CMA & Palmetto/J1MAC News

The following information has been received by ANCO.


****CMA NEWS****
The California Medical Association's (CMA) CMA Alert was published and is available online at http://www.calphys.org/html/news.asp. It 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


****PALMETTO/J1MAC NEWS****
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.


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address, J1MAC@PalmettoGBA.com, is no longer active.


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.


J1 Part B EDI Communications Tip
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~EDI~General~J1%20Part%20B%20EDI%20Communications%20Tip?opendocument

When communicating with Palmetto GBA, please indicate whether you are a
Northern California or Southern California J1 provider in all
communications. This will help us expedite research and your requests.


Medicare Provider Feedback Town Hall Meeting
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20A~Articles~General~Medicare%20Provider%20Feedback%20Town%20Hall%20Meeting?opendocument

The Centers for Medicare & Medicaid Services (CMS) requests your
participation in a Town Hall meeting on September 22, 2008, from 2:00 PM to
4:00 PM (Eastern Time). The meeting will be held via conference call as
well as in the auditorium at the Centers for Medicare & Medicaid Services,
7500 Security Boulevard, Baltimore, Maryland 21244.


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 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.


October Update to the 2008 Medicare Physician Fee Schedule Database
(MPFSDB)
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Publications~Fee%20Schedules~October%20Update%20to%20the%202008%20Medicare%20Physician%20Fee%20Schedule%20Database%20(MPFSDB)?opendocument

Physicians and providers who submit claims to Palmetto GBA for services
rendered to Medicare beneficiaries paid based on the MPFSDB. The October
2008 MFSDB changes are outlined in this article.


Overpayment Refund Form: Medicare Part A and B
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20A~Resources~Forms~Overpayment%20Refund%20Form:%20Medicare%20Part%20A%20and%20B?opendocument

An updated Medicare Overpayment form is now available online. Overpayments
are Medicare funds a Provider, Physician/Supplier or Beneficiary has
received in excess of amounts due and payable by Medicare. Once a
determination of overpayment has been made, the amount is a debt owed to
the United States Government. When you identify an overpayment, please send
a check with the completed form to Medicare for that amount. This will
prevent offsets or delay of future claim payments.


Physician Opt Out Lists
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~Physician%20Opt%20Out%20Lists?opendocument

The Palmetto GBA Web site contains listings of health professionals who
have elected to opt out of the Medicare program for the following areas:
Northern California, Southern California, Hawaii and Nevada


Physician Signature Requirements for Diagnostic Tests
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~Physician%20Signature%20Requirements%20for%20Diagnostic%20Tests?opendocument

A physician’s signature is not required on orders for clinical diagnostic
tests (including x-ray, laboratory, and other diagnostic tests) that are
paid on the basis of the clinical laboratory fee schedule, the Medicare
physician fee schedule, or for physician pathology services. While a
physician order is not required to be signed, the physician must clearly
document in the medical record his or her intent that the test be
performed. Make sure that your office, billing, and/or laboratory staffs
are aware of this updated guidance regarding the signature requirement for
diagnostic tests.


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.


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.


Why is a Provider ID not linked to a J1 Submitter ID?
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~FAQs~EDI~Why%20is%20a%20Provider%20ID%20not%20linked%20to%20a%20J1%20Submitter%20ID?opendocument

This article outlines the steps needed to "relink" a J1 provider number to
a billing service or clearinghouses's Submitter ID.


“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.