August 12, 2008
Reading Materials
- New from the Medicare Learning Network
- Pricer Updates
- Medicare Pilot Program Will Offer Beneficiaries Choices for Maintaining Their Own Personal Health Records
- Release of Out-of-Pocket Limits for Medigap Plans K & L for Calendar Year 2009
New from the Medicare Learning Network
The April 2008 version of the Rural Health Clinic Fact
Sheet, which provides information about Rural Health
Clinic (RHC) services, Medicare certification as a RHC, RHC visits,
RHC payments, cost reports, and annual reconciliation, 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."
An updated version of The Physician's
Guide to Medicare Coverage of Kidney Dialysis and Kidney Transplant
Services booklet is now available in downloadable format
from the Centers for Medicare & Medicaid Services Medicare
Learning Network. This booklet explains how Medicare helps
pay for kidney dialysis and kidney transplant services in the Original
Medicare Plan, also known as "fee-for-service." To download your copy,
visit http://www.cms.hhs.gov/MLNProducts/,
scroll down to "MLN Publications" and search for the booklet title.
Just a reminder that the following fact sheets are now available in
print format from the 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."
- Federally Qualified Health Center Fact Sheet (revised April 2008) which provides information about Federally Qualified Health Center (FQHC) designation; covered FQHC services; FQHC preventive primary services that are not covered; FQHC payments; and the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.
- Medicare Disproportionate Share Hospital Fact Sheet (revised April 2008) which 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.
- Inpatient Psychiatric Facility Prospective Payment System Fact Sheet (revised May 2008) which provides general information about the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS), how payment rates are set, and the Rate Year 2009 update to the IPF PPS.
TopPricer Updates
The provider data distributed with the Inpatient Rehabilitation Facility (IRF) PPS PC Pricer has been updated as of July 2008. The FY2007 and FY2008 IRF PC Pricers on this page, http://www.cms.hhs.gov/PCPricer/06_IRF.asp, under "Inpatient Rehabilitation Facility PPS PC Pricer" have been updated with the latest provider data. If you use the IRF PC Pricer, please go to the page above and download the latest version of the IRF PC Pricers posted 08/04/2008.
The provider data distributed with the HH PPS PC Pricer has been updated as of July 2008 on the page, http://www.cms.hhs.gov/PCPricer/05_HH.asp. If you use the HH PPS PC Pricer, please go to the page above and download the latest version of the PC Pricer.
Medicare Pilot Program Will Offer Beneficiaries Choices for Maintaining Their Own Personal Health Records
The Centers for Medicare & Medicaid Services (CMS) today announced a pilot program to test options for beneficiaries with Original Medicare to maintain their health records electronically. Under this pilot in Arizona and Utah, a beneficiary may choose one of the selected commercial personal health record (PHR) tools, and Medicare will transfer up to two years of the individual's claims data into the individual's PHR.
Beneficiaries who select one of the participating PHR vendors can also add other personal health information if they choose. Depending on the specific product, they may be able to authorize links to other personal electronic information such as pharmacy data. PHRs can offer links to tools that help consumers manage their health such as wellness programs for tracking diet and exercise, medical devices, health education information, and applications to detect potential medication interactions.
Beneficiaries can elect to allow family members to have access to their PHR. They can also provide access to the PHR to their health care providers.
If PHR vendors want more information about this pilot, they can visit http://www.NoridianMedicare.com/phr/ or they can send an email to solicitation@medicarephr.org.
To read the entire CMS press release issued today, August 8, 2008 click here: http://www.cms.hhs.gov/center/press.asp
Release of Out-of-Pocket Limits for Medigap Plans K & L for Calendar Year 2009
CMS released the 2009 out-of-pocket (OOP) limits for Medigap plans K & L; the limits are $4,620 and $2,310, respectively. The OOP limits for Medigap plans K and L are updated each year and are based on estimates of the United States Per Capita Costs (USPCC) of the Medicare program published by CMS. The full text of the announcement is available on the CMS website at: http://www.cms.hhs.gov/Medigap/.
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