Register now for The Forum 2010

April 19-21, 2010; Red Lion Hotel Aurora, CO
Registration for the Forum 2010 is ongoing. Please visit the CRHC website for registration, sponsor and exhibitor information. An updated Forum agenda with session descriptions is now available. All session presentations and handouts will be available for download (for registered attendees only) beginning on April 12. For more information contact Rich Marquez, RHC Program Coordinator at rm@coruralhealth.org or 303.577.0373.

IHI Web-Based Program: Reducing Avoidable Emergency Department Visits

The Institute for Healthcare Improvement (IHI) is offering a new web-based program, Reducing Avoidable Emergency Department Visits beginning May 13, to share lessons and best practices. During this Web&ACTION’s three virtual sessions, expert faculty will provide you with a proven framework that you can begin to test in your own setting. Hospitals with fewer than 50 beds can enroll for a discounted fee. For more information, click here.

Provider Statistical and Reimbursement Report (PS&R) Ordering Instructions

Contact the TrailBlazer Audit and Reimbursement Home Office Team assigned to your facility to order a PS&R for cost reporting periods ending prior to January 31, 2009, from the legacy PS&R system.

Providers must register in the national PS&R system and produce their own summary PS&R reports from the PS&R Redesign for cost reporting periods ending on or after January 31, 2009.

Detail PS&R reports must also be ordered directly by the provider through the national PS&R Redesign system for cost reporting periods ending on or after January 31, 2009. TrailBlazer will then receive the detail PS&R request through the national PS&R system and handle the distribution, due to the sensitive data contained within these reports. Once the request is approved, TrailBlazer will send a billing notice to the provider informing them of the amount due, if any. The provider must remit payment to TrailBlazer, following the instructions in the billing notice. Once payment is received by TrailBlazer, the detail PS&R will be shipped via encrypted compact discs to the provider’s physical location.

Note: If a provider orders a detail PS&R report, the option is given to exclude Protected Health Information (PHI). If this is checked and PHI is excluded, there will be no identifiable data on the claims list other than the service dates to link to a patient. If PHI is not excluded, TrailBlazer will encrypt the file prior to the report being sent to the provider. There is no charge for summary PS&R reports. There is also no charge for the first detail PS&R report of the provider’s cost reporting period. Additional detail PS&R reports are subject to a fee.

New Online Application for Medicare

People who want to apply for Medicare now can do so online at http://www.socialsecurity.gov/. Select the “Retirement/Medicare” link in the middle of the page. The whole process can take less than 10 minutes.

Obama to nominate Berwick to head CMS

According to Modern Healthcare magazine, an administration official says President Obama will nominate healthcare scholar Donald Berwick to be CMS administrator. Berwick, a pediatrician and noted health policy expert, is president and CEO of the Institute for Healthcare Improvement (IHI). Berwick, if confirmed by the Senate, would take over an agency that has not had a permanent chief executive since Mark McClellan stepped down in the fall of 2006. Both Medicare and Medicaid will be undergoing significant changes as part of the healthcare overhaul Obama signed into law days ago. The administration official spoke on condition of anonymity because the president has not made his decision public. For more information, click here.

Beginner's Guide to Medicare Seminar

March 25, 2010
This seminar is intended for new providers or providers with new office staff and will provide an overview of Medicare. A variety of topics will be covered including the four parts of Medicare, how to determine eligibility and claim submission requirements.   For more in formation, click here.

Important Grant Deadlines

Several big grants are due in April--if you're planning on submitting an application, please take note of these deadlines:

• April 1 – Gates Family Foundation
• April 1 – Helen K. and Arthur E. Johnson Foundation
• April 1 – The Telluride Foundation
• April 15 – The Colorado Health Foundation
• April 30 – Bonfils-Stanton Foundation

Clarity Group Free Webinar: The Strategic Management of Quality-Safety-Satisfaction Data in the Small and Rural Healthcare Arena

April 9, 2010; 10:00am-12:00am CST
The strategic management of data begins with an understanding that capturing data across the healthcare system is central to beginning to understand the processes that impact patient care. This complimentary program is designed for CAHs and small hospitals and provides 3 different models of how small and rural healthcare organizations have converted to an electronic system for data collection and what they have learned as a result. For more information and to register, click here.

RHC/FQHC Cost Report Update

Cost reports for freestanding and provider-based Rural Health Clinic (RHC)/Federally Qualified Health Center (FQHC) providers with an FY end of October 31, 2009, or after must be processed using the following cost report transmittals that will capture data for administration of the H1N1 vaccine. If cost reports are submitted using a prior transmittal number, they must be resubmitted by the provider on the latest transmittal indicated below, which contains the proper calculations for H1N1 vaccines.The applicable cost report forms and instructions will be available on the CMS Paper-Based Manuals Web page.

Cost Report	Transmittal Number
RHC/FQHC CMS 222-92	T-8
Hospital CMS 2552-96	T-21
Skilled Nursing Facility (SNF) CMS 2540-96	T-17
Home Health Agency (HHA) CMS 1728-94	T-14

IHI – Hand Hygiene How-To Guide

The purpose of this How-to Guide, from the Institute for Healthcare Improvement (IHI), is to help organizations reduce health-care-associated infections, including infections due to antibiotic-resistant organisms, by improving hand hygiene practices and use of gloves among health care workers. To access the guide, click here.

THE Consortium Webinar: Breach Notification & EMR Selection Webinar

April 15, 2010; 12:00pm-1:15pm

Please join us for the next Consortium Webinar where we will discuss the latest HIPAA regulations on Breach Notification, and the Electronic Health Record (EHR) Selection Process. You will learn what policies and procedures you need to have in place in case of a breach of confidential information, and we will walk you through the preparedness and readiness. The webinar is FREE for THE Consortium members and $99 for non-members. For more information and to register, click here.

Forum 2010 Early Registration Extended to 3/31!

Get more information and register now for The Forum 2010! The early registration period has been extended to March 31, 2010, so register now and save 50% percent in registration and lodging costs associated with comparable national conferences, and $50 off the regular Forum registration rate. Also check out the latest Forum agenda that has been updated with session descriptions.

Deadline for Reserving Your Hotel Room at the Discounted Rate is April 6, 2010

Reserve your room at the Red Lion Hotel Denver Southeast by April 6 to take advantage of the discounted $89 single/double occupancy.  Call 303.695.1700 and use group code 2010 RURA.

Welcome to the New Weekly Update!

As a Colorado Critical Access Hospital or Rural Health Clinic you have been subscribed to the Weekly Update.  You have already been receiving weekly emails from the Colorado Rural Health Center updating you on important information for CAHs and RHCs, but with this new format, everything is organized and archived to make it more accessible and useful!  Now all Weekly Update articles are stored online, and new articles are emailed to you weekly.  Take some time to check out the new format, and let us know what you think.

Two important notes:

1. All posts have labels assigned to them, based on their content.  Labels are things like "Funding" and "Resources" that help categorize the information.  If you are only interested in seeing posts on a specific topic, the right hand side of the Weekly Update site lists all label options--just click on the one you're interested in.  The labels "RHCs" and "CAHs" separate the posts into information relevant to RHCs and information relevant to CAHs.
2. You are currently subscribed to receive a Weekly Update email every week on Thursday with the new posts for the last week.  If you would like to change this subscription, simply click "unsubscribe" at the bottom of any of your Weekly Update emails, and then re-subscribe on the Weekly Update site at whatever frequency (Daily, Weekly, Monthly) you prefer.  We understand that your time is valuable, and don't want to clog your inbox!

If you have questions, please email sm@coruralhealth.org.  Enjoy your reading!

CMS Rural Health Open Door Forum

April 20, 2010; 2pm-3pm ET
The next CMS Rural Health Open Door Forum is scheduled for Tuesday, April 20, 2010 from 2pm-3pmET. If you wish to participate, dial 1-800-837-1935 Conference ID 61774379. These CMS calls address RHC, CAH, and FQHC issues, as well as some inclusion of other questions and concerns that occur in clinical practice pertaining to other CMS payment systems that also extend into these settings. For more information, click here.

TrailBlazer J4 Medicare Tour – Colorado Workshops

June 15, 2010 & June 17, 2010
TrailBlazer has announced the Colorado Workshop locations and dates for its annual J4 Medicare Tour: 6/15/2010 - Colorado Springs; 6/17/2010 - Grand Junction. These TrailBlazer workshops are for Part A and Part B providers and will offer an assortment of topics to assist the provider community with their Medicare billing needs. The cost to attend is $125. For more information and to register, click here.

Medicare Physician Fee Schedule Fact Sheet

The Medicare Physician Fee Schedule Fact Sheet (March 2010) has been revised to include information about the two-month zero percent update to the 2010 Medicare Physician Fee Schedule (MPFS), effective for dates of service January 1 – March 31, 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 CMS Medicare Learning Network (MLN).

Internet-Based PECOS Reminders

Internet-Based PECOS Unavailable March 29 – April 5, 2010

Due to scheduled maintenance, the Internet-based Provider Enrollment, Chain and Ownership System (PECOS) will be unavailable Monday, March 29, 2010, through Monday, April 5, 2010. Please note that the TrailBlazer Provider Enrollment Helpline will be unable to assist with PECOS-related inquiries during this time. If you would like to enroll or make a change to your existing Medicare enrollment record:

• Use Internet-based PECOS prior to March 29, 2010, or after April 5, 2010. For more information about Internet-based PECOS, see the appropriate “Getting Started” guide available in the Downloads section on the CMS Medicare Provider-Supplier Enrollment Web page. There are “Getting Started” guides for physicians and non-physician practitioners and for provider and supplier organizations.
• Complete and submit the paper Medicare provider enrollment application(s) (CMS-855) along with any required supporting documentation and mail the application(s) to the Medicare contractor. The CMS-855 forms are downloadable from the CMS Forms Web page.

Internet-Based PECOS Reminders and Tips for Physicians and Non-Physician Practitioners

Physicians and NPPs who have not enrolled or updated their Medicare enrollment since November 2003 will need to complete an initial enrollment application. Internet-based PECOS does not contain information for physicians and NPPs enrolled before November 2003 who have not updated their enrollment record.

CMS Will Not Enforce Supervision Requirements for Outpatient Therapeutic Services in CAHs for CY 2010

Important news on the Physician Supervision regulations!

The Centers for Medicare & Medicaid Services (CMS) will instruct all of its Medicare contractors not to evaluate or enforce the supervision requirements for therapeutic services provided to outpatients in Critical Access Hospitals (CAHs) from January 1, 2010 to December 31, 2010. CMS plans to revisit the issue of supervision for therapeutic services provided to hospital outpatients in CAHs through the annual rulemaking cycle for calendar year (CY) 2011. CMS continues to expect CAHs to fulfill all other Medicare program requirements when providing services to Medicare beneficiaries and when billing Medicare for those services. While CMS is instructing contractors not to enforce the supervision requirements in CAHs for CY 2010, we continue to emphasize quality and safety for services provided to all patients in CAHs.

For more information about Medicare and CAH’s please see CMS’s website.

Register Now: The Forum 2010

ONLY ONE DAY LEFT FOR EARLY REGISTRATION! 

The Forum is a two-day conference that will bring together participants from all over Colorado and the surrounding states for an essential educational, training, and networking event for all safety net clinics, members of the clinic team, and other interested parties. This year, the event has expanded its reach to include other states and clinic types in order to address the central issues facing us all. The CRHC and ClinicNET have partnered this year to present this event. The Forum offers a comprehensive agenda and has a special focus for 2010 on HIT. For more information and to register, click here.

Take Advantage of Our RHC Services!

CRHC offers dozens of programs and services to help RHCs manage their finances, improve patient care, add Health Information Technology, stay current on CMS changes, be prepared for an unexpected RHC survey, recruit and retain healthcare providers, and more!  Some services are offered completely FREE of charge, and fees for the rest are lower than you'll find anywhere else--some services, such as our Financial Excellence in Revenue Management (FERM) program, will immediately show financial returns that far exceed your original cost!  Contact Rich Marquez at rm@coruralhealth.org or 303.577.0373 for more information today!

APN/PAs Spared 10% Cuts!

CRHC is pleased to announce that the Joint Budget Committee did not approve the Colorado Department of Health Care Policy and Financing recommendation to cut Medicaid reimbursement rates for Advance Practice Nurses and Physician Assistants (APN/PA) by 10% to help balance the state budget for FY10-11. Unfortunately due to the state’s fiscal situation, the JBC did support an across the board 1% Medicaid provider reimbursement cut. While CRHC does not support the idea of balancing the state budget on the backs of healthcare providers, CRHC considers the JBC actions regarding APN/PAs a victory for rural healthcare providers and patients.

Thanks to all of you who contacted the JBC and for your continued support of ensuring that rural Coloradans have access to quality, affordable healthcare services!

THE Consortium Webinar

March 17
Please join the Technology for Healthcare Excellence (THE) Consortium’s next educational Webinar, “Key HIPAA Issues and Current Analysis of Meaningful Use/Incentive Funding”, on March 17th from 12-1:15 pm MT. Agenda items include: Key HIPAA Regulations - “Staying Compliant with Business Associates”; new clarification on incentive funding; review of the comments on Meaningful Use that have been submitted; and a discussion on what is expected to remain in the final rule. For more information and to register, click here.

2010 OPPS Physician Supervision Requirements

The Centers for Medicare & Medicaid (CMS) has received many questions and comments since the 2010 Outpatient Prospective Payment System (OPPS) went into effect, especially in regards to the physician supervision requirements for outpatient therapeutic services. According to information gathered on a recent call with CMS:

• Although the CAH Conditions of Participation don't require a CAH to have a physician on-site 24/7, the 2010 OPPS Final Rule does require a physician or non-physician practitioner (NPP) to be on-site and immediately available whenever the CAH is providing OP therapeutic services in order to bill for these services, including normal business hours, after hours/overnight. Having the physician or NPP on-call is not sufficient to meet the 2010 OPPS final rule billing requirements for these services. Observation services and IV treatments are included in OP therapeutic services.
• An ED physician or NPP could potentially provide direct supervision of OP therapeutic services (within their scope). It is up to the CAH's discretion to determine if the ED physician can meet the "immediately available" criteria under the rule depending on their patient volume.
• "Immediately available" means the physician or NPP can be interrupted - for example, a surgeon performing an 8-hour surgery is not considered immediately available.

CRHC needs to hear from you. Please email Terri Hurst th@coruralhealth.org and let us know the impact this rule has on your facility's ability to provide OP therapeutic services.

IRS to Honor Medical Resident FICA Refund Claims

According to WebCPA, the Internal Revenue Service has made an administrative determination to accept the position that medical residents are excepted from FICA payroll taxes based on the student exception for tax periods ending before April 1, 2005, when new IRS regulations went into effect. For more information, click here.

Licensure - State Board of Health Hearing

The State Board of Health Hearing on the proposed changes to the hospital general licensure regulations is scheduled for March 17. Click here for a memo from CHA describing the status and actions needed regarding the hearing on March 17. Attachment A contains a summary of the regulatory changes and concerns; Attachment B contains a list of recommendations for Parts 3,4,5,6,7 and 9 of Chapter II, that CHA will send to the State Board of Health. Attachment C is the February 25, 2010, draft of the regulations and Attachment D is a draft letter from CHA you can use as a template and modify as needed to send to the State Board of Health. Please contact Gail Finley at gail.finley@cha.com or 720.330.6011, should you have any questions.

Redesigned Provider Statistical and Reimbursement System

The current PS&R system (Legacy PS&R) has been in use for over twenty years. CMS has redesigned the system and it is now operational. The PS&R Redesign is a centralized, web-based application programmed using current technology. It includes enhancements that will improve access and delivery, as well as increase the system's flexibility

The PS&R Redesign will be utilized for filing and settling all cost reports with fiscal years ending on January 31, 2009 and later. Cost reports with fiscal years ending prior to January 31, 2009 will continue to be filed and settled with the Legacy PS&R system. Due to this transition, the Legacy PS&R will not produce reports containing dates of service after January 30, 2009. Reports for fiscal years containing claims with a service through date of January 31, 2009 and later must be produced by the PS&R Redesign.

CMS will delay the implementation of Phase 2 until January 3, 2011:

• Change Request (CR) 6417, "Expansion of the Current Scope of Editing for Ordering/Referring Providers for Claims Processed by Medicare Carriers and Part B Medicare Administrative Contractors (MACs)
• CR 6421, "Expansion of the Current Scope of Editing for Ordering/Referring Providers for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Supplier Claims Processed by DME MACs"
• CRs 6417 and 6421 are applicable to Part B claims only

Access an overview of the system, user manuals, quick guides, and other helpful information on the CMS website.

Medicare Physician Fee Schedule Update

On March 2, 2010, President Obama signed into law the Temporary Extension Act of 2010. Among other things, this law extends through March 31, 2010, the zero percent update to the Medicare Physician Fee Schedule (MPFS) that was in effect for claims with dates of service January 1 - February 28, 2010. Effective immediately, claims with dates of service on or after March 1 that were being held by Medicare contractors will be released for processing and payment. Please keep in mind that the statutory payment floors still apply and, therefore, clean electronic claims cannot be paid before 14 calendar days after the date they are received by Medicare contractors (29 calendar days for clean paper claims).

Note: Part A claims suspended in location SMDAY1 with reason code WW001 will be released for processing.

2010 CCNE Nurse Leadership Development Training

The Colorado Center for Nursing Excellence (CCNE) is offering an EXTRA HRSA leadership & Coaching project in April. This class is for your facility to send new nurse managers and senior staff for coaching or anyone who was not able to attend the class during the time the course was held for your facility.

Leadership Attendees: April 15-16, and April 22-23, 8-5pm
Coaching Attendees: April 20-21, 8-4pm

Each Leader needs to fill out the Leader Sign-up sheet and email or fax (303.715.0347) to Wendy Krzeczowski (wendy@coloradonursingcenter.org )to be registered. Each Coach needs to fill out the Coach sign-up sheet to be registered and receive the CPQ via mail. Deadline for Registration is March 15, 2010.

Save the Date: 2010 CAH Advisory Council Meeting

Nov 4-5, 2010
This annual meeting brings together participants from CRHC, CAHs, and community partners to discuss Colorado’s CAH Program accomplishments and gather input on direction for the coming year. More details to come.

CRHC is Now Hiring!

CRHC is now hiring for a Director of Workforce Programs and a Recruitment Specialist. Click below to download the job descriptions.

• Director of Workforce Programs (closes March 19)
• Recruitment Specialist (closes March 12)