Riverbend

ListServ Messages 06/27/2008

Riverbend GBA Listserv June 23, 2008

 

New Listserv Format from RGBA

Reminder, Be sure to review to the end of this e-mail document for information that may affect our provider.

 

Information from The CMS.

 

New:

MM6104 2008 Physician Quality Reporting Initiative (PQRI) Establishment of Alternative Reporting Periods and Reporting Criteria

http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6104.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

 

Date: June 24, 2008

Start Time: 2:00 PM Eastern Daylight Time (EDT)

(Please dial in at least 15 minutes prior to call start time.)

Conference Leader(s): Sheila Lambowitz and Natalie Highsmith

 

Dial: 1-800-837-1935 & Reference Conference ID: 50249977

 

TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880 and for Internet Relay services click here http://www.consumer.att.com/relay/which/index.html .A Relay Communications Assistant will help.

 

ENCORE: 1-800-642-1687; Conf. ID#50249977

Encore is an audio recording of this call that can be accessed by dialing 1-800-642-1687 and entering the conference ID, beginning 2 hours after the call has ended. The recording expires

after 5 business days.

 

For Forum Schedule updates, Listserv registration and Frequently Asked Questions please visit our website at www.cms.hhs.gov/opendoorforums/

 

Thank you for your interest in CMS Open Door Forums

 

July 1 is coming! Medicare DMEPOS Competitive Bidding Program News

 

Ombudsman Program

The Ombudsmen for the DMEPOS Competitive Bidding Program are now available to assist providers, suppliers, and beneficiaries by providing information and education and by facilitating the resolution of complaints and concerns. The ombudsmen's role is to investigate and address complaints by providers, suppliers, and beneficiaries specifically related to the Competitive Bidding Program. There are eight ombudsmen who are located within the initial Competitive Bidding Areas (CBAs).

 

You may contact an ombudsman:

 

For general information about the DMEPOS Competitive Bidding Program;

To obtain assistance in locating a contract supplier;

For educational programs and activities;

To report concerns about the program, a supplier, or a referral agent;

The quality of services or items, and/or suspected fraud or abuse; and

For assistance with questions, issues, and complaints specifically pertaining to the competitive bidding program and policies.

 

You may find a list of the ombudsmen with contact information on the DMEPOS

Competitive Bidding Implementation Contractor (CBIC) website at www.dmecompetitivebid.com

DMEPOS Competitive Bidding Program Competitive Bidding Areas (CBAs) Are Defined by Zip Codes

Two CBA zip code files have been posted on the Competitive Bidding Implementation Contractor (CBIC) website: one file containing mail order zip codes per CBA and one file containing non-mail order zip codes per CBA. These files will be updated on a quarterly basis, as needed, to reflect changes in zip codes included in the various CBAs. Although the boundaries of a CBA will not change during a competitive bidding contract period, zip codes in general do change from time to time (e.g., when one zip code/area is subdivided into two or more new zip codes/areas, etc.).

 

Zip codes contained in each CBA can be accessed through the CMS DMEPOS Competitive Bidding website at located at www.cms.hhs.gov/DMEPOSCompetitivebid/ Just click on the Metropolitan Statistical Areas, Competitive Bidding Areas, and Zip Codes tab and scroll down to Related Links Outside CMS

 

Important Requirements of the Grandfathered Supplier Provision

Non contract suppliers located in the 10 DMEPOS Competitive Bidding Areas (CBAs) should have taken the appropriate steps to notify beneficiaries whose permanent residence is in a CBA of their decision to become, or not to become grandfathered suppliers for each competitively bid item. These decisions should be conveyed through a written notification to the beneficiary before July 1, the start date of the new program. IMPORTANT NOTE: This notification should only be sent to beneficiaries who maintain a permanent residence in a CBA. Suppliers can determine if a beneficiary resides in a CBA by comparing the beneficiarys zip code to the zip code files on the Competitive Bidding Implementation Contractors web site.

 

Suppliers that choose to become grandfathered should maintain a record as to whether the beneficiary chose to continue to receive the item from the grandfathered supplier, chose to go to a contract supplier, or did not respond.

 

For suppliers that choose not to become grandfathered, the beneficiary will have to switch to a contract supplier.

 

CMS expects suppliers to work together to ensure there is no break in service or in the furnishing of medically necessary items (e.g. oxygen, enteral nutrition, CPAP). In order for this transition to occur, a coordinated effort including delivery and pick-up of supplies must take place.

For more detailed information on this topic, please refer to the MLN Matters article MM5978 and the Medicare Learning Network’s Tip Sheet for Grandfathered Suppliers on the CMS DMEPOS Competitive Bidding website located at www.cms.hhs.gov/DMEPOSCompetitivebid/

Go to the Provider Educational Products and Resources tab and scroll to the Downloads section.

 

Reminder:

 

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 8in Nashville; and July 15in 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 25, 2008

 

Urgent Message from Riverbend GBA

 

Riverbend GBA has been advised that The CMS Verizon Network is currently experiencing an outage. This is effecting all incoming calls to the Medicare Provider Service Center. Callers dialing 1.888.829.8126 are receiving a fast busy. Our Telecommunication team has reported this to Verizon, and we will notify you as more information becomes available.

 

Urgent Message from Riverbend GBA

 

The CMS Verizon Network is now available;service has been restored to theMedicare Provider Service Center at 1-888-829-8126. We apologize for any inconvenience this may have caused, and appreciate your patience during the period of restoration of service to you.

 

New Listserv Format from RGBA!

 

Reminder! Be sure to review to the end of this e-mail document for information that may affect your provider.

 

Information from Riverbend GBA:For Providers Transitioning to Highmark Medicare Services ONLY

 

Effective immediately, Riverbend Government Benefits Administrator (Riverbend) will no longer sell 3270 Emulation Software licenses for Direct Data Entry (DDE) connectivity to our Medicare providers transitioning to Highmark Medicare Services as the Jurisdiction 12 (J12) Medicare Administrative Contractor (MAC). Highmark Medicare Services has notified Riverbend they will not support this software or its connection to the Fiscal Intermediary Standard System (FISS). For those providers who have purchased a 3270 Emulation Software license, Riverbend will continue to support your software, connectivity, and all user access through August 31, 2008 until the New Jersey Contract is transitioned from Riverbend to Highmark Medicare Services. For those providers currently interested in DDE service, you may contact our BlueCross and BlueShield of Tennessee Enrollment Staff at 800-924-7141 to learn about options available today with Riverbend that can be moved to the new J12 MAC without interruption.

 

For EDI assistance and support call Highmark Medicare Services dedicated toll free telephone numbers or contact them via their Web sites listed below.

 

Call 1-866-488-0546, Press Option 3, for all J12 transition-related EDI questions such as: connectivity, testing, and claim submission/report retrieval information.

 

Call 1-866-488-0546, Press Option 2 for all Part A post-transition EDI assistance once your EDI billing has transitioned to the Highmark Medicare Services EDI platform. You will be provided with details regarding your specific cutover date.

 

Highmark Medicare Services J12 Transition Webpage http://www.highmarkmedicareservices.com/transition/j12/index.html

Highmark Medicare Services EDI General Information Webpage http://www.highmarkmedicareservices.com/parta/edi/index-edi.html

PC-ACE Software Update:

Riverbend GBA is pleased to announce the latest release of the PCACE electronic billing software. This release includes CMS updates for 3rd quarter 2008 (effective July 1, 2008) PCACE version 1.93 is now available for downloading from the RGBA website:

http://www.rgbagov.com/Tools/Electronic-Billing-EDI/Downloads.shtml

 

The full install and updates along with the User Manual, Installation directions and Quick Tips guide are all available at the above mentioned link. If you have any problems downloading the software, please contact the eBusiness Service Center (423) 535-5717.

 

New:

MM6094 July 2008 Update of the Hospital Outpatient Prospective Payment System (OPPS)

http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6094.pdf

 

MM6085 Screening Pelvic Examination

http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6085.pdf

 

MM6111 October Quarterly Update to 2008 Annual Update of HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement

http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6111.pdf

 

MM6060 New Waived Tests

http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6060.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

 

Special Open Door Forum:2008 Physician Quality Reporting Initiative – Participation by Family Physicians

 

Tuesday, July 1, 2008

2:00 PM – 3:30 PM Eastern Time

 

(Conference Call Only)

 

The Centers for Medicare and Medicaid Services (CMS), along with the American Academy of Family Physicians (AAFP) will host a special open door forum to discuss participation in the 2008 Physician Quality Reporting Initiative (PQRI). This toll-free call will take place on Tuesday, July 1, 2008 from 2:00 pm until 3:30 pm, ET. The purpose of this forum is to provide information that will encourage PQRI participation. The focus will be on the simple steps that Family physicians can use to collect and report quality data to be eligible for an incentive payment from CMS. Family physicians are encouraged to participate.

 

Conference Leaders: Michael Rapp, MD (CMS) & Bruce Bagley, MD (AAFP)

Conference Moderator: Tressa Mundell (CMS)

We look forward to your participation.

Open Door Forum Participation Instructions:

Capacity is limited so dial in early. You may begin dialing into this forum as early as 1:30 PM ET.

Dial in: 1-800-837-1935

Reference Conference ID: 53531104

TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880 and for Internet Relay services click here http://www.consumer.att.com/relay/which/index.html . A Relay Communications Assistant will help.

An audio recording of this Special Door Forum will be posted to the Special Open Door Forum Website at http://www.cms.hhs.gov/OpenDoorForums/05_ODF_SpecialODF.asp and will be available beginning July 8, 2008.

For automatic emails of Open Door Forum schedule updates (E-Mailing list subscriptions) and to view Frequently Asked Questions please visit our website at http://www.cms.hhs.gov/OpenDoorForums/ .

Thank you for your interest in CMS Open Door Forums.

 

Riverbend GBA Listserv of June 26, 2008.

 

New Listserv Format from RGBA!

 

Reminder! Be sure to review to the end of this e-mail document for information that may affect your provider.

 

Information from The CMS.

New:

MM6090 Claim Status Category Code and Claim Status Code Update

http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6090.pdf

 

MM6095 July 2008 Update to the Ambulatory Surgical Center (ASC) Payment System; Summary of Payment Policy Changes

http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6095.pdf

 

 

The Skilled Nursing Facilities/Long Term Care Open Door Forum held on June 24, 2008 had reached over participant capacity and therefore, no more callers could be entered into the conference. However, for those persons who were not able to participate on the call, an audio replay (Encore) is now available and can be accessed by dialing 1-800-642-1687 and entering conference ID 50249977. Encore service will expire after June 30, 2008.

 

Thank you for your interests in CMS Open Door Forums.

 

 

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 fifth 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. until 5:00 p.m., EDT, on Wednesday, July 9, 2008.

 

This call will provide information on accessing your 2007 PQRI Feedback Report (for those of you who participated in 2007); an overview of the 2008 PQRI participation options, and a question and answer session.

 

The Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) (P.L. 110-173), which was enacted on December 29, 2007, 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#TopOfPage, 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 Ms. Rachel Nelson.

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

 

Conference call details:

Date: July 9, 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 July 8, 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/070908 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 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), 7/9/2008, until 11:59 p.m. (EDT), 7/16/2008. The call in data for the replay is (800) 642-1687 and the passcode is 52755102.

 

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

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