in Mississippi and August 29th in Alabama. The following website is provided to help answer your questions about waivers and modifications that apply during the State of Emergency: http://www.cms.hhs.gov/Emergency/02_Hurricanes.asp.
September 2, 2008
Register Today!
Be part of a groundbreaking opportunity. CMS along with industry partners from health and technology are hosting a National E-prescribing Conference on October 6 – 7, 2008 at the Sheraton Boston Hotel, Boston, MA.
Our goal in holding this conference is to educate providers and beneficiary constituencies on the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) e-prescribing program and help promote the adoption of e-prescribing throughout the health care community.
Join us to find out how to earn incentives from Medicare, learn how e-prescribing can work for your business, and get answers to your questions about privacy, security, and risk management. Register for the conference now at www.e-prescribeconference.com .
Please share this message with your colleagues and members.
We look forward to seeing you in Boston in October!
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