March 6, 2009, CMS Weekly Update
March is National Nutrition Month® ~ Please join with the Centers for Medicare & Medicaid Services (CMS) in promoting increased awareness of nutrition, healthful eating and the medical nutrition therapy (MNT) benefit covered by Medicare. More than 13.7 million Americans at least 60 years or older are diagnosed with diabetes or chronic kidney disease[1]. MNT provided by a registered dietitian or nutrition professional may result in improved diabetes and renal disease management and other health outcomes and may help delay disease progression.
Medicare Coverage
Medicare provides coverage of medical nutrition therapy (MNT) for beneficiaries diagnosed with diabetes and/or renal disease (except for those receiving dialysis) and post renal transplant when provided by a registered dietitian or nutrition professional who meets the provider qualifications requirement. A referral by the beneficiary’s treating physician indicating a diagnosis of diabetes or renal disease is required. Medicare provides coverage for 3 hours of MNT in the first year and 2 hours in subsequent years, and additional hours in certain situations.
NOTE: For the purpose of this benefit, renal disease means chronic renal insufficiency or the medical condition of a beneficiary who has been discharged from the hospital after a successful renal transplant for up to 36 months post transplant. Chronic renal insufficiency means a reduction in renal function not severe enough to require dialysis or transplantation [Glomerular Filtration Rate (GFR) 13-50 ml/min/1.73m2].
What Can You Do?
As a trusted source of health care information, your patients rely on their physician’s or other health care professional’s recommendations. CMS requests your help to ensure that all eligible people with Medicare take full advantage of the medical nutrition therapy benefit. Talk with your eligible Medicare patients about the benefits of managing diabetes and renal disease through MNT and encourage them to make an appointment with a registered dietitian or nutrition professional qualified to provide MNT services covered by Medicare.
For More Information
- CMS has developed a variety of educational products and resources to help health care professionals and their staff become familiar with coverage, coding, billing, and reimbursement for all preventive services covered by Medicare.
For information to share with your Medicare patients, visit http://www.medicare.gov
For more information about National Nutrition Month®, or to “Find a Nutrition Professional” please visit http://www.eatright.org.
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[1] Department of Health and Human Services. Centers for Disease Control and Prevention, “2007 National Diabetes Fact Sheet,” accessed at: http://apps.nccd.cdc.gov/ddtstrs/FactSheet.aspx. The United States Renal Data System, “2008 USRDS Annual Data Report (ADR) Atlas,” accessed at: http://www.usrds.org/2008/pdf/V1_Precis_2008.pdf.
Thank you for your support in helping CMS spread the word about the benefits of good nutrition, healthful eating and the medical nutrition therapy benefit covered by Medicare that may help people with Medicare learn to control and manage their medical conditions.
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March is National Colorectal Cancer Awareness Month! In conjunction with National Colorectal Cancer Awareness Month, the Centers for Medicare & Medicaid Services (CMS) reminds health care professionals that Medicare provides coverage for certain colorectal cancer screenings. Colorectal cancer affects both men and women of all racial and ethnic groups, is most often found in people age 50 and older, and the risk increases with age. Screening can help prevent and detect colorectal cancer in its earliest stages when out comes are most favorable.
Medicare Covered Colorectal Cancer Screenings
Medicare provides coverage of colorectal cancer screenings for the early detection of colorectal cancer. All Medicare beneficiaries age 50 and older are covered; however, when an individual is at high risk, there is no minimum age required to receive a screening colonoscopy or a barium enema rendered in place of the screening colonoscopy. An individual is considered to be at high risk for colorectal cancer if he or she has had colorectal cancer before or has a history of polyps, has a family member who has had colorectal cancer or a history of polyps, or has a personal history of inflammatory bowel disease, including Crohn’s Disease and ulcerative colitis.
Medicare provides coverage for the following colorectal cancer screenings subject to certain coverage, frequency, and payment limitations:
- Fecal Occult Blood Test (FOBT)
- Colonoscopy
- Sigmoidoscopy
- Barium Enema (as an alternative to a covered screening flexible sigmoidoscopy or screening colonoscopy)
Prevention Is Key
Colorectal cancer is the second leading cause of death from cancer in the United States; however it doesn't have to be. Colorectal cancer is largely preventable through screening. The United States Preventive Services Task Force (USPSTF) found convincing evidence that certain screenings for colorectal cancer can detect early-stage cancer and adenomatous polyps and reduce colorectal cancer mortality (see the USPSTF link below for more information). CMS needs your help to ensure that all eligible people with Medicare get screened for colorectal cancer. Talk with your Medicare patients and their caregivers about the importance of getting screened. Patients who were screened before becoming Medicare beneficiaries should be encouraged to continue with screening at clinically appropriate intervals.
For More Information
- CMS has developed a variety of educational products and resources to help health care professionals and their staff become familiar with coverage, coding, billing, and reimbursement for all preventive services covered by Medicare.
- The National Colorectal Cancer Roundtable, which is convened by the Centers for Disease Control and Prevention (CDC) and the American Cancer Society, provides resources for providers, including a guide for primary care physicians: http://www.nccrt.org/
Colorectal cancer is preventable, treatable, and beatable. Encourage your patients to get screened—it could save their lives. Thank you.
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Announcement Concerning Discontinuation of the Original E1...
This likely doesn’t impact many of you at this point but just a reminder that the original E1 eligibility query will no longer be supported after April 1, 2009.
Effective April 1, 2009, CMS will discontinue support for the original E1 eligibility query and continue to support only the “Enhanced E1” moving forward. The original E1 returns the most recent date of service to pharmacies. However, if there is no current plan enrollment for the beneficiary, the date of service returned by the original E1 may be for either previously terminated coverage, or for prospective coverage that is not yet effective. In these instances, the pharmacy receives billing information for a plan that no longer has, or does not yet have, the beneficiary as a current enrollee. These limitations continue to cause problems for the pharmacies that still rely on the original version.
The Enhanced E1 was implemented in December 2006 to provide enhanced search capability, additional data elements in the response, and more explicit messaging when the TrOOP Facilitator is unable to identify the plan enrollment. For more information on the Enhanced E1, please see this tip sheet.
Next Steps for Pharmacists …
Since CMS will no longer be supporting the original E1, some pharmacies will need to work with their software vendors to upgrade/reprogram the pharmacy’s software or amend existing contractual arrangements to request and receive the enhanced version of the E1. As a result of the change, all pharmacies will have access to the improved functionality of the enhanced E1; including the additional data elements and explicit messaging that assists pharmacists with processing beneficiary prescriptions.
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Enhancements/Updates to NPPES effective March 7, 2009
On March 7, 2009, the National Plan and Provider Enumeration System (NPPES) will undergo system maintenance. As such, neither NPPES nor the National Provider Identifier (NPI) Registry will be available on March 7, 2009.
The following enhancements will be incorporated into NPPES:
- The NPPES application help page text will be revised to ensure consistency with the instructions found on the revised National Provider Identifier (NPI) Application/Update Form (CMS-10114 (11/08)).
- NPPES web users will be required to change their passwords after the Enumerator has reset them. When the Enumerator resets a user’s password, the user will be redirected to the password reset page in order to change the reset password to a password of his/her choice. NPPES will also enforce a minimum password length of 8 characters.
The following enhancements will be incorporated into the NPI Registry:
- The ‘doing business as’ (DBA) search feature will be restored.
- The NPI Registry will be updated daily.
- The NPI Registry will display all results in all capital letters.. This change will not affect the way information is displayed in a health care provider’s NPPES record.
Electronic File Interchange (EFI)
In addition, the EFI User Manual and Technical Companion Guide have been revised. The upcoming changes will not impact the EFI XML Schema.
Additional Information
Health care providers can apply for an NPI online at https://nppes.cms.hhs.gov . Health care providers needing assistance with applying for an NPI or updating their data in NPPES records may contact the NPI Enumerator at 1-800-465-3203 or email the request to the NPI Enumerator at CustomerService@NPIEnumerator.com.
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Attention: Teaching Hospitals, Hospice Providers and Long Term Care Hospitals (LTCHs):
CMS Implementation of Certain Medicare Provisions of The American Recovery and Reinvestment Act (ARRA) of 2009.
The ARRA was signed into law on February 17, 2009.
Indirect Medical Education (IME): In the Fiscal Year (FY) 2008 Inpatient Prospective Payment System (IPPS) final rule, CMS adopted a policy to phase-out the capital IPPS teaching adjustment. The ARRA changes the final rule 50 percent adjustment that would apply in FY 2009 to 100 percent effective for discharges occurring on or after October 1, 2008 through September 30, 2009.
Providers are not required to take any actions and should continue to submit claims. Medicare contractors will automatically reprocess affected claims and make adjusted payments within six months following the installation of the revised payment systems.
Hospice: In the FY 2009 Hospice wage index final rule, CMS adopted a policy in which the budget neutrality adjustment factor, which is applied to the hospice wage index, was reduced by 25 percent. This was to be the first year of a 3-year phase-out. The ARRA delays the phase-out of the Medicare hospice budget neutrality adjustment factor by one year, essentially removing the 25 percent reduction in FY 2009.
Providers are not required to take any actions and should continue to submit claims. Medicare contractors will automatically reprocess affected claims and make adjusted payments within six months following the installation of the revised payment systems.
LTCH: ARRA makes one additional exception to the moratorium on the expansion of existing LTCHs and expands the categories of LTCHs that would be subject to the delay or change in application of the 25 percent payment provision.
CMS will issue further instructions and educational materials on the LTCH provision and other ARRA provisions in the near future.
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DMEPOS Supplier Accreditation – Get It Now
Deadline is September 30, 2009
CMS wants to remind suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) who bill Medicare under Part B that they must obtain accreditation by September 30, 2009. In order to retain or obtain a Medicare Part B billing number, all DMEPOS suppliers (except for exempted professionals and other persons as specified by the Secretary) must comply with Medicare’s supplier and quality standards and become accredited. DMEPOS suppliers should contact an accreditation organization right away to obtain information about the accreditation process and submit an application.
DMEPOS suppliers who submitted a completed application to an accrediting organization, on or before January 31, 2009, will have an accreditation decision (either full accreditation or denied accreditation) on or before the September 30, 2009 deadline.
DMEPOS suppliers submitting applications to an accrediting organization, on or after February 1, 2009, may or may not have their accreditation decision by the September 30, 2009 deadline.
The accreditation requirement applies to suppliers of durable medical equipment, medical supplies, home dialysis supplies and equipment, therapeutic shoes, parenteral/enteral nutrition, transfusion medicine and prosthetic devices, prosthetics and orthotics. Pharmacies, pedorthists, mastectomy fitters, orthopedic fitters/technicians and athletic trainers must also meet the September 30, 2009 deadline for DMEPOS accreditation.
Certain eligible professionals and other persons as specified by the Secretary are exempt from the accreditation requirement.
Further information on the DMEPOS accreditation requirements along with a list of the accreditation organizations and those professionals and other persons exempted from accreditation may be found at www.cms.hhs.gov/medicareprovidersupenroll.
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2009 Physician Quality Reporting Initiative Program Update
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the posting of two additional resource documents for providers participating in the Physician Quality Reporting Initiative (PQRI) Program. The following resources were discussed during the February 18, 2009 National Provider Call hosted by CMS, have now been posted to the PQRI web page at www.cms.hhs.gov/PQRI on the CMS website:
January 1, 2008 – September 30, 2008 Aggregate Quality Data Code (QDC) Error Report-This report contains aggregate-level information about the quality data codes submitted between January 1, 2008 through September 30, 2008, by measure, for the PQRI program. This information is available as a downloadable document on the "Analysis and Payment" section page in the “Downloads” section.
Status Update regarding CPT II Coding Issue for the 2009 PQRI- This report gives an update regarding a recently identified CPT II coding issue, which affected several QDCs used for reporting a number of quality measures through the claims-based reporting method for 2009 PQRI. For information and guidance regarding this issue, please see the downloadable document on the "Measures/Codes" section page in the “Downloads” section.
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Availability of Five-Star Preview Reports
The Five Star Preview Reports are now available. Please visit your Quality Improvement Evaluation System (QIES) mailbox (available through your electronic connection to the State servers for submission of Minimum Data Set (MDS) data) to review your results. To access these reports, select the Certification and Survey Provider Enhanced Reports (CASPER) Reporting link located at the bottom of the Login page.
Once in the CASPER Reporting system, click on the 'Folders' button and access the Five Star Report in your 'st LTC facid' folder, where 'st' is the 2-digit postal code of the state in which your facility is located and 'facid' is the state assigned facility identifier of your facility.
A new version of the Five-Star Quality Rating Technical Users' Guide and an accompanying Summary of Updates to the Technical Users' Guide document are accessible on the Five-Star Quality Rating System Web page at http://www.cms.hhs.gov/CertificationandComplianc/13_FSQRS.asp.
We have also reinstituted the help desk at 1-800-839-9290 which will be open from 9AM to 5PM EST through March 5, 2009 to address any concerns.
Nursing Home Compare was updated with February’s Five-Star data on February 26, 2009.
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Medicare Part B Competitive Acquisition Program (CAP) – 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 on the 2009 CAP Postponement is available on the Centers for Medicare and Medicaid Services website at: http://www.cms.hhs.gov/CompetitiveAcquisforBios/01_overview.asp .
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CMS Releases Preliminary 2010 Medicare Advantage Growth Trend and
2010 Payment Policies for Medicare Advantage and Prescription Drug Plans
The Centers for Medicare & Medicaid Services (CMS) recently issued the “Advance Notice” of changes in methods that will be used to calculate capitation rates for payments to Medicare Advantage organizations for 2010. The Advance Notice also announces policy and technical changes to the payment methodology for Medicare Advantage and Medicare prescription drug plans. The Advance Notice is issued annually 45 days before the final rates are announced, in accordance with statute.
The technical adjustments announced in the Advance Notice issued today include a preliminary estimate of a 0.5 percent increase in the National Per Capita Medicare Advantage Growth Percentage. For 2010, Part C capitation rates will be based on 2009’s county capitation rates updated by the Medicare Advantage Growth Percentage. The Growth Percentage is the estimated growth in per capita expenditures for all Medicare beneficiaries whether they are receiving their coverage through Medicare Advantage or Medicare prescription drug plans. The final capitation rates for each county will be announced in the Rate Announcement scheduled for publication on April 6, 2009. The county capitation rates define the upper limit for CMS payments to Medicare Advantage plans.
The Advance Notice also describes changes in risk adjustment of payments to Medicare Advantage and to Medicare prescription drug plans. Under risk adjustment, higher payments are directed to plans enrolling beneficiaries with greater health care costs. The notice announces preliminary estimates of the normalization factors used to maintain average Part C and Part D risk scores at 1.0 in the payment year. The preliminary estimate of the normalization factor applied to Part C risk scores for aged and disabled beneficiaries is 1.041.
The Advance Notice may be viewed at http://www.cms.hhs.gov/MedicareAdvtgSpecRateStats/AD/list.asp#TopOfPage.
Comments on the Advance Notice are invited and must be submitted by 6 p.m. EST on Friday, March 6, 2009. Comments may be submitted by e-mail to AdvanceNotice2010@cms.hhs.gov.
The Fact Sheet may be viewed at: http://www.cms.hhs.gov/center/press.asp
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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
Revised Skilled Nursing Facility (SNF) Spell of Illness Quick Reference Chart
The revised Skilled Nursing Facility (SNF) Spell of Illness Quick Reference Chart (January 2009), which provides Medicare claims processing information related to SNF spells of illness, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/SNFSpellIllnesschrt.pdf .
New:
MM6371 – Claims Processing Instructions for Diagnostic Tests Subject to the Anti-Markup Pricing Limitation
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6371.pdf
MM6362 – Reporting the National Provider Identifier (NPI) on Claims for Reference Laboratory and Purchased Diagnostic Services Performed Outside the Billing Jurisdiction
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6362.pdf
MM6370 – New Waived Tests
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6370.pdf
MM6321 – Outpatient Therapy Caps with Exceptions in Calendar Year (CY) 2009
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6321.pdf
Revised:
MM6139 – Implementation of New Provider Authentication Requirements for Medicare Contractor Provider Telephone and Written Inquiries
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6139.pdf
SE0902 – Important Information for Providers Serving Medicare Beneficiaries Enrolled in Private Fee-for-Service Plans
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0902.pdf
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A Drop-In Item for Your Membership News Vehicles
Help your association members stay up-to-date on the latest Medicare-related information! Below is a brief news item that we encourage you to put in your next newsletter, bulletin, or whatever vehicle you use to provide your members with news they need to know. Through their electronic mailing lists, Medicare contractors serve as a valuable source of news and information regarding Medicare business in specific provider practice locations, including local coverage determinations and local provider education events. So do your members a favor and help us spread the word!
“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 at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip on the CMS website.”
Anything you can do to help us get the word out about the contractor listservs to the Medicare FFS provider community is very much appreciated, as is all the great work you do in the provider education/outreach area.
