Practice News & Headlines

August 30, 2010

Physicians and Non-Physician Practitioners: Have you tried Internet-based PECOS for your Medicare enrollment actions?  

It’s easy to use and offers a host of advantages over the paper-based enrollment process. Want more control over your enrollment information?  The Internet-based Provider Enrollment, Chain and Ownership System (PECOS) does that! Want more control when adding or changing a reassignment of benefits?  Internet-based PECOS does that, too! Using Internet-based PECOS Is Easy!  Learn how to use the system by reading the Medicare Physician and Non-Physician Practitioner Getting Started Guide.  And if you encounter problems or have questions as you navigate the system, there is help available! Don’t wait – Set your practice free from paper – Start using Internet-based PECOS today!

CMS to Host Listening Session Regarding Confidential Feedback Reports and the Implementation of a Value-Based Payment Modifier for Physicians

September 24, 2010 from 10am-4pm ET at CMS Headquarters in Baltimore, MD

CMS will host a listening session on September 24th as part of the transition to a value-based purchasing program for services of physicians and certain other professionals, as well as other related provisions under the Patient Protection and Affordable Care Act (known as the Affordable Care Act (ACA)). The ACA contains provisions that continue and expand the Physician Feedback Program and also require implementation of a value-based payment modifier to the Fee-For-Service physician fee schedule. The purpose of the listening session is to solicit comments on approaches being considered as we implement these provisions.

Physicians, physician associations, and all others interested in the use of confidential feedback reports as one means of enhancing quality and efficiency are invited to participate, in person or by calling in to the teleconference. The meeting is open to the public, but attendance is limited to space and teleconference lines available. Persons interested in attending the meeting or participating by teleconference must register by completing the on-line registration via the CMS Web site at http://www.eventsvc.com/palmettogba/092410.

For the complete Federal Register notice, which includes registration information, visit http://edocket.access.gpo.gov/2010/pdf/2010-19128.pdf on the web.

Follow-Up National Provider Call regarding ICD-10 Implementation in a 5010 Environment

The Centers for Medicare & Medicaid Services (CMS) will host a follow-up national provider conference call on "ICD-10 Implementation in a 5010 Environment". Subject matter experts will review basic information on both ICD-10 and 5010 and explain how they are interrelated.  A question and answer session will follow the presentations. 

When:    Monday, September 13, 2010 

Time:  1pm – 1:30pm ET

Target Audience: Medical coders, physician office staff, provider billing staff, health records staff, vendors, educators, system maintainers and all Medicare fee-for-service (FFS) providers. The following topics will be discussed:

ICD-10

• ICD-10 implementation for services provided on and after October 1, 2013
• Differences between ICD-10 and ICD-9-CM codes 
• ICD-10-CM basic information for all users
• Tools for converting codes – General Equivalence Mappings (GEMs)
• Proposal to freeze ICD-9-CM and ICD-10 code updates except for new technologies and diseases

HIPAA Version 5010

• Compliance dates and timelines (No contingencies)
• 5010 before and after ICD-10 Implementation 
• Readiness review for implementing HIPAA version  5010 and D.0
• What you need to be doing to prepare
• Medicare fee-for-service activities update
• Other issues and considerations

For more information and to register for this informative session, please go to http://www.cms.gov/ICD10/02c_CMS_Sponsored_Calls.asp on the CMS website. Registration will close at 12pm ET on September 10, 2010, or when available space has been filled. No exceptions will be made. Please register early.

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August 23, 2010

Highmark Medicare Services - Provider Enrollment Teleconferences/Webinars Medicare Part B

In response to customer feedback, Highmark Medicare Services will be offering a series of Provider Enrollment educational teleconferences and webinars.  These sessions will be jointly conducted by Highmark Medicare Services’ Provider Outreach and Education staff and Provider Enrollment experts.

Session Two - How to Complete Paper CMS-855 Forms – Coming in September

Webinar materials and registration will be available in late August. This webinar will focus on instructions for completing paper CMS-855 forms.  Three unique webinars will be offered for Part B Providers and other Supplier Types.  Each webinar will include information on how to avoid return of and development on submitted applications, helpful hints, frequently asked questions, and an orientation to the various tutorials and information available on our internet Enrollment Center.  Highmark Medicare Services Provider Enrollment experts will be available to address specific questions related to the completion of paper CMS-855 forms.

Please review the dates and topics below. 

September 8 – 10:00 am – 11:30 am

Clinics/Group Practices – This includes new enrollment, reactivating, voluntarily terminating, revalidating, and changing Medicare information for clinics/group practices.  The CMS-855B and CMS-855R forms will be discussed.

September 9 – 2:00 pm – 3:30 pm

Physicians and Non-physician Practitioners – This includes new enrollment, reactivating, voluntarily terminating, revalidating, and changing Medicare information for physicians and non-physician practitioners.  The CMS-855I and CMS-855R forms will be discussed.

September 15 – 1:00 pm – 2:30 pm

Other Supplier Types –   This includes new enrollment, reactivating, voluntarily terminating, revalidating, and changing Medicare information for supplier types such as ambulance services, ASCs, ICLs, IDTFs, mass immunizers, etc..  The CMS-855B form will be discussed.

Session Three:  How to use Internet-based PECOS (PECOS Web) – Webinars will begin in October

This webinar is for providers interested in transitioning from use of paper CMS-855 forms to PECOS Web.  By completing the “interest” form, Highmark Medicare Services will contact you to arrange a PECOS Web training webinar tailored to your specific needs.  The webinar will include general information and helpful hints related to utilization of PECOS Web and a complete overview of the PECOS Web screens and process.  Our interest form will be available shortly.

COMPARATIVE BILLING REPORTS

The Centers for Medicare & Medicaid Services mailed its first-ever comparative billing reports (CBRs) to as many as 5,000 physical therapists during the week of Aug. 9, according to an Aug. 16 e-mail notice from CMS.

The CBRs, produced by SafeGuard Services LLC and distributed by Livanta LLC under contracts with CMS, compare providers' individual billing practices for specific procedures and services with their peer group. CMS developed the program to reduce improper payments and to educate providers on Medicare billing requirements.

CMS has issued similar reports in the past, including the Program for Evaluating Payment Patterns Electronic Report (PEPPER) sent to inpatient hospitals, and Resource-Based Relative Value Scale (RBRVS) feedback reports sent to physicians, but this is the first time CMS has issued CBRs, agency spokesman Peter Ashkenaz told BNA Aug. 17.

The initial CBRs apply to outpatient physical therapy services provided by independent physical therapists and are based on 2009 Medicare claims data.

Physical therapists were chosen due to an identified vulnerability in their billing procedures centered on use of the KX modifier. The KX modifier is required to indicate that a service was medically necessary and justified by medical records, that the physical therapy financial limitation cap was met, and that a patient's condition requires further treatment.

Moving forward, SafeGuard will produce and send new CBRs to Livanta each month for distribution to providers.

Information on the CBR program is at http://www.safeguard-servicesllc.com/cbr/default.asp.

Dear State Medicaid Director (SMD) Letter on Health Information Technology (HIT) – attached

CMCS is pleased to announce the release of a letter to State Medicaid directors regarding implementation of section 4201 of the American Recovery and Reinvestment Act of 2009 (the Recovery Act), and our recently published final regulations regarding the use of health information technology (HIT) in the Medicaid program.  http://www.cms.gov/smdl/downloads/SMD10016.pdf

The Recovery Act provides 100 percent Federal financial participation (FFP) to States for incentive payments to eligible Medicaid providers to adopt, implement, upgrade, and meaningfully use certified EHR technology, and 90 percent FFP for State administrative expenses related to the program.  CMS has now promulgated final regulations that also govern State administrative expenses related to operation of these programs.  The letter and the accompanying enclosures provide more detailed guidance from CMS on the expectations relating to the activities and potential uses of the 90/10 matching funds.

We hope you will find this information helpful.  We look forward to collaborating with State Medicaid agencies and learning from these experiences as we provide technical assistance, policy guidance, and Federal resources to ensure successful development and implementation of Medicaid EHR Incentive Programs. 

Questions regarding this guidance may be directed to Mr. Rick Friedman, Director, Division of State Systems,  at 410-786-4451, or Richard.Friedman@cms.hhs.gov.

MLN Matters Article #SE1022 - Medical Record Retention and Media Formats for Medical Records

The Centers for Medicare & Medicaid Services (CMS) has released MLN Matters Special Edition Article #SE1022 to outline CMS’ policies and timeframes concerning the retention of medical records.  This article is informational in nature and does not change or revise current policies and procedures.  For more details, please read the article at http://www.cms.gov/MLNMattersArticles/downloads/SE1022.pdf on the CMS website.

Medical Record Retention and Media Formats for Medical Records

The Centers for Medicare & Medicaid Services (CMS) has released MLN Matters Special Edition Article #SE1022 to outline CMS’ policies and timeframes concerning the retention of medical records.  This article is informational in nature and does not change or revise current policies and procedures.  For more details, please read the article at http://www.cms.gov/MLNMattersArticles/downloads/SE1022.pdf on the CMS website.

CIGNA Training

Download the schedule of Electronic Services Training sessions that will be offered in September and October.  This is an opportunity for you, your staff and your partners to attend an educational session without leaving your desk.  Please take the opportunity to participate in these sessions and feel free to share the information with others.  If you have new associates in your areas (front desk, billing, referrals, collections, etc.), this is a great opportunity to learn about our website, online precertification, the Cost of Care Estimator and much more.  Please take the time to attend one or more of the educational sessions.

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