Riverbend

Latest News for Providers

Reminders for August 21, 2008

For Providers Transitioning to Highmark Medicare Services ONLY

Effective August 25, 2008, Riverbend Government Benefits Administrator (Riverbend) will no longer process any New Jersey Electronic Data Interchange (EDI) Enrollment and Maintenance requests.

For EDI-transition related assistance and support, such as connectivity, testing, and claim submission/report retrieval information, please call Highmark Medicare Services’ EDI Helpdesk at 1-866-488-0546, option 3,  or visit their Web pages listed below.

Highmark Medicare Services J12 Transition Web page: http://www.highmarkmedicareservices.com/transition/j12/index.html

Highmark Medicare Services EDI General Information Web page: http://www.highmarkmedicareservices.com/parta/edi/index-edi.html

Additionally, if you need to request a brand new Medicare Part A Logon ID for Direct Data Entry (DDE) or access to HIQA for beneficiary eligibility, or to make changes such as adding a provider number or numbers to your existing Medicare Part A Logon ID, then please visit the following Highmark Medicare Services’ Web page for more information: http://www.highmarkmedicareservices.com/transition/j12/communications-sipp3.htm

Reminders for August 20, 2008

Reminders for August 11, 2008

CMS Seeks Cosponsors for Educational Conference on E-prescribing Incentive Payment Program

The Centers for Medicare & Medicaid Services (CMS) today (Friday, August 8, 2008) announced a conference to educate physicians and other stakeholders about a newly enacted federal program of incentive payments to encourage the use of electronic prescribing.  CMS is requesting interested public and private sector organizations to join the agency as cosponsors of the conference, which will be held Oct. 6 through 7, 2008, in Boston.  

The new incentive program will help spread adoption of e-prescribing throughout the health care community,â€� said CMS Acting Administrator Kerry Weems.  E-prescribing has many benefits for patients, providers, health plans, and pharmacies.  Not only is e-prescribing more efficient than paper prescriptions, it is also safer.  E-prescribing can help reduce the number of adverse drug events, which for Medicare beneficiaries alone is estimated at 530,000 a year.

The many benefits of e-prescribing include:

Physicians have electronic access to each patients prescription history, helping them avoid prescribing drugs that may result in harmful drug interactions;

E-prescribing eliminates the possibility of medication errors caused by illegible prescribing clinician handwriting;

E-prescribing reduces confusion and miscommunication, resulting in fewer phone calls and faxes between the physicians office and the pharmacy; and

With access to a patients insurance and formulary information at the point of care, physicians can prescribe a drug that is both covered and affordable, resulting in fewer trips to the pharmacy.

The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) established a five-year program of incentive payments to eligible professionals who are “successful electronic prescribers.  Successful prescribers are those who either report applicable electronic prescribing measures established under the Physician Quality Reporting Initiative (PQRI) or who electronically submit prescriptions under Medicare Part D at a level determined by CMS. The incentive payment program begins on January 1, 2009.  The conference will serve to educate affected constituencies on the MIPPA program and CMS plans for implementation.

The notice invites interested parties to submit proposals detailing how they could support CMS, in a non-fiduciary relationship, by developing conference content, identifying speakers, and implementing outreach activities to educate affected provider, business, and consumer stakeholders about this new program.  Interested organizations may include:

Physician and provider organizations (including those representing primary care, specialty care, surgical, and medicine-based specialties);

Organizations representing health care professionals;

Organizations representing pharmacy industry stakeholders, including retail and community pharmacies;

Organizations representing state and local officials; and

Organizations representing a broad range of beneficiary interests.

Reminders for August 5, 2008

Agenda - Special Open Door Forum:

Developing Outpatient Therapy Payment Alternatives

The agenda has been posted for the Special Open Door Forum on Developing Outpatient Therapy Payment Alternatives which is scheduled for Wednesday, August 6, 2008. To view the agenda, click on the following link: http://www.cms.hhs.gov/OpenDoorForums/05_ODF_SpecialODF.asp, and select the link that corresponds to this agenda in the “Downloads� section of the page.

Agenda - Special Open Door Forum: Changes in Conditions of Participation Requirements and Payment Provisions for Rural Health Clinics and Federally Qualified Health Centers Proposed Rule

 The agenda has been posted for the Special Open Door Forum on Changes in Conditions of Participation Requirements and Payment Provisions for Rural Health Clinics and Federally Qualified Health Centers Proposed Rule which is scheduled for Tuesday, August 5, 2008. To view the agenda, click on the following link: http://www.cms.hhs.gov/OpenDoorForums/05_ODF_SpecialODF.asp, and select the link that corresponds to this agenda in the “Downloadsâ€� section of the page

Prospective payment system (PPS) hospitals may apply to the Medicare Geographic Classification Review Board (MGCRB or Board) to be reclassified to another area for the purposes of using the wage index value.  To be reclassified, they must meet certain criteria found at 42 C.F.R. Section 412.230ff.  PPS hospitals must also complete the application required by the MGCRB and, for reclassifications effective Federal Fiscal Year (FFY) 2010, file it with the Board by 5:00pm, EDT, September 2, 2008.

This is to advise you that individual and group instructions and applications for FFY 2010 are now available.  PPS hospitals may obtain them from the Internet at http://cms.hhs.gov/MGCRB/02_instructions_and_applications.asp.  PPS hospitals may also obtain the application and instructions by contacting Terry Rivers at (423) 535-3223.

Hospitals needing further information may call the Board’s office at 410.786.1174.

Reminders for August 4, 2008

 NPPES & the NPI Registry will be Unavailable on August 10^th

On August 10, 2008, the National Plan and Provider Enumeration System (NPPES) will undergo system maintenance.  Neither NPPES nor the NPI Registry will be available on August 10, 2008.  CMS will be implementing some enhancements/updates to the system. A detailed listing of the NPPES enhancements/updates can be found at http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/Revised_NPPES_Enhancements.pdf on the CMS NPI web page. 

 Reminder for July 24, 2008

CR 6088 has been rescinded.  You may view this information in its entirety at  http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6088.pdf

Reminder: Medicare Provides Coverage of Diabetes Screening Tests

This article conveys no new policy information. This article serves as a reminder to health care professionals and their staff that Medicare pays for diabetes screening tests. To ensure proper reimbursement for these screening tests the correct procedure and diagnosis codes and modifier (when appropriate) must be used when filing claims. http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0821.pdf

July 18, 2008

New 2008 Medicare Physician Fee Schedule Payment Rates Effective for Dates of Service July 1, 2008 through December 31, 2008 

Physicians, non-physician practitioners and other providers of services paid under the MPFS should begin to receive payment at the 0.5 % update rates in approximately 10 business days, or less.  Medicare contractors are currently working to update their payment system with the new rates.

In the meantime, to avoid a disruption to the payment of claims for physicians, non-physician practitioners and other providers of services paid under the MPFS, Medicare contractors will continue to process the claims that have been on hold on a rolling basis (first in/first out) for payment at the -10.6% update level.  After your local contractor begins to pay claims at the new 0.5% rate, to the extent possible, the contractor will begin to automatically reprocess any claims paid at the lower rates.   

Under the Medicare statute, Medicare pays the lower of submitted charges or the Medicare fee schedule amount.  Claims with dates of service July 1 and later billed with a submitted charge at least at the level of the January 1 – June 30, 2008, fee schedule amount will be automatically reprocessed.  Any lesser amount will require providers to contact their local contractor for direction on obtaining adjustments.  Non-participating physicians who submitted unassigned claims at the reduced nonparticipation amount also will need to request an adjustment.

Contractor websites are being updated with the new rates and these should be available shortly. Be aware that any published MLN Matters articles affected by the new law will be revised or rescinded as appropriate. Finally, be on the alert for more information about other legislative provisions which may affect you.

Extension of Therapy Cap Exceptions

The Medicare Improvements for Patients and Providers Act of 2008 was enacted on July 15, 2008.  One provision of this legislation extends the effective date of the exceptions process to the therapy caps to December 31, 2009.  Outpatient therapy service providers may now resume submitting claims with the KX modifier for therapy services that exceed the cap furnished on or after July 1, 2008.  

For physical therapy and speech language pathology services combined, the limit on incurred expenses is $1810 for calendar year 2008.  For occupational therapy services, the limit is $1810.  Deductible and coinsurance amounts applied to therapy services count toward the amount accrued before a cap is reached.   Services that meet the exceptions criteria and report the KX modifier will be paid beyond this limit.                                                                                                   

Before this legislation was enacted, outpatient therapy service providers were previously instructed to not submit the KX modifier on claims for services furnished on or after July 1, 2008.  The extension of the therapy cap exceptions is retroactive to July 1, 2008.   As a result, providers may have already submitted some claims without the KX modifier that would qualify for an exception.  

Providers submitting these claims using the 837 institutional electronic claim format or the UB-04 paper claim format would have had these claims rejected for exceeding the cap.   These providers should resubmit these claims appending the KX modifier so they may now be processed and paid.  Providers submitting these claims using the 837 professional electronic claim format or the CMS-1500 paper claim format would have had these claims denied for exceeding the cap.   These providers should request to have their claims adjusted in order to have the contractor pay the claim.    

In all cases, if the beneficiary was notified of their liability and the beneficiary made payment for services that now qualify for exceptions, any such payments should be refunded to the beneficiary.

Reinstatement of the Moratorium That Allows Independent Laboratories to Bill for the TC of Physician Pathology Services Furnished to Hospital Patients

In the final physician fee schedule regulation published in the Federal Register on November 2, 1999, the Centers for Medicare & Medicaid Services (CMS) stated that it would implement a policy to pay only the hospital for the technical component (TC) of physician pathology services furnished to hospital patients.  Prior to this proposal, any independent laboratory could bill the carrier under the physician fee schedule for the TC of physician pathology services for hospital patients.  At the request of the industry, to allow independent laboratories and hospitals sufficient time to negotiate arrangements, the implementation of this rule was administratively delayed.  Subsequent legislation formalized a moratorium on the implementation of the rule.  As such, during this time, the carriers and, more recently, Medicare Administrative Contractors (MAC) have continued to pay for the TC of physician pathology services when an independent laboratory furnishes this service to an inpatient or outpatient of a covered hospital.

The most recent extension of the moratorium, established by the Medicare, Medicaid, and SCHIP Extension Act (MMSEA), Section 104, expired on June 30, 2008.  A new extension of the moratorium has been established by the Medicare Improvements for Patients and Providers Act of 2008, Section 136, retroactive to July 1, 2008. 

A previous communication indicated that the moratorium had ended and that independent laboratories may no longer bill Medicare for the TC of physician pathology services furnished to patients of a covered hospital, regardless of the beneficiary's hospitalization status (inpatient or outpatient) on the date that the service was performed.  This prohibition is rescinded and the moratorium will continue effective for claims with dates of service on and after July 1, 2008, but prior to January 1, 2010.

Extension of Payment Rule for Brachytherapy and Therapeutic Radiopharmaceuticals

July 10, 2008

In preparation for the transition of NJ Providers from Riverbend to Highmark Riverbend will be performing a test of this transition July 19^th.  This test will require that DDE processing be unavailable Saturday July 19^th for NJ, TN, and RHC providers. All providers will be able to submit their electronic 837 claims as normal, but will not be able to use the DDE system

July 9, 2008

Expiration of Moratorium That Allowed Independent Laboratories to Bill for the TC of Physician Pathology Services Furnished to Hospital Patients

In the final physician fee schedule regulation published in the Federal Register on November 2, 1999, the Centers for Medicare & Medicaid Services (CMS) stated that it would implement a policy to pay only the hospital for the technical component (TC) of physician pathology services furnished to hospital patients. Prior to this proposal, any independent laboratory could bill the carrier under the physician fee schedule for the TC of physician pathology services for hospital patients. At the request of the industry, to allow independent laboratories and hospitals sufficient time to negotiate arrangements, the implementation of this rule was administratively delayed. Subsequent legislation formalized a moratorium on the implementation of the rule. As such, during this time, the carriers and, more recently, Medicare Administrative Contractors (MAC) have continued to pay for the TC of physician pathology services when an independent laboratory furnishes this service to an inpatient or outpatient of a covered hospital.

The most recent extension of the moratorium was established by the Medicare, Medicaid, and SCHIP Extension Act (MMSEA). Section 104 of the MMSEA expired on June 30, 2008, thus ending the moratorium. Therefore, independent laboratories may no longer bill Medicare for the TC of physician pathology services furnished to patients of a covered hospital, regardless of the beneficiary's hospitalization status (inpatient or outpatient) on the date that the service was performed. This prohibition is effective for claims with dates of service on and after July 1, 2008.

July 7, 2008

For Providers Transitioning to Highmark Medicare Services ONLY
Effective immediately, Riverbend Government Benefits Administrator (Riverbend) will no longer sell 3270 Emulation Software licenses for Direct Data Entry (DDE) connectivity to our Medicare providers transitioning to Highmark Medicare Services as the Jurisdiction 12 (J12) Medicare Administrative Contractor (MAC). Highmark Medicare Services has notified Riverbend they will not support this software or its connection to the Fiscal Intermediary Standard System (FISS). For those providers who have purchased a 3270 Emulation Software license, Riverbend will continue to support your software, connectivity, and all user access through August 31, 2008 until the New Jersey Contract is transitioned from Riverbend to Highmark Medicare Services. For those providers currently interested in DDE service, you may contact our BlueCross and BlueShield of Tennessee Enrollment Staff at 800-924-7141 to learn about options available today with Riverbend that can be moved to the new J12 MAC without interruption.

For EDI assistance and support call Highmark Medicare Services’ dedicated toll-free telephone numbers or contact them via their Web sites listed below.

Call 1-866-488-0546, Press Option 3, for all J12 transition-related EDI questions such as: connectivity, testing, and claim submission/report retrieval information.

Call 1-866-488-0546, Press Option 2 for all Part A post-transition EDI assistance once your EDI billing has transitioned to the Highmark Medicare Services’ EDI platform. You will be provided with details regarding your specific cutover date.Highmark Medicare Services J12 Transition Webpage

http://www.highmarkmedicareservices.com/transition/j12/index.html

Highmark Medicare Services EDI General Information Webpage

http://www.highmarkmedicareservices.com/parta/edi/index-edi.html

July 3, 2008

The Questions and Answers below apply to the recent decision by the Centers for Medicare & Medicare Services to hold claims paid under the Medicare physician fee schedule (MPFS) up to 10 business days that contain July 2008 dates of service.

Q1. Will claims containing services paid under the MPFS be held that contain both June and July dates of service?

A1. Yes, your local contractor will hold the entire claim for 10 business days.

Q2. Will claims be held that contain both services paid under the MPFS and services paid under a separate fee schedule?

A2. Yes, claims that contain both services paid and not paid under the MPFS will be held. For example, a claim with a July date containing an Evaluation and Management code and a drug code would be held.

Q3. Does the holding of claims paid under the MPFS also include anesthesia and purchased diagnostic services?

A3. Yes, contractors will hold all claims with dates of service July 1, 2008, and after that contain services paid under the MPFS, including anesthesia and purchased diagnostic services.�

Expiration of Therapy Cap Exceptions

The exceptions to outpatient therapy caps expire on June 30, 2008. Outpatient therapy service providers should not submit claims with the KX modifier for services furnished on or after July 1, 2008. To the extent possible, CMS is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of outpatient physical therapy, occupational therapy and speech-language pathology claims for services furnished by physicians, non-physician practitioners, and therapists paid under the physician fee schedule, beginning July 1.

For physical therapy and speech language pathology services combined, the limit on incurred expenses is $1810. For occupational therapy services, the limit is $1810. Deductible and coinsurance amounts applied to therapy services count toward the amount accrued before a cap is reached. Therapy cap accruals began on January 1, 2008, and some patients may have reached the annual limits by June 30, 2008.

Providers may access the accrued amount or remaining amount of therapy services from the Medicare beneficiary eligibility inquiry and response transactions. Specifically:

· For CWF users, the system returns the “applied� amount. See CR4115 at http://www.cms.hhs.gov/transmittals/downloads//R759CP.pdf

· For users of the HETS 270/271, the system returns the “remaining� amount. See the page 18 of the 270/271 user guide at http://www.cms.hhs.gov/HETSHelp/Downloads/HETS%20270-271%20User%20Companion%20Guide.pdf

· The Medicare contractors’ Interactive Voice Response units (IVR) return either the remaining or applied amounts based upon contractor programming. For those few contractors that do not provide this information on their IVRs, providers can call the contractors’ customer service representatives.

For additional information, Providers and Suppliers should also read the Medicare Claims Processing Manual, chapter 5, section 10. 2 at

http://www.cms.hhs.gov/manuals/downloads/clm104c05TXT.pdf

Patients Who Have Reached Their Limit(s) on Outpatient Therapy Services:

Note that patients who have reached their limit(s) on outpatient therapy services, other than those who reside in a Medicare-certified part of a skilled nursing facility, may obtain medically necessary therapy services that exceed the caps if the services are furnished and billed by the outpatient department of a hospital. In other settings, outpatient therapy services in excess of the caps are not covered, and the therapy provider may charge for those services. An Advance

Beneficiary Notice is recommended, but not required for services that exceed therapy caps. An ABN is available at the following link: http://www.cms.hhs.gov/BNI/02_ABNGABNL.asp#TopOfPage (click on ABN-CMS-R-131 Form). In the box titled "Reason Medicare will not pay" the following language is suggested Medicare will not pay more than $1810 for expenses incurred for physical therapy and speech-language pathology services combined or for occupational services in 2008.

Patients may be referred to this website for further information:

http://www.medicare.gov/Publications/Pubs/pdf/10988.pdf which will be activated by July 3, 2008.

We will continue to be in communication with you with further information about payment of Medicare physician fee schedule claims. In addition, be on the alert for more information about other legislative provisions which may affect you.�

July 1, 2008

Correct Coding Edits

Due to an omission in the Correct Coding Edits housed in the Integrated Ooutpatient Code Editor (IOCE), the Centers for Medicare & Medicaid Services (CMS) will be reissuing the July version 9.2. All contractors have been instructed by The Centers for Medicare and Medicaid Services to hold all outpatient claims with dates of service beginning July 1, 2008, until the successful installation of the revised IOCE.

CMS Information

To the extent possible, CMS is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, non-physician practitioners, and other providers of services paid under the Medicare physician fee schedule, beginning July 1. In this regard, CMS has instructed its contractors to hold these claims for the first 10 business days of July, for dates of service in July. This should have minimum impact on provider cash flow because, under current law, electronic claims are not paid any sooner than 14 days (29 days for paper claims) after the date of receipt. Meanwhile, all claims for services delivered on or before June 30 will be processed and paid under normal procedures.

After 10 business days, contractors will begin releasing claims into processing under the fee schedule which implements current law. This, of course, could result in claims being processed with the negative 10.6 percent update. If a new law is enacted which changes the negative 10.6 percent update, retroactive to July 1, CMS is prepared to automatically reprocess most of those claims which have already been processed.

Under the Medicare statute, Medicare pays the lower of submitted charges and the Medicare fee schedule amount. Claims with dates of service July 1 and later billed with a submitted charge at least at the level of the January 1-June 30, 2008, fee schedule will be automatically reprocessed, if Congress retroactively reinstates the update that was in effect for that time period. Any lesser amount will likely require providers to re-submit a revised claim.

To the extent possible, providers may hold claims in-house until it becomes clearer as to whether new legislation will be enacted or until cash flow becomes problematic. This will reduce the need for providers to reconcile two payments (i.e., the initial claim and the reprocessed claim), and it will simplify provider billings of beneficiary coinsurance and payment calculations for payers which are secondary to Medicare.

In addition, be on the alert for more information about other legislative provisions which may affect you.

Clarification ofMail Order in the Centers for Medicare & Medicaid Services (CMS) DMEPOS Competitive Bidding Program

The CMS has postedinformation on the Competitive Bidding ImplementationContractor (CBIC) website to clarify its policy with regard to mail order suppliers. This posting provides further guidance on common carriers and local storefront suppliers. Please visit the Supplier’s FAQ section at http://www.dmecompetitivebid.com for more information.

June 30, 2008

Last Day

The Skilled Nursing Facilities/Long Term Care Open Door Forum held on June 24, 2008 had reached over participant capacity and therefore, no more callers could be entered into the conference. However, for those persons who were not able to participate on the call, an audio replay (Encore) is now available and can be accessed by dialing 1-800-642-1687 and entering conference ID 50249977. Encore service will expire after June 30, 2008.

Thank you for your interests in CMS Open Door Forums.

June 26th, 2008

CMS has issued Transmittal 438 to Provider Reimbursement Manual Part I for the purpose of updating mailing and web site addresses for the Provider Reimbursement Review Board (PRRB).  

June 24th, 2008

Transmittal 18

June 19, 2008The Medicare DMEPOS Competitive Bidding Program Begins July 1^st - Just Two Weeks Away - Are You Prepared

All Medicare Fee-For-Service (FFS) Providers: The Centers for Medicare & Medicaid Services (CMS) urges FFS providers and suppliers to understand the new Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding program. If your practice location is in one of the 10 Competitive Bidding Areas (CBA) you probably will be affected. If you are not located in a CBA, but treat Medicare patients who permanently reside in a CBA, you also need to understand the program. Be ready for July 1^st, 2008. All the information that you need to know as a DMEPOS supplier or an enrolled Medicare provider who refers beneficiaries for DMEPOS is available on the CMS DMEPOS Competitive Bidding dedicated website located at www.cms.hhs.gov/DMEPOScompetitivebid.June 19, 2008Direct Data Entry (DDE) of Part A Claims with RatesWith the most recent installation of theFiscal Intermediary Shared System (FISS) Release, providers began experiencing a problem whenentering claims that contained line item rates using the DDE System. After entering the claim with a line item rate, the system was removing the rate information and the claim would Return to Provider (RTP) back toyou with reason code 32213. The FISS maintainer has created a fix for this condition, to ensure that any rate entered remains on the claim. This fix will be installed in production on July 7, 2008. In the meantime, the maintainer has provided a workaround thatyou can utilize to eliminate seeing these claims RTP:To prevent the claim from Returning to the Provider during claim entry via DDE,you should press the enter key after charges have been keyed. This should cause the rate(s) to be retained.You may then scroll forward using the PF8 key. Please note that this workaround resolves the dropped rate issue only ifyou are manually keying claims via the DDE system. Ifyou utilize any sort of screen scraping process or are keying claims via a clearinghouse, this workaround will not apply.You will need to wait until the permanent fix is installed with the July 2008 Quarterly Release. Latest NPI Information

In an effort toensure that the data submitted to the National Plan and Provider Enumeration System (NPPES)for organizational entities is accurate, CMS initiated NPPES-IRS datamatch to ensure that the legal business name(LBN) and employer identification number(EIN) in NPPES is consistent with the IRS data.

In phase 1 of the NPPES-IRS datamatch, CMSnotified more than1,000 organizational entities withobvious invalid EIN and/or LBN's to review and update their NPI records.On June 5, 2008, the Enumerator deactivated alarge percentage of these type II NPIsin NPPES.

Next week, CMS will begin phase 2 of this project and will mail out notification letters to organization entities that have a EIN/LBN combination in NPPES thatis different than the information maintained by the IRS. CMS expects that the providers and suppliers will either update or correct their NPPES record or that the Enumerator will take the necessary steps to deactivate organizational entities who have submitted incorrect information to NPPES.Additional InformationIf your NPI has been deactivated, follow the steps below:

1. Verify your TIN (Tax Identification Number) and the LBN (legal business name) with the IRS prior to re-applying for a new NPI.
2. Submit an 855A with the IRS verified TIN and/or LBN and your new NPI.
3. Indicate on your 855A or cover letter that you are having claims processing problems related to the NPI Crosswalk. (Posted 06/09/08)

FISS Issues

The system issue referenced on the RGBA Website and in the LISTSERV message dated June 3, 2008 below has been resolved. Payments for the check date of June 4, 2008 are being mailed today. The EFT transactions for the June 4, 2008 payment were also transmitted today with an effective date of June 6, 2008.

The financial cycle for paid date of June 6, 2008 is currently in process. We will update you on the progress of this cycle as it becomes available.

Electronic remittances for the June 4, 2008 payment were distributed this morning and should be available in your mailbox today. The electronic remittance for the June 6, 2008 payment will be distributed tomorrow morning and available in your mailbox tomorrow.

We again apologize for any inconvenience this has caused.

Update:  The EDC issues have been resolved.  We will keep you posted of any further updates or changes.  6/4/2008

ALERT FOR JUNE 4, 2008

As a result of EDC system issues FISS will not be available beginning at 12:00 p.m. today.  Riverbend has been notified by the EDC that the core cycle was not completed June 3, 2008 and it is imperative that this cycle be completed.   Therefore FISS will be taken down to correct the system issues. It is expected the system will be unavailable for approximately two hours.  We will continue to keep you updated with the latest information. (Posted 6/4/2008)

Due to system issues at the Enterprise Data Center (EDC), Riverbend’s financial cycle for paid date of 6/4/08 did not complete successfully last night. Therefore, there will be a delay in the ability to view your check amount and electronic remittance advices today. We are working closely with the EDC and awaiting a resolution. We will update you as new information becomes available. We apologize for any inconvenience this may have caused.
(Posted 6/3/2008)

Timely filing issues are now being handled by the Riverbend Government Benefits Administrator Customer Service Representatives. The guidelines referenced by the customer service unit are in the Center for Medicare and Medicaid Services (CMS) regulations, Internet Only Manual (IOM), Publication 100-04, Chapter 1, Section 70.7.1-70.7.2.

Providers are no longer required to submit a request in writing for a review of claims rejected for timely filing. We are asking providers to place a call to the service unit regarding timely filing issues. (Posted 5/29/08)

Reminder that Exceptions to Therapy Caps are Restricted as of July 1, 2008.  You may view the information in its entirety at www.cms.hhs.gov/MLNMattersArticles/downloads/SE0815.pdf

May 23, 2008 Only Days Away

Need More NPI Information?

Still not sure what an NPI is and how you can get it, share it and use it?  As always, more information and education on the NPI can be found through the CMS NPI page http://www.cms.hhs.gov/NationalProvIdentStand/01_Overview.asp#TopOfPage on the CMS website.  Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203.  To view your information on the NPPES Website or to apply for an NPI on line visit https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.instructions

The Medicare Remit Easy Print brochure has been updated and is now available to order print copies or to download as a PDF file. This brochure provides an overview of free software that enables physicians and suppliers to view and print remittance information. To view the PDF file, go to http://www.cms.hhs.gov/MLNProducts/downloads/MedicareRemit_0408.pdf. Print copies may be ordered by visiting the MLN Product Ordering Page at http://cms.meridianksi.com/kc/main/kc_frame.asp?kc_ident=kc0001&loc=5 on the CMS Website. (Posted 5/22/08)

Payment for Complex Rehabilitative Power Mobility Device Services that Span the Implementation Date of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Programs in Competitive Bidding Areas

CMS will be issuing instructions in the near future about a one-time DMEPOS competitive bidding transition policy for suppliers of purchased Group 3 single or multiple power option power mobility devices (PMDs) furnished to beneficiaries in competitive bidding areas (CBAs). In specific cases described below, suppliers who, prior to July 1, 2008, begin furnishing services related to providing these devices, but do not deliver the final PMD product until July 1, 2008, or later will be paid based on the 2008 fee schedule amounts for furnishing these PMDs to beneficiaries residing in Round One CBAs. This transition policy applies to both contract and noncontract suppliers.The HCPCS codes subject to the transition policy include PMD codes K0856 thru K0864 and related accessories provided at the time the PMD is delivered to a beneficiary who resides in a Round One CBA. The specific claims subject to the transition policy are items that are delivered for use in the beneficiary’s home on or after July 1, 2008, for which the supplier has:· A signed order from the physician that is dated between April 1, 2008 and May 31, 2008; and· Documentation that the face-to-face beneficiary examination by the physician that is necessary to determine medical necessity for the PMD occurred before July 1, 2008.This documentation should be maintained by the supplier, but does not need to be submitted at the time the claim for the PMD is submitted. However, it should be made available upon request.Suppliers should use the date of the physician order as the date of service on the claim (other than this limited, one-time exception, suppliers should be aware that the date of service that is recorded on a DMEPOS claim is the date that the item is delivered). In addition, suppliers should include on the claim for the PMD all accessories provided with the PMD and should use the same date of service used for the PMD for these items. Suppliers should report the date the PMD and related accessories were delivered for use in the beneficiary’s home in the narrative section of the claim. (Posted 5/22/08)

On February 2, 2007, CMS published a notice of intent with comment regarding a new occupational mix survey (72 FR 5055). This new survey is the 2007-2008 Medicare Occupational Mix Survey (Form CMS-10079 (2008)). The final notice with comments was published on September 14, 2007 (72 FR 52568). The 2007-2008 survey provides for the collection of hospital-specific wages and hours data for a 1-year prospective reporting period (that is, from July 1, 2007 through June 30, 2008), additional clarifications to the survey instructions, the elimination of the RN subcategories, some refinements to the definitions for the occupational categories, and the inclusion of additional cost centers that typically provide nursing services. The survey and supporting documentation can be accessed through CMSs web site at: http://www.cms.hhs.gov/PaperWorkReductionActof1995 .  You may view Change Request 5992 in its entirety:  http://www.cms.hhs.gov/transmittals/downloads/R339OTN.pdf

The April 2008 version of theSole CommunityHospital Fact Sheet, which provides information about Sole Community Hospital classification and payments,is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network athttp://www.cms.hhs.gov/MLNProducts/downloads/2007sch.pdf. If this url does not take you directly to thefact sheet, please cut and paste it into your browser. (Posted 5/22/08)Revised ACCREDITATION Deadlines FOR DMEPOS Competitive Bidding!

In order to participate in the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program, suppliers must meet quality standards and be accredited by a CMS-approved Deemed Accreditation Organization. Suppliers that are interested in bidding in the second round of the program must be aware of changes to two key deadlines:

Suppliers must be accredited or have applied for accreditation by July 21, 2008 (change from May 14, 2008) to submit a bid for the second round of competitive bidding. CMS cannot accept a bid from any supplier that is not accredited or that has not applied for accreditation by July 21, 2008.

Suppliers will need to be accredited to be awarded a contract. The accreditation deadline for the second round of competitive bidding is January 14, 2009 (change from October 31, 2008). Suppliers must be accredited before this date to be awarded a contract. Suppliers should apply for accreditation immediately to allow adequate time to process their applications.

CMS has extended these deadlines because a significant number of suppliers in the 70 metropolitan statistical areas (MSAs) included in Round Two of the DMEPOS Competitive Bidding Program have not yet applied for accreditation. Suppliers in these MSAs that do not meet these accreditation deadlines cannot become DMEPOS competitive bidding contract suppliers and will therefore be unable to furnish competitively bid items to any beneficiary residing in any part of the competitive bidding area during the contract period.

Suppliers can determine if they are serving beneficiaries in a Round 2 MSA by visiting the following web site: http://www.census.gov/population/www/estimates/metrodef.html

and looking up their MSAs in the section called “counties with metropolitan and micropolitan statistical area codes.� (In this file, MSAs are called CBSAs.) For example, the Los Angeles-Long Beach-Santa Ana, CA MSA is comprised of two counties: Los Angeles and Orange.

We urge all suppliers serving Medicare beneficiaries in the 70 Round Two MSAs to apply for accreditation now.

For a list of the CMS-approved Deemed Accreditation Organizations, visit http://www.cms.hhs.gov/MedicareProviderSupEnroll/01_Overview.asp. For information about the Medicare DMEPOS Competitive Bidding program, visit http://www.cms.hhs.gov/DMEPOSCompetitiveBid/ .

MEDICARE ANNOUNCES THE CONTRACT SUPPLIERS FOR THE FIRST ROUND OF THE MEDICARE DMEPOS COMPETITIVE BIDDING PROGRAM

The Centers for Medicare & Medicaid Services (CMS) has announced the contract suppliers for the first round of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program.  The competitive bidding program will offer beneficiaries in the designated competitive bidding areas (CBAs) access to quality DMEPOS products and services with lower out-of-pocket costs. 

A total of 325 suppliers receiving 1,345 contracts were selected for the ten Round 1 communities. To participate in the program, suppliers were required to meet Medicare's financial and quality standards.  In addition, suppliers had to be accredited by one of CMS' approved accrediting organizations to be eligible to receive a contract.

To take advantage of the savings available under the program, people with Medicare living in one of the CBAs will need to choose a new supplier if their current supplier is not a contract supplier or a supplier who may be allowed to offer items and supplies as a grandfathered supplier.  Grandfathered suppliers are those who chose to continue to provide certain rented durable medical equipment, oxygen and oxygen equipment for existing clients.   

As a Medicare provider, CMS has many educational and informational resources available to assist you in your role as a DMEPOS supplier or referral agent.  All of these resources, including the single payment amounts, links to both provider and beneficiary educational materials, and the most current news and announcements regarding the program, can be accessed through our DMEPOS Competitive Bidding web page at www.cms.hhs.gov/DMEPOSCompetitiveBid/ .   (Posted 5/22/08) 

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 third 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 Wednesday, May 28, 2008.

This call will provide an overview of the alternative reporting periods and alternative criteria for satisfactorily reporting quality measures for the 2008 PQRI as authorized by the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) (P.L. 110-173) which was enacted on December 29, 2007.

MMSEA requires that for 2008 and 2009 the Secretary establish alternative reporting periods and alternative criteria for satisfactorily reporting groups of measures. It also requires that for 2008 and 2009 the Secretary establish alternative reporting periods and alternative criteria for satisfactorily reporting quality measures data through registries.

In 2008, eligible professionals may earn an incentive payment of 1.5 percent of their total allowed charges for Physician Fee Service covered professional services furnished during the respective alternative reporting periods based on data submitted via these mechanisms. While TRHCA established a cap on incentive payments for 2007, based on an average per measure payment amount, there is no cap on incentive payments under MMSEA for 2008 and 2009.

These provisions provide increased opportunities for eligible professionals to report PQRI quality measures and the possibility to earn incentive payments for satisfactory reporting.

A PowerPoint slide presentation will be posted to the PQRI webpage at, http://www.cms.hhs.gov/PQRI/30_EducationalResources.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, Dr. Daniel Green and Rachel Nelson.

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

Conference call details:
Date: May 28, 2008
Conference Title: 2008 Physician Quality Reporting Initiative National Provider Call
Time: 3:30 p.m. -5:00 p.m. 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 May 27, 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/052808

1. Fill in all required data.
2. Verify your time zone is displayed correctly the drop down box.
3. Click "Register". 
4. 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 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 5/28/2008 until 11:59 p.m. EDT 6/5/2008. The call-in data for the replay is (800) 642-1687 and the passcode is 46870023.

If you require services for the hearing impaired please send an email to Medicare.TTT@PalmettoGBA.com. (Posted 5/22/08)
 

ESRD Drug HCPCS

Date: May 27, 2008
Conference Title: Medicare DMEPOS Competitive Bidding Program Q&A session Time: 1:00-2:30 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 1:00 p.m. EDT on May 26, 2008, or when available space has been filled.  No exceptions will be made, so please be sure to register prior to this time.

1. To register for the call participants need to go to: http://www2.eventsvc.com/palmettogba/052908
2. Fill in all required data.  
3. Click "Register".
4. You will be taken to the “Thank you for registeringâ€� 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.

National Provider Conference Call with Question & Answer Session The Centers for Medicare & Medicaid Services (CMS) Provider Communications Group will host the third 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 Wednesday, May 28, 2008.
This call will provide an overview of the  alternative reporting periods and alternative criteria for satisfactorily reporting quality measures for the 2008 PQRI as authorized by the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) (P.L. 110-173) which was enacted on December 29, 2007.
 
MMSEA requires that for 2008 and 2009 the Secretary establish alternative reporting periods and alternative criteria for satisfactorily reporting groups of measures.  It also requires that for 2008 and 2009 the Secretary establish alternative reporting periods and alternative criteria for satisfactorily reporting quality measures data through registries.

In 2008, eligible professionals may earn an incentive payment of 1.5 percent of their total allowed charges for Physician Fee Service covered professional services furnished during the respective alternative reporting periods based on data submitted via these mechanisms.  While TRHCA established a cap on incentive payments for 2007, based on an average per measure payment amount, there is no cap on incentive payments under MMSEA for 2008 and 2009.

These provisions provide increased opportunities for eligible professionals to report PQRI quality measures and the possibility to earn incentive payments for satisfactory reporting.

A PowerPoint slide presentation will be posted to the PQRI webpage at, http://www.cms.hhs.gov/PQRI/30_EducationalResources.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, Dr. Daniel Green and Rachel Nelson.

Following the presentation, callers will have an opportunity to ask questions of CMS subject matter experts.
Conference call details:
Date: May 28, 2008
Conference Title: 2008 Physician Quality Reporting Initiative National Provider Call
Time: 3:30 p.m. -5:00 p.m. 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 May 27, 2008, or when available space has been filled.  No exceptions will be made, so please be sure to register prior to this time.

1. To register for the call participants need to go to: http://www2.eventsvc.com/palmettogba/052808
   
2. Fill in all required data.
   
3. Verify your time zone is displayed correctly the drop down box. Click "Register".
   

NPI News for Medicare FFS Providers

NPIs for Secondary ProvidersIf the entity that is required to be identified in the secondary provider field (i.e., the ordering/referring/attending/operating/supervising/purchased service/other/service facility provider or prescriber) does not furnish an NPI, the billing provider must attempt to obtain that NPI in order to enter it on the claim.  The billing provider may use the NPI Registry () to obtain the secondary provider NPI or it may need to directly contact the ordering/referring/attending/operating/supervising/purchased service/other/service facility or prescriber in order to obtain the NPI.

If the billing provider has exhausted all possibilities of finding the NPI of the ordering/referring/attending/operating/supervising/purchased service/other or prescriber, Medicare FFS is permitting the billing provider (in the X12N 837 transactions) or the service provider (in the NCPDP 5.1 transaction) to use their own NPI as the identifier for those secondary providers.  Medicare will reject claims if Medicare policy requires a secondary identifier and there is no NPI present.

For service facility location loop, if the billing provider is still unable to obtain the NPI of the entity, no identifier should be reported in that loop.  New FAQ Available Regarding Use of an NPI in the Prescriber ID field on NCPDP Transactions View this FAQ at on the CMS website.  Transcript for April 17th NPI Roundtable Now AvailableView the transcript at on the CMS website.  CMS will Host NPI National Roundtable Q&A Session on May 19, 2008CMS will host a national NPI Roundtable Q&A session to address questions from the Medicare provider community prior to May 23rd.  This Roundtable will be on May 19th from 2-3:30PM EDT.    

Questions will not be collected during the registration process for this call.  There will be no presentations during this call; we will open the lines to take questions following a brief introduction. For registration details, visit on the CMS website. (Posted 5/14/2008)

Change Request 5978: Installment 1 of New Chapter in Medicare Internet Only Manual for DMEPOS Competitive Bidding Program

The Centers for Medicare & Medicaid Services (CMS) has published the first of several installments by adding a new chapter 36 to the existing Medicare Claims Processing Manual (Pub. 100-04) which provides instructions for Medicare contractors for the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program. This first installment contains instructions regarding the overall policy of the Medicare DMEPOS Competitive Bidding Program including, but not limited to, policy on grandfathered suppliers and items, and transfer of title of capped rental DME items, oxygen and oxygen equipment. Suppliers should be aware of the notification requirement to its Medicare customers who maintain a permanent residence in competitive bidding areas (CBAs) and are furnished grandfathered items. To view sample notification letters that suppliers may use to notify Medicare beneficiaries of whether or not they elect to become a grandfathered supplier, please visit the CBIC website at: http://www.dmecompetitivebid.com/ Posted 5/12/2008

Subsequent installments of this chapter on the Medicare DMEPOS Competitive Bidding Program will contain additional instructions and information about the program. In addition, the instructions within this first installment may be revised in subsequent installments in order to clarify language or add additional information on policy.

To view the first installment of Chapter 36 of the Claims Processing Manual entitled, “Competitive Bidding Program for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)� (Change Request 5978), please visit the CMS website at: http://www.cms.hhs.gov/transmittals/downloads/R1502CP.pdf

New DMEPOS Competitive Bidding Web Page Re-Design

CMS announces the release of its newly redesigned web page on the DMEPOS Competitive Bidding Program. This dedicated web page provides the most current and reliable information for Medicare providers, suppliers and referral agents. The web address is: http://www.cms.hhs.gov/DMEPOSCompetitiveBid. Bookmark this NEW page as new information and resources will continue to be posted.

Transmittal 437CMS has issued Transmittal 437 to the Provider Reimbursement Manual Part I for the purpose of updating the calendar year inflation factors for previous years' reasonable compensation ranges. The factor for CY 2007 has been added and the factor for CY 1997 has been deleted.

New Jersey Providers

Highmark Medicare Services plans to fulfill CMS' requirement to consolidate LCDs by the first segment cutover, which is July 11, 2008 for the MD/DCMA/DE Part B workloads. These consolidated LCDs, as well as any claim processing edits, will be effective for all of the other states when that locale cuts over to J12 MAC. CMS has not finalized the implementation schedule for these other locales, but once finalized, Highmark Medicare Services will publish those cutover dates. Until each locale's cutover date, any and all current legacy contractor LCDs and applicable claim processing edits remain in effect. (posted 4/30/08)

NPPES & NPI Registry will be Unavailable on April 21st due to Implementation of Enhancements/Upgrades to the System

On April 21, 2008, the National Plan and Provider Enumeration System (NPPES) will undergo system maintenance during the day. Neither NPPES nor the NPI Registry will be available on April 21, 2008. CMS will be implementing several enhancements/updates to the system.For more information, view (http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/NPPES-Enhancements.pdf) on the CMS website.(Posted 4/19/2008)
 

FISS Financial Cycle Payments

Riverbend has identified and reported a system issue that has resulted ina blankpayment field for the financial cycle payment run date of April 9, 2008. The issue has been reported to the data center and we will continue to keep our provider community updated. (Posted 4/08/2008)

Consolidated Provider Profile Report and the OBRA Hold Report

Riverbend would like remind providers as a result of the EDC transition providers no longer receive the Consolidated Provider Profile Report and the OBRA Hold Report. You mayretrieve your OBRA Hold Report through Direct Data Entry (DDE). These claims can be accessed by going into Inquiry, select Option 12, "Claims". After the screen appears, tab to the "S/LOC" field and key in PB9996. This is the location that houses all claims in the OBRA Hold Location. You may also select 01 Inquires and select claim count summary 56 and the status location for the OBRA Hold is PB9996. (03/26/2008)

VERIFY YOUR NPI DATA IN PECOS

If you are experiencing claims problems due to NPI/legacy mismatches, Riverbend Government Benefits Administrator can now provide a copy of your PECOS Enrollment Record Data (ERD).This report may assist organizational entities that have an established PECOS enrollment record in verifying the NPI/legacy number match(es) maintained by Medicare.

To request an ERD report, please provide the following information on company letterhead:

• Provider’s legal business name Doing business as name, if applicable
• Medicare PTAN
• Signature of authorized official
• Signature of delegated official, if applicable
• Fax number for the authorized or delegated official
• Email address of the requestor (You will be notified via email if an ERD report is not available for your facility.)

These reports will only be faxed to the authorized or delegated official who requests the ERD report.ERD reports will not be sent to clearinghouses, third-party billing agents, chain home office or any individual or organization not previously identified as an authorized or delegated official.

You may submit your request via fax to (423) 535-1530 or in writing to:

Riverbend Government Benefits Administrator
ATTN: Provider Enrollment Unit-ERD Report
730 Chestnut Street
Chattanooga, TN 37402

The Medicare Appeals Process: Five Levels to Protect Providers, Physicians and Other Suppliers brochure has been updated and is now available to order print copies or as a downloadable PDF file. To view the PDF file, go to http://www.cms.hhs.gov/MLNProducts/downloads/MedicareAppealsProcess.pdfor to order hard copies, please visit the MLN Product Ordering Page at http://cms.meridianksi.com/kc/main/kc_frame.asp?kc_ident=kc0001&loc=5on the CMS website.Change Request 5647 regarding Medicare Advantage Beneficiaries (posted 3/5/08)

CR5647

Capturing Days on Which Medicare Beneficiaries are Entitled to Medicare Advantage (MA) in the Medicare/Supplemental Security Income (SSI) Fraction

In our continuing effort to keep our providers updated Riverbend issued information regarding Medi 3100-08. This article was based on Change Request (CR) 5647, which states that, as of January 7, 2008, hospitals (this includes acute care hospitals paid under the inpatient prospective payment system), inpatient rehabilitation facilities (IRF), and long term care hospitals (LTCH)) must begin to submit "no pay" bills to their Medicare contractor for stays by Medicare Advantage (MA) beneficiaries. This will allow for the days of those stays to be eventually captured in the DSH (or low income patient (LIP) for IRF) calculations. As of February 27, 2008 these claims are processing correctly. However, please note that as result of the previous issue beneficiaries may receive an MSN stating; “Our records show that you are enrolled in a health maintenance organization. Your provider must bill this service to them�. If you receive calls or questions from beneficiaries for this issue you should advise them to disregard the information. (02/28/2008)

Timely Processing of Mammography Claims

Some facilities that receive certification from the American College of Radiology (ACR) are submitting claims formammography services the following day after certification, which is before the systems are capable of being updated with new certification data.Riverbend would like tosuggest that providers hold their mammography claims for seven (7) business days to allow for any changes in certification data to be uploaded accordingly. After the (7) seven business day hold, providers may submit their claims for payment.

January 2008 FISS Claims Issue

Riverbend has identified an issue with claims that were submitted between December 31, 2007 and January 3, 2008. Per CMS these claims were being held until the installation of the quarterly FISS release which occurred January 6, 2008. There were changes in the quarterly release that impacted the processing of these claims. Riverbendbegan restarting the return to provider (RTP’d) claims as ofMonday, January 07, 2008. There is no provider action required for this issue. We will continue to keep providers updated.

Transmittal 434 to the Provider Reimbursement Manual Part 1 (12/27/2007)
On December 21, 2007, CMS issued Transmittal 434( ) to the Provider Reimbursement Manual Part 1. The purpose of this Transmittal is to update the Medicare Payment Rates for routine SNF-type services by swing-bed hospitals during calendar year 2008. These rates shouild be used to carve out swing-bed costs on the hospital cost report.

Important information from CMS regarding NPI procedures

This memorandum is to clarify the type of assistance that the NPI Enumerator can and cannot provide to health care providers. The NPI Enumerator is responsible for assisting providers in applying and updating their NPI information in the National Plan and Provider Enumeration System (NPPES).

Health care providers SHOULDcontact the NPI Enumerator for the following issues:

• Status of NPI applications, updates, or deactivations;
• Forgotten/lost NPIs;
• Lost NPI Notifications;
• Trouble accessing NPPES;
• Forgotten passwords/User IDs;
• Paper application requests; and
• Assistance in completing the NPI application/update form (web-based or paper).

Health care providers needing the above types of assistance may contact the NPI Enumerator at 1-800-465-3203, TTY 1-800-692-2326 or email the request to the NPI Enumerator at CustomerService@NPIEnumerator.com.

Providers should be familiar with the information available on the CMS NPI web page at:http://www.cms.hhs.gov/NationalProvIdentStand/, including the NPI Frequently Asked Questions and the NPI Application/Update form for assistance with questions for which the NPI Enumerator is not responsible.Providers can also refer to the“Application Help� tab located on the NPPES website (https://nppes.cms.hhs.gov). (12/21/2007)

Transmittal 23

CMS has issued Transmittal 23 to the Provider Reimbursement Manual Part 2, Chapter 1. This Transmittal updates Chapter 1 to reflect further clarification to existing instructions, and incorporates specific instructions regarding the electronic filing of some additional cost reports. This Transmittal applies to all provider types and should be read by all providers.Please contact David Arendale at (423) 535-5662 with any questions.

9-Digit ZIP Code ListOctober 22, 2007 with CR 5208 Medicare requires the submission of 9-digit ZIP codes for services. CR 5730 adds revisions to the list.

Medicare Geographic Classification Applications for FFY 2009

Prospective payment system (PPS) hospitals may apply to the Medicare Geographic Classification Review Board (MGCRB or Board) to be reclassified to another area for the purposes of using the wage index value. To be reclassified, they must meet certain criteria found at 42 C.F.R. Section 412.230ff. PPS hospitals must also complete the application required by the MGCRB and, for reclassifications effective Federal Fiscal Year (FFY) 2009, file it with the Board by 5:00pm, EDT, September 4, 2007.

This is to advise you that individual and group instructions and applications for FFY 2009 are now available. PPS hospitals may obtain them from the Internet at http://cms.hhs.gov/MGCRB/02_instructions_and_applications.asp. PPS hospitals may also obtain the application and instructions by contacting Terry Rivers at (423) 535-3223.

Hospitals needing further information may call the Board’s office at 410.786.1174.

Claims Imaging

As of August 1, 2007, Riverbend began imaging all Additional Documentation Requests (ADRs) and medical records submitted to Medical Review.

This process will impact providers not currently following the guidelines for the submission of requested medical records.

It is now more important than ever to ensure all medical records sent to Riverbend are sent appropriately.The Additional Documentation Request (ADR) should be attached to the top of the requested records. Each set of records must be separately identifiable by the person responsible for imaging the records. In the past, when requested medical records were sent un-stapled, a mail associate would match the ADR to the records as a courtesy to the provider. The department imaging the medical records will not make determinations of which records go with each ADR. Every piece of paper attached to the ADR will be scanned as one record.

When sending more than one ADR to Riverbend in the same envelope, make sure each set of records are separately and securely attached to the corresponding ADR.

Tips for correctly sending requested medical records can be found on our Web site at www.rgbagov.comunder the Provider tab and then the Medical Review section.

Provider Statistical and Reimbursement System

The PS&R is currently being redesigned and the new system will soon be available. The Redesigned PS&R System will be utilized for all cost reports with fiscal years ending February 28, 2007, and later. These cost reports will be both filed and settled using the redesigned PS&R. Cost reports with fiscal years ending prior to February 28, 2007, will continue to be filed and settled utilizing the current (Legacy) PS&R system. As a result of this transition, the Legacy PS&R system will not produce reports containing dates of service after February 27, 2007. PS&R reports with a through date of February 28, 2007, and later must be produced by the Redesigned PS&R system.
Due to this conversion to the Redesigned PS&R, there will be a short time period where we will be unable to produce interim PS&R reports. Interim PS&R reports are not a requirement and the inability to produce these reports will be temporary. This will not have any impact on cost report submissions. The Redesigned PS&R system will be available in time to produce reports for providers with fiscal years ending February 28, 2007 and later.? (JSM/TDL-7270, 2-27-07)

All users of the secure website please note that for paid dates on or after February 28, 2007 no report will be generated. Reports will only be generated for paid through dates of February 27, 2007. We will keep you posted as we learn more about the Redesigned PS&R.

Instructions Regarding DMEPOS Cometitive Bidding Program

The Medicare Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program Final Regulation is now published at the Federal Registeron theCompetitive Biddingpage. CMS has also announced the first 10 metropolitan areas in which competition will occur, as well as the first items to be competitively bid. Visit the CMS website at www.cms.hhs.gov/CompetitiveAcqforDMEPOS/ to view the rule and for additional information. (Posted 04/30/07)

Announcement Regarding Part B Paid Claims that Overlap Non-pay SNF Claims

As was discussed at the March 28, 2007 Skilled Nursing Facility-Long Term Care Open Door Forum, Part B paid claims that overlap non-pay SNF claims are rejecting in error. On April 27, 2007 CMS released a change request that addresses the situation: Change Request Number 5587, Transmittal Number R274OTN, Invalid Skilled Nursing Facility (SNF) Information Unsolicited Responses (IURs) from CWF. This CR can be found at the CMS website 2007 Transmittals page: www.cms.hhs.gov/Transmittals/2007Trans/list.asp?sortByDID=2a&filterType=none&filterByDID=-99&sortOrder=ascending&intNumPerPage=10&submit.x=7&submit.y=14.
CMS has commissioned the CWF maintainer to create a program that will automatically identify the Part B claims that were erroneously rejected for the FIs, Part A MACs, MCS carriers, and DME MACs. The FISS maintainer has created an additional utility that will automatically adjust the Part B claims and reinstate the payment that was erroneously recouped. The FIs will be utilizing this program during the weekend of May 26th and 27th. The applicable providers will be able to view the corrected claims during the week of May 28th through June 1st and should expect payment shortly thereafter. Regarding the Part B MCS carriers and DME MACs, these contractors will be manually adjusting these claims now that CR 5587 has been released. The applicable providers will begin seeing these claims online and should expect to receive payment immediately thereafter. Part B providers are encouraged to allow the Medicare contractors to reprocess these claims and to not resubmit or adjust them in the meantime. If there are any questions or concerns relating to the timeframes in which these claims will be reprocessed, please contact the appropriate FI, carrier, or DME MAC. (Posted 05/02/07)

New Contractor Workload Number for Cahaba Part A Iowa Data

The purpose of this change request is to notify all interested parties that the Centers for Medicare & Medicaid Services (CMS) has a need to assign a new contractor workload number for the Cahaba Part A Iowa workload. This change is a result of a scheduling conflict in the HIGLAS and MAC implementations as they relate to the Cahaba Part A Iowa workload. Therefore, the CMS has decided to create a separate contractor workload number for the Cahaba Iowa Part A workload and separate the Cahaba RHHI and Iowa Part A workloads into separate CICS regions in the data center. To review this Change Request in its entirety click on the title of this announcement. (Posted 5/3/07)

National Provider Indentifier

Effective May 29, 2007, Riverbend GBA Part A will begin editing the NPI/legacy ID combinations for validity against the NPI crosswalk file. Where a match cannot be located on the crosswalk, claims will be returned to the provider or rejected . When the claim is returned, verify that the correct NPI was submitted. If correct, you will need to verify that your legacy identifier (OSCAR/PIN) number corresponds with the NPI on file with National Plan and Provider Enumeration System (NPPES). NPPES may be contacted online at nppes.cms.hhs.gov. More information and education on the NPI may be found at the CMS NPI page, www.cms.hhs.gov/NationalProvIdentStand", on the CMS website. Providers can apply for an NPI online at nppes.cms.hhs.gov. If your NPPES information is correct and you have included ALL Medicare legacy identifiers (OSCAR) in NPPES, but you are experiencing problems with your claims that contain a valid NPI, you may need to submit a Medicare enrollment application (i.e., the CMS-855). (Posted 5/7/07)

Change of Address for Mailing Checks

Riverbend Government Benefits Administrator (RGBA) has changed the process for receiving checks from all Medicare participating providers. Effective May 31, 2007, all checks mailed to RGBA for payment of a Medicare overpayment must be mailed to the following address:
Riverbend GBA, Inc.
PO Box 1000, Dept. 831
Memphis, TN 38148-0831

Physician Quality Reporting Initiative (PQRI) Letter to Medicare Beneficiaries

The Centers for Medicare & Medicaid Services has posted a letter to Medicare beneficiaries with important information about the Physician Quality Reporting Initiative (PQRI) at, www.cms.hhs.gov/PQRI on the CMS website. The letter is from Medicare to the patient explaining what the program is, and the implications for the patient. Physicians may choose to provide a copy to their patients in support of their PQRI participation. To access the letter, visit, www.cms.hhs.gov/PQRI

Additional Guidance for the CMS 855

CMS has released instructions that submission of CMS-855 changes containing only the NPI and legacy numbers must be accompanied by some sort of statement as to whether the provider is experiencing claims processing difficulties. In some cases, it may be necessary for the provider to submit a complete CMS 855. If you are experiencing claims processing difficulties, please contact the Customer Service Line at 1-888-829-8126 to determine if a full CMS 855 is needed. (Posted 7/11/07)

MCPSS - Partners in Satisfaction

RGBA would like to thank those providers who participated in the 2007 Medicare Provider Satisfaction Survey (MCPSS) conducted last spring. The MCPSS is an excellent tool for determining the importance of services we provide. RGBA has recently received its results and is dedicated to addressing concerns expressed by our providers. Your feedback is being used to identify our opportunities for improvement and benchmarking our performance. Public release of the 2007 MCPSS is scheduled late July/early August. To learn more about the MCPSS, visit CMS' website at www.cms.hhs.gov/MCPSSor visit www.MCPSStudy.org

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 4:00 p.m. EDT 5/27/2008 until 11:59 p.m. EDT 6/4/2008.  The call in data for the replay is (800) 642-1687 and the passcode is 47261135. 2008 Physician Quality Reporting Initiative (PQRI)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 4:00 p.m. EDT 5/27/2008 until 11:59 p.m. EDT 6/4/2008.  The call in data for the replay is (800) 642-1687 and the passcode is 47261135. 2008 Physician Quality Reporting Initiative (PQRI)