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ListServ Message 10/03/2008
September 29, 2008
Please read to the end of this Listserv Message to identify any information that may affect your facility.
Information from The CMS.
Subscribers Note The Medicare Learning Network's (MLN) web based training courses and product ordering page are currently unavailable while we perform system maintenance and upgrades. We expect the system will be available again around 10/1/2008. Thank you for your interest in the Medicare Learning Network. If you have any questions, please send them to MLN@cms.hhs.gov
New:
MM6178 Incorporation of Recent Regulatory Revisions into Chapter 10 of the Program Integrity Manual (PIM) http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6178.pdf
MM6193 Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Pricer Update FY 2009
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6193.pdf
MM6169 Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 14.3, Effective October 1, 2008
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6169.pdf
MM6196 October 2008 Update of the Hospital Outpatient Prospective Payment System (OPPS)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6196.pdf
Revised:
MM6129 New Requirement for Ordering/Referring Information on Ambulatory Surgical Center (ASC) Claims for Diagnostic Services
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6129.pdf
MM6183 Limitation on Recoupment (935) for Provider, Physicians and Suppliers Overpayments
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6183.pdf
October 1, 2008, Existing MUEs Posted on the CMS Website
The Centers for Medicare and Medicaid Services (CMS) developed the Medically Unlikely Edit (MUE) program to reduce the paid claims error rate for Part B claims. The first edits were implemented January 1, 2007. Subsequently there have been quarterly updates increasing the number of edits. The edits were developed based on anatomic considerations, HCPCS/CPT code descriptors, CPT instructions, CMS policies, nature of service/procedure, nature of analyte, nature of equipment, and clinical judgment. Prior to implementation, all edits were reviewed by national healthcare organizations, and their alternative recommendations were taken into consideration. In 2008, CMS has been refining the edits based on 100% submitted claims data from a six month period in 2006.
CMS is pleased to announce that beginning October 1, 2008, coincident with implementation of MUE version 2.3, the majority of existing MUEs will be made public and posted on the CMS website accessed through the MUE webpage at http://www.cms.hhs.gov/NationalCorrectCodInitEd/08_MUE.asp#TopOfPage .
The published MUE will consist of most of the codes with MUE values of 1-3. At some future time, these edits will also be available from the National Technical Information Service.
CMS will not publish all MUE values that are 4 or higher because of CMS concerns about fraud and abuse. National healthcare organizations and contractors with information about MUE values that are not published on the CMS website should continue to maintain confidentiality of those values. In addition, a minimal number of MUEs with lower values believed by CMS to be particularly vulnerable to fraud and abuse may not be published.
CMS will update the MUE values on its website on a quarterly basis coincident with each quarterly version of MUE. Future postings of MUE values will also include some codes with MUE values of 4 or more.
CMS is concerned that providers will incorrectly interpret MUE values as utilization guidelines. MUE values do NOT represent units of service that may be reported without concern about medical review. Providers should continue to only report services that are medically reasonable and necessary.
National Healthcare Organizations may notice that some MUE values differ from the ones originally implemented based on their alternative recommendations. Some MUE values have been modified in 2008 based on the data refinement using the 100% submitted claims data from a six month period in 2006. The data refinement has resulted in some MUE values being increased and others decreased.
Further information about the MUE program and requests for reconsideration of MUE values may be viewed in the FAQ (Frequently Asked Questions) link from the CMS MUE webpage cited above.
The latest release of PC-ACE Pro32 software is now available on the RGBA website!
This release is version 1.95 and includes mandates from CMS. The software is located at the following link:
http://www.rgbagov.com/Tools/Electronic-Billing-EDI/Downloads.shtml . Please call the e-business department at 423.535.5717 if you have any questions.
The next CMS Hospital/Hospital Quality Open Door Forum scheduled for…
Date: October 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): Jeffrey Rich, M.D./Mark Levine, M.D./Natalie Highsmith
Open Door Participation Instructions:
There are 2 ways to participate, by phone or onsite.
1. To participate by phone:
Dial: 1-800-837-1935 & Reference Conference ID 58370592
Persons participating by phone do not need to RSVP.
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 http://www.consumer.att.com/relay/which/index.html.
A Relay Communications Assistant will help.
2. To participate onsite:
Your RSVP is required. Please send a reply to CMS HOSPITALODF-L@cms.hhs.gov by 2:00 PM EDT, October 7, 2008. Be sure to include the title of the forum Hospital/Hospital Quality in the subject line of your message, and send us your name, organization/representation and telephone number. 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# 58370592
Encore is an audio recording of this call that can be accessed by dialing 1 800 642 1687 and entering the Conf. ID. This recording will be accessible beginning Monday, October 13, 2008 and will expire 3 business days after the holiday.
For Forum Schedule updates, Listserv registration and Frequently Asked Questions please visit our website at www.cms.hhs.gov/OpenDoorForums/. Thank you.
End of Listserv Message.
Provider Outreach and Education Advisory Groups (POEAG) open to new membership!
The Provider Outreach and Education department of Riverbend GBA currently has active Advisory Groups in the following specialties:
End Stage Renal Disease (ESRD)
Hospital - Tennessee
Rural Health Clinic (RHC)
Skilled Nursing Facility (SNF)
The Advisory Groups provide a unique opportunity for our providers to make recommendations directly to us, to supply input and feedback on training topics, education strategy, materials, and avenues of dissemination, including Webinars and workshops. The Provider Advisory Groups meet quarterly. Members participate via teleconference, allowing you easy access from any site. As a participant, we encourage you to take an active role in asking questions and sharing your insight and opinions. Following the meetings, minutes from each will be posted on the website as soon as they are available.
To request membership in a POEAG Advisory Group, or to continue an existing membership, please complete the application attached to Medi Letter 3275-08 at: http://www.rgbagov.com/Publications/MediLetterPDF/3275-08.pdf and fax to (423) 535-5235, Attn: POE Advisory Group.
If your specialty is not represented in one of the established groups and you are interested in pioneering an Advisory Group, please complete and return the Registration form. We welcome your input and will consider the implementation of additional groups based on the responses received.
Thank you,
Provider Outreach and Education
Riverbend GBA
September 30, 2008
Please read to the end of this messages for information that my affect your facility.
Information from CMS.
New:
SE0822 Clarification of Medicare Payment for Routine Costs in a Clinical Trial
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0822.pdf
MM6062 2008 Jurisdiction List for Durable Medical Equipment Prosthetics, Orthotics, and Supply (DMEPOS) Healthcare Common Procedure Coding System (HCPCS) Codes http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6062.pdf
Note: Click the hyperlink to view the full story.
CMS Updates to Coverage Pages
Mon, 29 Sep 2008 16:30:44 0500
Date: 09/29/2008
Subject: CMS Updates to Coverage Pages
Content: Updates to Coverage pages for September 29, 2008
CMS 1390 N on Display at the Federal Register
CMS 1390 N (Medicare Program; Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates: Final Fiscal Year 2009 Wage Indices and Payment Rates) went on display at the Federal Register on September 29, 2008. The Notice includes tables listing the final wage indices, hospital reclassifications, payment rates, impacts, and other related tables effective for fiscal year (FY) 2009. It will be published on October 3. To view the Notice, go to the web page at:
http://www.cms.hhs.gov/AcuteInpatientPPS/IPPS/itemdetail.asp?filterType=none&filterByDID=0&sortByDID=4&sortOrder=descending&itemID=CMS1215562&intNumPerPage=10
Important Information about Reporting Hospital Quality Data for Annual Payment Update Program
Because of the recent hurricanes’ devastating impact, the Centers for Medicare & Medicaid Services (CMS) will grant a data submission waiver to Prospective Payment System (PPS) hospitals. Due to the hurricanes, some hospitals are unable to meet the submission of quality data requirements for the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) for Fiscal Year 2010.
The CMS is exercising its authority to waive data submission requirements under Section 1886(b) (3) (A) (vii) (II) of the Social Security Act, in the following states:
Louisiana
Texas
Process:
The submission waiver for Hospital Quality Alliance Acute Myocardial Infarction (AMI), Heart Failure, Pneumonia, and Surgical Care Improvement Project (SCIP) clinical process measures is granted for the second calendar quarter 2008 for all hospitals in counties designated as directly affected by the storm(s) (see Appendix A for a list of counties as designated by FEMA). The submission waiver for HCAHPS survey measure is granted for the third calendar quarter 2008 for all hospitals in counties designated as directly affected by the storm(s) (see Appendix A for a list of counties as designated by FEMA). In addition, hospitals in other counties in these states are authorized to submit requests for a data submission waiver to their CMS Regional Division of Quality Improvement office based on individual circumstances.
Clinical Process Measure Data Submission Schedule
Discharges Due to Clinical Warehouse
2Q-08 Apr-Jun 08 Nov-15-08
HCAHPS Data Submission Schedule
Discharges Due to Clinical Warehouse
3Q-08 July-Sept.08 Jan-14-09
The rationale for waivers for the clinical process measures listed above for second quarter 2008 is that hospital medical records were destroyed due to the storm, and hospitals are unable to report data for this period. The rationale for waivers for the HCAHPS survey measure for third quarter 2008 is that hospitals ability to contact and survey patients may have been impaired during and after the storm, and hospitals may be unable to report data for this period.
Additionally, the validation waiver for Hospital Quality Alliance Acute Myocardial Infarction (AMI), Heart Failure, Pneumonia, and Surgical Care Improvement Project (SCIP) clinical process measures is granted for the first calendar quarter 2008 for all hospitals in counties designated as directly affected by the storm(s) (see Appendix A for a list of counties as designated by FEMA). In addition, hospitals in other counties in these states are authorized to submit requests for a data submission waiver to their CMS Regional Division of Quality Improvement office based on individual circumstances.
Under Section 1886(b) (3) (A) (vii) (II) of the Social Security Act that hospitals shall submit data in a form and manner, and at a time, specified by the Secretary, CMS has authority to modify the submission requirements for hospitals.
Hospitals that have questions about this process should contact their local Quality Improvement Organization (QIO). A list of QIO contacts for each state/territory is available online at:
http://www.qualitynet.org/dcs/ContentServer?cid=1138900297541&pagename=QnetPublic%2FPage%2FQnetTier3&c=Page.
Appendix A:
List of Counties by State Designated Disaster Counties
Louisiana
All parishes.
Texas
Angelina, Austin, Brazoria, Chambers, Cherokee, Fort Bend, Galveston, Grimes, Hardin, Harris, Houston, Jasper, Jefferson, Liberty, Madison, Matagorda, Montgomery, Nacogdoches, Newton, Orange, Polk, Sabine, San Augustine, San Jacinto, Trinity, Tyler, Walker, Waller, and Washington Counties.
End of Listserv Message
October 2, 2008
Medicare Part B Drug Competitive Acquisition Program (CAP): 2009 CAP Postponement Article
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A Medicare Learning Network (MLN) Matters Special Edition article on the 2009 CAP postponement is now available on the CMS website. This article contains billing, drug ordering, claims processing, and other information for Participating CAP Physicians on the transition from CAP to the ASP buy and bill methodology for 2009. This article is available on the CMS website at: http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0833.pdf.
Additional information on the CAP and the programs postponement for 2009 is available on the CMS CAP website at: http://www.cms.hhs.gov/CompetitiveAcquisforBios/01_overview.asp.
MEDICARE PUBLISHES BILLING EDITS TO REDUCE PAYMENT ERRORS
The Centers for Medicare & Medicaid Services today announced that, beginning October 1, 2008, it will publish most ofh the edits utilized in its Medically Unlikely Edit (MUE) program to improve the accuracy of claims payments.
It is always our aim to ensure that CMS pays for appropriate services, at the same time protecting the Medicare Trust funds and the American taxpayer, said CMS Acting Administrator Kerry Weems.This program is going to help us dramatically reduce costly payment errors.
CMS established the MUE program to reduce payment errors for Medicare Part B claims. Claims processing contractors utilize these edits to assure that providers and suppliers do not report excessive services. The edits are applied during the electronic processing of all claims.
To view the entire Press Release, please see: ttp://www.cms.hhs.gov/apps/media/press_releases.asp
The edits are published on the CMS Web site at http://www.cms.hhs.gov/NationalCorrectCodInitEd/08_MUE.asp#TopOfPage
Below is the October Flu Shot Reminder for release through provider/contractor listservs, MLN Matters News Flash and provider partners email notifications.
October Flu Shot Reminder
Flu Season Is Upon Us! Begin now to take advantage of each office visit as an opportunity to encourage your patients to get a flu shot. It’s still their best defense against combating the flu this season. 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 personnel can spread the highly contagious flu virus to patients. Protect Yourself. Don’t Get the Flu. Don’t Give the Flu. Get Your Flu Shot.
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, please go to ttp://www.cms.hhs.gov/MLNProducts/Downloads/flu_products.pdf
on the CMS website.
The next CMS Ambulance Open Door Forum is scheduled for...
Date: October 15, 2008
Start Time: 2:00 PM Eastern Daylight Time (EDT)
(Please dial in at least 15 minutes prior to call start time.)
Conference Leader(s): Bill Rogers, M.D./Natalie Highsmith
Open Door Forum Participation Instructions:
There are 2 ways to participate, onsite or by phone.
1. To participate onsite at the Hubert H. Humphrey Building, RSVP and Security clearance is required. The RSVP deadline is October 10, 2008 no later than 2:00 PM EDT. To RSVP, send your name, organization and telephone number to MBULANCEODF-L@cms.hhs.gov. Be sure to include "Ambulance" in the subject line.
Upon entry into the building, you will be required to present to Security a Government-issued photo identification, preferably valid driver's license.
Please arrive no later than 1:30 PM.
2. To participate by phone:
Dial: 1-800-837-1935 & Reference Conference ID: 58370825
(Persons participating by phone are not required to RSVP.)
TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880 and for Internet Relay services click here http://www.consumer.att.com/relay/which/index.html . A Relay Communications Assistant will help.
ADDRESS:
Hubert H. Humphrey Bldg.
200 Independence Avenue S.W.
Washington, D.C. 20201
Map & Directions: http://www.hhs.gov/about/hhhmap.html
ENCORE: 1-800-642-1687; Conf. ID# 58370825
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.
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that a newself service look up toolis now available on the PQRI Portal at, http://www.qualitynet.org/pqri on the internet, which allows an eligible professional at the Tax Identification Number (TIN) levelto see if their 2007 PQRI Feedback Report is available. Once on the site, go to the Verify TIN Report Portlet which is located at the bottom left of the page. Enterthe TIN and a message appears that indicates if a2007 PQRI Feedback Report is or is not available.
This self service look up tool does not allow the eligible professional to view their 2007 PQRI Feedback Report. The availability of the 2007 PQRI Feedback Report is helpful for the eligible professional to know because it enables them to decide if they need to register for an IACS account at this time so that they can log into the PQRI Portal and view their 2007 PQRI Feedback Report. Additional information can be found in MLN Matters Special Edition articles 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) and SE0831 Steps for Organizations to Access Their 2007 Physician Quality Reporting Initiative (PQRI) Feedback Reports http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0831.pdf) .
In addition, the eligible professional can call the QualityNet Help Desk in order to determine if a 2007 PQRI Feedback Report is available. The representatives at the QualityNet Help Desk can only inform the provider if a 2007 PQRI Feedback Report is available; theyare unable to disclose the information on the 2007 PQRI Feedback Report. The QualityNet Help Desk can be reached via telephone at 1-866-288-8912 from the hours of 7am-7pm CST or via email at Qnetsupport@ifmc.sdps.org.
NOTE: The TIN must be the one used by the eligible professional to submit Medicare claims and valid PQRI quality data codes for dates of service July 1 – December 31, 2007.
End of Listserv Message.
October 3, 2008
Please review to the end of this document for any information that may affect your facility.
The following Medi Letters are posted to the RGBA Website for your review.
MediNumber: 3291-08 |
MediNumber: 3290-08 |
MediNumber: 3289-08 |
MediNumber: 3288-08 |
MediNumber: 3287-08 |
MediNumber: 3286-08 |
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MediNumber: 3283-08 |
CMS Issues New Resources on ESRD Conditions for Coverage
Frequently Asked Questions
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.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 has developed a Frequently Asked Questions document that condenses many of the questions we received from you. The FAQs are available online at http://www.cms.hhs.gov/center/esrd.asp.
Crosswalk: Former Conditions versus Revised Conditions
As another tool to help you understand the new Conditions for Coverage, CMS has developed a crosswalk that compares the former conditions to the final revised conditions, which were issued in the Federal Register on April 15, 2008. The crosswalk will help you navigate the new organization structure of the condition as well as some revised provisions of the conditions themselves. The crosswalk is available online at http://www.cms.hhs.gov/center/esrd.asp.
We hope you find these tools helpful as you work to implement the revised conditions. For more information, please visit us online at http://www.cms.hhs.gov/CFCsAndCoPs/13_ESRD.asp.
End of Listserv Message.
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