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Other Medicare Updates
Medicare’s Practical Guide to the E-Prescribing Incentive Program” is now available online
The guide explains the e-prescribing incentive program, how eligible professionals can participate, and how to choose a qualified e-prescribing system. To read or print the guide, visit: http://www.cms.hhs.gov/partnerships/downloads/11399.pdf.
By adopting e-prescribing through Medicare’s program, eligible professionals can save time, enhance office and pharmacy productivity, and improve patient safety and quality of care while earning incentives from Medicare.
For additional information about e-prescribing, you can also visit:
* www.cms.hhs.gov/PQRI. Select “E-prescribing Incentive Program”;
* www.cms.hhs.gov/eprescribing. (for information on Part D e-prescribing standards that will be effective April 1, 2009); and
* www.ehealthinitiative.org to download “A Clinician’s Guide to Electronic Prescribing.”
New From the Medicare Learning Network
The Adult Immunizations (October 2008) brochure for health care providers has been updated and is now available in downloadable PDF format from the Centers for Medicare & Medicaid Services Medicare Learning Network. This brochure provides an overview of Medicare’s coverage of influenza, pneumococcal, and hepatitis B vaccines and their administration. To view, download, and print, please go to http://www.cms.hhs.gov/MLNProducts/downloads/Adult_Immunization.pdf on the CMS website.
New Institutional NCCI Edits to Be Applied to Claims
NCCI edits are updated quarterly and the institutional version is one calendar quarter behind the physician version. In the past, the Outpatient Code Editor (OCE) has not applied the NCCI edits for the following categories of services: anesthesiology, evaluation and management, and mental health services. Effective 1/1/09, these categorical exclusions will be removed and there will be a large number of new institutional NCCI edits applied to claims. These institutional NCCI edits will be available on or about 1/1/09 on the following CMS Website: http://www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEHOPPS/list.asp#TopOfPage .
To review the types of NCCI edits that were previously excluded from the institutional version but are currently included in the physician version for these categories, refer to the NCCI files on the following site: http://www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/list.asp#TopOfPage . One may use anesthesiology, evaluation and management, or mental health services CPT or Level II HCPCS codes to search these files. A subset of the corresponding edits in the physician version is being added to the institutional version. Consistent with longstanding practice, CMS makes specific decisions about NCCI edits that are appropriate for facilities, incorporating comments on potential edits from relevant professional associations and, therefore, the institutional NCCI edits may differ from the physician NCCI edits.
Affected providers should begin immediately to educate their staff about the application of the additional categories of NCCI edits to their claims. Note that at this time no additional providers will be subject to NCCI edits.
Medicare Proposes Revised Coverage Policy for Bariatric Surgery as a Diabetes Treatment
CMS Seeks Comments from Public on Proposal to Limit Coverage to Morbidly Obese Patients
The Centers for Medicare & Medicaid Services (CMS) announced on November 7, 2008, its proposal to clarify its policies for Medicare coverage of bariatric surgery as a treatment for beneficiaries with type 2 (or non-insulin-dependent) diabetes.
Following an extensive evidence review, CMS proposes to revise its existing coverage policy for bariatric surgery. The proposed decision notes that type 2 diabetes is one of the co-morbidities CMS would consider in determining whether bariatric surgery would be covered for a Medicare beneficiary who is morbidly obese. An individual with a body-mass index (BMI) of at least 35 is considered morbidly obese.
To read the CMS Press release issued on (11/07/08) click here: http://www.cms.hhs.gov/apps/media/press_releases.asp
Today’s proposed decision memorandum is available on CMS’ Coverage Web site at http://www.cms.hhs.gov/center/coverage.asp.
CMS Issues Improper payment Rates for Medicare, Medicaid and SCHIP
CMS recently reported it protected roughly $400 million of taxpayer dollars as improper payments for Medicare fee-for-service (FFS) decreased from 3.9 percent in Fiscal Year (FY) 2007 to 3.6 percent, or $10.4 billion, in FY 2008. The Medicare, Medicaid and SCHIP improper payment rates are issued annually as part of the HHS Agency Financial Report.
In addition to improved Medicare FFS payments for FY 2008, CMS reports its first Medicare Advantage improper payment rate of 10.6 percent, or $6.8 billion, in payments made in Calendar Year (CY) 2006. Also being reported for the first time are the FY 2007 national composite error rates for Medicaid and for SCHIP. The Medicaid composite error rate is 10.5 percent, or $32.7 billion of which the federal share is $18.6 billion, and, for SCHIP, the rate is 14.7 percent, or $1.2 billion, with a federal share of $0.8 billion.
To read the complete CMS Press release issued on (11/07/08) click here: http://www.cms.hhs.gov/apps/media/press_releases.asp
November Flu Shot Reminder
Flu season is here! Medicare patients give many reasons for not getting their annual flu shot, including—“It causes the flu"; "I don’t need it"; "It has side effects"; "It’s not effective"; "I didn’t think about it"; "I don’t like needles!” The fact is that every year in the United States, on average, about 36,000 people die from influenza. Greater than 90 percent of these deaths occur in individuals 65 years of age and older. You can help your Medicare patients overcome these odds and their personal barriers through patient education. Talk with your Medicare patients about the importance of getting an annual flu shot--and don’t forget to immunize yourself and your staff. Protect yourself, your patients, and your family and friends. Get Your Flu Shot – Not the Flu. Remember - Influenza vaccine plus its administration are covered Part B benefits. Note that influenza vaccine is NOT a Part D covered drug.
For information about Medicare’s coverage of the influenza virus vaccine and its administration as well as related educational resources for health care professionals and their staff, please go to http://www.cms.hhs.gov/MLNProducts/Downloads/flu_products.pdf on the CMS website. To download the Medicare Part B Immunization Billing quick reference chart, go to http://www.cms.hhs.gov/MLNProducts/downloads/qr_immun_bill.pdf on the CMS website. A copy of this quick reference chart can be ordered, free of charge, by going to the MLN Products web page and clicking on “MLN Product Ordering Page” in the Related Links Inside CMS section of the web page.
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Advancing Excellence is a new coalition based, two-year campaign that launched in September 2006. The campaign is reinvigorating efforts to improve the quality of care and quality of life for those living or recuperating in America's nursing homes. 
My InnerView’s Quality ProfileTM tool assists leaders in monitoring pressure ulcers and physical restraints within their nursing homes as well as sets organizational targets for clinical quality improvement. Our Satisfaction Surveys allow facilities to measure resident, family and staff satisfaction.
Kansas Culture Change Coalition is a group that provides support to long-term care organizations striving to develop systems that value the dignity of each individual who lives and works within their setting. It is an organization of diverse interest groups that combine their talents to effect change that is hard to do as individuals. The Kansas Culture Change Coalition maintains the vision of the Pioneer Network that supports a culture of aging that is life affirming, satisfying, humane, and meaningful. Culture Change can transform a "facility" into a "home, a "patient/resident" into a "person", and a "schedule" into a "choice". 
KFMC’s work with KS nursing homes assists nursing home staff with improving care processes on the clinical quality measures. Nursing homes who have committed to working with KFMC over the past five years have made significant progress in reducing quality measure rates. 
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