TriSpan Health Services News Room

In The News

For an opportunity to get the most up-to-date Medicare regulations from Trispan Health Services.
TRISPAN HEALTH SERVICES LIST-SERV

Our list-serv is a great way to receive updates on a weekly basis regarding the frequent changes in the Medicare program.  The updates are sent via email to you each Friday and sometimes more often for time sensitive documents.  If you would like to become a list-serv member, please follow this Email Registration link and fill out the information requested.  You will immediately begin receiving the TriSpan updates. 

For your security, TriSpan Health Services will protect electronic mailing list(s) addresses from unauthorized access or inappropriate usage. Electronic mailing lists, or any portions or information contained therein, will not be shared, sold or in any way transferred to any other organization or entity.  In special or unique circumstances where such a transference or sharing of list-serv information to another organization or entity is deemed to be in the best interests of CMS or the Medicare program, TriSpan must first obtain written permission from the Centers for Medicare and Medicaid Services Regional Office Coordinator.

Please take this opportunity to become a member of our list-serv.

Check here for the latest SNF RUG RATES. (New rates posted 11/15/2007)

CHECK HERE FOR THE LATEST IN FISS HOLDS AND PROBLEMS (posted 6/24/2008)

The Fiscal Intermediary Standard System (FISS) is a national CMS developed system that processes claims for Medicare Part A contractors. Problems and issues have to be reported to, recognized and resolved by the system maintainer. The time frame for resolutions is controlled by CMS. Problems may take significant time to fix depending on the complexity, other changes in process, available funding, etc. CMS often directs contractors to hold claims when payment problems are identified. Once a resolution is developed it is tested, given a project number and assigned to a FISS release. Releases are generally installed every quarter.

Contractors can not change FISS directly and often do not know when a particular problem will be corrected until the content of a release is announced by CMS and the system maintainer. Therefore, the attached chart does not include anticipated resolution dates for all problems.

To assist providers who are experiencing systems issues, TriSpan has developed this FISS Holds and Problems communication. It provides a status of the most commonly reported claims issues. This communication will be updated regularly and posted to TriSpan's website, www.trispan.com. Medicare providers can view the changing systems issues and resolutions in a timely, efficient manner.

Providers are encouraged to review this information prior to contacting the Provider Contact Center about claims problems.

Clarification of Mail Order in the Centers for Medicare & Medicaid Services (CMS) DMEPOS Competitive Bidding Program:

The CMS has posted information on the Competitive Bidding Implementation Contractor (CBIC) website to clarify its policy with regard to mail order suppliers. This posting provides further guidance on common carriers and local storefront suppliers. Please visit the Supplier's FAQ section at http://www.dmecompetitivebid.com/ for more information.
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SOLE COMMUNITY HOSPITAL FACT SHEET
Article posted 6/13/2008

The April 2008 version of the Sole Community Hospital Fact Sheet, which provides information about Sole Community Hospital classification and payments, is now available in print format from the Centers for Medicare & Medicaid Services Medicare Learning Network. To place your order, visit http://www.cms.hhs.gov/mlngeninfo/, scroll down to "Related Links Inside CMS" and select "MLN Product Ordering Page."
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The April 2008 version of the Critical Access Hospital Fact Sheet is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/CritAccessHospfctsht.pdf.  The fact sheet provides information about eligible Critical Access Hospital (CAH) providers; CAH designation; CAH payments; reasonable cost payment principles that do not apply to CAHs; election of Standard Method or Optional (Elective) Payment Method; Medicare Rural Pass-Through funding for certain anesthesia services; Health Professional Shortage Area Incentive payments; Physician Scarcity Area Bonus payments; Medicare Prescription Drug, Improvement, and Modernization Act of 2003; and grants to states under the Medicare Rural Hospital Flexibility Program.
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The Clinical Laboratory Fee Schedule Fact Sheet, which provides general information about the Clinical Laboratory Fee Schedule, coverage of clinical laboratory services, and how payment rates are set, is now available in downloadable and print formats from the Centers for Medicare & Medicaid Services Medicare Learning Network.

To view online, visit http://www.cms.hhs.gov/MLNProducts/downloads/clinical_lab_fee_schedule_fact_sheet.pdf.

To place your order, visit http://www.cms.hhs.gov/mlngeninfo/, scroll down to "Related Links Inside CMS" and select "MLN Product Ordering Page."
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The April 2008 version Rural Referral Center Fact Sheet, which provides information about Rural Referral Center program requirements, is now available in downloadable format Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/RuralRefCtrfctsht2008.pdf .

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MEDICARE DISPROPORTIONATE SHARE HOSPITAL FACT SHEET
Article posted 5/29/2008

The April 2008 version of the Medicare Disproportionate Share Hospital Fact Sheet is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/2008_mdsh.pdf .  This fact sheet provides information about methods to qualify for the Medicare Disproportionate Share Hospital (DSH) adjustment; Medicare Prescription Drug, Improvement, and Modernization Act of 2003 and Deficit Reduction Act of 2005; number of beds in hospital determination; and Medicare DSH payment adjustment formulas.

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If you've ever had difficulty locating information on specific Medicare topics, then the Medicare Learning Network (MLN) Product & Resource Guide can help! This valuable tool was designed to familiarize CMS staff and Medicare contractors with the inventory of MLN products available and includes a chart of MLN Products suggestions by provider type.  The MLN Product & Resource Guide has recently been revised and posted on the CMS website at http://www.cms.hhs.gov/ContractorLearningResources/03_MLNContractorTraining&Education.asp in the Downloads section at the bottom of the Contractor Training Page.
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The CMS Online Manual System: A Web-based Manual System for Medicare Contractors, Providers and State Agencies brochure has been updated and is now available to order print copies or to download as a PDF file. This brochure explains how to navigate the CMS Online Manual System.

To view the PDF file, go to

http://www.cms.hhs.gov/MLNProducts/downloads/on-linebrochure.pdf.

Print copies may be ordered by visiting http://www.cms.hhs.gov/mlngeninfo/, scroll down to "Related Links Inside CMS" and select "MLN Product Ordering Page."
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THE OUTPATIENT MAINTENANCE DIALYSIS - END-STAGE RENAL DISEASE FACT SHEET
Article posted 4/7/2008

The Outpatient Maintenance Dialysis - End-Stage Renal Disease Fact Sheet, which provides general information about outpatient maintenance dialysis for End-Stage Renal Disease, the composite payment rate system, and separately billable items and services, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/ESRDpaymtfctsht08-508.pdf  .

Visit the Medicare Learning Network - It's Free!
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THE AMBULANCE FEE SCHEDULE FACT SHEET
Article posted 3/28/2008

The Ambulance Fee Schedule Fact Sheet, which provides general information about the Ambulance Fee Schedule, is now available in downloadable and print format from the Centers for Medicare & Medicaid Services Medicare Learning Network.

To view online, visit http://www.cms.hhs.gov/MLNProducts/downloads/AmbulanceFeeSched_508.pdf .

To place your order, visit

http://www.cms.hhs.gov/mlngeninfo/, scroll down to "Related Links Inside CMS" and select "MLN Product Ordering Page."
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ACUTE INPATIENT PROSPECTIVE PAYMENT SYSTEM FACT SHEET
Article posted 3/27/2008

The Acute Inpatient Prospective Payment System Fact Sheet (revised November 2007), which provides general information about the Acute Inpatient Prospective Payment System (IPPS) and how IPPS rates are set, is now available in downloadable format at http://www.cms.hhs.gov/MLNProducts/downloads/AcutePaymtSysfctsht.pdf from the Centers for Medicare & Medicaid Services Medicare Learning Network. If the url above does not take you directly to the fact sheet, please copy and paste the url in your web browser.

The revised Acute Inpatient Prospective Payment System Fact Sheet

(November 2007), which provides general information about the Acute

Inpatient Prospective Payment System (IPPS) and how IPPS rates are set,

is now available in print format from the Centers for Medicare &

Medicaid Services Medicare Learning Network. To place your order, visit

http://www.cms.hhs.gov/mlngeninfo/, scroll down to "Related Links Inside CMS" and select "MLN Product

Ordering Page."
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THE MEDICARE PHYSICIAN FEE SCHEDULE FACT SHEET
Article posted 3/27/2008

The revised Medicare Physician Fee Schedule Fact Sheet (January 2008), which provides general information about the Medicare Physician Fee Schedule, is now available in downloadable and print format from the Centers for Medicare & Medicaid Services Medicare Learning Network.

To view online, visit http://www.cms.hhs.gov/MLNProducts/downloads/MedcrePhysFeeSchedfctsht.pdf .

To place your order, visit http://www.cms.hhs.gov/mlngeninfo/, scroll down to "Related Links Inside CMS" and select "MLN Product Ordering Page."
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THE AMBULATORY SURGICAL CENTER FEE SCHEDULE FACT SHEET
Article posted 3/11/2008

The Ambulatory Surgical Center Fee Schedule Fact Sheet, which provides general information about the Ambulatory Surgical Center (ASC) Fee Schedule, ASC payments, and how ASC payment amounts are determined, is now available in print format from the Centers for Medicare & Medicaid Services Medicare Learning Network.

To place your order, visit http://www.cms.hhs.gov/mlngeninfo/, scroll down to "Related Links Inside CMS" and select "MLN Product Ordering Page."
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OUR HEALTH, OUR COMMUNITY: MEDICARE, MEDICAID AND SCHIP OUTREACH TO AMERICAN INDIANS/ALASKAN NATIVES
Article posted 3/11/2008

The Centers for Medicare & Medicaid Services (CMS) is making the following DVD available for Indian Health providers: Our Health, Our Community: Medicare, Medicaid and SCHIP outreach to American Indians/Alaskan Natives is a brief informational DVD on the benefits of enrolling in Medicare, Medicaid and SCHIP for the American Indian/Alaskan Native audience. This DVD can be used in hospital, clinic, and physician office waiting rooms, local TV stations, exhibits, training events, or any place American Indians and Alaskan Natives are gathered. (ICN# 6940) (Dec 2007) Run time is 7mins, 51 seconds

This product is only for those providers that serve the American Indian and Alaskan Native populations. To order a free copy, visit http://www.cms.hhs.gov/mlngeninfo/, scroll down to "Related Links Inside CMS" and select "MLN Product Ordering Page." 
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THE HOSPITAL OUTPATIENT PROSPECTIVE PAYMENT SYSTEM FACT SHEET
Article posted 3/10/2008

The Hospital Outpatient Prospective Payment System Fact Sheet (revised January 2008), which provides general information about the Hospital Outpatient Prospective Payment System, ambulatory payment classifications, and how payment rates are set, is now available in print format from the Centers for Medicare & Medicaid Services Medicare Learning Network.

To place your order, visit http://www.cms.hhs.gov/mlngeninfo/, scroll down to "Related Links Inside CMS" and select "MLN Product Ordering Page."

To view online, visit http://www.cms.hhs.gov/MLNProducts/downloads/HospitalOutpaysysfctsht.pdf on the CMS Website.
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MEDICARE APPEALS PROCESS
Article posted 3/10/2008

The Medicare Appeals Process: Five Levels to Protect Providers, Physicians and Other Suppliers brochure has been updated and is now available to order print copies or as a downloadable PDF file.

To view the PDF file, go to:
http://www.cms.hhs.gov/MLNProducts/downloads/MedicareAppealsProcess.pdf .  To order hard copies, please visit http://www.cms.hhs.gov/mlngeninfo/, scroll down to "Related Links Inside CMS" and select "MLN Product Ordering Page." 
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On September 5, 2007, the Centers for Medicare & Medicaid Services (CMS) announced that Wisconsin Physicians Service Insurance Corporation (WPS) has been awarded the Medicare contract to provide Part A and Part B administrative services for the states of Iowa, Kansas, Missouri and Nebraska.  The implementation schedule is as follows:
                        Part A                                                    Part B                         
            Nebraska: December 1, 2007                Iowa: February 1, 2008
            Kansas: March 1, 2008                         Kansas: March 1, 2008
            Iowa: May 1, 2008                               Missouri (Western): March 1, 2008
            Missouri: May 1, 2008                          Nebraska: March 1, 2008
                                                                         Missouri (Eastern): June 1, 2008                      

Please use the J5 Medicare Administrative Contract (MAC) Implementation Checklist to ensure that your office is informed and prepared for this transition.
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The revised Skilled Nursing Facility (SNF) Spell of Illness Quick Reference Chart (January 2008), which provides Medicare claims processing information related to SNF spells of illness, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at:
http://www.cms.hhs.gov/MLNProducts/downloads/SNFSpellIllnesschrt.pdf
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COMPREHENSIVE ERROR RATE TESTING (CERT)
Article posted 1/30/2008

What is CERT?
CERT is a program established by CMS to monitor and report the accuracy of Medicare Fee-For-Service (FFS) payments.  The CERT program measures the error rate for claims submitted to Carriers, Durable Medical Equipment Regional Carriers (DMERCs), Fiscal Intermediaries (FIs), and Medicare Administrative Contractors (MACs).

Who are the CERT contractors?
The CERT Review Contractor (CRC) is AdvanceMed of Richmond, Virginia. The CRC is responsible for reviewing medical documentation to determine the accuracy of claims payment. The CERT Documentation Contractor (CDC) is located in Annapolis, Maryland. The CDC is responsible for requesting and receiving all documentation from providers.

How does the process work?
CMS calculates the Medicare FFS error rate and estimate of improper claim payments using a methodology the OIG approved. The CERT methodology includes:

• Randomly selecting a sample of approximately 120,000 submitted claims
• Requesting medical records from providers who submitted the claims
• Reviewing the claims and medical records for compliance with Medicare coverage, coding, and billing rules

Why does the provider play a crucial role in CERT? 
Contractors ultimately depend on the provider to accomplish low error rates.  Therefore, when billing your claims, please submit them accurately in accordance with published Medicare coverage, coding, and billing guidelines. Also, please ensure that the medical documentation is complete and accurately reflects the services billed to Medicare.  If your claims are selected in the sample, please respond to the CDC with the requested documentation in a timely manner.  Always make sure that your enrollment information is up to date so that CERT may contact you easily and allow time for you to respond.  You can also update your contact information online at http://www.certcdc.com/certproviderportal/.

Where can I find additional information on the CERT program?
More frequently asked questions are addressed in the CERT Fact Sheet located on the TriSpan Website at http://www.trispan.com/factsheets/CERT.pdf .
You may also visit the CERT webpage located on the CMS website at http://www.cms.hhs.gov/CERT/.
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The Centers for Medicare & Medicaid Services (CMS) today issued a proposed payment rule designed to assure that long-term care hospitals (LTCHs) continue to receive appropriate payment for services provided while giving them incentives to provide more efficient care to Medicare beneficiaries.  LTCHs are a type of acute care hospital that treats some of Medicare's most severely ill or medically complex patients.  The new policies and payment rates would apply to services provided to individuals who are discharged from these hospitals on or after July 1, 2008.

"The proposals announced today will help make sure Medicare beneficiaries who need longer term inpatient care get high quality services appropriate to their medical conditions," CMS Acting Administrator Kerry Weems said.  "The proposals seek increased incentives for efficient delivery of care, ensuring that beneficiaries and taxpayers get the best value for the Medicare dollar."

Comments on the proposed rule are due by March 24, 2008, and a final rule will be issued later in the spring.

To view the entire press release:
http://www.cms.hhs.gov/apps/media/press_releases.asp
The proposed rule will be posted on the CMS Web site at:
http://www.cms.hhs.gov/LongTermCareHospitalPPS/LTCHPPSRN/list.asp.
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SKILLED NURSING FACILITY PROSPECTIVE PAYMENT SYSTEM FACT SHEET
Article posted 12/21/2007

The Skilled Nursing Facility Prospective Payment System Fact Sheet (October 2007), which provides the elements of the Skilled Nursing Facility Prospective Payment System, is now available in print and downloadable formats from the Centers for Medicare & Medicaid Services Medicare Learning Network.
To place your order, visit http://www.cms.hhs.gov/mlngeninfo/, scroll down to "Related Links Inside CMS" and select "MLN Product Ordering Page." 
To view in downloadable format visit http://www.cms.hhs.gov/MLNProducts/downloads/snfprospaymtfctsht.pdf.
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THE HOSPITAL-ACQUIRED CONDITIONS AND PRESENT ON ADMISSION INDICATOR FACT SHEETS
Article posted 12/19/2007

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the release of two new educational products, The Hospital-Acquired Conditions (HAC) in Acute Inpatient Prospective Payment System (IPPS) Hospitals Fact Sheet and The Present On Admission (POA) Indicator Reporting by Acute Inpatient Prospective Payment System (IPPS) Hospitals Fact Sheet. These Fact Sheets provide information on this quality of care initiative including, the list of affected and exempt hospitals, the implementation timeline, and a detailed chart on the category of conditions, as well as general reporting requirements and information on coding, documentation, and claims.

The Fact Sheets are available at http://www.cms.hhs.gov/HospitalAcqCond/07_EducationalResources.asp, in the "Downloads" section of the Educational Resources web page on the CMS website.
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The following publications can now be ordered from the Centers for Medicare & Medicaid Services Medicare Learning Network by visiting http://www.cms.hhs.gov/mlngeninfo, scrolling down to "Related Links Inside CMS" and selecting "MLN Product Ordering Page"

*The Rural Health Bookmark, which offers Medicare providers, suppliers, and physicians information about rural educational resources.

*Medicare Resident, Practicing Physician, and Other Health Care Professional Training Program Bookmark, which provides information about the Medicare Resident, Practicing Physician, and Other Health Care Professional Training Program.
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MEDICARE SECONDARY PAYER RECOVERY CONTRACTOR (MSPRC)
Article posted 9/14/2007

The Centers for Medicare & Medicaid Services (CMS) has awarded a contract for a national Medicare Secondary Payer Recovery Contractor (MSPRC) to Chickasaw Nation Industries, Inc.- Administration Services, LLC (CNI).   They will be responsible for recovery of liability insurance, no-fault insurance, workers’ compensation and group health plans. This information is located at http://www.cms.hhs.gov/MSPRecovclaimpro/ and http://www.cms.hhs.gov/MSPRGenInfo/02_contactMSPRC.asp#TopOfPage
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MEDICARE SECONDARY PAYER (MSP) FACT SHEET
Article posted 9/14/2007

The Medicare Secondary Payer (MSP) fact sheet provides a general overview of the MSP provisions for individuals involved in the admission and billing procedures at provider, physician and other supplier settings.  This fact sheet also provides a list of common situations when Medicare is the primary or secondary payer and is located at
http://www.cms.hhs.gov/mlnproducts/downloads/msp_fact_sheet.pdf
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RURAL HEALTH CLINIC FACT SHEET
Article posted 6/22/2007

The Rural Health Clinic Fact Sheet, which provides information about Rural Health Clinic (RHC) services; RHC designation; RHC payments; annual reconciliation; and the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, is located at http://www.cms.hhs.gov/MLNProducts/downloads/rhcfactsheet.pdf.
Print format is now available from the Centers for Medicare & Medicaid Services Medicare Learning Network. To place your order for this product, visit http://www.cms.hhs.gov/mlngeninfo, scroll down to "Related Links Inside CMS," and select "MLN Product Ordering Page."
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INPATIENT PSYCHIATRIC FACILITY PROSPECTIVE PAYMENT SYSTEM FACT SHEET
Article posted 6/11/2007

The downloadable version of the Inpatient Psychiatric Facility Prospective Payment System Fact Sheet, which has been revised to include information about the Rate Year 2008 updates, is now available on the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/InpatientPsychFac.pdf  The fact sheet also provides general information about the Inpatient Psychiatric Facility Prospective Payment System and how payment rates are set.
The print version of the fact sheet is now available from the Centers of Medicare & Medicaid Services Medicare Learning Network. To place your order for this product, visit www.cms.hhs.gov/mlngeninfo, scroll down to “Related Links Inside CMS,” and select “MLN Product Ordering Page.”
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THE MEDICARE GUIDE TO RURAL HEALTH SERVICES
Article posted 6/11/2007

The Medicare Guide to Rural Health Services Information for Providers, Suppliers, and Physicians (Second Edition) which contains rural information pertaining to rural health facility types, coverage and payment policies, and rural provisions under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 and the Deficit Reduction Act of 2005 is now available in downloadable format on the Centers for Medicare & Medicaid Services Medicare Learning Network Publications Page located at http://www.cms.hhs.gov/MLNProducts/downloads/MedicareRuralHealthGuide.pdf .
Print format is now available from the Centers for Medicare & Medicaid Services Medicare Learning Network. To place your order for this product, visit http://www.cms.hhs.gov/mlngeninfo, scroll down to "Related Links Inside CMS," and select "MLN Product Ordering Page."
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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, http://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.
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NEW WEB-BASED TRAINING COURSE FOR PROFESSIONAL PROVIDERS
(Article posted 12/19/2006)

Understanding the Remittance Advice for Professional Providers Web-based training (WBT) course is now available through the Medicare Learning Network. This WBT course is designed to provide professional providers and their billing staff with general remittance advice (RA) information. This course provides instructions to help professional providers interpret the RA received from Medicare and reconcile it against submitted claims.

Course participants will receive guidance on how to read Electronic Remittance Advices (ERAs) and Standard Paper Remittance Advices (SPRs). The course also provides an overview of software that Medicare provides free to providers for viewing ERAs. The course takes approximately 90 minutes to complete and participants may receive .2 CEUs for successful completion.

To register to take this WBT course, participants can go to the Medicare Learning Network's Page Located at http://www.cms.hhs.gov/mlngeninfo/01_overview.asp? and click on the link called MLN Product Ordering page then select the course title.
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