The U.S. Department of Health and Human Services (HHS) announced Friday it will essentially freeze the current Medicare physician payment system because the Congress left Washington for its July 4 recess without reaching agreement on legislation to avert the scheduled 10.6% pay cut. Congressional staff report the freeze could last up to 10 days past the statutory July 1 deadline, which means that the Senate will have three days after it reconvenes July 7 to pass a payment fix before the HHS freeze is lifted.
New talks between Senate Democrats and Republicans will need to resolve this issue before July 10. Until then, physician payments will stay as is.
Advocacy by all physicians continues to put pressure on the Senate to pass needed legislation to avert the payment cuts.
Monday, June 30, 2008
Friday, June 27, 2008
Lymphoma Research Foundation: Educational Forum on Lymphoma 2008
Lymphoma Research Foundation and Lymphoma Foundation Canada, in collaboration with Cancer Legal Resource Center, CLL Information Group, Cutaneous Lymphoma Foundation, International Waldenstrom's Macroglobulinemia Foundation, National Marrow Donor Program(R), Planet Cancer and UCSF Osher Center for Integrative Medicine, Present:
13th Annual
North American Educational Forum on Lymphoma
For Lymphoma Patients, Survivors and Loved Ones
September 26 - 28, 2008
San Francisco, CA | Hotel Nikko
The premier patient education and networking forum for lymphoma patients, survivors, loved ones and healthcare professionals in North America!
Over 600 lymphoma patients, survivors and loved ones attended in 2007!
This year's agenda will include more information by disease type than ever before!
About the Forum
The North American Educational Forum on Lymphoma is the most comprehensive lymphoma-specific educational conference in North America! This 2 1/2 day annual program provides people with lymphoma and their loved ones with critical information about making the best decisions on treatment options, patient support issues and the latest in lymphoma research.
Program Chairs
Laurie Sehn, MD, MPH
British Columbia Cancer Agency
Julie M. Vose, MD
University of Nebraska Medical Center
Program Agenda
View the complete agenda and speaking faculty here.
New for 2008
* Expanded Conference Structure: More disease- and treatment-specific breakout sessions, an expanded and new research panel format, comprehensive clinical trials education by disease type, special topic post-conference workshops and much more!
* Expert Speaking Faculty: Hear a variety of presentations and have your specific questions answered by our expert speaking faculty comprised of over 25 lymphoma specialists and patient support experts from around the world.
* Unrivaled Networking: Meet other people with your same type of lymphoma from around the world and exchange ideas and experiences. Networking opportunities include: welcome reception, meals, extended breaks and disease-specific breakout sessions.
Hotel Accommodations
Special group rates are available from September 25, 2008 to September 29, 2008. View hotel information and rates here.
Registration Information
The early registration fee for lymphoma patients, survivors and loved ones is $50 USD per person until August 1, 2008. After August 1, 2008, the registration fee increases to $75 USD per person. Registration fees include the following meals: Friday Welcome Reception and breakfast, lunch and refreshments on Saturday and Sunday. REGISTER EARLY as space is limited!
FOUR EASY WAYS TO REGISTER
Web: Click Here
Call: (800) 500-9976
Fax: (310) 204-7043
Mail: Lymphoma Research Foundation
8800 Venice Boulevard, Suite 207
Los Angeles, CA 90034
Program Supporters
The 2008 North American Educational Forum on Lymphoma is supported by unrestricted educational grants to the Lymphoma Research Foundation from:
Presenting Sponsor:
Genentech BioOncology | Biogen Idec
Gold Sponsors:
Celgene
Cephalon Oncology
Merck Oncology
Millennium Pharmaceuticals, Inc.
Silver Sponsor:
Lilly Oncology
What 2007 Attendees Have Said
* "I was extremely impressed with the expertise of the presenters and the whole flow of the conference. We could not have been taken better care of."
* "The amount of information could have been much more overwhelming if it had not been cushioned by care and attention."
* "The effort to provide contact with others of similar diagnoses was particularly appreciated!"
* "The breakout sessions on my type of lymphoma were by far the most valuable and connecting with fellow patients. It was very hopeful."
* "This was great for our needs."
* "The program was well done . . . all staff and speakers worked seamlessly with a good discussion between speakers and audience. Thank you!"
* "Very good how you helped attendees interact so often with fellow patients. We were given very useful updates."
* "The selection of topics was representative of many patient concerns."
* "Program provided me with helpful info in understanding my lymphoma."
Online information available at
http://www.lymphoma.org/site/pp.asp?c=chKOI6PEImE&b=3905329
13th Annual
North American Educational Forum on Lymphoma
For Lymphoma Patients, Survivors and Loved Ones
September 26 - 28, 2008
San Francisco, CA | Hotel Nikko
The premier patient education and networking forum for lymphoma patients, survivors, loved ones and healthcare professionals in North America!
Over 600 lymphoma patients, survivors and loved ones attended in 2007!
This year's agenda will include more information by disease type than ever before!
About the Forum
The North American Educational Forum on Lymphoma is the most comprehensive lymphoma-specific educational conference in North America! This 2 1/2 day annual program provides people with lymphoma and their loved ones with critical information about making the best decisions on treatment options, patient support issues and the latest in lymphoma research.
Program Chairs
Laurie Sehn, MD, MPH
British Columbia Cancer Agency
Julie M. Vose, MD
University of Nebraska Medical Center
Program Agenda
View the complete agenda and speaking faculty here.
New for 2008
* Expanded Conference Structure: More disease- and treatment-specific breakout sessions, an expanded and new research panel format, comprehensive clinical trials education by disease type, special topic post-conference workshops and much more!
* Expert Speaking Faculty: Hear a variety of presentations and have your specific questions answered by our expert speaking faculty comprised of over 25 lymphoma specialists and patient support experts from around the world.
* Unrivaled Networking: Meet other people with your same type of lymphoma from around the world and exchange ideas and experiences. Networking opportunities include: welcome reception, meals, extended breaks and disease-specific breakout sessions.
Hotel Accommodations
Special group rates are available from September 25, 2008 to September 29, 2008. View hotel information and rates here.
Registration Information
The early registration fee for lymphoma patients, survivors and loved ones is $50 USD per person until August 1, 2008. After August 1, 2008, the registration fee increases to $75 USD per person. Registration fees include the following meals: Friday Welcome Reception and breakfast, lunch and refreshments on Saturday and Sunday. REGISTER EARLY as space is limited!
FOUR EASY WAYS TO REGISTER
Web: Click Here
Call: (800) 500-9976
Fax: (310) 204-7043
Mail: Lymphoma Research Foundation
8800 Venice Boulevard, Suite 207
Los Angeles, CA 90034
Program Supporters
The 2008 North American Educational Forum on Lymphoma is supported by unrestricted educational grants to the Lymphoma Research Foundation from:
Presenting Sponsor:
Genentech BioOncology | Biogen Idec
Gold Sponsors:
Celgene
Cephalon Oncology
Merck Oncology
Millennium Pharmaceuticals, Inc.
Silver Sponsor:
Lilly Oncology
What 2007 Attendees Have Said
* "I was extremely impressed with the expertise of the presenters and the whole flow of the conference. We could not have been taken better care of."
* "The amount of information could have been much more overwhelming if it had not been cushioned by care and attention."
* "The effort to provide contact with others of similar diagnoses was particularly appreciated!"
* "The breakout sessions on my type of lymphoma were by far the most valuable and connecting with fellow patients. It was very hopeful."
* "This was great for our needs."
* "The program was well done . . . all staff and speakers worked seamlessly with a good discussion between speakers and audience. Thank you!"
* "Very good how you helped attendees interact so often with fellow patients. We were given very useful updates."
* "The selection of topics was representative of many patient concerns."
* "Program provided me with helpful info in understanding my lymphoma."
Online information available at
http://www.lymphoma.org/site/pp.asp?c=chKOI6PEImE&b=3905329
ASCO's Cancer Policy Alert Published
Late last night, after a political back-and-forth, the Senate failed to move H.R. 6331, the legislation that would have averted the 10.6% cut to final passage. Earlier this week, the House of Representatives passed H.R. 6331, The Medicare Improvements for Patients and Providers Act of 2008, by an overwhelming vote of 355-59. Since both the House and Senate have adjourned for the July 4th recess, this means that the 10.6% cut to physician payments will go into effect on July 1st . It is possible, but not guaranteed, that the Congress will pass a bill in July to adjust physician payments retroactively.
Thank you to all who contacted their Members of Congress in the lead up to these votes. Please continue to call and visit your Senators, Representatives, and their staff in their district offices while they are home for the week of June 30 - July 4. Thank those who supported H.R. 6331 and urge all Senators and Representatives to pass an SGR patch as soon as they return to Washington, DC, after the July 4 district work period. Your calls, letters, e-mails, and in-person visits make a huge impact and are critical to keeping this issue at the top of the priority list.
ASCO will continue to advocate for immediate legislative action when Congress returns from recess. For more information, contact ASCO's Cancer Policy & Clinical Affairs Department at 703-299-1050 or publicpolicy@asco.org.
Thank you to all who contacted their Members of Congress in the lead up to these votes. Please continue to call and visit your Senators, Representatives, and their staff in their district offices while they are home for the week of June 30 - July 4. Thank those who supported H.R. 6331 and urge all Senators and Representatives to pass an SGR patch as soon as they return to Washington, DC, after the July 4 district work period. Your calls, letters, e-mails, and in-person visits make a huge impact and are critical to keeping this issue at the top of the priority list.
ASCO will continue to advocate for immediate legislative action when Congress returns from recess. For more information, contact ASCO's Cancer Policy & Clinical Affairs Department at 703-299-1050 or publicpolicy@asco.org.
ACCC'S NATIONAL ONCOLOGY ECONOMICS CONFERENCE: HOTEL/TRAVEL SAVINGS ALERT
Are you planning to attend the Association of Community Cancer Centers 25th National Oncology Economics Conference in San Francisco, September 17–20, 2008?
Save money by making your hotel and travel reservations early!
Host Hotel
Hyatt Regency San Francisco
5 Embarcadero Center
San Francisco, CA 94111
Phone: 415.788.1234
Fax: 415.398.2567
www.hyatt.com
Hotel Accommodations
Rooms are filling fast. Don't miss out. The Hyatt is holding rooms for the ACCC conference at a reduced rate until August 18, 2008 (or until the block of rooms is sold out): Single or Double rooms are $235 plus tax (currently 14% plus $.13 per night). Suites, triple, and quad occupancy are available at an additional cost.
For room reservations, please call central reservations at 888.421.1442, and refer to the group and conference name in order to obtain the discount. Online reservations are also available, please click here. The reduced rate is available from September 16-20, 2008. If you wish to extend your stay, the special group rate may be available up to three days before and after the conference based on hotel availability.
Hyatt requires a credit card or one night's prepayment by check or money order to hold hotel reservations. Reservations must be cancelled 24 hours in advance of your scheduled day of arrival. Cancellations received after this time will be charged one night's room and tax. Check-in time is 3:00 pm; check-out time is 12:00 noon.
Official Travel Agency
Association Travel Concepts (ATC) is the official travel agency for this conference. Please contact ATC for discounted airline and car rental reservations at 800.458.9383 or by email atreservations@atcmeetings.com. Discounts are available for travel between September 14–September 23, 2008. You may also book online at www.atcmeetings.com where you can check Internet fares. Please click here for more information.
Registration Fees
Register by August 15 for the best rate! Members, registered and paid by August 15, just $490. Second registrant, just $350. Registration fees include official program events, materials, social events and all scheduled meal functions as outlined in the agenda.
Read our brochure.
REGISTER BY AUGUST 15 FOR THE BEST RATE!
Save money by making your hotel and travel reservations early!
Host Hotel
Hyatt Regency San Francisco
5 Embarcadero Center
San Francisco, CA 94111
Phone: 415.788.1234
Fax: 415.398.2567
www.hyatt.com
Hotel Accommodations
Rooms are filling fast. Don't miss out. The Hyatt is holding rooms for the ACCC conference at a reduced rate until August 18, 2008 (or until the block of rooms is sold out): Single or Double rooms are $235 plus tax (currently 14% plus $.13 per night). Suites, triple, and quad occupancy are available at an additional cost.
For room reservations, please call central reservations at 888.421.1442, and refer to the group and conference name in order to obtain the discount. Online reservations are also available, please click here. The reduced rate is available from September 16-20, 2008. If you wish to extend your stay, the special group rate may be available up to three days before and after the conference based on hotel availability.
Hyatt requires a credit card or one night's prepayment by check or money order to hold hotel reservations. Reservations must be cancelled 24 hours in advance of your scheduled day of arrival. Cancellations received after this time will be charged one night's room and tax. Check-in time is 3:00 pm; check-out time is 12:00 noon.
Official Travel Agency
Association Travel Concepts (ATC) is the official travel agency for this conference. Please contact ATC for discounted airline and car rental reservations at 800.458.9383 or by email atreservations@atcmeetings.com. Discounts are available for travel between September 14–September 23, 2008. You may also book online at www.atcmeetings.com where you can check Internet fares. Please click here for more information.
Registration Fees
Register by August 15 for the best rate! Members, registered and paid by August 15, just $490. Second registrant, just $350. Registration fees include official program events, materials, social events and all scheduled meal functions as outlined in the agenda.
Read our brochure.
REGISTER BY AUGUST 15 FOR THE BEST RATE!
NHIC/Medicare Website Updates
The following updates have been posted to the NHIC/Medicare website and are available at http://www.medicarenhic.com/cal_prov/updates.shtml
The Allowance Limits for Medicare Part B Drugs for July and revised ones for the past two quarters are now available.
Two new educational articles have been added: PQRI Notification of New Quarterly Updates to the Ambulance Fee Schedule Public Use File (PUF) and 2008 PQRI Establishment of Alternative Reporting Periods and Reporting Criteria.
The Allowance Limits for Medicare Part B Drugs for July and revised ones for the past two quarters are now available.
Two new educational articles have been added: PQRI Notification of New Quarterly Updates to the Ambulance Fee Schedule Public Use File (PUF) and 2008 PQRI Establishment of Alternative Reporting Periods and Reporting Criteria.
Palmetto/J1MAC Website Updates
The following updates have been posted to the Palmetto/J1MAC website.
J1 Transition Events Calendar
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/J1%20Transition%20Events%20Calendar?opendocument
Please download the latest version of the J1 Transition Events Calendar to
replace what you may have previously downloaded from our Web site. This
version has the most up-to-date dates and times for the J1 transition
workshops, PTT calls, and Web-based trainings. Based on our customers'
feedback, we've noted the Pacific Time zones on all of our calendar events.
Applies to:
Part A Transition: General
Part B Transition: General
----------
Part B Transition Web-based Trainings
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Part%20B%20Transition%20Web-based%20Trainings?opendocument
Palmetto GBA will be conducting Web-based trainings to answer your
questions concerning the transition. You will have an opportunity to hear
directly from your Medicare Administrative Contractor (MAC) regarding such
topics as transition dates, what is needed to continue to bill
electronically, how the Local Coverage Determination (LCD) process will
work, the differences in claims processing guidelines and much more. You
can now register to attend an upcoming Web-based training, find the call-in
number, and download training materials.
Applies to:
Part B Transition: General
J1 Transition Events Calendar
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/J1%20Transition%20Events%20Calendar?opendocument
Please download the latest version of the J1 Transition Events Calendar to
replace what you may have previously downloaded from our Web site. This
version has the most up-to-date dates and times for the J1 transition
workshops, PTT calls, and Web-based trainings. Based on our customers'
feedback, we've noted the Pacific Time zones on all of our calendar events.
Applies to:
Part A Transition: General
Part B Transition: General
----------
Part B Transition Web-based Trainings
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Part%20B%20Transition%20Web-based%20Trainings?opendocument
Palmetto GBA will be conducting Web-based trainings to answer your
questions concerning the transition. You will have an opportunity to hear
directly from your Medicare Administrative Contractor (MAC) regarding such
topics as transition dates, what is needed to continue to bill
electronically, how the Local Coverage Determination (LCD) process will
work, the differences in claims processing guidelines and much more. You
can now register to attend an upcoming Web-based training, find the call-in
number, and download training materials.
Applies to:
Part B Transition: General
CMS/Medicare: 2008 Physician Quality Reporting Initiative (PQRI) ~ National Provider Call to be held on July 9th
The Centers for Medicare & Medicaid Services (CMS), Provider Communications Group, will host the fifth in a series of national provider conference calls on the 2008 Physician Quality Reporting Initiative (PQRI). This toll-free call will take place from 3:30 p.m. – 5:00 p.m., EDT, on Wednesday, July 9, 2008.
This call will provide information on accessing your 2007 PQRI Feedback Report (for those of you who participated in 2007); an overview of the 2008 PQRI participation options, and a question and answer session.
The Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) (P.L. 110-173), which was enacted on December 29, 2007, requires that for 2008 and 2009 the Secretary establish alternative reporting periods and alternative criteria for satisfactorily reporting groups of measures. It also requires that for 2008 and 2009 the Secretary establish alternative reporting periods and alternative criteria for satisfactorily reporting quality measures data through registries.
In 2008, eligible professionals may earn an incentive payment of 1.5 percent of their total allowed charges for Physician Fee Service 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.
A PowerPoint slide presentation will be posted to the PQRI web page at http://www.cms.hhs.gov/PQRI/02_CMSSponsoredCalls.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 Ms. Rachel Nelson.
Following the presentation, callers will have an opportunity to ask questions of CMS subject matter experts.
Conference call details:
Date: July 9, 2008
Conference Title: 2008 Physician Quality Reporting Initiative National Provider Call
Time: 3:30-5:00 (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 3:30 p.m. (EDT) on July 8, 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/070908
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 5:30 p.m. (EDT), 7/9/2008, until 11:59 p.m. (EDT), 7/16/2008. The call in data for the replay is (800) 642-1687 and the passcode is 52755102.
If you require services for the hearing impaired please send an email to Medicare.TTT@PalmettoGBA.com.
This call will provide information on accessing your 2007 PQRI Feedback Report (for those of you who participated in 2007); an overview of the 2008 PQRI participation options, and a question and answer session.
The Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) (P.L. 110-173), which was enacted on December 29, 2007, requires that for 2008 and 2009 the Secretary establish alternative reporting periods and alternative criteria for satisfactorily reporting groups of measures. It also requires that for 2008 and 2009 the Secretary establish alternative reporting periods and alternative criteria for satisfactorily reporting quality measures data through registries.
In 2008, eligible professionals may earn an incentive payment of 1.5 percent of their total allowed charges for Physician Fee Service 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.
A PowerPoint slide presentation will be posted to the PQRI web page at http://www.cms.hhs.gov/PQRI/02_CMSSponsoredCalls.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 Ms. Rachel Nelson.
Following the presentation, callers will have an opportunity to ask questions of CMS subject matter experts.
Conference call details:
Date: July 9, 2008
Conference Title: 2008 Physician Quality Reporting Initiative National Provider Call
Time: 3:30-5:00 (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 3:30 p.m. (EDT) on July 8, 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/070908
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 5:30 p.m. (EDT), 7/9/2008, until 11:59 p.m. (EDT), 7/16/2008. The call in data for the replay is (800) 642-1687 and the passcode is 52755102.
If you require services for the hearing impaired please send an email to Medicare.TTT@PalmettoGBA.com.
ASH Practice Update
The ASH Practice Update was published today and is available at http://www.hematology.org/policy/practice/06262008.cfm#1.
It features:
Medicare Physician Payment Fix – Senate Plans to Vote before July 4 Recess
Health Information Technology Legislation Introduced in the House
PQRI Update: 2007 Confidential Reports, Payment Available in July
Have a Pressing Clinical Question?
It features:
Medicare Physician Payment Fix – Senate Plans to Vote before July 4 Recess
Health Information Technology Legislation Introduced in the House
PQRI Update: 2007 Confidential Reports, Payment Available in July
Have a Pressing Clinical Question?
DHCS/MediCal: Provider Payments During Period Without State Budget
If the State of California does not enact the Fiscal Year 2008-09 budget by June 30, 2008, the Department of Health Care Services (DHCS) will direct the fiscal intermediary (EDS) to continue to pay to Medi-Cal practitioners per federal mandate and continue to pay Medi-Cal institutional providers through the Medical Providers Interim Payment (MPIP) fund until the loan is exhausted by the anticipated date of July 17, 2008. After that date, Medi-Cal institutional providers will not receive payment until a budget is enacted, as DHCS has no authority to do so.
After the MPIP Fund is exhausted in approximately mid-July (please check the Medi-Cal website for Budget information concerning the MPIP Fund), institutional providers can expect to begin receiving Value of Claim (VOC) letters. Through the new automated VOC process, all Medi-Cal providers whose held payments equal or exceed $5,000.00 will be automatically sent a VOC letter on a weekly basis. This letter will be based on the amount approved for payment (often referred to as the “In Process” amount) each Monday and will be cumulative each week. The letter will also inform providers for which programs payments are owed and how much is owed by program (Healthy Families, Medi-Cal, etc.). This letter will be sent to the “Pay-To” address on file. Providers who have not updated their “Pay-To” address with Provider Enrollment Division (via a Medi-Cal Supplemental Changes DHCS 6209 form, revised 2/08), may not receive this letter. Providers who want this letter but have not received it and have a correct Pay-To address on the Provider Master File, can contact the Telephone Service Center (TSC) after the MPIP loan is exhausted at 1-800-541-5555 and choose option 15, and then option 13.
After the MPIP Fund is exhausted in approximately mid-July (please check the Medi-Cal website for Budget information concerning the MPIP Fund), institutional providers can expect to begin receiving Value of Claim (VOC) letters. Through the new automated VOC process, all Medi-Cal providers whose held payments equal or exceed $5,000.00 will be automatically sent a VOC letter on a weekly basis. This letter will be based on the amount approved for payment (often referred to as the “In Process” amount) each Monday and will be cumulative each week. The letter will also inform providers for which programs payments are owed and how much is owed by program (Healthy Families, Medi-Cal, etc.). This letter will be sent to the “Pay-To” address on file. Providers who have not updated their “Pay-To” address with Provider Enrollment Division (via a Medi-Cal Supplemental Changes DHCS 6209 form, revised 2/08), may not receive this letter. Providers who want this letter but have not received it and have a correct Pay-To address on the Provider Master File, can contact the Telephone Service Center (TSC) after the MPIP loan is exhausted at 1-800-541-5555 and choose option 15, and then option 13.
Thursday, June 26, 2008
CMS/Medicare Website Updates
The following updates have been posted to the CMS/Medicare website.
MM6090 – Claim Status Category Code and Claim Status Code Update
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6090.pdf
MM6090 – Claim Status Category Code and Claim Status Code Update
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6090.pdf
ASCO's Cancer Policy Today Published
The American Society of Clinical Oncology's (ASCO) Cancer Policy Today was published and is available online at http://view.exacttarget.com/?j=fe5d157674620579721c&m=ff311d707460&ls=fe0112707160057f72157377&l=fea516737564057975&s=fe1f15797d620479731d75&ju=fe3115797665047e771077.
It features:
Contact Your Senators and ask them to Avert Physician Payment Cuts
NIH Appropriations Update
FDA Warns Companies Against Selling Fake Cancer "Cures"
House Passes Conquer Childhood Cancer Act
Participate in the Physician Practice Information Survey
ASCO Conducting Learning Needs Assessment of Member Physicians
It features:
Contact Your Senators and ask them to Avert Physician Payment Cuts
NIH Appropriations Update
FDA Warns Companies Against Selling Fake Cancer "Cures"
House Passes Conquer Childhood Cancer Act
Participate in the Physician Practice Information Survey
ASCO Conducting Learning Needs Assessment of Member Physicians
BREAKING NEWS ON MEDICARE LEGISLATION: NOT OVER YET
As you most likely know by now, yesterday the House of Representatives voted overwhelmingly in favor (355-59) of Medicare legislation that would avert a 10.6% cut in Medicare physician services payments. This bill (H.R. 6331) is referred to as the Baucus Bill because it is the legislation that Senate Finance Chairman Baucus attempted to pass last week in the Senate but did not have the 60 votes needed to close off endless debate (i.e., invoke cloture).
Unfortunately, as of now, it appears that this lopsided vote is a bit misleading. It is unclear this morning if the Senate will even vote on the bill that the House passed or, if it does vote, if it has the 60 votes to pass on the Senate floor or the 67 votes needed to overcome a presidential veto. This is because the bill that passed the House contains cuts to Medicare Advantage fee-for-service, which the President is opposed to and has threatened to veto any bill containing these cuts. It will be difficult for enough Senate Republicans to vote for the House-passed bill that cuts Medicare Advantage if it even comes to the Senate floor for a vote. So many House Members voted for the bill because even those opposed to the Medicare Advantage cuts in the bill knew that the bill would not likely pass in the Senate or even come up for a vote. As we have said before, most Members do not want Medicare payments to be cut 10.6% in this politically charged year.
As the House was taking action on H.R. 6331, Chairman Baucus and Senate Finance Ranking Member Grassley were working on a compromise Medicare bill. It appears that this bill would be an 18-month patch as well, but would only freeze Medicare payments in 2009, which would apparently be an effective 0.5% cut from 2008 levels. This bill would not cut Medicare Advantage fee-for-service plans.
So, the Senate is faced with the dilemma of what bill to take up and when, with time in short supply. Because of this, there is talk that the House is considering passing a 30-day extension to the current Medicare bill, which would give Congress till after the July 4th break to come back and fix this critical situation facing practices and their Medicare patients.
Unfortunately, as of now, it appears that this lopsided vote is a bit misleading. It is unclear this morning if the Senate will even vote on the bill that the House passed or, if it does vote, if it has the 60 votes to pass on the Senate floor or the 67 votes needed to overcome a presidential veto. This is because the bill that passed the House contains cuts to Medicare Advantage fee-for-service, which the President is opposed to and has threatened to veto any bill containing these cuts. It will be difficult for enough Senate Republicans to vote for the House-passed bill that cuts Medicare Advantage if it even comes to the Senate floor for a vote. So many House Members voted for the bill because even those opposed to the Medicare Advantage cuts in the bill knew that the bill would not likely pass in the Senate or even come up for a vote. As we have said before, most Members do not want Medicare payments to be cut 10.6% in this politically charged year.
As the House was taking action on H.R. 6331, Chairman Baucus and Senate Finance Ranking Member Grassley were working on a compromise Medicare bill. It appears that this bill would be an 18-month patch as well, but would only freeze Medicare payments in 2009, which would apparently be an effective 0.5% cut from 2008 levels. This bill would not cut Medicare Advantage fee-for-service plans.
So, the Senate is faced with the dilemma of what bill to take up and when, with time in short supply. Because of this, there is talk that the House is considering passing a 30-day extension to the current Medicare bill, which would give Congress till after the July 4th break to come back and fix this critical situation facing practices and their Medicare patients.
CMA Update
The House passed legislation to stop the 15% Medicare payment cuts before the July 1st deadline. Under the rules, the bill required a 2/3 majority. Despite massive health plan opposition and a Republican Caucus recommendation to vote NO, physicians WON! Once a 2/3 majority was clear, many Republicans switched their votes to Yes to join in the great victory.
All Californians voted YES, except
No=Campbell, Doolittle, Herger, Lungren, Radanovich, Royce. Not voting=Nunes and Speier.
Please be sure to follow-up and thank the Representatives who voted with us.
CMA appreciates the incredible lobbying that the county medical societies, physician leaders and the grassroots did yesterday. I heard from most of the offices yesterday and they were getting hit with a huge volume of physician phone calls. It made all the difference. Thank you.
This House victory is significant for many reasons. It puts enormous pressure on the U.S. Senate to pass a bill in the next 3 days. The major Republican support in the House provides cover to the Senate Republicans who may have been on the fence about these minor Medicare Advantage reforms. And the House majority is veto proof so any legislation that is close to this bill can overcome White House veto threats.
SENATE ACTION- KEEP THE MOMENTUM GOING
While a Senate package has not yet emerged, it is likely to be very close to the House bill.
Please keep calling Senators Feinstein 202 224 3841 and Senator Boxer 202 224 3553.
Urge them to pass a bill to stop the Medicare payment cuts and include a CA GPCI fix.
All Californians voted YES, except
No=Campbell, Doolittle, Herger, Lungren, Radanovich, Royce. Not voting=Nunes and Speier.
Please be sure to follow-up and thank the Representatives who voted with us.
CMA appreciates the incredible lobbying that the county medical societies, physician leaders and the grassroots did yesterday. I heard from most of the offices yesterday and they were getting hit with a huge volume of physician phone calls. It made all the difference. Thank you.
This House victory is significant for many reasons. It puts enormous pressure on the U.S. Senate to pass a bill in the next 3 days. The major Republican support in the House provides cover to the Senate Republicans who may have been on the fence about these minor Medicare Advantage reforms. And the House majority is veto proof so any legislation that is close to this bill can overcome White House veto threats.
SENATE ACTION- KEEP THE MOMENTUM GOING
While a Senate package has not yet emerged, it is likely to be very close to the House bill.
Please keep calling Senators Feinstein 202 224 3841 and Senator Boxer 202 224 3553.
Urge them to pass a bill to stop the Medicare payment cuts and include a CA GPCI fix.
DHCS/MediCal Updates
Due to Medi-Cal expenditures coming in under budget, the Administration directed EDS to release one additional checkwrite than originally planned. This warrant reflects the paid claims intended for the June 19, 2008 checkwrite date. In addition, Long Term Care (LTC) providers, Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) will also be paid for claims intended for the June 26, 2008 checkwrite date. These funds will be released from the State Controller's Office on June 26, 2008, which corresponds with an Electronic Fund Transfer (EFT) date of June 30, 2008. All remaining checkwrites are expected to be released as scheduled on July 2, 2008.
Site link: http://files.medi-cal.ca.gov/pubsdoco/newsroom/newsroom_budget_info.asp
Please continue to check the Web site for further updates, and thank you for your support of the Program.
Site link: http://files.medi-cal.ca.gov/pubsdoco/newsroom/newsroom_budget_info.asp
Please continue to check the Web site for further updates, and thank you for your support of the Program.
Wednesday, June 25, 2008
CMS/Medicare Website Updates
The following updates have been posted to the CMS/Medicare website.
MM6111 – October Quarterly Update to 2008 Annual Update of HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6111.pdf
MM6060 – New Waived Tests
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6060.pdf
MM6111 – October Quarterly Update to 2008 Annual Update of HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6111.pdf
MM6060 – New Waived Tests
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6060.pdf
ASCO's Cancer Policy Alert--House Passes Medicare Bill
The American Society of Clinical Oncology's (ASCO) Cancer Policy Alert was published today and is available at http://view.exacttarget.com/?j=fe641576746701787116&m=ff311d707460&ls=fe0112707160057f72157377&l=fea516737564057975&s=fe1f15797d620479731d75&ju=fe221579776c0179711d73.
Today, the U.S. House of Representatives passed H.R. 6331 by a veto-proof vote of 355-59. This bill would prevent the 10.6% cut for physician payments that is scheduled to go into effect on July 1st due to the sustainable growth rate (SGR). The bill would maintain the current 0.5% increase from 2007, effective July 1 - December 31, 2008. On January 1, 2009, the payments would be increased by 1.1%.
Also today, U.S. Senate Finance Committee Chairman Max Baucus (D-MT) and Ranking Member Chuck Grassley (R-IA) have agreed to a compromise to move similar legislation through the Senate. It remains unclear if the Senate will take up the Baucus/Grassley compromise or H.R. 6331.
Please contact your Senators to urge them to prevent the SGR cuts before they take effect July 1, 2008.
ASCO will continue to keep you updated as details develop. Please contact ASCO's Cancer Policy & Clinical Affairs Department at 703-299-1050 or publicpolicy@asco.org.
Today, the U.S. House of Representatives passed H.R. 6331 by a veto-proof vote of 355-59. This bill would prevent the 10.6% cut for physician payments that is scheduled to go into effect on July 1st due to the sustainable growth rate (SGR). The bill would maintain the current 0.5% increase from 2007, effective July 1 - December 31, 2008. On January 1, 2009, the payments would be increased by 1.1%.
Also today, U.S. Senate Finance Committee Chairman Max Baucus (D-MT) and Ranking Member Chuck Grassley (R-IA) have agreed to a compromise to move similar legislation through the Senate. It remains unclear if the Senate will take up the Baucus/Grassley compromise or H.R. 6331.
Please contact your Senators to urge them to prevent the SGR cuts before they take effect July 1, 2008.
ASCO will continue to keep you updated as details develop. Please contact ASCO's Cancer Policy & Clinical Affairs Department at 703-299-1050 or publicpolicy@asco.org.
ASCO e-News Published
ASCO's e-News was published today and is available at http://view.exacttarget.com/?j=fe571576746700747d1c&m=ff2d16787160&ls=fdf012737160047b7712777c&l=fe611574726c047c741c&s=fdf2157972640d79751d7073&ju=fe251579776c0074751174.
It features:
ASCO Daily News Wrap-Up Edition Available Online
Editors Sought for ASCO Daily News and ASCO News & Forum
2008 Annual Meeting Video Podcasts Now Available
2008 Annual Meeting Virtual Meeting Includes General Poster Presentations and Podcasts
View Most Popular Annual Meeting Abstracts by Disease Type
JSMO Offers Annual Meeting Japanese-language Podcasts
Submit an Abstract for the ASCO-NCI-EORTC Annual Meeting on Molecular Markers in Cancer
Attend 2008 UICC World Cancer Congress
Cancer Policy Alert: Contact Your Senators as Legislation to Halt Medicare Physician Payment Cuts Moves to the Floor, ASCO Runs Ad to Promote Research Funding
For Your Patients: Cancer.Net Feature Articles Explore Seasonal Cancer Issues, Cancer in Young Adults
For Your Patients: Cancer.Net Podcasts Describe Ultrasound Procedures, Annual Meeting Highlights
JCO Early Release Articles Examine Toxicity After Chemoradiation for Head and Neck Cancer; Erythropoietin and Granulocyte-colony Stimulating Factor Treatment for Myelodysplastic Syndrome; Rituximab and/or Therapy With Autotransplant for Follicular Lymphoma; Benefits of Postremission Cytarabine for Acute Myeloid Leukemia; Wilms Tumor 1 Gene Mutations Predict Poor Outcome for Acute Myeloid Leukemia
Future JCO Table of Contents
It features:
ASCO Daily News Wrap-Up Edition Available Online
Editors Sought for ASCO Daily News and ASCO News & Forum
2008 Annual Meeting Video Podcasts Now Available
2008 Annual Meeting Virtual Meeting Includes General Poster Presentations and Podcasts
View Most Popular Annual Meeting Abstracts by Disease Type
JSMO Offers Annual Meeting Japanese-language Podcasts
Submit an Abstract for the ASCO-NCI-EORTC Annual Meeting on Molecular Markers in Cancer
Attend 2008 UICC World Cancer Congress
Cancer Policy Alert: Contact Your Senators as Legislation to Halt Medicare Physician Payment Cuts Moves to the Floor, ASCO Runs Ad to Promote Research Funding
For Your Patients: Cancer.Net Feature Articles Explore Seasonal Cancer Issues, Cancer in Young Adults
For Your Patients: Cancer.Net Podcasts Describe Ultrasound Procedures, Annual Meeting Highlights
JCO Early Release Articles Examine Toxicity After Chemoradiation for Head and Neck Cancer; Erythropoietin and Granulocyte-colony Stimulating Factor Treatment for Myelodysplastic Syndrome; Rituximab and/or Therapy With Autotransplant for Follicular Lymphoma; Benefits of Postremission Cytarabine for Acute Myeloid Leukemia; Wilms Tumor 1 Gene Mutations Predict Poor Outcome for Acute Myeloid Leukemia
Future JCO Table of Contents
Tuesday, June 24, 2008
Medicare Bill Update -- Immediate Action Needed
With only this week left to avert a 10.6% cut in Medicare physician fees, Congress is trying to pass legislation. Although the House has a form of the bill Senator Baucus introduced in the Senate (last week) scheduled for a vote tomorrow, this House bill is likely to fail to get a needed 2/3rds majority (it is being voted on “under suspension,” which is an expedited vote that requires a super majority of 2/3rds of the House).
It now looks like the Senate is going to introduce new legislation, late today or more likely tomorrow. The Senate Democrats are trying to win over enough Republicans to get at least 60 votes to close off discussion (invoke cloture), pass the bill in the Senate, and send it over to the House for a vote. It is not clear whether a compromise can be worked out with the White House to avert a threatened veto or if 67 votes in the Senate can be mustered to overcome a presidential veto.
Please call your Senators immediately. The message is simple: Pass a Medicare bill that includes the Part B prompt pay solution.
It now looks like the Senate is going to introduce new legislation, late today or more likely tomorrow. The Senate Democrats are trying to win over enough Republicans to get at least 60 votes to close off discussion (invoke cloture), pass the bill in the Senate, and send it over to the House for a vote. It is not clear whether a compromise can be worked out with the White House to avert a threatened veto or if 67 votes in the Senate can be mustered to overcome a presidential veto.
Please call your Senators immediately. The message is simple: Pass a Medicare bill that includes the Part B prompt pay solution.
Friday, June 20, 2008
ACCC's 25th National Oncology Economics Conference
Creative Solutions & Strategies
You and your cancer care team can't afford to miss the Association of Community Cancer Centers 25th National Oncology Economics Conference in San Francisco, September 17-20, 2008. You'll find Practical Ideas andInnovative Approaches to help your patients, staff, and the bottom line!
Why should you attend? Lots of great reasons:
Receive BENCHMARKING data and examine return on investment for new technologies and treatments
Maximize reimbursement, and improve EFFICIENCIES and patient satisfaction
Discover NEW TRENDS before your competition
And take a PEEK INTO THE FUTURE: 2009 legislative and regulatory initiatives and changes that may affect your program's financial health.
Read our brochure here.
REGISTER BY AUGUST 15 FOR THE BEST RATE!
Members, registered & paid by August 15, just $490. Second registrant, just $350.
Meeting Highlights
Economics of Clinical Trials. The economics of clinical trials are affected by the administrative time involved in initiating the trial as well as how well a site collects revenue throughout the trial. This session will examine both clinical and cooperative group trials and discuss techniques to reduce the time it takes to start a clinical trial as well as strategies to ensure that a trial is financially successful.
Integrating a Physician Practice and an Academic Center. Learn the goals and the intense process associated with developing a truly unique affiliation between a private physician practice and an NCI-designated cancer center, bringing to the community the full benefit of the academic center's expertise without sacrificing the convenience and comfort of community-based care.
IGRT Operations and Economics: Can They Co-Exist? The addition of new technologies such as electronic brachytherapy and "no dose" localization techniques are adding to the choices available and yet complicating pro formas. This session will examine how to keep our clinicians satisfied with the latest technologies and our CFOs satisfied with our pro forma's return on investment.
Economics of Insurance Contracts. Have you ever wanted to know the inside secrets of managed care companies—how they operate and what motivates them? In this session you will learn from a reformed managed care executive with 18 years of experience who will examine how the managed care companies work and more importantly how you can succeed in your relationship with them.
And much more, including the models for multi-institutional joint ventures, increasing your revenue stream, model supportive care programs, and effective reimbursement management.
How to Register
Go to the NEW ACCC Member Log-in page, type in your email address. If you've not set up your password yet, the default password is Password1. Once you have successfully logged in, you can set up your own password. Then, you can register online under ONLINE EVENT REGISTRATION.
Click here to register.
Remember, ACCC Members,—bring a friend! A member that registers for the meeting at the full rate ($490 or higher) may register a second person, member or non-member, from an institution or practice at a discounted rate. (This offer applies only to cancer care providers—no industry representatives.)
The Hyatt Regency San Francisco is holding rooms for the ACCC meeting at a reduced rate until August, 18, 2008 (or until the block of rooms is sold out).
For room reservations, please call Hyatt central reservations at 888.421.1442, and refer to ACCC and conference name in order to obtain the discount.
You and your cancer care team can't afford to miss the Association of Community Cancer Centers 25th National Oncology Economics Conference in San Francisco, September 17-20, 2008. You'll find Practical Ideas andInnovative Approaches to help your patients, staff, and the bottom line!
Why should you attend? Lots of great reasons:
Receive BENCHMARKING data and examine return on investment for new technologies and treatments
Maximize reimbursement, and improve EFFICIENCIES and patient satisfaction
Discover NEW TRENDS before your competition
And take a PEEK INTO THE FUTURE: 2009 legislative and regulatory initiatives and changes that may affect your program's financial health.
Read our brochure here.
REGISTER BY AUGUST 15 FOR THE BEST RATE!
Members, registered & paid by August 15, just $490. Second registrant, just $350.
Meeting Highlights
Economics of Clinical Trials. The economics of clinical trials are affected by the administrative time involved in initiating the trial as well as how well a site collects revenue throughout the trial. This session will examine both clinical and cooperative group trials and discuss techniques to reduce the time it takes to start a clinical trial as well as strategies to ensure that a trial is financially successful.
Integrating a Physician Practice and an Academic Center. Learn the goals and the intense process associated with developing a truly unique affiliation between a private physician practice and an NCI-designated cancer center, bringing to the community the full benefit of the academic center's expertise without sacrificing the convenience and comfort of community-based care.
IGRT Operations and Economics: Can They Co-Exist? The addition of new technologies such as electronic brachytherapy and "no dose" localization techniques are adding to the choices available and yet complicating pro formas. This session will examine how to keep our clinicians satisfied with the latest technologies and our CFOs satisfied with our pro forma's return on investment.
Economics of Insurance Contracts. Have you ever wanted to know the inside secrets of managed care companies—how they operate and what motivates them? In this session you will learn from a reformed managed care executive with 18 years of experience who will examine how the managed care companies work and more importantly how you can succeed in your relationship with them.
And much more, including the models for multi-institutional joint ventures, increasing your revenue stream, model supportive care programs, and effective reimbursement management.
How to Register
Go to the NEW ACCC Member Log-in page, type in your email address. If you've not set up your password yet, the default password is Password1. Once you have successfully logged in, you can set up your own password. Then, you can register online under ONLINE EVENT REGISTRATION.
Click here to register.
Remember, ACCC Members,—bring a friend! A member that registers for the meeting at the full rate ($490 or higher) may register a second person, member or non-member, from an institution or practice at a discounted rate. (This offer applies only to cancer care providers—no industry representatives.)
The Hyatt Regency San Francisco is holding rooms for the ACCC meeting at a reduced rate until August, 18, 2008 (or until the block of rooms is sold out).
For room reservations, please call Hyatt central reservations at 888.421.1442, and refer to ACCC and conference name in order to obtain the discount.
NHIC/Medicare: Website Update
The following updates have been posted to the NHIC/Medicare website and may be viewed online at http://www.medicarenhic.com/cal_prov/updates.shtml
The Questions & Answers from the ABN and National & Local Coverage Determinations Webinar have been posted.
A new educational article has been posted: Evaluation and Management Services - Nursing Facility, Prolonged Services and Critical Care Visits.
The Update to the Indicators for the Physician Fee Schedule have been posted.
The Questions & Answers from the ABN and National & Local Coverage Determinations Webinar have been posted.
A new educational article has been posted: Evaluation and Management Services - Nursing Facility, Prolonged Services and Critical Care Visits.
The Update to the Indicators for the Physician Fee Schedule have been posted.
Palmetto/J1MAC Website Updates
The following updates have been posted to the Palmetto/J1MAC website.
Future Effective Date - Part B LCDs for American Samoa, Guam, Hawaii,
Northern Mariana Islands and Nevada
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Future%20Effective%20Date%20-%20Part%20B%20LCDs%20for%20American%20Samoa%2C%20Guam%2C%20Hawaii%2C%20Northern%20Mariana%20Islands%20and%20Nevada?opendocument
The consolidated J1 A/B MAC Part B LCDs for American Samoa, Guam, Hawaii,
Northern Mariana Islands and Nevada will begin their notice period on
6-16-08. These J1 Part B LCDs will become effective on 8-4-08. To view
these LCDs, please follow the steps in this article.
Applies to:
Part B Transition: General
----------
Future Effective Date - Part B LCDs for Northern and Southern California
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Future%20Effective%20Date%20-%20Part%20B%20LCDs%20for%20Northern%20and%20Southern%20California?opendocument
The consolidated J1 A/B MAC Part B LCDs for Northern and Southern
California will begin their notice period on 6-16-08. These J1 Part B LCDs
will become effective on 9-2-08. To view these LCDs, please follow the
steps in this article.
Applies to:
Part B Transition: General
----------
Part B Transition Web-based Trainings
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Part%20B%20Transition%20Web-based%20Trainings?opendocument
Palmetto GBA will be conducting Web-based trainings to answer your
questions concerning the transition. You will have an opportunity to hear
directly from your Medicare Administrative Contractor (MAC) regarding such
topics as transition dates, what is needed to continue to bill
electronically, how the Local Coverage Determination (LCD) process will
work, the differences in claims processing guidelines and much more. You
can now register to attend an upcoming Web-based training and download
training materials.
Applies to:
Part B Transition: General
----------
Future Effective Date - Part B LCDs for American Samoa, Guam, Hawaii,
Northern Mariana Islands and Nevada
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Future%20Effective%20Date%20-%20Part%20B%20LCDs%20for%20American%20Samoa%2C%20Guam%2C%20Hawaii%2C%20Northern%20Mariana%20Islands%20and%20Nevada?opendocument
The consolidated J1 A/B MAC Part B LCDs for American Samoa, Guam, Hawaii,
Northern Mariana Islands and Nevada will begin their notice period on
6-16-08. These J1 Part B LCDs will become effective on 8-4-08. To view
these LCDs, please follow the steps in this article.
Applies to:
Part B Transition: General
----------
Future Effective Date - Part B LCDs for Northern and Southern California
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Future%20Effective%20Date%20-%20Part%20B%20LCDs%20for%20Northern%20and%20Southern%20California?opendocument
The consolidated J1 A/B MAC Part B LCDs for Northern and Southern
California will begin their notice period on 6-16-08. These J1 Part B LCDs
will become effective on 9-2-08. To view these LCDs, please follow the
steps in this article.
Applies to:
Part B Transition: General
----------
Part B Transition Web-based Trainings
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Part%20B%20Transition%20Web-based%20Trainings?opendocument
Palmetto GBA will be conducting Web-based trainings to answer your
questions concerning the transition. You will have an opportunity to hear
directly from your Medicare Administrative Contractor (MAC) regarding such
topics as transition dates, what is needed to continue to bill
electronically, how the Local Coverage Determination (LCD) process will
work, the differences in claims processing guidelines and much more. You
can now register to attend an upcoming Web-based training and download
training materials.
Applies to:
Part B Transition: General
----------
CMS/Medicare: Medicare Fee-for-Service (FFS) National Provider Identifier (NPI) Update & Part B Issues Identified
As of 5/23/08, the National Provider Identifier (NPI) became mandatory on all HIPAA claims transactions and on Medicare paper transactions as well. All transactions must be submitted with the NPI in fields requiring a provider identifier (see items 1-3 below concerning the reporting of the Taxpayer Identification Number (TIN)). The Centers for Medicare & Medicaid Services (CMS) continues to see progress with NPI compliance and most Medicare contractors are reporting over 95 percent of claims contain only NPI. However, for some of the relatively few claims which continue to reject, we have determined that some of the reasons are related to the following issues identified for Part B claims:
1) The Employer Identification Number (EIN) or Social Security Number (SSN) being submitted in the 2010AA / REF02 (Billing Provider Secondary Identifier), 2010AB / REF02 (Pay to Provider Secondary Identifier) and/or 2310B / REF02 (Rendering Provider Secondary Identifier) of the Medicare X12N 837P transaction does not match the TIN information on the Medicare crosswalk.
2) While EIN or SSN is not required to be submitted in the 2310B loop for Medicare claims, if submitted, the appropriate qualifier must be submitted in the 2310B / REF01.
· Qualifier EI must be submitted in the 2310B / REF01 when an EIN is being submitted in the REF02.
· Qualifier SY must be submitted in the 2310B / REF01 when an SSN is being submitted in the REF02.
3) The Medicare legacy provider identifier is being submitted in the primary and/or secondary provider loops. Legacy provider numbers are no longer allowed on ANY Medicare claim or transaction. If sent, the claim or transaction will reject.
Medicare providers should review this list and take appropriate actions to resolve problems they may be experiencing. As a result, providers may decide to stop sending non-required segments, such as the TIN in 2310B/REF02 of the X12N 837P transaction. Providers may also want to consult their clearinghouses or software vendors for additional advice to solve the issues listed in this message.
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 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.
1) The Employer Identification Number (EIN) or Social Security Number (SSN) being submitted in the 2010AA / REF02 (Billing Provider Secondary Identifier), 2010AB / REF02 (Pay to Provider Secondary Identifier) and/or 2310B / REF02 (Rendering Provider Secondary Identifier) of the Medicare X12N 837P transaction does not match the TIN information on the Medicare crosswalk.
2) While EIN or SSN is not required to be submitted in the 2310B loop for Medicare claims, if submitted, the appropriate qualifier must be submitted in the 2310B / REF01.
· Qualifier EI must be submitted in the 2310B / REF01 when an EIN is being submitted in the REF02.
· Qualifier SY must be submitted in the 2310B / REF01 when an SSN is being submitted in the REF02.
3) The Medicare legacy provider identifier is being submitted in the primary and/or secondary provider loops. Legacy provider numbers are no longer allowed on ANY Medicare claim or transaction. If sent, the claim or transaction will reject.
Medicare providers should review this list and take appropriate actions to resolve problems they may be experiencing. As a result, providers may decide to stop sending non-required segments, such as the TIN in 2310B/REF02 of the X12N 837P transaction. Providers may also want to consult their clearinghouses or software vendors for additional advice to solve the issues listed in this message.
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 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, June 19, 2008
CMS/Medicare: Medicare Part B Drugs Average Sales Price Files -- July 2008
The Centers for Medicare & Medicaid Services (CMS) has made available the Medicare Part B Drug and Biological Average Sales Price (ASP) Payment Amounts for July 1, 2008 to September 30, 2008 on the CMS website at http://www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/01a_2008aspfiles.asp. The files are located in the "Downloads" section of this web page.
Palmetto/J1MAC Website Update
The following updates have been posted to the Palmetto/J1MAC website.
Part B Transition Web-based Trainings
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Part%20B%20Transition%20Web-based%20Trainings?opendocument
Palmetto GBA will be conducting Web-based trainings to answer your
questions concerning the transition. You will have an opportunity to hear
directly from your Medicare Administrative Contractor (MAC) regarding such
topics as transition dates, what is needed to continue to bill
electronically, how the Local Coverage Determination (LCD) process will
work, the differences in claims processing guidelines and much more.
Please register to attend one of the upcoming trainings.
Applies to:
Part B Transition: General
----------
Part B Transition Web-based Trainings
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Part%20B%20Transition%20Web-based%20Trainings?opendocument
Palmetto GBA will be conducting Web-based trainings to answer your
questions concerning the transition. You will have an opportunity to hear
directly from your Medicare Administrative Contractor (MAC) regarding such
topics as transition dates, what is needed to continue to bill
electronically, how the Local Coverage Determination (LCD) process will
work, the differences in claims processing guidelines and much more.
Please register to attend one of the upcoming trainings.
Applies to:
Part B Transition: General
----------
PQRI Clarification (from Bobbi Buell)
Please read this newsletter carefully, if you planned on reporting PQRI measures starting July 1, 2008. Medicare published Transmittal #355, Change Request 6104, dated June 13, 2008. This clarifies that you may only report from July 1-December 31 using one of the NEW PQRI submission methodologies. Since none of these methodologies (claims groups or registries) particularly applies to Oncology, it may not be possible for many of you to start July 1, 2008. Read the fine print here and decide what you want to do.
When CMS first published this information, they stated that they were opening up the reporting periods, but further clarification from CMS in Washington demonstrates that they were not being that generous!
On April 17, 2008, CMS posted a news article with the headline "Physician Quality Reporting Initiative (PQRI): Important New Program Changes Make It Easier than Ever to Participate!". As usual, CMS was not making anything easier. This news article stated that there was an alternative reporting period and announced new mechanisms for reporting. Many folks read this and believed that there were both: new reporting mechanisms and the ability to start reporting July 1. That was incorrect. You must use one of these new mechanisms to qualify for the new reporting period. Otherwise, unless you are using a the new claims groups or a registry, the reporting period started January 1.
To clarify this point, CMS released a new transmittal (Transmittal #355, CR 6104, dated June 13, 2008) stating the PQRI reporting requirements starting July 1, 2008 and becoming effective July 7, 2008. It clearly states the difference between what you can report starting January 1 and what you can report starting July 1, 2008. This was also clarified in the CMS conference call May 29, 2008.
There are two new ways to report starting July 1, 2008. They are:
Through a Medicare-certified registry (interesting that registries will not be named until 8/31/2008) OR
Through claims reporting groups. There are only groups for diabetes mellitus, End Stage Renal Disease, Chronic Kidney Disease, or Preventive Care (includes many different measures). If you are in a multi-specialty practice, you might look at these options on the CMS website.
The only other way you can start reporting now is to choose measures (and there are 60--but I have provided the Hem-Onc below--but there may be many others that you choose to use) that only require PQRI measures once per reporting period (for this year, that is 1/1/08-12/31/08). So, what you need to do is to search by diagnosis plus included procedure codes and make sure that you can still make at least 3 at 80% of your volume by reporting from now until the end of the year. Here are the once per year measures in Hem-Onc with abbreviated descriptors. Please read the coding guidelines in detail before you start reporting them:
Measure #67-MDS Baseline Cytogenetic Testing
Measure #68-MDS Erythropoetin Documentation of Iron Stores
Measure #69-Multiple Myeloma Biphosphonate Therapy
Measure #70-CLL Baseline Flow Cytometry
Measure #71-Breast Cancer Stages on Tamoxifen/AIs
Measure #72-Colon Cancer Stage III Chemotherapy
Measure #73-Chemotherapy Plan Documented Before Chemotherapy (limited by type of cancer)
Measure #74-Radiation Oncology in Breast-Conserving Surgery
Measure #101-Prostate Cancer Evaluation
Measure #103-Treatment Options for Localized Prostate Cancer
When CMS first published this information, they stated that they were opening up the reporting periods, but further clarification from CMS in Washington demonstrates that they were not being that generous!
On April 17, 2008, CMS posted a news article with the headline "Physician Quality Reporting Initiative (PQRI): Important New Program Changes Make It Easier than Ever to Participate!". As usual, CMS was not making anything easier. This news article stated that there was an alternative reporting period and announced new mechanisms for reporting. Many folks read this and believed that there were both: new reporting mechanisms and the ability to start reporting July 1. That was incorrect. You must use one of these new mechanisms to qualify for the new reporting period. Otherwise, unless you are using a the new claims groups or a registry, the reporting period started January 1.
To clarify this point, CMS released a new transmittal (Transmittal #355, CR 6104, dated June 13, 2008) stating the PQRI reporting requirements starting July 1, 2008 and becoming effective July 7, 2008. It clearly states the difference between what you can report starting January 1 and what you can report starting July 1, 2008. This was also clarified in the CMS conference call May 29, 2008.
There are two new ways to report starting July 1, 2008. They are:
Through a Medicare-certified registry (interesting that registries will not be named until 8/31/2008) OR
Through claims reporting groups. There are only groups for diabetes mellitus, End Stage Renal Disease, Chronic Kidney Disease, or Preventive Care (includes many different measures). If you are in a multi-specialty practice, you might look at these options on the CMS website.
The only other way you can start reporting now is to choose measures (and there are 60--but I have provided the Hem-Onc below--but there may be many others that you choose to use) that only require PQRI measures once per reporting period (for this year, that is 1/1/08-12/31/08). So, what you need to do is to search by diagnosis plus included procedure codes and make sure that you can still make at least 3 at 80% of your volume by reporting from now until the end of the year. Here are the once per year measures in Hem-Onc with abbreviated descriptors. Please read the coding guidelines in detail before you start reporting them:
Measure #67-MDS Baseline Cytogenetic Testing
Measure #68-MDS Erythropoetin Documentation of Iron Stores
Measure #69-Multiple Myeloma Biphosphonate Therapy
Measure #70-CLL Baseline Flow Cytometry
Measure #71-Breast Cancer Stages on Tamoxifen/AIs
Measure #72-Colon Cancer Stage III Chemotherapy
Measure #73-Chemotherapy Plan Documented Before Chemotherapy (limited by type of cancer)
Measure #74-Radiation Oncology in Breast-Conserving Surgery
Measure #101-Prostate Cancer Evaluation
Measure #103-Treatment Options for Localized Prostate Cancer
CMS/Medicare: PQRI National Provider Call (June 18th) PowerPoint Presentation
2008 Physician Quality Reporting Initiative (PQRI): PowerPoint Presentation for National Provider Call (June 18th) is now available
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that the PowerPoint presentation for the June 18th National Provider Call is posted to the PQRI webpage on the CMS website.
To access the PowerPoint presentation, visit http://www.cms.hhs.gov/PQRI on the CMS website and click on the CMS Sponsored Calls tab. Once on the CMS Sponsored Calls page, scroll down to the "Downloads" section and click on the "National Provider Call 06/18/08" link.
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that the PowerPoint presentation for the June 18th National Provider Call is posted to the PQRI webpage on the CMS website.
To access the PowerPoint presentation, visit http://www.cms.hhs.gov/PQRI on the CMS website and click on the CMS Sponsored Calls tab. Once on the CMS Sponsored Calls page, scroll down to the "Downloads" section and click on the "National Provider Call 06/18/08" link.
Oncology Congress 2008
Complimentary and Special Rates for ANCO Clinicians to Attend Oncology Congress 2008
September 25 - 28 | Hilton San Francisco
Complimentary and Special Rates for ANCO Members
As one of Oncology Congress' partnering cancer centers, ANCO is able to extend a special rate.
The first 50 to register will attend complimentary. After that, physicians pay $395, nurses and other clinicians pay $195, fellows and residents are complimentary.
Either click here to register: https://www5.compusystems.com/servlet/AttendeeRegLoginServlet?evt_uid=619&CampaignCode=EM61C
OR
Visit www.oncologycongress.com and enter priority code ANCO.
Featuring Your Northern California Colleagues
From Stanford (hosting partner)
Sandra J. Horning, MD - Presenting a session on Lymphoma
Ranjana Advani, MD - Presenting a session on Lymphoma
From UC Davis
David R. Gandara, MD - Presenting on Lung Cancer
From UCSF
Emily K. Bergsland, MD - Presenting on Colon Cancer
Alan P. Venook, MD - Presenting on Colon Cancer
Boris C. Bastian, MD - Presenting on Melanoma
Mohammed Kashani-Sabat, MD - Presenting on Melanoma
Donald I. Abrams, MD - Presenting on Integrative Medicine
John K. Chan, MD - Presenting on Ovarian Carcinoma
Mack Roach, III, MD - Presenting on Prostate Cancer
Hope S. Rugo, MD - Presenting on Breast Cancer
Jonathan P. Terdiman, MD - Presenting on Colon Cancer
Bonnie N. Joe, MD, PhD - Presenting on Colon Cancer
Exciting Plenary Sessions:
* Pearls and Perils of Biomarkers - Presented by David P. Carbone, MD, PhD
* A View into the Future of a Practicing Oncologist - Presented by Joseph V. Simone, MD
* Hype and Hope of Immunotherapy - Presented by Hakan Mellstedt, MD, PhD & Supported by The Lancet Oncology
Lively Debates Include:
* Expectant Management Should be the Standard of Care for Most Patients with Prostate Cancer
* Androgen Deprivation Therapy Should be Part of Care for All Men with Intermediate Prostate Cancer
* All Patients With Early Breast Cancer Should have an MRI for Staging
* Intraperitoneal Chemotherapy is the Treatment of Choice for Patients with Small-volume Residual Advanced Ovarian Carcinoma
* Patients with Advanced Ovarian Carcinoma Who Achieve a Clinical Complete Remission Should be Offered Maintenance Therapy
* Targeted Agents Should be Continued Until Progress in Patient with Colorectal Cancer
A Multidisciplinary Program with Sessions on:
Bladder Cancer Breast Cancer Cervical Cancer Colon Cancer
Head & Neck Cancer Integrative Medicine Leukemia Liver Cancer
Lymphoma Lung Cancer Melanoma Myeloma
Ovarian Cancer Palliative Care Pancreatic Cancer Practice Management
Prostate Cancer Renal Cell Cancer Sarcoma Supportive Care
Testicular Cancer
Plus 2 Days of Content Programmed Specifically for Oncology Nurses!
Attend the Dr. Waun Ki Hong Founding Chairman's Dinner Reception and Silent Auction
Saturday, September 28
Featuring Author Dr. Robin Cook
Best selling author of medical mystery thrillers Coma, Outbreak and Fatal Care.† The first 25 registered dinner guests will receive a copy of Dr. Cook's newest novel Foreign Body, which will be released in August.
And the Oncotones!
Enjoy the sounds of the Oncotones, a band consisting of† oncologists, healthcare professionals and professional musicians.
Participate in the Silent Auction
Proceeds benefit CancerCare
To Register
Click here https://www5.compusystems.com/servlet/AttendeeRegLoginServlet?evt_uid=619&CampaignCode=EM61C
OR
Visit www.oncologycongress.com and enter priority code ANCO.
* Remember the first 50 to register are complimentary!
September 25 - 28 | Hilton San Francisco
Complimentary and Special Rates for ANCO Members
As one of Oncology Congress' partnering cancer centers, ANCO is able to extend a special rate.
The first 50 to register will attend complimentary. After that, physicians pay $395, nurses and other clinicians pay $195, fellows and residents are complimentary.
Either click here to register: https://www5.compusystems.com/servlet/AttendeeRegLoginServlet?evt_uid=619&CampaignCode=EM61C
OR
Visit www.oncologycongress.com and enter priority code ANCO.
Featuring Your Northern California Colleagues
From Stanford (hosting partner)
Sandra J. Horning, MD - Presenting a session on Lymphoma
Ranjana Advani, MD - Presenting a session on Lymphoma
From UC Davis
David R. Gandara, MD - Presenting on Lung Cancer
From UCSF
Emily K. Bergsland, MD - Presenting on Colon Cancer
Alan P. Venook, MD - Presenting on Colon Cancer
Boris C. Bastian, MD - Presenting on Melanoma
Mohammed Kashani-Sabat, MD - Presenting on Melanoma
Donald I. Abrams, MD - Presenting on Integrative Medicine
John K. Chan, MD - Presenting on Ovarian Carcinoma
Mack Roach, III, MD - Presenting on Prostate Cancer
Hope S. Rugo, MD - Presenting on Breast Cancer
Jonathan P. Terdiman, MD - Presenting on Colon Cancer
Bonnie N. Joe, MD, PhD - Presenting on Colon Cancer
Exciting Plenary Sessions:
* Pearls and Perils of Biomarkers - Presented by David P. Carbone, MD, PhD
* A View into the Future of a Practicing Oncologist - Presented by Joseph V. Simone, MD
* Hype and Hope of Immunotherapy - Presented by Hakan Mellstedt, MD, PhD & Supported by The Lancet Oncology
Lively Debates Include:
* Expectant Management Should be the Standard of Care for Most Patients with Prostate Cancer
* Androgen Deprivation Therapy Should be Part of Care for All Men with Intermediate Prostate Cancer
* All Patients With Early Breast Cancer Should have an MRI for Staging
* Intraperitoneal Chemotherapy is the Treatment of Choice for Patients with Small-volume Residual Advanced Ovarian Carcinoma
* Patients with Advanced Ovarian Carcinoma Who Achieve a Clinical Complete Remission Should be Offered Maintenance Therapy
* Targeted Agents Should be Continued Until Progress in Patient with Colorectal Cancer
A Multidisciplinary Program with Sessions on:
Bladder Cancer Breast Cancer Cervical Cancer Colon Cancer
Head & Neck Cancer Integrative Medicine Leukemia Liver Cancer
Lymphoma Lung Cancer Melanoma Myeloma
Ovarian Cancer Palliative Care Pancreatic Cancer Practice Management
Prostate Cancer Renal Cell Cancer Sarcoma Supportive Care
Testicular Cancer
Plus 2 Days of Content Programmed Specifically for Oncology Nurses!
Attend the Dr. Waun Ki Hong Founding Chairman's Dinner Reception and Silent Auction
Saturday, September 28
Featuring Author Dr. Robin Cook
Best selling author of medical mystery thrillers Coma, Outbreak and Fatal Care.† The first 25 registered dinner guests will receive a copy of Dr. Cook's newest novel Foreign Body, which will be released in August.
And the Oncotones!
Enjoy the sounds of the Oncotones, a band consisting of† oncologists, healthcare professionals and professional musicians.
Participate in the Silent Auction
Proceeds benefit CancerCare
To Register
Click here https://www5.compusystems.com/servlet/AttendeeRegLoginServlet?evt_uid=619&CampaignCode=EM61C
OR
Visit www.oncologycongress.com and enter priority code ANCO.
* Remember the first 50 to register are complimentary!
Wednesday, June 18, 2008
Palmetto/J1MAC Website Update
Part B Transition Web-based Trainings
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Part%20B%20Transition%20Web-based%20Trainings?opendocument
Palmetto GBA will be conducting Web-based trainings to answer your
questions concerning the transition. You will have an opportunity to hear
directly from your Medicare Administrative Contractor (MAC) regarding such
topics as transition dates, what is needed to continue to bill
electronically, how the Local Coverage Determination (LCD) process will
work, the differences in claims processing guidelines and much more.
Please register to attend one of the upcoming trainings.
Applies to:
Part B Transition: General
----------
Transition Communication
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Transition%20Communication?opendocument
Palmetto GBA Publishes a Transition Communication article to Assist
Providers with a Smooth Transition to the Jurisdiction 1 (J1) Medicare
Administrative Contractor (MAC). The Palmetto GBA J1 Web site is filled
with very important transition information. We understand that getting to
all of the available information may be confusing. We have published an
article that incorporates important transition information with direct Web
site links. We hope this article provides a concise overview of transition
information. We do caution, however, not to use this article alone for
transition information because our Web site is updated almost daily with
pertinent information for a successful and smooth implementation.
Applies to:
Part A Transition: General
Part B Transition: General
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Part%20B%20Transition%20Web-based%20Trainings?opendocument
Palmetto GBA will be conducting Web-based trainings to answer your
questions concerning the transition. You will have an opportunity to hear
directly from your Medicare Administrative Contractor (MAC) regarding such
topics as transition dates, what is needed to continue to bill
electronically, how the Local Coverage Determination (LCD) process will
work, the differences in claims processing guidelines and much more.
Please register to attend one of the upcoming trainings.
Applies to:
Part B Transition: General
----------
Transition Communication
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Transition%20Communication?opendocument
Palmetto GBA Publishes a Transition Communication article to Assist
Providers with a Smooth Transition to the Jurisdiction 1 (J1) Medicare
Administrative Contractor (MAC). The Palmetto GBA J1 Web site is filled
with very important transition information. We understand that getting to
all of the available information may be confusing. We have published an
article that incorporates important transition information with direct Web
site links. We hope this article provides a concise overview of transition
information. We do caution, however, not to use this article alone for
transition information because our Web site is updated almost daily with
pertinent information for a successful and smooth implementation.
Applies to:
Part A Transition: General
Part B Transition: General
DHCS/MediCal Updates
Coming in August - Blood and Blood Derivatives Billing Changes
This article serves as a reminder that, effective for dates of service on or after August 1, 2008, the Department of Health Care Services (DHCS) will discontinue the use of the current Medi-Cal interim codes for blood products and some services related to administering those products. These interim codes will be replaced by Healthcare Common Procedure Coding System (HCPCS) Level II and Current Procedural Terminology (CPT-4) codes so as to be in compliance with provisions of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, Public Law 104-191, 45 CFR 162.1000.
Complete details of the billing changes, including manual replacement pages (MRPs), can be found in the June release of the Medi-Cal Updates bulletin, which can be accessed from the Medi-Cal Web site by clicking on the “Publications” tab on the Home page. Click here to access the page: Provider bulletins
This article serves as a reminder that, effective for dates of service on or after August 1, 2008, the Department of Health Care Services (DHCS) will discontinue the use of the current Medi-Cal interim codes for blood products and some services related to administering those products. These interim codes will be replaced by Healthcare Common Procedure Coding System (HCPCS) Level II and Current Procedural Terminology (CPT-4) codes so as to be in compliance with provisions of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, Public Law 104-191, 45 CFR 162.1000.
Complete details of the billing changes, including manual replacement pages (MRPs), can be found in the June release of the Medi-Cal Updates bulletin, which can be accessed from the Medi-Cal Web site by clicking on the “Publications” tab on the Home page. Click here to access the page: Provider bulletins
Tuesday, June 17, 2008
Palmetto/J1MAC Website Update
The following updates have been posted to the Palmetto/J1MAC website.
Electronic Funds Transfer (EFT) FAQs and Updated Information
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Electronic%20Funds%20Transfer%20(EFT)%20FAQs%20and%20Updated%20Information?opendocument
Read new EFT FAQs and other updated information.
Applies to:
Part A Transition: General
Part B Transition: General
----------
Palmetto GBA Announces Capability to Remove Profile
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Palmetto%20GBA%20Announces%20Capability%20to%20Remove%20Profile?opendocument
If you're receiving J1 A/B MAC e-mails and no longer want to, or if you're
receiving duplicate e-mails and you want to stop the duplication, you now
have the ability to remove your e-mail profile. There is now a link on the
J1 home page called Remove Profile which is next to the View My Profile
link at the top right corner of the J1 Web site.
Applies to:
Part A Transition: General
Part B Transition: General
----------
Part B Web-based Trainings
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Part%20B%20Web-based%20Trainings?opendocument
Palmetto GBA will be conducting Web-based trainings to answer your
questions concerning the transition. You will have an opportunity to hear
directly from your Medicare Administrative Contractor (MAC) regarding such
topics as transition dates, what is needed to continue to bill
electronically, how the Local Coverage Determination (LCD) process will
work, the differences in claims processing guidelines and much more.
Please register to attend one of the upcoming trainings.
Applies to:
Part B Transition: General
----------
PTT-2008-6-03-PartB.pdf
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/PTT-2008-6-03-PartB.pdf?opendocument
Read the June 3, 2008, Part B J1 A/B MAC Meeting Minutes.
Applies to:
Part B Transition: General
----------
Transition Communication
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Transition%20Communication?opendocument
Palmetto GBA Publishes a Transition Communication article to Assist
Providers with a Smooth Transition to the Jurisdiction 1 (J1) Medicare
Administrative Contractor (MAC)
Applies to:
Part A Transition: General
Part B Transition: General
----------
Electronic Funds Transfer (EFT) FAQs and Updated Information
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Electronic%20Funds%20Transfer%20(EFT)%20FAQs%20and%20Updated%20Information?opendocument
Read new EFT FAQs and other updated information.
Applies to:
Part A Transition: General
Part B Transition: General
----------
Palmetto GBA Announces Capability to Remove Profile
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Palmetto%20GBA%20Announces%20Capability%20to%20Remove%20Profile?opendocument
If you're receiving J1 A/B MAC e-mails and no longer want to, or if you're
receiving duplicate e-mails and you want to stop the duplication, you now
have the ability to remove your e-mail profile. There is now a link on the
J1 home page called Remove Profile which is next to the View My Profile
link at the top right corner of the J1 Web site.
Applies to:
Part A Transition: General
Part B Transition: General
----------
Part B Web-based Trainings
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Part%20B%20Web-based%20Trainings?opendocument
Palmetto GBA will be conducting Web-based trainings to answer your
questions concerning the transition. You will have an opportunity to hear
directly from your Medicare Administrative Contractor (MAC) regarding such
topics as transition dates, what is needed to continue to bill
electronically, how the Local Coverage Determination (LCD) process will
work, the differences in claims processing guidelines and much more.
Please register to attend one of the upcoming trainings.
Applies to:
Part B Transition: General
----------
PTT-2008-6-03-PartB.pdf
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/PTT-2008-6-03-PartB.pdf?opendocument
Read the June 3, 2008, Part B J1 A/B MAC Meeting Minutes.
Applies to:
Part B Transition: General
----------
Transition Communication
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Transition%20Communication?opendocument
Palmetto GBA Publishes a Transition Communication article to Assist
Providers with a Smooth Transition to the Jurisdiction 1 (J1) Medicare
Administrative Contractor (MAC)
Applies to:
Part A Transition: General
Part B Transition: General
----------
THIS WEEK AT ACCC: JUNE 16-20, 2008
The following information is provided by the Association of Community Cancer Centers (ACCC). ANCO is an Institutional Member of ACCC. This information is available online at http://www.accc-cancer.org/mediaroom/newsletters/media_ACCC_june16_08.html.
It features:
Mid-West Copes with Historic Flooding, ACCC Expresses Support
CMS Recognizes DrugDex Compendium as Additional Information Source
See You in San Francisco in September: ACCC's Oncology Economics Conference
Tell Your Pharmacists: ACCC to Host Oncology Pharmacy Meeting
Baucus Medicare Bill Fails to Overcome Republican Filibuster
ACCC Sends Comments to CMS on NCA for CT Colonography
Oncology Practices: Have You Completed ACCC's Survey?
Children's Health Protection Act of 2008 Introduced in Senate
Velcade and Vidaza Receive New AHFS-DI Compendium Indications
Heard on the ACCC Listserv: Breathing Life into Support Groups
ACCC's CE Blackboard: New Continuing Education Programs for You
ACCC Launches New Online Survivorship Program Resources
ACCC Launches New Online Services and Database
State Medical Oncology Societies Host Upcoming Meetings
It features:
Mid-West Copes with Historic Flooding, ACCC Expresses Support
CMS Recognizes DrugDex Compendium as Additional Information Source
See You in San Francisco in September: ACCC's Oncology Economics Conference
Tell Your Pharmacists: ACCC to Host Oncology Pharmacy Meeting
Baucus Medicare Bill Fails to Overcome Republican Filibuster
ACCC Sends Comments to CMS on NCA for CT Colonography
Oncology Practices: Have You Completed ACCC's Survey?
Children's Health Protection Act of 2008 Introduced in Senate
Velcade and Vidaza Receive New AHFS-DI Compendium Indications
Heard on the ACCC Listserv: Breathing Life into Support Groups
ACCC's CE Blackboard: New Continuing Education Programs for You
ACCC Launches New Online Survivorship Program Resources
ACCC Launches New Online Services and Database
State Medical Oncology Societies Host Upcoming Meetings
B7 (Provider Ineligible) Denials & NHIC/Medicare’s Option Code Project
ANCO member practices (especially group practices) may have received or may receive claims denials with denial code B7 (provider ineligible) due to provider identification (PTAN) number deactivation by the carrier.
The reason for these denials is that your physicians’ PTAN have been deactivated for non-use, OR are not attached to your group identification number, OR your group identification number is not linked to your physicians’ PTANs.
To avoid and resolve these denials you will need to submit Forms 855R and 855I (if the physicians have not updated their Medicare enrollment since 2003). Submit these forms immediately! These forms are available at
CMS 855R Application
http://www.cms.hhs.gov/cmsforms/downloads/cms855r.pdf
CMS 855I Application
http://www.cms.hhs.gov/cmsforms/downloads/cms855i.pdf
Please note that Form 855R does not have a place for reactivation. However, NHIC/Medicare advises providers to write “REACTIVATION” across the open space in section 1 on page 3 of the form.
Submit these forms to the following address using the Option Code Project (in order to expedite processing) cover sheet:
Northern California
Medicare Provider Certification
P.O. Box 2812
Chico, CA 95927-2812
For additional information, please contact NHIC/Medicare customer service at (877) 527-6613, option 3.
NHIC/Medicare is committed to processing clean applications submitted by July 1st with the Option Code Project cover sheet by August 1st.
OPTION CODE PROJECT COVER SHEET should contain the following text:
Place this page at the beginning of provider application(s) to assist with expediting.
OPTION
Code
Project
Group ID Number: __________________
The reason for these denials is that your physicians’ PTAN have been deactivated for non-use, OR are not attached to your group identification number, OR your group identification number is not linked to your physicians’ PTANs.
To avoid and resolve these denials you will need to submit Forms 855R and 855I (if the physicians have not updated their Medicare enrollment since 2003). Submit these forms immediately! These forms are available at
CMS 855R Application
http://www.cms.hhs.gov/cmsforms/downloads/cms855r.pdf
CMS 855I Application
http://www.cms.hhs.gov/cmsforms/downloads/cms855i.pdf
Please note that Form 855R does not have a place for reactivation. However, NHIC/Medicare advises providers to write “REACTIVATION” across the open space in section 1 on page 3 of the form.
Submit these forms to the following address using the Option Code Project (in order to expedite processing) cover sheet:
Northern California
Medicare Provider Certification
P.O. Box 2812
Chico, CA 95927-2812
For additional information, please contact NHIC/Medicare customer service at (877) 527-6613, option 3.
NHIC/Medicare is committed to processing clean applications submitted by July 1st with the Option Code Project cover sheet by August 1st.
OPTION CODE PROJECT COVER SHEET should contain the following text:
Place this page at the beginning of provider application(s) to assist with expediting.
OPTION
Code
Project
Group ID Number: __________________
Monday, June 16, 2008
CMS/Medicare: Reminder: 2008 Physician Quality Reporting Initiative (PQRI) ~ National Provider Call Announcement
The following information is provided by CMS/Medicare.
The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host the fourth in a series of national provider conference calls on the 2008 Physician Quality Reporting Initiative (PQRI). This toll-free call will take place from 3:30 p.m. – 5:00 p.m., EDT, on Wednesday, June 18, 2008.
This call will provide information on accessing your 2007 PQRI Feedback Report for those of you who participated in 2007 and an overview of the 2008 PQRI participation options and a question and answer session. Alternative reporting periods and alternative criteria for satisfactorily reporting quality measures for the 2008 PQRI as authorized by the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) (P.L. 110-173) which was enacted on December 29, 2007.
MMSEA requires that for 2008 and 2009 the Secretary establish alternative reporting periods and alternative criteria for satisfactorily reporting groups of measures. It also requires that for 2008 and 2009 the Secretary establish alternative reporting periods and alternative criteria for satisfactorily reporting quality measures data through registries.
In 2008, eligible professionals may earn an incentive payment of 1.5 percent of their total allowed charges for Physician Fee Service 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.
A PowerPoint slide presentation will be posted to the PQRI webpage at, (http://www.cms.hhs.gov/PQRI/02_CMSSponsoredCalls.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.
Conference call details:
Date: June 18, 2008
Conference Title: 2008 Physician Quality Reporting Initiative National Provider Call
Time: 3:30-5:00 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 3:30 p.m. EDT on June 17, 2008, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
1. To register for the call, participants need to go to: (http://www2.eventsvc.com/palmettogba/061808)
2. Fill in all required data.
3. Verify your time zone is displayed correctly the drop down box.
4. Click "Register".
5. 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 5:30 p.m. EDT 6/18/2008 until 11:59 p.m. EDT 6/25/2008. The call in data for the replay is (800) 642-1687 and the passcode is 47474458.
If you require services for the hearing impaired please send an email to Medicare.TTT@PalmettoGBA.com.
The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host the fourth in a series of national provider conference calls on the 2008 Physician Quality Reporting Initiative (PQRI). This toll-free call will take place from 3:30 p.m. – 5:00 p.m., EDT, on Wednesday, June 18, 2008.
This call will provide information on accessing your 2007 PQRI Feedback Report for those of you who participated in 2007 and an overview of the 2008 PQRI participation options and a question and answer session. Alternative reporting periods and alternative criteria for satisfactorily reporting quality measures for the 2008 PQRI as authorized by the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) (P.L. 110-173) which was enacted on December 29, 2007.
MMSEA requires that for 2008 and 2009 the Secretary establish alternative reporting periods and alternative criteria for satisfactorily reporting groups of measures. It also requires that for 2008 and 2009 the Secretary establish alternative reporting periods and alternative criteria for satisfactorily reporting quality measures data through registries.
In 2008, eligible professionals may earn an incentive payment of 1.5 percent of their total allowed charges for Physician Fee Service 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.
A PowerPoint slide presentation will be posted to the PQRI webpage at, (http://www.cms.hhs.gov/PQRI/02_CMSSponsoredCalls.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.
Conference call details:
Date: June 18, 2008
Conference Title: 2008 Physician Quality Reporting Initiative National Provider Call
Time: 3:30-5:00 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 3:30 p.m. EDT on June 17, 2008, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
1. To register for the call, participants need to go to: (http://www2.eventsvc.com/palmettogba/061808)
2. Fill in all required data.
3. Verify your time zone is displayed correctly the drop down box.
4. Click "Register".
5. 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 5:30 p.m. EDT 6/18/2008 until 11:59 p.m. EDT 6/25/2008. The call in data for the replay is (800) 642-1687 and the passcode is 47474458.
If you require services for the hearing impaired please send an email to Medicare.TTT@PalmettoGBA.com.
Palmetto/J1MAC Implementation Timeline & Transition Workshops for California
The following information is provided by Palmetto/J1MAC.
The timeline is available online at http://www.palmettogba.com/Palmetto/J1.nsf/files/ImplementationTimeline.pdf/$FIle/ImplementationTimeline.pdf.
The workshop schedule is available online at http://www.palmettogba.com/Palmetto/J1.nsf/docsCat/Part%20B%20J1%20AB%20MAC%20Transition%20Workshop%20Registration.
The timeline is available online at http://www.palmettogba.com/Palmetto/J1.nsf/files/ImplementationTimeline.pdf/$FIle/ImplementationTimeline.pdf.
The workshop schedule is available online at http://www.palmettogba.com/Palmetto/J1.nsf/docsCat/Part%20B%20J1%20AB%20MAC%20Transition%20Workshop%20Registration.
NHIC/Medicare Website Updates
The following updates have been posted to the NHIC/Medicare website and may be viewed at http://www.medicarenhic.com/cal_prov/updates.shtml.
The Chiropractic Services Billing Guide has been updated.
The July 2008 Fee Schedules have been posted.
The Chiropractic Services Billing Guide has been updated.
The July 2008 Fee Schedules have been posted.
Friday, June 13, 2008
Palmetto/J1MAC Website Update
The following updates have been posted to the Palmetto/J1MAC website.
Future Effective Date - Part B LCDs for American Samoa, Guam, Hawaii,
Northern Mariana Islands and Nevada
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Future%20Effective%20Date%20-%20Part%20B%20LCDs%20for%20American%20Samoa%2C%20Guam%2C%20Hawaii%2C%20Northern%20Mariana%20Islands%20and%20Nevada?opendocument
The consolidated J1 A/B MAC Part B LCDs for American Samoa, Guam, Hawaii,
Northern Mariana Islands and Nevada will begin their notice period on
6-16-08. These J1 Part B LCDs will become effective on 8-4-08. To view
these LCDs, please follow the steps in this article.
Applies to:
Part B Transition: General
----------
Future Effective Date - Part B LCDs for Northern and Southern California
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Future%20Effective%20Date%20-%20Part%20B%20LCDs%20for%20Northern%20and%20Southern%20California?opendocument
The consolidated J1 A/B MAC Part B LCDs for Northern and Southern
California will begin their notice period on 6-16-08. These J1 Part B LCDs
will become effective on 9-2-08. To view these LCDs, please follow the
steps in this article.
Applies to:
Part B Transition: General
----------
Jurisdiction 1 (J1) Local Coverage Determination (LCD) Notification
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Jurisdiction%201%20(J1)%20Local%20Coverage%20Determination%20(LCD)%20Notification?opendocument
This article is part of the Palmetto GBA Team’s J1 consolidation process
and serves as notification of the LCDs that will be in effect as of the
segment operational dates.
Applies to:
Part A Transition: General
Part B Transition: General
----------
Part B J1 A/B MAC Transition Workshop Registration
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Part%20B%20J1%20AB%20MAC%20Transition%20Workshop%20Registration?opendocument
Please register now for one of the upcoming Part B Transition Workshops in
Nevada, California or Hawaii.
Applies to:
Part B Transition: General
Future Effective Date - Part B LCDs for American Samoa, Guam, Hawaii,
Northern Mariana Islands and Nevada
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Future%20Effective%20Date%20-%20Part%20B%20LCDs%20for%20American%20Samoa%2C%20Guam%2C%20Hawaii%2C%20Northern%20Mariana%20Islands%20and%20Nevada?opendocument
The consolidated J1 A/B MAC Part B LCDs for American Samoa, Guam, Hawaii,
Northern Mariana Islands and Nevada will begin their notice period on
6-16-08. These J1 Part B LCDs will become effective on 8-4-08. To view
these LCDs, please follow the steps in this article.
Applies to:
Part B Transition: General
----------
Future Effective Date - Part B LCDs for Northern and Southern California
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Future%20Effective%20Date%20-%20Part%20B%20LCDs%20for%20Northern%20and%20Southern%20California?opendocument
The consolidated J1 A/B MAC Part B LCDs for Northern and Southern
California will begin their notice period on 6-16-08. These J1 Part B LCDs
will become effective on 9-2-08. To view these LCDs, please follow the
steps in this article.
Applies to:
Part B Transition: General
----------
Jurisdiction 1 (J1) Local Coverage Determination (LCD) Notification
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Jurisdiction%201%20(J1)%20Local%20Coverage%20Determination%20(LCD)%20Notification?opendocument
This article is part of the Palmetto GBA Team’s J1 consolidation process
and serves as notification of the LCDs that will be in effect as of the
segment operational dates.
Applies to:
Part A Transition: General
Part B Transition: General
----------
Part B J1 A/B MAC Transition Workshop Registration
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Part%20B%20J1%20AB%20MAC%20Transition%20Workshop%20Registration?opendocument
Please register now for one of the upcoming Part B Transition Workshops in
Nevada, California or Hawaii.
Applies to:
Part B Transition: General
Thursday, June 12, 2008
ASCO's Cancer Policy Today Published
ASCO's Cancer Policy Today was published and may be viewed online at http://view.exacttarget.com/?j=fe5915757c640d7f7211&m=ff311d707460&ls=fe0112707160057f72157377&l=fea516737564057975&s=fe1f15797d620479731d75&ju=fe2915797561027f741c76.
It features:
Contact Your Senators as Legislation to Halt Medicare Physician Payment Cuts Moves to the Floor
Congressional Quarterly Sponsors Forum Addressing Innovations in Cancer Research
ASCO Runs Ad to Promote Research Funding
NCCN Drugs & Biologics Compendium Named as Reference for Medicare Coverage
NIH Enhances Peer Review Effort
Congressional Briefing Highlights Pediatric Cancer Survivorship Legislation
ASCO Submits Survivorship Research Project to NIH
Participate in the Physician Practice Information Survey
It features:
Contact Your Senators as Legislation to Halt Medicare Physician Payment Cuts Moves to the Floor
Congressional Quarterly Sponsors Forum Addressing Innovations in Cancer Research
ASCO Runs Ad to Promote Research Funding
NCCN Drugs & Biologics Compendium Named as Reference for Medicare Coverage
NIH Enhances Peer Review Effort
Congressional Briefing Highlights Pediatric Cancer Survivorship Legislation
ASCO Submits Survivorship Research Project to NIH
Participate in the Physician Practice Information Survey
CMS/Medicare Website Updates
The following updates have been posted to the CMS/Medicare website.
MM6049 – July 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/MM6049.pdf
MM6087 – July Update to the 2008 Medicare Physician Fee Schedule Database (MPFSDB)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6087.pdf
MM6049 – July 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/MM6049.pdf
MM6087 – July Update to the 2008 Medicare Physician Fee Schedule Database (MPFSDB)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6087.pdf
Palmetto/J1MAC Website Update
The following updates have been posted to the Palmetto/J1MAC website.
Part B J1 A/B MAC Transition Workshop Registration
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Part%20B%20J1%20AB%20MAC%20Transition%20Workshop%20Registration?opendocument
Please register for one of the upcoming Part B Transition Workshops in
Nevada, California or Hawaii.
Applies to:
Part B Transition: General
Part B J1 A/B MAC Transition Workshop Registration
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Part%20B%20J1%20AB%20MAC%20Transition%20Workshop%20Registration?opendocument
Please register for one of the upcoming Part B Transition Workshops in
Nevada, California or Hawaii.
Applies to:
Part B Transition: General
ASCO Medicare Updates
The following CMS/Medicare updates are provided by the American Society of Clinical Oncology (ASCO).
Reporting of Hematocrit or Hemoglobin Levels for the Administration of ESAs
On May 16, 2008, the Centers for Medicare and Medicaid Services (CMS) revised their Medlearn Matters article, MM5699 for the administration of ESAs. They have deleted the words "decimal implied" in the third paragraph under the 'What You Need to Know' section that discusses reporting of the MEA segment. The values for the most recent numeric test result should be reported with decimals. All other information remains the same.
Remember, effective for services on or after January 1, 2008, you must report the most recent hemoglobin or hematocrit levels on any claim for a Medicare patient receiving: (1) ESA administrations, or (2) Part B anti-anemia drugs other than ESAs used in the treatment of cancer that are not self-administered. In addition, non-ESRD claims for the administration of ESAs must also contain one of three new Healthcare Common Procedure Coding System (HCPCS) modifiers effective January 1, 2008. An instruction sheet on reporting hematocrit/hemoglobin in conjunction with claims for Erythropoiesis-Stimulating Agents (ESAs) is available on the ASCO website.
Skilled Nursing Facility Consolidated Billing July 2008 HCPCS Code Update - CR6009
Change Request (CR) 6009 provides updates to the lists of Healthcare Common Procedure Coding System (HCPCS) codes that are excluded from the consolidated billing provision of the SNF Prospective Payment System (PPS). CR 6009 adds HCPCS code J9303 (Injection, Panitumumab, 10MG) to the Major Category III.A. Chemotherapy services FI/A/B MAC Exclusion List retroactive to January 1, 2008.
Recent Update to Medicare's Prolonged Services Coding Guidelines - CR 5972
Change Request (CR) 5972 updated the sections of the Medicare Claims Processing Manual that address Prolonged Services codes in order to be consistent with changes/deletions in codes and changes in typical/average time units in the American Medical Association Current Terminology Procedural Terminology (CPT) coding system.
The CMS updates to the Medicare Claims Processing Manual sections are as follows:
· In keeping with current Medicare payment policy for physician presence and supporting documentation, CMS defines Prolonged Services, and explains the required evaluation and management (E&M) companion codes;
· Corrected and updated the tables for threshold times to reflect code changes and current typical/average time units associated with the CPT levels of care in code families; and
· In a new Subsection (30.6.15.1 (H)), explained how to report physician visits for counseling and/or coordination of care when the visit is based on time, and when the counseling and/or coordination service is prolonged.
For more information, and to review the MedLearn Matter article, MM5972, click on the "Change Request (CR) 5972" link above.
Reporting of Hematocrit or Hemoglobin Levels for the Administration of ESAs
On May 16, 2008, the Centers for Medicare and Medicaid Services (CMS) revised their Medlearn Matters article, MM5699 for the administration of ESAs. They have deleted the words "decimal implied" in the third paragraph under the 'What You Need to Know' section that discusses reporting of the MEA segment. The values for the most recent numeric test result should be reported with decimals. All other information remains the same.
Remember, effective for services on or after January 1, 2008, you must report the most recent hemoglobin or hematocrit levels on any claim for a Medicare patient receiving: (1) ESA administrations, or (2) Part B anti-anemia drugs other than ESAs used in the treatment of cancer that are not self-administered. In addition, non-ESRD claims for the administration of ESAs must also contain one of three new Healthcare Common Procedure Coding System (HCPCS) modifiers effective January 1, 2008. An instruction sheet on reporting hematocrit/hemoglobin in conjunction with claims for Erythropoiesis-Stimulating Agents (ESAs) is available on the ASCO website.
Skilled Nursing Facility Consolidated Billing July 2008 HCPCS Code Update - CR6009
Change Request (CR) 6009 provides updates to the lists of Healthcare Common Procedure Coding System (HCPCS) codes that are excluded from the consolidated billing provision of the SNF Prospective Payment System (PPS). CR 6009 adds HCPCS code J9303 (Injection, Panitumumab, 10MG) to the Major Category III.A. Chemotherapy services FI/A/B MAC Exclusion List retroactive to January 1, 2008.
Recent Update to Medicare's Prolonged Services Coding Guidelines - CR 5972
Change Request (CR) 5972 updated the sections of the Medicare Claims Processing Manual that address Prolonged Services codes in order to be consistent with changes/deletions in codes and changes in typical/average time units in the American Medical Association Current Terminology Procedural Terminology (CPT) coding system.
The CMS updates to the Medicare Claims Processing Manual sections are as follows:
· In keeping with current Medicare payment policy for physician presence and supporting documentation, CMS defines Prolonged Services, and explains the required evaluation and management (E&M) companion codes;
· Corrected and updated the tables for threshold times to reflect code changes and current typical/average time units associated with the CPT levels of care in code families; and
· In a new Subsection (30.6.15.1 (H)), explained how to report physician visits for counseling and/or coordination of care when the visit is based on time, and when the counseling and/or coordination service is prolonged.
For more information, and to review the MedLearn Matter article, MM5972, click on the "Change Request (CR) 5972" link above.
Medicare Updates its List of Recognized Sources to Help Make Coverage Decisions for Anti-Cancer Chemotherapy Drugs
The following information is provided by NHIC/Medicare.
A compendium is a comprehensive listing of Food & Drug Administration (FDA)-approved drugs and biologicals or of a specific subset of drugs and biologicals. Compendia are used to improve the effectiveness and quality of care for Medicare beneficiaries by developing and disseminating current, authoritative information on cancer therapies to clinicians, patients and other decision makers.
The Centers for Medicare & Medicaid Services (CMS) will now recognize the National Comprehensive Cancer Network (NCCN) Drugs & Biologics Compendium as an additional source of information in determining which drugs should be covered under Medicare Part B when used to treat patients undergoing cancer treatment through chemotherapy. CMS will no longer use the now obsolete American Medical Association Drug Evaluations (AMA-DE) compendium as a source for making these decisions. Both of these changes will be reflected in CMS’ Medicare Benefit Policy Manual.
The Compendia List and related CMS Press Release can be found on the CMS website at:
Compendia List: http://www.cms.hhs.gov/CoverageGenInfo/02_compendia.asp
CMS Press Release Link: http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=3145&
A compendium is a comprehensive listing of Food & Drug Administration (FDA)-approved drugs and biologicals or of a specific subset of drugs and biologicals. Compendia are used to improve the effectiveness and quality of care for Medicare beneficiaries by developing and disseminating current, authoritative information on cancer therapies to clinicians, patients and other decision makers.
The Centers for Medicare & Medicaid Services (CMS) will now recognize the National Comprehensive Cancer Network (NCCN) Drugs & Biologics Compendium as an additional source of information in determining which drugs should be covered under Medicare Part B when used to treat patients undergoing cancer treatment through chemotherapy. CMS will no longer use the now obsolete American Medical Association Drug Evaluations (AMA-DE) compendium as a source for making these decisions. Both of these changes will be reflected in CMS’ Medicare Benefit Policy Manual.
The Compendia List and related CMS Press Release can be found on the CMS website at:
Compendia List: http://www.cms.hhs.gov/CoverageGenInfo/02_compendia.asp
CMS Press Release Link: http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=3145&
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:
06/24/08 at 2:00 pm CT
07/24/08 at 10:00 am CT
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:
06/24/08 at 2:00 pm CT
07/24/08 at 10:00 am CT
CMA ASKS ALL PHYSICIANS TO PLEASE CALL U.S. SENATORS TODAY!
The following information is provided by the California Medical Association (CMA).
PHYSICIANS PLEASE CALL U.S. SENATORS TODAY TO STOP THE MEDICARE CUTS
The California Medical Association is now asking for your help TODAY -
Wednesday, June 11, to make phone calls to Senators Feinstein
(202-224-3841) and Boxer (202-224-3553) to urge them to support S 3101
to stop the Medicare payment cuts!
Unfortunately, e-mails will not get read in time.
A procedural vote on S. 3101 is scheduled for Thursday, June 12.
The Senate must get 60 votes on the motion tomorrow in order to consider
S. 3101 on the Senate floor next week.
If the vote fails tomorrow it is not clear whether the Senate can act
again in time to stop the cuts before July 1st.
The vote is very close.
S. 3101 is the Senate Finance Committee Chairman Baucus' Medicare
legislation that would stop the 10% Medicare SGR cut on July 1st and the
5% cut on January 1st 2009. It would also provide payment updates of
0.5% for the rest of 2008 and a 1.1% update in 2009. This bill would
give Congress time to develop a long-term overhaul of the SGR.
Further, if the Senate can garner 60 votes for the legislation, Chairman
Baucus will consider the request made by Senator Feinstein to include
the CMA California GPCI fix in the final package.
The GPCI solution would increase payments to physicians in Santa Cruz,
Sonoma, Monterey, San Diego, Santa Barbara, Sacramento, Marin, El
Dorado, Placer and San
Luis Obispo. It would stop the cuts already scheduled for Alameda,
Napa, Solano, San Francisco, San Mateo, Santa Clara.
Finally, it would hold the remaining counties harmless from payment
reductions.
ACTION: THE CMA ASKS THAT YOU PLEASE CALL TODAY:
1) THANK SENATORS FEINSTEIN AND BOXER FOR THE PAST SUPPORT OF
PHYSICIANS.
2) URGE THE SENATORS TO VOTE "YES" ON THE CLOTURE MOTION TO CONSIDER S.
3101, the only bill on the Senate floor that halts the SGR cuts and
improves payments. (While Senators Feinstein and Boxer will be
supporting the motion, they still need to hear from California
physicians.)
3) URGE THE SENATORS TO CONTINUE FIGHTING TO INCLUDE THE CMA CALIFORNIA
GPCI FIX IN THE FINAL BILL.
____________________________________________________________________
SENATOR FEINSTEIN 202 224 3841 SENATOR BOXER 202 224 3553
___________________________________________________________________
PHYSICIANS PLEASE CALL U.S. SENATORS TODAY TO STOP THE MEDICARE CUTS
The California Medical Association is now asking for your help TODAY -
Wednesday, June 11, to make phone calls to Senators Feinstein
(202-224-3841) and Boxer (202-224-3553) to urge them to support S 3101
to stop the Medicare payment cuts!
Unfortunately, e-mails will not get read in time.
A procedural vote on S. 3101 is scheduled for Thursday, June 12.
The Senate must get 60 votes on the motion tomorrow in order to consider
S. 3101 on the Senate floor next week.
If the vote fails tomorrow it is not clear whether the Senate can act
again in time to stop the cuts before July 1st.
The vote is very close.
S. 3101 is the Senate Finance Committee Chairman Baucus' Medicare
legislation that would stop the 10% Medicare SGR cut on July 1st and the
5% cut on January 1st 2009. It would also provide payment updates of
0.5% for the rest of 2008 and a 1.1% update in 2009. This bill would
give Congress time to develop a long-term overhaul of the SGR.
Further, if the Senate can garner 60 votes for the legislation, Chairman
Baucus will consider the request made by Senator Feinstein to include
the CMA California GPCI fix in the final package.
The GPCI solution would increase payments to physicians in Santa Cruz,
Sonoma, Monterey, San Diego, Santa Barbara, Sacramento, Marin, El
Dorado, Placer and San
Luis Obispo. It would stop the cuts already scheduled for Alameda,
Napa, Solano, San Francisco, San Mateo, Santa Clara.
Finally, it would hold the remaining counties harmless from payment
reductions.
ACTION: THE CMA ASKS THAT YOU PLEASE CALL TODAY:
1) THANK SENATORS FEINSTEIN AND BOXER FOR THE PAST SUPPORT OF
PHYSICIANS.
2) URGE THE SENATORS TO VOTE "YES" ON THE CLOTURE MOTION TO CONSIDER S.
3101, the only bill on the Senate floor that halts the SGR cuts and
improves payments. (While Senators Feinstein and Boxer will be
supporting the motion, they still need to hear from California
physicians.)
3) URGE THE SENATORS TO CONTINUE FIGHTING TO INCLUDE THE CMA CALIFORNIA
GPCI FIX IN THE FINAL BILL.
____________________________________________________________________
SENATOR FEINSTEIN 202 224 3841 SENATOR BOXER 202 224 3553
___________________________________________________________________
Wednesday, June 11, 2008
ASCO E-News Published
The following information is provided by the American Society of Clinical Oncology (ASCO). View it online at http://view.exacttarget.com/?j=fe5f15757d62027d7710&m=ff2d16787160&ls=fdfd12727d6c007f75147277&l=fe60157472670d797416&s=fdf2157972640d79751d7073&ju=fe3715797565077c741676.
It features:
ASCO Ad in USA Today Calls for Increased Research Funding
ASCO Daily News Available Online
Submit an Abstract for the ASCO-NCI-EORTC Annual Meeting on Molecular Markers in Cancer
Register and Reserve Housing for 2008 Breast Cancer Symposium
Register and Reserve Housing for 2008 Clinical Trials Workshop
Presentations from 2008 Genitourinary Cancers Symposium Now Available at No Cost
ASCO Joins Frosted Pink with A Twist and Mary Lou Retton to Raise Awareness of Cancer
Attend 2008 UICC World Cancer Congress
Cancer Policy Alert: President Bush Signs Genetic Information Nondiscrimination Act; NIH Enhances Peer Review Effort
For Your Patients: News and Information from the 2008 ASCO Annual Meeting
JCO Early Release Articles Examine Paradoxical Actions of Estrogen in Breast Cancer; Imatinib Therapy for Chronic Myeloid Leukemia; Lung Cancer Staging Techniques and Induction Therapy; Endobronchial Ultrasound With Transbronchial Needle Aspiration for Restaging the Mediastinum in Lung Cancer
Future JCO Table of Contents
It features:
ASCO Ad in USA Today Calls for Increased Research Funding
ASCO Daily News Available Online
Submit an Abstract for the ASCO-NCI-EORTC Annual Meeting on Molecular Markers in Cancer
Register and Reserve Housing for 2008 Breast Cancer Symposium
Register and Reserve Housing for 2008 Clinical Trials Workshop
Presentations from 2008 Genitourinary Cancers Symposium Now Available at No Cost
ASCO Joins Frosted Pink with A Twist and Mary Lou Retton to Raise Awareness of Cancer
Attend 2008 UICC World Cancer Congress
Cancer Policy Alert: President Bush Signs Genetic Information Nondiscrimination Act; NIH Enhances Peer Review Effort
For Your Patients: News and Information from the 2008 ASCO Annual Meeting
JCO Early Release Articles Examine Paradoxical Actions of Estrogen in Breast Cancer; Imatinib Therapy for Chronic Myeloid Leukemia; Lung Cancer Staging Techniques and Induction Therapy; Endobronchial Ultrasound With Transbronchial Needle Aspiration for Restaging the Mediastinum in Lung Cancer
Future JCO Table of Contents
ACCC DRUG UPDATE: JUNE 10, 2008
The following information is provided by the Association of Community Cancer Centers (ACCC). ANCO is an Institutional Member of ACCC. View this information online at http://www.accc-cancer.org/mediaroom/newsletters/media_drugupdate_061008.htm.
Zoledronic acid (Zometa) has been accepted by the American Hospital Formulary Service Drug Information (AHFS-DI) drug compendium as treatment for prevention of aromatase inhibitor-associated bone loss (AIBL) in postmenopausal women. The oncology determination table is available online. AHFS-DI is published by the American Society of Health-System Pharmacists (ASHP).
Bayer HealthCare Pharmaceuticals, Inc. (Wayne, N.J.) announced that a reformulation of the liquid Leukine® (sargramostim) 500 mcg vial has been approved by the FDA and is now available for patients and physicians in the U.S. The new formulation does not include EDTA (edetate disodium), which was in the product's liquid 500 mcg vial manufactured from January 2006 to January 2008.
In January 2008 Bayer withdrew the previously marketed liquid Leukine 500 mcg vial from the U.S. market in order to reformulate it to eliminate EDTA in light of an increase in spontaneous reporting of certain labeled adverse events, including syncope (fainting). The timing of increased reporting of these adverse events coincided with the change in the formulation of liquid Leukine to include EDTA in 2006. With the approval and relaunch of liquid Leukine in a non-EDTA formulation, Bayer is closing a special access program that reserved priority access to lyophilized Leukine 250 mcg vials, which do not contain EDTA, for patients with the greatest medical need. Sufficient supply of the new, non-EDTA liquid and lyophilized formulations of Leukine is now available to meet cancer care market demand.
The Centers for Medicare & Medicaid Services (CMS) announced its decision to recognize the National Comprehensive Cancer Network (NCCN) Drugs & Biologics Compendium™ as an additional source of information used to determine which drugs and biologics may be covered under Medicare Part B for patients with cancer. The NCCN Compendium will be used by CMS for national coverage determinations and by intermediaries and carriers for local determinations. The major application will be in determinations about coverage for the use of drugs and biologics in oncology beyond the FDA-approved indication.
CMS also announced the termination of the use of the American Medical Association Drug Evaluations (AMA-DE) Compendium, which has not been updated or published since 1995.
A Medicare law directs CMS to consider certain listed compendia when deciding whether or not the use of a drug is medically accepted for the treatment of cancer. The law also allows the agency to revise the list. Both of these revisions will be reflected in CMS' Medicare Benefit Policy Manual.
NCCN is developing a library of standard chemotherapy order templates. The information contained in the Templates is based on the NCCN Clinical Practice Guidelines in Oncology and the NCCN Drugs & Biologics Compendium. The Templates include chemotherapy, supportive care agents, monitoring parameters, and safety instructions. Special instructions for self-administered chemotherapeutic agents are also provided. The following Templates are now available: chronic myelogenous leukemia, as well as bladder, kidney, ovarian, and prostate cancers. Click here to visit the NCCN website.
Zoledronic acid (Zometa) has been accepted by the American Hospital Formulary Service Drug Information (AHFS-DI) drug compendium as treatment for prevention of aromatase inhibitor-associated bone loss (AIBL) in postmenopausal women. The oncology determination table is available online. AHFS-DI is published by the American Society of Health-System Pharmacists (ASHP).
Bayer HealthCare Pharmaceuticals, Inc. (Wayne, N.J.) announced that a reformulation of the liquid Leukine® (sargramostim) 500 mcg vial has been approved by the FDA and is now available for patients and physicians in the U.S. The new formulation does not include EDTA (edetate disodium), which was in the product's liquid 500 mcg vial manufactured from January 2006 to January 2008.
In January 2008 Bayer withdrew the previously marketed liquid Leukine 500 mcg vial from the U.S. market in order to reformulate it to eliminate EDTA in light of an increase in spontaneous reporting of certain labeled adverse events, including syncope (fainting). The timing of increased reporting of these adverse events coincided with the change in the formulation of liquid Leukine to include EDTA in 2006. With the approval and relaunch of liquid Leukine in a non-EDTA formulation, Bayer is closing a special access program that reserved priority access to lyophilized Leukine 250 mcg vials, which do not contain EDTA, for patients with the greatest medical need. Sufficient supply of the new, non-EDTA liquid and lyophilized formulations of Leukine is now available to meet cancer care market demand.
The Centers for Medicare & Medicaid Services (CMS) announced its decision to recognize the National Comprehensive Cancer Network (NCCN) Drugs & Biologics Compendium™ as an additional source of information used to determine which drugs and biologics may be covered under Medicare Part B for patients with cancer. The NCCN Compendium will be used by CMS for national coverage determinations and by intermediaries and carriers for local determinations. The major application will be in determinations about coverage for the use of drugs and biologics in oncology beyond the FDA-approved indication.
CMS also announced the termination of the use of the American Medical Association Drug Evaluations (AMA-DE) Compendium, which has not been updated or published since 1995.
A Medicare law directs CMS to consider certain listed compendia when deciding whether or not the use of a drug is medically accepted for the treatment of cancer. The law also allows the agency to revise the list. Both of these revisions will be reflected in CMS' Medicare Benefit Policy Manual.
NCCN is developing a library of standard chemotherapy order templates. The information contained in the Templates is based on the NCCN Clinical Practice Guidelines in Oncology and the NCCN Drugs & Biologics Compendium. The Templates include chemotherapy, supportive care agents, monitoring parameters, and safety instructions. Special instructions for self-administered chemotherapeutic agents are also provided. The following Templates are now available: chronic myelogenous leukemia, as well as bladder, kidney, ovarian, and prostate cancers. Click here to visit the NCCN website.
CMS Rescinds "Incident To" Policy that was to go into effect June 2, 2008
CMS has rescinded Transmittal 87, CR 5288, which contained some extremely stringent requirements/clarifications to Medicare's "Incident to" policy. Key points included:
A practice or clinic must be physician owned and operated in order to bill Medicare for incident to services;
A requirement for very explicit and extensive documentation within the patient's medical record as it relates to the credentials of the treating personnel;
A patient care plan which contains details as to which services will be provided by a physician versus other healthcare provider, such as a nurse practitioner or physician assistant; and,
An actual authorization in the patient chart for services provided incident to the physician/NPP initial service.
To view the actual CMS document wherein Transmittal 87 is rescinded, visit http://www.cms.hhs.gov/Transmittals/downloads/R87BP.pdf.
You may view the original Change Request (CR) 5288 at http://www.cms.hhs.gov/ContractorLearningResources/downloads/JA5288.pdf on the CMS website.
A practice or clinic must be physician owned and operated in order to bill Medicare for incident to services;
A requirement for very explicit and extensive documentation within the patient's medical record as it relates to the credentials of the treating personnel;
A patient care plan which contains details as to which services will be provided by a physician versus other healthcare provider, such as a nurse practitioner or physician assistant; and,
An actual authorization in the patient chart for services provided incident to the physician/NPP initial service.
To view the actual CMS document wherein Transmittal 87 is rescinded, visit http://www.cms.hhs.gov/Transmittals/downloads/R87BP.pdf.
You may view the original Change Request (CR) 5288 at http://www.cms.hhs.gov/ContractorLearningResources/downloads/JA5288.pdf on the CMS website.
Palmetto/J1MAC Website Update
The following information is provided by Palmetto/J1MAC.
Electronic Funds Transfer (EFT) Web-Based Training on June 11, 2008
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Electronic%20Funds%20Transfer%20(EFT)%20Web-Based%20Training%20on%20June%2011%2C%202008?opendocument
Please register for the next J1 A/B MAC EFT Web-based training session is
scheduled for June 11, 2008 at 1:00 p.m. EST. The presentation materials
are now available to view and/or download.
Applies to:
Part A Transition: General
Part B Transition: General
----------
Part B J1 A/B MAC Transition Workshop Registration
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Part%20B%20J1%20AB%20MAC%20Transition%20Workshop%20Registration?opendocument
Please register for one of the upcoming Part B Transition Workshops in
Nevada, California or Hawaii.
Applies to:
Part B Transition: General
Electronic Funds Transfer (EFT) Web-Based Training on June 11, 2008
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Electronic%20Funds%20Transfer%20(EFT)%20Web-Based%20Training%20on%20June%2011%2C%202008?opendocument
Please register for the next J1 A/B MAC EFT Web-based training session is
scheduled for June 11, 2008 at 1:00 p.m. EST. The presentation materials
are now available to view and/or download.
Applies to:
Part A Transition: General
Part B Transition: General
----------
Part B J1 A/B MAC Transition Workshop Registration
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Part%20B%20J1%20AB%20MAC%20Transition%20Workshop%20Registration?opendocument
Please register for one of the upcoming Part B Transition Workshops in
Nevada, California or Hawaii.
Applies to:
Part B Transition: General
Monday, June 9, 2008
THIS WEEK AT ACCC: JUNE 9-13, 2008
The following information is provided by the Association of Community Cancer Centers (ACCC). ANCO is an Institutional Member of ACCC. You can read This Week at ACCC online at http://www.accc-cancer.org/mediaroom/newsletters/media_ACCC_june09_08.html.
It features:
CMS Recognizes NCCN Compendium for Medicare Part B Coverage
See You in San Francisco in September: ACCC's Oncology Economics Conference
Tell Your Pharmacists: ACCC to Host Oncology Pharmacy Meeting
Baucus Unveils Medicare Measure To Block Impending Physician Pay Cut
CMS Outlines Rights of Medicare Hospice Patients
Heard on the ACCC Listserv: Billing for IV Emend
ACCC's CE Blackboard: New Continuing Education Programs for You
Zometa Receives New AHFS-DI Compendium Indication
ACCC Launches New Online Survivorship Program Resources
ACCC Launches New Online Services and Database
State Medical Oncology Societies Host Upcoming Meetings
It features:
CMS Recognizes NCCN Compendium for Medicare Part B Coverage
See You in San Francisco in September: ACCC's Oncology Economics Conference
Tell Your Pharmacists: ACCC to Host Oncology Pharmacy Meeting
Baucus Unveils Medicare Measure To Block Impending Physician Pay Cut
CMS Outlines Rights of Medicare Hospice Patients
Heard on the ACCC Listserv: Billing for IV Emend
ACCC's CE Blackboard: New Continuing Education Programs for You
Zometa Receives New AHFS-DI Compendium Indication
ACCC Launches New Online Survivorship Program Resources
ACCC Launches New Online Services and Database
State Medical Oncology Societies Host Upcoming Meetings
Palmetto/J1MAC Website Update
The following updates have been posted to the Palmetto/J1MAC website.
Electronic Funds Transfer (EFT) Web-Based Training on June 11, 2008
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Electronic%20Funds%20Transfer%20(EFT)%20Web-Based%20Training%20on%20June%2011%2C%202008?opendocument
Please register for the next J1 A/B MAC EFT Web-based training session is
scheduled for June 11, 2008 at 1:00 p.m. EST. The presentation materials
are now available to view and/or download.
Applies to:
Part A Transition: General
Part B Transition: General
----------
Part B J1 A/B MAC Transition Workshop Registration
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Part%20B%20J1%20AB%20MAC%20Transition%20Workshop%20Registration?opendocument
Please register for one of the upcoming Part B Transition Workshops in
Nevada, California or Hawaii.
Applies to:
Part B Transition: General
Electronic Funds Transfer (EFT) Web-Based Training on June 11, 2008
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Electronic%20Funds%20Transfer%20(EFT)%20Web-Based%20Training%20on%20June%2011%2C%202008?opendocument
Please register for the next J1 A/B MAC EFT Web-based training session is
scheduled for June 11, 2008 at 1:00 p.m. EST. The presentation materials
are now available to view and/or download.
Applies to:
Part A Transition: General
Part B Transition: General
----------
Part B J1 A/B MAC Transition Workshop Registration
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Part%20B%20J1%20AB%20MAC%20Transition%20Workshop%20Registration?opendocument
Please register for one of the upcoming Part B Transition Workshops in
Nevada, California or Hawaii.
Applies to:
Part B Transition: General
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 The Physical & Occupational Therapy Billing Guide has been updated.
Three new educational articles have been added: NPI- Top Claim Rejections, Laboratory and Pathology Specimens Date of Service and NPI for Self-Referred Screening Mammography - Contractor Instruction.
Palmetto GBA EDI will assume full responsibility for Northern and Southern California Part B providers on 9/2/08. For more details and contact numbers, please refer to the article: Important Jurisdiction 1 EDI Information.
The The Physical & Occupational Therapy Billing Guide has been updated.
Three new educational articles have been added: NPI- Top Claim Rejections, Laboratory and Pathology Specimens Date of Service and NPI for Self-Referred Screening Mammography - Contractor Instruction.
Palmetto GBA EDI will assume full responsibility for Northern and Southern California Part B providers on 9/2/08. For more details and contact numbers, please refer to the article: Important Jurisdiction 1 EDI Information.
Friday, June 6, 2008
CMS/Medicare: Medicare Updates its List of Recognized Sources to Help Make Coverage Decisions for Anti-Cancer Chemotherapy Drugs
A compendium is a comprehensive listing of Food & Drug Administration (FDA)-approved drugs and biologicals or of a specific subset of drugs and biologicals. Compendia are used to improve the effectiveness and quality of care for Medicare beneficiaries by developing and disseminating current, authoritative information on cancer therapies to clinicians, patients and other decision makers.
The Centers for Medicare & Medicaid Services (CMS) will now recognize the National Comprehensive Cancer Network (NCCN) Drugs & Biologics Compendium as an additional source of information in determining which drugs should be covered under Medicare Part B when used to treat patients undergoing cancer treatment through chemotherapy. CMS will no longer use the now obsolete American Medical Association Drug Evaluations (AMA-DE) compendium as a source for making these decisions. Both of these changes will be reflected in CMS’ Medicare Benefit Policy Manual.
The Compendia List and related CMS Press Release can be found on the CMS website at:
Compendia List: http://www.cms.hhs.gov/CoverageGenInfo/02_compendia.asp
CMS Press Release Link: http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=3145&
The Centers for Medicare & Medicaid Services (CMS) will now recognize the National Comprehensive Cancer Network (NCCN) Drugs & Biologics Compendium as an additional source of information in determining which drugs should be covered under Medicare Part B when used to treat patients undergoing cancer treatment through chemotherapy. CMS will no longer use the now obsolete American Medical Association Drug Evaluations (AMA-DE) compendium as a source for making these decisions. Both of these changes will be reflected in CMS’ Medicare Benefit Policy Manual.
The Compendia List and related CMS Press Release can be found on the CMS website at:
Compendia List: http://www.cms.hhs.gov/CoverageGenInfo/02_compendia.asp
CMS Press Release Link: http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=3145&
CMS/Medicare Website Updates
The following updates have been posted to the CMS/Medicare website.
MM5021 – Clinical Laboratory Fee Schedule - New Waived Tests
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6021.pdf
MM6053 – Part B Drug Competitive Acquisition Program (CAP) Quarterly Drug Update
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6053.pdf
MM6087 – July Update to the 2008 Medicare Physician Fee Schedule Database (MPFSDB)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6087.pdf
MM5021 – Clinical Laboratory Fee Schedule - New Waived Tests
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6021.pdf
MM6053 – Part B Drug Competitive Acquisition Program (CAP) Quarterly Drug Update
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6053.pdf
MM6087 – July Update to the 2008 Medicare Physician Fee Schedule Database (MPFSDB)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6087.pdf
CMS/Medicare: Register Now to Access Your 2007 Physician Quality Reporting Initiative (PQRI) Feedback Report
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that 2007 PQRI Final Feedback Reports will be made available in mid-July on a secure website. Reports will be available to each practice, identified by Taxpayer Identification Number (TIN), under which at least one eligible professional reported 2007 PQRI quality measures data. Reports available to the practice will include information on reporting rates, clinical performance, and incentives earned by individual professionals, with summary information on reporting success and incentives earned at the practice (TIN) level.
Although the PQRI feedback reports are not yet available on this website, CMS recommends that practices take the time now to set up their online account so they can access their report as soon as it is available. The first step is for the professionals and appropriate staff to register for access through a new CMS security system known as the Individuals Authorized Access to CMS Computer Services - Provider Community (IACS-PC).
At this time, only practices with multiple professionals or individual professionals with staff members who will access the PQRI feedback reports should register in IACS. The first step in establishing the practice as an IACS-PC organization is registering a security official for the organization. Because the process of verifying the security official’s authorization to access the practice’s confidential information is not fully automated and can take some time, such practices should begin registering their representatives for IACS accounts now.
If you are an individual professional who will access this service personally, and have no staff who will use the system on your behalf, wait until further notice to register in IACS. This registration process is simpler and less time consuming.
Please do not register if you did not submit PQRI quality-measures data for 2007.
The following MLN Matters articles address key questions and answers about the registration process and can be found at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0747.pdf and http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0753.pdf on the CMS website.
More information about registering in IACS and accessing 2007 PQRI Participant Feedback Reports will soon be posted on http://www.cms.hhs.gov/PQRI.
Although the PQRI feedback reports are not yet available on this website, CMS recommends that practices take the time now to set up their online account so they can access their report as soon as it is available. The first step is for the professionals and appropriate staff to register for access through a new CMS security system known as the Individuals Authorized Access to CMS Computer Services - Provider Community (IACS-PC).
At this time, only practices with multiple professionals or individual professionals with staff members who will access the PQRI feedback reports should register in IACS. The first step in establishing the practice as an IACS-PC organization is registering a security official for the organization. Because the process of verifying the security official’s authorization to access the practice’s confidential information is not fully automated and can take some time, such practices should begin registering their representatives for IACS accounts now.
If you are an individual professional who will access this service personally, and have no staff who will use the system on your behalf, wait until further notice to register in IACS. This registration process is simpler and less time consuming.
Please do not register if you did not submit PQRI quality-measures data for 2007.
The following MLN Matters articles address key questions and answers about the registration process and can be found at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0747.pdf and http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0753.pdf on the CMS website.
More information about registering in IACS and accessing 2007 PQRI Participant Feedback Reports will soon be posted on http://www.cms.hhs.gov/PQRI.
Palmetto/J1MAC Website Update
The following updates have been posted to the Palmetto/J1MAC website.
Electronic Funds Transfer (EFT) Web-Based Training on June 11, 2008
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Electronic%20Funds%20Transfer%20(EFT)%20Web-Based%20Training%20on%20June%2011%2C%202008?opendocument
The next J1 A/B MAC Electronic Funds Transfer (EFT) Web-based
training session is scheduled for June 11, 2008 at 1:00 p.m. EST. The
presentation materials are now available to view and/or download.
Applies to:
Part A Transition: General
Part B Transition: General
----------
Jurisdiction 1 EDI Early Boarding Began May 1st!
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Jurisdiction%201%20EDI%20Early%20Boarding%20Began%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
----------
Part B J1 A/B MAC Transition Workshop Registration
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Part%20B%20J1%20AB%20MAC%20Transition%20Workshop%20Registration?opendocument
Palmetto GBA will be conducting workshops throughout the J1 region and will
be available to answer your questions concerning the transition. You will
have an opportunity to hear directly from your Medicare Administrative
Contractor (MAC) regarding such topics as transition dates, information
needed to continue to bill electronically, the Local Coverage Determination
process, differences in claims processing guidelines and much more. The
transition workshop schedule has been finalized and has been posted to the
Web site. We encourage you to register as soon as possible for the 3-hour
workshops as seating is limited. We are providing morning sessions and
will repeat the session in the afternoon. Please note there are separate
Part A and Part B workshops. We look forward to meeting you and
addressing your Medicare questions.
Applies to:
Part B Transition: General
Electronic Funds Transfer (EFT) Web-Based Training on June 11, 2008
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Electronic%20Funds%20Transfer%20(EFT)%20Web-Based%20Training%20on%20June%2011%2C%202008?opendocument
The next J1 A/B MAC Electronic Funds Transfer (EFT) Web-based
training session is scheduled for June 11, 2008 at 1:00 p.m. EST. The
presentation materials are now available to view and/or download.
Applies to:
Part A Transition: General
Part B Transition: General
----------
Jurisdiction 1 EDI Early Boarding Began May 1st!
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Jurisdiction%201%20EDI%20Early%20Boarding%20Began%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
----------
Part B J1 A/B MAC Transition Workshop Registration
http://www.palmettogba.com/palmetto/j1.nsf/DocsCat/Part%20B%20J1%20AB%20MAC%20Transition%20Workshop%20Registration?opendocument
Palmetto GBA will be conducting workshops throughout the J1 region and will
be available to answer your questions concerning the transition. You will
have an opportunity to hear directly from your Medicare Administrative
Contractor (MAC) regarding such topics as transition dates, information
needed to continue to bill electronically, the Local Coverage Determination
process, differences in claims processing guidelines and much more. The
transition workshop schedule has been finalized and has been posted to the
Web site. We encourage you to register as soon as possible for the 3-hour
workshops as seating is limited. We are providing morning sessions and
will repeat the session in the afternoon. Please note there are separate
Part A and Part B workshops. We look forward to meeting you and
addressing your Medicare questions.
Applies to:
Part B Transition: General
Thursday, June 5, 2008
CMS/Medicare: 2008 Physician Quality Reporting Initiative (PQRI))--National Provider Call Announcement
The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host the fourth in a series of national provider conference calls on the 2008 Physician Quality Reporting Initiative (PQRI). This toll-free call will take place from 3:30 p.m. – 5:00 p.m., EDT, on Wednesday, June 18, 2008.
This call will provide information on accessing your 2007 PQRI Feedback Report for those of you who participated in 2007 and an overview of the 2008 PQRI participation options and a question and answer session. Alternative reporting periods and alternative criteria for satisfactorily reporting quality measures for the 2008 PQRI as authorized by the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) (P.L. 110-173) which was enacted on December 29, 2007.
MMSEA requires that for 2008 and 2009 the Secretary establish alternative reporting periods and alternative criteria for satisfactorily reporting groups of measures. It also requires that for 2008 and 2009 the Secretary establish alternative reporting periods and alternative criteria for satisfactorily reporting quality measures data through registries.
In 2008, eligible professionals may earn an incentive payment of 1.5 percent of their total allowed charges for Physician Fee Service 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.
A PowerPoint slide presentation will be posted to the PQRI webpage at http://www.cms.hhs.gov/PQRI/02_CMSSponsoredCalls.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.
Conference call details:
Date: June 18, 2008
Conference Title: 2008 Physician Quality Reporting Initiative National Provider Call
Time: 3:30-5:00 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 3:30 p.m. EDT on June 17, 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/061808
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 5:30 p.m. EDT 6/18/2008 until 11:59 p.m. EDT 6/25/2008. The call in data for the replay is (800) 642-1687 and the passcode is 47474458.
If you require services for the hearing impaired please send an email toMedicare.TTT@PalmettoGBA.com.
This call will provide information on accessing your 2007 PQRI Feedback Report for those of you who participated in 2007 and an overview of the 2008 PQRI participation options and a question and answer session. Alternative reporting periods and alternative criteria for satisfactorily reporting quality measures for the 2008 PQRI as authorized by the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) (P.L. 110-173) which was enacted on December 29, 2007.
MMSEA requires that for 2008 and 2009 the Secretary establish alternative reporting periods and alternative criteria for satisfactorily reporting groups of measures. It also requires that for 2008 and 2009 the Secretary establish alternative reporting periods and alternative criteria for satisfactorily reporting quality measures data through registries.
In 2008, eligible professionals may earn an incentive payment of 1.5 percent of their total allowed charges for Physician Fee Service 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.
A PowerPoint slide presentation will be posted to the PQRI webpage at http://www.cms.hhs.gov/PQRI/02_CMSSponsoredCalls.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.
Conference call details:
Date: June 18, 2008
Conference Title: 2008 Physician Quality Reporting Initiative National Provider Call
Time: 3:30-5:00 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 3:30 p.m. EDT on June 17, 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/061808
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 5:30 p.m. EDT 6/18/2008 until 11:59 p.m. EDT 6/25/2008. The call in data for the replay is (800) 642-1687 and the passcode is 47474458.
If you require services for the hearing impaired please send an email toMedicare.TTT@PalmettoGBA.com.
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