The following information has been received by ANCO.
****CMA NEWS****
The California Medical Association's (CMA) Alert was published and is available online at http://www.calphys.org/html/news.asp. This edition features:
• CMAs long-running court battle over MediCal provider cuts heads to Supreme Court
• House of Representatives votes to repeal health care reform; Senate unlikely to act
• CMA introduces new biweekly column on state politics
• Webinar: How to enroll in the federal EHR incentive programs
****PALMETTO/J1MAC NEWS****
Reminder: Physician Quality Reporting System: Town Hall Meeting February 9,
2011
CMS will host a Town Hall meeting on February 9, 2011, to discuss the
Physician Quality Reporting System (formerly Physician Quality Reporting
Initiative). The purpose is to solicit input from participating
stakeholders on individual quality measures and measures groups being
considered for possible inclusion in the proposed set of quality measures
for use in the 2012 Physician Quality Reporting System and key components
of its design. Interested parties are invited to participate, either onsite
at CMS headquarters in Baltimore, Maryland, or via teleconference. The
meeting is open to the public; however, attendance is limited to space and
teleconference lines available.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8DALEV0751?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Rescheduled: National Provider Call on 2011 Physician Quality Reporting
System & eRx Incentive Program
For those who registered to participate in January 18 national provider
call, please be aware that the call is being rescheduled to January 27,
2011, 1:30 p.m. to 3 p.m. ET. Due to inclement weather conditions in the
Washington, DC/Baltimore metropolitan area, some of the presenters for this
call have been prevented from attending.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8DAN7J8527?opendocument&utm_source=J1BL&utm_campaign=J1BLs
J1 PCC Closing Schedule: January 28, 2011
Share with your staff - The J1 Provider Contact Center (PCC) will be closed
for training on Friday, January 28, 2011, from 11 a.m. to 3 p.m. PT.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/8D4TRF1003?opendocument
Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC)
and Medicare Remit Easy Print (MREP) Update
This J1 A/B MAC MLN Matters article (CR 7250) announces the latest update
of Remittance Advice Remark Codes (RARCs) and Claim Adjustment Reason Codes
(CARCs), effective April 1, 2011. The reason and remark code sets must be
used to report payment adjustments in remittance advice transactions. The
RARC list is maintained by the Centers for Medicare & Medicaid Services
(CMS) and used by all payers. Providers are encouraged to review the
information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8DBNQY6144?opendocument&utm_source=J1BL&utm_campaign=J1BLs
February 2011 J1 A/B MAC Medicare Advisory
The February 2011 J1 A/B MAC Medicare Advisory is now available on the J1
Web site. Providers are encouraged to review the information and to share
with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8DERNB8217?opendocument&utm_source=J1BL&utm_campaign=J1BLs
J1 Provider Outreach and Education Event Calendar
J1 Part A providers, join us for a free Webinar on Medicare Secondary Payer
(MSP) Conditional Payment Billing on January 26, 2011. J1 Part B providers,
check out the free Webinar on ICD-10 and HIPAA5010 on January 26. Also,
mark your calendar to attend an Ask the Contractor Teleconference (ACT) on
2011 Medicare Updates on January 27, 2011.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~7TAL2C7131?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Have Your Remittance Advice On Hand When You Call the Provider Contact
Center (PCC)
Share with your staff - The Centers for Medicare & Medicaid Services (CMS)
Internet-Only Manuals (IOMs) provide instructions and requirements for
Medicare Contractors on how to handle provider requests for information
that is already available on a Remittance Advice (RA). Please review the
enclosed article and make sure you have your RA on hand when calling the
Provider Contact Center.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8DEL7R2754?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Notice of New Interest Rate for Medicare Overpayments and Underpayments:
Second Notification for FY 2011
The Department of the Treasury has notified the Department of Health and
Human Services that the private consumer rate has been changed to 11.25
percent effective January 24, 2011, for Medicare overpayments and
underpayments.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8DFGLY2184?opendocument&utm_source=J1BL&utm_campaign=J1BLs
The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!
Wednesday, January 26, 2011
Friday, January 14, 2011
ACCC, ASH, CMA, & Palmetto/J1MAC News
The following information has been received by ANCO.
****ACCC NEWS****
The Association of Community Cancer Centers (ACCC) Connect was published and is available online at http://www.accc-cancer.org/mediaroom/newsletters/2011/ACCConnect-1-12-2011.html. ANCO is an Institutional Member of ACCC. This edition features:
• Exceptional Times--Exceptional Meeting: ACCC's 37th Annual National Meeting
• Are You Getting the Most from ACCC's New Reimbursement and Patient Assistance Programs Guide?
• Shortage of Chemo Drugs Raising Concerns
• How do You Manage Patients with Advanced Prostate Cancer? Case Study Submissions Accepted
• ACCC's Part B--Drug Information Guide January Update Available
****ASH NEWS****
The American Society of Hematology (ASH) Practice Update was published and is available online at http://www.hematology.org/Practice/Practice-Updates/6323.aspx. This edition features:
• Congres Reconvenes: House Republications Plan to Repeal Health Reform
• Medicare Updates Physician Payment Rates for 2011
• Medicare Releases Revisions to the January 2011 Average Sales Price (ASP)
• ASH Comments on Proposed Rule for Medicaid RAC Program
• Problems Accessing Melphalan (Alkeran) Reported
• ASH Submits Comments to FDA Regading Approval Pathway for Biosimilar and Interchangeable Biological Products
• CMS Updates for Physicians (EHR, eRx)
****CMA NEWS****
The California Medical Association (CMA) Alert was published and is available online at http://www.calphys.org/html/news.asp. This edition features:
• Governor Brown's proposed budget would dramatically cut health and human services
• CMS launches website for physicians to enroll in EHR program
• Medicare releases new fee schedule for 2011
• Free webinars on HIPAA version 5010 help physicians prepare for January 1st, 2012 deadline
****PALMETTO/J1MAC NEWS****
CMS Launches the 2011 Medicare Contractor Provider Satisfaction Survey
(MCPSS)
It’s that time again. It's time for you to let your voice be heard! The
Centers for Medicare & Medicaid Services (CMS) has launched its annual
Medicare Contractor Provider Satisfaction Survey (MCPSS). This survey
offers Medicare FFS providers and suppliers an opportunity to give CMS
feedback on their interactions with Medicare FFS contractors related to
seven key business functions: provider inquiries, provider outreach and
education, claims processing, appeals, provider enrollment, medical review,
and provider audit and reimbursement.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CUGBA1237?opendocument&utm_source=J1BL&utm_campaign=J1BLs
J1 Part B LCD Retired
The J1 Part B Local Coverage Determination (LCD), Intracoronary
Brachytherapy (L28274), was retired on January 1, 2011.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/8CUMCS1367?opendocument
CMS Expands Healthcare Provider Directory: First Phase of Physician Compare
Web Site
The Centers for Medicare & Medicaid Services (CMS) enhanced the online
Physician Directory tool with new information about physicians and other
health care workers in their communities and the services those
professionals provide. The new feature, called Physician Compare, expands
and updates CMS’ Healthcare Provider Directory, which has helped millions
of beneficiaries find Medicare-participating doctors online for over a
decade.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CUG7Y8568?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Physician Quality Reporting System Town Hall Meeting: February 9
The Centers for Medicare & Medicaid Services (CMS) will host a Town Hall
Meeting on February 9, 2011, 10 a.m. to 4 p.m. ET
to discuss the Physician Quality Reporting System. The purpose of the Town
Hall Meeting is to solicit input from participating stakeholders on
individual quality measures and measures groups being considered for
possible inclusion in the proposed set of quality measures for use in the
2012 Physician Quality Reporting System and key components of the design of
the Physician Quality Reporting System.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CUFZE4528?opendocument&utm_source=J1BL&utm_campaign=J1BLs
National Provider Teleconference: Preparing for ICD-10 Implementation in
2011
The Centers for Medicare & Medicaid Services (CMS) will host a national
provider teleconference on 'Preparing for ICD-10 Implementation in 2011' on
January 12, 2011. Subject matter experts will review basic information on
the transition to ICD-10 and discuss implementation planning and
preparation strategies for this year. A question and answer session will
follow the presentations.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CUGVD3253?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Correction to Article: G0101 and G0182 - Incorrect Adjustments Impacting
Part B Providers in Northern California, Southern California, Ohio and West
Virginia
An error was discovered in the article, ‘G0101 and G0182 - Incorrect
Adjustments Impacting Part B Providers in Northern California, Southern
California, Ohio and West Virginia’, which was published to the J1 Web site
and sent out on listserv on January 6, 2011. The ‘G0101’ code in the title
is incorrect; the correct code is ‘G0181’. The article title has been
corrected on the Web site.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/8CVLNU2451?opendocument
Share with your staff - The 2011 J1 Mammography Fee Schedule has been
updated on our Web site.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~7ZFTY68431?opendocument&utm_source=J1BL&utm_campaign=J1BLs
The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!
****ACCC NEWS****
The Association of Community Cancer Centers (ACCC) Connect was published and is available online at http://www.accc-cancer.org/mediaroom/newsletters/2011/ACCConnect-1-12-2011.html. ANCO is an Institutional Member of ACCC. This edition features:
• Exceptional Times--Exceptional Meeting: ACCC's 37th Annual National Meeting
• Are You Getting the Most from ACCC's New Reimbursement and Patient Assistance Programs Guide?
• Shortage of Chemo Drugs Raising Concerns
• How do You Manage Patients with Advanced Prostate Cancer? Case Study Submissions Accepted
• ACCC's Part B--Drug Information Guide January Update Available
****ASH NEWS****
The American Society of Hematology (ASH) Practice Update was published and is available online at http://www.hematology.org/Practice/Practice-Updates/6323.aspx. This edition features:
• Congres Reconvenes: House Republications Plan to Repeal Health Reform
• Medicare Updates Physician Payment Rates for 2011
• Medicare Releases Revisions to the January 2011 Average Sales Price (ASP)
• ASH Comments on Proposed Rule for Medicaid RAC Program
• Problems Accessing Melphalan (Alkeran) Reported
• ASH Submits Comments to FDA Regading Approval Pathway for Biosimilar and Interchangeable Biological Products
• CMS Updates for Physicians (EHR, eRx)
****CMA NEWS****
The California Medical Association (CMA) Alert was published and is available online at http://www.calphys.org/html/news.asp. This edition features:
• Governor Brown's proposed budget would dramatically cut health and human services
• CMS launches website for physicians to enroll in EHR program
• Medicare releases new fee schedule for 2011
• Free webinars on HIPAA version 5010 help physicians prepare for January 1st, 2012 deadline
****PALMETTO/J1MAC NEWS****
CMS Launches the 2011 Medicare Contractor Provider Satisfaction Survey
(MCPSS)
It’s that time again. It's time for you to let your voice be heard! The
Centers for Medicare & Medicaid Services (CMS) has launched its annual
Medicare Contractor Provider Satisfaction Survey (MCPSS). This survey
offers Medicare FFS providers and suppliers an opportunity to give CMS
feedback on their interactions with Medicare FFS contractors related to
seven key business functions: provider inquiries, provider outreach and
education, claims processing, appeals, provider enrollment, medical review,
and provider audit and reimbursement.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CUGBA1237?opendocument&utm_source=J1BL&utm_campaign=J1BLs
J1 Part B LCD Retired
The J1 Part B Local Coverage Determination (LCD), Intracoronary
Brachytherapy (L28274), was retired on January 1, 2011.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/8CUMCS1367?opendocument
CMS Expands Healthcare Provider Directory: First Phase of Physician Compare
Web Site
The Centers for Medicare & Medicaid Services (CMS) enhanced the online
Physician Directory tool with new information about physicians and other
health care workers in their communities and the services those
professionals provide. The new feature, called Physician Compare, expands
and updates CMS’ Healthcare Provider Directory, which has helped millions
of beneficiaries find Medicare-participating doctors online for over a
decade.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CUG7Y8568?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Physician Quality Reporting System Town Hall Meeting: February 9
The Centers for Medicare & Medicaid Services (CMS) will host a Town Hall
Meeting on February 9, 2011, 10 a.m. to 4 p.m. ET
to discuss the Physician Quality Reporting System. The purpose of the Town
Hall Meeting is to solicit input from participating stakeholders on
individual quality measures and measures groups being considered for
possible inclusion in the proposed set of quality measures for use in the
2012 Physician Quality Reporting System and key components of the design of
the Physician Quality Reporting System.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CUFZE4528?opendocument&utm_source=J1BL&utm_campaign=J1BLs
National Provider Teleconference: Preparing for ICD-10 Implementation in
2011
The Centers for Medicare & Medicaid Services (CMS) will host a national
provider teleconference on 'Preparing for ICD-10 Implementation in 2011' on
January 12, 2011. Subject matter experts will review basic information on
the transition to ICD-10 and discuss implementation planning and
preparation strategies for this year. A question and answer session will
follow the presentations.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CUGVD3253?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Correction to Article: G0101 and G0182 - Incorrect Adjustments Impacting
Part B Providers in Northern California, Southern California, Ohio and West
Virginia
An error was discovered in the article, ‘G0101 and G0182 - Incorrect
Adjustments Impacting Part B Providers in Northern California, Southern
California, Ohio and West Virginia’, which was published to the J1 Web site
and sent out on listserv on January 6, 2011. The ‘G0101’ code in the title
is incorrect; the correct code is ‘G0181’. The article title has been
corrected on the Web site.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/8CVLNU2451?opendocument
Share with your staff - The 2011 J1 Mammography Fee Schedule has been
updated on our Web site.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~7ZFTY68431?opendocument&utm_source=J1BL&utm_campaign=J1BLs
The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!
Friday, January 7, 2011
Palmetto/J1MAC News
The following information has been received by ANCO.
****PALMETTO/J1MAC NEWS****
2011 Revised Medicare Part B Fee Schedule: Northern California
The Northern California 2011 Revised Medicare Part B Fee Schedule is now
available and is effective for services performed on or after January 1,
2011.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8B8PAG2626?opendocument&utm_source=J1BL&utm_campaign=J1BLs
CMS Quarterly Provider Update
The Quarterly Provider Update is a comprehensive resource published by the
Centers for Medicare & Medicaid Services (CMS) on the first business day of
each quarter. It is a listing of all non-regulatory changes to Medicare
including program memoranda, manual changes and any other instructions that
could affect providers. Regulations and instructions published in the
previous quarter are also included in the update.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~7GLTKN5010?opendocument&utm_source=J1BL&utm_campaign=J1BLs
CMS Quarterly Provider Update
The Quarterly Provider Update is a comprehensive resource published by the
Centers for Medicare & Medicaid Services (CMS) on the first business day of
each quarter. It is a listing of all non-regulatory changes to Medicare
including program memoranda, manual changes and any other instructions that
could affect providers. Regulations and instructions published in the
previous quarter are also included in the update.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~7GLTKN5010?opendocument&utm_source=J1BL&utm_campaign=J1BLs
PC-ACE Pro32 version 2.26 Update File
PC-ACE Pro32 software has been updated to version 2.26 with several CMS
Medicare mandates and enhancements. All PC-ACE Pro32 users must download
and install the attached software update file immediately.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CTME56017?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Timely Claims Filing Requirement: Important Information
Effective immediately, the Centers for Medicare & Medicaid Services (CMS)
would like to remind Medicare fee-for-service physicians, providers and
suppliers, who are submitting claims to Medicare for payment, all claims
for services furnished on or after January 1, 2010, must be filed with your
Medicare contractor no later than one calendar year (12 months) from the
date of service or Medicare will deny them. This is a result of the Patient
Protection and Affordable Care Act (PPACA).
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8C5UT62660?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Registration Now Open for Medicare and Medicaid Electronic Health Record
(EHR) Incentive Program
The Centers for Medicare & Medicaid Services (CMS) encourages eligible
professionals, eligible hospitals and critical access hospitals to register
for the Medicare and/or Medicaid EHR Incentive Program(s) as soon as
possible. You can register before you have a certified EHR. Register even
if you do not have an enrollment record in the Provider Enrollment, Chain
and Ownership System (PECOS).
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CTGUS3370?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Medicare Fee-for-Service Implementation of HIPAA Version 5010 and D.0
Transactions: Fourteenth National Education Call
The Centers for Medicare & Medicaid Services (CMS) will host its fourteenth
national education call regarding Medicare fee-for-service (FFS)
implementation of HIPAA Version 5010 and D.0 transaction standards on
January 19, 2011. This session will focus on the errata impact to HIPAA
transactions and the Medicare FFS companion guides. Subject matter experts
will review how Medicare FFS is implementing the errata, review the
Medicare FFS companion guide and provide information to help the audience
through the transition to implementation. The presentation will be followed
by a Q&A session.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CTH6G2176?opendocument&utm_source=J1BL&utm_campaign=J1BLs
The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!
****PALMETTO/J1MAC NEWS****
2011 Revised Medicare Part B Fee Schedule: Northern California
The Northern California 2011 Revised Medicare Part B Fee Schedule is now
available and is effective for services performed on or after January 1,
2011.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8B8PAG2626?opendocument&utm_source=J1BL&utm_campaign=J1BLs
CMS Quarterly Provider Update
The Quarterly Provider Update is a comprehensive resource published by the
Centers for Medicare & Medicaid Services (CMS) on the first business day of
each quarter. It is a listing of all non-regulatory changes to Medicare
including program memoranda, manual changes and any other instructions that
could affect providers. Regulations and instructions published in the
previous quarter are also included in the update.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~7GLTKN5010?opendocument&utm_source=J1BL&utm_campaign=J1BLs
CMS Quarterly Provider Update
The Quarterly Provider Update is a comprehensive resource published by the
Centers for Medicare & Medicaid Services (CMS) on the first business day of
each quarter. It is a listing of all non-regulatory changes to Medicare
including program memoranda, manual changes and any other instructions that
could affect providers. Regulations and instructions published in the
previous quarter are also included in the update.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~7GLTKN5010?opendocument&utm_source=J1BL&utm_campaign=J1BLs
PC-ACE Pro32 version 2.26 Update File
PC-ACE Pro32 software has been updated to version 2.26 with several CMS
Medicare mandates and enhancements. All PC-ACE Pro32 users must download
and install the attached software update file immediately.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CTME56017?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Timely Claims Filing Requirement: Important Information
Effective immediately, the Centers for Medicare & Medicaid Services (CMS)
would like to remind Medicare fee-for-service physicians, providers and
suppliers, who are submitting claims to Medicare for payment, all claims
for services furnished on or after January 1, 2010, must be filed with your
Medicare contractor no later than one calendar year (12 months) from the
date of service or Medicare will deny them. This is a result of the Patient
Protection and Affordable Care Act (PPACA).
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8C5UT62660?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Registration Now Open for Medicare and Medicaid Electronic Health Record
(EHR) Incentive Program
The Centers for Medicare & Medicaid Services (CMS) encourages eligible
professionals, eligible hospitals and critical access hospitals to register
for the Medicare and/or Medicaid EHR Incentive Program(s) as soon as
possible. You can register before you have a certified EHR. Register even
if you do not have an enrollment record in the Provider Enrollment, Chain
and Ownership System (PECOS).
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CTGUS3370?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Medicare Fee-for-Service Implementation of HIPAA Version 5010 and D.0
Transactions: Fourteenth National Education Call
The Centers for Medicare & Medicaid Services (CMS) will host its fourteenth
national education call regarding Medicare fee-for-service (FFS)
implementation of HIPAA Version 5010 and D.0 transaction standards on
January 19, 2011. This session will focus on the errata impact to HIPAA
transactions and the Medicare FFS companion guides. Subject matter experts
will review how Medicare FFS is implementing the errata, review the
Medicare FFS companion guide and provide information to help the audience
through the transition to implementation. The presentation will be followed
by a Q&A session.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CTH6G2176?opendocument&utm_source=J1BL&utm_campaign=J1BLs
The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!
Sunday, January 2, 2011
Palmetto/J1MAC News
The following information has been received by ANCO.
****PALMETTO/J1MAC NEWS****
ANSI v5010: ANSI 837 v5010 Testing Procedures
The ANSI 837 v5010 Testing Procedures document includes testing
instructions for J1 Part A, J1 Part B, NC Part A , LA Part A, MS Part A and
Railroad Medicare to ensure your new ANSI-formatted electronic claims
software meets format and quality standards. These instructions are
applicable to ANSI v5010 testing from January 1, 2011 through April 3,
2011. Additional testing will need to be performed once the errata is
installed on April 4, 2011. Updated ANSI 837 v5010 testing instructions
will be published at that time. No one will be placed in ANSI v5010
production until successful errata testing is completed.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CMP5M6351?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Get Ready for Version 5010
In January, the health care industry will have less than a year left to
prepare for the Version 5010 transaction set change on January 1, 2012. To
assist with compliance, the Centers for Medicare & Medicaid Services (CMS)
is supporting an education effort, Get Ready 5010, that will kick off with
a series of free Webinars scheduled from January 11 through 13, 2011.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CMKB31537?opendocument&utm_source=J1BL&utm_campaign=J1BLs
J1 Open Draft LCD Meeting: California, January 18, 2011
Share with your staff - Palmetto GBA J1 A/B MAC will host an Open Draft
Local Coverage Determination (LCD) meeting in California, January 18, 2011.
The general public is invited to submit information related to the proposed
LCDs for Palmetto GBA's consideration.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~7TKQ3P7107?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Multiple Procedure Payment Reduction (MPPR) for Selected Therapy Services
This J1 A/B MLN Matters article (CR 7050a) was revised on December 22,
2010, to reflect changes made to CR 7050 on December 21, 2010. The CR 7050
was revised based on policy changes required by the Physician Payment and
Therapy Relief Act of 2010, which changed the multiple payment procedure
reduction for therapy services in the office setting or a non-institutional
setting to 20 percent, instead of 25 percent. The CR release date,
transmittal number and Web address for accessing CR 7050 were also revised.
This article announces that Medicare is applying a new multiple procedure
payment reduction (MPPR) to the practice expense (PE) component of payment
of select therapy services paid under the MPFS. Providers are encouraged to
review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BGSDE5876?opendocument&utm_source=J1BL&utm_campaign=J1BLs
J1 Part B LCD (DL31628) Comment Period January 13 through March 7, 2011
The comment period for J1 Part B Local Coverage Determination (LCD),
Molecular Profiling for Unknown Primary Cancers (UPC) DL31628, will begin
on January 13 and end on March 7, 2011.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/8CLTWT8785?opendocument
CMS Quarterly Provider Update
The Quarterly Provider Update is a comprehensive resource published by the
Centers for Medicare & Medicaid Services (CMS) on the first business day of
each quarter. It is a listing of all non-regulatory changes to Medicare
including program memoranda, manual changes and any other instructions that
could affect providers. Regulations and instructions published in the
previous quarter are also included in the update.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~7GLTKN5010?opendocument&utm_source=J1BL&utm_campaign=J1BLs
The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!
****PALMETTO/J1MAC NEWS****
ANSI v5010: ANSI 837 v5010 Testing Procedures
The ANSI 837 v5010 Testing Procedures document includes testing
instructions for J1 Part A, J1 Part B, NC Part A , LA Part A, MS Part A and
Railroad Medicare to ensure your new ANSI-formatted electronic claims
software meets format and quality standards. These instructions are
applicable to ANSI v5010 testing from January 1, 2011 through April 3,
2011. Additional testing will need to be performed once the errata is
installed on April 4, 2011. Updated ANSI 837 v5010 testing instructions
will be published at that time. No one will be placed in ANSI v5010
production until successful errata testing is completed.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CMP5M6351?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Get Ready for Version 5010
In January, the health care industry will have less than a year left to
prepare for the Version 5010 transaction set change on January 1, 2012. To
assist with compliance, the Centers for Medicare & Medicaid Services (CMS)
is supporting an education effort, Get Ready 5010, that will kick off with
a series of free Webinars scheduled from January 11 through 13, 2011.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CMKB31537?opendocument&utm_source=J1BL&utm_campaign=J1BLs
J1 Open Draft LCD Meeting: California, January 18, 2011
Share with your staff - Palmetto GBA J1 A/B MAC will host an Open Draft
Local Coverage Determination (LCD) meeting in California, January 18, 2011.
The general public is invited to submit information related to the proposed
LCDs for Palmetto GBA's consideration.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~7TKQ3P7107?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Multiple Procedure Payment Reduction (MPPR) for Selected Therapy Services
This J1 A/B MLN Matters article (CR 7050a) was revised on December 22,
2010, to reflect changes made to CR 7050 on December 21, 2010. The CR 7050
was revised based on policy changes required by the Physician Payment and
Therapy Relief Act of 2010, which changed the multiple payment procedure
reduction for therapy services in the office setting or a non-institutional
setting to 20 percent, instead of 25 percent. The CR release date,
transmittal number and Web address for accessing CR 7050 were also revised.
This article announces that Medicare is applying a new multiple procedure
payment reduction (MPPR) to the practice expense (PE) component of payment
of select therapy services paid under the MPFS. Providers are encouraged to
review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BGSDE5876?opendocument&utm_source=J1BL&utm_campaign=J1BLs
J1 Part B LCD (DL31628) Comment Period January 13 through March 7, 2011
The comment period for J1 Part B Local Coverage Determination (LCD),
Molecular Profiling for Unknown Primary Cancers (UPC) DL31628, will begin
on January 13 and end on March 7, 2011.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/8CLTWT8785?opendocument
CMS Quarterly Provider Update
The Quarterly Provider Update is a comprehensive resource published by the
Centers for Medicare & Medicaid Services (CMS) on the first business day of
each quarter. It is a listing of all non-regulatory changes to Medicare
including program memoranda, manual changes and any other instructions that
could affect providers. Regulations and instructions published in the
previous quarter are also included in the update.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~7GLTKN5010?opendocument&utm_source=J1BL&utm_campaign=J1BLs
The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!
Friday, December 31, 2010
DHCS/MediCal & Palmetto/J1MAC News
The following information has been received by ANCO.
****DHCS/MediCal NEWS****
The December Medi-Cal Bulletin has just been made available to providers. It spells out the action being taken by them to resolve the Zometa denials & payment methodology.
****PALMETTO/J1MAC NEWS****
2011 Medicare Physician Fee Schedule: Update
On December 15, 2010, President Obama signed into law the Medicare and
Medicaid Extenders Act of 2010 (MMEA). Section 101 of the MMEA prevents a
payment cut for physicians that would have taken effect on January 1, 2011.
While the physician fee schedule update will be zero percent, other changes
to the relative value units (RVUs) used to calculate the fee schedule rates
must be budget neutral. To make those changes budget neutral, the
conversion factor must be adjusted for 2011. CMS is currently developing
the 2011 Medicare Physician Fee Schedule (MPFS) to implement the zero
percent update, and we expect all 2011 claims to be processed timely, in
compliance with the new legislation. The 2011 fees schedules will be posted
on this Web site as soon as they are finalized.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CKSB42356?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Claim Status Category and Claim Status Code Update
This J1 A/B MAC MLN Matters article, based on Change Request (CR) 7259,
explains that the claim status codes and claim status category codes for
use by Medicare contractors with the Health Claim Status Request and
Response ASC X12N 276/277, along with the 277 Health Care Claim
Acknowledgement, were updated during the January 2011 meeting of the
National Code Maintenance Committee, where code changes were also approved.
Included in the code lists are specific details, including the date when a
code was added, changed or deleted. Medicare contractors will implement
these changes on April 4, 2011. All providers should ensure that their
billing staffs are aware of the updated codes and the timeframe for
implementations.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CKHLF1313?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Electronic Health Records Incentives Registration Starts January 3, 2011
Beginning January 3, 2011, registration will be available for eligible
health care professionals and eligible hospitals who wish to participate in
the Medicare EHR incentive program. Eligible professionals and eligible
hospitals must register in order to participate in the Medicare and
Medicaid EHR incentive programs. This article provides key dates you should
know if you plan to participate in this incentive program.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CKK7M6807?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Expansion of the Current Scope of Editing for Ordering/Referring Providers
for claims processed by Medicare Carriers and Part B Medicare
Administrative Contractors (MACs)
This J1 Part B MLN Matters article (CR 6417d) was revised on December 17,
2010, to reflect the changes in the release of revised Change Request (CR)
6417 on December 16, 2010. The CR was revised to show the implementation
date for phase two is being delayed and will not begin on January 3, 2011.
A placeholder date of July 5, 2011, has been stated in revised CR 6417.
This placeholder date is being issued to give the Centers for Medicare &
Medicaid Services (CMS) more flexibility to determine the appropriate date
for nonpayment of claims that fail the ordering/referring provider edits.
CR 6417 requires Medicare implementation of system edits to assure that
Part B providers and suppliers bill for ordered or referred items or
services only when those items or services are ordered or referred by
physicians and non-physician practitioners who are eligible to order/refer
such services. Physicians and non-physician practitioners who order or
refer must be enrolled in the Medicare Provider Enrollment, Chain and
Ownership System (PECOS) and must be of the type/specialty eligible to
order/refer services for Medicare beneficiaries. Please share with your
staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~84HMMV6711?opendocument&utm_source=J1BL&utm_campaign=J1BLs
2011 Electronic Prescribing (eRx) Incentive Program Update
In November 2010, the Centers for Medicare & Medicaid Services announced
that, beginning in 2012, eligible professionals who are not successful
electronic prescribers may be subject to a payment adjustment on their
Medicare Part B Physician Fee Schedule (PFS) covered professional services.
Section 132 of the Medicare Improvements for Patients and Providers Act of
2008 (MIPPA) authorizes CMS to apply this payment adjustment whether or not
the eligible professional is planning to participate in the eRx Incentive
Program.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CKJ3Q1816?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Physician Quality Reporting System: Town Hall Meeting on February 9, 2011
The Centers for Medicare & Medicaid Services (CMS) will host a Town Hall
Meeting to discuss the Physician Quality Reporting System. The meeting will
be held on February 9, 2011, from 10 a.m. until 4 p.m. in Baltimore,
Maryland and via teleconference. The purpose of the Town Hall Meeting is
to solicit input from participating stakeholders on key components of the
design of the Physician Quality Reporting System and individual quality
measures and measures groups being considered for possible inclusion in the
2012 Physician Quality Reporting System.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CKFEP0785?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Electronic Health Records Incentive Programs: Important Information About
Provider Registration
Registration begins January 3, 201; are you ready? The new CMS Electronic
Health Records (EHR) Web page can help. This new Web page is updated,
reorganized and more user-friendly. Be sure to check it out and register
soon.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CKLVS6122?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Home Health Face-to-Face Encounter Certification Requirement
Section 6407 of the Affordable Care Act of 2010 established a physician
face-to-face encounter requirement for certification of eligibility for
Medicare home health services. The certifying physician must document that
he or she, or a non-physician practitioner (NPP) working with the
physician, has seen the patient.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CKS325738?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Hospice Face-to-Face Encounter Requirement
Effective January 1, 2011, Section 3131(b) of the Affordable Care Act of
2010 requires a hospice physician or nurse practitioner (NP) to have a
face-to-face encounter with every hospice patient prior to the patient’s
180th-day recertification and each subsequent recertification.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CKSJ67267?opendocument&utm_source=J1BL&utm_campaign=J1BLs
The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!
****DHCS/MediCal NEWS****
The December Medi-Cal Bulletin has just been made available to providers. It spells out the action being taken by them to resolve the Zometa denials & payment methodology.
****PALMETTO/J1MAC NEWS****
2011 Medicare Physician Fee Schedule: Update
On December 15, 2010, President Obama signed into law the Medicare and
Medicaid Extenders Act of 2010 (MMEA). Section 101 of the MMEA prevents a
payment cut for physicians that would have taken effect on January 1, 2011.
While the physician fee schedule update will be zero percent, other changes
to the relative value units (RVUs) used to calculate the fee schedule rates
must be budget neutral. To make those changes budget neutral, the
conversion factor must be adjusted for 2011. CMS is currently developing
the 2011 Medicare Physician Fee Schedule (MPFS) to implement the zero
percent update, and we expect all 2011 claims to be processed timely, in
compliance with the new legislation. The 2011 fees schedules will be posted
on this Web site as soon as they are finalized.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CKSB42356?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Claim Status Category and Claim Status Code Update
This J1 A/B MAC MLN Matters article, based on Change Request (CR) 7259,
explains that the claim status codes and claim status category codes for
use by Medicare contractors with the Health Claim Status Request and
Response ASC X12N 276/277, along with the 277 Health Care Claim
Acknowledgement, were updated during the January 2011 meeting of the
National Code Maintenance Committee, where code changes were also approved.
Included in the code lists are specific details, including the date when a
code was added, changed or deleted. Medicare contractors will implement
these changes on April 4, 2011. All providers should ensure that their
billing staffs are aware of the updated codes and the timeframe for
implementations.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CKHLF1313?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Electronic Health Records Incentives Registration Starts January 3, 2011
Beginning January 3, 2011, registration will be available for eligible
health care professionals and eligible hospitals who wish to participate in
the Medicare EHR incentive program. Eligible professionals and eligible
hospitals must register in order to participate in the Medicare and
Medicaid EHR incentive programs. This article provides key dates you should
know if you plan to participate in this incentive program.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CKK7M6807?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Expansion of the Current Scope of Editing for Ordering/Referring Providers
for claims processed by Medicare Carriers and Part B Medicare
Administrative Contractors (MACs)
This J1 Part B MLN Matters article (CR 6417d) was revised on December 17,
2010, to reflect the changes in the release of revised Change Request (CR)
6417 on December 16, 2010. The CR was revised to show the implementation
date for phase two is being delayed and will not begin on January 3, 2011.
A placeholder date of July 5, 2011, has been stated in revised CR 6417.
This placeholder date is being issued to give the Centers for Medicare &
Medicaid Services (CMS) more flexibility to determine the appropriate date
for nonpayment of claims that fail the ordering/referring provider edits.
CR 6417 requires Medicare implementation of system edits to assure that
Part B providers and suppliers bill for ordered or referred items or
services only when those items or services are ordered or referred by
physicians and non-physician practitioners who are eligible to order/refer
such services. Physicians and non-physician practitioners who order or
refer must be enrolled in the Medicare Provider Enrollment, Chain and
Ownership System (PECOS) and must be of the type/specialty eligible to
order/refer services for Medicare beneficiaries. Please share with your
staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~84HMMV6711?opendocument&utm_source=J1BL&utm_campaign=J1BLs
2011 Electronic Prescribing (eRx) Incentive Program Update
In November 2010, the Centers for Medicare & Medicaid Services announced
that, beginning in 2012, eligible professionals who are not successful
electronic prescribers may be subject to a payment adjustment on their
Medicare Part B Physician Fee Schedule (PFS) covered professional services.
Section 132 of the Medicare Improvements for Patients and Providers Act of
2008 (MIPPA) authorizes CMS to apply this payment adjustment whether or not
the eligible professional is planning to participate in the eRx Incentive
Program.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CKJ3Q1816?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Physician Quality Reporting System: Town Hall Meeting on February 9, 2011
The Centers for Medicare & Medicaid Services (CMS) will host a Town Hall
Meeting to discuss the Physician Quality Reporting System. The meeting will
be held on February 9, 2011, from 10 a.m. until 4 p.m. in Baltimore,
Maryland and via teleconference. The purpose of the Town Hall Meeting is
to solicit input from participating stakeholders on key components of the
design of the Physician Quality Reporting System and individual quality
measures and measures groups being considered for possible inclusion in the
2012 Physician Quality Reporting System.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CKFEP0785?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Electronic Health Records Incentive Programs: Important Information About
Provider Registration
Registration begins January 3, 201; are you ready? The new CMS Electronic
Health Records (EHR) Web page can help. This new Web page is updated,
reorganized and more user-friendly. Be sure to check it out and register
soon.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CKLVS6122?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Home Health Face-to-Face Encounter Certification Requirement
Section 6407 of the Affordable Care Act of 2010 established a physician
face-to-face encounter requirement for certification of eligibility for
Medicare home health services. The certifying physician must document that
he or she, or a non-physician practitioner (NPP) working with the
physician, has seen the patient.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CKS325738?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Hospice Face-to-Face Encounter Requirement
Effective January 1, 2011, Section 3131(b) of the Affordable Care Act of
2010 requires a hospice physician or nurse practitioner (NP) to have a
face-to-face encounter with every hospice patient prior to the patient’s
180th-day recertification and each subsequent recertification.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CKSJ67267?opendocument&utm_source=J1BL&utm_campaign=J1BLs
The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!
Monday, December 27, 2010
ASH & Palmetto/J1MAC News
The following information has been received by ANCO.
****ASH NEWS****
The American Society of Hematology's (AS) Practice Update was published and is available online at http://www.hematology.org/Advocacy/Testimony/2010/6287.aspx. This edition features:
• Stopgap Funding Bill Omits CMS Funding Increase Needed to Implement Health Reform
• CMS Releases 2011 Electronic Prescribing (eRx) Incentive Program Update
• CMS to Host Town Hall Meeting to Discuss PQRS
• Medicare Releases Updates of the Quarterly Average Sales Price (ASP)
****PALMETTO/J1MAC NEWS****
Place of Service Indicator for HCPCS Codes G0339 and G0340
The Pricing Indicator Code on the Alpha-Numeric HCPCS File has been changed
from '00' to '13' for HCPCS codes G0339 and G0340. This change is effective
for services furnished in CY 2006 – CY 2010. While this change was
accurately reflected in the annual published PFS Relative Value Files
beginning in CY 2006, no corresponding change was made to the pricing
indicator on the Alpha-Numeric HCPCS File. The Alpha-Numeric HCPCS File is
being updated to reflect the correct pricing indicator code.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CCQT65222?opendocument&utm_source=J1BL&utm_campaign=J1BLs
January 2011 J1 A/B MAC Medicare Advisory
The January 2011 J1 A/B MAC Medicare Advisory is now available on the J1
Web site. Providers are encouraged to review the information and to share
with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CCH5W2540?opendocument&utm_source=J1BL&utm_campaign=J1BLs
CERT Appeals: Providing Documentation
When services are denied or down-coded by the CERT Review Contractor and an
overpayment is identified, providers are entitled to file a Part B
redetermination request to Palmetto GBA. We are seeing a growing number of
appeals for which the medical records sent by providers and third-party
medical billing companies are missing key components of the documentation
necessary to conduct the review. Prior to filing an appeal, we suggest you
follow the steps listed in this article.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CBPRW2370?opendocument&utm_source=J1BL&utm_campaign=J1BLs
J1 Part B LCDs Revised
The following J1 Part B LCDs have been revised: Cardiac Catheterization,
Diagnostic L28244, Injections- Tendon, Ligament, Ganglion Cyst, Tunnel
Syndromes and Morton’s Neuroma L28271, and Intensity Modulated Radiation
Therapy (IMRT) L28272.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/8CBSNU2143?opendocument
A New Home Health Certification Requirement: Home Health Face-to-Face
Encounter
A new Medicare home health law goes into effect on January 1, 2011, that
affirms the role of the physician as the person who orders home health care
based on personal examination of the patient. Effective in January, a
physician who certifies a patient as eligible for Medicare home health
services must see the patient. The law also allows the requirement to be
satisfied if a non-physician practitioner (NPP) sees the patient, when the
NPP is working for, or in collaboration with, the physician.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CCP295540?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Signatures Required on Requisitions for Clinical Diagnostic Laboratory
Tests: Effective January 1, 2011
Effective January 1, 2011, a physician’s or qualified non-physician
practitioner’s (NPP’s) signature is required on all requisitions for
clinical diagnostic laboratory tests paid under the clinical laboratory fee
schedule. This is a change from previous Medicare guidelines and is
included in the November 29, 2010, Medicare Physician Fee Schedule final
rule. CMS guidelines regarding signatures on requisitions for clinical
diagnostic laboratory tests will be updated soon. Updated information will
be posted on the CMS Web site.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CCRRD7180?opendocument&utm_source=J1BL&utm_campaign=J1BLs
J1 PCC Closed in Observance of the Holidays December 23-24 and December 31,
2010
The J1 Provider Contact Center (PCC) will be closed in observance of the
holidays on December 23, December 24 and December 31, 2010. The PCC will
reopen on Monday, December 27, 2010, at 7 a.m. PT after Christmas and
reopen on Monday, January 3, 2011, at 7 a.m. PT after New Year's Day.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CDNZ38731?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Palmetto GBA Launches Going Beyond Diagnosis Blog
Palmetto GBA launched the Going Beyond Diagnosis blog! Claims denied for
insufficient documentation in medical records? Use the ICF to communicate
treatment plans efficiently. Visit the blog to collaborate with our Medical
Affairs area and share your experiences with the ICF.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8C5JMW3232?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Signatures on Requisitions for Clinical Diagnostic Laboratory Tests
In the November 29, 2010 Medicare Physician Fee Schedule final rule, the
Centers for Medicare & Medicaid Services (CMS) finalized its proposed
policy to require a physician's or qualified non-physician practitioner's
(NPP) signature on requisitions for clinical diagnostic laboratory tests
paid under the clinical laboratory fee schedule effective January 1, 2011.
A requisition is the actual paperwork, such as a form, which is provided to
a clinical diagnostic laboratory that identifies the test or tests to be
performed for a patient. Although many physicians, NPPs and clinical
diagnostic laboratories may be aware of, and are able to comply with, this
policy, CMS is concerned that some physicians, NPPs and clinical diagnostic
laboratories are not aware of, or do not understand, this policy. As such,
CMS will focus in the first calendar quarter of 2011 on developing
educational and outreach materials to educate those affected by this
policy. As it becomes available, CMS will post this information on the CMS
Web site and use the other channels available to communicate with providers
to ensure this information is widely distributed. Once the first quarter of
2011 educational campaign is fully underway, CMS will expect requisitions
to be signed.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CCRRD7180?opendocument&utm_source=J1BL&utm_campaign=J1BLs
The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!
****ASH NEWS****
The American Society of Hematology's (AS) Practice Update was published and is available online at http://www.hematology.org/Advocacy/Testimony/2010/6287.aspx. This edition features:
• Stopgap Funding Bill Omits CMS Funding Increase Needed to Implement Health Reform
• CMS Releases 2011 Electronic Prescribing (eRx) Incentive Program Update
• CMS to Host Town Hall Meeting to Discuss PQRS
• Medicare Releases Updates of the Quarterly Average Sales Price (ASP)
****PALMETTO/J1MAC NEWS****
Place of Service Indicator for HCPCS Codes G0339 and G0340
The Pricing Indicator Code on the Alpha-Numeric HCPCS File has been changed
from '00' to '13' for HCPCS codes G0339 and G0340. This change is effective
for services furnished in CY 2006 – CY 2010. While this change was
accurately reflected in the annual published PFS Relative Value Files
beginning in CY 2006, no corresponding change was made to the pricing
indicator on the Alpha-Numeric HCPCS File. The Alpha-Numeric HCPCS File is
being updated to reflect the correct pricing indicator code.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CCQT65222?opendocument&utm_source=J1BL&utm_campaign=J1BLs
January 2011 J1 A/B MAC Medicare Advisory
The January 2011 J1 A/B MAC Medicare Advisory is now available on the J1
Web site. Providers are encouraged to review the information and to share
with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CCH5W2540?opendocument&utm_source=J1BL&utm_campaign=J1BLs
CERT Appeals: Providing Documentation
When services are denied or down-coded by the CERT Review Contractor and an
overpayment is identified, providers are entitled to file a Part B
redetermination request to Palmetto GBA. We are seeing a growing number of
appeals for which the medical records sent by providers and third-party
medical billing companies are missing key components of the documentation
necessary to conduct the review. Prior to filing an appeal, we suggest you
follow the steps listed in this article.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CBPRW2370?opendocument&utm_source=J1BL&utm_campaign=J1BLs
J1 Part B LCDs Revised
The following J1 Part B LCDs have been revised: Cardiac Catheterization,
Diagnostic L28244, Injections- Tendon, Ligament, Ganglion Cyst, Tunnel
Syndromes and Morton’s Neuroma L28271, and Intensity Modulated Radiation
Therapy (IMRT) L28272.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/8CBSNU2143?opendocument
A New Home Health Certification Requirement: Home Health Face-to-Face
Encounter
A new Medicare home health law goes into effect on January 1, 2011, that
affirms the role of the physician as the person who orders home health care
based on personal examination of the patient. Effective in January, a
physician who certifies a patient as eligible for Medicare home health
services must see the patient. The law also allows the requirement to be
satisfied if a non-physician practitioner (NPP) sees the patient, when the
NPP is working for, or in collaboration with, the physician.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CCP295540?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Signatures Required on Requisitions for Clinical Diagnostic Laboratory
Tests: Effective January 1, 2011
Effective January 1, 2011, a physician’s or qualified non-physician
practitioner’s (NPP’s) signature is required on all requisitions for
clinical diagnostic laboratory tests paid under the clinical laboratory fee
schedule. This is a change from previous Medicare guidelines and is
included in the November 29, 2010, Medicare Physician Fee Schedule final
rule. CMS guidelines regarding signatures on requisitions for clinical
diagnostic laboratory tests will be updated soon. Updated information will
be posted on the CMS Web site.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CCRRD7180?opendocument&utm_source=J1BL&utm_campaign=J1BLs
J1 PCC Closed in Observance of the Holidays December 23-24 and December 31,
2010
The J1 Provider Contact Center (PCC) will be closed in observance of the
holidays on December 23, December 24 and December 31, 2010. The PCC will
reopen on Monday, December 27, 2010, at 7 a.m. PT after Christmas and
reopen on Monday, January 3, 2011, at 7 a.m. PT after New Year's Day.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CDNZ38731?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Palmetto GBA Launches Going Beyond Diagnosis Blog
Palmetto GBA launched the Going Beyond Diagnosis blog! Claims denied for
insufficient documentation in medical records? Use the ICF to communicate
treatment plans efficiently. Visit the blog to collaborate with our Medical
Affairs area and share your experiences with the ICF.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8C5JMW3232?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Signatures on Requisitions for Clinical Diagnostic Laboratory Tests
In the November 29, 2010 Medicare Physician Fee Schedule final rule, the
Centers for Medicare & Medicaid Services (CMS) finalized its proposed
policy to require a physician's or qualified non-physician practitioner's
(NPP) signature on requisitions for clinical diagnostic laboratory tests
paid under the clinical laboratory fee schedule effective January 1, 2011.
A requisition is the actual paperwork, such as a form, which is provided to
a clinical diagnostic laboratory that identifies the test or tests to be
performed for a patient. Although many physicians, NPPs and clinical
diagnostic laboratories may be aware of, and are able to comply with, this
policy, CMS is concerned that some physicians, NPPs and clinical diagnostic
laboratories are not aware of, or do not understand, this policy. As such,
CMS will focus in the first calendar quarter of 2011 on developing
educational and outreach materials to educate those affected by this
policy. As it becomes available, CMS will post this information on the CMS
Web site and use the other channels available to communicate with providers
to ensure this information is widely distributed. Once the first quarter of
2011 educational campaign is fully underway, CMS will expect requisitions
to be signed.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CCRRD7180?opendocument&utm_source=J1BL&utm_campaign=J1BLs
The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!
Wednesday, December 22, 2010
Palmetto/J1MAC News
The following information has been received by ANCO.
****PALMETTO/J1MAC NEWS****
Timely Claims Filing Requirement: Important Information
Effective immediately, the Centers for Medicare & Medicaid Services (CMS)
would like to remind Medicare fee-for-service physicians, providers and
suppliers, who are submitting claims to Medicare for payment, all claims
for services furnished on or after January 1, 2010, must be filed with your
Medicare contractor no later than one calendar year (12 months) from the
date of service or Medicare will deny them. This is a result of the Patient
Protection and Affordable Care Act (PPACA).
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8C5UT62660?opendocument&utm_source=J1BL&utm_campaign=J1BLs
J1 Provider Contact Center (PCC) Training and Holiday Closure Schedule for
Fiscal Year 2011
The J1 PCC Training and Holiday Closure Schedule for Fiscal Year 2011 is
now available on our Web site.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8C5QKU5678?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Skilled Nursing Facility and Nursing Facility Reporting of Physician
Consultation Services
If a physician or non-physician practitioner is furnishing that
practitioner’s first E/M service for a Medicare beneficiary in a SNF or NF
during the patient’s facility stay, even if that service is provided prior
to the federally mandated visit, the practitioner may bill the most
appropriate E/M code that reflects the services the practitioner furnished,
whether that code be an initial nursing facility care code or a subsequent
nursing facility care code if documentation and medical necessity do not
meet the requirements for billing an initial nursing facility care code.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8C5SMM5368?opendocument&utm_source=J1BL&utm_campaign=J1BLs
J1 PCC to Close in Observance of the Holidays
The J1 Provider Contact Center (PCC) will be closed in observance of the
Christmas holiday on Thursday, December 23, 2010, and Friday, December 24,
2010. The PCC will reopen on Monday, December 27, 2010, at 7 a.m. PT. The
PCC will also be closed on Friday, December 31, 2010, in observance of New
Year's Day and will reopen on Monday, January 3, 2011, at 7 a.m. PT. Please
share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/8C6KTX6101?opendocument
2011 Coding Update
The 2011 Coding Update contains a wealth of information that will be
helpful to your office. This publication includes information on 2011
additions, deletions and changes for HCPCS, CDT and CPT codes and
modifiers, proper use of modifiers and more.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8C8LMQ2367?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Incorrect Adjustments Impacting Part B Providers in Northern California,
Southern California, Ohio and West Virginia
This article announces that Palmetto GBA recently completed adjustments for
claims that originally processed from September 2, 2008, to October 28,
2010, with HCPCS codes G0181 and G0182. These adjustments incorrectly
canceled the original payment. The adjustments will appear on remittance
advices dated December 14, 2010, through December 20, 2010. The adjusted
claims will have the remark code CO-151, which states: 'Payment adjusted
because the payer deems the information submitted does not support this
many/frequency of services'. Providers will also receive demand letters for
these adjusted claims. Providers are encouraged to review the information
and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8C8SVY1100?opendocument&utm_source=J1BL&utm_campaign=J1BLs
President Obama Signs the Medicare and Medicaid Extenders Act of 2010
On Wednesday, December 15, 2010, President Obama signed into law the
Medicare and Medicaid Extenders Act of 2010 (MMEA). This new law prevents a
scheduled payment cut for physicians who treat Medicare patients from
taking effect. The Centers for Medicare & Medicaid Services (CMS) is
pleased that this law has addressed key issues for beneficiaries and
providers, and we are actively engaged in implementing these changes.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CBLM37813?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Incorrect Adjustments Impacting Part B Providers in Northern California,
Southern California, Ohio and West Virginia
Palmetto GBA has identified a problem with adjustments to some claims for
Care Plan Oversight (HCPCS codes G0181 and G0182). This issue impacts Part
B providers in northern California, southern California, Ohio and West
Virginia only for claims processed from September 2, 2008, through October
28,2010. If you received an overpayment letter for these services issued
during this timef rame, you do not need to take any action. Palmetto GBA
will send corrected notices to all affected providers.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CBMDT3161?opendocument&utm_source=J1BL&utm_campaign=J1BLs
The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!
****PALMETTO/J1MAC NEWS****
Timely Claims Filing Requirement: Important Information
Effective immediately, the Centers for Medicare & Medicaid Services (CMS)
would like to remind Medicare fee-for-service physicians, providers and
suppliers, who are submitting claims to Medicare for payment, all claims
for services furnished on or after January 1, 2010, must be filed with your
Medicare contractor no later than one calendar year (12 months) from the
date of service or Medicare will deny them. This is a result of the Patient
Protection and Affordable Care Act (PPACA).
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8C5UT62660?opendocument&utm_source=J1BL&utm_campaign=J1BLs
J1 Provider Contact Center (PCC) Training and Holiday Closure Schedule for
Fiscal Year 2011
The J1 PCC Training and Holiday Closure Schedule for Fiscal Year 2011 is
now available on our Web site.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8C5QKU5678?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Skilled Nursing Facility and Nursing Facility Reporting of Physician
Consultation Services
If a physician or non-physician practitioner is furnishing that
practitioner’s first E/M service for a Medicare beneficiary in a SNF or NF
during the patient’s facility stay, even if that service is provided prior
to the federally mandated visit, the practitioner may bill the most
appropriate E/M code that reflects the services the practitioner furnished,
whether that code be an initial nursing facility care code or a subsequent
nursing facility care code if documentation and medical necessity do not
meet the requirements for billing an initial nursing facility care code.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8C5SMM5368?opendocument&utm_source=J1BL&utm_campaign=J1BLs
J1 PCC to Close in Observance of the Holidays
The J1 Provider Contact Center (PCC) will be closed in observance of the
Christmas holiday on Thursday, December 23, 2010, and Friday, December 24,
2010. The PCC will reopen on Monday, December 27, 2010, at 7 a.m. PT. The
PCC will also be closed on Friday, December 31, 2010, in observance of New
Year's Day and will reopen on Monday, January 3, 2011, at 7 a.m. PT. Please
share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/8C6KTX6101?opendocument
2011 Coding Update
The 2011 Coding Update contains a wealth of information that will be
helpful to your office. This publication includes information on 2011
additions, deletions and changes for HCPCS, CDT and CPT codes and
modifiers, proper use of modifiers and more.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8C8LMQ2367?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Incorrect Adjustments Impacting Part B Providers in Northern California,
Southern California, Ohio and West Virginia
This article announces that Palmetto GBA recently completed adjustments for
claims that originally processed from September 2, 2008, to October 28,
2010, with HCPCS codes G0181 and G0182. These adjustments incorrectly
canceled the original payment. The adjustments will appear on remittance
advices dated December 14, 2010, through December 20, 2010. The adjusted
claims will have the remark code CO-151, which states: 'Payment adjusted
because the payer deems the information submitted does not support this
many/frequency of services'. Providers will also receive demand letters for
these adjusted claims. Providers are encouraged to review the information
and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8C8SVY1100?opendocument&utm_source=J1BL&utm_campaign=J1BLs
President Obama Signs the Medicare and Medicaid Extenders Act of 2010
On Wednesday, December 15, 2010, President Obama signed into law the
Medicare and Medicaid Extenders Act of 2010 (MMEA). This new law prevents a
scheduled payment cut for physicians who treat Medicare patients from
taking effect. The Centers for Medicare & Medicaid Services (CMS) is
pleased that this law has addressed key issues for beneficiaries and
providers, and we are actively engaged in implementing these changes.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CBLM37813?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Incorrect Adjustments Impacting Part B Providers in Northern California,
Southern California, Ohio and West Virginia
Palmetto GBA has identified a problem with adjustments to some claims for
Care Plan Oversight (HCPCS codes G0181 and G0182). This issue impacts Part
B providers in northern California, southern California, Ohio and West
Virginia only for claims processed from September 2, 2008, through October
28,2010. If you received an overpayment letter for these services issued
during this timef rame, you do not need to take any action. Palmetto GBA
will send corrected notices to all affected providers.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CBMDT3161?opendocument&utm_source=J1BL&utm_campaign=J1BLs
The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!
Subscribe to:
Posts (Atom)