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_12-30-2009.html. ANCO is an Institutional Member of ACCC. This edition features:
• CMS Waits Action by Congress on SGR
• ACCC Submits Comments to CMS on PET to Identify Bone Metastasis
• Several New HCPCS Codes to Take Effect in 2010
• Infusion Nurses Society Releases Updated Reference Text, Includes FDA-approved Treatment for Anthracycline Extravasation
****CMS NEWS****
SE0931 – Expiration of Various Payment Provisions Under the Medicare Program
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0931.pdf
SE0929 – 2010 Annual Participation Enrollment Program Extension
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0929.pdf
MM6796 – Emergency Update to the 2010 Medicare Physician Fee Schedule Database (MPFSDB)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6796.pdf
MM6540 – Tracking the Hospice Attending Physician’s National Provider Identifier (NPI) for Validating Hospice Part B Payments
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6540.pdf
The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host a national provider conference call on the 2010 Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (eRx). This toll-free call will take place from 1:30 p.m. – 3:30 p.m., EST, on Tuesday, January 12, 2010.
The PQRI is voluntary quality reporting program that provides an incentive payment to identified individual eligible professionals (EPs), and beginning with the 2010 PQRI, group practices who satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-For-Service (FFS) beneficiaries.
The PQRI was first implemented in 2007 as a result of section 101 of the Tax Relief and Health Care Act of 2006 (TRHCA), and further expanded as a result of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), and the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).
The eRx Incentive Program is an incentive program for eligible professionals initially implemented in 2009 as a result of section 132(b) of the MIPPA. The eRx Incentive Program promotes the adoption and use of eRx systems by individual eligible professionals (and beginning with the 2010 eRx Incentive Program, group practices).
The topics covered on this national provider call will include:
· Program Announcements & Updates; and
· Introduction to 2010 PQRI – How to Get Started.
Following the presentation, the lines will be opened to allow participants to ask questions of CMS PQRI and eRx 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 eRx 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: January 12, 2010
Conference Title: Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (eRx)- 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 January 9, 2010, 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/011210
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****
Implementation of the Health Insurance Portability and Accountability Act
(HIPAA) Version 5010 276/277 Claim Status Second Phase
This J1 A/B MAC MLN Matters article (CR6721) provides technical directions
to Medicare Shared System Maintainers and Medicare Contractors regarding
the implementation of the Health Insurance Portability and Accountability
Act (HIPAA) of 1996 for the Accredited Standards Committee (ASC) X12
Version 005010 Health Care Claim Status Request and Response (276/277)
transaction sets. Providers need to be aware of their own requirements to
be fully compliant with the X12 5010 standards by January 1, 2012. Please
be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7Z6Q8G3726?opendocument
MCPSS Media Kit 2010
CMS is conducting the fifth administration of the Medicare Contractor
Provider Satisfaction Survey (MCPSS) and will be sending random survey
samples to Medicare fee-for-service providers and suppliers.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7Z6PQB7826?opendocument
Payment for Implantable Tissue Markers: Healthcare Common Procedure Coding
System (HCPCS) Code A4648
This J1 Part B MLN Matters article (CR6579) clarifies guidance regarding
payment for implantable tissue markers. When billed on a physician claim
and used in conjunction with the Current Procedural Terminology (CPT) code
for the placement of interstitial devices for radiation therapy guidance
(e.g., fiducial markers, dosimeter), prostate (via needle, any approach),
single or multiple, the use of implantable tissue markers is separately
billable and payable by Medicare. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7Z6MGV3723?opendocument
Place of Service (POS) and Date of Service (DOS) Instructions for
Interpretation of Diagnostic Tests
This J1 Part B MLN Matters article (CR6375) informs Medicare contractors
(FIs, carriers and A/B MACs) about the correct place of service (POS) codes
and the date of service (DOS) for the interpretation of diagnostic tests.
Be sure your billing staff is aware of the correct DOS and is aware of how
Medicare contractors determine correct POS coding to assure proper payment
of your claims. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7Z6MAX5504?opendocument
J1 Provider Outreach and Education Event Calendar
Check out the educational events we will host in the new January 2010
Palmetto GBA J1 Provider Outreach and Education Events calendar on our Web
site!
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7TAL2C7131?opendocument
Health Professional Shortage Area (HPSA)
This article details important reminders for physicians who provide
services to Medicare beneficiaries in an area designated as a geographic
Health Professional Shortage Area (HPSA). Please be sure to share with your
staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7Z8QDA0878?opendocument
J1 PCC Closed for New Year's Day January 1, 2010
The J1 Provider Contact Center (PCC) will be closed in observance of New
Year's Day on Friday, January 1, 2010.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7Z7PZB7045?opendocument
January 2010 J1 A/B MAC Medicare Advisory
The January 2010 J1 A/B MAC Medicare Advisory is available on the Web site.
Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7Z8K9G3785?opendocument
Medicare Remit EasyPrint (MREP) Software for J1 Part B
Medicare Remit EasyPrint (MREP) version 2.7 is available for download.
Please note that the Remittance Advice Remark Codes (RARCs) and Claim
Adjustment Reason Codes (CARCs) must be downloaded from the Washington
Publishing Company (WPC) Web site to be used in conjunction with the
updated MREP Software. You can save time and money by taking advantage of
FREE MREP software now available to view and print the ANSI 835!
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7HVMA20718?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, December 31, 2009
Thursday, December 24, 2009
ASH, CMS, & Palmetto/J1MAC News
The following information has been received by ANCO.
****ASH NEWS****
The American Society of Hematology (ASH) Practice Update was published and is available at http://www.hematology.org/Practice/Practice-Updates/4710.aspx. This edition features:
• MEDICARE CHANGES AFFECTING PHYSICIAN PAYMENT BEGINNING JANUARY 1, 2010
• CMS Eliminates Use of Consultation Codes: As of January 1, 2010 Providers Directed to Report Other Evaluation Management (E/M) Visit Codes
• Medicare Physician Fee Freeze through February 28, 2010
• CMS Will Hold Medicare Claims January 1 to January 15, 2010
• CMS Posts January 2010 ASP Pricing
****CMS NEWS****
SE0929 – 2010 Annual Participation Enrollment Program Extension
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0929.pdf
MM6753 – Positron Emission Tomography (PET) (FDG) for Cervical Cancer
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6753.pdf
This is a clarification to the listserv message that was issued on December 21, 2009. The President has signed the Department of Defense Appropriations Act of 2010 which provides for a zero percent (0%) update to the 2010 Medicare Physician Fee Schedule for a two month period, January 1, 2010 through February 28, 2010.
The Centers for Medicare & Medicaid Services (CMS) is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, non-physician practitioners, and other providers of services paid under the Medicare physician fee schedule, beginning January 1, 2010. In this regard, CMS has instructed its contractors to hold claims for services paid under the Medicare Physician Fee Schedule (MPFS) for up to the first 10 business days of January (January 1 through January 15) for 2010 dates of service. This should have minimum impact on provider cash flow because, by law, clean electronic claims are not paid any sooner than 14 calendar days (29 days for paper claims) after the date of receipt. Meanwhile, all claims for services delivered on or before December 31, 2009, will be processed and paid under normal procedures.
The holding of claims allows Medicare contractors time to receive the new, updated payment files and perform necessary testing before paying claims at the new rates. CMS has instructed contractors to begin processing claims at the new rates no later than January 19, 2010. Please note that most contractors are closed on the January 18 Martin Luther King Day holiday. Therefore, even absent a new update, most claims likely would not have been paid any sooner than January 19, 2010, given the aforementioned statutory 14-day payment floor.
CMS has extended the 2010 Annual Participation Enrollment Program end date from January 31, 2010, to March 17, 2010– therefore, the enrollment period now runs from November 13, 2009, through March 17, 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 March 17, 2010.
In addition, be on the alert for more information about other legislative provisions which may affect you.
****PALMETTO/J1MAC NEWS****
Time Limit for Filing Medicare Claims
Medicare law designates specific time limits for submitting claims for
physician and other Part B services. The terms of the law require that a
claim be filed no later than the end of the calendar year following the
year in which the service was furnished, except as indicated within this
article.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7HNFMM6252?opendocument
Updated Information Regarding the Holding of Claims for Services Paid Under
The 2010 Medicare Physician Fee Schedule
The Centers for Medicare & Medicaid Services (CMS) has instructed its
contractors to hold claims for services paid under the Medicare Physician
Fee Schedule (MPFS) for up to the first 10 business days of January
(January 1 through January 15) for 2010 dates of service.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YZRZ76754?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 (ASH) Practice Update was published and is available at http://www.hematology.org/Practice/Practice-Updates/4710.aspx. This edition features:
• MEDICARE CHANGES AFFECTING PHYSICIAN PAYMENT BEGINNING JANUARY 1, 2010
• CMS Eliminates Use of Consultation Codes: As of January 1, 2010 Providers Directed to Report Other Evaluation Management (E/M) Visit Codes
• Medicare Physician Fee Freeze through February 28, 2010
• CMS Will Hold Medicare Claims January 1 to January 15, 2010
• CMS Posts January 2010 ASP Pricing
****CMS NEWS****
SE0929 – 2010 Annual Participation Enrollment Program Extension
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0929.pdf
MM6753 – Positron Emission Tomography (PET) (FDG) for Cervical Cancer
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6753.pdf
This is a clarification to the listserv message that was issued on December 21, 2009. The President has signed the Department of Defense Appropriations Act of 2010 which provides for a zero percent (0%) update to the 2010 Medicare Physician Fee Schedule for a two month period, January 1, 2010 through February 28, 2010.
The Centers for Medicare & Medicaid Services (CMS) is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, non-physician practitioners, and other providers of services paid under the Medicare physician fee schedule, beginning January 1, 2010. In this regard, CMS has instructed its contractors to hold claims for services paid under the Medicare Physician Fee Schedule (MPFS) for up to the first 10 business days of January (January 1 through January 15) for 2010 dates of service. This should have minimum impact on provider cash flow because, by law, clean electronic claims are not paid any sooner than 14 calendar days (29 days for paper claims) after the date of receipt. Meanwhile, all claims for services delivered on or before December 31, 2009, will be processed and paid under normal procedures.
The holding of claims allows Medicare contractors time to receive the new, updated payment files and perform necessary testing before paying claims at the new rates. CMS has instructed contractors to begin processing claims at the new rates no later than January 19, 2010. Please note that most contractors are closed on the January 18 Martin Luther King Day holiday. Therefore, even absent a new update, most claims likely would not have been paid any sooner than January 19, 2010, given the aforementioned statutory 14-day payment floor.
CMS has extended the 2010 Annual Participation Enrollment Program end date from January 31, 2010, to March 17, 2010– therefore, the enrollment period now runs from November 13, 2009, through March 17, 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 March 17, 2010.
In addition, be on the alert for more information about other legislative provisions which may affect you.
****PALMETTO/J1MAC NEWS****
Time Limit for Filing Medicare Claims
Medicare law designates specific time limits for submitting claims for
physician and other Part B services. The terms of the law require that a
claim be filed no later than the end of the calendar year following the
year in which the service was furnished, except as indicated within this
article.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7HNFMM6252?opendocument
Updated Information Regarding the Holding of Claims for Services Paid Under
The 2010 Medicare Physician Fee Schedule
The Centers for Medicare & Medicaid Services (CMS) has instructed its
contractors to hold claims for services paid under the Medicare Physician
Fee Schedule (MPFS) for up to the first 10 business days of January
(January 1 through January 15) for 2010 dates of service.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YZRZ76754?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, December 23, 2009
CMA, CMS, & Palmetto/J1MAC News
The following information has been received by ANCO.
****CMA NEWS****
The California Medical Association (CMA) Alert was published and is available online at www.cmaalert.org. This edition features:
Congress Approves Stopgap Measure to Delay Medicare Cuts
Medicare Participation Decision Deadline Extended to January 31, 2010
CMS Eliminates Medicare Consult Codes
Senate Pushing for Health Reform Vote Before Christmas
State Proposes Sweeping Changes to Medi-Cal Program
Judge Rules Rescission Lawsuit Against Blue Cross Can Proceed
Has Your IPA or Health Plan Stopped Paying Claims?
Save the Date: 2010 California Health Care Leadership Academy Is April 9-11 in San Diego
****CMS NEWS****
To the extent possible and in consideration of possible legislative changes, the Centers for Medicare & Medicaid Services (CMS) is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, non-physician practitioners, and other providers of services paid under the Medicare physician fee schedule, beginning January 1, 2010. In this regard, CMS has instructed its contractors to hold claims containing services paid under the Medicare Physician Fee Schedule (MPFS) for the first 10 business days of January (January 1 through January 15) for 2010 dates of service. This should have minimum impact on provider cash flow because, under current law, clean electronic claims are not paid any sooner than 14 calendar days (29 days for paper claims) after the date of receipt. Meanwhile, all claims for services delivered on or before December 31, 2009, will be processed and paid under normal procedures.
After 10 business days, contractors will begin releasing held claims into processing under the fee schedule which implements current law. This, of course, could result in claims being processed with the negative 21.2 percent update. If a new law is enacted which changes the negative update effective January 1, CMS will correctly process claims under the new law and, if necessary, CMS is prepared to automatically reprocess most of those claims which have already been processed at the lower rate.
Under the Medicare statute, Medicare payments to physicians and other affected providers are based upon the lesser of the actual charge or the MPFS amount. Providers who submit charges that are greater than the negative 2010 MPFS will automatically have their claims reprocessed. Physicians who submit charges that are equal to or less than the 2010 MPFS amount will need to request an adjustment. Submitted charges on claims cannot be altered without a request from the physician/provider.
To the extent possible, providers may hold claims in-house until it becomes clearer as to whether new legislation will be enacted or until cash flow becomes problematic. This will reduce the need for providers to reconcile two payments (i.e., the initial claim and the reprocessed claim), and it will simplify provider billings of beneficiary coinsurance and payment calculations for payers which are secondary to Medicare.
CMS has extended the 2010 Annual Participation Enrollment Program end date from January 31, 2010, to March 17, 2010– therefore, the enrollment period now runs from November 13, 2009, through March 17, 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 March 17, 2010.
In addition, be on the alert for more information about other legislative provisions which may affect you.
The Centers for Medicare and Medicaid Services (CMS) has posted the revised January 2010 ASP pricing file and crosswalk. All are available for download at: http://www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/01a19_2010aspfiles.asp
****PALMETTO/J1MAC NEWS****
Information regarding the Holding of Claims for Services Paid Under the
2010 Medicare Physician Fee Schedule
The Centers for Medicare & Medicaid Services (CMS) has instructed its
contractors to hold claims containing services paid under the Medicare
Physician Fee Schedule (MPFS) for the first 10 business days of January
(January 1 through January 15) for 2010 dates of service. This should have
minimum impact on provider cash flow because, under current law, clean
electronic claims are not paid any sooner than 14 calendar days (29 days
for paper claims) after the date of receipt. Meanwhile, all claims for
services delivered on or before December 31, 2009, will be processed and
paid under normal procedures.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YXP3P3276?opendocument
Introduction to PC-ACE Pro32
Everything you've wanted to know about PC-ACE Pro32, Palmetto GBA's claims
entry software, but we're afraid to ask.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YXKRZ5802?opendocument
Revisions to Consultation Services Payment Policy
This J1 A/B MAC MLN Matters article (CR6740) was revised on December 17,
2009, to correct the ‘initial hospital day codes’ referenced on the top of
page 4. This article alerts providers that effective January 1, 2010, the
Current Procedural Terminology (CPT) consultation codes are no longer
recognized for Medicare Part B payment. Effective for services furnished on
or after January 1, 2010, providers should code a patient evaluation and
management visit with E/M codes that represents where the visit occurs and
that identify the complexity of the visit performed. Please be sure to
share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YUT8H8112?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 (CMA) Alert was published and is available online at www.cmaalert.org. This edition features:
Congress Approves Stopgap Measure to Delay Medicare Cuts
Medicare Participation Decision Deadline Extended to January 31, 2010
CMS Eliminates Medicare Consult Codes
Senate Pushing for Health Reform Vote Before Christmas
State Proposes Sweeping Changes to Medi-Cal Program
Judge Rules Rescission Lawsuit Against Blue Cross Can Proceed
Has Your IPA or Health Plan Stopped Paying Claims?
Save the Date: 2010 California Health Care Leadership Academy Is April 9-11 in San Diego
****CMS NEWS****
To the extent possible and in consideration of possible legislative changes, the Centers for Medicare & Medicaid Services (CMS) is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, non-physician practitioners, and other providers of services paid under the Medicare physician fee schedule, beginning January 1, 2010. In this regard, CMS has instructed its contractors to hold claims containing services paid under the Medicare Physician Fee Schedule (MPFS) for the first 10 business days of January (January 1 through January 15) for 2010 dates of service. This should have minimum impact on provider cash flow because, under current law, clean electronic claims are not paid any sooner than 14 calendar days (29 days for paper claims) after the date of receipt. Meanwhile, all claims for services delivered on or before December 31, 2009, will be processed and paid under normal procedures.
After 10 business days, contractors will begin releasing held claims into processing under the fee schedule which implements current law. This, of course, could result in claims being processed with the negative 21.2 percent update. If a new law is enacted which changes the negative update effective January 1, CMS will correctly process claims under the new law and, if necessary, CMS is prepared to automatically reprocess most of those claims which have already been processed at the lower rate.
Under the Medicare statute, Medicare payments to physicians and other affected providers are based upon the lesser of the actual charge or the MPFS amount. Providers who submit charges that are greater than the negative 2010 MPFS will automatically have their claims reprocessed. Physicians who submit charges that are equal to or less than the 2010 MPFS amount will need to request an adjustment. Submitted charges on claims cannot be altered without a request from the physician/provider.
To the extent possible, providers may hold claims in-house until it becomes clearer as to whether new legislation will be enacted or until cash flow becomes problematic. This will reduce the need for providers to reconcile two payments (i.e., the initial claim and the reprocessed claim), and it will simplify provider billings of beneficiary coinsurance and payment calculations for payers which are secondary to Medicare.
CMS has extended the 2010 Annual Participation Enrollment Program end date from January 31, 2010, to March 17, 2010– therefore, the enrollment period now runs from November 13, 2009, through March 17, 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 March 17, 2010.
In addition, be on the alert for more information about other legislative provisions which may affect you.
The Centers for Medicare and Medicaid Services (CMS) has posted the revised January 2010 ASP pricing file and crosswalk. All are available for download at: http://www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/01a19_2010aspfiles.asp
****PALMETTO/J1MAC NEWS****
Information regarding the Holding of Claims for Services Paid Under the
2010 Medicare Physician Fee Schedule
The Centers for Medicare & Medicaid Services (CMS) has instructed its
contractors to hold claims containing services paid under the Medicare
Physician Fee Schedule (MPFS) for the first 10 business days of January
(January 1 through January 15) for 2010 dates of service. This should have
minimum impact on provider cash flow because, under current law, clean
electronic claims are not paid any sooner than 14 calendar days (29 days
for paper claims) after the date of receipt. Meanwhile, all claims for
services delivered on or before December 31, 2009, will be processed and
paid under normal procedures.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YXP3P3276?opendocument
Introduction to PC-ACE Pro32
Everything you've wanted to know about PC-ACE Pro32, Palmetto GBA's claims
entry software, but we're afraid to ask.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YXKRZ5802?opendocument
Revisions to Consultation Services Payment Policy
This J1 A/B MAC MLN Matters article (CR6740) was revised on December 17,
2009, to correct the ‘initial hospital day codes’ referenced on the top of
page 4. This article alerts providers that effective January 1, 2010, the
Current Procedural Terminology (CPT) consultation codes are no longer
recognized for Medicare Part B payment. Effective for services furnished on
or after January 1, 2010, providers should code a patient evaluation and
management visit with E/M codes that represents where the visit occurs and
that identify the complexity of the visit performed. Please be sure to
share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YUT8H8112?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, December 17, 2009
CMS & Palmetto/J1MAC News
The following information has been received by ANCO.
****CMS NEWS****
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the posting of 2010 Physician Quality Reporting Initiative (PQRI) educational products to the PQRI webpage at www.cms.hhs.gov/PQRI on the CMS website:
2010 PQRI Quality Measure List- this document identifies the 179 quality measures (this includes 175 individual quality measures and the 4 measures in the Back Pain measures group, which are not reportable as individual PQRI quality measures) selected for the 2010 PQRI
2010 PQRI Quality Data Code (QDC) Categories – a table that outlines, for each measure, each QDC that should be reported for a corresponding quality action performed by the individual EP as noted in the measures specification. This determines how each code will be used when calculating performance rates. This also clarifies those measures that require 2 or more QDCs to report satisfactorily. Insufficiently reporting the QDCs (as specified in the 2010 PQRI measure specifications) will result in invalid reporting.
2010 Single Source Code Master- this file includes a numerical listing of all codes included in 2010 PQRI for incorporation into billing software.
2010 PQRI Measure Specifications Manual for Claims and Registry; Reporting of Individual Measures and Release Notes- this zip file contains two documents which are the authoritative documents that describe 1) the 2010 measure specifications (including codes and reporting instructions) for the 175 individual PQRI quality measures for claims or registry-based reporting and 2) changes from the 2009 PQRI Measure Specifications in the form of release notes delineated by measure number.
2010 PQRI Implementation Guide- provides guidance about how to implement 2010 PQRI claims-based reporting of measures to facilitate satisfactory reporting of quality data codes by EPs.
2010 PQRI Measures Groups Specifications Manual and Release Notes- measures group specifications that are different from those of the individual measures that form the group. The specifications and instructions for measures group reporting are, therefore, provided in a separate manual. This zip file contains two documents which are the authoritative documents that describe 1) the 2010 measures groups specifications (including codes and reporting instructions) for the 13 PQRI measures groups for claims or registry-based reporting and 2) changes from the 2009 PQRI Measures Groups Specifications Manual in the form of release notes.
Getting Started with 2010 PQRI Reporting of Measures Groups - provides guidance about implementing the 2010 PQRI measures groups.
2010 PQRI Measure Applicability Validation Process for Claims-Based Reporting of Individual Measures- provides guidance for those eligible professionals who satisfactorily submit quality-data codes for fewer than three PQRI measures, and how the measure-applicability validation process will determine whether they should have submitted QDCs for additional measures.
2010 PQRI Measure-Applicability Validation Process Release Notes- the release notes for the changes occurring for the 2010 PQRI Measure Applicability Validation Process (MAV).
2010 Measure-Applicability Validation Process Flow Chart- a chart that depicts the Measure Applicability Validation Process (MAV)
Group Practice Reporting Option (GPRO) Requirements for Submission of 2010 PQRI Data- provides guidance on how a group practice can self-nominate to participate in the GPRO for 2010 data submission.
2010 PQRI GPRO Disease Modules and Preventive Care Measures- a document containing a list of the 2010 PQRI GPRO Measures
2010 PQRI GPRO Narrative Measure Specifications- this document contains descriptions of the 2010 PQRI GPRO measures.
Registry Requirements for Submission of 2010 PQRI Data on Behalf of Eligible Professionals- this document describes the high-level requirements for a registry to qualify to submit under the registry-based reporting alternatives for 2010. This document also outlines how a registry can become qualified for 2010 data submission.
To access the 2010 PQRI educational products, visit the following page http://www.cms.hhs.gov/PQRI/02_Spotlight.asp on the CMS website. Once on the Spotlight page, view the listing of educational products and the corresponding webpages where they can be found.
Further information on the 2010 PQRI Program may be found in the final 2010 Medicare Physician Fee Schedule rule with comment period (74 FR 61788 through 61861) that was published in the Federal Register on October 30, 2009. The final rule can be found on the Physician Quality Reporting Initiative webpage at www.cms.hhs.gov/PQRI on the CMS website, click on the Statute/Regulations/Program Instructions section page at left.
Reporting for the 2010 PQRI begins January 1, 2010. Please note there is no need to sign up or pre-register in order to participate.
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the posting of 2010 Electronic Prescribing Incentive (eRx) Program educational products to the eRx webpage at www.cms.hhs.gov/ERxIncentive on the CMS website:
· 2010 eRx Measure Specifications and Release Notes- Provides guidance on the 2010 eRx measure specifications for claims or registry-based reporting and release notes describing changes from the 2009 eRx measure specifications.
· Claims-Based Reporting Principles for the 2010 eRx Incentive Program- provides guidance on the principles for reporting the eRx measure on claims for the 2010 eRx Incentive Program.
· 2010 EHR Measure Specifications for eRx and Release Notes- provides guidance on The 2010 EHR measure specifications for eRx and release notes. In addition it details the specifications contain a detailed description of data element names and codes.
· 2010 EHR Downloadable Resource- an Excel spreadsheet listing 2010 EHR information.
· Group Practice Reporting Option (GPRO) Requirements for Submission of 2010 eRx Data- provides guidance on the Group Practice Reporting Option (GPRO) requirements for submission of 2010 eRx data.
· GPRO eRx Measure Specifications- provides guidance on the specifications for the eRx measure for use in the 2010 eRx GPRO.
To access the 2010 eRx educational products, visit the following page http://www.cms.hhs.gov/PQRI/02_Spotlight.asp on the CMS website. Once on the Spotlight page, view the listing of educational products and the corresponding webpages they can be found on.
Further information on the 2010 eRx Incentive Program may be found in the final 2010 Medicare Physician Fee Schedule rule with comment period (74 FR 61788 through 61861) that was published in the Federal Register on October 30, 2009. The final rule can be found on the Electronic Prescribing Incentive Program webpage at www.cms.hhs.gov/ERxIncentive on the CMS website, click on the Statute/Regulations/Program Instructions section page at left.
Reporting for the 2010 eRx begins January 1, 2010. Please note there is no need to sign up or pre-register in order to participate.
MM6742 – Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy Print (MREP) Update
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6742.pdf
MM6540 – Tracking the Hospice Attending Physician’s National Provider Identifier (NPI) for Validating Hospice Part B Payments
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6540.pdf
MM6723 – Claim Status Category Code and Claim Status Code Update
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6723.pdf
MM6740 – Revisions to Consultation Services Payment Policy
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6740.pdf
This article pertains to Change Request (CR) 6740, which alerts physicians and non-physician practitioners that effective January 1, 2010, the Current Procedural Terminology (CPT) consultation codes (ranges 99241-99245 and 99251-99255) are no longer recognized for Medicare Part B payment. Effective for services furnished on or after January 1, 2010, physicians and non-physician practitioners should code a patient evaluation and management visit with E/M codes that represent where the visit occurs and that identify the complexity of the visit performed. For more information, please view the article located at: http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6740.pdf on the CMS website.
****PALMETTO/J1MAC NEWS****
The following J1 Part B LCDs have been revised: Botulinum Toxin Types A and
B Policy, CT Colonography (Virtual Colonoscopy), MammaPrint Test – Breast
Cancer Prognosis, Paravertebral Facet Joint Block and Facet Joint
Denervation, Plastic Surgery, Treatment of Varicose Veins of the Lower
Extremities and Urodynamics.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YMQVN3575?opendocument
J1 Part B LCD Updates
The following J1 Part B Local Coverage Determinations (LCDs) have been
revised: Ambulance Services L28235, Cardiovascular Nuclear Medicine,
Myocardial Perfusion Imaging and Cardiac Blood Pool Studies L28246,
Category III CPT Codes L28248, Intensity Modulated Radiation Therapy (IMRT)
L28272, Multidetector Computed Tomography of the Heart and Great Vessels
L28281, Nervous System Studies - Autonomic Function, Nerve and
Electromyography L28282, Pulmonary Function Testing L28295 and Vestibular
Function Testing L28314.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YRSHK8131?opendocument
J1 PCC Closing for Training Friday, December 18
The J1 Provider Contact Center (PCC) will be closed for training on Friday,
December 18, 2009, between 11 a.m. and 3 p.m. PST.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7QHNCM4448?opendocument
Part B LCD Ready for Comment
The following J1 Part B LCDs will be ready for comment: Circulating Tumor
Cell Marker Assays, Flow Cytometry, In Vitro Chemosensitivity &
Chemoresistance Assays, Physical Medicine and Rehabilitation Policy. The
comment period begins on January 7, 2010 and ends on March 1, 2010.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YMRA76424?opendocument
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) is pleased to announce the posting of 2010 Physician Quality Reporting Initiative (PQRI) educational products to the PQRI webpage at www.cms.hhs.gov/PQRI on the CMS website:
2010 PQRI Quality Measure List- this document identifies the 179 quality measures (this includes 175 individual quality measures and the 4 measures in the Back Pain measures group, which are not reportable as individual PQRI quality measures) selected for the 2010 PQRI
2010 PQRI Quality Data Code (QDC) Categories – a table that outlines, for each measure, each QDC that should be reported for a corresponding quality action performed by the individual EP as noted in the measures specification. This determines how each code will be used when calculating performance rates. This also clarifies those measures that require 2 or more QDCs to report satisfactorily. Insufficiently reporting the QDCs (as specified in the 2010 PQRI measure specifications) will result in invalid reporting.
2010 Single Source Code Master- this file includes a numerical listing of all codes included in 2010 PQRI for incorporation into billing software.
2010 PQRI Measure Specifications Manual for Claims and Registry; Reporting of Individual Measures and Release Notes- this zip file contains two documents which are the authoritative documents that describe 1) the 2010 measure specifications (including codes and reporting instructions) for the 175 individual PQRI quality measures for claims or registry-based reporting and 2) changes from the 2009 PQRI Measure Specifications in the form of release notes delineated by measure number.
2010 PQRI Implementation Guide- provides guidance about how to implement 2010 PQRI claims-based reporting of measures to facilitate satisfactory reporting of quality data codes by EPs.
2010 PQRI Measures Groups Specifications Manual and Release Notes- measures group specifications that are different from those of the individual measures that form the group. The specifications and instructions for measures group reporting are, therefore, provided in a separate manual. This zip file contains two documents which are the authoritative documents that describe 1) the 2010 measures groups specifications (including codes and reporting instructions) for the 13 PQRI measures groups for claims or registry-based reporting and 2) changes from the 2009 PQRI Measures Groups Specifications Manual in the form of release notes.
Getting Started with 2010 PQRI Reporting of Measures Groups - provides guidance about implementing the 2010 PQRI measures groups.
2010 PQRI Measure Applicability Validation Process for Claims-Based Reporting of Individual Measures- provides guidance for those eligible professionals who satisfactorily submit quality-data codes for fewer than three PQRI measures, and how the measure-applicability validation process will determine whether they should have submitted QDCs for additional measures.
2010 PQRI Measure-Applicability Validation Process Release Notes- the release notes for the changes occurring for the 2010 PQRI Measure Applicability Validation Process (MAV).
2010 Measure-Applicability Validation Process Flow Chart- a chart that depicts the Measure Applicability Validation Process (MAV)
Group Practice Reporting Option (GPRO) Requirements for Submission of 2010 PQRI Data- provides guidance on how a group practice can self-nominate to participate in the GPRO for 2010 data submission.
2010 PQRI GPRO Disease Modules and Preventive Care Measures- a document containing a list of the 2010 PQRI GPRO Measures
2010 PQRI GPRO Narrative Measure Specifications- this document contains descriptions of the 2010 PQRI GPRO measures.
Registry Requirements for Submission of 2010 PQRI Data on Behalf of Eligible Professionals- this document describes the high-level requirements for a registry to qualify to submit under the registry-based reporting alternatives for 2010. This document also outlines how a registry can become qualified for 2010 data submission.
To access the 2010 PQRI educational products, visit the following page http://www.cms.hhs.gov/PQRI/02_Spotlight.asp on the CMS website. Once on the Spotlight page, view the listing of educational products and the corresponding webpages where they can be found.
Further information on the 2010 PQRI Program may be found in the final 2010 Medicare Physician Fee Schedule rule with comment period (74 FR 61788 through 61861) that was published in the Federal Register on October 30, 2009. The final rule can be found on the Physician Quality Reporting Initiative webpage at www.cms.hhs.gov/PQRI on the CMS website, click on the Statute/Regulations/Program Instructions section page at left.
Reporting for the 2010 PQRI begins January 1, 2010. Please note there is no need to sign up or pre-register in order to participate.
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the posting of 2010 Electronic Prescribing Incentive (eRx) Program educational products to the eRx webpage at www.cms.hhs.gov/ERxIncentive on the CMS website:
· 2010 eRx Measure Specifications and Release Notes- Provides guidance on the 2010 eRx measure specifications for claims or registry-based reporting and release notes describing changes from the 2009 eRx measure specifications.
· Claims-Based Reporting Principles for the 2010 eRx Incentive Program- provides guidance on the principles for reporting the eRx measure on claims for the 2010 eRx Incentive Program.
· 2010 EHR Measure Specifications for eRx and Release Notes- provides guidance on The 2010 EHR measure specifications for eRx and release notes. In addition it details the specifications contain a detailed description of data element names and codes.
· 2010 EHR Downloadable Resource- an Excel spreadsheet listing 2010 EHR information.
· Group Practice Reporting Option (GPRO) Requirements for Submission of 2010 eRx Data- provides guidance on the Group Practice Reporting Option (GPRO) requirements for submission of 2010 eRx data.
· GPRO eRx Measure Specifications- provides guidance on the specifications for the eRx measure for use in the 2010 eRx GPRO.
To access the 2010 eRx educational products, visit the following page http://www.cms.hhs.gov/PQRI/02_Spotlight.asp on the CMS website. Once on the Spotlight page, view the listing of educational products and the corresponding webpages they can be found on.
Further information on the 2010 eRx Incentive Program may be found in the final 2010 Medicare Physician Fee Schedule rule with comment period (74 FR 61788 through 61861) that was published in the Federal Register on October 30, 2009. The final rule can be found on the Electronic Prescribing Incentive Program webpage at www.cms.hhs.gov/ERxIncentive on the CMS website, click on the Statute/Regulations/Program Instructions section page at left.
Reporting for the 2010 eRx begins January 1, 2010. Please note there is no need to sign up or pre-register in order to participate.
MM6742 – Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy Print (MREP) Update
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6742.pdf
MM6540 – Tracking the Hospice Attending Physician’s National Provider Identifier (NPI) for Validating Hospice Part B Payments
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6540.pdf
MM6723 – Claim Status Category Code and Claim Status Code Update
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6723.pdf
MM6740 – Revisions to Consultation Services Payment Policy
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6740.pdf
This article pertains to Change Request (CR) 6740, which alerts physicians and non-physician practitioners that effective January 1, 2010, the Current Procedural Terminology (CPT) consultation codes (ranges 99241-99245 and 99251-99255) are no longer recognized for Medicare Part B payment. Effective for services furnished on or after January 1, 2010, physicians and non-physician practitioners should code a patient evaluation and management visit with E/M codes that represent where the visit occurs and that identify the complexity of the visit performed. For more information, please view the article located at: http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6740.pdf on the CMS website.
****PALMETTO/J1MAC NEWS****
The following J1 Part B LCDs have been revised: Botulinum Toxin Types A and
B Policy, CT Colonography (Virtual Colonoscopy), MammaPrint Test – Breast
Cancer Prognosis, Paravertebral Facet Joint Block and Facet Joint
Denervation, Plastic Surgery, Treatment of Varicose Veins of the Lower
Extremities and Urodynamics.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YMQVN3575?opendocument
J1 Part B LCD Updates
The following J1 Part B Local Coverage Determinations (LCDs) have been
revised: Ambulance Services L28235, Cardiovascular Nuclear Medicine,
Myocardial Perfusion Imaging and Cardiac Blood Pool Studies L28246,
Category III CPT Codes L28248, Intensity Modulated Radiation Therapy (IMRT)
L28272, Multidetector Computed Tomography of the Heart and Great Vessels
L28281, Nervous System Studies - Autonomic Function, Nerve and
Electromyography L28282, Pulmonary Function Testing L28295 and Vestibular
Function Testing L28314.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YRSHK8131?opendocument
J1 PCC Closing for Training Friday, December 18
The J1 Provider Contact Center (PCC) will be closed for training on Friday,
December 18, 2009, between 11 a.m. and 3 p.m. PST.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7QHNCM4448?opendocument
Part B LCD Ready for Comment
The following J1 Part B LCDs will be ready for comment: Circulating Tumor
Cell Marker Assays, Flow Cytometry, In Vitro Chemosensitivity &
Chemoresistance Assays, Physical Medicine and Rehabilitation Policy. The
comment period begins on January 7, 2010 and ends on March 1, 2010.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YMRA76424?opendocument
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, December 14, 2009
ASH, CMS, & Palmetto/J1MAC News
The following information has been received by ANCO.
****ASH NEWS****
The American Society of Hematology (ASH) Practice Update was published and is available online at http://www.hematology.org/Practice/Practice-Updates/4667.aspx. This edition features:
CMS Will Eliminate Consultation Codes – Effective January 1, 2010
Senate Works on Health Reform Legislation to Reach Passable Compromise
Let ASH Help You - Submit Your Medicare Reimbursement Questions to the Society Today
ASH Expresses Concern to CMS about New Medicare Enrollment Policy
Medicare Extends 2010 Annual Participation Enrollment Program
FDA Requests Help in Reporting New Cancer Cases For Patients Taking Stelara
Medicare Paid Over $92 Million in Incentives for 2008 Physician Quality Reporting Initiative
Medicare Releases Quarterly CCI Update
New Medicare Learning Network Booklet: How to Use the Medicare Coverage Database Search Tool
Don’t Miss the Only Official Highlights of ASH - Occurring Near You
****CMS NEWS****
MM6753 – Positron Emission Tomography (PET) (FDG) for Cervical Cancer
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6753.pdf
****PALMETTO/J1MAC NEWS****
2010 Annual Update to the Therapy Code List
This J1 A/B MAC MLN Matters article (CR6719) updates the therapy code list
for Calendar Year (CY) 2010 with one ‘Sometimes Therapy’ Code (laryngeal
function studies (e.g., aerodynamic testing and acoustic testing). Note
that this code always represents therapy services when performed by
therapists and requires the use of a therapy modifier. Please be sure to
share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YJMUB5278?opendocument
Open Draft LCD Meetings January 2010
Palmetto GBA J1 A/B Medicare Administrative Contractor (MAC) has scheduled
Open Draft Local Coverage Determination (LCD) meetings in California,
Nevada and Hawaii for January, 2010.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YDPHY0633?opendocument
Requirements to Prevent the Misuse of Modifiers PA, PB and PC on Incoming
Claims
This J1 A/B MAC MLN Matters article (CR6718) advises you that the PA, PB
and PC modifiers are often being submitted incorrectly on claims. This can
cause incorrect denials. The Centers for Medicare & Medicaid Services (CMS)
issued this article to direct contractors on handling incorrect claims in
order to alleviate the issue. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YJMQ43785?opendocument
J1 PCC Training and Holiday Closure Schedule for First Quarter Fiscal Year
2010
The J1 Provider Contact Center (PCC) training and holiday closure schedule
for the first quarter of the fiscal year (FY) 2010 is now available on our
Web site.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YDNNS3230?opendocument
My claim was returned with the message 'the procedure code is inconsistent
with the modifier used or a required modifier is missing.' Both HCPCS
modifier Q0 and CPT modifier 26 should be valid for the procedure code. Why
wasn’t my claim processed?
Functional (pricing) modifiers must be submitted in the first modifier
field in order for claims to be processed and reimbursed correctly. To
avoid processing delays, submit any informational (statistical) modifiers
after the functional modifier.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7XUL3Q0075?opendocument
Using the Redetermination/Reopening Request Form
To reduce the number of incorrectly submitted redetermination requests and
avoid unnecessary delay in forwarding requests to the proper department, we
strongly encourage providers to use the J1 Part B Redetermination/Reopening
Request Form. Redetermination requests received with an EDI Fax Cover Sheet
will be returned to you with no action taken.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YKQNG0476?opendocument
Updated: Medical Nutrition Therapy NCD Codes Denied in Error
Medical Nutrition Therapy claims processed on and after September 21, 2009,
were denied in error when submitted with a covered diagnosis. A mass
adjustment on 153 claims was completed on December 1, 2009, for services
previously denied in error.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7X4QUF1887?opendocument
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 (ASH) Practice Update was published and is available online at http://www.hematology.org/Practice/Practice-Updates/4667.aspx. This edition features:
CMS Will Eliminate Consultation Codes – Effective January 1, 2010
Senate Works on Health Reform Legislation to Reach Passable Compromise
Let ASH Help You - Submit Your Medicare Reimbursement Questions to the Society Today
ASH Expresses Concern to CMS about New Medicare Enrollment Policy
Medicare Extends 2010 Annual Participation Enrollment Program
FDA Requests Help in Reporting New Cancer Cases For Patients Taking Stelara
Medicare Paid Over $92 Million in Incentives for 2008 Physician Quality Reporting Initiative
Medicare Releases Quarterly CCI Update
New Medicare Learning Network Booklet: How to Use the Medicare Coverage Database Search Tool
Don’t Miss the Only Official Highlights of ASH - Occurring Near You
****CMS NEWS****
MM6753 – Positron Emission Tomography (PET) (FDG) for Cervical Cancer
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6753.pdf
****PALMETTO/J1MAC NEWS****
2010 Annual Update to the Therapy Code List
This J1 A/B MAC MLN Matters article (CR6719) updates the therapy code list
for Calendar Year (CY) 2010 with one ‘Sometimes Therapy’ Code (laryngeal
function studies (e.g., aerodynamic testing and acoustic testing). Note
that this code always represents therapy services when performed by
therapists and requires the use of a therapy modifier. Please be sure to
share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YJMUB5278?opendocument
Open Draft LCD Meetings January 2010
Palmetto GBA J1 A/B Medicare Administrative Contractor (MAC) has scheduled
Open Draft Local Coverage Determination (LCD) meetings in California,
Nevada and Hawaii for January, 2010.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YDPHY0633?opendocument
Requirements to Prevent the Misuse of Modifiers PA, PB and PC on Incoming
Claims
This J1 A/B MAC MLN Matters article (CR6718) advises you that the PA, PB
and PC modifiers are often being submitted incorrectly on claims. This can
cause incorrect denials. The Centers for Medicare & Medicaid Services (CMS)
issued this article to direct contractors on handling incorrect claims in
order to alleviate the issue. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YJMQ43785?opendocument
J1 PCC Training and Holiday Closure Schedule for First Quarter Fiscal Year
2010
The J1 Provider Contact Center (PCC) training and holiday closure schedule
for the first quarter of the fiscal year (FY) 2010 is now available on our
Web site.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YDNNS3230?opendocument
My claim was returned with the message 'the procedure code is inconsistent
with the modifier used or a required modifier is missing.' Both HCPCS
modifier Q0 and CPT modifier 26 should be valid for the procedure code. Why
wasn’t my claim processed?
Functional (pricing) modifiers must be submitted in the first modifier
field in order for claims to be processed and reimbursed correctly. To
avoid processing delays, submit any informational (statistical) modifiers
after the functional modifier.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7XUL3Q0075?opendocument
Using the Redetermination/Reopening Request Form
To reduce the number of incorrectly submitted redetermination requests and
avoid unnecessary delay in forwarding requests to the proper department, we
strongly encourage providers to use the J1 Part B Redetermination/Reopening
Request Form. Redetermination requests received with an EDI Fax Cover Sheet
will be returned to you with no action taken.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YKQNG0476?opendocument
Updated: Medical Nutrition Therapy NCD Codes Denied in Error
Medical Nutrition Therapy claims processed on and after September 21, 2009,
were denied in error when submitted with a covered diagnosis. A mass
adjustment on 153 claims was completed on December 1, 2009, for services
previously denied in error.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7X4QUF1887?opendocument
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, December 9, 2009
CMA & Palmetto/J1MAC News
The following information has been received by ANCO.
****CMA NEWS****
The California Medical Association (CMA) Alert was published and is available online at http://www.calphys.org/html/news.asp. This edition features:
CMA Clarifies Medical Liability Provisions in Health Reform Bills
CMS Delays Implementation of PECOS Enrollment Policy
CMA Heads to Washington to Fight for Improvements to Senate Health Reform Bill
CMA Urges CMS to Restore Payments for Consultation Codes
Physicians: Be Prepared for Disruption in Medicare Cash Flow this Month
DOI Lawsuit Against PacifiCare Begins Today
New E-Mail Scam Preys on Patients' H1N1 Fears
State Extends H1N1 Vaccine Thimerosal Exemption
CMA Publishes H1N1 Billing Guide
State Resurrects Regulations that Would Expand Scope of Nonphysicians
AHRQ Looking for Practices to Participate in E-Prescribing Implementation Study
****PALMETTO/J1MAC NEWS****
FAQs: Healthcare Integrated General Ledger Accounting System (HIGLAS)
Transition
Share with your staff - FAQs regarding the J1 Part B Healthcare Integrated
General Ledger Accounting System (HIGLAS) transition have been posted to
our Web site!
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YETAB5204?opendocument
J1 Provider Outreach and Education Event Calendar
J1 Part B providers, join Palmetto GBA J1 Provider Outreach and Education
team on December 15 for a Part B Ask the Contractor Teleconference (ACT) on
Medicare Updates!
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 (CMA) Alert was published and is available online at http://www.calphys.org/html/news.asp. This edition features:
CMA Clarifies Medical Liability Provisions in Health Reform Bills
CMS Delays Implementation of PECOS Enrollment Policy
CMA Heads to Washington to Fight for Improvements to Senate Health Reform Bill
CMA Urges CMS to Restore Payments for Consultation Codes
Physicians: Be Prepared for Disruption in Medicare Cash Flow this Month
DOI Lawsuit Against PacifiCare Begins Today
New E-Mail Scam Preys on Patients' H1N1 Fears
State Extends H1N1 Vaccine Thimerosal Exemption
CMA Publishes H1N1 Billing Guide
State Resurrects Regulations that Would Expand Scope of Nonphysicians
AHRQ Looking for Practices to Participate in E-Prescribing Implementation Study
****PALMETTO/J1MAC NEWS****
FAQs: Healthcare Integrated General Ledger Accounting System (HIGLAS)
Transition
Share with your staff - FAQs regarding the J1 Part B Healthcare Integrated
General Ledger Accounting System (HIGLAS) transition have been posted to
our Web site!
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YETAB5204?opendocument
J1 Provider Outreach and Education Event Calendar
J1 Part B providers, join Palmetto GBA J1 Provider Outreach and Education
team on December 15 for a Part B Ask the Contractor Teleconference (ACT) on
Medicare Updates!
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, December 7, 2009
ACCC, 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_12-2-2009.html. ANCO is an Institutional Member of ACCC. This edition features:
• Who Will Care for Tomorrow's Cancer Patients? ACCC Looks for Answers
• Next Week: Bring Out the Best in Your Cancer Service Line
• 2009 PQRI Conference Call on December 10
• Cancer Screenings Brochure Available From CMS
• Heard on ACCC's ListServ: Family Members in the Radiation Center
• Oncologists Optimistic about Future of Oncology Clinical Trials While Citing Cost as Barrier
****CMS NEWS****
MM6662 – Annual Update of HCPCS Codes Used for Home Health (HH) Consolidated Billing Enforcement
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6662.pdf
MM6728 – Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 16.0, Effective January 1, 2010
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6728.pdf
MM6540 – Tracking the Hospice Attending Physician’s National Provider Identifier (NPI) for Validating Hospice Part B Payments
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6540.pdf
The Centers for Medicare & Medicaid Services (CMS) would like to remind Physician Quality Reporting Initiative (PQRI) participants that there is a “Verify Report Portlet” look-up tool available on the PQRI Portal for Eligible Professionals (EPs) to verify if a 2007 re-run and/or 2008 PQRI feedback report exists for your organization's Tax Identification Number (TIN) or National Provider Identifier (NPI). The TIN or NPI must be the one used by the EP to submit Medicare claims and valid PQRI quality data codes. This tool is available at (https://www.qualitynet.org/portal/server.pt) on the internet.
If a report is available for your organization’s TIN or NPI there are two ways to access 2007 re-run and/or 2008 PQRI feedback reports:
1) An individual EP can simply call their respective Carrier or A/B MAC provider contact center to request confidential 2007 PQRI re-run and/or 2008 PQRI feedback reports that will contain information based on their individual NPI. If an EP is part of a group practice, each EP in the group practice must individually call their respective Carrier or A/B MAC provider contact center to request a feedback report based on the 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 this 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.
or
2) EPs can logon to the secure PQRI Portal on QualityNet at (http://www.qualitynet.org/portal/server.pt) to access their feedback report(s) based their TIN, or for a group. Access to the PQRI Portal requires registration in the Individuals Authorized Access to CMS Computer Services (IACS) system to obtain a userID and password.
Important Information on Updating IACS User Accounts and Passwords
CMS would like to remind users that the CMS Security policy requires IACS passwords to be changed every 60 days. An IACS user who has not changed his or her password in over 60 days will be prompted to do so at the next login attempt.
An IACS user who has not changed his or her password in over 120 days will first be prompted to answer the security questions established at registration. After successfully answering security questions, the user will then be prompted for a password change.
Updating IACS user accounts and passwords is essential to maintaining this access and functionality.
Resources
The IACS account management page is at (https://applications.cms.hhs.gov/category.html?name=acctmngmt).Click on “My Profile” to login, change your password, or use the “Forgot Password?” option.
If you are having difficulty with IACS registration or disabled accounts, follow the self-service instructions below on how to recover your IACS userId and/or password and/or change your IACS password.
Instructions for Retrieving Your IACS UserID
1. Go to the CMS Applications portal at (https://applications.cms.hhs.gov)
2. Enter the portal; select the Account Management tab, and then the “Forgot Your User ID?” link in the Account Management section. Follow the online instructions.
3. You will receive an email at the email address on record.
Instructions for Retrieving Your IACS Password
1. Go to the CMS Applications portal at (https://applications.cms.hhs.gov/warning.html)
2. Enter the portal; select the Account Management tab, and then “My Profile” link in the Account Management section.
3. Enter your UserID
4. Click on “Forgot Your Password?” button on the login page and follow the online instructions.
5. You will receive a onetime password in an email at the email address on record.
Instructions to Login and Change Your IACS Password:
1. Go to the CMS Applications portal at (https://applications.cms.hhs.gov)
2. Enter the portal; select the Account Management tab
3. Select the My Profile link
4. Login using your UserID and onetime temporary Password.
5. The system will prompt you to change your password.
6. Enter your new password in both the New Password and Confirm New Password fields and then select the Change Password button.
7. The system will take you back to the My Profile screen.
8. Log out.
Once you have successfully changed your password you may login and access your PQRI feedback report(s) on the PQRI portal at (https://www.qualitynet.org/portal/server.pt).
If you are still having difficulty with IACS registration or disabled accounts, please contact the External Users Services (EUS) Help Desk
at 1-866-484-8049, TTY/TDD at 1-866-523-4759 (Monday – Friday 7:00 a.m.-7:00 p.m. EST) or via e-mail at EUSSupport@cgi.com.
The IACS home page for the Provider/Supplier user Community, which includes PQRI, is at (http://www.cms.hhs.gov/IACS/04_Provider_Community.asp#TopOfPage) on the CMS website. Provider Community users should direct questions or concerns to the External User Services (EUS) Help Desk at 1-866-484-8049, TTY/TDD at 1-866-523-4759 (Monday - Friday 7:00 a.m.-7:00 p.m. EST) or via email atEUSSupport@cgi.com.
The PQRI Portal is available at (https://www.qualitynet.org/portal/server.pt) on the internet. Although the “Forgot Password” link on the PQRI Portal sends users to the IACS website, IACS and the PQRI Portal are two separate websites.
Additional information about PQRI can be found at (http://www.cms.hhs.gov/PQRI) on the CMS website. 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.
Users who still have questions or need assistance should contact the QualityNet Help Desk at 1-866-288-8912 (Monday-Friday 7:00 a.m.-7:00 p.m. CST) or qnetsupport@sdps.org.
****PALMETTO/J1MAC NEWS****
December 2009 J1 A/B MAC Medicare Advisory
Updates and changes were made to the December 2009 J1 A/B MAC Medicare
Advisory. It 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
Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 16.0,
Effective January 1, 2010
This J1 Part B MLN Matters article (CR 6728) provides a reminder for
physicians to take note of the quarterly updates to Correct Coding
Initiative (CCI) edits. The last quarterly release of the edit module was
issued in October 2009. The Centers for Medicare & Medicaid Services (CMS)
developed the National Correct Coding Initiative (CCI) to promote national
correct coding methodologies and to control improper coding that leads to
inappropriate payment in Part B claims. Please be sure to share with your
staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YBT823658?opendocument
Annual Update of HCPCS Codes Used for Home Health (HH) Consolidated Billing
Enforcement
This J1 A/B MAC MLN Matters article (CR6662) provides the annual Home
Health (HH) consolidated billing update effective January 1, 2010. The
Centers for Medicare & Medicaid Services (CMS) periodically updates the
lists of Health Care Common Procedure Codes System (HCPCS) codes subject to
the consolidated billing provision of the Home Health Prospective Payment
System (HH PPS). Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YCN4K0087?opendocument
HIGLAS Transition: Impact on J1 Part B Medicare Providers
Palmetto GBA Jurisdiction 1 MAC has updated the Healthcare Integrated
General Ledger Accounting System (HIGLAS) transition time table posted on
our Web site. The HIGLAS transition will be completed December 16, 2009. At
the same time, processing backlogged files and issuing payments will begin.
From December 16 to December 30, 2009, providers may experience a
significant reduction in payments due to the early claim payments issued
immediately prior to the transition. Providers need to monitor and manage
their cash flows during this time period.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7Y3LRC5231?opendocument
J1 Provider Outreach and Education Event Calendar
What's new in December 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
Technical Corrections To The Relative Value Units
This article reflects technical corrections to the relative value units,
including various CPT codes, and to the CY 2010 conversion factor contained
in the CY 2010 Medicare physician fee schedule final rule. Please be sure
to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YBTF22165?opendocument
2010 J1 Part B Fee Schedules
The 2010 J1 Part B Fee Schedules for California are now available and are
effective January 1, 2010. The 2010 J1 Part B Fee Schedules for Nevada,
Hawaii, Guam, American Samoa and the Northern Mariana Islands will be
coming soon.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7Y3GZA7365?opendocument
J1 EDI Enrollment Packet
The Jurisdiction 1 A/B MAC EDI Enrollment Packet has been updated with a
new form. The Provider Authorization form must be completed by the provider
to authorize a clearinghouse and/or billing service as an electronic
submitter and recipient of electronic claims data. Please begin using this
updated packet immediately.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7XPTLJ4585?opendocument
Therapy Cap Values for Calendar Year (CY) 2010
This J1 A/B MAC MLN Matters article (CR6660a) describes the policy for
outpatient therapy caps for 2010 and announces that therapy caps for 2010
will be $1,860. This article was revised on November 24, 2009, to reflect a
revised CR 6660 that the Centers for Medicare & Medicaid Services (CMS)
issued on November 23, 2009. As a result of the revised CR, the article was
revised to include Regional Home Health Intermediaries as an additional
contractor type involved with this issue. The CR release date, transmittal
number and Web address for accessing CR 6660 were also changed. Also,
carriers were added as a contractor type involved as they were
inadvertently not included in the original article. All other information
remains the same. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YCMRD2255?opendocument
ACT Call: Medicare Updates - December 15, 2009
Join us for a J1 Part B Ask the Contractor Teleconference (ACT) regarding
Medicare Part B General Updates on Tuesday, December 15, 2009, at 12:30
p.m. PST.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YERHB5637?opendocument
ACT Minutes: Top 10 Claim Submission Errors - November 19, 2009
The meeting minutes of the J1 Part A Ask the Contractor Teleconference on
November 19, 2009, is now available on our Web site.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YESW92524?opendocument
J1 Provider Outreach and Education Event Calendar
Check out the new Palmetto GBA J1 Provider Outreach and Education events
added to our December 2009 online Events calendar!
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7TAL2C7131?opendocument
Tracking the Hospice Attending Physician’s National Provider Identifier
(NPI) for Validating Hospice Part B Payments
This J1 A/B MAC MLN Matters article (CR6540) is meant to ensure that the
hospice-reported data in the Notice of Election (NOE) and claims for the
attending physician, which may be a Nurse Practitioner (NP), meet the
definition of attending physician/NP in the Code of Federal Regulations
(CFR), while also reporting the hospice physician responsible for
certifying the terminal illness. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YEMNL2613?opendocument
Webinar: Bundled Services December 16
Palmetto GBA J1 Part B providers, join us on Wednesday, December 16, 2009,
for a free Webinar on Bundled Services!
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YERCG5273?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_12-2-2009.html. ANCO is an Institutional Member of ACCC. This edition features:
• Who Will Care for Tomorrow's Cancer Patients? ACCC Looks for Answers
• Next Week: Bring Out the Best in Your Cancer Service Line
• 2009 PQRI Conference Call on December 10
• Cancer Screenings Brochure Available From CMS
• Heard on ACCC's ListServ: Family Members in the Radiation Center
• Oncologists Optimistic about Future of Oncology Clinical Trials While Citing Cost as Barrier
****CMS NEWS****
MM6662 – Annual Update of HCPCS Codes Used for Home Health (HH) Consolidated Billing Enforcement
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6662.pdf
MM6728 – Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 16.0, Effective January 1, 2010
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6728.pdf
MM6540 – Tracking the Hospice Attending Physician’s National Provider Identifier (NPI) for Validating Hospice Part B Payments
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6540.pdf
The Centers for Medicare & Medicaid Services (CMS) would like to remind Physician Quality Reporting Initiative (PQRI) participants that there is a “Verify Report Portlet” look-up tool available on the PQRI Portal for Eligible Professionals (EPs) to verify if a 2007 re-run and/or 2008 PQRI feedback report exists for your organization's Tax Identification Number (TIN) or National Provider Identifier (NPI). The TIN or NPI must be the one used by the EP to submit Medicare claims and valid PQRI quality data codes. This tool is available at (https://www.qualitynet.org/portal/server.pt) on the internet.
If a report is available for your organization’s TIN or NPI there are two ways to access 2007 re-run and/or 2008 PQRI feedback reports:
1) An individual EP can simply call their respective Carrier or A/B MAC provider contact center to request confidential 2007 PQRI re-run and/or 2008 PQRI feedback reports that will contain information based on their individual NPI. If an EP is part of a group practice, each EP in the group practice must individually call their respective Carrier or A/B MAC provider contact center to request a feedback report based on the 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 this 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.
or
2) EPs can logon to the secure PQRI Portal on QualityNet at (http://www.qualitynet.org/portal/server.pt) to access their feedback report(s) based their TIN, or for a group. Access to the PQRI Portal requires registration in the Individuals Authorized Access to CMS Computer Services (IACS) system to obtain a userID and password.
Important Information on Updating IACS User Accounts and Passwords
CMS would like to remind users that the CMS Security policy requires IACS passwords to be changed every 60 days. An IACS user who has not changed his or her password in over 60 days will be prompted to do so at the next login attempt.
An IACS user who has not changed his or her password in over 120 days will first be prompted to answer the security questions established at registration. After successfully answering security questions, the user will then be prompted for a password change.
Updating IACS user accounts and passwords is essential to maintaining this access and functionality.
Resources
The IACS account management page is at (https://applications.cms.hhs.gov/category.html?name=acctmngmt).Click on “My Profile” to login, change your password, or use the “Forgot Password?” option.
If you are having difficulty with IACS registration or disabled accounts, follow the self-service instructions below on how to recover your IACS userId and/or password and/or change your IACS password.
Instructions for Retrieving Your IACS UserID
1. Go to the CMS Applications portal at (https://applications.cms.hhs.gov)
2. Enter the portal; select the Account Management tab, and then the “Forgot Your User ID?” link in the Account Management section. Follow the online instructions.
3. You will receive an email at the email address on record.
Instructions for Retrieving Your IACS Password
1. Go to the CMS Applications portal at (https://applications.cms.hhs.gov/warning.html)
2. Enter the portal; select the Account Management tab, and then “My Profile” link in the Account Management section.
3. Enter your UserID
4. Click on “Forgot Your Password?” button on the login page and follow the online instructions.
5. You will receive a onetime password in an email at the email address on record.
Instructions to Login and Change Your IACS Password:
1. Go to the CMS Applications portal at (https://applications.cms.hhs.gov)
2. Enter the portal; select the Account Management tab
3. Select the My Profile link
4. Login using your UserID and onetime temporary Password.
5. The system will prompt you to change your password.
6. Enter your new password in both the New Password and Confirm New Password fields and then select the Change Password button.
7. The system will take you back to the My Profile screen.
8. Log out.
Once you have successfully changed your password you may login and access your PQRI feedback report(s) on the PQRI portal at (https://www.qualitynet.org/portal/server.pt).
If you are still having difficulty with IACS registration or disabled accounts, please contact the External Users Services (EUS) Help Desk
at 1-866-484-8049, TTY/TDD at 1-866-523-4759 (Monday – Friday 7:00 a.m.-7:00 p.m. EST) or via e-mail at EUSSupport@cgi.com.
The IACS home page for the Provider/Supplier user Community, which includes PQRI, is at (http://www.cms.hhs.gov/IACS/04_Provider_Community.asp#TopOfPage) on the CMS website. Provider Community users should direct questions or concerns to the External User Services (EUS) Help Desk at 1-866-484-8049, TTY/TDD at 1-866-523-4759 (Monday - Friday 7:00 a.m.-7:00 p.m. EST) or via email atEUSSupport@cgi.com.
The PQRI Portal is available at (https://www.qualitynet.org/portal/server.pt) on the internet. Although the “Forgot Password” link on the PQRI Portal sends users to the IACS website, IACS and the PQRI Portal are two separate websites.
Additional information about PQRI can be found at (http://www.cms.hhs.gov/PQRI) on the CMS website. 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.
Users who still have questions or need assistance should contact the QualityNet Help Desk at 1-866-288-8912 (Monday-Friday 7:00 a.m.-7:00 p.m. CST) or qnetsupport@sdps.org.
****PALMETTO/J1MAC NEWS****
December 2009 J1 A/B MAC Medicare Advisory
Updates and changes were made to the December 2009 J1 A/B MAC Medicare
Advisory. It 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
Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 16.0,
Effective January 1, 2010
This J1 Part B MLN Matters article (CR 6728) provides a reminder for
physicians to take note of the quarterly updates to Correct Coding
Initiative (CCI) edits. The last quarterly release of the edit module was
issued in October 2009. The Centers for Medicare & Medicaid Services (CMS)
developed the National Correct Coding Initiative (CCI) to promote national
correct coding methodologies and to control improper coding that leads to
inappropriate payment in Part B claims. Please be sure to share with your
staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YBT823658?opendocument
Annual Update of HCPCS Codes Used for Home Health (HH) Consolidated Billing
Enforcement
This J1 A/B MAC MLN Matters article (CR6662) provides the annual Home
Health (HH) consolidated billing update effective January 1, 2010. The
Centers for Medicare & Medicaid Services (CMS) periodically updates the
lists of Health Care Common Procedure Codes System (HCPCS) codes subject to
the consolidated billing provision of the Home Health Prospective Payment
System (HH PPS). Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YCN4K0087?opendocument
HIGLAS Transition: Impact on J1 Part B Medicare Providers
Palmetto GBA Jurisdiction 1 MAC has updated the Healthcare Integrated
General Ledger Accounting System (HIGLAS) transition time table posted on
our Web site. The HIGLAS transition will be completed December 16, 2009. At
the same time, processing backlogged files and issuing payments will begin.
From December 16 to December 30, 2009, providers may experience a
significant reduction in payments due to the early claim payments issued
immediately prior to the transition. Providers need to monitor and manage
their cash flows during this time period.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7Y3LRC5231?opendocument
J1 Provider Outreach and Education Event Calendar
What's new in December 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
Technical Corrections To The Relative Value Units
This article reflects technical corrections to the relative value units,
including various CPT codes, and to the CY 2010 conversion factor contained
in the CY 2010 Medicare physician fee schedule final rule. Please be sure
to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YBTF22165?opendocument
2010 J1 Part B Fee Schedules
The 2010 J1 Part B Fee Schedules for California are now available and are
effective January 1, 2010. The 2010 J1 Part B Fee Schedules for Nevada,
Hawaii, Guam, American Samoa and the Northern Mariana Islands will be
coming soon.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7Y3GZA7365?opendocument
J1 EDI Enrollment Packet
The Jurisdiction 1 A/B MAC EDI Enrollment Packet has been updated with a
new form. The Provider Authorization form must be completed by the provider
to authorize a clearinghouse and/or billing service as an electronic
submitter and recipient of electronic claims data. Please begin using this
updated packet immediately.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7XPTLJ4585?opendocument
Therapy Cap Values for Calendar Year (CY) 2010
This J1 A/B MAC MLN Matters article (CR6660a) describes the policy for
outpatient therapy caps for 2010 and announces that therapy caps for 2010
will be $1,860. This article was revised on November 24, 2009, to reflect a
revised CR 6660 that the Centers for Medicare & Medicaid Services (CMS)
issued on November 23, 2009. As a result of the revised CR, the article was
revised to include Regional Home Health Intermediaries as an additional
contractor type involved with this issue. The CR release date, transmittal
number and Web address for accessing CR 6660 were also changed. Also,
carriers were added as a contractor type involved as they were
inadvertently not included in the original article. All other information
remains the same. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YCMRD2255?opendocument
ACT Call: Medicare Updates - December 15, 2009
Join us for a J1 Part B Ask the Contractor Teleconference (ACT) regarding
Medicare Part B General Updates on Tuesday, December 15, 2009, at 12:30
p.m. PST.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YERHB5637?opendocument
ACT Minutes: Top 10 Claim Submission Errors - November 19, 2009
The meeting minutes of the J1 Part A Ask the Contractor Teleconference on
November 19, 2009, is now available on our Web site.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YESW92524?opendocument
J1 Provider Outreach and Education Event Calendar
Check out the new Palmetto GBA J1 Provider Outreach and Education events
added to our December 2009 online Events calendar!
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7TAL2C7131?opendocument
Tracking the Hospice Attending Physician’s National Provider Identifier
(NPI) for Validating Hospice Part B Payments
This J1 A/B MAC MLN Matters article (CR6540) is meant to ensure that the
hospice-reported data in the Notice of Election (NOE) and claims for the
attending physician, which may be a Nurse Practitioner (NP), meet the
definition of attending physician/NP in the Code of Federal Regulations
(CFR), while also reporting the hospice physician responsible for
certifying the terminal illness. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YEMNL2613?opendocument
Webinar: Bundled Services December 16
Palmetto GBA J1 Part B providers, join us on Wednesday, December 16, 2009,
for a free Webinar on Bundled Services!
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7YERCG5273?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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