Coding & Compliance - January 2010
"2010 Changes to Medicare Part D"
This year there are multiple changes for Medicare Part D. The checklist below should assist you to ensure compliance with these changes.
Medicare will need to know how the script was obtained:
Effective January 1, 2010, all Medicare Part D claims for new prescriptions must have a Prescription Origin Code (POC) in the NCPDP Telecommunication Standard 5.1 option field 419DJ. Accepted valid values are: 1 - written, 2 - telephonic, 3 - electronic, 4 - facsimile
Staff training on Fraud, Waste, and Abuse:
CMS requires that all Part D Providers and staff receive training by December 31, 2009. The training should be documented.
DMEPOS Accreditation Effective January 1, 2010:
The DMEPOS accreditation will expire January 1, 2010. Currently the NCPA (National Community Pharmacists Association) is requesting an extension, but this has not been approved.
Prompt Pay:
Effective January 1, 2010 Medicare Part D “must” pay retail pharmacies within 14 days, or 30 days for claims that are not submitted electronically.
Certain Products May Not Be Covered:
CMS and the FDA released the 2010 non-matched NDC list. The NDC list can be reviewed on the Medicare Part D Formulary Guidance Web site, http://blue.regence.com/providerWorkshop/partD/formulary.html For any prescription submitted after January 1, 2010 these products will not be
covered by Medicare Part D.
Changes to the Low Income Subsidy Program:
Effective January 1, 2010 the POS Facilitated Enrollment process will be operated through Humana instead of WellPoint. The program will be called the Limited Income Newly Eligible Transition or Limited Income NET.
Breach Notification Plan:
Effective February 22, 2010 enforcement penalties will begin for breaches of unsecured protected health information (PHI) that are not handled correctly. This rule applies to pharmacies and other HIPAA covered entities and their business associates, and is a result of the Health Information Technology for Economic and Clinical Health (HITECH) Act. The HITECH Act includes privacy provisions that are part of the existing federal privacy laws and regulations already in effect under HIPAA.
Make time to verify that your providers and staff are aware of these changes.
We wish all of our newsletter subscribers a great 2010!
Click here for a printable version of this newsletter: CCJan2010
