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CMS Launched E-Prescribing Incentive Program Jan. 2009
Medicare’s Practical Guide to the E-Prescribing Incentive Program can help you understand how you can qualify to participate and even how to get financial assistance to implement e-prescribing in your practice.

Medicare Contractor for Michigan Changes
The Medicare contractor for Michigan will be changing from Wisconsin Physician Services (WPS) to National Government Services (NGS). Please watch your mail carefully for communications from the Centers for Medicare & Medicaid Services (CMS) and/or NGS. The NGS website is www.ngsmedicare.com/ngsmedicare/HomePage.aspx.

Details on ICD-10 Implementation Date 2013 Push Back
On January 15, 2009, the Centers for Medicare & Medicaid Services (CMS) announced that they are postponing the International Classification of Diseases, Tenth Revision (ICD-10) implementation date to October 1, 2013, to allow health care providers and payers to prepare for the massive transition. ICD-10 is the newly developed procedure coding system and the postponed implementation is designed to give health care providers and payers time to learn and train on the new system and adjust their business systems to handle the increase in codes. For additional information on ICD-10, visit CMS’s website at http://www.cms.hhs.gov/ICD10/.

CMS Issues 2009 Medicare Enrollment Changes
According to information from the Medical Group Managers Association (MGMA), the final 2009 Medicare physician fee schedule includes a number of changes that will have a detrimental effect on medical practices and practitioners' ability to enroll in the Medicare program. Most significantly, beginning on January 1, the Centers for Medicare & Medicaid Services (CMS) will limit the ability of practices to retroactively bill for services provided to Medicare patients by defining the effective date for billing privileges for practitioners and medical practices as the later of:

•the filing date of a Medicare enrollment application that was subsequently approved by a Medicare contractor; or
•the date an enrolled physician or non-physician practitioner began furnishing services at a new practice location.

CMS has provided for limited circumstances in which medical practices and practitioners will be able to retroactively bill for services provided prior to the effective date.

The agency will now instruct contractors to deny applications that are not completed correctly instead of rejecting them. Denied applications can only be reopened if they are appealed. Practices and practitioners have a limited time in which they can file an appeal. Denial notices from Medicare contractors should clearly indicate this time limitation and appeal requirements.

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.

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.