Monday, August 24, 2009

CMA & Palmetto/J1MAC News

The following information has been received by ANCO.


****CMA NEWS****
The California Medical Association (CMA) Alert was published and is available online at http://www.calphys.org/html/news.asp. This edition features:

Supreme Court Upholds Constitutionality of California’s Landmark Malpractice Reform Law

Health Reform Remains Hot Topic Over August Recess

Best Practices: Understanding Your Revenue Stream

Reminder – Review New Blue Shield Rates Prior to 10/1 Effective Date

Friday Is the Last Day to Request Your CPPI Patient Data

Proposed Optometrist Regulations Would Compromise Patient Safety

CDC Issues H1N1 Vaccination Recommendations

State Legislative Update

Physician EHR Case Study Chapter 2: A Spoonful of Sugar


****PALMETTO/J1MAC NEWS****
J1 Part B LCD Update
The following Part B LCDs have been revised: 3D Interpretation and
Reporting of Imaging Studies, Bone Mass Measurement, Erythropoietin
Stimulating Agents (ESA) and Vertebroplasty, Kyphoplasty; Percutaneous
(This LCD will be listed under Active).
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7V3PU45345?opendocument

Thursday, August 20, 2009

CMS News

The following information has been received by ANCO.


****CMS NEWS****
MM6606 – Update to the Hospice Payment Rates, Hospice Cap, Hospice Wage Index, and the Hospice Pricer for FY 2010
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6606.pdf

MM6585 – October 2009 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6585.pdf

MM6524 – Clinical Laboratory Fee Schedule – Medicare Travel Allowance Fees for Collection of Specimens
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6524.pdf

MM6407 – Medicare Claims Processing Manual Clarifications for Skilled Nursing Facility (SNF) and Therapy Billing
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6407.pdf

MM6518 – Appropriate Use of Modifier 50 and Add-On Current Procedural Terminology Codes (CPT) for Facet Joint Injection Services
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6518.pdf

Wednesday, August 19, 2009

CMS 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 2:30 p.m. – 4:30 p.m., EDT, on Thursday, August 20, 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:

Status of the 2007 re-run and 2008 PQRI Incentive payments and feedback reports;
How to access the 2007 re-run and 2008 PQRI feedback reports; Resources to assist eligible professionals; and
Briefing on PQRI and eRx proposals for 2010 contained in the 2010 PFS proposed rule.
A PowerPoint slide presentation will be posted to the PQRI webpage at, http://www.cms.hhs.gov/PQRI, on the CMS website for you to download prior to the call so that you can follow along with the presenter.

Following this 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, section, as well as educational products are available on the e-prescribing dedicated web page located at http://www.cms.hhs.gov/ERxIncentive. Feel free to download the resources prior to the call so that you may ask questions of the CMS presenters.

Conference call details:

Date: 8/20/2009
Conference Title: 2009 Physician Quality Reporting Initiative National Provider Call
Time: 2:30 p.m. EDT

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 today at 2:30 p.m. EDT, 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://www2.eventsvc.com/palmettogba/082009

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 you 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.

Monday, August 17, 2009

CMS News

The following information has been received by ANCO.


****CMS NEWS****
The following ICD-10-CM/PCS publications are now available from the Centers for Medicare & Medicaid Services Medicare Learning Network:

· ICD-10-CM/PCS Myths & Facts (June 2009), which presents correct information in response to some myths regarding the ICD-10-Clinical Modification/Procedure Coding System, is now available in print format. To place your order, visit http://www.cms.hhs.gov/MLNGenInfo/ , scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page.”

· ICD-10-CM-PCS Bookmark (revised August 2009), which provides information about the ICD-10-Clinical Modification/Procedure Coding System including the benefits of adopting the coding system, recommended steps to be taken in order to plan and prepare for implementation of the coding system, and where additional information about the coding system can be found, is now available in downloadable format at http://www.cms.hhs.gov/MLNProducts/downloads/ICD-10ClinModBookmrk.pdf .

Wednesday, August 12, 2009

Palmetto/J1MAC News

The following information has been received by ANCO.


****PALMETTO/J1MAC NEWS****
ACT Call: CERT - August 25, 2009
The J1 Part B ACT on Comprehensive Error Rate Testing (CERT) is scheduled
for Tuesday, August 25 at 12:30 p.m. PST. To participate, please call (866)
284-9338 with Conference ID 24753139.
http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7UKT428603?opendocument


J1 Provider Contact Center To Be Closed for Training Friday, August 14
The J1 PCC will be closed for training on Friday, August 14, 2009, from 11
a.m. to 3 p.m. PST.
http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7UKR758603?opendocument


Medicare Secondary Payer: Explanation Form for Secondary Insured Claims
After reviewing the number of paper claims that have been denied or
returned for illegible, missing, invalid information, Palmetto GBA wanted
to give providers a form to help clarify common problems. The explanation
form can be submitted with any Medicare Secondary Payer paper claim. Please
share with your staff.
http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7UNRQE1426?opendocument

Tuesday, August 11, 2009

CMA, CMS, Palmetto/J1MAC News

The following information has been received by ANCO.

All ANCO Online LIstServ postings are archived at the ANCO Online ListSev blog available online at http://anco-online.blogspot.com/.


****CMA NEWS****
The California Medical Association (CMA) Alert was published and is available online at http://www.calphys.org/html/news.asp. This edition features:

FTC Delays Enforcement of Red Flag Rules for Another 3 Months

Have You Corrected Your CPPI Quality Data?

Physician Case Study: To EHR or not EHR, that Is the Question

Best Practices: Building a Defensible Fee Schedule

Blue Shield Fee Schedule Changes Take Effect October 1

CMA Submits Brief to Appeals Court in Rescission Case

Health Reform – Much Undecided as Congress Goes on Recess

Gov. Schwarzenegger Deepens Health Care Cuts

Don’t Miss Your Chance to Influence CMA Policy

IMQ Receives Six-Year Recognition from ACCME

Nominate a Senior Physician for CMA’s Young-at-Heart Award


****CMS NEWS****
The Centers for Medicare & Medicaid Services reminds physicians and non-physician practitioners, and group practices that they are required to notify their designated Medicare contractor regarding (a) a change in ownership, (2) a change in practice location, including a change in reassignment of benefits, or (3) any final adverse action (e.g., license suspension/revocation or felony conviction) within 30 days of the reportable event. By reporting changes as soon as possible, but within 30 days of the reportable event, physicians, non-physician practitioners, and group practices will help to ensure that their claims are processed correctly.

Physicians, non-physician practitioners, and group practices are also encouraged to update their Medicare enrollment information on file with the Medicare contractor if the physician, non-physician practitioner, or group practice has not done so since November 2003.

Physicians, non-physicians practitioners, and group practices can use CMS’ electronic enrollment process, known as Internet-based Provider Enrollment, Chain and Ownership System (PECOS), to enroll or make a change in an existing enrollment record.

Information regarding physician, non-physician practitioner, and group practice reporting responsibility and other informational material regarding provider enrollment can be found on the Medicare Provider/Supplier Enrollment web site, www.cms.hhs.gov/MedicareProviderSupEnroll, and in the documents available for downloading in the Downloads section of each web page.


****PALMETTO/J1MAC NEWS****
Effective Date Changes: Provider Enrollment Applications
This table is to assist providers determine the effective date of Medicare
billing privileges based on the incorporation of physician fee schedule
regulatory changes into Chapter 10 of the Program Integrity Manual.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7UMQLW2758?opendocument


J1 Provider Outreach and Education Event Calendar
The Palmetto GBA J1 Learning and Education August 2009 Event Calendar is
now available on our Web site.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7TAL2C7131?opendocument


Radiopharmaceutical Drugs that Require An Invoice for Pricing
The list of HCPCS codes for radiopharmaceutical drugs that require an
invoice for pricing has been updated. An invoice is required with each
claim in order for the service to be priced for radiopharmaceuticals that
Palmetto GBA does not have pricing available for.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7RAQMD6147?opendocument

Thursday, August 6, 2009

CMS & Palmetto/J1MAC News

The following information has been received by ANCO.


****CMS NEWS****
MM6587 – Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 15.3, Effective October 1, 2009
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6587.pdf


SE0914 – Guidance on Using Internet-based Provider Enrollment, Chain and Ownership System (PECOS)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0914.pdf


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 2:30 p.m. – 4:30 p.m., EDT, on Thursday, August 20, 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:

Status of the 2007 re-run and 2008 PQRI Incentive payments and feedback reports;
How to access the 2007 re-run and 2008 PQRI feedback reports; and
Resources to assist eligible professionals.

Following this 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, section, as well as educational products are available on the e-prescribing dedicated web page located at http://www.cms.hhs.gov/ERxIncentive. Feel free to download the resources prior to the call so that you may ask questions of the CMS presenters.

Conference call details:
Date: 8/20/2009
Conference Title: 2009 Physician Quality Reporting Initiative National Provider Call
Time: 2:30 p.m. EDT

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 2:30 p.m. EDT on 8/19/2009, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.

1. To register for the call participants need to go to:http://www2.eventsvc.com/palmettogba/082009

2. Fill in all required data.

3. Verify your time zone is displayed correctly the drop down box.

4. Click "Register".

5. 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 you 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.


****PALMETTO/J1MAC NEWS****
CMS Updates to Coverage Pages
Share with your staff - The Centers for Medicare and Medicaid (CMS) has
made the following changes to the Medicare Coverage pages: 1) Posted final
decision memo for Pharmacogenomic Testing for Warfarin Response 2) Updated
Bariatric Surgery Facility list.
http://www.palmettogba.com/Palmetto/Providers.nsf/vMasterDID/7ULHX92685?opendocument


ACT Minutes: Recovery Audit Contractor (RAC) - July 14, 2009 (PDF, 54 KB)
The meeting minutes of the July 14 Palmetto GBA J1 Ask the Contractor
Teleconference (ACT) on Recovery Audit Contractor (RAC) appeals process and
recoupment are now available on our Web site.
http://www.palmettogba.com/Palmetto/Providers.nsf/vMasterDID/7UGQ7V4822?opendocument


Guidance on Using Internet-based Provider Enrollment, Chain and Ownership
System (PECOS)
This Special Edition (SE) 0914 article alerts physicians, non-physician
practitioners, providers and suppliers that the Centers for Medicare &
Medicaid Services (CMS) is reaching out to assist those providers and
suppliers who wish to use Internet-based PECOS for enrollment in Medicare
and/or to maintain the currency of the enrollment data they have on file
with Medicare. The availability of Internet-based PECOS to DMEPOS suppliers
will be announced at a future date.
http://www.palmettogba.com/Palmetto/Providers.nsf/vMasterDID/7UMN6Q4834?opendocument


Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 15.3,
Effective October 1, 2009
The MLN article (CR6587) reminds physicians to take note of the quarterly
updates to Correct Coding Initiative (CCI) edits. The last quarterly
release of the edit module was issued in July 2009.
http://www.palmettogba.com/Palmetto/Providers.nsf/vMasterDID/7UMNP40106?opendocument

Sunday, August 2, 2009

ASCO, COA, CMS, & Palmetto/J1MAC News

The following information has been received by ANCO.


****ASCO NEWS****
Representatives Charlie Gonzalez (D-TX) and Mike Rogers (R-MI) are circulating a "Dear Colleague" letter (http://www.asco.org/ASCOv2/Department%20Content/Cancer%20Policy%20and%20Clinical%20Affairs/Downloads/Policy%20Issues/Medicare%20and%20Quality%20Care/Gonzalez%20Rogers%20Dear%20Colleague%20Letter%20073009.pdf ) to members of the House of Representatives, urging their colleagues to join them in signing a letter to U.S. Health and Human Services Secretary Kathleen Sebelius. The letter to Secretary Sebelius expresses deep concern about the proposed cuts to oncology and cardiology in the Medicare fee schedule and asks CMS to abstain from using the flawed data that justify the cuts.

Cancer and heart disease are the top two causes of death for Medicare patients. ASCO and the American College of Cardiology (ACC) - the professional organizations representing doctors who treat these diseases - are encouraging members of Congress to sign the letter to Secretary Sebelius.

ASCO is stating in no uncertain terms that the proposed cuts to oncology and cardiology will place vital patient care services, like chemotherapy, at risk.

The letter to Secretary Sebelius highlights the serious flaws in the American Medical Association (AMA) survey that was the basis for determining the proposed cuts, including:

The survey's findings that the cost of providing cardiology and oncology services has dropped substantially over the last five years defies logic and is inconsistent with recognized trends.
The sample sizes for oncology and cardiology were too small to be representative and do not capture the conditions faced by patients and providers throughout the United States, especially in rural and low-income urban areas.
The survey process lacked transparency. The public should have the opportunity to fully review the entire data set before such significant policy changes are implemented.

ASCO applauds Reps. Gonzalez and Rogers for their leadership and longstanding support of the cancer community.

WE NEED YOUR HELP IN THIS EFFORT. Please call (http://capwiz.com/asco/callalert/index.tt?alertid=13812581) or write your Representative and ask him or her to sign the letter to Secretary Sebelius. You can find everything you need to contact your member of Congress - including talking points, contact information and a draft email/letter - on ASCO's Grassroots Action Network (http://capwiz.com/asco/issues/alert/?alertid=13779296).

It is critical for you to call your Representative this week, before the House of Representatives recesses for the month of August.

Contact ASCO's Cancer Policy and Clinical Affairs Department with any questions, or to share your story about how this proposed cuts will harm your practice and your patients, at 571-483-1670 or publicpolicy@asco.org.


****COA NEWS****
On the COA website at www.communityoncology.org under the Immediate Action Needed section is a tool that will allow you to estimate the impact of changes proposed by CMS in the 2010 Medicare Physician Fee Schedule. We encourage you to use the tool to estimate the impact of the cuts on your practice. The leadership team of the COA Administrators’ Network used the tool and collectively found the following:

Oncology-specific cuts related to infusion room services are estimated to be 20.6% in 2010
The total impact of the cuts is 6.4%, factoring in an increase in E&M payments and the elimination of the consultation codes
Please note that these estimates assume that Congress will act in health care reform legislation to avert the 21.5% cut. If this does not happen, the total estimated impact of the Medicare cuts would be 26.5% for oncology practices. Run the estimates for your practice. If you have any questions about using the tool, please contact Ricky Newton .


****CMS NEWS****
IMPORTANT NOTICE regarding the National Correct Coding Initiative (NCCI) Edits for Physicians (version number 15.2, effective 7/1/09 – 9/30/09) posted on the Centers for Medicare & Medicaid Services (CMS) website:
The Column 1 /Column 2 edits file for the CPT* code range 34000 – 39999 posted on July 2, 2009, was not updated with the July 2009 changes. The file has been corrected and is now available on the NCCI Edits web page at http://www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/list.asp. This was the only file that was not updated. The direct link to the corrected file is
http://www.cms.hhs.gov/apps/ama/license.asp?file=/NationalCorrectCodInitEd/downloads/ccigrp5b.zip


This message is for health care providers, particularly physicians and other practitioners, who have obtained National Provider Identifiers (NPIs) and have records in the National Plan and Provider Enumeration System (NPPES). The Centers for Medicare & Medicaid Services (CMS) recommends that each health care provider, including individual physicians and non-physician practitioners:

· Secure and maintain their own NPPES account information (i.e., User ID, Password, and Secret Question/Answer) for safety and accessibility purposes. Health care providers should maintain the confidentiality of their User ID, password, and Secret Question/Answer in order to protect their NPPES information from unauthorized access.

Reset their NPPES passwords at least once a year. See the NPPES Application Help page at https://nppes.cms.hhs.gov/NPPES/Help.do and select the ‘Reset Password Page’ for applicable rules. Those rules indicate the length, format, content and requirements of NPPES passwords.

Review their NPPES records in order to ensure that the information reflects current and correct information. Covered health care providers are required to update their NPPES information within 30 days of the effective date of the change.

Viewing NPPES Information
Health care providers, including physicians and non-physician practitioners, can view their NPPES information in one of two ways:

(1) By accessing the NPPES record at https://nppes.cms.hhs.gov/NPPES/Welcome.do and following the NPI hyperlink and selecting Login. The user will be prompted to enter the User ID and password that he/she previously created. *

* If the health care provider has forgotten the password, enter the User ID and click the “Reset Forgotten Password” button to navigate to the Reset Password Page. If the health care provider enters an incorrect User ID and Password combination three times, the User ID will be disabled. Please contact the NPI Enumerator at 1-800-465-3203 if the account is disabled or if the health care provider has forgotten the User ID.

OR

(2) By accessing the NPI Registry at https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do. The NPI Registry gives the health care provider an online view of Freedom of Information Act (FOIA)-disclosable NPPES data. The health care provider can search for its information using the name or NPI as the criterion. Information regarding NPPES data that are FOIA-disclosable can be found at http://www.cms.hhs.gov/NationalProvIdentStand/ by selecting ‘Data Dissemination’.

Please note: Business Mailing Address and Business Practice location information (full address and corresponding telephone numbers) are key data elements that are FOIA-disclosable. Health care providers should not report their residential address unless it is their Business Mailing Address or Business Practice location. The NPPES data appearing on the NPI Registry cannot be deleted; however, it can be updated or changed.

Updating NPPES Information
Health care providers, including physicians and non-physician practitioners, can correct, add, or delete information in their NPPES records by accessing their NPPES records at https://nppes.cms.hhs.gov/NPPES/Welcome.do and following the NPI hyperlink and selecting Login. The user will be prompted to enter the User ID and password that he/she previously created.

Please note: Required information cannot be deleted from an NPPES record; however, required information can be changed/updated to ensure that NPPES captures the correct information. Certain information is inaccessible via the web, thus requiring the change/update to be made via paper application. The paper NPI Application/Update Form (CMS-10114) can be downloaded and printed at http://www.cms.hhs.gov/cmsforms/downloads/CMS10114.pdf.

Deactivating the NPI
Health care providers, including physicians and non-physician practitioners, can deactivate their NPIs if the NPIs are no longer required or needed. Reasons for deactivation include retirement, business dissolved, or death of the health care provider. A request for deactivation must be submitted via paper application. The paper NPI Application/Update Form (CMS-10114) can be downloaded and printed at http://www.cms.hhs.gov/cmsforms/downloads/CMS10114.pdf. Health care providers should review the instructions located on the application regarding deactivations in order to properly complete the deactivation request. The Power of Attorney or Executor of the Will may complete the application for deactivation due to death of the health care provider.

*****
Physicians: Did your academic medical institution or medical school university obtain your NPI for you? If so, please be sure to read an upcoming special listserv message on this topic.

*****
Need More Information?
Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203. Having trouble viewing any of the URLs in this message? If so, try to cut and paste any URL in this message into your web browser to view the intended information.

Visit CMS’ dedicated NPI web page at www.cms.hhs.gov/NationalProvIdentStand for additional NPI information.


****PALMETTO/J1MAC NEWS****
August 2009 J1 A/B MAC Medicare Advisory
The August 2009 J1 A/B MAC Mediare Advisory has been posted to the J1 Web
site.
http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7UDRMA1283?opendocument

Provider Specialty 87 as Provider Type 64 v.s. Provider Type 40 Update
Due to the different provider types (Provider Type 64 v.s. Provider Type
40) used in Palmetto GBA and the Outgoing Contractor (OGC) for Specialty
87 providers, some services were denied in error. A mass adjustment was
performed with 0 claims found for NCA, 22 claims for SCA and 53 claims for
HI/NV.
http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7RBS575234?opendocument