CMS & Palmetto/J1MAC News

The following information has been received by ANCO.


****CMS NEWS****
Centers for Medicare & Medicaid Services
Special Open Door Forum:
2009 Physician Quality Reporting Initiative (PQRI) &
Electronic Prescribing (E-Prescribing) Incentive Programs
with the American Academy of Orthopaedic Surgeons and the American Association of Orthopaedic Executives

Tuesday, May 19, 2009
3:30pm-5pm ET
Conference Call Only

The Centers for Medicare & Medicaid Services (CMS) will co-host a Special Open Door Forum on the 2009 PQRI and E-Prescribing Incentive Programs with the American Academy of Orthopaedic Surgeons (AAOS) and the American Association of Orthopaedic Executives (AAOE).

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.

Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorizes a new and separate incentive program for individual eligible professionals who are successful electronic prescribers (e-Prescribers) as defined by MIPPA. This new incentive is separate from and is in addition to the quality reporting incentive program authorized by Division B of the Tax Relief and Health Care Act of 2006 - Medicare Improvements and Extension Act of 2006 (MIEA-TRHCA) and known as the Physician Quality Reporting Initiative (PQRI).

This Special Open Door Forum will be geared towards orthopaedic-specific topics related to participation in the PQRI and E-Prescribing Incentive Programs. Following the presentation, the telephone lines will be opened to allow participants to ask questions of the AAOS/AAOE presenters, including Robert H. Haralson, III, MD, MBA; Toya M. Sledd, MPH, MBA; Barbara Sack, MHSA, CMPE; as well as CMS PQRI subject matter expert, Sylvia Publ.

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

We look forward to your participation.

Special Open Door Forum Participation Instructions:
Dial: 1-800-837-1935 Conference ID 94236628

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 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 May 28, 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/ .


****PALMETTO/J1MAC NEWS****
Limits on Billed Amounts: Instructions for Submitting Claims
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~Limits%20on%20Billed%20Amounts%20Instructions%20for%20Submitting%20Claims?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/EFB6A9D625B136F5852575B50044D97E?opendocument

This J1 Part B article provides instructions for submitting claims to Part
B claims processing system (the Multi-Carrier System or MCS) when the total
charge on a single claim exceeds $99,999.99.


Modification of the Working Common File (CWF) Copybook to Transmit "WC"
Qualifier Alpha Codes to Various Systems
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20A~MLN%20Matters%20Articles~All%20Part%20A%20MLNs~Modification%20of%20the%20Working%20Common%20File%20(CWF)%20Copybook%20to%20Transmit%20"WC"%20Qualifier%20Alpha%20Codes%20to%20Various%20Systems?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/8525746A00550AA3852575B500605A4D?opendocument

This MLN Matters article, change request 6438, allows from the transfer of
the WC modifier's alpha codes from the CWF system to other important
Medicare systems.


Provider Enrollment Application Finder Help Tool
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~Provider%20Enrollment~General~Provider%20Enrollment%20Application%20Finder%20Help%20Tool?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/46C6740D13ABD39C852575B50044D988?opendocument

Are you unsure which provider enrollment application you need to complete
to obtain a provider number? Confused about what documents you should send
with your application? The Provider Enrollment Application Finder Help Tool
provides answers to these questions and more. By completing a quick
questionnaire, you can find out which application to submit, which sections
to complete, and what other documentation must be submitted with the
application. Try it today!


Revised: Medicare Claims Processing Manual Clarifications for Skilled
Nursing Facility (SNF) and Therapy Billing
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20A~MLN%20Matters%20Articles~All%20Part%20A%20MLNs~Revised%20Medicare%20Claims%20Processing%20Manual%20Clarifications%20for%20Skilled%20Nursing%20Facility%20(SNF)%20and%20Therapy%20Billing?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/8525746A00550AA38525758B00535476?opendocument

The revised MLN article (CR6407), Medicare Claims Processing Manual
Clarifications for Skilled Nursing Facility (SNF) and Therapy Billing is
now available on our Web site.