- Riverbend GBA

ListServ Messages 05/23/2008

Riverbend Listserv of May 20, 2008.

The Riverbend GBA Listserv message has taken on a new form. We will now notify you once per day via Listserv unless of course an urgent need arises that requires immediate notification to our providers. The once a day notification will consist of several messages, so be sure to review to the end of the document for information that may affect your provider.

You may now also review the Listserv messages via our Website at: http://www.rgbagov.com/Providers/Announcements/ListServ/index.shtml.

May 23, 2008 Is Only Days Away…Are You Ready? Need More NPI Information?

Still 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 http://www.cms.hhs.gov/NationalProvIdentStand/01_Overview.asp#TopOfPage 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. To view your information on the NPPES Website or to apply for an NPI on line visit https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.instructions

Payment for Complex Rehabilitative Power Mobility Device Services that Span the Implementation Date of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Programs in Competitive Bidding Areas

CMS will be issuing instructions in the near future about a one-time DMEPOS competitive bidding transition policy for suppliers of purchased Group 3 single or multiple power option power mobility devices (PMDs) furnished to beneficiaries in competitive bidding areas (CBAs). In specific cases described below, suppliers who, prior to July 1, 2008, begin furnishing services related to providing these devices, but do not deliver the final PMD product until July 1, 2008, or later will be paid based on the 2008 fee schedule amounts for furnishing these PMDs to beneficiaries residing in Round One CBAs. This transition policy applies to both contract and noncontract suppliers.

The HCPCS codes subject to the transition policy include PMD codes K0856 thru K0864 and related accessories provided at the time the PMD is delivered to a beneficiary who resides in a Round One CBA. The specific claims subject to the transition policy are items that are delivered for use in the beneficiary’s home on or after July 1, 2008, for which the supplier has:

· A signed order from the physician that is dated between April 1, 2008 and May 31, 2008; and

· Documentation that the face-to-face beneficiary examination by the physician that is necessary to determine medical necessity for the PMD occurred before July 1, 2008.

This documentation should be maintained by the supplier, but does not need to be submitted at the time the claim for the PMD is submitted. However, it should be made available upon request.

Suppliers should use the date of the physician order as the date of service on the claim (other than this limited, one-time exception, suppliers should be aware that the date of service that is recorded on a DMEPOS claim is the date that the item is delivered). In addition, suppliers should include on the claim for the PMD all accessories provided with the PMD and should use the same date of service used for the PMD for these items. Suppliers should report the date the PMD and related accessories were delivered for use in the beneficiary’s home in the narrative section of the claim.

Note: If you have problems accessing any hyperlink in this message, please copy and paste the URL into your Internet browser. If you received this message in error, please go to http://www.cms.hhs.gov/apps/mailinglists/ to unsubscribe to the appropriate listserv. Please DO NOT respond to this email. This email is a service of CMS and routed through an electronic mail server to communicate Medicare policy and operational changes and/or updates. Responses to this email are not routed to CMS personnel. Inquiries may be sent by going to http://www.cms.hhs.gov/ContactCMS/ .Thank you.

Revised ACCREDITATION Deadlines FOR DMEPOS Competitive Bidding!

In order to participate in the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program, suppliers must meet quality standards and be accredited by a CMS-approved Deemed Accreditation Organization. Suppliers that are interested in bidding in the second round of the program must be aware of changes to two key deadlines:

Suppliers must be accredited or have applied for accreditation by July 21, 2008 (change from May 14, 2008) to submit a bid for the second round of competitive bidding. CMS cannot accept a bid from any supplier that is not accredited or that has not applied for accreditation by July 21, 2008.

Suppliers will need to be accredited to be awarded a contract. The accreditation deadline for the second round of competitive bidding is January 14, 2009 (change from October 31, 2008). Suppliers must be accredited before this date to be awarded a contract. Suppliers should apply for accreditation immediately to allow adequate time to process their applications.

CMS has extended these deadlines because a significant number of suppliers in the 70 metropolitan statistical areas (MSAs) included in Round Two of the DMEPOS Competitive Bidding Program have not yet applied for accreditation. Suppliers in these MSAs that do not meet these accreditation deadlines cannot become DMEPOS competitive bidding contract suppliers and will therefore be unable to furnish competitively bid items to any beneficiary residing in any part of the competitive bidding area during the contract period.

Suppliers can determine if they are serving beneficiaries in a Round 2 MSA by visiting the following web site: http://www.census.gov/population/www/estimates/metrodef.html and looking up their MSAs in the section called “counties with metropolitan and micropolitan statistical area codes.” (In this file, MSAs are called CBSAs.) For example, the Los Angeles-Long Beach-Santa Ana, CA MSA is comprised of two counties: Los Angeles and Orange. We urge all suppliers serving Medicare beneficiaries in the 70 Round Two MSAs to apply for accreditation now.

For a list of the CMS-approved Deemed Accreditation Organizations, visit http://www.cms.hhs.gov/MedicareProviderSupEnroll/01_Overview.asp. For information about the Medicare DMEPOS Competitive Bidding program, visit http://www.cms.hhs.gov/DMEPOSCompetitiveBid/ .

MEDICARE ANNOUNCES OVER 320 WINNING SUPPLIERS SELECTED FOR COMPETITIVE BIDDING PROGRAM FOR DURABLE MEDICAL EQUIPMENT, PROSTHETICS, ORTHOTICS, AND SUPPLIES

New program saves money for beneficiaries and provides access to high quality products from community suppliers

The Centers for Medicare & Medicaid Services (CMS) released the names of the 325 suppliers that have signed contracts with Medicare to provide certain medical equipment and supplies to beneficiaries in 10 communities across the U.S. at significantly lower prices than they are paying now.

The new competitive bidding program goes into effect on July 1, 2008, in 10 communities. This program uses the local, competitive marketplace to lower the costs for certain durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) for Medicare beneficiaries who use Medicare-contracted suppliers to obtain medical items and supplies. Because beneficiaries pay 20 percent coinsurance on the cost of DMEPOS, they will directly benefit from the savings.

Consumers, physicians and other providers can find a list of Medicare contract suppliers in the 10 initial areas of the program by visiting www.medicare.gov (under “Search Tools” select “Find Suppliers of Medical Equipment in Your Area) or by calling 1-800-MEDICARE (TTY users should call 1-877-486-2048). People can also visit the local offices of the various partner groups, such as their State Health Insurance and Assistance Program, Area Office on Aging and a number of community organizations that can provide information on the program.

CMS today also announced that it is extending the deadline for suppliers in the 70 second round metropolitan statistical areas (MSAs) to become accredited. CMS is extending the deadline because a significant number of suppliers in those communities have not yet applied for accreditation.

Additional information on the DMEPOS competitive bidding program is available at www.cms.hhs.gov/DMEPOSCompetitiveBid.

To read the entire CMS Press release issued today please go here: http://www.cms.hhs.gov/apps/media/press_releases.asp

Also, CMS has issued a Fact Sheet located here: http://www.cms.hhs.gov/apps/media/fact_sheets.asp

Note: Click the hyperlink to view the full story.

CMS Updates to Coverage Pages
Tue, 20 May 2008 07:36:00 -0500

Date: 05/20/2008
Subject: CMS Updates to Coverage Pages
Content: Updates to Coverage pages for May 20, 2008

Riverbend Listserv May 21, 2008.

Riverbend GBA has discovered an error in the HCPCS file that resulted in certain ESRD drug HCPCS to incorrectly reimburse at 100%. We are currently working to correct the impacted HCPCS files under our highest priority action status.

Once the file is corrected, you will be advised, and RGBA will begin a mass adjustments process to correct the affected claims. Providers will not be required to perform any action to correct these claims.

We apologize for any inconvenience this may have caused you or your facility.

Riverbend GBA Listserv May 23, 2008

The NPI is here. The NPI is now. Are you using it?

NPI News for Medicare FFS Providers

It’s May 22^nd – Are you Ready?

As of May 23, Medicare FFS will require and send NPI-Only in ALL provider identifier fields for all HIPAA and paper transactions where a provider identifier is required. If you send Medicare a transaction with a Medicare legacy identifier in any of the provider fields, your claim will be rejected. These transactions include all electronic and paper claims (837I, 837P, NCPDP, DDE and paper CMS-1500 and UB-04), the 276/277 claims status transaction, the 270/271 eligibility transaction, 835 remittance advice and SPR paper remittance.

NPIs for Secondary ProvidersIf the entity that is required to be identified in the secondary provider field (i.e., the ordering/referring/attending/operating/supervising/purchased service/other/service facility provider or prescriber) does not furnish an NPI, the billing provider must attempt to obtain that NPI in order to enter it on the claim. The billing provider may use the NPI Registry (https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do) to obtain the secondary provider’s NPI or it may need to directly contact the ordering/referring/attending/operating/supervising/purchased service/other/service facility or prescriber in order to obtain the NPI.

· If the billing provider has exhausted all possibilities of finding the NPI of the ordering/referring/attending/operating/supervising/purchased service/other or prescriber, Medicare FFS is permitting the billing provider (in the X12N 837 transactions) or the service provider (in the NCPDP 5.1 transaction) to use their own NPI as the identifier for those secondary providers. Medicare will reject claims if Medicare policy requires a secondary identifier and there is no NPI present.

· For service facility location loop, if the billing provider is still unable to obtain the NPI of the entity, no identifier should be reported in that loop.

Transcript for April 17^th NPI Roundtable Now Available

View the transcript at http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/Transcript_for_April_17th_NPI_Roundtable.pdf on the CMS website.

Need More Information?

Still 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.

Reminder: CMS to Host Second National Provider Education Call on May 27th, 2008The Centers for Medicare & Medicaid Services (CMS) will host the second national provider education conference call to address the implementation of the new Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding program scheduled to begin on July 1, 2008. This call is being conducted for Medicare fee-for-service DMEPOS suppliers, physicians, and other providers – all of which may be affected by the program. CMS Subject Matter Experts will be available to answer questions and address some of the exceptions and situations you may encounter as the program is implemented. To view a PowerPoint presentation that was used in the first national call, please click here: http://www.cms.hhs.gov/DMEPOSCompetitiveBid/Downloads/policy_teleconference_final.pdf

Conference call details:

Date: May 27, 2008

Conference Title: Medicare DMEPOS Competitive Bidding Program Q&A session

Time: 1:00-2:30 EDT

In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation. If you cannot attend the call, replay information is available below.

Registration will close at 1:00 p.m. EDT on May 26, 2008, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.

1. To register for the call participants need to go to: http://www2.eventsvc.com/palmettogba/052908

2. Fill in all required data.

3. Verify your time zone is displayed correctly the drop down box.

4. Click "Register".

5. You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.

For those of you who will be unable to attend, a replay option will be available shortly following the end of the call. This replay will be accessible from 4:00 p.m. EDT 5/27/2008 until 11:59 p.m. EDT 6/4/2008. The call in data for the replay is (800) 642-1687 and the passcode is 47261135.

Revised Accreditation Deadlines for Round 2 DMEPOS Competitive Bidding

ü Suppliers must be accredited or have applied for accreditation by July 21, 2008 (change from May 14, 2008) to submit a bid for the second round of competitive bidding. CMS cannot accept a bid from any supplier that is not accredited or that has not applied for accreditation by July 21, 2008.

ü Suppliers will need to be accredited to be awarded a contract. The accreditation deadline for the second round of competitive bidding is January 14, 2009 (change from October 31, 2008). Suppliers must be accredited before this date to be awarded a contract. Suppliers should apply for accreditation immediately to allow adequate time to process their applications.

Suppliers can determine if they are serving beneficiaries in a Round 2 MSA by visiting the following web site: http://www.census.gov/population/www/estimates/metrodef.html

and looking up their MSAs in the section called “counties with metropolitan and micropolitan statistical area codes.” (In this file, MSAs are called CBSAs.) For example, the Los Angeles-Long Beach-Santa Ana, CA MSA is comprised of two counties: Los Angeles and Orange.

We urge all suppliers serving Medicare beneficiaries in the 70 Round Two MSAs to apply for accreditation now.

2008 Physician Quality Reporting Initiative (PQRI)

National Provider Conference Call with Question & Answer Session

The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host the third in a series of national provider conference calls on the 2008 Physician Quality Reporting Initiative (PQRI). This toll-free call will take place from 3:30 p.m. – 5:00 p.m., EDT, on Wednesday, May 28, 2008.

This call will provide an overview of the alternative reporting periods and alternative criteria for satisfactorily reporting quality measures for the 2008 PQRI as authorized by the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) (P.L. 110-173) which was enacted on December 29, 2007.

MMSEA requires that for 2008 and 2009 the Secretary establish alternative reporting periods and alternative criteria for satisfactorily reporting groups of measures. It also requires that for 2008 and 2009 the Secretary establish alternative reporting periods and alternative criteria for satisfactorily reporting quality measures data through registries.

In 2008, eligible professionals may earn an incentive payment of 1.5 percent of their total allowed charges for Physician Fee Service covered professional services furnished during the respective alternative reporting periods based on data submitted via these mechanisms. While TRHCA established a cap on incentive payments for 2007, based on an average per measure payment amount, there is no cap on incentive payments under MMSEA for 2008 and 2009.

These provisions provide increased opportunities for eligible professionals to report PQRI quality measures and the possibility to earn incentive payments for satisfactory reporting.

A PowerPoint slide presentation will be posted to the PQRI webpage at, http://www.cms.hhs.gov/PQRI/30_EducationalResources.asp , on the CMS website for you to download prior to the call so that you can follow along with the presenters, Dr. Michael Rapp, Dr. Daniel Green and Rachel Nelson.

Following the presentation, callers will have an opportunity to ask questions of CMS subject matter experts.

Conference call details:

Date: May 28, 2008

Conference Title: 2008 Physician Quality Reporting Initiative National Provider Call

Time: 3:30 p.m. -5:00 p.m. EDT

Registration will close at 3:30 p.m. EDT on May 27, 2008, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.

To register for the call participants need to go to: http://www2.eventsvc.com/palmettogba/052808
Fill in all required data.
Verify your time zone is displayed correctly the drop down box.
Click "Register".
You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and save this page in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.

For those of you unable to attend, a replay option will be available shortly following the end of the call. This replay will be accessible from 5:30 p.m. EDT 5/28/2008 until 11:59 p.m. EDT 6/5/2008. The call-in data for the replay is (800) 642-1687 and the passcode is 46870023.

If you require services for the hearing impaired please send an email to Medicare.TTT@PalmettoGBA.com.

MEDICARE ANNOUNCES THE CONTRACT SUPPLIERS FOR THE FIRST ROUND OF THE MEDICARE DMEPOS COMPETITIVE BIDDING PROGRAM

The Centers for Medicare & Medicaid Services (CMS) has announced the contract suppliers for the first round of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. The competitive bidding program will offer beneficiaries in the designated competitive bidding areas (CBAs) access to quality DMEPOS products and services with lower out-of-pocket costs.

A total of 325 suppliers receiving 1,345 contracts were selected for the ten Round 1 communities. To participate in the program, suppliers were required to meet Medicare's financial and quality standards. In addition, suppliers had to be accredited by one of CMS' approved accrediting organizations to be eligible to receive a contract.

To take advantage of the savings available under the program, people with Medicare living in one of the CBAs will need to choose a new supplier if their current supplier is not a contract supplier or a supplier who may be allowed to offer items and supplies as a grandfathered supplier. Grandfathered suppliers are those who chose to continue to provide certain rented durable medical equipment, oxygen and oxygen equipment for existing clients.

As a Medicare provider, CMS has many educational and informational resources available to assist you in your role as a DMEPOS supplier or referral agent. All of these resources, including the single payment amounts, links to both provider and beneficiary educational materials, and the most current news and announcements regarding the program, can be accessed through our DMEPOS Competitive Bidding web page at www.cms.hhs.gov/DMEPOSCompetitiveBid/ .

The list of contract suppliers is now available on www.dmecompetitivebid.com/cs .

Subject: Availability of the Final Federal Fiscal Year (FY) 2009 Wage Index Data Public Use Files

and Deadline for Requesting Corrections to the DataPlease see important information enclosed in the attached documents relating to the FY 2009 Wage Index Public Use Files.

Note there is a June 9, 2008 deadlineMay 19, 2008

The Centers for Medicare & Medicaid Services (CMS) released the final FY 2009 wage index data public use files (PUFs) on May 12, 2008. The files are available for the limited purpose of identifying any potential data entry or transmission errors made by CMS or the fiscal intermediaries, NOT for the initiation of new revision requests. The files include: 1) a file containing the Worksheet S-3 wage data from cost reports beginning during FY 2005, 2) a file containing the 1st quarter calendar year (CY) 2006 occupational mix survey data (that is, for the period January 1, 2006 through March 31, 2006), and 3) a file containing the 2nd quarter CY 2006 occupational mix survey data (that is, for the period April 1, 2006 through June 30, 2006). Data that were incorrect in the February preliminary wage data PUFs, but for which no revision request was received by the March 11, 2008 deadline, will not be considered for correction at this stage. Hospitals should promptly review their final wage index data files to ensure that their Worksheet S-3 wage and occupational mix data are accurate. All requests from hospitals for corrections to their FY 2009 wage index data files must be submitted to and received by both their fiscal intermediaries (FIs)/Medicare Administrative Contractors (MACs) and CMS on or before June 9, 2008.

Hospitals should be reminded that the average hourly wages and wage index values published in the proposed rule are based on data submitted to us by February 29, 2008. Therefore, the data in the proposed rule does not reflect the wage data to be used to calculate the final FY 2009 wage index. In order to ensure the hospital’s wage data are accurately reflected in CMS’s files prior to the calculation of the final FY 2009 wage index, hospitals must review the final wage index data PUFs.

Availability of the Final Wage Index PUFs

The three FY 2009 wage index data PUFs are available on the Internet beginning May 12, 2008. The data will be used in the development of the final FY 2009 wage index, which will be published in the Federal Register by August 1, 2008. The final FY 2009 wage index data files are available on the Internet at CMS’s web site. The address for CMS’s web site 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 data files available to individual State hospital associations. Hospitals may want to check with their State hospital associations to see if the associations have or will be receiving the files. CMS will notify the American Hospital Association, the Federation of American Hospitals, and the Association of American Medical Colleges regarding the release of the files.

We strongly encourage all hospitals to access the final FY 2009 wage index file and verify the accuracy of their Worksheet S-3 wage data. The June 9, 2008 deadline will be hospitals’ last opportunity to request corrections to their data files for the FY 2009 wage index.

Requesting Corrections to the Wage Index Data

As noted in the wage index development timetable (previously sent, and attached for your convenience), hospitals have the right to request corrections to their wage index data files if they can establish that the FI/MAC or CMS made a data entry or transmission error in the final FY 2009 wage index data files. A hospital requesting a correction must submit its request, along with complete, appropriate detailed documentation, to both its FI/MAC and CMS, no later than June 9, 2008. Note that June 9 is the deadline for the FIs’/MACs’ and CMS’s receipt of correction requests from hospitals. Requests postmarked by June 9, 2008, but not received until after June 9, are unacceptable.

Neither the FI/MAC nor CMS will consider the following types of requests in conjunction with this process:

Requests for corrections to your wage data that was submitted too late to be included in the data transmitted by the FIs/MACs to CMS on or before April 14, 2008;

Requests for correction of errors that were not, but could have been, identified during the hospital’s review of the preliminary wage index data files released in February 2008; or,

Requests to revisit factual determinations or policy interpretations made by the FI/MAC or CMS during the wage data correction process prior to the May 2008 release of the final FY 2009 wage index files.

Data that were incorrect in the February wage index public use files, but for which no revision request from the hospital was received by the FI/MAC as of the March 11, 2008 deadline will not be changed at this stage for inclusion in the wage index. Please note that, while FIs/MACs may make other revisions to hospitals’ wage data at this time as part of the ongoing cost report settlement process, these changes will not be incorporated into the data to be used for the wage index.

The FI/MAC and CMS will review each request upon receipt and will determine whether or not the request meets the criteria for correction of the final wage index files. If a correction is necessary, the wage data will be revised accordingly and will be included in the FY 2009 wage index, effective October 1, 2008. CMS will send each hospital a letter explaining CMS’s decision regarding the hospital’s correction request.

If you have any questions, please contact Tiffany McGuire at Tiffany.McGuire@rgbagov.com or Lorraine Rachmiel at Lorraine.Rachmiel@rgbagov.com .

ATTACHMENT BELOW:

FY 2009 Wage Index Development Timetable

CMS Address

Centers for Medicare & Medicaid Services

c/o Wage Index Team, CMM/PPG/DAC

Room C4-08-06

7500 Security Boulevard

Baltimore, Maryland 21244-1850

2007-2008 Occupational Mix Survey for FY2010

Section 304(c) of Public Law 106-554 amended section 1886(d)(3)(E) of the Social Security Act and requires CMS to collect data every 3 years on occupational mix of employees for each short-term, acute care hospital participating in the Medicare program.

The 2007-2008 occupational mix survey notice, CR 5992, has been reissued as a one-time-notice. CMS is administering a new Wage Index Occupational Mix Survey to be used in computing the wage index beginning with FY 2010. Hospitals are required to submit the Occupational Mix Survey for the July 1, 2007 - June 30, 2008 collection period by September 1, 2008. The files necessary to complete the Occupational Mix Survey are located on the RGBA website at http://www.rgbagov.com/Providers/Hospital/Audit-Reimbursement/wageindex.shtml and can be located on the CMS website at http://www.cms.hhs.gov/AcuteInpatientPPS/WIFN/list.asp#TopOfPage.

Located on the RGBA website is an Excel file that has two tabs: One is the 2007-2008 Occupational Mix survey form that HOSPITALS MUST complete and submit to their Fiscal Intermediary or A/B Medicare Administrative Contractor. The second tab contains the 2007-2008 Occupational Mix survey hospital instructions and definitions. CMS requires that hospitals use the excel spreadsheet when submitting their 2007-2008 Occupational Mix survey data to their Fiscal Intermediary or A/B Medicare Administrative Contractor.

Providers serviced by the Tennessee office shall submit their surveys to the following address:

Tiffany McGuire

Senior Auditor

Riverbend Government Benefits Administrator

85 North Danny Thomas Blvd.

Memphis, TN 38103

Or via email to Tiffany.McGuire@rgbagov.com

New Jersey providers shall submit their surveys to Highmark Medicare Services at the following address:

Jeff David

Provider Audit

Highmark Medicare Services

120 Fifth Avenue, Suite P5301

Pittsburgh, PA 15222-3099

Or via email to jeffrey.david@highmarkmedicareservices.com

Riverbend GBA Listserv May 23, 2008

The NPI is here. The NPI is now. Are you using it?NPI News for Medicare FFS Providers

It’s May 22^nd – Are you Ready?

NPIs for Secondary Providers

If the entity that is required to be identified in the secondary provider field (i.e., the ordering/referring/attending/operating/supervising/purchased service/other/service facility provider or prescriber) does not furnish an NPI, the billing provider must attempt to obtain that NPI in order to enter it on the claim. The billing provider may use the NPI Registry (https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do) to obtain the secondary provider’s NPI or it may need to directly contact the ordering/referring/attending/operating/supervising/purchased service/other/service facility or prescriber in order to obtain the NPI.

· For service facility location loop, if the billing provider is still unable to obtain the NPI of the entity, no identifier should be reported in that loop.

Transcript for April 17^th NPI Roundtable Now Available

View the transcript at http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/Transcript_for_April_17th_NPI_Roundtable.pdf on the CMS website.

Need More 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 web page.

RGBA Holiday Payment Schedule

In recognition of the Memorial Day holiday, RGBA, Inc. will be changing the payment cycle for the week ending May 30, 2008 as follows:

Monday Wednesday Friday May 26th May 28th May 30th No Payment Cycle Payment Mailed Payment & Remittance Advice Mailed For the week ending June 6th, we will resume our normal payment cycles.

Let’s Go Paperless…

We are encouraging all providers to submit their cost report supporting documentation on electronic media instead of in hardcopy. We can accept flash drives, compact discs (CD), or 3 ¼ floppy disks. Logs for bad debts, disproportionate share, injections, etc. that are submitted electronically (Excel versions please!) are much easier for our staff to review. We can accept Excel files, Word documents, .tif and .pdf files. Please ensure your electronic files are properly labeled so our staff can determine what the files represent.

Submitting electronic files in lieu of paper will also reduce your postage cost for mailing the cost report since it won’t weigh nearly as much. CMS does still require that you submit the certification page of the cost report and the CMS Form 339 Questionnaire with original signatures so we still require hardcopies of these documents.

If you are unable to provide all of your supporting documentation electronically, please do not use staples, spiral binders or notebooks to separate or hold your data. Effective, May 1, 2008, Riverbend will image all incoming mail (including cost reports). Paper clips, binder clips, rubber bands, or folders are acceptable. If you are submitting more than one cost report in a package, please ensure proper separation of the various reports.

If you have questions, contact Riverbend’s Provider Audit & Reimbursement department at (423) 535-5906.

May 19, 2008

Subject: Availability of the Final Federal Fiscal Year (FY) 2009 Wage Index Data Public Use Files and Deadline for Requesting Corrections to the Data

The Centers for Medicare & Medicaid Services (CMS) released the final FY 2009 wage index data public use files (PUFs) on May 12, 2008. The files are available for the limited purpose of identifying any potential data entry or transmission errors made by CMS or the fiscal intermediaries, NOT for the initiation of new revision requests. The files include: 1) a file containing the Worksheet S-3 wage data from cost reports beginning during FY 2005, 2) a file containing the 1^st quarter calendar year (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). Data that were incorrect in the February preliminary wage data PUFs, but for which no revision request was received by the March 11, 2008 deadline, will not be considered for correction at this stage. Hospitals should promptly review their final wage index data files to ensure that their Worksheet S-3 wage and occupational mix data are accurate. All requests from hospitals for corrections to their FY 2009 wage index data files must be submitted to and received by both their fiscal intermediaries (FIs)/Medicare Administrative Contractors (MACs) and CMS on or before June 9, 2008.

Availability of the Final Wage Index PUFs

The three FY 2009 wage index data PUFs are available on the Internet beginning May 12, 2008. The data will be used in the development of the final FY 2009 wage index, which will be published in the Federal Register by August 1, 2008. The final FY 2009 wage index data files are available on the Internet at CMS’s web site. The address for CMS’s web site is: http://www.cms.hhs.gov. To access the PUFs directly, the address is: http://www.cms.hhs.gov/AcuteInpatientPPS/WIFN/list.asp#TopOfPage .

Requesting Corrections to the Wage Index Data

As noted in the wage index development timetable (previously sent, and attached for your convenience), hospitals have the right to request corrections to their wage index data files if they can establish that the FI/MAC or CMS made a data entry or transmission error in the final FY 2009 wage index data files. A hospital requesting a correction must submit its request, along with complete, appropriate detailed documentation, to both its FI/MAC and CMS, no later than June 9, 2008. Note that June 9 is the deadline for the FIs’/MACs’ and CMS’s receipt of correction requests from hospitals. Requests postmarked by June 9, 2008, but not received until after June 9, are unacceptable.

Neither the FI/MAC nor CMS will consider the following types of requests in conjunction with this process:

· Requests for corrections to your wage data that was submitted too late to be included in the data transmitted by the FIs/MACs to CMS on or before April 14, 2008;

· Requests for correction of errors that were not, but could have been, identified during the hospital’s review of the preliminary wage index data files released in February 2008; or,

· Requests to revisit factual determinations or policy interpretations made by the FI/MAC or CMS during the wage data correction process prior to the May 2008 release of the final FY 2009 wage index files.

If you have any questions, please contact Tiffany McGuire at Tiffany.McGuire@rgbagov.com or Lorraine Rachmiel at Lorraine.Rachmiel@rgbagov.com.

ATTACHMENT (Below)

FY 2009 Wage Index Development Timetable

CMS Address

Centers for Medicare & Medicaid Services

c/o Wage Index Team, CMM/PPG/DAC

Room C4-08-06

7500 Security Boulevard

Baltimore, Maryland 21244-1850

FY 2009 Hospital Wage Index Development Timetable(October 2007 through October 2008) October 5, 2 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.

Ambulatory Surgical Center (ASC) Email Updates

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11/28/2007
Thu, 22 May 2008 10:56:00 -0500

Date: 11/28/2007
Subject: Ambulatory Surgical Center (ASC) E-mail Updates

New CMS email System

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12/06/2007
Thu, 22 May 2008 10:56:00 -0500

Date: 12/06/2007
Subject: Welcome Message
Content: Welcome to the new CMS email system.

2008 Physician Quality Reporting Initiative (PQRI): New Educational Product is available

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce a new educational resource have been posted to the PQRI webpage on the CMS website. The print version will be available shortly.

2008 PQRI Fact Sheet: Alternative Reporting Periods and Alternative Criteria for Satisfactorily Reporting for 2008: Measures Groups and Registry-Based Reporting- This Fact Sheet provides an overview of the changes to the 2008 Physician Quality Reporting Initiative Reporting options, such as, alternative reporting periods, and alternative criteria for satisfactorily reporting for 2008 measures groups, and registry-based reporting.

To access this new and all available educational resources, visit http://www.cms.hhs.gov/PQRI on the CMS website and click on the Educational Resources tab. Once on the Educational Resources page, scroll down to the “Downloads” section and click on the “2008 PQRI Reporting Fact Sheet” link.

Revised Accreditation Deadlines for Round 2 DMEPOS Competitive Bidding

Suppliers can determine if they are serving beneficiaries in a Round 2 MSA by visiting the following web site: http://www.census.gov/population/www/estimates/metrodef.html

We urge all suppliers serving Medicare beneficiaries in the 70 Round Two MSAs to apply for accreditation now.

Reminder:

3rd Qtr. 2008 Riverbend GBA Ask-the-Contractor Teleconference (ACT)!

Thursday, May 29, 2008, 2:00 PM EST.

Toll Free call in number: 1-877-856-1962.

There will be 100 call-in lines available!

Participants may dial in 15 minutes before the teleconference begins.

Please submit any questions before May 22, 2008 that you would like answered on the call to:

http://www.rgbagov.com/Education/Training/training.do

Points of Interest to be discussed will include the “Medicare Competitive Bidding Program for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)” outlined in the following MLN Articles:

http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0805.pdf

http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0806.pdf

http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0807.pdf

Riverbend

Provider Portal

ListServ Messages 05/23/2008

Requesting Corrections to the Wage Index Data

Ambulatory Surgical Center (ASC) Email Updates