HPI News

The Centers for Medicare & Medicaid Services (CMS) - HIPAA Version 5010 Updates

2010-02-04T09:55:00.000-05:00

New from the Medicare Learning Network (MLN): The Centers for Medicare & Medicaid Services (CMS) has released two new HIPAA Version 5010 fact sheets, as well as two companion checklists, to assist providers in transitioning to 5010.

Version 5010 is the new version of the X12 standards for HIPAA transactions; version D.0 is the new version of the National Council for Prescription Drug Program (NCPDP) standards for pharmacy and supplier transactions; and version 3.0 is a new NCPDP standard for Medicaid pharmacy subrogation.

The implementation of HIPAA Version 5010 presents substantial changes in the content of the data that providers submit with their claims, as well as the data available to them in response to their electronic inquiries for eligibility or claims status. These new educational materials inform providers of these changes and how they need to plan for their implementation. This information is designed for Medicare Fee-For-Service providers; however, it may be of interest to all health care providers. Go to the CMS 5010 website at http://www.cms.hhs.gov/Versions5010andD0/ and click on “Educational Resources” to view these new educational products.

"Wellmont taps veteran Burgin for interim CEO post"

2010-02-03T16:21:00.005-05:00

According to a press release from Wellmont Health Systems, a retired healthcare executive will provide interim leadership as Wellmont continues its national search for their next chief executive.

Bob Burgin, a retired healthcare executive who served for more than two decades as president and CEO of Mission Hospitals in Asheville, N.C., has assumed the responsibilities of interim CEO. Burgin has been as a member of the Wellmont board of directors since July 2009.

Outgoing President and CEO Mike Snow, will leave the system later this month to become chief operating officer of Amedisys Inc.

“Bob’s exemplary record at Mission speaks for itself, and he has demonstrated a keen understanding of the opportunities and challenges facing our hospitals during his tenure on the Wellmont board,” said Roger K. Mowen Jr., board chairman. “His experience as a Wellmont board member enables him to hit the ground running, which is a tremendous benefit to our organization and the patients we serve.

“Bob is an experienced leader who will provide strong, steady leadership for our health system during this time of transition.”

With Burgin’s selection as interim CEO, Mowen said, the Wellmont board of directors will now turn its attention to a national search for a permanent president and CEO. The board will work with an executive search firm to identify and select a top candidate, a process expected to be complete within six months.

Click here to read the full Johnson City Press article from February 2, 2010.

Above quoted from http://timesnews.net/article.php?id=9020259

Revised Medicare Physician Fee Schedule Fact Sheet

2010-02-02T15:52:00.000-05:00

The Medicare Physician Fee Schedule Fact Sheet (February 2010) has been revised to include information about the two month zero percent (0%) update to the 2010 Medicare Physician Fee Schedule (MPFS) effective only for dates of service January 1, 2010 through February 28, 2010. This fact sheet, which also provides information about MPFS payment rates and the MPFS payment rates formula, is available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at: http://www.cms.hhs.gov/MLNProducts/downloads/MedcrePhysFeeSchedfctsht.pdf

Medicare Learning Network

2010-01-21T10:50:00.000-05:00

Did You Resolve To Learn Something New This Year?
New Information Is Just A Click Away.

The Medicare Learning Network (MLN) web-based training courses are a perfect way to make good on that resolution. You can choose from a variety of courses that cover Medicare Program policy topics, ranging from general overviews to specific billing and coding information, as well as important education on new CMS initiatives.

You won’t have to miss a moment in the office because you can access any course 24 hours a day, 7 days a week—and it’s easy to complete the courses at your own pace. Each course is a compact learning opportunity; you gain a significant amount of information in just a short period of time. Stay on track with our Learning Management System. The System charts your completed courses and evaluations, and even remembers the chapters you have completed if you are not able to finish in one sitting.
Here is another benefit: many of our courses offer continuing education credits to help you meet academic requirements to obtain or maintain your license or certification.

And, remember—like all Medicare Learning Network products—our web-based training courses are free of charge.

Resolve to visit the MLN Products page today. Find out more information and click on Web-Based Training to get started!

HITECH/HIPAA Information Page

2010-01-06T10:45:00.003-05:00

On February 17, 2009 the American Recovery and Reinvestment Act (ARRA) (a/k/a the Stimulus Bill) was signed into law. A subset of ARRA is the Health Information Technology for Economic and Clinical Health Act (HITECH Act). The HITECH Act authorizes a $36 billion investment in Health Information Technology (HIT) and Health Information Exchanges (HIE) to improve quality, care coordination and to lower costs.

The HITECH Act is divided into four parts:

Subtitle A: Promotion of HIT

Subtitle B: Testing of HIT

Subtitle C: Grants and Loan Funding

Subtitle D: Privacy

New Privacy and Security rules went into effect on September 23, 2009. However, HHS will not enforce the new rules until February 22, 2010. But some states are beginning to enforce the new rules effective immediately.

Below are four of the major changes to the privacy rules:

Creates new obligations for Covered Entities and their Business Associates and modifies individual rights under the Privacy Rule.

Creates new civil money penalties and enforcement mechanisms.

Applies HIPAA Security & Privacy Rule standards to Business Associates as matter of law.

Requires "notification" after a breach of "unsecured PHI" is discovered by Covered Entity or Business Associate.

The following link will take you to the HITECH/HIPAA Information/Resource page on the Highlands Wellmont Health Network (HWHN) website. In order to have consistent and updated resources we opted to place all information relative to HIPAA/HITECH Act on one site rather than duplicate this information at both the HPI and HWHN websites.

Click Here

CMS News from the Medicare Learning Network

2010-01-04T12:16:00.002-05:00

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 eliminates consultation codes – FAQs, and guidance available

2009-12-17T09:45:00.000-05:00

In the final 2010 physician fee schedule, the Centers for Medicare & Medicaid Services (CMS) eliminated the use of all consultation codes (inpatient and office/outpatient codes for various places of service except for telehealth consultation G-codes) on a budget-neutral basis. Instead, CMS increased the work relative value units (RVUs) for new and established office visits, as well as initial hospital and initial nursing facility visits.

Recently, CMS released Transmittal 1875 and MLN Matters 6740 which provides guidance to practices on how to bill for services for Medicare Part B patients now that consultation codes have been eliminated. CMS announced that the modifier to distinguish the admitting physician from other physicians who may furnish care is “-AI.” The admitting physician should append the “-AI” modifier along with initial visit codes to their claims while other physicians who perform initial evaluations should only bill the appropriate evaluation and management (E/M) code. CMS instructs providers to select the appropriate E/M codes based on the content of services provided and not the level of documentation.

According to agency, documentation should merely support the level of services provided. CMS advises practices to take time and/or controlling factors into consideration when determining the level of service provided. In this transmittal, CMS also clarifies billing procedures for:

Observation services;

Inpatient hospital care;

Emergency departments; and

Nursing facility services

(From MGMA Washington Connexion 12/17/09)

24/7 Access to Virginia Prescription Monitoring Program (PMP) Now Available

2009-12-03T11:48:00.000-05:00

The Virginia Prescription Monitoring Program (PMP) is pleased to announce that requests for prescription history informa¬tion on drugs in Schedules II, III, or IV for a specific individual may now be made online, 24 hours a day, seven days a week, with an automated response being received within approximately one minute. This newly automated process has significantly increased the number of requests that can be processed daily and allows a prescriber or pharmacist to request information during nights and weekends when the information may be needed the most.

The prescription monitoring program collects prescription data for Schedule II-IV drugs into a central database which can then be used by limited authorized users to assist in deterring the illegitimate use of prescription drugs. The information collected in this program is maintained by the Virginia Department of Health Professions, and strict security and confidentiality measures are enforced. Only those persons authorized by law can be provided information from the database, and the list of authorized persons is very limited. Prescribers and dispensers may query the database to assist in determining treatment history and to rule out the possibility that a patient is "doctor shopping" or "scamming" in order to obtain controlled substances.

As of May 13th, 2009, prescribers are no longer required to obtain individual written consent from their patients to receive a PMP Report. A written notice in a public area of your office staring that your practice may utilize the PMP program to obtain patient histories is sufficient. If you prefer, you may continue to obtain individual written consent for each patient.

If you are a prescriber or pharmacist and have not registered to use the program you will find registration form & instructions at http://www.dhp.virginia.gov/dhp_programs/pmp/default.asp

New USP Standards for Heparin Products Will Result in Decreased Potency

2009-12-03T11:01:00.000-05:00

The United States Food and Drug Administration (FDA) recently alerted health care professionals to a change in heparin manufacturing that is expected to decrease the potency of the com¬mon blood-clotting drug. Adjustments may be needed to achieve the desired anticoagulant effect in some patients. While the United States Pharmacopeia (USP) manufacturing controls took effect October 1, 2009, for production, FDA asked manufacturers to not ship the new product to customers until October 8, 2009, or later. For more information from FDA or USP on this subject, visit http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm184502.htm or www.usp.org/hottopics/heparin.html

Quarterly CCI edits posted

2009-12-03T10:30:00.000-05:00

The Centers for Medicare & Medicaid Services (CMS) recently posted the Correct Coding Initiative (CCI) edits that take effect Jan. 1. In the agency’s words, the purpose of the CCI is “to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims.”
Read a CMS CCI educational article.

CMS streamlines the 2010 Medicare electronic prescribing bonus program

2009-11-30T10:16:00.000-05:00

The physician fee schedule final regulation outlines a simplified approach for groups seeking the 2 percent Medicare electronic prescribing (e-prescribing) incentive bonus. For 2010, the rule requires eligible providers to report an e-prescribing code only when a patient visit generates an e-prescription. The provider only needs to report the code 25 times during the 2010 reporting period, which spans the entire calendar year. The Centers for Medicare & Medicaid Services (CMS) will base incentive payments on the covered professional services furnished by an eligible professional during the reporting year.

In addition, the number of eligible denominator codes has increased. Beginning in 2012, the program will impose penalties on eligible providers who are not successful e-prescribers.

FTC Extends Enforcement Deadline for Identity Theft Red Flags Rule

2009-11-09T10:15:00.000-05:00

At the request of Members of Congress, the Federal Trade Commission is delaying enforcement of the “Red Flags” Rule until June 1, 2010, for financial institutions and creditors subject to enforcement by the FTC.

The Rule was promulgated under the Fair and Accurate Credit Transactions Act, in which Congress directed the Commission and other agencies to develop regulations requiring “creditors” and “financial institutions” to address the risk of identity theft. The resulting Red Flags Rule requires all such entities that have “covered accounts” to develop and implement written identity theft prevention programs to help identify, detect, and respond to patterns, practices, or specific activities – known as “red flags” – that could indicate identity theft.

The Commission previously delayed the enforcement of the Rule for entities under its jurisdiction until November 1, 2009. The Commission staff has continued to provide guidance to entities within its jurisdiction, both through materials posted on the dedicated Red Flags Rule Web site (www.ftc.gov/redflagsrule), and in speeches and participation in seminars, conferences and other training events to numerous groups. The Commission also published a compliance guide for business, and created a template that enables low risk entities to create an identity theft program with an easy-to-use online form. FTC staff has published numerous general and industry-specific articles, released a video explaining the Rule, and continues to respond to inquiries from the public. To assist further with compliance, FTC staff has worked with a number of trade associations that have chosen to develop model policies or specialized guidance for their members.

On October 30, 2009, the U.S. District Court for the District of Columbia ruled that the FTC may not apply the Red Flags Rule to attorneys. Today’s announcement that the Commission will delay enforcement of the Rule until June 1, 2010, does not affect the separate timeline of that proceeding and any possible appeals. Nor does it affect other federal agencies’ ongoing enforcement for financial institutions and creditors subject to their oversight.

EMR Summit November 12th

2009-11-02T17:31:00.003-05:00

Please click here to view and/or print the brochure for the upcoming EMR Summit November 12th from 2:00 P.M. - 8:30 P.M. at the Meadowview Marriott.

Please click here to register for this event.

FDA Alert: New USP Standards for Heparin Products Will Result in Decreased Potency

2009-10-02T10:29:00.001-04:00

Adjustments may be needed to achieve desired anticoagulant effect

The U.S. Food and Drug Administration today alerted health care professionals to a change in heparin manufacturing that is expected to decrease the potency of the common blood-clotting drug.

To ensure the quality of heparin and to guard against potential contamination, the United States Pharmacopeia (USP), a nonprofits standards-setting organization, adopted new manufacturing controls for heparin effective Oct. 1, 2009. These changes include a modification of the reference standard for the drug’s unit dose.

Manufacturers in the United States and Canada label the amount of heparin included in their products based on USP standards. The changes adopted by the USP for the heparin unit dose match the World Health Organization’s International Standard (IS) unit dose definition that has been in use in Europe for many years. The revised USP reference standard and unit definition for heparin is about 10 percent less potent than the former USP unit.

A unit is the measure of a drug’s activity in the body. For heparin, a unit dose is the measure of the drug’s ability to block the blood’s natural clotting ability (anticoagulation). Heparin’s potency is determined by the dose of the drug required to produce a specific level of anticoagulation.

Manufacturers for the U.S. market have begun to make heparin using the new USP standard. The FDA has asked that they not ship this new product to customers until Oct. 8, 2009, or later. The delay will give health care providers and facilities time to learn about the changes and to make adjustments to their pharmacy procedures and dosing practices, according to John Jenkins, M.D. director of the Office of New Drugs in the FDA’s Center for Drug Evaluation and Research.

“Although the FDA-approved labeling for heparin has not changed, including the recommended doses, it is essential that health care professionals be aware of the potential difference in potency between the old and new vials of heparin when administering the drug,” said Jenkins.

Four companies market heparin in the United States. APP, the largest manufacturer, markets heparin in vials; Hospira markets heparin in intravenous bags, vials, and syringes; Baxter markets heparin in intravenous bags, and B. Braun markets heparin in intravenous bags. The FDA has asked that all manufacturers identify their new products to help pharmacies and health care professionals differentiate it from the former product.

By federal law, prescription and over–the–counter medicines available in the United States must meet USP's public standards, when such standards exist. The revised standards for heparin are contained in a new USP monograph.

The monograph was revised, in part, in response to a 2007-2008 incident of heparin contamination involving a manufacturing step in China. The contaminated heparin was associated with deaths and other adverse events in the United States. The monograph was changed to include a test for the contaminant.

For more information go to:

FDA Alert to Health Care Professionals
http://www.fda.gov//Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm184502.htm

USP Heparin Information
http://www.usp.org/hottopics/heparin.html

Revised ICD-10-CM/PCS: An Introduction Fact Sheet Available in Print from CMS

2009-10-01T09:21:00.000-04:00

The revised publication titled ICD-10-CM/PCS: An Introduction Fact Sheet (August 2009), which provides general information about the International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) including benefits of adopting the new coding system, structural differences between ICD-9-CM and ICD-10-CM/PCS, and implementation planning recommendations, is now available in print format from the Centers for Medicare & Medicaid Services 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.” “The Related Links Inside CMS” page lists numerous other resources available on a wide range of topics.

MEDICARE PROVIDER FEEDBACK TOWN HALL MEETING

2009-09-29T09:24:00.004-04:00

October 29, 2009
2:00 - 4:00 PM ET

The Centers for Medicare & Medicaid Services (CMS) requests your participation in a Town Hall meeting on October 29, 2009, from 2:00 PM to 4:00 PM (Eastern Time). The meeting will be held via conference call as well as in the auditorium at the Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244.

The purpose of the meeting is to capture individual provider feedback on relevant Fee-for-Service (FFS) Medicare policy and operational issues. By doing so, we advance CMS’ efforts to enhance our relationship with providers and suppliers. This Town Hall meeting also provides a venue to allow CMS staff to engage individual providers and suppliers through the following year. This meeting is open to all Medicare FFS providers and suppliers that participate in the Medicare program.

The agenda topics include: 5010, ICD-10, Medicare Contracting Reform: Lessons Learned from Medicare Administrative Contractor (MAC) Implementations, Recovery Audit Contractors (RACs), Provider Communications, and Program Integrity as noted in the September 25, 2009 Federal Register Notice. Meeting agenda and discussion materials will be available to download at http://www.cms.hhs.gov/center/provider.asp by October 23, 2009. CMS will conduct a discussion session at the meeting that offers meeting participants an opportunity to provide feedback on agenda topics.

Please note: Due to time constraints not all participants will have an opportunity to speak, but written submissions will be accepted at MFG@cms.hhs.gov through November 6, 2009. CMS will give consideration to feedback received, but written responses will not be provided.

Meeting Registration Details

All participants must pre-register for the meeting through on-line registration located at http://registration.intercall.com/go/cms2. Registration will open on September 28, 2009 and will close on October 23, 2009. Registered participants may be contacted for follow-up meetings to solicit additional individual opinions and clarify any issues that may arise during the October 29th Town Hall meeting.

Upon registering, you will receive a confirmation page to indicate the completion of your registration. Please print this page as your registration receipt. We encourage you to complete your registration as soon as possible. Registration after 5:00 p.m. on October 23, 2009 will not be accepted.

Meeting Participation Details

All persons attending the meeting in person will be required to show a photographic identification (a valid driver's license or passport). Further details can be found in the September 25, 2009 Federal Register Notice. All persons participating via conference call will receive dial-in information with their confirmation email.

Additional Questions/Information

For questions or additional information about the Medicare Provider Feedback Town Hall Meeting, please send an email to MFG@cms.hhs.gov

The Centers for Medicare & Medicaid Services (CMS) Updates Physician Payment Information for Value-Driven Health Care

2009-09-28T13:15:00.000-04:00

To support the delivery of high-quality, efficient health care and enable consumers to make more informed health care decisions, the U.S. Department of Health and Human Services is making cost and quality data available to all Americans. As part of this initiative, Medicare posted information in 2007 and 2008 about the payments it made during the previous year for common and elective procedures and services provided by Hospitals, Ambulatory Surgery Centers (ASCs), Hospital Outpatient Departments, and Physicians.

The Hospital information is posted on the Hospital Compare Website where it can be viewed along with hospital quality information. The Hospital compare website may be found at www.medicare.gov.

On August 28, 2009, Medicare posted an update to the Ambulatory Surgery Center data. The Physician payment data was posted on September 25, 2009. Hospital Outpatient Department data will be updated later this year. The information is being displayed in the same format as in previous years, updated with calendar year (CY) 2008 data. The posting updates may be found at: www.cms.hhs.gov/HealthCareConInit/.

What’s New with 2009 Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing (E-Prescribing) Incentive Programs

2009-09-21T16:39:00.004-04:00

New Medicare Learning Network Education Product

New and Revised MLN Articles on the Physician Quality Reporting Initiative

Three Physician Quality Reporting Initiative Help Desk Resources Now Available for Eligible Professionals

Medicare Learning Network Announces Availability of the 2009 PQRI and E-Prescribing Program Web-based Training Course

The Centers for Medicare & Medicaid Services (CMS) Medicare Learning Network (MLN) is pleased to announce that the Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (E-Prescribing) Web-based Training Course is now available.

The course provides information to physicians, health care professionals, and medical administrative staff on the completion, submission and maintenance of the documentation required to successfully participate in Physician Quality Reporting Initiative (PQRI) and Electronic Prescription Incentive (E-Prescribing) programs. The course offers continuing education credits; please see the course description page for the details.

The course can be accessed by going to http://www.cms.hhs.gov/MLNGenInfo on the CMS website and scrolling down to the “Related Links Inside CMS” section and selecting Web Based Training (WBT) Modules. Once on the web-based training module page, select the Physician Quality Reporting Initiative and Electronic Prescribing Incentive Program WBT from the list provided.

Medicare Learning Network Announces New and Revised MLN Articles on the 2009 PQRI

~New-MM6514- Coding and Reporting Principles for the Physician Quality Reporting Initiative (PQRI) and the Electronic Prescribing (E-Prescribing) Incentive Programs
http://www.cms.hhs.gov/mlnmattersarticles/downloads/MM6514.pdf

~Revised-SE0830- Steps for Individual Eligible Professionals to Access Their 2007 Physician Quality Reporting Initiative (PQRI) Feedback Reports Personally
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0830.pdf

~Revised-SE0831- Steps for Organizations to Access Their 2007 Physician Quality Reporting Initiative (PQRI) Feedback Reports
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0831.pdf

These new and revised articles are intended to assist eligible professionals and group practices who report PQRI quality measures data to Medicare.

Three Physician Quality Reporting Initiative Help Desk Resources are Available for Eligible Professionals

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce three PQRI Help Desk Resources to assist eligible professionals with their questions on the Physician Quality Reporting Initiative.

Provider Call Center Directory

Remittance Advice Notices

Incentive payment distribution status

Adjustments made to incentive payment due to sanctions/overpayments

External User Services (EUS) – 7:00 AM – 7:00 PM EST

Registering/creating an IACS account

Accessing an IACS account

Changing an IACS account

Approving users into an organization

QualityNet Help Desk – 7:00 AM – 7:00 PM CST

General CMS PQRI & ERX Information

PQRI Portal Password Issues

PQRI feedback report availability and access

All publicly available information on the CMS Physician Quality Reporting Initiative can be found at http://www.cms.hhs.gov/PQRI, on the CMS website.

All publicly available information on the CMS Electronic Prescribing Incentive Program can be found at http://www.cms.hhs.gov/ERxIncentive on the CMS website.

Tennesssee Medicare Part B Providers

2009-09-11T13:47:00.001-04:00

Ask Cahaba B

The Open Door Forums offered by the Centers for Medicare and Medicaid Services (CMS) have opened communication channels with providers on a national basis. Cahaba GBA, LLC, Medicare Part B contractor has adopted a similar approach to communicating with our enrolled providers by organizing toll-free Ask the Contractor Teleconferences (ACT), which will focus on specific topics.

Initially, we will present providers with the most common reasons why Medicare Part B claims are “returned as unprocessable” to providers who bill Cahaba GBA Medicare Part B. We will also discuss a few current Medicare updates. Subsequently, we will go over pre-solicited questions specific to the topic of claim submission errors. If time permits, the call will be opened to providers to ask questions. A wrap-up session will conclude the call.

Topic
Claim Submission Errors

Date & Time
September 25, 2009
10:30 am -12:00 pm CST, 11:30 am -1:00 pm EST

Registration is limited to the first 250 providers. Please use one telephone line per practice. Participants may submit questions in advance for discussion during this teleconference. For additional details regarding this event, visit our web site at https://www.cahabagba.com/apps/course_registration/al/course_summary.jsp?EID=212

Thank you,

Provider Outreach and Education (POE)
Cahaba GBA- J10 A/B MAC

Free CME Performance Improvement Opportunity - From The Consortium for Southeastern Hypertension Control (COSEHC)

2009-09-04T13:11:00.001-04:00

Linked below is a communication we received from The Consortium for Southeastern Hypertension Control (COSEHC) regarding an opportunity for primary care providers to participate in a study which could potentially reduce morbidity and mortality from hypertensive related conditions for our patient population. The provider will be offered free of charge a 16 hour CME program and may earn an additional 5 CME credits for participating in a full year of the project. COSEHC will provide $2,000 compensation to the practice at the end of the project year once all data is collected.

Once you review the linked material, if you are interested in participating please contact Debra Simmons, Executive Director of COSEHC directly at 336-716-1130 or dwirth@wfubmc.edu HPI is merely disseminating the information to our membership. HPI is not involved in the enrollment or administration of this project.

Please click here to view the material.

UPDATES FROM MEDICARE INTERMEDIARY CAHABA

2009-09-04T10:22:00.002-04:00

Effective August 29, 2009, the Tennessee Medicare intermediary changed from Cigna to Cahaba GBA. This change is called the “J10 Transition”. Two important announcements from Cahaba follow. Please be sure you have enrolled in Cahaba GBA’s List Serve to receive regular updates & notices. You can enroll by going to http://www.cahabagba.com/J10

Help For Questions/Problems With the Change to Cahaba GBA
Cahaba GBAs’ Provider Outreach and Education department will be hosting a J10 A/B MAC Post Transition teleconference on Wednesday, September 23, 2009 at 10:00 a.m. - 11:30 a.m. CST; 11:00 a.m. - 12:30 p.m. EST. This teleconference will focus on any post transition concerns or issues related to our Tennessee Part B providers. Participants are encouraged to submit questions they would like addressed during the teleconference by 5:00 p.m. (CT) on Thursday, September 17, 2009. Questions submitted should relate to the topic being presented.

Registration deadline is Friday, September 18, 2009. For more details on how to register, please visit our Web site at https://www.cahabagba.com/apps/course_registration/al/calendar.jsp.

Hurry since registration fills up quickly!

Instructions for Providers Receiving Payment by Electronic Funds Transfer (EFT): Tennessee Medicare Part B providers accustomed to receiving Medicare payments via Electronic File Transfer (EFT), who have not submitted a new CMS-588 form to Cahaba GBA, MUST submit a CMS-588/EFT form (http://www.cms.hhs.gov/cmsforms/downloads/CMS588.pdf), “Authorization Agreement for Electronic Funds Transfer”, immediately.

Providers that have not submitted the CMS-588 EFT form will not receive Medicare payments until the new CMS-588 is received by Cahaba GBA. If you have already submitted the EFT form, please do not send in another one. As long as you have sent it to the appropriate Cahaba address or fax below, we have your form.

To ensure we receive your CMS-588/EFT form quickly, please fax to (912) 921-4993 or (912) 927-6946 and mail the hardcopy original to one of the addresses referenced below.

Cahaba GBA, LLC
Provider Enrollment TN Part B
P O Box 830170
Birmingham, AL 35283-0170

Overnight:
Cahaba GBA, LLC
Provider Enrollment TN Part B
300 Corporate Parkway
Birmingham, AL 35242

EFT Resources:

Form CMS-588: http://www.cms.hhs.gov/cmsforms/downloads/CMS588.pdf

EFT Instructions: http://www.cms.hhs.gov/ElectronicBillingEDITrans/13_EFT.asp

Tips On Completing the CMS-588: http://www.cahabagba.com/j10/CMS588_tips.pdf

URGENT MESSAGE TO ALL PROVIDERS WHO RECEIVE MEDICARE PAYMENTS VIA ELECTRONIC FUNDS TRANSFER (EFT)

2009-09-04T09:30:00.001-04:00

Tennessee Medicare Part B providers accustomed to receiving Medicare payments via Electronic File Transfer (EFT), who have not submitted a new CMS-588 form to Cahaba GBA, MUST submit a CMS-588/EFT form (http://www.cms.hhs.gov/cmsforms/downloads/CMS588.pdf), Authorization Agreement for Electronic Funds Transfer, IMMEDIATELY.

PROVIDERS THAT HAVE NOT SUBMITTED THE CMS-588 EFT FORM WILL NOT RECEIVE MEDICARE PAYMENTS UNTIL THE NEW CMS-588 IS RECEIVED BY CAHABA GBA. IF YOU HAVE ALREADY SUBMITTED THE EFT FORM, PLEASE DO NOT SEND IN ANOTHER ONE. AS LONG AS YOU HAVE SENT IT TO THE APPROPRIATE CAHABA ADDRESS OR FAX BELOW, WE HAVE YOUR FORM.

To ensure we receive your CMS-588/EFT form quickly, please fax to (912) 921-4993 or (912) 927-6946 and mail the hardcopy original to one of the addresses referenced below.

Cahaba GBA, LLC
Provider Enrollment TN Part B
P O Box 830170
Birmingham, AL 35283-0170

Overnight:
Cahaba GBA, LLC
Provider Enrollment TN Part B
300 Corporate Parkway
Birmingham, AL 35242

EFT Resources:

Form CMS-588: http://www.cms.hhs.gov/cmsforms/downloads/CMS588.pdf

EFT Instructions: http://www.cms.hhs.gov/ElectronicBillingEDITrans/13_EFT.asp

Tips On Completing the CMS-588: http://www.cahabagba.com/j10/CMS588_tips.pdf

Thank you,
Provider Enrollment(PE)
Cahaba GBA- J10 A/B MAC

CMS releases H1N1 vaccine and administration codes

2009-09-03T09:26:00.002-04:00

In anticipation of the vaccine for H1N1 influenza, the Centers for Medicare & Medicaid Services (CMS) has created two new codes for medical providers. G9142 (Influenza A [H1N1] vaccine, any route of administration) describes the vaccine, while G9141 (Influenza A [H1N1] immunization administration, including physician counseling the patient/family) describes the administration of the vaccine. Both codes become effective on Oct. 1.

CMS anticipates the H1N1 vaccine will be supplied to providers at no cost, although Medicare will pay for its administration. From the CMS adult immunizations Website, “Medicare will cover immunizations for H1N1 influenza, also called the "swine flu." There will be no coinsurance or copayment applied to this benefit, and beneficiaries will not have to meet their deductible. H1N1 influenza vaccine is currently under production and will be available in the Fall of 2009.”

Read details in the CMS MLN education article MM6617.

Read the 2008-2009 Immunizers’ Question & Answer Guide to Medicare Coverage of Influenza and Pneumococcal Vaccinations.

Review the Centers for Disease Control & Prevention Novel H1N1 Influenza: Resources for Clinicians Web page.

Important Information for Tennessee Medicare Part B Providers on Corrected Claims from Cahaba GBA

2009-09-02T15:31:00.001-04:00

An analysis done by the Cahaba Government Benefit Administrators®, LLC Process Control area reveals a large number of paper claims being submitted with the wording “Corrected Claim” written on the form; however, there is no cover letter attached indicating what has changed from the original claim and no instructions of what action the provider is expecting Cahaba GBA to take.

Cahaba GBA will begin returning these claims to providers on September 7, 2009. Cahaba asks that providers follow the instructions below that pertain to your situation:

• If you file paper claims and need to make a simple correction to your claim, please call our telephone Clerical Error Reopening (CER) line. Calling our toll free lines to make simple claim corrections is the fastest, most efficient and cost effective way to correct your claim.

Examples of simple corrections and the applicable telephone numbers can be found on our website at https://www.cahabagba.com/part_B/claims/clerical_error_reopen.htm

• If you file electronically and your claim was denied, you may refile the claim electronically with the necessary corrections.

• If you file electronically and your claim was paid; however, you still need to make a simple correction, please call our telephone CER line.

Please remember that CMS requires all claims to be filed electronically unless your office meets certain specific exception criteria. For more information, please visit our website at http://www.cahabagba.com/part_b/edi/hipaa_electronic_submission_medicare_claims.htm

Cahaba GBA sincerely appreciates your assistance in our effort to reduce the number of “corrected claims” received.

TENNESSEE MEDICARE PART B CUTOVER DATE IS AUGUST 29, 2009

2009-08-27T16:06:00.000-04:00

On January 07, 2009, the Centers for Medicare & Medicaid Services announced Cahaba Government Benefit Administrators®, LLC is the Medicare Administrative Contractor (MAC) for Jurisdiction 10 comprised of Alabama, Georgia, and Tennessee. As the J10 MAC, Cahaba GBA will be responsible for the administration of all Medicare Part A and Part B claims in Alabama, Georgia and Tennessee.

The Centers for Medicare and Medicaid Services (CMS) needs to change the contractor workload numbers for the Part A and Part B workloads in the states of Alabama, Georgia and Tennessee when workload is transitioned to the J10 A/B MAC.

Part B Tennessee
J10 MAC Workload No.: 10302
Effective Date: 08/29/2009
Current Contractor No.: 05440

Tennessee Part B claims submitted to the J10 A/B MAC, Cahaba GBA, after 4:00 p.m. CT (5:00 p.m. ET) on Friday, August 28, 2009 MUST have the new workload/receiver ID, 10302, in segments ISA08 and GS03 as well as in loop 1000B, segment NM109. Also, electronic claim status inquiries (276/277) must have the new workload/receiver ID, 10302, in segments ISA08 and GS03 as well as in loop 2100A, segment NM109. Claims and claim status inquiries sent without the new workload ID WILL REJECT. Please contact your vendor to insure your system is updated. Failure to submit the correct workload/receiver ID will cause your claims to reject during the front-end editing process.

Electronic Funds Transfer (EFT)
All providers currently receiving payments from CIGNA Government Services via EFT, MUST submit a new CMS-588/EFT form (http://www.cms.hhs.gov/cmsforms/downloads/CMS588.pdf), Authorization Agreement for Electronic Funds Transfer, IMMEDIATELY to avoid an interruption in EFT payment. This is required even if Cahaba GBA’s financial institution is the same as that of CIGNA Government Services. Providers that do not complete and submit the CMS-588/EFT form prior to cutover will not receive Medicare payments.

Please Note: If you are a group practice and have multiple physicians within your organization, only one CMS-588/EFT for the group is needed. A separate CMS-588/EFT for each provider within the group is not required. Additionally, group practices with multiple locations that are all under the same Tax ID number and have their Medicare payments deposited to one bank account are only required to send in one CMS-588/EFT Agreement. However, if the Medicare payments for each location are deposited to different bank accounts, a separate CMS-588/EFT form is needed for each location and/or bank account payable to the group practice.

If you have not already done so, you MUST submit the CMS-588/EFT form to Cahaba GBA IMMEDIATELY even if you recently updated your information with CIGNA Government Services.

Completed CMS-588/EFT forms should be sent to:

Cahaba GBA Provider Enrollment-TN-Part B P.O. Box 830170 Birmingham, AL 35283-0170

EFT Resources:

• Form CMS-588: http://www.cms.hhs.gov/cmsforms/downloads/CMS588.pdf
• EFT Instructions: http://www.cms.hhs.gov/ElectronicBillingEDITrans/13_EFT.asp
• Tips On Completing the CMS-588: http://www.cahabagba.com/j10/CMS588_tips.pdf

Further Communication
Providers may subscribe to our listserv by visiting the Cahaba GBA website at http://www.cahabagba.com/j10/email_service.htm. Listserv messages will be sent to the providers that will further explain the upcoming EDI changes and what they need to do to prepare for the upcoming transitions.