Bulletin Board

Physicians who may be eligible for the Medicare Health Professional Shortage Area (HPSA) bonus payment should be aware of the following information and educational resources regarding determining eligibility, in order to minimize errors during the post-payment review process.
 Information on the HPSA bonus, including the list of zip codes eligible for automatic payment, can be found at on the CMS website at http://www.CMS.gov/HPSApsaPhysicianBonuses/01_overview.asp. Two MLN Matters articles are available which go into further detail:
o “2012 Annual Update for the HPSA Bonus Payments” (MM7517) is available at http://www.CMS.gov/HPSApsaPhysicianBonuses/01_overview.asp., and
o “HPSA Bonus Payment Policy Reminders” (SE1202) is available at http://www.CMS.gov/MLNMattersArticles/downloads/SE1202.pdf.
 Websites to help determine existing designations and eligibility for the Medicare HPSA physician bonus include:
o http://HPSAfind.HRSA.gov/HPSAsearch.aspx – to identify designations within a state,
o http://www.FFIEC.gov/geocode/default.aspx – to identify census tracts by entering an address), and
o http://DataWarehouse.HRSA.gov/geoadvisor/ShortageDesignationAdvisor.aspx – to see if an area is listed as being in an eligible area.

National Provider Call: Claims-Based Reporting for the Physician Quality Reporting System & Electronic Prescribing
Tue Feb 21; 1:30-3pm ET

The Centers for Medicare & Medicaid Services (CMS) will host a National Provider Call on the Physician Quality Reporting System & Electronic Prescribing Incentive Program. Subject matter experts will provide an overview on claims-based reporting for both programs, followed by a question and answer session.

Target Audience: All Medicare Fee-For-Service Providers, Medical Coders, Physician Office Staff, Provider Billing Staff, Electronic Health Records Staff, and Vendors

Agenda:
 Opening Remarks
 Program Announcements
 Overview of claims-based reporting for the Physician Quality Reporting System
 Overview of claims-based reporting for the eRx Incentive Program
 Question & Answer Session

Registration Information: n order to receive the call-in information, you must register for the call. Registration will close at 12pm on the day of the call or when available space has been filled; no exceptions will be made, so please register early. For more details, including instructions on registering for the call, please visit http://www.eventsvc.com/blhtechnologies.

Presentation: The presentation for this call will be posted at least one day in advance http://www.CMS.gov/PQRS/04_CMSSponsoredCalls.asp in the “Downloads” section of the page.

CMS NEWS: Three demonstration projects to begin aim to strengthen Medicare by eliminating fraud, waste, and abuse
FOR IMMEDIATE RELEASE

February 3, 2012

CMS announces the Prior Authorization of Power Mobility Devices (PMDs) Demonstration and
the Recovery Audit Prepayment Review Demonstration

On November 15, 2011 Centers for Medicare and Medicare (CMS) announced three demonstration projects that aim to strengthen Medicare by eliminating fraud, waste, and abuse. Reductions in improper payments will help ensure the sustainability of the Medicare Trust Funds and protect beneficiaries who depend upon the Medicare program.

CMS is pleased to announce that the Prior Authorization of Power Mobility Devices (PMDs) Demonstration and the Recovery Audit Prepayment Review Demonstration which were delayed from their initial January 1, 2012 start date are expected to move forward on or after June 1, 2012. For additional information on these demonstrations please visit http://go.cms.gov/cert-demos
These demonstrations will begin after receipt of a paperwork reduction act (PRA) Office of Management and Budget (OMB) control number. The CMS posted a PRA notification from these demonstrations on February 3, 2012 at http://www.cms.gov/PaperworkReductionActof1995/PRAL/list.asp
The CMS significantly revised the Prior Authorization of PMDs demonstration in response to provider and supplier concerns. For more information on the adopted changes please visit http://go.cms.gov/PAdemo
The Part A to Part B Rebilling Demonstration began on January 1, 2012.

Click here to view Federal Register notice: https://s3.amazonaws.com/public-inspection.federalregister.gov/2012-02821.pdf

CMS Provider Education Resources - 2/3/2012

General Information
February 03, 2012

CMS asks that TrailBlazer share the following information received from CMS' Provider Education Resources Listservs.
The links contained in the attached PDF document may direct you to sites other than TrailBlazer.


Below is a summary of the messages included in the attachment.
• Only One Electronic Remittance Advice Recipient per NPI/Legacy ID beginning Sunday, April 1st.
• Physician Self-Referral Prohibition: Additional Information on Exception Process for Physician-Owned Hospitals.
• Envelope Control/Reference Number Matching for Version 5010 Claim Transitions.
• National Provider Call: Claims-Based Reporting for the Physician Quality Reporting System & Electronic Prescribing, Tuesday.
• Two Important Electronic Health Record (EHR) Incentive Program Messages.
• Two Affordable Care Act Messages.
• Extension of Licensure Deadline for the Round 2 and National Mail-Order Competitions of the DMEPOS Competitive Bidding Program.

TrailBlazer Note:
CMS released Technical Direction Letter (TDL) 12148, dated December 22, 2011, which includes updated instructions for the ASC X12 Version 5010 transition. As stated in TDL 12148, TrailBlazer will not reject compliant ASC X12 Version 4010A1 transactions prior to April 1, 2012. The exact date and time 4010A1 transactions will be rejected will be published at a later date.
Stay informed - Improve office efficiency and claims reimbursement by staying current on Medicare billing and policy changes by sharing this listserv with others in your organization. To register and subscribe to listservs or to view current listserv subscriptions, click Manage subscriptions under Listserv Notifications on the Medicare home page.

On Tue Nov 15, 2011, the Centers for Medicare & Medicare (CMS) announced three demonstration projects that aim to strengthen Medicare by eliminating fraud, waste, and abuse. Reductions in improper payments will help ensure the sustainability of the Medicare Trust Funds and protect beneficiaries who depend upon the Medicare program.

CMS is pleased to announce that the Prior Authorization of Power Mobility Devices (PMDs) Demonstration and the Recovery Audit Prepayment Review Demonstration – which were delayed from their initial Sun Jan 1 start-date – are expected to move forward on or after Fri June 1, 2012. For additional information on these demonstrations, please visit http://go.CMS.gov/cert-demos.

These demonstrations will begin after receipt of a Paperwork Reduction Act (PRA) Office of Management and Budget control number. CMS posted a PRA notification for these demonstrations on Fri Feb 3 at http://www.CMS.gov/PaperworkReductionActof1995/PRAL/list.asp.

CMS significantly revised the Prior Authorization of PMDs demonstration in response to provider and supplier concerns. For more information on the adopted changes please visit http://go.CMS.gov/PAdemo.

The Part A to Part B Rebilling Demonstration began on Sun Jan 1, 2012.

To view the relevant Federal Register notice, visit https://s3.amazonaws.com/public-inspection.federalregister.gov/2012-02821.pdf

CMS NEWS: Health reform law saves $2.1 billion for 3.6 million Americans with Medicare

FOR IMMEDIATE RELEASE Contact: CMS Public Affairs
Thursday, February 2, 2012 (202) 690-6145

Health reform law saves $2.1 billion for 3.6 million Americans with Medicare
New data show average American with Medicare to save nearly $4,200 through 2021 thanks to health reform

3.6 million people with Medicare saved $2.1 billion on their prescription drugs in 2011 thanks to the Affordable Care Act according to data issued today by the Department of Health and Human Services (HHS). Savings for people with Medicare will increase over time. According to a new report issued today from HHS, the average person with Medicare will save nearly $4,200 by 2021 because of the new law.

“The Affordable Care Act is already saving money for millions of Americans with Medicare,” said HHS Secretary Kathleen Sebelius. “As we move forward, we will close the donut hole completely and save even more money for everyone with Medicare.”

The Affordable Care Act provides a 50 percent discount on brand-name prescription drugs and this year, a 14% discount on generics. Last year, it provided a seven percent discount on covered generic medications for people who hit the prescription drug coverage gap known as the donut hole last year, with 2,814,646 beneficiaries receiving $32.1 million in savings on generics.

In 2011, the 3.6 million Americans who hit the donut hole saved an average of $604 on the cost of their prescription drugs.

Data also show that women especially benefitted from the law’s provision with 2.05 million women saving $1.2 billion on their prescription drugs.

By 2020, the donut hole will be closed completely. The new report released today by the Department of Health and Human Services finds that this provision and other features of the health reform law will generate substantial savings for people with Medicare. Typical Medicare beneficiaries will save an average of nearly $4,200 from 2011 to 2021. People with high prescription drug costs could save as much as $16,000.

The savings are a product of provisions in the Affordable Care Act and other cost trends that:
• • Decrease prescription drug costs for seniors
• • Make preventive services like mammograms free for everyone in Medicare
• • Reduce growth in Part B premiums (for physician services)
• •
These announcements come one day after HHS announced that in 2012, Medicare Advantage premiums have fallen by seven percent on average and enrollment has risen by about 10 percent since last year. For more details on that announcement, visit http://www.hhs.gov/news/press/2012pres/02/20120201a.html
For state-by-state savings figures for today’s donut hole announcement, visit: http://www.cms.gov/Plan-Payment/
For more information about donut hole savings, visit http://www.cms.gov/apps/media/fact_sheets.asp
For the report regarding savings those with Medicare will see over time, visit http://www.aspe.hhs.gov/_/index.cfm
###

CMS Announces Prior Authorization of Power Mobility Devices Demonstration and Recovery Audit Prepayment Review Demonstration

On Tue Nov 15, 2011, the Centers for Medicare & Medicare (CMS) announced three demonstration projects that aim to strengthen Medicare by eliminating fraud, waste, and abuse. Reductions in improper payments will help ensure the sustainability of the Medicare Trust Funds and protect beneficiaries who depend upon the Medicare program.

CMS is pleased to announce that the Prior Authorization of Power Mobility Devices (PMDs) Demonstration and the Recovery Audit Prepayment Review Demonstration – which were delayed from their initial Sun Jan 1 start-date – are expected to move forward on or after Fri June 1, 2012. For additional information on these demonstrations, please visit http://go.CMS.gov/cert-demos.

These demonstrations will begin after receipt of a Paperwork Reduction Act (PRA) Office of Management and Budget control number. CMS posted a PRA notification for these demonstrations on Fri Feb 3 at http://www.CMS.gov/PaperworkReductionActof1995/PRAL/list.asp.

CMS significantly revised the Prior Authorization of PMDs demonstration in response to provider and supplier concerns. For more information on the adopted changes please visit http://go.CMS.gov/PAdemo.

The Part A to Part B Rebilling Demonstration began on Sun Jan 1, 2012.

To view the relevant Federal Register notice, visit https://s3.amazonaws.com/public-inspection.federalregister.gov/2012-02821.pdf

CMS NEWS: Three demonstration projects to begin aim to strengthen Medicare by eliminating fraud, waste, and abuse

FOR IMMEDIATE RELEASE

February 3, 2012

CMS announces the Prior Authorization of Power Mobility Devices (PMDs) Demonstration and
the Recovery Audit Prepayment Review Demonstration

On November 15, 2011 Centers for Medicare and Medicare (CMS) announced three demonstration projects that aim to strengthen Medicare by eliminating fraud, waste, and abuse. Reductions in improper payments will help ensure the sustainability of the Medicare Trust Funds and protect beneficiaries who depend upon the Medicare program.

CMS is pleased to announce that the Prior Authorization of Power Mobility Devices (PMDs) Demonstration and the Recovery Audit Prepayment Review Demonstration which were delayed from their initial January 1, 2012 start date are expected to move forward on or after June 1, 2012. For additional information on these demonstrations please visit http://go.cms.gov/cert-demos

These demonstrations will begin after receipt of a paperwork reduction act (PRA) Office of Management and Budget (OMB) control number. The CMS posted a PRA notification from these demonstrations on February 3, 2012 at http://www.cms.gov/PaperworkReductionActof1995/PRAL/list.asp

The CMS significantly revised the Prior Authorization of PMDs demonstration in response to provider and supplier concerns. For more information on the adopted changes please visit http://go.cms.gov/PAdemo

The Part A to Part B Rebilling Demonstration began on January 1, 2012.

Click here to view Federal Register notice: https://s3.amazonaws.com/public-inspection.federalregister.gov/2012-02821.pdf

One Year Milestone for the Medicare and Medicaid EHR Incentive Programs Marked on Tue Jan 3

Tue Jan 3 was the one-year anniversary of the start of registration for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. Over the past year, there has been a tremendous amount of interest in the incentive programs as providers across the country have implemented EHRs. Year-one highlights include:
 43 states have started their Medicaid EHR Incentive Programs
 More than 176,000 people have registered for the Medicare and/or Medicaid EHR Incentive Programs
 More $2.5 billion has been paid in incentive payments to eligible professionals (EPs) and eligible hospitals and critical access hospitals (CAHs) across the country

CMS has created useful resources for participants in the Medicare and Medicaid EHR Incentive Programs, including:
1. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals – This interactive guide walks EPs through every aspect of the Medicare program, and provides helpful resources and tips along the way.
2. Updated User Guides – CMS has updated the registration and attestation user guides, which direct EPs and eligible hospitals through the CMS registration and attestation system. There are five guides that can be downloaded from the Educational Materials page of the EHR website.
3. Provider Testimonial Videos – These videos, which can be found on the CMS YouTube channel, highlight providers’ experiences participating in the EHR Incentive Programs.

A Look Ahead
As we move into 2012 and the second participation year of the Medicare and Medicaid EHR Incentive Programs, CMS is hopeful that providers will begin or continue their participation in the programs, and take advantage of these incentives for meaningful use of EHRs.

If you are considering registering for the programs, but have not done so yet, take a look at the CMS EHR website and use our eligibility tool to find out if you can participate.

Remember that 2012 is the last year in which EPs can receive a full incentive payment in the Medicare EHR Incentive Program; beginning in 2013, EPs will receive a smaller overall total payment.

Want more information about the EHR Incentive Programs? Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

National Provider Call: Claims-Based Reporting for the Physician Quality Reporting System & Electronic Prescribing
Tue Feb 21; 1:30-3pm ET

The Centers for Medicare & Medicaid Services (CMS) will host a National Provider Call on the Physician Quality Reporting System & Electronic Prescribing Incentive Program. Subject matter experts will provide an overview on claims-based reporting for both programs, followed by a question and answer session.

Target Audience: All Medicare Fee-For-Service Providers, Medical Coders, Physician Office Staff, Provider Billing Staff, Electronic Health Records Staff, and Vendors

Agenda:
 Opening Remarks
 Program Announcements
 Overview of claims-based reporting for the Physician Quality Reporting System
 Overview of claims-based reporting for the eRx Incentive Program
 Question & Answer Session

Registration Information: n order to receive the call-in information, you must register for the call. Registration will close at 12pm on the day of the call or when available space has been filled; no exceptions will be made, so please register early. For more details, including instructions on registering for the call, please visit http://www.eventsvc.com/blhtechnologies.

Presentation: The presentation for this call will be posted at least one day in advance http://www.CMS.gov/PQRS/04_CMSSponsoredCalls.asp in the “Downloads” section of the page.