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.