CMS Weekly Update
MEDICARE PHYSICIANS AND NON-PHYSICIAN PRACTITIONERS
INTERNET-BASED MEDICARE ENROLLMENT
February 19, 2009
Now there’s a better way for physicians and non-physician practitioners to enroll or make a change in their Medicare enrollment information. The Internet-based Provider Enrollment, Chain and Ownership System (PECOS) will allow physicians and non-physician practitioners to enroll, make a change in their Medicare enrollment, or view their Medicare enrollment information on file with Medicare.
Internet-based PECOS is a scenario-driven application process with front-end editing capabilities and built-in help screens. The scenario-driven application process will ensure that physicians and non-physician practitioners complete and submit only the information necessary to enroll or make a change in their Medicare enrollment record.
There are three basic steps to completing an enrollment action using Internet-based PECOS. Physicians and non-physician practitioners must:
- Have an NPPES User ID and password to use Internet-based PECOS. For security reasons, physicians and non-physician practitioners should change passwords periodically, at least once a year. For information on how to change a password, go to the NPPES Application Help page available at https://nppes.cms.hhs.gov/NPPES/Welcome.do and select the “Reset Password Page” under the NPPES Application help page.
- Go to Internet-based PECOS at https://pecos.cms.hhs.gov and complete, review, and submit the electronic enrollment application via Internet-based PECOS.
- Print, sign and date the two-page Certification Statement and mail the Certification Statement and all supporting paper documentation to the Medicare contractor within 7 days of electronic submission.
Note: A Medicare contractor will not process an Internet enrollment application without the signed and dated Certification Statement. In addition, the effective date of filing an enrollment application is the date the Medicare contractor receives the signed Certification Statement that is associated with the Internet submission.
While CMS encourages physicians and non-physician practitioners print and retain a copy of the enrollment record for their records, physicians and non-physician practitioners should only mail the two-page Certification Statement to the designated contractor.
Additional Information
For information about Internet-based PECOS, including important information that physicians and non-physician practitioners should know before submitting a Medicare enrollment application via Internet-based PECOS, go to www.cms.hhs.gov/MedicareProviderSupEnroll.
The Centers for Medicare & Medicaid Services (CMS) will make Internet-based PECOS to all organizational providers and suppliers (except durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers) later this year.
Medicare DMEPOS Competitive Bidding Program Announcement
MEDICARE ANNOUNCES THE DELAY OF THE EFFECTIVE DATE FOR THE INTERIM FINAL RULE WITH COMMENT PERIOD (IFC) FOR THE COMPETITIVE ACQUISITION PROGRAM FOR CERTAIN DURABLE MEDICAL EQUIPMENT, PROSTHETICS, ORTHOTICS, AND SUPPLIES (DMEPOS)
The Centers for Medicare & Medicaid Services has delayed the effective date for the Interim Final Rule with Comment Period that implements certain provisions of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) for the Round 1 Rebid of the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Acquisition Program. The effective date was originally February 17, 2009 and is now April 18, 2009.
The original comment period on the Interim Final Rule remains unchanged. The public has until March 17, 2009, to submit comments on the substantive policy issues discussed in the rule.
Visit the CMS web site at www.cms.hhs.gov/CompetitiveAcqforDMEPOS/ to view additional information.
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Federal Register Dated 02/10/09 – Vol. 74, NO. 26
Centers for Medicare & Medicaid Services
PROPOSED RULES
Medicare Program:
Changes to the Competitive Acquisition of Certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) by Certain Provisions of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), 6557-6558
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Your Medicare Contractor Can Help Keep You Informed!
Did you know that your local Medicare contractor (carrier, fiscal intermediary, or Medicare Administrative Contractor (MAC)) is a valuable source of news and
information regarding Medicare business in your specific practice location? Through their electronic mailing lists, your local contractor can quickly provide you with information pertinent to your geographic area, such as local coverage determinations, local provider education activities, etc. If you have not done so already, you should go to your local contractor website and sign up for their listserv or e-mailing list. Many contractors have links on their home page to take you to their registration page to subscribe to their listserv. If you do not see a link on the homepage, just search their site for “listserv” or “e-mail list” to find the registration page. If you do not know the Web address of your contractor’s homepage, it is available on the CMS website.
2009 Physician Quality Reporting Initiative (PQRI) Updates
Important Information about Managing Your Physician Quality Reporting Initiative (PQRI) Email Updates!
Previously, Physician Quality Reporting Initiative (PQRI) messages regarding recent news, policy changes, and updates were disseminated through all Medicare provider mailing lists. However, effective immediately, PQRI messages will only be sent out through the Medicare physician mailing list.
Therefore, if you are not currently subscribed to the Medicare physician mailing list, you can sign up by visiting https://list.nih.gov/cgi-bin/show_list_archives on the internet. Once on the page, scroll down to the Physicians-L link, and click on it. This will bring you to a page titled “Archives of PHYSICIANS-L@List.NIH.Gov”; once on that page, click on the link that reads “join or leave the list, update options (second bullet). This screen will allow you to join the PHYSICIANS-L mailing list.
For More Information--New information is continually added to the most reliable source of information about PQRI on the CMS website: http://www.cms.hhs.gov/PQRI. Here you will find the latest information on the 2009 PQRI, new and revised Frequently Asked Questions (FAQ), updates on issues related to both the 2007 and 2008 PQRI, new educational products, and access to the latest information you need to successfully participate in PQRI.
Physician Quality Reporting Initiative (PQRI): Frequently Asked Questions Update
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that updates to many of the Frequently Asked Questions (FAQS) on the Physician Quality Reporting Initiative (PQRI) are now available on the PQRI webpage. A number of FAQs have been revised, while many new FAQS have been added to the system. The purpose of the FAQs is to provide detailed answers to common questions regarding the PQRI program. Among the various FAQs included in this update are several related to the 2007 PQRI data re-run. The FAQs may be found in the “Related Links Inside CMS” section of the PQRI webpage at http://www.cms.hhs.gov/pqri/ on the CMS website.
New Educational Products Now Available
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that two new educational resources have been posted to the PQRI webpage on the CMS website.
The following items are now available for download on the PQRI Educational Resources web page:
2009 PQRI Fact Sheet: What's New for the 2009 PQRI- This Fact Sheet provides an overview of the 2009 PQRI and highlights the changes from the 2008 PQRI program.
2009 PQRI Made Simple – Reporting the Preventive Care Measures Group- This Tip Sheet provides quick, easy to understand instructions on how to satisfactorily participate in the 2009 PQRI for those who wish to report quality data using claims for the Preventive Care Measures Group.
To access these new, and all, available educational resources, visit http://www.cms.hhs.gov/PQRI on the CMS website and click on the Educational Resources tab. Once on the Educational Resources page, scroll down to the “Downloads” section and click on the “2009 PQRI Fact Sheet: What’s New for the 2009 PQRI” and the “2009 PQRI Made Simple- Reporting the Preventive Care Measures Group” links.
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Pricer Updates
The CY 2009 Home Health PPS (HH PPS) PC Pricer and the provider data distributed with the HH PPS PC Pricers have been updated as of January 2009 on the page, http://www.cms.hhs.gov/PCPricer/05_HH.asp, under the Downloads section. If you use the HH PPS PC Pricer, please go to the page above and download the latest versions of the PC Pricers.
The provider data for the Inpatient Psychiatric Facility (IPF) PPS PC Pricers for FY 2009 has been updated. If you use the IPF PPS PC Pricer 2009.A and 2009.4, please go to the page, http://www.cms.hhs.gov/PCPricer/09_inppsy.asp, under the Downloads section, and download the latest versions of the IPF PPS PC Pricers, posted 02/06/2009.
The Provider Specific data for the FY 2009 IRF PPS PC Pricer has been updated and is ready to be downloaded from the page, http://www.cms.hhs.gov/PCPricer/06_IRF.asp, under the Downloads section. If you use the IRF PPS PC Pricer, please go to the page above and download the latest version of the IRF PC Pricer, posted 02/05/2009.
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Medicare Part B Competitive Acquisition Program (CAP) Updates
Reminder about Unused CAP Drugs and CAP Emergency Restocking--The following is a reminder about the remaining CAP deadlines:
CAP physicians must return any unused CAP drugs to the Approved CAP Vendor by February 28, 2009.
CAP drugs are the property of the Approved CAP Vendor. Therefore, physicians who have not returned these drugs to the Approved CAP Vendor on or before February 28, 2009 will be liable for the cost of drugs.
Please note that CAP physicians may contact the Approved CAP Vendor to discuss the option of purchasing unused CAP drugs.
The Approved CAP Vendor will not send replacement products under the CAP emergency restocking provision (J2 modifier claims) after February 28, 2009.
CAP physicians who have not submitted a prescription order and a request for replacement drugs under the emergency restocking provision will not be able to bill Medicare under the Average Sales Price (ASP) system for the CAP drugs that they administered on or before December 31, 2008 from their private stock.
For more information
Physicians who participated in the CAP during 2008 are encouraged to contact the Approved CAP Vendor and reconcile their inventories as soon as possible. Contact information for the Approved CAP Vendor, BioScrip, is available on their website at www.bioscrip.com.
Additional information about the CAP and the 2009 postponement is available at: http://www.cms.hhs.gov/CompetitiveAcquisforBios/01_overview.asp and in the Special Edition MLN Matters articles SE0833 – Medicare Part B Drug Competitive Acquisition Program (CAP) Postponed for 2009, which can be found at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0833.pdf
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MEDICARE ANNOUNCES FINAL COVERAGE POLICY FOR BARIATRIC SURGERY AS A DIABETES TREATMENT FOR CERTAIN INDIVIDUALS
CMS Clarifies Bariatric Surgery Coverage Policy
The Centers for Medicare & Medicaid Services (CMS) recently announced a clarification in its policy for Medicare coverage of bariatric surgery as a treatment for certain beneficiaries with type 2 (or non-insulin-dependent) diabetes. The decision specifies type 2 diabetes as one of the co-morbidities CMS would consider in determining whether bariatric surgery would be covered for a Medicare beneficiary who is morbidly obese, as long as the surgery is furnished at a CMS-approved facility. An individual with a body-mass index (BMI) of at least 35 is considered morbidly obese. Normal body-mass index is considered to be between 18.5 and 25.
As part of this decision, CMS announced bariatric surgery will not be covered by Medicare when it is used to treat type 2 diabetes in a beneficiary with a BMI below 35. While recent medical reports claimed that bariatric surgery may be helpful for these patients, CMS did not find convincing medical evidence that bariatric surgery improved health outcomes for these non-morbidly obese individuals.
In 2006, CMS expanded coverage of bariatric surgery for Medicare beneficiaries who received surgery in high-volume centers from highly qualified surgeons (as certified by the American College of Surgeons or the American Society for Bariatric Surgery, and as reported on the Medicare Coverage Web site). Under the 2006 decision, to be considered for coverage, Medicare beneficiaries were required to have a BMI of 35 or higher, and to have exhibited a serious health condition in addition to morbid obesity, such as hypertension, coronary artery disease, or osteoarthritis. In that same decision, CMS covered four types of bariatric surgery procedures: gastric bypass, open and laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and open and laparoscopic biliopancreatic diversion with duodenal switch. No other bariatric surgery procedure is currently covered.
Today’s decision memorandum is available on CMS’ Coverage Web site at
http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=219
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Medicare Remit Easy Print (MREP) Software Codes Update for Medicare Fee-for-Service Professional Providers and Suppliers
The latest Claim Adjustment Reason Codes and Remittance Advice Remark Codes are available in the Codes.ini file for the MREP software. You can access this file in the Zipped folder for “Medicare Remit Easy Print - Version 2.5” at http://www.cms.hhs.gov/AccesstoDataApplication/02_MedicareRemitEasyPrint.asp on the CMS website.
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February Flu Shot Reminder
It’s Not Too Late to Give and Get the Flu Shot!
In the US, the peak of flu season typically occurs anywhere from late December through March; however, flu season can last as late as May. Each office visit presents an opportunity for you to talk with your patients about the importance of getting an annual flu shot and a one time pneumococcal vaccination. Protect yourself, your patients, and your family and friends by getting and giving the flu shot. Don’t Get the Flu. Don’t Give the Flu.
Remember - Influenza and pneumococcal vaccinations plus their administration are covered Part B benefits. Note that influenza and pneumococcal vaccines are NOT Part D covered drugs.
Health care professionals and their staff can learn more about Medicare’s Part B coverage of adult immunizations and related provider education resources, by reviewing Special Edition MLN Matters article SE0838 http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0838.pdf on the CMS website.
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Medicare Low Income Subsidy (LIS) – Don’t forget that prescription drug assistance for your Medicare patients is available.
Do you have Medicare patients who cannot afford their medications? Extra help is available to help cover prescription costs for qualified individuals once enrolled in a Medicare Prescription Drug Plan. If they qualify and are not already enrolled in a Medicare plan, they will be given a special election period to enroll with coverage starting the 1st of the following month.
Have your patients call Social Security Administration, 1-800-772-1213, and ask about applying for ‘Extra Help.’ Brochures explaining this Low Income Subsidy (extra help) are available for your office at www.ssa.gov
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New From the Medicare Learning Network
Medicare Fee-for-Service Provider/Supplier Web Pages Bookmark--A bookmark is available for all Medicare Fee-for-Service (FFS) providers and suppliers and their staff to use as a one-stop resource for the Medicare FFS provider and supplier web pages available on the CMS website. This bookmark includes a link to the web page which has a download that allows you to access and peruse the Medicare FFS web pages available, and to stay abreast of policy and operational updates to FFS initiatives. This bookmark is available at the MLN Product Ordering page. To order free of charge, visit http://www.cms.hhs.gov/MLNProducts/80_FFS_Provider_Web_Pages.asp , scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page.” The format is an Educational Tool.
The following revised publications are now available in print format from the Centers for Medicare & Medicaid Services Medicare Learning Network. To place an order for these publications, visit http://www.cms.hhs.gov/MLNGenInfo/ , scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page.”
- Facilitators, trainers, educators, and physicians: Medicare Resident, Practicing Physician, and Other Health Care Professional Training Facilitator's Kit(October 2008) provides all the information and instructions necessary to prepare for and present a Medicare Resident, Practicing Physician, and Other Health Care Professional Training Program including instructions for facilitators, customization guide, a PowerPoint presentation with speaker notes, pre- and post-assessments, master assessment answer keys, and evaluation tools. The Facilitator’s Kit contains the following materials:
- Medicare Physician Guide: A Resource for Residents, Practicing Physicians, and Other Health Care Professionals;
- Facilitator's Guide; and
- Medicare Resident, Practicing Physician, and Other Health Care Professional Training: An Introduction video.
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- Medicare Resident, Practicing Physician, and Other Health Care Professional Training Program Bookmark (November 2008) provides information about the Medicare Resident, Practicing Physician, and Other Health Care Professional Training Program.
- Rural Health Bookmark(November 2008) offers Medicare providers, suppliers, and physicians information about rural educational resources.
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