CMS & Palmetto/J1MAC News

The following information has been received by ANCO.


****CMS NEWS****
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the posting of 2010 Physician Quality Reporting Initiative (PQRI) educational products to the PQRI webpage at www.cms.hhs.gov/PQRI on the CMS website:

2010 PQRI Quality Measure List- this document identifies the 179 quality measures (this includes 175 individual quality measures and the 4 measures in the Back Pain measures group, which are not reportable as individual PQRI quality measures) selected for the 2010 PQRI

2010 PQRI Quality Data Code (QDC) Categories – a table that outlines, for each measure, each QDC that should be reported for a corresponding quality action performed by the individual EP as noted in the measures specification. This determines how each code will be used when calculating performance rates. This also clarifies those measures that require 2 or more QDCs to report satisfactorily. Insufficiently reporting the QDCs (as specified in the 2010 PQRI measure specifications) will result in invalid reporting.

2010 Single Source Code Master- this file includes a numerical listing of all codes included in 2010 PQRI for incorporation into billing software.

2010 PQRI Measure Specifications Manual for Claims and Registry; Reporting of Individual Measures and Release Notes- this zip file contains two documents which are the authoritative documents that describe 1) the 2010 measure specifications (including codes and reporting instructions) for the 175 individual PQRI quality measures for claims or registry-based reporting and 2) changes from the 2009 PQRI Measure Specifications in the form of release notes delineated by measure number.

2010 PQRI Implementation Guide- provides guidance about how to implement 2010 PQRI claims-based reporting of measures to facilitate satisfactory reporting of quality data codes by EPs.

2010 PQRI Measures Groups Specifications Manual and Release Notes- measures group specifications that are different from those of the individual measures that form the group. The specifications and instructions for measures group reporting are, therefore, provided in a separate manual. This zip file contains two documents which are the authoritative documents that describe 1) the 2010 measures groups specifications (including codes and reporting instructions) for the 13 PQRI measures groups for claims or registry-based reporting and 2) changes from the 2009 PQRI Measures Groups Specifications Manual in the form of release notes.

Getting Started with 2010 PQRI Reporting of Measures Groups - provides guidance about implementing the 2010 PQRI measures groups.

2010 PQRI Measure Applicability Validation Process for Claims-Based Reporting of Individual Measures- provides guidance for those eligible professionals who satisfactorily submit quality-data codes for fewer than three PQRI measures, and how the measure-applicability validation process will determine whether they should have submitted QDCs for additional measures.

2010 PQRI Measure-Applicability Validation Process Release Notes- the release notes for the changes occurring for the 2010 PQRI Measure Applicability Validation Process (MAV).

2010 Measure-Applicability Validation Process Flow Chart- a chart that depicts the Measure Applicability Validation Process (MAV)

Group Practice Reporting Option (GPRO) Requirements for Submission of 2010 PQRI Data- provides guidance on how a group practice can self-nominate to participate in the GPRO for 2010 data submission.

2010 PQRI GPRO Disease Modules and Preventive Care Measures- a document containing a list of the 2010 PQRI GPRO Measures

2010 PQRI GPRO Narrative Measure Specifications- this document contains descriptions of the 2010 PQRI GPRO measures.

Registry Requirements for Submission of 2010 PQRI Data on Behalf of Eligible Professionals- this document describes the high-level requirements for a registry to qualify to submit under the registry-based reporting alternatives for 2010. This document also outlines how a registry can become qualified for 2010 data submission.

To access the 2010 PQRI educational products, visit the following page http://www.cms.hhs.gov/PQRI/02_Spotlight.asp on the CMS website. Once on the Spotlight page, view the listing of educational products and the corresponding webpages where they can be found.

Further information on the 2010 PQRI Program may be found in the final 2010 Medicare Physician Fee Schedule rule with comment period (74 FR 61788 through 61861) that was published in the Federal Register on October 30, 2009. The final rule can be found on the Physician Quality Reporting Initiative webpage at www.cms.hhs.gov/PQRI on the CMS website, click on the Statute/Regulations/Program Instructions section page at left.

Reporting for the 2010 PQRI begins January 1, 2010. Please note there is no need to sign up or pre-register in order to participate.

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the posting of 2010 Electronic Prescribing Incentive (eRx) Program educational products to the eRx webpage at www.cms.hhs.gov/ERxIncentive on the CMS website:

· 2010 eRx Measure Specifications and Release Notes- Provides guidance on the 2010 eRx measure specifications for claims or registry-based reporting and release notes describing changes from the 2009 eRx measure specifications.

· Claims-Based Reporting Principles for the 2010 eRx Incentive Program- provides guidance on the principles for reporting the eRx measure on claims for the 2010 eRx Incentive Program.

· 2010 EHR Measure Specifications for eRx and Release Notes- provides guidance on The 2010 EHR measure specifications for eRx and release notes. In addition it details the specifications contain a detailed description of data element names and codes.

· 2010 EHR Downloadable Resource- an Excel spreadsheet listing 2010 EHR information.

· Group Practice Reporting Option (GPRO) Requirements for Submission of 2010 eRx Data- provides guidance on the Group Practice Reporting Option (GPRO) requirements for submission of 2010 eRx data.

· GPRO eRx Measure Specifications- provides guidance on the specifications for the eRx measure for use in the 2010 eRx GPRO.

To access the 2010 eRx educational products, visit the following page http://www.cms.hhs.gov/PQRI/02_Spotlight.asp on the CMS website. Once on the Spotlight page, view the listing of educational products and the corresponding webpages they can be found on.

Further information on the 2010 eRx Incentive Program may be found in the final 2010 Medicare Physician Fee Schedule rule with comment period (74 FR 61788 through 61861) that was published in the Federal Register on October 30, 2009. The final rule can be found on the Electronic Prescribing Incentive Program webpage at www.cms.hhs.gov/ERxIncentive on the CMS website, click on the Statute/Regulations/Program Instructions section page at left.

Reporting for the 2010 eRx begins January 1, 2010. Please note there is no need to sign up or pre-register in order to participate.


MM6742 – Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy Print (MREP) Update
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6742.pdf


MM6540 – Tracking the Hospice Attending Physician’s National Provider Identifier (NPI) for Validating Hospice Part B Payments
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6540.pdf


MM6723 – Claim Status Category Code and Claim Status Code Update
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6723.pdf


MM6740 – Revisions to Consultation Services Payment Policy
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6740.pdf
This article pertains to Change Request (CR) 6740, which alerts physicians and non-physician practitioners that effective January 1, 2010, the Current Procedural Terminology (CPT) consultation codes (ranges 99241-99245 and 99251-99255) are no longer recognized for Medicare Part B payment. Effective for services furnished on or after January 1, 2010, physicians and non-physician practitioners should code a patient evaluation and management visit with E/M codes that represent where the visit occurs and that identify the complexity of the visit performed. For more information, please view the article located at: http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6740.pdf on the CMS website.


****PALMETTO/J1MAC NEWS****
The following J1 Part B LCDs have been revised: Botulinum Toxin Types A and
B Policy, CT Colonography (Virtual Colonoscopy), MammaPrint Test – Breast
Cancer Prognosis, Paravertebral Facet Joint Block and Facet Joint
Denervation, Plastic Surgery, Treatment of Varicose Veins of the Lower
Extremities and Urodynamics.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YMQVN3575?opendocument


J1 Part B LCD Updates
The following J1 Part B Local Coverage Determinations (LCDs) have been
revised: Ambulance Services L28235, Cardiovascular Nuclear Medicine,
Myocardial Perfusion Imaging and Cardiac Blood Pool Studies L28246,
Category III CPT Codes L28248, Intensity Modulated Radiation Therapy (IMRT)
L28272, Multidetector Computed Tomography of the Heart and Great Vessels
L28281, Nervous System Studies - Autonomic Function, Nerve and
Electromyography L28282, Pulmonary Function Testing L28295 and Vestibular
Function Testing L28314.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YRSHK8131?opendocument


J1 PCC Closing for Training Friday, December 18
The J1 Provider Contact Center (PCC) will be closed for training on Friday,
December 18, 2009, between 11 a.m. and 3 p.m. PST.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7QHNCM4448?opendocument


Part B LCD Ready for Comment
The following J1 Part B LCDs will be ready for comment: Circulating Tumor
Cell Marker Assays, Flow Cytometry, In Vitro Chemosensitivity &
Chemoresistance Assays, Physical Medicine and Rehabilitation Policy. The
comment period begins on January 7, 2010 and ends on March 1, 2010.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YMRA76424?opendocument


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