Riverbend

ListServ Message 02/29/2008

February 25, 2008

Important Information from The CSM.
The NPI is here. The NPI is now. Are you using it?
ATTENTION: Fee-For-Service (FFS) Medicare Physicians, Non-Physician Practitioners & Other Suppliers

Reminder Effective March 1, 2008, when required for Medicare claim submission, all 837P and CMS-1500 claims must have an NPI or NPI/legacy pair in the required primary provider fields. Failure to include an NPI will cause the claim to reject. Visit the CMS NPI web page at http://www.cms.hhs.gov/NationalProvIdentStand/02_WhatsNew.asp for more details.

TEST NPI-only NOW

If you have been submitting claims with both an NPI and a Medicare legacy number and those claims have been paid, you need to test your ability to get paid using only your NPI by submitting one or two claims today with just the NPI (i.e., no Medicare legacy number). IftheMedicare NPI Crosswalk cannot match your NPI toyourMedicare legacy number,the claim with an NPI-only will reject. You can and should do this test now! If the claim is processed and you are paid, continue to increase the volume of claims sent with only your NPI.If the claims rejects, go into your NPPES record and validate that the information you are sending on the claim is the same information in NPPES. If it is different, make the updates in NPPES and resend a small batch of claims 3-4 days later. If your claims are still rejecting, you may need to update your Medicare enrollment information to correct this problem. Call your Medicare carrier, FI, or A/B MAC enrollment staff or the National Supplier Clearinghousefor adviceright away. Have a copy of your NPPES record available. The enrollment telephone numbers are likely to be quite busy, so don't wait.

Need More Information?

Not sure what an NPI is and how you can get it, share it and use it? As always, more information and education on the NPI can be found through the CMS NPI page www.cms.hhs.gov/NationalProvIdentStand on the CMS website. 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.

Getting an NPI is free - not having one can be costly.

Riverbend GBA received notification from The CMS instructing FI’s to hold claims with dates of service beginning January 1, 2008 that contain the following HCPCs: 82374, 82435, 82565, 82947, 84132, 84295 and 84520.

Information has now been received that corrections to these codes are scheduled for production on March 3, 2008.

Please see our web site at http://www.rgbagov.com/Tools/FISS-Hold-Locations/ for the updated information.

Don’t miss the 2008 Rural Health Clinic Workshop Recipes for Success, Where You are the Main Ingredient!

The TN Chapter HFMA is proud to present the Rural Health Clinic (RHC) Reunion workshop featuring speakers from Riverbend Government Benefits Administrator, Inc. in Nashville, TN on March 4, 2008.The location will be the Willis Conference Center Nashville, TN.. Registration is available at the following link: http://www.tnhfma.org/custpage.cfm/frm/9053/sec_id/9053.

February 26, 2008

Information from The CMS.

New:
MM5847 Clarification of Bone Mass Measurement (BMM) Billing Requirements Issued in CR 5521 http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5847.pdf

MM5897 Change in the Amount in Controversy Requirement for Administrative Law Judge Hearings and Federal District Court Appeals http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5897.pdf

MM5868 Update to the Implementation Date for Home Health Agencies (HHAs) Providing Durable Medical Equipment (DME) in Competitive Bidding Areas http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5868.pdf

MM5932 Teaching Physician Requirements for End Stage Renal Disease Monthly Capitation Payment (ESRD MCP) http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5932.pdf

MM5909 Items and Special Services Having Special DME Review Considerations http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5909.pdf

MM5931 Manualization of Payment for Outpatient End Stage Renal Disease (ESRD) Related Services http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5931.pdf

MM5793 Payment for Initial Hospital Care Services (Codes 99221 – 99223) and Observation or Inpatient Care Services (Including Admission and Discharge Services) (Codes 99234 – 99236) http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5793.pdf

MM5898 Comprehensive Outpatient Rehabilitation Facility (CORF) Billing Requirement Updates for FY 2008 http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5898.pdf

MM5910 Clarification to CR 5744 Payment Allowance Update for the Influenza Virus Vaccine CPT 90660 and further instruction regarding the Pneumococcal Vaccine Current Procedural Terminology (CPT) 90669 http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5910.pdf

MM5948 Part B Drug Competitive Acquisition Program (CAP) Quarterly Drug List Update http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5948.pdf

MM5794 Subsequent Hospital Visits and Hospital Discharge Day Management Services (Codes 99231 99239) http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5794.pdf

MM5791 Payment for Hospital Observation Services (Codes 99217 - 99220) and Observation or Inpatient Care Services (Including Admission and Discharge Services Codes 99234 - 99236) http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5791.pdf

MM5855 Systems Changes for Prescription Order Numbers for the Competitive Acquisition Program (CAP) for Part B Drugs and Biologicals http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5855.pdf

MM5936 Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 14.1, Effective April 1, 2008 http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5936.pdf

Information from The CMS.
The Ambulance Fee Schedule Fact Sheet, which provides general information about the Ambulance Fee Schedule, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/AmbulanceFeeSched_508.pdf

SUBJECT: Availability of the Proposed Federal Fiscal Year (FY) 2009 Wage Index Public Use Files (PUFs) and Deadline for Requesting Corrections to the Wage Index Data.

On Monday, February 25, 2008, the Centers for Medicare & Medicaid Services (CMS) released the proposed FY 2009 wage index PUFs. This letter addresses the criteria and process for hospitals to request corrections to their wage index data. All requests from hospitals for corrections to their FY 2009 wage index data must be submitted to and received by their Fiscal Intermediaries or Medicare Administrative Contractors (FI/MACs) on or before March 11, 2008.

Availability of Wage Index PUFs

A single PUF that includes three spreadsheets is available on the Internet beginning February 25, 2008: 1) a file containing the Worksheet S-3 wage data from cost reports beginning during Federal FY 2005, 2) a file containing the 1^st quarter CY 2006 occupational mix survey data (that is, for the period January 1, 2006 through March 31, 2006), and 3) a file containing the 2^nd quarter CY 2006 occupational mix survey data (that is, for the period April 1, 2006 through June 30, 2006). These files include data for all hospitals in our database as of February 22, 2008. These data will be used in the development of the proposed FY 2008 wage index, to be published in the Federal Register in Spring 2008. The average hourly wage comparison PUF (FY 2008 versus FY 2009) is also posted on CMS’s website.

The FY 2009 wage index PUFs are available on the Internet at CMS’s home page. The address for CMS’s home page is: http://www.cms.hhs.gov. To access the PUFs directly, the address is: http://www.cms.hhs.gov/AcuteInpatientPPS/WIFN/list.asp#TopOfPage.

Alternatively, the American Hospital Association generally makes the wage index files available to individual State hospital associations. Hospitals may want to check with their State hospital association to see if they have or will be getting the files. CMS will notify the American Hospital Association, the Federation of American Health Systems, and the Association of American Medical Colleges of the release of the files.

Hospital Requests for Corrections to the Wage Index Data

As noted in the wage index development timetable (previously sent, and below for your convenience), hospitals may request: 1) corrections to errors in the February PUF due to CMS or FI/MAC mishandling of the wage index data, and 2) corrections to FI/MAC desk review adjustments included in the February PUF. No newly initiated wage data revisions will be accepted by the FI/MACs at this point, as it is too late in the process for the FI/MACs to timely handle new data. A hospital that wishes to correct its data under these criteria must submit its request along with complete appropriate detailed documentation to the FI/MAC’s office no later than March 11, 2008. Note that March 11 is the deadline for the FI/MACs’ receipt of correction requests from hospitals. Requests postmarked by March 11, but not received until after March 11, are unacceptable.

All hospitals are required to verify the accuracy of their wage data in the February PUFs. The March 11 deadline is the final opportunity for hospitals to request corrections to their wage index data before we post the final wage index files in May. After the May PUFs are posted, changes to the wage index data will be limited to only situations involving errors by CMS or the FI/MACs that the hospital could not have known about before CMS’s release of the May final PUFs.
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If a hospital disagrees with the FI/MAC’s resolution of a requested change, the hospital may contact CMS (via letter, and send a copy to the FI/MAC) in an effort to resolve policy disputes. Any such contacts must be made by April 21, 2008, in order to allow time for consideration, and must clearly identify the policy issue involved. CMS will not consider matters pertaining to the adequacy of supporting documentation. FI/MACs are in the best position to evaluate matters regarding the adequacy of cost data and cost finding, and these matters should be resolved earlier in the cost reporting process (the cost reporting periods ended nearly 2 years ago).

If you have any questions regarding the release of the Public Use File, please contact Tiffany McGuire at (901) 544-2502 or Tiffany.McGuire@rgbagov.com in our Memphis office or Lorraine Rachmiel at (908) 497-4965 or Lorraine.Rachmiel@rgbagov.com in our New Jersey office.

Sincerely,

Cindy Hauke
Audit Manager
Provider Reimbursement

ATTACHMENT: FY 2009 Wage Index Development Timetable

FY 2009 Hospital Wage Index Development Timetable
(October 2007 through October 2008)

October 5, 2007

Task:

Release of four preliminary FY 2009 wage index files: 1) unaudited FY 2005 Worksheet S-3

wage data file, 2) 1^st quarter CY 2006 occupational mix survey data (that is, from January 1, 2006

through March 31, 2006), 3) 2^nd quarter CY 2006 occupational mix survey data (that is, from

April 1, 2006 through June 30, 2006), and 4) combined 6 months (1^st and 2^nd quarters)

occupational mix survey data. The FY 2005 wage data file includes Worksheet S-3 wage data

from cost reports submitted to HCRIS through June 30, 2007. The CY 2006 occupational mix

files include survey data that hospitals submitted to their FIs/MACs by June 8, 2007. The files

exclude hospitals designated as CAHs as of September 21, 2007.

Notice sent from CMS to FIs/MACs regarding the December 7, 2007 deadline for hospitals to request revisions to the wage index data as reflected in the preliminary files. Notice must be forwarded by the FIs/MACs to hospitals they service to alert hospitals to the availability of the preliminary wage data file for their review and to inform hospitals that this will be their final opportunity to request revisions.

December 7, 2007

Deadline for hospitals to request revisions to their Worksheet S-3 wage data and occupational mix data as included in the October PUFs and to provide documentation to support the request. FIs/MACs must receive the revision requests and supporting documentation by this date. FIs/MACs will have approximately 10 weeks to complete their reviews, make determinations, and transmit revised data to CMS’s Division of Acute Care (DAC).

February 13, 2008

Deadline for FIs/MACs to complete all desk reviews for hospital wage data and transmit revised Worksheet S-3 wage data and occupational mix data to DAC. Worksheet S-3 wage data must be sent to DAC in electronic format (HCRIS hdt format or the Excel manual template provided by CMS). Occupational mix data must be sent to DAC on the electronic Excel spreadsheet provided by DAC.

February 18, 2008
Deadline for FIs/MACs to notify State hospital associations regarding hospitals that fail to respond to issues raised during the desk reviews. The purpose of the letter is to inform the State association and its member hospitals that a hospital’s failure to respond to matters raised by the FI/MAC can result in lowering an area’s wage index value and, therefore, lower Medicare payments for all hospitals in the area.

February 25, 2008

Release of revised FY 2009 wage index and occupational mix files as PUFs on the CMS web site. These data will have been desk reviewed and verified by the FIs/MACs before being published. Also, a file including each urban and rural area’s average hourly wages for the FYs 2008 (final) and 2009 (preliminary) wage indexes will be provided on the CMS web site.

March 11, 2008

Deadline for hospitals to submit requests (including supporting documentation) for: 1) corrections to errors in the February PUFs due to CMS or FI/MAC mishandling of the wage index data, or 2) revisions of desk review adjustments to their wage index data as included in the February PUFs (and to provide documentation to support the request). FIs/MACs must receive the requests and supporting documentation by this date. No new requests for wage index and occupational mix data revisions will be accepted by the FIs/MACs at this point, as it is too late in the process to handle data that is new to the FIs/MACs in a timely manner.

April/May

Approximate date proposed rule will be published; includes proposed wage index, which is calculated based on the revised wage index data from February; 60-day public comment period and 45-day withdrawal deadline for hospitals applying for geographic reclassification.

April 14, 2008

Deadline for FIs/MACs to transmit final revised wage index data (in HCRIS hdt format or by the Excel manual template) to DAC for inclusion in the final wage index. Worksheet S-3 wage data must be transmitted in HCRIS hdt format or by the Excel manual template. Occupational mix data must be sent to DAC on the electronic Excel spreadsheet provided by DAC. All wage index data revisions must be transmitted to DAC by this date. FIs/MACs must also send written notification to hospitals regarding the hospitals’ March 10, 2008 correction/revision requests by this date.

April 21, 2008

Deadline for hospitals to appeal FI/MAC determinations and request CMS’ intervention in cases where the hospital disagrees with the FI’s/MAC’s determination. It should be noted that during this review, we do not consider issues such as the adequacy of a hospital’s supporting documentation, as we believe that the FIs/MACs are generally in the best position to make evaluations regarding the appropriateness of these types of issues (which should have been resolved earlier in the process). Requests must be submitted to CMS (and a copy sent to the FI/MAC) by this date. The request must include all correspondence between the hospital and FI/MAC that document the hospital’s attempt to resolve the dispute earlier in the process.

Late April

Final FY 2009 wage index data compiled and sent by CMS to FIs/MACs for verification. This verification of the final wage and occupational mix data by the FIs/MACs is necessary to ensure that the correct data for each hospital has been properly transmitted and received. The FIs/MACs will have approximately one week in which to complete the verification.

Notice sent from CMS to each FI/MAC regarding the May 9, 2008 release of the final FY 2009 wage index data PUFs and the June 6, 2008 deadline for hospitals to request corrections to the wage and occupational mix data as reflected in the final files. Notice must be forwarded by FIs/MACs to hospitals they service to alert hospitals to the availability of the final wage index and occupational mix data files for their review, and to inform hospitals that this will be their last opportunity to request corrections to errors in the final data. Changes to data will be limited to situations involving errors by CMS or the FI/MAC that the hospital could not have known about before review of the final May PUFs. Data that was incorrect in the October or February wage index data PUFs, but for which no correction request was received by the March 11, 2008 deadline, will not be considered for correction at this stage.

May 9, 2008

Release of final FY 2009 wage index and occupational mix data PUFs on CMS web page. Hospitals will have approximately one month to verify their data and submit correction requests to both CMS and their FI/MAC to correct errors due to CMS or FI/MAC mishandling of the final wage and occupational mix data.

June 9, 2008

Deadline for hospitals to submit correction requests to both CMS and their FI/MAC to correct errors due to CMS or FI/MAC mishandling of the final wage and occupational mix data. CMS and the FIs/MACs must receive all requests by this date. We emphasize that data that were incorrect in the October or February wage index data PUFs, but for which no correction request was received by the March 11, 2008 deadline, will not be changed at this stage for inclusion in the wage index. Each correction request must include all information and supporting documentation needed for CMS and the FI/MAC to determine whether or not the hospital’s request meets the criteria for a correction to their data at this point in the wage index development. The FIs/MACs and DAC will review each request upon receipt and consult to determine whether or not the request qualifies for correction of the final wage and occupational mix data.

August 1, 2008

Approximate date for publication of the FY 2009 final rule; wage index includes final wage index data corrections.

October 1, 2008 Effective date of FY 2009 wage index.

The following message is being re-distributed through the RGBA List Serve.

An important message to ALL subscribers of the RGBA List serve.
Please do not respond to the List Serve messages you receive from the healthnews mailbox. Please, NEVER, "Reply to All" on the healthnews Listserve. This mailbox is not monitored for responses, and is only used as a messaging system for our providers that have requested to receive specified information when The CMS notifies RGBA of new information.

If you desire to not receive these publications, please go www.Riverbendgba.com and un-subscribe under the REDS List Serve tab. This is the only way to assure you have un-subscribed. After you have unsubscribed you will no longer receive timely notifications regarding important information pertaining to Medicare information.

Your cooperation and adherence to this request is greatly appreciated by Riverbend GBA, and all of the participants of this Listserve message system. Thank You

Update – Limited Seating and Going Fast!!!!!
Don’t miss the 2008 Rural Health Clinic Workshop
Recipes for Success
Where You are the Main Ingredient!

The TN Chapter HFMA is proud to present the Rural Health Clinic (RHC) Reunion workshop featuring speakers from Riverbend Government Benefits Administrator, Inc. in Nashville, TN on March 4, 2008.The location will be the Willis Conference Center Nashville, TN

Registration is available at the following link: http://www.tnhfma.org/custpage.cfm/frm/9053/sec_id/9053

February 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 (Employer’s 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.

February 29, 2008

The following Flash newsletter has been posted to the RGBA Website at:

http://www.rgbagov.com/Publications/Flash/2008/FlashNo08-03.pdf

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.

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

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.
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#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. End of Listserv.