Riverbend

ListServ Message 09/05/2008

September 3, 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.

Hurricane Gustav- State of Emergency Notice
A State of Emergency has been declared by the President and the Secretary of Health and Human Services as a result of Hurricane Gustav in Louisiana and Texas as of August 27^th, August 28^th in Mississippi and August 29^th in Alabama. The following website is provided to help answer your questions about waivers and modifications that apply during the State of Emergency: http://www.cms.hhs.gov/Emergency/02_Hurricanes.asp.

Updates to the Physician Quality Reporting Initiative (PQRI) Web Page
CMS is pleased to announce that several section pages on the PQRI web page have been updated to include the following:

The Overview page has been updated to announce the posting of the Registries that qualified for 2008 PQRI and information about the availability of the 2007 Feedback Reports.

The Reporting page has been updated to add the list of Registries that qualified for 2008 PQRI as a new downloadable file under the Downloads section.

On the CMS Sponsored Calls page, the updated slides from the July 9 National Provider Call has been posted as a downloadable file under the Downloads section.

The Educational Resources page has been updated to add the 2008 Errata Sheet: Getting Started with Claims-Based Reporting of Measures Groups� as a new downloadable file under the Downloads section.

The 2007 PQRI Educational Resources page has been updated to add the two new Special Edition MLN articles on accessing the 2007 Feedback Reports (by individuals and by organizations) as new downloadable files under the Downloads section.

All publicly available information on the CMS Physician Quality Reporting Initiative can be found at (http://www.cms.hhs.gov/PQRI), on the CMS website.

MEDICARE PROVIDER FEEDBACK TOWN HALL MEETING

September 22, 2008
2:00 - 4:00 PM ET

The Centers for Medicare & Medicaid Services (CMS) requests your participation in a Town Hall meeting on September 22, 2008, from 2:00 PM to 4:00 PM (Eastern Time). The meeting will be held via conference call as well as in the auditorium at the Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244.

The purpose of the meeting is to capture individual provider feedback on relevant Fee-for-Service (FFS) Medicare policy and operational issues. By doing so we advance CMS’ efforts to enhance our relationship with providers and suppliers. This Town Hall meeting also provides a venue to allow CMS staff to continue a process to engage individual providers and suppliers through the following year. This meeting is open to all Medicare FFS providers and suppliers that participate in the Medicare program.

The agenda topics include: 5010-Possible next version of HIPAA standards for claims and other transactions; Recovery Auditing and Medicare Administrative Contractor (MAC) Transitions as noted in the September 22, 2008 Federal Register Notice. Meeting agenda and discussion materials will be available to download at (www.cms.hhs.gov/center/provider.asp) by September 19, 2008. CMS will conduct a dialogue session at the meeting that offers meeting participants an opportunity to provide feedback on agenda topics.

Please note: Due to time constraints not all participants will have an opportunity to speak, but written submissions will be accepted at MFG@cms.hhs.gov through September 30, 2008. CMS will give consideration to feedback received but written responses will not be provided.

Meeting Registration Details

All participants must pre-register for the meeting through on-line registration located at (http://registration.intercall.com/go/cms2). Registration will open on August 29, 2008 and will close on September 17, 2008. Registered participants may be contacted for follow-up meetings to solicit additional individual opinions and clarify any issues that may arise during the September 22 Town Hall meeting.

You will receive a confirmation page to indicate the completion of your registration. Please print this page as your registration receipt. We encourage you to complete your registration as soon as possible. Registration after 5:00 p.m. on September 17, 2008 will not be accepted.

Meeting Participation Details
All persons attending the meeting in person will be required to show a photographic identification (a valid driver's license or passport). Further details can be found in the August 22, 2008 Federal Register Notice. All persons participating via conference call will receive dial-in information with their confirmation email.

Additional Questions/Information
For questions or additional information about the Medicare Provider Feedback Town Hall Meeting, please send an email to MFG@cms.hhs.gov

Save the Date: National E-Prescribing Conference
Register Today! Be part of a groundbreaking opportunity. CMS along with industry partners from health and technology are hosting a National E-prescribing Conference on October 6 – 7, 2008 at the Sheraton Boston Hotel, Boston, MA.

Our goal in holding this conference is to educate providers and beneficiary constituencies on the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) e-prescribing program and help promote the adoption of e-prescribing throughout the health care community.

Join us to find out how to earn incentives from Medicare, learn how e-prescribing can work for your business, and get answers to your questions about privacy, security, and risk management. Register for the conference now at www.e-prescribeconference.com .

Please share this message with your colleagues and members.

We look forward to seeing you in Boston in October!

Local Coverage Determination (LCD) L1682 has been reviewed for reconsideration of ICD-9 codes that support Exposure to Cardiotoxic agents (chemotherapeutic and external).

ICD-9 Codes that Support Medical Necessity has been updated with the following:
V67.2 – Follow-up examination following chemotherapy
V72.81 – Pre-Op cardiovascular examination
V81.2 – Screening examination for other and unspecified cardiovascular

The LCD may be viewed at: http://www.rgbagov.com/publications/lcd/lcd-files/1682.html
All the Local Coverage Determinations have been reviewed and New Jersey has been removed from the Primary Geographic Jurisdiction.

End of Listserv Message.

September 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.

New and Revised information posted to the CMS Website:

New:
MM6180 – October Update to the 2008 Medicare Physician Fee Schedule Database (MPFSDB)http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6180.pdf

MM6099 – Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) Imaging for Infection and Inflammation http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6099.pdf

MM6176 – Update of the Intern-to-Bed Ratio for Method II Teaching Critical Access Hospitals (CAHs) http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6176.pdf

MM6150 – 2009 Annual Update for the Health Professional Shortage Area (HPSA) Bonus Payments http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6150.pdf 

MM6100 – Physician Signature Requirements for Diagnostic Tests http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6100.pdf

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

MM6048 – Continuous Positive Airway Pressure (CPAP) Therapy for Obstructive Sleep Apnea (OSA)http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6048.pdf

MM6145 – Screening DNA Stool Test for Colorectal Cancer http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6145.pdf
Sunset of ESRD Final Rule Rollout Mailbox

Thank you to all of our colleagues in the renal care community who submitted questions to the Centers for Medicare & Medicaid Services (CMS) about our recently released ESRD Conditions for Coverage final rule. We received a good number of interesting and important questions from you to our ESRD Final Rule Rollout mailbox. In response to these inquiries, we have already provided many of you with individual responses to your questions; however, to share the benefit of these questions with the entire community, CMS is working on a “Frequently Asked Questions� document that will condense many of the questions we received through the mailbox. That document will be posted online in the coming weeks—we will let you know once it is available for public download.

With the imminent publication of our “Frequently Asked Questions� document, we have decided to sunset the ESRD Final Rule Rollout mailbox. As of September 1, we will no longer monitor the mailbox for new questions.

For more information about the new rule, please visit us online at http://www.cms.hhs.gov/CFCsAndCoPs/13_ESRD.asp. If you have an immediate inquiry, please contact Lauren Oviatt at Lauren.Oviatt@cms.hhs.gov.

Important Information for all Direct Data Entry (DDE) Users.

When signing in to the FISS/DDE system, you will continue to key FI from the BCBST sign-on screen. You will also continue to see the EDC’s TPX menu.

Riverbend GBA has requested that the EDC change the Session Description for session id “FSSPNJ� (FISS PROD FOR NJ/TENN) to only say (FISS PROD FOR TENN). The session ID ‘FSSPNJ’ will not change and providers still need to access that session to get to FISS. The second option will continue to take you into the FISS session (please see Red X below).

TPX MENU FOR AL10295 Cmdkey PF12/24 Jump PA1 Menu PA2 Print PF14 Cmdchar

Sessid Sesskey Session Description

_ CAVIEW PF CA View
X FSSPNJ PF FISS Prod for NJ/Tenn
_ FSSPNJ2 PF FISS Prod for NJ/Tenn
_ FSSUNJ PF FISS UAT for NJ/Tenn
_ FSSUNJ2 PF FISS UAT for NJ/Tenn #2
_ TPXADMIN PF TPX Administration
_ TSOEDCA PF TSO EDCA

Holding of Certain ScreeningPapSmearClaimsBilledbyOPPS Providers
Due to systems issues related to an incorrectdeductible and coinsurance assignment of Screening Pap Smears claimscontaining Healthcare Common Procedure Coding (HCPCS) code Q0091, (Screening Papanicolaou (Pap) smear, obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) on OPPS claims, effective immediately, CMS will be instructingtheir contractors to hold allclaims containingHCPCS code Q0091 submitted by OPPS facilities.These claims will be held by contractors until the successful implementationof theOutpatient Code Editor (OCE), scheduled for January 5, 2009. In the interim, OPPS facilities may choose not to submitHCPCS code Q0091 until the successful implementationof theOCE, in order to avoida delay in reimbursementfor other services submitted on the claim. Interest will be paid on clean claims held longer than 30 days after the date of receipt.

Updated ESRD PC Pricer Now Available
The Centers for Medicare & Medicaid Services (CMS) has updated the PC Pricer web page at (http://www.cms.hhs.gov/PCPricer/02e_ESRD_Pricer.asp) to include an ESRD PC Pricer that uses the same pricing logic as the Medicare claims processing system. This version of the software will replace the current version (referred to as the ESRD Calculator) in January 2009. Both pricing tools will continue to be available through the end of this calendar year. The CMS is encouraging renal dialysis facilities to download the updated version of the ESRD PC Pricer and begin familiarizing themselves with it as soon as possible. Feedback on the latest version of this PC Pricer should be directed to Wendy.Tucker@cms.hhs.gov.

Local Coverage Determination (LCD) L13232 Ferrlecit and Venofer, has been reviewed and coverage for Venofer has been revised. The FDA has approved Venofer for the following; Patients with iron deficiency anemia, undergoing hemodialysis and receiving erythropoietin therapy; peritoneal dialysis dependent chronic kidney disease patients receiving an erythropoietin and non-dialysis dependent chronic kidney disease patients receiving or not receiving an erythropoietin.The LCD can be viewed at: http://www.rgbagov.com/publications/lcd/lcd-files/13232.html

End of Listserv Message.

September 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.

The following Medi-Letters have been posted to the RGBA Website from August 19, through September 4, 2008.

MediNumber: 3268-08 MMNumber: MM6099 Date: 2008-09-04 Provider Audience: All Providers Title: Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) Imaging for Infection and Inflammation This article is based on Change Request (CR) 6099 instructing that the Centers for Medicare & Medicaid Services (CMS) is continuing its national non-coverage policy for the off-label indications of fluorodeoxyglucose (FDG) Positron emission tomography (PET) imaging for chronic osteomyelitis, infection of hip arthroplasty, and fever of unknown origin. MLN Matters Article RGBA Medi Letter

MediNumber: 3267-08 MMNumber: MM6100 Date: 2008-09-04 Provider Audience: Title: Physician Signature Requirements for Diagnostic Tests CR 6100, from which this article is taken, updates the Medicare Benefit Policy Manual, Chapter 15 (Covered Medical and Other Health Services), Section 80 (Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests) Subsection 80.6.1 (Definitions); to incorporate language previously contained in Section 15021 of the Medicare Carriers Manual, but inadvertently omitted when the Medicare Benefit Policy Manual was published. MLN Matters Article RGBA Medi Letter

MediNumber: 3266-08 MMNumber: MM6150 Date: 2008-09-04 Provider Audience: All Providers Title: 2009 Annual Update for the Health Professional Shortage Area (HPSA) Bonus Payments CR 6150, from which this article is taken provides your carriers, FIs, and A/B MACs with the names of the test and final files for the Health Professional Shortage Area (HPSA) bonus payments for 2009 and alerts providers that the 2009 file will be posted to the Centers for Medicare & Medicaid Services (CMS) website when it is available. MLN Matters Article RGBA Medi Letter

MediNumber: 3265-08 MMNumber: MM6176 Date: 2008-09-04 Provider Audience: All Providers Title: Update of the Intern-to-Bed Ratio for Method II Teaching Critical Access Hospitals (CAHs) This article is based on Change Request (CR) 6176 which notifies Medicare contractors that they should update the intern-to-bed ratio on the Provider Specific File for Method II teaching CAHs when the field contains zeroes. Your Medicare contractor will contact you to obtain your intern to bed ratio. An intern-to-bed ratio greater than zero is used to determine if the Method II CAH is a teaching hospital, and the Centers for Medicare & Medicaid Services (CMS) identifies teaching hospitals by an intern-to-bed ratio greater than 0. MLN Matters Article RGBA Medi Letter

MediNumber: 3264-08 MMNumber: MM6185 Date: 2008-09-04 Provider Audience: All Providers Title: Medicare Coverage of Artificial Hearts CR 6185, from which this article is taken, announces that Medicare has issued a national coverage determination (NCD) (effective on May 1, 2008), that establishes limited coverage for artificial hearts when implanted in patients enrolled in Medicare-approved clinical studies meeting all of the Coverage with Evidence Development (CED) criteria. MLN Matters Article RGBA Medi Letter

MediNumber: 3259-08 MMNumber: MM5849 Date: 2008-08-20 Provider Audience: All Providers Title: Transition of Responsibility for Medical Review from Quality Improvement Organizations (QIOs) This article was changed on August 19, 2008, to correct the effective date, which should have been stated as August 1, 2008, NOT April 1, 2008. All other information remains unchanged. MLN Matters Article RGBA Medi Letter

MediNumber: 3258-08 MMNumber: MM6121 Date: 2008-08-19 Provider Audience: All Providers Title: 2008 Reminder for Roster Billing and Centralized Billing for Influenza and Pneumococcal Vaccinations This article is based on Change Request (CR) 6121 which reminds the Medicare physician community of the requirements to correctly enroll in order to conduct Mass Immunization Roster Billing and Centralized Billing of Medicare for influenza and pneumococcal immunizations. Remember that centralized billers participation is limited to one year and such billers must reapply each year they wish to be a centralized biller. The yearly reapplication process is not required for Mass Immunizer Roster Billers. MLN Matters Article RGBA Medi Letter

MediNumber: 3257-08 MMNumber: MM6124 Date: 2008-08-19 Provider Audience: All Providers Title: Revisions to the Competitive Acquisition Program (CAP) for Part B Drugs and Biologicals Medicare systems to allow individual Competitive Acquisition Program (CAP) claims with different prescription order numbers to not be denied as duplicate claims though they are for the same patient, contain the same date of service, and contain the same Healthcare Common Procedure Coding System (HCPCS) drug code. This will also apply to an individual CAP claim that contains multiple lines that appear to be duplicates except for different prescription order numbers. MLN Matters Article RGBA Medi Letter

MediNumber: 3256-08 MMNumber: MM6131 Date: 2008-08-19 Provider Audience: All Providers Title: Implementation of a New Claim Adjustment Reason Code (CARC) No.213. Non-compliance with the physician self-referral prohibition legislation or payer policy CR 6131, from which this article is taken, instructs carriers, FIs, A/B MACs, RHHIs, and DME MACs (effective January 1, 2009) to use the new Claim Adjustment Reason Code (CARC) #213 when denying claims based on non-compliance with the physician self-referral prohibition. Make sure that your billing staffs are aware of this new CARC code. MLN Matters Article RGBA Medi Letter

MediNumber: 3255-08 MMNumber: MM6125 Date: 2008-08-19 Provider Audience: All Providers Title: Reporting Withholding Due to IRS Federal Payment Levy Program (FPLP) on the Remittance Advice Your Medicare payments could be reduced if the Internal Revenue Service (IRS) needs to collect overdue taxes that you owe. The Taxpayer Relief Act of 1997, Section 1024, authorizes the IRS to reduce certain federal payments, including Medicare payments, to allow collection of overdue taxes. Should you owe such taxes and your payments are reduced, your remittance advice will reflect a provider level adjustment code (PLB) of â??WUâ?? in the PLB03-1 data field. MLN Matters Article RGBA Medi Letter

MediNumber: 3254-08 MMNumber: MM6158 Date: 2008-08-19 Provider Audience: All Providers Title: Part B Drug Competitive Acquisition Program (CAP) Quarterly Drug Update This article is based on Change Request (CR) 6158, which provides notice that there will be a Part B CAP Quarterly Drug List Update effective October 1, 2008. When available, the October 2008 list of drugs supplied under the CAP will be posted at http://www.cms.hhs.gov/CompetitiveAcquisforBios /02_infophys.asp#TopofPage on the Centers for Medicare & Medicaid Services (CMS) website. MLN Matters Article RGBA Medi Letter

Information from The CMS.

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.

The next CMS End Stage Renal Disease (ESRD)Open Door Forum is scheduled for:
Date:Thursday, September 18, 2008
Start Time: 2:00PM Eastern Time (ET)
Topic: Implementation of the new ESRD Conditions of Coverage through the survey and certification process

Conference Leaders: Thomas Hamilton, Angela Brice-Smith, Jan Tarantino, Judith Kari, and Natalie Highsmith

The focus of this ESRD Open Door Forum will be the implementation of the new ESRD Conditions of Coverage through the survey and certification process.The effective date of these new regulations is October 14, 2008.

On this call, the following topics will be discussed:
An overview of the implementation: highlights and timelines
The building of new Interpretive Guidance and other materials
Community outreach and the training of surveyors
Questions and answers

We look forward to your participation
Open Door Forum Participation Instructions:
There are 2 ways to participate, by phone or onsite.
To participate by phone: Dial: 1-800-837-1935 & Reference Conference ID: 58370205
(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.

To participate in person:
To participate onsite at the Hubert H. Humphrey Building: Your RSVP for Building Security Clearance is required. The RSVP deadline is September 16, 2008, 2:00 PM ET. To RSVP, send your name, organization and telephone number to ESRDODF-L@cms.hhs.gov . Be sure to enter “ESRD� 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 1:30 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#58370205
Encore is a recording of this call that can be accessed by dialing 1-800-642-1687 and entering the onference ID, beginning on Monday, September 22, 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 list of drugs available under the CAP has been updated and is now available in the ‘Downloads’ section on the CMS CAP “Information for Physicians� page at: http://www.cms.hhs.gov/CompetitiveAcquisforBios/02_infophys.asp.

The following drug has been added to the CAP effective October 1, 2008: Vivitrol® naltrexone (J2315).

Availability of an Interim Study of Alternative Payment Localities under the Medicare Physician Fee Schedule Medicare is statutorily required to adjust payments for physician fee schedule services to account for differences in costs due to geographic location. There are currently 89 different localities which have not been revised since 1997. In the CY 2009 Physician Fee Schedule notice of proposed rulemaking which was released on June 30, 2008, we indicated that we would post on the CMS website a preliminary study of several options for revising the payment localities. The report entitled: “Review of Alternative GPCI Payment Locality Structures�, which was produced by Acumen, LLC under contract to CMS, may currently be found at the following link: http://www.cms.hhs.gov/PhysicianFeeSched/downloads/ReviewOfAltGPCIs.pdf .

Our study of possible alternative payment locality configurations is in the early stages of development. At this time we are not proposing to make any changes to the payment localities. We encourage interested parties to submit comments on the options presented in the report as well as suggestions for other options. These comments will be considered in the development of possible future notice and comment rulemaking. When we are ready to propose any changes to the locality configuration, we will provide extensive opportunities for public comment (for example, a town hall meeting or open door forum) on specific proposals before implementing any change.

Electronic comments on the interim report may be submitted to CMS MPFS@cms.hhs.gov until October 20, 2008.

End of Listserv Message.