CMS End-Stage-Renal-Disease (ESRD) Network External Stakeholder Meetings

The Centers for Medicare & Medicaid Services (CMS) will be hosting a series of End-Stage-Renal-Disease Stakeholder Meetings to discuss the End-Stage-Renal-Disease (ESRD) Network (NW) Program.

HHS Proposes Adoption of ICD-10 Code Sets and Updated Electronic Transaction Standards - Proposed Changes Would Improve Disease Tracking and Speed Transition to an Electronic Health Care Environment

The Department of Health and Human Services (HHS) announced Friday a long-awaited proposed regulation that would replace the ICD-9-CM code sets now used to report health care diagnoses and procedures with greatly expanded ICD-10 code sets, effective October 1, 2011.

LOWER MEDICARE PART D COSTS THAN EXPECTED IN 2009 - Beneficiary Satisfaction Remains High

The Centers for Medicare & Medicare Services (CMS) recently announced that as Medicare’s Part D prescription drug program enters its fourth year, beneficiary satisfaction rates remain high, program costs remain lower than originally expected and Medicare prescription drug plan bids reflect nationwide drug price trends.

In addition to average premiums for 2009, CMS has announced: the 2009 national average monthly bid; the base beneficiary premium; the regional low-income subsidy premium amounts for 2009; and the 2009 Medicare Advantage regional preferred provider organization benchmarks. To view this information visit here.

Pricer Updates

The provider data distributed with the IPF PPS PC Pricer has been updated as of July 2008. Download the latest version posted 08/12/2008.

Due to receiving updated quarterly provider data, the SNF PPS PC Pricer has been revised. Download the latest version posted 08/11/2008.

SNF Claims Receiving Reason Code 38305

Skilled Nursing Facilities are receiving reason code 38305 when trying to submit claims for their patients that have gone from skilled care to non-skilled and then back to skilled care, often within the same month. We are working diligently to get this problem resolved as quickly as possible.

Attention PC-ACE Customers: New PC-ACE Pro32 Version 1.94 Upgrade Available via Internet Download - UPGRADE NOW!

PC-ACE Pro32 is a software program that enables electronic billing for both Medicare Part A and Part B claims in a HIPAA-compliant format. To provide the most up-to-date information within PC-ACE Pro32, the software program is updated quarterly. The most current upgrade, which is PC-ACE Pro32 version 1.94, was released on July 31, 2008. The Centers for Medicare & Medicaid Services (CMS) require you to upgrade your software program within 90 day of availability, so please take time now to upgrade immediately.

To streamline the distribution process for software program upgrades, the PC-ACE Pro32 software program is available via an internet download from our website. This internet download is available free of charge for all new and existing PC-ACE Pro32 customers. Download instructions were mailed to existing PC-ACE Pro32 customers on the release date. As of September 5, 2006, there is a quarterly $25 shipping and handling fee for all PC-ACE Pro32 requests via CD-ROM. This fee will be billed at $100 annually, covering the initial shipping and handling of the CD-ROM and the shipping and handling for any additional upgrades issued within the next year. To save time and money for you and the Medicare program, we strongly encourage you to download this program when enrolling or upgrading.

View the PC-ACE Pro32 Release Newsletter.

If you would like more information about PC-ACE Pro32 or would like to enroll to begin using this software program, please visit our EDI technical page.

If you have questions or require additional assistance, please contact an EDI Analyst at: 1-866-488-0546. Please take time now to upgrade immediately.

Evaluation & Management Services Guide

The July 2008 version of the Evaluation & Management Services Guide, which provides evaluation and management services information about medical record documentation, International Classification of Diseases and Current Procedural Terminology codes, and key elements of service, is now available on the Centers for Medicare & Medicaid Services Medicare Learning Network - click link above.

Nationwide Network of Contractors to Work with Providers to Improve Quality and Safety of Health Care for Medicare Beneficiaries

The Centers for Medicare & Medicaid Services (CMS) has awarded contracts for the 9th Statement of Work (SOW) for the 53 contractors participating in Medicare's Quality Improvement Organization (QIO) Program.

For more information, please visit here.

Special CMS Listening Session on Electronic Prescribing - August 13, 2008; 3:30 - 4:30 (Eastern Time) 2:30 - 3:30 (Central Time)

The Centers for Medicare & Medicaid Services (CMS), Region V, Chicago will host a special listening session to hear your perspective and obtain your input on the new electronic prescribing provisions set forth in the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).

Section 132 of MIPPA authorizes the Secretary for Health and Human Services to provide incentive payments from 2009 through 2013 to successful electronic prescribers. As described in Section 132, successful electronic prescribers are based on either the reporting of applicable electronic prescribing measures established under the Physician Quality Reporting Initiative (PQRI) or through the use of Part D data.

CMS is planning a two day conference to explain the new electronic prescribing incentives. We will provide further details about the conference on this call. In addition, we want to get your perspective on current topics of interest related to electronic prescribing and discuss some of the more pragmatic issues and challenges to adoption.

Call-information for this week’s audio conference will be distributed via email prior to the call. We look forward to your participation.

Public and private-sector organizations considering becoming co-sponsors for the two day conference with CMS can access the notice in the Federal Register -  here. 

To submit questions or comments prior to or after the Special CMS Listening Session on electronic prescribing, you may send them to: jorge.nevarez@cms.hhs.gov 

Now Available from the Medicare Learning Network

• The April 2008 version of the Rural Health Clinic Fact Sheet, to place your order, click link above, scroll down to "Related Links Inside CMS" and select "MLN Product Ordering Page."  
• The Physician’s Guide to Medicare Coverage of Kidney Dialysis and Kidney Transplant Services booklet, to download your copy, click link above, scroll down to "MLN Publications" and search for the booklet title.
• MEDICARE PILOT PROGRAM WILL OFFER BENEFICIARIES CHOICES FOR MAINTAINING THEIR OWN PERSONAL HEALTH RECORDS.  The Centers for Medicare & Medicaid Services (CMS) today announced a pilot program to test options for beneficiaries with Original Medicare to maintain their health records electronically.  Click here for more information.
• Release of Out-of-Pocket Limits for Medigap Plans K & L for Calendar Year 2009 - CMS released the 2009 out-of-pocket (OOP) limits for Medigap plans K & L; the limits are $4,620 and $2,310, respectively.

Skilled Nursing Facility (SNF) Consolidated Billing (CB) - Lunch and Learn - August 14, 2008

Please note that the "Handouts" are now available for the Skilled Nursing Facility (SNF) Consolidated Billing (CB) Lunch and Learn on August 14, 2008.

MLN Matters Articles from CMS

New:

MM6002 – Clarification on the Correct Condition Code to Report on Provider Adjustment Requests to Indicate a Health Insurance Prospective Payment System (HIPPS) Code Change 

MM6006 – New Hemophilia Clotting Factor and HCPCS Code 

MM6107 – Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) 

MM6132 – Requirement to Educate Providers Regarding Centers for Medicare & Medicaid Services (CMS) Use of Medicare Cost Report Data

MM6155 – Update to Hospice Payment Rates, Hospice Cap, Hospice Wage Index, and the Hospice Pricer for FY 2009 

MM6145 – Screening DNA Stool Test for Colorectal Cancer 

MM6036 – Revisions to the Chapter 14 of the Medicare Program Integrity Manual 

MM6138 – Prothrombin Time (PT/INR) Monitoring for Home Anticoagulation Management 

MM6007 – Manual Revisions to Reflect Special Billing Instructions for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items as a Result of the DMEPOS Competitive Bidding Program

MM6048 – Continuous Positive Airway Pressure (CPAP) Therapy for Obstructive Sleep Apnea (OSA) 

SE0747 – Individuals Authorized Access to CMS Computer Services (IACS)- Provider/Supplier Community (IACS-PC): THE FIRST IN A SERIES OF ARTICLES

SE0753 – Individuals Authorized Access to CMS Computer Services – Provider/Supplier Community (IACS-PC): THE SECOND IN A SERIES OF ARTICLES ON THE IACS 

SE0754 – Individuals Authorized Access to CMS Computer Services – Provider/Supplier Community (IACS-PC): THE THIRD IN A SERIES OF ARTICLES ON THE IACS-PC 

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

The Centers for Medicare & Medicaid Services (CMS) today 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.

Summer 2008 edition of “The Pulse of CMS” Provider Newsletter

The CMS Philadelphia Regional Office editorial board is proud to share with our provider partners the Summer 2008 edition of "The Pulse of CMS" provider newsletter. This edition features articles regarding the passage of the new MIPPA legislation, the nursing home quality rating system, new bene protections in Part D, among many more topics. The next edition of "The Pulse" will be published in October.

Medicare Guide to Rural Health Services Information for Providers, Suppliers, and Physicians (April 2008)

The CD-ROM version of the revised Medicare Guide to Rural Health Services Information for Providers, Suppliers, and Physicians (April 2008) is now available from the Centers for Medicare & Medicaid Services Medicare Learning Network. This guide contains rural health information pertaining to rural health facility types, coverage and payment policies, and rural provisions under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 and the Deficit Reduction Act of 2005. To place your order, visit the link above, scroll down to "Related Links Inside CMS" and select "MLN Product Ordering Page."

Inpatient PPS PC Pricer

The provider data distributed with the Inpatient PPS PC Pricer has been updated as of July 2008. The Inpatient PPS PC Pricer on the page,in the Downloads section has been updated with the latest provider data. If you use the Inpatient PPS PC Pricer, please go to the link above and download the latest version of the PC Pricer posted 08/05/2008.