The following information has been received by ANCO.
****ASCO NEWS****
The American Society of Clinical Oncology's (ASCO) Cancer Policy Today was published and is available online at http://view.exacttarget.com/?j=fe54157874620c7b7d11&m=ff311d707460&ls=fdf912757061027e75117274&l=fe5d15747c6d027d7717&s=fe1f15797d620479731d75&jb=ffcf14&ju=fe25167177630d7b731578. ANCO is a state/regional affiliate of ASCO. This edition features:
ASCO Issues Comments on ICD-10 Proposed Regulations
Electronic Prescribing Update
CMS Announces Permanent Recovery Audit Contractors
Federal Court Rules that "Least Costly Alternative" Policy Not Authorized by Medicare Law
Social Security Initiative Will Speed Disability Claims for Patients with Cancer
CMS Issues Instructions on the Compendia for Off-Label Anti-Cancer Drug Coverage
ASCO Urges Against Auditing Consultations
ASCO Holds State Affiliate Leadership Conference
****PALMETTO/J1MAC NEWS****
2008 Web Safari for Medicare Part B Providers– November 3 and 12, 2008
http://www.palmettogba.com/Palmetto/Providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~2008%20Web%20Safari%20for%20Medicare%20Part%20B%20Providers–%20November%203%20and%2012,%202008%20?opendocument
Are you new to Palmetto GBA? Do you want to navigate the Palmetto GBA Web
site like a pro? Plan to join Palmetto GBA for an informative Webinar to
learn more about the features our Web site has to offer and how to use the
site more effectively.
Medicare Improvements for Patients and Providers Act, 2008
http://www.palmettogba.com/Palmetto/Providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~Medicare%20Improvements%20for%20Patients%20and%20Providers%20Act,%202008?opendocument
On July 15, 2008, the Medicare Improvements for Patients and Providers Act
of 2008 was enacted, making changes to the Medicare program. Information
about some of the changes is outlined in this article. CMS will be
implementing other provisions of the legislation in the coming months and
will announce additional information as it becomes available.
Part B LCD Update
http://www.palmettogba.com/Palmetto/Providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Part%20B%20LCD%20Update?opendocument
Click on the link to view the J1 A/B MAC Part B LCDs that have been
revised.
Friday, October 31, 2008
Thursday, October 30, 2008
CMS Issues Compendia-based Off-label Cancer Chemotherapy Instructions
The following information has been received by ANCO.
CMS's instructions to Medicare Fiscal Intermediaries, Carriers and Medicare Administrative Contractors (MACs) regarding Compendia interpretation and application has been released. CR 6191, with an implementation date of November 25, 2008, attempts to clarify for Medicare contractors how to utilize the four authoritative sources of Compendia when granting an approval or denial for a “medically-accepted” indication of a drug or biological used off-label in an anti-cancer chemotherapeutic regimen.
The four approved sources are:
1) American Hospital Formulary Service-Drug Information, existing
2) National Comprehensive Cancer Network Drugs and Biologics Compendium, effective June 5, 2008
3) Thomson Micromedex DrugDex, effective June 10, 2008
4) Clinical Pharmacology, effective July 2, 2008
The complete CMS Compendia Update may be downloaded by clicking on the link: www.cms.hhs.gov/transmittals/downloads/R96BP.pdf
Within the document, CMS instructs:
Contractors shall recognize medically accepted indications as those that:
· are favorably listed in one or more of the compendia listed above, or,
· the contractor determines from a review of the peer-reviewed literature as described above that it is a medically accepted indication, unless CMS has determined that the use is not medically accepted, or any of the listed compendia list the use as not medically accepted, or words to that effect.
CMS is aware that the listed compendia employ various rating and recommendation systems that may not be readily cross-walked from compendium to compendium. In general, a use is identified by a compendium as medically accepted if the:
1) indication is a Category 1 or 2A in NCCN, or Class I, Class IIa, or Class IIb in DrugDex; or,
2) narrative text in AHFS or Clinical Pharmacology is supportive.
A use is not medically accepted by a compendium if the:
1) indication is a Category 3 in NCCN or a Class III in DrugDex; or,
2) narrative text in AHFS or Clinical Pharmacology is “not supportive.”
CMS's instructions to Medicare Fiscal Intermediaries, Carriers and Medicare Administrative Contractors (MACs) regarding Compendia interpretation and application has been released. CR 6191, with an implementation date of November 25, 2008, attempts to clarify for Medicare contractors how to utilize the four authoritative sources of Compendia when granting an approval or denial for a “medically-accepted” indication of a drug or biological used off-label in an anti-cancer chemotherapeutic regimen.
The four approved sources are:
1) American Hospital Formulary Service-Drug Information, existing
2) National Comprehensive Cancer Network Drugs and Biologics Compendium, effective June 5, 2008
3) Thomson Micromedex DrugDex, effective June 10, 2008
4) Clinical Pharmacology, effective July 2, 2008
The complete CMS Compendia Update may be downloaded by clicking on the link: www.cms.hhs.gov/transmittals/downloads/R96BP.pdf
Within the document, CMS instructs:
Contractors shall recognize medically accepted indications as those that:
· are favorably listed in one or more of the compendia listed above, or,
· the contractor determines from a review of the peer-reviewed literature as described above that it is a medically accepted indication, unless CMS has determined that the use is not medically accepted, or any of the listed compendia list the use as not medically accepted, or words to that effect.
CMS is aware that the listed compendia employ various rating and recommendation systems that may not be readily cross-walked from compendium to compendium. In general, a use is identified by a compendium as medically accepted if the:
1) indication is a Category 1 or 2A in NCCN, or Class I, Class IIa, or Class IIb in DrugDex; or,
2) narrative text in AHFS or Clinical Pharmacology is supportive.
A use is not medically accepted by a compendium if the:
1) indication is a Category 3 in NCCN or a Class III in DrugDex; or,
2) narrative text in AHFS or Clinical Pharmacology is “not supportive.”
Wednesday, October 29, 2008
CMS News
The following information has been received by ANCO.
****CMS NEWS****
The revised Medicare Physician Guide: A Resource for Residents, Practicing Physicians, and Other Health Care Professionals (October 2008), which offers general information about the Medicare Program, becoming a Medicare provider or supplier, Medicare reimbursement, Medicare payment policies, evaluation and management services, protecting the Medicare Trust Fund, inquiries, overpayments, and appeals, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/physicianguide.pdf.
****CMS NEWS****
The revised Medicare Physician Guide: A Resource for Residents, Practicing Physicians, and Other Health Care Professionals (October 2008), which offers general information about the Medicare Program, becoming a Medicare provider or supplier, Medicare reimbursement, Medicare payment policies, evaluation and management services, protecting the Medicare Trust Fund, inquiries, overpayments, and appeals, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/physicianguide.pdf.
Tuesday, October 28, 2008
ACCC, ASCO, & CMA News
The following information has been received by ANCO.
****ACCC NEWS****
The Association of Community Cancer Center's (ACCC) This Week at ACCC was published and is available at http://www.accc-cancer.org/mediaroom/newsletters/media_ACCCNEWSLETTER_10-27-2008.html. ANCO is an Institutional Member of ACCC. This edition features:
CMS Releases Guidance on Use of Drug Compendia
Limited Space Available at ACCC's Highly Acclaimed Hospital Summit
CMS Updates Data on Medicare Outpatient Payments to Hospitals
NCI Online Research Portfolio Offers More Information, New Tools
Medicare Reimbursement for New FDA-Approved Drugs
Credit Woes Catching up with Radiation-Oncology Firms
Regional Oncology Symposia Coming to Tampa and Philadelphia
Call for Nominations for ACCC's Board
Welcome Aboard to ACCC's Newest Members
Q&A on ACCC's Listserv: Uninsured Patients; Exercise Programs
ACCC's CE Blackboard: Upcoming Video-Webcast on CML
One in Four Teenage Girls Receives HPV Vaccine
Survey: Chemotherapy Dosing in Obese Patients
State Medical Oncology Societies Host Upcoming Meetings
****ASCO NEWS****
The American Society Clinical Oncology's (ASCO) e-News was published and is available at http://view.exacttarget.com/?j=fe6015787460057e711d&m=ff2d16787160&ls=fdf012777067017f71167870&l=fe5a1575746c027b7112&s=fdf2157972640d79751d7073&jb=ffcf14&ju=fe2a167177610774771c75. ANCO is a state/regional affiliate of ASCO. This edition features:
Voting Now Open for 2009 ASCO Election
Slide Revision: 2008 Annual Meeting Plenary Session
Frosted Pink with a Twist Raises Cancer Awareness Nationwide
Apply Now for 2009 Translational Research Professorship
Apply Now for the 2009 Susan G. Komen for the Cure®/ASCO Loan Repayment Program
ASCO Launches First MOC Module
Register and Reserve Housing for the 2009 Genitourinary Cancers Symposium
Register and Reserve Housing for 2009 Gastrointestinal Cancers Symposium
Members-Only Housing Open for 2009 ASCO Annual Meeting
Submit an Abstract for the 2009 ASCO Annual Meeting
Accepting Applications for 2009 ASCO State Affiliate Grants
Accepting Applications for 2009 IDEA Grant
Presentations from 2008 Annual Meeting Available at No Cost
Annual Meeting Summaries Available on ASCO.org
Video Podcasts from the 2008 Breast Cancer Symposium Now Available
Deadline Approaching for CDA and YIA Grants
Apply for 2009 ACRA in Breast Cancer or 2009 ACRA in Glioma
Cancer Policy Alert: ASCO and Komen for the Cure Announce Diversity in Oncology Initiative, CMS Announces Permanent Recovery Audit Contractors, OIG Issues 2009 Work Plan
For Your Patients: Latest Cancer.Net Feature Discusses Proton Therapy
Cancer.Net Podcasts: Pap Test - What to Expect
What's New in JCO: Early Release Articles Published
See What's Coming Up in JCO
****CMA NEWS****
The California Medical Association's (CMA) Alert was published and is available at http://www.calphys.org/html/news.asp. This edition features:
HHS Proposes Move to ICD-10 by 2011
Please Tell Us About Your Medicare Payment Problems
CMA Objects to FTC Interpretation of “Red Flag” Identity Theft Rules
Balance Billing Regs Apply to Care Provided on or After October 15
Subscribe to CMA’s Press Clips
Member Benefit of the Week: 6% off athenaCollector
****ACCC NEWS****
The Association of Community Cancer Center's (ACCC) This Week at ACCC was published and is available at http://www.accc-cancer.org/mediaroom/newsletters/media_ACCCNEWSLETTER_10-27-2008.html. ANCO is an Institutional Member of ACCC. This edition features:
CMS Releases Guidance on Use of Drug Compendia
Limited Space Available at ACCC's Highly Acclaimed Hospital Summit
CMS Updates Data on Medicare Outpatient Payments to Hospitals
NCI Online Research Portfolio Offers More Information, New Tools
Medicare Reimbursement for New FDA-Approved Drugs
Credit Woes Catching up with Radiation-Oncology Firms
Regional Oncology Symposia Coming to Tampa and Philadelphia
Call for Nominations for ACCC's Board
Welcome Aboard to ACCC's Newest Members
Q&A on ACCC's Listserv: Uninsured Patients; Exercise Programs
ACCC's CE Blackboard: Upcoming Video-Webcast on CML
One in Four Teenage Girls Receives HPV Vaccine
Survey: Chemotherapy Dosing in Obese Patients
State Medical Oncology Societies Host Upcoming Meetings
****ASCO NEWS****
The American Society Clinical Oncology's (ASCO) e-News was published and is available at http://view.exacttarget.com/?j=fe6015787460057e711d&m=ff2d16787160&ls=fdf012777067017f71167870&l=fe5a1575746c027b7112&s=fdf2157972640d79751d7073&jb=ffcf14&ju=fe2a167177610774771c75. ANCO is a state/regional affiliate of ASCO. This edition features:
Voting Now Open for 2009 ASCO Election
Slide Revision: 2008 Annual Meeting Plenary Session
Frosted Pink with a Twist Raises Cancer Awareness Nationwide
Apply Now for 2009 Translational Research Professorship
Apply Now for the 2009 Susan G. Komen for the Cure®/ASCO Loan Repayment Program
ASCO Launches First MOC Module
Register and Reserve Housing for the 2009 Genitourinary Cancers Symposium
Register and Reserve Housing for 2009 Gastrointestinal Cancers Symposium
Members-Only Housing Open for 2009 ASCO Annual Meeting
Submit an Abstract for the 2009 ASCO Annual Meeting
Accepting Applications for 2009 ASCO State Affiliate Grants
Accepting Applications for 2009 IDEA Grant
Presentations from 2008 Annual Meeting Available at No Cost
Annual Meeting Summaries Available on ASCO.org
Video Podcasts from the 2008 Breast Cancer Symposium Now Available
Deadline Approaching for CDA and YIA Grants
Apply for 2009 ACRA in Breast Cancer or 2009 ACRA in Glioma
Cancer Policy Alert: ASCO and Komen for the Cure Announce Diversity in Oncology Initiative, CMS Announces Permanent Recovery Audit Contractors, OIG Issues 2009 Work Plan
For Your Patients: Latest Cancer.Net Feature Discusses Proton Therapy
Cancer.Net Podcasts: Pap Test - What to Expect
What's New in JCO: Early Release Articles Published
See What's Coming Up in JCO
****CMA NEWS****
The California Medical Association's (CMA) Alert was published and is available at http://www.calphys.org/html/news.asp. This edition features:
HHS Proposes Move to ICD-10 by 2011
Please Tell Us About Your Medicare Payment Problems
CMA Objects to FTC Interpretation of “Red Flag” Identity Theft Rules
Balance Billing Regs Apply to Care Provided on or After October 15
Subscribe to CMA’s Press Clips
Member Benefit of the Week: 6% off athenaCollector
Thursday, October 23, 2008
ASH, CMS, & NCI News
The following information has been received by ANCO.
****ASH NEWS****
The American Society of Hematology's (ASH) Practice Update was published and is available at http://www.hematology.org/policy/practice/10232008.cfm#1. It features:
Medicare Provides Guidance to Healthcare Professionals on New E-prescribing Initiative
Presidential Candidates Share Views on Health Issues
MedPAC Considers Recommendations on Public Reporting of Physician's Financial Interests
AMA Releases Guide to Help Physicians Select Health Information Technology Systems
ASH Practice Forum: The Patient, the Hematologist, and the Unexpected
Save the date – or dates – for Highlights of ASH®
****CMS NEWS****
MM6093 – National Provider Identifier (NPI) for Secondary Providers
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6093.pdf
***NCI NEWS***
NCI’s Office of Advocacy Relations will host its next Understanding NCI: Toll-Free Teleconference on “NCI’s Cancer Information Service: Reaching the Community with Evidence-Based Resources” on Wednesday, October 29 from 2:00–3:00 p.m., ET. The featured speakers will be Ms. Mary Anne Bright, Associate Director of NCI’s Office of Public Information and Resource Management, Ms. Lenora Johnson, Director, Office of Communications and Education, and Ms. Carolyn Messner, Director of Education and Training at CancerCare. A question and answer session for participants will follow their presentations.
No registration is required for participation. To join the teleconference, dial toll-free 800-857-6584; the passcode is: CIS. Toll-free playback will be available through November 29 at 800-216-6079. For more information about the Understanding NCI Teleconference Series and to learn about past teleconferences, go to: http://advocacy.cancer.gov/.
****ASH NEWS****
The American Society of Hematology's (ASH) Practice Update was published and is available at http://www.hematology.org/policy/practice/10232008.cfm#1. It features:
Medicare Provides Guidance to Healthcare Professionals on New E-prescribing Initiative
Presidential Candidates Share Views on Health Issues
MedPAC Considers Recommendations on Public Reporting of Physician's Financial Interests
AMA Releases Guide to Help Physicians Select Health Information Technology Systems
ASH Practice Forum: The Patient, the Hematologist, and the Unexpected
Save the date – or dates – for Highlights of ASH®
****CMS NEWS****
MM6093 – National Provider Identifier (NPI) for Secondary Providers
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6093.pdf
***NCI NEWS***
NCI’s Office of Advocacy Relations will host its next Understanding NCI: Toll-Free Teleconference on “NCI’s Cancer Information Service: Reaching the Community with Evidence-Based Resources” on Wednesday, October 29 from 2:00–3:00 p.m., ET. The featured speakers will be Ms. Mary Anne Bright, Associate Director of NCI’s Office of Public Information and Resource Management, Ms. Lenora Johnson, Director, Office of Communications and Education, and Ms. Carolyn Messner, Director of Education and Training at CancerCare. A question and answer session for participants will follow their presentations.
No registration is required for participation. To join the teleconference, dial toll-free 800-857-6584; the passcode is: CIS. Toll-free playback will be available through November 29 at 800-216-6079. For more information about the Understanding NCI Teleconference Series and to learn about past teleconferences, go to: http://advocacy.cancer.gov/.
Wednesday, October 22, 2008
CMS, Palmetto/J1MAC, & DHCS/MediCal News
The following information has been received by ANCO.
****CMS NEWS****
The ICD-10-Clinical Modification/Procedure Coding System Fact Sheet, which provides general information about the International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) including benefits of adopting the new coding system, structural differences between ICD-9 CM and ICD-10-CM/PCS, and implementation planning recommendations, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/ICD-10factsheet2008.pdf .
****PALMETTO/J1MAC NEWS****
CMS Announces Updates to the Physician Quality Reporting Initiative Web
page
http://www.palmettogba.com/palmetto/Providers.nsf/DocsCat/Providers~Current%20News~CMS%20Announces%20Updates%20to%20the%20Physician%20Quality%20Reporting%20Initiative%20Web%20page?opendocument
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce a
new E-Prescribing Incentive Program section page on the Physician Quality
Reporting Initiative (PQRI) Web page at
www.cms.hhs.gov/pqri/03_EPrescribingIncentiveProgram.asp#TopOfPage on the
CMS website. This new section page will provide information about the new
E-Prescribing incentive program that was authorized by the Medicare
Improvements for Patients and Providers Act of 2008 (MIPPA).
ICD-10-CM/PCS National Provider Conference Call for Other Part A and Part B
Providers
http://www.palmettogba.com/palmetto/Providers.nsf/DocsCat/Providers~Current%20News~ICD-10-CMPCS%20National%20Provider%20Conference%20Call%20for%20Other%20Part%20A%20and%20Part%20B%20Providers?opendocument
Other Part A and Part B providers may now register for the Centers for
Medicare & Medicaid Services ICD-10-CM/PCS National Provider Conference
Call that will be conducted on November 12, 2008 from 12:30 p.m. - 2:30
p.m. EST. To register for this call, go to
http://www.cms.hhs.gov/icd10/Downloads/ICD10_otherproviders.pdf. To find
additional information about this conference call and to access the ICD-10
Overview Presentation that will be discussed during the call, go to
http://www.cms.hhs.gov/ICD10/07_Sponsored_Calls.asp.
Medicare Fee-for-Service Professional Providers and Suppliers: Version 2.5
of the MREP Software Available for Download
http://www.palmettogba.com/palmetto/Providers.nsf/DocsCat/Providers~Current%20News~Medicare%20Fee-for-Service%20Professional%20Providers%20and%20Suppliers:%20Version%202.5%20of%20the%20MREP%20Software%20Available%20for%20Download%20?opendocument
Version 2.5 of the MREP software is available for download at
http://www.cms.hhs.gov/AccesstoDataApplication/02_MedicareRemitEasyPrint.asp
on the CMS Web site. For a description of the changes in this version,
see the "What's New" section of the MREP User Guide - Version 2.5 at
http://www.cms.hhs.gov/AccesstoDataApplication/Downloads/EasyPrintUserGuide.pdf.
Please note: The latest Codes.ini file is now available. This file is
necessary when the MREP software is distributed.
NPPES - Keeping It Safe and Keeping it Updated
http://www.palmettogba.com/palmetto/Providers.nsf/DocsCat/Providers~Current%20News~NPPES%20-%20Keeping%20It%20Safe%20and%20Keeping%20it%20Updated?opendocument
This message is for healthcare providers, particularly physicians and other
practitioners, who have obtained National Provider Identifiers (NPIs) and
have records in the National Plan and Provider Enumeration System (NPPES).
Provider Enrollment Application Status Lookup Tool
http://www.palmettogba.com/palmetto/Providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~Provider%20Enrollment~Provider%20Enrollment%20Application%20Status%20Lookup%20Tool?opendocument
To assist J1 providers in obtaining the status of their enrollment
applications, we are pleased to announce a new provider self-service tool.
The Provider Enrollment Application Status Lookup tool will be located on
the Palmetto GBA J1 Part B Web site, www.Palmettogba.com/J1B/Enroll, under
Resources/Provider Enrollment and under Tools and Top Links at
www.PalmettoGBA.com/J1B: http://www.palmettogba.com/palmetto/IVR.nsf
The ICD-10 Clinical Modification/Procedure Coding System (CM/PCS) - The
Next Generation of Coding
http://www.palmettogba.com/palmetto/Providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~The%20ICD-10%20Clinical%20ModificationProcedure%20Coding%20System%20(CMPCS)%20-%20The%20Next%20Generation%20of%20Coding?opendocument
Note: This article was revised on October 9, 2008, to update the Web site
addresses and other information in the “Additional Information” section of
this article. All other information remains the same.
Your Clearinghouse or Billing Service Can Help with your J1 EDI Issues
http://www.palmettogba.com/palmetto/Providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20A~EDI~General~Your%20Clearinghouse%20or%20Billing%20Service%20Can%20Help%20with%20your%20J1%20EDI%20Issues?opendocument
Important information for J1 EDI Submitters - Providers, Clearinghouses and
Billing Services - regarding the EDI process. Please read this information
prior to contacting the Palmetto GBA Technology Support Center.
2008 Web Safari for Medicare Part B Providers – October 29, 2008
http://www.palmettogba.com/palmetto/Providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~2008%20Web%20Safari%20for%20Medicare%20Part%20B%20Providers%20–%20October%2029,%202008?opendocument
Are you new to Palmetto GBA? Do you want to navigate the Palmetto GBA Web
site like a pro? Plan to join Palmetto GBA for an informative Webinar to
learn more about the features our Web site has to offer and how to use the
site more effectively.
****DHCS/MEDI-CAL NEWS****
Effective November 1, 2008, providers must enter their Medi-Cal registered National Provider Identifier (NPI) numbers on all Treatment Authorization Requests(TARs). Providers were notified in the September Medi-Cal Update that all Medi-Cal legacy numbers would be end-dated effective October 1, 2008. As a result, the TAR system can no longer accept Medi-Cal legacy numbers; therefore, TARs submitted with a legacy number will not be processed.
NPI numbers that are successfully registered with the Department of Health Care Services (DHCS) Provider Enrollment Division (PED) can be used for all past and future dates of service.
Questions regarding the NPI number registration process can be directed to the Telephone Service Center (TSC) at 1-800-541-5555.
Rendering Medi-Cal providers must register their National Provider Identifier (NPI) using their individual Medi-Cal provider numbers. Each member of a provider group must register their individual NPI separately from the group’s NPI. A provider group may register an individual provider’s NPI on their behalf, but the group must ensure that it uses the correct NPI and Medi-Cal provider number.
Rendering providers can register their NPI using the NPIC tool (http://files.medi-cal.ca.gov/pubsdoco/npi/npi_reginfo.asp). After reviewing the important information on the “Register/Update/Inquire NPIs” page, providers can click the “Continue to Register/Update/Inquire NPIs” button at the bottom of the page to complete the NPI registration.
Rendering providers can also submit the National Provider Identifier Registration Form (http://files.medi-cal.ca.gov/pubsdoco/provappsenroll/16enrollment_DHCS6218.pdf (DHCS 6218) to register their NPI. After completing the required information, return the form with the National Plan and Provider Enumeration System (NPPES) verification document to the address shown at the bottom of the form.
The NPIC tool and the National Provider Identifier Registration Form (DHCS 6218) may only be used to register an NPI when the initial NPI registration has not been completed. If a rendering provider’s NPI is already registered, then a Medi-Cal Supplemental Changes (http://files.medi-cal.ca.gov/pubsdoco/provappsenroll/10enrollment_DHCS6209.pdf) (DHCS 6209) form must be completed and submitted to Provider Enrollment Division (PED) for any NPI-related updates.
Providers can call the Telephone Service Center (TSC) at 1-800-541-5555 by choosing option 16 and then option 18 to obtain forms, ask questions about NPI registration or verify a rendering provider’s registration status.
****CMS NEWS****
The ICD-10-Clinical Modification/Procedure Coding System Fact Sheet, which provides general information about the International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) including benefits of adopting the new coding system, structural differences between ICD-9 CM and ICD-10-CM/PCS, and implementation planning recommendations, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/ICD-10factsheet2008.pdf .
****PALMETTO/J1MAC NEWS****
CMS Announces Updates to the Physician Quality Reporting Initiative Web
page
http://www.palmettogba.com/palmetto/Providers.nsf/DocsCat/Providers~Current%20News~CMS%20Announces%20Updates%20to%20the%20Physician%20Quality%20Reporting%20Initiative%20Web%20page?opendocument
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce a
new E-Prescribing Incentive Program section page on the Physician Quality
Reporting Initiative (PQRI) Web page at
www.cms.hhs.gov/pqri/03_EPrescribingIncentiveProgram.asp#TopOfPage on the
CMS website. This new section page will provide information about the new
E-Prescribing incentive program that was authorized by the Medicare
Improvements for Patients and Providers Act of 2008 (MIPPA).
ICD-10-CM/PCS National Provider Conference Call for Other Part A and Part B
Providers
http://www.palmettogba.com/palmetto/Providers.nsf/DocsCat/Providers~Current%20News~ICD-10-CMPCS%20National%20Provider%20Conference%20Call%20for%20Other%20Part%20A%20and%20Part%20B%20Providers?opendocument
Other Part A and Part B providers may now register for the Centers for
Medicare & Medicaid Services ICD-10-CM/PCS National Provider Conference
Call that will be conducted on November 12, 2008 from 12:30 p.m. - 2:30
p.m. EST. To register for this call, go to
http://www.cms.hhs.gov/icd10/Downloads/ICD10_otherproviders.pdf. To find
additional information about this conference call and to access the ICD-10
Overview Presentation that will be discussed during the call, go to
http://www.cms.hhs.gov/ICD10/07_Sponsored_Calls.asp.
Medicare Fee-for-Service Professional Providers and Suppliers: Version 2.5
of the MREP Software Available for Download
http://www.palmettogba.com/palmetto/Providers.nsf/DocsCat/Providers~Current%20News~Medicare%20Fee-for-Service%20Professional%20Providers%20and%20Suppliers:%20Version%202.5%20of%20the%20MREP%20Software%20Available%20for%20Download%20?opendocument
Version 2.5 of the MREP software is available for download at
http://www.cms.hhs.gov/AccesstoDataApplication/02_MedicareRemitEasyPrint.asp
on the CMS Web site. For a description of the changes in this version,
see the "What's New" section of the MREP User Guide - Version 2.5 at
http://www.cms.hhs.gov/AccesstoDataApplication/Downloads/EasyPrintUserGuide.pdf.
Please note: The latest Codes.ini file is now available. This file is
necessary when the MREP software is distributed.
NPPES - Keeping It Safe and Keeping it Updated
http://www.palmettogba.com/palmetto/Providers.nsf/DocsCat/Providers~Current%20News~NPPES%20-%20Keeping%20It%20Safe%20and%20Keeping%20it%20Updated?opendocument
This message is for healthcare providers, particularly physicians and other
practitioners, who have obtained National Provider Identifiers (NPIs) and
have records in the National Plan and Provider Enumeration System (NPPES).
Provider Enrollment Application Status Lookup Tool
http://www.palmettogba.com/palmetto/Providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~Provider%20Enrollment~Provider%20Enrollment%20Application%20Status%20Lookup%20Tool?opendocument
To assist J1 providers in obtaining the status of their enrollment
applications, we are pleased to announce a new provider self-service tool.
The Provider Enrollment Application Status Lookup tool will be located on
the Palmetto GBA J1 Part B Web site, www.Palmettogba.com/J1B/Enroll, under
Resources/Provider Enrollment and under Tools and Top Links at
www.PalmettoGBA.com/J1B: http://www.palmettogba.com/palmetto/IVR.nsf
The ICD-10 Clinical Modification/Procedure Coding System (CM/PCS) - The
Next Generation of Coding
http://www.palmettogba.com/palmetto/Providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~The%20ICD-10%20Clinical%20ModificationProcedure%20Coding%20System%20(CMPCS)%20-%20The%20Next%20Generation%20of%20Coding?opendocument
Note: This article was revised on October 9, 2008, to update the Web site
addresses and other information in the “Additional Information” section of
this article. All other information remains the same.
Your Clearinghouse or Billing Service Can Help with your J1 EDI Issues
http://www.palmettogba.com/palmetto/Providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20A~EDI~General~Your%20Clearinghouse%20or%20Billing%20Service%20Can%20Help%20with%20your%20J1%20EDI%20Issues?opendocument
Important information for J1 EDI Submitters - Providers, Clearinghouses and
Billing Services - regarding the EDI process. Please read this information
prior to contacting the Palmetto GBA Technology Support Center.
2008 Web Safari for Medicare Part B Providers – October 29, 2008
http://www.palmettogba.com/palmetto/Providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~2008%20Web%20Safari%20for%20Medicare%20Part%20B%20Providers%20–%20October%2029,%202008?opendocument
Are you new to Palmetto GBA? Do you want to navigate the Palmetto GBA Web
site like a pro? Plan to join Palmetto GBA for an informative Webinar to
learn more about the features our Web site has to offer and how to use the
site more effectively.
****DHCS/MEDI-CAL NEWS****
Effective November 1, 2008, providers must enter their Medi-Cal registered National Provider Identifier (NPI) numbers on all Treatment Authorization Requests(TARs). Providers were notified in the September Medi-Cal Update that all Medi-Cal legacy numbers would be end-dated effective October 1, 2008. As a result, the TAR system can no longer accept Medi-Cal legacy numbers; therefore, TARs submitted with a legacy number will not be processed.
NPI numbers that are successfully registered with the Department of Health Care Services (DHCS) Provider Enrollment Division (PED) can be used for all past and future dates of service.
Questions regarding the NPI number registration process can be directed to the Telephone Service Center (TSC) at 1-800-541-5555.
Rendering Medi-Cal providers must register their National Provider Identifier (NPI) using their individual Medi-Cal provider numbers. Each member of a provider group must register their individual NPI separately from the group’s NPI. A provider group may register an individual provider’s NPI on their behalf, but the group must ensure that it uses the correct NPI and Medi-Cal provider number.
Rendering providers can register their NPI using the NPIC tool (http://files.medi-cal.ca.gov/pubsdoco/npi/npi_reginfo.asp). After reviewing the important information on the “Register/Update/Inquire NPIs” page, providers can click the “Continue to Register/Update/Inquire NPIs” button at the bottom of the page to complete the NPI registration.
Rendering providers can also submit the National Provider Identifier Registration Form (http://files.medi-cal.ca.gov/pubsdoco/provappsenroll/16enrollment_DHCS6218.pdf (DHCS 6218) to register their NPI. After completing the required information, return the form with the National Plan and Provider Enumeration System (NPPES) verification document to the address shown at the bottom of the form.
The NPIC tool and the National Provider Identifier Registration Form (DHCS 6218) may only be used to register an NPI when the initial NPI registration has not been completed. If a rendering provider’s NPI is already registered, then a Medi-Cal Supplemental Changes (http://files.medi-cal.ca.gov/pubsdoco/provappsenroll/10enrollment_DHCS6209.pdf) (DHCS 6209) form must be completed and submitted to Provider Enrollment Division (PED) for any NPI-related updates.
Providers can call the Telephone Service Center (TSC) at 1-800-541-5555 by choosing option 16 and then option 18 to obtain forms, ask questions about NPI registration or verify a rendering provider’s registration status.
Tuesday, October 21, 2008
ACCC & Palmetto/J1MAC News
The following information has been received by ANCO.
All ANCO Online LIstServ postings are archived at the ANCO Online ListSev blog available at http://anco-online.blogspot.com/.
****ACCC NEWS****
The Association of Community Cancer Center's (ACCC) This Week at ACCC was published and is available at http://www.accc-cancer.org/mediaroom/newsletters/media_ACCCNEWSLETTER_10-20-2008.html. ANCO is an Institutional Member of ACCC.
This edition features:
CMS Announces RAC Program Details
ACCC's Highly Acclaimed Hospital Summit: Portable and Practical Information
Strategic Planning for Hospital Cancer Programs: Vision Matters
FDA Launches Updated Website of Approved/Unapproved Drugs
Regional Oncology Symposia Coming to Tampa and Philadelphia
Call for Nominations for ACCC's Board
FDA Grants Full Approval to Ontak for Cutaneous T-Cell Lymphoma
Q&A on ACCC's Listserv: Downsizing Your Linacs
ACCC's CE Blackboard: Upcoming Video-Webcast on CML
RTOG and US Oncology Announce Collaboration
Survey: Chemotherapy Dosing in Obese Patients
State Medical Oncology Societies Host Upcoming Meetings
****PALMETTO/J1MAC NEWS****
Availability of an Interim Study of Alternative Payment Localities Under
the Medicare Physician Fee Schedule
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Current%20News~Availability%20of%20an%20Interim%20Study%20of%20Alternative%20Payment%20Localities%20Under%20the%20Medicare%20Physician%20Fee%20Schedule?opendocument
Medicare is statutorily required to adjust payments for physician fee
schedule services to account for differences in costs due to geographic
location. There are currently 89 different localities which have not been
revised since 1997. In the CY 2009 Physician Fee Schedule notice of
proposed rulemaking which was released on June 30, 2008, we indicated that
we would post on the CMS website a preliminary study of several options for
revising the payment localities. The report entitled: "Review of
Alternative GPCI Payment Locality Structures", which was produced by
Acumen, LLC under contract to CMS, may currently be found at the following
link:
http://www.cms.hhs.gov/PhysicianFeeSched/downloads/ReviewOfAltGPCIs.pdf.
Provider Enrollment Application Status Lookup Tool
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~Provider%20Enrollment~Provider%20Enrollment%20Application%20Status%20Lookup%20Tool?opendocument
To assist J1 providers in obtaining the status of their enrollment
applications, we are pleased to announce a new provider self-service tool.
The Provider Enrollment Application Status Lookup tool will be located on
the Palmetto GBA J1 Part B Web site, www.Palmettogba.com/J1B/Enroll, under
Resources/Provider Enrollment and under Tools and Top Links at
www.PalmettoGBA.com/J1B
Upcoming Training for the Medicare Part B Drugs Competitive Acquisition
Program (CAP)
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Current%20News~Upcoming%20Training%20for%20the%20Medicare%20Part%20B%20Drugs%20Competitive%20Acquisition%20Program%20(CAP)?opendocument
Noridian Administrative Services, the designated carrier for the CAP,
offers interactive, online workshops about the CAP for Part B Drugs and
Biologicals. These workshops train CAP vendors and elected physicians on a
variety of CAP topics, including how to transition out of the CAP at the
end of 2008 due to the postponement of the program for 2009. NAS staff
will also be available to answer questions. Interested parties may view
additional information about and register for these workshops on the
Noridian Web site at:
https://www.noridianmedicare.com/cap_drug/train/schedule.html
All ANCO Online LIstServ postings are archived at the ANCO Online ListSev blog available at http://anco-online.blogspot.com/.
****ACCC NEWS****
The Association of Community Cancer Center's (ACCC) This Week at ACCC was published and is available at http://www.accc-cancer.org/mediaroom/newsletters/media_ACCCNEWSLETTER_10-20-2008.html. ANCO is an Institutional Member of ACCC.
This edition features:
CMS Announces RAC Program Details
ACCC's Highly Acclaimed Hospital Summit: Portable and Practical Information
Strategic Planning for Hospital Cancer Programs: Vision Matters
FDA Launches Updated Website of Approved/Unapproved Drugs
Regional Oncology Symposia Coming to Tampa and Philadelphia
Call for Nominations for ACCC's Board
FDA Grants Full Approval to Ontak for Cutaneous T-Cell Lymphoma
Q&A on ACCC's Listserv: Downsizing Your Linacs
ACCC's CE Blackboard: Upcoming Video-Webcast on CML
RTOG and US Oncology Announce Collaboration
Survey: Chemotherapy Dosing in Obese Patients
State Medical Oncology Societies Host Upcoming Meetings
****PALMETTO/J1MAC NEWS****
Availability of an Interim Study of Alternative Payment Localities Under
the Medicare Physician Fee Schedule
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Current%20News~Availability%20of%20an%20Interim%20Study%20of%20Alternative%20Payment%20Localities%20Under%20the%20Medicare%20Physician%20Fee%20Schedule?opendocument
Medicare is statutorily required to adjust payments for physician fee
schedule services to account for differences in costs due to geographic
location. There are currently 89 different localities which have not been
revised since 1997. In the CY 2009 Physician Fee Schedule notice of
proposed rulemaking which was released on June 30, 2008, we indicated that
we would post on the CMS website a preliminary study of several options for
revising the payment localities. The report entitled: "Review of
Alternative GPCI Payment Locality Structures", which was produced by
Acumen, LLC under contract to CMS, may currently be found at the following
link:
http://www.cms.hhs.gov/PhysicianFeeSched/downloads/ReviewOfAltGPCIs.pdf.
Provider Enrollment Application Status Lookup Tool
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~Provider%20Enrollment~Provider%20Enrollment%20Application%20Status%20Lookup%20Tool?opendocument
To assist J1 providers in obtaining the status of their enrollment
applications, we are pleased to announce a new provider self-service tool.
The Provider Enrollment Application Status Lookup tool will be located on
the Palmetto GBA J1 Part B Web site, www.Palmettogba.com/J1B/Enroll, under
Resources/Provider Enrollment and under Tools and Top Links at
www.PalmettoGBA.com/J1B
Upcoming Training for the Medicare Part B Drugs Competitive Acquisition
Program (CAP)
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Current%20News~Upcoming%20Training%20for%20the%20Medicare%20Part%20B%20Drugs%20Competitive%20Acquisition%20Program%20(CAP)?opendocument
Noridian Administrative Services, the designated carrier for the CAP,
offers interactive, online workshops about the CAP for Part B Drugs and
Biologicals. These workshops train CAP vendors and elected physicians on a
variety of CAP topics, including how to transition out of the CAP at the
end of 2008 due to the postponement of the program for 2009. NAS staff
will also be available to answer questions. Interested parties may view
additional information about and register for these workshops on the
Noridian Web site at:
https://www.noridianmedicare.com/cap_drug/train/schedule.html
Sunday, October 19, 2008
Palmetto/J1MAC News
The following information has been received by ANCO.
****PALMETTO/J1MAC NEWS****
Notice of New Interest Rate for Medicare Overpayments & Underpayments: 1st
Update for FY 2009
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~South%20Carolina%20Part%20B%20Carrier~Articles~General~Notice%20of%20New%20Interest%20Rate%20for%20Medicare%20Overpayments%20Underpayments:%201st%20Update%20for%20FY%202009%20?opendocument
The Department of the Treasury has notified the Department of Health and
Human Services that the private consumer rate has been changed to 11.375%
effective October 22, 2008.
****PALMETTO/J1MAC NEWS****
Notice of New Interest Rate for Medicare Overpayments & Underpayments: 1st
Update for FY 2009
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~South%20Carolina%20Part%20B%20Carrier~Articles~General~Notice%20of%20New%20Interest%20Rate%20for%20Medicare%20Overpayments%20Underpayments:%201st%20Update%20for%20FY%202009%20?opendocument
The Department of the Treasury has notified the Department of Health and
Human Services that the private consumer rate has been changed to 11.375%
effective October 22, 2008.
Friday, October 17, 2008
CMS News
The following information has been received by ANCO.
****CMS NEWS****
The Centers for Medicare & Medicaid Services (CMS) recommends that each health care provider, including individual physicians and non-physician practitioners:
• Know and maintain their NPPES User Ids and passwords.
• Reset their NPPES passwords at least once a year. See the NPPES Application Help page regarding the ‘Reset Password’ rules. Those rules indicate the length, format, content and requirements of NPPES passwords.
• Review their NPPES records in order to ensure that the information reflects current and correct information.
Maintaining NPPES Account Information for Safety and Accessibility
Health care providers, including physicians and non-physician practitioners, should maintain their own NPPES account information (i.e., User ID, Password, and Secret Question/Answer) for safety and accessibility purposes.
Viewing NPPES Information
Health care providers, including physicians and non-physician practitioners, can view their NPPES information in one of two ways:
(1) By accessing the NPPES record at https://nppes.cms.hhs.gov/NPPES/Welcome.do and following the NPI hyperlink and selecting Login. The user will be prompted to enter the User ID and password that he/she previously created. *
* If the health care provider has forgotten the password, enter the User ID and click the “Reset Forgotten Password” button to navigate to the Reset Password Page. If the health care provider enters an incorrect User ID and Password combination three times, the User ID will be disabled. Please contact the NPI Enumerator at 1-800-465-3203 if the account is disabled or if the health care provider has forgotten the User ID.
OR
(2) By accessing the NPI Registry at https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do. The NPI Registry gives the health care provider an online view of Freedom of Information Act (FOIA)-disclosable NPPES data. The health care provider can search for its information using the name or NPI as the criterion.
Updating NPPES Information
Health care providers, including physicians and non-physician practitioners, can correct, add, or delete information in their NPPES records by accessing their NPPES records at https://nppes.cms.hhs.gov/NPPES/Welcome.do and following the NPI hyperlink and selecting Login. The user will be prompted to enter the User ID and password that he/she previously created.
Please note: Required information cannot be deleted from an NPPES record; however, required information can be changed/updated to ensure that NPPES captures the correct information. Certain information is inaccessible via the web, thus requiring the change/update to be made via paper application. The paper NPI Application/Update Form can be downloaded and printed at http://www.cms.hhs.gov/cmsforms/downloads/CMS10114.pdf.
Need More Information?
Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203. Having trouble viewing any of the URLs in this message? If so, try to cut and paste any URL in this message into your web browser to view the intended information.
Note: All current and past CMS NPI communications are available by clicking "CMS Communications" in the left column of the www.cms.hhs.gov/NationalProvIdentStand CMS webpage.
Other Part A and Part B providers may now register for the Centers for Medicare & Medicaid Services (CMS)
ICD-10-CM/PCS National Provider Conference Call that will be conducted on November 12, 2008, from
12:30 p.m. – 2:30 p.m. EST. To register for this call, go to http://www.cms.hhs.gov/icd10/Downloads/ICD10_otherproviders.pdf. For additional information about this conference call and to access the ICD-10 Overview Presentation that will be discussed during the call, go to http://www.cms.hhs.gov/ICD10/07_Sponsored_Calls.asp.
****CMS NEWS****
The Centers for Medicare & Medicaid Services (CMS) recommends that each health care provider, including individual physicians and non-physician practitioners:
• Know and maintain their NPPES User Ids and passwords.
• Reset their NPPES passwords at least once a year. See the NPPES Application Help page regarding the ‘Reset Password’ rules. Those rules indicate the length, format, content and requirements of NPPES passwords.
• Review their NPPES records in order to ensure that the information reflects current and correct information.
Maintaining NPPES Account Information for Safety and Accessibility
Health care providers, including physicians and non-physician practitioners, should maintain their own NPPES account information (i.e., User ID, Password, and Secret Question/Answer) for safety and accessibility purposes.
Viewing NPPES Information
Health care providers, including physicians and non-physician practitioners, can view their NPPES information in one of two ways:
(1) By accessing the NPPES record at https://nppes.cms.hhs.gov/NPPES/Welcome.do and following the NPI hyperlink and selecting Login. The user will be prompted to enter the User ID and password that he/she previously created. *
* If the health care provider has forgotten the password, enter the User ID and click the “Reset Forgotten Password” button to navigate to the Reset Password Page. If the health care provider enters an incorrect User ID and Password combination three times, the User ID will be disabled. Please contact the NPI Enumerator at 1-800-465-3203 if the account is disabled or if the health care provider has forgotten the User ID.
OR
(2) By accessing the NPI Registry at https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do. The NPI Registry gives the health care provider an online view of Freedom of Information Act (FOIA)-disclosable NPPES data. The health care provider can search for its information using the name or NPI as the criterion.
Updating NPPES Information
Health care providers, including physicians and non-physician practitioners, can correct, add, or delete information in their NPPES records by accessing their NPPES records at https://nppes.cms.hhs.gov/NPPES/Welcome.do and following the NPI hyperlink and selecting Login. The user will be prompted to enter the User ID and password that he/she previously created.
Please note: Required information cannot be deleted from an NPPES record; however, required information can be changed/updated to ensure that NPPES captures the correct information. Certain information is inaccessible via the web, thus requiring the change/update to be made via paper application. The paper NPI Application/Update Form can be downloaded and printed at http://www.cms.hhs.gov/cmsforms/downloads/CMS10114.pdf.
Need More Information?
Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203. Having trouble viewing any of the URLs in this message? If so, try to cut and paste any URL in this message into your web browser to view the intended information.
Note: All current and past CMS NPI communications are available by clicking "CMS Communications" in the left column of the www.cms.hhs.gov/NationalProvIdentStand CMS webpage.
Other Part A and Part B providers may now register for the Centers for Medicare & Medicaid Services (CMS)
ICD-10-CM/PCS National Provider Conference Call that will be conducted on November 12, 2008, from
12:30 p.m. – 2:30 p.m. EST. To register for this call, go to http://www.cms.hhs.gov/icd10/Downloads/ICD10_otherproviders.pdf. For additional information about this conference call and to access the ICD-10 Overview Presentation that will be discussed during the call, go to http://www.cms.hhs.gov/ICD10/07_Sponsored_Calls.asp.
ASCO, ASH, CMS, & Palmetto/J1MAC News
The following information has been received by ANCO.
****ASCO NEWS****
The American Society of Clinical Oncology's (ASCO) Cancer Policy Today was published and is available at http://view.exacttarget.com/?j=fe5d157875610078771d&m=ff311d707460&ls=fdf912757061027e75117274&l=fe5d15747c6d027d7717&s=fe1f15797d620479731d75&jb=ffcf14&ju=fe23167174620c7c7d1c79. ANCO is a state/regional affiliate of ASCO.
This edition features:
ASCO and Komen for the Cure Announce Diversity in Oncology Initiative
NIH Policy for Fiscal Year 2009 Grant Submissions
Sen. Cardin Attends Maryland/DC State Society Meeting
CMS Announces Permanent Recovery Audit Contractors
CMS Announces "Medically Unlikely Edits"
OIG Issues 2009 Work Plan
Drug Administration CPT Code Changes for 2009
ASCO/AMA Survey Update
****ASH NEWS****
The American Society of Hematology's (ASH) Advocacy Update was published and is available at http://www.hematology.org/policy/advocacy/10162008.cfm#5. It features:
NIH Funded at Current Level Through March 2009; Budget Outlook Uncertain
Presidential Candidates Share Views on Health Issues
New NIH Policy Reduces Number of Grant Application Resubmissions
ASH Submits Comments to NRC on the Security and Continued Use of Cesium-137 Chloride Sources
Medicare Clarifies Clinical Trials Policy
Dr. Zerhouni to Step Down as NIH Director
NIH Releases Analysis of Comments on Public Access Policy
Visa Waiver Program Extended
ASH Grassroots Network Breakfast
****CMS NEWS****
Version 2.5 of the MREP software is available for download at http://www.cms.hhs.gov/AccesstoDataApplication/02_MedicareRemitEasyPrint.asp on the CMS website. For a description of the changes in this version, see the “What’s New” section of the MREP User Guide – Version 2.5 at http://www.cms.hhs.gov/AccesstoDataApplication/Downloads/EasyPrintUserGuide.pdf.
Note: The latest Codes.ini file is now available. This file is necessary when the MREP software is distributed.
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce a new E-Prescribing Incentive Program section page on the Physician Quality Reporting Initiative (PQRI) webpage at www.cms.hhs.gov/pqri/03_EPrescribingIncentiveProgram.asp#TopOfPage on the CMS website. This new section page will provide information about the new E-Prescribing incentive program that was authorized by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).
Included on this page in the Downloads section is an “Introduction to E-Prescribing Incentive Program” Fact Sheet that describes the MIPPA provisions for the E-Prescribing incentive program. Additional information about the E-Prescribing incentive program and how to qualify for the E-Prescribing incentive for the 2009 reporting year will be posted in early November.
Information is continually being added, so please visit the Physician Quality Reporting Initiative webpage at https://www.cms.hhs.gov/PQRI on the CMS website often.
****PALMETTO/J1MAC NEWS****
2009 Medicare Participation Enrollment & Fee Schedule Information
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~2009%20Medicare%20Participation%20Enrollment%20Fee%20Schedule%20Information?opendocument
We are again excited to provide you with a CD-ROM packed full of useful
information, which will include the 2009 Medicare Participation Enrollment
form along with some valuable additional information. Fee schedule
information will only be available on our Web site. We anticipate that the
CD-ROM will be mailed in November 2008.
****ASCO NEWS****
The American Society of Clinical Oncology's (ASCO) Cancer Policy Today was published and is available at http://view.exacttarget.com/?j=fe5d157875610078771d&m=ff311d707460&ls=fdf912757061027e75117274&l=fe5d15747c6d027d7717&s=fe1f15797d620479731d75&jb=ffcf14&ju=fe23167174620c7c7d1c79. ANCO is a state/regional affiliate of ASCO.
This edition features:
ASCO and Komen for the Cure Announce Diversity in Oncology Initiative
NIH Policy for Fiscal Year 2009 Grant Submissions
Sen. Cardin Attends Maryland/DC State Society Meeting
CMS Announces Permanent Recovery Audit Contractors
CMS Announces "Medically Unlikely Edits"
OIG Issues 2009 Work Plan
Drug Administration CPT Code Changes for 2009
ASCO/AMA Survey Update
****ASH NEWS****
The American Society of Hematology's (ASH) Advocacy Update was published and is available at http://www.hematology.org/policy/advocacy/10162008.cfm#5. It features:
NIH Funded at Current Level Through March 2009; Budget Outlook Uncertain
Presidential Candidates Share Views on Health Issues
New NIH Policy Reduces Number of Grant Application Resubmissions
ASH Submits Comments to NRC on the Security and Continued Use of Cesium-137 Chloride Sources
Medicare Clarifies Clinical Trials Policy
Dr. Zerhouni to Step Down as NIH Director
NIH Releases Analysis of Comments on Public Access Policy
Visa Waiver Program Extended
ASH Grassroots Network Breakfast
****CMS NEWS****
Version 2.5 of the MREP software is available for download at http://www.cms.hhs.gov/AccesstoDataApplication/02_MedicareRemitEasyPrint.asp on the CMS website. For a description of the changes in this version, see the “What’s New” section of the MREP User Guide – Version 2.5 at http://www.cms.hhs.gov/AccesstoDataApplication/Downloads/EasyPrintUserGuide.pdf.
Note: The latest Codes.ini file is now available. This file is necessary when the MREP software is distributed.
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce a new E-Prescribing Incentive Program section page on the Physician Quality Reporting Initiative (PQRI) webpage at www.cms.hhs.gov/pqri/03_EPrescribingIncentiveProgram.asp#TopOfPage on the CMS website. This new section page will provide information about the new E-Prescribing incentive program that was authorized by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).
Included on this page in the Downloads section is an “Introduction to E-Prescribing Incentive Program” Fact Sheet that describes the MIPPA provisions for the E-Prescribing incentive program. Additional information about the E-Prescribing incentive program and how to qualify for the E-Prescribing incentive for the 2009 reporting year will be posted in early November.
Information is continually being added, so please visit the Physician Quality Reporting Initiative webpage at https://www.cms.hhs.gov/PQRI on the CMS website often.
****PALMETTO/J1MAC NEWS****
2009 Medicare Participation Enrollment & Fee Schedule Information
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~2009%20Medicare%20Participation%20Enrollment%20Fee%20Schedule%20Information?opendocument
We are again excited to provide you with a CD-ROM packed full of useful
information, which will include the 2009 Medicare Participation Enrollment
form along with some valuable additional information. Fee schedule
information will only be available on our Web site. We anticipate that the
CD-ROM will be mailed in November 2008.
Thursday, October 16, 2008
ASCO, CMA, CMS, & Palmetto/J1MAC News
The following information has been received by ANCO.
****ASCO NEWS****
The American Society of Clinical Oncology (ASCO) e-News was published and is available at http://view.exacttarget.com/?j=fe59157875670374771c&m=ff2d16787160&ls=fdee12777561067c701d7873&l=fe6515757467037e7015&s=fdf2157972640d79751d7073&jb=ffcf14&ju=fe38167174600c79771570. ANCO is a state/regional affiliate of ASCO.
This edition features:
Frosted Pink with a Twist Raises Cancer Awareness Nationwide
2009 Election News Available Online
2008 Chicago Multidisciplinary Symposium in Thoracic Oncology Approaching
Register Now for the 2009 Genitourinary Cancers Symposium
Members Only Housing Open for 2009 ASCO Annual Meeting
Applications Now Open for 2009 ASCO State Affiliate Grants
2009 IDEA Grant Applications Available
Presentations from 2008 Annual Meeting Now Available at No Cost
Video Podcasts from the 2008 Breast Cancer Symposium Now Available
Annual Meeting Summaries Available on ASCO.org
JCO Adopts New Online Publishing Policy
Opportunity to Apply for the 2009 Susan G. Komen for the Cure®/ASCO Loan Repayment Program Approaching
Apply for 2009 ACRA in Breast Cancer or 2009 ACRA in Glioma
Apply Today for CDA and YIA Grants from The ASCO Cancer Foundation
Cancer Policy Alert: Oct. 1: President Signs Continuing Resolution to Fund Government Program; Members of Congress Urge Congressional Leadership to Exclude Prompt Pay Discount from ASP; New Guidance on Recent ESA Label Changes
For Your Patients: Latest Cancer.Net Feature Articles Explain Bone Marrow Biopsy and Aspiration, and Post-Mastectomy Procedures
"What's New in the JCO: Early Release Articles Published"
See What's Coming Up in JCO
****CMA NEWS****
The California Medical Association's (CMA) Alert was published and is available at http://www.calphys.org/html/news.asp.
It features:
Highlights from CMA’s 2008 House of Delegates
CMA Advocacy Works: Blue Cross Agrees to Amend Physician Contracts
Proposition 4 Creates New Legal Liabilities for Doctors
Feds Temporarily Extend Family PACT Program
Physicians Still Facing Severe Medicare Payment Problems
CMA Balance Billing Advocacy Toolkit Available
Physicians Urged to Verify Accuracy of CPPI Quality Data
San Bernardino County Physician Installed as CMA’s 141st President
Orange County Physician Elected CMA President-Elect
Board Highlights Now Available
2008 Legislative Wrap Up
CMA Seminars Train Physician Office Staff in Proper Billing and Collections Procedures
Member Benefit of the Week: 6% off athenaCollector
****CMS NEWS****
Noridian Administrative Services, the designated carrier for the CAP, offers interactive, online workshops about the CAP for Part B Drugs and Biologicals. These workshops train CAP vendors and elected physicians on a variety of CAP topics, including how to transition out of the CAP at the end of 2008 due to the postponement of the program for 2009. NAS staff will also be available to answer questions. Interested parties may view additional information about and register for these workshops on the Noridian website at:
https://www.noridianmedicare.com/cap_drug/train/schedule.html
Upcoming workshops will be held on the following dates:
10/22/08 at 2:00 pm CST
11/24/08 at 2:00 pm CST
Additional information about the CAP and the 2009 postponement is available at: http://www.cms.hhs.gov/CompetitiveAcquisforBios/01_overview.asp
****PALMETTO/J1MAC NEWS****
Provider Enrollment Application Status Lookup Tool
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~Provider%20Enrollment~Provider%20Enrollment%20Application%20Status%20Lookup%20Tool?opendocument
To assist J1 providers in obtaining the status of their enrollment
applications, we are pleased to announce a new provider self-service tool.
The Provider Enrollment Application Status Lookup tool will be located on
the Palmetto GBA J1 Part B Web site, www.Palmettogba.com/J1B/Enroll, under
Resources/Provider Enrollment and under Tools and Top Links at
www.PalmettoGBA.com/J1B: http://www.palmettogba.com/palmetto/IVR.nsf
Modifier Lookup: Your Resource for Correct Claim Submission
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~Modifier%20Lookup~Modifier%20Lookup:%20Your%20Resource%20for%20Correct%20Claim%20Submission?opendocument
Is documentation required with the claim when submitting a modifier? If
HCPCS modifiers GN and KX are both required, which modifier should be
submitted first? Find these answers and more in the Modifier Lookup. This
handy tool contains all the information you need to document and correctly
submit modifiers. Palmetto GBA revises the information in the Modifier
Lookup frequently based on your questions and new published guidance.
****ASCO NEWS****
The American Society of Clinical Oncology (ASCO) e-News was published and is available at http://view.exacttarget.com/?j=fe59157875670374771c&m=ff2d16787160&ls=fdee12777561067c701d7873&l=fe6515757467037e7015&s=fdf2157972640d79751d7073&jb=ffcf14&ju=fe38167174600c79771570. ANCO is a state/regional affiliate of ASCO.
This edition features:
Frosted Pink with a Twist Raises Cancer Awareness Nationwide
2009 Election News Available Online
2008 Chicago Multidisciplinary Symposium in Thoracic Oncology Approaching
Register Now for the 2009 Genitourinary Cancers Symposium
Members Only Housing Open for 2009 ASCO Annual Meeting
Applications Now Open for 2009 ASCO State Affiliate Grants
2009 IDEA Grant Applications Available
Presentations from 2008 Annual Meeting Now Available at No Cost
Video Podcasts from the 2008 Breast Cancer Symposium Now Available
Annual Meeting Summaries Available on ASCO.org
JCO Adopts New Online Publishing Policy
Opportunity to Apply for the 2009 Susan G. Komen for the Cure®/ASCO Loan Repayment Program Approaching
Apply for 2009 ACRA in Breast Cancer or 2009 ACRA in Glioma
Apply Today for CDA and YIA Grants from The ASCO Cancer Foundation
Cancer Policy Alert: Oct. 1: President Signs Continuing Resolution to Fund Government Program; Members of Congress Urge Congressional Leadership to Exclude Prompt Pay Discount from ASP; New Guidance on Recent ESA Label Changes
For Your Patients: Latest Cancer.Net Feature Articles Explain Bone Marrow Biopsy and Aspiration, and Post-Mastectomy Procedures
"What's New in the JCO: Early Release Articles Published"
See What's Coming Up in JCO
****CMA NEWS****
The California Medical Association's (CMA) Alert was published and is available at http://www.calphys.org/html/news.asp.
It features:
Highlights from CMA’s 2008 House of Delegates
CMA Advocacy Works: Blue Cross Agrees to Amend Physician Contracts
Proposition 4 Creates New Legal Liabilities for Doctors
Feds Temporarily Extend Family PACT Program
Physicians Still Facing Severe Medicare Payment Problems
CMA Balance Billing Advocacy Toolkit Available
Physicians Urged to Verify Accuracy of CPPI Quality Data
San Bernardino County Physician Installed as CMA’s 141st President
Orange County Physician Elected CMA President-Elect
Board Highlights Now Available
2008 Legislative Wrap Up
CMA Seminars Train Physician Office Staff in Proper Billing and Collections Procedures
Member Benefit of the Week: 6% off athenaCollector
****CMS NEWS****
Noridian Administrative Services, the designated carrier for the CAP, offers interactive, online workshops about the CAP for Part B Drugs and Biologicals. These workshops train CAP vendors and elected physicians on a variety of CAP topics, including how to transition out of the CAP at the end of 2008 due to the postponement of the program for 2009. NAS staff will also be available to answer questions. Interested parties may view additional information about and register for these workshops on the Noridian website at:
https://www.noridianmedicare.com/cap_drug/train/schedule.html
Upcoming workshops will be held on the following dates:
10/22/08 at 2:00 pm CST
11/24/08 at 2:00 pm CST
Additional information about the CAP and the 2009 postponement is available at: http://www.cms.hhs.gov/CompetitiveAcquisforBios/01_overview.asp
****PALMETTO/J1MAC NEWS****
Provider Enrollment Application Status Lookup Tool
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~Provider%20Enrollment~Provider%20Enrollment%20Application%20Status%20Lookup%20Tool?opendocument
To assist J1 providers in obtaining the status of their enrollment
applications, we are pleased to announce a new provider self-service tool.
The Provider Enrollment Application Status Lookup tool will be located on
the Palmetto GBA J1 Part B Web site, www.Palmettogba.com/J1B/Enroll, under
Resources/Provider Enrollment and under Tools and Top Links at
www.PalmettoGBA.com/J1B: http://www.palmettogba.com/palmetto/IVR.nsf
Modifier Lookup: Your Resource for Correct Claim Submission
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~Modifier%20Lookup~Modifier%20Lookup:%20Your%20Resource%20for%20Correct%20Claim%20Submission?opendocument
Is documentation required with the claim when submitting a modifier? If
HCPCS modifiers GN and KX are both required, which modifier should be
submitted first? Find these answers and more in the Modifier Lookup. This
handy tool contains all the information you need to document and correctly
submit modifiers. Palmetto GBA revises the information in the Modifier
Lookup frequently based on your questions and new published guidance.
Wednesday, October 15, 2008
ION, NCCC, and Pfizer Meeting Announcements
The following information has been received by ANCO.
****ION MEETING****
ION Web Event: A Novel Approach to Improving Outcomes in MBC
ION programs are created with the needs of our members in mind. There is an upcoming ION Web cast that may be of special interest to you:
A Novel Approach to Improving Outcomes in MBC
This event will take place on Thursday October 16, 2008 at 2 pm EDT. The speaker will be William Gradishar, M.D., from Northwestern University Medical School. All ION members, including physicians, nurses, practice administrators, and other clinical staff, are welcome to attend.
Topics of discussion will focus on Abraxane and efficacy, response rates, higher dose delivery, convenient dosing, and convenient administration vs. solvent-based paclitaxel.
You can register for this event on the WEB (at https://www.iononline.com/login.aspx?msg=2&linkback=%2fMeetingManager%2fconfRegistration.aspx%3fevent_id%3d572) or by FAX (at http://image.ipnonline-email.com/lib/ff021071716705/d/1/101408%20abraxis%20web.pdf) . We hope you find this program educational, and we look forward to bringing you more valuable programs in the future.
To register, you must be logged into www.iononline.com. For login assistance, please contact member services at 1-888-536-7697 Ext:6847 or memberid@iononline.com.
****NCCC MEETING****
Cancer Survivorship Conference: "Now What? The New Normal of Cancer Survivorship after Treatment"
November 8, 2008 8:00 am - 3:30 pm
UCSF Mission Bay Conference Ctr., San Francisco
Admission is free.
Presented by the Northern California Cancer Center, this conference is for cancer survivors (all disease sites), family, friends, and medical professionals. The morning general session will include: transitioning to a primary care physician; medical issues ( fatigue, "chemobrain," joint pain); psychosocial issues (living with uncertainty, dating, depression, intimacy, communications); survivor stories. Afternoon breakout sessions will address: nutrition and lifestyle changes; genetic risk; family and caregiving matters; financial issues (e.g. employment, life and health insurance, estate planning); treatment side effects; sexual function (fertility, intimacy, communication); and integrative medicine. Speakers represent Marin Cancer Institute, Kaiser, Palo Alto Medical Fndn., Stanford, and UCSF; two cancer survivors will also participate. CEUs available for RN, MFT, LCSW.
Visit http://www.acteva.com/booking.cfm?bevaID=162724&CFID=11040346&CFTOKEN=76933568 for more information.
Contact: education@nccc.org or 888-315-5988
****PFIZER MEETING****
Pfizer Oncology cordially invites you to attend Integrating Clinical Pathways into Oncology Practice with Linda Bosserman, M.D., F.A.C.P. This clinical dinner education meeting takes place November 13th at 6:30PM at the Hotel Nikko, 222 Mason Street, San Francisco (415-394-1111).
Please FAX your RSVP to Advanced Health Media at (866) 600-5828.
If you have any questions or would like to RSVP by phone, please call Advanced Health Media at
(800) 292-6204 using Meeting ID#EZ008266 (5130523). Thank you!
****ION MEETING****
ION Web Event: A Novel Approach to Improving Outcomes in MBC
ION programs are created with the needs of our members in mind. There is an upcoming ION Web cast that may be of special interest to you:
A Novel Approach to Improving Outcomes in MBC
This event will take place on Thursday October 16, 2008 at 2 pm EDT. The speaker will be William Gradishar, M.D., from Northwestern University Medical School. All ION members, including physicians, nurses, practice administrators, and other clinical staff, are welcome to attend.
Topics of discussion will focus on Abraxane and efficacy, response rates, higher dose delivery, convenient dosing, and convenient administration vs. solvent-based paclitaxel.
You can register for this event on the WEB (at https://www.iononline.com/login.aspx?msg=2&linkback=%2fMeetingManager%2fconfRegistration.aspx%3fevent_id%3d572) or by FAX (at http://image.ipnonline-email.com/lib/ff021071716705/d/1/101408%20abraxis%20web.pdf) . We hope you find this program educational, and we look forward to bringing you more valuable programs in the future.
To register, you must be logged into www.iononline.com. For login assistance, please contact member services at 1-888-536-7697 Ext:6847 or memberid@iononline.com.
****NCCC MEETING****
Cancer Survivorship Conference: "Now What? The New Normal of Cancer Survivorship after Treatment"
November 8, 2008 8:00 am - 3:30 pm
UCSF Mission Bay Conference Ctr., San Francisco
Admission is free.
Presented by the Northern California Cancer Center, this conference is for cancer survivors (all disease sites), family, friends, and medical professionals. The morning general session will include: transitioning to a primary care physician; medical issues ( fatigue, "chemobrain," joint pain); psychosocial issues (living with uncertainty, dating, depression, intimacy, communications); survivor stories. Afternoon breakout sessions will address: nutrition and lifestyle changes; genetic risk; family and caregiving matters; financial issues (e.g. employment, life and health insurance, estate planning); treatment side effects; sexual function (fertility, intimacy, communication); and integrative medicine. Speakers represent Marin Cancer Institute, Kaiser, Palo Alto Medical Fndn., Stanford, and UCSF; two cancer survivors will also participate. CEUs available for RN, MFT, LCSW.
Visit http://www.acteva.com/booking.cfm?bevaID=162724&CFID=11040346&CFTOKEN=76933568 for more information.
Contact: education@nccc.org or 888-315-5988
****PFIZER MEETING****
Pfizer Oncology cordially invites you to attend Integrating Clinical Pathways into Oncology Practice with Linda Bosserman, M.D., F.A.C.P. This clinical dinner education meeting takes place November 13th at 6:30PM at the Hotel Nikko, 222 Mason Street, San Francisco (415-394-1111).
Please FAX your RSVP to Advanced Health Media at (866) 600-5828.
If you have any questions or would like to RSVP by phone, please call Advanced Health Media at
(800) 292-6204 using Meeting ID#EZ008266 (5130523). Thank you!
Tuesday, October 14, 2008
ACCC, ASH, CMS, & Palmetto News
The following information has been received by ANCO.
****ACCC NEWS****
The Association of Community Cancer Center's (ACCC) This Week at ACCC was published and is available at http://www.accc-cancer.org/mediaroom/newsletters/media_ACCCNEWSLETTER_10-13-2008.html. ANCO is an Institutional Member of ACCC. This edition features:
ACCC's Highly Acclaimed Hospital Summit: Portable and Practical Information
CMS Enhances Program Integrity Efforts to Fight Medicare Fraud/Waste
Initiative to Speed Clinical Trial Negotiations Moves Forward
Are You Going to All Digital Mammography? Learn the challenges
Regional Oncology Symposia Coming to Tampa and Philadelphia
Call for Nominations for ACCC's Board
Several Colorectal Cancer Screening Methods Are Equally Effective, Panel Says
Q&A on ACCC's Listserv: Exercise Programs
ACCC's CE Blackboard: New Program on CML
State Medical Oncology Societies Host Upcoming Meetings
****ASH NEWS****
The Centers for Medicare and Medicaid Services recently released a special edition MedLearn article on the Medicare clinical trials policy, "Clarification of Medicare Payment for Routine Costs in a Clinical Trial." This article provides clarification regarding Medicare payment of routine costs associated with clinical trials. Visit http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0822.pdf to read this article.
****CMS NEWS****
The ICD-10-Clinical Modification/Procedure Coding System Bookmark is now available from the Centers for Medicare & Medicaid Services Medicare Learning Network. This bookmark explains the ICD-10-Clinical Modification/Procedure Coding System (CM/PCS) including the benefits of adopting the system, recommended steps to be taken in order to plan and prepare for implementation of the system, and where additional information about the system can be found. To place your order, visit http://www.cms.hhs.gov/MLNProducts/01_Overview.asp , scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page.” If you have problems accessing this hyperlink, please copy and paste the URL into your Internet browser.
****PALMETTO/J1MAC NEWS****
Non-acceptance of Legacy Provider Numbers on Incoming Medicare Claims
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~NPI~Non-acceptance%20of%20Legacy%20Provider%20Numbers%20on%20Incoming%20Medicare%20Claims%20?opendocument
With the implementation of the National Provider Identifier (NPI) on May
23, 2008, Medicare ceased accepting legacy provider numbers, qualified by
1C and 1G within the secondary provider REF segments, on incoming Medicare
American National Standards Institute (ANSI) X12N 837 4010A1 claims.
Effective October 6, 2008, providers should note that, with one qualified
exception, Medicare will reject all incoming Medicare X12N 837 4010A1
claims that contain legacy identifiers.
November 18, 2008, 9am – 11am: Open Draft LCD Meeting Scheduled for
California
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~November%2018,%202008,%209am%20–%2011am:%20Open%20Draft%20LCD%20Meeting%20Scheduled%20for%20California?opendocument
Palmetto GBA J1 A/B MAC has scheduled an Open Draft LCD meeting in
California in order to allow for the submission of information related to
the proposed LCDs on November 18, 2008, from 9am – 11am. Click on the link
to view more details.
Provider Enrollment Application Status Lookup Tool
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~Provider%20Enrollment~Provider%20Enrollment%20Application%20Status%20Lookup%20Tool?opendocument
The “Provider Enrollment Application Status Lookup” tool will be located on
the Palmetto GBA J1 Web site, www.Palmettogba.com/J1B, under Resources and
will be available for use beginning October 13, 2008. Click on the link to
learn more!
The ICD-10 Clinical Modification/Procedure Coding System (CM/PCS)—The Next
Generation of Coding
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~The%20ICD-10%20Clinical%20ModificationProcedure%20Coding%20System%20(CMPCS)—The%20Next%20Generation%20of%20Coding?opendocument
This Special Edition article (SE 0832) outlines general information for
providers detailing the International Classification of Diseases, 10th
Edition (ICD-10) classification system. Compared to the current ICD-9
classification system, ICD-10 offers more detailed information and the
ability to expand specificity and clinical information in order to capture
advancements in clinical medicine. Providers may want to become familiar
with the new coding system.
Denials: Top Reasons and Procedures
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~Denial%20Finder~Denials:%20Top%20Reasons%20and%20Procedures?opendocument
The Palmetto GBA Denial Finder tool includes resources for resolving the
top claim rejections and denial reasons. Save time and resources by
looking here before you pick up the phone: access denial reasons in plain
language; scroll through the titles to locate your procedure; and use the
Palmetto GBA search engine to search by remark code. Be sure to share this
tool within your office.
****ACCC NEWS****
The Association of Community Cancer Center's (ACCC) This Week at ACCC was published and is available at http://www.accc-cancer.org/mediaroom/newsletters/media_ACCCNEWSLETTER_10-13-2008.html. ANCO is an Institutional Member of ACCC. This edition features:
ACCC's Highly Acclaimed Hospital Summit: Portable and Practical Information
CMS Enhances Program Integrity Efforts to Fight Medicare Fraud/Waste
Initiative to Speed Clinical Trial Negotiations Moves Forward
Are You Going to All Digital Mammography? Learn the challenges
Regional Oncology Symposia Coming to Tampa and Philadelphia
Call for Nominations for ACCC's Board
Several Colorectal Cancer Screening Methods Are Equally Effective, Panel Says
Q&A on ACCC's Listserv: Exercise Programs
ACCC's CE Blackboard: New Program on CML
State Medical Oncology Societies Host Upcoming Meetings
****ASH NEWS****
The Centers for Medicare and Medicaid Services recently released a special edition MedLearn article on the Medicare clinical trials policy, "Clarification of Medicare Payment for Routine Costs in a Clinical Trial." This article provides clarification regarding Medicare payment of routine costs associated with clinical trials. Visit http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0822.pdf to read this article.
****CMS NEWS****
The ICD-10-Clinical Modification/Procedure Coding System Bookmark is now available from the Centers for Medicare & Medicaid Services Medicare Learning Network. This bookmark explains the ICD-10-Clinical Modification/Procedure Coding System (CM/PCS) including the benefits of adopting the system, recommended steps to be taken in order to plan and prepare for implementation of the system, and where additional information about the system can be found. To place your order, visit http://www.cms.hhs.gov/MLNProducts/01_Overview.asp , scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page.” If you have problems accessing this hyperlink, please copy and paste the URL into your Internet browser.
****PALMETTO/J1MAC NEWS****
Non-acceptance of Legacy Provider Numbers on Incoming Medicare Claims
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~NPI~Non-acceptance%20of%20Legacy%20Provider%20Numbers%20on%20Incoming%20Medicare%20Claims%20?opendocument
With the implementation of the National Provider Identifier (NPI) on May
23, 2008, Medicare ceased accepting legacy provider numbers, qualified by
1C and 1G within the secondary provider REF segments, on incoming Medicare
American National Standards Institute (ANSI) X12N 837 4010A1 claims.
Effective October 6, 2008, providers should note that, with one qualified
exception, Medicare will reject all incoming Medicare X12N 837 4010A1
claims that contain legacy identifiers.
November 18, 2008, 9am – 11am: Open Draft LCD Meeting Scheduled for
California
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~November%2018,%202008,%209am%20–%2011am:%20Open%20Draft%20LCD%20Meeting%20Scheduled%20for%20California?opendocument
Palmetto GBA J1 A/B MAC has scheduled an Open Draft LCD meeting in
California in order to allow for the submission of information related to
the proposed LCDs on November 18, 2008, from 9am – 11am. Click on the link
to view more details.
Provider Enrollment Application Status Lookup Tool
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~Provider%20Enrollment~Provider%20Enrollment%20Application%20Status%20Lookup%20Tool?opendocument
The “Provider Enrollment Application Status Lookup” tool will be located on
the Palmetto GBA J1 Web site, www.Palmettogba.com/J1B, under Resources and
will be available for use beginning October 13, 2008. Click on the link to
learn more!
The ICD-10 Clinical Modification/Procedure Coding System (CM/PCS)—The Next
Generation of Coding
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~The%20ICD-10%20Clinical%20ModificationProcedure%20Coding%20System%20(CMPCS)—The%20Next%20Generation%20of%20Coding?opendocument
This Special Edition article (SE 0832) outlines general information for
providers detailing the International Classification of Diseases, 10th
Edition (ICD-10) classification system. Compared to the current ICD-9
classification system, ICD-10 offers more detailed information and the
ability to expand specificity and clinical information in order to capture
advancements in clinical medicine. Providers may want to become familiar
with the new coding system.
Denials: Top Reasons and Procedures
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~Denial%20Finder~Denials:%20Top%20Reasons%20and%20Procedures?opendocument
The Palmetto GBA Denial Finder tool includes resources for resolving the
top claim rejections and denial reasons. Save time and resources by
looking here before you pick up the phone: access denial reasons in plain
language; scroll through the titles to locate your procedure; and use the
Palmetto GBA search engine to search by remark code. Be sure to share this
tool within your office.
Tuesday, October 7, 2008
Importance of Oral Therapies in Oncology
US Oncology Physician Services, an ANCO Corporate Member, invites you to participate in an upcoming webcast entitled Importance of Oral Therapies in Oncology.
The webcast takes place on October 17th at 9AM.
The interactive webcast will discuss the impact of oral oncolytics on the practice and patient; managing oral medications (clinical issues, concerns, and challenges); patient adherence and safety; and, strategies for enhancing quality care.
For more information and to register, please visit www.opspharmacist.com/opes.
The webcast takes place on October 17th at 9AM.
The interactive webcast will discuss the impact of oral oncolytics on the practice and patient; managing oral medications (clinical issues, concerns, and challenges); patient adherence and safety; and, strategies for enhancing quality care.
For more information and to register, please visit www.opspharmacist.com/opes.
ACCC & Palmetto/J1MAC News
The following information has been received by ANCO.
****ACCC NEWS****
The Association of Community Cancer Center's (ACCC) This Week at ACCC was published and is available at http://www.accc-cancer.org/mediaroom/newsletters/media_ACCCNEWSLETTER_10-06-2008.html.
It features:
ACCC's Highly Acclaimed Hospital Summit : Portable and Practical Information
Final Survey Released About Off-Label Drug Use by Practices
Medicare Publishes Billing Edits to Help Reduce Payment Errors
Regional Oncology Symposia Coming to Tampa and Philadelphia
Call for Nominations for ACCC's Board
AHFS Issues Off-Label Use Determination for Levoleucovorin
Q&A on ACCC's Listserv: Vincristine Administration
ACCC's CE Blackboard: Continuing Education Programs for You
State Medical Oncology Societies Host Upcoming Meetings
Intensive Course Offered in Clinical Cancer Genetics
****PALMETTO/J1MAC NEWS****
The following updates have been posted to the Palmetto/J1MAC website.
Competitive Acquisition Program (CAP) for Part B Drugs and Biologicals
Vendor Identification Number, Physician Election, and Iron Dextran Payment
Update
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~Drugs%20and%20Biologicals~%20Competitive%20Acquisition%20Program%20(CAP)%20for%20Part%20B%20Drugs%20and%20Biologicals%20Vendor%20Identification%20Number,%20Physician%20Election,%20and%20Iron%20Dextran%20Payment%20Update%20?opendocument
This article is based on Change Request (CR) 6210, which updates
instructions regarding Vendor Identification Number (VIN) Q103 in CAP
claims processing and other related processes. The CR also updates
procedures pertaining to CAP physician election and addresses the procedure
for paying CAP claims for Iron dextran products.
2009 Annual Update of Healthcare Common Procedure Coding System (HCPCS)
Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) for the
Common Working File (CWF)
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~2009%20Annual%20Update%20of%20Healthcare%20Common%20Procedure%20Coding%20System%20(HCPCS)%20Codes%20for%20Skilled%20Nursing%20Facility%20(SNF)%20Consolidated%20Billing%20(CB)%20for%20the%20Common%20Working%20File%20(CWF)?opendocument
This article is based on Change Request (CR) 6220 which provides the 2009
annual update of Healthcare Common Procedure Coding System (HCPCS) Codes
for Skilled Nursing Facility Consolidated Billing (SNF CB). The updates
will be posted to CMS' Web site by the first week of December 2008.
Laboratory National Coverage Determination (NCD) Edit Software for October
2008
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~Lab~Laboratory%20National%20Coverage%20Determination%20(NCD)%20Edit%20Software%20for%20October%202008%20?opendocument
This article is based on Change Request (CR) 6213 which announces the
changes that will be included in the October 2008 release of the edit
module for clinical diagnostic Laboratory National Coverage Determinations
(NCDs). The last quarterly release of the edit module was issued in July
2008. CR 6213 incorporates all changes from July 2008 to the present and
has no other changes.
Medicare Publishes Billing Edits to Reduce Payment Errors
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Current%20News~Medicare%20Publishes%20Billing%20Edits%20to%20Reduce%20Payment%20Errors?opendocument
The Centers for Medicare & Medicaid Services (CMS) recently announced that,
beginning October 1, 2008, it will publish most of the edits utilized in
its Medically Unlikely Edit (MUE) program to improve the accuracy of claims
payments. CMS established the MUE program to reduce payment errors for
Medicare Part B claims. Claims processing contractors utilize these edits
to assure that providers and suppliers do not report excessive services.
The edits are applied during the electronic processing of all claims.
Medicare Remit EasyPrint (MREP) Software for J1 Part B
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~EDI~Software%20Manuals~Medicare%20Remit%20EasyPrint%20(MREP)%20Software%20for%20J1%20Part%20B?opendocument
Medicare Remit EasyPrint (MREP) software has been updated to version 2.5.
November 18, 2008, 9am – 11am: Open Draft LCD Meeting Scheduled for
California
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~November%2018,%202008,%209am%20–%2011am:%20Open%20Draft%20LCD%20Meeting%20Scheduled%20for%20California?opendocument
Palmetto GBA J1 A/B MAC has scheduled an Open Draft LCD meeting in
California in order to allow for the submission of information related to
the proposed LCDs on November 18, 2008, from 9am – 11am. Click on the link
to view more details.
October 9, 2008
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Learning%20Education~Post%20Transition%20Teleconference%20Call~October%209,%202008?opendocument
Click this link to view the Part B October 7, 2008, PTT Call information.
Physician Opt Out List
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~Physician%20Opt%20Out%20List?opendocument
Palmetto GBA is currently in the process of compiling the list of health
professionals who have elected to opt out of the Medicare program. This
list should be completed and posted to the J1 Web site by the end of
October. In the interim, please refer to the most current lists provided to
you by Noridian and/or National Heritage Insurance Company.
Reasonable Charge Update for 2009 for Splints, Casts, Dialysis Supplies,
Dialysis Equipment, and Certain Intraocular Lenses
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Publications~Fee%20Schedules~Reasonable%20Charge%20Update%20for%202009%20for%20Splints,%20Casts,%20Dialysis%20Supplies,%20Dialysis%20Equipment,%20and%20Certain%20Intraocular%20Lenses%20?opendocument
Change Request 6221, from which this article is taken, instructs Palmetto
GBA how to calculate reasonable charges for the payment of claims for
splints, casts, dialysis supplies, dialysis equipment, and intraocular
lenses furnished in calendar year 2009. CR6221 also announces that the 2009
Inflation-Indexed Charge IIC update factor is 5.0 percent.
Time Limit for Filing Medicare Claims
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Ohio%20Part%20B%20Carrier~Publications~Physician-Supplier%20Guide~Claims%20Filing:%20Medicare~Time%20Limit%20for%20Filing%20Medicare%20Claims?opendocument
Medicare law designates specific time limits for submitting claims for
physician and other Part B services. The terms of the law require that a
claim be filed no later than the end of the calendar year following the
year in which the service was furnished. Exceptions are outlined in this
article.
****ACCC NEWS****
The Association of Community Cancer Center's (ACCC) This Week at ACCC was published and is available at http://www.accc-cancer.org/mediaroom/newsletters/media_ACCCNEWSLETTER_10-06-2008.html.
It features:
ACCC's Highly Acclaimed Hospital Summit : Portable and Practical Information
Final Survey Released About Off-Label Drug Use by Practices
Medicare Publishes Billing Edits to Help Reduce Payment Errors
Regional Oncology Symposia Coming to Tampa and Philadelphia
Call for Nominations for ACCC's Board
AHFS Issues Off-Label Use Determination for Levoleucovorin
Q&A on ACCC's Listserv: Vincristine Administration
ACCC's CE Blackboard: Continuing Education Programs for You
State Medical Oncology Societies Host Upcoming Meetings
Intensive Course Offered in Clinical Cancer Genetics
****PALMETTO/J1MAC NEWS****
The following updates have been posted to the Palmetto/J1MAC website.
Competitive Acquisition Program (CAP) for Part B Drugs and Biologicals
Vendor Identification Number, Physician Election, and Iron Dextran Payment
Update
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~Drugs%20and%20Biologicals~%20Competitive%20Acquisition%20Program%20(CAP)%20for%20Part%20B%20Drugs%20and%20Biologicals%20Vendor%20Identification%20Number,%20Physician%20Election,%20and%20Iron%20Dextran%20Payment%20Update%20?opendocument
This article is based on Change Request (CR) 6210, which updates
instructions regarding Vendor Identification Number (VIN) Q103 in CAP
claims processing and other related processes. The CR also updates
procedures pertaining to CAP physician election and addresses the procedure
for paying CAP claims for Iron dextran products.
2009 Annual Update of Healthcare Common Procedure Coding System (HCPCS)
Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) for the
Common Working File (CWF)
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~2009%20Annual%20Update%20of%20Healthcare%20Common%20Procedure%20Coding%20System%20(HCPCS)%20Codes%20for%20Skilled%20Nursing%20Facility%20(SNF)%20Consolidated%20Billing%20(CB)%20for%20the%20Common%20Working%20File%20(CWF)?opendocument
This article is based on Change Request (CR) 6220 which provides the 2009
annual update of Healthcare Common Procedure Coding System (HCPCS) Codes
for Skilled Nursing Facility Consolidated Billing (SNF CB). The updates
will be posted to CMS' Web site by the first week of December 2008.
Laboratory National Coverage Determination (NCD) Edit Software for October
2008
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~Lab~Laboratory%20National%20Coverage%20Determination%20(NCD)%20Edit%20Software%20for%20October%202008%20?opendocument
This article is based on Change Request (CR) 6213 which announces the
changes that will be included in the October 2008 release of the edit
module for clinical diagnostic Laboratory National Coverage Determinations
(NCDs). The last quarterly release of the edit module was issued in July
2008. CR 6213 incorporates all changes from July 2008 to the present and
has no other changes.
Medicare Publishes Billing Edits to Reduce Payment Errors
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Current%20News~Medicare%20Publishes%20Billing%20Edits%20to%20Reduce%20Payment%20Errors?opendocument
The Centers for Medicare & Medicaid Services (CMS) recently announced that,
beginning October 1, 2008, it will publish most of the edits utilized in
its Medically Unlikely Edit (MUE) program to improve the accuracy of claims
payments. CMS established the MUE program to reduce payment errors for
Medicare Part B claims. Claims processing contractors utilize these edits
to assure that providers and suppliers do not report excessive services.
The edits are applied during the electronic processing of all claims.
Medicare Remit EasyPrint (MREP) Software for J1 Part B
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~EDI~Software%20Manuals~Medicare%20Remit%20EasyPrint%20(MREP)%20Software%20for%20J1%20Part%20B?opendocument
Medicare Remit EasyPrint (MREP) software has been updated to version 2.5.
November 18, 2008, 9am – 11am: Open Draft LCD Meeting Scheduled for
California
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~November%2018,%202008,%209am%20–%2011am:%20Open%20Draft%20LCD%20Meeting%20Scheduled%20for%20California?opendocument
Palmetto GBA J1 A/B MAC has scheduled an Open Draft LCD meeting in
California in order to allow for the submission of information related to
the proposed LCDs on November 18, 2008, from 9am – 11am. Click on the link
to view more details.
October 9, 2008
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Learning%20Education~Post%20Transition%20Teleconference%20Call~October%209,%202008?opendocument
Click this link to view the Part B October 7, 2008, PTT Call information.
Physician Opt Out List
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~Physician%20Opt%20Out%20List?opendocument
Palmetto GBA is currently in the process of compiling the list of health
professionals who have elected to opt out of the Medicare program. This
list should be completed and posted to the J1 Web site by the end of
October. In the interim, please refer to the most current lists provided to
you by Noridian and/or National Heritage Insurance Company.
Reasonable Charge Update for 2009 for Splints, Casts, Dialysis Supplies,
Dialysis Equipment, and Certain Intraocular Lenses
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Publications~Fee%20Schedules~Reasonable%20Charge%20Update%20for%202009%20for%20Splints,%20Casts,%20Dialysis%20Supplies,%20Dialysis%20Equipment,%20and%20Certain%20Intraocular%20Lenses%20?opendocument
Change Request 6221, from which this article is taken, instructs Palmetto
GBA how to calculate reasonable charges for the payment of claims for
splints, casts, dialysis supplies, dialysis equipment, and intraocular
lenses furnished in calendar year 2009. CR6221 also announces that the 2009
Inflation-Indexed Charge IIC update factor is 5.0 percent.
Time Limit for Filing Medicare Claims
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Ohio%20Part%20B%20Carrier~Publications~Physician-Supplier%20Guide~Claims%20Filing:%20Medicare~Time%20Limit%20for%20Filing%20Medicare%20Claims?opendocument
Medicare law designates specific time limits for submitting claims for
physician and other Part B services. The terms of the law require that a
claim be filed no later than the end of the calendar year following the
year in which the service was furnished. Exceptions are outlined in this
article.
Friday, October 3, 2008
Palmetto/J1MAC News
The following updates have been posted to the Palmetto/J1MAC website.
2009 CAP Postponement Article
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Current%20News~2009%20CAP%20Postponement%20Article?opendocument
A Medicare Learning Network (MLN) Matters Special Edition article on the
2009 CAP postponement is now available on the CMS website. This article
contains billing, drug ordering, claims processing, and other information
for Participating CAP Physicians on the transition from CAP to the ASP “buy
and bill” methodology for 2009. This article is available on the CMS Web
site at: http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0833.pdf.
Claim Corrections and Appeals: Tips for Faster Service
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~Appeals~Claim%20Corrections%20and%20Appeals:%20Tips%20for%20Faster%20Service?opendocument
Palmetto GBA processes “reopenings” (claim corrections) and redetermination
requests (first level appeals) for all Jurisdiction 1 providers, including
requests related to claims that were processed by the previous contractors.
We are committed to providing you with the best possible service for these
requests. To ensure that we are able to handle your requests for
reopenings and redeterminations correctly and efficiently, please include a
copy of your original remittance notice and any other written communication
from the previous contractor, such as an automated development request
(letter), with all written requests for reopenings and redeterminations.
CMS Quarterly Provider Update
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~CMS%20Quarterly%20Provider%20Update?opendocument
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.
Contacting Your New J1 A/B MAC
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20A~Articles~General~Contacting%20Your%20New%20J1%20AB%20MAC?opendocument
Since the J1 A/B MAC transition is complete, the J1 Transitional e-mail
address, J1MAC@PalmettoGBA.com, is no longer active.
Limitation on Recoupment (935) for Provider, Physicians and Suppliers
Overpayments
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~Overpayment~Limitation%20on%20Recoupment%20(935)%20for%20Provider,%20Physicians%20and%20Suppliers%20Overpayments?opendocument
This article provides more detail on these general points and clarifies
which overpayments are subject to this limitation on recoupment and which
types of overpayments are not subject to this limitation. Make sure that
your billing staffs are aware of these changes.
NPI Development Letters: Rendering and Billing PTANs Needed
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~NPI~NPI%20Development%20Letters:%20Rendering%20and%20Billing%20PTANs%20Needed?opendocument
Palmetto GBA must request your legacy identifier information when we cannot
find a one-to-one match for your National Provider Identifier (NPI) and
your Provider Transaction Access Number (PTAN- also referred to as the
'Medicare legacy number'). These letters require specific information to
be completed and returned to Palmetto GBA in order for your claims to
continue processing. Please see an example of the critical portions of this
letter that we want to bring to your attention.
Part B LCD Update
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Part%20B%20LCD%20Update?opendocument
Click the link to view the J1 A/B MAC Part B LCDs have been revised.
Remark Code MA130: Stop, Correct, and Resubmit
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~Remark%20Code%20MA130:%20Stop,%20Correct,%20and%20Resubmit?opendocument
Services that are rejected by Palmetto GBA with remark code MA130 must be
corrected and resubmitted. MA130 indicates that the claim could not be
processed because it contained one or more billing errors. Services
rejected with remark code MA130 do not have appeal rights and cannot be
“reopened” to correct errors. MA130 is always accompanied by other, more
specific remark codes on your remittance notice. Review your remittance
notice carefully to ensure that you have identified all of the remark codes
before correcting and resubmitting the service.
Requests for Medical Records from Medicare
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~New%20to%20Medicare~Requests%20for%20Medical%20Records%20from%20Medicare?opendocument
Send responses to all correspondence from Palmetto GBA to the specific
address listed in the body of the Palmetto GBA request letter. Sending
your responses to Palmetto GBA “Automated Development Letters” to incorrect
addresses may significantly delay our ability to assist you. In all cases,
it is imperative that you return the records to the requesting entity
within the timeframe specified.
Resolving Common NPI Problems
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~NPI~Resolving%20Common%20NPI%20Problems?opendocument
Palmetto GBA is rejecting claims that are submitted with valid NPIs that
cannot be matched to existing PTANs. The NPI/ PTAN combination may be
used to identify the Billing, Pay-to, or Rendering Provider (the Pay-to
Provider is identified only if it is different from the Billing Provider).
This applies to claims that are submitted by corporations formed by
physicians and non-physician practitioners and by physicians and
non-physician practitioners that submit claims directly to Palmetto GBA.
The purpose of this article is to identify common crosswalk issues we are
encountering and to provide guidance in how to resolve these problems.
The ICD-10 Clinical Modification/Procedure Coding System (CM/PCS)—The Next
Generation of Coding
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~The%20ICD-10%20Clinical%20ModificationProcedure%20Coding%20System%20(CMPCS)—The%20Next%20Generation%20of%20Coding?opendocument
This Special Edition article (SE 0832) outlines general information for
providers detailing the International Classification of Diseases, 10th
Edition (ICD-10) classification system. Compared to the current ICD-9
classification system, ICD-10 offers more detailed information and the
ability to expand specificity and clinical information in order to capture
advancements in clinical medicine. Providers may want to become familiar
with the new coding system.
Written Correspondence from Palmetto GBA
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~NPI~Written%20Correspondence%20from%20Palmetto%20GBA?opendocument
Palmetto GBA may request additional information from you in order to
process your submitted claims. These letters, also called “additional
development requests,” require actions on your behalf and may be time
sensitive. It is very important that you advise your staff of the urgency
of responding to such requests from Palmetto GBA.
“NPI Only” Claim Submission Problems: Minimizing Delays
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~NPI~“NPI%20Only”%20Claim%20Submission%20Problems:%20Minimizing%20Delays?opendocument
If you are experiencing problems submitting claims due to issues with your
NPI number, please be aware that Palmetto GBA will request additional
information from you to resolve some of these situations. The most common
reason for our requests for more information is the existence of multiple
locations (and multiple PTANs) when we do not have sufficient information
to match your NPI with your physical location. These requests may cause
delays in processing your claims.
2009 CAP Postponement Article
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Current%20News~2009%20CAP%20Postponement%20Article?opendocument
A Medicare Learning Network (MLN) Matters Special Edition article on the
2009 CAP postponement is now available on the CMS website. This article
contains billing, drug ordering, claims processing, and other information
for Participating CAP Physicians on the transition from CAP to the ASP “buy
and bill” methodology for 2009. This article is available on the CMS Web
site at: http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0833.pdf.
Claim Corrections and Appeals: Tips for Faster Service
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~Appeals~Claim%20Corrections%20and%20Appeals:%20Tips%20for%20Faster%20Service?opendocument
Palmetto GBA processes “reopenings” (claim corrections) and redetermination
requests (first level appeals) for all Jurisdiction 1 providers, including
requests related to claims that were processed by the previous contractors.
We are committed to providing you with the best possible service for these
requests. To ensure that we are able to handle your requests for
reopenings and redeterminations correctly and efficiently, please include a
copy of your original remittance notice and any other written communication
from the previous contractor, such as an automated development request
(letter), with all written requests for reopenings and redeterminations.
CMS Quarterly Provider Update
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~CMS%20Quarterly%20Provider%20Update?opendocument
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.
Contacting Your New J1 A/B MAC
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20A~Articles~General~Contacting%20Your%20New%20J1%20AB%20MAC?opendocument
Since the J1 A/B MAC transition is complete, the J1 Transitional e-mail
address, J1MAC@PalmettoGBA.com, is no longer active.
Limitation on Recoupment (935) for Provider, Physicians and Suppliers
Overpayments
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~Overpayment~Limitation%20on%20Recoupment%20(935)%20for%20Provider,%20Physicians%20and%20Suppliers%20Overpayments?opendocument
This article provides more detail on these general points and clarifies
which overpayments are subject to this limitation on recoupment and which
types of overpayments are not subject to this limitation. Make sure that
your billing staffs are aware of these changes.
NPI Development Letters: Rendering and Billing PTANs Needed
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~NPI~NPI%20Development%20Letters:%20Rendering%20and%20Billing%20PTANs%20Needed?opendocument
Palmetto GBA must request your legacy identifier information when we cannot
find a one-to-one match for your National Provider Identifier (NPI) and
your Provider Transaction Access Number (PTAN- also referred to as the
'Medicare legacy number'). These letters require specific information to
be completed and returned to Palmetto GBA in order for your claims to
continue processing. Please see an example of the critical portions of this
letter that we want to bring to your attention.
Part B LCD Update
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Part%20B%20LCD%20Update?opendocument
Click the link to view the J1 A/B MAC Part B LCDs have been revised.
Remark Code MA130: Stop, Correct, and Resubmit
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~Remark%20Code%20MA130:%20Stop,%20Correct,%20and%20Resubmit?opendocument
Services that are rejected by Palmetto GBA with remark code MA130 must be
corrected and resubmitted. MA130 indicates that the claim could not be
processed because it contained one or more billing errors. Services
rejected with remark code MA130 do not have appeal rights and cannot be
“reopened” to correct errors. MA130 is always accompanied by other, more
specific remark codes on your remittance notice. Review your remittance
notice carefully to ensure that you have identified all of the remark codes
before correcting and resubmitting the service.
Requests for Medical Records from Medicare
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~New%20to%20Medicare~Requests%20for%20Medical%20Records%20from%20Medicare?opendocument
Send responses to all correspondence from Palmetto GBA to the specific
address listed in the body of the Palmetto GBA request letter. Sending
your responses to Palmetto GBA “Automated Development Letters” to incorrect
addresses may significantly delay our ability to assist you. In all cases,
it is imperative that you return the records to the requesting entity
within the timeframe specified.
Resolving Common NPI Problems
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~NPI~Resolving%20Common%20NPI%20Problems?opendocument
Palmetto GBA is rejecting claims that are submitted with valid NPIs that
cannot be matched to existing PTANs. The NPI/ PTAN combination may be
used to identify the Billing, Pay-to, or Rendering Provider (the Pay-to
Provider is identified only if it is different from the Billing Provider).
This applies to claims that are submitted by corporations formed by
physicians and non-physician practitioners and by physicians and
non-physician practitioners that submit claims directly to Palmetto GBA.
The purpose of this article is to identify common crosswalk issues we are
encountering and to provide guidance in how to resolve these problems.
The ICD-10 Clinical Modification/Procedure Coding System (CM/PCS)—The Next
Generation of Coding
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~The%20ICD-10%20Clinical%20ModificationProcedure%20Coding%20System%20(CMPCS)—The%20Next%20Generation%20of%20Coding?opendocument
This Special Edition article (SE 0832) outlines general information for
providers detailing the International Classification of Diseases, 10th
Edition (ICD-10) classification system. Compared to the current ICD-9
classification system, ICD-10 offers more detailed information and the
ability to expand specificity and clinical information in order to capture
advancements in clinical medicine. Providers may want to become familiar
with the new coding system.
Written Correspondence from Palmetto GBA
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~NPI~Written%20Correspondence%20from%20Palmetto%20GBA?opendocument
Palmetto GBA may request additional information from you in order to
process your submitted claims. These letters, also called “additional
development requests,” require actions on your behalf and may be time
sensitive. It is very important that you advise your staff of the urgency
of responding to such requests from Palmetto GBA.
“NPI Only” Claim Submission Problems: Minimizing Delays
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~NPI~“NPI%20Only”%20Claim%20Submission%20Problems:%20Minimizing%20Delays?opendocument
If you are experiencing problems submitting claims due to issues with your
NPI number, please be aware that Palmetto GBA will request additional
information from you to resolve some of these situations. The most common
reason for our requests for more information is the existence of multiple
locations (and multiple PTANs) when we do not have sufficient information
to match your NPI with your physical location. These requests may cause
delays in processing your claims.
Thursday, October 2, 2008
Medicare Part B Drug Competitive Acquisition Program (CAP): 2009 CAP Postponement
A Medicare Learning Network (MLN) Matters Special Edition article on the 2009 CAP postponement is now available on the CMS website. This article contains billing, drug ordering, claims processing, and other information for Participating CAP Physicians on the transition from CAP to the ASP “buy and bill” methodology for 2009. This article is available on the CMS website at: http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0833.pdf.
Additional information on the CAP and the program’s postponement for 2009 is available on the CMS CAP website at: http://www.cms.hhs.gov/CompetitiveAcquisforBios/01_overview.asp.
Additional information on the CAP and the program’s postponement for 2009 is available on the CMS CAP website at: http://www.cms.hhs.gov/CompetitiveAcquisforBios/01_overview.asp.
ASCO, CMS, Palmetto/J1MAC News
The following information has been received by ANCO.
All ANCO Online LIstServ postings are archived at the ANCO Online ListSev blog available at http://anco-online.blogspot.com/.
***ASCO NEWS***
The American Society of Clinical Oncology's (ASCO) CANCER POLICY TODAY was published and is available at http://view.exacttarget.com/?j=fe6115777c65067a7715&m=ff311d707460&ls=fdf912757061027e75117274&l=fe5d15747c6d027d7717&s=fe1f15797d620479731d75&jb=ffcf14&ju=fe36167175660c7f731474. It features:
President Signs Continuing Resolution to Fund Government Programs
Members of Congress Urge Congressional Leadership to Exclude Prompt Pay Discount from ASP
New Guidance on Recent ESA Label Changes
ASCO Responds to OHRP on Human Subjects Protection
ASCO Comments on FDA Draft Guidance on Statement of Investigator Form (Form FDA 1572)
ASCO Comments on DEA e-Prescribing Rule for Controlled Substances
NIH Announces New Roadmap Transformative R01 Funding Program
NCI Director Testifies on Recommendations for Federal Biospecimen Storage and Tracking
Congress Passes Michelle's Law
Your Participation Needed for Physician Practice Information Survey
New and Revised ICD-9-CM Codes
Job Openings at NIH
FDA Safety Alert Regarding Tarceva (erlotinib)
NIH Currently Accepting Applications for Loan Repayment Programs
ASCO Conducting Learning Needs Assessment of Member Physicians
Join ASCO's Advocacy Network
ASCO Extends Resources to Practice Administrators
***CMS NEWS***
New article(s) have been posted to MLN MATTERS, as follows:
SE0832 – The ICD-10 Clinical Modification/Procedure Coding System (CM/PCS)—The Next Generation of Coding
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0832.pdf
PHYSICIAN QUALITY REPORTING INITIATIVE SELF SERVE LOOK-UP TOOL IS NOW AVAILABLE
The Centers for Medicare and Medicaid Services (CMS) is pleased to announce that a new self-service look-up tool is now available on the PQRI Portal at http://www.qualitynet.org/pqri on the Internet, which allows an eligible professional at the Tax Identification Number (TIN) level to see if their 2007 PQRI Feedback Report is available. Once on the site, go to the "Verify TIN Report Portlet" which is located at the bottom left of the page. Enter the TIN and a message appears that indicates if a 2007 PQRI Feedback Report is or is not available.
This self-service look-up tool does not allow the eligible professional to view their 2007 PQRI Feedback Report. The availability of the 2007 PQRI Feedback Report is helpful for eligible professionals to know because it enables them to decide if they need to register for an IACS account at this time so that they can log into the PQRI Portal and view their 2007 PQRI Feedback Report.
In addition, the eligible professional can call the QualityNet Help Desk in order to determine if a 2007 PQRI Feedback Report is available. The representatives at the QualityNet Help Desk can only inform the provider if a 2007 PQRI Feedback Report is available; they are unable to disclose the information on the 2007 PQRI Feedback Report. The QualityNet Help Desk can be reached via telephone at 1-866-288-8912 from the hours of 7am-7pm CST or via email at Qnetsupport@ifmc.sdps.org.
NOTE: The TIN must be the one used by the eligible professional to submit Medicare claims and valid PQRI quality data codes for dates of service July 1 – December 31, 2007.
MEDICARE PUBLISHES BILLING EDITS TO REDUCE PAYMENT ERRORS
The Centers for Medicare & Medicaid Services today announced that, beginning October 1, 2008, it will publish most of the edits utilized in its Medically Unlikely Edit (MUE) program to improve the accuracy of claims payments.
“It is always our aim to ensure that CMS pays for appropriate services, at the same time protecting the Medicare Trust funds and the American taxpayer,” said CMS Acting Administrator Kerry Weems. “This program is going to help us dramatically reduce costly payment errors.”
CMS established the MUE program to reduce payment errors for Medicare Part B claims. Claims processing contractors utilize these edits to assure that providers and suppliers do not report excessive services. The edits are applied during the electronic processing of all claims.
To view the entire Press Release, please see: http://www.cms.hhs.gov/apps/media/press_releases.asp
The edits will be published on the CMS Web site at http://www.cms.hhs.gov/NationalCorrectCodInitEd/08_MUE.asp#TopOfPage
***PALMETTO/J1MAC NEWS***
TIME LIMIT FOR FILING MEDICARE CLAIMS
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Ohio%20Part%20B%20Carrier~Publications~Physician-Supplier%20Guide~Claims%20Filing:%20Medicare~Time%20Limit%20for%20Filing%20Medicare%20Claims?opendocument
Medicare law designates specific time limits for submitting claims for
physician and other Part B services. The terms of the law require that a
claim be filed no later than the end of the calendar year following the
year in which the service was furnished. Exceptions are outlined in this
article.
PALMETTO ADVANCE PAYMENT REQUIREMENTS
Palmetto GBA and the Centers for Medicare & Medicaid Services (CMS) will consider, in limited circumstances, an advance payment for Part B providers who are experiencing financial hardship due to claims that are unable to process within established time limits. This applies to claims that have been submitted, but payment has not been made due to a system malfunction. This does not apply to claims that have not paid due to claims submission errors.
Advance payment may be made if all of the following conditions are met:
* Palmetto GBA is unable to process the claim timely.
* CMS determines that the prompt payment interest provision specified in section 1842(c) of the Act is insufficient to make a claimant whole.
* CMS provides written approval to Palmetto GBA, to make an advance payment.
Advance payment cannot be made if any of the following conditions is met. The provider:
* Is delinquent in repaying a Medicare overpayment.
* Has been advised of being under active medical review or program integrity investigation.
* Has not submitted any claims.
* Has not accepted claims' assignments within the most recent 180-day period preceding the system malfunction.
If you meet all required conditions and would like to request advance payments, you must submit a written request to Palmetto GBA. The request must include the reason your cash balance is seriously impaired, along with financial information to show hardship.
The following is an example of an acceptable format:
a. Cash on hand as of ________ $_____
b. Expected payments from all sources (not including any advance payments) in the next 30 days $_____
c. Expected expenses in next 30 days $_____
d. Cash position in next 30 days (a + b - c) $_____
Palmetto GBA then calculates the amount of the advance payment and forwards the request to CMS for approval. The amount of the advance payment is calculated at 80 percent of the anticipated payment based on historical data for claims paid. Historical data is defined as a representative 90-day assigned claims payment trend within the most recent 180-day experience before the system malfunction. Generally, the advance payment will be no more than the amount paid, on a daily average, for the 90 day period before the system malfunction.
If approved, you agree that Palmetto GBA will recover the advance payment by applying the amount due to future payments. The decision to approve an advance payment and the amount of the payment are at CMS's discretion and are not subject to review or appeal.
The complete listing of the requirements for advance payments for Part B services are found in the Federal Register at www.gpoaccess.gov/cfr/index.html. Click on "Retrieve by CFR Citation," and type 42 in the Title box, 421 in the Part box and 214 in the Section box. Then click on "Go."
Please note that CMS expects these requests to be limited. In most cases, corrections can be made and claims finalized before an advance payment request can be processed.
J1 Advance Payment Requests should be sent or faxed to:
J1 MAC – Palmetto GBA
Attn: Vicky Bowers AG-325
"MSC J1-4084"
17 Technology Circle
Columbia, SC 29203-9591
FAX (803) 763-5575
All ANCO Online LIstServ postings are archived at the ANCO Online ListSev blog available at http://anco-online.blogspot.com/.
***ASCO NEWS***
The American Society of Clinical Oncology's (ASCO) CANCER POLICY TODAY was published and is available at http://view.exacttarget.com/?j=fe6115777c65067a7715&m=ff311d707460&ls=fdf912757061027e75117274&l=fe5d15747c6d027d7717&s=fe1f15797d620479731d75&jb=ffcf14&ju=fe36167175660c7f731474. It features:
President Signs Continuing Resolution to Fund Government Programs
Members of Congress Urge Congressional Leadership to Exclude Prompt Pay Discount from ASP
New Guidance on Recent ESA Label Changes
ASCO Responds to OHRP on Human Subjects Protection
ASCO Comments on FDA Draft Guidance on Statement of Investigator Form (Form FDA 1572)
ASCO Comments on DEA e-Prescribing Rule for Controlled Substances
NIH Announces New Roadmap Transformative R01 Funding Program
NCI Director Testifies on Recommendations for Federal Biospecimen Storage and Tracking
Congress Passes Michelle's Law
Your Participation Needed for Physician Practice Information Survey
New and Revised ICD-9-CM Codes
Job Openings at NIH
FDA Safety Alert Regarding Tarceva (erlotinib)
NIH Currently Accepting Applications for Loan Repayment Programs
ASCO Conducting Learning Needs Assessment of Member Physicians
Join ASCO's Advocacy Network
ASCO Extends Resources to Practice Administrators
***CMS NEWS***
New article(s) have been posted to MLN MATTERS, as follows:
SE0832 – The ICD-10 Clinical Modification/Procedure Coding System (CM/PCS)—The Next Generation of Coding
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0832.pdf
PHYSICIAN QUALITY REPORTING INITIATIVE SELF SERVE LOOK-UP TOOL IS NOW AVAILABLE
The Centers for Medicare and Medicaid Services (CMS) is pleased to announce that a new self-service look-up tool is now available on the PQRI Portal at http://www.qualitynet.org/pqri on the Internet, which allows an eligible professional at the Tax Identification Number (TIN) level to see if their 2007 PQRI Feedback Report is available. Once on the site, go to the "Verify TIN Report Portlet" which is located at the bottom left of the page. Enter the TIN and a message appears that indicates if a 2007 PQRI Feedback Report is or is not available.
This self-service look-up tool does not allow the eligible professional to view their 2007 PQRI Feedback Report. The availability of the 2007 PQRI Feedback Report is helpful for eligible professionals to know because it enables them to decide if they need to register for an IACS account at this time so that they can log into the PQRI Portal and view their 2007 PQRI Feedback Report.
In addition, the eligible professional can call the QualityNet Help Desk in order to determine if a 2007 PQRI Feedback Report is available. The representatives at the QualityNet Help Desk can only inform the provider if a 2007 PQRI Feedback Report is available; they are unable to disclose the information on the 2007 PQRI Feedback Report. The QualityNet Help Desk can be reached via telephone at 1-866-288-8912 from the hours of 7am-7pm CST or via email at Qnetsupport@ifmc.sdps.org.
NOTE: The TIN must be the one used by the eligible professional to submit Medicare claims and valid PQRI quality data codes for dates of service July 1 – December 31, 2007.
MEDICARE PUBLISHES BILLING EDITS TO REDUCE PAYMENT ERRORS
The Centers for Medicare & Medicaid Services today announced that, beginning October 1, 2008, it will publish most of the edits utilized in its Medically Unlikely Edit (MUE) program to improve the accuracy of claims payments.
“It is always our aim to ensure that CMS pays for appropriate services, at the same time protecting the Medicare Trust funds and the American taxpayer,” said CMS Acting Administrator Kerry Weems. “This program is going to help us dramatically reduce costly payment errors.”
CMS established the MUE program to reduce payment errors for Medicare Part B claims. Claims processing contractors utilize these edits to assure that providers and suppliers do not report excessive services. The edits are applied during the electronic processing of all claims.
To view the entire Press Release, please see: http://www.cms.hhs.gov/apps/media/press_releases.asp
The edits will be published on the CMS Web site at http://www.cms.hhs.gov/NationalCorrectCodInitEd/08_MUE.asp#TopOfPage
***PALMETTO/J1MAC NEWS***
TIME LIMIT FOR FILING MEDICARE CLAIMS
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Ohio%20Part%20B%20Carrier~Publications~Physician-Supplier%20Guide~Claims%20Filing:%20Medicare~Time%20Limit%20for%20Filing%20Medicare%20Claims?opendocument
Medicare law designates specific time limits for submitting claims for
physician and other Part B services. The terms of the law require that a
claim be filed no later than the end of the calendar year following the
year in which the service was furnished. Exceptions are outlined in this
article.
PALMETTO ADVANCE PAYMENT REQUIREMENTS
Palmetto GBA and the Centers for Medicare & Medicaid Services (CMS) will consider, in limited circumstances, an advance payment for Part B providers who are experiencing financial hardship due to claims that are unable to process within established time limits. This applies to claims that have been submitted, but payment has not been made due to a system malfunction. This does not apply to claims that have not paid due to claims submission errors.
Advance payment may be made if all of the following conditions are met:
* Palmetto GBA is unable to process the claim timely.
* CMS determines that the prompt payment interest provision specified in section 1842(c) of the Act is insufficient to make a claimant whole.
* CMS provides written approval to Palmetto GBA, to make an advance payment.
Advance payment cannot be made if any of the following conditions is met. The provider:
* Is delinquent in repaying a Medicare overpayment.
* Has been advised of being under active medical review or program integrity investigation.
* Has not submitted any claims.
* Has not accepted claims' assignments within the most recent 180-day period preceding the system malfunction.
If you meet all required conditions and would like to request advance payments, you must submit a written request to Palmetto GBA. The request must include the reason your cash balance is seriously impaired, along with financial information to show hardship.
The following is an example of an acceptable format:
a. Cash on hand as of ________ $_____
b. Expected payments from all sources (not including any advance payments) in the next 30 days $_____
c. Expected expenses in next 30 days $_____
d. Cash position in next 30 days (a + b - c) $_____
Palmetto GBA then calculates the amount of the advance payment and forwards the request to CMS for approval. The amount of the advance payment is calculated at 80 percent of the anticipated payment based on historical data for claims paid. Historical data is defined as a representative 90-day assigned claims payment trend within the most recent 180-day experience before the system malfunction. Generally, the advance payment will be no more than the amount paid, on a daily average, for the 90 day period before the system malfunction.
If approved, you agree that Palmetto GBA will recover the advance payment by applying the amount due to future payments. The decision to approve an advance payment and the amount of the payment are at CMS's discretion and are not subject to review or appeal.
The complete listing of the requirements for advance payments for Part B services are found in the Federal Register at www.gpoaccess.gov/cfr/index.html. Click on "Retrieve by CFR Citation," and type 42 in the Title box, 421 in the Part box and 214 in the Section box. Then click on "Go."
Please note that CMS expects these requests to be limited. In most cases, corrections can be made and claims finalized before an advance payment request can be processed.
J1 Advance Payment Requests should be sent or faxed to:
J1 MAC – Palmetto GBA
Attn: Vicky Bowers AG-325
"MSC J1-4084"
17 Technology Circle
Columbia, SC 29203-9591
FAX (803) 763-5575
Wednesday, October 1, 2008
Recent News from ACCC, ASCO, CMA, CMS, & Palmetto/J1MAC
The following information was received by ANCO during the ListServ's down time. Ordinarily these items would have been posted separately. They are aggregated here for your convenience.
All ANCO Online LIstServ postings are archived at the ANCO Online ListSev blog available at http://anco-online.blogspot.com/.
***ACCC NEWS***
The Association of Community Cancer Center's (ACCC) This Week at ACCC was published and is available at http://www.accc-cancer.org/mediaroom/newsletters/media_ACCCNEWSLETTER_9-29-2008.html. It features:
CMS to Issue Guidance on Use of Recognized Compendia, But Gives No Date
ACCC's Highly Acclaimed Hospital Summit Back By Popular Demand
CMS to Host ICD-10-CM/PCS National Provider Conference Calls
Regional Oncology Symposia Coming to Tampa and Philadelphia
Most Cancer Clinical Trials Go Unpublished
Alimta Receives New FDA Indication
Q&A on ACCC's Listserv: The Value of a Dedicated Surgical Oncology Wing
ACCC's CE Blackboard: Continuing Education Programs for You
State Medical Oncology Societies Host Upcoming Meetings
Intensive Course Offered in Clinical Cancer Genetics
***ASCO NEWS***
ASCO has prepared additional guidance for members related to the FDA’s recent label changes for ESAs in cancer. Please review the attached document “Important Information for Physicians about Changes Affecting the FDA-Approved Use of Erythropoiesis Stimulating Agents (ESAs)”.
ASCO's e-News was published and is available at http://view.exacttarget.com/?j=fe5315777d63027d731d&m=ff2d16787160&ls=fdf7127671650c7f7d177275&l=fe5c157575630475731c&s=fdf2157972640d79751d7073&ju=fe2516707c6d017b771075. It features:
ASCO Announces Candidates for 2009 Election
Members Only Housing Now Open for 2009 ASCO Annual Meeting
Applications Now Open for 2009 ASCO State Affiliate Grants
2008 Chicago Multidisciplinary Symposium in Thoracic Oncology
Annual Meeting Summaries Now Available on ASCO.org
Latest Issue of Journal of Oncology Practice Available Online
Registration Now Open for the 2009 Gastrointestinal Cancers Symposium
2008 Breast Cancer Symposium Virtual Meeting Includes General Poster Presentations
ASCO Joins "Frosted Pink with A Twist" and Mary Lou Retton to Raise Awareness of Cancer
Apply Today for CDA and YIA Grants from The ASCO Cancer Foundation
Cancer Policy Alert: CMS Announces CAP Postponement, ASCO Comments on FDA Advisory Committee Draft Guidance
Translational Cancer Medicine 2008: Bridging the Lab and the Clinic in Cancer Medicine
Aging and Cancer: Two Sides of the Same Coin?
For Your Patients: Special Cancer.Net Podcast: Look Good...Feel Better
For Your Patients: Latest Cancer.Net Feature Articles Explain Pharmacogenomics and Angiogenesis
New JCO Early Release Articles Published
See What's Coming Up in JCO
***CMA NEWS***
The California Medical Association's (CMA) CMA Alert was published and is available at http://www.calphys.org/html/news.asp. It features:
Serious Medicare Payment Problems Persist
You’re Invited to a Medicare Payment Workshop in Sacramento, Friday October 3 at 6pm
CMA Takes Legal Action to Stop Unlawful DMHC Regulation
CMA Urges CMS to Extend Family PACT Waiver
Governor Approves State Budget; Structural Problems Remain
CMA’s Annual House of Delegates Convenes this Weekend
CMA Doctors Get Out in the Community
Physicians Urged to Verify Accuracy of CPPI Quality Data
Save the Date: CMA’s 34th Annual Legislative Leadership Conference Is April 14
Member Benefit of the Week: 30 - 50% off Epocrates
***CMS NEWS***
ICD-10-CM/PCS National Provider Conference Calls With Question & Answer Session
The Centers for Medicare & Medicaid Services (CMS) will host a series of national provider calls (see below) that will provide an overview of ICD-10 and how it differs from ICD-9-CM. The presentations will include the major impacts providers should consider when planning to update any systems with ICD-10 codes. Issues such as differences in code length, alpha-numeric characters, and increased details captured by the codes will be explained. For the provider, payer, vendor, and publishing community, this overview will help them think about future reporting, system updates, and training, considering that ICD-10 may be implemented in the future.
The presenters will include members of the Cooperating Parties for ICD-9-CM, a formal coalition that has been working together on ICD-10 issues. The role of each will be explained, along with a similar role they will play should ICD-10 be implemented. The Cooperating Parties include CMS, Centers for Disease Control and Prevention (CDC), American Health Information Management Association (AHIMA), and American Hospital Association (AHA).
A PowerPoint slide presentation has been posted on the ICD-10 Web Page at http://www.cms.hhs.gov/ICD10 for you to download prior to the conference call so that you can follow along with the presentation.
Conference Call Details:
Separate conference calls have been scheduled for each provider type. The same information will be presented at each conference call. Participants may select one of the times listed below to attend a conference call. Select the appropriate link below, according to your provider type, to register for a conference call.
Provider Type and Date and Time of Conference Call:
Hospital Staff
October 14, 2008
12:30 p.m. – 2:30 p.m. EDT
To register go to http://www.cms.hhs.gov/ICD10/downloads/ICD10_hospital.pdf.
Other Part A and Part B Providers
November 12, 2008
12:30 p.m. – 2:30 p.m. EST
Registration information for this conference call will be forthcoming.
Physicians
November 17, 2008
12:30 p.m. – 2:30 p.m. EST
Registration information for this conference call will be forthcoming.
For those who are unable to attend, a transcript will be posted on the ICD-10 Web Page at http://www.cms.hhs.gov/ICD10 shortly after the conference call.
New Article Posted to MLN Matters
SE0822 – Clarification of Medicare Payment for Routine Costs in a Clinical Trial
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0822.pdf
***PALMETTO/J1MAC NEWS***
E-mail Updates: Why You Can’t Afford to Miss Them
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~New%20to%20Medicare~E-mail%20Updates:%20Why%20You%20Can’t%20Afford%20to%20Miss%20Them?opendocument
Palmetto GBA sends e-mail updates to registered subscribers to share
time-sensitive information, changes in guidelines and processes, and
information on documentation and claim submission...sign up today! It is a
challenge for everyone to keep up with the latest news. Imagine how much
more efficiently you could manage your practice or facility, ensure your
compliance with federal rules and regulations, and have confidence in the
accuracy of your claims and your reimbursement from Medicare.
Enrollment Applications: Status and Priority
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~Provider%20Enrollment~Enrollment%20Applications:%20Status%20and%20Priority?opendocument
Palmetto GBA is receiving a high volume of calls to verify receipt of
enrollment applications and to report “billing problems” related to NPI
numbers. We understand the urgency of resolving billing problems and
updating enrollment information and are working as quickly as possible to
provide the best possible service to you.
Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 14.3,
Effective October 1, 2008
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~Quarterly%20Update%20to%20Correct%20Coding%20Initiative%20(CCI)%20Edits,%20Version%2014.3,%20Effective%20October%201,%202008?opendocument
This article is based on Change Request (CR) 6169, which provides a
reminder for physicians to take note of the quarterly updates to Correct
Coding Initiative (CCI) edits. The latest package of CCI edits, Version
14.3, will be effective October1, 2008. Version 14.3 of the CCI edits will
include all previous versions and updates from January 1, 1996 to the
present.
Update to the Healthcare Provider Taxonomy Codes (HPTC) Version 8.0 –
October 1, 2008
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~EDI~General~Update%20to%20the%20Healthcare%20Provider%20Taxonomy%20Codes%20(HPTC)%20Version%208.0%20–%20October%201,%202008?opendocument
CMS has released the summary of changes reflected in the Health Care
Provider Taxonomy Code (HPTC) list version 8.0. Medicare carriers and
DMERCs will update their HPTC tables with this new version effective on
October 1, 2008.
Part B LCD Update
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Coverage~Medical%20Policies~Part%20B%20LCD%20Update?opendocument
J1 A/B MAC Part B LCDs have been revised. Please click on the
above link to see the complete list.
Clarification of Medicare Payment for Routine Costs in a Clinical Trial
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~Clinical%20Trials~Clarification%20of%20Medicare%20Payment%20for%20Routine%20Costs%20in%20a%20Clinical%20Trial%20?opendocument
This Special Edition article provides clarification regarding Medicare
payment of routine costs associated with clinical trials. CMS reminds
providers that the manual policy (chapter 16, section 40 of the Medicare
Benefit Policy Manual) states: “40 No Legal Obligation to Pay for or
Provide Services. Be sure your billing staff is aware of this information.
October 2008 J1 A/B MAC Medicare Advisory
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20A~Publications~Medicare%20Advisory~October%202008%20J1%20AB%20MAC%20Medicare%20Advisory%20?opendocument
This is the first issue of the J1 A/B MAC Medicare Advisory. To ensure no
information is excluded, we have combined information from July, August and
September into the October Issue.
All ANCO Online LIstServ postings are archived at the ANCO Online ListSev blog available at http://anco-online.blogspot.com/.
***ACCC NEWS***
The Association of Community Cancer Center's (ACCC) This Week at ACCC was published and is available at http://www.accc-cancer.org/mediaroom/newsletters/media_ACCCNEWSLETTER_9-29-2008.html. It features:
CMS to Issue Guidance on Use of Recognized Compendia, But Gives No Date
ACCC's Highly Acclaimed Hospital Summit Back By Popular Demand
CMS to Host ICD-10-CM/PCS National Provider Conference Calls
Regional Oncology Symposia Coming to Tampa and Philadelphia
Most Cancer Clinical Trials Go Unpublished
Alimta Receives New FDA Indication
Q&A on ACCC's Listserv: The Value of a Dedicated Surgical Oncology Wing
ACCC's CE Blackboard: Continuing Education Programs for You
State Medical Oncology Societies Host Upcoming Meetings
Intensive Course Offered in Clinical Cancer Genetics
***ASCO NEWS***
ASCO has prepared additional guidance for members related to the FDA’s recent label changes for ESAs in cancer. Please review the attached document “Important Information for Physicians about Changes Affecting the FDA-Approved Use of Erythropoiesis Stimulating Agents (ESAs)”.
ASCO's e-News was published and is available at http://view.exacttarget.com/?j=fe5315777d63027d731d&m=ff2d16787160&ls=fdf7127671650c7f7d177275&l=fe5c157575630475731c&s=fdf2157972640d79751d7073&ju=fe2516707c6d017b771075. It features:
ASCO Announces Candidates for 2009 Election
Members Only Housing Now Open for 2009 ASCO Annual Meeting
Applications Now Open for 2009 ASCO State Affiliate Grants
2008 Chicago Multidisciplinary Symposium in Thoracic Oncology
Annual Meeting Summaries Now Available on ASCO.org
Latest Issue of Journal of Oncology Practice Available Online
Registration Now Open for the 2009 Gastrointestinal Cancers Symposium
2008 Breast Cancer Symposium Virtual Meeting Includes General Poster Presentations
ASCO Joins "Frosted Pink with A Twist" and Mary Lou Retton to Raise Awareness of Cancer
Apply Today for CDA and YIA Grants from The ASCO Cancer Foundation
Cancer Policy Alert: CMS Announces CAP Postponement, ASCO Comments on FDA Advisory Committee Draft Guidance
Translational Cancer Medicine 2008: Bridging the Lab and the Clinic in Cancer Medicine
Aging and Cancer: Two Sides of the Same Coin?
For Your Patients: Special Cancer.Net Podcast: Look Good...Feel Better
For Your Patients: Latest Cancer.Net Feature Articles Explain Pharmacogenomics and Angiogenesis
New JCO Early Release Articles Published
See What's Coming Up in JCO
***CMA NEWS***
The California Medical Association's (CMA) CMA Alert was published and is available at http://www.calphys.org/html/news.asp. It features:
Serious Medicare Payment Problems Persist
You’re Invited to a Medicare Payment Workshop in Sacramento, Friday October 3 at 6pm
CMA Takes Legal Action to Stop Unlawful DMHC Regulation
CMA Urges CMS to Extend Family PACT Waiver
Governor Approves State Budget; Structural Problems Remain
CMA’s Annual House of Delegates Convenes this Weekend
CMA Doctors Get Out in the Community
Physicians Urged to Verify Accuracy of CPPI Quality Data
Save the Date: CMA’s 34th Annual Legislative Leadership Conference Is April 14
Member Benefit of the Week: 30 - 50% off Epocrates
***CMS NEWS***
ICD-10-CM/PCS National Provider Conference Calls With Question & Answer Session
The Centers for Medicare & Medicaid Services (CMS) will host a series of national provider calls (see below) that will provide an overview of ICD-10 and how it differs from ICD-9-CM. The presentations will include the major impacts providers should consider when planning to update any systems with ICD-10 codes. Issues such as differences in code length, alpha-numeric characters, and increased details captured by the codes will be explained. For the provider, payer, vendor, and publishing community, this overview will help them think about future reporting, system updates, and training, considering that ICD-10 may be implemented in the future.
The presenters will include members of the Cooperating Parties for ICD-9-CM, a formal coalition that has been working together on ICD-10 issues. The role of each will be explained, along with a similar role they will play should ICD-10 be implemented. The Cooperating Parties include CMS, Centers for Disease Control and Prevention (CDC), American Health Information Management Association (AHIMA), and American Hospital Association (AHA).
A PowerPoint slide presentation has been posted on the ICD-10 Web Page at http://www.cms.hhs.gov/ICD10 for you to download prior to the conference call so that you can follow along with the presentation.
Conference Call Details:
Separate conference calls have been scheduled for each provider type. The same information will be presented at each conference call. Participants may select one of the times listed below to attend a conference call. Select the appropriate link below, according to your provider type, to register for a conference call.
Provider Type and Date and Time of Conference Call:
Hospital Staff
October 14, 2008
12:30 p.m. – 2:30 p.m. EDT
To register go to http://www.cms.hhs.gov/ICD10/downloads/ICD10_hospital.pdf.
Other Part A and Part B Providers
November 12, 2008
12:30 p.m. – 2:30 p.m. EST
Registration information for this conference call will be forthcoming.
Physicians
November 17, 2008
12:30 p.m. – 2:30 p.m. EST
Registration information for this conference call will be forthcoming.
For those who are unable to attend, a transcript will be posted on the ICD-10 Web Page at http://www.cms.hhs.gov/ICD10 shortly after the conference call.
New Article Posted to MLN Matters
SE0822 – Clarification of Medicare Payment for Routine Costs in a Clinical Trial
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0822.pdf
***PALMETTO/J1MAC NEWS***
E-mail Updates: Why You Can’t Afford to Miss Them
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~New%20to%20Medicare~E-mail%20Updates:%20Why%20You%20Can’t%20Afford%20to%20Miss%20Them?opendocument
Palmetto GBA sends e-mail updates to registered subscribers to share
time-sensitive information, changes in guidelines and processes, and
information on documentation and claim submission...sign up today! It is a
challenge for everyone to keep up with the latest news. Imagine how much
more efficiently you could manage your practice or facility, ensure your
compliance with federal rules and regulations, and have confidence in the
accuracy of your claims and your reimbursement from Medicare.
Enrollment Applications: Status and Priority
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~Provider%20Enrollment~Enrollment%20Applications:%20Status%20and%20Priority?opendocument
Palmetto GBA is receiving a high volume of calls to verify receipt of
enrollment applications and to report “billing problems” related to NPI
numbers. We understand the urgency of resolving billing problems and
updating enrollment information and are working as quickly as possible to
provide the best possible service to you.
Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 14.3,
Effective October 1, 2008
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~Quarterly%20Update%20to%20Correct%20Coding%20Initiative%20(CCI)%20Edits,%20Version%2014.3,%20Effective%20October%201,%202008?opendocument
This article is based on Change Request (CR) 6169, which provides a
reminder for physicians to take note of the quarterly updates to Correct
Coding Initiative (CCI) edits. The latest package of CCI edits, Version
14.3, will be effective October1, 2008. Version 14.3 of the CCI edits will
include all previous versions and updates from January 1, 1996 to the
present.
Update to the Healthcare Provider Taxonomy Codes (HPTC) Version 8.0 –
October 1, 2008
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~EDI~General~Update%20to%20the%20Healthcare%20Provider%20Taxonomy%20Codes%20(HPTC)%20Version%208.0%20–%20October%201,%202008?opendocument
CMS has released the summary of changes reflected in the Health Care
Provider Taxonomy Code (HPTC) list version 8.0. Medicare carriers and
DMERCs will update their HPTC tables with this new version effective on
October 1, 2008.
Part B LCD Update
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Coverage~Medical%20Policies~Part%20B%20LCD%20Update?opendocument
J1 A/B MAC Part B LCDs have been revised. Please click on the
above link to see the complete list.
Clarification of Medicare Payment for Routine Costs in a Clinical Trial
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~Clinical%20Trials~Clarification%20of%20Medicare%20Payment%20for%20Routine%20Costs%20in%20a%20Clinical%20Trial%20?opendocument
This Special Edition article provides clarification regarding Medicare
payment of routine costs associated with clinical trials. CMS reminds
providers that the manual policy (chapter 16, section 40 of the Medicare
Benefit Policy Manual) states: “40 No Legal Obligation to Pay for or
Provide Services. Be sure your billing staff is aware of this information.
October 2008 J1 A/B MAC Medicare Advisory
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20A~Publications~Medicare%20Advisory~October%202008%20J1%20AB%20MAC%20Medicare%20Advisory%20?opendocument
This is the first issue of the J1 A/B MAC Medicare Advisory. To ensure no
information is excluded, we have combined information from July, August and
September into the October Issue.
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