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


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