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ASCO Comments on FDA Draft Guidance on Statement of Investigator Form (Form FDA 1572)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