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


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