CMS & Palmetto/J1MAC News

The following information has been received by ANCO.


****CMS NEWS****
The Centers for Medicare & Medicaid Services (CMS) today announced final changes to policies and payment rates for services to be furnished during calendar year (CY 2010) by over 1 million physicians and nonphysician practitioners who are paid under the Medicare Physician Fee Schedule (MPFS). The MPFS sets payment rates for more than 7,000 types of services in physician offices, hospitals, and other settings. Today’s action complies with federal law, which requires these policies and payment rates to be announced by Nov. 1.

Current law requires CMS to adjust the MPFS payment rates annually based on an update formula which requires application of the Sustainable Growth Rate (SGR) that was adopted in the Balanced Budget Act of 1997. This formula has yielded negative updates every year beginning in CY 2002, although CMS was able to take administrative steps to avert a reduction in CY 2003, and Congress has taken a series of legislative actions to prevent reductions in CYs 2004-2009. In the absence of Congressional action for the CY 2010 physician update, the final rule with comment period will reduce the conversion factor for services on or after Jan. 1, 2010 by 21.2 percent rather than the -21.5 percent projected in the proposed rule. The difference is due to the use of the most recently available data on CMS spending for physicians’ services.

“The Administration tried to avert the pending fee schedule cut in the FY 2010 budget proposal that it submitted to Congress, and remains committed to repealing the SGR,” said Jonathan Blum, director of the CMS Center for Medicare Management. “In the meantime, CMS is finalizing its proposal to remove physician-administered drugs from the definition of ‘physicians’ services’ for purposes of computing the physician fee schedule update. While this decision will not affect payments for services during CY 2010, CMS projects it will have a positive effect on future payment updates.”


In the final rule with comment period, CMS is also adopting several refinements to Medicare payments to physicians which will improve payment rates for primary care services relative to other services. For 2010, for purposes of establishing the practice expense (PE) relative value units (RVUs), CMS had proposed to include data about physicians’ practice costs from a new survey, the Physician Practice Information Survey (PPIS), designed and conducted by the American Medical Association. CMS is finalizing the proposal, but will phase it in over a four year period. In addition, CMS will not use the PPIS data to determine the practice expenses for medical oncology, but instead will continue to use specialty supplemental survey data , as indicated by the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA).

CMS is also finalizing its proposal to stop making payment for consultation codes other than the G codes that are used to bill for telehealth consultations, and to redistribute the resulting savings to increase payments for the existing evaluation and management (E/M) services. CMS will adjust the payment for the surgical global period to reflect the higher value of the office visits furnished during the global period.

In the final rule with comment period, CMS is adopting two significant modifications to its proposal to increase the equipment utilization percentage that is assumed for purposes of setting PE RVUs. CMS will increase the equipment utilization rate assumption used to determine the practice expense for expensive equipment priced over one million dollars from 50 to 90 percent but will phase in this change over a four year period. CMS also will not apply this change to expensive therapeutic equipment.

CMS is increasing payment for the Initial Preventive Physical Exam (IPPE), also called the “Welcome to Medicare” visit to be more in line with payment rates for higher complexity services. Originally established in the MMA, the IPPE benefit now pays for an initial assessment of key elements of a beneficiary’s health within one year of the beneficiary’s enrollment in Medicare Part B.

Taking all changes in the final rule with comment period into account, CMS projects that payments to general practitioners, family physicians, internists, and geriatric specialists will increase by between 5 and 8 percent, prior to application of the negative update required by the SGR.

The final rule with comment period also implements a number of provisions in the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) including:

· Adding new Medicare benefit categories for cardiac and pulmonary rehabilitation services and for chronic kidney disease (CKD) education beginning Jan. 1, 2010. The final rule with comment period outlines what these programs will entail, how they will be
paid under the MPFS and the criteria for covering these services.
· Increasing the Medicare share of payments for outpatient mental health services to 55 percent from 50 percent, beginning a gradual transition to bring payment parity for mental health and medical services furnished to Medicare beneficiaries.
· Implementing a requirement that suppliers of the technical component of advanced imaging services be accredited beginning Jan. 1, 2012. The accreditation requirement will apply to mobile units, physicians’ offices, and independent diagnostic testing facilities that create the images, but will not apply to the physician who interprets them. CMS will address suppliers’ accountability, business integrity, physician and technician training, service quality, and performance management through additional guidance.

The final rule with comment period contains a number of provisions to promote improvement in quality of care and patient outcomes through revisions to the Electronic Prescribing Incentive Program (e-Prescribing Program) and the Physician Quality Reporting Initiative (PQRI). Specifically, the final rule simplifies the reporting requirements for the electronic prescribing measure, provides eligible professionals with more reporting options, and establishes a new process for group practices to be considered successful electronic prescribers. Eligible professionals or group practices that meet the requirements of each program in CY 2010 will be eligible for incentive payments for each program equal to 2.0 percent of their total estimated allowed charges for the reporting periods.

In addition, CMS is adding measures for eligible professionals to report under the PQRI, providing a mechanism for participants to submit quality measure data from a qualified electronic health record and creating a process for group practices to use for reporting the quality measures.

The final rule with comment will appear in the Nov. 25, 2009 Federal Register. CMS will accept comments on designated provisions of the final rule with comment period until Dec. 29, 2009, and will respond to all comments at a later date. Unless otherwise specified, the new payment rates and policies will apply to services furnished to Medicare beneficiaries on or after Jan. 1, 2010.

To view a copy of the final rule with comment period and supporting documentation, please see:
http://www.cms.hhs.gov/PhysicianFeeSched/PFSFRN/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=4&sortOrder=descending&itemID=CMS1230135&intNumPerPage=10 .

A fact sheet providing more information about the e-Prescribing Program and PQRI provisions can be found at:

www.cms.hhs.gov/apps/media/fact_sheets.asp


MM6632 – FDG PET for Solid Tumors and Myeloma
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6632.pdf


The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host a national provider conference call on the 2009 Physician Quality Reporting Initiative (PQRI). This toll-free call will take place from 1:00 p.m. – 3:00 p.m., EST, on Tuesday, November 10, 2009.

The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) made the PQRI program permanent, but only authorized incentive payments through 2010. Eligible professionals who meet the criteria for satisfactory submission of quality measures data for services furnished during the reporting period, January 1, 2009 - December 31, 2009, will earn an incentive payment of 2.0 percent of their total allowed charges for Physician Fee Schedule (PFS) covered professional services furnished during that same period. The 2009 PQRI consists of 153 quality measures and 7 measures groups.

The topics covered on this national provider call will include:

· Updates on 2008 PQRI and 2007 PQRI re-run incentive payments & feedback reports;
· Results from the 2008 PQRI and 2007 PQRI re-run;
· An update on 2010 PQRI and E-prescribing programs; and
· What to expect on your feedback report.

Following the presentation, the lines will be opened to allow participants to ask questions of CMS PQRI subject matter experts.

Educational products are available on the PQRI dedicated web page located at http://www.cms.hhs.gov/PQRI , on the CMS website, in the Educational Resources section,as well as educational products are available on the e-prescribing dedicated web page located at http://www.cms.hhs.gov/ERxIncentive on the CMS website. Feel free to download the resources prior to the call so that you may ask questions of the CMS presenters.

Conference call details:

Date: November 10, 2009

Conference Title: Physician Quality Reporting Initiative (PQRI) - National Provider Call

Time: 1:00 p.m. EST

In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation. Registration will close at 1:00 p.m. EST on November 9, 2009, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.

To register for the call participants need to go to:
http://www.eventsvc.com/palmettogba/111009b
Fill in all required data.

Verify your time zone is displayed correctly the drop down box.

Click "Register".

You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.

For those of who will be unable to attend, a transcript of the call will be available at least one week after the call at http://www.cms.hhs.gov/pqri on the CMS website.

If you require services for the hearing impaired please send an email to: Medicare.TTT@PalmettoGBA.com.


****PALMETTO/J1MAC NEWS****
J1 Part B LCD Update
The following J1 Part B LCDs have been revised: Allergy Testing L28234 and
Radiation Oncology: External Beam/Teletherapy L28297. Please review and
share with your staff members.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7WZLP36638?opendocument


New User-Friendly EFT Form Available
A new user-friendly EFT authorization form is now available on the Palmetto
GBA J1 Web site. Please review and share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7W6Q9R8283?opendocument


2009 PQRI National Provider Call with Question & Answer Session
The Centers for Medicare & Medicaid Services' (CMS) Provider Communications
Group will host a national provider conference call on the 2009 Physician
Quality Reporting Initiative (PQRI). This toll-free call will take place
from 1 p.m. to 3 p.m., EST, on Tuesday, November 10, 2009.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7X9JFU1052?opendocument


2010 Medicare Participation Enrollment & Fee Schedule Information
We are again excited to provide you with a CD-ROM packed full of useful
information, which will include the 2010 Medicare Participation Enrollment
form along with some valuable additional information. We anticipate that
the CD-ROM will be mailed in November 2009. Please review and share with
your staff members.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7X9NJJ8048?opendocument


Alternative Process for Individual Eligible Professionals to Access
Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing
(E-Prescribing) Feedback Reports
Individual Eligible Professionals (EP) requesting reports based on their
individual National Provider Identifier (NPI) have an alternative means of
accessing those reports. Physicians and other practitioners who qualify as
individual EPs under the Centers for Medicare & Medicaid Services (CMS)
Physician Quality Reporting Initiative (PQRI), and the 2009 E-Prescribing
Incentive Program can
request feedback reports through their claims processing contractor. Please
review and share with your staff members.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7X9KZJ2274?opendocument


FDG PET for Solid Tumors and Myeloma
CR6632 was revised on October 22, 2009, to clarify the language in the What
You Need to Know and Background sections. All other information remains
unchanged. Please review and share with your staff members.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7X2R6T8231?opendocument


J1 Part B LCD Update
The J1 Part B LCDs have been revised. Please review and share with your
staff members.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7X9K9V0655?opendocument


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