The following updates have been posted to the Palmetto/J1MAC website.
Electronic Funds Transfer (EFT) Agreement Form Tips
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Electronic%20Funds%20Transfer%20(EFT)%20Agreement%20Form%20Tips?opendocument
The Electronic Funds Transfer (EFT) Agreement Form needs to be completed
for conversion to the J1 Medicare Administrative Contractor (MAC). Helpful
tips are now available to assist you in this process.
Applies to:
Part A Transition: EDI
Part B Transition: EDI
----------
J1 EDI Application Form
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/J1%20EDI%20Application%20Form?opendocument
Applies to:
Part A Transition: EDI
Part B Transition: EDI
----------
Wednesday, April 30, 2008
CMS/Medicare: CMS to Host NPI Roundtable on May 14, 2008 - Register Today!
CMS will host a national NPI Roundtable to address additional questions from the Medicare provider community regarding Medicare's NPI implementation. The Roundtable will be on May 14th from 2-3:30PM EDT. Providers will be able to submit questions through the online registration system at the time of sign up for the call. For registration details, visit http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/listserv_wording_5-14-08_call.pdf 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 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.
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: Revised Advance Beneficiary Notice (ABN) of Noncoverage
A revised Advance Beneficiary Notice (ABN) of Noncoverage (CMS-R-131) was released on March 3, 2008, and providers are authorized to begin using the notice immediately. Beginning September 3, 2008, all providers, practitioners, and suppliers paid under Part B, as well as hospice providers and religious non-medical health care institutions (RNHCIs) paid exclusively under Part A, must use the revised ABN in place of the ABN-G (CMS-R-131-G) and ABN-L (CMS-R-131-L). Revised manual instructions in Chapter 30 of the Claims Processing Manual (Pub. 100-04) will be published within the next few weeks and a Medicare Learning Network (MLN) Matters article will also be released at that time. The revised ABN and form instructions can be accessed at http://www.cms.hhs.gov/bni.
ASCO e-News Published
The ASCO e-News was published today and is available at http://view.exacttarget.com/?j=fe62157577650c747416&m=ff2d16787160&ls=fdef127170660c7d701d747d&l=fe5a15747365017a7d11&s=fdf2157972640d79751d7073&ju=fe21157877610d7e701079.
It features:
Submit an Abstract for the 2008 ASCO-NCI-EORTC Annual Meeting on Molecular Markers in Cancer
Annual Meeting Virtual Meeting and Podcast Access Available for Purchase by Non-Attendees
ASCO Annual Meeting Program Online Now Available
Presentations from 2008 Gastrointestinal Cancers Symposium Now Available at No Cost
2008 ASCO Educational Book Now Available Online
Submit An Abstract for the 2008 Breast Cancer Symposium
Society Offers Two New Membership Dues Payment Options
ASCO Seeks Editor for Journal of Oncology Practice
Attend 2008 UICC World Cancer Congress
Cancer Policy Alert: ASCO Urges All Members of the Senate to Support the Comprehensive Cancer Care Improvement Act; ASCO Submits Comments on Evidentiary Priorities for Research in the Medicare Population
Submit Artwork for the 2009 "Expressions of Hope" Calendar
For Your Patients: New Cancer.Net Features Discuss Cancer Vaccines, Breast MRI for Early Detection
For Your Patients: Cancer.Net Podcast Explores Dietary and Herbal Supplements
JCO Early Release Articles Examine HIV-specific Differences in Anal Squamous Cell Carcinoma; Mammography before Breast Cancer Diagnosis in Women 80-plus Years; Risedronate Prevents Bone Loss in Breast Cancer Survivors; Lenalidomide Toxicity in Chronic Lymphocytic Leukemia; Granulocyte-macrophage Colony-stimulating Factor Potentiates Rituximab in Relapsed Follicular Lymphoma
Future JCO Table of Contents
REMINDERS
Register and reserve housing for 2008 ASCO Annual Meeting
Register and reserve housing for 2008 Best of ASCO Meetings
Apply online for 2008 Anticancer Agent Development workshop
It features:
Submit an Abstract for the 2008 ASCO-NCI-EORTC Annual Meeting on Molecular Markers in Cancer
Annual Meeting Virtual Meeting and Podcast Access Available for Purchase by Non-Attendees
ASCO Annual Meeting Program Online Now Available
Presentations from 2008 Gastrointestinal Cancers Symposium Now Available at No Cost
2008 ASCO Educational Book Now Available Online
Submit An Abstract for the 2008 Breast Cancer Symposium
Society Offers Two New Membership Dues Payment Options
ASCO Seeks Editor for Journal of Oncology Practice
Attend 2008 UICC World Cancer Congress
Cancer Policy Alert: ASCO Urges All Members of the Senate to Support the Comprehensive Cancer Care Improvement Act; ASCO Submits Comments on Evidentiary Priorities for Research in the Medicare Population
Submit Artwork for the 2009 "Expressions of Hope" Calendar
For Your Patients: New Cancer.Net Features Discuss Cancer Vaccines, Breast MRI for Early Detection
For Your Patients: Cancer.Net Podcast Explores Dietary and Herbal Supplements
JCO Early Release Articles Examine HIV-specific Differences in Anal Squamous Cell Carcinoma; Mammography before Breast Cancer Diagnosis in Women 80-plus Years; Risedronate Prevents Bone Loss in Breast Cancer Survivors; Lenalidomide Toxicity in Chronic Lymphocytic Leukemia; Granulocyte-macrophage Colony-stimulating Factor Potentiates Rituximab in Relapsed Follicular Lymphoma
Future JCO Table of Contents
REMINDERS
Register and reserve housing for 2008 ASCO Annual Meeting
Register and reserve housing for 2008 Best of ASCO Meetings
Apply online for 2008 Anticancer Agent Development workshop
Tuesday, April 29, 2008
THIS WEEK AT ACCC: APRIL 21-25, 2008
This Week at ACCC (Association of Community Cancer Centers) has been published and is available at http://www.accc-cancer.org/mediaroom/newsletters/media_ACCC_april28_08.html. ANCO is an Institutional Member of ACCC.
This Week at ACCC features:
Genetic Information Nondiscrimination Act Clears Senate
ACCC Listserv Archive Available
New Continuing Education Programs on ACCC's Blackboard
Reduction in Breast Cancer Incidence Differs by Race
Southwest Oncology Group Renews Focus on Gynecologic Malignancies
NCI Sponsors 5th Annual Meeting on Cancer Informatics
This Week at ACCC features:
Genetic Information Nondiscrimination Act Clears Senate
ACCC Listserv Archive Available
New Continuing Education Programs on ACCC's Blackboard
Reduction in Breast Cancer Incidence Differs by Race
Southwest Oncology Group Renews Focus on Gynecologic Malignancies
NCI Sponsors 5th Annual Meeting on Cancer Informatics
Palmetto/J1MAC Website Updates
The following updates have been posted to the Palmetto/J1MAC website.
Jurisdiction 1 EDI Early Boarding Begins May 1st!
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Jurisdiction%201%20EDI%20Early%20Boarding%20Begins%20May%201st!?opendocument
Take advantage of Palmetto GBA's Early Boarding for EDI connectivity.
Jurisdiction 1 EDI Submitters can begin the early boarding process on May
1, 2008. Transition now and ensure that you get prompt attention to support
questions and ensure that there is no disruption of your J1 claims
processing.
Applies to:
Part A Transition: EDI
Part B Transition: EDI
----------
New Medical Director Announced
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/New%20Medical%20Director%20Announced?opendocument
The Palmetto Team introduces its newest member, Dr. Arthur Lurvey.
Applies to:
Part A Transition: General
Part B Transition: General
Jurisdiction 1 EDI Early Boarding Begins May 1st!
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Jurisdiction%201%20EDI%20Early%20Boarding%20Begins%20May%201st!?opendocument
Take advantage of Palmetto GBA's Early Boarding for EDI connectivity.
Jurisdiction 1 EDI Submitters can begin the early boarding process on May
1, 2008. Transition now and ensure that you get prompt attention to support
questions and ensure that there is no disruption of your J1 claims
processing.
Applies to:
Part A Transition: EDI
Part B Transition: EDI
----------
New Medical Director Announced
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/New%20Medical%20Director%20Announced?opendocument
The Palmetto Team introduces its newest member, Dr. Arthur Lurvey.
Applies to:
Part A Transition: General
Part B Transition: General
CMS/Medicare: 2008 Physician Quality Reporting Initiative National Provider Conference Call
Registration will close at 1:30 p.m. EDT on April 29, 2008, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
2008 Physician Quality Reporting Initiative (PQRI)
National Provider Conference Call with Question & Answer Session
The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host the second in a series of national provider conference calls on the 2008 Physician Quality Reporting Initiative (PQRI). This toll-free call will take place from 1:30 p.m. – 3:30 p.m., EDT, on Wednesday, April 30, 2008.
The Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) was enacted on December 29, 2007. MMSEA authorizes CMS to make PQRI incentive payments for satisfactorily reporting quality measures data in 2008.
MMSEA also provides professionals greater flexibility for participating in the 2008 PQRI by authorizing CMS to establish alternative reporting criteria and alternative reporting periods for the reporting of measures groups and for the submission of data on PQRI quality measures through clinical data registries.
In 2008, eligible professionals may earn an incentive payment of 1.5 percent of their total allowed charges for physician fee schedule covered professional services furnished during the respective alternative reporting periods based on data submitted via these mechanisms. While TRHCA established a cap on incentive payments for 2007, based on an average per measure payment amount, there is no cap on incentive payments under MMSEA for 2008 and 2009.
These provisions provide increased opportunities for eligible professionals to report PQRI quality measures and the possibility to earn incentive payments for satisfactory reporting. This call will provide an overview of these new flexibilities.
A PowerPoint slide presentation will be posted to the PQRI webpage at http://www.cms.hhs.gov/PQRI/30_EducationalResources.asp, on the CMS website for you to download prior to the call so that you can follow along with the presenters, Dr. Michael Rapp, Dr. Daniel Green and Rachel Nelson. Following the presentation, callers will have an opportunity to ask questions of CMS subject matter experts.
NOTE: We are pleased to announce that CMS will be offering continuing education units (CEUs) for eligible participants; the agenda and details on how to register to obtain CEUs for this call is forthcoming.
Conference call details:
Date: April 30, 2008
Conference Title: 2008 Physician Quality Reporting Initiative National Provider Call
Time: 1:30-3:30 p.m. EDT
In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation. If you cannot attend the call, replay information is available below.
Registration will close at 1:30 p.m. EDT on April 29, 2008, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
To register for the call participants need to go to:
http://www2.eventsvc.com/palmettogba/event/2f7d0cda539b41dfb0fa57ad119b2ba9
Fill in all required data.
Verify your time zone is displayed correctly the drop down box.
Click "Register".
You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.
For those of you who will be unable to attend, a replay option will be available shortly following the end of the call. This replay will be accessible from 3:30 p.m. EDT 4/30/2008 until 11:59 p.m. EDT 5/07/2008. The call in data for the replay is (800) 642-1687 and the passcode is 42860144.
If you require services for the hearing impaired please send an email to: Medicare.TTT@PalmettoGBA.com.
2008 Physician Quality Reporting Initiative (PQRI)
National Provider Conference Call with Question & Answer Session
The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host the second in a series of national provider conference calls on the 2008 Physician Quality Reporting Initiative (PQRI). This toll-free call will take place from 1:30 p.m. – 3:30 p.m., EDT, on Wednesday, April 30, 2008.
The Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) was enacted on December 29, 2007. MMSEA authorizes CMS to make PQRI incentive payments for satisfactorily reporting quality measures data in 2008.
MMSEA also provides professionals greater flexibility for participating in the 2008 PQRI by authorizing CMS to establish alternative reporting criteria and alternative reporting periods for the reporting of measures groups and for the submission of data on PQRI quality measures through clinical data registries.
In 2008, eligible professionals may earn an incentive payment of 1.5 percent of their total allowed charges for physician fee schedule covered professional services furnished during the respective alternative reporting periods based on data submitted via these mechanisms. While TRHCA established a cap on incentive payments for 2007, based on an average per measure payment amount, there is no cap on incentive payments under MMSEA for 2008 and 2009.
These provisions provide increased opportunities for eligible professionals to report PQRI quality measures and the possibility to earn incentive payments for satisfactory reporting. This call will provide an overview of these new flexibilities.
A PowerPoint slide presentation will be posted to the PQRI webpage at http://www.cms.hhs.gov/PQRI/30_EducationalResources.asp, on the CMS website for you to download prior to the call so that you can follow along with the presenters, Dr. Michael Rapp, Dr. Daniel Green and Rachel Nelson. Following the presentation, callers will have an opportunity to ask questions of CMS subject matter experts.
NOTE: We are pleased to announce that CMS will be offering continuing education units (CEUs) for eligible participants; the agenda and details on how to register to obtain CEUs for this call is forthcoming.
Conference call details:
Date: April 30, 2008
Conference Title: 2008 Physician Quality Reporting Initiative National Provider Call
Time: 1:30-3:30 p.m. EDT
In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation. If you cannot attend the call, replay information is available below.
Registration will close at 1:30 p.m. EDT on April 29, 2008, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
To register for the call participants need to go to:
http://www2.eventsvc.com/palmettogba/event/2f7d0cda539b41dfb0fa57ad119b2ba9
Fill in all required data.
Verify your time zone is displayed correctly the drop down box.
Click "Register".
You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.
For those of you who will be unable to attend, a replay option will be available shortly following the end of the call. This replay will be accessible from 3:30 p.m. EDT 4/30/2008 until 11:59 p.m. EDT 5/07/2008. The call in data for the replay is (800) 642-1687 and the passcode is 42860144.
If you require services for the hearing impaired please send an email to: Medicare.TTT@PalmettoGBA.com.
CMS/Medicare Website Updates
The following updates have been posted to the CMS/Medicare website.
MM5818 – Erythropoiesis Stimulating Agents (ESAs) in Cancer and Related Neoplastic Conditions
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5818.pdf
MM5818 – Erythropoiesis Stimulating Agents (ESAs) in Cancer and Related Neoplastic Conditions
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5818.pdf
CMS/Medicare: National Provider Identifier (NPI) Information for Medicare Fee-for-Service (FFS) Providers--May 7th is "Legacy Free" Day!
CMS, in collaboration with the Healthcare Information and Management Systems Society (HIMSS), has requested clearinghouses that submit claims to FFS Medicare to participate in a one day NPI preparation exercise. Specifically, on Wednesday, May 7, 2008, participating clearinghouses should submit Medicare claims with NPI-only in all provider identifier fields for which a provider uses NPI/legacy pairs. On May 8th, participating clearinghouses will revert back to sending Medicare NPI/legacy pairs as received from the providers.
Through its monthly NPI messages, CMS has been requesting providers to begin testing NPI-only by sending a group of claims with NPI alone in primary provider fields. This “exercise” will result in feedback from your Medicare contractor on your readiness as it pertains to your National Provider Identifiers.
On May 7, 2008, participating clearinghouses will send Medicare claims with NPI-only in provider fields which originally contain NPI/legacy pairs from the provider. In other words, clearinghouses will strip the legacy identifiers when they are submitted as part of an NPI/legacy pair. Of course, fields already containing NPI-only will be sent to Medicare, as usual, and secondary provider identifier fields containing legacy-only will be sent to Medicare, as usual.
This exercise will help Medicare providers evaluate their NPI readiness prior to the May 23, 2008 deadline.
The outcomes of this exercise are described below:
Claims are processed and paid by Medicare. Under this scenario, the provider can feel confident that their cash flow will not be affected by the May 23rd implementation date.
Or
Claims are rejected or suspended. Under this scenario, the provider will know in advance that there are problems that must be resolved prior to May 23rd. Resolution might include changes to the NPESS data or to the 855 enrollment record.
Again, on May 8, 2008, participating clearinghouses will revert back to sending Medicare NPI/legacy pairs, if sent to them by the provider.
Participating clearinghouses will be soon notifying provider clients about details so pay close attention to Clearinghouse communications.
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.
Through its monthly NPI messages, CMS has been requesting providers to begin testing NPI-only by sending a group of claims with NPI alone in primary provider fields. This “exercise” will result in feedback from your Medicare contractor on your readiness as it pertains to your National Provider Identifiers.
On May 7, 2008, participating clearinghouses will send Medicare claims with NPI-only in provider fields which originally contain NPI/legacy pairs from the provider. In other words, clearinghouses will strip the legacy identifiers when they are submitted as part of an NPI/legacy pair. Of course, fields already containing NPI-only will be sent to Medicare, as usual, and secondary provider identifier fields containing legacy-only will be sent to Medicare, as usual.
This exercise will help Medicare providers evaluate their NPI readiness prior to the May 23, 2008 deadline.
The outcomes of this exercise are described below:
Claims are processed and paid by Medicare. Under this scenario, the provider can feel confident that their cash flow will not be affected by the May 23rd implementation date.
Or
Claims are rejected or suspended. Under this scenario, the provider will know in advance that there are problems that must be resolved prior to May 23rd. Resolution might include changes to the NPESS data or to the 855 enrollment record.
Again, on May 8, 2008, participating clearinghouses will revert back to sending Medicare NPI/legacy pairs, if sent to them by the provider.
Participating clearinghouses will be soon notifying provider clients about details so pay close attention to Clearinghouse communications.
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.
CMA Alert: UnitedHealthcare Cutting Physician Fees Without Notice
The California Medical Association (CMA) published its CMA Alert today.
It is available at http://www.calphys.org/html/news.asp and features:
UnitedHealthcare Cutting Physician Fees Without Notice or Opportunity to Terminate
Senate Finance Committee Working on Legislation to Stop Medicare Cuts
New Medicare Contractor’s “Early Boarding” Program Opens 5/1
Most California Physicians Eligible for New Blues Settlement
U.S. House Committee Passes Bill that Would Block Federal Medicaid Cuts, Bush Threatens Veto
CMA Kills Psychologists Prescribing Bill
Hundreds of Doctors March on Capitol to Protest Medi-Cal Cuts
There Is Still Time to Register for CMA’s 11th Annual Health Care Leadership Academy
It is available at http://www.calphys.org/html/news.asp and features:
UnitedHealthcare Cutting Physician Fees Without Notice or Opportunity to Terminate
Senate Finance Committee Working on Legislation to Stop Medicare Cuts
New Medicare Contractor’s “Early Boarding” Program Opens 5/1
Most California Physicians Eligible for New Blues Settlement
U.S. House Committee Passes Bill that Would Block Federal Medicaid Cuts, Bush Threatens Veto
CMA Kills Psychologists Prescribing Bill
Hundreds of Doctors March on Capitol to Protest Medi-Cal Cuts
There Is Still Time to Register for CMA’s 11th Annual Health Care Leadership Academy
NCCN Updates Non-Hodgkin's Lymphoma Guidelines
The National Comprehensive Cancer Network (NCCN) announces several new updates to the NCCN Clinical Practice Guidelines in Oncology for Non-Hodgkin's Lymphoma (NHL). These changes highlight leading developments in the treatment of NHL and represent the recognized standard for clinical care in oncology in both the community and the academic practice settings.
The NHL Guidelines now include bendamustine (Treanda, Cephalon) as a treatment option for chronic lymphocytic leukemia (CLL). Specifically, bendamustine is included as a single agent for first-line therapy. For second-line therapy, it can be used as a single agent or in combination with rituximab (Rituxan, Genentech).
Bendamustine was recently approved by the FDA for the treatment of patients with CLL based on the results of a pivotal phase III study, which showed that bendamustine was more effective than chlorambucil in patients with untreated CLL. Results of this international phase III study were presented at the 2007 American Society of Hematology Annual Meeting. At a median follow-up of 18.5 months, bendamustine produced a significantly higher overall response rate (68% vs. 39% for chlorambucil with a complete response of 30% vs. 2% for chlorambucil), median progression-free survival (21.7 months vs. 9.3 months with chlorambucil) and median duration of remission (18.9 months vs. 6.1 months with chlorambucil).
Bendamustine with or without rituximab is also included as an option for second-line therapy for patients with follicular lymphoma (FL) and mantle cell lymphoma (MCL) with a category 2B designation. This recommendation is based on the available data suggesting well-documented activity for bendamustine in patients with FL and MCL.
For more information, visit www.nccn.org.
The NHL Guidelines now include bendamustine (Treanda, Cephalon) as a treatment option for chronic lymphocytic leukemia (CLL). Specifically, bendamustine is included as a single agent for first-line therapy. For second-line therapy, it can be used as a single agent or in combination with rituximab (Rituxan, Genentech).
Bendamustine was recently approved by the FDA for the treatment of patients with CLL based on the results of a pivotal phase III study, which showed that bendamustine was more effective than chlorambucil in patients with untreated CLL. Results of this international phase III study were presented at the 2007 American Society of Hematology Annual Meeting. At a median follow-up of 18.5 months, bendamustine produced a significantly higher overall response rate (68% vs. 39% for chlorambucil with a complete response of 30% vs. 2% for chlorambucil), median progression-free survival (21.7 months vs. 9.3 months with chlorambucil) and median duration of remission (18.9 months vs. 6.1 months with chlorambucil).
Bendamustine with or without rituximab is also included as an option for second-line therapy for patients with follicular lymphoma (FL) and mantle cell lymphoma (MCL) with a category 2B designation. This recommendation is based on the available data suggesting well-documented activity for bendamustine in patients with FL and MCL.
For more information, visit www.nccn.org.
Monday, April 28, 2008
NCCN Regional Guidelines Symposium (Non-Small Cell Lung Cancer)
Register now for a continuing education event hosted by City of Hope - NCCN Clinical Practice Guidelines in Oncology Symposium™: Non-Small Cell Lung Cancer - featuring the latest information from the NCCN Clinical Practice Guidelines in Oncology™.
Date: Monday, May 5, 2008
8:00AM - 12:15 PM (registration starts at 7:30 AM)
Place: Westin Pasadena
191 North Los Robles
Pasadena, California
Fee:
Physicians, Pharmacists, and other health care professionals $50
Nurses $25
Industry $495
* If cancellation is necessary, please notify NCCN. A substitute attendee may be sent in your place. Registration fees are non-refundable.
Speakers at this event include experts in cancer care from NCCN Member Institutions addressing such topics as:
NCCN Guidelines Overview
8:00 - 8:20 AM
Kristina M. Gregory, RN, MSN, OCN
National Comprehensive Cancer Network
Workup, Prognostic Factors, and Markers
8:25 - 9:00 AM
Renato Martins, MD, MPH
Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
Therapy for Stages I, IIA, IIB, and IIIA (T3, N1) Non-Small Cell Lung Cancer
9:05 - 9:40 AM
Frederic W. Grannis, Jr., MD
City of Hope
Treatment Options for Unresectable Stage III Non-Small Cell Lung Cancer
10:05 - 10:45 AM
David S. Ettinger, MD
The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Neoadjuvant Combined Modality Therapy for Potentially Resectable Stage III Non-Small Cell Lung Cancer
10:50 - 11:30 AM
Francisco Robert, MD
University of Alabama at Birmingham Comprehensive Cancer Center
Management of Metastatic Non-Small Cell Lung Cancer
11:35 AM - 12:15 PM
Gregory A. Otterson, MD
Arthur G. James Cancer Hospital & Richard J. Solove Research Institute at The Ohio State University
Lunch will be provided.
Agenda and faculty subject to change.
Supported by educational grants from Amgen, AstraZeneca and Abraxis BioScience, Bristol-Myers Squibb and ImClone Systems, Eli Lilly and Company, Genentech BioOncology and OSI Oncology, and sanofi-aventis U.S.
Click here for fast, easy online registration, the complete agenda, and accreditation information.
Visit www.nccn.org for information on other NCCN programs.
Date: Monday, May 5, 2008
8:00AM - 12:15 PM (registration starts at 7:30 AM)
Place: Westin Pasadena
191 North Los Robles
Pasadena, California
Fee:
Physicians, Pharmacists, and other health care professionals $50
Nurses $25
Industry $495
* If cancellation is necessary, please notify NCCN. A substitute attendee may be sent in your place. Registration fees are non-refundable.
Speakers at this event include experts in cancer care from NCCN Member Institutions addressing such topics as:
NCCN Guidelines Overview
8:00 - 8:20 AM
Kristina M. Gregory, RN, MSN, OCN
National Comprehensive Cancer Network
Workup, Prognostic Factors, and Markers
8:25 - 9:00 AM
Renato Martins, MD, MPH
Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
Therapy for Stages I, IIA, IIB, and IIIA (T3, N1) Non-Small Cell Lung Cancer
9:05 - 9:40 AM
Frederic W. Grannis, Jr., MD
City of Hope
Treatment Options for Unresectable Stage III Non-Small Cell Lung Cancer
10:05 - 10:45 AM
David S. Ettinger, MD
The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Neoadjuvant Combined Modality Therapy for Potentially Resectable Stage III Non-Small Cell Lung Cancer
10:50 - 11:30 AM
Francisco Robert, MD
University of Alabama at Birmingham Comprehensive Cancer Center
Management of Metastatic Non-Small Cell Lung Cancer
11:35 AM - 12:15 PM
Gregory A. Otterson, MD
Arthur G. James Cancer Hospital & Richard J. Solove Research Institute at The Ohio State University
Lunch will be provided.
Agenda and faculty subject to change.
Supported by educational grants from Amgen, AstraZeneca and Abraxis BioScience, Bristol-Myers Squibb and ImClone Systems, Eli Lilly and Company, Genentech BioOncology and OSI Oncology, and sanofi-aventis U.S.
Click here for fast, easy online registration, the complete agenda, and accreditation information.
Visit www.nccn.org for information on other NCCN programs.
CMS/Medicare: Medicare Learning Network (MLN) Messages
As Medicare’s May 23rd National Provider Identifier (NPI) implementation approaches, the Centers for Medicare & Medicaid Services (CMS) reminds providers to visit the NPI MLN Matters national provider education articles, courtesy of the Medicare Learning Network.
The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses will use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty.
The Medicare Learning Network has created many MLN Matters articles on the various aspects of Medicare’s NPI implementation. A comprehensive list of the NPI articles is available at http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/MMArticles_NPI.pdf on the CMS website.
New MLN Quarterly Journal Ad—NPI MLN Matters Articles -- This quarter’s journal ad features the MLN Matters articles available regarding Medicare’s implementation of the National Provider Identifier (NPI).
Each calendar quarter, the Medicare Learning Network creates a journal advertisement based on an initiative or new product of particular importance during that time frame. National, state and local associations are encouraged to use this journal ad in their publications and/or newsletters and websites, as appropriate.
The files for this quarter’s ad, as well as future ads, can be found at www.cms.hhs.gov/MLNGenInfo on the CMS Website. Once on the page, click on Quarterly MLN Journal Ad (zip file) in the Downloads Section
Medicare Learning Network (MLN) Bookmark Now Available!
The MLN Bookmark lists: the topics covered by the educational products and services of the MLN, the various product types available to the learner, as well as the web address for the MLN. This product is appropriate for distribution at health care professional conferences, provider outreach and education activities and other appropriate types of provider/supplier events.
The MLN Bookmark is available for download at http://www.cms.hhs.gov/MLNProducts/downloads/MLNBookmrk-006960.pdf on the CMS website. You can also order hard copies of the bookmark through the MLN Product Ordering page at http://cms.meridianksi.com/kc/main/kc_frame.asp?kc_ident=kc0001&loc=5 on the web.
A version of the MLN Bookmark is also available for distribution to Indian Health Care Professionals. To view this bookmark, go to
http://www.cms.hhs.gov/MLNProducts/downloads/MLN-AIANBookmrk006954.pdf or to order hard copies go to http://cms.meridianksi.com/kc/main/kc_frame.asp?kc_ident=kc0001&loc=5 on the web.
The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses will use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty.
The Medicare Learning Network has created many MLN Matters articles on the various aspects of Medicare’s NPI implementation. A comprehensive list of the NPI articles is available at http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/MMArticles_NPI.pdf on the CMS website.
New MLN Quarterly Journal Ad—NPI MLN Matters Articles -- This quarter’s journal ad features the MLN Matters articles available regarding Medicare’s implementation of the National Provider Identifier (NPI).
Each calendar quarter, the Medicare Learning Network creates a journal advertisement based on an initiative or new product of particular importance during that time frame. National, state and local associations are encouraged to use this journal ad in their publications and/or newsletters and websites, as appropriate.
The files for this quarter’s ad, as well as future ads, can be found at www.cms.hhs.gov/MLNGenInfo on the CMS Website. Once on the page, click on Quarterly MLN Journal Ad (zip file) in the Downloads Section
Medicare Learning Network (MLN) Bookmark Now Available!
The MLN Bookmark lists: the topics covered by the educational products and services of the MLN, the various product types available to the learner, as well as the web address for the MLN. This product is appropriate for distribution at health care professional conferences, provider outreach and education activities and other appropriate types of provider/supplier events.
The MLN Bookmark is available for download at http://www.cms.hhs.gov/MLNProducts/downloads/MLNBookmrk-006960.pdf on the CMS website. You can also order hard copies of the bookmark through the MLN Product Ordering page at http://cms.meridianksi.com/kc/main/kc_frame.asp?kc_ident=kc0001&loc=5 on the web.
A version of the MLN Bookmark is also available for distribution to Indian Health Care Professionals. To view this bookmark, go to
http://www.cms.hhs.gov/MLNProducts/downloads/MLN-AIANBookmrk006954.pdf or to order hard copies go to http://cms.meridianksi.com/kc/main/kc_frame.asp?kc_ident=kc0001&loc=5 on the web.
Friday, April 25, 2008
NHIC/Medicare Website Updates
The following updates have been posted to the NHIC/Medicare website at http://www.medicarenhic.com/cal_prov/updates.shtml
Two new educational articles have been posted: Use of an 8-Digit Registry Number on Clinical Trial Claims and Care Plan Oversight Documentation Requirements.
Registration is now being accepted for the May 21 webinar: National and Local Coverage Determinations and the Use of the New
Advanced Beneficiary Notice of Noncoverage.
The Questions & Answers from the previous webinar are now available: Care Plan Oversight and Skilled Nursing Facility Consolidated Billing.
Two new educational articles have been posted: Use of an 8-Digit Registry Number on Clinical Trial Claims and Care Plan Oversight Documentation Requirements.
Registration is now being accepted for the May 21 webinar: National and Local Coverage Determinations and the Use of the New
Advanced Beneficiary Notice of Noncoverage.
The Questions & Answers from the previous webinar are now available: Care Plan Oversight and Skilled Nursing Facility Consolidated Billing.
CMS/Medicare: May 23rd is Only 4 Weeks Away - Are You Prepared?
Important Information for Medicare FFS Providers
Clarification of 4/3/2008 Statement “Institutional Providers Submitting Taxonomy Codes to Identify Subparts –What Medicare is using to Obtain NPI/OSCAR Match”
Providers who submit Medicare claims may continue to send their Medicare Provider Taxonomy Codes. However, Medicare Fee-For-Service claims processing systems will not use this data to adjudicate claims. The taxonomy codes will be crossed over to the secondary payers as CMS understands that some payers may use this information to adjudicate claims.
When to Update NPPES if an Update to Medicare Enrollment Information is Also Needed
The NPI Final Rule requires covered providers to update their required NPPES data within 30 days of the change. If a Medicare provider needs to update information in NPPES, it will also need to update the corresponding information in its Medicare enrollment record via the CMS-855. Providers should not make updates to NPPES data until after their CMS-855s are processed and those updates are effective in the Medicare enrollment system (PECOS, or the NSC for Medicare DMEPOS suppliers). After the update is effective in PECOS or the NSC (whichever is appropriate), providers have up to 30 days to make the corresponding updates in NPPES. In a change of ownership (CHOW) situation, for example, the new owner would not make changes in the NPPES record of the provider that is being sold until after the CMS-855 is processed and its changes are effective in the Medicare enrollment system. If a new NPI is to be obtained as part of the CHOW and an existing NPI is to be deactivated (those decisions are up to the buyer and the seller), the NPI should not be deactivated until after all claims using that NPI reach final settlement (this could involve health plans in addition to Medicare).
May 23rd is Only 4 Weeks Away, ARE YOU PREPARED?
URGENT: CMS continues to be concerned about the low percentage of claims being submitted with an NPI alone in the primary provider identifier fields. See below for specific steps to begin using the NPI alone in the primary provider identifier fields.
Don’t be Surprised on May 23…TRY 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 sending a small batch of claims with 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 try sending NPI-only 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 MACor at 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.
If you bill Medicare using a billing service or clearinghouse, you should work with them to establish a way to try sending NPI-only claims. It may be difficult for some of these 3rd party vendors to send small batches of your NPI-only claims and continue sending NPI and Legacy claims as well, so contact them and develop an alternative solution so you can try NPI-only.
Sending a sample of NPI-only claims 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.
NPIs in Secondary Provider Fields
May 23, 2008, is also the deadline for using the NPI-only in the secondary provider identifier fields on a claim transaction. This includes the prescriber field in a Medicare fee-for-service retail pharmacy drug claim submitted in an NCPDP 5.1 transaction. CMS will be providing guidance with respect to the reporting of NPIs in the Service Facility Location loop in the X12 N 837 claims transactions.
NPIs on ALL HIPAA Standard Transactions
May 23, 2008 is also the deadline for the use of NPI on ALL HIPAA standard transactions (e.g., 837I, 837P, NCPDP, DDE, 276/277, 270/271 and 835).
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.
Clarification of 4/3/2008 Statement “Institutional Providers Submitting Taxonomy Codes to Identify Subparts –What Medicare is using to Obtain NPI/OSCAR Match”
Providers who submit Medicare claims may continue to send their Medicare Provider Taxonomy Codes. However, Medicare Fee-For-Service claims processing systems will not use this data to adjudicate claims. The taxonomy codes will be crossed over to the secondary payers as CMS understands that some payers may use this information to adjudicate claims.
When to Update NPPES if an Update to Medicare Enrollment Information is Also Needed
The NPI Final Rule requires covered providers to update their required NPPES data within 30 days of the change. If a Medicare provider needs to update information in NPPES, it will also need to update the corresponding information in its Medicare enrollment record via the CMS-855. Providers should not make updates to NPPES data until after their CMS-855s are processed and those updates are effective in the Medicare enrollment system (PECOS, or the NSC for Medicare DMEPOS suppliers). After the update is effective in PECOS or the NSC (whichever is appropriate), providers have up to 30 days to make the corresponding updates in NPPES. In a change of ownership (CHOW) situation, for example, the new owner would not make changes in the NPPES record of the provider that is being sold until after the CMS-855 is processed and its changes are effective in the Medicare enrollment system. If a new NPI is to be obtained as part of the CHOW and an existing NPI is to be deactivated (those decisions are up to the buyer and the seller), the NPI should not be deactivated until after all claims using that NPI reach final settlement (this could involve health plans in addition to Medicare).
May 23rd is Only 4 Weeks Away, ARE YOU PREPARED?
URGENT: CMS continues to be concerned about the low percentage of claims being submitted with an NPI alone in the primary provider identifier fields. See below for specific steps to begin using the NPI alone in the primary provider identifier fields.
Don’t be Surprised on May 23…TRY 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 sending a small batch of claims with 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 try sending NPI-only 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 MACor at 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.
If you bill Medicare using a billing service or clearinghouse, you should work with them to establish a way to try sending NPI-only claims. It may be difficult for some of these 3rd party vendors to send small batches of your NPI-only claims and continue sending NPI and Legacy claims as well, so contact them and develop an alternative solution so you can try NPI-only.
Sending a sample of NPI-only claims 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.
NPIs in Secondary Provider Fields
May 23, 2008, is also the deadline for using the NPI-only in the secondary provider identifier fields on a claim transaction. This includes the prescriber field in a Medicare fee-for-service retail pharmacy drug claim submitted in an NCPDP 5.1 transaction. CMS will be providing guidance with respect to the reporting of NPIs in the Service Facility Location loop in the X12 N 837 claims transactions.
NPIs on ALL HIPAA Standard Transactions
May 23, 2008 is also the deadline for the use of NPI on ALL HIPAA standard transactions (e.g., 837I, 837P, NCPDP, DDE, 276/277, 270/271 and 835).
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.
Thursday, April 24, 2008
CMS/Medicare: Reminder Notice: 2008 Physician Quality Reporting Initiative (PQRI) National Provider Call
2008 Physician Quality Reporting Initiative (PQRI)
National Provider Conference Call with Question & Answer Session
Registration will close at 1:30 p.m. EDT on April 29, 2008, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host the second in a series of national provider conference calls on the 2008 Physician Quality Reporting Initiative (PQRI). This toll-free call will take place from 1:30 p.m. – 3:30 p.m., EDT, on Wednesday, April 30, 2008.
The Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) was enacted on December 29, 2007. MMSEA authorizes CMS to make PQRI incentive payments for satisfactorily reporting quality measures data in 2008.
MMSEA also provides professionals greater flexibility for participating in the 2008 PQRI by authorizing CMS to establish alternative reporting criteria and alternative reporting periods for the reporting of measures groups and for the submission of data on PQRI quality measures through clinical data registries.
In 2008, eligible professionals may earn an incentive payment of 1.5 percent of their total allowed charges for physician fee schedule covered professional services furnished during the respective alternative reporting periods based on data submitted via these mechanisms. While TRHCA established a cap on incentive payments for 2007, based on an average per measure payment amount, there is no cap on incentive payments under MMSEA for 2008 and 2009.
These provisions provide increased opportunities for eligible professionals to report PQRI quality measures and the possibility to earn incentive payments for satisfactory reporting. This call will provide an overview of these new flexibilities.
A PowerPoint slide presentation will be posted to the PQRI webpage at http://www.cms.hhs.gov/PQRI/30_EducationalResources.asp on the CMS website for you to download prior to the call so that you can follow along with the presenters, Dr. Michael Rapp, Dr. Daniel Green and Rachel Nelson. Following the presentation, callers will have an opportunity to ask questions of CMS subject matter experts.
NOTE: We are pleased to announce that CMS will be offering continuing education units (CEUs) for eligible participants; the agenda and details on how to register to obtain CEUs for this call is forthcoming.
Conference call details:
Date: April 30, 2008
Conference Title: 2008 Physician Quality Reporting Initiative National Provider Call
Time: 1:30-3:30 p.m. EDT
In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation. If you cannot attend the call, replay information is available below.
Registration will close at 1:30 p.m. EDT on April 29, 2008, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
To register for the call participants need to go to:
http://www2.eventsvc.com/palmettogba/event/2f7d0cda539b41dfb0fa57ad119b2ba9
Fill in all required data.
Verify your time zone is displayed correctly the drop down box.
Click "Register".
You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.
For those of you who will be unable to attend, a replay option will be available shortly following the end of the call. This replay will be accessible from 3:30 p.m. EDT 4/30/2008 until 11:59 p.m. EDT 5/07/2008. The call in data for the replay is (800) 642-1687 and the passcode is 42860144.
If you require services for the hearing impaired please send an email to: Medicare.TTT@PalmettoGBA.com.
National Provider Conference Call with Question & Answer Session
Registration will close at 1:30 p.m. EDT on April 29, 2008, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host the second in a series of national provider conference calls on the 2008 Physician Quality Reporting Initiative (PQRI). This toll-free call will take place from 1:30 p.m. – 3:30 p.m., EDT, on Wednesday, April 30, 2008.
The Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) was enacted on December 29, 2007. MMSEA authorizes CMS to make PQRI incentive payments for satisfactorily reporting quality measures data in 2008.
MMSEA also provides professionals greater flexibility for participating in the 2008 PQRI by authorizing CMS to establish alternative reporting criteria and alternative reporting periods for the reporting of measures groups and for the submission of data on PQRI quality measures through clinical data registries.
In 2008, eligible professionals may earn an incentive payment of 1.5 percent of their total allowed charges for physician fee schedule covered professional services furnished during the respective alternative reporting periods based on data submitted via these mechanisms. While TRHCA established a cap on incentive payments for 2007, based on an average per measure payment amount, there is no cap on incentive payments under MMSEA for 2008 and 2009.
These provisions provide increased opportunities for eligible professionals to report PQRI quality measures and the possibility to earn incentive payments for satisfactory reporting. This call will provide an overview of these new flexibilities.
A PowerPoint slide presentation will be posted to the PQRI webpage at http://www.cms.hhs.gov/PQRI/30_EducationalResources.asp on the CMS website for you to download prior to the call so that you can follow along with the presenters, Dr. Michael Rapp, Dr. Daniel Green and Rachel Nelson. Following the presentation, callers will have an opportunity to ask questions of CMS subject matter experts.
NOTE: We are pleased to announce that CMS will be offering continuing education units (CEUs) for eligible participants; the agenda and details on how to register to obtain CEUs for this call is forthcoming.
Conference call details:
Date: April 30, 2008
Conference Title: 2008 Physician Quality Reporting Initiative National Provider Call
Time: 1:30-3:30 p.m. EDT
In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation. If you cannot attend the call, replay information is available below.
Registration will close at 1:30 p.m. EDT on April 29, 2008, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
To register for the call participants need to go to:
http://www2.eventsvc.com/palmettogba/event/2f7d0cda539b41dfb0fa57ad119b2ba9
Fill in all required data.
Verify your time zone is displayed correctly the drop down box.
Click "Register".
You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.
For those of you who will be unable to attend, a replay option will be available shortly following the end of the call. This replay will be accessible from 3:30 p.m. EDT 4/30/2008 until 11:59 p.m. EDT 5/07/2008. The call in data for the replay is (800) 642-1687 and the passcode is 42860144.
If you require services for the hearing impaired please send an email to: Medicare.TTT@PalmettoGBA.com.
Complete ASCO Annual Meeting Program Now Available Online
Now Available Online: Complete 2008 ASCO Annual Meeting Program
The online program includes the following features:
· Abstract and presentation titles for all sessions including the Plenary Session, Clinical Science Symposia, Translational Oral Sessions, and more
· Links from Education Sessions to 2008 ASCO Educational Book manuscripts
· Program search by keyword, speaker, session type, or abstract number
· Ability to create and save a personalized meeting itinerary in MS Excel or Outlook
NEW! Our Specialty Quickprint function will help you plan your meeting experience by suggesting an itinerary for you. Sessions are selected on the basis of your specialty and include Special Sessions and track sessions as well as other sessions of interested.
Browse the complete Annual Meeting program at www.asco.org/AMprogram.
The early registration deadline for the 2008 ASCO Annual Meeting is April 25. Act now to take advantage of best rates.
Register for the Meeting at www.asco.org/annualmeeting.
2008 ASCO Educational Book Now Available
This publication is the comprehensive resource for Education Session materials from the 2008 ASCO Annual Meeting, allowing the entire oncology community to benefit from discussions of critical research updates in a point-of-care context. Available now in online, print, and CD-ROM formats.
Visit www.asco.org/edbook for details.
The online program includes the following features:
· Abstract and presentation titles for all sessions including the Plenary Session, Clinical Science Symposia, Translational Oral Sessions, and more
· Links from Education Sessions to 2008 ASCO Educational Book manuscripts
· Program search by keyword, speaker, session type, or abstract number
· Ability to create and save a personalized meeting itinerary in MS Excel or Outlook
NEW! Our Specialty Quickprint function will help you plan your meeting experience by suggesting an itinerary for you. Sessions are selected on the basis of your specialty and include Special Sessions and track sessions as well as other sessions of interested.
Browse the complete Annual Meeting program at www.asco.org/AMprogram.
The early registration deadline for the 2008 ASCO Annual Meeting is April 25. Act now to take advantage of best rates.
Register for the Meeting at www.asco.org/annualmeeting.
2008 ASCO Educational Book Now Available
This publication is the comprehensive resource for Education Session materials from the 2008 ASCO Annual Meeting, allowing the entire oncology community to benefit from discussions of critical research updates in a point-of-care context. Available now in online, print, and CD-ROM formats.
Visit www.asco.org/edbook for details.
Tuesday, April 22, 2008
THIS WEEK AT ACCC: APRIL 21-25, 2008
The following information is provided by the Association of Community Cancer Centers (ACCC). ANCO is an Institutional Member of ACCC.
This Week at ACCC was published today and is available at http://www.accc-cancer.org/mediaroom/newsletters/media_ACCC_april21_08.html
It features:
Payments for Inpatient Hospital Care Would Rise by $4 Billion Under Proposal
CMS Taking Steps to Improve PQRI
New Continuing Education Programs on ACCC's Blackboard
ACCC Listserv Archive Available
Back-packs to be Available Through Pediatric Oncology Campaign
This Week at ACCC was published today and is available at http://www.accc-cancer.org/mediaroom/newsletters/media_ACCC_april21_08.html
It features:
Payments for Inpatient Hospital Care Would Rise by $4 Billion Under Proposal
CMS Taking Steps to Improve PQRI
New Continuing Education Programs on ACCC's Blackboard
ACCC Listserv Archive Available
Back-packs to be Available Through Pediatric Oncology Campaign
Monday, April 21, 2008
CMS/Medicare: National Plan and Provider Enumeration System & National Provider Identifier Registry Unavailable April 21st
On April 21, 2008, the National Plan and Provider Enumeration System (NPPES) will undergo system maintenance during the day. Neither NPPES nor the NPI Registry will be available on April 21, 2008. CMS will be implementing several enhancements/updates to the system. For more information, view (http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/NPPES-Enhancements.pdf) on the CMS website.
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 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 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 web page.
DHS/MediCal Proprietary Form Reminder
The following information is provided by DHS/MediCal.
Proprietary Claim Form Reminder
New versions of Medi-Cal and Child Health and Disability Prevention (CHDP) proprietary forms are available from Medi-Cal. These new forms are updated to accommodate the 10-digit National Provider Identifier (NPI). Medi-Cal began advertising and distributing the newer version proprietary forms July 1, 2007 so that providers may have plenty of time to use old stock and order new. Ordering the newer version proprietary forms is quick and cost-free. Simply call the Telephone Support Center (TSC) at 1-800-541-5555 to fill your order today. As previously announced in monthly bulletins, as of April 15, 2008, Medi-Cal is no longer accepting the old, non-NPI compliant version of these forms.
At the direction of the Department of Health Care Services, the non-NPI compliant forms will be returned and may result in claim timeliness issues. By not using the updated forms, providers' reimbursements may be cutback or denied due to timeliness if non-NPI compliant forms have to be returned.
Timeliness Appeal
Should a provider's claim become untimely due to a rejected non-NPI compliant form, a system is in place to process requests to appeal the timeliness issue. Providers must submit an appeal by attaching the official reject letter to substantiate timely billing. Appeals must be filed within 90-days of last action, so the provider must get the appeal to the Appeals Unit within 90-days of the rejection letter date. As with all other appeals, failure to submit an appeal within this 90-day time period will result in the appeal being denied.
The following list identifies the proprietary forms that have been revised and must be submitted in place of the old, non-NPI compliant forms.
Form Number Form Name
18-1 Request for Extension of Stay in Hospital
18-2 Request for Extension of Stay in Hospital (Fax)
18-3 Request for Mental Health Stay in Hospital
20-1 Long Term Care Treatment Authorization Request
25-1 Payment Request for Long Term Care
30-1 Pharmacy Claim Form
30-4 Compound Drug Pharmacy Claim Form
50-1 Treatment Authorization Request
50-2 Treatment Authorization Request (Fax)
50-3 Treatment Authorization Request (Vision Care)
55-1 Medi-Cal Managed Care Authorization Form (Discharge Planning Option)
60-1 Claims Inquiry Form
90-1 Appeal Form
PM 160 CHDP Assessment Confidential Screening/Billing Report
PM 160INF CHDP Assessment Confidential Screening/Billing Report (Information Only)
TAR 3 Form Treatment Authorization Request Attachment Form
For assistance, providers may contact the Telephone Service Center (TSC) at 1-800-541-5555 or visit the Medi-Cal Web site at www.medi-cal.ca.gov and access the NPI link on the “Featured” tab.
Proprietary Claim Form Reminder
New versions of Medi-Cal and Child Health and Disability Prevention (CHDP) proprietary forms are available from Medi-Cal. These new forms are updated to accommodate the 10-digit National Provider Identifier (NPI). Medi-Cal began advertising and distributing the newer version proprietary forms July 1, 2007 so that providers may have plenty of time to use old stock and order new. Ordering the newer version proprietary forms is quick and cost-free. Simply call the Telephone Support Center (TSC) at 1-800-541-5555 to fill your order today. As previously announced in monthly bulletins, as of April 15, 2008, Medi-Cal is no longer accepting the old, non-NPI compliant version of these forms.
At the direction of the Department of Health Care Services, the non-NPI compliant forms will be returned and may result in claim timeliness issues. By not using the updated forms, providers' reimbursements may be cutback or denied due to timeliness if non-NPI compliant forms have to be returned.
Timeliness Appeal
Should a provider's claim become untimely due to a rejected non-NPI compliant form, a system is in place to process requests to appeal the timeliness issue. Providers must submit an appeal by attaching the official reject letter to substantiate timely billing. Appeals must be filed within 90-days of last action, so the provider must get the appeal to the Appeals Unit within 90-days of the rejection letter date. As with all other appeals, failure to submit an appeal within this 90-day time period will result in the appeal being denied.
The following list identifies the proprietary forms that have been revised and must be submitted in place of the old, non-NPI compliant forms.
Form Number Form Name
18-1 Request for Extension of Stay in Hospital
18-2 Request for Extension of Stay in Hospital (Fax)
18-3 Request for Mental Health Stay in Hospital
20-1 Long Term Care Treatment Authorization Request
25-1 Payment Request for Long Term Care
30-1 Pharmacy Claim Form
30-4 Compound Drug Pharmacy Claim Form
50-1 Treatment Authorization Request
50-2 Treatment Authorization Request (Fax)
50-3 Treatment Authorization Request (Vision Care)
55-1 Medi-Cal Managed Care Authorization Form (Discharge Planning Option)
60-1 Claims Inquiry Form
90-1 Appeal Form
PM 160 CHDP Assessment Confidential Screening/Billing Report
PM 160INF CHDP Assessment Confidential Screening/Billing Report (Information Only)
TAR 3 Form Treatment Authorization Request Attachment Form
For assistance, providers may contact the Telephone Service Center (TSC) at 1-800-541-5555 or visit the Medi-Cal Web site at www.medi-cal.ca.gov and access the NPI link on the “Featured” tab.
NHIC/Medicare Website Updates
The following updates have been posted to the NHIC/Medicare website at http://www.medicarenhic.com/cal_prov/updates.shtml
The Questions and Answers from the Provider Enrollment Webinar have been posted.
The listings of Opt-Out Providers have been updated.
The Medicare Secondary Payer Billing Guide has been updated.
The minutes from the March meeting of the Provider Outreach & Education Advisory Group (POE-AG) have been posted.
The Questions and Answers from the Provider Enrollment Webinar have been posted.
The listings of Opt-Out Providers have been updated.
The Medicare Secondary Payer Billing Guide has been updated.
The minutes from the March meeting of the Provider Outreach & Education Advisory Group (POE-AG) have been posted.
Palmetto/J1MAC Web Site Update
J1 LCD Consolidation Process
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/J1%20LCD%20Consolidation%20Process?opendocument
The J1 LCD Consolidation Process has been posted to the Local Coverage
Determinations section of the J1 Transition Web site.
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/J1%20LCD%20Consolidation%20Process?opendocument
The J1 LCD Consolidation Process has been posted to the Local Coverage
Determinations section of the J1 Transition Web site.
CMS/Medicare: Upcoming Training for the Medicare Part B Drugs Competitive Acquisition Program (CAP)
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 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:
4/22/08 at 2:00 pm CST
5/28/08 at 10:00 am CST
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:
4/22/08 at 2:00 pm CST
5/28/08 at 10:00 am CST
CMS/Medicare: 2008 Physician Quality Reporting Initiative (PQRI) National Provider Call
The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host the second in a series of national provider conference calls on the 2008 Physician Quality Reporting Initiative (PQRI). This toll-free call will take place from 1:30 p.m. – 3:30 p.m., EDT, on Wednesday, April 30, 2008.
The Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) was enacted on December 29, 2007. MMSEA authorizes CMS to make PQRI incentive payments for satisfactorily reporting quality measures data in 2008.
MMSEA also provides professionals greater flexibility for participating in the 2008 PQRI by authorizing CMS to establish alternative reporting criteria and alternative reporting periods for the reporting of measures groups and for the submission of data on PQRI quality measures through clinical data registries.
In 2008, eligible professionals may earn an incentive payment of 1.5 percent of their total allowed charges for physician fee schedule covered professional services furnished during the respective alternative reporting periods based on data submitted via these mechanisms. While TRHCA established a cap on incentive payments for 2007, based on an average per measure payment amount, there is no cap on incentive payments under MMSEA for 2008 and 2009.
These provisions provide increased opportunities for eligible professionals to report PQRI quality measures and the possibility to earn incentive payments for satisfactory reporting. This call will provide an overview of these new flexibilities.
A PowerPoint slide presentation will be posted to the PQRI webpage at http://www.cms.hhs.gov/PQRI/30_EducationalResources.asp on the CMS website for you to download prior to the call so that you can follow along with the presenters, Dr. Michael Rapp, Dr. Daniel Green and Rachel Nelson. Following the presentation, callers will have an opportunity to ask questions of CMS subject matter experts.
NOTE: We are pleased to announce that CMS will be offering continuing education units (CEUs) for eligible participants; the agenda and details on how to register to obtain CEUs for this call is forthcoming.
Conference call details:
Date: April 30, 2008
Conference Title: 2008 Physician Quality Reporting Initiative National Provider Call
Time: 1:30-3:30 p.m. EDT
In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation. If you cannot attend the call, replay information is available below.
Registration will close at 1:30 p.m. EDT on April 29, 2008, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
To register for the call participants need to go to:
http://www2.eventsvc.com/palmettogba/event/2f7d0cda539b41dfb0fa57ad119b2ba9
Fill in all required data.
Verify your time zone is displayed correctly the drop down box.
Click "Register".
You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.
For those of you who will be unable to attend, a replay option will be available shortly following the end of the call. This replay will be accessible from 3:30 p.m. EDT 4/30/2008 until 11:59 p.m. EDT 5/07/2008. The call in data for the replay is (800) 642-1687 and the passcode is 42860144.
If you require services for the hearing impaired please send an email to:Medicare.TTT@PalmettoGBA.com.
The Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) was enacted on December 29, 2007. MMSEA authorizes CMS to make PQRI incentive payments for satisfactorily reporting quality measures data in 2008.
MMSEA also provides professionals greater flexibility for participating in the 2008 PQRI by authorizing CMS to establish alternative reporting criteria and alternative reporting periods for the reporting of measures groups and for the submission of data on PQRI quality measures through clinical data registries.
In 2008, eligible professionals may earn an incentive payment of 1.5 percent of their total allowed charges for physician fee schedule covered professional services furnished during the respective alternative reporting periods based on data submitted via these mechanisms. While TRHCA established a cap on incentive payments for 2007, based on an average per measure payment amount, there is no cap on incentive payments under MMSEA for 2008 and 2009.
These provisions provide increased opportunities for eligible professionals to report PQRI quality measures and the possibility to earn incentive payments for satisfactory reporting. This call will provide an overview of these new flexibilities.
A PowerPoint slide presentation will be posted to the PQRI webpage at http://www.cms.hhs.gov/PQRI/30_EducationalResources.asp on the CMS website for you to download prior to the call so that you can follow along with the presenters, Dr. Michael Rapp, Dr. Daniel Green and Rachel Nelson. Following the presentation, callers will have an opportunity to ask questions of CMS subject matter experts.
NOTE: We are pleased to announce that CMS will be offering continuing education units (CEUs) for eligible participants; the agenda and details on how to register to obtain CEUs for this call is forthcoming.
Conference call details:
Date: April 30, 2008
Conference Title: 2008 Physician Quality Reporting Initiative National Provider Call
Time: 1:30-3:30 p.m. EDT
In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation. If you cannot attend the call, replay information is available below.
Registration will close at 1:30 p.m. EDT on April 29, 2008, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
To register for the call participants need to go to:
http://www2.eventsvc.com/palmettogba/event/2f7d0cda539b41dfb0fa57ad119b2ba9
Fill in all required data.
Verify your time zone is displayed correctly the drop down box.
Click "Register".
You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.
For those of you who will be unable to attend, a replay option will be available shortly following the end of the call. This replay will be accessible from 3:30 p.m. EDT 4/30/2008 until 11:59 p.m. EDT 5/07/2008. The call in data for the replay is (800) 642-1687 and the passcode is 42860144.
If you require services for the hearing impaired please send an email to:Medicare.TTT@PalmettoGBA.com.
CMS/Medicare: Physician Quality Reporting Initiative (PQRI): Important New Program Changes Make It Easier than Ever to Participate!
The Centers for Medicare & Medicaid Services (CMS) today announced new options under the PQRI program that make it easier than ever to participate.
CMS is pleased to announce that a new PQRI law now allows CMS to offer:
· New reporting approaches that give you more options to successfully participate;
· New, alternate reporting periods to allow you to begin reporting on July 1, 2008, and still receive an incentive payment (1.5% of allowable charges for services provided from July 1 through December 31, 2008); and
· New options to submit quality measures data to CMS through a qualified, established clinical data registry, in which you may already be participating.
Also, for the 2008 reporting period, the new law removed the limit (cap) on your incentive.
How Can You Learn More?
· Join our Open Door Forum. Keep informed of developments of interest to you and other physicians and health care practitioners by subscribing to CMS’ Physicians, Nurses, and Allied Health Open Door Forum ListServ. The Forum will hold its next meeting on Tuesday, April 22, 2008. To sign up for the ListServ and receive PQRI updates and Forum meeting invitations by e-mail, visit http://www.cms.hhs.gov/OpenDoorForums/23_ODF_PNAHP.asp on the CMS website.
· Attend our National Provider Conference Call with Q&A Session. CMS will host the second in a series of national provider conference calls on the 2008 Physician Quality Reporting Initiative. This toll-free call will take place from 1:30 p.m. – 3:30 p.m., EDT, on Wednesday, April 30, 2008. Following the presentation, callers will have an opportunity to ask questions of CMS subject matter experts. We are pleased to announce that CMS will be offering continuing educations units (CEUs) for eligible participants. The agenda and details on how to register for the call are forthcoming.
· Visit our website. For more information about these new PQRI program changes, including how you can participate, visit us at http://www.cms.hhs.gov/PQRI on the CMS website.
CMS is pleased to announce that a new PQRI law now allows CMS to offer:
· New reporting approaches that give you more options to successfully participate;
· New, alternate reporting periods to allow you to begin reporting on July 1, 2008, and still receive an incentive payment (1.5% of allowable charges for services provided from July 1 through December 31, 2008); and
· New options to submit quality measures data to CMS through a qualified, established clinical data registry, in which you may already be participating.
Also, for the 2008 reporting period, the new law removed the limit (cap) on your incentive.
How Can You Learn More?
· Join our Open Door Forum. Keep informed of developments of interest to you and other physicians and health care practitioners by subscribing to CMS’ Physicians, Nurses, and Allied Health Open Door Forum ListServ. The Forum will hold its next meeting on Tuesday, April 22, 2008. To sign up for the ListServ and receive PQRI updates and Forum meeting invitations by e-mail, visit http://www.cms.hhs.gov/OpenDoorForums/23_ODF_PNAHP.asp on the CMS website.
· Attend our National Provider Conference Call with Q&A Session. CMS will host the second in a series of national provider conference calls on the 2008 Physician Quality Reporting Initiative. This toll-free call will take place from 1:30 p.m. – 3:30 p.m., EDT, on Wednesday, April 30, 2008. Following the presentation, callers will have an opportunity to ask questions of CMS subject matter experts. We are pleased to announce that CMS will be offering continuing educations units (CEUs) for eligible participants. The agenda and details on how to register for the call are forthcoming.
· Visit our website. For more information about these new PQRI program changes, including how you can participate, visit us at http://www.cms.hhs.gov/PQRI on the CMS website.
CMS/Medicare: Quality Reporting Initiative Will Help Improve Health Care for Beneficiaries and Provide Incentives for Eligible Professionals
The Centers for Medicare & Medicaid Services (CMS) today announced steps it is taking to encourage physicians and other eligible professionals to take part in the Physician Quality Reporting Initiative (PQRI), a program designed to improve the quality of care provided to Medicare beneficiaries. These steps, including a variety of new reporting options, will make it easier for eligible professionals to participate and receive feedback on their performance.
The 2008 PQRI Program allows the use of 119 measures that were published in the Physician Fee Schedule for 2008.
Details about how an eligible professional can qualify for an incentive payment under this new option are available at http:// www.cms.hhs.gov/PQRI on the CMS website.
2008 PQRI: Establishment of Alternative Reporting Periods and Reporting Criteria is posted at http://www.cms.hhs.gov/PQRI/downloads/2008PQRIalterrptperiods.pdf on the CMS website.
To read the CMS Press Release issued today (4/17) click here: http://www.cms.hhs.gov/apps/media/press_releases.asp on the CMS website.
The 2008 PQRI Program allows the use of 119 measures that were published in the Physician Fee Schedule for 2008.
Details about how an eligible professional can qualify for an incentive payment under this new option are available at http:// www.cms.hhs.gov/PQRI on the CMS website.
2008 PQRI: Establishment of Alternative Reporting Periods and Reporting Criteria is posted at http://www.cms.hhs.gov/PQRI/downloads/2008PQRIalterrptperiods.pdf on the CMS website.
To read the CMS Press Release issued today (4/17) click here: http://www.cms.hhs.gov/apps/media/press_releases.asp on the CMS website.
Reminder: ASH Practice Survey Closes April 30th!
This is a reminder that the ASH Practice Survey, which focuses on how hematology is practiced in the United States, closes on April 30th. The survey is designed for members who are practicing hematology – whether or not they are board-certified or members of ASH. The survey results will be useful for strategic planning.
The survey is located at http://www.surveymonkey.com/s.aspx?sm=I_2fxKEbJBkjvOC00zO_2bXK2A_3d_3d and should take about 5 minutes to complete. The survey will be available for entry through April 30. After that date, ASH staff will be analyzing the data and will provide you with the results from your society and also the national aggregate data.
Participate Today--ASH Practice Survey
The American Society of Hematology (ASH) is conducting a survey of practicing hematologists. Please take a few minutes today to participate in the survey and help ASH better understand the needs of the hematologist practitioner. All surveys must be completed by April 30.
Please contact Carol Schwartz, cschwartz@hematology.org, 202-292-0258, if you have any questions and/or need additional information. Thank you very much for collaborating with us on this project.
The survey is located at http://www.surveymonkey.com/s.aspx?sm=I_2fxKEbJBkjvOC00zO_2bXK2A_3d_3d and should take about 5 minutes to complete. The survey will be available for entry through April 30. After that date, ASH staff will be analyzing the data and will provide you with the results from your society and also the national aggregate data.
Participate Today--ASH Practice Survey
The American Society of Hematology (ASH) is conducting a survey of practicing hematologists. Please take a few minutes today to participate in the survey and help ASH better understand the needs of the hematologist practitioner. All surveys must be completed by April 30.
Please contact Carol Schwartz, cschwartz@hematology.org, 202-292-0258, if you have any questions and/or need additional information. Thank you very much for collaborating with us on this project.
Palmetto/J1MAC Web Site Update
EDI Updates Now on J1 Transition Web Site
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/EDI%20Updates%20Now%20on%20J1%20Transition%20Web%20Site?opendocument
New EDI information has been posted to the J1 Transition Web site at
www.PalmettoGBA.com/J1. Access the site and go to EDI in the left hand
menu. Updates have been posted to all categories. You can also view updates
to EDI FAQs by going to FAQs in the left hand menu and choosing EDI from
the list of categories.
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/EDI%20Updates%20Now%20on%20J1%20Transition%20Web%20Site?opendocument
New EDI information has been posted to the J1 Transition Web site at
www.PalmettoGBA.com/J1. Access the site and go to EDI in the left hand
menu. Updates have been posted to all categories. You can also view updates
to EDI FAQs by going to FAQs in the left hand menu and choosing EDI from
the list of categories.
ASCO EHR Field Guide
ASCO is pleased to present The Oncology Electronic Health Record Field Guide: Selecting and Implementing an EHR, a comprehensive handbook designed to assist oncology practices in selecting, purchasing, and implementing an EHR.
This Field Guide is the only oncology-specific consumer manual developed to guide oncology practices in the selection of current and future oncology-specific EHRs for clinical practice management and quality-of-care measurement and improvement. The chapters in this guide address core functionalities desired in an oncology-specific EHR and includes the following topics: Identifying an EHR project team; Making a selection; Building a budget; Using the EHR to support quality of care and patient safety; Post-implementation management.
The guide can be purchased at www.asco.org/ehrfieldguide in two formats, print and electronic. The electronic version is available as a downloadable PDF.
ASCO is sponsoring its 2nd EHR Lab at the 2008 Annual Meeting in Chicago, Illinois. Attendees will have an opportunity to learn about EHR technologies appropriate for their practices and gain hands-on experience with the latest EHRs. Vendors will demonstrate the capacity of their products to provide clinical decision support and experts will be onsite to answer questions attendees may have about the adoption and use of EHR technology.
The Lab, located in McCormick Place, East Building, Room E253, will be open:
· Friday, May 30, 2008 1:00 PM - 6:00 PM
· Saturday, May 31, 2008 9:00 AM - 5:00 PM
· Sunday, June 1, 2008 9:00 AM - 5:00 PM
This Field Guide is the only oncology-specific consumer manual developed to guide oncology practices in the selection of current and future oncology-specific EHRs for clinical practice management and quality-of-care measurement and improvement. The chapters in this guide address core functionalities desired in an oncology-specific EHR and includes the following topics: Identifying an EHR project team; Making a selection; Building a budget; Using the EHR to support quality of care and patient safety; Post-implementation management.
The guide can be purchased at www.asco.org/ehrfieldguide in two formats, print and electronic. The electronic version is available as a downloadable PDF.
ASCO is sponsoring its 2nd EHR Lab at the 2008 Annual Meeting in Chicago, Illinois. Attendees will have an opportunity to learn about EHR technologies appropriate for their practices and gain hands-on experience with the latest EHRs. Vendors will demonstrate the capacity of their products to provide clinical decision support and experts will be onsite to answer questions attendees may have about the adoption and use of EHR technology.
The Lab, located in McCormick Place, East Building, Room E253, will be open:
· Friday, May 30, 2008 1:00 PM - 6:00 PM
· Saturday, May 31, 2008 9:00 AM - 5:00 PM
· Sunday, June 1, 2008 9:00 AM - 5:00 PM
Thursday, April 17, 2008
ASCO's Cancer Policy Today Published
ASCO's Cancer Policy Today was published and is available at http://view.exacttarget.com/?j=fe5f157575610774751d&m=ff311d707460&ls=fe0112707160057f72157377&l=fea516737564057975&s=fe1f15797d620479731d75&ju=fe3015787561017c771174
This edition features:
ASCO Urges Senators to Support Comprehensive Cancer Care Improvement Act
FDA Releases Draft 5-year Drug Safety Plan as Part of PDUFA IV
ASCO Submits Comments on Evidentiary Priorities for Research in the Medicare Population
House Energy and Commerce Committee Advances Family Smoking Prevention Act
This edition features:
ASCO Urges Senators to Support Comprehensive Cancer Care Improvement Act
FDA Releases Draft 5-year Drug Safety Plan as Part of PDUFA IV
ASCO Submits Comments on Evidentiary Priorities for Research in the Medicare Population
House Energy and Commerce Committee Advances Family Smoking Prevention Act
Wednesday, April 16, 2008
Palmetto/J1MAC Website Update
The following information is provided by Palmetto/J1MAC.
The J1 EDI Application Form has been posted to the J1 Transition Web site.
Visit http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/J1%20EDI%20Application%20Form?opendocument for more information.
The J1 EDI Application Form has been posted to the J1 Transition Web site.
Visit http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/J1%20EDI%20Application%20Form?opendocument for more information.
CMS/Medicare Website Updates
The following information is provided by CMS/Medicare.
MM5971 – CR 5550 Clarification - Signature Requirements
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5971.pdf
SE0812 – Use of Professional Society Practice Parameters in Properly Providing Allergen Immunotherapy to Medicare Beneficiaries
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0812.pdf
MM5971 – CR 5550 Clarification - Signature Requirements
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5971.pdf
SE0812 – Use of Professional Society Practice Parameters in Properly Providing Allergen Immunotherapy to Medicare Beneficiaries
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0812.pdf
Tuesday, April 15, 2008
Palmetto/J1MAC Website Update
Detailed instructions for submitting your Electronic Funds Transfer agreement to Palmetto/J1MAC, California's new Medicare carrier, are available at
http://www.palmettogba.com/Palmetto/J1.nsf/docsCat/EFT%20Agreement%20Instructions?opendocument?open&cat=
http://www.palmettogba.com/Palmetto/J1.nsf/docsCat/EFT%20Agreement%20Instructions?opendocument?open&cat=
Phase I JAK2 inhibitor for myelofibrosis
The following information is provided by the University of California, San Francisco (UCSF), an ANCO Institutional Member.
We have recently been activated for an amended phase I protocol that is
investigating lower doses than initially tested when the original study
opened in 2007 (see below). The reason is that while activity was observed,
neuropathy was noted in some patients. This study is thus looking at lower
doses and alternate treatment schedules, and there will be careful
neurologic follow-up. UCSF is the first of the four sites to be open, and
we can accrue up to 12 patients, so we would like to accommodate as many
interested patients as we can.
A Phase I Dose-Escalation Study of the Safety, Pharmacokinetics and
Pharmacodynamics of XL019 Administered to Subjects with Myeloproliferative
Disorders
Dr. Neil Shah at UCSF is running a study involving XL019, a potent,
ATP-competitive and reversible inhibitor of JAK2. This is a first in human
study aimed at patients with myeloproliferative disorders. Many of these
patients have a dominant gain-of-function mutation in the JAK2 gene that the
drug targets, although JAK2-positive status is not required for eligibility.
Eligible patients will have one of the following diagnoses: primary
myelofibrosis (MF), post-polycythemia vera MF, or post-essential
thrombocythemia MF, who require therapy. Patients can be newly diagnosed
intermediate of high risk, or have relapsed or refractory disease. There
will be two dosing cohorts: once per day, or three times per week. Twelve
enrollment slots are currently available. The drug is given as an oral
formulation. If you have a potentially eligible patient, please contact Dr.
Shah’s research coordinator, Patty Olszynski, at 415-502-1564.
We have recently been activated for an amended phase I protocol that is
investigating lower doses than initially tested when the original study
opened in 2007 (see below). The reason is that while activity was observed,
neuropathy was noted in some patients. This study is thus looking at lower
doses and alternate treatment schedules, and there will be careful
neurologic follow-up. UCSF is the first of the four sites to be open, and
we can accrue up to 12 patients, so we would like to accommodate as many
interested patients as we can.
A Phase I Dose-Escalation Study of the Safety, Pharmacokinetics and
Pharmacodynamics of XL019 Administered to Subjects with Myeloproliferative
Disorders
Dr. Neil Shah at UCSF is running a study involving XL019, a potent,
ATP-competitive and reversible inhibitor of JAK2. This is a first in human
study aimed at patients with myeloproliferative disorders. Many of these
patients have a dominant gain-of-function mutation in the JAK2 gene that the
drug targets, although JAK2-positive status is not required for eligibility.
Eligible patients will have one of the following diagnoses: primary
myelofibrosis (MF), post-polycythemia vera MF, or post-essential
thrombocythemia MF, who require therapy. Patients can be newly diagnosed
intermediate of high risk, or have relapsed or refractory disease. There
will be two dosing cohorts: once per day, or three times per week. Twelve
enrollment slots are currently available. The drug is given as an oral
formulation. If you have a potentially eligible patient, please contact Dr.
Shah’s research coordinator, Patty Olszynski, at 415-502-1564.
ASCO e-news Published
The following information is provided by the American Society of Clinical Oncology (ASCO).
ASCO e-News was published today as is available at
http://view.exacttarget.com/?j=fe68157575650c7c7315&m=ff2d16787160&ls=fdf612717465007473167977&l=fe5c15747063017f7012&s=fdf2157972640d79751d7073&ju=fe3b15787565047d771775
It features:
ASCO Announces 2008 Special Awards Recipients
Society Launches Cancer.Net, New Patient Resource Website
Submit an Abstract for the 2008 Breast Cancer Symposium
ASCO Seeks Editor for Journal of Oncology Practice
ASCO Develops New Chemotherapy Treatment Plan Template
ASCO News & Forum Explores Activities of Denali Oncology Group, Newest State Affiliate
2008 ASCO Annual Meeting Abstracts to be Publicly Released in May
ASCO-SEP, Society's New Self-evaluation Tool, Now Available for Purchase
Attend 2008 UICC World Cancer Congress
Cancer Policy Alert: Health and Medical Organizations Urge Senators to Cosponsor Medicare Act, Oncology Electronic Health Record Field Guide Available for Purchase
Submit Artwork for the 2009 "Expressions of Hope" Calendar
For Your Patients: New Cancer.Net Articles Explore Accuracy of Medical News, Late Effects of Childhood Cancer
For Your Patients: New Podcast Describes Features of Cancer.Net
JCO Early Release Articles Examine ErbB-2 and Adjuvant Chemotherapy for Stage II Breast Cancer; Cetuximab plus Irinotecan after Fluoropyrimidine and Oxaliplatin Failure for Metastatic Colorectal Cancer; Graft-versus-lymphoma Effect for T-Cell Lymphomas; Minimum Standards and Exemplary Attributes of Clinical Trial Sites
Future JCO Table of Contents
ASCO e-News was published today as is available at
http://view.exacttarget.com/?j=fe68157575650c7c7315&m=ff2d16787160&ls=fdf612717465007473167977&l=fe5c15747063017f7012&s=fdf2157972640d79751d7073&ju=fe3b15787565047d771775
It features:
ASCO Announces 2008 Special Awards Recipients
Society Launches Cancer.Net, New Patient Resource Website
Submit an Abstract for the 2008 Breast Cancer Symposium
ASCO Seeks Editor for Journal of Oncology Practice
ASCO Develops New Chemotherapy Treatment Plan Template
ASCO News & Forum Explores Activities of Denali Oncology Group, Newest State Affiliate
2008 ASCO Annual Meeting Abstracts to be Publicly Released in May
ASCO-SEP, Society's New Self-evaluation Tool, Now Available for Purchase
Attend 2008 UICC World Cancer Congress
Cancer Policy Alert: Health and Medical Organizations Urge Senators to Cosponsor Medicare Act, Oncology Electronic Health Record Field Guide Available for Purchase
Submit Artwork for the 2009 "Expressions of Hope" Calendar
For Your Patients: New Cancer.Net Articles Explore Accuracy of Medical News, Late Effects of Childhood Cancer
For Your Patients: New Podcast Describes Features of Cancer.Net
JCO Early Release Articles Examine ErbB-2 and Adjuvant Chemotherapy for Stage II Breast Cancer; Cetuximab plus Irinotecan after Fluoropyrimidine and Oxaliplatin Failure for Metastatic Colorectal Cancer; Graft-versus-lymphoma Effect for T-Cell Lymphomas; Minimum Standards and Exemplary Attributes of Clinical Trial Sites
Future JCO Table of Contents
THIS WEEK AT ACCC: APRIL 14-18, 2008
The following information is provided by the Association of Community Cancer Centers (ACCC). ANCO is an Institutional Member of ACCC.
This Week at ACCC was published today and is available at
http://www.accc-cancer.org/mediaroom/newsletters/media_ACCC_april14_08.html
It features:
Senate Finance Heading for 18-month SGR Fix
ACCC Continues Legislative Effort on ASP
Centers of Excellence and More, on ACCC's Listserv
ACCC Listserv Archive Available
Gene Signatures Enhance Breast Cancer Risk Estimates
Tell Your Patients: Free Telephone Survivorship Education Workshop
This Week at ACCC was published today and is available at
http://www.accc-cancer.org/mediaroom/newsletters/media_ACCC_april14_08.html
It features:
Senate Finance Heading for 18-month SGR Fix
ACCC Continues Legislative Effort on ASP
Centers of Excellence and More, on ACCC's Listserv
ACCC Listserv Archive Available
Gene Signatures Enhance Breast Cancer Risk Estimates
Tell Your Patients: Free Telephone Survivorship Education Workshop
Monday, April 14, 2008
CMA Alert: Medical Board Changing CME Requirements
The California Medical Association (CMA) Alert has been published as is available at http://www.calphys.org/html/news.asp.
Included in this issues is:
• Medical Board Changing CME Requirements
• End to Healthy Families/MediCal Bridge May Interrupt Access to Care for Poor Children
• CMA Finds Serious Problems with United Healthcare's Imaging Accreditation Requirements
• CMA Objects to the Department of Public Health's Refusal to License Physician-Owned Surgery Centers
• HealthNet Agrees to Amend Contract to Comply with RICO Settlement
• DMHC Proposes New Balance Billing Rules
Included in this issues is:
• Medical Board Changing CME Requirements
• End to Healthy Families/MediCal Bridge May Interrupt Access to Care for Poor Children
• CMA Finds Serious Problems with United Healthcare's Imaging Accreditation Requirements
• CMA Objects to the Department of Public Health's Refusal to License Physician-Owned Surgery Centers
• HealthNet Agrees to Amend Contract to Comply with RICO Settlement
• DMHC Proposes New Balance Billing Rules
NHIC/Medicare Website Updates
The following updates have been posted to the NHIC/Medicare website.
Two new educational articles are now available: Radiopharmaceutical Imaging Agents - Billing Proper Quantities and The Reopening Process.
The Questions and Answers from the National Provider Identifier ACT have been posted.
Visit http://www.medicarenhic.com/cal_prov/updates.shtml to read more about these updates.
Two new educational articles are now available: Radiopharmaceutical Imaging Agents - Billing Proper Quantities and The Reopening Process.
The Questions and Answers from the National Provider Identifier ACT have been posted.
Visit http://www.medicarenhic.com/cal_prov/updates.shtml to read more about these updates.
Friday, April 11, 2008
ASH Practice Update
The following information is provided by the American Society of Hematology (ASH) and is fully available at http://www.hematology.org/policy/practice/04102008.cfm.
ASH to Meet With Senate Finance Committee Chair Baucus to Discuss New Medicare Bill
Senate Finance Committee Chair Max Baucus (D-MT) is developing a bill that would delay the scheduled 10 percent reduction in physician reimbursements for 18 months. It is anticipated that this bill would cost $8.4 billion over five years and give physicians a 1 percent payment increase through 2009. While it would halt the 10 percent pay cut scheduled to go into effect July 1, the measure would provide "balloon financing" so that a 21 percent pay cut would go into effect January 1, 2010.
ASH previously reported on and endorsed Senator Debbie Stabenow's (D-MI) bill, the Save Medicare Act of 2008 (S.2785). The Stabenow bill would provide a 0.5 percent update through the end of 2008, averting the July 1 anticipated 10.6 percent cut. This bill would give physicians a 1.8 percent payment increase for 18 months without balloon financing language, which sets up higher pay cuts in the future to compensate for temporary changes. The Congressional Budget Office says that such a proposal would cost almost $40 billion over five years and $84 billion over 10 years. Unlike the Baucus bill, this bill does not include balloon financing, so physicians would not be faced with a pay cut in 2010; however, the bill does not specify how the increase in physician fees would be paid.
At this point, the major controversy with legislation to avert physician payment cuts is how to pay for it. Chairman Baucus has opted for balloon financing. Senator Stabenow has not specifically identified a financing mechanism, and Finance Committee Republicans have conditioned their support for any 18-month fix on negotiators' ability to agree on offsets but are not willing to decrease federal payments to Medicare Advantage plans. Under current law, this year's Medicare Advantage plan payments are projected to be 13 percent higher than payments to traditional Medicare plans.
ASH will be meeting with Chairman Baucus on April 11 and will keep the practice community apprised of all developments.
Participate Today - ASH Practice Survey
The ASH Committee on Practice is conducting a survey of practicing hematologists. Please take a few minutes today to participate in the survey, and help ASH better understand the needs of the hematologist practitioner. All surveys must be completed by April 30. Results of the survey will be shared in June.
Medicaid Tamper-Resistant Prescription Pads Requirement Effective April 1, 2008
On April 1, 2008, the first phase of the new requirement on the use of tamper-resistant prescription pads in the Medicaid program went into effect. To be considered "tamper-resistant," prescription pads must contain at least one of three characteristics by April 1, 2008, and all three characteristics by October 1, 2008. These baseline characteristics are: (1) One or more industry-recognized features designed to prevent unauthorized copying of a completed or blank prescription form; (2) One or more industry-recognized features designed to prevent the erasure or modification of information written on the prescription pad by the prescriber; (3) One or more industry-recognized features designed to prevent the use of counterfeit prescription forms. States are free to exceed the above minimum standard as to what constitutes a tamper-resistant prescription pad. Each State Medicaid agency has issued its own guidance on this requirement and this information can be obtained by contacting the state Medicaid agencies.
The limitation on payment and the requirement for the use of tamper-resistant prescription pads does not apply to: (1) Drugs provided in nursing facilities, intermediate care facilities for the mentally retarded, institutions for mental disease, and other specified institutional and clinical settings; (2) Prescriptions that the managed care entity pays; (3) Electronic prescriptions transmitted to the pharmacy; (4) Prescriptions faxed to the pharmacy; or (5) Prescriptions communicated to the pharmacy by telephone by a prescriber. In addition, a pharmacy may fill an entire prescription on an emergency basis provided that the prescriber provides the pharmacy with a verbal, faxed, electronic, or compliant written prescription within 72 hours after the date on which the prescription was filled. Refer to the CMS Frequently Asked Questions document for more information. CMS will be monitoring implementation progress to assure a smooth transition.
Congress Requests Information on Marketing, 'Bundling' Contracts for Anemia Medications
The House Energy and Commerce Committee has submitted a letter to Amgen and a letter to Johnson & Johnsonrequesting information on marketing and "bundling" contracts related to anemia medications. The intent of these requests is to investigate the ability of the Food and Drug Administration to protect the public from excessive risks from prescription drugs.
Specifically, the Committee requested information on the amount that Johnson & Johnson has spent on consumer television and print advertisements for the drug Procrit since 2001. The Committee is also asking for an explanation of the decision to discontinue the ads for Procrit in 2005.
The Committee has requested different information from Amgen, which does not advertise Epogen and Aranesp directly to consumers. The Committee seeks copies of contracts in which Amgen provided discounts on Neupogen and Neulasta to physicians who prescribed Aranesp. The Committee also has requested copies of television and print ads for both Neupogen and Neulasta.
Medicare Issues Final Rule on Electronic-Prescribing for the Part D Drug Benefit
The Centers for Medicare and Medicaid Services (CMS) released its final rule for establishing standards on electronic prescribing under the Medicare prescription drug benefit. The rule establishes standards for the electronic transmission of information on the medications covered under the Medicare prescription drug plans of beneficiaries and the availability of generic versions of those treatments. The standards allow physicians and other health-care providers, pharmacies, and Medicare prescription drug plan sponsors to share information about medications taken by beneficiaries. In addition, the standards allow pharmacies to inform physicians and other providers when patients obtain their prescriptions. The rule does not require physicians, pharmacies, and other providers to adopt e-prescribing in order to participate in Medicare.
This final rule on Part D e-prescribing standards (CMS-0016-F/CMS-0018-F) and the earlier final rule establishing e-prescribing foundation standards (CMS-0011-F) will be available online.
State Legislatures Require Reporting of Drug Company Physician Gifts
In recent months, state legislatures across the country have begun introducing legislation requiring pharmaceutical companies to report the value of meals, travel, and other gifts and perks that they provide to physicians. Many legislatures' bills are in the mold of Arizona SB 1250, which was recently introduced in the Arizona Senate. The bill requires, on pain of hefty fines, that all drug manufacturers disclose the total cost of marketing their products in the state as well as all promotional expenses, food, travel, and gifts to health-care providers that are of more than $25 value. Reimbursement associated with clinical trial expenses is generally exempt from this requirement. Similar legislation is currently in force in only a handful of states, but more than a dozen state legislatures are currently considering such bills. In addition, a few states have gone even further.
The Massachusetts, California, and Illinois legislatures are all considering bills that would ban nearly all drug company gifts of more than nominal value. ASH will continue to follow this important issue and keep its membership apprised of any new developments.
Consumers, Health Care Purchasers, Physicians, and Health Insurers Unveil Agreement on Principles for Physician Performance Reporting
Leading consumer, employer, and labor organizations, in collaboration with leading physician groups and health insurers, have developed the "Patient Charter for Physician Performance Measurement, Reporting and Tiering Programs." This charter creates a national set of principles to guide measuring and reporting to consumers about doctors' performance.
The charter has broad support including from the American Medical Association, American College of Surgeons, Aetna, Cigna, United Health Group, Wellpoint, America's Health Plans, AFL-CIO, and AARP.
Key points that address the needs of consumers and the concerns of doctors include:
Consumers can make informed decisions based on quality and cost, with guidance about how to use the information and an understanding of limitations on the data.
Measurement is based on sound national standards and methodology.
Both consumers and physicians have input into the measurement process and reporting of results to assure that the information is trusted by physicians and meaningful to consumers.
Measurement is a transparent process so that both consumers and physicians can understand the basis upon which performance is being measured and reported.
Physicians have adequate notice and opportunity to correct any errors.
Physicians will have information that helps them improve the quality of care that they provide.
For additional information, visit the Consumer-Purchaser Disclosure Project's Web site.
ASH to Meet With Senate Finance Committee Chair Baucus to Discuss New Medicare Bill
Senate Finance Committee Chair Max Baucus (D-MT) is developing a bill that would delay the scheduled 10 percent reduction in physician reimbursements for 18 months. It is anticipated that this bill would cost $8.4 billion over five years and give physicians a 1 percent payment increase through 2009. While it would halt the 10 percent pay cut scheduled to go into effect July 1, the measure would provide "balloon financing" so that a 21 percent pay cut would go into effect January 1, 2010.
ASH previously reported on and endorsed Senator Debbie Stabenow's (D-MI) bill, the Save Medicare Act of 2008 (S.2785). The Stabenow bill would provide a 0.5 percent update through the end of 2008, averting the July 1 anticipated 10.6 percent cut. This bill would give physicians a 1.8 percent payment increase for 18 months without balloon financing language, which sets up higher pay cuts in the future to compensate for temporary changes. The Congressional Budget Office says that such a proposal would cost almost $40 billion over five years and $84 billion over 10 years. Unlike the Baucus bill, this bill does not include balloon financing, so physicians would not be faced with a pay cut in 2010; however, the bill does not specify how the increase in physician fees would be paid.
At this point, the major controversy with legislation to avert physician payment cuts is how to pay for it. Chairman Baucus has opted for balloon financing. Senator Stabenow has not specifically identified a financing mechanism, and Finance Committee Republicans have conditioned their support for any 18-month fix on negotiators' ability to agree on offsets but are not willing to decrease federal payments to Medicare Advantage plans. Under current law, this year's Medicare Advantage plan payments are projected to be 13 percent higher than payments to traditional Medicare plans.
ASH will be meeting with Chairman Baucus on April 11 and will keep the practice community apprised of all developments.
Participate Today - ASH Practice Survey
The ASH Committee on Practice is conducting a survey of practicing hematologists. Please take a few minutes today to participate in the survey, and help ASH better understand the needs of the hematologist practitioner. All surveys must be completed by April 30. Results of the survey will be shared in June.
Medicaid Tamper-Resistant Prescription Pads Requirement Effective April 1, 2008
On April 1, 2008, the first phase of the new requirement on the use of tamper-resistant prescription pads in the Medicaid program went into effect. To be considered "tamper-resistant," prescription pads must contain at least one of three characteristics by April 1, 2008, and all three characteristics by October 1, 2008. These baseline characteristics are: (1) One or more industry-recognized features designed to prevent unauthorized copying of a completed or blank prescription form; (2) One or more industry-recognized features designed to prevent the erasure or modification of information written on the prescription pad by the prescriber; (3) One or more industry-recognized features designed to prevent the use of counterfeit prescription forms. States are free to exceed the above minimum standard as to what constitutes a tamper-resistant prescription pad. Each State Medicaid agency has issued its own guidance on this requirement and this information can be obtained by contacting the state Medicaid agencies.
The limitation on payment and the requirement for the use of tamper-resistant prescription pads does not apply to: (1) Drugs provided in nursing facilities, intermediate care facilities for the mentally retarded, institutions for mental disease, and other specified institutional and clinical settings; (2) Prescriptions that the managed care entity pays; (3) Electronic prescriptions transmitted to the pharmacy; (4) Prescriptions faxed to the pharmacy; or (5) Prescriptions communicated to the pharmacy by telephone by a prescriber. In addition, a pharmacy may fill an entire prescription on an emergency basis provided that the prescriber provides the pharmacy with a verbal, faxed, electronic, or compliant written prescription within 72 hours after the date on which the prescription was filled. Refer to the CMS Frequently Asked Questions document for more information. CMS will be monitoring implementation progress to assure a smooth transition.
Congress Requests Information on Marketing, 'Bundling' Contracts for Anemia Medications
The House Energy and Commerce Committee has submitted a letter to Amgen and a letter to Johnson & Johnsonrequesting information on marketing and "bundling" contracts related to anemia medications. The intent of these requests is to investigate the ability of the Food and Drug Administration to protect the public from excessive risks from prescription drugs.
Specifically, the Committee requested information on the amount that Johnson & Johnson has spent on consumer television and print advertisements for the drug Procrit since 2001. The Committee is also asking for an explanation of the decision to discontinue the ads for Procrit in 2005.
The Committee has requested different information from Amgen, which does not advertise Epogen and Aranesp directly to consumers. The Committee seeks copies of contracts in which Amgen provided discounts on Neupogen and Neulasta to physicians who prescribed Aranesp. The Committee also has requested copies of television and print ads for both Neupogen and Neulasta.
Medicare Issues Final Rule on Electronic-Prescribing for the Part D Drug Benefit
The Centers for Medicare and Medicaid Services (CMS) released its final rule for establishing standards on electronic prescribing under the Medicare prescription drug benefit. The rule establishes standards for the electronic transmission of information on the medications covered under the Medicare prescription drug plans of beneficiaries and the availability of generic versions of those treatments. The standards allow physicians and other health-care providers, pharmacies, and Medicare prescription drug plan sponsors to share information about medications taken by beneficiaries. In addition, the standards allow pharmacies to inform physicians and other providers when patients obtain their prescriptions. The rule does not require physicians, pharmacies, and other providers to adopt e-prescribing in order to participate in Medicare.
This final rule on Part D e-prescribing standards (CMS-0016-F/CMS-0018-F) and the earlier final rule establishing e-prescribing foundation standards (CMS-0011-F) will be available online.
State Legislatures Require Reporting of Drug Company Physician Gifts
In recent months, state legislatures across the country have begun introducing legislation requiring pharmaceutical companies to report the value of meals, travel, and other gifts and perks that they provide to physicians. Many legislatures' bills are in the mold of Arizona SB 1250, which was recently introduced in the Arizona Senate. The bill requires, on pain of hefty fines, that all drug manufacturers disclose the total cost of marketing their products in the state as well as all promotional expenses, food, travel, and gifts to health-care providers that are of more than $25 value. Reimbursement associated with clinical trial expenses is generally exempt from this requirement. Similar legislation is currently in force in only a handful of states, but more than a dozen state legislatures are currently considering such bills. In addition, a few states have gone even further.
The Massachusetts, California, and Illinois legislatures are all considering bills that would ban nearly all drug company gifts of more than nominal value. ASH will continue to follow this important issue and keep its membership apprised of any new developments.
Consumers, Health Care Purchasers, Physicians, and Health Insurers Unveil Agreement on Principles for Physician Performance Reporting
Leading consumer, employer, and labor organizations, in collaboration with leading physician groups and health insurers, have developed the "Patient Charter for Physician Performance Measurement, Reporting and Tiering Programs." This charter creates a national set of principles to guide measuring and reporting to consumers about doctors' performance.
The charter has broad support including from the American Medical Association, American College of Surgeons, Aetna, Cigna, United Health Group, Wellpoint, America's Health Plans, AFL-CIO, and AARP.
Key points that address the needs of consumers and the concerns of doctors include:
Consumers can make informed decisions based on quality and cost, with guidance about how to use the information and an understanding of limitations on the data.
Measurement is based on sound national standards and methodology.
Both consumers and physicians have input into the measurement process and reporting of results to assure that the information is trusted by physicians and meaningful to consumers.
Measurement is a transparent process so that both consumers and physicians can understand the basis upon which performance is being measured and reported.
Physicians have adequate notice and opportunity to correct any errors.
Physicians will have information that helps them improve the quality of care that they provide.
For additional information, visit the Consumer-Purchaser Disclosure Project's Web site.
CMS/Medicare Website Updates
CMS NPI subject matter experts will be available to address questions from the provider community on April 17, 2008 from 2-3:30PM ET. Participants are able to submit questions using the online registration system for this call. To register, visit http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/listserv_wording_4-10-08_call.pdf on the CMS website. Registration closes on Wednesday, April 16th so register today!
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 "CMSCommunications" in the left column of the www.cms.hhs.gov/NationalProvIdentStand CMS webpage.
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 "CMSCommunications" in the left column of the www.cms.hhs.gov/NationalProvIdentStand CMS webpage.
Wednesday, April 9, 2008
CMS/Medicare: Healthcare Common Procedure Coding System (HCPCS) File Update
The following information is provided by CMS/Medicare.
The Centers for Medicare & Medicaid Services is pleased to announce the scheduled release of modifications to the Healthcare Common Procedure Coding System (HCPCS) code set. These changes have been posted to the HCPCS website at www.cms.hhs.gov/HCPCSReleaseCodeSets/02_HCPCS_Quarterly_Update.asp . Changes are effective on the date indicated on the update.
The Centers for Medicare & Medicaid Services is pleased to announce the scheduled release of modifications to the Healthcare Common Procedure Coding System (HCPCS) code set. These changes have been posted to the HCPCS website at www.cms.hhs.gov/HCPCSReleaseCodeSets/02_HCPCS_Quarterly_Update.asp . Changes are effective on the date indicated on the update.
CMS/Medicare: Clinical Laboratory Fee Schedule Fact Sheet
The following information is provided by CMS/Medicare.
The Clinical Laboratory Fee Schedule Fact Sheet, which provides general information about the Clinical Laboratory Fee Schedule, coverage of clinical laboratory services, and how payment rates are set, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/clinical_lab_fee_schedule_fact_sheet.pdf
The Clinical Laboratory Fee Schedule Fact Sheet, which provides general information about the Clinical Laboratory Fee Schedule, coverage of clinical laboratory services, and how payment rates are set, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/clinical_lab_fee_schedule_fact_sheet.pdf
THIS WEEK AT ACCC: APRIL 7-11, 2008
The latest edition of This Week at ACCC has been published and can be viewed at http://www.accc-cancer.org/mediaroom/newsletters/media_ACCC_april07_08.html
This edition includes:
Oncology Pharmacist Takes Helm as New ACCC President
ACCC Releases Revised Cancer Program Guidelines, New Survivorship Section
Welcome to ACCC's 2008–2009 Board of Trustees
Highly Successful ACCC Annual Meeting, Presentations Available Online
ACCC Bylaws Changes Approved
ACCC's Listserv: Archive Is Available
Trial Suggests HRT Increases Breast Cancer Recurrence Risk
Teleconference About CCOPs Slated for April 10
NCI Issues Colorectal Cancer Progress Report
ANCO is an Institutional Member of ACCC.
This edition includes:
Oncology Pharmacist Takes Helm as New ACCC President
ACCC Releases Revised Cancer Program Guidelines, New Survivorship Section
Welcome to ACCC's 2008–2009 Board of Trustees
Highly Successful ACCC Annual Meeting, Presentations Available Online
ACCC Bylaws Changes Approved
ACCC's Listserv: Archive Is Available
Trial Suggests HRT Increases Breast Cancer Recurrence Risk
Teleconference About CCOPs Slated for April 10
NCI Issues Colorectal Cancer Progress Report
ANCO is an Institutional Member of ACCC.
DHS/MediCal: NPI Update
Now that Medi-Cal has implemented voluntary usage of the NPI, efforts are underway to ensure the Medi-Cal provider community is moving forward to become compliant by the industry implementation date of May 23, 2008. Additionally, Medi-Cal plans to end-date Medi-Cal legacy numbers on May 23, 2008, so we are asking for your assistance in alerting your membership of upcoming deadlines and consequences.
Test NPI-Only NOW
Medi-Cal is recommending providers who have been submitting claims successfully during the “dual-use” period with both an NPI and a Medi-Cal legacy provider number to test the new NPI-only claims process by initially submitting only one or two claims. If these claims are processed successfully, providers are then requested to submit all subsequent claims using only the NPI.
Proprietary Claim 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 claims processing. Providers may use their supply of old proprietary forms through April 14, 2008 only. Since July 2007, these updated forms have been available for ordering from Medi-Cal. These forms include, but are not limited to: Pharmacy and Long Term Care claim forms, Treatment Authorization Request forms, Claims Inquiry, Appeal forms, and CHDP form. Providers should order the updated forms now to be ready for the April 15, 2008 implementation.
Below is a short readiness survey that will aid us in assisting your member providers in meeting the NPI compliance deadline. Please take a few minutes to complete and return the survey to: norlanie.mostajo@eds.com.
We request your cooperation in sharing this information with your membership, including a notice in your newsletters. For assistance with any of the above issues, providers may contact the Telephone Service Center (TSC) at 1-800-541-5555, option 16, then option 18 for the NPI Helpdesk or visit the Medi-Cal Web site at www.medi-cal.ca.gov and access the NPI link on the “Featured” tab.
As a result of the industry-wide NPI usage mandated by CMS, we’d like to get some feedback from your membership concerning their readiness to transition from the Medi-Cal legacy number to the NPI by May 23, 2008.
1. Do you anticipate your member providers will be able to transition in accordance with CMS guidelines and meet the May 23, 2008 deadline?
_________Yes ____________No
If no, please check item(s) below and explain obstacles preventing transition:
____Have not obtained an NPI from NPPES
____Have not registered NPI with Medi-Cal
____Need to change/update NPI registration configuration through Provider Enrollment Division (PED)
____Test results involve errors – need to reconfigure and retest
____Clearinghouse not ready
____Software vendor not ready
____Other _________________________________________________
Comments:
______________________________________________________________
_______________________________________________________________
2. Please identify ways in which the DHCS may assist with this transition:
____ Need assistance with obtaining an NPI from NPPES
____ Need assistance with NPI registration
____ Need assistance with testing NPI
____ Need assistance with change/update of NPI registration
____ Other___________________________________________________
Test NPI-Only NOW
Medi-Cal is recommending providers who have been submitting claims successfully during the “dual-use” period with both an NPI and a Medi-Cal legacy provider number to test the new NPI-only claims process by initially submitting only one or two claims. If these claims are processed successfully, providers are then requested to submit all subsequent claims using only the NPI.
Proprietary Claim 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 claims processing. Providers may use their supply of old proprietary forms through April 14, 2008 only. Since July 2007, these updated forms have been available for ordering from Medi-Cal. These forms include, but are not limited to: Pharmacy and Long Term Care claim forms, Treatment Authorization Request forms, Claims Inquiry, Appeal forms, and CHDP form. Providers should order the updated forms now to be ready for the April 15, 2008 implementation.
Below is a short readiness survey that will aid us in assisting your member providers in meeting the NPI compliance deadline. Please take a few minutes to complete and return the survey to: norlanie.mostajo@eds.com.
We request your cooperation in sharing this information with your membership, including a notice in your newsletters. For assistance with any of the above issues, providers may contact the Telephone Service Center (TSC) at 1-800-541-5555, option 16, then option 18 for the NPI Helpdesk or visit the Medi-Cal Web site at www.medi-cal.ca.gov and access the NPI link on the “Featured” tab.
As a result of the industry-wide NPI usage mandated by CMS, we’d like to get some feedback from your membership concerning their readiness to transition from the Medi-Cal legacy number to the NPI by May 23, 2008.
1. Do you anticipate your member providers will be able to transition in accordance with CMS guidelines and meet the May 23, 2008 deadline?
_________Yes ____________No
If no, please check item(s) below and explain obstacles preventing transition:
____Have not obtained an NPI from NPPES
____Have not registered NPI with Medi-Cal
____Need to change/update NPI registration configuration through Provider Enrollment Division (PED)
____Test results involve errors – need to reconfigure and retest
____Clearinghouse not ready
____Software vendor not ready
____Other _________________________________________________
Comments:
______________________________________________________________
_______________________________________________________________
2. Please identify ways in which the DHCS may assist with this transition:
____ Need assistance with obtaining an NPI from NPPES
____ Need assistance with NPI registration
____ Need assistance with testing NPI
____ Need assistance with change/update of NPI registration
____ Other___________________________________________________
Monday, April 7, 2008
PLWC is now Cancer.Net
People Living With Cancer (PLWC) is now Cancer.Net.
Their April 2008 Bulletin is available at the following link:
http://view.exacttarget.com/?j=fe5315747d630c7d721d&m=ff2d17787264&ls=fdf1117674630179771c707d&l=fefa1c707c6705&s=fdf815727065077f7d16767c&ju=fe2315777d600075751276
Their April 2008 Bulletin is available at the following link:
http://view.exacttarget.com/?j=fe5315747d630c7d721d&m=ff2d17787264&ls=fdf1117674630179771c707d&l=fefa1c707c6705&s=fdf815727065077f7d16767c&ju=fe2315777d600075751276
ASH Practice Survey
The American Society of Hematology (ASH) is conducting a survey of practicing hematologists. Please take a few minutes today to participate in the survey and help ASH better understand the needs of the hematologist practitioner.
All surveys must be completed by April 30.
The survey is located at http://www.surveymonkey.com/s.aspx?sm=I_2fxKEbJBkjvOC00zO_2bXK2A_3d_3d and should take about 5 minutes to complete. After that date, ASH staff will be analyzing the data and will provide you with the results from your society and also the national aggregate data.
Please contact Carol Schwartz, cschwartz@hematology.org, (202) 292-0258, if you have any questions and/or need additional information.
All surveys must be completed by April 30.
The survey is located at http://www.surveymonkey.com/s.aspx?sm=I_2fxKEbJBkjvOC00zO_2bXK2A_3d_3d and should take about 5 minutes to complete. After that date, ASH staff will be analyzing the data and will provide you with the results from your society and also the national aggregate data.
Please contact Carol Schwartz, cschwartz@hematology.org, (202) 292-0258, if you have any questions and/or need additional information.
Best Practices in Reimbursement
Oncology Pharmaceutical Services, an ANCO Corporate Member, presents Best Practices in Reimbursement, a webcast taking place on Wednesday, April 17th.
For more information or to register, visit www.opspharmacist.com/opes
For more information or to register, visit www.opspharmacist.com/opes
Friday, April 4, 2008
Tailoring The Treatment of Non-Small Cell Lung Cancer
OSI Pharmaceuticals, an ANCO Corporate Member, is supporting Tailoring the Treatment of Non-Small Cell Lung Cancer (NSCLC): From the Surgeon to the Oncologist, a CME-accredited meeting series that will bring faculty (one oncologist and one surgeon) to your practice for a breakfast, lunch, or dinner presentation.
To take advantage of this unique educational opportunity, please contact rpilotti@curryrockefellergroup.com
To take advantage of this unique educational opportunity, please contact rpilotti@curryrockefellergroup.com
National Provider Identifier (NPI): Understanding the Readiness of Other Health Plans, Steps to Facilitate a Smooth Transition to NPI-Only Medicare Bi
CMS encourages all health care providers to ensure they understand the readiness of other health plans with which they interact, especially if those health plans may be primary or secondary to Medicare. Medicare will only accept/send NPI-only transactions beginning May 23rd and providers need to understand from these other plans what will happen if they are unable to send/receive NPI-only transactions.
Important Information for Medicare FFS Providers
CMS is pleased to announce that Medicare is receiving more than 98% of claims with an NPI. The next milestone - May 23rd- requires providers to take the next step so they do not risk disruption in cash flow. Begin billing with NPI-only now to test how May 23rd will impact you.
CMS is concerned that the percentage of Medicare claims with NPI-only is not growing fast enough.
Steps to Facilitate a Smooth Transition to NPI-Only
1) Bill with Medicare legacy ID & NPI
· Once claims are successfully processed, move to Step 2.
2) Bill with NPI –Only
· Start with a small batch of claims. If, or when, the results are positive, begin sending a greater volume and move to Step 3.
· Billing with NPI-only also tests the ability to receive the NPI on 835 transactions.
3) Test NPI-Only on Other HIPAA Transactions
· CMS will require use of the NPI on the 270/271, 276/277 and NCPDP transactions. Providers should begin testing the use of the NPI on these transactions, in small quantities, prior to May 23rd to ensure a smooth transition. Also, be prepared to accept the NPI-only on the 835 remittance advice transaction.
Institutional Providers Submitting Taxonomy Codes to Identify Subparts –
UPDATE: Medicare is Using Alternative Data to Obtain NPI/OSCAR Match
On January 1, 2007, Medicare implemented change request (CR) 5243, which required the submission of taxonomy codes all claims submitted by institutional Medicare providers who submit claims for their primary facility and its subparts (such as psychiatric unit, rehabilitation unit, etc.).
The intent of CR 5243 was to enable Medicare to appropriately crosswalk a provider NPI to each of the provider's subparts through the reporting of taxonomy codes in the claims. Medicare has found that using taxonomy codes has been unsuccessful in obtaining a one-to-one match on the crosswalk for those providers having one NPI tied to multiple OSCAR/Certification numbers. As a result, the taxonomy code is no longer used as part of the crosswalk criteria that are used to attempt to match an NPI with an OSCAR/Certification Number. Currently, the fiscal intermediary shared system (FISS) uses these matching criteria to obtain a one-to-one match between an institutional Medicare provider’s NPI and its OSCAR/Certification Number:
§ First level of match: Type of bill (TOB) to OSCAR/Certification Number
If the system is unable to identify a valid match, the search will continue with the next level of match.
§ Second level of match: Revenue code to OSCAR/Certification Number
If the system is unable to identify a valid match, the search will continue with the next level of match.
§ Third and final level of match: Facility ZIP code on the claim This final level prompts the systems logic to limit the list of appropriate OSCAR numbers by matching the facility ZIP code on the claim against the ZIP code of the master address in the FISS provider address file.
Note: If the system is unable to make a valid match, the claim will suspend with reason code 32105, and the provider will receive an additional development letter (ADR) requesting the OSCAR number.
Action Required by Institutional Providers with Subparts
Providers are strongly encouraged to enumerate their subparts. The following documents may assist providers in answering additional questions on this subject.
§ CMS Medicare Subpart Expectations paper may be accessed on the CMS Web site athttp://www.cms.hhs.gov/NationalProvIdentStand/Downloads/Medsubparts01252006.pdf
§ Read NPI Fact Sheet titled “For Health Care Providers Who are Organizations” athttp://www.cms.hhs.gov/NationalProvIdentStand/Downloads/NPI_FactSheet_Org_Provi_web_07-03-07.pdf
§ Review the article titled “Information Regarding National Plan and Provider Enumeration System Errors, Using the NPI on Medicare Claims and 835 Remittance Advice Changes” available in the August 2007 Medicare A Bulletin athttp://www.floridamedicare.com/Part_A/Medicare_A_Bulletins/Archive/110043.pdf
§ Review Special Edition article http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0608.pdf
§ National Plan and Provider Enumeration System (NPPES) https://nppes.cms.hhs.gov/NPPES.
Encourage Clearinghouses to Allow Testing of NPI-Only
It has come to CMS’ attention that some clearinghouses may not allow important NPI-only testing prior to May 23rd. CMS encourages Medicare providers to work with their clearinghouses to allow use of the NPI-only to facilitate this testing. If you do not test, you will not be aware, in advance, of any problems that could prohibit Medicare from processing and paying claims.
Registration Available for NPI Roundtable
CMS subject matter experts will be available to address questions from the provider community on April 17, 2008 from 2-3:30PM ET. Participants are able to submit questions using the online registration system for this call. To register, visit http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/listserv_wording_4-10-08_call.pdf on the CMS website.
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 CMS webpage.
Important Information for Medicare FFS Providers
CMS is pleased to announce that Medicare is receiving more than 98% of claims with an NPI. The next milestone - May 23rd- requires providers to take the next step so they do not risk disruption in cash flow. Begin billing with NPI-only now to test how May 23rd will impact you.
CMS is concerned that the percentage of Medicare claims with NPI-only is not growing fast enough.
Steps to Facilitate a Smooth Transition to NPI-Only
1) Bill with Medicare legacy ID & NPI
· Once claims are successfully processed, move to Step 2.
2) Bill with NPI –Only
· Start with a small batch of claims. If, or when, the results are positive, begin sending a greater volume and move to Step 3.
· Billing with NPI-only also tests the ability to receive the NPI on 835 transactions.
3) Test NPI-Only on Other HIPAA Transactions
· CMS will require use of the NPI on the 270/271, 276/277 and NCPDP transactions. Providers should begin testing the use of the NPI on these transactions, in small quantities, prior to May 23rd to ensure a smooth transition. Also, be prepared to accept the NPI-only on the 835 remittance advice transaction.
Institutional Providers Submitting Taxonomy Codes to Identify Subparts –
UPDATE: Medicare is Using Alternative Data to Obtain NPI/OSCAR Match
On January 1, 2007, Medicare implemented change request (CR) 5243, which required the submission of taxonomy codes all claims submitted by institutional Medicare providers who submit claims for their primary facility and its subparts (such as psychiatric unit, rehabilitation unit, etc.).
The intent of CR 5243 was to enable Medicare to appropriately crosswalk a provider NPI to each of the provider's subparts through the reporting of taxonomy codes in the claims. Medicare has found that using taxonomy codes has been unsuccessful in obtaining a one-to-one match on the crosswalk for those providers having one NPI tied to multiple OSCAR/Certification numbers. As a result, the taxonomy code is no longer used as part of the crosswalk criteria that are used to attempt to match an NPI with an OSCAR/Certification Number. Currently, the fiscal intermediary shared system (FISS) uses these matching criteria to obtain a one-to-one match between an institutional Medicare provider’s NPI and its OSCAR/Certification Number:
§ First level of match: Type of bill (TOB) to OSCAR/Certification Number
If the system is unable to identify a valid match, the search will continue with the next level of match.
§ Second level of match: Revenue code to OSCAR/Certification Number
If the system is unable to identify a valid match, the search will continue with the next level of match.
§ Third and final level of match: Facility ZIP code on the claim This final level prompts the systems logic to limit the list of appropriate OSCAR numbers by matching the facility ZIP code on the claim against the ZIP code of the master address in the FISS provider address file.
Note: If the system is unable to make a valid match, the claim will suspend with reason code 32105, and the provider will receive an additional development letter (ADR) requesting the OSCAR number.
Action Required by Institutional Providers with Subparts
Providers are strongly encouraged to enumerate their subparts. The following documents may assist providers in answering additional questions on this subject.
§ CMS Medicare Subpart Expectations paper may be accessed on the CMS Web site athttp://www.cms.hhs.gov/NationalProvIdentStand/Downloads/Medsubparts01252006.pdf
§ Read NPI Fact Sheet titled “For Health Care Providers Who are Organizations” athttp://www.cms.hhs.gov/NationalProvIdentStand/Downloads/NPI_FactSheet_Org_Provi_web_07-03-07.pdf
§ Review the article titled “Information Regarding National Plan and Provider Enumeration System Errors, Using the NPI on Medicare Claims and 835 Remittance Advice Changes” available in the August 2007 Medicare A Bulletin athttp://www.floridamedicare.com/Part_A/Medicare_A_Bulletins/Archive/110043.pdf
§ Review Special Edition article http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0608.pdf
§ National Plan and Provider Enumeration System (NPPES) https://nppes.cms.hhs.gov/NPPES.
Encourage Clearinghouses to Allow Testing of NPI-Only
It has come to CMS’ attention that some clearinghouses may not allow important NPI-only testing prior to May 23rd. CMS encourages Medicare providers to work with their clearinghouses to allow use of the NPI-only to facilitate this testing. If you do not test, you will not be aware, in advance, of any problems that could prohibit Medicare from processing and paying claims.
Registration Available for NPI Roundtable
CMS subject matter experts will be available to address questions from the provider community on April 17, 2008 from 2-3:30PM ET. Participants are able to submit questions using the online registration system for this call. To register, visit http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/listserv_wording_4-10-08_call.pdf on the CMS website.
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 CMS webpage.
CMS/Medicare Website Updates
The following information is provided by CMS/Medicare.
SE0810 – Announcing the Release of the Revised CMS-855 Medicare Enrollment Applications
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0810.pdf
SE0810 – Announcing the Release of the Revised CMS-855 Medicare Enrollment Applications
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0810.pdf
Understanding NCI: Toll-Free Teleconference Series
NCI’s Office of Advocacy Relations (OAR) will host its second teleconference, “Clinical Trials in Your Community: NCI’s Community Clinical Oncology Program (CCOPs),” on Thursday, April 10, 2008, from 2:00 – 3:00 p.m., EST.
The featured speakers are: Dr. Lori Minasian, Chief, Community Oncology and Preventive Trials Research Group, Division of Cancer Prevention, NCI; Dr. John Kugler, Principal Investigator, Illinois Oncology Research Association CCOP, Illinois CancerCare; and Ms. Laura Matus, Volunteer Coordinator, Illinois CancerCare. A Question & Answer session for participants will follow.
No registration is required for participation. To join the teleconference, dial toll-free within the U.S. 1-800-857-6584. The passcode is: Prevention.
If you have friends or colleagues who cannot participate “live” on the day of the teleconference, they can listen to the replay of the call through May 10, 2008 by dialing toll-free 1-800-284-7027.
To learn more about CCOPs, visit:
http://dcp.cancer.gov/programs-resources/programs/ccop.
For more information about the Understanding NCI: Toll-Free Teleconference Series and to learn about past teleconferences, please visit: http://advocacy.cancer.gov/.
The featured speakers are: Dr. Lori Minasian, Chief, Community Oncology and Preventive Trials Research Group, Division of Cancer Prevention, NCI; Dr. John Kugler, Principal Investigator, Illinois Oncology Research Association CCOP, Illinois CancerCare; and Ms. Laura Matus, Volunteer Coordinator, Illinois CancerCare. A Question & Answer session for participants will follow.
No registration is required for participation. To join the teleconference, dial toll-free within the U.S. 1-800-857-6584. The passcode is: Prevention.
If you have friends or colleagues who cannot participate “live” on the day of the teleconference, they can listen to the replay of the call through May 10, 2008 by dialing toll-free 1-800-284-7027.
To learn more about CCOPs, visit:
http://dcp.cancer.gov/programs-resources/programs/ccop.
For more information about the Understanding NCI: Toll-Free Teleconference Series and to learn about past teleconferences, please visit: http://advocacy.cancer.gov/.
ASCO Cancer Policy Today Published
The latest edition of ASCO Cancer Policy Today has been published and is attached as a .pdf file.
Topics include:
Health and Medical Organizations Urge Senators to Cosponsor Medicare Act
Oncology Electronic Health Record Field Guide Available
New ESA Instruction Sheet Available on ASCO Web site
Visit http://www.asco.org/ASCO/Legislative+%26+Regulatory/Legislative+and+Regulatory+Issues/Cancer+Policy+News/Cancer+Policy+Today/April+3%3A+Health+and+Medical+Organizations+Urge+Senators+to+Cosponsor+Medicare+Act%2C+Oncology+Electronic+Health+Record+Field+Guide+Available to read more.
Topics include:
Health and Medical Organizations Urge Senators to Cosponsor Medicare Act
Oncology Electronic Health Record Field Guide Available
New ESA Instruction Sheet Available on ASCO Web site
Visit http://www.asco.org/ASCO/Legislative+%26+Regulatory/Legislative+and+Regulatory+Issues/Cancer+Policy+News/Cancer+Policy+Today/April+3%3A+Health+and+Medical+Organizations+Urge+Senators+to+Cosponsor+Medicare+Act%2C+Oncology+Electronic+Health+Record+Field+Guide+Available to read more.
NHIC/Medicare Website Updates
The following updates have been posted to the NHIC/Medicare website.
The April update to the Physician Fee Schedules and the Updates to the Indicators have been posted.
The Allowance Limits for Medicare Part B Drugs for April and revised ones for the past two quarters are now available.
Visit http://www.medicarenhic.com/cal_prov/updates.shtml to read more.
The April update to the Physician Fee Schedules and the Updates to the Indicators have been posted.
The Allowance Limits for Medicare Part B Drugs for April and revised ones for the past two quarters are now available.
Visit http://www.medicarenhic.com/cal_prov/updates.shtml to read more.
ASH Practice Update
The latest American Society of Hematology Practice Update has been published and includes:
Legislation Introduced to Prevent Medicare Physician Payment Cuts
Republican Congressmen Introduce Legislation to Address Physician Payment Reforms
Updated Medicare Average Sales Price Payments Available
Medicare Expands Use of Home Anticoagulation Management
Medicare Physician Fee Schedule Fact Sheet Available
Medicare Awards Contracts in Eastern Region
Medicare Clarifies ESA Coverage Memo
Read more at http://www.hematology.org/policy/practice.
Legislation Introduced to Prevent Medicare Physician Payment Cuts
Republican Congressmen Introduce Legislation to Address Physician Payment Reforms
Updated Medicare Average Sales Price Payments Available
Medicare Expands Use of Home Anticoagulation Management
Medicare Physician Fee Schedule Fact Sheet Available
Medicare Awards Contracts in Eastern Region
Medicare Clarifies ESA Coverage Memo
Read more at http://www.hematology.org/policy/practice.
ASCO e-News Published
ASCO's e-News was published and include:
Submit An Abstract for the 2008 Breast Cancer Symposium
ASCO Seeks Editor for Journal of Oncology Practice
ASCO Develops New Chemotherapy Treatment Plan Template
ASCO News & Forum Explores Activities of Denali Oncology Group, Newest State Affiliate
2008 ASCO Annual Meeting Abstracts to be Publicly Released in May
ASCO-SEP, Society's New Self-evaluation Tool, Now Available for Purchase
Attend 2008 UICC World Cancer Congress
Cancer Policy Alert: FDA Advisory Committee Votes to Continue ESA Use in Cancer Patients, Reps. Eshoo, Barton Introduce Pathway for Biosimilars Act
Submit Artwork for the 2009 "Expressions of Hope" Calendar
For Your Patients: Latest Cancer.Net Feature Examines Late Effects of Childhood Cancer
For Your Patients: New Cancer.Net Podcast Discusses Meeting with a Genetic Counselor
JCO Early Release Articles Examine PET/CT and PET Alone on Expected Management of Patients With Cancer; Lymph Node Metastases in Rectal Cancer after Neoadjuvant Chemoradiotherapy; Thalidomide Plus Dexamethasone Compared with Dexamethasone for Newly Diagnosed Multiple Myeloma; Prostate-Specific Membrane Antigen-directed Immunoconjugate MLN2704 in Patients with Progressive Metastatic Castration-resistant Prostate Cancer
Future JCO Table of Contents
Visit http://view.exacttarget.com/?j=fe6a15747d67047d7410&m=ff2d16787160&ls=fdf712707266017c7c167677&l=fe8f16737763027872&s=fdf2157972640d79751d7073&ju=fe2d1577726d047e771772 to read more.
Submit An Abstract for the 2008 Breast Cancer Symposium
ASCO Seeks Editor for Journal of Oncology Practice
ASCO Develops New Chemotherapy Treatment Plan Template
ASCO News & Forum Explores Activities of Denali Oncology Group, Newest State Affiliate
2008 ASCO Annual Meeting Abstracts to be Publicly Released in May
ASCO-SEP, Society's New Self-evaluation Tool, Now Available for Purchase
Attend 2008 UICC World Cancer Congress
Cancer Policy Alert: FDA Advisory Committee Votes to Continue ESA Use in Cancer Patients, Reps. Eshoo, Barton Introduce Pathway for Biosimilars Act
Submit Artwork for the 2009 "Expressions of Hope" Calendar
For Your Patients: Latest Cancer.Net Feature Examines Late Effects of Childhood Cancer
For Your Patients: New Cancer.Net Podcast Discusses Meeting with a Genetic Counselor
JCO Early Release Articles Examine PET/CT and PET Alone on Expected Management of Patients With Cancer; Lymph Node Metastases in Rectal Cancer after Neoadjuvant Chemoradiotherapy; Thalidomide Plus Dexamethasone Compared with Dexamethasone for Newly Diagnosed Multiple Myeloma; Prostate-Specific Membrane Antigen-directed Immunoconjugate MLN2704 in Patients with Progressive Metastatic Castration-resistant Prostate Cancer
Future JCO Table of Contents
Visit http://view.exacttarget.com/?j=fe6a15747d67047d7410&m=ff2d16787160&ls=fdf712707266017c7c167677&l=fe8f16737763027872&s=fdf2157972640d79751d7073&ju=fe2d1577726d047e771772 to read more.
CMA Alert Published
CMA Alert was published and includes:
Transition to New Medicare Carrier in California Has Begun
Medical Board Diversion Program Shutting Down;
Interim Recommendations Available at CMA Website
Get Your Medical-Legal Questions Answered at CMA
ON-CALL; Free to Members and Newly Updated for 2008
Bill to Fund Physician Loan Repayment Program Advances
Bill to Stop Medicare Payment Cuts Introduced in Senate
Medi-Cal Prescriptions Must Be Written on Tamper-Resistant Pads Beginning Tomorrow
Don’t Miss Doctor Day in Sacramento; Deadline to RSVP Is April 2
Early-Bird Registration Deadline forCMA’s Leadership Academy Is April 4
Member Benefit of the Week: Up to 15% off Hertz Car Rental
Visit http://www.calphys.org/html/news.asp to read more.
Transition to New Medicare Carrier in California Has Begun
Medical Board Diversion Program Shutting Down;
Interim Recommendations Available at CMA Website
Get Your Medical-Legal Questions Answered at CMA
ON-CALL; Free to Members and Newly Updated for 2008
Bill to Fund Physician Loan Repayment Program Advances
Bill to Stop Medicare Payment Cuts Introduced in Senate
Medi-Cal Prescriptions Must Be Written on Tamper-Resistant Pads Beginning Tomorrow
Don’t Miss Doctor Day in Sacramento; Deadline to RSVP Is April 2
Early-Bird Registration Deadline forCMA’s Leadership Academy Is April 4
Member Benefit of the Week: Up to 15% off Hertz Car Rental
Visit http://www.calphys.org/html/news.asp to read more.
THIS WEEK AT ACCC: MARCH 31-APRIL 4, 2008
ACCC's This Week at ACCC was published and includes:
This is the Week! ACCC's Baltimore Meeting Gets Underway
ACCC Continues Legislative Effort on ASP Issue, Thanks New Supporters
As Easy as 1,2,3. Join ACCC's Listserv Today
New HHS Hospital Comparison Website Includes Patient Perspectives
Sneak Peek: ACCC Meeting to Showcase 60 Exhibitors
Tell Your Patients: Telephone Survivorship Education Workshop
State Medical Oncology Societies Host Upcoming Meetings
Visit http://www.accc-cancer.org/mediaroom/newsletters/media_ACCC_march31_08.html to read this issue.
This is the Week! ACCC's Baltimore Meeting Gets Underway
ACCC Continues Legislative Effort on ASP Issue, Thanks New Supporters
As Easy as 1,2,3. Join ACCC's Listserv Today
New HHS Hospital Comparison Website Includes Patient Perspectives
Sneak Peek: ACCC Meeting to Showcase 60 Exhibitors
Tell Your Patients: Telephone Survivorship Education Workshop
State Medical Oncology Societies Host Upcoming Meetings
Visit http://www.accc-cancer.org/mediaroom/newsletters/media_ACCC_march31_08.html to read this issue.
CMS/Medicare Website Updates
The following information is provided by CMS/Medicare.
MM5982 – April 2008 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5982.pdf
MM5982 – April 2008 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5982.pdf
Blue Cross of California & PrecisionRx Specialty Solutions
Blue Cross of California has announced changes to its members’ prescription drug benefit that requires beneficiaries to obtain specialty medications from its network specialty pharmacy, PrecisionRx Specialty Solutions. In its letter to providers, Blue Cross of California states that Effective April 1, 2008, members taking oral and adjunct oncology, transplant, and a small number of other specialty medications will also need to obtain these from our network specialty pharmacy.
ANCO, CMA, and Blue Cross teleconferenced on March 31st to discuss the impact of this change on medical oncology practices. ANCO, CMA, and Blue Cross agreed that:
1. The changes only impact Blue Cross beneficiaries with a pharmacy benefit provided by Blue Cross.
2. Only oral and other drugs requiring a prescription must be filled via PrecisionRx.
3. If a physician buys and bills Blue Cross for an injectable drug administered in the physician office setting, then they may purchase that drug from their regular supplier of choice and bill Blue Cross under the beneficiary’s medical benefit. In other words, there will be no change in how medical oncologists buy and bill for injectable drugs administered in the physician office setting.
Please let ANCO know if you encounter any difficulties with Blue Cross vis-à-vis billing for your non-prescription injectable drugs administered in the physician-office setting.
ANCO, CMA, and Blue Cross teleconferenced on March 31st to discuss the impact of this change on medical oncology practices. ANCO, CMA, and Blue Cross agreed that:
1. The changes only impact Blue Cross beneficiaries with a pharmacy benefit provided by Blue Cross.
2. Only oral and other drugs requiring a prescription must be filled via PrecisionRx.
3. If a physician buys and bills Blue Cross for an injectable drug administered in the physician office setting, then they may purchase that drug from their regular supplier of choice and bill Blue Cross under the beneficiary’s medical benefit. In other words, there will be no change in how medical oncologists buy and bill for injectable drugs administered in the physician office setting.
Please let ANCO know if you encounter any difficulties with Blue Cross vis-à-vis billing for your non-prescription injectable drugs administered in the physician-office setting.
Subscribe to:
Posts (Atom)