CMS/Medicare: Physician Fee Schedule Fact Sheet Available in Print

The revised Medicare Physician Fee Schedule Fact Sheet (January 2008), which provides general information about the Medicare Physician Fee Schedule, is now available in print format from the Centers for Medicare & Medicaid Services Medicare Learning Network. To place your order, visit http://www.cms.hhs.gov/mlngeninfo/, scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page.”

CMS/Medicare: National Provider Identifier (NPI)--May 23rd is Only Two Months Away, Be Prepared!

The NPI will be Required for all HIPAA Standard Transactions on May 23rd

As of May 23, 2008, the NPI will be required for all HIPAA standard transactions. This means:

– For all primary and secondary provider fields, only the NPI will be accepted and sent on all HIPAA electronic transactions (837I, 837P, NCPDP, DDE, 276/277, 270/271 and 835), paper claims (UB-04 and CMS-1500) and SPR remittance advice.

– The reporting of Medicare legacy identifiers in any primary or secondary provider fields will result in the rejection of the transaction.

REMINDER: May 23rd is Only Two Months Away, Be Prepared!
TEST NPI-only NOW
Now that the NPI is required on all Medicare claims in the primary provider fields, if your claims are being successfully processed with NPI/legacy pairs (and most are) now is the time to begin testing claims using the NPI alone. If the Medicare NPI Crosswalk cannot match your NPI to your Medicare legacy number, the claim with an NPI-only will reject. You can and should do this test now! If the claim is processed and you are paid, continue to increase the volume of claims sent with only your NPI. If the claims reject, go into your NPPES record and validate that the information you are sending on the claim is consistent with the information in NPPES. If it is different, make the updates in NPPES and resend a small batch of claims 3-4 days later. If your claims are still rejecting, you may need to update your Medicare enrollment information to correct this problem. Call the Customer Service Representative at your Medicare carrier, FI, or A/B MAC enrollment staff or your DME MAC to discuss your situation and, if necessary, have it investigated. Have a copy of your NPPES record or your NPI Registry record available. The contractor telephone numbers are likely to be quite busy, so don't wait.

Doing this testing now will allow time for any needed corrections prior to May 23, 2008, the date when only the NPI will be accepted in all provider fields.

Need More Information?
Still not sure what an NPI is and how you can get it, share it and use it? As always, more information and education on the NPI can be found through the CMS NPI page www.cms.hhs.gov/NationalProvIdentStand on the CMS website. 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.

CMS/Medicare Website Updates

The following updates have been posted to the CMS/Medicare website.


MM5923 – Additional Clarification to Chapter 17, Section 40, Regarding Processing of Drug Claims with the JW Modifier
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5923.pdf

MM5913 – New Waived Tests
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5913.pdf

Revised:
MM5655 – Clarification on Billing for the Oral Three Drug Combination Anti-Emetic (Aprepitant)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5655.pdf

MM5818 – Erythropoiesis Stimulating Agents (ESAs) in Cancer and Related Neoplastic Conditions
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5818.pdf

NHIC/Medicare Website Updates

The following updates have been posted to the NHIC/Medicare website.

Two new educational articles have been added: Correct Use of Modifiers for Foot Care Services andProper Reimbursement for PT/OT Services Rendered in the Outpatient Hospital Setting

The Questions & Answers from the 2008 Updates Webinar have been added.

Registration is now being accepted for a Webinar on Consolidated Billing/Care Plan Oversight to be held on March 28.

Visit http://www.medicarenhic.com/cal_prov/updates.shtml to read these updates.

Register to Attend 2008 Best of ASCO Meetings

Oncology professionals who are unable to attend the 2008 ASCO Annual Meeting - as well as attendees who wish to review the cutting-edge science presented at the Meeting - can now register for the upcoming Best of ASCO Meetings. The Best of ASCO Meetings condense highlights from the ASCO Annual Meeting into a two-day program presented in two locations - Boston, Massachusetts, and Los Angeles, California.

The summary meetings will feature high-impact abstracts presented at the 2008 ASCO Annual Meeting that represent the most relevant scientific findings in primary disease sites and practice-changing advances in cancer prevention and treatment. For the first time, the Best of ASCO West meeting will be held in conjunction with the World Conference on Interventional Oncology’s (WCIO) Annual Meeting.

Attendees will have the opportunity to examine advances in scientific and translational cancer research, evaluate the role of new diagnostic techniques and therapeutic approaches, and gain the knowledge to implement new disease management and patient care strategies and to revise existing ones. Research in the fields of breast cancer, developmental therapeutics, gastrointestinal cancer (colorectal and noncolorectal), genitourinary cancer, gynecologic cancer, head and neck cancer, leukemia, lung cancer, lymphoma, melanoma, and patient care will be presented.

The extensive peer-review abstract selection and program planning processes increase the value of the Best of ASCO Meetings and exemplify the uniqueness of the event.

To facilitate the timely dissemination of these important developments in oncology research, the 2008 Best of ASCO Meetings will be held in close proximity to the end of the Annual Meeting:

Best of ASCO East—June 27-28, 2008
Renaissance Boston Waterfront Hotel—Boston, Massachusetts

Registration and housing reservations for Best of ASCO East are now available online. Visit www.asco.org/boa to register and to obtain more information about the Best of ASCO meetings.

In collaboration with the WCIO, ASCO is offering a unique educational opportunity. The 2008 Best of ASCO West will be featured as a track within the WCIO meeting, where attendees will be able to hear about the latest in cancer care and novel areas of interventional oncology. ASCO and the WCIO welcome their members to attend this exciting new event.

WCIO/Best of ASCO West—June 22-25, 2008
Hyatt Regency Century Plaza—Los Angeles, California

Visit the WCIO website for program and registration information.


Register to attend 2008 Best of ASCO Meetings

NCCC's Young Women's Breast Cancer Conference (April 5, 2008)

The Northern California Cancer Center (NCCC) calls your attention to an educational program for young women diagnosed with breast cancer. The program has been organized by CPMC in partnership with NCCC. Issues to be discussed include emotional, physicial and psychosocial concerns- intimacy, dating, sexuality, fertility, treatment, hormones, depression, communicating with children, family, friends, colleagues, etc. Please let your colleagues and patients know of this program. Registration is free; lunch is provided.

If you have questions or which to register, please contact 415.600.3906 or email Carol Kronenwetter, PhD kronenc@sutterhealth.org

ASCO Policy Today Published

ASCO's Cancer Policy Today was published on March 20th. Among the articles are:

FDA Advisory Committee Votes to Continue ESA Use in Cancer Patients

Senators Stabenow, Bunning Introduce Save Medicare Act

Senate Passes Amendment for $2.1B NIH Funding Increase

ASCO Launches New Treatment Plan and Summary Template

CMS Issues New Advanced Beneficiary Notice Forms

ESA Class Label Changes and ODAC Meeting

The following information is provided by AMGEN, an ANCO Corporate Member.

Amgen and Ortho Biotech received updated safety information last week to their package inserts from the U.S. Food and Drug Administration (FDA), which includes updates to the BOXED WARNINGS and WARNINGS sections in the labeling information for the ESA class of drugs including Aranesp® (darbepoetin alfa), EPOGEN® (Epoetin alfa) and Procrit® (Epoetin alfa).

The updated BOXED WARNING states that ESAs, when administered to target a hemoglobin of ≥ 12 g/dL, shortened overall survival and/or time-to-tumor progression in clinical studies in patients with breast, non-small cell lung, head and neck, lymphoid and cervical cancers.

Please note that the previous BOXED WARNING limited the breast cancer patients to patients with advanced breast cancer and did not include patients with cervical cancer.

In the WARNINGS: Increased Mortality and/or Tumor Progression section, the interim results of the PREPARE study in neo-adjuvant breast cancer as well as follow up data from the Gynecologic Oncology Group study in cervical cancer were added to the text and table.

Amgen is informing healthcare professionals about the revisions to the U.S. prescribing information through a joint “Dear Healthcare Professional” letter with Ortho Biotech and will post the letter and updated prescribing information on www.amgen.com and www.aranesp.com.

In addition to communicating the changes in the labeling, the DHCP letter also announces the efforts by both companies to ensure that HCPs are disclosing to their patients important benefit and risk information about the ESA class before the initiation of this treatment.


ODAC
FDA’s Oncologic Drugs Advisory Committee (ODAC) recently met to discuss the cumulative safety and the benefit/risk profile of ESAs in oncology. Amgen takes very seriously the safety signals seen in recently disclosed trials where ESAs were used outside of the labeled indication. If you are interested, the presentations made by Amgen and the FDA to the ODAC are posted on www.amgen.com in the section called ESAs in the News.

New JOP Editor Sought and ASCO Annual Election Results

The Journal of Oncology Practice is seeking a new editor-in-chief. ANCO encourages members to submit their CVs. Also, click on the link below to see the 2008 ASCO election results.

Editor Search for Journal of Oncology Practice Now Open
ASCO is seeking candidates for the position of Editor-in-Chief for Journal of Oncology Practice. JOP includes articles on quality of care, practice organization and management, health services, legislative and legal issues, and business-related concerns for practicing oncologists. The Editor-in-Chief is responsible for oversight of six issues of approximately 58 editorial pages each. Candidates must be ASCO members.

The Editor-in-Chief’s five-year term will begin in September 2008. Members of the Clinical Practice Committee and the Publications Committee will recommend a candidate for approval by the ASCO President and Board of Directors.

Interested candidates should submit a curriculum vitae and letter of interest that includes a brief statement of their vision for JOP by May 23, 2008. ASCO members may also nominate candidates for the position. Submit a CV and letter of interest or nominations to:

Terry Van Schaik
Director of Journal Publications
ASCO
330 John Carlyle St., Suite 300
Alexandria, VA 22314

Candidates may also submit materials or request more information by sending an e-mail to vanschat@asco.org.


Election results are now posted on ASCO.org.

CMS/Medicare: Medicare Part B Drugs Average Sales Price Files (April 2008)

The Centers for Medicare & Medicaid Services (CMS) has made available the Medicare Part B Drug and Biological Average Sales Price (ASP) Payment Amounts for April 1, 2008 to June 30, 2008 on the CMS website at http://www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/01a_2008aspfiles.asp. The files are located in the "Downloads" section of this web page.

CMS/Medicare Website Updates

The following updates have been posted to the CMS/Medicare website.

MM5655 – Clarification on Billing for the Oral Three Drug Combination Anti-Emetic (Aprepitant)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5655.pdf

DHS/MediCal: Cut-Off Date for Old Proprietary Forms

Medi-Cal proprietary forms were updated to accommodate the 10-digit NPI. Beginning April 15, 2008, only the updated proprietary forms will be accepted for processing. Since July 2007, the updated proprietary forms have been available for ordering from Medi-Cal. These include, but are not limited to, Pharmacy and Long Term Care claim forms, Treatment Authorization Request, Claims Inquiry, Appeal and CHDP forms. This information is available on the Medi-Cal web site in the following link: http://files.medi-cal.ca.gov/pubsdoco/npi/articles/npi_9208.asp

If providers currently have an inventory of the old proprietary forms, they may continue to use those through April 14, 2008.

Should you have any questions or need additional information, please call the Telephone Service Center (TSC) at 1-800-541-5555 or visit the Medi-Cal Web site.

Palmetto/J1MAC Presentation

The web link below should get you to a Palmetto/J1MAC PowerPoint presentation that provides background information on Palmetto, introduces timelines and other important information regarding the J1MAC, and lays out some details regarding the transition period.

http://www.palmettogba.com/Palmetto/J1.nsf/docsCat/Welcome%20to%20Palmetto%20GBA?opendocument?open&cat=

ASCO Policy Alert Published

The Oncologic Drugs Advisory Committee to the FDA met yesterday to discuss the use of erythropoiesis stimulating agents (ESAs). The Committee addressed many different aspects of ESA use, including new studies that have been released since its last meeting in May of 2007. Below is a summary of the Committee's key recommendations. ASCO has also prepared a more in-depth summary including an outline of each question the Committee addressed. In summary, the ODAC recommended:

Allowing ESAs to continue to be marketed for the chemotherapy-induced anemia (CIA) indication.

Not to restrict use only to patients with small cell lung cancer.

To modify the current indication to include a statement that ESA use is not indicated for patients receiving potentially curative treatments.

To modify the current indication to include a statement that ESA use is not indicated for patients with metastatic breast and/or head and neck cancers.[1]

That the FDA require the implementation of a signed informed consent/patient agreement for the treatment of CIA, but voted against the FDA mandating a restricted distribution system for oncology patients receiving ESAs.

A representative for ASCO and the American Society of Hematology (ASH) described the recent changes to the ASCO/ASH ESA guideline, and described plans for further updates focusing on providing tools for enhanced physician-patient communication regarding use of ESAs.

ODAC is an advisory committee to the FDA. We do not yet know which of these recommendations FDA will accept or when and how they will be implemented. ASCO will keep you apprised of additional developments.

[1] The original question did not include the word "metastatic"; the Committee asked that it be added, following the vote on potentially curative treatments.

CMS/Medicare Website Updates

The following updates have been posted to the CMS/Medicare website.


SE0804 – Opportunity to Participate in Third Annual Medicare Contractor Provider Satisfaction Survey (MCPSS) Ends in April
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0804.pdf

MM5942 – Remittance Advice Remark Code (RARC) and Claim Adjustment Reason Code (CARC) Update
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5942.pdf

MM5840 – Manual Updates to Chapter 6, Skilled Nursing Facility (SNF) Inpatient Part A Billing, for No-Payment and Medicare Advantage (MA) Claims
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5840.pdf

NHIC/Medicare Website Updates

The following updates have been posted to the NHIC/Medicare website.

The 2008 Medicare Workshop Guide is now available.

Two new educational articles have been added: Modifier 22, and Evaluation and Management Services Updates

The following LCDs was revised: Independent Diagnostic Testing Facilities (IDTF) - Revised - Updated LCD regarding annual HCPCS/CPT changes. Per CR 5856 added information to the Documentation Requirements Section regarding the IDTF's responsibility in maintaining documentation of the beneficiaries' written clinical complaint, and that any changed in ownership, location, general supervision, and adverse legal action must be reported to the contractor. It can be accessed from the Active Index on the LCD Indices page.

ANCO/MOASC Seek Support for AB2440 (Laird)

ANCO and MOASC are joint sponsors of AB2440 (Laird), which would require the Department of Health Care Services (DHCS) to update CPT, HCPCS, and ICD-9 codes in a timely manner.

In order to be paid for serving DHCS/MediCal patients, physicians must know current coverage policy and use current procedure (CPT), drug (HCPCS), and diagnosis (ICD-9) codes. These coding systems are updated annually in October and Medicare requires their use no later than January 1st.

Unfortunately, DHCS does not implement the new codes until well after January 1st, usually not until the second half of the year. This creates an administrative burden on the practice because they need to keep two coding systems in place.

With respect to procedures, many new chemotherapy administration codes have been introduced that cannot be used because DHCS has not implemented current codes. And, some codes have been changed requiring practices to use old codes. This results in oncology practices losing fair compensation and reimbursement, a disincentive to treating DHCS beneficiaries.

Not updating the codes on time can also cost the state money. For example, current diagnosis coding for neutropenia (low white blood cell counts, often caused by chemotherapy, leading to a susceptibility to infection) requires five digits. Previous neutropenia coding only required four digits. Hence, current coding is more specific. Not all anti-neutropenia drugs will be paid for all the current codes. By using the four-digit code, DHCS is actually paying for uncovered diagnoses.

AB2440 (Laird) seeks to find a resolution to this problem. This bill would give the Department sixty days to implement the new codes. If the Department fails to meet this deadline, a provider will be allowed to bill utilizing current year codes or bill under a miscellaneous code until the new codes have been implemented. Further, the bill states that the Department cannot reject or delay a provider’s reimbursement claim due to the provider’s use of current year codes or miscellaneous codes.

Please send a letter of support for AB2440 to the following legislators by the close of business on Friday, March 14th:
Assemblymember Merv Dymally
State Capitol, Room 6005
Sacramento, CA 95814
FAX: (916) 319-2152

Assemblymember John Laird
State Capitol, Room 6026
Sacramento, CA 95814
FAX: (916) 319-2127

Send a copy to ANCO/MOASC’s advocates:

Kris Rosa
Noteware Government Relations
1201 K Street, Suite 1030
Sacramento, CA 95814
FAX: (916) 448-9777

Thank you for your support of AB2440.

CMS/Medicare: National Provider Identifier (NPI)--What to do if your 837P or CMS-1500 Medicare Claim Rejects & More

Verifying NPPES Data
CMS has found a significant number of instances where either the Legal Business Name (LBN) and/or Employer Identification Number (EIN) of an organization health care provider who has been assigned an NPI do not match Internal Revenue Service (IRS) records. In some cases, this is caused by health care providers who are individuals who erroneously applied for NPIs as organizations and who reported their Social Security Numbers in the EIN field. As a first step to improving the quality of information in the National Plan and Provider Enumeration System (NPPES), we are requesting that organization health care providers verify their LBN and EIN within NPPES. This is especially important if the organization health care provider is experiencing any Medicare claims processing issues.

Important Information for Medicare FFS Providers
Effective March 1, 2008, all 837P and CMS-1500 claims received must have an NPI or NPI/legacy pair in the required primary provider fields. Failure to include an NPI will cause the claim to reject!

What to do if your 837P or CMS-1500 Claim Rejects
Check your record in the National Plan and Provider Enumeration System (NPPES)
o Validate that the legacy identifier sent on the claim is reported in your NPPES record. If the legacy identifier is not there, it needs to be added.
o Validate that the Legal Business Name (for a provider/supplier who is an organization) or the Legal Name (for a provider/supplier who is an individual or a sole proprietorship) is correct.
o Validate that the correct Entity type was selected at the time of NPI application. Individuals obtain an NPI as Entity Type 1. Organizations obtain an NPI as Entity Type 2 NPI.
(Note: If you enumerated through the EFI alternative or submitted a paper NPI application, you should use the NPI Registry to check the content of your NPPES record. Make sure to have the Customer Service Representative at your Medicare contractor verify your Employer Identification Number (EIN) because the NPI Registry does not display EINs.)
If the above validation is successful and your claims continue to reject, call the Customer Service Representative at your Medicare Contractor.
o Have a copy of your NPPES record or your NPI Registry record in hand. A copy of your NPPES record can be printed from NPPES by going online at https://nppes.cms.hhs.gov and using the User ID and password selected when you applied for your NPI. If you obtained your NPI through the EFI alternative or submitted a paper NPI application, you should print your record from the NPI Registry at https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do . EINs and Social Security Numbers (SSNs) are not displayed in the NPI Registry.
o Have the claim reject number and message
o Be prepared to give the following information:
1. Legal Business Name of the organization or Legal Name of the individual
2. Contractor Tracking Number (if known)
3. Approximate date (month/year) when the CMS-855 enrollment application was submitted or last updated
4. Provider/Supplier Tax Identification Number (EIN or SSN)
5. National Provider Identifier (NPI)
6. Medicare legacy Identifier
7. Practice location on claim (i.e., where is the practice located (e.g., 100 Main St., New Orleans, LA)
8. Contact Information where you can be reached if further discussion is needed

Some Clearinghouses Continue to Strip Information from Medicare Claims
It has come to CMS' attention that some clearinghouses continue to strip NPIs, as well as other information, from Medicare claims. If your clearinghouse continues to strip your NPI from your claims for any reason, notify your Medicare Contractor immediately so that CMS can work with your clearinghouse to resolve the issue.

In some cases, clearinghouses are stripping the SY qualifier and the SSN from claims that contain an NPI. Based on business requirement 4320.17 (outlined in Transmittal number 204, dated February 1, 2006), the qualifier SY is an acceptable qualifier for use on Medicare claims. See below block for specific details. You should share this information with your clearinghouse if you suspect they are stripping the SY qualifier and the SSN from your claims.

4320.17: Shared systems shall reject as non-compliant with the implementation guide any 837 version 4010A1 claim that contains XX in NM108, the NPI in NM109, and 1C or 1G as applicable in REF01of the same loop, but which lacks another REF01 in the billing or pay-to-provider loop with the EI (Employer Identification Number) qualifier and number or the SY (SSN, applies to carriers & DMERCs only) qualifier and number to convey the taxpayer identifier.


TEST NPI-only NOW
If you have been submitting claims with both an NPI and a Medicare legacy number and those claims have been paid, you need to test your ability to get paid using only your NPI by submitting one or two claims today with just the NPI (i.e., no Medicare legacy number). If the Medicare NPI Crosswalk cannot match your NPI to your Medicare legacy number, the claim with an NPI-only will reject. You can and should do this test now! If the claim is processed and you are paid, continue to increase the volume of claims sent with only your NPI. If the claims reject, go into your NPPES record and validate that the information you are sending on the claim is consistent with the information in NPPES. If it is different, make the updates in NPPES and resend a small batch of claims 3-4 days later. If your claims are still rejecting, you may need to update your Medicare enrollment information to correct this problem. Call your Medicare carrier, FI, or A/B MAC enrollment staff or your DME MAC. Have a copy of your NPPES record or your NPI Registry record available. The contractor telephone numbers are likely to be quite busy, so don't wait.

Need More Information?
Still not sure what an NPI is and how you can get it, share it and use it? As always, more information and education on the NPI can be found through the CMS NPI page www.cms.hhs.gov/NationalProvIdentStand on the CMS website. 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.

NHIC/Medicare Website Updates

The following updates have been posted to the NHIC/Medicare website.

The Claim Form CMS-1500 Instructions online learning module has been updated.

Registration is now being accepted for two webinars: Skilled Nursing Facility Consolidated Billing/Care Plan Oversight and Provider Enrollment Application Process.

The Introduction to Medicare Billing Guide has been revised.

New/Revised educational articles: Appeals Process for 2008, Appeals Reminder, Change in the Amount of Controversy Requirement for Federal District Court Appeals, Review of Immunization Administration Code,CLIA Edits - HCPCS Codes Subject to and Excluded from Edits, and Top 10 Duplicate Claim Submitters by Specialty.

The Draft LCD Open Meeting scheduled for April has been cancelled.

There is still time to register for the 2008 Medicare Workshops. Registration is free, and the following topics will be discussed: Medicare Updates, Error Reduction, and Electronic Data Interchange.

ASCO's Cancer Policy Today Published

ASCO's Cancer Policy Today was published on March 7th. Among the articles are:

ASCO Urges Congress to Increase Health Program Funding

NIH Requests Comments on Peer-Review Process

ASCO and NCCS Educate Reporters About Cancer Policy Issues at Briefing

AMA's Physician Practice Information Survey

New ESA Instruction Sheet Available from ASCO Website

Registration Open for the WCIO 2008 & Best of ASCO

Registration for the World Congress on Interventional Oncology (WCIO) and Beset of ASCO has opened. Both meetings are taking place in Los Angeles from June 22nd-25th.

Visit http://www.wcio2008.com/ for more information and to register.

CMS/Medicare Website Updates

The following information is provided by CMS/Medicare.

MM5655 – Clarification on Billing for the Oral Three Drug Combination Anti-Emetic (Aprepitant)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5655.pdf

MM5906 – Collapsing Medicare Provider Transaction Access Numbers (PTANs) to Ensure a One-to-One National Provider Identifier (NPI) Match
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5906.pdf

MM5926 – Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) Edits
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5926.pdf

MM5947 – Claim Status Category Code and Claim Status Code Update
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5947.pdf

MM5890 – Additional Information on Reporting a National Provider Identifier (NPI) for Ordering/Referring and Attending/Operating/Other/Service facility for Medicare Claims
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5890.pdf


The Medicare Appeals Process: Five Levels to Protect Providers, Physicians and Other Suppliers brochure has been updated and is now available to order print copies or as a downloadable PDF file. To view the PDF file, go to http://www.cms.hhs.gov/MLNProducts/downloads/MedicareAppealsProcess.pdf or to order hard copies, please visit the MLN Product Ordering Page at http://cms.meridianksi.com/kc/main/kc_frame.asp?kc_ident=kc0001&loc=5 on the CMS website.

NCI: 6th Annual Cancer Survivorship Series--Living With, Through & Beyond Cancer

On Tuesday, April 22nd, CancerCare, in collaboration with the National Cancer Institute: Office of Cancer Survivorship and Office of Communications and Education, Lance Armstrong Foundation, Intercultural Cancer Council, Living Beyond Breast Cancer and National Coalition for Cancer Survivorship, will present the first of a three-part telephone education workshop program, The Sixth Annual Cancer Survivorship Series: Living With, Through & Beyond Cancer.

This free series, made possible by support from National Cancer Institute: Office of Cancer Survivorship and Office of Communications and Education and Lance Armstrong Foundation, offers cancer survivors, their families, friends and healthcare professionals practical information to help them cope with concerns and issues that arise after treatment ends.

Part I, which takes place on April 22nd is entitled, The Importance of Communicating with Your Doctor About Follow-Up Care. The faculty for this program includes Richard N. Boyajian, RN, MS, Cancer Survivor, Nurse Practitioner, Lance Armstrong Foundation Adult Survivorship Clinic, Perini Family Survivors' Center, Dana-Farber Cancer Institute; Thomas J. Smith, MD, FACP, Professor and Chair, Division of Hematology/Oncology and Palliative Care, Massey Cancer Center-Virginia Commonwealth University; and Debra L. Friedman, MD, Director, Survivorship Program, Fred Hutchinson Cancer Research Center.

Part II, Rediscovering Intimacy in Your Relationships Following Treatment, will take place on May 13th. And Part III, Survivors Too: Family, Friends and Loved Ones, will take place on June 24th. All of the of the workshops take place from 1:30 to 2:30 pm Eastern Time.

These workshops are free – no phone charges apply. However, pre-registration is required. To register simply go to the CancerCare website.


We are very excited to offer this series to you. We hope that you will join us and that you will share this information with your patients and colleagues.

NHIC/Medicare Protest of J1 MAC Award to Palmetto Fails

Palmetto GBA is the new A/B Medicare Administrative Contractor for Jurisdiction 1, which includes California, Hawaii, Nevada, Guam, and the Northern Mariana Islands.

Palmetto has posted a welcome statement to providers as well as giving some brief information on what is coming. They have also established an email listserv for the transition (select e-mail updates). We encourage you to sign up to stay posted on what to expect in the coming months.

CMS/Medicare: Competitive Acquisition Program (CAP)

Noridian Administrative Services (NAS), 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 number of CAP topics and requirements such as billing for CAP claims, and NAS personnel are available to answer questions. Physicians and/or their staff are strongly encouraged to attend.

Interested parties may view additional information about and register for these workshops at https://www.noridianmedicare.com/cap_drug/train/workshops/index.html

Upcoming workshops will be held on the following dates:

• 3/12/08 at 10:00 am CST

• 4/22/08 at 2:00 pm CST

• 5/28/08 at 10:00 am CST

CMS/Medicare: HCPCS, NPI, & PQRI

The following information is provided by CMS/Medicare.

HCPCS
The Centers for Medicare & Medicaid Services has reposted the recent scheduled release of modifications to the Healthcare Common Procedure Coding System (HCPCS) code set to incorporate new changes. The revised update has been posted to the HCPCS website at http://www.cms.hhs.gov/HCPCSReleaseCodeSets/02_HCPCS_Quarterly_Update.asp.

NPI

Effective March 1, 2008, all 837P and CMS-1500 claims must have an NPI or NPI/legacy pair in the required primary provider fields. Failure to include an NPI will cause the claim to reject!

Background
One of the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA, Title II) required the Department of Health and Human Services (HHS) to establish unique national identifiers for providers. The purpose of these provisions is to improve the efficiency and effectiveness of the electronic transmission of health information. On March 1, 2008, Medicare claims submitted by physicians and other practitioners, laboratories, ambulance company suppliers, DMEPOS suppliers and others that bill Medicare are required to include the new National Provider Identifier (NPI).

Providers must use this information when they submit their claims to Medicare carriers, A/B Medicare Administrative Carriers (MACs), and DME MACs when they use certain electronic and paper Medicare claims (specifically the X12N 837P electronic claim and the CMS-1500 paper claims).

Hospitals, skilled nursing facilities, home health care agencies and other such institutional providers were required to begin using their NPI beginning on January 1, 2008

The deadlines for submitting Medicare claims using the NPI are necessary to help the Centers for Medicare & Medicaid Services (CMS), the Medicare contractors and health care providers prepare for the final May 23, 2008 deadline for full NPI compliance. While the final NPI Rule required compliance on May 23, 2007,CMS stated in the NPI National Contingency Guidance that it will not take enforcement action against covered entities that deploy contingency plans through May 23, 2008, provided that conditions in the Guidance were met.

CMS is anticipating that some providers will experience some problems with claims submitted after March 1 – problems could arise in the following situations:
The provider does not have an NPI
The provider does not submit their NPI on their claim
The provider has already received an NPI, but the NPI is not consistent with the provider’s enrollment information received by the contractor.

Providers whose claims are rejected and returned to them should immediately contact their contractor before resubmitting that claim or submitting new claims for services provided to Medicare beneficiaries. Contact information for the Medicare contractors can be found at www.cms.hhs.gov/MLNGenInfo/ under “Downloads.” The file is named, “Provider Call Center Toll-Free Numbers Directory.”

Current Status
Physicians, non-physician practitioners, labs, ambulance company suppliers, DME suppliers, and others who traditionally bill carriers and DME MACs (2/22/08)

91.3% of Medicare carrier claims and 88.5% of DME MAC claims are being submitted with an NPI or NPI/legacy pair in the primary provider identifier fields (these numbers are consistent with institutional provider NPI use before the January 1 change).

For claims submitted with an NPI, the current reject rate for carrier and DME MAC claims ranges from 1-12%, depending on the carrier. CMS has received very few complaints from providers.

Institutional Providers (January 1, 2008, deadline)

In mid-January, the NPI submission rate jumped to 99% - compared to 90% in December.

Currently, the submission rate is over 99.9%. Less than 0.1% of claims are being rejected for not having an NPI in the appropriate fields.

The March 1, 2008, Deadline--Expectations for March 1
A small portion of claims will continue to be submitted without an NPI. These claims will be rejected. Providers have had over two years to acquire and test their NPI.

Some rejections may occur because a contractor has not completed processing a provider’s enrollment application, submitted by the provider to fix inconsistencies between a provider’s NPI and Medicare’s provider enrollment files.

Medicare Risk Mitigation
CMS and the Medicare contractors are taking aggressive steps to ensure that providers will be paid for treating Medicare beneficiaries after March 1.

Medicare contractors are enhancing their toll-free phone lines by expanding the number of people available to answer calls. Throughout the month of February, CMS has intensified its planning efforts to assist contractors to prepare for the March 1 implementation date. In February 2008, CMS held a training session with contractor call centers and CMS regional office staff to ensure they are able to address provider inquiries on NPI issues.

Daily calls with the carriers, A/B MACs, and DME MACS are scheduled to monitor the status of successful and rejected claims, inquiries, enrollment backlog status, and other relevant information.

Each contractor has created a NPI Coordination Team to quickly identify and resolve claims processing issues related to the submission of the NPI or NPI-Legacy combination, expedite the processing of enrollment applications, and address other issues that may arise.

CMS has implemented temporary measures to allow the Medicare contractors time to address some of the backlog issues, but at some contractors, more work is needed.

Current Claims Process as of March 1
Currently, most Medicare providers (and their claims clearinghouse vendors) are submitting claims that include their new NPI. For those providers who don’t have an NPI, they are submitting claims using their legacy provider numbers. When the claim is submitted, Medicare’s computer systems will check to confirm that the claim includes an NPI. If there is no NPI, the claim will be rejected and the provider will receive an error message pointing to the lack of an NPI. If the provider has an NPI, the provider should make sure that the number is on the claim and resubmit the claim. If at that point the claim is again rejected, the provider should immediately contact the Medicare contractor to ensure that all provider records are correct before resubmitting the claim.

Contact information for the Medicare contractors can be found at www.cms.hhs.gov/MLNGenInfo/ under “Downloads.” The file is named, “Provider Call Center Toll-Free Numbers Directory.”

Medicare contractors expect to be able to handle all incoming calls, but some callers may experience extended hold times. CMS is urging providers to be patient – their issues will be addressed.

The Future – May 23, 2008
With May 23, 2008 less than three months away, CMS and the Medicare health care providers must make sure they are ready for full NPI implementation. Providers must be certain their NPI information and Medicare enrollment information is accurate and up-to-date before that date. Further, if providers’ claims are being successfully processed with NPI/legacy pairs (and most are) now is the time for them to begin testing claims using only the NPI. Providers should start with small volumes of these NPI-only claims and gradually increase their submissions. Doing this testing now will allow time for any needed corrections prior to the May 23, 2008, deadline when claims must include the NPI only.

What to do if your 837P and CMS-1500 Claims are Rejected
• Check your record in the National Plan and Provider Enumeration System (NPPES)
Validate that the legacy identifier sent on the claim is reported in the provider/supplier’s NPI Registry record. If the legacy identifier is not there, instruct the provider/supplier to add it.
Validate that the Legal Business Name (if the provider/supplier is an organization) or the Legal Name (if the provider/supplier is an individual or a sole proprietorship) is correct.
Validate that the correct Entity type was selected by the provider/supplier when applying for the NPI. Individuals obtain an NPI as Entity Type 1. Organizations obtain an NPI as Entity Type 2 NPI.
(Note: If you enumerated through the EFI alternative, you should use the NPI Registry to check the content of the NPPES file. Make sure to have the Customer Service Representative at your Medicare contractor verify your TIN/EIN as the NPI Registry does not list this information.)

• If these claims are still rejecting, call your Medicare Contractor
Have a copy of the NPPES record in hand. A copy of the NPPES record can be obtained online at https://nppes.cms.hhs.gov . The Employer Identification Number or Social Security Number will not be shown on this print out.
Have the claim reject number and message
Be prepared to give the following information:
Legal Business Name of the Organization
Contractor Tracking Number (if known)
Approximate date (month/year) when the 855 enrollment application was submitted
Provider/Supplier Tax Identification Number or Social Security Number (SSN)
National Provider Identifier (NPI)
Medicare legacy Identifier
Practice location on claim (i.e. where is the practice located (e.g. 100 Main St. New Orleans, LA)
Contact Information where Provider/Supplier can be reached if further discussion is needed

TEST NPI-only NOW
If you have been submitting claims with both an NPI and a Medicare legacy number and those claims have been paid, you need to test your ability to get paid using only your NPI by submitting one or two claims today with just the NPI (i.e., no Medicare legacy number). If the Medicare NPI Crosswalk cannot match your NPI to your Medicare legacy number, the claim with an NPI-only will reject. You can and should do this test now! If the claim is processed and you are paid, continue to increase the volume of claims sent with only your NPI. If the claims rejects, go into your NPPES record and validate that the information you are sending on the claim is the same information in NPPES. If it is different, make the updates in NPPES and resend a small batch of claims 3-4 days later. If your claims are still rejecting, you may need to update your Medicare enrollment information to correct this problem. Call your Medicare carrier, FI, or A/B MAC enrollment staff or the National Supplier Clearinghouse for advice right away. Have a copy of your NPPES record available. The enrollment telephone numbers are likely to be quite busy, so don't wait.

Transcript from February 6th Roundtable now Available
The transcript from the February 6th NPI Roundtable on the FFS Medicare Implementation is now available at http://www.cms.hhs.gov/NationalProvIdentStand/06_implementation.asp on the CMS NPI web page.

Need More Information?
Still not sure what an NPI is and how you can get it, share it and use it? As always, more information and education on the NPI can be found through the CMS NPI page www.cms.hhs.gov/NationalProvIdentStand on the CMS website. Providers can apply for an NPI online athttps://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 "CMSCommunications" in the left column of the www.cms.hhs.gov/NationalProvIdentStand CMSwebpage.

PQRI
The Centers for Medicare & Medicaid Services (CMS) is now accepting quality measure suggestions for consideration for possible inclusion in the proposed set of quality measures to be published in the 2009 Medicare Physician Fee Schedule (MPFS) Proposed Rule for the Physician Quality Reporting Initiative (PQRI). For details, visit http://www.cms.hhs.gov/pqri and select the Measures/Codes tab on the left side of the page. Next, scroll down to the Downloads section and select “Notice of 2009 Measure Suggestions.”

Updates to the 2008 PQRI Tool Kit
The PQRI Tool Kit has been updated to include a downloadable file containing Data Collection Worksheets for all 119 2008 PQRI quality measures. To access this file, please go to http://www.cms.hhs.gov/PQRI, and select the PQRI Tool Kit tab on the left side of the page. Then, scroll down to the Downloads section and select “2008 PQRI Data Collection Worksheets”.

NEW Frequently Asked Questions (FAQs)
CMS updates the FAQs for PQRI on an ongoing basis, as inquiry volumes and new program developments indicate the need for new or updated FAQs. The following new FAQs may be of particular interest at this time, as they focus on the process for validating whether a professional participating in the 2008 PQRI is reporting on a sufficient number of measures.

#8973 -- Question: Is there a Measure Applicability Validation (MAV) process for 2008 Physician Quality Reporting Initiative (PQRI)?
#8973 -- Answer: Yes. The PQRI 2008 Measure Applicability Validation Process for Claims-Based Participation is described in a document available for download from the Analysis and Payment page of the PQRI section of the CMS website (at url:http://www.cms.hhs.gov/PQRI/25_AnalysisAndPayment.asp).

#8974 -- Question: How does the two-step validation process work for the Physician Quality Reporting Initiative (PQRI)?
#8974 -- Answer: Professionals who report successfully on each of fewer than three measures are subject to the 2008 PQRI Measure Applicability Validation (MAV) process for claims-based participation. Professionals who report on three or more measures are not subject to MAV. (The 2008 PQRI Measure Finder Tool is available to assist you in finding measures that may apply to your practice, and is available for download from the PQRI Toolkit page of the CMS website at: http://www.cms.hhs.gov/PQRI/Downloads/2008PQRIMeasureFinderTool.zip )

Step 1 of MAV relates measures to one another by placing them in closely related clusters. This test is based on the concept that if one measure in a cluster of measures related to a particular clinical topic or professional service is applicable to a professional’s practice, then other closely related measures (measures in that same cluster) may also be applicable. The 2008 PQRI MAV clusters and the measures included in each are described in the document titled "2008 Measure-Applicability Validation Process for Claims-Based Participation", which is available for download from the Analysis and Payment page of the PQRI section of the CMS web site. CMS has not included in any clusters certain measures that are not suited for MAV clustering in the 2008 PQRI, for reasons described in the MAV process document.

Step 2 of MAV looks to see if an eligible professional treated more than a minimum number (threshold) of eligible cases that met the requirements of other measures within the cluster. For 2008 claims-based participation in PQRI, measure-specific thresholds may be determined based on analysis of data that will become available during the reporting period. In no case, however, will any measure’s 2008 PQRI applicability threshold be less than 30 reportable instances. The cases to which a measure applies are identified by the line-item diagnosis and service codes billed for each rendering NPI. Any complicating diagnoses on the Part B base claim are not considered in 2008 PQRI analyses for claims-based participation. Cases that count toward the applicability threshold for any individual NPI will also not include those for which the qualifying diagnosis and procedure codes are identified by another rendering professional’s individual NPI. Eligible professionals who pass Step 2 of 2008 PQRI MAV will be eligible for the PQRI incentive payment.

NHIC/Medicare Website Updates

The following updates have been posted to the NHIC/Medicare website:

• Check out the two new web pages: Forms (listing of all forms in one place), and Medicare Secondary Payer & Overpayments.

• New/Revised Educational Articles added: Rejection of X12 276 Claim Status Requests That Lack National Provider Identifiers (NPIs); NHIC, Corp. Evaluation & Management (E/M) Coding Requirements; Independent Laboratories Billing the Technical Component of Physician Pathology Services; Modifier 25 Update; and Correct Reporting of Diagnosis Codes on Screening Mammography Claims - Billing Instructions

• The Preventive Services Billing Guide has been updated.

Read about these updates here.

CMA Alert Published

The latest CMA Alert was published on March 3rd featuring:

• All Medicare Claims (Including Paper Claims) Must Now Include NPI

• 40% of Physicians Have Not Yet Registered their NPI with Medi-Cal

• Insurers Admit Need for External Review of Policy Cancellations

• Another United Claims Processing Error: 8,700 California Claims Paid Incorrectly

• United Healthcare to Retroactively Pay for Previously Denied Preventive Health Services

• Leadership Academy Registration Now Open

Download the latest edition here.

ASCO e-News Published

ASCO's latest e-News was published on March 3rd.

It includes information about:

• 2008 Anticancer Agent Development Workshop

• 2008 Genitorurinary Cancers Symposium

• ASCO-SEP Self-evaluation Tool

• 2008 UICC World Cancer Congress

• Latest Cancer Policy Alerts

• PLWC Addresses Management of Peripheral Neuropathy

• JCO Early Release Articles and Future Tables of Contents

Download the latest ASCO e-News here.

Managing in Whitewater Times

The Association of Northern California Oncologists is pleased to host two talks for oncology practices entitled

MANAGING IN WHITEWATER TIMES
with
Roberta Buell, MBA
Managing Partner, Sausalito Healthcare Partners
&
Michael Sanderson
President, RemitDATA

The speakers will provide concepts, examples, and tools with which to:
• manage managed care;
• manage the top line;
• manage cash cycles; and,
• manage practice efficiencies

Roberta Buell, MBA, is an accomplished health care regulatory and reimbursement expert. Michael Sanderson, RemitDATA, will assist Ms. Buell with reimbursement data and payment trends from over 1,500 community-based oncologists.

Support for these meetings is provided by International Oncology Network, Oncology Supply, and RemitDATA.

These talks are scheduled for:

Monday, March 24th
1-4PM
Hyatt Regency
1209 L Street
Sacramento • (916) 443-1234

Tuesday, March 25th
9AM-12PM
San Jose Fairmont
170 South Market Street
San Jose • (408) 998-1900

Download a copy of the meeting announcement and registration form here.

ANCO Relaunches Weblog

Welcome to the relaunch of the Association of Northern California Oncologists (ANCO) Weblog, our online news service.

The latest information will be posted on this Weblog. We encourage members to bookmark anco-online.blogspot.com. You can also access the Weblog from the Association's website, www.anco-online.org.

Items in this Weblog have been previously distributed via ListServ (e-mail) and/or FAX broadcast.

I hope readers find this Weblog useful.