Riverbend

ListServ Message 08/29/2008

August 25, 2008

The following Listserv information is being distributed through Riverbend GBA.  Please review to the nd of this document for information that may affect your facility.

Medical Review Quarterly posted to the RGBA Website
Volume 16 No 3, of the Medical Review Quarterly has been published and is available for your review.. It can be found at the following link.
http://www.rgbagov.com/Publications/Medical-Review-quarterly/2008/Medical_Review_QuarterlyVol16No3.pdf

Riverbend has gone Paperless!
As of May 1, 2008 all incoming correspondence received by Riverbend is being imaged into electronic format. To help ensure your information is being routed to the appropriate area as quickly as possible, we encourage you to use our RGBA Document Routing Form. Please complete this form and allow it to serve as a cover to the correspondence you are sending to us. This form will assist you in providing us with all of the information necessary to handle your correspondence in the most expeditious manner. This form can be located at http://www.rgbagov.com/About-Us/

Riverbend GBA Website Information

Please visit our Website for more information relating to CMS Publications, as well as helpful information pertaining to your claims submission and payment processes.  
You may review our Website at www.rgbagov.com. 

Important information from CMS pertaining to the MLN Matters articles and can be viewed at:
http://www.rgbagov.com/Publications/Medi-Letters/mediLetter.do

Information from The CMS
Information from The CMSThe Centers for Medicare & Medicaid Services (CMS) is pleased to announce that 2007 PQRI Final Feedback Reports are available on a secure website. Two MLN Matters articles on accessing the reports are now available that can assist individual eligible professionals and group practices that reported valid 2007 PQRI quality measures data to Medicare.  The reports are organized by Tax Identification Number (TIN).  For eligible professionals reporting measures for 2007 PQRI under a group practice TIN, the group practice determines who can access the Feedback Report for the group practice or organization.

The first article, “Steps for Individual Eligible Professionals to Access Their 2007 PQRI Feedback Reports Personally”, SE0830, can be accessed at  (http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0830.pdf)

The second article, “Steps for Organizations to Access Their 2007 PQRI Feedback Reports”,  SE0831, is available at (http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0831.pdf).

Once you are registered in the Individuals Authorized Access to CMS Computer Services (IACS) system and have access to the PQRI feedback report application, any questions about the Feedback Report should be directed to the Report Delivery System Help Desk referenced at the end of the end of the MLN Matters articles.  Additional educational resources and information about the PQRI program is available at, (http://www.cms.hhs.gov/PQRI/).

End of Listserv Message.

August 27, 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.

Important Reminder for ALL Riverbend GBA Providers of Service

To accommodate the J12 transition of NJ providers from Riverbend GBA to Highmark Medicare Services we need to adjust our normal system availability. Starting on Friday August 29^th Riverbend system will be unavailable at 5 PM EST through the whole Labor Day Weekend. The system will be available at the normal times starting Tuesday September 2^nd at 7 AM EST.

This scheduled downtime will affect all Riverbend providers’ access to DDE Processing, and certain IVR functionality. Once the system is available on Tuesday, September 2^nd, only the providers not moving to Highmark Medicare Services will be able to access Riverbend’s systems.

For NJ Providers moving to Highmark Medicare Services the cutoff for submitting EDI Claims to Riverbend will be 4 PM EST Friday August 29th. After this cutoff all EDI claims will have to be submitted to Highmark Medicare Services.

Riverbend GBA will be Closed September 1, 2008.  The Payment cycle changes are indicated below.

Riverbend Government Benefits Administrator will be closed on September 1, 2008 in recognition of Labor Day.  As a result, there will be some changes to our normal payment cycle.

For the week ending September 5^th, there will be 2 payment runs: September 3^rd and September 5^th.  Remittance advices will be mailed on Friday September 5, 2008.   For the week ending September 12^th, we will resume with our normal payment cycle with a payment run on September 8^th.

Information from The CMS.

Revised:
MM5849 – Transition of Responsibility for Medical Review from Quality Improvement Organizations (QIOs)http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5849.pdf

MM6125 – Reporting Withholding Due to IRS Federal Payment Levy Program (FPLP) on the remittance Advice http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6125.pdf

The next CMS Rural Health Open Door Forum is scheduled for...
Date: September 9, 2008
Start Time: 2:00 PM Eastern Daylight Time (EDT)
(Please dial in at least 15 minutes before call start time.)

Conference Leader(s): Terry Kay/John Hammerlund/Natalie Highsmith

Information from The CMS.

Open Door Forum Participation Instructions:
Dial: 1-800-837-1935
Reference Conference ID: 58369369
TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial -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#:  58369369
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.

Information for Eligible Professionals Who Participated in the 2007 Physician Quality Reporting Initiative (PQRI)

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that 2007 PQRI Final Feedback Reports are available on a secure website. Two MLN Matters articles on accessing the ports are now available that can assist individual eligible professionals and group practices that reported valid 2007 PQRI quality measures data to Medicare.  The reports are organized by Tax identification Number (TIN). For eligible professionals reporting measures for 2007 PQRI under a group practice TIN, the group practice determines who can access the Feedback Report for the group practice or organization.

The first article, “Steps for Individual Eligible Professionals to Access Their 2007 PQRI Feedback Reports Personally”, MM SE0830, can be accessed at, http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0830.pdf

The second article, “Steps for Organizations to Access Their 2007 PQRI Feedback Reports”, is available at, http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0831.pdf.

Once you are registered in the Individuals Authorized Access to CMS Computer Services (IACS) system and have access to the PQRI feedback report application, any questions about the Feedback Report should be directed to the Report Delivery System Help Desk referenced at the end of the end of the MLN Matters articles.  Additional educational resources and information about the PQRI program is available at, http://www.cms.hhs.gov/PQRI.

End of Listserv Message.

August 28, 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.

Important Reminder for ALL Riverbend GBA Providers of Service
To accommodate the J12 transition of NJ providers from Riverbend GBA to Highmark Medicare Services we need to adjust our normal system availability. Starting on Friday August 29^th Riverbend system will be unavailable at 5 PM EST through the whole Labor Day Weekend. The system will be available at the normal times starting Tuesday September 2^nd at 7 AM EST.

This scheduled downtime will affect all Riverbend providers’ access to DDE Processing, and certain IVR functionality. Once the system is available on Tuesday, September 2^nd, only the providers not moving to Highmark Medicare Services will be able to access Riverbend’s systems.

For NJ Providers moving to Highmark Medicare Services the cutoff for submitting EDI Claims to Riverbend will be 4 PM EST Friday August 29th. After this cutoff all EDI claims will have to be submitted to Highmark Medicare Services.

Riverbend GBA will be Closed September 1, 2008.  The Payment cycle changes are indicated below.
Riverbend Government Benefits Administrator will be closed on September 1, 2008 in recognition of Labor Day.  As a result, there will be some changes to our normal payment cycle.

For the week ending September 5^th, there will be 2 payment runs: September 3^rd and September 5^th.  Remittance advices will be mailed on Friday September 5, 2008.   For the week ending September 12^th, we will resume with our normal payment cycle with a payment run on September 8^th.

Riverbend has gone Paperless!

As of May 1, 2008 all incoming correspondence received by Riverbend is being imaged into electronic format. To help ensure your information is being routed to the appropriate area as quickly as possible, we encourage you to use our RGBA Document Routing Form. Please complete this form and allow it to serve as a cover to the correspondence you are sending to us. This form will assist you in providing us with all of the information necessary to handle your correspondence in the most expeditious manner. This form can be located at http://www.rgbagov.com/About-Us/

MEDICARE PROVIDERS REMAIN SATISFIED WITH FEE-FOR-SERVICE CONTRACTORS
                                                                                
The Centers for Medicare & Medicaid Services (CMS) reported today that Medicare health care providers continue to be satisfied with services provided by Medicare fee-for-service contractors showing a relatively smooth transition to the new Medicare Administrative Contractors (MACs). 

The average score based on a satisfaction survey across all contractors was 4.51 on a scale of 1 to 6. This year’s average score was comparable to last year’s average score of 4.56. 

The Medicare Contractor Provider Satisfaction Survey (MCPSS), conducted by CMS for the third year, is designed to gather and report objective, quantifiable data on provider satisfaction with the fee-for-service contractors who process and pay Medicare claims. In 2007, more than one billion claims were processed and paid to approximately one million health care providers who provided medically necessary items and services to 44 million beneficiaries. 

The survey is mandated by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003. Specifically, the law calls for CMS to develop contract performance requirements, including measuring provider satisfaction with Medicare contractors. The MCPSS enables CMS to make valid comparisons of provider satisfaction between contractors and, over time, improvements to Medicare.

Tthe summary report of the survey findings is available on the CMS Web site in the MCPSS section at www.cms.hhs.gov/MCPSS.   
 
The CMS press release issued today can be viewed at: http://www.cms.hhs.gov/apps/media/press_releases.asp 

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 seventh 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 Thursday, September 18, 2008.

This call will provide an update on registry reporting for 2008; information on the E-prescribing measure for 2008 PQRI (measure #125) and proposed measures for 2009 PQRI; incentives for electronic prescribing; 2007 PQRI feedback reports and incentive payments, and a question and answer session.

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, and Dr. Daniel Green.

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

Conference call details:
Date:September 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 September 17, 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/091808 
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 9/18/2008 until 11:59 p.m. EDT 9/25/2008.  The call in data for the replay is (800) 642-1687 and the passcode is 61954941.

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

MEDICARE ENHANCES CONSUMER INFORMATION ON HOSPITAL CARE

The Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS), today announced important additions to the Hospital Compare consumer Web site (http://www.hospitalcompare.hhs.gov/) that will give consumers even better insight into the quality of care provided by their local hospitals.

The improvements include the addition of a mortality measure for pneumonia and, for the first time on Hospital Compare, publicly reported measures for hospital care of children.  Previously, Hospital Compare had provided only quality information based on hospitalizations of adult patients.

Since its inception in March 2005 Hospital Compare has become a popular tool for consumers and their care givers in making health care decisions.  The addition of patient experience data and Medicare payment and volume information in March 2008 caused the number of page views to jump from an average of 600,000 per month to more than 2.5 million per month.  Page views for this year to date have totaled more than 20 million.

“Reporting quality data on the care provided hospital patients is a key to our continuing effort to provide better, value-based health care for all Americans,” HHS Secretary Mike Leavitt said.  “Expanding the scope of measures is making Hospital Compare a more valuable tool for all health care consumers.”

Earlier this year, Medicare added patient satisfaction information to the Web site.  Today’s additions bring the total to 26 process of care measures, three outcome of care measures, two children’s asthma care measures, and 10 patient experience of care measures.  Hospital Compare also contains information about the number of certain elective hospital procedures provided to patients and what Medicare pays for those services.

“CMS’ goal for updating and enhancing the Hospital Compare Web site is to provide usable and accurate information about hospital performance to providers and communities that will encourage hospitals to excel in the quality of care they provide,” said CMS Acting Administrator Kerry Weems. “With these new enhancements, consumers and health care providers will be able to look at individual hospital mortality scores.  We hope that this new information will cement the Web site’s role as a key driver in improving the quality and reliability of care in the nation’s hospitals.”
"The 30-day Medicare mortality data will strengthen quality improvement partnerships in hospitals by encouraging better handoffs and communication," said Carolyn M. Clancy, M.D., AHRQ's director.  The addition of pediatric quality measures also is an important step in ensuring that our nation's hospitals provide high quality health care.”

The measure on pneumonia 30-day mortality joins existing 30-day mortality measures heart failure (HF) and heart attack (AMI), which CMS began reporting last summer.  Since last summer, CMS has seen improvement nationally on mortality rates for heart attack.  The rate of 30-day heart attack mortality dropped from 16.3 percent reported in 2007 to 16.1 percent reported in 2008.

Hospitals varied less in their rates: for example, there are no longer any hospitals whose heart attack mortality rates were low enough to classify them as “worse than the U.S. national rate” under CMS’ mortality rate classification system.  In other words, CMS’ calculations predicted that while some hospitals’ rates are lower than the U.S. national rate, they are not low enough to consider them “worse” than the U.S. national rate with a great degree of certainty (or “statistical significance”).

The pneumonia mortality measure, like its predecessors, has been endorsed by the National Quality Forum (NQF) and is supported by the Hospital Quality Alliance (HQA). The mortality outcome measures are risk-adjusted and take into account previous health problems to “level the playing field” among hospitals. The measures are also intended to help ensure accuracy in performance reporting. 

In addition to new information about pneumonia mortality, CMS is releasing new information to the Hospital Compare Web site that will allow consumers and hospitals to drill down beyond the categorical information of the mortality measures for each hospital -- whether the hospital’s mortality rate is “Better than,” “No different from,” or “Worse than” the U.S. national rate.
This new data information includes each hospital’s risk-standardized mortality rate, an estimate of the rate’s certainty (also known as the interval estimate), and the number of eligible cases for each hospital.  By posting hospital RSMRs, interval estimates, and number of eligible cases, CMS is giving consumers and communities additional insight into the performance of their local hospitals in hopes that this will prompt all hospitals to work toward achieving the level of the top-performing hospitals in the country.

This information will also serve as a benchmark where Medicare beneficiaries and other consumers can determine – on a year-by-year basis – whether their hospital is improving for these important outcome measures.

The children’s asthma care measures added today are relievers for inpatient asthma, and systemic corticosteroids for inpatient asthma.  By including these measures, CMS and HQA begin providing the public with information about the quality of children’s care in hospitals, including in pediatric hospitals, for the first time.

Through the Hospital Compare Web site, CMS is working to implement the principles of a value-based system in the Medicare program. The enhancements to the site further empower consumer choice and create incentives by motivating providers to provide better care for less money. An Executive Order issued in 2006 by President Bush directed that federal agencies that sponsor or subsidize health care commit to the four cornerstones of value-driven health care: ensuring transparent quality and price information, interoperable health information technology and incentives for high-quality, efficient health care delivery (http://www.hhs.gov/valuedriven).
The Hospital Quality Alliance is instrumental in facilitating CMS’s communication with hospitals and helping to motivate those hospitals to continually analyze and improve the quality of their care.  Collaboration by the members of the HQA continues to ensure that public reporting efforts for hospitals are supported by a broad cross section of the health care community.

Public reporting of these and other measures is intended to empower patients and their families with information with which to engage their local hospitals and physicians in active discussions about quality of care. 

To help hospitals use the 30-day mortality data as a quality improvement tool, CMS provided detailed reports to each hospital listed on the Web site.  CMS believes that all hospitals, regardless of their mortality rates, should use the data available in these free, detailed reports to find ways to continually improve the care they deliver.

CMS urges consumers not to view any one process or outcome measure on Hospital Compare as a tool to “shop” for a hospital.  The information contained on Hospital Compare is one additional tool for consumers to use in making healthcare decisions, although consumers should gather information from multiple sources when choosing a hospital.  For example, patients and caregivers could use the Web site to help them discuss plans of care with their trusted healthcare providers.  In an emergency situation, patients should always go to the nearest, most easily accessible facility.

CMS Broadcast on Innovative Employer Caregiving Programs 
The next Caregiving broadcast sponsored by the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services New Freedom Initiative Subcommittee (NFI) is scheduled for September 17, 2008,  from 1:00 p.m.—2:00 p.m. (Eastern Time).

The broadcast will focus on Innovative Employer Caregiving Programs and include presentations from employers and other organizations that have developed and conducted successful programs for employed caregivers.  Presenters will discuss their experience with these programs and how they can be replicated by others to help employed caregivers.

If you are an Employer looking to expand or create services and programs to support your employed caregivers, a Caregiver working full or part-time and caring for a loved one, an Organization that provides caregiver services, or any one else with an interest in Caregiving, please make plans now to join us on September 17^th.

To learn more about the broadcast or to register as an individual viewer or as a host viewing site, please go to: http://www.blsmeetings.net/caregivers/.

We hope you can join us for what promises to be a very informative discussion.  A promotional flyer related to this broadcast is attached to this e-mail message.

CENTERS FOR MEDICARE & MEDICAID SERVICES

Special Open Door Forum:
DMEPOS Accreditation - MIPPA 2008 Guidance
Wednesday, September 3, 2008
2pm-3:30 pm Eastern Daylight Time
Conference Call Only

The purpose of this Special Open Door Forum (ODF) is to provide guidance to DMEPOS providers on the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). 

Background: 
MIPPA section 154(b) added a new subparagraph (F).  This subparagraph states that eligible professionals and other persons are exempt from meeting the September 30, 2009 accreditation deadline until CMS determines that the quality standards are specifically designed to apply to such professionals and other persons. MIPPA also states that CMS may exempt such professionals and persons from the quality standards based on their licensing, accreditation or other mandatory quality requirements that may apply. 

We look forward to your participation.

Open Door Participation Instructions:
Dial: 1-800-837-1935 & Reference Conference ID: 61231070
Note: 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 ttp://www.consumer.att.com/relay/which/index.html . A Relay Communications Assistant will help.

An audio recording of this Special 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 accessible for downloading beginning September 10, 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

End of Listserv Message.


August 29, 2008

Important Information Regarding Pending Appeals for New Jersey providers ONLY:
Riverbend Government Benefits Administrator has completed appeals sent to us through a received date of July 16^th.  Any appeal received after that date has been transferred to Highmark Medicare Services for processing.

All denial letters received by New Jersey providers up through today have instructions to send appeal requests to Riverbend.  However, as of August 30, 2008, all appeal requests must be submitted to Highmark.  For all instructions regarding submitting appeals to Highmark, access the “Quick Reference Guide for Appeals” on the Highmark web site.  You may access this guide at: http://www.highmarkmedicareservices.com/parta/selfservice/pdf/qr-med-a-appeals.pdf
Highmark requests that Part A New Jersey providers send redetermination and clerical error opening equests to the following address:

Highmark Medicare Services
Attn: Part A Appeals Department
P.O. Box 890420
Camp Hill, PA 17089-0420