CMS & Palmetto/J1MAC News

The following information has been received by ANCO.


****CMS NEWS****
The audio transcripts of the ICD-10-CM/PCS Conference Calls that were sponsored by the Centers for Medicare & Medicaid Services in 2008 for Hospital Staff (October 14), Other Part A and Part B Providers (November 12), and Physicians (November 17) are now available and can be accessed in the Downloads Section at http://www.cms.hhs.gov/ICD10/07_Sponsored_Calls.asp .


Now there is a better way for provider and supplier organizations to enroll in Medicare or make a change to their Medicare enrollment information. The Centers for Medicare & Medicaid Services (CMS) announces the availability of Internet-based Provider Enrollment, Chain and Ownership System (PECOS) to provider and supplier organizations. They may use Internet-based PECOS to enroll in Medicare, make a change in their Medicare enrollment information, view their existing Medicare enrollment information, voluntarily withdraw from the Medicare program, or check on the status of an Internet-submitted Medicare enrollment application.

Internet-based PECOS is already available to physicians and non-physician practitioners in all 50 States and theDistrict of Columbia. (CMS expects to make Internet-based PECOS available to suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) in the future.)

FAST

By submitting an initial Medicare enrollment application through Internet-based PECOS, a provider or supplier organization’s enrollment application can be processed as much as 50 percent faster than by paper. This means that it will take less time to enroll or make a change in an existing enrollment record.

For information about the types of changes that enrolled Medicare provider and supplier organizations must report, go to the Downloads Section of the Medicare provider/supplier enrollment page: www.cms.hhs.gov/MedicareProviderSupEnroll.

SECURE

Internet-based PECOS meets all required Government security standards in terms of data entry, data transmission, and the electronic storage of Medicare enrollment information. Only individuals whose identities have been verified by CMS and who have been approved by a provider or supplier organization’s Authorized Official may use Internet-based PECOS on behalf of that provider or supplier organization. The PECOS User IDs and passwords that these individuals establish will protect the access to the given provider or supplier organization’s Medicare enrollment information. PECOS users should change their passwords frequently—at least once a year. By safeguarding their User IDs and passwords, PECOS users will be taking an important step in protecting the provider or supplier organization’s Medicare enrollment information. CMS does not disclose Medicare provider or supplier enrollment information to anyone except when authorized or required to do so by law.

EASY TO USE

Internet-based PECOS is a scenario-driven application process with front-end editing capabilities and built-in help screens. The scenario-driven application process ensures that provider and supplier organizations complete and submit only the information necessary to facilitate the action they wish to take. The CMS External User Services (EUS) Help Desk (1-866-484-8049) is available and staffed to respond to questions about using Internet-basedPECOS, such as navigating through the screens, and to receive reports of systems problems as noted by users.

Obtaining Approval to Use Internet-based PECOS for a Provider or Supplier Organization

There are several steps that must be completed before a provider or supplier organization can use Internet-basedPECOS. These steps are described in detail in the document entitled, “Getting Started with Internet-based Provider Enrollment, Chain and Ownership System (PECOS) – Information for Provider and Supplier Organizations,” which will soon be available in the Downloads Section on the Medicare provider/supplier enrollment page: http://www.cms.hhs.gov/MedicareProviderSupEnroll. Below is an overview of the process.

(1) The first step is taken by the Authorized Official (AO) of the provider or supplier organization. This is done only one time. He or she will register in the Internet-based PECOS Identification and Authentication System (PECOS I&A) by going to https://pecos.cms.hhs.gov. CMS will verify the information provided and the CMS EUS Help Desk will notify the AO of the verification.

(2) An individual who will use Internet-based PECOS to submit enrollment applications for the provider or supplier organization will also register in PECOS I&A. This individual may be an employee of the provider or supplier organization, or an employee of a separate organization. CMS will verify the information provided and the permission of the AO for that individual to use Internet-based PECOS on behalf of the provider or supplier organization. The individual will complete the Security Consent Form and have it signed by an official of his or her employer and by the AO of the provider or supplier organization. The individual will mail the signed and dated Security Consent Form to the CMS EUS Help Desk. The AO will need to periodically log on to Internet-based PECOS to see if there is a pending request for permission to access Internet-based PECOS on behalf of the provider or supplier organization. More than one person may be approved to use Internet-based PECOS on behalf of a given provider or supplier organization, but the Security Consent Form is completed only one time.


(3) Once the registration and verification processes are completed, the CMS EUS Help Desk will notify the AO of the establishment of the relationship between the provider or supplier organization and the organization that will be using Internet-based PECOS on its behalf.

It may take several weeks for the registration and verification processes to be completed. Therefore, we encourage the AO of a provider or supplier organization to begin the registration process now—before the provider or supplier organization has the need to use Internet-based PECOS to submit a Medicare enrollment application or enrollment update.

If a provider or supplier organization has an immediate need to submit a Medicare enrollment application to enroll or to report a change in enrollment information and the steps above have not been successfully completed, the provider or supplier organization should complete and submit the paper version of the Medicare enrollment application (CMS-855).
Submitting an Enrollment Application using Internet-based PECOS

After the steps above are successfully completed, the individual who will be using Internet-based PECOS is considered a PECOS user. If a PECOS user has not already done so, he or she should visit the Medicare provider enrollment web site (www.cms.hhs.gov/MedicareProviderSupEnroll) to download and read the documents relating to Internet-based PECOS. CMS advises PECOS users to avail themselves of this information before logging on to Internet-based PECOS.

After reading the informational documents referenced above, a PECOS user will log on to Internet-based PECOSat https://pecos.cms.hhs.gov. He or she will complete, review, and submit the Medicare enrollment application over the Internet to the designated Medicare contractor. Internet-based PECOS will guide the user through each of these processes. (Internet-based PECOS enables the user to print a copy of the enrollment application, if desired. We recommend this be done so the provider or supplier organization has a copy for its records.)

As part of the enrollment application submittal process, the AO of the provider or supplier organization must sign and date the 2-page Certification Statement that the user will print from Internet-based PECOS. The user must mail the signed and dated Certification Statement, along with any required supporting paper documentation, to the designated Medicare contractor. The Medicare contractor will not begin processing the application that was submitted over the Internet until it has received the signed and dated Certification Statement.

Limitations of Internet-based PECOS

At this time, Internet-based PECOS is unable to handle changes of ownership applications from provider and supplier organizations. Therefore, changes of ownership must be submitted using the paper Medicare enrollment application (CMS-855) process. Internet-based PECOS will be able to accommodate changes of ownership at a future date.

Additional Information

Several documents about Internet-based PECOS for provider and supplier organizations will soon be available in the Downloads Section of the Medicare provider/supplier enrollment web page: www.cms.hhs.gov/MedicareProviderSupEnroll.


CMS is hosting this Special Open Door Forum for Part B provider recovery audit contractors (RACs) on April 14, 2009. The purpose of this forum is to introduce providers to the new contractors and provide more information about the RAC program.

Section 302 of the Tax Relief and Health Care Act of 2006 makes the RAC Program permanent and requires the Secretary to expand the program to all 50 states by no later than 2010. On October 6, 2008, CMS announced awards for the four permanent RACs. Each RAC will be responsible for identifying overpayment and underpayments in approximately ¼ of the country. CMS has planned a gradual expansion to all 50 states. For further details, visit the website at http://www.cms.hhs.gov/RAC.

We look forward to your participation.

Open Door Forum Instructions:
**Capacity is limited so dial in early. You may begin dialing into this forum as early as 1:45 PM ET.**
Dial: 1-800-837-1935
Reference Conference ID 92489480
Note: TTY Communications Relay Services are available for the Hearing Impaired. For TTY services
dial 7-1-1 or 1-800-855-2880 and for Internet Relay services click here: http://www.consumer.att.com/relay/which/index.html. A Relay Communications Assistant will help.

An audio recording of this Special Forum will be posted to the Special ODF website at http://www.cms.hhs.gov/OpenDoorForums/05_ODF_SpecialODF.asp and will be accessible for downloading beginning April 22, 2009 and available for 30 days.

For automatic emails of Open Door Forum schedule updates (E-Mailing list subscriptions) and to view Frequently Asked Questions please visit our website at: http://www.cms.hhs.gov/OpenDoorForums/


The following Medicare payment policy publications are now available in print format from the 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.”

Outpatient Maintenance Dialysis – End-Stage Renal Disease Fact Sheet (revised February 2009), which provides general information about outpatient maintenance dialysis for End-Stage Renal Disease, the composite payment rate system, and separately billable items and services.

Medicare Physician Fee Schedule Fact Sheet (revised January 2009), which provides general information about the Medicare Physician Fee Schedule.

Hospital Outpatient Prospective Payment System Fact Sheet (revised January 2009), which provides general information about the Hospital Outpatient Prospective Payment System, ambulatory payment classifications, and how payment rates are set.

Hospice Payment System Fact Sheet (revised January 2009), which provides general information about the Medicare hospice benefit including coverage of hospice services, certification requirements, election periods, and how payment rates are set.

Clinical Laboratory Fee Schedule Fact Sheet (revised February 2009), which provides general information about the Clinical Laboratory Fee Schedule, coverage of clinical laboratory services, and how payment rates are set.

Acute Inpatient Prospective Payment System Fact Sheet (revised January 2009), which provides general information about the Acute Inpatient Prospective Payment System (IPPS) including IPPS payment rates and how IPPS payment rates are set.

Home Health Prospective Payment System Fact Sheet (revised December 2008), which provides information about coverage of home health services and elements of the Home Health Prospective Payment System.

Ambulance Fee Schedule Fact Sheet (revised January 2009), which provides general information about the Ambulance Fee Schedule.

Ambulatory Surgical Center Fee Schedule Fact Sheet (revised January 2009), which provides general information about the Ambulatory Surgical Center (ASC) Fee Schedule, ASC payments, and how ASC payment amounts are determined.


****PALMETTO/J1MAC NEWS****
Emergency Update to the 2009 Medicare Physician Fee Schedule Database
(MPFSDB)
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20A~MLNs~General~Emergency%20Update%20to%20the%202009%20Medicare%20Physician%20Fee%20Schedule%20Database%20(MPFSDB)?opendocument

If the above link does not work in your e-mail program, please use the
temporary alternate link provided below.
http://www.palmettogba.com/palmetto/providers.nsf/docsCat/EFEF1368EB5FEB608525758B006F0F18?opendocument

CR 6351 is a J1 Part A and B article titled Emergency Update to the 2009
Medicare Physician Fee Schedule Database (MPFSDB).

Incorrect Provider Option Combinations Update
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~Incorrect%20Provider%20Option%20Combinations%20Update?opendocument

If the above link does not work in your e-mail program, please use the
temporary alternate link provided below.
http://www.palmettogba.com/palmetto/providers.nsf/docsCat/8525746A00550AA385257571005BFF57?opendocument

This article has been updated for clarification. The following incorrect
provider option combinations will be rejected and must be resubmitted as
new claims with the correct information.

Medicare Claims Processing Manual Clarifications for Skilled Nursing
Facility (SNF) and Therapy Billing
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20A~MLNs~All%20Part%20A%20MLNs~Medicare%20Claims%20Processing%20Manual%20Clarifications%20for%20Skilled%20Nursing%20Facility%20(SNF)%20and%20Therapy%20Billing?opendocument

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temporary alternate link provided below.
http://www.palmettogba.com/palmetto/providers.nsf/docsCat/8525746A00550AA38525758B00535476?opendocument

Share with your billing staff - CR6407 provides clarifications to the
Medicare Claims Processing Manual for Skilled Nursing Facility (SNF) and
therapy billing, which indicate that effective January 1, 2009, the new
Current Procedural Terminology (CPT) code 95992 is bundled under the
Medicare Physician Fee Schedule (MPFS).

Physician Supervision
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~Provider%20Enrollment~IDTF~Physician%20Supervision?opendocument

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Federal regulations require that diagnostic tests payable under the
physician fee schedule have to be performed under the supervision of an
individual meeting the definition of a physician in Section 1861(r) of the
Social Security Act to be covered under Medicare.

Internet-based Medicare Enrollment is Available in All States and the
District of Columbia
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20A~Resources~Provider%20Enrollment~Internet-based%20Medicare%20Enrollment%20is%20Available%20in%20All%20States%20and%20the%20District%20of%20Columbia?opendocument

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temporary alternate link provided below.
http://www.palmettogba.com/palmetto/providers.nsf/docsCat/8525746A00550AA38525758C004BFF5E?opendocument

The Centers for Medicare & Medicaid Services (CMS) announces the
availability of Internet-based Provider Enrollment, Chain and Ownership
System (PECOS) to provider and supplier organizations.

Overview of Internet-based Provider Enrollment, Chain and Ownership System
(PECOS)
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20A~Resources~Provider%20Enrollment~Overview%20of%20Internet-based%20Provider%20Enrollment%20Chain%20and%20Ownership%20System%20(PECOS)?opendocument

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temporary alternate link provided below.
http://www.palmettogba.com/palmetto/providers.nsf/docsCat/8525746A00550AA38525758D006524EA?opendocument

This J1 article provides an overview of the Internet-based Provider
Enrollment, Chain and Ownership System (PECOS) and its limitations. Basic
information on how to access and navigate through the system, application
status check and standard processing timeframe is included.