Medicare Part B
(* = off-site link)
Electronic Mailing Lists
- August 19, 2008
-
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.
-
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.
-
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.
-
Join us for our next Ask the Contractor Teleconference (ACT) on August 27, 2008 at 9:30 am. During this teleconference we will discuss the most current Medicare changes and allow you to interact directly with representatives from various departments within Highmark Medicare Services.
-
Join us for our next Ask the Contractor Teleconference (ACT) on August 26, 2008 at 9:30 am. During this teleconference we will discuss the most current Medicare changes and allow you to interact directly with representatives from various departments within Highmark Medicare Services.
-
- August 18, 2008
-
The Centers for Medicare & Medicaid Services (CMS) announced today that all physician groups participating in the Physician Group Practice (PGP) Demonstration improved the quality of care delivered to patients with congestive heart failure, coronary artery disease, and diabetes mellitus during performance year 2 of the demonstration. For more information about the PGP demonstration may be found here . To learn more about the PQRI please visit here.
-
Noridian Administrative Services, the designated carrier for the CAP, offers interactive, online workshops about the CAP for Part B Drugs and Biologicals. These workshops train CAP vendors and elected physicians on a variety of CAP topics, and NAS staff can also answer questions. Interested parties may view additional information about and register for these workshops by clicking the link above.
-
- August 15, 2008
-
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.
Claims Denied - MD/DCMA/DE Part B
An issue has been identified concerning certain clinical laboratory and radiology services that are incorrectly denying with Ref Remark Code N347 indicating that the service was paid by another contractor. The denials are resulting from claims that were posted to the Common Working File (CWF) from TrailBlazers last batch cycle for MD and DC/DE Part B claims on 7/11/08.
The CWF reply file from the posting of those claims was not entered into the first batch for Highmark Medicare Services by the Enterprise Data Center. When Highmark Medicare Services resent the same claims to CWF in an attempt to repost for payment, CWF rejected the claims as having already been approved for payment by TrailBlazer. These CWF rejections resulted in incorrect claim denials. Highmark Medicare Services will identify the claims impacted by the incorrect denial and will automatically adjust the claims for proper payment. Additional information concerning the recovery process will be posted to our website when available. We apologize for any inconvenience this has caused.
-
- August 14, 2008
-
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.
-
Join us for our Office and Outpatient Evaluation and Management Workshop. You will participate in an interactive educational experience that will focus on coding outpatient and office visits and scoring medical documentation examples. You will begin by learning the principles of E/M coding requirements. This includes an overview of the score sheet.
-
The location for the New Physician Office Seminar scheduled for September 16, 2008 in Hunt Valley, MD has been changed. The new location for this Seminar will be at the Marriott Burkshire Conference Hotel, 10 W. Burke Ave, Towson, Maryland, 21204. If you already registered for the Seminar please note the change. An email will be sent to you announcing the new location change.
-
- August 13, 2008
-
Comprehensive Error Rate Testing (CERT) reports show Emergency Department Services representing over 12% of E/M claims errors. To help reduce errors, Highmark Medicare Services would like you to join us for a special webinar. This internet only program will walk you through the Medicare guidelines and present a coding example. Webinar technology allows you to see the scoring of documentation and ask your questions in real time. There is limited space available for this exciting program, so register today!
-
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.
-
- August 12, 2008
August 13, 2008 PQRI Conference Call
The PowerPoint presentation for the National Provider Call can now be accessed on the internet. The slides should be posted there by COB Monday, August 11, 2008. They can be accessed by clicking on "8/13/08 National Provider Call Slides" found on the left side navigation box on the PQRI Portal page – this information is not password protected.
In addition, information to access the PowerPoint presentation will be posted on the PQRI website under the "CMS Sponsored Calls" page, at least one day prior to the call.
IVR Not Available August 16th
As a result of standard system maintenance, the IVR will not be available from 4:30 Friday evening until 7:00 AM Monday morning.
MLN Matters Articles from CMS
New:
SE0816 – Medicare Payments for Part B Mental Health Services
SE0829 – CR 5971 Clarification - Signature Requirements
MM5683 – Beneficiary Submitted Claims
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
Revised:
MM5993 – Critical Care Visits and Neonatal Intensive Care (Codes 99291 - 99292)
MM6048 – Continuous Positive Airway Pressure (CPAP) Therapy for Obstructive Sleep Apnea (OSA)
- August 11, 2008
-
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.
-
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.
-
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."
-