Riverbend

ListServ Message 09/26/2008

September 23, 2008

Riverbend GBA has been notified by CDS that eleven regions of FISS is currently down, and the Tennessee Region is one of them. We have been given an estimated time of 9:30 ET before FISS will again be available for production. RBGA will keep you informed on any changes.

Please read to the end of this e-mail for information that may affect your facility.

MEDICARE PAYMENTS COULD BE REDUCED

THIS IS A REMINDER: Beginning October 1, 2008 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 “WU” in the PLB03-1 data field. For more information, please see MLN Matters Article #MM6125 available at: http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6125.pdf

CMS Announces Medicare Premiums, Deductibles for 2009

The standard Medicare Part B monthly premium will be $96.40 in 2009, the same as the Part B premium for 2008. This is the first year since 2000 that there was no increase in the standard premium over the prior year.

The 2009 Part B premium of $96.40 is the same as the amount projected in the 2008 Medicare Trustees Report issued in March. This monthly premium paid by beneficiaries enrolled in Medicare Part B covers a portion of the cost of physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and other items.

By law, the standard premium is set to cover approximately one-fourth of the average cost of Part B services incurred by beneficiaries aged 65 and over. The remaining Part B costs are financed by Federal general revenues. The income to the program from premiums and general revenues are paid into the Part B account of the Supplementary Medical Insurance trust fund, and Part B expenditures are drawn from this account.

Normally, the Part B premium increases at the same rate as average Part B expenditures from year to year. A number of factors explain why the premium can be kept level for 2009.

Growth is expected in 2009 for most areas of the Medicare Part B program, including growth in the cost and use of physician and outpatient hospital care, home health services, physician-administered drugs, ambulatory surgical center services, durable medical equipment, independent lab and physician’s office lab services, as well as growth in the Medicare Advantage program. In most years, this would result in the need for an increase in the Part B premium and general revenue financing.

To view this Fact Sheet in its entirety go to: http://www.cms.hhs.gov/apps/media/fact_sheets.asp

Center for Medicare Management Centers for Medicare & Medicaid Services

The revised Guidelines for Teaching Physicians, Interns, and Residents (July 2008), which provides information about payment for physician services in teaching settings, general documentation guidelines, and evaluation and management documentation guidelines, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at:http://www.cms.hhs.gov/MLNProducts/downloads/gdelinesteachgresfctsht.pdf.

September 21 thru 27, 2008 is National Adult Immunization Awareness Week. This annual health observance is a great opportunity to promote the importance of adult immunizations. The Centers for Medicare & Medicaid Services (CMS) reminds health care professionals that Medicare Part B reimburses health care providers who accept the Medicare-approved payment amount for influenza, pneumococcal, and hepatitis B vaccines and their administration. All adults 65 and older should get influenza and pneumococcal shots. People with Medicare who are under 65 but have chronic illness, including heart disease, lung disease, diabetes or end-stage renal disease should get a flu shot. People at medium to high risk for hepatitis B should get hepatitis B shots. CMS needs your help to ensure that people with Medicare take full advantage of these vital preventive benefits. You can help by talking with your Medicare patients about their risk for these vaccine-preventable diseases covered by Medicare and the steps they can take to help reduce their risk of contracting these diseases, including getting vaccinated. With flu season approaching, remember to start vaccinating as soon as you receive vaccine. And remember to continue to vaccinate as long as you have vaccine available, even after the new year. And finally, don’t forget, health care workers also need to protect themselves. Get Your Flu Shot. Not the Flu.

For more information about Medicare’s coverage of adult immunizations and a list of related educational resources, please visit CMS’ Medicare Learning Network Preventive Services Educational Products web page (http://www.cms.hhs.gov/MLNProducts/35_PreventiveServices.asp#TopOfPage) on the CMS website.

For information about National Adult Immunization Awareness Week, please visit the National Foundation for Infectious Diseases at http://www.nfid.org/ on the web.

Thank You.

Note on Payment for Imaging Services

The Deficit Reduction Act of 2005 capped the Medicare physician fee schedule (MPFS) payment for the technical component (TC) of most imaging services at the outpatient prospective payment system (OPPS) payment rate. The cap applies to both TC-only and the TC of global services. Where the payment is capped, the MPFS files may disclose only the capped payment amount. Several providers have requested disclosure of both the capped and uncapped amounts. Such information can be found at http://www.cms.hhs.gov/PFSlookup/02_PFSSearch.asp#TopOfPage.

Medicare Issues New Rules to Enforce Marketing Requirements During Upcoming Health and Drug Plan Enrollment Period

The two regulations issued today include prohibitions on telemarketing and other unsolicited sales contacts. The new rules also prohibit financial incentives that could encourage agents and brokers to maximize commissions by inappropriately moving, or churning, beneficiaries from one plan to another each year. Plans must be in compliance with these provisions when they begin their marketing activities on October 1.

The final rule implementing MIPPA marketing requirements may be viewed at http://www.cms.hhs.gov/HealthPlansGenInfo/.

The Interim Final Rule dealing with agent commissions and other MIPPA provisions may be viewed at http://www.cms.hhs.gov/HealthPlansGenInfo/.

Comments are due at 5:00 p.m. Eastern time on November 15, 2008. Guidance for MA plans under Part C and PDPs under Part D plans may be viewed http://www.cms.hhs.gov/HealthPlansGenInfo/Downloads/MIPPA_Imp_memo091208Final.pdf

Fact Sheets with more information on each rule may be viewed at
ttp://www.cms.hhs.gov/apps/media/fact_sheets.asp.

To read more of the CMS press release issued 9/15/08 click here:http://www.cms.hhs.gov/apps/media/press_releases.asp

Way to go CDS!

FISS is now available! Thank you for your patience while the CDS worked to make FISS once again available for production…before their actual estimated timeframe!

The CDS has reported receiving ‘abends” in the TN region making it imperative that FISS be brought down at 11:30 am for about 10 minutes. CDS hopes that by restarting the region will correct the issue.

If this action does not resolve these issues, FISS may need to be brought down again. RGBA will keep you informed of any additional information from the CDS.

Please read to the end of this message for information that may affect your facility.

Important Information for all BBS users

The EC Gateway will be taken offline to undergo an upgrade on Saturday September 27, and Sunday, September 28, 2008. For this upgrade, The BBS will be brought down at 12:00 noon Friday, September 26, 2008. During this scheduled downtime, providers will not be able to access electronic mailboxes, submit claims, or retrieve (download) files from the BBS. The BBS will again be available early Monday morning September 29, 2008. A message is also being placed on the ECG Welcome screen as a reminder, so please read all messages on the Welcome screen upon entering the BBS.

The EC Gateway Welcome screen is being changed and will affect providers that have scripted their login and transmission process. If you have problems sending claims after this change takes place, you will need to bypass your script and dial in manually.

The ECG Welcome screen will return to its normal settings after the system is brought back online Monday morning. If you have any questions, please do not hesitate to call e-business at 423.535.5717 for assistance.

IMPORTANT INFORMATION CONCERNING COBC

GHI has returned approximately 120 claims to RGBA on 9/19/08 with error code H20600. After researching several claims it appears ‘EI’ is being submitted in Loop 2310A Segment REF02 (Attending Physician Secondary Identification). ‘EI’ is not a valid qualifier for Loop 2310A for your 4010A1 claim files. Please review the 837 Guide for a list of valid qualifier’s to be used in the 2310A Loop. If an incorrect qualifier is used, GHI will reject the claims and they will not cross over to the secondary insurer.

If you are unfamiliar with the correction process for this issue, please contact your software vendor or clearinghouse and advise them of this information as soon as possible to prevent future claims being returned.

Flu Shot Reminder

Flu Season Is Coming! It’s not too early to start vaccinating as soon as you receive vaccine. Encourage your patients to get a flu shot as it is still their best defense against the influenza virus. (Medicare provides coverage of the flu vaccine without any out-of-pocket costs to the Medicare patient. No deductible or copayment/coinsurance applies.) And don’t forget, health care workers also need to protect themselves. Get Your Flu Shot. Not the Flu.

Remember Influenza vaccine plus its administration are covered Part B benefits. Note that influenza vaccine is NOT a Part D covered drug.

For information about Medicare’s coverage of the influenza virus vaccine and its administration as well as related educational resources for health care professions and their staff, please go to http://www.cms.hhs.gov/MLNProducts/Downloads/flu_products.pdf on the CMS website. To download the Medicare Part B Immunization Billing quick reference chart, go to http://www.cms.hhs.gov/MLNProducts/downloads/qr_immun_bill.pdf on the CMS website.

Please read to the end of this message for information that may affect your facility.

Important Information for all BBS users

The EC Gateway will be taken offline to undergo an upgrade on Saturday September 27, and Sunday, September 28, 2008. For this upgrade, The BBS will be brought down at 12:00 noon Friday, September 26, 2008. During this scheduled downtime, providers will not be able to access electronic mailboxes, submit claims, or retrieve (download) files from the BBS. The BBS will again be available early Monday morning September 29, 2008. A message is also being placed on the ECG Welcome screen as a reminder, so please read all messages on the Welcome screen upon entering the BBS.

The EC Gateway Welcome screen is being changed and will affect providers that have scripted their login and transmission process. If you have problems sending claims after this change takes place, you will need to bypass your script and dial in manually.

The ECG Welcome screen will return to its normal settings after the system is brought back online Monday morning. If you have any questions, please do not hesitate to call e-business at 423.535.5717 for assistance.

IMPORTANT INFORMATION CONCERNING COBC

GHI has returned approximately 120 claims to RGBA on 9/19/08 with error code H20600. After researching several claims it appears ‘EI’ is being submitted in Loop 2310A Segment REF02 (Attending Physician Secondary Identification). ‘EI’ is not a valid qualifier for Loop 2310A for your 4010A1 claim files. Please review the 837 Guide for a list of valid qualifier’s to be used in the 2310A Loop. If an incorrect qualifier is used, GHI will reject the claims and they will not cross over to the secondary insurer.

If you are unfamiliar with the correction process for this issue, please contact your software vendor or clearinghouse and advise them of this information as soon as possible to prevent future claims being returned.

Information from The CMS.

The agenda and presentation slides for the Physician Quality Reporting Initiative (PQRI) Special Open Door Forum on September 24, 2008, have been posted to the website at: www.cms.hhs.gov/pqri/02_CMSSponsoredCalls.asp#TopOfPage.

Information from The CMS.

Due to a technical malfunction in the recording system, we have experienced a delay in making accessible the Encore audio recording service for the September 18, 2008 CMS End Stage Renal Disease Open Door Forum. The issues have been resolved and the recording is now available.To access, dial 1-800-642-1687 and key in the conference ID 58370205 followed by the pound key. This recording will be available until Friday, September 26, 2008.

Thank you for your patience.

Medicare Part B Drugs Average Sales Price Files -- October 2008

The Centers for Medicare & Medicaid Services (CMS) has made available the Medicare Part B Drug and Biological Average Sales Price (ASP) Payment Amounts for October 1, 2008 to December 31, 2008 on the CMS website at http://www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/01a_2008aspfiles.asp#TopOfPage. The files are located in the Downloads section of this web page.

The revised Guidelines for Teaching Physicians, Interns, and Residents (July 2008), which provides information about payment for physician services in teaching settings, general documentation guidelines, and evaluation and management documentation guidelines, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/gdelinesteachgresfctsht.pdf.

End of Listserv Message.

Please read to the end of this message for information that may affect your facility.

Important Information for all Providers Submitting Claims to Riverbend GBA Through EC Gateway!!!!

The EC Gateway will be taken offline to undergo an upgrade on Saturday September 27, and Sunday, September 28, 2008. For this upgrade, The BBS will be brought down at 12:00 noon Friday, September 26, 2008. During this scheduled downtime, providers will not be able to access electronic mailboxes, submit claims, or retrieve (download) files from the BBS. The BBS will again be available early Monday morning September 29, 2008. A message is also being placed on the ECG Welcome screen as a reminder, so please read all messages on the Welcome screen upon entering the BBS.

The EC Gateway Welcome screen is being changed and will affect providers that have scripted their login and transmission process. If you have problems sending claims after this change takes place, you will need to bypass your script and dial in manually.

The ECG Welcome screen will return to its normal settings after the system is brought back online Monday morning. If you have any questions, please do not hesitate to call e-business at 423.535.5717 for assistance.

ICD-10-CM/PCS National Provider Conference Calls With Question & Answer Session

The Centers for Medicare & Medicaid Services (CMS) will host a series of national provider calls (see below) that will provide an overview of ICD 10 and how it differs from ICD 9 CM. The presentations will include the major impacts providers should consider when planning to update any systems with ICD-10 codes. Issues such as differences in code length, alpha-numeric characters, and increased details captured by the codes will be explained. For the provider, payer, vendor, and publishing community, this overview will help them think about future reporting, system updates, and training, considering that ICD-10 may be implemented in the future.

The presenters will include members of the Cooperating Parties for ICD 9 CM, a formal coalition that has been working together on ICD-10 issues. The role of each will be explained, along with a similar role they will play should ICD-10 be implemented. The Cooperating Parties include CMS, Centers for Disease Control and Prevention (CDC), American Health Information Management Association (AHIMA), and American Hospital Association (AHA).

A PowerPoint slide presentation has been posted on the ICD-10 Web Page at http://www.cms.hhs.gov/ICD10 for you to download prior to the conference call so that you can follow along with the presentation.

Conference Call Details:

Separate conference calls have been scheduled for each provider type. The same information will be presented at each conference call. Participants may select one of the times listed below to attend a conference call. Select the appropriate link below, according to your provider type, to register for a conference call.

Provider Type and Date and Time of Conference Call:

Hospital Staff
October 14, 2008
12:30 p.m. – 2:30 p.m. EDT
To register go to http://www.cms.hhs.gov/ICD10/downloads/ICD10_hospital.pdf.

Other Part A and Part B Providers
November 12, 2008
12:30 p.m. – 2:30 p.m. EST
Registration information for this conference call will be forthcoming.
Physicians
November 17, 2008
12:30 p.m. – 2:30 p.m. EST

Registration information for this conference call will be forthcoming. For those who are unable to attend, a transcript will be posted on the ICD-10 Web Page at http://www.cms.hhs.gov/ICD10 shortly after the conference call.
Flu Shot Reminder

Flu Season Is Coming! It’s not too early to start vaccinating as soon as you receive vaccine. Encourage your patients to get a flu shot as it is still their best defense against the influenza virus. (Medicare provides coverage of the flu vaccine without any out-of-pocket costs to the Medicare patient. No deductible or copayment/coinsurance applies.) And don’t forget, health care workers also need to protect themselves. Get Your Flu Shot. Not the Flu.

Remember - Influenza vaccine plus its administration are covered Part B benefits. Note that influenza vaccine is NOT a Part D covered drug.

For information about Medicare’s coverage of the influenza virus vaccine and its administration, as well as related educational resources for health care professionals and their staff, please go to http://www.cms.hhs.gov/MLNProducts/Downloads/flu_products.pdf on the CMS website. To download the Medicare Part B Immunization Billing quick reference chart, go to http://www.cms.hhs.gov/MLNProducts/downloads/qr_immun_bill.pdf on the CMS website.

End of Listserv Message