Your Friday Reading Materials CMS asks that you share this important information with all of your association members and State and local chapters. Thanks! Happy Friday everyone! Today's items include information on: New From the Medicare Learning Network Medicare Publishes New Information on Quality of Care at Dialysis Facilities New Institutional NCCI Edits to Be Applied to Claims Medicare Proposes Revised Coverage Policy for Bariatric Surgery As a Diabetes Treatment CMS Issues Improper Payment Rates for Medicare, Medicaid, and SCHIP Award of New A/B MAC Contracts November Flu Shot Reminder CDC Updates for Clinicians (attached) New From the Medicare Learning Network The Adult Immunizations (October 2008) brochure for health care providers has been updated and is now available in downloadable PDF format from the Centers for Medicare & Medicaid Services Medicare Learning Network. This brochure provides an overview of Medicare's coverage of influenza, pneumococcal, and hepatitis B vaccines and their administration. To view, download, and print, please go to http://www.cms.hhs.gov/MLNProducts/downloads/Adult_Immunization.pdf on the CMS website. Medicare Publishes New Information on Quality of Care at Dialysis Facilities Changes to Web Site Will Help Consumers Compare Care and Make Informed Health Care Choices The Centers for Medicare & Medicaid Services (CMS) recently announced important additions to the Dialysis Facility Compare consumer Web site (http://www.medicare.gov/dialysis) that will give consumers even better insight into the quality of care provided by their local dialysis patient facilities. The improvements include two new quality measures that demonstrate how well dialysis patients are treated for anemia (low red blood cell count) as well as updated information that will help patients better understand survival rates by facility. Dialysis Facility Compare links consumers with detailed information about the 4,700 dialysis facilities certified by Medicare, and allows users to compare facilities in a geographic region. Users can review information about the size of the facility, the types of dialysis offered, the facilities' ownership, and whether the facility offers evening treatment shifts. Consumers can also compare dialysis facilities based on three key quality measures " how well patients at a facility have their anemia under control, how well patients at a facility have waste removed from their blood during dialysis, and whether the patients treated at a facility generally live as long as expected. Dialysis Facility Compare also links users to resources that support family members and specialized groups of kidney patients. "Dialysis Facility Compare is yet another tool that equips consumers with the tools they need to seek better, value-based health care," said CMS Acting Administrator Kerry Weems. "Adding more information on the Dialysis Facility Compare Web site about anemia "a condition that affects many dialysis patients "and patient survival will help us all learn more about how well the country's dialysis facilities are serving Medicare beneficiaries and the entire health care system." Dialysis Facility Compare has featured information about anemia control since the Web site was launched in 2001. Historically, the Web site has shown the percentage of patients in a facility whose hematocrit levels were at 33 percent or more (or hemoglobin levels of 11 g/dL or more), based on clinical practice guidelines at the time. However, recent evidence about increased risk of certain adverse events associated with the use of erythropoiesis stimulating agents (ESAs), which are used to treat anemia, has raised concerns about patients who hemogloblin levels are too high as well as patients whose hemoglobin levels are too low. The Food and Drug Administration has responded by requiring manufacturers to develop a Medication Guide and to ensure that this information is provided to patients. As a result, Dialysis Facility Compare will now feature two anemia measures "one measure will show the percentage of patients whose hemoglobin levels are considered too low (i.e., below 10 g/dL) and a second measure will show the percentage of patients whose hemoglobin levels are considered too high (i.e., above 12 g/dL). "These two new measures better reflect recent medical evidence about the challenges of managing anemia," said CMS Chief Medical Officer and Director of the agency's Office of Clinical Standards & Quality, Barry Straube, M.D. "Our new measures will help patients and health care providers to better understand how a facility's patients are treated for anemia, a condition for which studies have shown that over- and under-treatment can affect patients' health status and quality of life." In addition to adding new information about anemia treatment, CMS has also updated the way it reports patient survival rates on Dialysis Facility Compare. Since 2001, CMS has reported survival rates by comparing a facility's expected patient survival rate to its actual patient survival rate. (The expected survival rate takes into account the patients' personal characteristics, health, and dialysis history. The actual survival rate is the rate each facility reports to CMS about how many patients have survived in a given timeframe.) Facilities' survival rates were then rated as belonging to one of three categories: "Better than Expected" (by 20 percent or more), "As Expected" or "Worse than Expected" (by 20 percent or more). This method of calculating patient survival resulted in a finding of "As Expected" for 94 percent of dialysis facilities nationwide, with only 3 percent in the "Better" or "Worse" categories, respectively. To help consumers make better distinctions among facilities' survival rates, CMS updated the statistical method it used to classify facilities in the three categories. While consumers will continue to see facilities placed into one of these categories, they will find fewer facilities in the "As Expected" category, and more facilities in the "Better" or "Worse" categories. These enhancements are only one part of CMS' plans to improve the quality of care in America's dialysis facilities. Earlier this year, CMS revised its conditions for coverage regulations for the first time in over 30 years, which updated the health and safety standards that dialysis facilities must meet to receive Medicare coverage. A key element of this regulation was the development of a new Web-based data entry framework for dialysis facilities nationwide, which will eventually provide substantially more detailed information for consumers as part of Dialysis Facility Compare. CMS is also working to implement a value-based purchasing program to pay for dialysis services, which will reward facilities for providing high-quality, efficient, and effective care. The Dialysis Facility Compare Web site can be viewed at www.medicare.gov/dialysis. Other provider compare Websites are available through www.medicare.gov or directly at www.medicare.gov/HHCompare for information about home health agencies and nursing homes. For information on hospitals, visit www.hospitalcompare.hhs.gov. CMS also provides comparative resources about Medicare Advantage (www.medicare.gov/MPPF) and Medicare prescription drug plans (www.medicare.gov/MPDPF). New Institutional NCCI Edits to Be Applied to Claims NCCI edits are updated quarterly and the institutional version is one calendar quarter behind the physician version. In the past, the Outpatient Code Editor (OCE) has not applied the NCCI edits for the following categories of services: anesthesiology, evaluation and management, and mental health services. Effective 1/1/09, these categorical exclusions will be removed and there will be a large number of new institutional NCCI edits applied to claims. These institutional NCCI edits will be available on or about 1/1/09 on the following CMS Website: http://www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEHOPPS/list.asp. To review the types of NCCI edits that were previously excluded from the institutional version but are currently included in the physician version for these categories, refer to the NCCI files on the following site: http://www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/list.asp. One may use anesthesiology, evaluation and management, or mental health services CPT or Level II HCPCS codes to search these files. A subset of the corresponding edits in the physician version is being added to the institutional version. Consistent with longstanding practice, CMS makes specific decisions about NCCI edits that are appropriate for facilities, incorporating comments on potential edits from relevant professional associations and, therefore, the institutional NCCI edits may differ from the physician NCCI edits. Affected providers should begin immediately to educate their staff about the application of the additional categories of NCCI edits to their claims. Note that at this time no additional providers will be subject to NCCI edits. MEDICARE PROPOSES REVISED COVERAGE POLICY FOR BARIATRIC SURGERY AS A DIABETES TREATMENT CMS Seeks Comments from Public on Proposal to Limit Coverage to Morbidly Obese Patients The Centers for Medicare & Medicaid Services (CMS) announced today its proposal to clarify its policies for Medicare coverage of bariatric surgery as a treatment for beneficiaries with type 2 (or non-insulin-dependent) diabetes. Following an extensive evidence review, CMS proposes to revise its existing coverage policy for bariatric surgery. The proposed decision notes that type 2 diabetes is one of the co-morbidities CMS would consider in determining whether bariatric surgery would be covered for a Medicare beneficiary who is morbidly obese. An individual with a body-mass index (BMI) of at least 35 is considered morbidly obese. To read the CMS Press release issued today (11/07/08) click here: http://www.cms.hhs.gov/apps/media/press_releases.asp Today's proposed decision memorandum is available on CMS' Coverage Web site at http://www.cms.hhs.gov/center/coverage.asp. CMS ISSUES IMPROPER PAYMENT RATES FOR MEDICARE, MEDICAID, and SCHIP CMS today reported it protected roughly $400 million of taxpayer dollars as improper payments for Medicare fee-for-service (FFS) decreased from 3.9 percent in Fiscal Year (FY) 2007 to 3.6 percent, or $10.4 billion, in FY 2008. The Medicare, Medicaid and SCHIP improper payment rates are issued annually as part of the HHS Agency Financial Report. In addition to improved Medicare FFS payments for FY 2008, CMS reports its first Medicare Advantage improper payment rate of 10.6 percent, or $6.8 billion, in payments made in Calendar Year (CY) 2006. Also being reported for the first time are the FY 2007 national composite error rates for Medicaid and for SCHIP. The Medicaid composite error rate is 10.5 percent, or $32.7 billion of which the federal share is $18.6 billion, and, for SCHIP, the rate is 14.7 percent, or $1.2 billion, with a federal share of $0.8 billion. To read the complete CMS Press release issued today (11/07/08) click here: http://www.cms.hhs.gov/apps/media/press_releases.asp CMS SELECTS NATIONAL HERITAGE INSURANCE CORPORATION TO ADMINISTER MEDICARE CLAIMS PAYMENT IN MAINE, MASSACHUSETTS, NEW HAMPSHIRE, RHODE ISLAND AND VERMONT The Centers for Medicare & Medicaid Services (CMS) recently announced that National Heritage Insurance Corporation (NHIC) has been awarded a contract of up to five years for the combined administration of Part A and Part B Medicare claims payment in Maine, Massachusetts, New Hampshire, Rhode Island and Vermont. NHIC will serve as the first point of contact for the processing and payment of Medicare fee-for-service claims from hospitals, skilled nursing facilities, physicians and other health care practitioners in Maine, Massachusetts, New Hampshire, Rhode Island and Vermont. The new Part A/Part B Medicare Administrative Contractor (A/B MAC) was selected using competitive procedures in accordance with federal procurement rules. The new contractor will take claims payment work now performed by three fiscal intermediaries and two carriers in Maine, Massachusetts, New Hampshire, Rhode Island and Vermont. The A/B MAC contract, which has an approximate value of $176 million over five years, will fulfill the requirements of the Medicare Modernization Act's (MMA) contracting reform provisions. As the A/B MAC contractor, NHIC will immediately begin implementation activities and will assume full responsibility for the claims processing work in its five-state jurisdiction no later than May 2009. NHIC will be reaching out to providers and state medical associations to provide education and information about the implementation. For more details, visit NHIC's website at www.medicarenhic.com. CMS awarded the first A/B MAC contract in July 2006 to Noridian Administrative Services, LLC, headquartered in Fargo, N.D. The list of new contractors and the states they cover, along with other information, can be found at http://www.cms.hhs.gov/MedicareContractingReform/ To read the CMS press release issued 11/19, click here: http://www.cms.hhs.gov/apps/media/press_releases.asp November Flu Shot Reminder Flu season is here! Medicare patients give many reasons for not getting their annual flu shot, including ""It causes the flu"; "I don't need it"; "It has side effects"; "It's not effective"; "I didn't think about it"; "I don't like needles!" The fact is that every year in the United States, on average, about 36,000 people die from influenza. Greater than 90 percent of these deaths occur in individuals 65 years of age and older. You can help your Medicare patients overcome these odds and their personal barriers through patient education. Talk with your Medicare patients about the importance of getting an annual flu shot--and don't forget to immunize yourself and your staff. Protect yourself, your patients, and your family and friends. Get Your Flu Shot " Not the Flu. Remember - Influenza vaccine plus its administration are covered Part B benefits. Note that influenza vaccine is NOT a Part D covered drug. For information about Medicare's coverage of the influenza virus vaccine and its administration as well as related educational resources for health care professionals and their staff, please go to http://www.cms.hhs.gov/MLNProducts/Downloads/flu_products.pdf on the CMS website. To download the Medicare Part B Immunization Billing quick reference chart, go to http://www.cms.hhs.gov/MLNProducts/downloads/qr_immun_bill.pdf on the CMS website. A copy of this quick reference chart can be ordered, free of charge, by going to the MLN Products web page and clicking on "MLN Product Ordering Page" in the Related Links Inside CMS section of the web page. | 
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