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ListServ Message 08/08/2008
August 4, 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.
Subscriber’s Note: Articles MM6002 and MM6006 were revised prior to the initial post date and, so, appear as revised even though this is their initial posting.
New:
SE0816 – Medicare Payments for Part B Mental Health Services
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0816.pdf
SE0829 – CR 5971 Clarification - Signature Requirements
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0829.pdf
MM5683 – Beneficiary Submitted Claims
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5683.pdf
MM6002 – Clarification on the Correct Condition Code to Report on Provider Adjustment Requests
to Indicate a Health Insurance Prospective Payment System (HIPPS) Code Change
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6002.pdf
MM6006 – New Hemophilia Clotting Factor and HCPCS Code
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6006.pdf
MM6145 – Screening DNA Stool Test for Colorectal Cancer
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6145.pdf
MM6036 – Revisions to the Chapter 14 of the Medicare Program Integrity Manual
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6036.pdf
MM6138 – Prothrombin Time (PT/INR) Monitoring for Home Anticoagulation Management
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6138.pdf
MM6042 – Medicare Improvements for Patients and Providers Act of 2008 - Legislative Change to Independent Laboratory Billing for the Technical Component (TC) of Physician Pathology Services
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6042.pdf
Revised:
MM6048 – Continuous Positive Airway Pressure (CPAP) Therapy for Obstructive Sleep Apnea (OSA)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6048.pdf
Agenda - Special Open Door Forum: Changes in Conditions of Participation Requirements and
Payment Provisions for Rural Health Clinics and Federally Qualified Health Centers Proposed Rule
The agenda has been posted for the Special Open Door Forum on Changes in Conditions of Participation Requirements and Payment Provisions for Rural Health Clinics and Federally Qualified Health Centers Proposed Rule which is scheduled for Tuesday, August 5, 2008. To view the agenda, click on the following link:
http://www.cms.hhs.gov/OpenDoorForums/05_ODF_SpecialODF.asp#TopOfPage, and select the link hat corresponds to this agenda in the “Downloads” section of the page.
Thank you for your continued interest in CMS Open Door Forums.
New from the Medicare Learning Network
2007 PQRI Final Feedback Reports
New from the Medicare Learning Network
The following fact sheet is 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.
The 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.
2007 PQRI Final Feedback Reports
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 eassigned 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.
Note: Click the hyperlink to view the full story.
CMS Updates to Coverage Pages
Mon, 04 Aug 2008 12:28:00 -0500
Date: 08/04/2008
Subject: CMS Updates to Coverage Pages
Content: Updates to Coverage pages for August 4, 2008
The NPI is here. The NPI is now. Are you using it?
NPPES & the NPI Registry will be Unavailable on August 10th
On August 10, 2008, the National Plan and Provider Enumeration System (NPPES) will undergo system maintenance. Neither NPPES nor the NPI Registry will be available on August 10, 2008. CMS will be implementing some enhancements/updates to the system. A detailed listing of the NPPES enhancements/updates can be found at http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/Revised_NPPES_Enhancements.pdf on the CMS NPI web page.
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.
August is National Immunization Awareness Month (NIAM)! The goal of NIAM is to increase awareness about immunizations across the life span, from infants to the elderly. Getting immunized is a lifelong effort regardless of age, sex, race, ethnic background or country of origin. As parents prepare their children for school, students enter college and healthcare workers prepare for the upcoming flu season, the month of August and NIAM present an excellent opportunity to remind individuals that they can help protect themselves, their families, friends and their communities from serious, life-threatening infections by staying up-to-date with their immunizations.
Medicare helps beneficiaries with the cost of adult immunizations by providing coverage for pneumococcal, influenza and hepatitis B vaccines. Medicare covers the cost of pneumococcal and influenza vaccines and their administration by recognized providers. No beneficiary co-insurance or co-payment applies and a beneficiary does not have to meet his or her deductible to receive an influenza or pneumococcal immunization. Medicare also covers hepatitis B vaccination for persons at high or intermediate risk. The coinsurance or co-payment applies for hepatitis B vaccination after the yearly deductible has been met.
How Can You Help?
As a health care professional, you play an important role in helping your Medicare patients and others understand the importance of disease prevention through immunizations. Your recommendation is one the most important factors in increasing immunization rates among people with Medicare. Be aware of the recommended vaccines for adults of all ages and particularly seniors. Encourage your Medicare patients to stay up-to-date on recommended vaccines including those adult immunizations covered by Medicare (an annual influenza vaccination, a pneumococcal vaccination and the hepatitis B vaccination (for beneficiaries at high to intermediate risk)) by encouraging utilization of these benefits as appropriate.
For More Information
The Centers for Medicare & Medicaid Services (CMS) has developed a variety of provider education and outreach resources to help providers and suppliers to learn more about Medicare’s coverage, coding, billing and reimbursement of influenza, pneumococcal, and hepatitis B immunizations. Resources include:
The Guide to Preventive Services for Providers, Physicians, Suppliers and Other Health Care Professionals http://www.cms.hhs.gov/MLNProducts/downloads/mps_guide_web-061305.pdf
Quick Reference Information: Medicare Part B Immunization Billing Chart http://www.cms.hhs.gov/MLNProducts/downloads/qr_immun_bill.pdf
Adult Immunizations Brochure
http://www.cms.hhs.gov/MLNProducts/downloads/Adult_Immunization.pdf
The MLN Preventive Services Educational Products Web Page http://www.cms.hhs.gov/MLNProducts/35_PreventiveServices.asp#TopOfPage
For information to share with your Medicare patients, please visit www.medicare.gov on the Web.
· To learn more about National Immunization Awareness Month, please visit http://www.cdc.gov/vaccines/events/niam/default.htm#add on the Web.
Thank you for supporting the effort to increase awareness and promote utilization of vaccines that can prevent infectious disease and save lives.
Visit the Medicare Learning Network ~ it’s free!
End of Listserv Message.
August 5, 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.
Prospective payment system (PPS) hospitals may apply to the Medicare Geographic Classification Review Board (MGCRB or Board) to be reclassified to another area for the purposes of using the wage index value. To be reclassified, they must meet certain criteria found at 42 C.F.R. Section 412.230ff. PPS hospitals must also complete the application required by the MGCRB and, for reclassifications effective Federal Fiscal Year (FFY) 2010, file it with the Board by 5:00pm, EDT, September 2, 2008.
This is to advise you that individual and group instructions and applications for FFY 2010 are now available. PPS hospitals may obtain them from the Internet at
ttp://cms.hhs.gov/MGCRB/02_instructions_and_applications.asp. PPS hospitals may also obtain the pplication and instructions by contacting Terry Rivers at (423) 535-3223.
Hospitals needing further information may call the Board’s office at 410.786.1174.
This listserv message is being resubmitted as a reminder of the payment floor explanation.
The Medicare Claims Processing Manual; 100-04, Chapter 1, General Billing Requirements located at: http://www.cms.hhs.gov/manuals/downloads/clm104c01.pdf provides payment floor explanations for both clean and non-clean claims received by an FI/Carrier. The information listed below is excerpts from the manual, and will aide providers in accurately determining within which time-frame Medicare payment will be made for your claims.
Section 80.2.1.2 of the Medicare Claims Processing Manual; 100-04 Chapter 1 - General Billing Requirements, defines the Payment Floor Standards as:
The “payment floor” establishes a waiting period during which time the contractor may not pay, issue, mail, or otherwise finalize the initial determination on a clean claim. The “payment floor date” is the earliest day after receipt of the clean claim that payment may be made. The payment floor date is determined by counting the number of days since the day the claim was received, i.e., the count begins the day after the day of receipt.
Based on the waiting periods, the payment floor dates are as follows:
Claim Receipt Date Payment Floor Date
07-01-04 and later 14th day for HIPAA-compliant EMC 27th day for paper and non-HIPAA EMC
01/01/2006 and later 29th day for paper
Section 80.3 of the Medicare Claims Processing Manual; 100-04 Chapter 1 - General Billing
equirements, defines Other Claims (other than clean) as:
Claims that do not meet the definition of “clean” claims are “other” claims. “Other” claims require investigation or development external to the carrier or FI’s Medicare operation on a prepayment basis. “Other” claims are those that are not approved by CWF for payment that the FI identifies as requiring outside development.
Examples are claims on which the provider’s FI/carrier:
• Requests additional information from the provider or another external source. This includes
outine data omitted from the bill, medical information, or information to resolve discrepancies;
• Requests information or assistance from another contractor. This includes requests for charge
data from the carrier, or any other request for information from the carrier;
• Develops Medicare Secondary Payer (MSP) information;
• Requests information necessary for a coverage determination;
• Performs sequential processing when an earlier claim is in development; and
• Performs outside development as a result of a CWF edit.
Section 80.2.2 the Medicare Claims Processing Manual; 100-04 Chapter 1 - General Billing equirements, clarifies interest payments- Interest Payment on Clean Non-PIP Claims Not Paid imely as:
Interest must be paid on clean claims if payment is not made within the applicable number of calendar days (i.e., 30 days) after the date of receipt as described above. The applicable number of days is also known as the payment ceiling. For example, a clean claim received on October 1, 1993, must have been paid before the end of business on October 31, 1993. Interest is not paid on:
• Claims requiring external investigation or development by the provider’s FI or carrier;
• Claims on which no payment is due;
• Full denials;
• Claims for which the provider is receiving PIP; or
• HH PPS RAPs
Interest is paid at the rate used for §3902(a) of title 3l, U.S. Code (relating to interest penalties for failure to make prompt payments). The interest rate is determined by the applicable rate on the day of payment.
Providers are encouraged to review these manual sections for clarification regarding clean and non-clean claims and payment floor application.
New and Revised MLN Articles from The CMS.
New:
MM6155 – Update to Hospice Payment Rates, Hospice Cap, Hospice Wage Index, and the Hospice Pricer for FY 2009 http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6155.pdf
MM6132 – Requirement to Educate Providers Regarding Centers for Medicare & Medicaid Services CMS) Use of Medicare Cost Report Data
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6132.pdf
MM6107 – Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6107.pdf
Revised:
SE0753 – Individuals Authorized Access to CMS Computer Services – Provider/Supplier Community (IACS-PC): THE SECOND IN A SERIES OF ARTICLES ON THE IACS
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0753.pdf
SE0747 – Individuals Authorized Access to CMS Computer Services (IACS)- Provider/Supplier Community (IACS-PC): THE FIRST IN A SERIES OF ARTICLES
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0747.pdf
SE0754 – Individuals Authorized Access to CMS Computer Services – Provider/Supplier Community (IACS-PC): THE THIRD IN A SERIES OF ARTICLES ON THE IACS-PC
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0754.pdf
MM5993 – Critical Care Visits and Neonatal Intensive Care (Codes 99291 - 99292)tp://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5993.pdf
MM6007 – Manual Revisions to Reflect Special Billing Instructions for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items as a Result of the DMEPOS Competitive Bidding Program http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6007.pdf
Agenda - Special Open Door Forum: Developing Outpatient Therapy Payment Alternatives
The agenda has been posted for the Special Open Door Forum on Developing Outpatient Therapy Payment Alternatives which is scheduled for Wednesday, August 6, 2008. To view the agenda, click on the following link: http://www.cms.hhs.gov/OpenDoorForums/05_ODF_SpecialODF.asp, and select the link that corresponds to this agenda in the “Downloads” section of the page.
End of Listserv.
August 5, 2008
The following Webinars are available for registration on the RGBA Website. You may register at:
http://www.rgbagov.com/Education/Schedule-Events/Workshop-Registration/event.do
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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. |
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Time: 2:00 PM ET |
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Date: 2008-08-07 |
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August 6, 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.
On August 1, 2008, CMS issued Change Request 6132 regarding CMS’ use of Medicare Cost Report data.
CMS stresses to Medicare providers the importance of filing complete and valid Medicare Cost Reports with their Fiscal Intermediary. Medicare Cost Reports represent the only nationally-available data to CMS and to the Medicare Payment Advisory Commission (MedPAC) on which statutorily-required payment updates in aggregate and by subclass (urban/rural, hospital-based/freestanding, etc.) can be appropriately based.
Some providers are failing to completely fill out their cost reports with valid data, often times due to the misconception that the data submitted on the cost report does not impact their payments. It is crucial that Medicare providers understand the importance of submitting complete and accurate data on their cost reports.
Data obtained from the provider’s cost report plays a key role in the development of price indexes, such as the market basket indexes, used to update PPS payments. Cost reports are essential in CMS’ evaluation of Medicare payment adequacy.
Market baskets are designed to measure the price inflation that providers face in the provision of the medical care services they deliver. They are used by CMS to annually update payments for the various providers paid by Prospective Payment Systems. Data from the cost report is used to develop the major cost weights that are used in the market baskets. The data is also used to determine the labor-related share of a given market basket. The labor-related share is used along with the area wage index to determine the geographic adjustment to Medicare payments. This geographic adjustment can vary widely; therefore, individual hospitals’ payment levels can be very sensitive to the changes, and errors, in measuring the labor-related share. For more information on Market Baskets, see http://www.cms.hhs.gov/MedicareProgramRatesStats/04_MarketBasketData.asp.
To carry out the payment setting processes, CMS typically uses cost data from Worksheets A, B, D, and G of the cost report, provider characteristics and salary data from the S worksheets, and payment data from Worksheet E and other cost report worksheets (the worksheet location of which varies by provider-type).
CMS has provided a provider education article at http://www.cms.hhs.gov/MLNMattersArticles/.
The Following Medi-Letters were posted to the RGBA Website from July 23 through August 4, 2008.
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MediNumber: 3245-08 | |
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MediNumber: 3244-08 | |
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MediNumber: 3243-08 | |
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MediNumber: 3242-08 | |
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MediNumber: 3241-08 | |
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MediNumber: 3240-08 | |
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MediNumber: 3239-08 | |
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MediNumber: 3238-08 | |
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MediNumber: 3237-08 | |
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MediNumber: 3236-08 | |
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MediNumber: 3235-08 | |
Third Qtr Ask the Contractor Teleconference (ACT) Thursday, August 21, 2008, at 2:00 PM EST.
The participant toll free number: 1-877-718-5099.
Providers should submit any questions you would like answered on the call in advance to the GM-Education e-mailbox at: http://www.rgbagov.com/Education/Training/training.do . Please submit before August 18th,to allow adequate research time by the RGBA staff.
End of Listserv.
August 7, 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.
New:
SE0830 – Steps for Individual Eligible Professionals to Access Their 2007 Physician Quality Reporting Initiative (PQRI) Feedback Reports Personally
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0830.pdf
SE0831 – Steps for Organizations to Access Their 2007 Physician Quality Reporting Initiative (PQRI) Feedback Reports http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0831.pdf
The provider data distributed with the Inpatient PPS PC Pricer has been updated as of July 2008. The Inpatient PPS PC Pricer on the page, http://www.cms.hhs.gov/PCPricer/03_inpatient.asp, in the Downloads section has been updated with the latest provider data. If you use the Inpatient PPS PC Pricer, please go to the page above and download the latest version of the PC Pricer posted 8/05/2008.
The CD-ROM version of the revised Medicare Guide to Rural Health Services Information for Providers, Suppliers, and Physicians (April 2008) is now available from the Centers for Medicare & Medicaid Services Medicare Learning Network. This guide contains rural health information pertaining to rural health facility types, coverage and payment policies, and rural provisions under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 and the Deficit Reduction Act of 2005. To place your order, visit http://www.cms.hhs.gov/mlngeninfo/ , scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page.”
Visit the Medicare Learning Network - It's Free!
End of Listserv Message.
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