| NHIC, Corp.DME MAC A ListServe | For Immediate Release |
| January 23, 2009 Weekly What's New The following publications have been posted to the DME MAC A What's New page:1099-MISC Form Information March ACT Call Information Now available - Recent Modifier Additions and Changes (KE, KL, RA, RB, etc.) New Common Working File (CWF) Medicare Secondary Payer (MSP) Type for Workers' Compensation Medicare Set-aside Arrangements (WCMSAs), to Stop Conditional Payments (MM5371) Therapeutic Shoes for Diabetics - Physician Documentation Requirements Written Inquiries - Response by Telephone CMS Outlines Foundation to Improving Health Care - Roadmaps Issued to Guide Reform of Health Care System (CMS Message 2009-01-16) Department of Health & Human Services (HHS) Issues Final ICD-10 Code Sets and Updated Electronic Transaction (CMS Message 2009-01-21) Revised Online Education Tutorial - Glucose Monitor Billing CMS has announced that an Interim Final Rule with Comment Period, which implements certain provisions of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) for the Round 1 Rebid of the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Acquisition Program, is on display at the Federal Register. CMS has also announced the appointment of new members to serve on the Program Advisory and Oversight Committee (PAOC) for the DMEPOS competitive bidding program. Visit the CMS Web site at http://www.cms.hhs.gov/CompetitiveAcqforDMEPOS/ to view the list of PAOC members and for the latest information on the DMEPOS competitive bidding program. To view the Press Release, please click: http://www.cms.hhs.gov/apps/media/press_releases.asp (CMS Message 2009-01-16) For more information visit: http://www.medicarenhic.com/dme/dme_whats_new.shtml Medicare Remit Easy Print (MREP) Version 2.5The "codes.ini" file can be downloaded to be used with your current version of MREP. This file contains updates to the Claim Adjustment Reason Code (CARC) and Remittance Advice Remark Code (RARC) lists. MREP Version 2.5 can be accessed on the CMS Web site at http://www.cms.hhs.gov/AccesstoDataApplication/02_MedicareRemitEasyPrint.aspTo download MREP Version 2.5, choose Medicare Remit Easy Print - Version 2.5 [ZIP, 1.67 MB].For a description of the changes in this version, refer to the "What's New" section of the MREP User Guide - Version 2.5. For Instructions on how to import the new CARC/RARC codes, refer to Page 65 of the MREP User Guide - Version 2.5 at: http://www.cms.hhs.gov/AccesstoDataApplication/Downloads/EasyPrintUserGuide.pdf. CMS OUTLINES FOUNDATION TO IMPROVING HEALTH CARE - Roadmaps Issued to Guide Reform of Health Care System (CMS Message 2009-01-20)The Centers for Medicare & Medicaid Services (CMS) today issued Quality Measurement, Resource Use Measurement, and Value-Based Purchasing Roadmaps for the traditional Medicare Fee-For-Service Program."These documents are intended to offer a vision for the future and potential options for CMS to pursue to improve the quality and value of health care delivered in the United States and to shift the Medicare FFS program away from paying providers based solely on the volume of services and instead paying them for quality and value of care," said Kerry Weems, CMS acting Administrator.Health care today represents one-seventh of the economy with spending totaling more than $2 trillion annually. By 2017, the nation is expected to spend roughly $4 trillion on health care: 21 percent of gross domestic product.Medicare costs are continuing to skyrocket as well. Last spring, the Medicare Part A Hospital Insurance Trust Fund had been projected to go bankrupt in 2019, 11 years from now. The Medicare chief actuary recently observed that because of the current economic crisis, this date could be moved three years earlier - 2016."It is incumbent on us to use the lessons we've learned with many of the tools we have implemented to help the nation's health care leaders as they look to improve the health care system in a time that's even more critical because the projected rate of growth in health care costs is climbing at an unsustainable rate," said Weems.The papers linked to http://www.cms.hhs.gov/QualityInitiativesGenInfo/ outline the activities that CMS has undertaken to implement value driven health care, including summaries of the various projects to test the policy and concepts designed to provide high quality, affordable health care. The papers provide steps to implement quality and resource use measurement to improve the delivery of care and offer a roadmap to assist in implementing value-based purchasing for Medicare's FFS payment systems.These papers are also intended to provide information to policy makers about the demonstrations and pilot programs that are already underway and to articulate the overarching principles guiding further efforts.The concept behind value-based purchasing is to encourage care delivery patterns that are not only high quality, but also cost-efficient and to move away from the traditional FFS payment systems that pay health care providers to perform services without regard to their quality. In order for a value-based purchasing payment to function, it must be based on standardized quality measures provide information about care that is accurate, reliable, and relevant in a patient-centered way and also based on resource-use measures that can evaluate health care performance in a way that enables comparisons of how efficiently health care is delivered. Medicare DMEPOS Competitive Bidding Program Announcements (CMS Message 2009-01-16)The Centers for Medicare & Medicaid Services (CMS) has announced that an Interim Final Rule with Comment Period, which implements certain provisions of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) for the Round 1 Rebid of the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Acquisition Program, is on display at the Federal Register.CMS has also announced the appointment of new members to serve on the Program Advisory and Oversight Committee (PAOC) for the DMEPOS competitive bidding program.Visit the CMS web site at http://www.cms.hhs.gov/CompetitiveAcqforDMEPOS/ to view the list of PAOC members and for the latest information on the DMEPOS competitive bidding program.To view the Press Release, please click: http://www.cms.hhs.gov/apps/media/press_releases.asp. Department of Health & Human Services (HHS) Issues Final ICD-10 Code Sets and Updated Electronic Transaction Standards Rules (CMS Message 2009-01-21)The U.S. Department of Health and Human Services (HHS) recently 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."The ICD-10 rule titled "HIPAA Administrative Simplification: Modifications to Medical Data Code Set Standards to Adopt ICD-10-CM and ICD-10-PCS" is available in text format at http://edocket.access.gpo.gov/2009/E9-743.htm and in pdf format at http://edocket.access.gpo.gov/2009/pdf/E9-743.pdf .The updated X12 transaction standards, version 5010, rule titled "Health Insurance Reform; Modifications to the Health Insurance Portability and Accountability Act (HIPAA) Electronic Transaction Standards" is available in text format at http://edocket.access.gpo.gov/2009/E9-740.htm and in pdf format at http://edocket.access.gpo.gov/2009/pdf/E9-740.pdf .A fact sheet describing both rules may be viewed at: HHS MODIFIES HIPAA CODE SETS (ICD-10) AND ELECTRONIC TRANSACTIONS STANDARDS OVERVIEW . |
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