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/policy/practice/04092009.cfm#1. This edition features:

Register Now: Join ASH Webinar on April 28 to Help Ensure You Receive PQRI and E-Prescribing Bonuses for Participation

ASH Works With NGS Regarding Coverage of Intravenous Palonosetron

CMS Open Door Call to Provide Information on Recovery Audit Contractor Program

ASH Urges Congress to Replace Current SGR Formula

Health-Care Reform Debate Continues in Washington

NQF Releases Updated Safe Practices for Better Healthcare


****CMS NEWS****
The Centers for Medicare & Medicaid Services (CMS) issued a final national coverage determination (NCD) to expand coverage for initial testing with positron emission tomography (PET) for Medicare beneficiaries who are diagnosed with and treated for most solid tumor cancers.
This NCD removes a clinical study requirement for PET scan use in these patients.

Since 2005, Medicare coverage of PET scans for diagnosing some forms of cancer and guiding treatment has been tied to a requirement that providers collect clinical information about how the scans have affected doctors’ treatment decisions. This information was gathered through the National Oncologic PET Registry (NOPR) observational study. Today’s decision removes the requirement to report data to the NOPR when the PET scan is used to support initial treatment (or diagnosis and “staging”) of most solid tumor cancers.

Medicare collects data from the NOPR under CMS’ Coverage with Evidence Development (CED) program. CED allows Medicare to develop evidence about how a medical technology is used in clinical practice so that Medicare can do the following:

(a) clarify the impact of these items and services on the health of Medicare beneficiaries;
(b) consider future changes in coverage for the technology; and
(c) generate clinical information that will improve the evidence base upon which providers base their recommendations to Medicare beneficiaries regarding the technology.

This decision is based, in part, on the information generated as a result of CMS’ 2005 decision to require NOPR reporting for many cancer PET scans. As a result of this evidence from NOPR, CMS reconsidered its 2005 coverage policy. This decision is the first time that CMS has reconsidered a coverage policy based on new evidence developed under the CED program.

“This expansion in coverage for PET scans shows that the Coverage with Evidence Development program is a success,” said CMS Acting Administrator Charlene Frizzera. “CED allowed us to cover an emerging technology, learn more about its usage in clinical practice, and adjust our coverage policies accordingly. Thanks to CED, Medicare beneficiaries have greater access to cutting edge medical technologies and treatments.”

This decision applies to PET scans used to support initial diagnosis and treatment for most types of solid tumor cancers. It also expands coverage of PET scans for subsequent follow up testing in beneficiaries who have cervical or ovarian cancer, or who are being treated for myeloma, a cancer that affects white blood cells. For these cancers, NOPR data collection will no longer be required.

It is important to note that today’s decision still requires clinicians to report data to the NOPR when using PET scans to monitor the progress of treatment or remission of cancer in some cases. Although the evidence generated by the NOPR study helped CMS determine that PET scans are useful in helping guide treatment when cancer is first diagnosed, scientific evidence is not as strong in showing that PET scans are as useful in making subsequent treatment decisions for some types of cancer.

A minimally invasive diagnostic imaging procedure, PET uses a radioactive tracer to evaluate glucose metabolism in tumors and in normal tissue. The test may provide important clinical information to guide the initial treatment approach (e.g., diagnosis and “staging”) for many cancers.

This additional information may help physicians to distinguish benign from cancerous lesions and better determine the extent of a tumor’s growth or metastasis. PET scans have also been used in subsequent testing for cancer patients, e.g., to monitor cancer progression or remission after cancer treatment has begun.

More information about the types of cancer covered by this new policy is available in CMS’ final decision memorandum. Read the final decision on the CMS Web site at http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=218.


Nearly $36 million in funding is being distributed to the 54 State Health Insurance Assistance Programs (SHIPs) to help people with Medicare get more information about their health care choices.

The $35.8 million in funding is the first installment of federal grant funds provided to SHIPs by the Centers for Medicare & Medicaid Services (CMS) for the grant year beginning April 1, 2009, and ending March 31, 2010. An additional $1.5 million in performance-based funding will be awarded in September 2009. SHIPs are state-based programs that use community-based networks to provide Medicare beneficiaries with local, personalized assistance on a wide variety of Medicare and health insurance topics.

“State Health Insurance Assistance Programs serve an important role in providing information and support to people with Medicare where they live,” said CMS Acting Administrator Charlene Frizzera. “These funds help ensure SHIPs continue their work with state and local governments, community-based organizations and others to meet the needs, beyond health care, of our Medicare beneficiaries.”

CMS expects the SHIPs to use the 2009 funding to conduct targeted community-based outreach to people with Medicare who may be unable to access other sources of information. SHIPs will also provide outreach and assistance to current and newly eligible Medicare beneficiaries and their caregivers, with a special emphasis on reaching people who will most likely be eligible for Medicare’s low-income subsidy if they enroll in Medicare prescription drug coverage.

CMS will continue to support the quality of services provided by SHIPs through training, technical assistance, theSHIP Resource Center, and the online tools at www.medicare.gov to help people with Medicare.


The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the 2009 Data Submission Specifications for use in the 2009 PQRI Electronic Health Record (EHR) test are now posted on the QualityNet website.

As described in the Medicare Physician Fee Schedule (PFS) 2009 Final Rule, CMS is testing EHR data submission in cooperation with electronic health record vendors. These vendors were selected from those who self-nominated per a process described in the 2008 final PFS rule. The 2009 testing process will be similar to the testing process used for 2008. EHR vendors that are successful with the 2009 testing process will be "qualified" for possible PQRI data submission via EHRs if this means of data submission is used in a future PQRI reporting year. There is no incentive payment available through EHR-based data submission for 2009.

The Measure Specifications for the 2009 EHR test measures are also available on the QualityNet website by clicking on "PQRI" from the dropdown menu under the "Physician Offices" tab; then, click on the EHR Specifications link from the left navigation bar. The following link will take you to the QualityNet website on the internet: http://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier3&cid=1214232460333

A link to the QualityNet website is also available at http://www.cms.hhs.gov/PQRI on the CMS PQRI website under the “Related Links Outside CMS” tab. Additional information related to the EHR test is also available on the CMS PQRI website under the “Reporting” and “Measures/Codes” sections listed in the left navigation bar.

Detailed information on the 2009 PQRI program requirements may be found in the final 2009 Medicare PFS rule with comment period that was published in the Federal Register on November 19, 2008. A copy of the final rule with comment period is on display at the Federal Register and can be viewed at http://edocket.access.gpo.gov/2008/pdf/E8-14949.pdf on the internet. Additionally, the CMS PQRI web page http://www.cms.hhs.gov/PQRI on the CMS website is the primary resource for FAQs, helpful tools, and information on the PQRI program.

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2009 Physician Quality Reporting Initiative
National Provider Call with Question & Answer Session

The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host fourth in a series national provider conference calls on the 2009 Physician Quality Reporting Initiative (PQRI). This toll-free call will take place from 2:30 p.m. – 4:30 p.m., EDT, on Wednesday, April 22, 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:

An update on the prostate cancer measures-2008: Measure #101; 2008-2009: Measure #102, #104, and #105;

An update on Medicare enrollment;

Tips for satisfactorily participating in the 2009 PQRI; and

Planning for the 2010 PQRI reporting options.

Following this 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. Feel free to download the resources prior to the call so that you may ask questions of the CMS presenters.

Conference call details:

Date: April 22, 2009
Conference Title: 2009 Physician Quality Reporting Initiative-National Provider Call
Time: 2:30 p.m. EDT

In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation. If you cannot attend the call, replay information is available below.

Registration will close at 2:30 p.m. EDT on April 21, 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://www2.eventsvc.com/palmettogba/042209

Fill in all required data.

Verify your time zone is displayed correctly the drop down box.

Click "Register".

You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.

For those of you who will be unable to attend, a replay option will be available shortly following the end of the call. This replay will be accessible from 3:30 p.m. EDT 4/22/2009 until 11:59 p.m. EDT 4/29/2009. The call in data for the replay is (800) 642-1687 and the passcode is 90578004.

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


****PALMETTO/J1MAC NEWS****
Incorporation of Physician Fee Schedule Regulatory Changes into Chapter 10
of the Program Integrity Manual (PIM) revised
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~MLNs~General~Incorporation%20of%20Physician%20Fee%20Schedule%20Regulatory%20Changes%20into%20Chapter%2010%20of%20the%20Program%20Integrity%20Manual%20(PIM)%20revised?opendocument

If the above link does not work in your e-mail program, please use the
temporary alternate link provided below.
http://www.palmettogba.com/palmetto/providers.nsf/docsCat/8525746A00550AA38525758A005FE2CF?opendocument

CR6310b deletes the reference to electronic funds tranfer payments being
made only to a banking institution located in the state where the practice
is located. The original change request incorporates changes to the
physician fee schedule into Chapter 10 of the Program Integrity Manual
(PIM).