Riverbend

ListServ Message 02/01/2008

January 28, 2008

Information from The CMS.

New:

MM5946 - January 2008 Update of the Hospital Outpatient Prospective Payment System (OPPS) - Manualization http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5946.pdf

Important Information from The CMS and Riverbend GBA.
In our continuing effort to keep our providers updated Riverbend issued information regarding Medi 3100-08. This article was based on Change Request (CR) 5647, which states that, as of January 7, 2008, hospitals (this includes acute care hospitals paid under the inpatient prospective payment system, inpatient rehabilitation facilities (IRF), and long term care hospitals (LTCH)) must begin to submit "no pay" bills to their Medicare contractor for stays by Medicare Advantage (MA) beneficiaries. This will allow for the days of those stays to be eventually captured in the DSH (or low income patient (LIP) for IRF) calculations.

As of February 27, 2008 these claims are processing correctly. However, please note that as result of the previous issue beneficiaries may receive an MSN stating; “Our records show that you are enrolled in a Health Maintenance Organization.Your provider must bill this service to them�. If you receive calls or questions from beneficiaries for this issue you should advise them to disregard the information.

Important information from Riverbend GBA.

You may have noticed more COBC Detailed Error Reports for claims not crossing over to the supplemental insurer due to Error Code: H20600

We have checked several incoming claim files for claims that received this error and it appears Loop 2310A REF01 (Attending Physician Secondary Identification) is being populated incorrectly.

The REF01 segment in Loop 2310A is being populated with an EI qualifier (Employers Identification Number) but the REF02 segment is being populated with the Provider UPIN number or other various numbers.

To help insure claims do not receive this error and cross over to the supplemental insurer please use 1G (Provider UPIN Number) in the REF01 segment of Loop 2310A, along with the Provider UPIN number.

January 29, 2008

Please see the attached file for information regarding the above subject.

The Centers for Medicare & Medicaid Services (CMS) is now accepting quality measure suggestions for consideration for possible inclusion in the proposed set of quality measures to be published in the 2009 Medicare Physician Fee Schedule (MPFS) Proposed Rule for the Physician Quality Reporting Initiative (PQRI). For details, visit http://www.cms.hhs.gov/pqri and select the Measures/Codes tab on the left side of the page. Next, scroll down to the Downloads section and select Notice of 2009 Measure Suggestions.

February Flu Shot Reminder
It’s Not Too Late to Give and Get the Flu Shot!
In the U.S., the peak of flu season typically occurs anywhere from late December through March; however, flu season can last as late as May. Each office visit presents an opportunity for you to talk with your patients about the importance of getting an annual flu shot and a one time pneumococcal vaccination. Protect yourself, your patients, and your family and friends by getting and giving the flu shot. Don’t Get the Flu. Don’t Give the Flu. Get Vaccinated!

Remember Influenza and pneumococcal vaccinations and their administration are covered Part B benefits. Note that influenza and pneumococcal vaccines are NOT Part D covered drugs. You and your staff can learn more about Medicare’s coverage of adult immunizations and related provider education resources, by reviewing Special Edition MLN Matters article SE0748 http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0748.pdf on the CMS website.

The Centers for Medicare & Medicaid Services has reposted the recent scheduled release of modifications to the Healthcare Common Procedure Coding System (HCPCS) code set to incorporate new changes. The revised update has been posted to the HCPCS website at http://www.cms.hhs.gov/HCPCSReleaseCodeSets/02_HCPCS_Quarterly_Update.asp.

January 29, 2008

Information from Riverbend GBA.
The self administered drug exclusion list has been updated with one new drug, J3490, Chorionic Gonadotropin Alfa, Recombinant (Ovidrel).

You will find the updated article at: http://www.rgbagov.com/Publications/LCD/self_admin_drug_exclusion.pdf

January 29, 2008

Information from The CMS.

Physician Quality Reporting Initiative (PQRI): Opportunity to Suggest Measures for Consideration for Inclusion in 2009

The Centers for Medicare and Medicaid Services (CMS) is now accepting quality measure suggestions for consideration for possible inclusion in the proposed set of quality measures to be published in the 2009 Medicare Physician Fee Schedule (MPFS) Proposed Rule for the PQRI.

For more information on this opportunity to suggest measures for consideration for inclusion in 2009, please go to http://www.cms.hhs.gov/PQRI, and select the Measures/Codes tab on the left side of the page. Next, scroll down to the Downloads section and select “Notice of 2009 Measure Suggestions.

Updates to the 2008 PQRI Tool Kit:
The PQRI Tool Kit has been updated to include a downloadable file containing Data Collection Worksheets for all 119 2008 PQRI quality measures. To access this file, please go to http://www.cms.hhs.gov/PQRI, and select the PQRI Tool Kit tab on the left side of the page. Then, scroll down to the Downloads section and select “2008 PQRI Data Collection Worksheets.

NEW Frequently Asked Questions (FAQs):
CMS updates the FAQs for PQRI on an ongoing basis, as inquiry volumes and new program developments indicate the need for new or updated FAQs. The following new FAQs may be of particular interest at this time, as they focus on the process for validating whether a professional participating in the 2008 PQRI is reporting on a sufficient number of measures.

#8973 -- Question: Is there a Measure Applicability Validation (MAV) process for 2008 Physician Quality Reporting Initiative (PQRI)?

#8973 -- Answer: Yes. The PQRI 2008 Measure Applicability Validation Process for Claims-Based Participation is described in a document available for download from the Analysis and Payment page of the PQRI section of the CMS website (at url: http://www.cms.hhs.gov/PQRI/25_AnalysisAndPayment.asp#TopOfPage).

#8974 -- Question: How does the two-step validation process work for the Physician Quality Reporting Initiative (PQRI)?

#8974 -- Answer: Professionals who report successfully on each of fewer than three measures are subject to the 2008 PQRI Measure Applicability Validation (MAV) process for claims-based participation. Professionals who report on three or more measures are not subject to MAV. (The 2008 PQRI Measure Finder Tool is available to assist you in finding measures that may apply to your practice, and is available for download from the PQRI Toolkit page of the CMS website at: http://www.cms.hhs.gov/PQRI/Downloads/2008PQRIMeasureFinderTool.zip)

Step 1 of MAV relates measures to one another by placing them in closely related clusters. This test is based on the concept that if one measure in a cluster of measures related to a particular clinical topic or professional service is applicable to a professional’s practice, then other closely related measures (measures in that same cluster) may also be applicable. The 2008 PQRI MAV clusters and the measures included in each are described in the document titled "2008 Measure-Applicability Validation Process for Claims-Based Participation", which is available for download from the Analysis and Payment page of the PQRI section of the CMS web site. CMS has not included in any clusters certain measures that are not suited for MAV clustering in the 2008 PQRI, for reasons described in the MAV process document.

Step 2 of MAV looks to see if an eligible professional treated more than a minimum number (threshold) of eligible cases that met the requirements of other measures within the cluster. For 2008 claims-based participation in PQRI, measure-specific thresholds may be determined based on analysis of data that will become available during the reporting period. In no case, however, will any measure’s 2008 PQRI applicability threshold be less than 30 reportable instances. The cases to which a measure applies are identified by the line-item diagnosis and service codes billed for each rendering NPI. Any complicating diagnoses on the Part B base claim are not considered in 2008 PQRI analyses for claims-based participation. Cases that count toward the applicability threshold for any individual NPI will also not include those for which the qualifying diagnosis and procedure codes are identified by another rendering professional’s individual NPI. Eligible professionals who pass Step 2 of 2008 PQRI MAV will be eligible for the PQRI incentive payment.

January 29, 2008

You Are Cordially Invited To Attend the
2008 2^nd Quarter Ask the Contractor Teleconference (ACT)
February 20, 2008
2:00 P.M. EST
Dial In Number: 1-877-852-6573
Hosted by:
Riverbend Government Benefits Administrator, Inc.
All providers are welcome and are encouraged to join the call.
Representatives from all areas of RGBA will be available.

The Ask The Contractor Teleconference is scheduled for 90 minute. If you have questions for Riverbend that you would like answered during this call, you are encouraged to e-mail those to us as soon as possible to ensure any necessary research is completed by the scheduled date. Please send your questions to: education@rgbagov.com .

Once the call is completed, there will be a replay for 30 days. The replay can be accessed by calling 888.203.1112, and entering replay pass code 3422025.

January 29, 2008

For Medicare Providers that are currently completing an 855A, please see the information below regarding the “Most Common Errors� noted on the 855A. By following this guideline, our goal is to help you complete the 855A in a manner that will enable the approval process to be initiated on your first submission. This information is also listed on our Website at www.rgbagov.com

The link to the information below is: http://www.rgbagov.com/Providers/Enrollment/Common-Errors/855A.shtml

Most Common Errors on the CMS 855A Section 1A

Marking the wrong reason for submitting the application

Missing the NPI and Medicare number on Change of Ownership and Change of Information applications.

On CHOW applications, the NPI reported for new owner is the NPI of the old owner. New owner needs a NPI for the facility that matches the legal business name and tax id number for the new owner.

Section 1B
Failure to complete all sections required for the type of application being submitted

Section 2A
Marking the incorrect type of provider

Section 2B1
Legal Business Name does not match IRS documentation.
Missing IRS Documentation.
Missing the Medicare Year-End cost report date.
Missing the Incorporation Date and State where incorporated
Missing incorporation documentation
For sole proprietor, the tax identification number (TIN) is the individual’s SSN not the Employer dentification Number (EIN) for the provider.
For sole proprietor, the name on the 1st line of the IRS CP575 is the legal business name. The name on the 2nd line is the Doing Business Name (DBA) name.

Section 2B2
Failure to check not applicable box if not completing this section for licensure
Failure to check not applicable box if not completing this section for certification

Section 2C
The address for the facility is missing.
Failure to provide the additional 4 digits of the zip code

Section 2D
This section does not have “yes� or “no� marked.

Section 2F
The legal business name does not match the one reported in Section 2B1 of the old owners CHOW 855A.

Section 3
This section does not have “yes� or “no� marked.

Section 4A
City/Town or State left blank.
The zip code is missing the additional 4 digits
Missing telephone and fax numbers
NPI number missing and/or no NPI documentation attached.
NPI documentation does not match name or address on 855A.
The NPI reported is for a physician and not the facility
For a CHOW, the NPI reported in 4A does not match the NPI reported in 1A.
CLIA number is missing. Enter “N/A� if it does not apply or “Pending� if you have applied but not received the number.
Medicare number reported is not a Part A or OSCAR number.
For sole proprietor, the NPI reported on the 855 should be associated with the individuals SSN in NPPES.

Section 4B
EFT (CMS Form 588) agreement and/or documentation is missing
Did not answer special payments address, or did not include the plus 4 in the zip code.

Section 5A
This section should have the box marked for Not applicable or be completed.
Zip code is missing the additional 4 digits.
Failure to complete this section for the home office in Section 7.
Missing IRS documentation for tax id numbers for all entities reported.

Section 5B
If 5A is completed then this section should be answered yes or no.
If 5A is not completed then this section should be left blank.

Section 6A1
Entire section is left blank. This section should be completed for each officer, owners, partners and/or managing employees of the facility.
Failure to report at least one person as a managing employee.
Failure to complete this section for the authorized and/or delegated official.
Failure to complete this section for the Administrator or CEO of the home office in Section 7.
issing or incorrect Social Security numbers or dates of birth
Reporting NPI and Medicare number that do not belong to the individual in this section.

Section 6A2
Failure to mark fields all that apply.
Failure to report at least one person as a managing employee.

Section 6B1
If 6A is completed then this section should be answered yes or no.
If 6A is not completed then this section should be left blank.

Section 7
Failure to complete this section or mark that it is not applicable
If section is completed, ensure the Home Office fee-for-service contractor and Home Office Chain
number is listed.
If section is completed, need to include additional 4 digits in the zip code.

Section 8
Failure to complete this section or mark that it is not applicable
If completed, ensure a copy of the billing agreement is attached and enter an effective date.
If completed, need to include additional 4 digits in the zip code

Section 12
Failure to mark the box that indicates that this section does not apply if the section is not
completed.

Section 15
Signature and dates in this section are not an original signature. Do not submit copies or stamped signature. Use blue ink to authenticate signature.
This section should be signed and dated by an officer, owner or partner of the facility, not a
managing employee.
A section 6 must be completed on the individual signing this section of the application.
The person signing is not officer, partner, or owner of the applicant/facility but is an officer or partner of an owning or parent company.

Section 16
Application does not have an original signature and date
Person signing this section must also have a section 6
Person signing this section must be an officer, partner, or owner of the applicant but not of an
owning or parent company.
The person has indicated in Section 6 that they are a contracted managing employee. Delegated officials must be W-2 employees.

Missing Documentation
IRS verification of the TIN reported in Sections 2B1, 5 or 7.
NPI notification from NPPES for the NPI reported in 4A.
EFT Agreement.
Copy of adverse legal action documentation if applicable.
Attestation from government entities that they are liable for any debts owed to CMS when applicable.
Copy of the final bill of sale or sales agreement with all exhibits referenced in the agreement for a change of ownership
The names/entities on the bill of sales or sales agreement do not match the names on the old and new owner CHOW 855As.

January 29, 2008
Important information from Riverbend GBA.
The latest release of The CMS software PC-ACE is now available for downloading on the RGBA website at: http://www.rgbagov.com/Tools/Electronic-Billing-EDI/Downloads.shtml

This release of PC-ACE (version 1.89) contains all the January 2008 updates from CMS including annual HCPCS updates and edits requiring the mandatory reporting of the NPI (National Provider Identifier) on all Medicare-A claims.

Providers are encouraged to download this PC-ACE release immediately to ensure full compliance with CMS mandates.

If you need assistance with downloading the software, please contact the e-Business Service Center, (423) 755-5717.

January 30, 2008
Important Information from The CMS.
On Saturday, February 16, 2008, the CWF Keystone Host will be conducting a history purge. 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 the Health Insurance Query for Part A Master Record (HIQA), which is usually available until noon on Saturdays.

All files received from satellites for Friday’s cycle will be completed prior to bringing CWF production down. If for any reason satellite files are received late Saturday morning, they will be processed by CWF after the history purge has been completed.

January 31, 2008
Information from The CMS.
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the availability of the latest Medicare Learning Networkprovider education product entitled, Guided Pathways to Medicare Resources for Medicare Fee for Service Health Care Professionals.

Guided Pathways has been developed as an educational tool for fee for service FFS health care staff who are relatively unfamiliar with the Medicare Program, as well as for those professionals looking for easy access to the many resources on the CMS website. Using a road trip motif, the pathways lead users through nine broad sections of information covering the Medicare Program, with links to further pertinent information. The pathways also provide links to other government resources pertaining to Medicare FFS items. Guided Pathways can be accessed at http://www.cms.hhs.gov/apps/training/guidedpathways/index.html on the CMS website.

Located in the Provider Communications Group within CMS, the Medicare Learning Network (MLN)is the brand name for official CMS educational products designed to promote national consistency of information developed for Medicare FFS initiatives. Most importantly, it is available to help you! Each quarter the MLN will send updates on the latest products available ~ so be on the lookout!

For more information on the Medicare Learning Network, please visit http://www.cms.hhs.gov/MLNGenInfo/ on the CMS website. Questions and requests for additional information can be sent to the MLN Mailbox at MLN@cms.hhs.gov.

January Flu Shot Reminder
It’s Not Too Late to Get the Flu Shot. We are in the midst of flu season and a flu vaccine is still the best way to prevent infection and the complications associated with the flu. But revaccination is necessary each year because flu viruses change each year. Please encourage your Medicare patients who haven’t already done so to get their annual flu shot. And dont forget to immunize yourself and your staff. Protect yourself, your patients, and your family and friends. Get Your Flu Shot Not the Flu!

Remember Influenza vaccination is a covered Part B benefit. Note that influenza vaccine is NOT a Part D covered drug. Health care professionals and their staff can learn more about Medicare’s coverage of adult immunizations and related provider education resources, by reviewing Special Edition MLN Matters article SE0748
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0748.pdf on the CMS website.

End of Listserv Message.