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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