CMS asks that you share this important information with all of your association members and State and local chapters. Thanks! Happy Friday everyone! Information items today include: Medicare Publishes Billing Edits to Reduce Payment Errors CMS Provides Guidance on DMEPOS Accreditation for Pharmacy Suppliers New From the Medicare Learning Network Medicare Solicits Nominees for Advisory Panel for Next Phase of DMEPOS Competitive Bidding Program CMS Issues New Resources on ESRD Conditions for Coverage CMS Issues Final Rule to Empower Medicaid Beneficiaries to Direct Personal Assistance Services Your October Flu Shot Reminder Your Latest CDC Updates (In Downloads section) Medicare Publishes Billing Edits to Reduce Payment Errors The Centers for Medicare & Medicaid Services (CMS) recently announced that, beginning October 1, 2008, it will publish most of the edits utilized in its Medically Unlikely Edit (MUE) program to improve the accuracy of claims payments. "It is always our aim to ensure that CMS pays for appropriate services, at the same time protecting the Medicare Trust funds and the American taxpayer," said CMS Acting Administrator Kerry Weems. "This program is going to help us dramatically reduce costly payment errors." CMS established the MUE program to reduce payment errors for Medicare Part B claims. Claims processing contractors utilize these edits to assure that providers and suppliers do not report excessive services. The edits are applied during the electronic processing of all claims. These edits check the number of times a service is reported by a provider or supplier for the same patient on the same date of service. Providers and suppliers report services on claims using HCPCS/CPT codes along with the number of times (i.e., units of service) that the service is provided. Prior studies, including one by the U.S Department of Health and Human Services' Office of the Inspector General in May 2006, identified significant Medicare overpayments because provider or supplier claims sometimes report services with too many units of service. These errors may be caused by numerous factors, including clerical errors and coding errors. CMS first implemented the MUE program January 1, 2007, with edits for about 2,600 HCPCS/CPT codes. There have been quarterly updates adding additional codes. The October 1, 2008, version of MUE will contain edits for about 9,700 HCPCS/CPT codes that have been assigned unit values for MUEs. MUEs are cumulative for each quarter. However, CMS will not publish all MUEs on October 1, 2008. CMS has not yet determined if there have been any savings in the MUE program since it was implemented. The edits were developed by CMS with the cooperation and participation of national health care organizations representing physicians, hospitals, non-physician practitioners, laboratories, and durable medical equipment suppliers. CMS also utilized claims data in its analysis of MUE. The edits can be found on the CMS Website at http://www.cms.hhs.gov/NationalCorrectCodInitEd/08_MUE.asp#TopOfPage. At the start of each calendar quarter, CMS will publish most MUEs active for that quarter. Although the October 1, 2008, publication will contain most MUEs, additional ones will be published on January 1, 2009. CMS is not able to publish all active MUEs because some are primarily designed to detect and deter questionable payments rather than billing errors. Publishing those MUEs would diminish their effectiveness. CMS Provides Guidance on DMEPOS Accreditation for Pharmacy Suppliers On September 3, 2008, the Centers for Medicare & Medicaid Services (CMS) announced a list of Durable Medical Equipment Prosthetics/Orthotics, and Supplies (DMEPOS) providers that were exempt from meeting the quality standards for DMEPOS accreditation. CMS would like to clarify that pharmacists and pharmacies were not included in this provider exemption; therefore, pharmacists and pharmacies do need to obtain accreditation. For example, if a pharmacy is providing DMEPOS supplies to Medicare beneficiaries, such as diabetic supplies and enteral/parenteral nutrition, they would need to be accredited by the September 30, 2009 deadline. For more information about DMEPOS Accreditation, please visit the web page at http://www.cms.hhs.gov/medicareprovidersupenroll/. New from the Medicare Learning Network Medicare Part B Drug Competitive Acquisition Program (CAP): 2009 CAP Postponement Article A Medicare Learning Network (MLN) Matters Special Edition article on the 2009 CAP postponement is now available on the CMS website. This article contains billing, drug ordering, claims processing, and other information for Participating CAP Physicians on the transition from CAP to the ASP "buy and bill" methodology for 2009. This article is available on the CMS website at: http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0833.pdf. Additional information on the CAP and the program's postponement for 2009 is available on the CMS CAP website at: http://www.cms.hhs.gov/CompetitiveAcquisforBios/01_overview.asp. ICD-10-CM/PCS Article Now Available A new MLN Matters Special Edition Article entitled, "SE0832 " The ICD-10 Clinical Modification/Procedure Coding System (CM/PCS) "The Next Generation of Coding," has recently been released. Go to http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0832.pdf to view it. MEDICARE SOLICITS NOMINEES FOR ADVISORY PANEL FOR NEXT PHASE OF DURABLE MEDICAL EQUIPMENT COMPETITIVE BIDDING PROGRAM MEMBERS TO PROVIDE GUIDANCE ON OPERATIONAL ISSUES The Centers for Medicare & Medicaid Services (CMS) is soliciting nominations for individuals to serve on the Program Advisory and Oversight Committee (PAOC) that advises CMS on various issues relating to the competitive bidding program for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). The PAOC was initially established in 2004, as required by the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), to advise CMS on the design and implementation of a competitive bidding program for DMEPOS that would build on the successes of two pilot projects that had shown that competitive bidding could reduce prices of DMEPOS without adversely affecting beneficiary access or compromising quality. Because the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) delayed implementation of and made certain changes to the competitive bidding program, and extended the PAOC for two years through December 31, 2011, CMS is ending the term of service for current PAOC members. The PAOC will be comprised of 10 and 12 members from the following broad categories: - Beneficiary/consumer representatives;
- Physicians and other practitioners;
- Suppliers;
- Professional standards organizations;
- Financial standards specialists (that is, economist/certified public accountant); and
- Association representatives.
- CMS may consider nominees for additional categories if it finds that their expertise will help to ensure the successful implementation of the program
Nominations are due to CMS by November 3, 2008. For more information, please see the CMS Web site at: http://www.cms.hhs.gov/center/dme.asp To read the CMS press release issued on October 1, 2008, click here: http://www.cms.hhs.gov/apps/media/press_releases.asp Centers for Medicare & Medicaid Services Issues New Resources on ESRD Conditions for Coverage Frequently Asked Questions Thank you to all of our colleagues in the renal care community who submitted questions to the Centers for Medicare & Medicaid Services (CMS) about our recently released ESRD Conditions for Coverage final rule. In response to these inquiries, we have already provided many of you with individual responses to your questions; however, to share the benefit of these questions with the entire community, CMS has developed a "Frequently Asked Questions" document that condenses many of the questions we received from you. The FAQs are available online at http://www.cms.hhs.gov/center/esrd.asp on the CMS website. To view them, click on the second Spotlight. Crosswalk: Former Conditions versus Revised Conditions As another tool to help you understand the new Conditions for Coverage, CMS has developed a crosswalk that compares the former conditions to the final revised conditions, which were issued in the Federal Register on April 15, 2008. The crosswalk will help you navigate the new organization structure of the condition as well as some revised provisions of the conditions themselves. The crosswalk is available online at http://www.cms.hhs.gov/center/esrd.asp on the CMS website. To view the Crosswalk, click on the third Spotlight. We hope you find these tools helpful as you work to implement the revised conditions. For more information, please visit us online at http://www.cms.hhs.gov/CFCsAndCoPs/13_ESRD.asp on the CMS website. CMS ISSUES FINAL RULE TO EMPOWER MEDICAID BENEFICIARIES TO DIRECT PERSONAL ASSISTANCE SERVICES A final rule that would allow more Medicaid beneficiaries to be in charge of their own personal assistance services, including personal care services, instead of having those services directed by an agency, was recently announced by the Centers for Medicare & Medicaid Services (CMS). The rule, on display today at the Federal Register, guides states who wish to allow Medicaid beneficiaries who need help with the activities of daily living to hire, direct, train or fire their own personal care workers. Beneficiaries could even hire qualified family members who may already be familiar with the individual's needs to perform personal assistance (not medical) services. A copy of the regulation is available on the Federal Register's Website at: http://federalregister.gov/OFRUpload/OFRData/2008-23102_PI.pdf The press release has been posted to the CMS Newsroom at: http://www.cms.hhs.gov/apps/media/press_releases.asp October Flu Shot Reminder Flu Season Is Upon Us! Begin now to take advantage of each office visit as an opportunity to encourage your patients to get a flu shot. It's still their best defense against combating the flu this season. (Medicare provides coverage of the flu vaccine without any out-of-pocket costs to the Medicare patient. No deductible or copayment/coinsurance applies.) And don't forget, health care personnel can spread the highly contagious flu virus to patients. Protect Yourself. Don't Get the Flu. Don't Give the Flu. Get Your Flu Shot. 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, please go to http://www.cms.hhs.gov/MLNProducts/Downloads/flu_products.pdf on the CMS website.
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