ANCO Online ListServ: 2009

Thursday, December 31, 2009

ACCC, CMS & Palmetto/J1MAC News

Thursday, December 24, 2009

ASH, CMS, & Palmetto/J1MAC News

The following information has been received by ANCO.

****ASH NEWS****
The American Society of Hematology (ASH) Practice Update was published and is available at http://www.hematology.org/Practice/Practice-Updates/4710.aspx. This edition features:

• MEDICARE CHANGES AFFECTING PHYSICIAN PAYMENT BEGINNING JANUARY 1, 2010

• CMS Eliminates Use of Consultation Codes: As of January 1, 2010 Providers Directed to Report Other Evaluation Management (E/M) Visit Codes

• Medicare Physician Fee Freeze through February 28, 2010

• CMS Will Hold Medicare Claims January 1 to January 15, 2010

• CMS Posts January 2010 ASP Pricing

****CMS NEWS****
SE0929 – 2010 Annual Participation Enrollment Program Extension
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0929.pdf

MM6753 – Positron Emission Tomography (PET) (FDG) for Cervical Cancer
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6753.pdf

This is a clarification to the listserv message that was issued on December 21, 2009. The President has signed the Department of Defense Appropriations Act of 2010 which provides for a zero percent (0%) update to the 2010 Medicare Physician Fee Schedule for a two month period, January 1, 2010 through February 28, 2010.

The Centers for Medicare & Medicaid Services (CMS) is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, non-physician practitioners, and other providers of services paid under the Medicare physician fee schedule, beginning January 1, 2010. In this regard, CMS has instructed its contractors to hold claims for services paid under the Medicare Physician Fee Schedule (MPFS) for up to the first 10 business days of January (January 1 through January 15) for 2010 dates of service. This should have minimum impact on provider cash flow because, by law, clean electronic claims are not paid any sooner than 14 calendar days (29 days for paper claims) after the date of receipt. Meanwhile, all claims for services delivered on or before December 31, 2009, will be processed and paid under normal procedures.

The holding of claims allows Medicare contractors time to receive the new, updated payment files and perform necessary testing before paying claims at the new rates. CMS has instructed contractors to begin processing claims at the new rates no later than January 19, 2010. Please note that most contractors are closed on the January 18 Martin Luther King Day holiday. Therefore, even absent a new update, most claims likely would not have been paid any sooner than January 19, 2010, given the aforementioned statutory 14-day payment floor.

CMS has extended the 2010 Annual Participation Enrollment Program end date from January 31, 2010, to March 17, 2010– therefore, the enrollment period now runs from November 13, 2009, through March 17, 2010.

The effective date for any Participation status change during the extension, however, remains January 1, 2010, and will be in force for the entire year.

Contractors will accept and process any Participation elections or withdrawals, made during the extended enrollment period that are received or post-marked on or before March 17, 2010.

In addition, be on the alert for more information about other legislative provisions which may affect you.

****PALMETTO/J1MAC NEWS****
Time Limit for Filing Medicare Claims
Medicare law designates specific time limits for submitting claims for
physician and other Part B services. The terms of the law require that a
claim be filed no later than the end of the calendar year following the
year in which the service was furnished, except as indicated within this
article.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7HNFMM6252?opendocument

Updated Information Regarding the Holding of Claims for Services Paid Under
The 2010 Medicare Physician Fee Schedule
The Centers for Medicare & Medicaid Services (CMS) has instructed its
contractors to hold claims for services paid under the Medicare Physician
Fee Schedule (MPFS) for up to the first 10 business days of January
(January 1 through January 15) for 2010 dates of service.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YZRZ76754?opendocument

The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!

Wednesday, December 23, 2009

CMA, CMS, & Palmetto/J1MAC News

The following information has been received by ANCO.

****CMA NEWS****
The California Medical Association (CMA) Alert was published and is available online at www.cmaalert.org. This edition features:

Congress Approves Stopgap Measure to Delay Medicare Cuts
Medicare Participation Decision Deadline Extended to January 31, 2010

CMS Eliminates Medicare Consult Codes

Senate Pushing for Health Reform Vote Before Christmas

State Proposes Sweeping Changes to Medi-Cal Program

Judge Rules Rescission Lawsuit Against Blue Cross Can Proceed

Has Your IPA or Health Plan Stopped Paying Claims?

Save the Date: 2010 California Health Care Leadership Academy Is April 9-11 in San Diego

****CMS NEWS****
To the extent possible and in consideration of possible legislative changes, the Centers for Medicare & Medicaid Services (CMS) is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, non-physician practitioners, and other providers of services paid under the Medicare physician fee schedule, beginning January 1, 2010. In this regard, CMS has instructed its contractors to hold claims containing services paid under the Medicare Physician Fee Schedule (MPFS) for the first 10 business days of January (January 1 through January 15) for 2010 dates of service. This should have minimum impact on provider cash flow because, under current law, clean electronic claims are not paid any sooner than 14 calendar days (29 days for paper claims) after the date of receipt. Meanwhile, all claims for services delivered on or before December 31, 2009, will be processed and paid under normal procedures.

After 10 business days, contractors will begin releasing held claims into processing under the fee schedule which implements current law. This, of course, could result in claims being processed with the negative 21.2 percent update. If a new law is enacted which changes the negative update effective January 1, CMS will correctly process claims under the new law and, if necessary, CMS is prepared to automatically reprocess most of those claims which have already been processed at the lower rate.

Under the Medicare statute, Medicare payments to physicians and other affected providers are based upon the lesser of the actual charge or the MPFS amount. Providers who submit charges that are greater than the negative 2010 MPFS will automatically have their claims reprocessed. Physicians who submit charges that are equal to or less than the 2010 MPFS amount will need to request an adjustment. Submitted charges on claims cannot be altered without a request from the physician/provider.

To the extent possible, providers may hold claims in-house until it becomes clearer as to whether new legislation will be enacted or until cash flow becomes problematic. This will reduce the need for providers to reconcile two payments (i.e., the initial claim and the reprocessed claim), and it will simplify provider billings of beneficiary coinsurance and payment calculations for payers which are secondary to Medicare.

CMS has extended the 2010 Annual Participation Enrollment Program end date from January 31, 2010, to March 17, 2010– therefore, the enrollment period now runs from November 13, 2009, through March 17, 2010.

The effective date for any Participation status change during the extension, however, remains January 1, 2010, and will be in force for the entire year.

Contractors will accept and process any Participation elections or withdrawals, made during the extended enrollment period that are received or post-marked on or before March 17, 2010.

In addition, be on the alert for more information about other legislative provisions which may affect you.

The Centers for Medicare and Medicaid Services (CMS) has posted the revised January 2010 ASP pricing file and crosswalk. All are available for download at: http://www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/01a19_2010aspfiles.asp

****PALMETTO/J1MAC NEWS****
Information regarding the Holding of Claims for Services Paid Under the
2010 Medicare Physician Fee Schedule
The Centers for Medicare & Medicaid Services (CMS) has instructed its
contractors to hold claims containing services paid under the Medicare
Physician Fee Schedule (MPFS) for the first 10 business days of January
(January 1 through January 15) for 2010 dates of service. This should have
minimum impact on provider cash flow because, under current law, clean
electronic claims are not paid any sooner than 14 calendar days (29 days
for paper claims) after the date of receipt. Meanwhile, all claims for
services delivered on or before December 31, 2009, will be processed and
paid under normal procedures.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YXP3P3276?opendocument

Introduction to PC-ACE Pro32
Everything you've wanted to know about PC-ACE Pro32, Palmetto GBA's claims
entry software, but we're afraid to ask.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YXKRZ5802?opendocument

Revisions to Consultation Services Payment Policy
This J1 A/B MAC MLN Matters article (CR6740) was revised on December 17,
2009, to correct the ‘initial hospital day codes’ referenced on the top of
page 4. This article alerts providers that effective January 1, 2010, the
Current Procedural Terminology (CPT) consultation codes are no longer
recognized for Medicare Part B payment. Effective for services furnished on
or after January 1, 2010, providers should code a patient evaluation and
management visit with E/M codes that represents where the visit occurs and
that identify the complexity of the visit performed. Please be sure to
share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YUT8H8112?opendocument

The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!

Thursday, December 17, 2009

CMS & Palmetto/J1MAC News

The following information has been received by ANCO.

****CMS NEWS****
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the posting of 2010 Physician Quality Reporting Initiative (PQRI) educational products to the PQRI webpage at www.cms.hhs.gov/PQRI on the CMS website:

2010 PQRI Quality Measure List- this document identifies the 179 quality measures (this includes 175 individual quality measures and the 4 measures in the Back Pain measures group, which are not reportable as individual PQRI quality measures) selected for the 2010 PQRI

2010 PQRI Quality Data Code (QDC) Categories – a table that outlines, for each measure, each QDC that should be reported for a corresponding quality action performed by the individual EP as noted in the measures specification. This determines how each code will be used when calculating performance rates. This also clarifies those measures that require 2 or more QDCs to report satisfactorily. Insufficiently reporting the QDCs (as specified in the 2010 PQRI measure specifications) will result in invalid reporting.

2010 Single Source Code Master- this file includes a numerical listing of all codes included in 2010 PQRI for incorporation into billing software.

2010 PQRI Measure Specifications Manual for Claims and Registry; Reporting of Individual Measures and Release Notes- this zip file contains two documents which are the authoritative documents that describe 1) the 2010 measure specifications (including codes and reporting instructions) for the 175 individual PQRI quality measures for claims or registry-based reporting and 2) changes from the 2009 PQRI Measure Specifications in the form of release notes delineated by measure number.

2010 PQRI Implementation Guide- provides guidance about how to implement 2010 PQRI claims-based reporting of measures to facilitate satisfactory reporting of quality data codes by EPs.

2010 PQRI Measures Groups Specifications Manual and Release Notes- measures group specifications that are different from those of the individual measures that form the group. The specifications and instructions for measures group reporting are, therefore, provided in a separate manual. This zip file contains two documents which are the authoritative documents that describe 1) the 2010 measures groups specifications (including codes and reporting instructions) for the 13 PQRI measures groups for claims or registry-based reporting and 2) changes from the 2009 PQRI Measures Groups Specifications Manual in the form of release notes.

Getting Started with 2010 PQRI Reporting of Measures Groups - provides guidance about implementing the 2010 PQRI measures groups.

2010 PQRI Measure Applicability Validation Process for Claims-Based Reporting of Individual Measures- provides guidance for those eligible professionals who satisfactorily submit quality-data codes for fewer than three PQRI measures, and how the measure-applicability validation process will determine whether they should have submitted QDCs for additional measures.

2010 PQRI Measure-Applicability Validation Process Release Notes- the release notes for the changes occurring for the 2010 PQRI Measure Applicability Validation Process (MAV).

2010 Measure-Applicability Validation Process Flow Chart- a chart that depicts the Measure Applicability Validation Process (MAV)

Group Practice Reporting Option (GPRO) Requirements for Submission of 2010 PQRI Data- provides guidance on how a group practice can self-nominate to participate in the GPRO for 2010 data submission.

2010 PQRI GPRO Disease Modules and Preventive Care Measures- a document containing a list of the 2010 PQRI GPRO Measures

2010 PQRI GPRO Narrative Measure Specifications- this document contains descriptions of the 2010 PQRI GPRO measures.

Registry Requirements for Submission of 2010 PQRI Data on Behalf of Eligible Professionals- this document describes the high-level requirements for a registry to qualify to submit under the registry-based reporting alternatives for 2010. This document also outlines how a registry can become qualified for 2010 data submission.

To access the 2010 PQRI educational products, visit the following page http://www.cms.hhs.gov/PQRI/02_Spotlight.asp on the CMS website. Once on the Spotlight page, view the listing of educational products and the corresponding webpages where they can be found.

Further information on the 2010 PQRI Program may be found in the final 2010 Medicare Physician Fee Schedule rule with comment period (74 FR 61788 through 61861) that was published in the Federal Register on October 30, 2009. The final rule can be found on the Physician Quality Reporting Initiative webpage at www.cms.hhs.gov/PQRI on the CMS website, click on the Statute/Regulations/Program Instructions section page at left.

Reporting for the 2010 PQRI begins January 1, 2010. Please note there is no need to sign up or pre-register in order to participate.

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the posting of 2010 Electronic Prescribing Incentive (eRx) Program educational products to the eRx webpage at www.cms.hhs.gov/ERxIncentive on the CMS website:

· 2010 eRx Measure Specifications and Release Notes- Provides guidance on the 2010 eRx measure specifications for claims or registry-based reporting and release notes describing changes from the 2009 eRx measure specifications.

· Claims-Based Reporting Principles for the 2010 eRx Incentive Program- provides guidance on the principles for reporting the eRx measure on claims for the 2010 eRx Incentive Program.

· 2010 EHR Measure Specifications for eRx and Release Notes- provides guidance on The 2010 EHR measure specifications for eRx and release notes. In addition it details the specifications contain a detailed description of data element names and codes.

· 2010 EHR Downloadable Resource- an Excel spreadsheet listing 2010 EHR information.

· Group Practice Reporting Option (GPRO) Requirements for Submission of 2010 eRx Data- provides guidance on the Group Practice Reporting Option (GPRO) requirements for submission of 2010 eRx data.

· GPRO eRx Measure Specifications- provides guidance on the specifications for the eRx measure for use in the 2010 eRx GPRO.

To access the 2010 eRx educational products, visit the following page http://www.cms.hhs.gov/PQRI/02_Spotlight.asp on the CMS website. Once on the Spotlight page, view the listing of educational products and the corresponding webpages they can be found on.

Further information on the 2010 eRx Incentive Program may be found in the final 2010 Medicare Physician Fee Schedule rule with comment period (74 FR 61788 through 61861) that was published in the Federal Register on October 30, 2009. The final rule can be found on the Electronic Prescribing Incentive Program webpage at www.cms.hhs.gov/ERxIncentive on the CMS website, click on the Statute/Regulations/Program Instructions section page at left.

Reporting for the 2010 eRx begins January 1, 2010. Please note there is no need to sign up or pre-register in order to participate.

MM6742 – Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy Print (MREP) Update
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6742.pdf

MM6540 – Tracking the Hospice Attending Physician’s National Provider Identifier (NPI) for Validating Hospice Part B Payments
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6540.pdf

MM6723 – Claim Status Category Code and Claim Status Code Update
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6723.pdf

MM6740 – Revisions to Consultation Services Payment Policy
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6740.pdf
This article pertains to Change Request (CR) 6740, which alerts physicians and non-physician practitioners that effective January 1, 2010, the Current Procedural Terminology (CPT) consultation codes (ranges 99241-99245 and 99251-99255) are no longer recognized for Medicare Part B payment. Effective for services furnished on or after January 1, 2010, physicians and non-physician practitioners should code a patient evaluation and management visit with E/M codes that represent where the visit occurs and that identify the complexity of the visit performed. For more information, please view the article located at: http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6740.pdf on the CMS website.

****PALMETTO/J1MAC NEWS****
The following J1 Part B LCDs have been revised: Botulinum Toxin Types A and
B Policy, CT Colonography (Virtual Colonoscopy), MammaPrint Test – Breast
Cancer Prognosis, Paravertebral Facet Joint Block and Facet Joint
Denervation, Plastic Surgery, Treatment of Varicose Veins of the Lower
Extremities and Urodynamics.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YMQVN3575?opendocument

J1 Part B LCD Updates
The following J1 Part B Local Coverage Determinations (LCDs) have been
revised: Ambulance Services L28235, Cardiovascular Nuclear Medicine,
Myocardial Perfusion Imaging and Cardiac Blood Pool Studies L28246,
Category III CPT Codes L28248, Intensity Modulated Radiation Therapy (IMRT)
L28272, Multidetector Computed Tomography of the Heart and Great Vessels
L28281, Nervous System Studies - Autonomic Function, Nerve and
Electromyography L28282, Pulmonary Function Testing L28295 and Vestibular
Function Testing L28314.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YRSHK8131?opendocument

J1 PCC Closing for Training Friday, December 18
The J1 Provider Contact Center (PCC) will be closed for training on Friday,
December 18, 2009, between 11 a.m. and 3 p.m. PST.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7QHNCM4448?opendocument

Part B LCD Ready for Comment
The following J1 Part B LCDs will be ready for comment: Circulating Tumor
Cell Marker Assays, Flow Cytometry, In Vitro Chemosensitivity &
Chemoresistance Assays, Physical Medicine and Rehabilitation Policy. The
comment period begins on January 7, 2010 and ends on March 1, 2010.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YMRA76424?opendocument

The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!

Monday, December 14, 2009

ASH, CMS, & Palmetto/J1MAC News

The following information has been received by ANCO.

****ASH NEWS****
The American Society of Hematology (ASH) Practice Update was published and is available online at http://www.hematology.org/Practice/Practice-Updates/4667.aspx. This edition features:

CMS Will Eliminate Consultation Codes – Effective January 1, 2010

Senate Works on Health Reform Legislation to Reach Passable Compromise

Let ASH Help You - Submit Your Medicare Reimbursement Questions to the Society Today

ASH Expresses Concern to CMS about New Medicare Enrollment Policy

Medicare Extends 2010 Annual Participation Enrollment Program

FDA Requests Help in Reporting New Cancer Cases For Patients Taking Stelara

Medicare Paid Over $92 Million in Incentives for 2008 Physician Quality Reporting Initiative

Medicare Releases Quarterly CCI Update

New Medicare Learning Network Booklet: How to Use the Medicare Coverage Database Search Tool

Don’t Miss the Only Official Highlights of ASH - Occurring Near You

****CMS NEWS****
MM6753 – Positron Emission Tomography (PET) (FDG) for Cervical Cancer
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6753.pdf

****PALMETTO/J1MAC NEWS****
2010 Annual Update to the Therapy Code List
This J1 A/B MAC MLN Matters article (CR6719) updates the therapy code list
for Calendar Year (CY) 2010 with one ‘Sometimes Therapy’ Code (laryngeal
function studies (e.g., aerodynamic testing and acoustic testing). Note
that this code always represents therapy services when performed by
therapists and requires the use of a therapy modifier. Please be sure to
share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YJMUB5278?opendocument

Open Draft LCD Meetings January 2010
Palmetto GBA J1 A/B Medicare Administrative Contractor (MAC) has scheduled
Open Draft Local Coverage Determination (LCD) meetings in California,
Nevada and Hawaii for January, 2010.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YDPHY0633?opendocument

Requirements to Prevent the Misuse of Modifiers PA, PB and PC on Incoming
Claims
This J1 A/B MAC MLN Matters article (CR6718) advises you that the PA, PB
and PC modifiers are often being submitted incorrectly on claims. This can
cause incorrect denials. The Centers for Medicare & Medicaid Services (CMS)
issued this article to direct contractors on handling incorrect claims in
order to alleviate the issue. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YJMQ43785?opendocument

J1 PCC Training and Holiday Closure Schedule for First Quarter Fiscal Year
2010
The J1 Provider Contact Center (PCC) training and holiday closure schedule
for the first quarter of the fiscal year (FY) 2010 is now available on our
Web site.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YDNNS3230?opendocument

My claim was returned with the message 'the procedure code is inconsistent
with the modifier used or a required modifier is missing.' Both HCPCS
modifier Q0 and CPT modifier 26 should be valid for the procedure code. Why
wasn’t my claim processed?
Functional (pricing) modifiers must be submitted in the first modifier
field in order for claims to be processed and reimbursed correctly. To
avoid processing delays, submit any informational (statistical) modifiers
after the functional modifier.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7XUL3Q0075?opendocument

Using the Redetermination/Reopening Request Form
To reduce the number of incorrectly submitted redetermination requests and
avoid unnecessary delay in forwarding requests to the proper department, we
strongly encourage providers to use the J1 Part B Redetermination/Reopening
Request Form. Redetermination requests received with an EDI Fax Cover Sheet
will be returned to you with no action taken.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YKQNG0476?opendocument

Updated: Medical Nutrition Therapy NCD Codes Denied in Error
Medical Nutrition Therapy claims processed on and after September 21, 2009,
were denied in error when submitted with a covered diagnosis. A mass
adjustment on 153 claims was completed on December 1, 2009, for services
previously denied in error.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7X4QUF1887?opendocument

The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!

Wednesday, December 9, 2009

CMA & Palmetto/J1MAC News

The following information has been received by ANCO.

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

CMA Clarifies Medical Liability Provisions in Health Reform Bills

CMS Delays Implementation of PECOS Enrollment Policy

CMA Heads to Washington to Fight for Improvements to Senate Health Reform Bill

CMA Urges CMS to Restore Payments for Consultation Codes

Physicians: Be Prepared for Disruption in Medicare Cash Flow this Month

DOI Lawsuit Against PacifiCare Begins Today

New E-Mail Scam Preys on Patients' H1N1 Fears

State Extends H1N1 Vaccine Thimerosal Exemption

CMA Publishes H1N1 Billing Guide

State Resurrects Regulations that Would Expand Scope of Nonphysicians

AHRQ Looking for Practices to Participate in E-Prescribing Implementation Study

****PALMETTO/J1MAC NEWS****
FAQs: Healthcare Integrated General Ledger Accounting System (HIGLAS)
Transition
Share with your staff - FAQs regarding the J1 Part B Healthcare Integrated
General Ledger Accounting System (HIGLAS) transition have been posted to
our Web site!
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YETAB5204?opendocument

J1 Provider Outreach and Education Event Calendar
J1 Part B providers, join Palmetto GBA J1 Provider Outreach and Education
team on December 15 for a Part B Ask the Contractor Teleconference (ACT) on
Medicare Updates!
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7TAL2C7131?opendocument

The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!

Monday, December 7, 2009

ACCC, CMS & Palmetto/J1MAC News

The following information has been received by ANCO.

****ACCC NEWS****
The Association of Community Cancer Center's (ACCC) Connect was published and is available online at http://www.accc-cancer.org/mediaroom/newsletters/2009/media_ACCConnect_12-2-2009.html. ANCO is an Institutional Member of ACCC. This edition features:

• Who Will Care for Tomorrow's Cancer Patients? ACCC Looks for Answers
• Next Week: Bring Out the Best in Your Cancer Service Line
• 2009 PQRI Conference Call on December 10
• Cancer Screenings Brochure Available From CMS
• Heard on ACCC's ListServ: Family Members in the Radiation Center
• Oncologists Optimistic about Future of Oncology Clinical Trials While Citing Cost as Barrier

****CMS NEWS****
MM6662 – Annual Update of HCPCS Codes Used for Home Health (HH) Consolidated Billing Enforcement
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6662.pdf

MM6728 – Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 16.0, Effective January 1, 2010
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6728.pdf

MM6540 – Tracking the Hospice Attending Physician’s National Provider Identifier (NPI) for Validating Hospice Part B Payments
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6540.pdf

The Centers for Medicare & Medicaid Services (CMS) would like to remind Physician Quality Reporting Initiative (PQRI) participants that there is a “Verify Report Portlet” look-up tool available on the PQRI Portal for Eligible Professionals (EPs) to verify if a 2007 re-run and/or 2008 PQRI feedback report exists for your organization's Tax Identification Number (TIN) or National Provider Identifier (NPI). The TIN or NPI must be the one used by the EP to submit Medicare claims and valid PQRI quality data codes. This tool is available at (https://www.qualitynet.org/portal/server.pt) on the internet.

If a report is available for your organization’s TIN or NPI there are two ways to access 2007 re-run and/or 2008 PQRI feedback reports:

1) An individual EP can simply call their respective Carrier or A/B MAC provider contact center to request confidential 2007 PQRI re-run and/or 2008 PQRI feedback reports that will contain information based on their individual NPI. If an EP is part of a group practice, each EP in the group practice must individually call their respective Carrier or A/B MAC provider contact center to request a feedback report based on the individual NPI. To obtain a list of Provider Contact Centers, visit (http://www.cms.hhs.gov/MLNProducts/Downloads/CallCenterTollNumDirectory.zip) on the CMS website. In addition to PQRI information, these reports will provide individual EPs with information on their Medicare Part B Physician Fee Schedule allowed charges for the 2007 or 2008 PQRI reporting period, upon which an incentive payment is based.

Additional information about this alternative feedback report request process can be found by accessing special edition Medicare Learning Network (MLN) article (SE0922) “Alternative Process for Individual Eligible Professionals to Access Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing (E-Prescribing) Feedback Reports.” Visit (http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0922.pdf) on the CMS website.

or
2) EPs can logon to the secure PQRI Portal on QualityNet at (http://www.qualitynet.org/portal/server.pt) to access their feedback report(s) based their TIN, or for a group. Access to the PQRI Portal requires registration in the Individuals Authorized Access to CMS Computer Services (IACS) system to obtain a userID and password.

Important Information on Updating IACS User Accounts and Passwords

CMS would like to remind users that the CMS Security policy requires IACS passwords to be changed every 60 days. An IACS user who has not changed his or her password in over 60 days will be prompted to do so at the next login attempt.

An IACS user who has not changed his or her password in over 120 days will first be prompted to answer the security questions established at registration. After successfully answering security questions, the user will then be prompted for a password change.

Updating IACS user accounts and passwords is essential to maintaining this access and functionality.

Resources
The IACS account management page is at (https://applications.cms.hhs.gov/category.html?name=acctmngmt).Click on “My Profile” to login, change your password, or use the “Forgot Password?” option.

If you are having difficulty with IACS registration or disabled accounts, follow the self-service instructions below on how to recover your IACS userId and/or password and/or change your IACS password.

Instructions for Retrieving Your IACS UserID
1. Go to the CMS Applications portal at (https://applications.cms.hhs.gov)
2. Enter the portal; select the Account Management tab, and then the “Forgot Your User ID?” link in the Account Management section. Follow the online instructions.
3. You will receive an email at the email address on record.

Instructions for Retrieving Your IACS Password
1. Go to the CMS Applications portal at (https://applications.cms.hhs.gov/warning.html)
2. Enter the portal; select the Account Management tab, and then “My Profile” link in the Account Management section.
3. Enter your UserID
4. Click on “Forgot Your Password?” button on the login page and follow the online instructions.
5. You will receive a onetime password in an email at the email address on record.

Instructions to Login and Change Your IACS Password:
1. Go to the CMS Applications portal at (https://applications.cms.hhs.gov)
2. Enter the portal; select the Account Management tab
3. Select the My Profile link
4. Login using your UserID and onetime temporary Password.
5. The system will prompt you to change your password.
6. Enter your new password in both the New Password and Confirm New Password fields and then select the Change Password button.
7. The system will take you back to the My Profile screen.
8. Log out.

Once you have successfully changed your password you may login and access your PQRI feedback report(s) on the PQRI portal at (https://www.qualitynet.org/portal/server.pt).

If you are still having difficulty with IACS registration or disabled accounts, please contact the External Users Services (EUS) Help Desk
at 1-866-484-8049, TTY/TDD at 1-866-523-4759 (Monday – Friday 7:00 a.m.-7:00 p.m. EST) or via e-mail at EUSSupport@cgi.com.

The IACS home page for the Provider/Supplier user Community, which includes PQRI, is at (http://www.cms.hhs.gov/IACS/04_Provider_Community.asp#TopOfPage) on the CMS website. Provider Community users should direct questions or concerns to the External User Services (EUS) Help Desk at 1-866-484-8049, TTY/TDD at 1-866-523-4759 (Monday - Friday 7:00 a.m.-7:00 p.m. EST) or via email atEUSSupport@cgi.com.

The PQRI Portal is available at (https://www.qualitynet.org/portal/server.pt) on the internet. Although the “Forgot Password” link on the PQRI Portal sends users to the IACS website, IACS and the PQRI Portal are two separate websites.

Additional information about PQRI can be found at (http://www.cms.hhs.gov/PQRI) on the CMS website. For more information on the 2007 re-run and 2008 PQRI feedback reports or incentive payments, see the "PQRI and eRx Quick-Reference Support Guide for Eligible Professionals" at (http://www.cms.hhs.gov/PQRI/Downloads/PQRI-eRxEPQuickRefGuideDiagram_100209.pdf) on the CMS website.

Users who still have questions or need assistance should contact the QualityNet Help Desk at 1-866-288-8912 (Monday-Friday 7:00 a.m.-7:00 p.m. CST) or qnetsupport@sdps.org.

****PALMETTO/J1MAC NEWS****
December 2009 J1 A/B MAC Medicare Advisory
Updates and changes were made to the December 2009 J1 A/B MAC Medicare
Advisory. It is available on the Web site. Please be sure to share this
with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7Y5M4G5545?opendocument

Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 16.0,
Effective January 1, 2010
This J1 Part B MLN Matters article (CR 6728) provides a reminder for
physicians to take note of the quarterly updates to Correct Coding
Initiative (CCI) edits. The last quarterly release of the edit module was
issued in October 2009. The Centers for Medicare & Medicaid Services (CMS)
developed the National Correct Coding Initiative (CCI) to promote national
correct coding methodologies and to control improper coding that leads to
inappropriate payment in Part B claims. Please be sure to share with your
staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YBT823658?opendocument

Annual Update of HCPCS Codes Used for Home Health (HH) Consolidated Billing
Enforcement
This J1 A/B MAC MLN Matters article (CR6662) provides the annual Home
Health (HH) consolidated billing update effective January 1, 2010. The
Centers for Medicare & Medicaid Services (CMS) periodically updates the
lists of Health Care Common Procedure Codes System (HCPCS) codes subject to
the consolidated billing provision of the Home Health Prospective Payment
System (HH PPS). Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YCN4K0087?opendocument

HIGLAS Transition: Impact on J1 Part B Medicare Providers
Palmetto GBA Jurisdiction 1 MAC has updated the Healthcare Integrated
General Ledger Accounting System (HIGLAS) transition time table posted on
our Web site. The HIGLAS transition will be completed December 16, 2009. At
the same time, processing backlogged files and issuing payments will begin.
From December 16 to December 30, 2009, providers may experience a
significant reduction in payments due to the early claim payments issued
immediately prior to the transition. Providers need to monitor and manage
their cash flows during this time period.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7Y3LRC5231?opendocument

J1 Provider Outreach and Education Event Calendar
What's new in December 2009? The updated Palmetto GBA J1 Event Calenar is
now available on our Web site!
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7TAL2C7131?opendocument

Technical Corrections To The Relative Value Units
This article reflects technical corrections to the relative value units,
including various CPT codes, and to the CY 2010 conversion factor contained
in the CY 2010 Medicare physician fee schedule final rule. Please be sure
to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YBTF22165?opendocument

2010 J1 Part B Fee Schedules
The 2010 J1 Part B Fee Schedules for California are now available and are
effective January 1, 2010. The 2010 J1 Part B Fee Schedules for Nevada,
Hawaii, Guam, American Samoa and the Northern Mariana Islands will be
coming soon.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7Y3GZA7365?opendocument

J1 EDI Enrollment Packet
The Jurisdiction 1 A/B MAC EDI Enrollment Packet has been updated with a
new form. The Provider Authorization form must be completed by the provider
to authorize a clearinghouse and/or billing service as an electronic
submitter and recipient of electronic claims data. Please begin using this
updated packet immediately.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7XPTLJ4585?opendocument

Therapy Cap Values for Calendar Year (CY) 2010
This J1 A/B MAC MLN Matters article (CR6660a) describes the policy for
outpatient therapy caps for 2010 and announces that therapy caps for 2010
will be $1,860. This article was revised on November 24, 2009, to reflect a
revised CR 6660 that the Centers for Medicare & Medicaid Services (CMS)
issued on November 23, 2009. As a result of the revised CR, the article was
revised to include Regional Home Health Intermediaries as an additional
contractor type involved with this issue. The CR release date, transmittal
number and Web address for accessing CR 6660 were also changed. Also,
carriers were added as a contractor type involved as they were
inadvertently not included in the original article. All other information
remains the same. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YCMRD2255?opendocument

ACT Call: Medicare Updates - December 15, 2009
Join us for a J1 Part B Ask the Contractor Teleconference (ACT) regarding
Medicare Part B General Updates on Tuesday, December 15, 2009, at 12:30
p.m. PST.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YERHB5637?opendocument

ACT Minutes: Top 10 Claim Submission Errors - November 19, 2009
The meeting minutes of the J1 Part A Ask the Contractor Teleconference on
November 19, 2009, is now available on our Web site.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YESW92524?opendocument

J1 Provider Outreach and Education Event Calendar
Check out the new Palmetto GBA J1 Provider Outreach and Education events
added to our December 2009 online Events calendar!
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7TAL2C7131?opendocument

Tracking the Hospice Attending Physician’s National Provider Identifier
(NPI) for Validating Hospice Part B Payments
This J1 A/B MAC MLN Matters article (CR6540) is meant to ensure that the
hospice-reported data in the Notice of Election (NOE) and claims for the
attending physician, which may be a Nurse Practitioner (NP), meet the
definition of attending physician/NP in the Code of Federal Regulations
(CFR), while also reporting the hospice physician responsible for
certifying the terminal illness. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YEMNL2613?opendocument

Webinar: Bundled Services December 16
Palmetto GBA J1 Part B providers, join us on Wednesday, December 16, 2009,
for a free Webinar on Bundled Services!
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YERCG5273?opendocument

The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!

Monday, November 30, 2009

CMS & Palmetto/J1MAC News

The following information has been received by ANCO.

****CMS NEWS****
MM6685 – New Waived Tests
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6685.pdf

MM6660 – Therapy Cap Values for Calendar Year (CY) 2010
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6660.pdf

****PALMETTO/J1MAC NEWS****
December 2009 J1 A/B MAC Medicare Advisory
The December 2009 J1 A/B MAC Medicare Advisory is available on the Web
site. Please be sure to share this with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7Y5M4G5545?opendocument

Monday, November 23, 2009

CMS & Palmetto/J1MAC News

Wednesday, November 18, 2009

CMA, CMS, & Palmetto/J1MAC News

The following information has been received by ANCO.

****CMA NEWS****
The California Medical Association's (CMA) Alert was published and is available online at http://www.calphys.org/html/alert111609.asp. This edition features:

Blue Shield Planning to Publish Physician Ratings Based on Faulty CPPI Data

U.S. House Introduces Bill that Would Exempt Small Health Care Organizations from Red Flags Rule

Are Your Payors in Good Financial Health?

2010 Medicare Payment Rule Cuts Physician Payments by 21.2%; Eliminates Payment for Consultations

U.S. House to Take Critical SGR Vote this Week; Physicians Urged to Call

Appeals Court Protects California’s Voter-Enacted Drug Treatment Program

Blue Cross Extends Healthy Families Continuity of Care Plan

****CMS NEWS****
Due to recent revisions that were made to the 2010 Medicare Physician Fee Schedule (MPFS), the Centers for Medicare & Medicaid Services (CMS) has extended the 2010 Annual Participation Enrollment Program end date from December 31, 2009, to January 31, 2010 – therefore, the enrollment period now runs from November 13, 2009, through January 31, 2010.

The effective date for any Participation status change during the extension, however, remains January 1, 2010; and will be in force for the entire year.

Contractors will accept and process any Participation elections or withdrawals, made during the extended enrollment period that are received or post-marked on or before January 31, 2010.

Note: This is an extension of the annual participation enrollment period dates in CR 6637 (Transmittal 1832 -- Calendar Year (CY) 2010 Participation Enrollment and Medicare Participating Physicians and Suppliers Directory (MEDPARD) Procedures), dated October 16, 2009.

The Participation Agreement (CMS-Form 460) is available on the CD-ROM that is sent out annually by your Medicare contractor during the Annual Participation Enrollment period. Your contractor will also make the Participation Agreement available to you by placing it on their Websites with Participation enrollment (and termination) instructions.

MM6660 – Therapy Cap Values for Calendar Year (CY) 2010
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6660.pdf

MM6690 – Update to Medicare Deductible, Coinsurance, and Premium Rates for 2010
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6690.pdf

MM6723 – Claim Status Category Code and Claim Status Code Update
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6723.pdf

MM6708 – January 2010 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/MM6708.pdf

SE0929 – 2010 Annual Participation Enrollment Program Extension
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0929.pdf

****PALMETTO/J1MAC NEWS****
California Contractor Advisory Committee Meeting Minutes
The following are minutes from the California Contractor Advisory Committee
Meeting on October 13, 2009, in San Francisco, CA. Please be sure to share
with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7XRT268315?opendocument

CMS No Longer Recognizes HCPCS Code for Payment of Non-Outpatient Hospital
Claims
The following article announces that, effective immediately, the Centers
for Medicare & Medicaid Services (CMS) will no longer recognize the
Healthcare Common Procedure Coding System (HCPCS) Code for payment of
non-outpatient hospital claims. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7XVLYX8318?opendocument

J1 Provider Outreach and Education Event Calendar
What's new in November 2009? The updated Palmetto GBA J1 Event Calenar is
now available on our Web site!
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7TAL2C7131?opendocument

The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!

Monday, November 16, 2009

CMS & Palmetto/J1MAC News

The following information has been received by ANCO.

****CMS NEWS****
More than 85,000 physicians and other eligible professionals who successfully reported quality-related data to Medicare under the 2008 Physician Quality Reporting Initiative (PQRI) received incentive payments totaling more than $92 million, the Centers for Medicare & Medicaid Services (CMS) announced today, well above the $36 million paid in 2007.

The number of eligible professionals who earned an incentive payment increased by one-third from 2007, when 56,700 eligible professionals earned an incentive payment. In 2007, eligible professionals could only participate in the program during a 6-month reporting period. In 2008, the program expanded to allow reporting for either a 6-month or a 12-month period.

“We are very pleased with the results for 2008,” said Charlene Frizerra, Acting CMS Administrator. “More health professionals have successfully reported data, and the substantial growth in the national total for PQRI incentive payments demonstrates that Medicare can align payment with quality incentives.

To read the entire CMS Press release issued today (11/13) click here: http://www.cms.hhs.gov/apps/media/press_releases.asp

To read the entire CMS Fact Sheet issued today (11/13) click here: http://www.cms.hhs.gov/apps/media/fact_sheets.asp

CMS recently announced its plan for the 2010 PQRI Program as part of the Medicare Physician Fee Schedule final rule. A fact sheet on the 2010 PQRI Program is available online at http://www.cms.hhs.gov/apps/media/press/factsheet.asp?Counter=3541&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date.

More information about the PQRI program, including participation guidance and the criteria to qualify for an incentive payment is available at www.cms.hhs.gov/PQRI.

****PALMETTO/J1MAC NEWS****
Radiopharmaceutical Drugs that Require An Invoice for Pricing
The list of HCPCS codes for radiopharmaceutical drugs that require an
invoice for pricing has been updated. An invoice is required with each
claim in order for the service to be priced for radiopharmaceuticals that
Palmetto GBA does not have pricing available for.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7RAQMD6147?opendocument

The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!

Friday, November 13, 2009

ASH, CMS & Palmetto/J1MAC News

The following information has been received by ANCO.

****ASH NEWS****
The American Society of Hematology's (ASH) Practice Update was published and is available online at http://www.hematology.org/Practice/Practice-Updates/4498.aspx. This edition features:

• House Advances Health-Care Reform Legislation: Now Is the Time to Take Action to Support Physician Payment Fix
• ASH Practice Forum: New American Health-Care Policy and the Practice of Hematology
• Medicare Releases Final 2010 Payment Regulations; Physician Payment to Be Cut 21 Percent Absent Congressional Action
• Medicare Announces Changes to Hospital Outpatient Payment in 2010
• Medicare RAC Program Goes National – What You Need to Know
• FDA Issues Drug Warning on Dexferrum (Iron Dextran Injection)
• Medicare Contractors to Review Claims Data Related to Chemotherapy Administration
• CMS Announces 2008 PQRI Payments and Feedback Reports
• ASH Annual Meeting: Policy & Practice Events You Will Want to Attend
• Four Dates, Six Locations, One Great Program – The Only Official Highlights of ASH

****CMS NEWS****
MM6670 – Instructions for Processing Claims Containing Anti-Markup Services but with Partial Information Completed in Item 20 of the CMS-1500 Claim Form
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6670.pdf

MM6717 – Changes to the Laboratory National Coverage Determination (NCD) Edit Software for January 2010
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6717.pdf

Centers for Medicare & Medicaid Services
Special Open Door Forum:
2009 Physician Quality Reporting Initiative (PQRI) Program with the American College of Emergency Physicians (ACEP)/CEP America
Thursday, November 12, 2009
2:00-3:30 pm ET Conference Call Only

The Centers for Medicare & Medicaid Services (CMS) will co-host a Special Open Door Forum on the 2009 PQRI Program with the American College of Emergency Physicians/CEP America. The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) made the PQRI program permanent, but only authorized incentive payments through 2010. Eligible professionals who meet the criteria for satisfactory submission of quality measures data for services furnished during the reporting period, January 1, 2009 - December 31, 2009, will earn an incentive payment of 2.0 percent of their total allowed charges for Physician Fee Schedule (PFS) covered professional services furnished during that same period. The 2009 PQRI consists of 153 quality measures and 7 measures groups.

This Special Open Door Forum will be geared towards emergency medicine-specific topics related to participation in the PQRI Program. Following the presentation, the telephone lines will be opened to allow participants to ask questions of the ACEP/CEP America presenters, including: Dennis Beck, MD FACEP; Richards Newell, MD MPH; and Mike Granovsky, MD FACEP, as well as CMS PQRI subject matter experts.

PQRI information and educational products are available on the PQRI dedicated web page located at http://www.cms.hhs.gov/PQRI, on the CMS website.

We look forward to your participation.

Special Open Door Forum Participation Instructions:
Dial: 1-800-837-1935 Conference ID 31712023
Note: TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will A Relay Communications Assistant will help.
An audio recording and transcript of this Special Forum will be posted to the Special Open Door Forum website at http://www.cms.hhs.gov/OpenDoorForums/05_ODF_SpecialODF.asp and will be accessible for downloading beginning November 23, 2009.
For automatic emails of Open Door Forum schedule updates (E-Mailing list subscriptions) and to view Frequently Asked Questions please visit our website at http://www.cms.hhs.gov/opendoorforums/.
Thank you for your interest in CMS Open Door Forums.

****PALMETTO/J1MAC NEWS****
How to Determine If You Are an Independent Diagnostic Testing Facility
(IDTF)?
Are you an Independent Diagnostice Testing Facility? If a substantial
portion of the entity’s business involves the performance of diagnostic
tests, the diagnostic testing services might be a sufficiently separate
business to warrant enrollment as an independent diagnostic testing
facility. In that case, the physician or group can continue to be enrolled
as a physician or a group practice of physicians, but must also enroll as
an independent diagnostic testing facility.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7QMR824802?opendocument

Updated: Independent Diagnostic Testing Facility Table
The updated version of the Independent Diagnostic Testing Facility Table
(IDTF) is now available on the Palmetto GBA J1 Web site.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7QUPVL5118?opendocument

Reason/Remark Code Lookup
Check out the handy PDF lists of the current Medicare specific
Reason/Denial Codes and the Remark Codes on the Palmetto GBA J1 Web site!
These two PDF lists will be updated annually.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7XMTNC3288?opendocument

Updated: Independent Diagnostic Testing Facilities:Therapeutic
Procedures/Effect on Availability of Codes
The Independent Diagnostic Testing Facility (IDTF) Local Coverage
Determination (LCD) was retired, as there were CPT codes listed in the LCD
that were not diagnostic services or were inappropriate for an IDTF. A mass
adjustment was completed on August 24, 2009, with 619 claims adjusted in
Southern California, 259 claims in Northern California and 28 claims in
Hawaii and Nevada.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7T4KKD1007?opendocument

2010 Medicare Physician Fee Schedule (MPFS) Amounts Currently Unavailable
The 2010 Medicare Physician Fee Schedule (MPFS) amounts are currently
unavailable until further notice, but will be posted as soon as they become
available. Please check this Web site periodically for any updates.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7XPMAE2184?opendocument

The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!

Monday, November 9, 2009

CMS & Palmetto/J1MAC News

The following information has been received by ANCO.

****CMS NEWS****
The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host a national provider conference call on the 2009 Physician Quality Reporting Initiative (PQRI). This toll-free call will take place from 1:00 p.m. – 3:00 p.m., EST, on Tuesday, November 10, 2009.

The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) made the PQRI program permanent, but only authorized incentive payments through 2010. Eligible professionals who meet the criteria for satisfactory submission of quality measures data for services furnished during the reporting period, January 1, 2009 - December 31, 2009, will earn an incentive payment of 2.0 percent of their total allowed charges for Physician Fee Schedule (PFS) covered professional services furnished during that same period. The 2009 PQRI consists of 153 quality measures and 7 measures groups.

The topics covered on this national provider call will include:

· Updates on 2008 PQRI and 2007 PQRI re-run incentive payments & feedback reports;
· Results from the 2008 PQRI and 2007 PQRI re-run;
· An update on 2010 PQRI and E-prescribing programs; and
· What to expect on your feedback report.

Following the presentation, the lines will be opened to allow participants to ask questions of CMS PQRI subject matter experts.

Educational products are available on the PQRI dedicated web page located at http://www.cms.hhs.gov/PQRI , on the CMS website, in the Educational Resources section, as well as educational products are available on the e-prescribing dedicated web page located at http://www.cms.hhs.gov/ERxIncentive on the CMS website. Feel free to download the resources prior to the call so that you may ask questions of the CMS presenters.

Conference call details:

Date: November 10, 2009

Conference Title: Physician Quality Reporting Initiative (PQRI) - National Provider Call

Time: 1:00 p.m. EST

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. Registration will close at 1:00 p.m. EST on November 9, 2009, 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://www.eventsvc.com/palmettogba/111009b
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 who will be unable to attend, a transcript of the call will be available at least one week after the call at http://www.cms.hhs.gov/pqri on the CMS website.

If you require services for the hearing impaired please send an email to:Medicare.TTT@PalmettoGBA.com.

MM6547 – Processing of Non-Covered International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Procedure Codes on Inpatient Hospital Claims
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6547.pdf

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that PQRI feedback reports are now available for the 2007 re-run and 2008 PQRI programs. Incentive payments for 2008 PQRI were distributed in October 2009. Incentive payments for the 2007 PQRI re-run will be distributed to eligible professionals (EPs) that are newly incentive-eligible in November 2009.

CMS has posted two educational guides on understanding the PQRI incentive payments for the 2007 re-run and for 2008. To access “A Guide for Understanding the 2007 Re-Run PQRI Incentive Payment” visit http://www.cms.hhs.gov/PQRI on the CMS website and click on the 2007 PQRI Program section page at the left. To access “A Guide for Understanding the 2008 PQRI Incentive Payment” visit http://www.cms.hhs.gov/PQRI on the CMS website and click on the 2008 PQRI Program section page at the left.

How to Access Feedback Reports based on Individual National Provider Identifiers (NPIs)
CMS has created an alternative feedback report request process for EPs requesting PQRI feedback reports based on their individual NPI. It is not necessary for EPs requesting a feedback report based on their individual NPI to register in the Individuals Authorized Access to CMS Computer Services (IACS) system to use the alternative feedback report request process.

Individual eligible professionals can simply call their respective Carrier or A/B MAC Provider Contact Center to request confidential 2007 PQRI re-run and 2008 PQRI feedback reports that will contain information based on their individual NPI. To obtain a list of Provider Contact Centers, visit http://www.cms.hhs.gov/MLNProducts/Downloads/CallCenterTollNumDirectory.zip on the CMS website. In addition to PQRI information, these reports will provide individual EPs with information on their Medicare Part B Physician Fee Schedule allowed charges for the 2007 or 2008 PQRI reporting period, upon which an incentive payment is based.

Additional information about the alternative feedback report request process can be found by accessing special edition Medicare Learning Network (MLN) article (SE0922) “Alternative Process for Individual Eligible Professionals to Access Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing (E-Prescribing) Feedback Reports.” Visit http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0922.pdf on the CMS website.

How to Access Feedback Reports based on Tax Identification Numbers (TINs)
EPs requesting feedback reports based on Tax Identification Numbers (TINs) or by groups will be required to access their PQRI feedback reports through the secure PQRI Portal on QualityNet athttp://www.qualitynet.org/portal/server.pt on the internet. The “Verify TIN Report Portlet” on the Home Page of the PQRI Portal can be utilized to verify if a feedback report exists for your organization's TIN or individual NPI. A user login must be established before reports can be accessed. If you do not have an IACS account, you must apply for an account to gain access to the PQRI Portal and retrieve the feedback reports. Information on establishing an IACS Account is available in Section 3 of the PQRI Portal User Guide. To access the PQRI User Guide go to http://www.qualitynet.org/portal/server.pt on the Internet.

If you have established an IACS account and have received a user name and password, but have forgotten your password, you can retrieve it through the Home Page of the PQRI Portal by clicking on “Forgot Your Password?” This will route you to the CMS Account Management page at https://applications.cms.hhs.gov/category.html?name=acctmngmt on the CMS website. Please contact the EUS Help Desk at 1-866-484-8049 or TTY: 1-866-523-4759 if you are having difficulty accessing your IACS account or to obtain a new one.

Once your user login is established, click on “Sign In” on the Home Page of the PQRI Portal, which will route you to the Sign In screen. (Note that the Sign In page requires your IACS credentials, not any Quality Net credentials you may possess.) Enter your User Name and Password in the fields provided and click on “Sign In.” You will then be asked to read and accept the Terms and Conditions.

After accepting the Terms and Conditions, you will be routed to the PQRI Report Delivery System (RDS) Reports Portlet where confidential feedback reports can be retrieved. Available reports will be listed in the main body of the page. Only reports that are relevant to your TIN organization or individual practice will display.

To view a report, click on the report name. The selected report will display on the screen. To keep a copy of the report, you will need to save the report to your computer. Detailed information on available reports can be found in “User Guide: 2007 Re-Run and 2008 PQRI Feedback Reports” available at http://www.cms.hhs.gov/PQRI/Downloads/UserGuide2007Re-Runand2008PQRIFeedbackReports.pdf on the CMS website.

To log off of the PQRI Portal, click on “Log Off” in the upper left hand corner of the page.
Help Desk Resources

For more information on the 2007 re-run and 2008 PQRI feedback reports or incentive payments, see the “PQRI and eRx Quick-Reference Support Guide for Eligible Professionals” at http://www.cms.hhs.gov/PQRI/Downloads/PQRI-eRxEPQuickRefGuideDiagram_100209.pdf on the CMS website.

Additional information about PQRI can be found at http://www.cms.hhs.gov/PQRI on the CMS website.

****PALMETTO/J1MAC NEWS****
Billing for Services Related to Voluntary Uses of Advance Beneficiary
Notices of Non-coverage (ABN)
This J1 A/B MLN article (CR6563) announces recent instructions for the use
of modifiers in association with Advance Beneficiary Notices (ABN).
Effective April 1, 2010, two HCPCS level-2 modifiers have been updated to
distinguish between voluntary and required uses of liability notices. Those
modifiers are: 1) -GA, which has been redefined to mean Waiver of
Liability Statement Issued as Required by Payer Policy and should be used
to report when a required ABN was issued for a service; and 2) -GX, which
has been created with the definition Notice of Liability Issued, Voluntary
Under Payer Policy and is to be used to report when a voluntary ABN was
issued for a service. Please be sure to share with with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7XGMNE6600?opendocument

October Update to the 2009 Medicare Physician Fee Schedule Database
(MPFSDB) (SCAL)
Effective October 5, 2009, for dates of service performed on or after
January 1, 2009, the Centers for Medicare and Medicaid Services (CMS) has
made a change to the following CPT codes on the 2009 Medicare Physician Fee
Schedule Database (MPFSDB). Please review.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7WNPT77105?opendocument

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