Riverbend

ListServ Messages 06/20/2008

May 27, 2008
New Listserv Format!

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.

Riverbend GBA LCD Update:

Local Coverage Determination L13239 Neupogen and Neulasta has been reviewed and the ASCO link has been updated. The FAQ link in the Appendices was removed as this link could not be restored.

The updated LCD can be viewed at http://www.rgbagov.com/publications/lcd/lcd-files/13239.html

MLN Articles posted by The CSM.
New:

MM6027 – Correction to Determinations of Early Episodes versus Later Episodes under the Home Health Prospective Payment System (HH PPS)http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6027.pdf

MM5991 – Medical and Other Health Services Furnished to SNF Patients http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5991.pdf

MM5815 – New Chapter in Medicare Claims Processing Manual for Independent Diagnostic Testing Facilities (IDTF)http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5815.pdf

MM6047 – Revisions to the Billing Requirements for ESRD-Related Epotein Alfa (EPO) and Darbepoetin Alfa (Aranesp) Administrations Provided During Unscheduled or Emergency Dialysis Treatments in the Outpatient Hospital Setting http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6047.pdf

Revised:

MM5288 – Incident to Policy Update http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5288.pdf

MM5699 – Reporting of Hematocrit or Hemoglobin Levels on All Claims for the Administration of Erythropoiesis Stimulating Agents (ESAs), Implementation of New Modifiers for Non-ESRD ESA Indications, and Reporting of Hematocrit or Hemoglobin Levels on all Non-ESRD, Non-ESA Claims Requesting Payment for Anti-Anemia Drugs http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5699.pdf

MM5860 – Adjusting Inpatient Prospective Payment System (IPPS) Reimbursement for Replaced Devices Offered Without Cost or With a Credit http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5860.pdf

DO NOT respond to this email. This list is used as one way communication only and is NOT monitored. If you have questions/comments, please use the FEEDBACK form page at http://www.cms.hhs.gov/apps/feedback.asp; the Privacy Policy can be viewed at: http://www.cms.hhs.gov/AboutWebsite/02_Privacy%20Policy.asp and information on the Freedom of Information Act (FOIA) can be viewed at: http://www.cms.hhs.gov/AboutWebsite/04_FOIA.asp

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.

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

May 29, 2008

New Listserv Format!

The Riverbend GBA Listserv message has taken on a new format! 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.

Important information from The CMS.

Note: These MLNs were made available by The CMS on April 22, 2008. This information was originally published via Medi-Letter 3160 located on the RGBA Website at: http://www.rgbagov.com/Publications/MediLetterPDF/3160-08.pdf and Medi Letter 3161 located at:

http://www.rgbagov.com/Publications/MediLetterPDF/3161-08.pdf , dated April 25, 2008. Please use the links provided to review these two MLN Articles.

Subscriber’s Note: Article MM5929 was revised almost immediately after release, so the “NEW� article has a revised date attached.

New:

MM5929 – Establish Pre-Payment Auto-denial Edits in Applicable States for DMEPOS Suppliers of Oxygen and Oxygen Equipment (DME MACs only)

http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5929.pdf

MM5981 – New HCPCS Codes for the April 2008 Update

http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5981.pdf

DO NOT respond to this email. This list is used as one way communication only and is NOT monitored. If you have questions/comments, please use the FEEDBACK form page at http://www.cms.hhs.gov/apps/feedback.asp; the Privacy Policy can be viewed at: http://www.cms.hhs.gov/AboutWebsite/02_Privacy%20Policy.asp and information on the Freedom of Information Act (FOIA) can be viewed at: http://www.cms.hhs.gov/AboutWebsite/04_FOIA.asp

Important Information regarding claims submission!

News Flash - The NPI will be Required for all HIPAA Standard Transactions on May 23rd.

As of May 23, 2008, the NPI will be required for all HIPAA standard transactions. This means:

For all primary and secondary provider fields, only the NPI will be accepted and sent on all HIPAA electronic transactions (837I, 837P, NCPDP, DDE, 276/277, 270/271 and 835), paper claims (UB-04 and CMS-1500) and SPR remittance advice; and

Reporting of Medicare legacy identifiers in any primary or secondary provider fields will result in the rejection of the transaction.

Important information from Riverbend GBA.

Timely filing issues are now being handled by the Riverbend Government Benefits Administrator Customer Service Representatives. The guidelines referenced by the customer service unit are in the Center for Medicare and Medicaid Services (CMS) regulations, Internet Only Manual (IOM), Publication 100-04, Chapter 1, Section 70.7.

1-70.7.2. Providers are no longer required to submit a request in writing for a review of claims rejected for timely filing.Please call our service line at 1-888-829-8126 to request any needed review of a timely filing rejection.

Providers may check Medicare claims (prior to submission to RGBA) for timeliness by using our interactive feature on the �Tools� option located on the RGBA Website at: http://www.rgbagov.com/Tools/

Information from The CMS.

The April 2008 version of the Medicare Disproportionate Share Hospital Fact Sheet is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network

at http://www.cms.hhs.gov/MLNProducts/downloads/2008_mdsh.pdf . This fact sheet provides information about methods to qualify for the Medicare Disproportionate Share Hospital (DSH) adjustment; Medicare Prescription Drug, Improvement, and Modernization Act of 2003 and Deficit Reduction Act of 2005; number of beds in hospital determination; and Medicare DSH payment adjustment formulas.

Important Information from The CMS.

2008 Physician Quality Reporting Initiative (PQRI) National Provider Call PowerPoint Presentation-May 28th, 2008 is now available

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that the PowerPoint presentation that will be used during the May 28^th, 2008 PQRI National provider call is now available on the CMS website.

This presentation will provide an overview of the establishment of 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. In addition, the presentation includes a detailed discussion of the Measures Groups, and how to successfully initiate Measures Group reporting.

To access the presentation, go to, http://www.cms.hhs.gov/PQRI, and select the CMS Sponsored Calls tab on the left side of the page. Next, scroll down to the Downloads section under the heading PowerPoint Presentations and select “National Provider Call 05/28/2008�

Information from The CMS.

New Tip Sheet for Referral Agents under the DMEPOS Competitive Bidding Program

Medicare providers in the 10 Competitive Bidding Areas (CBAs) who order or refer Medicare beneficiaries for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) can now access a tip sheet that describes the DMEPOS Competitive Bidding program and outlines the important role you will play as someone who may assist beneficiaries residing in or traveling to competitive bidding areas (CBAs) take the proper actions before July 1, 2008. Many beneficiaries will be required to transition to a contract supplier. For some items, however, Medicare beneficiaries can choose to continue their relationship with current suppliers.

Examples:

1. Medicare patients in the 10 CBAs who use oxygen will need to take action to either transition to a new contract supplier, or, in the case where their current oxygen supplier elects to become a grandfathered supplier, continue services with their current non-contract supplier.
   
   
2. Medicare patients in the 10 CBAs who use enteral nutrients, supplies, and equipment must transition to a contract supplier as of July 1, 2008. If they reside in a Skilled Nursing Facility (SNF)/Nursing Facility (NF) that is not a contract supplier, the SNF/NF will have to make new arrangements with a contract supplier to furnish items to their residents. If they live at home, the beneficiary must make new arrangements with a contract supplier.
   
   

The “Referral Agent� tip sheet can be found on the CMS dedicated website at, http://www.cms.hhs.gov/DMEPOSCompetitiveBid. Just click on the Provider Educational Products and Resources tab and scroll down to the “Downloads� section.

Information to the OPO Community:

The following information was communicated to transplant centers earlier, however, due to the increasing correspondence related to unrelated living donations we wanted to share this information with the OPO community as well.

On October 26, 2007, CMS issued a Joint Signature Memorandum (JSM) to all Fiscal Intermediaries (FIs) and Part A/B Medicare Administrative Contractors (MACs) for the purpose of communicating to us that a company known as MatchingDonors, Inc. operating through a web site at www.matchingdonors.com, had been notifying transplant centers and physician organization members about its service. MatchingDonors is a web-based donor-recipient matching service that lists individuals who potentially intend to donate an organ and individuals in need of a transplant. Another organization, the National Kidney Registry, also operates a living-donor/recipient matching service.

In the notifications sent by MatchingDonors to transplant centers, the organization states that Medicare will reimburse the fees paid by transplant centers for placing waiting list candidates on MatchingDonors’ web site listing. MatchingDonor charges rates as high as $595 for a lifetime membership. The National Kidney Registry charges a $750 registry fee and states that potential recipients may be able to be reimbursed by Medicare.

Medicare’s payment policy on organ acquisition costs contained in Section 1861(v)(1)(A) of the Social Security Act states in part that the reasonable cost of any services should exclude costs that are unnecessary in the efficient delivery of needed health services.

The Organ Transplant Act of 1984 created the Organ Procurement and Transplant Network (OPTN) and is operated by the United Network of Organ Sharing (UNOS) under contract with the Health Resources and Services Administration. Medicare’s payment policy was written to allow payment for fees paid to OPTN and UNOS. UNOS is professionally recognized throughout the transplant community as the single registry of individuals waiting for an organ transplant. Because potential recipients already have a means of being matched with altruistic donors by the functions of the OPTN member institutions and Medicare already reimburses hospitals for the cost of enrolling in the OPTN registry, paying MatchingDonors or the National Kidney Registry for this function would be unnecessary and duplicative, and would be inconsistent with Section 1861(v)(1)(A) of the Act.

Therefore, any costs claimed as a result of fees paid to the National Kidney Registry, MatchingDonors, Inc., MatchingDonors.com, MatchingDonors.org, or MatchingDonors.org, Inc., (or any like organization) will be disallowed on the Medicare cost report as they are duplicative fees thathave been paid to OPTN and UNOS.

Please feel free to contactJudy Field at (423) 535-7741 orDebbie Scott at (423)535-6243 with any questions