| NHIC, Corp.DME MAC A ListServe | For Immediate Release |
| January 16, 2009 DMEPOS Accreditation Deadline is September 30, 2009 - CMS Encourages Suppliers to Submit Applications by January 31, 2009 (CMS Message 2009-01-15) Medicare Announces Next Steps On Competitive Bidding Program For Certain Medical Equipment And Supplies (CMS Message 2009-01-15) HHS Issues Final ICD-10 Code Sets and Updated Electronic Transaction Standards Rules (CMS Message 2009-01-15) New Guided Pathways (December 2008) Medicare Learning Network (MLN) products (CMS Message 2009-01-15) DMEPOS Accreditation Deadline is September 30, 2009 - CMS Encourages Suppliers to Submit Applications by January 31, 2009 (CMS Message 2009-01-15)The Centers for Medicare & Medicaid Services (CMS) wants to ensure that suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) who bill Medicare for Part B services have ample time to complete the accreditation process and thus receive an accreditation decision by the September 30, 2009 deadline. In order to meet this deadline, CMS is encouraging all enrolled DMEPOS suppliers, except those eligible professionals and other persons exempted by law, to submit a complete accreditation application to an accreditation organization by January 31, 2009.The accreditation requirement applies to suppliers of durable medical equipment, medical supplies, home dialysis supplies and equipment, therapeutic shoes, parenteral/enteral nutrition, transfusion medicine and prosthetic devices, prosthetics and orthotics. Pharmacies, pedorthists, mastectomy fitters, orthopedic fitters/technicians and athletic trainers must also meet the September 30, 2009 deadline for DMEPOS accreditation. A DMEPOS supplier that wishes to become accredited should contact an Accreditation Organization and obtain information about the accreditation process.Section 302 (b) (1) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), required the Secretary of the Department of Health and Human Services (HHS) to establish and implement quality standards for DMEPOS suppliers, except those eligible professionals and other persons exempted by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). In order to retain or obtain a Medicare Part B DMEPOS number, all DMEPOS suppliers must comply with these standards and become accredited.Certain eligible professionals and other persons are exempted from the accreditation requirement including physicians, physical and occupational therapists, qualified speech-language pathologists, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, certified nurse-midwives, clinical social workers, clinical psychologists, registered dietitians/nutrition professionals, orthotists, prosthetists, opticians and audiologists.Further information on the DMEPOS accreditation requirements along with a list of the accreditation organizations may be found at http://www.cms.hhs.gov/medicareprovidersupenroll. Medicare Announces Next Steps On Competitive Bidding Program For Certain Medical Equipment And Supplies (CMS Message 2009-01-15)The Centers for Medicare & Medicaid Services (CMS) today issued an interim final regulation with comment period that incorporates changes required by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).This, along with a new Federal advisory committee, are the next steps before CMS restarts the Medicare Competitive Bidding Program for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) consistent with these regulations."Because of concerns about the implementation of the competitive bidding program, Congress called for a delay of the program and made certain changes, which this new regulation carries out," said Kerry Weems, CMS acting administrator. "Implementing the law's changes and appointing members to the program's oversight committee are the first steps to take to restart the competitive bidding process."As part of MIPPA, Congress enacted a temporary delay in the competitive bidding program for Round One Competitive Bidding Areas. The law required CMS to terminate the existing contracts that were awarded in Round One and recompete the contracts in 2009. Additionally, the new law establishes a special document review process and a requirement for contracted suppliers to report relationships with suppliers with whom they subcontract. MIPPA also excluded certain DMEPOS items and areas from competitive bidding and provided an exemption to the program for hospitals that furnish certain types of DMEPOS items to their own patients. CMS plans to issue additional information about the program in the upcoming months, including a complete timetable of the Round One rebidding process.The prior Round One of the DMEPOS competitive bidding program was implemented on July 1, 2008, in 10 competitive bidding areas, as mandated by the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA). Round One was projected to result in average annual savings of 26 percent when compared to payments under the traditional fee schedules, based on competitive bids submitted by equipment suppliers in the 10 areas. MIPPA delayed Round One of the program, but did not fundamentally change the nature of the competitive bidding program or the existing competitive bidding regulations.In the lead up to Round One competitive bidding last year, many suppliers submitted bids outside of the competitive range, and there were many concerns about financial documentation and standards accompanying the bids. In addition, there were questions about contracting and subcontracting arrangements for winning suppliers and state licensure issues.In addition, CMS announced the new Program Advisory and Oversight Committee (PAOC) members, who will provide advice to the Secretary on a number of issues related to the implementation of the program and will assist the Secretary focus on key operational issues because of their expertise in a broad range of issues, including quality standards, accreditation, and beneficiary issues.The committee includes representatives of beneficiaries and consumers, physicians and other practitioners, suppliers, organizations that help to establish professional standards, states, financial standards experts and representatives from industry associations. The new members are as follows:Peter Amico, Prime Care Supplies Inc. of Holtsville, N.Y.Kendra Betz, U.S. Department of Veterans AffairsRichard Boulger, University of Iowa Business Solutions CenterDoran Edwards, Advanced HealthCare Consulting LLC of Columbia, S.C.Sue ElHessen, Careers Unlimited Inc. of Bellflower, Calif.Joseph Furlong, American Home Patient of Brentwood, Tenn.Walter Gorski, AAHomecareRita Hostak, Sunrise Medical Inc. of Mathews, N.C.Thomas Jeffers, Hill-Rom, Inc. of Batesville, Ind.Ruben King-Shaw, All-Med Services of Florida Inc.Ann Kohler, National Association of State Medicaid DirectorsJeffrey Mansell, Texas Department of State Health ServicesSharad Mansukani, NationsHealth Inc. of Sunrise, Fla.Thomas Milam, AmMed Direct LLC of Antioch, Tenn.Barbara Rogers, National Emphysema/COPD AssociationEsta Willman, Medi-Source, Yucca Valley, Calif.Debra Zak, The Joint Commission, Des Plaines, Ill."CMS is excited about the expertise our new PAOC members bring to the table," said CMS Acting Administrator Kerry Weems. "Their broad range of knowledge and practical, 'on the ground' experience will be invaluable as we move forward with the competitive acquisition program."When combined with Medicare's accreditation and quality standards efforts, the competitive bidding program will help to assure that high quality service and items continue to be available to beneficiaries who need medical equipment to use at home. The program will also assist CMS in addressing fraud and abuse issues in the current DMEPOS non-competitive system cited by the U.S. Department of Health and Human Services Office of Inspector General and the U.S. Government Accountability Office.Additional information on the DMEPOS competitive bidding program is available at: http://www.cms.hhs.gov/DMEPOSCompetitiveBid/01_overview.asp#TopOfPage HHS Issues Final ICD-10 Code Sets and Updated Electronic Transaction Standards Rules (CMS Message 2009-01-15)The U.S. Department of Health and Human Services (HHS) today released two final rules that will facilitate the United States' ongoing transition to an electronic health care environment through adoption of a new generation of diagnosis and procedure codes and updated standards for electronic health care and pharmacy transactions.The first final rule replaces the ICD-9-CM code sets now used to report health care diagnoses and procedures with greatly expanded ICD-10 code sets, with a compliance date of Oct. 1, 2013. The second final rule adopts an updated X12 standard, Version 5010, for certain electronic health care transactions, an updated version of the National Council for Prescription Drug Programs (NCPDP) standard, Version D.0, for electronic pharmacy-related transactions, and a standard for Medicaid pharmacy subrogation transactions. Version 5010 includes updated standards for claims, remittance advice, eligibility inquiries, referral authorization, and other administrative transactions. Version 5010 also accommodates the use of the ICD-10 code sets, which are not supported by Version 4010/4010A1, the current X12 standard."These regulations will move the nation toward a more efficient, quality-focused health care system by helping accelerate the widespread adoption of health information technology," HHS Secretary Mike Leavitt said. "The greatly expanded ICD-10 code sets will fully support quality reporting, pay-for-performance, bio-surveillance, and other critical activities. The updated X12 transaction standards, Version 5010, provide the framework needed to support the ICD-10 codes."Adoption of the ICD-10 code sets is expected to:Support Medicare's value-based purchasing initiative and antifraud and abuse activities by accurately defining services and providing specific diagnosis and treatment information;Provide the precision needed for a number of emerging uses such as pay-for-performance and biosurveillance. Biosurveillance is the automated monitoring of information sources that may help in detecting an emerging epidemic, whether naturally occurring or as the result of bioterrorism;Support comprehensive reporting of quality data;Ensure more accurate payments for new procedures, fewer rejected claims, improved disease management, and harmonization of disease monitoring and reporting worldwide; andAllow the United States to compare its data with international data to track the incidence and spread of disease and treatment outcomes because the United States is one of the few developed countries not using ICD-10.ICD-10 will also improve claims processing and payment, and, through the use of health care technology that utilizes ICD-10, assist health care practitioners in making treatment decisions by more precisely matching diagnoses and procedures to the appropriate code. For example:Pressure ulcers are a common condition in elderly Medicare beneficiaries with chronic illnesses. Under the current ICD-9-CM system, health care practitioners can identify the severity or location of a pressure ulcer but the coding system cannot link those elements if the patient has more than one ulcer. Under a single ICD-10 code, a patient's medical history will identify the severity and location of each pressure ulcer;ICD-9 has only one code for angioplasty, the widely used procedure for widening a narrowed or obstructed blood vessel. ICD-10 provides 1,170 coded descriptions, with a granularity that pinpoints the location of the blockage and the device used for each patient;ICD-9 codes do not provide sufficient detail to distinguish whether a condition occurred on a patient's left or right side. ICD-10 will improve care by providing that basic type of information; andICD-9 includes separate codes for medication errors and other external causes of injury, which are reported separately from the actual condition. Under ICD-10, information about medication errors and external causes of injury will be embedded in the code for the condition. Therefore a single, more informative code will provide a ready source of information to help medical professionals prevent medical errors and improve quality of care.ICD-9-CM, Volumes 1 and 2, and Volume 3, was developed nearly 30 years ago. In 2000, under authority provided by HIPAA, HHS adopted the ICD-9-CM code sets as the official standard medical data code sets for use in the health care administrative transactions to report diagnoses and inpatient hospital procedures. HIPAA "covered entities," which include health plans, health care clearinghouses, and health care providers who transmit any electronic health information in connection with a transaction for which a standard has been adopted by HHS, are required to use the ICD-9-CM code sets.ICD-9-CM is widely viewed as outdated because of the limited ability to accommodate new procedures and diagnoses within the established hierarchy of the coding system. ICD-9-CM contains only 17,000 codes, and Volume 3, which contains the hospital inpatient procedure codes, has been running out of available space for several years, resulting in placement of procedure codes outside of the clinical hierarchy where they appropriately belong. By contrast, the ICD-10-CM and ICD-10-PCS code sets contain more than 155,000 codes and can accommodate a host of new diagnoses and procedures. The additional codes will facilitate the implementation of electronic health records (EHRs) because they will allow for the provision of more detail that will, in turn, enhance EHR utility for providers and patients. This granularity will also help to improve efficiencies by helping to more precisely identify specific health conditions and provide a richer set of information about the patient for research and treatment."HHS received more than 3,000 comments on the ICD-10 proposed rule, and support for transition to the ICD-10-CM and ICD-10-PCS code sets is strong throughout the health care industry," said Kerry Weems, acting administrator of the Centers for Medicare & Medicaid Services (CMS). "A number of commenters asked for a delay in the compliance dates for both ICD-10 and Version 5010, citing implementation costs, the need to train health care personnel, and to assure ample time for testing between trading partners. HHS recognized these concerns and the final rules delay the implementation dates between the proposed and final rules by 21 months for the 5010 standards, and by 24 months for the ICD-10 codes. We look forward to working with all parties to ensure a smooth conversion to the updated transaction standards and ICD-10 code set."In addition to updating the current standards with Version 5010 for some health care transactions and Version D.0 for pharmacy transactions, the second final rule adopts a standard for the Medicaid pharmacy subrogation transaction, NCPDP Version 3.0. Subrogation is the process by which state Medicaid agencies recoup funds for payments they have made for pharmacy services for Medicaid recipients, in cases where another third party payer has primary financial responsibility.The transaction standards final rule sets compliance dates of Jan. 1, 2012, for Version 5010, Version D.0 and Version 3.0 (except that small health plans have an additional year and must be compliant with Version 3.0 on Jan. 1, 2013). These dates provide covered entities nearly three years from publication of the final rule to achieve compliance, a timeframe many commenters suggested is needed.For the ICD-10 code sets, the final rule sets the compliance date at Oct. 1, 2013, providing nearly five years from the date of publication for the industry to implement the new code sets. The Oct. 1 compliance date also corresponds with the effective date for annual changes to Medicare payment systems.The ICD-10 code sets final rule concurrently adopts the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for diagnosis coding, and the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) for inpatient hospital procedure coding. The new codes replace the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Volumes 1 and 2, and the International Classification of Diseases, Ninth Revision, Clinical Modification (CM) Volume 3 for diagnosis and procedure codes, respectively.Both regulations are on display today at the Federal Register and may be viewed at http://www.archives.gov/federal-register/public-inspection/index.html. Click on View the Regular Filing Documents.Both regulations will be published on Jan. 16, 2009, and may be viewed that day and thereafter at http://www.gpoaccess.gov/fr/browse.html. Click "Go" next to where 2009 appears in the year selection box for "Back Issues (HTML Only)."A fact sheet describing both rules may be viewed at http://www.cms.hhs.gov/apps/media/fact_sheets.asp. New Guided Pathways (December 2008) Medicare Learning Network (MLN) products (CMS Message 2009-01-15)Try the NEWGuided Pathways (December 2008) Medicare Learning Network (MLN) products! These three booklets incorporate existing MLN products and other Centers for Medicare & Medicaid Services (CMS) resources into well organized sections that can help Medicare Fee-for-Service (FFS) providers and suppliers find information to understand and navigate the Medicare Program. The three Guided Pathways booklets guide learners to resources that provide a fundamental overview of Medicare, as well as detailed FFS policies and requirements. Click on the following link to access the Guided Pathways educational web guide and booklets: http://www.cms.hhs.gov/MLNEdWebGuide/30_Guided_Pathways.asp |
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