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/4940.aspx. This edition features:
Contact the Senate Now to Prevent the 21 Percent Medicare Physician Payment Cut
FDA Announces New Safety Program for Erythropoiesis-Stimulating Agents
President Obama and Congress Convene Health Reform Summit
ASH Shares Support of BCR-ABL1 Testing in Chronic Myeloid Leukemia
The Social Security Administration Expands Its List of Compassionate Allowances
2010 PQRI and E-Prescribing Incentive Program National Provider Call With Q&A Session
Medicare Revises Its Definition of Compendia for Off-Label Indications in Anticancer Chemotherapeutic Regimens
Medicare Releases Quarterly Correct Coding Initiative Update
Don't Miss the Official Highlights of ASH® Latin America
****CMS NEWS****
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. As you are aware, the Department of Defense Appropriations Act of 2010 provided a zero percent (0%) update to the 2010 MPFS effective for dates of service January 1, 2010, through February 28, 2010.
We believe Congress is working to avoid the negative update that will take effect March 1. Consequently, CMS has instructed its contractors to hold claims containing services paid under the MPFS for the first 10 business days of March. The holding of MPFS claims will only affect claims with dates of service March 1, 2010, and forward. This hold should have a minimum impact on provider cash flow because, under current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt. Be on the alert for more information about the 2010 Medicare Physician Fee Schedule Update.
The Centers for Medicare & Medicaid Services (CMS) is conducting the fifth national administration of theMedicare Contractor Provider Satisfaction Survey (MCPSS). This survey is designed to collect quantifiable data on providers’ satisfaction with the performance of the Medicare fee-for-service (FFS) contractors that process and pay their Medicare claims. CMS conducts the MCPSS on an annual basis and uses the results for Medicare contractor oversight and process improvement initiatives.
In January, CMS notified approximately 30,000 Medicare FFS providers and suppliers that they had been randomly selected to participate in the 2010 MCPSS study. As representatives of the more than 1.5 million providers nationwide who serve Medicare beneficiaries across the country, these providers and suppliers have an opportunity to give CMS valuable feedback on their satisfaction, attitudes, perceptions, and opinions about the services provided by their respective contractor.
If you have been notified that you were selected to participate in this study and have not yet done so, CMS is listening and wants to hear from you. Please take a few minutes to go online and complete your survey via a secure online Internet survey tool. Responding online is a convenient, easy, and quick way to provide CMS with your feedback. Survey questionnaires can also be submitted by mail, secure fax, and over the telephone. The survey takes approximately 20 minutes to complete.
CMS has contracted with SciMetrika, a public health consulting firm, to administer this important survey and report statistical data to CMS. If you received notification that you were selected to participate in the MCPSS study and you no longer have your online survey tool access information or need help accessing the survey tool, please call the MCPSS Provider Helpline at 1-800-835-7012 or send an email to MCPSS@scimetrika.com.
Please Note: Only providers and suppliers notified that they have been randomly selected to take part in the 2010 MCPSS may participate in this study. A new random sample of providers and suppliers is selected annually to participate in the MCPSS study.
For more information about the MCPSS, please visit the CMS MCPSS website athttp://www.cms.hhs.gov/mcpss, or read the CMS MLN Matters Special Edition article at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE1005.pdf featuring the survey.
CMS urges you to please take a few moments to complete your survey today.
****PALMETTO/J1MAC NEWS****
Certain Drugs Rejected Incorrectly
This Alert announces that certain HCPCS drug codes may have been rejected
incorrectly for no invoice. This affects services processed from February
10, 2010, through Febuary 18, 2010. The issue has been forwarded to the
Systems Department for investigation. When the issue is resolved, a mass
adjustment will be performed for any services rejected incorrectly.
Providers are encouraged to review the information and to share with your
staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/832KQT6638?opendocument
March 2010 J1 A/B MAC Medicare Advisory
The March 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/82ZN2A6010?opendocument
2010 Physician Quality Reporting Initiative & Electronic Prescribing
Incentive Program National Provider Call
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. to 3:30
p.m. EST, on Wednesday, March 10, 2010.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82ZH477208?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!
Sunday, February 28, 2010
Friday, February 26, 2010
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/alert022210.asp?anchorID#0. This edition features:
• CMA Coalition Receives $31 Million EHR Grant
• CMS Delays PECOS Enrollment Policy Until January 2011; CMA Publishes PECOS Enrollment Guide for Physicians
• Medicare SGR Cut Looming Once Again
• Medicare Participation Status Deadline is March 17 (For Now)
• Judge Expected to Rule this Week on CMA's Medical Board Furlough Lawsuit
• CA Attorney General Asks US Supreme Court to Review MediCal Injunction
• California Pneumonia Vaccination Rates Among Worst in Nation
• Blue Cross Health Families Continuity of Care Plan Ends March 31
• CMA Physicians to Testify Against DMHC Attempt to Legitimize Illegal Discount Health Plans
• Leadership Academy to Tackle Hospital-Physician Alignment Issues
• CMA Announces 2010 Webinar Series
****CMS NEWS****
SE1010 – Questions and Answers on Reporting Physician Consultation Services
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE1010.pdf
MM6740 – Revisions to Consultation Services Payment Policy
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6740.pdf
The revised Medicare Appeals Process brochure (January 2010), which provides an overview of the Medicare Part A and Part B administrative appeals process available to providers, physicians and other suppliers who provide services and supplies to Medicare beneficiaries, as well as details on where to obtain more information about this appeals process, is now available in downloadable format from the Centers for Medicare & Medicaid ServicesMedicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/MedicareAppealsProcess.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 Wednesday, March 10, 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).
Following a few program announcements and updates, 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: March 10, 2010
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 March 9, 2010, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
1. To register for the call participants need to go to:
http://www.eventsvc.com/palmettogba/031010
2. Fill in all required data.
3. Verify your time zone is displayed correctly the drop down box.
4. Click "Register".
5. You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.
For those of 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****
ANSI ASC X12N 837 version 4010A1 Companion Document
Please note that the format for National Drug Codes (NDC) is 5-4-2 (11
positions with no dashes). Claims that contain NDC codes in any other
format will be rejected.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7GLSEP7805?opendocument
CERT Denials Related to Orders for Laboratory & Pathology Testing
This article applies to independent clinical/pathology labs and in-house
office laboratory services performed by medical practices. To better
address problems identified during reviews conducted by the CERT
contractor, the Palmetto GBA medical review staff examined records for
several claims related to laboratory errors for which denials for testing
procedures were generated. We found recurring, widespread problems with
various aspects of the 'ordering' process. Issues with orders were
ultimately the reason why the laboratory procedures were deemed medically
unnecessary by CERT and denied. Check this article to determine how you
can avoid these issues.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82XN3A2776?opendocument
Overpayment Refund Form: Medicare Part A and B
An updated interactive J1 A/B Medicare Overpayment form is now available
online.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7JBHHJ3014?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/alert022210.asp?anchorID#0. This edition features:
• CMA Coalition Receives $31 Million EHR Grant
• CMS Delays PECOS Enrollment Policy Until January 2011; CMA Publishes PECOS Enrollment Guide for Physicians
• Medicare SGR Cut Looming Once Again
• Medicare Participation Status Deadline is March 17 (For Now)
• Judge Expected to Rule this Week on CMA's Medical Board Furlough Lawsuit
• CA Attorney General Asks US Supreme Court to Review MediCal Injunction
• California Pneumonia Vaccination Rates Among Worst in Nation
• Blue Cross Health Families Continuity of Care Plan Ends March 31
• CMA Physicians to Testify Against DMHC Attempt to Legitimize Illegal Discount Health Plans
• Leadership Academy to Tackle Hospital-Physician Alignment Issues
• CMA Announces 2010 Webinar Series
****CMS NEWS****
SE1010 – Questions and Answers on Reporting Physician Consultation Services
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE1010.pdf
MM6740 – Revisions to Consultation Services Payment Policy
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6740.pdf
The revised Medicare Appeals Process brochure (January 2010), which provides an overview of the Medicare Part A and Part B administrative appeals process available to providers, physicians and other suppliers who provide services and supplies to Medicare beneficiaries, as well as details on where to obtain more information about this appeals process, is now available in downloadable format from the Centers for Medicare & Medicaid ServicesMedicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/MedicareAppealsProcess.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 Wednesday, March 10, 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).
Following a few program announcements and updates, 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: March 10, 2010
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 March 9, 2010, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
1. To register for the call participants need to go to:
http://www.eventsvc.com/palmettogba/031010
2. Fill in all required data.
3. Verify your time zone is displayed correctly the drop down box.
4. Click "Register".
5. You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.
For those of 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****
ANSI ASC X12N 837 version 4010A1 Companion Document
Please note that the format for National Drug Codes (NDC) is 5-4-2 (11
positions with no dashes). Claims that contain NDC codes in any other
format will be rejected.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7GLSEP7805?opendocument
CERT Denials Related to Orders for Laboratory & Pathology Testing
This article applies to independent clinical/pathology labs and in-house
office laboratory services performed by medical practices. To better
address problems identified during reviews conducted by the CERT
contractor, the Palmetto GBA medical review staff examined records for
several claims related to laboratory errors for which denials for testing
procedures were generated. We found recurring, widespread problems with
various aspects of the 'ordering' process. Issues with orders were
ultimately the reason why the laboratory procedures were deemed medically
unnecessary by CERT and denied. Check this article to determine how you
can avoid these issues.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82XN3A2776?opendocument
Overpayment Refund Form: Medicare Part A and B
An updated interactive J1 A/B Medicare Overpayment form is now available
online.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7JBHHJ3014?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, February 22, 2010
CMS & Palmetto/J1MAC News
The following information has been received by ANCO.
****CMS NEWS****
MM6806 – Revision of Definition of Compendia as Authoritative Source for Use in the Determination of a Medically-Accepted Indication of Drugs/Biologicals Used Off-label in Anti-Cancer Chemotherapeutic Regimens
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6806.pdf
The Centers for Medicare and Medicaid Services (CMS) has issued a Notice of Proposed Rule Making (NPRM) for the Medicare and Medicaid EHR incentive programs established by the Recovery Act. The HITECH provisions are a subset of the Recovery Act. The rule, sometimes called the “meaningful use NPRM,” proposes a definition for the meaningful use of certified EHR technology as well as many other policy proposals. Join us to learn the basics of the rule from the CMS experts.
Learn about
· CMS’ proposed rule for the EHR incentive programs including:
o Who is eligible
o What constitutes meaningful use
o How to demonstrate meaningful use
o What incentives are available under Medicare and Medicaid
· How to make comments
· Where to find additional resources
Hear first hand from the CMS Experts
When: Tuesday, February 23rd
Time: 1:30-2:30 pm EST
We suggest you call in early as lines are limited.
To join the meeting, dial 1-866-501-5502
The conference ID is 58353012
Materials will be available on the morning of the call at
http://www.cms.hhs.gov/NationalMedicareTrainingProgram/10_Audio_Conference_Training.asp
****PALMETTO/J1MAC NEWS****
2010 Coding & Reimbursement Update
The 2010 Coding & Reimbursement Update contains a wealth of information
that will be helpful to your office. Some of the articles in this
publication include: Additions, Deletions and Changes for HCPCS, CDT, and
CPT codes and modifiers; Proper use of modifiers and more.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7Z9Q8Q1420?opendocument
Update: Pricing for Lupron Injections
This Alert announces that claims processed on January 4, 2010, through
January 19, 2010, were priced incorrectly. Services were paid at the
submitted charge instead of the correct price. This was due to a MCS System
field change. The pricing error was due to the system reading the year of
service incorrectly. A mass adjustment was performed to issue corrected
payments. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82RRYT1885?opendocument
Medicare Systems Edit Refinements Related to Hospice Services
This J1 A/B MAC MLN Matters article (CR6778) announces revisions for
existing Medicare standard systems edits to allow Medicare fee for service
(FFS) claims to process for beneficiaries in a Medicare Advantage plan on
the date of a Medicare hospice election. This article also adds new edits
ensuring the appropriate place of service is reported for hospice general
inpatient care (GIP), respite and continuous home care (CHC). Lastly, this
article provides a technical correction to the Medicare Benefit Policy
Manual regarding the requirement for nursing care related to hospice
continuous home care. Providers are encouraged to review the information
and share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82SNGD4105?opendocument
New Waived Tests
This J1 Part B MLN Matters article (CR6800) alerts clinical laboratories
and providers that the Centers for Medicare & Medicaid Services (CMS) has
listed the latest tests approved by the Food and Drug Administration (FDA)
as waived tests under the Clinical Laboratory Improvement Amendments of
1988 (CLIA). CLIA regulations require a laboratory facility to be
appropriately certified for each test it performs. To ensure that Medicare
and Medicaid only pay for laboratory tests categorized as waived complexity
under CLIA in facilities with a CLIA certificate of waiver, laboratory
claims are currently edited at the CLIA certificate level. The tests newly
added to the waived tests are in the table in the Background Section of
this article. Providers and clinical labs are encouraged to review this
information and share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82RQAA7884?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****
MM6806 – Revision of Definition of Compendia as Authoritative Source for Use in the Determination of a Medically-Accepted Indication of Drugs/Biologicals Used Off-label in Anti-Cancer Chemotherapeutic Regimens
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6806.pdf
The Centers for Medicare and Medicaid Services (CMS) has issued a Notice of Proposed Rule Making (NPRM) for the Medicare and Medicaid EHR incentive programs established by the Recovery Act. The HITECH provisions are a subset of the Recovery Act. The rule, sometimes called the “meaningful use NPRM,” proposes a definition for the meaningful use of certified EHR technology as well as many other policy proposals. Join us to learn the basics of the rule from the CMS experts.
Learn about
· CMS’ proposed rule for the EHR incentive programs including:
o Who is eligible
o What constitutes meaningful use
o How to demonstrate meaningful use
o What incentives are available under Medicare and Medicaid
· How to make comments
· Where to find additional resources
Hear first hand from the CMS Experts
When: Tuesday, February 23rd
Time: 1:30-2:30 pm EST
We suggest you call in early as lines are limited.
To join the meeting, dial 1-866-501-5502
The conference ID is 58353012
Materials will be available on the morning of the call at
http://www.cms.hhs.gov/NationalMedicareTrainingProgram/10_Audio_Conference_Training.asp
****PALMETTO/J1MAC NEWS****
2010 Coding & Reimbursement Update
The 2010 Coding & Reimbursement Update contains a wealth of information
that will be helpful to your office. Some of the articles in this
publication include: Additions, Deletions and Changes for HCPCS, CDT, and
CPT codes and modifiers; Proper use of modifiers and more.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7Z9Q8Q1420?opendocument
Update: Pricing for Lupron Injections
This Alert announces that claims processed on January 4, 2010, through
January 19, 2010, were priced incorrectly. Services were paid at the
submitted charge instead of the correct price. This was due to a MCS System
field change. The pricing error was due to the system reading the year of
service incorrectly. A mass adjustment was performed to issue corrected
payments. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82RRYT1885?opendocument
Medicare Systems Edit Refinements Related to Hospice Services
This J1 A/B MAC MLN Matters article (CR6778) announces revisions for
existing Medicare standard systems edits to allow Medicare fee for service
(FFS) claims to process for beneficiaries in a Medicare Advantage plan on
the date of a Medicare hospice election. This article also adds new edits
ensuring the appropriate place of service is reported for hospice general
inpatient care (GIP), respite and continuous home care (CHC). Lastly, this
article provides a technical correction to the Medicare Benefit Policy
Manual regarding the requirement for nursing care related to hospice
continuous home care. Providers are encouraged to review the information
and share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82SNGD4105?opendocument
New Waived Tests
This J1 Part B MLN Matters article (CR6800) alerts clinical laboratories
and providers that the Centers for Medicare & Medicaid Services (CMS) has
listed the latest tests approved by the Food and Drug Administration (FDA)
as waived tests under the Clinical Laboratory Improvement Amendments of
1988 (CLIA). CLIA regulations require a laboratory facility to be
appropriately certified for each test it performs. To ensure that Medicare
and Medicaid only pay for laboratory tests categorized as waived complexity
under CLIA in facilities with a CLIA certificate of waiver, laboratory
claims are currently edited at the CLIA certificate level. The tests newly
added to the waived tests are in the table in the Background Section of
this article. Providers and clinical labs are encouraged to review this
information and share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82RQAA7884?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, February 18, 2010
NCI & Palmetto/J1MAC News
The following information has been received by ANCO.
****NCI NEWS****
Do you find it challenging to keep enough NCI patient education materials on hand? Would you like an alternative that helps you get as much as you need, whenever you need it?
NCI’s Contents & Covers program helps you to make your own copies of select NCI patient education materials, so you can meet the needs of the patients, friends, and families that your organization serves. Using Contents & Covers, you can:
• Meet ongoing demand without concern for ordering limits or shipping time
• Print materials in a timely manner, as you need them
• Copy or print in a convenient 8 ½ x 11 format
What’s available through Contents & Covers?
As of now, available publications include:
Chemotherapy and You https://cissecure.nci.nih.gov/ncipubs/detail.aspx?rodid=P117
Radiation Therapy and You https://cissecure.nci.nih.gov/ncipubs/detail.aspx?prodid=P123
Eating Hints https://cissecure.nci.nih.gov/ncipubs/detail.aspx?prodid=P118
Facing Forward: Life After Cancer Treatment https://cissecure.nci.nih.gov/ncipubs/detail.aspx?prodid=P119
What You Need to Know About Breast Cancer https://cissecure.nci.nih.gov/ncipubs/detail.aspx?prodid=P017
What You Need to Know About Cancer https://cissecure.nci.nih.gov/ncipubs/detail.aspx?prodid=P018
How does it work?
You can make copies of NCI patient education materials in three easy steps:
1. Download the inside Contents of select publications (without their covers) from the NCI Publications Web site. Using the downloaded PDF file, you can print 1 or more copies from your computer. If you need many copies at one time, it might be more cost-effective for you to photocopy them.
2. Order professionally printed, color front and back Covers from the NCI Publications Web site or by calling 1-800-4-CANCER. Covers are provided in packs of 25 sets (enough to bind 25 publications)
Or, Download front and back Covers from the NCI Publications Web site.
3. Bind the Contents to the Covers to make your own NCI patient education materials.
How do I get more information?
See if the Contents & Covers program is right for your organization. Go online to our detailed fact sheet to see descriptions, inventory numbers, and complete ordering instructions or call 1-800-4-CANCER and select the option to order publications.
****PALMETTO/J1MAC NEWS****
J1 Part B LCDs Updates
Check out the following revised J1 Part B LCDs on the J1 Part B Web site:
Blepharoplasty, Blepharoptosis and Brow Lift L28239; Cytogenetic Studies
L28251; Injection of Spinal Canal L28270 and Oncotype Dx Test - Breast
Cancer Prognosis L28287.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82RLMU3470?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!
****NCI NEWS****
Do you find it challenging to keep enough NCI patient education materials on hand? Would you like an alternative that helps you get as much as you need, whenever you need it?
NCI’s Contents & Covers program helps you to make your own copies of select NCI patient education materials, so you can meet the needs of the patients, friends, and families that your organization serves. Using Contents & Covers, you can:
• Meet ongoing demand without concern for ordering limits or shipping time
• Print materials in a timely manner, as you need them
• Copy or print in a convenient 8 ½ x 11 format
What’s available through Contents & Covers?
As of now, available publications include:
Chemotherapy and You https://cissecure.nci.nih.gov/ncipubs/detail.aspx?rodid=P117
Radiation Therapy and You https://cissecure.nci.nih.gov/ncipubs/detail.aspx?prodid=P123
Eating Hints https://cissecure.nci.nih.gov/ncipubs/detail.aspx?prodid=P118
Facing Forward: Life After Cancer Treatment https://cissecure.nci.nih.gov/ncipubs/detail.aspx?prodid=P119
What You Need to Know About Breast Cancer https://cissecure.nci.nih.gov/ncipubs/detail.aspx?prodid=P017
What You Need to Know About Cancer https://cissecure.nci.nih.gov/ncipubs/detail.aspx?prodid=P018
How does it work?
You can make copies of NCI patient education materials in three easy steps:
1. Download the inside Contents of select publications (without their covers) from the NCI Publications Web site. Using the downloaded PDF file, you can print 1 or more copies from your computer. If you need many copies at one time, it might be more cost-effective for you to photocopy them.
2. Order professionally printed, color front and back Covers from the NCI Publications Web site or by calling 1-800-4-CANCER. Covers are provided in packs of 25 sets (enough to bind 25 publications)
Or, Download front and back Covers from the NCI Publications Web site.
3. Bind the Contents to the Covers to make your own NCI patient education materials.
How do I get more information?
See if the Contents & Covers program is right for your organization. Go online to our detailed fact sheet to see descriptions, inventory numbers, and complete ordering instructions or call 1-800-4-CANCER and select the option to order publications.
****PALMETTO/J1MAC NEWS****
J1 Part B LCDs Updates
Check out the following revised J1 Part B LCDs on the J1 Part B Web site:
Blepharoplasty, Blepharoptosis and Brow Lift L28239; Cytogenetic Studies
L28251; Injection of Spinal Canal L28270 and Oncotype Dx Test - Breast
Cancer Prognosis L28287.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82RLMU3470?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 & Palmetto/J1MAC News
The following information has been received by ANCO.
****CMS NEWS****
The Centers for Medicare & Medicaid Services (CMS) has identified a problem where claims were not automatically crossing over to supplemental payers even though the provider remittance advice indicated otherwise. This problem began January 5, 2010. Part A institutional claims and Part B professional claims, with the exception of supplier claims processed by Durable Medical Equipment Medicare Administrative Contractors (DME MACs), were impacted by this problem. Claims processed by DME MACs were not impacted.
Part A Institutional Claims
No action is required by Part A institutional providers. As of February 2, 2010, CMS successfully implemented a systems fix to ensure that all Part A institutional claims are now crossing over to supplemental payers as indicated on the remittance advice received by providers. As part of the fix, CMS’ Medicare contractors were able to identify claims processed between January 5 and February 1, 2010, where the provider remittance advice indicated that the affected claims were crossed over to various supplemental payers but were not. On February 2, 2010, the affected Medicare contractors began to send the affected claims to the Coordination of Benefits Contractor (COBC) to be crossed over to supplemental payers. This effort is now largely completed. Please allow until March 1, 2010, for supplemental payers to receive and process these claims before attempting to balance bill them for any remaining balances after Medicare.
Part B Professional Claims
Action is required on behalf of Part B professional providers where a remittance advice with an issue date between January 5, 2010, and February 12, 2010, has two or more service lines for a beneficiary where both of the following apply:
· One service line is 100 percent reimbursable (i.e., the approved amount and amount to be paid are equal,) AND
· One service line where part of or the entire Medicare approved amount is applied to the Part B deductible and/or carries co-insurance amounts.
CMS is not able to forward these beneficiary claims to supplemental payers even though the remittance advice may indicate otherwise. Providers will need to identify these claims by reviewing their remittance advice with an issue date between January 5, 2010, and February 12, 2010, that contain the criteria noted above. Once identified, providers will need to take action to balance bill the beneficiary’s supplemental payer. As of February 12, 2010, this system problem was fixed and all claims are crossing over to supplemental payers as indicated on the provider remittance advice.
The CMS has already notified supplemental payers of these issues. We regret any inconvenience you may experience related to this Medicare claim supplemental payer crossover problem.
****PALMETTO/J1MAC NEWS****
Claims Processed with Remittance Advice Remark Code N265
Share with your staff - In compliance with the final implementation phase
of Change Request (CR) 6417, effective April 5, 2010, claims submitted with
the RA remark code N265 will be rejected. To help providers avoid claim
rejections and reimbursement delays, Palmetto GBA recommends immediate
provider actions to correct two specific billing errors before April 5.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82PLZX7134?opendocument
Healthcare Provider Taxonomy Codes (HPTC): April 1, 2010 Update
CMS has released the summary of changes reflected in the Health Care
Provider Taxonomy Code (HPTC) list. Medicare carriers and DME MACs will
update their HPTC tables with this new version effective on April 1, 2010.
Please review the information and stay current on all HIPAA requirements to
assure timely processing of your claims.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7VBKAL6460?opendocument
ACT Minutes: New Year, Fresh Start - January 26, 2010
The minutes of the J1 Part B ACT call on January 26, 2010, is now available
on our Web site.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82PUH27852?opendocument
Instructions on How to Process Negative Claim Adjustment Reason Code (CARC)
Adjustment Amounts when Certain CARCs Appear on Medicare Secondary Payer
Claims
This J1 A/B MAC MLN Matter article (CR6736) provides Medicare contractors
with processing instructions for claim adjustment reason code (CARC)
adjustment amounts that are negative when certain CARCs appear on incoming
Medicare Secondary Payer (MSP) claims. Medicare contractors will
automatically reprocess any MSP claims retroactive to July 5, 2009, and
remove the positive Claim Adjustment Segment (CAS) CARC adjustment from the
primary payer payment amount where a CARC adjustment was added to the
primary payer payment amount when the same CAS CARC adjustment was received
as a negative adjustment. Providers are encouraged to review the
information and share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82QPN67656?opendocument
Medicare Claims Crossover to Supplemental Payer Problem
The Centers for Medicare & Medicaid Services (CMS) has identified a problem
where claims were not automatically crossing over to supplemental payers
even though the provider remittance advice indicated otherwise. This
problem began January 5, 2010. No action is required by Part A
institutional providers. Action is required on behalf of Part B
professional providers for certain claims. The affected Part B claims are
associated with a remittance advice dated between January 5, 2010, and
February 12, 2010, that contain two or more service lines for a beneficiary
and that meet both of the following criteria: one line is 100 percent
reimburseable, and at least some money was applied to the deductible.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82QRXL0601?opendocument
Palmetto GBA Online Learning Instructions
Palmetto GBA has revised the Online Learning Center user instructions to
reflect the recent update in the Webinar vendor Centra One system.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7XWSSK3475?opendocument
Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 16.1,
effective April 1, 2010
This J1 Part B MLN Matters article (CR6819) 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 January 2010. The National Correct Coding Initiative (CCI) was
developed to promote national correct coding methodologies and to control
improper coding that leads to inappropriate payment in Part B claims.
Providers are encouraged to review the information and share with their
staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82QPS64434?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) has identified a problem where claims were not automatically crossing over to supplemental payers even though the provider remittance advice indicated otherwise. This problem began January 5, 2010. Part A institutional claims and Part B professional claims, with the exception of supplier claims processed by Durable Medical Equipment Medicare Administrative Contractors (DME MACs), were impacted by this problem. Claims processed by DME MACs were not impacted.
Part A Institutional Claims
No action is required by Part A institutional providers. As of February 2, 2010, CMS successfully implemented a systems fix to ensure that all Part A institutional claims are now crossing over to supplemental payers as indicated on the remittance advice received by providers. As part of the fix, CMS’ Medicare contractors were able to identify claims processed between January 5 and February 1, 2010, where the provider remittance advice indicated that the affected claims were crossed over to various supplemental payers but were not. On February 2, 2010, the affected Medicare contractors began to send the affected claims to the Coordination of Benefits Contractor (COBC) to be crossed over to supplemental payers. This effort is now largely completed. Please allow until March 1, 2010, for supplemental payers to receive and process these claims before attempting to balance bill them for any remaining balances after Medicare.
Part B Professional Claims
Action is required on behalf of Part B professional providers where a remittance advice with an issue date between January 5, 2010, and February 12, 2010, has two or more service lines for a beneficiary where both of the following apply:
· One service line is 100 percent reimbursable (i.e., the approved amount and amount to be paid are equal,) AND
· One service line where part of or the entire Medicare approved amount is applied to the Part B deductible and/or carries co-insurance amounts.
CMS is not able to forward these beneficiary claims to supplemental payers even though the remittance advice may indicate otherwise. Providers will need to identify these claims by reviewing their remittance advice with an issue date between January 5, 2010, and February 12, 2010, that contain the criteria noted above. Once identified, providers will need to take action to balance bill the beneficiary’s supplemental payer. As of February 12, 2010, this system problem was fixed and all claims are crossing over to supplemental payers as indicated on the provider remittance advice.
The CMS has already notified supplemental payers of these issues. We regret any inconvenience you may experience related to this Medicare claim supplemental payer crossover problem.
****PALMETTO/J1MAC NEWS****
Claims Processed with Remittance Advice Remark Code N265
Share with your staff - In compliance with the final implementation phase
of Change Request (CR) 6417, effective April 5, 2010, claims submitted with
the RA remark code N265 will be rejected. To help providers avoid claim
rejections and reimbursement delays, Palmetto GBA recommends immediate
provider actions to correct two specific billing errors before April 5.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82PLZX7134?opendocument
Healthcare Provider Taxonomy Codes (HPTC): April 1, 2010 Update
CMS has released the summary of changes reflected in the Health Care
Provider Taxonomy Code (HPTC) list. Medicare carriers and DME MACs will
update their HPTC tables with this new version effective on April 1, 2010.
Please review the information and stay current on all HIPAA requirements to
assure timely processing of your claims.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7VBKAL6460?opendocument
ACT Minutes: New Year, Fresh Start - January 26, 2010
The minutes of the J1 Part B ACT call on January 26, 2010, is now available
on our Web site.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82PUH27852?opendocument
Instructions on How to Process Negative Claim Adjustment Reason Code (CARC)
Adjustment Amounts when Certain CARCs Appear on Medicare Secondary Payer
Claims
This J1 A/B MAC MLN Matter article (CR6736) provides Medicare contractors
with processing instructions for claim adjustment reason code (CARC)
adjustment amounts that are negative when certain CARCs appear on incoming
Medicare Secondary Payer (MSP) claims. Medicare contractors will
automatically reprocess any MSP claims retroactive to July 5, 2009, and
remove the positive Claim Adjustment Segment (CAS) CARC adjustment from the
primary payer payment amount where a CARC adjustment was added to the
primary payer payment amount when the same CAS CARC adjustment was received
as a negative adjustment. Providers are encouraged to review the
information and share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82QPN67656?opendocument
Medicare Claims Crossover to Supplemental Payer Problem
The Centers for Medicare & Medicaid Services (CMS) has identified a problem
where claims were not automatically crossing over to supplemental payers
even though the provider remittance advice indicated otherwise. This
problem began January 5, 2010. No action is required by Part A
institutional providers. Action is required on behalf of Part B
professional providers for certain claims. The affected Part B claims are
associated with a remittance advice dated between January 5, 2010, and
February 12, 2010, that contain two or more service lines for a beneficiary
and that meet both of the following criteria: one line is 100 percent
reimburseable, and at least some money was applied to the deductible.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82QRXL0601?opendocument
Palmetto GBA Online Learning Instructions
Palmetto GBA has revised the Online Learning Center user instructions to
reflect the recent update in the Webinar vendor Centra One system.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7XWSSK3475?opendocument
Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 16.1,
effective April 1, 2010
This J1 Part B MLN Matters article (CR6819) 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 January 2010. The National Correct Coding Initiative (CCI) was
developed to promote national correct coding methodologies and to control
improper coding that leads to inappropriate payment in Part B claims.
Providers are encouraged to review the information and share with their
staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82QPS64434?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!
Sunday, February 14, 2010
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 at http://www.hematology.org/Practice/Practice-Updates/4897.aspx. This edition features:
• Seven Month “Fix” to Physician Payment Included in Draft Legislation on Jobs
• FDA Recalls Defective Infusion Needles
• CMS Open Door Forum Scheduled for February 17 About Medicare Provider & Supplier Enrollment
• Medicare Average Sales Price Updates Available
****CMS NEWS****
MM6528 (Rescinded) – Compliance Standards for Consignment Closets and Stock and Bill Arrangements
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6528.pdf
MM6819 – Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 16.1, effective April 1, 2010
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6819.pdf
MM6812 – Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) Edits
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6812.pdf
MM6702 – Implementation of a New Skilled Nursing Facility (SNF) Consolidated Billing (CB) Edit for Facility Services Billed by Ambulatory Surgical Centers (ASCs)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6702.pdf
MM6800 – New Waived Tests
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6800.pdf
MM6778 – Medicare Systems Edit Refinements Related to Hospice Services
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6778.pdf
****PALMETTO/J1MAC NEWS****
Earn CEUs with CMA Hosted Webinars
Medicare billers, coders, practice managers and physicians, refresh your
Medicare knowledge and earn continuing education credits! The California
Medical Association (CMA) will be hosting a series of Medicare Webinars in
partnership with Palmetto GBA. Mark your calendar and register with the CMA
today.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82LPNA5131?opendocument
J1PCC to Close on February 15
The J1PCC will be closed on Monday, February 15, 2010, in observance of the
holiday. We will reopen on Tuesday, February 16, 2010, at 7 a.m. PST.
Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82LKJN3518?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 at http://www.hematology.org/Practice/Practice-Updates/4897.aspx. This edition features:
• Seven Month “Fix” to Physician Payment Included in Draft Legislation on Jobs
• FDA Recalls Defective Infusion Needles
• CMS Open Door Forum Scheduled for February 17 About Medicare Provider & Supplier Enrollment
• Medicare Average Sales Price Updates Available
****CMS NEWS****
MM6528 (Rescinded) – Compliance Standards for Consignment Closets and Stock and Bill Arrangements
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6528.pdf
MM6819 – Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 16.1, effective April 1, 2010
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6819.pdf
MM6812 – Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) Edits
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6812.pdf
MM6702 – Implementation of a New Skilled Nursing Facility (SNF) Consolidated Billing (CB) Edit for Facility Services Billed by Ambulatory Surgical Centers (ASCs)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6702.pdf
MM6800 – New Waived Tests
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6800.pdf
MM6778 – Medicare Systems Edit Refinements Related to Hospice Services
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6778.pdf
****PALMETTO/J1MAC NEWS****
Earn CEUs with CMA Hosted Webinars
Medicare billers, coders, practice managers and physicians, refresh your
Medicare knowledge and earn continuing education credits! The California
Medical Association (CMA) will be hosting a series of Medicare Webinars in
partnership with Palmetto GBA. Mark your calendar and register with the CMA
today.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82LPNA5131?opendocument
J1PCC to Close on February 15
The J1PCC will be closed on Monday, February 15, 2010, in observance of the
holiday. We will reopen on Tuesday, February 16, 2010, at 7 a.m. PST.
Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82LKJN3518?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, February 12, 2010
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 http://www.calphys.org/html/news.asp. This edition features:
• CMA Files Lawsuit Against Governor for Condoning Violations of State Scope of Practice Laws
• CMA Objects to DMHC Attempt to Legitimize Illegal Discount Health Plans
• Dustin Corcoran Named CMA CEO
• CMA Doctors Want Health Reform That Increases Access to Affordable Care; Docs Split on Congressional Health Reform Legislation
• CMA Defends Corporate Bar
• Medicare Posts List of PECOS-Enrolled Physicians Online
• CMA Continues Discussions with Blue Shield about Insurer's Plans to Publish Faulty Quality Data
• CMA Endorses Hector De La Torre for State Insurance Commissioner
• CMA Comments on Joint Commission's New Medical Staff Standards
• CMA Foundation to Launch California Cervical Cancer Awareness Campaign
****CMS NEWS****
Revision of Definition of Compendia as Authoritative Source for Use in the Determination of a Medically-Accepted Indication of Drugs/Biologicals Used Off-label in Anti-Cancer Chemotherapeutic Regimens
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6806.pdf
Billing and Processing for Healthy Control Group Volunteers in a Qualified Clinical Trial
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6776.pdf
The National Provider Identifier (NPI): What You Need to Know Booklet is Now Available for Download! The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated the adoption of a standard, unique health identifier for each health care provider. The NPI Final Rule, published on January 23, 2004, established the NPI as this standard. Covered entities under HIPAA are required by regulation to use NPIs to identify health care providers in HIPAA standard transactions. This booklet contains information previously available in NPI fact sheet and tip sheets and can be found at: (http://www.cms.hhs.gov/MLNProducts/downloads/NPIBooklet.pdf).
****PALMETTO/J1MAC NEWS****
April 2010 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing
Files and Revisions to Prior Quarterly Pricing Files
This J1 A/B MAC MLN Matters article (CR6804) instructs Medicare contractors
to download and implement the April 2010 Average Sales Price (ASP) drug
pricing file for Medicare Part B drugs, and if released by the Centers for
Medicare & Medicaid Services (CMS), the revised January 2010, October 2009,
July 2009 and April 2009 files. Medicare will use the April 2010 ASP and
not otherwise classified (NOC) drug pricing files to determine the payment
limit for claims for separately payable Medicare Part B drugs processed or
reprocessed on or after April 5, 2010, with dates of service April 1, 2009,
through June 30, 2010. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82CQR57653?opendocument
Instructions for Processing Claims Containing Anti-Markup Services but with
Partial Information Completed in Item 20 of the CMS-1500 Claim Form
This J1 Part B MLN Matters article (CR6670a) was revised on February 1,
2010, to reflect a revised CR 6670 that was issued on January 29, 2010.
Within this article, the CR release date, transmittal number and the Web
address for accessing CR 6670 were revised. All other information remains
the same. This article also provides Medicare contractors with instructions
for processing claims for diagnostic services that are subject to the
‘anti-markup payment limitation' and that are billed with missing or
incomplete information in Item 20 of the form CMS-1500 or its electronic
equivalent. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82CLQR7864?opendocument
Healthcare Provider Taxonomy Codes (HPTC): April 1, 2010 Update
CMS has released the summary of changes reflected in the Health Care
Provider Taxonomy Code (HPTC) list. Medicare carriers and DME MACs will
update their HPTC tables with this new version effective on April 1, 2010.
Please review the information and stay current on all HIPAA requirements to
assure timely processing of your claims.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7VBKAL6460?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 Files Lawsuit Against Governor for Condoning Violations of State Scope of Practice Laws
• CMA Objects to DMHC Attempt to Legitimize Illegal Discount Health Plans
• Dustin Corcoran Named CMA CEO
• CMA Doctors Want Health Reform That Increases Access to Affordable Care; Docs Split on Congressional Health Reform Legislation
• CMA Defends Corporate Bar
• Medicare Posts List of PECOS-Enrolled Physicians Online
• CMA Continues Discussions with Blue Shield about Insurer's Plans to Publish Faulty Quality Data
• CMA Endorses Hector De La Torre for State Insurance Commissioner
• CMA Comments on Joint Commission's New Medical Staff Standards
• CMA Foundation to Launch California Cervical Cancer Awareness Campaign
****CMS NEWS****
Revision of Definition of Compendia as Authoritative Source for Use in the Determination of a Medically-Accepted Indication of Drugs/Biologicals Used Off-label in Anti-Cancer Chemotherapeutic Regimens
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6806.pdf
Billing and Processing for Healthy Control Group Volunteers in a Qualified Clinical Trial
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6776.pdf
The National Provider Identifier (NPI): What You Need to Know Booklet is Now Available for Download! The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated the adoption of a standard, unique health identifier for each health care provider. The NPI Final Rule, published on January 23, 2004, established the NPI as this standard. Covered entities under HIPAA are required by regulation to use NPIs to identify health care providers in HIPAA standard transactions. This booklet contains information previously available in NPI fact sheet and tip sheets and can be found at: (http://www.cms.hhs.gov/MLNProducts/downloads/NPIBooklet.pdf).
****PALMETTO/J1MAC NEWS****
April 2010 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing
Files and Revisions to Prior Quarterly Pricing Files
This J1 A/B MAC MLN Matters article (CR6804) instructs Medicare contractors
to download and implement the April 2010 Average Sales Price (ASP) drug
pricing file for Medicare Part B drugs, and if released by the Centers for
Medicare & Medicaid Services (CMS), the revised January 2010, October 2009,
July 2009 and April 2009 files. Medicare will use the April 2010 ASP and
not otherwise classified (NOC) drug pricing files to determine the payment
limit for claims for separately payable Medicare Part B drugs processed or
reprocessed on or after April 5, 2010, with dates of service April 1, 2009,
through June 30, 2010. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82CQR57653?opendocument
Instructions for Processing Claims Containing Anti-Markup Services but with
Partial Information Completed in Item 20 of the CMS-1500 Claim Form
This J1 Part B MLN Matters article (CR6670a) was revised on February 1,
2010, to reflect a revised CR 6670 that was issued on January 29, 2010.
Within this article, the CR release date, transmittal number and the Web
address for accessing CR 6670 were revised. All other information remains
the same. This article also provides Medicare contractors with instructions
for processing claims for diagnostic services that are subject to the
‘anti-markup payment limitation' and that are billed with missing or
incomplete information in Item 20 of the form CMS-1500 or its electronic
equivalent. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/82CLQR7864?opendocument
Healthcare Provider Taxonomy Codes (HPTC): April 1, 2010 Update
CMS has released the summary of changes reflected in the Health Care
Provider Taxonomy Code (HPTC) list. Medicare carriers and DME MACs will
update their HPTC tables with this new version effective on April 1, 2010.
Please review the information and stay current on all HIPAA requirements to
assure timely processing of your claims.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7VBKAL6460?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, February 4, 2010
CMS & Palmetto/J1MAC News
The following information has been received by ANCO.
****CMS NEWS****
The Medicare Physician Fee Schedule Fact Sheet (February 2010) has been revised to include information about the two month zero percent (0%) update to the 2010 Medicare Physician Fee Schedule (MPFS) effective only for dates of service January 1, 2010 through February 28, 2010. This fact sheet, which also provides information about MPFS payment rates and the MPFS payment rates formula, is available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/MedcrePhysFeeSchedfctsht.pdf .
MM6804 – April 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/MM6804.pdf
MM6791 – Associating Hospice Visits to the Level of Care
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6791.pdf
****PALMETTO/J1MAC NEWS****
J1 Provider Outreach and Education Event Calendar
Palmetto GBA J1 Provider Outreach and Education team is offering multiple
educational events this February. Check out our updated online Events
calendar today.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7TAL2C7131?opendocument
Claims Fail to Crossover to Coordination of Benefits Contractor (COBC)
Palmetto GBA has been alerted of a problem with claims not crossing over to
the Coordination of Benefits Contractor (COBC) since January 21, 2010, from
a faulty file sent to the Common Working File (CWF) with incomplete data.
As a result, no claims have been crossing over to the COBC. CWF is aware of
this problem and is working with Group Health Incorporated (GHI), the
crossover company, to correct it. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/829U6H4858?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 Medicare Physician Fee Schedule Fact Sheet (February 2010) has been revised to include information about the two month zero percent (0%) update to the 2010 Medicare Physician Fee Schedule (MPFS) effective only for dates of service January 1, 2010 through February 28, 2010. This fact sheet, which also provides information about MPFS payment rates and the MPFS payment rates formula, is available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/MedcrePhysFeeSchedfctsht.pdf .
MM6804 – April 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/MM6804.pdf
MM6791 – Associating Hospice Visits to the Level of Care
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6791.pdf
****PALMETTO/J1MAC NEWS****
J1 Provider Outreach and Education Event Calendar
Palmetto GBA J1 Provider Outreach and Education team is offering multiple
educational events this February. Check out our updated online Events
calendar today.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7TAL2C7131?opendocument
Claims Fail to Crossover to Coordination of Benefits Contractor (COBC)
Palmetto GBA has been alerted of a problem with claims not crossing over to
the Coordination of Benefits Contractor (COBC) since January 21, 2010, from
a faulty file sent to the Common Working File (CWF) with incomplete data.
As a result, no claims have been crossing over to the COBC. CWF is aware of
this problem and is working with Group Health Incorporated (GHI), the
crossover company, to correct it. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/829U6H4858?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, February 1, 2010
Palmetto/J1MAC News
The following information has been received by ANCO.
****PALMETTO/J1MAC NEWS****
J1 Part B LCD Update
Share with your staff - The J1 Part B LCD, Erythropoietin Stimulating
Agents L29888, has been revised.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/825RFR5648?opendocument
February 2010 J1 A/B MAC Medicare Advisory
The February 2010 J1 A/B MAC Medicare Advisory is now available on the Web
site. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/826KL72110?opendocument
Providers Randomly Selected to Participate in the Medicare Contractor
Provider Satisfaction Survey (MCPSS) Urged to Respond
This J1 A/B MAC Special Edition MLN Matters article (SE1005) alerts
providers that the Centers for Medicare & Medicaid Services (CMS) has
launched the fifth annual national administration of the MCPSS. If you
received a letter indicating you were randomly selected to participate in
the 2010 MCPSS, CMS urges you to take a few minutes to go online and
complete this important survey via a secure Internet Web site. Responding
online is a convenient, easy and quick way to provide CMS with your
feedback on the performance of your FFS contractor. Survey questionnaires
can also be submitted by mail, secure fax and over the telephone. Please be
sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/826NSE8614?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!
****PALMETTO/J1MAC NEWS****
J1 Part B LCD Update
Share with your staff - The J1 Part B LCD, Erythropoietin Stimulating
Agents L29888, has been revised.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/825RFR5648?opendocument
February 2010 J1 A/B MAC Medicare Advisory
The February 2010 J1 A/B MAC Medicare Advisory is now available on the Web
site. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/826KL72110?opendocument
Providers Randomly Selected to Participate in the Medicare Contractor
Provider Satisfaction Survey (MCPSS) Urged to Respond
This J1 A/B MAC Special Edition MLN Matters article (SE1005) alerts
providers that the Centers for Medicare & Medicaid Services (CMS) has
launched the fifth annual national administration of the MCPSS. If you
received a letter indicating you were randomly selected to participate in
the 2010 MCPSS, CMS urges you to take a few minutes to go online and
complete this important survey via a secure Internet Web site. Responding
online is a convenient, easy and quick way to provide CMS with your
feedback on the performance of your FFS contractor. Survey questionnaires
can also be submitted by mail, secure fax and over the telephone. Please be
sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/826NSE8614?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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