CMS & Palmetto/J1MAC News

The following information has been received by ANCO.


****CMS NEWS****
Revised--Special Edition MLN Matters Article #SE0929 - 2010 Annual Participation Enrollment Program Extension
This article was revised on December 22, 2009, to show that the 2010 Annual Participation Enrollment Program has been extended through March 17, 2010. Due to recent revisions that were made to the 2010 Medicare Physician Fee Schedule (MPFS), CMS has extended the 2010 Annual Participation Enrollment Program end date from December 31, 2009, to March 17, 2010 – therefore, the enrollment period now runs from November 13, 2009, through March 17, 2010. The effective date for any Participation status change during the extension, however, remains January 1, 2010; and will be in force for the entire year. For more information, please view the article located at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0929.pdf on the CMS website.


QRI and eRx measures-related documents. The updated documents are now available on the CMS PQRI webpage at http://www.cms.hhs.gov/PQRI and the CMS eRx webpage at http://www.cms.hhs.gov/ERxincentive respectively on the CMS website.

2010 Measures Groups Specification Update

Version 3.0 of the Measures Groups Specifications Manual released in November 2009 for 2010 PQRI has been revised. Version 3.1 of the 2010 PQRI Measures Groups Specifications Manual and Release Notes reflects a change to the denial remark code note for several Measures Groups. Correct G-codes specific to each Measures Group have been replaced within this document. For further details, the updated “2010 PQRI Measures Groups Specifications Manual and Release Notes” is now available on the CMS PQRI webpage at http://www.cms.hhs.gov/pqri, on the CMS website. Click on the “Measures Codes” section page on the left.

2010 Measure Specifications Update

Version 4.0 of the Measure Specifications Manual and Release Notes, which was released in November 2009 for PQRI 2010, has been updated.
· Two updates were made to Version 4.1 of the Measure Specifications Manual
o Measure #193: Additional information was added to the note for Numerator Coding option CPT II 4256F
o Measure #94: CPT 92567 was added to the Denominator Coding
· Version 4.1 of the Release Notes was updated in several areas:
o Two temporary measure numbers have been replaced with final measure numbers
o Measure #21 and Measure #22: A CPT code that was listed as being deleted from the Denominator Coding was revised to reflect the correct code
o Measure #48: CPT codes listed as being added and deleted from the Denominator Coding have been updated to reflect they were only added to the measure.

The updated version of the “2010 PQRI Measure Specifications Manual for Claims and Registry Reporting of Individual Measures and Release Notes” is now available on the CMS PQRI webpage at http://www.cms.hhs.gov/pqri, on the CMS website. Click on the “Measures Codes” section page on the left.

Final 2010 EHR Measures Specifications

The final “2010 EHR Measures Specifications” and “2010 EHR Measures Specifications - Release Notes” have been modified and are now available on the CMS PQRI website. Please note, changes were made to this document, as some encounter codes were identified as non-covered services under the Medicare Physician Fee Schedule and will not be counted in the denominator population for PQRI reporting calculations. To access these final documents, please visit the CMS PQRI webpage at http://www.cms.hhs.gov/pqri, on the CMS website. Click on the “Alternative Reporting Mechanisms” section page on the left.

2010 PQRI Single Source Code Master Update

The “2010 PQRI Single Source Code Master” document released in November 2009 for PQRI 2010 has been revised to add CPT 92567 to the Denominator Coding for Measure #94. The updated document is now available on the CMS PQRI webpage at http://www.cms.hhs.gov/pqri, on the CMS website. Click on the “Measures Codes” section page on the left.

2010 eRx Measure Specifications Update

Version 1.0 of the 2010 eRx Release Notes released in November for 2010 eRx has also been revised. The updated Version 1.1 of the eRx Release Notes now correctly reflects a change in the Denominator Updates section of the document. To access this updated document, please see the “2010 eRx Measures Specifications and Release Notes”, which available on the CMS Electronic Prescribing Incentive Program (eRx) webpage at http://www.cms.hhs.gov/ERxincentive, on the CMS website. Click on the “E-Prescribing Measure” section page on the left.


The revised Understanding the Remittance Advice (RA) for Professional Providers Web-Based Training (WBT), has been made available by the Centers for Medicare & Medicaid Services (CMS) Medicare Learning Network (MLN). Available for Continuing Education credit, this course provides instructions to help fee-for-service Medicare providers and their billing staffs interpret the RA received from Medicare and reconcile it against submitted claims. It additionally provides guidance on how to read Electronic Remittance Advices (ERAs) and Standard Paper Remittance Advices (SPRs), as well as information for balancing an RA. This course also presents an overview of software that Medicare provides free to providers in order to view ERAs. This training can be accessed by visiting http://www.cms.hhs.gov/MLNgeninfo/ and scrolling to the “Related Links Inside CMS” page section. Within these links, select Web Based Training (WBT) Modules and then Understanding the Remittance Advice for Professional Providers from the list of training courses provided.


CMS and ONC Issue Regulations Proposing a Definition of ‘Meaningful Use’ and Setting Standards for Electronic Health Record Incentive Program

Public Encouraged to Comment on New Regulations

The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) encourage public comment on two regulations issued today that lay a foundation for improving quality, efficiency and safety through meaningful use of certified electronic health record (EHR) technology. The regulations will help implement the EHR incentive programs enacted under the American Recovery and Reinvestment Act of 2009 (Recovery Act).

A proposed rule issued by CMS outlines proposed provisions governing the EHR incentive programs, including defining the central concept of “meaningful use” of EHR technology. An interim final regulation (IFR) issued by ONC sets initial standards, implementation specifications, and certification criteria for EHR technology. Both regulations are open to public comment.

“Widespread adoption of electronic health records holds great promise for improving health care quality, efficiency, and patient safety,” said, National Coordinator for Health Information Technology David Blumenthal, M.D., M.P.P. “The Recovery Act’s financial incentives demonstrate Congress’ and the Administration’s commitment to help providers adopt and make meaningful use of EHR technology so they can give better care and their patients’ experience of care will improve. Over time, we believe the EHR incentive program under Medicare and Medicaid will accelerate and facilitate health information technology adoption by more individual providers and organizations throughout the health care system.”

“These regulations are closely linked,” said Charlene Frizzera, CMS Acting Administrator. “CMS’s proposed regulation would define and specify how to demonstrate ‘meaningful use’ of EHR technology, which is a prerequisite for receiving the Medicare incentive payments. Our rule also outlines the proposed payment methodologies for the Medicare and Medicaid EHR incentive programs. ONC’s regulation sets forth the standards and specifications that will enhance the interoperability, functionality, utility and security of health information technology.”

CMS and ONC worked closely to develop the two rules and received input from hundreds of technical subject matters experts, health care providers, and other key stakeholders. Numerous public meetings to solicit public comment were held by three Federal advisory committees: the National Committee on Vital and Health Statistics (NCVHS), the Health IT Policy Committee (HITPC), and the Health IT Standards Committee (HITSC). HITSC presented its final recommendations to the National Coordinator in August 2009. These recommendations, along with all other input were considered to help inform the development of the regulations announced today.

The IFR issued by ONC describes the standards that must be met by certified EHR technology to exchange healthcare information among providers and between providers and patients. This initial set of standards begins to define a common language to ensure accurate and secure health information exchange across different EHR systems. The IFR describes standard formats for clinical summaries and prescriptions; standard terms to describe clinical problems, procedures, laboratory tests, medications and allergies; and standards for the secure transportation of this information using the Internet.

The IFR calls for the industry to standardize the way in which EHR information is exchanged between organizations, and sets forth criteria required for an EHR technology to be certified. These standards will support meaningful use and data exchange among providers who must use certified EHR technology to qualify for the Medicare and Medicaid incentives.

Under the statute, HHS is required to adopt an initial set of standards for EHR technology by Dec. 31, 2009. The IFR will go into effect 30 days after publication, with an opportunity for public comment and refinement over the next 60 days. A final rule will be issued in 2010. “We strongly encourage stakeholders to provide comments on these standards and specifications,” Dr. Blumenthal said.

The Recovery Act established programs to provide incentive payments to eligible professionals and eligible hospitals participating in Medicare and Medicaid that adopt and make “meaningful use” of certified EHR technology. Incentive payments may begin as soon as October 2010 to eligible hospitals. Incentive payments to other eligible providers may begin in January 2011.

The proposed rule would define the term "meaningful EHR user" as an eligible professional or eligible hospital that, during the specified reporting period, demonstrates meaningful use of certified EHR technology in a form and manner consistent with certain objectives and measures presented in the regulation. These objectives and measures would include use of certified EHR technology in a manner that improves quality, safety, and efficiency of health care delivery, reduces health care disparities, engages patients and families, improves care coordination, improves population and public health, and ensures adequate privacy and security protections for personal health information.

The proposed rule would define meaningful use for the Medicare EHR incentive programs. It proposes one definition that would apply to eligible professionals participating in the Medicare fee-for-service and the Medicare Advantage EHR incentive programs as well as a proposed definition that would apply to eligible hospitals and critical access hospitals. These definitions also would serve as the minimum standard for eligible professionals and eligible hospitals participating in the Medicaid EHR incentive program. The rule proposes that states could request CMS approval to implement additional meaningful use measures, as appropriate, but could not request approval of fewer or less rigorous meaningful use measures than required by the rule.

This rule proposes a phased approach to implement the proposed requirements for demonstrating meaningful use. This approach would initially establish reasonable criteria for meaningful use based on currently available technological capabilities and providers’ practice experience. CMS will establish stricter and more extensive criteria for demonstrating meaningful use over time, as anticipated developments in technology and providers’ capabilities occur.

CMS provides a 60-day comment period on the proposed rule. “The definition and requirements for demonstrating meaningful use of EHR technology are proposals. CMS welcomes and will give serious consideration to comments that improve our proposal while achieving the goals Congress established for the EHR incentive programs,” Frizzera said.

The CMS proposed rule and fact sheets may be viewed at http://www.cms.hhs.gov/Recovery/11_HealthIT.asp

ONC’s interim final rule may be viewed at http://healthit.hhs.gov/standardsandcertification. In early 2010 ONC intends to issue a notice of proposed rulemaking related to the certification of health information technology

Additional Website resources:

The Recovery Act Health IT Page is: http://www.cms.hhs.gov/Recovery/11_HealthIT.asp.

DIRECT Link to CMS Regulation: http://www.federalregister.gov/OFRUpload/OFRData/2009-31217_PI.pdf.

A copy of the ONC Regulation is available at: http://healthit.hhs.gov/standardsandcertification.

The HHS Press Release is available at: https://www.cms.hhs.gov/apps/media/press_releases.asp.

The CMS Fact Sheets are available at: https://www.cms.hhs.gov/apps/media/fact_sheets.asp.


The written and audio transcript summaries of the ICD-10-CM/PCS Medicare Severity - Diagnosis Related Group Conversion Project National Provider Conference Call, which was conducted by the Centers for Medicare & Medicaid Services on November 19, 2009, are now available in the Downloads Section at http://www.cms.hhs.gov/ICD10/06a_2009_CMS_Sponsored_Calls.asp .


****PALMETTO/J1MAC NEWS****
2010 Coding Update
The 2010 Coding Update contains a wealth of information that will be
helpful to your office. Some of the articles in this publication include:
Additions, Deletions and Changes for HCPCS, CDT, and CPT codes and
modifiers; Proper use of modifiers and more.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7Z9Q8Q1420?opendocument


J1 A/B MAC Palmetto GBA Assigned ICD-9-CM Codes for National Coverage
Determinations
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7RCMMD8585?opendocument


Emergency Update to the 2010 Medicare Physician Fee Schedule Database
(MPFSDB)
This J1 A/B MAC MLN Matters article (CR6796) is associated with CR 6796
include a legislative change to the CY 2010 conversion factor update and
changes as a result of technical corrections to the malpractice relative
value units. The conversion factor for CY 2010 is $36.0846. This article
amends payment files that were issued to Medicare contractors based on the
2010 Medicare Physician Fee Schedule (MPFS) Final Rule. Please be sure to
share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7ZDQVL0370?opendocument


Expiration of Various Payment Provisions Under the Medicare Program
The Centers for Medicare and Medicaid issued special edition MLN Matters
Article SE0931 to notify affected providers that a number of Medicare
payment provisions will no longer be in effect when the provisions sunset
as of December 31, 2009.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7Z9PW37844?opendocument


Summary of Policies in the 2010 Medicare Physician Fee Schedule (MPFS) and
the Telehealth Originating Site Facility Fee Payment Amount
This J1 A/B MAC MLN Matters article (CR6756) was revised on December 30,
2009, to reflect a revised CR 6756, which was issued on December 29, 2009.
The CR release date, transmittal number (see above), and the Web address
for accessing CR 6756 were changed. This article provides a summary of the
policies in the 2010 MPFS and announces the telehealth originating site
facility fee payment amount. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7ZDQM75774?opendocument


Expiration of Therapy Cap Exceptions Process
In this article, the exceptions to outpatient therapy caps expired on
December 31, 2009. Outpatient therapy service providers should not submit
claims with the specified modifier for services furnished on or after
January 1, 2010. The therapy caps are determined on a calendar year basis,
so all patients will begin a new cap year on January 1, 2010. Please be
sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7ZEKMK2570?opendocument


J1 A/B MAC Palmetto GBA Assigned ICD-9-CM Codes for National Coverage
Determinations
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7RCMMD8585?opendocument


Northern California 2010 Revised Medicare Part B Fee Schedule
The Northern California 2010 Revised Medicare Part B Fee Schedule is now
available and is effective for services performed on or after January 1,
2010.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7ZDQMR7321?opendocument


Tracking the Hospice Attending Physician’s National Provider Identifier
(NPI) for Validating Hospice Part B Payments
This J1 Part A/B MAC MLN Matters article (CR6540b) is a revision and is
meant to ensure that the hospice reported data in the Notice of Election
(NOE) and claims for the attending physician which may be a Nurse
Practitioner (NP) meet the definition of attending physician/NP in the Code
of Federal Regulations (CFR), while also reporting the hospice physician
responsible for certifying the terminal illness. Please be sure to share
with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7ZELZX0570?opendocument


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