New From the Medicare Learning Network
Now Available to Order! The Expanded Benefits Brochure (January 2009). This tri-fold brochure provides health care professionals with an overview of Medicare’s coverage of three preventive services: the initial preventive physical examination (IPPE), also known as the Welcome to “Medicare Physical” Exam or the “Welcome to Medicare” visit, ultrasound screening for abdominal aortic aneurysms, and cardiovascular screening blood tests. To view, download and print this brochure, please go to the CMS Medicare Learning Network (MLN) at http://www.cms.hhs.gov/MLNProducts/downloads/Expanded_Benefits.pdf. To order free of charge, visit http://www.cms.hhs.gov/MLNProducts/, scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page.”
The ABC’s of Providing the Initial Preventive Physical Examination Quick Reference Information (January 2009 Resource). This resource tool is now available in either a two-sided laminated chart or in a tear off pad. It can be used by Medicare fee-for-service physicians and qualified non-physician practitioners as a guide when providing the initial preventive physical examination (IPPE) (also known as the “Welcome to Medicare” Physical Exam or the “Welcome to Medicare” Visit). The two-sided reference identifies the components and elements of the IPPE; provides eligibility requirements, procedure codes to use when filing claims, FAQs, and suggestions for preparing patients for the IPPE; and lists references for additional information. To view, download and print this resource, please go to the CMS Medicare Learning Network (MLN) at http://www.cms.hhs.gov/MLNProducts/downloads/MPS_QRI_IPPE001a.pdf. To order free of charge the laminated chart or tear off pad, visit http://www.cms.hhs.gov/MLNProducts/, scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page.”
The revised publication titled Inpatient Rehabilitation Facility Prospective Payment System Fact Sheet (October 2008), which provides information about Inpatient Rehabilitation Facility Prospective Payment System rates and classification criterion, is now available in print format from the Centers for Medicare & Medicaid Services Medicare Learning Network. To place your order, visit http://www.cms.hhs.gov/MLNGenInfo/ , scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page.”
Electronic Prescribing (E-Prescribing) Incentive Program: New Educational Product is Now Available!
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that a new Medicare Learning Network educational resource has been posted to the Electronic Prescribing (E-Prescribing) Incentive Program section page on the PQRI webpage:
2009 Electronic Prescribing Incentive Program Made Simple- This Fact Sheet provides detailed information on how to participate in the 2009 Electronic Prescribing (E-Prescribing) Incentive Program by reporting the E-Prescribing measure.
To access this new educational product, as well as all available E-Prescribing educational resources, visit http://www.cms.hhs.gov/PQRI on the CMS website and click on the Electronic Prescribing Incentive Program tab. Once on the E-Prescribing page, scroll down to the “Downloads” section and click on the “2009 Electronic Prescribing Incentive Program Made Simple” link.
Medicare Part B Competitive Acquisition Program (CAP) – Reminder about CAP Claims Submission Deadlines and Unused CAP Drugs
The following is a reminder about upcoming CAP deadlines. It is very important that physicians who participated in the CAP during 2008 understand and comply with these deadlines because failure to do so will affect physicians’ ability to be reimbursed.
CAP Drugs Administered During 2008
- All CAP drug claims must be submitted on or before January 30, 2009. CAP drug claims and corresponding physicians’ drug administration claims must have a date of service on or before December 31, 2008.
- CAP drugs that have not been administered by December 31, 2008 are the property of the Approved CAP Vendor.
- Do not submit CAP claims for dates of service after December 31, 2008 because they will be denied.
- CAP claims submitted by the Approved CAP Vendor for dates of service after December 31, 2008 will also be denied.
CAP Drugs NOT Administered by December 31, 2008
- 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.
Emergency Restocking of CAP Drugs for Dates of Services on or before December 31, 2008
- When permitted under the emergency restocking provision, physicians may submit a prescription order for a CAP drug to replace what they used from their own stock. Physicians may request replacement drugs ONLY if the date of service is on or before December 31, 2008, AND the corresponding drug administration claim has been submitted on or before January 30, 2009.
- Physicians must request replacement drugs by January 30, 2009.
- 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 as described above will not be able to bill Medicare under the 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 .
RTI’s 24 month contract includes two phases. The first phase consists primarily of reviewing the relevant literature and policy materials and compiling stakeholder input. The second phase involves conducting analyses utilizing administrative and clinical assessment data. CMS will be reporting on the first phase in a Report to Congress which is due June 2009. The RTI analysis will continue through 2009 with a final report to CMS by late 2010.
Comments should be limited. Longer written comments may be submitted via e-mail to IRFReporttoCongress@cms.hhs.gov. If possible, comments should be submitted to CMS in writing in advance of the Special ODF. If you have any questions please feel free to contact Julie Stankivic at (410) 786-5725.
Physician Quality Reporting Initiative (PQRI) Updates
Frequently Asked Questions
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 for 2009 PQRI 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.
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.
Notification of Error in Attachment D to Chapter 8 of the “OASIS Implementation Manual”
Section D (4) (c) (3) of Attachment D in the “OASIS Implementation Manual” contains an error. Currently, this section of the document incorrectly lists the Neuro 3-Stroke diagnosis group. The correct diagnosis group is Neuro 1-Brain Disorders and Paralysis. Case Scenario #4 also incorrectly assigns a diagnosis from the Neuro 3-Stroke diagnosis group. The correct diagnosis assignment in Scenario #4 should be from the Neuro 1- Brain Disorders and Paralysis diagnosis group. Revisions to the above section of Attachment D, to include revisions to the associated Case Scenario #4, will be posted in the near future. Questions related to Attachment D should be sent to: AskOasisAttachD@cms.hhs.gov.
“Attachment D” to Chapter 8 of the “OASIS Implementation Manual” is currently posted in the “Downloads” section of the “OASIS B1 User Manual website: http://www.cms.hhs.gov/HomeHealthQualityInits/14_HHQIOASISUserManual.asp.
CMS Updates End Stage Renal Disease (ESRD) PC Pricer
The Centers for Medicare & Medicaid Services (CMS) has updated the PC Pricer web page at http://www.cms.hhs.gov/PCPricer/02e_ESRD_Pricer.asp#TopOfPage to include the updated ESRD PC Pricer with the rates for 2009. The PC Pricer is located in the Downloads section of the web page.
Flu Shot Reminder
It’s seasonal flu time again! If you have Medicare patients who haven’t yet received their flu shot, you can help them reduce their risk of contracting the seasonal flu and potential complications by recommending an annual influenza and a one-time pneumococcal vaccination. Medicare provides coverage of flu and pneumococcal vaccines and their administration. – 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.
Health care professionals and their staff can learn more about Medicare’s coverage of the influenza vaccine and other Medicare Part B covered vaccines and related provider education resources created by CMS, by reviewing Special Edition MLN Matters article SE0838 http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0838.pdf on the CMS website.