CMS & Palmetto/J1MAC News

The following information has been received by ANCO.


****CMS NEWS****
MM6417 – Expansion of the Current Scope of Editing for Ordering/Referring Providers for claims processed by Medicare Carriers and Part B Medicare Administrative Contractors (MACs)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6417.pdf

MM6455 – Ensuring Only Clinical Trial Services Receive Fee-for-Service (FFS) Payment on Claims Billed for Managed Care Beneficiaries
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6455.pdf

MM6330 – Clarification on Use of National Drug Codes (NDCs) in 837 I Billing
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6330.pdf

MM6431 – Billing Routine Costs of Clinical Trials
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6431.pdf


****PALMETTO/J1MAC NEWS****
PC-ACE Pro32 version 2.12 update file
http://www.palmettogba.com/palmetto/Providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~EDI~Software%20Manuals~PC-ACE%20Pro32%20version%20212%20update%20file?opendocument

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temporary alternate link provided below.
http://www.palmettogba.com/palmetto/Providers.nsf/docsCat/8525746A00550AA3852574F7007E6407?opendocument

The PC-ACE Pro32 software has been updated with several CMS Medicare
mandates and enhancements. All PC-ACE Pro32 users must download and install
the attached software update file immediately.


Updated: Independent Diagnostic Testing Facility Table
http://www.palmettogba.com/palmetto/Providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~Provider%20Enrollment~IDTF~Updated%20Independent%20Diagnostic%20Testing%20Facility%20Table?opendocument

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temporary alternate link provided below.
http://www.palmettogba.com/palmetto/Providers.nsf/docsCat/8525746A00550AA385257590006C0948?opendocument

This table shows the CPT codes, physician supervision levels and physician
and technician requirements for independent diagnostic testing facilities.


Important Information Regarding the Centers for Medicare & Medicaid
Services (CMS) National Claims Crossover Process
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20A~MLNs~All%20Part%20A%20MLNs~Important%20Information%20Regarding%20the%20Centers%20for%20Medicare%20Medicaid%20Services%20(CMS)%20National%20Claims%20Crossover%20Process?opendocument

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temporary alternate link provided below.
http://www.palmettogba.com/palmetto/providers.nsf/docsCat/8525746A00550AA3852575AD004610FA?opendocument

CR SE0909, which includes information on the National Claims Crossover
Process, requests that providers allow sufficient time for the Medicare
crossover process before attempting to balance bill their patients’
supplemental insurers and payers for amounts remaining after Medicare’s
payment determination on their submitted claims.