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ListServ Message 10/10/2008
October 6, 2008
Riverbend GBA has been made aware that due to CDS changes to our session ID selections, (in the sign-in menus), Direct Data Entry users are currently unable to access the proper region of FISS, to access current claims data. If you are currently in FISS/DDE, you will need to log out until further notice. Once the region ID update is made, we will notify you that you can again access your current data for processing.
We appreciate your patience while we wait for this update to take place.
DDE users should now be able to access DDE/FISS. However you must FIRST log completely off, then log back in. Thank you for your patience while this was corrected.
We are still monitoring an issue with several of our new DDE users that were getting a blank TPX screen last week; we are looking into whether you are seeing the proper TPX screen, or if you are reverting back to a blank screen. We will keep you informed of our findings.
October 6, 2008
Please read to the end of this message for information that may affect your provider.
Information from The CMS.
Subject: An Additional Item Regarding the SNF PC Pricer
The Centers for Medicare & Medicaid Services (CMS) has released the SNF PC Pricer for FY 2009. If you use SNF PC Pricer software, please go to the web page at http://www.cms.hhs.gov/PCPricer/04_SNF.asp#TopOfPage and down load version FY 2009.0, posted on October 1, 2008.
MEDICARE SOLICITS NOMINEES FOR ADVISORY PANEL FOR NEXT PHASE OF DURABLE MEDICAL EQUIPMENT COMPETITIVE BIDDING PROGRAM MEMBERS TO PROVIDE GUIDANCE ON OPERATIONAL ISSUES
The Centers for Medicare & Medicaid Services (CMS) is soliciting nominations for individuals to serve on the Program Advisory and Oversight Committee (PAOC) that advises CMS on various issues relating to the competitive bidding program for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS).
The PAOC was initially established in 2004, as required by the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), to advise CMS on the design and implementation of a competitive bidding program for DMEPOS that would build on the successes of two pilot projects that had shown that competitive bidding could reduce prices of DMEPOS without adversely affecting beneficiary access or compromising quality.
Because the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) delayed implementation of and made certain changes to the competitive bidding program, and extended the PAOC for two years through December 31, 2011, CMS is ending the term of service for current PAOC members.
The PAOC will be comprised of 10 and 12 members from the following broad categories:
Beneficiary/consumer representatives;
Physicians and other practitioners;
Suppliers;
Professional standards organizations;
Financial standards specialists (that is, economist/certified public accountant); and
Association representatives.|
CMS may consider nominees for additional categories if it finds that their expertise will help to ensure the successful implementation of the program.
Nominations are due to CMS by November 3, 2008. For more information, please see the CMS Web site at: http://www.cms.hhs.gov/center/dme.asp
To read the CMS press release issued on October 1, 2008, click here: http://www.cms.hhs.gov/apps/media/press_releases.asp
CMS ENHANCES PROGRAM INTEGRITY EFFORTS TO FIGHT FRAUD, WASTE AND ABUSE IN MEDICARE
The Centers for Medicare & Medicaid Services (CMS) today announced aggressive new steps to find and prevent waste, fraud and abuse in Medicare. CMS is working closer with beneficiaries and providers; consolidating its fraud detection efforts; strengthening its oversight of medical equipment suppliers and home health agencies; and launching the national recovery audit contractor (RAC) program.The new national RACs can be found at http://www.cms.hhs.gov/RAC
For more information about CMS RAC Web site, please visit: http://www.cms.hhs.gov/RAC/Downloads/RAC%20Expansion%20Schedule%20Web.pdf
To read the CMS Press release issued today click here: http://www.cms.hhs.gov/apps/media/press_releases.asp
New from the Medicare Learning Network
Medicare Part B Drug Competitive Acquisition Program (CAP): 2009 CAP Postponement Article
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 program's postponement for 2009 is available on the CMS CAP website at: http://www.cms.hhs.gov/CompetitiveAcquisforBios/01_overview.asp.
ICD-10-CM/PCS Article Now Available
A new MLN Matters Special Edition Article entitled, SE0832 - The ICD-10 Clinical Modification/Procedure Coding System (CM/PCS)-The Next Generation of Coding, has recently been released. Go to http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0832.pdf
to view it.
Centers for Medicare & Medicaid Services 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 on the CMS website. To view them, click on the second Spotlight.
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 on the CMS website. To view the Crosswalk, click on the third Spotlight.
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 on the CMS website.
Medicare Publishes Billing Edits to Reduce Payment Errors
The Centers for Medicare & Medicaid Services (CMS) recently announced that, beginning October 1, 2008, it will publish most of 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. These edits check the number of times a service is reported by a provider or supplier for the same patient on the same date of service. Providers and suppliers report services on claims using HCPCS/CPT codes along with the number of times (i.e., units of service) that the service is provided.
Prior studies, including one by the U.S Department of Health and Human Services Office of the Inspector General in May 2006, identified significant Medicare overpayments because provider or supplier claims sometimes report services with too many units of service. These errors may be caused by numerous factors, including clerical errors and coding errors.
CMS first implemented the MUE program January 1, 2007, with edits for about 2,600 HCPCS/CPT codes. There have been quarterly updates adding additional codes. The October 1, 2008, version of MUE will contain edits for about 9,700 HCPCS/CPT codes that have been assigned unit values for MUEs. MUEs are cumulative for each quarter. However, CMS will not publish all MUEs on October 1, 2008. CMS has not yet determined if there have been any savings in the MUE program since it was implemented.
The edits were developed by CMS with the cooperation and participation of national health care organizations representing physicians, hospitals, non-physician practitioners, laboratories, and durable medical equipment suppliers. CMS also utilized claims data in its analysis of MUE.
The edits can be found on the CMS Website at http://www.cms.hhs.gov/NationalCorrectCodInitEd/08_MUE.asp#TopOfPage.
At the start of each calendar quarter, CMS will publish most MUEs active for that quarter. Although the October 1, 2008, publication will contain most MUEs, additional ones will be published on January 1, 2009. CMS is not able to publish all active MUEs because some are primarily designed to detect and deter questionable payments rather than billing errors. Publishing those MUEs would diminish their effectiveness.
Compliance with the DMEPOS Quality Standards: What You Need To Know
JOIN THE CMS CONFERENCE!
Tuesday, October 14, 2008
1:00-5:30 PM EST
CMS Auditorium, Baltimore, MD 21244
On October 14, the Centers for Medicare & Medicaid Services will conduct an on-site conference that will provide guidance to the DMEPOS suppliers on how to comply with the DMEPOS quality standards.
Goal
The goal of this conference is to provide non-accredited DMEPOS suppliers with technical guidance on the new DMEPOS quality standards.
Section I- Supplier Business Service Requirements
Section II- Supplier Product-Specific Service Requirements
Appendices A, B & C
Speaker
Sandra Bastinelli, Director,
Division ofMedical Review & Education,
Program Integrity Group
Office of Financial Management, CMS
Target Audience
Non-accredited DMEPOS suppliers
Web Registration (on-site conference only)
CMS Website: http://www.cms.hhs.gov/apps/events/default.asp
Select upcoming events,
Find the conference (listed by name/date), and Click on Register Audio Line
Call-In-Number: 1-877-357-7851
Conference Id Number: 57781268
CMS Provides Guidance on DMEPOS Accreditation for Pharmacy Suppliers
On September 3, 2008, the Centers for Medicare & Medicaid Services (CMS) announced a list of durable Medical Equipment Prosthetics/Orthotics, and Supplies (DMEPOS) providers that were exempt from meeting the quality standards for DMEPOS accreditation. CMS would like to clarify that pharmacists and pharmacies were not included in this provider exemption; therefore, pharmacists and pharmacies do need to obtain accreditation. For example, if a pharmacy is providing DMEPOS supplies to Medicare beneficiaries, such as diabetic supplies and enteral/parenteral nutrition, they would need to be accredited by the September 30, 2009 deadline. For more information about DMEPOS Accreditation, please visit the web page at http://www.cms.hhs.gov/medicareprovidersupenroll/.
End of Listserv Message.
October 9, 2008
Please read to the end of this Listserv Message for information that may affect your facility.
The next CMS Rural Health Open Door Forum is scheduled for...
Date: October 21, 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
Open Door Forum Participation Instructions:
There are 2 ways to participate, in person or by phone.
To participate in person at the Hubert H. Humphrey Building, RSVP and Security Clearance is required. RSVP no later than 2:00 PM EDT, October 17, 2008. To RSVP, send your name, organization and telephone number to RURALHEALTHODF-L@cms.hhs.gov. Be sure to include Rural Health 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.
To participate by phone:
Dial: 1-800-837-1935 & Reference Conference ID: 58371001
(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# 58371001
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 and 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 following Webinars are available for registration at: http: //www.rgbagov.com/Education/Schedule-Events/Workshop-Registration/event.do
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Description: Review of ICD-9 changes for 2008-2009 |
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Time: 2:00 PM EST |
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Date: 2008-10-16 |
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Description: Discussion of the last quarter probe summaries and results |
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Time: 2:00 PM EST |
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Date: 2008-11-04 |
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Description: Discussion of OPPS updates for 2009 |
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Time: 2:00 PM EST |
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Date: 2008-11-18 |
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Description: This Webinar will cover the MSP provisions as mandated by The CMS. Issues covered will be; responsibilities of each party involved, the claims flow process, how and when claims may be submitted for Medicare Secondary payment. This Webinar information is great for all levels of billing personnel. |
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Time: 2:00 PM ET |
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Date: 2008-10-22 |
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Description: This Webinar is designed for providers that recently obtained RHC status and provider number, but any RHC provider is welcome to join in. Topics covered will include; Riverbend GBA reports, UB-04 claims submission, payment schedules, payment processes, signing up for electronic claims, RGBA Website, reference materials and much more! |
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Time: 2:00 PM ET |
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Date: 2008-10-14 |
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Description: This Webinar covers the HIQA and DDE screens as they pertain to Medicare beneficiary eligibility, and information used to submit Medicare claims. Also, the DDE screens and their functions will be covered. This Webinar is designed for all levels of DDE and HIQA users. |
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Time: 2:00 PM ET |
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Date: 2008-10-28 |
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Description: This Webinar will cover Rural Health Clinic regulations as stated in Local Coverage Determination (LCD 4878). The RHC LCD is available on the RGBA Website at: http://www.rgbagov.com/Publications/LCD/lmrps.asp. Please locate and print this LCD prior to the Webinar and note any questions you may have for discussion during the Webinar. |
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Time: 2:00 PM ET |
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Date: 2008-10-30 |
ATTENTION All DDE Users!
Riverbend will be performing a disaster recovery test Saturday, October 25, 2008. To complete this testing successfully Riverbend will have a dark day meaning there will not be Direct Data Entry (DDE)access or IVR access on Saturday, October 25, 2008.
MEDICARE HOSTS NATIONAL CONFERENCE TO PROMOTE ELECTRONIC PRESCRIBING
Widespread Use of E-prescribing Would Eliminate Thousands of Annual Medication Errors
Boston, MA – October 7, 2008 – More than 1,400 health care professionals and industry leaders convened in Boston today at the National E‑prescribing Conference hosted by the Centers for Medicare & Medicaid Services (CMS) and 34 co-sponsoring organizations. Featuring U.S. Department of Health and Human Services Secretary (HHS) Mike Leavitt, CMS Acting Administrator Kerry Weems, Senator John Kerry (D-MA), Former House Speaker Newt Gingrich, Massachusetts Governor Deval Patrick, Rhode Island Governor Donald Carcieri, and Health Evolution Partners Chairman David Brailer, M.D., Ph.D., the conference addressed the potential of electronic prescribing (e-prescribing) to improve health care in the United States.
For more information, visit www.hhs.gov/valuedriven or www.cms.hhs.gov/pqri National E-prescribing Conference presentations can be downloaded at www.e-prescribeconference.com.
To read the CMS press release issued today (10/7) click here: http://www.cms.hhs.gov/apps/media/press_releases.asp
Reminder: The ICD-10-CM/PCS National Provider Conference Call for Hospital Staff will be conducted on October 14, 2008 from 12:30 p.m. – 2:30 p.m. EDT.
The Centers for Medicare & Medicaid Services (CMS) will host a series of national provider calls 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 in the Downloads Section of the ICD10 CMS Sponsored Calls Web Page at http://www.cms.hhs.gov/ICD10/07_Sponsored_Calls.asp for you to download prior to the conference call so that you can follow along with the presentation. This PowerPoint slide presentation has been revised (October 2008).
To register go to http://www.cms.hhs.gov/ICD10/downloads/ICD10_hospital.pdf.
For those who are unable to attend, a transcript will be posted on the ICD-10 CMS Sponsored Calls Web Page at shortly after the conference call.
End of Listserv Message.
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