2010 Physician Quality Reporting Initiative & Electronic Prescribing Incentive Program
The last day to register is Wednesday, April 14 by 3:30 pm EDT.
The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host a national provider conference call on the 2010 Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (eRx). This toll-free call will take place from 3:30 p.m. – 5:00 p.m., EDT, on Thursday, April 15, 2010.
The PQRI is voluntary quality reporting program that provides an incentive payment to identified individual eligible professionals (EPs), and beginning with the 2010 PQRI, group practices who satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-For-Service (FFS) beneficiaries.
The PQRI was first implemented in 2007 as a result of section 101 of the Tax Relief and Health Care Act of 2006 (TRHCA), and further expanded as a result of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), and the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).
The eRx Incentive Program is an incentive program for eligible professionals initially implemented in 2009 as a result of section 132(b) of the MIPPA. The eRx Incentive Program promotes the adoption and use of eRx systems by individual eligible professionals (and beginning with the 2010 eRx Incentive Program, group practices).
Following a few program announcements and updates, the lines will be opened to allow participants to ask questions of CMS PQRI and eRx subject matter experts.
Educational products are available on the PQRI dedicated web page located at, http://www.cms.hhs.gov/PQRI , on the CMS website, in the Educational Resources section, as well as educational products are available on the eRx dedicated web page located at http://www.cms.hhs.gov/ERxIncentive on the CMS website. Feel free to download the resources prior to the call so that you may ask questions of the CMS presenters.
Conference call details:
Date: April 15, 2010
Conference Title: Physician Quality Reporting Initiative (PQRI) - National Provider Call
Time: 3:30 p.m. EDT
In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation. Registration will close at 3:30 p.m. EDT on April 14, 2010, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
1. To register for the call participants need to go to:
http://www.eventsvc.com/palmettogba/041510
2. Fill in all required data.
3. Verify that your time zone is displayed correctly in the drop down box.
4. Click "Register".
5. You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.
For those of who will be unable to attend, a transcript of the call will be available at least one week after the call at http://www.cms.hhs.gov/pqri on the CMS website.
If you require services for the hearing impaired please send an email to: Medicare.TTT@PalmettoGBA.com.
Regards,
Raúl Alicea-Morales, MBA/HCM, CHA - Health Insurance Specialist - Centers for Medicare and Medicaid Services - P:787-771-3660 - F:212-266-0536
A new informational website about the flu, both seasonal and H1N1, visit www.flu.gov / www.stopmedicarefraud.com
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Hospital Open Door Forums Update
Please, pass this on to your Hospital’s colleagues. Thanks.
Regards,
Raúl Alicea-Morales, MBA/HCM, CHA - Health Insurance Specialist - Centers for Medicare and Medicaid Services - P:787-771-3660 - F:212-266-0536. A new informational website about the flu, both seasonal and H1N1, visit www.flu.gov / www.stopmedicarefraud.com
From: Centers for Medicare & Medicaid Services [mailto:cmslists@subscriptions.cms.hhs.gov]
Sent: Friday, April 09, 2010 7:44 PM
To: Alicea, Raul (CMS/CMHPO)
Subject: Hospital Open Door Forums Update
Note: Click the hyperlink to view the full story.
You are subscribed to Cms.hhs.gov- Hospital Open Door Forums for Centers for Medicare & Medicaid Services (CMS). This information has recently been updated, and is now available.
Dr. Richard Shinto se expresa sobre la Reforma Federal del presidente Obama
----- Mensaje reenviado ----
De: MSO News <MSONews@msopr.com>
Para: AMASADEEL@YAHOO.COM
Enviado: lun, marzo 29, 2010 3:41:13 PM
Asunto: Dr. Richard Shinto se expresa sobre la Reforma Federal del presidente Obama
De: MSO News <MSONews@msopr.com>
Para: AMASADEEL@YAHOO.COM
Enviado: lun, marzo 29, 2010 3:41:13 PM
Asunto: Dr. Richard Shinto se expresa sobre la Reforma Federal del presidente Obama
26 de marzo de 2010
Estimados proveedores y amigos:
Siempre me complace comunicarme con ustedes para estos temas de amplia discusión pública. Hoy llamo su atención a la propuesta legislativa del Proyecto Federal de Reforma de Salud del Presidente Obama, que se firmó el pasado martes, 23 de marzo.
Dicha acción histórica ha provocado innumerables debates públicos en torno al futuro de los planes Medicare Advantage, no sólo en Estados Unidos, sino en Puerto Rico.
Todos hemos sido testigos de la gran cobertura que la prensa y comentaristas le han brindado a tan importante tema. Sin duda, esta noticia ha generado y generará dudas entre algunos de ustedes y entre nuestros afiliados, en cuanto a ajustes en Medicare y Medicare Advantage se refiere.
Por eso consideramos importante aclarar varios puntos importantes en este momento:
· No se eliminarán los planes Medicare Advantage
· El impacto de la Reforma en Puerto Rico no será igual al que tendrá en los Estados Unidos
o La misma propuesta concede al Secretario de Salud del Gobierno Federal la flexibilidad de evaluar las necesidades particulares de la población de edad avanzada en Puerto Rico
· Se anticipan más fondos para servicios a beneficiarios de Medicaid en la Isla, y eso es beneficioso
· Los planes Medicare Advantage tenemos la encomienda de ofrecer servicios de calidad; asegurando que los fondos que se nos asignen se utilicen correctamente, y eso es algo que hemos mantenido en práctica desde que existimos como corporación Medicare Advantage
· La mayoría de las iniciativas de cuidado de salud serán implementadas después del 2012, lo cual nos permite continuar preparándonos adecuadamente en pro de ustedes, de nuestros afiliados y nuestros empleados
Me interesa resaltar que nuestra responsabilidad es mantenerles informados sobre este proyecto. Nuestro mensaje a ustedes y a nuestros afiliados es que deben permanecer tranquilos, ya que sus servicios y beneficios no se afectarán.
Recuerden que nuestra filosofía es hacer lo correcto y seguiremos brindándoles lo mejor de nuestras capacidades. Somos líderes y pioneros en este mercado y nos vamos a mantener como tales: sólidos y en crecimiento. Mantendremos nuestro enfoque en la salud y bienestar de los afiliados. Seguiremos dándoles lo mejor de nuestras capacidades. Y por último, no se dejen confundir por comentarios en la calle, o de personas mal informadas. Todos los ajustes que hemos venido haciendo tienen como fin el beneficio de cada afiliado, proveedor y empleado.
En MMM Healthcare, Inc. (MMM) y PMC Medicare Choice, Inc. (PMC) seguimos contando con el compromiso y la excelencia de todos ustedes que forman parte de nuestra familia en pos del bienestar de nuestros afiliados, que son sus pacientes.
Sigamos adelante. Quedo a sus órdenes personalmente o a través de nuestros gerentes para contestar cualquier pregunta.
Gracias por su atención y apoyo,
Richard Shinto, MD
Presidente y Principal Oficial Ejecutivo de Aveta Inc.
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Códigos CPT/HCPCS para evitar rechazos/denegaciones debido a conflicto de género/procedimiento
Last Modified: 3/18/2010 Location: FL, PR, USVI Business: Part A, Part B
Códigos CPT/HCPCS para evitar rechazos/denegaciones debido a conflicto de género/procedimiento
Como resultado de los problemas de transgénero y hermafrodita que las reclamaciones de Medicare Parte A y Parte B han encontrado, ha habido un incremento en las reclamaciones siendo rechazadas/denegadas debido a modificaciones específicas de género, diagnóstico y procedimiento. Efectivo para las fechas de servicio del 1 de abril de 2010 en adelante, la petición de cambio (CR) 6638 instruye lo siguiente: Reclamaciones de Parte A: Los proveedores institucionales deben reportar el código de condición 45 (categoría de género ambiguo) en servicios del cuidado ambulatorio y de hospitalización que pueden estar sujetos a modificación específica de género (i.e., servicios que son considerados para mujer u hombre solamente) para los beneficiarios que son transgénero, hermafroditas, o tienen genitales ambiguos. Reclamaciones de Parte B: Los médicos y profesionales de la salud que facturan reclamaciones profesionales de Parte B deben facturar los modificadores KX (los requisitos especificados en la póliza médica han sido cumplidos) en la línea de detalle con cualquier código(s) de procedimiento que son específicos de género para los beneficiarios que son transgénero, hermafroditas, o tienen genitales ambiguos.
Códigos CPT/HCPCS específicos de género
Para asistir a los proveedores en disminuir el número de rechazos/denegaciones, First Coast Service Options ha identificado los códigos CPT/HCPCS específicos de género que los sistemas de procesamiento de Medicare denegarán/rechazarán para los servicios procesados el 5 de abril de 2010 en adelante. Los códigos de error comunes de archivo de trabajo también son identificados:
Mamografía (códigos de error 59x5 y 5361)
76083
76085
76092
77052
77057
G0202
G0203
Prueba de Papanicolaou (códigos de error 84x1 y 536a)
G0123
G0124
G0141
G0143
G0144
G0145
G0147
G0148
P3000
P3001
Q0091
Q0060
Q0061
Examen pélvico/pecho (código de error 84x4)
G0101
Examen de próstata (códigos de error 84x6 y 5388)
55873
G0102
G0103
G0160
G0161
First Coast Service Options regresa a Puerto Rico para otra serie de eventos educativos. Nuestro equipo de educación estará en San Juan, Arecibo y Fajardo del 7 al 13 de abril.
(Si no puede leer este documento, puede solicitar una copia en tamaño regular llamando al 787-251-7723 (para enviarla por fax) ó a: afameppr@yahoo.com para enviarla por correo electrónico)
Medicare Claims Crossover to Supplemental Payer Problem
Please, distribute among your colleagues. Thanks.
Raúl Alicea-Morales, MBA/HCM, CHA - Health Insurance Specialist - Puerto Rico Field Office - P:787-771-3660 - F:212-266-0536 - C:787-300-0389
A new informational website about the flu, both seasonal and H1N1, visit www.flu.gov
From: 18 existing FFS provider listservs [mailto:ALL_FFS_PROVIDERS@LIST.NIH.GOV] On Behalf Of CMS CMSProviderResource
Sent: Tuesday, February 16, 2010 6:23 PM
To: ALL_FFS_PROVIDERS@LIST.NIH.GOV
Subject: Medicare Claims Crossover to Supplemental Payer Problem
Medicare Claims Crossover to Supplemental Payer Problem
Action Required by Some Health Care Providers to Receive Supplemental Payment
The Centers for Medicare & Medicaid Services (CMS) has identified a problem where claims were not automatically crossing over to supplemental payers even though the provider remittance advice indicated otherwise. This problem began January 5, 2010. Part A institutional claims and Part B professional claims, with the exception of supplier claims processed by Durable Medical Equipment Medicare Administrative Contractors (DME MACs), were impacted by this problem. Claims processed by DME MACs were not impacted.
Part A Institutional Claims
No action is required by Part A institutional providers. As of February 2, 2010, CMS successfully implemented a systems fix to ensure that all Part A institutional claims are now crossing over to supplemental payers as indicated on the remittance advice received by providers. As part of the fix, CMS’ Medicare contractors were able to identify claims processed between January 5 and February 1, 2010, where the provider remittance advice indicated that the affected claims were crossed over to various supplemental payers but were not. On February 2, 2010, the affected Medicare contractors began to send the affected claims to the Coordination of Benefits Contractor (COBC) to be crossed over to supplemental payers. This effort is now largely completed. Please allow until March 1, 2010, for supplemental payers to receive and process these claims before attempting to balance bill them for any remaining balances after Medicare.
Part B Professional Claims
Action is required on behalf of Part B professional providers where a remittance advice with an issue date between January 5, 2010, and February 12, 2010, has two or more service lines for a beneficiary where both of the following apply:
· One service line is 100 percent reimbursable (i.e., the approved amount and amount to be paid are equal,) AND
· One service line where part of or the entire Medicare approved amount is applied to the Part B deductible and/or carries co-insurance amounts.
CMS is not able to forward these beneficiary claims to supplemental payers even though the remittance advice may indicate otherwise. Providers will need to identify these claims by reviewing their remittance advice with an issue date between January 5, 2010, and February 12, 2010, that contain the criteria noted above. Once identified, providers will need to take action to balance bill the beneficiary’s supplemental payer. As of February 12, 2010, this system problem was fixed and all claims are crossing over to supplemental payers as indicated on the provider remittance advice.
The CMS has already notified supplemental payers of these issues. We regret any inconvenience you may experience related to this Medicare claim supplemental payer crossover problem.
Special Open Door Forum: Medicare Provider & Supplier Enrollment
Por Favor, aprovechen esta gran oportunidad, no la dejen pasar, en especial aquellos proveedores que han tenido problemas en accesar PECOS para certificarse. Separen la fecha del 17 de febrero de 2:00 p.m. a 3:30 p.m. para esta importante conferencia telefónica. El número a marcar es: 1-800-837-1935 al contestarles favor introducir el código: 52537484 y seguido el símbolo de libra #.
Raúl Alicea-Morales, MBA/HCM, CHA - Health Insurance Specialist - Puerto Rico Field Office - P:787-771-3660 - F:212-266-0536 - C:787-300-0389
A new informational website about the flu, both seasonal and H1N1, visit www.flu.gov
Centers for Medicare & Medicaid Services
Special Open Door Forum:
Medicare Provider & Supplier Enrollment
February 17, 2010
2:00 PM – 3:30 PM ET
Conference Call Only
The Centers for Medicare & Medicaid Services (CMS) will hold a Special Open Door Forum (ODF) to discuss Medicare provider enrollment issues. During this call, CMS staff will discuss:
• Internet-based Provider Enrollment, Chain and Ownership System (PECOS) for physicians, non-physician practitioners and provider and supplier organizations
• Provider and supplier reporting responsibilities
• Medicare ordering and referring Issues
• Revalidation efforts
Afterwards, there will be an opportunity for the public to ask questions.
We look forward to your participation.
Open Door Forum Instructions:
**Capacity is limited so dial in early. You may begin dialing into this forum as early as 1:45 PM ET.**
Dial: 1-800-837-1935
Reference Conference ID 52537484
Note: TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880 and for Internet Relay services click here http://www.consumer.att.com/relay/which/index.html. A Relay Communications Assistant will help.
An audio recording of this Special Forum will be posted to the Special ODF website at http://www.cms.hhs.gov/OpenDoorForums/05_ODF_SpecialODF.asp and will be accessible for downloading on or around Monday March 1, 2010 and available for 30 days.
For automatic emails of Open Door Forum schedule updates (E-Mailing list subscriptions) and to view Frequently Asked Questions please visit our website at: http://www.cms.hhs.gov/OpenDoorForums/.
Thank you.