Updates from the Medicare Learning Network(r) § “Implementation of Provider Enrollment Provisions in CMS-6028-FC” Released
§ “Recovery Audit Program Demonstration High-Risk Medical Necessity Vulnerabilities for Inpatient Hospitals” Podcast Released! § New Information for Compliance Officers and Billing and Coding Professionals § “Summary Information Regarding Medicare's Primary Care Incentive Payment Program” Released § “Capped Rental DME: Enforcement of Payment Requirements for Beneficiary-Owned Capped Rental Durable Medical Equipment” Revised § “Waiver of Coinsurance and Deductible for Preventive Services, Section 4104 of the Affordable Care Act” Revised § “Medical Privacy of Protected Health Information” Factsheet Revised >From the MLN: “Implementation of Provider Enrollment Provisions in >CMS-6028-FC” Released MLN Matters(r) Article #MM7350 - titled “Implementation of Provider Enrollment Provisions in CMS-6028-FC” - which explains how Medicare will implement certain provisions cited in CMS-6028-FC, as outlined in Change Request #7350, is now available at http://www.CMS.gov/MLNMattersArticles/downloads/MM7350.pdf<http://www.cms.gov/MLNMattersArticles/downloads/MM7350.pdf>. These provisions, effective Fri Mar 25, 2011, include [1] establishment of provider enrollment screening categories, [2] submission of application fees, [3] suspensions of payment based on credible allegations of fraud, and [4] authority to impose a temporary moratorium on the enrollment of new Medicare providers and suppliers of a particular type in a geographic area. >From the MLN: “Recovery Audit Program Demonstration High-Risk Medical >Necessity Vulnerabilities for Inpatient Hospitals” Podcast Released! [↑] The Medicare Learning Network(r) has released the first in a series of podcasts designed to educate Fee-For-Service providers about how to avoid common billing errors and other improper activities when dealing with the Medicare Program. This podcast - titled “Recovery Audit Program (RAP) Demonstration High-Risk Medical Necessity Vulnerabilities for Inpatient Hospitals” - is based on MLN Matters Article #SE1027 and discusses some of the 17 findings identified by the RAP in an effort to prevent future improper payment issues. To download this podcast, visit the MLN Multimedia webpage at http://www.CMS.gov/MLNProducts/MLM/list.asp<http://www.cms.gov/MLNProducts/MLM/list.asp> and click on ‘Provider Compliance’ from the list of topics. Stay tuned for future podcasts from the MLN! >From the MLN: New Information for Compliance Officers and Billing and Coding >Professionals [↑] As part of ongoing efforts by CMS to keep Medicare Fee-For-Service providers aware of new and improved products, CMS encourages you to visit the Provider Compliance<http://www.cms.gov/MLNProducts/45_ProviderCompliance.asp#TopOfPage> MLN web page, where you will find FFS provider materials to help you understand - and avoid - common billing errors and other improper activities identified through claim review programs. Be sure to pay particular attention to the listing of Provider Compliance National Educational Products<http://www.cms.gov/MLNProducts/Downloads/ProvCmpl_Products.pdf>, from which you can quickly link to each available product. Also take a moment to review the first two issues of the Medicare Quarterly Provider Compliance Newsletter (Volume 1, Issue 1<http://www.cms.gov/MLNProducts/downloads/MedQtrlyComp_Newsletter_ICN904943.pdf> and Volume 1, Issue 2<http://www.cms.gov/MLNProducts/downloads/MedQtrlyComp_Newsletter_ICN905712.pdf>). And like all MLN products, our downloadable compliance materials are available at no cost. >From the MLN: “Summary Information Regarding Medicare's Primary Care >Incentive Payment Program” Released [↑] MLN Matters(r) Special Edition Article #SE1109 - titled “Summary Information Regarding Medicare's Primary Care Incentive Payment Program (PCIP)” - has been released to clarify Medicare’s primary care incentive program. This article is based on Section 5501(a) of the Affordable Care Act, which provides for an incentive payment for primary care services furnished on or after Sat Jan 1, 2011, and before Fri Jan 1, 2016, by a primary care physician or non-physician practitioner. For more information, please read the article at http://www.CMS.gov/MLNMattersArticles/downloads/SE1109.pdf<http://www.cms.gov/MLNMattersArticles/downloads/SE1109.pdf>. >From the MLN: “Capped Rental DME: Enforcement of Payment Requirements for >Beneficiary-Owned Capped Rental Durable Medical Equipment” Revised [↑] MLN Matters(r) Special Edition Article #SE1103 - titled “Capped Rental DME: Enforcement of Payment Requirements for Beneficiary-Owned Capped Rental Durable Medical Equipment (DME)” - has been revised to show that oxygen equipment requirements were significantly changed on Thu Jan 1, 2009, as a result of Change Request #6297. For more information, please read the article at http://www.CMS.gov/MLNMattersArticles/downloads/SE1103.pdf<http://www.cms.gov/MLNMattersArticles/downloads/SE1103.pdf>. >From the MLN: “Waiver of Coinsurance and Deductible for Preventive Services, >Section 4104 of the Affordable Care Act” Revised [↑] MLN Matters(r) Article #MM7012 - titled “Waiver of Coinsurance and Deductible for Preventive Services, Section 4104 of the Affordable Care Act, Removal of Barriers to Preventive Services in Medicare” - has been revised to reflect recent changes to Change Request #7012, which announces that effective for dates of service on or after Sat Jan 1, 2011, Medicare will provide 100-percent payment for the Initial Preventive Physical Examination (IPPE), the Annual Wellness Visit (AWV), and certain preventive services. For more information, please read the article at http://www.CMS.gov/MLNMattersArticles/downloads/MM7012.pdf<http://www.cms.gov/MLNMattersArticles/downloads/MM7012.pdf>. >From the MLN: “Medical Privacy of Protected Health Information” Factsheet >Revised [↑] The revised publication titled “Medical Privacy of Protected Health Information” (revised January 2011) is now available from the Medicare Learning Network(r) at http://www.CMS.gov/MLNproducts/downloads/SE0726FactSheet.pdf<http://www.cms.gov/MLNproducts/downloads/SE0726FactSheet.pdf>. This factsheet contains resources and information regarding the HIPAA Privacy Rule and how this applies to customary healthcare practices and other information on the HHS HIPAA webpage. March Flu Shot Reminder It’s Not too Late to Give and Get the Flu Vaccine. Take advantage of each office visit and continue to protect your patients against the seasonal flu. Medicare will continue to pay for the seasonal flu vaccine and its administration for all Medicare beneficiaries through the entire flu season. The Centers for Disease Control and Prevention (CDC) recommends that patients, health care workers and caregivers be vaccinated against the seasonal flu. Protect your patients. Protect your family. Protect yourself. Get Your Flu Vaccine - Not the Flu. Remember - Influenza vaccine plus its administration are covered Part B benefits. Note that influenza vaccine is NOT a Part D covered drug. For information about Medicare’s coverage of the influenza vaccine and its administration, as well as related educational resources for health care professionals and their staff, please visit the following CMS websites: http://www.cms.gov/MLNProducts/Downloads/Flu_Products.pdf and http://www.cms.gov/AdultImmunizations. --------------------------------------------------------------------------------------- Note: If you have problems accessing any hyperlink in this message, please copy and paste the URL into your Internet browser. If you know someone who would like to subscribe to a Medicare Fee-For-Service (FFS) provider listserv, go to (http://www.cms.gov/prospmedicarefeesvcpmtgen/downloads/Provider_Listservs.pdf). If you would like to unsubscribe from a specific provider listserv, please go to (https://list.nih.gov/cgi-bin/wa.exe?INDEX) to unsubscribe or to leave the appropriate listserv. Please DO NOT respond to this email. 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