Although not a step-by-step guide, it does provide information on the following:

§  Helpful tips to avoid the most common application errors

§  Separate sections for both PECOS and paper submission of applications

§  Valuable contact information

§  Information regarding timeliness / turnaround time for processing applications

§  Information on where to mail the application

§  A reminder of what documents may need to be included

§  Answers to the most frequent asked questions

This CBT takes approximately 15 minutes to complete and while not answering every question, it covers a large percentage of the most common errors we see with submitted applications.

Thank you!

Please be aware of changes to the preferred and non-preferred status of some drugs on the preferred drug list, effective July 28, 2010.

Please visit: https://newyork.fhsc.com/

The preferred drug list can be found at:

https://newyork.fhsc.com/downloads/providers/NYRx_PDP_PDL.pdf

A ‘quicklist’ of preferred drugs only can be found at:

https://newyork.fhsc.com/downloads/providers/NYRx_PDP_PDLquicklist.pdf

All changes to the NYS Medicaid Preferred Drug List will be communicated to providers via the monthly Medicaid Update publications.  Notifications will no longer be mailed to providers.

We appreciate your support of the New York State Medicaid Program.

CMS denied NACDS’ request to reinstate the Jan. 3 deadline. However, the agency said that it will “for the time being, not implement changes that would automatically reject claims based on orders, certifications, and referrals made by providers” whose application have not been approved by July 6.

About 800,000 providers successfully have enrolled through PECOS, but “some providers have encountered problems,” CMS said, adding that it will continue to remind providers to enroll and help them with the procedure, as well as “process all applications expeditiously.”

The Centers for Medicare & Medicaid Services (CMS) is working with providers to address concerns about enrollment in the Provider Enrollment, Chain and Ownership System (PECOS) to ensure that Medicare beneficiaries continue to receive the health care services and items they need.  PECOS is the electronic system used to enroll physicians and eligible professionals into the Medicare program.

As part of those efforts, CMS will, for the time being, not implement changes that would automatically reject claims based on orders, certifications, and referrals made by providers that have not yet had their applications approved by July 6, 2010.   While more than 800,000 physicians and other health professionals have enrolled and have approved applications in the PECOS system, some providers have encountered problems.  CMS is continuing to update and streamline the process, and more providers have been enrolled in the past few days.

CMS issued an interim final regulation on May 5, 2010 implementing provisions of the Affordable Care Act that permit only a Medicare enrolled physician or eligible professional to certify or order  home health services, durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) , and certain items and services under Medicare Part B.  The new law applies to orders, referrals and certifications made on or after July 1.  The comment period for the regulation closes on July 6, after which the comments will be reviewed and considered before a final regulation is issued.

The Affordable Care Act provisions and the regulation were designed as steps to prevent fraud in Medicare by ensuring that only eligible and identifiable providers and suppliers can order and refer covered items and services to Medicare beneficiaries.

Many physicians and other providers and suppliers have continued to make good faith efforts to comply with the requirements of the law and regulation.  These efforts will be a significant factor in determining the procedures and processes that will be incorporated in the final rule.

While the regulation will be effective July 6, 2010, CMS will not implement automatic rejections of claims submitted by providers that have attempted to enroll in PECOS.  However, until the automatic rejections are operational, providers should not see any change in the processing of submitted claims, they will continue to be reviewed and paid as they have historically been reviewed and paid.

Additionally, though CMS is taking a more deliberative approach to using the PECOS enrollment system, the agency will employ a contingency plan to meet the ACA requirement that written orders and certifications are only issued by eligible professionals effective July 1.

CMS will continue to send informational notices to providers reminding them of the need to submit or update their enrollment and will work with the provider community to provide guidance on enrollment and will process all applications expeditiously.

Due to system issues, Part B providers and trading partners in Connecticut and New York are currently unable to access the MCS system.

Both electronic and paper remittance advice and Claims Status Response 277 files from the Wednesday, June 30 cycle will be delayed until late tonight, Thursday, July 1 or very early tomorrow, Friday, July 2.

Additionally, a Part B cycle will not run on Thursday, July, 1, 2010. Claims for July 1 will be processed on July 2, along with the claims for July 2. Payments will be subject to all CMS payment floor and claim timeliness guidelines. We expect remittances and 277 Claim Status Inquiry Response transactions to be available on Tuesday, July 6.

Thank you for your patience as we work to resolve these issues.

June 28, 2010

In consideration of the recent enactment of the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, which established a 2.2 percent update to the Medicare Physician Fee Schedule (MPFS), the Centers for Medicare & Medicare Services (CMS) is offering physicians and other practitioners, whose current participation status is non-participating, the opportunity to become participating (PAR).  This opportunity is being offered only to those physicians/practitioners whose current PAR status is non-participating.  This opportunity is available through July 16, 2010.

Non-participating physicians/practitioners who would like to become a participating physician/practitioner should download and complete the Medicare Participating Physician or Supplier Agreement (Form CMS-460).  The form can be obtained by using the following CMS web site link:

http://www.cms.gov/cmsforms/downloads/cms460.pdf

Any new CMS-460 form received during this limited enrollment period will be retroactive for claims with dates of service of January 1, 2010, and later.  However, the change in participation status will only apply to new MPFS claims submitted after your new status as a participating physician/practitioner is processed.  Claims previously submitted and processed will not be adjusted for only a change in participation status.

Medicare claims administration contractors (Medicare Administrative Contractors and carriers) will accept and process requests to become a participating physician/practitioner that are submitted on the CMS-460 form and are post-marked on or before July 16, 2010.

Diane Maupai  for

Robin Fritter, Director

Division of Provider Relations& Outreach

Provider Communications Group, CMS

(410) 786-7485

robin.fritter@cms.hhs.gov

PROPOSALS WOULD IMPLEMENT AFFORDABLE CARE ACT BENEFITS

The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule that would implement key provisions in the Affordable Care Act of 2010 that expand preventive services for Medicare beneficiaries, improve payments for primary care services, and promote access to health care services in rural areas.  The proposed policies would apply to payments under the Medicare Physician Fee Schedule for services furnished on or after January 1, 2011.

The proposed rule would implement provisions in the Affordable Care Act that will eliminate out-of-pocket costs for beneficiaries for most preventive services, including the new annual wellness visit.  This visit augments the benefits of the Initial Preventive Physical Examination (IPPE or “Welcome to Medicare Visit”) with an annual wellness visit that allows the physician and patient to develop a personalized prevention plan that includes not only the preventive services generally available to the Medicare population, but additional services that may be appropriate because of the patient’s individual risk factors.

The proposed rule would improve access to primary care services by implementing an incentive payment for primary care services furnished by primary care practitioners that can include physicians, nurse practitioners, clinical nurse specialists and physician assistants.  The proposed rule would also implement a payment incentive program for general surgeons performing major surgery in areas designated by the Secretary as Health Professional Shortage Areas (HPSAs), would allow physician assistants to order post-hospital extended care services in skilled nursing facilities, and would pay certified nurse midwives for their services under the Medicare Physician Fee Schedule (MPFS) at the same rates as physicians.

To read the entire CMS Press Release issued today (6/25) click here: http://www.cms.gov/apps/media/press_releases.asp

CMS Issued Fact Sheets (6/25) with additional details at: http://www.cms.gov/apps/media/fact_sheets.asp

The proposed rule is available at:  http://www.federalregister.gov/OFRUpload/OFRData/2010-15900_PI.pdf

Or  http://www.federalregister.gov/inspection.aspx#special

CMS will accept comments on the proposed rule until August 24, 2010, and will respond to them in a final rule to be issued on or about November 1, 2010.  Except as otherwise  specified, the payment policies and rates adopted in the final rule will be effective for services on or after January 1, 2011.

On June 25, 2010, President Obama signed into law the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010.”  This law establishes a 2.2 percent update to the Medicare Physician Fee Schedule (MPFS) payment rates retroactive from June 1 through November 30, 2010.  The Centers for Medicare & Medicaid Services (CMS) has directed Medicare claims administration contractors to discontinue processing claims at the negative update rates and to temporarily hold all claims for services rendered June 1, 2010, and later, until the new 2.2 percent update rates are tested and loaded into the Medicare contractors’ claims processing systems.  Effective testing of the new 2.2 percent update will ensure that claims are correctly paid at the new rates.  We expect to begin processing claims at the new rates no later than July 1, 2010.  Claims for services rendered prior to June 1, 2010, will continue to be processed and paid as usual.

Claims containing June 2010 dates of service which have been paid at the negative update rates will be reprocessed as soon as possible.  Under current law, Medicare payments to physicians and other providers paid under the MPFS are based upon the lesser of the submitted charge on the claim or the MPFS amount.  Claims containing June dates of service that were submitted with charges greater than or equal to the new 2.2 percent update rates will be automatically reprocessed.  Affected physicians/providers who submitted claims containing June dates of service with charges less than the 2.2 percent update amount will need to contact their local Medicare contractor to request an adjustment.  Submitted charges on claims cannot be altered without a request from the physician/provider.  Physicians/providers should not resubmit claims already submitted to their Medicare contractor.

Valerie A. Haugen, Director
Division of Provider Information Planning & Development
Provider Communications Group, CMS

Please be aware of changes to the preferred and non-preferred status of some drugs on the preferred drug list, effective June 17, 2010.

In addition to these changes, the New York State Medicaid Clinical Drug Review Program (CDRP) is expanding to require prior authorization for the following:

• Growth Hormones (Genotropin®, Nutropin®, Nutropin AQ®, Saizen®, Humatrope®, Norditropin®, Omnitrope®, Tev-Tropin®, and Zorbtive®) for enrollees 21 years of age or older effective June 17, 2010.

Please visit https://newyork.fhsc.com/

The preferred drug list can be found at:

https://newyork.fhsc.com/downloads/providers/NYRx_PDP_PDL.pdf

A ‘quicklist’ of preferred drugs only can be found at:

https://newyork.fhsc.com/downloads/providers/NYRx_PDP_PDLquicklist.pdf

Prior Authorization Forms and Worksheets can be found at:

https://newyork.fhsc.com/providers/PA_forms.asp

EFFECTIVE IMMEDIATELY all changes to the NYS Medicaid Preferred Drug List will be communicated to providers via the monthly Medicaid Update publications.  Notifications will no longer be mailed to providers.