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Join us for the May 7, 2013

CMS Stakeholder & Partner Education Series Webinar 

Hosted by the Partner Relations Group, Office of Communication

The CMS Stakeholder & Partner Education Series monthly webinar will be held on Tuesday, May 7, 2013 from 2:30 – 3:30 pm ET.


 
 
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Mastering the Fundamentals: Second in a Series   CAQH CORE and ASC X12 Joint Education Session   

An In-depth Look at Electronic Funds Transfer (EFT) and  Electronic Remittance Advice (ERA) Operating Rules   Wednesday, May 1, 2013 2:00 - 3:00 PM ET 

Register Now

There is no fee to attend.


 
 
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Notice to Industry April 19, 2013 

On August 10, 2012, the Department of Health and Human Services (HHS) published in the Federal Register an interim final rule with comment period (IFC) adopting operating rules for the health care electronic funds transfers (EFT) and remittance advice transactions (herein referred to as the EFT & ERA Operating Rule Set IFC) under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). These operating rules are authored by the Council for Affordable Quality Health Care Committee on Operating Rules for Information Exchange (CORE). The IFC is in effect now, and industry must comply with the policies adopted in that rule by January 1, 2014. (For free copies of the EFT & ERA Operating Rule Set, visit the CAQH website.

We understand from industry that there is some confusion about covered entities’ obligations under the IFC in light of CORE’s ongoing maintenance of CORE-defined Claim Adjustment Reason Code (CARC)/Remittance Advice Remark Code (RARC)/Claim Adjustment Group Code (CAGC) and NCPDP Reject Code combinations.


 
 
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CMS NEWS

FOR IMMEDIATE RELEASE                        Contact: CMS Media Relations Group

April 9, 2013                                                                              (202) 690-6145

CONTRACT SUPPLIERS SELECTED UNDER MEDICARE COMPETITIVE BIDDING PROGRAM 
13,126 CONTRACTS AWARDED TO SUPPLIERS OF MEDICAL EQUIPMENT AND SUPPLIES SELECTED THROUGH COMPETITIVE BIDDING IN 91 AREAS

The Centers for Medicare & Medicaid Services (CMS) today announced that 799* suppliers have been awarded contracts as part of Round 2 of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program to provide certain medical equipment and supplies (such as scooters, wheelchairs and oxygen) to beneficiaries in 91 communities across the country. Additionally, CMS announced 18 suppliers that accepted contracts to provide mail-order diabetic testing supplies at competitively bid prices nationwide.  The competitive bidding program, which has already resulted in $202 million in savings in its first year of implementation in nine areas, is expected to save the Medicare Part B Trust Fund an estimated $25.7 billion between 2013 and 2022. Beneficiaries are expected to save an estimated $17.1 billion as a result of lower coinsurance and premium payments.


 
 
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HIPAA Administrative Simplification Frequently Asked QuestionsThe Centers for Medicare & Medicaid Services (CMS) is pleased to announce that additions to the Frequently Asked Questions (FAQS) on HIPAA Administrative Simplification are now available on the CMS website.

The purpose of the FAQs is to provide detailed answers to common questions regarding Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification such as what is meant by “certification of compliance” with HIPAA operating rules and standards; and do the HIPAA transaction requirements, including the operating rules, apply to transactions between a health plan and its policyholders.

These and many other FAQs may be found on the Frequently Asked Questions webpage on the CMS website.

 
 
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FOR IMMEDIATE RELEASE                                                                                      Contact: CMS Media Affairs

April 1, 2013                                                                                                                                       202-690-6145 

CMS Ensures Greater Value For People In Medicare Drug And Health Plans

Rate Announcement Details Plan Payments & Other Program Updates for 2014

Today, the Centers for Medicare & Medicaid Services (CMS) issued the 2014 rate announcement and final call letter for Medicare Advantage (MA) and prescription drug benefit (Part D) programs. The announcements set a stable path for Medicare Advantage and implement a number of policies designed to improve payment accuracy. Health care spending has been slowing across the nation, with Medicare spending per beneficiary growing at only 0.4 percent per capita in 2012. For the first time since inception of the Part D program, the deductible for the defined standard plan will be lower in 2014 than in previous years. Today’s guidance will give people in Medicare health and drug plans more value in the care they receive and greater protections against increasing costs.


 
 
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As you continue your outreach and education planning on the Health Insurance Marketplace, we want to highlight some recent updates we’ve made to help keep you informed.  These include an engaging new online destination for resources –Marketplace.cms.gov.  Here are just some of the new things you’ll find on this site:

  • Information about upcoming Stakeholder Consultation opportunities is now posted, with ongoing discussions focusing on what’s happening in individual states or regions.
  • Brand Guidelines that provide standards related to the Health Insurance Marketplace identity mark (logo) and how to make a request to use the logo on your own materials.
  • An overview Training Presentation  that will help you understand and explain:
    • The Marketplace and who is eligible
    • The enrollment process
    • Options for those with limited income
  • Stay tuned for a Spanish version and a video presentation of this overview, coming soon.

 
 
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Data tool helps identify opportunities to improve care for beneficiaries with multiple chronic conditions 

A new Medicare Chronic Conditions Dashboard announced today by Marilyn Tavenner, Acting Administrator of the Centers for Medicare & Medicaid Services (CMS), furthers the Affordable Care Act’s goals for health promotion and the prevention and management of multiple chronic conditions. The dashboard offers researchers, physicians, public health professionals, and policymakers an easy-to-use tool to get current data on where multiple chronic conditions occur, which services they require, and how much Medicare spends helping beneficiaries with multiple chronic conditions.

“More than two-thirds of Medicare beneficiaries have multiple chronic diseases such as heart disease and diabetes, and that number will rise with an aging population,” said Acting Administrator Tavenner. “The Affordable Care Act addresses these health problems by making people with Medicare eligible for recommended preventive care without Part B deductibles or copayments. The health care law also promotes better health care coordination and management of chronic conditions through analysis of current data.”

The dashboard is part of the Department of Health and Human Services’ (HHS) Initiative on Multiple Chronic Conditions, established in 2009. The Multiple Chronic Conditions: A Strategic Framework was developed to serve as a national roadmap for HHS as well as public and private stakeholders to use to coordinate and improve the health of beneficiaries with multiple chronic conditions.
 
“The Dashboard is a major step forward to help people living with multiple chronic conditions,” said Assistant Secretary for Health Howard K. Koh, MD, MPH. “This web-based tool provides new and critical data that can help us develop better patient-centered approaches to improve health outcomes, lower costs, and maximize quality of life.
 
In calendar year 2011, spending for Medicare beneficiaries with two or more chronic conditions was about $276 billion, about 93 percent of all Medicare spending. Analytics based on Dashboard data can be an important tool to support policies to help slow the growth in costs for beneficiaries with multiple chronic conditions in years ahead.

The Dashboard helps users find, analyze, and apply summarized data from CMS’ Chronic Conditions Data Warehouse. The Dashboard will promote better understanding of overlapping medical conditions related to overall patient health, helping to identify common concurrent conditions and areas where prevention and treatment can improve care and lower costs.

CMS’s Medicare Chronic Conditions Dashboard may be accessed at http://www.ccwdata.org/business-intelligence/chronic-conditions/index.htm

Along with other CMS reports, such as Chronic Conditions among Medicare BeneficiariesChartbook, the Dashboard’s analytics will help CMS and its stakeholders identify states and populations that demonstrate success in care and management of beneficiaries with MCCs. Findings can inform programs, policies, and best practices for Medicare and the entire health care system, which is an essential step in transforming Medicare from a fee-for-service based payer to a value-based purchaser of care that links payments to quality and efficiency of care, rather than sheer volume of services. The Dashboard’s summarized data also is easier to use and protects patients’ privacy by not releasing individually-identifiable health information.

The release of the Dashboard reflects the Administration’s continued commitment to increasing the accessibility and usability of federally held data wherever possible and appropriate. Previous initiatives include the Medicare Data Sharing for Performance Measurement program, the Health Data Initiative, and CMS’s provision of data to support care coordination to Accountable Care Organizations and State Medicaid programs.

CMS’s Medicare Chronic Conditions Chartbooks and other reports may be accessed at

http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Chronic-Conditions/index.html.

Information on HHS’s Initiative on Multiple Chronic Conditions may be viewed at http://www.hhs.gov/ash/initiatives/mcc/index.html.

 
 
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http://www.cms.gov/Outreach-and-education/outreach/OpenDoorForums/ODF_Hospitals.html

The next CMS Hospital & Hospital Quality Open Door Forum scheduled for:  

Date:  Tuesday, April 2, 2013

Start Time:  2:00 PM Eastern Time (ET)

Please dial-in at least 15 minutes before call start time.

**This Agenda is Subject to Change**

I. Opening Remarks

Chair – Ing-Jye Cheng (CM)

Moderator – Matthew Brown (OPE)

II. Announcements & Updates

  1. FY2014 Hospital Wage Index Timetable
  2. Part B Inpatient Billing


 
 
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http://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/ODF_hhhdme.html

National Provider Calls: Medicare Shared Savings Program Application Process — Registration Now Open

Tuesday, April 9; 2:30-4pm ET— Preparing to Apply

Tuesday, April 23; 1:30-3pm ET— Tips on Completing a Successful Application

On October 20, 2011, CMS issued a final rule under the Affordable Care Act to establish the Medicare Shared Savings Program (Shared Savings Program). This initiative will help providers participate in Accountable Care Organizations (ACOs) to improve quality of care for Medicare patients. CMS will host two National Provider Calls in April on the Shared Savings Program application process.