Riverbend

ListServ Messages 06/20/2008

Riverbend GBA Listserv June 16, 2008
Riverbend GBA has received the following instructions from The CMS.

Contractors shall adjust and finalize previously processed IPPS and LTCH PPS claims that received Medicare Severity Diagnosis Related Group (MS-DRG) 999 in error. MS-DRGs in the 700 range were affected: MS-DRGs 707-730 (Diseases & Disorders of the Male Reproductive System); MS-DRGs 734-761 (Diseases & Disorders of the Female Reproductive System); MS-DRGs 765-782 (Pregnancy & Childbirth); and MS-DRGs 789-795 (Newborns & Other Neonates with Conditions Originating in the Perinatal Period).

The correction to this issue was installed into production the first weekend in May 2008, and completed on June 4, 2008. Riverbend GBA has appended the applicable condition code to these claims held that meet the above criteria and shall pay applicable interest.

New Listserv Format from RGBA! 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.

Information from The CMS.

CR 6091, Pub. 100-20 Rev. 352, Filename: R352OTN.pdf Notification of New Quarterly Updates to the Ambulance Fee Schedule Public Use File (PUF)

Please view the Medi Letter posted to the RGBA Website at: http://www.rgbagov.com/Publications/MediLetterPDF/3200-08.pdf

News On the Medicare DMEPOS Competitive Bid Program! New Tip Sheet and Transcript from May 13, 2008 National Provider Call New Tip Sheet for Mail Order Contract Diabetic Suppliers.

Under the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program, which is effective July 1, 2008, beneficiaries who permanently reside in, or travel to, the 10 designated competitive bidding areas (CBA) are required to obtain competitively bid items from a contract supplier, unless an exception applies. Mail order suppliers that provide diabetic testing supplies to a Medicare beneficiary may be affected by this program.

A new tip sheet is now available that further explains how this part of the program works.
This new resource 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.

Transcript from May 13, 2008 National Provider Call Now AvailableThe Centers for Medicare & Medicaid Services (CMS) held a national provider audio call for providers, suppliers, referral agents, and others interested in the DMEPOS Competitive Bidding Program on May 13, 2008. In addition to an overview of the program, questions and answers from participants were answered. To access the written transcript from this call, visit the CMS dedicated website at, http://www.cms.hhs.gov/DMEPOSCompetitiveBid. Just click on the Announcements and Communications tab and scroll down to the Downloads section.

National Provider Conference Call with Question & Answer Session

The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host the fourth 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, June 18, 2008.

This call will provide information on accessing your 2007 PQRI Feedback Report for those of you who participated in 2007 and an overview of the 2008 PQRI participation options and a question and answer session. 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/02_CMSSponsoredCalls.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: June 18, 2008
Conference Title: 2008 Physician Quality Reporting Initiative National Provider Call
Time: 3:30-5:00 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 3:30 p.m. EDT on June 17, 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/061808
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 5:30 p.m. EDT 6/18/2008 until 11:59 p.m. EDT 6/25/2008. The call in data for the replay is (800) 642-1687 and the passcode is 47474458.

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

Riverbend GBA Listserv June 16, 2008

The TN Chapter HFMA is proud to present a Medicare Part A and Part B workshop featuring speakers from Riverbend Government Benefits Administrator,Inc, and CIGNA Government Services in three different locations.The workshop will include a 2008 Medicare Update with breakout sessions you select based on your interests. Help Desks will be staffed at the end of the day to assist you with individual questions and concerns.

Three separate sessions will be held for your convenience: June 24 in Knoxville; July 8 in Nashville; and July 15th in Jackson. Make plans NOW to attend this event.

Please use the following link to review the Workshop materials, and to register http://www.tnhfma.org/custpage.cfm/frm/6937/sec_id/6937

Riverbend GBA Listserv June 17, 2008.

Riverbend GBA has been notified that providers are currently receiving an error message when checking Beneficiary eligibility via CWF’s HIQA transaction. Every transaction must have an intermediary number, however, when providers (both TN and NJ) enter 00390, they are getting an error that states Invalid Intermediary, and are unable to access any eligibility data.

This issue is currently being worked as a priority 1, and we will provide information as it becomes available. We appreciate your patience while we work to get this issue resolved.

The issue with accessing the Common Working File through HIQA has been resolved. You should now be able to retrieve Medicare Beneficiary eligibility information. Again, thank you for your patience while we worked with our Data Center to resolve this issue.

New Listserv Format from RGBA!

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.

Information from The CMS.

HHS Takes Action to Help Medicare Beneficiaries and Providers in Iowa and Indiana

HHS Secretary Mike Leavittdeclared a public health emergency in the flood-stricken states of Iowa and Indiana. The action gives HHS’ Centers for Medicare & Medicaid Services’ (CMS) Medicare beneficiaries and their health care providers greater flexibility in meeting emergency health needs. Secretary Leavitt acted under his authority in the Public Health Service Act.

Because of flood damage to local health care facilities, many beneficiaries have been evacuated to neighboring communities, where receiving hospitals and nursing homes may have no health care records, information on current health status or even verification of the person’s status as a Medicare beneficiary. CMS is assuring those facilities that in this circumstance, the normal burden of documentation will be waived and that they can act under a presumption of eligibility.

In response to the emergencies resulting from the Midwest flooding, CMS is providing resources to ensure effective health care coverage and quality of care for beneficiaries. The CMS extreme weather and emergencies relief activities resource link forMidwest Floods is located by clicking: http://www.cms.hhs.gov/emergency/20_midwestflooding.asp?

Questions and Answers on the Midwest Flood page can be downloaded by clicking on https://questions.cms.hhs.gov/cgi-bin/cmshhs.cfg/php/enduser/std_alp.php?p_pv=2.1019&p_prods=318%2C1019&prod_lvl1=318&prod_lvl2=1019 (click New -CMS Response to Midwest Floods Emergency go under File Attachments)

To read the HHS Public Health EmergencyNews Release issued click here:http://www.hhs.gov/news/press/2008pres/06/20080616a.html

Riverbend GBA has the following Webinars available for registration at:
Medicare Secondary Payer MSP

Description: This Webinar will cover the MSP provisions as mandated by The CMS. Issues covered will be; responsibilities of each party involved, the claims flow process, how and when claims may be submitted for Medicare Secondary payment. This Webinar information is great for all levels of billing personnel.
Time: 2:00 PM ET
Date: 2008-07-10

More

DDE and HIQA
New Rural Health Providers

Description: This Webinar is designed for providers that recently obtained RHC status and provider number, but any RHC provider is welcome to join in. Topics covered will include; Riverbend GBA reports, UB-04 claims submission, payment schedules, payment processes, signing up for electronic claims, RGBA Website, reference materials and much more!

Time: 2:00 PM ET

Date: 2008-07-17

More

Description: This Webinar covers the HIQA and DDE screens as they pertain to Medicare beneficiary eligibility, and information used to submit Medicare claims. Also, the DDE screens and their functions will be covered. This Webinar is designed for all levels of DDE and HIQA users.

Time: 2:00 PMET
Date: 2008-07-23

CMS to Rate Nursing Home Quality;
New Five Star System to be Added to Nursing Home Compare Site

The Centers for Medicare & Medicaid Services today announced it will soon launch a ground breaking ranking system of America’s nursing homes, giving each a star rating. CMS is requesting comments on the system designed to provide patients and their families an easy to understand assessment of nursing home quality, making meaningful distinctions between high performing and low performing homes.

This will be the first time that CMS will offer such a rating system for the fee-for-service, or traditional Medicare program. Currently, through the Compare Web site, CMS assists beneficiaries and their families in making nursing home choices by providing information on individual measures of quality of care, staffing, and survey inspection information.

The ratings will be posted on the agency’s Nursing Home Compare Web site by the end of this year. A sample screen shot of the proposed star ratings is available at www.cms.hhs.gov/PressContacts/10_PR_fivestar.asp. Medicare Compare can be found at www.medicare.gov.

CMS will also publish the Fire Safety Requirements for Long Term Care (LTC) Facilities final regulation that requires all nursing homes in the country to install sprinkler systems throughout their buildings if they wish to continue to participate in the Medicare and Medicaid programs.

To read the CMS press releases issued today please click here: http://www.cms.hhs.gov/apps/media/press_releases.asp

Riverbend GBA Listserv June 18, 2008

New Listserv Format from RGBA! 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.

Information from The CMS to all Direct Data Entry Users.

Direct Data Entry (DDE) of Part A Claims with Rates

With the most recent installation of the Fiscal Intermediary Shared System (FISS) Release, providers began experiencing a problem when entering claims that contained line item rates using the DDE System. After entering the claim with a line item rate, the system was removing the rate information and the claim would Return to Provider (RTP) back to you with reason code 32213.

The FISS maintainer has created a fix for this condition, to ensure that any rate entered remains on the claim. This fix will be installed in production on July 7, 2008. In the meantime, the maintainer has provided a workaround that you can utilize to eliminate seeing these claims RTP:

To prevent the claim from Returning to the Provider during claim entry via DDE, you should press the enter key after charges have been keyed. This should cause the rate(s) to be retained. You may then scroll forward using the PF8 key.

Please note that this workaround resolves the dropped rate issue only if you are manually keying claims via the DDE system. If you utilize any sort of screen scraping process or are keying claims via a clearinghouse, this workaround will not apply. You will need to wait until the permanent fix is installed with the July 2008 Quarterly Release.

The Medicare DMEPOS Competitive Bidding Program Begins July 1^st - Just Two Weeks Away - Are You Prepared?

All Medicare Fee-For-Service (FFS) Providers: The Centers for Medicare & Medicaid Services (CMS) urges FFS providers and suppliers to understand the new Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding program. If your practice location is in one of the 10 Competitive Bidding Areas (CBA) you probably will be affected. If you are not located in a CBA, but treat Medicare patients who permanently reside in a CBA, you also need to understand the program. Be ready for July 1^st, 2008.

All the information that you need to know as a DMEPOS supplier or an enrolled Medicare provider who refers beneficiaries for DMEPOS is available on the CMS DMEPOS Competitive Bidding dedicated website located at www.cms.hhs.gov/DMEPOScompetitivebid.New/Revised Provider Educational Products

DMEPOS Suppliers: CMS issued CR 6112, "Payment for Complex Rehabilitative Power Mobility Device Services that Span the Implementation Date of DMEPOS Competitive Bidding Programs in Competitive Bidding Areas". The companion MLN Matters article is now available on the CMS DMEPOS Competitive Bidding dedicated website.

All Medicare Fee-For-Service (FFS) Providers: Due to the release of CR6119 - Phase 2 of Manual Revisions to Reflect Payment Changes for DMEPOS Items as a Result of the DMEPOS Competitive Bidding Program and the Deficit Reduction Act of 2005 – many of the DMEPOS related Medicare Learning Network (MLN) products have been updated to reflect the changes in this new instruction. The revised products are now available on the CMS dedicated website.

For all products, go to www.cms.hhs.gov/DMEPOSCompetitiveBid, click on the Provider Educational Products and Resources tab on the left, and scroll down to the Downloads section. DMEPOS Suppliers that are Physical and Occupational Therapists

As stated in MLN Matters article SE0807, physical therapists and occupational therapists in private practice who are enrolled DMEPOS suppliers may eventually have the option to furnish certain types of competitively bid items to their own patients and be paid the single payment amount for such items without being contract suppliers, provided the following requirements are met:

· The items are limited to off-the-shelf (OTS) orthotics; and

· The items must be furnished only to their own patients as part of the physical or occupational therapy service.

However, this exception is not relevant in the first phase of the DMEPOS Competitive Bidding program beginning July 1, 2008. OTS orthotics are not included in the first phase of the Competitive Bidding program.

CMS announces the release of eight questions and answers on psychological and neuropsychological tests that are billed under the CPT code range 96101-96125. These Frequently Asked Questions (FAQs) provide clarification on Medicare billing and payment policy for these testing codes when performed by technicians, computers, physicians, clinical psychologists, independently practicing psychologists and other eligible qualified nonphysician practitioners. The scenarios under the FAQs also address situations where more than one of these testing codes can be billed for services furnished to the same patient. These FAQs are available at: https://questions.cms.hhs.gov/cgi-bin/cmshhs.cfg/php/enduser/std_alp.php?p_sid=HCq8-v6j&p_lva=9174&p_li=&p_accessibility=0&p_page=1&p_cv=&p_pv=3.605&p_prods=8%2C57%2C605&p_cats=&p_hidden_prods=&prod_lvl1=8&prod_lvl2=57&prod_lvl3=605&p_search_text=&p_new_search=1&p_search_type=answers.search_nl on the CMS Website.New and Revised MLN Articles

New:

MM6112 – Payment for Complex Rehabilitative Power Mobility Device (PMD) Services that Span the Implementation Date of DMEPOS Competitive Bidding Programs in Competitive Bidding Areas http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6112.pdf
MM6091 – Notification of New Quarterly Updates to the Ambulance Fee Schedule Public Use File (PUF) http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6091.pdf
MM6101 – July 2008 Quarterly Update for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6101.pdf
MM6075 – New "K" Code for Replacement Interface Material http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6075.pdf
MM6086 – Hospitals Exempt from Present on Admission (POA) Reporting (i.e. non-Inpatient Prospective Payment System (IPPS) Hospitals) and the Grouper http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6086.pdf SE0821 – Reminder – Medicare Provides Coverage of Diabetes Screening Tests http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0821.pdf

Revised:

SE0806 – Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program: Grandfathering, Repair and Replacement, Mail Order Diabetic Supplies and Advance Beneficiary Notices (ABNs) – The second in a series of articles on the new DMEPOS competitive bidding program. http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0806.pdf
SE0807 – Important Exceptions and Special Circumstances that Occur under the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program: – The third in a series of articles on the new DMEPOS competitive bidding program. http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0807.pdf
MM5978 – Phase 1 of Manual Revisions to Reflect Payment Changes for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Items as a Result of the DMEPOS Competitive Bidding Program and the Deficit Reduction Act of 2005 http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5978.pdf New:
MM6119 – Phase 2 Manual Revisions for the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6119.pdf
MM6046 – Inappropriate Denials of Claims for Percutaneous Transluminal Angioplasty (PTA) of Carotid Arteries Concurrent with Stenting Based on Facility Recertification Due Dates http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6046.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.aspThe NPI is here. The NPI is now. Are you using it?NPI News for Medicare FFS Providers

Medicare FFS NPI Update & Part B Issues Identified

As of 5/23/08, the National Provider Identifier (NPI) became mandatory on all HIPAA claims transactions and on Medicare paper transactions as well. All transactions must be submitted with the NPI in fields requiring a provider identifier (see items 1-3 below concerning the reporting of the Taxpayer Identification Number (TIN)). The Centers for Medicare & Medicaid Services (CMS) continues to see progress with NPI compliance and most Medicare contractors are reporting over 95 percent of claims contain only NPI. However, for some of the relatively few claims which continue to reject, we have determined that some of the reasons are related to the following issues identified for Part B claims:

1) The Employer Identification Number (EIN) or Social Security Number (SSN) being submitted in the 2010AA / REF02 (Billing Provider Secondary Identifier), 2010AB / REF02 (Pay to Provider Secondary Identifier) and/or 2310B / REF02 (Rendering Provider Secondary Identifier) of the Medicare X12N 837P transaction does not match the TIN information on the Medicare crosswalk.

2) While EIN or SSN is not required to be submitted in the 2310B loop for Medicare claims, if submitted, the appropriate qualifier must be submitted in the 2310B / REF01.

· Qualifier EI must be submitted in the 2310B / REF01 when an EIN is being submitted in the REF02.

· Qualifier SY must be submitted in the 2310B / REF01 when an SSN is being submitted in the REF02.

3) The Medicare legacy provider identifier is being submitted in the primary and/or secondary provider loops. Legacy provider numbers are no longer allowed on ANY Medicare claim or transaction. If sent, the claim or transaction will reject.

Medicare providers should review this list and take appropriate actions to resolve problems they may be experiencing. As a result, providers may decide to stop sending non-required segments, such as the TIN in 2310B/REF02 of the X12N 837P transaction. Providers may also want to consult their clearinghouses or software vendors for additional advice to solve the issues listed in this message.

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 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.Long Term Care Facilities Across America to Protect

Residents with Full Sprinkler Systems

CMS to Publish Final RuleLong term care facilities such as nursing homes across America will, for the first time, have to protect their residents by installing sprinkler systems throughout their buildings if they wish to continue to serve Medicare and Medicaid beneficiaries, under a new regulation to be issued by the Centers for Medicare & Medicaid Services. Facilities will have a five-year phase-in period to be fully compliant with the new rule.

Approximately three million elderly and disabled Americans reside in the nation’s 16,000 nursing homes, all of which must have comprehensive sprinkler systems in place by 2013. To date, there has never been a multiple-fatality fire in a facility with a sprinkler system that meets the requirements of today’s rule.

CMS is taking further action to protect the lives of our beneficiaries through a more comprehensive and effective approach to fire safety, said Kerry Weems, acting administrator of CMS. In the past, certain older facilities were exempt from having an automatic sprinkler system, but we now will hold all 16,000 nursing homes in the nation to this standard.

As an interim step taken prior to publication of this rule, CMS in March 2005 began requiring all long term care facilities that did not have sprinklers to install battery operated smoke alarms in all patient rooms and public areas. Although fatal fires in nursing homes are rare, in a July 2004 report, the Government Accountability Office estimated that automatic sprinkler systems can decrease the chance of fire-related deaths by 82 percent.

CMS has already taken many actions to increase resident safety over the past several years, including stepped-up frequency in the number of fire safety inspections performed.

The agency previously began publishing on its Nursing Home Compare Web site the number of fire safety violations, as well as information on the extent to which nursing homes had sprinkler systems, for every long term care facility in the country.

Under previous CMS regulations, newly constructed and rehabilitated nursing homes must be equipped with sprinkler systems. But prior to adoption of today’s rule, existing homes were not required to have such systems by the federal government.

CMS follows the fire safety guidelines developed by the National Fire Protection Association (NFPA) and all new sprinkler systems installed as a result of this rule will have to meet NFPA technical specifications. To be in compliance with the new rule, nursing homes must have sprinkler coverage in all areas such as resident rooms; kitchen, dining and activity areas; corridors; attics; canopies; overhangs; offices; waiting areas; closets; storage areas for trash and linen; and maintenance areas, etc.

This is an important new rule for protecting the health and safety of persons living in long term care facilities such as nursing homes who are, by definition, some of the most vulnerable among us, Weems said. It is widely believed by fire safety experts that automatic sprinkler systems are the single most effective fire protection step facilities can take.

Note: If you have problems accessing any hyperlink in this message, please try to copy and paste the URL into your Internet browser.

If you received this message as part of the All_FFS_Providers@list.nih.gov listserv, you are currently subscribed to one of eighteen Medicare Fee-For-Service provider listservs. If you would like to be removed from all NIH listservs, please go to https://list.nih.gov/LISTSERV_WEB/signoff.htm to unsubscribe. If you would like to unsubscribe from a specific provider listserv, please go to https://list.nih.gov/cgi-bin/show_list_archives to unsubscribe or to leave 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.