The following information has been received by ANCO.
****CMS NEWS****
MM6685 – New Waived Tests
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6685.pdf
MM6660 – Therapy Cap Values for Calendar Year (CY) 2010
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6660.pdf
****PALMETTO/J1MAC NEWS****
December 2009 J1 A/B MAC Medicare Advisory
The December 2009 J1 A/B MAC Medicare Advisory is available on the Web
site. Please be sure to share this with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7Y5M4G5545?opendocument
Monday, November 30, 2009
Monday, November 23, 2009
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 1:30 p.m. – 3:30 p.m., EST, on Thursday, December 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:
· Alternate feedback report request process;
· Update on incentive payments and feedback reports;
· Results from the 2008 PQRI and 2007 PQRI re-run; and
· Measures issues identified in 2008 PQRI.
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: December 10, 2009
Conference Title: Physician Quality Reporting Initiative (PQRI) - National Provider Call
Time: 1:30 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 1:30 p.m. EST on December 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/121009
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.
The Centers for Medicare & Medicaid Services (CMS) is now accepting quality measure suggestions for consideration for possible inclusion in the proposed set of quality measures for use in the 2011 Physician Quality Reporting Initiative (PQRI).
Interested parties have an additional opportunity to submit measure suggestions for the 2011 PQRI program beyond the request for 2011 measure suggestions included in the Calendar Year (CY) 2010 Medicare Physician Fee Schedule (PFS) proposed rule published in theFederal Register (74 FR 33587) on July 13, 2009. Interested parties who have already submitted measure suggestions in response to the request for 2011 PQRI measures included in the CY 2010 PFS proposed rule do not need to re-submit their measure suggestions.
To learn more about the 2011 PQRI Call for Measures, visit the CMS Quality Measures Management Information System (QMIS) website at http://www.cms.hhs.gov/apps/QMIS/CallforMeasures.asp on the CMS website.
All suggestions must be received by CMS no later than 5:00 p.m. EST December 16, 2009.
Please note: Suggesting individual measures or measures for a new or existing measures group does not guarantee that the measure(s) will be included in the proposed or final sets of measures of any proposed or final rules that address the 2011 PQRI. CMS will determine what individual measures and measures group(s) to include in the proposed set of quality measures, and after a period of public comment, the agency will make the final determination with regard to the final set of quality measures for the 2011 PQRI.
****PALMETTO/J1MAC NEWS****
Claim Status Category Code and Claim Status Code Update
This J1 Part A/B MLN Matters article (CR6723) explains that the claim
status codes and claim status category codes for use by Medicare
contractors with the Health Claim Status Request and Response ASC X12N
276/277 were updated during the September 2009 meeting of the national Code
Maintenance Committee and code changes approved at that meeting were posted
on the Internet on November 1, 2009. Please be sure to share with your
staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7XXT8Q7657?opendocument
J1 Part B LCDs Update
Share with your staff - The J1 Part B LCDs, Ambulance Services L28235 and
Diagnostic Colonoscopy L28253 have been revised.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7XYP9B7353?opendocument
Therapy Cap Values for Calendar Year (CY) 2010
This J1 Part A/B MLN Matters article (CR6660) describes the policy for
outpatient therapy caps for 2010 and announces that therapy caps for 2010
will be $1,860. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7XWTJR5402?opendocument
Update to Medicare Deductible, Coinsurances and Premium Rates for 2010
This J1 Part A/B MLN Matters article (CR6690) provides the Medicare rates
for deductible, coinsurance and premium payment amounts for calendar year
(CY) 2010. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7XXTP96437?opendocument
The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!
****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 1:30 p.m. – 3:30 p.m., EST, on Thursday, December 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:
· Alternate feedback report request process;
· Update on incentive payments and feedback reports;
· Results from the 2008 PQRI and 2007 PQRI re-run; and
· Measures issues identified in 2008 PQRI.
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: December 10, 2009
Conference Title: Physician Quality Reporting Initiative (PQRI) - National Provider Call
Time: 1:30 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 1:30 p.m. EST on December 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/121009
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.
The Centers for Medicare & Medicaid Services (CMS) is now accepting quality measure suggestions for consideration for possible inclusion in the proposed set of quality measures for use in the 2011 Physician Quality Reporting Initiative (PQRI).
Interested parties have an additional opportunity to submit measure suggestions for the 2011 PQRI program beyond the request for 2011 measure suggestions included in the Calendar Year (CY) 2010 Medicare Physician Fee Schedule (PFS) proposed rule published in theFederal Register (74 FR 33587) on July 13, 2009. Interested parties who have already submitted measure suggestions in response to the request for 2011 PQRI measures included in the CY 2010 PFS proposed rule do not need to re-submit their measure suggestions.
To learn more about the 2011 PQRI Call for Measures, visit the CMS Quality Measures Management Information System (QMIS) website at http://www.cms.hhs.gov/apps/QMIS/CallforMeasures.asp on the CMS website.
All suggestions must be received by CMS no later than 5:00 p.m. EST December 16, 2009.
Please note: Suggesting individual measures or measures for a new or existing measures group does not guarantee that the measure(s) will be included in the proposed or final sets of measures of any proposed or final rules that address the 2011 PQRI. CMS will determine what individual measures and measures group(s) to include in the proposed set of quality measures, and after a period of public comment, the agency will make the final determination with regard to the final set of quality measures for the 2011 PQRI.
****PALMETTO/J1MAC NEWS****
Claim Status Category Code and Claim Status Code Update
This J1 Part A/B MLN Matters article (CR6723) explains that the claim
status codes and claim status category codes for use by Medicare
contractors with the Health Claim Status Request and Response ASC X12N
276/277 were updated during the September 2009 meeting of the national Code
Maintenance Committee and code changes approved at that meeting were posted
on the Internet on November 1, 2009. Please be sure to share with your
staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7XXT8Q7657?opendocument
J1 Part B LCDs Update
Share with your staff - The J1 Part B LCDs, Ambulance Services L28235 and
Diagnostic Colonoscopy L28253 have been revised.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7XYP9B7353?opendocument
Therapy Cap Values for Calendar Year (CY) 2010
This J1 Part A/B MLN Matters article (CR6660) describes the policy for
outpatient therapy caps for 2010 and announces that therapy caps for 2010
will be $1,860. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7XWTJR5402?opendocument
Update to Medicare Deductible, Coinsurances and Premium Rates for 2010
This J1 Part A/B MLN Matters article (CR6690) provides the Medicare rates
for deductible, coinsurance and premium payment amounts for calendar year
(CY) 2010. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7XXTP96437?opendocument
The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!
Wednesday, November 18, 2009
CMA, CMS, & Palmetto/J1MAC News
The following information has been received by ANCO.
****CMA NEWS****
The California Medical Association's (CMA) Alert was published and is available online at http://www.calphys.org/html/alert111609.asp. This edition features:
Blue Shield Planning to Publish Physician Ratings Based on Faulty CPPI Data
U.S. House Introduces Bill that Would Exempt Small Health Care Organizations from Red Flags Rule
Are Your Payors in Good Financial Health?
2010 Medicare Payment Rule Cuts Physician Payments by 21.2%; Eliminates Payment for Consultations
U.S. House to Take Critical SGR Vote this Week; Physicians Urged to Call
Appeals Court Protects California’s Voter-Enacted Drug Treatment Program
Blue Cross Extends Healthy Families Continuity of Care Plan
****CMS NEWS****
Due to recent revisions that were made to the 2010 Medicare Physician Fee Schedule (MPFS), the Centers for Medicare & Medicaid Services (CMS) has extended the 2010 Annual Participation Enrollment Program end date from December 31, 2009, to January 31, 2010 – therefore, the enrollment period now runs from November 13, 2009, through January 31, 2010.
The effective date for any Participation status change during the extension, however, remains January 1, 2010; and will be in force for the entire year.
Contractors will accept and process any Participation elections or withdrawals, made during the extended enrollment period that are received or post-marked on or before January 31, 2010.
Note: This is an extension of the annual participation enrollment period dates in CR 6637 (Transmittal 1832 -- Calendar Year (CY) 2010 Participation Enrollment and Medicare Participating Physicians and Suppliers Directory (MEDPARD) Procedures), dated October 16, 2009.
The Participation Agreement (CMS-Form 460) is available on the CD-ROM that is sent out annually by your Medicare contractor during the Annual Participation Enrollment period. Your contractor will also make the Participation Agreement available to you by placing it on their Websites with Participation enrollment (and termination) instructions.
MM6660 – Therapy Cap Values for Calendar Year (CY) 2010
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6660.pdf
MM6690 – Update to Medicare Deductible, Coinsurance, and Premium Rates for 2010
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6690.pdf
MM6723 – Claim Status Category Code and Claim Status Code Update
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6723.pdf
MM6708 – January 2010 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/MM6708.pdf
SE0929 – 2010 Annual Participation Enrollment Program Extension
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0929.pdf
****PALMETTO/J1MAC NEWS****
California Contractor Advisory Committee Meeting Minutes
The following are minutes from the California Contractor Advisory Committee
Meeting on October 13, 2009, in San Francisco, CA. Please be sure to share
with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7XRT268315?opendocument
CMS No Longer Recognizes HCPCS Code for Payment of Non-Outpatient Hospital
Claims
The following article announces that, effective immediately, the Centers
for Medicare & Medicaid Services (CMS) will no longer recognize the
Healthcare Common Procedure Coding System (HCPCS) Code for payment of
non-outpatient hospital claims. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7XVLYX8318?opendocument
J1 Provider Outreach and Education Event Calendar
What's new in November 2009? The updated Palmetto GBA J1 Event Calenar is
now available on our Web site!
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7TAL2C7131?opendocument
The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!
****CMA NEWS****
The California Medical Association's (CMA) Alert was published and is available online at http://www.calphys.org/html/alert111609.asp. This edition features:
Blue Shield Planning to Publish Physician Ratings Based on Faulty CPPI Data
U.S. House Introduces Bill that Would Exempt Small Health Care Organizations from Red Flags Rule
Are Your Payors in Good Financial Health?
2010 Medicare Payment Rule Cuts Physician Payments by 21.2%; Eliminates Payment for Consultations
U.S. House to Take Critical SGR Vote this Week; Physicians Urged to Call
Appeals Court Protects California’s Voter-Enacted Drug Treatment Program
Blue Cross Extends Healthy Families Continuity of Care Plan
****CMS NEWS****
Due to recent revisions that were made to the 2010 Medicare Physician Fee Schedule (MPFS), the Centers for Medicare & Medicaid Services (CMS) has extended the 2010 Annual Participation Enrollment Program end date from December 31, 2009, to January 31, 2010 – therefore, the enrollment period now runs from November 13, 2009, through January 31, 2010.
The effective date for any Participation status change during the extension, however, remains January 1, 2010; and will be in force for the entire year.
Contractors will accept and process any Participation elections or withdrawals, made during the extended enrollment period that are received or post-marked on or before January 31, 2010.
Note: This is an extension of the annual participation enrollment period dates in CR 6637 (Transmittal 1832 -- Calendar Year (CY) 2010 Participation Enrollment and Medicare Participating Physicians and Suppliers Directory (MEDPARD) Procedures), dated October 16, 2009.
The Participation Agreement (CMS-Form 460) is available on the CD-ROM that is sent out annually by your Medicare contractor during the Annual Participation Enrollment period. Your contractor will also make the Participation Agreement available to you by placing it on their Websites with Participation enrollment (and termination) instructions.
MM6660 – Therapy Cap Values for Calendar Year (CY) 2010
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6660.pdf
MM6690 – Update to Medicare Deductible, Coinsurance, and Premium Rates for 2010
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6690.pdf
MM6723 – Claim Status Category Code and Claim Status Code Update
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6723.pdf
MM6708 – January 2010 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/MM6708.pdf
SE0929 – 2010 Annual Participation Enrollment Program Extension
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0929.pdf
****PALMETTO/J1MAC NEWS****
California Contractor Advisory Committee Meeting Minutes
The following are minutes from the California Contractor Advisory Committee
Meeting on October 13, 2009, in San Francisco, CA. Please be sure to share
with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7XRT268315?opendocument
CMS No Longer Recognizes HCPCS Code for Payment of Non-Outpatient Hospital
Claims
The following article announces that, effective immediately, the Centers
for Medicare & Medicaid Services (CMS) will no longer recognize the
Healthcare Common Procedure Coding System (HCPCS) Code for payment of
non-outpatient hospital claims. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7XVLYX8318?opendocument
J1 Provider Outreach and Education Event Calendar
What's new in November 2009? The updated Palmetto GBA J1 Event Calenar is
now available on our Web site!
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7TAL2C7131?opendocument
The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!
Monday, November 16, 2009
CMS & Palmetto/J1MAC News
The following information has been received by ANCO.
****CMS NEWS****
More than 85,000 physicians and other eligible professionals who successfully reported quality-related data to Medicare under the 2008 Physician Quality Reporting Initiative (PQRI) received incentive payments totaling more than $92 million, the Centers for Medicare & Medicaid Services (CMS) announced today, well above the $36 million paid in 2007.
The number of eligible professionals who earned an incentive payment increased by one-third from 2007, when 56,700 eligible professionals earned an incentive payment. In 2007, eligible professionals could only participate in the program during a 6-month reporting period. In 2008, the program expanded to allow reporting for either a 6-month or a 12-month period.
“We are very pleased with the results for 2008,” said Charlene Frizerra, Acting CMS Administrator. “More health professionals have successfully reported data, and the substantial growth in the national total for PQRI incentive payments demonstrates that Medicare can align payment with quality incentives.
To read the entire CMS Press release issued today (11/13) click here: http://www.cms.hhs.gov/apps/media/press_releases.asp
To read the entire CMS Fact Sheet issued today (11/13) click here: http://www.cms.hhs.gov/apps/media/fact_sheets.asp
CMS recently announced its plan for the 2010 PQRI Program as part of the Medicare Physician Fee Schedule final rule. A fact sheet on the 2010 PQRI Program is available online at http://www.cms.hhs.gov/apps/media/press/factsheet.asp?Counter=3541&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date.
More information about the PQRI program, including participation guidance and the criteria to qualify for an incentive payment is available at www.cms.hhs.gov/PQRI.
****PALMETTO/J1MAC NEWS****
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
The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!
****CMS NEWS****
More than 85,000 physicians and other eligible professionals who successfully reported quality-related data to Medicare under the 2008 Physician Quality Reporting Initiative (PQRI) received incentive payments totaling more than $92 million, the Centers for Medicare & Medicaid Services (CMS) announced today, well above the $36 million paid in 2007.
The number of eligible professionals who earned an incentive payment increased by one-third from 2007, when 56,700 eligible professionals earned an incentive payment. In 2007, eligible professionals could only participate in the program during a 6-month reporting period. In 2008, the program expanded to allow reporting for either a 6-month or a 12-month period.
“We are very pleased with the results for 2008,” said Charlene Frizerra, Acting CMS Administrator. “More health professionals have successfully reported data, and the substantial growth in the national total for PQRI incentive payments demonstrates that Medicare can align payment with quality incentives.
To read the entire CMS Press release issued today (11/13) click here: http://www.cms.hhs.gov/apps/media/press_releases.asp
To read the entire CMS Fact Sheet issued today (11/13) click here: http://www.cms.hhs.gov/apps/media/fact_sheets.asp
CMS recently announced its plan for the 2010 PQRI Program as part of the Medicare Physician Fee Schedule final rule. A fact sheet on the 2010 PQRI Program is available online at http://www.cms.hhs.gov/apps/media/press/factsheet.asp?Counter=3541&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date.
More information about the PQRI program, including participation guidance and the criteria to qualify for an incentive payment is available at www.cms.hhs.gov/PQRI.
****PALMETTO/J1MAC NEWS****
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
The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!
Friday, November 13, 2009
ASH, CMS & Palmetto/J1MAC News
The following information has been received by ANCO.
****ASH NEWS****
The American Society of Hematology's (ASH) Practice Update was published and is available online at http://www.hematology.org/Practice/Practice-Updates/4498.aspx. This edition features:
• House Advances Health-Care Reform Legislation: Now Is the Time to Take Action to Support Physician Payment Fix
• ASH Practice Forum: New American Health-Care Policy and the Practice of Hematology
• Medicare Releases Final 2010 Payment Regulations; Physician Payment to Be Cut 21 Percent Absent Congressional Action
• Medicare Announces Changes to Hospital Outpatient Payment in 2010
• Medicare RAC Program Goes National – What You Need to Know
• FDA Issues Drug Warning on Dexferrum (Iron Dextran Injection)
• Medicare Contractors to Review Claims Data Related to Chemotherapy Administration
• CMS Announces 2008 PQRI Payments and Feedback Reports
• ASH Annual Meeting: Policy & Practice Events You Will Want to Attend
• Four Dates, Six Locations, One Great Program – The Only Official Highlights of ASH
****CMS NEWS****
MM6670 – Instructions for Processing Claims Containing Anti-Markup Services but with Partial Information Completed in Item 20 of the CMS-1500 Claim Form
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6670.pdf
MM6717 – Changes to the Laboratory National Coverage Determination (NCD) Edit Software for January 2010
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6717.pdf
Centers for Medicare & Medicaid Services
Special Open Door Forum:
2009 Physician Quality Reporting Initiative (PQRI) Program with the American College of Emergency Physicians (ACEP)/CEP America
Thursday, November 12, 2009
2:00-3:30 pm ET Conference Call Only
The Centers for Medicare & Medicaid Services (CMS) will co-host a Special Open Door Forum on the 2009 PQRI Program with the American College of Emergency Physicians/CEP America. 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.
This Special Open Door Forum will be geared towards emergency medicine-specific topics related to participation in the PQRI Program. Following the presentation, the telephone lines will be opened to allow participants to ask questions of the ACEP/CEP America presenters, including: Dennis Beck, MD FACEP; Richards Newell, MD MPH; and Mike Granovsky, MD FACEP, as well as CMS PQRI subject matter experts.
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.
We look forward to your participation.
Special Open Door Forum Participation Instructions:
Dial: 1-800-837-1935 Conference ID 31712023
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 and transcript 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 November 23, 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/.
Thank you for your interest in CMS Open Door Forums.
****PALMETTO/J1MAC NEWS****
How to Determine If You Are an Independent Diagnostic Testing Facility
(IDTF)?
Are you an Independent Diagnostice Testing Facility? If a substantial
portion of the entity’s business involves the performance of diagnostic
tests, the diagnostic testing services might be a sufficiently separate
business to warrant enrollment as an independent diagnostic testing
facility. In that case, the physician or group can continue to be enrolled
as a physician or a group practice of physicians, but must also enroll as
an independent diagnostic testing facility.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7QMR824802?opendocument
Updated: Independent Diagnostic Testing Facility Table
The updated version of the Independent Diagnostic Testing Facility Table
(IDTF) is now available on the Palmetto GBA J1 Web site.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7QUPVL5118?opendocument
Reason/Remark Code Lookup
Check out the handy PDF lists of the current Medicare specific
Reason/Denial Codes and the Remark Codes on the Palmetto GBA J1 Web site!
These two PDF lists will be updated annually.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7XMTNC3288?opendocument
Updated: Independent Diagnostic Testing Facilities:Therapeutic
Procedures/Effect on Availability of Codes
The Independent Diagnostic Testing Facility (IDTF) Local Coverage
Determination (LCD) was retired, as there were CPT codes listed in the LCD
that were not diagnostic services or were inappropriate for an IDTF. A mass
adjustment was completed on August 24, 2009, with 619 claims adjusted in
Southern California, 259 claims in Northern California and 28 claims in
Hawaii and Nevada.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7T4KKD1007?opendocument
2010 Medicare Physician Fee Schedule (MPFS) Amounts Currently Unavailable
The 2010 Medicare Physician Fee Schedule (MPFS) amounts are currently
unavailable until further notice, but will be posted as soon as they become
available. Please check this Web site periodically for any updates.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7XPMAE2184?opendocument
The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!
****ASH NEWS****
The American Society of Hematology's (ASH) Practice Update was published and is available online at http://www.hematology.org/Practice/Practice-Updates/4498.aspx. This edition features:
• House Advances Health-Care Reform Legislation: Now Is the Time to Take Action to Support Physician Payment Fix
• ASH Practice Forum: New American Health-Care Policy and the Practice of Hematology
• Medicare Releases Final 2010 Payment Regulations; Physician Payment to Be Cut 21 Percent Absent Congressional Action
• Medicare Announces Changes to Hospital Outpatient Payment in 2010
• Medicare RAC Program Goes National – What You Need to Know
• FDA Issues Drug Warning on Dexferrum (Iron Dextran Injection)
• Medicare Contractors to Review Claims Data Related to Chemotherapy Administration
• CMS Announces 2008 PQRI Payments and Feedback Reports
• ASH Annual Meeting: Policy & Practice Events You Will Want to Attend
• Four Dates, Six Locations, One Great Program – The Only Official Highlights of ASH
****CMS NEWS****
MM6670 – Instructions for Processing Claims Containing Anti-Markup Services but with Partial Information Completed in Item 20 of the CMS-1500 Claim Form
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6670.pdf
MM6717 – Changes to the Laboratory National Coverage Determination (NCD) Edit Software for January 2010
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6717.pdf
Centers for Medicare & Medicaid Services
Special Open Door Forum:
2009 Physician Quality Reporting Initiative (PQRI) Program with the American College of Emergency Physicians (ACEP)/CEP America
Thursday, November 12, 2009
2:00-3:30 pm ET Conference Call Only
The Centers for Medicare & Medicaid Services (CMS) will co-host a Special Open Door Forum on the 2009 PQRI Program with the American College of Emergency Physicians/CEP America. 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.
This Special Open Door Forum will be geared towards emergency medicine-specific topics related to participation in the PQRI Program. Following the presentation, the telephone lines will be opened to allow participants to ask questions of the ACEP/CEP America presenters, including: Dennis Beck, MD FACEP; Richards Newell, MD MPH; and Mike Granovsky, MD FACEP, as well as CMS PQRI subject matter experts.
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.
We look forward to your participation.
Special Open Door Forum Participation Instructions:
Dial: 1-800-837-1935 Conference ID 31712023
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 and transcript 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 November 23, 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/.
Thank you for your interest in CMS Open Door Forums.
****PALMETTO/J1MAC NEWS****
How to Determine If You Are an Independent Diagnostic Testing Facility
(IDTF)?
Are you an Independent Diagnostice Testing Facility? If a substantial
portion of the entity’s business involves the performance of diagnostic
tests, the diagnostic testing services might be a sufficiently separate
business to warrant enrollment as an independent diagnostic testing
facility. In that case, the physician or group can continue to be enrolled
as a physician or a group practice of physicians, but must also enroll as
an independent diagnostic testing facility.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7QMR824802?opendocument
Updated: Independent Diagnostic Testing Facility Table
The updated version of the Independent Diagnostic Testing Facility Table
(IDTF) is now available on the Palmetto GBA J1 Web site.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7QUPVL5118?opendocument
Reason/Remark Code Lookup
Check out the handy PDF lists of the current Medicare specific
Reason/Denial Codes and the Remark Codes on the Palmetto GBA J1 Web site!
These two PDF lists will be updated annually.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7XMTNC3288?opendocument
Updated: Independent Diagnostic Testing Facilities:Therapeutic
Procedures/Effect on Availability of Codes
The Independent Diagnostic Testing Facility (IDTF) Local Coverage
Determination (LCD) was retired, as there were CPT codes listed in the LCD
that were not diagnostic services or were inappropriate for an IDTF. A mass
adjustment was completed on August 24, 2009, with 619 claims adjusted in
Southern California, 259 claims in Northern California and 28 claims in
Hawaii and Nevada.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7T4KKD1007?opendocument
2010 Medicare Physician Fee Schedule (MPFS) Amounts Currently Unavailable
The 2010 Medicare Physician Fee Schedule (MPFS) amounts are currently
unavailable until further notice, but will be posted as soon as they become
available. Please check this Web site periodically for any updates.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7XPMAE2184?opendocument
The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!
Monday, November 9, 2009
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
The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!
****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
The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!
Thursday, November 5, 2009
ACCC, CMA, CMS, & Palmetto/J1MAC News
The following information has been received by ANCO.
****ACCC NEWS****
The Association of Community Cancer Center's (ACCC) Connect was published and is available online at http://www.accc-cancer.org/mediaroom/newsletters/2009/media_ACCConnect_11-4-2009.html. ANCO is an Institutional Member of ACCC. This edition features:
• ACCC to Host Conference Call On New Rules from CMS
• How to Bring Out the Best in Your Cancer Service Line
• Prior Authorization, Gross Receipts Taxes, Both Subjects of ACCC Policy Statements
• Complimentary Access to DRUGDEX No Longer Available
• Oncologists Optimistic About Clinical Trials and Personalized Medicine
• Two Great Breast Cancer Resources for You and Your Patients
• Heard on ACCC's ListServ: When Are Cancer Registrars Producing Staging Sheets?
• Physicians: Take Our Survey on Cancer of Unknown Primary
****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:
• State Rejects Regulations that would Expand Scope of Practice for Nonphysicians
• CMA Urges Investigation of Chiropractor Unlawfully Practicing Medicine
• House Introduces New Health Reform Bills
• CDC Study: For Every Confirmed Case of H1N1, There Are Likely 79 Infections
• H1N1: What Questions Are Your Patients Asking?
• CMA Publishes H1N1 Billing Guide for Physicians
• CMA Urges DMHC to Investigate Access Issues for Healthy Families Patients in Humboldt County
• CMA Publishes Toolkit to Help You Understand the Impact Blue Cross Changes Will Have on Your Practice
• New York Acts to Halt Insurers Manipulating Data; CMA Lawsuit for California Still Pending
• Best Practices: Managing Call Volume
****CMA NEWS****
MM6533 – New Physician Specialty Code for Geriatric Psychiatry
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6533.pdf
MM6563 – Billing for Services Related to Voluntary Uses of Advance Beneficiary Notices of Noncoverage (ABNs)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6563.pdf
MM6683 – Validating the Billing of End Stage Renal Disease (ESRD) 50/50 Rule Modifier
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6683.pdf
****PALMETTO/J1MAC NEWS****
J1 Provider Outreach and Education Event Calendar
What's new in November 2009? The updated Palmetto GBA J1 Event Calenar is
now available on our Web site!
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7TAL2C7131?opendocument
Webinar: Palmetto GBA's New Online Provider Services Application - November
11
Want to check eligibility and claim status online? Join us on Wednesday,
November 11, 2009, for a free Webinar about Palmetto GBA's new Online
Provider Services Application.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7XFRGX6858?opendocument
The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!
****ACCC NEWS****
The Association of Community Cancer Center's (ACCC) Connect was published and is available online at http://www.accc-cancer.org/mediaroom/newsletters/2009/media_ACCConnect_11-4-2009.html. ANCO is an Institutional Member of ACCC. This edition features:
• ACCC to Host Conference Call On New Rules from CMS
• How to Bring Out the Best in Your Cancer Service Line
• Prior Authorization, Gross Receipts Taxes, Both Subjects of ACCC Policy Statements
• Complimentary Access to DRUGDEX No Longer Available
• Oncologists Optimistic About Clinical Trials and Personalized Medicine
• Two Great Breast Cancer Resources for You and Your Patients
• Heard on ACCC's ListServ: When Are Cancer Registrars Producing Staging Sheets?
• Physicians: Take Our Survey on Cancer of Unknown Primary
****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:
• State Rejects Regulations that would Expand Scope of Practice for Nonphysicians
• CMA Urges Investigation of Chiropractor Unlawfully Practicing Medicine
• House Introduces New Health Reform Bills
• CDC Study: For Every Confirmed Case of H1N1, There Are Likely 79 Infections
• H1N1: What Questions Are Your Patients Asking?
• CMA Publishes H1N1 Billing Guide for Physicians
• CMA Urges DMHC to Investigate Access Issues for Healthy Families Patients in Humboldt County
• CMA Publishes Toolkit to Help You Understand the Impact Blue Cross Changes Will Have on Your Practice
• New York Acts to Halt Insurers Manipulating Data; CMA Lawsuit for California Still Pending
• Best Practices: Managing Call Volume
****CMA NEWS****
MM6533 – New Physician Specialty Code for Geriatric Psychiatry
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6533.pdf
MM6563 – Billing for Services Related to Voluntary Uses of Advance Beneficiary Notices of Noncoverage (ABNs)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6563.pdf
MM6683 – Validating the Billing of End Stage Renal Disease (ESRD) 50/50 Rule Modifier
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6683.pdf
****PALMETTO/J1MAC NEWS****
J1 Provider Outreach and Education Event Calendar
What's new in November 2009? The updated Palmetto GBA J1 Event Calenar is
now available on our Web site!
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7TAL2C7131?opendocument
Webinar: Palmetto GBA's New Online Provider Services Application - November
11
Want to check eligibility and claim status online? Join us on Wednesday,
November 11, 2009, for a free Webinar about Palmetto GBA's new Online
Provider Services Application.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7XFRGX6858?opendocument
The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!
Monday, November 2, 2009
CMS & Palmetto/J1MAC News
The following information has been received by ANCO.
****CMS NEWS****
The Centers for Medicare & Medicaid Services (CMS) today announced final changes to policies and payment rates for services to be furnished during calendar year (CY 2010) by over 1 million physicians and nonphysician practitioners who are paid under the Medicare Physician Fee Schedule (MPFS). The MPFS sets payment rates for more than 7,000 types of services in physician offices, hospitals, and other settings. Today’s action complies with federal law, which requires these policies and payment rates to be announced by Nov. 1.
Current law requires CMS to adjust the MPFS payment rates annually based on an update formula which requires application of the Sustainable Growth Rate (SGR) that was adopted in the Balanced Budget Act of 1997. This formula has yielded negative updates every year beginning in CY 2002, although CMS was able to take administrative steps to avert a reduction in CY 2003, and Congress has taken a series of legislative actions to prevent reductions in CYs 2004-2009. In the absence of Congressional action for the CY 2010 physician update, the final rule with comment period will reduce the conversion factor for services on or after Jan. 1, 2010 by 21.2 percent rather than the -21.5 percent projected in the proposed rule. The difference is due to the use of the most recently available data on CMS spending for physicians’ services.
“The Administration tried to avert the pending fee schedule cut in the FY 2010 budget proposal that it submitted to Congress, and remains committed to repealing the SGR,” said Jonathan Blum, director of the CMS Center for Medicare Management. “In the meantime, CMS is finalizing its proposal to remove physician-administered drugs from the definition of ‘physicians’ services’ for purposes of computing the physician fee schedule update. While this decision will not affect payments for services during CY 2010, CMS projects it will have a positive effect on future payment updates.”
In the final rule with comment period, CMS is also adopting several refinements to Medicare payments to physicians which will improve payment rates for primary care services relative to other services. For 2010, for purposes of establishing the practice expense (PE) relative value units (RVUs), CMS had proposed to include data about physicians’ practice costs from a new survey, the Physician Practice Information Survey (PPIS), designed and conducted by the American Medical Association. CMS is finalizing the proposal, but will phase it in over a four year period. In addition, CMS will not use the PPIS data to determine the practice expenses for medical oncology, but instead will continue to use specialty supplemental survey data , as indicated by the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA).
CMS is also finalizing its proposal to stop making payment for consultation codes other than the G codes that are used to bill for telehealth consultations, and to redistribute the resulting savings to increase payments for the existing evaluation and management (E/M) services. CMS will adjust the payment for the surgical global period to reflect the higher value of the office visits furnished during the global period.
In the final rule with comment period, CMS is adopting two significant modifications to its proposal to increase the equipment utilization percentage that is assumed for purposes of setting PE RVUs. CMS will increase the equipment utilization rate assumption used to determine the practice expense for expensive equipment priced over one million dollars from 50 to 90 percent but will phase in this change over a four year period. CMS also will not apply this change to expensive therapeutic equipment.
CMS is increasing payment for the Initial Preventive Physical Exam (IPPE), also called the “Welcome to Medicare” visit to be more in line with payment rates for higher complexity services. Originally established in the MMA, the IPPE benefit now pays for an initial assessment of key elements of a beneficiary’s health within one year of the beneficiary’s enrollment in Medicare Part B.
Taking all changes in the final rule with comment period into account, CMS projects that payments to general practitioners, family physicians, internists, and geriatric specialists will increase by between 5 and 8 percent, prior to application of the negative update required by the SGR.
The final rule with comment period also implements a number of provisions in the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) including:
· Adding new Medicare benefit categories for cardiac and pulmonary rehabilitation services and for chronic kidney disease (CKD) education beginning Jan. 1, 2010. The final rule with comment period outlines what these programs will entail, how they will be
paid under the MPFS and the criteria for covering these services.
· Increasing the Medicare share of payments for outpatient mental health services to 55 percent from 50 percent, beginning a gradual transition to bring payment parity for mental health and medical services furnished to Medicare beneficiaries.
· Implementing a requirement that suppliers of the technical component of advanced imaging services be accredited beginning Jan. 1, 2012. The accreditation requirement will apply to mobile units, physicians’ offices, and independent diagnostic testing facilities that create the images, but will not apply to the physician who interprets them. CMS will address suppliers’ accountability, business integrity, physician and technician training, service quality, and performance management through additional guidance.
The final rule with comment period contains a number of provisions to promote improvement in quality of care and patient outcomes through revisions to the Electronic Prescribing Incentive Program (e-Prescribing Program) and the Physician Quality Reporting Initiative (PQRI). Specifically, the final rule simplifies the reporting requirements for the electronic prescribing measure, provides eligible professionals with more reporting options, and establishes a new process for group practices to be considered successful electronic prescribers. Eligible professionals or group practices that meet the requirements of each program in CY 2010 will be eligible for incentive payments for each program equal to 2.0 percent of their total estimated allowed charges for the reporting periods.
In addition, CMS is adding measures for eligible professionals to report under the PQRI, providing a mechanism for participants to submit quality measure data from a qualified electronic health record and creating a process for group practices to use for reporting the quality measures.
The final rule with comment will appear in the Nov. 25, 2009 Federal Register. CMS will accept comments on designated provisions of the final rule with comment period until Dec. 29, 2009, and will respond to all comments at a later date. Unless otherwise specified, the new payment rates and policies will apply to services furnished to Medicare beneficiaries on or after Jan. 1, 2010.
To view a copy of the final rule with comment period and supporting documentation, please see:
http://www.cms.hhs.gov/PhysicianFeeSched/PFSFRN/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=4&sortOrder=descending&itemID=CMS1230135&intNumPerPage=10 .
A fact sheet providing more information about the e-Prescribing Program and PQRI provisions can be found at:
www.cms.hhs.gov/apps/media/fact_sheets.asp
MM6632 – FDG PET for Solid Tumors and Myeloma
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6632.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 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.
****PALMETTO/J1MAC NEWS****
J1 Part B LCD Update
The following J1 Part B LCDs have been revised: Allergy Testing L28234 and
Radiation Oncology: External Beam/Teletherapy L28297. Please review and
share with your staff members.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7WZLP36638?opendocument
New User-Friendly EFT Form Available
A new user-friendly EFT authorization form is now available on the Palmetto
GBA J1 Web site. Please review and share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7W6Q9R8283?opendocument
2009 PQRI National Provider Call with Question & Answer Session
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 p.m. to 3 p.m., EST, on Tuesday, November 10, 2009.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7X9JFU1052?opendocument
2010 Medicare Participation Enrollment & Fee Schedule Information
We are again excited to provide you with a CD-ROM packed full of useful
information, which will include the 2010 Medicare Participation Enrollment
form along with some valuable additional information. We anticipate that
the CD-ROM will be mailed in November 2009. Please review and share with
your staff members.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7X9NJJ8048?opendocument
Alternative Process for Individual Eligible Professionals to Access
Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing
(E-Prescribing) Feedback Reports
Individual Eligible Professionals (EP) requesting reports based on their
individual National Provider Identifier (NPI) have an alternative means of
accessing those reports. Physicians and other practitioners who qualify as
individual EPs under the Centers for Medicare & Medicaid Services (CMS)
Physician Quality Reporting Initiative (PQRI), and the 2009 E-Prescribing
Incentive Program can
request feedback reports through their claims processing contractor. Please
review and share with your staff members.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7X9KZJ2274?opendocument
FDG PET for Solid Tumors and Myeloma
CR6632 was revised on October 22, 2009, to clarify the language in the What
You Need to Know and Background sections. All other information remains
unchanged. Please review and share with your staff members.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7X2R6T8231?opendocument
J1 Part B LCD Update
The J1 Part B LCDs have been revised. Please review and share with your
staff members.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7X9K9V0655?opendocument
The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!
****CMS NEWS****
The Centers for Medicare & Medicaid Services (CMS) today announced final changes to policies and payment rates for services to be furnished during calendar year (CY 2010) by over 1 million physicians and nonphysician practitioners who are paid under the Medicare Physician Fee Schedule (MPFS). The MPFS sets payment rates for more than 7,000 types of services in physician offices, hospitals, and other settings. Today’s action complies with federal law, which requires these policies and payment rates to be announced by Nov. 1.
Current law requires CMS to adjust the MPFS payment rates annually based on an update formula which requires application of the Sustainable Growth Rate (SGR) that was adopted in the Balanced Budget Act of 1997. This formula has yielded negative updates every year beginning in CY 2002, although CMS was able to take administrative steps to avert a reduction in CY 2003, and Congress has taken a series of legislative actions to prevent reductions in CYs 2004-2009. In the absence of Congressional action for the CY 2010 physician update, the final rule with comment period will reduce the conversion factor for services on or after Jan. 1, 2010 by 21.2 percent rather than the -21.5 percent projected in the proposed rule. The difference is due to the use of the most recently available data on CMS spending for physicians’ services.
“The Administration tried to avert the pending fee schedule cut in the FY 2010 budget proposal that it submitted to Congress, and remains committed to repealing the SGR,” said Jonathan Blum, director of the CMS Center for Medicare Management. “In the meantime, CMS is finalizing its proposal to remove physician-administered drugs from the definition of ‘physicians’ services’ for purposes of computing the physician fee schedule update. While this decision will not affect payments for services during CY 2010, CMS projects it will have a positive effect on future payment updates.”
In the final rule with comment period, CMS is also adopting several refinements to Medicare payments to physicians which will improve payment rates for primary care services relative to other services. For 2010, for purposes of establishing the practice expense (PE) relative value units (RVUs), CMS had proposed to include data about physicians’ practice costs from a new survey, the Physician Practice Information Survey (PPIS), designed and conducted by the American Medical Association. CMS is finalizing the proposal, but will phase it in over a four year period. In addition, CMS will not use the PPIS data to determine the practice expenses for medical oncology, but instead will continue to use specialty supplemental survey data , as indicated by the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA).
CMS is also finalizing its proposal to stop making payment for consultation codes other than the G codes that are used to bill for telehealth consultations, and to redistribute the resulting savings to increase payments for the existing evaluation and management (E/M) services. CMS will adjust the payment for the surgical global period to reflect the higher value of the office visits furnished during the global period.
In the final rule with comment period, CMS is adopting two significant modifications to its proposal to increase the equipment utilization percentage that is assumed for purposes of setting PE RVUs. CMS will increase the equipment utilization rate assumption used to determine the practice expense for expensive equipment priced over one million dollars from 50 to 90 percent but will phase in this change over a four year period. CMS also will not apply this change to expensive therapeutic equipment.
CMS is increasing payment for the Initial Preventive Physical Exam (IPPE), also called the “Welcome to Medicare” visit to be more in line with payment rates for higher complexity services. Originally established in the MMA, the IPPE benefit now pays for an initial assessment of key elements of a beneficiary’s health within one year of the beneficiary’s enrollment in Medicare Part B.
Taking all changes in the final rule with comment period into account, CMS projects that payments to general practitioners, family physicians, internists, and geriatric specialists will increase by between 5 and 8 percent, prior to application of the negative update required by the SGR.
The final rule with comment period also implements a number of provisions in the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) including:
· Adding new Medicare benefit categories for cardiac and pulmonary rehabilitation services and for chronic kidney disease (CKD) education beginning Jan. 1, 2010. The final rule with comment period outlines what these programs will entail, how they will be
paid under the MPFS and the criteria for covering these services.
· Increasing the Medicare share of payments for outpatient mental health services to 55 percent from 50 percent, beginning a gradual transition to bring payment parity for mental health and medical services furnished to Medicare beneficiaries.
· Implementing a requirement that suppliers of the technical component of advanced imaging services be accredited beginning Jan. 1, 2012. The accreditation requirement will apply to mobile units, physicians’ offices, and independent diagnostic testing facilities that create the images, but will not apply to the physician who interprets them. CMS will address suppliers’ accountability, business integrity, physician and technician training, service quality, and performance management through additional guidance.
The final rule with comment period contains a number of provisions to promote improvement in quality of care and patient outcomes through revisions to the Electronic Prescribing Incentive Program (e-Prescribing Program) and the Physician Quality Reporting Initiative (PQRI). Specifically, the final rule simplifies the reporting requirements for the electronic prescribing measure, provides eligible professionals with more reporting options, and establishes a new process for group practices to be considered successful electronic prescribers. Eligible professionals or group practices that meet the requirements of each program in CY 2010 will be eligible for incentive payments for each program equal to 2.0 percent of their total estimated allowed charges for the reporting periods.
In addition, CMS is adding measures for eligible professionals to report under the PQRI, providing a mechanism for participants to submit quality measure data from a qualified electronic health record and creating a process for group practices to use for reporting the quality measures.
The final rule with comment will appear in the Nov. 25, 2009 Federal Register. CMS will accept comments on designated provisions of the final rule with comment period until Dec. 29, 2009, and will respond to all comments at a later date. Unless otherwise specified, the new payment rates and policies will apply to services furnished to Medicare beneficiaries on or after Jan. 1, 2010.
To view a copy of the final rule with comment period and supporting documentation, please see:
http://www.cms.hhs.gov/PhysicianFeeSched/PFSFRN/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=4&sortOrder=descending&itemID=CMS1230135&intNumPerPage=10 .
A fact sheet providing more information about the e-Prescribing Program and PQRI provisions can be found at:
www.cms.hhs.gov/apps/media/fact_sheets.asp
MM6632 – FDG PET for Solid Tumors and Myeloma
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6632.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 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.
****PALMETTO/J1MAC NEWS****
J1 Part B LCD Update
The following J1 Part B LCDs have been revised: Allergy Testing L28234 and
Radiation Oncology: External Beam/Teletherapy L28297. Please review and
share with your staff members.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7WZLP36638?opendocument
New User-Friendly EFT Form Available
A new user-friendly EFT authorization form is now available on the Palmetto
GBA J1 Web site. Please review and share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7W6Q9R8283?opendocument
2009 PQRI National Provider Call with Question & Answer Session
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 p.m. to 3 p.m., EST, on Tuesday, November 10, 2009.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7X9JFU1052?opendocument
2010 Medicare Participation Enrollment & Fee Schedule Information
We are again excited to provide you with a CD-ROM packed full of useful
information, which will include the 2010 Medicare Participation Enrollment
form along with some valuable additional information. We anticipate that
the CD-ROM will be mailed in November 2009. Please review and share with
your staff members.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7X9NJJ8048?opendocument
Alternative Process for Individual Eligible Professionals to Access
Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing
(E-Prescribing) Feedback Reports
Individual Eligible Professionals (EP) requesting reports based on their
individual National Provider Identifier (NPI) have an alternative means of
accessing those reports. Physicians and other practitioners who qualify as
individual EPs under the Centers for Medicare & Medicaid Services (CMS)
Physician Quality Reporting Initiative (PQRI), and the 2009 E-Prescribing
Incentive Program can
request feedback reports through their claims processing contractor. Please
review and share with your staff members.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7X9KZJ2274?opendocument
FDG PET for Solid Tumors and Myeloma
CR6632 was revised on October 22, 2009, to clarify the language in the What
You Need to Know and Background sections. All other information remains
unchanged. Please review and share with your staff members.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7X2R6T8231?opendocument
J1 Part B LCD Update
The J1 Part B LCDs have been revised. Please review and share with your
staff members.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7X9K9V0655?opendocument
The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!
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