ListServ Message 08/01/2008
Riverbend GBA Listserv MessageWeek Ending August 1, 2008
The following Listserv information is being distributed through Riverbend GBA. Please review to the end of this document for information that may affect your facility.
The next CMS Skilled Nursing Facility (SNF)/Long-Term Care (LTC) Open Door Forum is scheduled for…
Date: August 7, 2008
Start Time: 1:00 PM Eastern Daylight Time (EDT)
(Please dial in at least 15 minutes prior to call start time.)
Conference Leader(s): Sheila Lambowitz/Natalie Highsmith
Open Door Forum Participation Instructions:
There are 2 ways to participate, by phone or onsite.
1. To participate by phone:
Dial: 1-800-837-1935 & Reference Conference ID: 53531894
(Persons participating by phone are not required to RSVP.)
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.
2.To participate onsite:
To participate in person at the Hubert H. Humphrey Building: Your RSVP for Building Security Clearance is required. The RSVP deadline is August 5, 2008, 2:00 PM EDT. To RSVP, send your name, organization and telephone number to SNF_LTCODF-L@cms.hhs.gov . Be sure to enter “SNF/LTC” in the subject line.
Upon entry into the building, you will be required to show your Government issued photo identification, preferably a valid driver's license, and are subject to baggage or vehicular search before entering the complex.
Please arrive no later than 12:30 PM.
ADDRESS:
Hubert H. Humphrey Bldg.
200 Independence Avenue S.W.
Washington, D.C. 20201
Map & Directions: http://www.hhs.gov/about/hhhmap.html
ENCORE: 1-800-642-1687; Conf. ID#53531894
Encore is an audio recording of this call that can be accessed by dialing 1-800-642-1687 and entering the conference ID, beginning Monday, August 11, 2008. The recording expires after 3 business days.
For Forum Schedule updates, Listserv registration and Frequently Asked Questions please visit our website at www.cms.hhs.gov/opendoorforums/
Thank you.
The following Medi-Letters were issued the weeks of July 14, 2008 and July 21, 2008 by Riverbend GBA:
MediNumber: 3230-08 |
MediNumber: 3229-08 |
MediNumber: 3228-08 |
MediNumber: 3227-08 |
|
MediNumber: 3235-08 |
MediNumber: 3234-08 |
MediNumber: 3233-08 |
MediNumber: 3232-08 |
MediNumber: 3231-08 |
Reminder for July 24, 2008
CR 6088 has been rescinded. You may view this information in its entirety at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6088.pdf
Reminder: Medicare Provides Coverage of Diabetes Screening Tests
This article conveys no new policy information. This article serves as a reminder to health care professionals and their staff that Medicare pays for diabetes screening tests. To ensure proper reimbursement for these screening tests the correct procedure and diagnosis codes and modifier (when appropriate) must be used when filing claims. http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0821.pdf
Extension of Therapy Cap Exceptions
The Medicare Improvements for Patients and Providers Act of 2008 was enacted on July 15, 2008. One provision of this legislation extends the effective date of the exceptions process to the therapy caps to December 31, 2009. Outpatient therapy service providers may now resume submitting claims with the KX modifier for therapy services that exceed the cap furnished on or after July 1, 2008.
For physical therapy and speech language pathology services combined, the limit on incurred expenses is $1810 for calendar year 2008. For occupational therapy services, the limit is $1810. Deductible and coinsurance amounts applied to therapy services count toward the amount accrued before a cap is reached. Services that meet the exceptions criteria and report the KX modifier will be paid beyond this limit.
Before this legislation was enacted, outpatient therapy service providers were previously instructed to not submit the KX modifier on claims for services furnished on or after July 1, 2008. The extension of the therapy cap exceptions is retroactive to July 1, 2008. As a result, providers may have already submitted some claims without the KX modifier that would qualify for an exception.
Providers submitting these claims using the 837 institutional electronic claim format or the UB-04 paper claim format would have had these claims rejected for exceeding the cap. These providers should resubmit these claims appending the KX modifier so they may now be processed and paid. Providers submitting these claims using the 837 professional electronic claim format or the CMS-1500 paper claim format would have had these claims denied for exceeding the cap. These providers should request to have their claims adjusted in order to have the contractor pay the claim.
In all cases, if the beneficiary was notified of their liability and the beneficiary made payment for services that now qualify for exceptions, any such payments should be refunded to the beneficiary.
Reinstatement of the Moratorium That Allows Independent Laboratories to Bill for the TC of Physician Pathology Services Furnished to Hospital Patients
In the final physician fee schedule regulation published in the Federal Register on November 2, 1999, the Centers for Medicare & Medicaid Services (CMS) stated that it would implement a policy to pay only the hospital for the technical component (TC) of physician pathology services furnished to hospital patients. Prior to this proposal, any independent laboratory could bill the carrier under the physician fee schedule for the TC of physician pathology services for hospital patients. At the request of the industry, to allow independent laboratories and hospitals sufficient time to negotiate arrangements, the implementation of this rule was administratively delayed. Subsequent legislation formalized a moratorium on the implementation of the rule. As such, during this time, the carriers and, more recently, Medicare Administrative Contractors (MAC) have continued to pay for the TC of physician pathology services when an independent laboratory furnishes this service to an inpatient or outpatient of a covered hospital.
The most recent extension of the moratorium, established by the Medicare, Medicaid, and SCHIP Extension Act (MMSEA), Section 104, expired on June 30, 2008. A new extension of the moratorium has been established by the Medicare Improvements for Patients and Providers Act of 2008, Section 136, retroactive to July 1, 2008.
A previous communication indicated that the moratorium had ended and that independent laboratories may no longer bill Medicare for the TC of physician pathology services furnished to patients of a covered hospital, regardless of the beneficiary's hospitalization status (inpatient or outpatient) on the date that the service was performed. This prohibition is rescinded and the moratorium will continue effective for claims with dates of service on and after July 1, 2008, but prior to January 1, 2010.
Extension of Payment Rule for Brachytherapy and Therapeutic Radiopharmaceuticals
The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), enacted on July 15, 2008, extends the use of the cost to charge payment methodology for Brachytherapy and Therapeutic Radiopharmaceuticals through January 1, 2010. This change is retroactive to July 1, 2008. Some claims have already been processed, however, using the Outpatient Prospective Payment System (OPPS) rates that were in effect until MIPAA enactment. To avoid a disruption in payment while the cost to charge payment methodology is re-implemented, impacted claims will continue to be paid based on the OPPS rates. Contractors will mass adjust all impacted OPPS claims with dates of service beginning July 1, 2008, as soon as the cost to charge payment methodology has been implemented. Reprocessing will be complete by September 30, 2008.
End of Listserv
The following Listserv information is being distributed through Riverbend GBA. Please review to the end of this document for information that may affect your facility.
CMS has released the following MLN Matters Article for your review: Continuous Positive Airway Pressure (CPAP) Therapy for Obstructive Sleep Apnea (OSA) Provider Types Affected: Physicians, providers and suppliers submitting claims to Medicare contractors (carriers, Fiscal Intermediaries (FIs), Part A/B Medicare Administrative Contractors (A/B MACs), and/or Durable Medical Equipment (DME) MACs) for OSA-related services provided to Medicare beneficiaries.
Impact on Providers: Providers need to be aware that effective for claims with dates of service on and after March 13, 2008, Medicare will allow for coverage of CPAP therapy based upon a positive diagnosis of OSA by home sleep testing (HST), subject to the requirements of CR6048. http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6048.pdf
SUBJECT: Screening DNA Stool Test for Colorectal Cancer: http://www.cms.hhs.gov/transmittals/downloads/R89NCD.pdf
End of Listserv
The following Listserv information is being distributed through Riverbend GBA. Please review to the end of this document for information that may affect your facility.
The next CMS Ambulance Open Door Forum is scheduled for...
Date: August 12, 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): Dr. Bill Rogers/Dr. Charlotte Yeh/Natalie Highsmith
Open Door Forum Participation Instructions:
There are 2 ways to participate, onsite or by phone.
1. To participate onsite at the Hubert H. Humphrey Building, RSVP and Security Clearance is required. The RSVP deadline is August 8, 2008 no later than 2:00 PM EDT. To RSVP, send your name, organization and telephone number to AMBULANCEODF-L@cms.hhs.gov. Be sure to include "Ambulance" in the subject line.
Upon entry into the building, you will be required to present to Security a Government-issued photo identification, preferably valid driver's license. Please arrive no later than 1:30 PM.
2. To participate by phone:Dial: 1-800-837-1935 & Reference Conference ID: 55464084
(Persons participating by phone are not required to RSVP.) 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.
ADDRESS:
Hubert H. Humphrey Bldg.
200 Independence Avenue S.W.
Washington, D.C. 20201
Map & Directions: http://www.hhs.gov/about/hhhmap.html
ENCORE: 1-800-642-1687; Conf. ID# 55464084. Encore is an audio recording of this call that can be accessed by dialing 1-800-642-1687 and entering the Conf. ID., beginning 2 hours after the call has ended. The recording expires after 3 business days.
For Forum Schedule updates, Listserv registration and Frequently Asked Questions please visit our website at http://www.cms.hhs.gov/OpenDoorForums/ . Thank you
CMS asks that you share this important information with all of your association members and State and local chapters. Thanks!
Good Monday morning to everyone ~ just a few items to kick off this work week, including information on:
· Availability of July 2008 Quarterly Provider Specific Files
· OPPS Pricer Web Page Update
· New Q & A Posted on Reporting of “Charges” On a Hospice Claim
· Electronic Prescribing
· Transcript Posted for July 15th Special ODF on PQRI
July 2008 Quarterly Provider Specific Files
The Centers for Medicare & Medicaid Services (CMS) has processed the July 2008 quarterly Provider Specific Files (PSF). Both text and (new this quarter) Statistical Analysis Software (SAS) data are available on the CMS website at http://www.cms.hhs.gov/ProspMedicareFeeSvcPmtGen/03_psf.asp , under the heading “Provider Specific Data for Public Use.” If you use the Provider Specific File data, please go to the page above and download the latest versions of the PSF Files.
Please Note: New this quarter -- SAS data sets are now available for Provider Specific File Data, in addition to the text files.
OPPS Pricer Web Page Update
The OPPS Pricer web page has recently been updated to include the July 2008 Provider Specific File. You may go to http://www.cms.hhs.gov/PCPricer/08_OPPS.asp to view the latest update.
New Q & A Posted on Reporting of “Charges” On a Hospice Claim
The Centers for Medicare & Medicaid Services (CMS) recently posted a new Question & Answer providing guidance on CR 5567 as it relates to the reporting of "charges" on the hospice claim. Go to the Hospice Center web page at http://www.cms.hhs.gov/center/hospice.asp on the CMS website.
HHS Takes New Steps to Accelerate Adoption of Electronic Prescribing Medicare Payments for Successful Electronic Prescribers, Reporting Quality Data are Important Steps Toward a Value-Driven Health Care System
Medicare is starting a new program to encourage physicians to adopt e-prescribing systems. Incentive payments will be available beginning in 2009 for physicians who meet the requirements of the program. The initiative is part of the Administration’s broader efforts to accelerate the adoption of health IT and the establishment of a health care system based on value.
Beginning in 2009, and during the next four years, Medicare will provide incentive payments to eligible professionals who are successful electronic prescribers. Eligible professionals will receive a 2 percent incentive payment in 2009 and 2010; a 1 percent incentive payment in 2011 and 2012; and a one half percent incentive payment in 2013.
Beginning in 2012, eligible professionals who are not successful electronic prescribers will receive a reduction in payment. Eligible professionals may be exempted from the reduction in payment, on a case-by-case basis, if it is determined that compliance with requirement for being a successful prescriber would result in significant hardship.
To read more, see the attached HHS Fact Sheet.
Transcript Posted for July 15th Special ODF: Physicians Quality Reporting Initiative- Participation by the American College of Physicians The transcript for the July 15th Special ODF: PQRI – Participation by the American College of Physicians has been posted on the Special ODF website at http://www.cms.hhs.gov/OpenDoorForums/05_ODF_SpecialODF.asp#TopOfPage, under the Downloads section. During the call, as transcribed on page 30, Dr. Hornback inadvertently stated 15% instead of 1.5% in his presentation regarding incentive payment. Please make note of the correct percentage rate 1.5% when reading the transcript.
Thank you.
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 sixth 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, August 13, 2008.
This call will provide an overview of the PQRI provisions in the new Medicare Improvements for Patients and Providers Act (MIPPA) of 2008; information on the E-prescribing measure for 2008 PQRI (measure #125) and proposed measures for 2009 PQRI; incentives for electronic prescribing outlined in the MIPPA; an update on registry reporting for 2008, and a question and answer session.
A PowerPoint slide presentation will be posted to the PQRI web page 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, and Dr. Daniel Green.
Following the presentation, callers will have an opportunity to ask questions of CMS subject matter experts.
Conference call details:
Date: August 13, 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 August 12, 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/081308
2. Fill in all required data.
3. Verify your time zone is displayed correctly the drop down box.
4. 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 8/13/2008 until 11:59 p.m. EDT 8/20/2008. The call in data for the replay is (800) 642-1687 and the passcode is 55967176.
If you require services for the hearing impaired please send an email to Medicare.TTT@PalmettoGBA.com.
End of Listserv
The following Listserv information is being distributed through Riverbend GBA. Please review to the end of this document for information that may affect your facility.
The Centers for Medicare & Medicaid Services (CMS) has announced that 2007 PQRI Final Feedback Reports are available on a secure website.
The first step is to register for access through a CMS security system known as the Individuals Authorized Access to CMS Computer Services (IACS). Do not register if you did not report PQRI quality measures in 2007.
There are two categories of user types in IACS: individual practitioner and organization. The CMS approval process differs depending on the type of user you are; therefore, it is important to register correctly.
Follow these instructions if you are a professional paid by Medicare directly (you have not reassigned Medicare payments to a group practice):
If you do not have employees, the CMS approval process requires you to register as an individual practitioner and access the PQRI 2007 feedback report personally. Some solo professionals have incorrectly registered in IACS as organizations, and have had to reregister as individual practitioners.
If you have employees and therefore are an organization for tax purposes, you may select one of 2 options:
Option 1: Register in IACS as an organization if you will use one or more employees to access IACS and/or your PQRI feedback reports, OR
Option 2: Register in IACS through the Individual Practitioner role if you will access the PQRI report personally.
If you are a professional who has reassigned Medicare payments to a group practice:
Do NOT register in IACS unless you are one of the individuals designated to do so by the group practice.
Group practices will register in IACS as organizations. Up to 2 individuals will be able to access the 2007 PQRI feedback report for each organization that registers in IACS. One 2007 PQRI feedback report will be prepared for each taxpayer identification number (TIN). The group practice will be responsible for sharing National Provider Identifier (NPI) level information with the appropriate professionals within the group practice.
For more Information:
IACS Quick Reference Guides may be found at http://www.cms.hhs.gov/IACS/04_Provider_Community.asp on the CMS website. Summary information about accessing the 2007 PQRI feedback reports for those registering as organizations and individual practitioners will soon be posted on http://www.cms.hhs.gov/PQRI on the CMS website.
HHS Takes New Steps to Accelerate Adoption of Electronic Prescribing Medicare Payments for Successful Electronic Prescribers, Reporting Quality Data are Important Steps Toward a Value-Driven Health Care System
Medicare is starting a new program to encourage physicians to adopt e-prescribing systems. Incentive payments will be available beginning in 2009 for physicians who meet the requirements of the program. The initiative is part of the Administration’s broader efforts to accelerate the adoption of health IT and the establishment of a health care system based on value.
Beginning in 2009, and during the next four years, Medicare will provide incentive payments to eligible professionals who are successful electronic prescribers. Eligible professionals will receive a 2 percent incentive payment in 2009 and 2010; a 1 percent incentive payment in 2011 and 2012; and a one half percent incentive payment in 2013.
Beginning in 2012, eligible professionals who are not successful electronic prescribers will receive a reduction in payment. Eligible professionals may be exempted from the reduction in payment, on a case-by-case basis, if it is determined that compliance with requirement for being a successful prescriber would result in significant hardship.
To read more, see the entire HHS Fact Sheet at http://www.hhs.gov/news/facts/eprescribing.html.
Note: Click the hyperlink to view the full story.
CMS Updates to Coverage Pages
Wed, 30 Jul 2008 16:10:00 -0500
Date: 07/30/2008
Subject: CMS Updates to Coverage Pages
Content: Updates to Coverage Pages for July 30, 2008
The following fact sheets are now available in print format from the Centers for Medicare & Medicaid Services Medicare Learning Network. To place your order, visit http://www.cms.hhs.gov/mlngeninfo/ , scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page.”
Federally Qualified Health Center Fact Sheet (revised April 2008) which provides information about Federally Qualified Health Center (FQHC) designation; covered FQHC services; FQHC preventive primary services that are not covered; FQHC payments; and the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.
Medicare Disproportionate Share Hospital Fact Sheet (revised April 2008) which 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.
Inpatient Psychiatric Facility Prospective Payment System Fact Sheet (revised May 2008) which provides general information about the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS), howpayment rates are set, and the Rate Year 2009 update to the IPF PPS.
End of Listserv Message.
The following Listserv information is being distributed through Riverbend GBA. Please review to the end of this document for information that may affect your facility.
The Centers for Medicare & Medicaid Services (CMS) has announced that 2007 PQRI Final Feedback Reports are available on a secure website.
The first step is to register for access through a CMS security system known as the Individuals Authorized Access to CMS Computer Services (IACS). Do not register if you did not report PQRI quality measures in 2007.
There are two categories of user types in IACS: individual practitioner and organization. The CMS approval process differs depending on the type of user you are; therefore, it is important to register correctly.
Follow these instructions if you are a professional paid by Medicare directly (you have not reassigned Medicare payments to a group practice):
If you do not have employees, the CMS approval process requires you to register as an individual practitioner and access the PQRI 2007 feedback report personally. Some solo professionals have incorrectly registered in IACS as organizations, and have had to reregister as individual practitioners.
If you have employees and therefore are an organization for tax purposes, you may select one of 2 options:
Option 1: Register in IACS as an organization if you will use one or more employees to access IACS and/or your PQRI feedback reports, OR
Option 2: Register in IACS through the Individual Practitioner role if you will access the PQRI report personally.
If you are a professional who has reassigned Medicare payments to a group practice:
Do NOT register in IACS unless you are one of the individuals designated to do so by the group practice.
Group practices will register in IACS as organizations. Up to 2 individuals will be able to access the 2007 PQRI feedback report for each organization that registers in IACS. One 2007 PQRI feedback report will be prepared for each taxpayer identification number (TIN). The group practice will be responsible for sharing National Provider Identifier (NPI) level information with the appropriate professionals within the group practice.
For more Information:IACS Quick Reference Guides may be found at http://www.cms.hhs.gov/IACS/04_Provider_Community.asp on the CMS website. Summary information about accessing the 2007 PQRI feedback reports for those registering as organizations and individual practitioners will soon be posted on http://www.cms.hhs.gov/PQRI on the CMS website.
Contact Us | Legal | Site Map
730 Chestnut Street - Chattanooga, Tennessee 37402
1-877-296-6189 (providers) | 1-800-MEDICARE (beneficiaries)
© 2004-2007
