ICD-10 Training

 

December ICD-10 webinar now available on-demand During the Dec. 17 webinar we checked in with three volunteers from earlier this year. Sandra Robben-Weber and Chris Hall updated us on their ICD-10 project planning efforts, and Elizabeth Etzler shared how they have used what was learned from their workflow analysis. All speakers lent their insights and experiences gained. View this informative webinar for some practical advice from your peers. You'll gain a better understanding of where to start and how, what to look out for, how to engage others in the practice, and much more! Click here to access the on-demand webinar. Click here to download the program slides. Interested in more ICD-10 webinars? View the full series at www.cms.org/icd-10/archived-webinars.   Resources from the December webinar Sandra mentioned the following document during the webinar and asked us to share it with the group: Pikes Peak PAHCOM ICD-10 Resources Triche mentioned the following article during the webinar and also asked us to share it with the group: Upcoming Healthcare Initiatives: Are you Ready, Have a Gameplan, or Starting to Stress?   Pledge to be ready by 10/1/14 Show your commitment to being ready for the transition to ICD-10. Add your name to the list of those who have pledged to participate in the Colorado ICD-10 Training Coalition's campaign. Sign our pledge and commit to having your practice ready for the transition to ICD-10 by Oct. 1, 2014. Click here.

THE Consortium Webinar

THE Consortium webinar on January 23, 2014.

 

https://cc.readytalk.com/r/8pw9gxhg6xmk&eom

Novitas Updates, Customer Service Training

Novitas Updates

 

Customer Service Training


JH Customer Contact Center January 10, 2014 Training Time Update - 1-855-252-8782 The Customer Service Units will close for training on January 10, 2014 at 3:30 CT. Our self- service technology, the Interactive Voice Response Unit (IVR), Direct Data Entry (DDE) and Professional Provider Telecommunication Network (PPTN) will still be available during this time.

 

JH Part A Webinar Handout: "Update - New Novitas Website" - January 7, 2014 (1:00pm-2:30pm CT)
Join us as we kick off the New Year with the new and improved Novitas Website.  We will demonstrate the improved Novitas Solutions website and show you how to navigate it.  We will inform you of the new available search tools while providing new tips to enhance your search results. You do not want to miss this event.  Register Today!

Novitas Update: New Law Includes Physician Update Fix through March 2014

Novitas Update:

 President Obama Signs the Pathway for SGR Reform Act of 2013



New Law Includes Physician Update Fix through March 2014


On December 26, 2013, President Obama signed into law the Pathway for SGR Reform Act of 2013. This new law prevents a scheduled payment reduction for physicians and other practitioners who treat Medicare patients from taking effect on January 1, 2014. The new law provides for a 0.5 percent update for such services through March 31, 2014. President Obama remains committed to a permanent solution to eliminating the Sustainable Growth Rate (SGR) reductions that result from the existing statutory methodology. The Administration will continue to work with Congress to achieve this goal. The new law extends several provisions of the Middle Class Tax Relief and Job Creation Act of 2012 (Job Creation Act) as well as provisions of the Affordable Care Act. Specifically, the following Medicare fee-for-service policies have been extended. We also have included Medicare billing and claims processing information associated with the new legislation. Please note that these provisions do not reflect all of the Medicare provisions in the new law, and more information about other provisions will be forthcoming.

HCPF’s ACA Implementation Newsletter

HCPF’s ACA Implementation Newsletter

The latest issue of the Department of Health Care Policy and Financing’s ACA Implementation News is now available online here.

CMS Call - 2-Midnight Benchmark for Inpatient Hospital Admissions — Registration Now Open

CMS Call - 2-Midnight Benchmark for Inpatient Hospital Admissions — Registration Now Open 

Tuesday, January 14; 1:30-3pm ET

 

To Register: Visit MLN Connects™ Upcoming Calls. Space may be limited, register early.

 

This MLN Connects Call provides an overview of the inpatient hospital admission and medical review criteria (also known as the 2-Midnight Rule) that was released on August 2, 2013 in the FY 2014 Inpatient Prospective Payment System/Long-Term Care Hospital final rule (CMS-1599-F). CMS will present case scenarios on the application of the rule to sample medical records. Following the presentation, CMS will address frequently asked questions received from providers.

 

Agenda:

• Summary of the 2-Midnight Rule
• Case example presentation
• Question and answer session

Target Audience: Hospitals, physicians and non-physician practitioners, case managers, medical and specialty societies, and other healthcare professionals.

Fee Schedule Calculator (Novitas Tools)

Novitas Tools

Fee Schedule Calculator
This self-service tool is now operational again. While the 2014 Physician fee schedules can be downloaded from our website, they are not yet available in this calculator, but will be coming soon! You can still check 2010-2013 codes.

Fee Schedule Calculator

Appeals Status Tool
As a reminder, our Appeals Status Tool is now working, you can check to see if your appeal was received, and whether it's pending or finalized! Please Note: It does take approximately 1 week from the date received to be entered in the tool

How to Let Grant Reviewers Know Your Sustainability Plan

How to Let Grant Reviewers Know Your Sustainability Plan:

 

No funders like to think that their grant will only fund a project for a short time.  Before investing in your project, your funder will want to know your plans for carrying the project into the future, with or without this particular funders help. Think of the sustainability part of your grant as the sequel to the story you told throughout your application. Make sure that your future funding section provides a solid and specific blueprint of how your agency intends to continue operating its programs and continuing to serve its clients and community. 

 

There is a menu of funding strategies out there that a volunteer organization for example, can draw on to compose a future funding plan.  It’s important to demonstrate that your entity has an effective strategy for raising funds to cover activities in the event the grant program goes away or doesn’t fund your project as you planed.  Don’t pull the rug out at the end of your proposal….instead provide reassurance that the training will go on, and that your organization will remain strong.  For more application assistance and questions, contact Lakesha Jones, Grants Manager at 720.248.2742 or by email at lj@coruralhealth.org.

 

2014 Physician Fee Schedule Novitas Update

Novitas is working diligently to post the 2014 physician fee schedule in file formats to which you are accustomed. In order to give you an opportunity to review the 2014 fees, we are posting the files in a basic text only format. This text file is formatted for viewing only. It is not formatted for importing into billing systems or other types of computer systems. We will notify you on our website and by electronic mail message when the 2014 physician fee schedules are available in formats appropriate for importing. We thank you for your patience.

Funding Opportunities for EMS and Trauma!

Now Accepting Applications -- Approximately $6.7 million is available through grants and system improvement funding for organizations involved in providing emergency medical and trauma services in Colorado.

Apply for these funds at www.coems.info under the "Funding Program" tab and the "Apply" link.

1. Read the FY15 funding Guide
2. Get your username and password for www.cemsis.com
3. Log in, update and submit your 2014 organizational profile
4. Complete and submit your funding application before 5 p.m. on Feb. 14, 2014

Contact your RETAC coordinator, Jeanne-Marie Bakehouse or Michael Gerber with questions.

Revalidation for Jurisdiction H (JH) Providers and Suppliers

Novitas has updated the Revalidation Request Mailing Schedule on our website. As outlined in the Schedule, mailings began on November 22, 2013 and will continue through December 30, 2013. These mailings comprise approximately 10,200 providers/suppliers. The Centers for Medicare and Medicaid Services (CMS) will publish the listing of providers/suppliers included in these mailings on their website approximately 3-4 weeks after all contractors have provided their mailing information for the months of November and December.

If you have questions related to the revalidation initiative, please visit our Enrollment Center for more information.

iCARE: Improving Communication and Readmissions in the Rural Setting Webinar

iCARE: Improving Communication and Readmissions 

in the Rural Setting Webinar

December 19th, 1:00-2:00 pm MT 

Hosted by the Colorado Rural Health Center 

Preventing readmissions is never easy, but addressing readmissions in a rural setting poses unique challenges that can be hard to overcome. Four years ago, the Colorado Rural Health Center (CRHC) started the Improving Communication and Readmissions project (iCARE). iCARE is a rural-focused statewide improvement project aligning with national trends and initiatives. Through iCARE Colorado's rural Critical Access Hospitals and their provider-based clinics are focused on three primary goals:

• Improving communication in transitions of care, 
• Reducing readmission rates, and 
• Improving clinical processes that contribute to readmission rates. 

During this webinar you'll learn more about iCARE, the work done to-date, and accomplishments of project participants. Join us to learn more about how readmissions are being addressed across Colorado and how some of these approaches may work for you!

Click Here for Free Registration

Speaker Bio:
Jen Dunn, Director of Programs, Colorado Rural Health Center
As the Director of Programs, Ms. Dunn is responsible for the oversight of the Critical Access Hospital, Rural Health Clinics, and EMS/Emergency Preparedness programs. She works extensively with the iCare program at CRHC and is an active member of the Healthy Transitions Colorado Operating Team. Through iCare, Ms. Dunn works with rural hospitals and clinics to reduce readmissions and make sure that Colorado's rural facilities stay ahead of national trends. Ms. Dunn earned a Bachelor's Degree from Concordia College in Moorhead, Minnesota and a Master's Degree in Public Administration from the University of Colorado at Denver.

ICD-10 Coder Academy by RT Welter

ICD-10 Coder Academy – Sign Up Today for Registration Discounts!

The Discounted Registration Deadline for the ICD-10 Coder Academy is quickly approaching! Sign any time between now and December 15th to save!

This interactive and hands-on ICD-10 training is designed to prepare coders for the AAPC and AHIMA ICD-10 proficiency examinations. Participants will gain the tools they need to appropriately select ICD-10-CM and ICD-10-PCS codes. These training sessions will be coder centric, and the content will be designed for those staff who will be responsible for applying (or verifying) these codes to documentation. Throughout the academy, participants will be given an assortment of scenarios to code to obtain the proficiency they need for coding in ICD-10.

Participants only needing ICD-10-CM training (physician and outpatient coding) should register for the first day of the academy only (Day 1).

Participants needing ICD-10-PCS training (hospital/inpatient coding) will need to register for the entire 3-day academy.
Overview of ICD-10 Academy Agenda — (lunch, snacks and drinks will be provided each day)

ICD-10-CM (Day 1) — AHIMA-approved ICD-10-CM/PCS trainers will educate coding staff regarding ICD-10-CM with a focus on:

• Convention changes and additions 
• Concept changes and additions 
• Chapter specific guideline changes and additions 
• Live coding workshop 

**This training has the approval of 8.0 CEU’s from the American Health Information Management Association (AHIMA) (AAPC members can submit these CEU’s to AAPC for credit)

ICD-10-PCS (Days 2 and 3) — AHIMA-approved ICD-10-CM/PCS trainers will educate coding staff regarding ICD-10-PCS with a focus on:

• The structure of ICD-10-PCS text and codes 
• The definition and application of each root operation 
• The method by which an ICD-10-PCS code is selected 
• Live coding workshops 

**This training has the approval of 16.0 CEU’s from the American Health Information Management Association (AHIMA) (AAPC members can submit these CEU’s to AAPC for credit)

Registration Discounts:

• Register by December 15, 2013 and receive $50.00 off the registration fee (per participant)!
• Practices registering 3+ participants will receive $50.00 off each registration fee (in addition to early registration discount if registered by December 15, 2013)
• Seating is limited, register now
• to guarantee your spot today!

CLICK HERE TO READ MORE

ICD-10 Webinar and Provider Readiness Survey

It's not too late to register for Dec. 17 

ICD-10 webinar: Year End Check-Up 

Time for a reality check - as of Dec. 17 there will be 288 days until the Oct. 1, 2014 ICD-10 deadline. Will you be ready?

During this webinar we will check in with three volunteers from earlier this year. Sandra Robben-Weber and Chris Hall will update us on their ICD-10 project planning efforts, and Elizabeth Etzler will let us know how they have used what was learned from their workflow analysis. They will share their insights and experiences gained.

Register for this informative webinar for some practical advice from your peers. You'll gain a better understanding of where to start and how, what to look out for, how to engage others in the practice, and much more!

Join us on Tuesday, Dec. 17, 12 - 1 p.m. for the year end check-up. Click here to register.

ICD-10 Provider Readiness Survey is now open The Department of Health Care Policy and Financing has developed an ICD-10 Provider Readiness Survey and encourages all providers and trading partners to complete it.

To access the survey, go to the ICD-10 page of the HCPF website and select "Click here to take the ICD-10 Readiness Survey." Or click here to go to the survey directly. The survey will close at the end of the year. Thank you in advance for your participation.

For more information, please head to the Colorado Medical Society website.

THE Consortium Webinar - Stage 2 MU and HIPAA

THE Consortium: December 17, 2013 Webinar  

Continued Deeper Dive into Stage 2 MU and HIPAA

Please gather your IT, QI and ICD-10 team and join us for the next in our series of Meaningful Use webinars on Tuesday, December 17, 2013 from 12:00 pm to 1:15 pm. We will continue our ongoing discussion regarding meaningful use and continue our deep dive into Stage 2-2014 Edition requirements!

To register, please click here. For more information or questions please email Danette Swanson at ds@couralhealth.org.

CMS Open Door Forum

Special Open Door Forum: Final Rule CMS-1599-F: 

Hospital Inpatient Admissions 

Discussion of the Hospital Inpatient Admission Order and Certification; 2 Midnight Benchmark for Inpatient Hospital Admissions

Thursday, December 19; 1-2 pm ET

CMS will host a third, follow-up call in its Special Open Door Forum (ODF) series to allow hospitals, practitioners, and other interested parties to ask questions on the physician order and physician certification, inpatient hospital admission and medical review criteria that were released on August 2, 2013 in the FY 2014 Inpatient Prospective Payment System (IPPS)/Long-Term Care Hospital (LTCH) final rule (CMS-1599-F) and corresponding medical review instruction. For recently released provider information, including updates to the frequently asked questions and a recently identified “rare & unusual circumstance,” please visit the Inpatient Hospital Reviews web page. Note: The “rare & unusual circumstance” appears in Section III.D.2 of the Download, “Reviewing Hospital Claims for Patient Status 11/27/2013.”

Feedback and questions on the two midnight provision for admission and medical review can be sent to IPPSAdmissions@cms.hhs.gov. Questions on Part B inpatient billing and the clarifications regarding the physician order and certification should be sent to the subject matter staff listed in the final rule.

Special Open Door Participation Instructions:
Conference call only
Participant Dial-In Number(s): (866) 501-5502; Conference ID # 16505942

For more information about ODF calls, see the Special Open Door website.

Therapy Caps for CAHs

Click here to view excerpts from the advance Federal Register of the CY 2014 Final Physician fee schedule dealing with therapy caps. As proposed, CMS has finalized their position, subjecting outpatient therapy services in CAHs to the therapy caps beginning 1/1/14. 

For more information or questions contact Samantha Hiner at sh@coruralhealth.org

CMS ICD - 10 Training Webinar

ICD-10 Training Webinar Video: 

Navigating ICD-10, the Provider Perspective

CMS has released a new recording of an ICD-10 training webinar conducted for the National Association of Community Health Centers. The video is available on the ICD-10 Provider Resources page.

This webinar includes information on:

• Changes in ICD code structure, code definitions, and the recurring patterns that help providers to understand the organization and content of ICD-10 codes 
• The importance of clinical documentation in order to accurately and thoroughly capture medical concepts to inform ICD-10 coding 
• Approaches to assess ICD-10 readiness, identify gaps, prioritize tasks, and monitor progress through continuous quality improvement 

Keep Up to Date on ICD-10
Visit the CMS ICD-10 website for the latest news and resources to help you prepare for the October 1, 2014, deadline. Sign up for CMS ICD-10 Industry Email Updates and follow us on Twitter.

Novitas Website Updates and Enhancements

Latest Website Updates and Enhancements
Novitas Solutions has been listening to your feedback, and we continue to focus on improving our website. Here are a few of the things we 've recently completed:

Search Function

• Filtering: Results may now be filtered by category (Claims, Customer Service, FAQs, etc)
• You can now search by phrases or using punctuation marks, such as quotation marks, e.g. "Functional Therapy Reporting G codes"
• Pressing the "enter" key will now initiate the search.

Appeals Status Tool
Our Appeals Status Tool is now properly functioning.

• Make sure to save this link as a favorite, for the quickest access!!
• Please Note: It takes approximately 1 week from the date received to be entered in the tool.

Here are a few things coming soon:

• An Enhanced, Interactive Fee Schedule Calculator (Part B)
• CERT Claim Identifier Look-up Tool
• We continue to split out the remaining content between JL and JH

For a full list of website issues and enhancements, please click here, or you can find the list at the top our homepage under "Pardon Our Dust..."

Medicare News from Novitas Solutions

The following JH MAC Local Coverage Determinations (LCDs) which were posted for notice on October 10, 2013 are now effective: 

Biomarkers Overview (L33638)

Molecular Diagnostics: Genitourinary Infectious Disease Testing (L33644)

Neuromuscular Junction Testing (L33650)

Pain Management of Peripheral Nerves by Injection (L33604)

Scanning Computerized Ophthalmic Diagnostic Imaging (L33590)

Transcranial Magnetic Stimulation (TMS) for the Treatment of Depression (L33660)

Trigger Point Injections (L33648)


The following JH MAC Local Coverage Determination (LCD) has been revised:
Vertebroplasty, Vertebral Augmentation, Percutaneous (L32685)


The following JH MAC Local Coverage Determination (LCD) has been retired for dates of service on and after December 5, 2013:
Transcranial Magnetic Stimulation for Depression (L32752)

SHIP Webinar January - ICD-10 Implementation Series

ICD-10 Implementation series

January 16, 2014 - Webinar #4

Click here to register your ICD-10 Implementation Team for this meeting.

Meeting Description:Please join us Thursday, January 16, 2013, from 12:00pm - 1:15pm to continue this step by step journey toward a successful ICD-10 Implementation on October 1, 2014.

During this second live webinar we will discuss:

• Progress with your homework assignment from previous webinars
• Are you on track?
• What's your next step?
• Discussion / Homework Remediation / Next Step
• Helpful resources and project materials will be provided throughout the series.

Click here to register or email Danette Swanson at ds@coruralhealth.org for more information.

CMS Customer Service Units and EDI Holiday Availability

Novitas Solutions, Inc. will be observing the Christmas holiday on Tuesday, December 24, 2013, and Wednesday, December 25, 2013, and the New Year’s holiday on Wednesday, January 1, 2014. Our business doors will be closed and the Customer Service Units will not be available. Please click here for full details of system availabilities.

CREATE Tip of the Week - Narrative Details

You have decided what type of training your staff requires to meet the service need. You have looked at your budget and decided that the money is not there, but how do you get this message across to grant reviewers effectively?

The answer is to be specific! The best way to get the ERC's attention is to be specific by providing as many details as you can about all the aspects of the training (course costs, other costs, travel costs, etc.) and the benefits of incorporating that training into your region (more providers, better quality of care, increasing knowledge, etc.). Your aim should be to offer support or evidence for everything you say. Make sure each sentence is information rich. Inevitably, this means it will be very dense reading, but that’s the nature of the genre.

One good way to save space, while maintaining the focus on your course request meeting the service needs of your area, try including community and service request statistical information. Examples included numbers of providers vs. number of type of service requests. Strings of multiple statistics help show the depth of your familiarity with your service area need and how the training you are seeking would help meet that need successfully.

For more ideas of how to be concise while including all the important information, within your CREATE application contact Lakesha Jones, Grants Manager at lj@coruralhealth.org or by phone at 720.248.2742.

REMEMBER our December CREATE application deadline is quickly approaching. Please submit your request for funding by December 9th in order to receive a review this month.

CMS Webinar onDurable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program

The Centers for Medicare & Medicaid Services will be hosting several webinars for partners and providers on

The Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program: Round 1 Recompete

The webinars will be conducted on the following dates:

• December 09, 2013 (11:00 am to 12:00 noon (EST))
• December 11, 2013 (1:00 pm to 2:00 pm (EST))
• December 12, 2013 (2:00 pm to 3:00 pm (EST)

Sign up for one of our webinars via the following link:
http://dmeposcb2013.eventbrite.com/

The Round 1 Rebid of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program was successfully implemented in nine areas on January 1, 2011. CMS is required by law to recompete contracts under the DMEPOS Competitive Bidding Program at least once every three years. The Round 1 Rebid contracts will expire on December 31, 2013. The Round 1 Recompete contracts and prices are scheduled to go into effect on January 1, 2014 in the same nine areas. There will also be some changes to the specific DMEPOS items that are part of the program in these areas starting on January 1, 2014.

When a round of the program goes into effect in a competitive bidding area (CBA), Original Medicare beneficiaries who obtain competitively bid items in that CBA will need to use a Medicare contract supplier for that round for Medicare to help pay unless an exception applies. It is important that prescribing physicians, social workers, discharge planners, and others who assist Medicare beneficiaries in Round 1 competitive bid areas with their health care needs and decisions understand this program so that they can help Medicare patients get covered medical equipment and supplies. To ensure that Medicare can help pay for Medicare patients’ medical equipment and supplies, partners and providers will have to help beneficiaries find a supplier that is a Medicare contract supplier.

Please forward this message to any partner who may benefit from this educational session. We also look forward to your participation and the opportunity to educate partners and providers about the program.

PLEASE NOTE: This program is intended for partners and providers who assist beneficiaries in obtaining and ordering items of DMEPOS. Each program is limited to 1,000 participants, so please register early. Additionally, please try to limit your registration to 1 event if possible. We have scheduled 3 webinars in order to accommodate everyone and will add additional webinars if we reach our maximum attendance.

This webinar will be presented in a lecture format only. Questions may be asked using the webinar chat feature but will not be answered live. All questions will be compiled into a Question and Answer document and distributed to all webinar participants.

If you would like to receive regular updates about the DMEPOS Competitive Bidding initiative sign up for our Referral Agent ListServ via the below link. https://public.govdelivery.com/accounts/USCMS/subscriber/new?pop=t&topic_id=USCMS_7814

If you have any questions about these webinars or are unable to attend due to reaching maximum attendance, please contact Tom Robinson at Thomas.robinson@cms.hhs.gov or Lynne Tierney at lynne.tierney@cms.hhs.gov.

MLN Matters and CMS: Medicare Benefit Policy Manual

Click here for the MLN Matters on Medicare Benefit Policy Manual and here for the CMS Manual System on Medicare Benefit Policy Manual.

SHIP Webinar - ICD-10 Implementation Series

ICD-10 implementation series - Webinar #3 

December 10, 2013

Please join us on Tuesday, December 10, 2013, from 12:00pm - 1:15pm to start this step by step journey toward a successful ICD-10 Implementation on October 1, 2014.

During this third live webinar we will continue our discussion about ICD-10 readiness and the tasks that should be completed as we move into the new year. We will also work on clinic settings, LTC, Home Health and Hospice -- please forward this information to any staff in those facilities in your organization and to other facilities in your community.

Rural Health Clinic Technical Assistance Call

The next Rural Health Clinic technical assistance call will be held Thursday, December 12th at 3:00 pm EASTERN.

As many of you may know, December 1st was World AIDS Day, and this call will focus on the role that RHCs can serve in prevention, testing, treatment, and resource referral in their communities.Speakers will provide information about HIV prevalence in rural areas and clinical resources available to RHCs.


Speakers include:

• Janice C Probst, PhD, South Carolina Rural Health Research Center 
• Deborah Parham Hopson, PhD, HRSA 
• Ronald H. Goldschmidt, MD, National HIV/AIDS Clinicians' Consultation Center 
• A representative from a regional AIDS Education Telehealth Training Center 

The call-in number is: 888-469-0986. The access code is: 2255226. There is no charge to participate. Please feel free to share with others whom you think might benefit from hearing this presentation.A recording and transcript of the call will be made available for those unable to listen/participate live.

The presenters will take questions from the audience. If you would like to submit a question ahead of time, please send it to: info@narhc.org and put “RHC TA Question” in the subject line.

The presenters’ slides will be available for download from the NARHC Website closer to the day of the call. A link will be provided when they are available.

Additional information:
As the result of advances in treatment, HIV has become a manageable chronic disease. However, many Americans living with HIV aren’t aware of their status, and others struggle to access lifesaving drug therapies due to cost and geography. Therefore, it is important that Americans at risk get tested, and those who have HIV begin and adhere to drug treatment regimens.

Earlier this year, the South Carolina Rural Health Research Center released a report titled HIV/AIDS in Rural America: Prevalence and Service Availability.Although rates of HIV/AIDS are lower in rural areas, rural residents disproportionately lack resources to treat HIV/AIDS. HRSA’s Ryan White Program funds a variety of resources, including the National HIV/AIDS Clinicians' Consultation Center and regional AIDS Education and Training Centers.

CMS releases OPPS and PFS final rules

Last week the Centers for Medicare and Medicaid Services (CMS) released their final rules for calendar 2014 for the outpatient prospective payment system (OPPS) and the physician fee schedule (PFS). Among other modifications to the OPPS, CMS announced its final determination to end the current enforcement moratorium for small, rural hospitals and Critical Access Hospitals in regards to compliance with “direct supervision” requirements for outpatient therapy services. As part of the physician fee schedule update, CMS indicated the method and manner in which they plan to enforce SGR and GPCI cuts that will take affect in January if Congress does not intervene. They also outlined how therapy caps will be applied to Critical Access Hospitals and modified their definition of “rural” for purposes of telehealth reimbursement. The OPPS final rule is available here and the PFS final rule is available here.

Updated Information about Incarcerated Beneficiary Claim Denial Corrections

CMS has a new web page focused on the 2013 claims denials associated with a beneficiary’s incarceration status.

CMS Makes Outpatient Facility Policy and Payment Changes

Rule would give hospitals and ASCs flexibility to lower per-case costs

On November 27, CMS released a final CY 2014 hospital outpatient and ambulatory surgical center (ASC) payment rule [CMS-1601-FC] that will give hospitals and ASCs new flexibility to lower outpatient facility costs and strengthen the long-term financial stability of Medicare. In addition, CMS will replace the current five levels of hospital clinic visit codes for both new and established patients with a single code describing all outpatient clinic visits. A single code and payment for clinic visits is more administratively simple for hospitals and better reflects hospital resources involved in supporting an outpatient visit. The current five levels of outpatient visit codes are designed to distinguish differences in physician work.

Provisions in the final Hospital Outpatient Prospective Payment System (OPPS) rule encourage more efficient delivery of outpatient facility services by packaging the payment for multiple supporting items and services into a single payment for a primary service similar to the way Medicare pays for hospital inpatient care. Supporting items and services that will be included in a single payment for a primary service to the hospital and not paid separately include drugs, biologicals, and radiopharmaceuticals that function as supplies when used in a diagnostic test or procedure; drugs and biologicals that function as supplies when used in a surgical procedure, including skin substitutes; certain clinical diagnostic laboratory services; certain procedures that are never done without a primary procedure (add-ons); and device removal procedures.

The CY 2014 final rule with comment period increases overall payments for hospital outpatient departments by an estimated 1.7 percent. The increase is based on the projected hospital market basket—an inflation rate for goods and services used by hospitals—of 2.5 percent, minus both a 0.5 percent adjustment for economy-wide productivity and a 0.3 percentage point adjustment required by statute. The rule also updates partial hospitalization payment rates for hospitals and community mental health centers.

As part of this broader proposal to consolidate payment for larger groups of services, the final rule with comment period also establishes an encounter-based or “comprehensive” payment for certain device-related procedures like cardiac stents and defibrillators, but in a change from the proposed rule, delays its effective date to 2015.

Full text of this excerpted CMS press release (issued November 27).

• Final Rule
• Fact Sheet

CMS Extends 2014 Annual Participation Enrollment Period through January 31

The 2014 Annual Participation Enrollment Program allows eligible physicians, practitioners, and suppliers an opportunity to change their participation status by December 31, 2013. Due to the later than usual release of the Medicare Physician Fee Schedule Final Rule, CMS is extending the 2014 annual participation enrollment period through January 31, 2014. Therefore, participation elections and withdrawals must be post-marked on or before January 31, 2014. The effective date for any participation status changes elected by providers during the extension remains January 1, 2014.

CMS Finalizes Physician Payment Rates for 2014

Final Rule Focuses on Improved Care Coordination

On November 27, CMS finalized payment rates and policies for 2014, including a major proposal to support care management outside the routine office interaction as well as other policies to promote high quality care and efficiency in Medicare. CMS’ care coordination policy is a milestone, and demonstrates Medicare’s recognition of the importance of care that occurs outside of a face-to-face visit for a wide range of beneficiaries beginning in 2015. The final rule sets payment rates for physicians and non-physician practitioners paid under the Medicare Physician Fee Schedule for 2014 and addresses the policies included in the proposed rule issued in July. CMS projects that total payments under the fee schedule in 2014 will be approximately $87 billion.

As part of CMS’ continuing effort to recognize the critical role primary care plays in providing care to beneficiaries with multiple chronic conditions, beginning in 2015, the agency is establishing separate payments for managing a patient’s care outside of a face-to-face visit for practices equipped to provide these services.

The 2014 payment rates increase payments for many medical specialties with some of the greatest increases going to providers of mental health services including psychiatry, clinical psychologists and clinical social workers.

CMS is finalizing a process to adjust payment rates for test codes on the Clinical Laboratory Fee Schedule (CLFS) based on technological changes. Currently, the payment rates for test codes on the CLFS do not change once they have been set (except for changes due to inflation and other statutory adjustments). This review process will enable CMS to pay more accurately for laboratory tests on the CLFS.

The final rule also includes several provisions regarding physician quality programs and the Physician Value-Based Payment Modifier (Value Modifier). As CMS continues to phase-in the Physician Value-Based Payment Modifier, for 2016 CMS is finalizing its proposals to apply the Physician Value Modifier to groups of physicians with 10 or more eligible professionals, and to apply upward and downward payment adjustments based on performance to groups of physicians with 100 or more eligible professionals. However, only upward adjustments based on performance (not downward adjustments) will be applied to groups of physicians with between 10 and 99 eligible professionals.

CMS also is finalizing several related proposals to the Physician Quality Reporting System (PQRS) for 2014, including a new option for individual eligible professionals to report quality measures through qualified clinical data registries. In 2014, quality measures will be aligned across quality reporting programs so that physicians and other eligible professionals may report a measure once to receive credit in all quality reporting programs in which that measure is used. Additionally, CMS is better aligning PQRS measures with the National Quality Strategy and meaningful use requirements, and transitioning away from process measures in favor of performance and outcome measures. Finally, certain data collected in 2012 for groups reporting certain PQRS measures under the Group Practice Reporting Option (GPRO) will be publicly reported on the CMS Physician Compare website in 2014.

“Aligning measures across quality programs focuses providers on the most important measures and makes it easier to participate in programs like PQRS, which are designed to emphasize quality for Medicare beneficiaries,” said Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer.

Full text of this excerpted CMS press release (issued November 27).

• Final Rule
• Fact Sheet: Final Policy and Payment Changes to the Medicare Physician Fee Schedule for CY 2014 
• Fact Sheet: Changes for CY 2014 Physician Quality Programs and the Value-Based Payment Modifier 
• Physician Fee Schedule
• Physician Value-Based Payment Modifier 
• PQRS

CMS Special Open Door Forum

The next Special Open Door Forum: Final Rule CMS-1599-F: Discussion of the Hospital Inpatient Admission Order and Certification; 2 Midnight Benchmark for Inpatient Hospital Admissions is scheduled for Thursday December 19, 2013 from 1:00pm – 2:00pm, ET. If you wish to participate, dial 1-866-501-5502; Conference ID: 16505942. Please see the Downloads section for the full announcement. 

For mre information, please click here. 

QHi and How CRHC Can Help

Quality Health Indicators (QHi) is a user driven program specifically designed to facilitate benchmarking for small rural facilities. Taking part in QHi is free for CAHs. Participants benchmark against self-defined peer groups to learn from the best practices of other organizations in order to adopt new processes in 4 categories:

• Clinical Quality
• Financial and Operational
• Employee Contribution
• Patient Satisfaction

As a proven technique for discovering and incorporating best practices into operations, benchmarking provides the opportunity to use interventions already built and tested by others, reducing the costs of making significant advances in the quality of care.

Whether you need help getting started with QHi, making sure data is submitted or analyzing your data, CRHC can help you navigate in multiple ways. Call Caleb Siem, CAH Program Manager, at 303.468.3498 for more information.

CREATE Tip of the Week - Entity Eligibility

This week’s tip focuses on what it means to be an "eligible entity" to apply for CREATE funding. Since CREATE is a part of the provider grant through CDPHE, it’s important to understand exactly what kind of EMS entity can apply for funding. All recognized training center and state approved EMS provider can apply. If an applying entity is neither, or is looking to establish a new training facility or provider program, the entity must have some mechanism in place to prove certification of learning. For example, an non-recognized EMS provider can partner with a community college or training center to sign off on students’ course work under their accreditation.

Please direct all questions about entity eligibility to Lakesha Jones, Grant Manger, at lj@couralhealth.org or Samantha Hiner, Program Coordinator at sh@coruralhealth.org. For more information on CREATE, visit our web page at http://coruralhealth.org/programs/create/.

Success stories? Photos? General comments about CREATE? We'd love to hear from you and feature your story in our blog. Email your feedback to Samantha Hiner, Programs Coordinator, at sh@coruralhealth.org.

Searching for a Local Coverage Determination (LCD)

Coming this December 2013, Novitas will begin to direct customers to the Medicare Coverage Database (MCD) for retired LCDs and previous versions of currently active LCDs. This change will provide our customers with a more robust LCD search functionality. The Medical Policy page of the Novitas Solutions website will be updated to provide links and detailed instructions to search for LCDs within the MCD. Active LCDs (current versions) and draft LCDs will continue to be available on the Novitas Solutions website and within the MCD.

Active and draft LCDs can be found on the Medical Policy page of the Novitas Solutions website and via the links below.

Jurisdiction L

Jurisdiction H

CREATE Tip of the Week - Entity Eligibility

In past CREATE Tips of the Week, we’ve talked about participant eligibility. This week’s tip touches on entity eligibility. Eligible entities have to be either a recognized training center or state recognized EMS provider. If an applying entity is neither, the entity must have some mechanism in place to prove certification of learning. For example, an entity that is neither a training center nor state recognized EMS provider can partner with a community college or training center, as long as the partnering entity will sign off on students’ course work under their accreditation.

Please direct all questions about entity eligibility to Lakesha Jones, Grant Manger, at lj@couralhealth.org or Samantha Hiner, Program Coordinator at sh@coruralhealth.org. For more information on CREATE, visit our web page at http://coruralhealth.org/programs/create/.

Success stories? Photos? General comments about CREATE? We'd love to hear from you and feature your story in our blog. Email your feedback to Samantha Hiner, Programs Coordinator, at sh@coruralhealth.org.

Announcements from the Federal Office of Rural Health Policy

Funding Opportunities
1. The Federal Office of Rural Health Policy is pleased to announce the release of the fiscal year 2014 Rural Health Network Development Planning Grant Program. The purpose of this program is to assist in the development of an integrated healthcare network. A technical assistance call will be held on Tuesday, December 3, 2013 at 1:00pm EST. Applications must be submitted into grants.gov by January 16, 2014.

To access the application visit: http://www.grants.gov/web/grants/search-grants.html and type in HRSA-14-043 in the funding opportunity box.

Adobe Connect and webinar information for December 3rd:

• To join the meeting as a guest: https://hrsa.connectsolutions.com/netplantechast/
• Toll-free call in number: 800-475-0512
• Participant Passcode for call in number: 5732913

2. Due to the government shutdown, the Federal Office of Rural Health Policy has made changes to the Rural Health Network Development funding opportunity, pushing back the due date for all applications to December 6, 2013. For more information on this funding announcement please visit http://www.grants.gov/view-opportunity.html?oppId=243713

Other Useful Information and Resources
1. CMS is requesting nominations for positions on the Advisory Panel on Hospital Outpatient Payment. Nominations are open until December 31st for the five positions. This panel advises CMS on payment changes for the Hospital Outpatient Prospective Payment System (OPPS). It also recommends levels of supervision for various outpatient therapeutic services. Panel members must have at least 5 years of relevant experience and be employed full time by an organization paid under OPPS. This is an opportunity for rural stakeholders to nominate qualified applicants with expertise on payment issues. Additional information about the panel and instructions for submitting nominations are available at: http://federalregister.gov/a/2013-26258

Novitas Service Impact Updates

As a result of recent system changes at Novitas, customers may experience the following temporary operational difficulties:
(Updated as of 11/26/2013)

Issue	Cause/Resolution	Status/Date Resolved	What Can You Do?
Not All Website Content Is Appropriately Tagged Or Split (Part A or Part B)	We are in the process of correcting website content  left from the disengagement, including: Content is still tagged incorrectly (e.g., a JH only page may still be tagged as JL/JH and would also show in a search for JL content). A/B content is not able to be split in search results.  Customers who select A or B will still see both A and B related search results.	11/26/2013: Content tagged incorrectly is being corrected when identified. A manual process of splitting all content is underway. Current goal to complete this is February, 2014.	No action is necessary.
Search Capability Is Not Functioning As Expected	Novitas is aware a search, after entering text in “Policy Search” or “Search”, cannot be initiated by pressing the “Enter” key. Using the mouse to click on or pressing the “Submit” button is necessary.	11/26/2013: Issue resolved 11/21/2013.  Pressing the “Enter” key can now be used to initiate a search on the internet	No action is necessary.
Website Content Pages Are Not Functioning Properly	We are experiencing various issues when trying to review content on our Website. Content is displaying in a small, scrolling upper portion of the browser window, rather than on the full screen. Browser compatibility between the various versions of Internet Explorer (IE) and a few mobile devices is being investigated. Updates will be made as issues as identified to ensure all customers can effectively use our website.	11/26/2013: Functionality (small scrolling window) issues continue, with the latest versions of Apple Safari, Google Chrome, and Internet Explorer Version 9.  All IT activity available to resolve this issue has been used. Manual format conversion (HTML to Word) of a large volume of documents, needed to complete resolution of this issue, is underway.	Internet Explorer Version 9 users can resolve these issues by updating to Internet Explorer version 10.
The Planned Interactive Fee Schedule Calculator Is Not Available	Novitas is committed to having an Interactive Fee Schedule Calculator available for our customers on the Novitas Website. Note: This information is available to our customers, but it requires redirection to the CMS website.	11/26/2013: Work to build an interactive fee schedule calculator, housed on our website, is underway. Resolution of issues encountered since 9/30/13 is expected by mid-January. Enhancements will follow. A projected completion date for the enhancements is yet to be determined.	No action is necessary.
Appeal is not in  Appeals Status Tool	Appeals received after September 23, 2013 may not be entered in the Appeals Status Tool as expected.  Therefore, this may not be an accurate method to determine if an Appeal request has been received by Novitas.	11/26/2013: Part A & Part B –Resolution complete 11/18/2013. Appeals will show within the status tool in approximately 1 week from the date received.	Please do not resubmit Appeal(s) or call the Customer Contact Center repeatedly as these actions compound problems.
Policy Pages (e.g., LCDs, Articles, and IDEs) Are Not Functioning Properly. The Policy Center on the website is not as robust as the previous version.	We continue to experience problems with printing of some LCDs and articles directly from the website. We are working diligently on resolving this issue.	11/26/2013: The print capability is being added to policies as the need is identified. We continue to prioritize issues and work to enhance the functionality of the policy area.	A Temporary work around, for policies that do not contain a print option (absence of picture of a printer and the word “Print” in the upper right corner of the screen), is as follows: • Pull up desired policy/article • Click within the title • Select Edit • Select All • Select Edit again • Copy • Paste into a word document We encourage providers to submit questions, concerns, and suggestions regarding the policy area of the website so that we can continue to enhance the webpage. Please visit the Medical Policy Center: Contact Information
CERT Claim ID (CID) tool is not functioning.	While coding modifications are being made, the CERT Claim ID tool is not available. Therefore, the tool cannot be used to determine the outcome of a review completed by CERT.	11/26/2013: Development of a solution has been initiated.  A date for resolutions has not yet been established.	Providers can email the CID toQuestcert@novitas-solutions.com .
Validation of Beneficiary Eligibility may not be processing correctly	Novitas is aware of issues with the process for validating beneficiary eligibility that is a result of an October release installed by the Fiscal Intermediary Shared System (FISS) and Common Working File (CWF) which is causing claims to reject erroneously, returning to the provider (RTP), or are unable to be processed. This issue appears to be limited to specific types of claims that are being sent back to the FISS under this new process and being applied to the claims incorrectly under certain circumstances. Novitas, and other contractors, are working with FISS to resolve these issues.	11/26/2013: Part A: Primary impact is being seen on certain Part A claims. Part B: Impact is greatest with Veteran Affairs (VA) and centralized flu claims. A fix for many of the FISS Reason Code related issues has been implemented. We continue to validate resolution of the issue.	No action is necessary.
Enrollment information not in Enrollment Inquiry Status Tool	CMS-855s received after September 23, 2013 may not be entered in the Provider Enrollment Inquiry Status Tool as expected. This may not be an accurate method to determine if a CMS-855 application has been received by Novitas. We are working diligently to correct this issue with a goal that all applications are available for viewing by mid-November.	11/26/2013: Applications received prior to October 28, 2013 are now available in the Status Tool.  Progress continues on those received after October 28, 2013.	Please do not resubmit your application as this compounds the problem. We suggest you check the status tool next week.
Enrollment determination letters are being duplicated	Due to technical issues, some providers/suppliers may have, or will, receive duplicate auto-generated letters from Novitas’ Provider Enrollment department.	11/26/2013: A solution for this problem was installed and duplicate letters are no longer generating. Monitoring continues to ensure resolution.	We appreciate your patience while we worked to resolve this issue.
Delays are occurring with processes (e.g., Medical Review, Claims Processing) requiringsubmission of  documentation	Due to recent system changes, technical difficulties have been encountered by Novitas Solutions’ Mailroom with respect to imaging of submitted documents such as medical records and responses to inquiries.  As a result, providers who have submitted medical records and/or other correspondence, in response to Additional Development Requests (ADR), Automated Development System (ADS) message or other communications such as submission of paperwork (PWK) may not be seeing these documents accurately reflected as such in the claims processing systems.	11/26/2013: No delays are being experienced for documents submitted via fax to image. Delays experienced with documents, submitted via other methods continue to decrease. Please be assured that documentation has not been “lost”.  Novitas Solutions continues to receive and process all incoming correspondence.	Providers should submit documents via fax to image when possible. Please do not resubmit your documents or call the Customer Contact Center repeatedly as these actions compound problems.
Delays: Medical Review	See description above.	Part B 11/26/2013: Front-line processing of ADR/ADS letters and PWKs remains current.  Medical Review will continue to automatically reopen and work any claims that time-out.  You will receive a letter notifying you of post-pay adjudication.	If you receive a non-response denial letter, please wait 10 business days before calling the Customer Contact Center or submitting an appeal. Monitor for receipt of the post-pay adjudication letter during this time-period.
Delays: Claims Processing-Part B	See description above.	11/26/2013: In the event that ADRs time-out (i.e. at day 45) for non-receipt of documentation, relative to the imaging issue, we will work directly with providers to reopen / reprocess claims accordingly.	No action is necessary.
Part B solicited cash refund checks  are not being processed timely	Novitas is experiencing delays in processing of Part B solicited cash.  Because of this delay, the automatic system offset may occur.  As a result: Novitas will still process your check as if we were processing it on the date of receipt.  This means that if interest was automatically assessed in error and not due, it will be returned. If your debt is resolved, we are required to apply your payment to any other outstanding Medicare debt. If no additional monies are owed to Medicare, a check will be returned to you for any balance that remains.	11/26/2013: Additional staff has been trained to assist with solicited cash workload. We continue making progress with increasing our daily processing level for this workload.	There is no further action you need to take.
Long Wait Timesfor Customer Service	Receipt of a high volume of calls in our Customer Contact Center is causing longer than usual wait times. We appreciate your patience.	11/26/2013: The wait time to reach a customer service representative continue to improve. We are taking the necessary steps to further reduce any delay providers may still be experiencing is ongoing.	No action is necessary.

Novitas appreciate your patience as we work through these issues. We will continue to provide updates as appropriate.