MEDICARE AND MEDICAID RESOURCES
Medicaid’s Tamper Resistant Prescription Requirement
Michigan
Medicaid Preferred Drug List
Centers for Medicare & Medicaid FAQ
Medicare
Learning Network - Hospice Payment System Fact Sheet
Updated Medicare/Medicaid Relationship Brochure Now Available
Drug Benefit Transition Resources
Drug Formulary Finder for Medicare Physicians
Medicare & Medicaid Services Tip Sheet
Standardized Codes and Exceptions Form for Medicare Prescription Drug Benefit
Medicare Part D Local and National Resources for You & Your
Patients
Information on NPI and Medicare Prescription Drug Coverage
Help is Here -Training Resources for CMS Partners
Medicare Part D Local and National Resources for You & Your
Patients
Quick
Reference Information for Providing Medicare Initial Preventive Physical Exam
Quick
Reference Information (Codes/Frequencies) for Medicare Preventive Services
Centers for Medicare &
Medicaid Services FAQ Sheet
The Centers for Medicare & Medicaid Services (CMS) now has over 50 Frequently
Asked Questions (FAQ) about the Physician Quality Reporting Initiative (PQRI)
available on its website! You can access these FAQs by visiting the PQRI webpage
at, www.cms.hhs.gov/PQRI, on the
CMS website. Once on the Overview page, scroll down to the “Related
Links Inside CMS” section and click on the “Frequently Asked Questions”
link.
Updated Medicare/Medicaid
Relationship Brochure Now Available
The updated Medicare/Medicaid Relationship Brochure is now available in downloadable
format on the Centers for Medicare & Medicaid Services MLN Publications
Page located at http://www.cms.hhs.gov/MLNProducts/downloads/Relationship_Brochure.pdf
on the CMS website.
The brochure discusses the relationship between Medicare beneficiaries who have limited income and resources might be getting help paying for their out-of-pocket medical and prescription expenses from their State Medicaid Program. For such persons who are eligible for full Medicaid coverage, the Medicaid program supplements Medicare coverage by providing services and supplies that is available under their State's Medicaid Program. Hard copies of the brochure will be available for ordering through the Medicare Learning Network in approximately six weeks.
Drug Benefit
Transition Resources
CMS developed a chart, which can be found on the Prescription Drug Coverage
section of the CMS website at http://www.cms.hhs.gov/partnerships/downloads/whatif1.pdf,
of potential situations beneficiaries, especially full benefit dual eligible
beneficiaries, may encounter. This list of scenarios is designed to assist
you and your colleagues to quickly respond to any inquiries or problems you
may receive.
Drug Formulary
Finder for Medicare Physicians
To help you care for your patients and easily obtain information about Part
D formularies and whether a specific drug is covered by a Part D plan, Epocrates,
Inc. has provided Part D formulary information through their free Epocrates
Rx® software, which is available through their web-based system or hand-held
PDA system. This is online and operational as of now and can be accessed through
www.epocrates.com.
CMS has also created a web-based formulary finder which can be found at the Medicare website. The CMS Formulary Finder provides a list of all Part D plans in a given state and links directly to a plan’s home page for a complete formulary. It also provides general information about a plan’s drug utilization and appeals process.
Medicare & Medicaid Services
Tip Sheet
The Centers for Medicare & Medicaid Services has released a tip sheet
to help physicians with the Medicare enrollment process. The tip sheet is
available at: www.cms.hhs.gov/MedicareProviderSupEnroll/downloads/Enrollmenttips.pdf
In addition the CMS 1500 Health Insurance Claim form has been revised to accommodate the National Provider Identifier. CMS hopes to start accepting claims on the revised form in January. For more information, go the National Uniform Claim Committee (NUCC) web site at www.nucc.org.
Standardized Codes and Exceptions
Form for Medicare Prescription Drug Benefit
Last week, the Centers for Medicare & Medicaid Services released a standardized
exceptions form, developed in conjunction with the AMA and America’s
Health Insurance Plans (AHIP). The form is designed to assist physicians in
applying for exceptions and prior authorizations on behalf of Medicare patients
enrolled in Part D. The form is available at:
http://www.cms.hhs.gov/MLNProducts/Downloads/Form_Exceptions_final.pdf
However, it’s not clear at this point if all the Part D plans will accept this form. Physicians should contact the plans about it before using the form.
Medicare Part D Local and National
Resources for You & Your Patients
Developed by America's Health Insurance Plans (AHIP) and the American
Medical Association (AMA), the Exceptions Request Form is a standardized form
that can be used by physicians to request an exception, and coverage, for
non-formulary drugs. Many health insurance plans are expected to begin incorporating
this new form immediately. The Exceptions Request Form is available at: http://www.cms.hhs.gov/MLNProducts/Downloads/Form_Exceptions_final.pdf
Local
Michigan Medicare/Medicaid Assistance Program (MMAP)
1-800-803-7174
http://www.mymmap.org
FREE Service Provider Kits, include brochures
for you and your patients, fact sheets, important numbers wallet cards, posters
for your office (including tear-off postcards requesting more information),
and an order form for more materials.
Help Line with Local Counselors who can help people
over the phone or in person to review prescription drug needs and assist in
selecting a prescription drug plan (PDP).
Medicare Rx Education Network - www.medicarerxeducation.com
Information Resource for those who can enroll in
the Medicare drug coverage program and for those who want to educate others
about the benefit. It offers sign-up information, fact sheets, articles, scripts,
brochures and links to multiple state-specific resources.
National
Centers for Medicare and Medicaid Services
1-800-MEDICARE
beneficiary tools: www.medicare.gov
background: www.cms.hhs.gov/medicarereform
FREE Service Provider Toolkits, include background
articles, posters, public service announcements, training materials and outreach
toolkits. www.cms.hhs.gov/medlearn/drugcoverage.asp
Medicare Prescription Drug Plan (PDP) Finder,
includes information on the plans in each state, PDP premiums and deductibles,
and how to enroll in a plan. www.medicare.gov
Medicare PDP Formulary Finder, offers information
on which plans include which prescription drugs and the number of network
pharmacies in the state. www.medicare.gov
Toll-free Help Line - 1-800-MEDICARE, putting both
you and your patients in touch with one of 9,000 trained experts on Medicare
Part D, 24/7.
Information on NPI and Medicare
Prescription Drug Coverage
Health care providers are required by law to apply for a National Provider
Identifier (NPI). To apply online, visit https://nppes.cms.hhs.gov.
The Centers for Medicare & Medicaid Services has just announced a new web page dedicated to providing all the latest NPI news for Fee-For-Service (FFS) Medicare providers! Visit http://www.cms.hhs.gov/providers/npi/default.asp on the web. While this page is dedicated to the FFS community, it contains helpful information and links that may benefit all health care providers.
Help is Here -Training Resources
for CMS Partners
Here is a list of the variety of training materials and tools to ensure
that organizations and individuals who will assist Medicare beneficiaries
with enrollment have the appropriate resources.
Comprehensive Resource Kit (Can be downloaded and ordered online.) http://www.cms.hhs.gov/partnerships/tools/materials/medicaretraining/hihresourcekit/default.asp?
Medicare Prescription Drug Coverage Toolkit
(Can be downloaded and ordered online.)
http://www.cms.hhs.gov/partnerships/tools/materials/medicaretraining/MPDCoutreachkit.asp
Plan Finder Tool Training Demonstration
http://media.cms.hhs.gov/
Key Resources to Learn More About Medicare Drug Coverage:
PDF Files:
Letter to Health Care Professionals
from the Department of Health & Human Services
Medicare
Drug Coverages Under Part A, Part B, and Part D
What drugs do Medicare Drug
Plans cover?
Websites:
Michigan Department
of Community Health
Michigan Medicare Medicaid
Assistance Program
Medicare Prescription
Drug Program
Social Security
Trading
Partners
Medicare Part D Local and National
Resources for You & Your Patients
Local
Michigan Medicare/Medicaid Assistance Program (MMAP)
1-800-803-7174
http://www.mymmap.org
FREE Service Provider Kits, include brochures
for you and your patients, fact sheets, important numbers wallet cards, posters
for your office (including tear-off postcards requesting more information),
and an order form for more materials.
Help Line with Local Counselors who can help people
over the phone or in person to review prescription drug needs and assist in
selecting a prescription drug plan (PDP).
Medicare Rx Education Network - www.medicarerxeducation.com
Information Resource for those who can enroll in
the Medicare drug coverage program and for those who want to educate others
about the benefit. It offers sign-up information, fact sheets, articles, scripts,
brochures and links to multiple state-specific resources.
National
Centers for Medicare and Medicaid Services
1-800-MEDICARE
beneficiary tools: www.medicare.gov
background: www.cms.hhs.gov/medicarereform
FREE Service Provider Toolkits, include background
articles, posters, public service announcements, training materials and outreach
toolkits. www.cms.hhs.gov/medlearn/drugcoverage.asp
Medicare and You 2006 Handbook - www.medicare.gov
Medicare Prescription Drug Plan (PDP) Finder,
includes information on the plans in each state, PDP premiums and deductibles,
and how to enroll in a plan. www.medicare.gov
Medicare PDP Formulary Finder, offers information
on which plans include which prescription drugs and the number of network
pharmacies in the state. www.medicare.gov
Toll-free Help Line - 1-800-MEDICARE, putting both
you and your patients in touch with one of 9,000 trained experts on Medicare
Part D, 24/7.
Copyright 2008 Michigan Osteopathic Association. All Rights Reserved