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


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