The following information has been received by ANCO.
All ANCO Online LIstServ postings are archived at the ANCO Online ListSev blog available online at http://anco-online.blogspot.com/.
****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/5120.aspx. This edition features:
• Please Complete a Brief Survey on Consult Code Elimination
• Congress Passes Another Short-Term Extension of the 2009 Medicare Physician Payment Rates to Restore 21 Percent Cut
• FDA Provides New Data About Revised USP Unit for Heparin
• Medicare to Host Conference Calls About the Recovery Audit Contracts (RAC) Program
• FDA Announces Drug Shortage of Mustargen
****CMS NEWS****
MM6698 – Signature Guidelines for Medical Review Purposes
http://www.cms.gov/MLNMattersArticles/downloads/MM6698.pdf
****PALMETTO/J1MAC NEWS****
May 2010 J1 A/B MAC Medicare Advisory
The May 2010 J1 A/B MAC MedicAre Advisory is now available on the Web site.
Providers are encouraged to review the information and to share with their
staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84RL2A3307?opendocument
Medicare Providers: What You Need to Know About Signatures & Documentation
In the past year, Palmetto GBA has seen an escalating number of errors
assessed by the Comprehensive Error Rate Testing (CERT) Review Contractor
due to signature problems on practitioners’ medical records, x-ray reports
and laboratory/radiology orders. The discovery of CERT errors may lead to
increased scrutiny of future services billed to Medicare. Your support and
understanding of this important issue are essential to ensuring the
accuracy of Medicare claims. We encourage you to share this information
with your staff in support of our efforts to assure that claims and
supporting documentation are properly indicated on claims submissions or
redetermination requests.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84VQSL3077?opendocument
Thursday, April 29, 2010
Thursday, April 22, 2010
ACCC, CMA, & 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/2010/ACCConnect-4-21-2010.html. ANCO is an Institutional Member of ACCC. This edition features:
• Physician Pay Cut Delayed through May 31
• Donald Berwick Nominated to CMS Administrator Post
• Access ACCC's Conference Call on Healthcare Reform
• Multiple Myeloma Webcast: Spotlight on Emerging Clinical Research and Its Impact on Community Practice.
• New Education Program to Study Challenges in Treating Small-Population Cancers in the Community Setting
• Master Class on Hematologic Malignancies
****CMA NEWS****
The California Medical Association's (CMA) Alert was published and is available online at http://www.calphys.org/html/news.asp. This edition features:
• New Physician Signage Regs Take Effect June 27
• Blue Shield Publishing Faulty Quality Data Despite CMA Objections
• Medicare Changes Coming: Timely Claim Filing and Therapy Cap Exceptions
• President Signs Bill Reversing Medicare Cuts, Extends Payment Freeze Through May 31
• California Interpretation of Emergency Transfer Laws More Restrictive Than Feds
• Get to Know CMA's New CEO
• First Issue of CMA's New Practice Management Bulletin Now Available: Subscribe Today
****PALMETTO/J1MAC NEWS****
Banking Transition
The CMS recently awarded new banking contracts to U.S. Bank and JP Morgan
Chase. Medicare providers do not have to take any action. However,
providers should be aware that the Medicare payments may be made by a
different bank than in the past because of these new banking contractors.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84NLDF7534?opendocument
Update: Potential Overpayment on Services Submitted with
Inpatient/Outpatient Place of Service
This Alert was updated from the Alert that posted to the J1 Part B Web site
on April 9, 2010. It announces that auditing is set up in our system to
deny services for Global and TC components when billed in specified
inpatient or outpatient settings and pathological lab services in inpatient
or outpatient settings. Claims with dates of service on or after March 30,
2009, could have been incorrectly paid and should have been denied as Part
A charges. A mass adjustment is being performed to recover the
overpayments. Providers may receive remittances with zero amounts as claims
may be reviewed that are not applicable. Providers are encouraged to review
the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84CRMB1010?opendocument
Response to Comments for Flow Cytometry (DL30692)
The Response to Comments for Flow Cytometry (DL30692) is now available on
the J1 Web site. Providers are encouraged to review the information and to
share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84PJBN5757?opendocument
Response to Comments for In Vitro Chemosensitivity & Chemoresistance Assays
The Response to Comments for In Vitro Chemosensitivity & Chemoresistance
Assays is now available on the J1 Web site. Providers are encouraged to
review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84PJHS0326?opendocument
Submitting Patient Information: Reminder
Palmetto GBA strongly suggests that you review your patients’ insurance
information at each encounter. Carefully checking for changes in coverage
effective dates, Medicare plans and numbers will ensure that your claims
are submitted accurately.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84PMGD4581?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/2010/ACCConnect-4-21-2010.html. ANCO is an Institutional Member of ACCC. This edition features:
• Physician Pay Cut Delayed through May 31
• Donald Berwick Nominated to CMS Administrator Post
• Access ACCC's Conference Call on Healthcare Reform
• Multiple Myeloma Webcast: Spotlight on Emerging Clinical Research and Its Impact on Community Practice.
• New Education Program to Study Challenges in Treating Small-Population Cancers in the Community Setting
• Master Class on Hematologic Malignancies
****CMA NEWS****
The California Medical Association's (CMA) Alert was published and is available online at http://www.calphys.org/html/news.asp. This edition features:
• New Physician Signage Regs Take Effect June 27
• Blue Shield Publishing Faulty Quality Data Despite CMA Objections
• Medicare Changes Coming: Timely Claim Filing and Therapy Cap Exceptions
• President Signs Bill Reversing Medicare Cuts, Extends Payment Freeze Through May 31
• California Interpretation of Emergency Transfer Laws More Restrictive Than Feds
• Get to Know CMA's New CEO
• First Issue of CMA's New Practice Management Bulletin Now Available: Subscribe Today
****PALMETTO/J1MAC NEWS****
Banking Transition
The CMS recently awarded new banking contracts to U.S. Bank and JP Morgan
Chase. Medicare providers do not have to take any action. However,
providers should be aware that the Medicare payments may be made by a
different bank than in the past because of these new banking contractors.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84NLDF7534?opendocument
Update: Potential Overpayment on Services Submitted with
Inpatient/Outpatient Place of Service
This Alert was updated from the Alert that posted to the J1 Part B Web site
on April 9, 2010. It announces that auditing is set up in our system to
deny services for Global and TC components when billed in specified
inpatient or outpatient settings and pathological lab services in inpatient
or outpatient settings. Claims with dates of service on or after March 30,
2009, could have been incorrectly paid and should have been denied as Part
A charges. A mass adjustment is being performed to recover the
overpayments. Providers may receive remittances with zero amounts as claims
may be reviewed that are not applicable. Providers are encouraged to review
the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84CRMB1010?opendocument
Response to Comments for Flow Cytometry (DL30692)
The Response to Comments for Flow Cytometry (DL30692) is now available on
the J1 Web site. Providers are encouraged to review the information and to
share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84PJBN5757?opendocument
Response to Comments for In Vitro Chemosensitivity & Chemoresistance Assays
The Response to Comments for In Vitro Chemosensitivity & Chemoresistance
Assays is now available on the J1 Web site. Providers are encouraged to
review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84PJHS0326?opendocument
Submitting Patient Information: Reminder
Palmetto GBA strongly suggests that you review your patients’ insurance
information at each encounter. Carefully checking for changes in coverage
effective dates, Medicare plans and numbers will ensure that your claims
are submitted accurately.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84PMGD4581?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, April 19, 2010
CMS & Palmetto/J1MAC News
The following information has been received by ANCO.
****CMS NEWS****
On April 15, 2010, President Obama signed into law the “Continuing Extension Act of 2010.” This law extends through May 31, 2010, the zero percent update to the MPFS that was in effect for claims with dates of service January 1, 2010, through March 31, 2010. The law is retroactive to April 1, 2010. Consequently, effective immediately, claims with dates of service April 1 and later which were being held by Medicare contractors are being released for processing and payment. Please keep in mind that the statutory payment floors still apply and, therefore, clean electronic claims cannot be paid before 14 calendar days after the date they are received by Medicare contractors (29 calendar days for clean paper claims).
Please watch your listservs and your contractor’s website for more information.
****PALMETTO/J1MAC NEWS****
On April 15, 2010, President Obama signed into law the "Continuing Extension Act of 2010." This law extends through May 31, 2010, the zero percent update to the MPFS that was in effect for claims with dates of service January 1, 2010 through March 31, 2010. The law is retroactive to April 1, 2010. Consequently, effective immediately, claims with dates of service April 1 and later, which were being held by Medicare contractors, are being released for processing and payment. Please keep in mind that the statutory payment floors still apply and, therefore, clean electronic claims cannot be paid before 14 calendar days after the date they are received by Medicare contractors (29 calendar days for clean paper claims).
Given the uncertainty regarding MPFS claims with dates of service June 1, 2010, and later, please watch your listservs and your contractor's website for more information.
J1 Part B LCDs Updates
The following J1 Part B Local Coverage Determinations (LCDs) have been
revised: Flow Cytometry L30692, In Vitro Chemosensitivity & Chemoresistance
Assays L30697 and CT Colonography (Virtual Colonoscopy) L28250.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84HR646420?opendocument
PC-ACE Pro32 version 2.20 Update File
PC-ACE Pro32 software has been updated to version 2.20 with several CMS
Medicare mandates and enhancements. All PC-ACE Pro32 users must download
and install the attached software update file immediately.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84FRCM4526?opendocument
Medicare Medical Records: Signature Requirements Acceptable and
Unacceptable Practices
While CMS guidelines mandate the presence of signatures specifically for
all 'medical review' purposes, modifiers, etc., records pertaining to any
procedures billed to Medicare are potentially subject to review by not only
Palmetto GBA, but other CMS contractors. Because of this, we are alerting
you to the importance of these signature requirements and if changes are
needed, we suggest you take immediate action. The contents of this article
are applicable to Medicare claims with dates of service on or after March
1, 2010, processed by or medical record submitted to Palmetto GBA for
Medical Review purposes on or after April 16, 2010.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84HT746343?opendocument
The Continuing Extension Act of 2010 Extends Zero Percent Medicare
Physician Fee Schedule (MPFS) Update
On April 15, 2010, President Obama signed into law the 'Continuing
Extension Act of 2010.' This law extends through May 31, 2010, the zero
percent update to the MPFS that was in effect for claims with dates of
service January 1, 2010 through March 31, 2010. The law is retroactive to
April 1, 2010. Consequently, effective immediately, claims with dates of
service April 1 and later, which were being held by Medicare contractors,
are being released for processing and payment. Please keep in mind that the
statutory payment floors still apply and, therefore, clean electronic
claims cannot be paid before 14 calendar days after the date they are
received by Medicare contractors (29 calendar days for clean paper claims).
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84KMXM0885?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****
On April 15, 2010, President Obama signed into law the “Continuing Extension Act of 2010.” This law extends through May 31, 2010, the zero percent update to the MPFS that was in effect for claims with dates of service January 1, 2010, through March 31, 2010. The law is retroactive to April 1, 2010. Consequently, effective immediately, claims with dates of service April 1 and later which were being held by Medicare contractors are being released for processing and payment. Please keep in mind that the statutory payment floors still apply and, therefore, clean electronic claims cannot be paid before 14 calendar days after the date they are received by Medicare contractors (29 calendar days for clean paper claims).
Please watch your listservs and your contractor’s website for more information.
****PALMETTO/J1MAC NEWS****
On April 15, 2010, President Obama signed into law the "Continuing Extension Act of 2010." This law extends through May 31, 2010, the zero percent update to the MPFS that was in effect for claims with dates of service January 1, 2010 through March 31, 2010. The law is retroactive to April 1, 2010. Consequently, effective immediately, claims with dates of service April 1 and later, which were being held by Medicare contractors, are being released for processing and payment. Please keep in mind that the statutory payment floors still apply and, therefore, clean electronic claims cannot be paid before 14 calendar days after the date they are received by Medicare contractors (29 calendar days for clean paper claims).
Given the uncertainty regarding MPFS claims with dates of service June 1, 2010, and later, please watch your listservs and your contractor's website for more information.
J1 Part B LCDs Updates
The following J1 Part B Local Coverage Determinations (LCDs) have been
revised: Flow Cytometry L30692, In Vitro Chemosensitivity & Chemoresistance
Assays L30697 and CT Colonography (Virtual Colonoscopy) L28250.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84HR646420?opendocument
PC-ACE Pro32 version 2.20 Update File
PC-ACE Pro32 software has been updated to version 2.20 with several CMS
Medicare mandates and enhancements. All PC-ACE Pro32 users must download
and install the attached software update file immediately.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84FRCM4526?opendocument
Medicare Medical Records: Signature Requirements Acceptable and
Unacceptable Practices
While CMS guidelines mandate the presence of signatures specifically for
all 'medical review' purposes, modifiers, etc., records pertaining to any
procedures billed to Medicare are potentially subject to review by not only
Palmetto GBA, but other CMS contractors. Because of this, we are alerting
you to the importance of these signature requirements and if changes are
needed, we suggest you take immediate action. The contents of this article
are applicable to Medicare claims with dates of service on or after March
1, 2010, processed by or medical record submitted to Palmetto GBA for
Medical Review purposes on or after April 16, 2010.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84HT746343?opendocument
The Continuing Extension Act of 2010 Extends Zero Percent Medicare
Physician Fee Schedule (MPFS) Update
On April 15, 2010, President Obama signed into law the 'Continuing
Extension Act of 2010.' This law extends through May 31, 2010, the zero
percent update to the MPFS that was in effect for claims with dates of
service January 1, 2010 through March 31, 2010. The law is retroactive to
April 1, 2010. Consequently, effective immediately, claims with dates of
service April 1 and later, which were being held by Medicare contractors,
are being released for processing and payment. Please keep in mind that the
statutory payment floors still apply and, therefore, clean electronic
claims cannot be paid before 14 calendar days after the date they are
received by Medicare contractors (29 calendar days for clean paper claims).
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84KMXM0885?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, April 15, 2010
CMS & Palmetto/J1MAC News
The following information has been received by ANCO.
****CMS NEWS****
The Centers for Medicare & Medicaid Services (CMS) has called a public meeting of the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) on Wednesday, April 21, 2010. The Committee generally provides advice and recommendations concerning the adequacy of scientific evidence needed to determine whether certain medical items and services can be covered under the Medicare statute. This meeting will examine currently available evidence on the use of Radiation Therapy for Localized Prostate Cancer. This meeting is open to the public in accordance with the Federal Advisory Committee Act (5 U.S.C. App. 2, section 10(a)).
CMS is hosting a webinar for this meeting. Webinar participants will be able to view presentations and will be connected to live audio. However, live video will not be streamed. Attendance is limited and requires registration. Registration will be closed at 5pm eastern time on April 19, 2010. Participants should be advised that the webinar is a listening only session; that is, no questions or interactions will be permitted and all lines will be muted.
Date: Wednesday, April 21, 2010
Time: 7:50am -8:00am, Eastern (Webinar Login)
8:00am-4:30pm, Eastern (Live MEDCAC Meeting)
Please register by going to this link (there is no cost to register):
https://webinar.cms.hhs.gov/_a7/medcacprostate421/event/registration.html
You will be required to develop a password. Passwords must be 8-32 characters, and contain at least one capital letter and one number.
MM6472 – Implementation of the Health Insurance Portability and Accountability Act (HIPAA) Version 005010 Medicare Administrative Contractors Requirements
http://www.cms.gov/MLNMattersArticles/downloads/MM6472.pdf
MM6896 – Update to the Medicare Claims Processing Manual (Publication 100-04, Chapter 15, Section 40)
http://www.cms.gov/MLNMattersArticles/downloads/MM6896.pdf
MM6870 – Reporting of Recoupment for Overpayment on the Remittance Advice (RA)
http://www.cms.gov/MLNMattersArticles/downloads/MM6870.pdf
SE1011 – Edits on the Ordering/Referring Providers in Medicare Part B Claims (Change Requests 6417, 6421, and 6696)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE1011.pdf
MM6696 – Ordering/Referring Providers Who Are Not Enrolled in Medicare
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6696.pdf
SE0931 – Sections 3103 and 3104 of the Patient Protection and Affordable Care Act (PPACA) Extends Certain Payment Provisions Under the Medicare Program Related to Therapy Cap Exceptions and the Billing by Independent Laboratories for the Technical Component of Physician Pathology Services Furnished to Hospital Patients
http://www.cms.gov/MLNMattersArticles/downloads/SE0931.pdf
MM6417 – Expansion of the Current Scope of Editing for Ordering/Referring Providers for claims processed by Medicare Carriers and Part B Medicare Administrative Contractors (MACs)
http://www.cms.gov/MLNMattersArticles/downloads/MM6417.pdf
MM6698 – Signature Guidelines for Medical Review Purposes
http://www.cms.gov/MLNMattersArticles/downloads/MM6698.pdf
The Centers for Medicare & Medicaid Services (CMS) will be hosting its fifth national provider call regarding the implementation of HIPAA Version 5010. There will be a brief presentation given by CMS followed by a Q&A session with CMS subject matter experts. Please note that this call is geared towards vendors, clearinghouses, and providers who are performing their own development of 5010.
Subject: Medicare Fee-For-Service Implementation of HIPAA version 5010 For Eligibility Inquiry and Response, 270/271 Transaction
Agenda:
· General Overview
· Medicare Specific Changes
o Service Type Codes
o Patient Matching Rules
o Error Handling
o Response Changes
· Timelines and Deadlines
· What you need to do to prepare
· 270/271 Errata
· Q & A
Conference call details:
Date: April 28, 2010
Conference Title: HIPAA Version 5010 national provider call: CMS’ discussion of Eligibility Inquiry and Response, 270/271 Transaction
Time: 2:00 p.m. – 3:30 p.m. ET
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 2:00 p.m. ET on April 27, 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/042810
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.
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 3:30 p.m. – 5:00 p.m., EDT, on Thursday, April 15, 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: April 15, 2010
Conference Title: Physician Quality Reporting Initiative (PQRI) - National Provider Call
Time: 3:30 p.m. EDT
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 3:30 p.m. EDT on April 14, 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/041510
Fill in all required data.
Verify that your time zone is displayed correctly in 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****
Potential Overpayment on Services Submitted with Inpatient/Outpatient Place
of Service
This Alert announces that auditing is set up in our system to deny services
for Global and TC components when billed in specified inpatient or
outpatient settings and pathological lab services in inpatient or
outpatient settings. Claims with dates of service on or after March 30,
2009, could have been incorrectly paid and should have been denied as Part
A charges. A mass adjustment is being performed to recover the
overpayments. Providers are encouraged to review the information and to
share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84CRMB1010?opendocument
Sections 3103 and 3104 of the Patient Protection and Affordable Care Act
(PPACA) Extends Certain Payment Provisions Under the Medicare Program
Related to Therapy Cap Exceptions and the Billing by Independent
Laboratories for the Technical Component of Physician Pathology Services
Furnished to Hospital Patients
This special edition article is being re-issued by the Centers for Medicare
& Medicaid Services (CMS) to notify affected providers that a number of
Medicare payment provisions, such as the Therapy Cap Exceptions Process and
Allowing Independent Laboratories to Bill for the Technical Component of
Physician Pathology Services Furnished to Hospital Patients, have been
extended as a result of the Patient Protection and Affordable Care Act
(PPACA). Previously, these provisions were to sunset as of December 31,
2009.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84CRYQ1687?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 called a public meeting of the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) on Wednesday, April 21, 2010. The Committee generally provides advice and recommendations concerning the adequacy of scientific evidence needed to determine whether certain medical items and services can be covered under the Medicare statute. This meeting will examine currently available evidence on the use of Radiation Therapy for Localized Prostate Cancer. This meeting is open to the public in accordance with the Federal Advisory Committee Act (5 U.S.C. App. 2, section 10(a)).
CMS is hosting a webinar for this meeting. Webinar participants will be able to view presentations and will be connected to live audio. However, live video will not be streamed. Attendance is limited and requires registration. Registration will be closed at 5pm eastern time on April 19, 2010. Participants should be advised that the webinar is a listening only session; that is, no questions or interactions will be permitted and all lines will be muted.
Date: Wednesday, April 21, 2010
Time: 7:50am -8:00am, Eastern (Webinar Login)
8:00am-4:30pm, Eastern (Live MEDCAC Meeting)
Please register by going to this link (there is no cost to register):
https://webinar.cms.hhs.gov/_a7/medcacprostate421/event/registration.html
You will be required to develop a password. Passwords must be 8-32 characters, and contain at least one capital letter and one number.
MM6472 – Implementation of the Health Insurance Portability and Accountability Act (HIPAA) Version 005010 Medicare Administrative Contractors Requirements
http://www.cms.gov/MLNMattersArticles/downloads/MM6472.pdf
MM6896 – Update to the Medicare Claims Processing Manual (Publication 100-04, Chapter 15, Section 40)
http://www.cms.gov/MLNMattersArticles/downloads/MM6896.pdf
MM6870 – Reporting of Recoupment for Overpayment on the Remittance Advice (RA)
http://www.cms.gov/MLNMattersArticles/downloads/MM6870.pdf
SE1011 – Edits on the Ordering/Referring Providers in Medicare Part B Claims (Change Requests 6417, 6421, and 6696)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE1011.pdf
MM6696 – Ordering/Referring Providers Who Are Not Enrolled in Medicare
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6696.pdf
SE0931 – Sections 3103 and 3104 of the Patient Protection and Affordable Care Act (PPACA) Extends Certain Payment Provisions Under the Medicare Program Related to Therapy Cap Exceptions and the Billing by Independent Laboratories for the Technical Component of Physician Pathology Services Furnished to Hospital Patients
http://www.cms.gov/MLNMattersArticles/downloads/SE0931.pdf
MM6417 – Expansion of the Current Scope of Editing for Ordering/Referring Providers for claims processed by Medicare Carriers and Part B Medicare Administrative Contractors (MACs)
http://www.cms.gov/MLNMattersArticles/downloads/MM6417.pdf
MM6698 – Signature Guidelines for Medical Review Purposes
http://www.cms.gov/MLNMattersArticles/downloads/MM6698.pdf
The Centers for Medicare & Medicaid Services (CMS) will be hosting its fifth national provider call regarding the implementation of HIPAA Version 5010. There will be a brief presentation given by CMS followed by a Q&A session with CMS subject matter experts. Please note that this call is geared towards vendors, clearinghouses, and providers who are performing their own development of 5010.
Subject: Medicare Fee-For-Service Implementation of HIPAA version 5010 For Eligibility Inquiry and Response, 270/271 Transaction
Agenda:
· General Overview
· Medicare Specific Changes
o Service Type Codes
o Patient Matching Rules
o Error Handling
o Response Changes
· Timelines and Deadlines
· What you need to do to prepare
· 270/271 Errata
· Q & A
Conference call details:
Date: April 28, 2010
Conference Title: HIPAA Version 5010 national provider call: CMS’ discussion of Eligibility Inquiry and Response, 270/271 Transaction
Time: 2:00 p.m. – 3:30 p.m. ET
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 2:00 p.m. ET on April 27, 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/042810
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.
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 3:30 p.m. – 5:00 p.m., EDT, on Thursday, April 15, 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: April 15, 2010
Conference Title: Physician Quality Reporting Initiative (PQRI) - National Provider Call
Time: 3:30 p.m. EDT
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 3:30 p.m. EDT on April 14, 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/041510
Fill in all required data.
Verify that your time zone is displayed correctly in 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****
Potential Overpayment on Services Submitted with Inpatient/Outpatient Place
of Service
This Alert announces that auditing is set up in our system to deny services
for Global and TC components when billed in specified inpatient or
outpatient settings and pathological lab services in inpatient or
outpatient settings. Claims with dates of service on or after March 30,
2009, could have been incorrectly paid and should have been denied as Part
A charges. A mass adjustment is being performed to recover the
overpayments. Providers are encouraged to review the information and to
share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84CRMB1010?opendocument
Sections 3103 and 3104 of the Patient Protection and Affordable Care Act
(PPACA) Extends Certain Payment Provisions Under the Medicare Program
Related to Therapy Cap Exceptions and the Billing by Independent
Laboratories for the Technical Component of Physician Pathology Services
Furnished to Hospital Patients
This special edition article is being re-issued by the Centers for Medicare
& Medicaid Services (CMS) to notify affected providers that a number of
Medicare payment provisions, such as the Therapy Cap Exceptions Process and
Allowing Independent Laboratories to Bill for the Technical Component of
Physician Pathology Services Furnished to Hospital Patients, have been
extended as a result of the Patient Protection and Affordable Care Act
(PPACA). Previously, these provisions were to sunset as of December 31,
2009.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84CRYQ1687?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, April 9, 2010
ACCC, ASH, CMA, CMS, DMHC/MediCal, & 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/2010/ACCConnect-4-7-2010.html. ANCO is an institutional member of ACCC. This edition features:
• Tuesday, April 13th, Conference Call: Healthcare Reform and Oncology
• New Education Program to Study Challenges in Treating Small-Population Cancers in the Community Setting
• Heard on ACCC's ListServ: Breast Center and Physicians' Time
• Healthcare Reform Establishes New Requirements for Tax-Exempt Hospitals
• Improving the Efficiency of Clinical Trials: Decreasing Times by 50%
• Medicare Will Cover PET Scans to Detect Bone Metastasis of Cancer Under CED Only
****ASH NEWS****
The American Society of Hematology's (ASH) Practice Update was published and is available online at http://www.hematology.org/Practice/Updates/. This edition features:
• Physician Payment Cuts Began April 1: CMS Holding Medicare Claims for the First 10 Days of April to Avoid Disruption
• Historic Health Reform Legislation Signed Into Law
• President Obama to Nominate Dr. Donald Berwick for CMS Administrator
• WinRho Box Warning Creates Reimbursement Implications
• 2010 PQRI & E-Prescribing Incentive Program National Provider Call With Q & A Session
• Patients Who Take a Proton-Pump Inhibitor With Medicine to Prevent Blood Clots Are Less Likely to Be Hospitalized for Bleeding Ulcers
Few Days Left to Register in Advance for Highlights of ASH® Latin America
****CMA NEWS****
The California Medical Association's (CMA) Alert was published and is available online at http://www.cmaalert.org. This edition features:
• Deep Medicare Cuts Took Efect April 1; CMS Orders Temporary Payment Hold
• Superior Court Judge Overturns Medical Board Furloughs; Appeals Court Temporarily Stays Ruling
• Field Poll: California's Don't Support Health Care Cuts
• Joint Commission Approves New Medical Staff Standard
• How Will Health Care Reform Affect Your Practice?
• Nominate an Outstanding Colleague for the CMA Foundation Leadership Awards
• Register Today for CMA's 36th Annual Legislative Leadership Conference
• First Issue of CMA's New Practice Management Bulletin Now Available
• Physician Billing Staff: Become a Certified Coder
****CMS NEWS****
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 3:30 p.m. – 5:00 p.m., EDT, on Thursday, April 15, 2010.
The PQRI is a 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: April 15, 2010
Conference Title: Physician Quality Reporting Initiative (PQRI) - National Provider Call
Time: 3:30 p.m. EDT
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 3:30 p.m. EDT on April 14, 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/041510
Fill in all required data.
Verify that your time zone is displayed correctly in the drop down box.
Click "Register".
You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.
For those of who will be unable to attend, a transcript of the call will be available at least one week after the call at http://www.cms.hhs.gov/pqri on the CMS website.
If you require services for the hearing impaired please send an email to: Medicare.TTT@PalmettoGBA.com.
The Centers for Medicare & Medicaid Services (CMS) has released a Special Edition MLN Matters article that provides guidance on the edits required to be identified in Part B claims from Medicare providers or suppliers who furnish items or services as a result of orders or referrals. Medicare providers and suppliers who order or refer items or services for Medicare beneficiaries must submit an enrollment application to Medicare by using Internet-based Provider Enrollment, Chain and Ownership System (PECOS), or by completing the paper enrollment application (CMS-855I). The article, SE1011, “Edits on the Ordering/Referring Providers in Medicare Part B Claims (Change Requests 6417, 6421, and 6696),” is available at http://www.cms.gov/MLNMattersArticles/downloads/SE1011.pdf on the CMS website.
The Centers for Medicare & Medicaid Services (CMS) changed its website address from www.cms.hhs.gov towww.cms.gov. Existing bookmarks and links from other websites will continue to work following this address change.
****DMHC/MediCal NEWS****
The eTAR application is an easy, effective, fast and free way to submit TARs. Providers that utilize the eTAR application are generally more successful when submitting TARs. Most Medi-Cal providers are activated to use eTAR. To verify access, go to www.medi-cal.ca.gov, select the Transactions tab and log in with your NPI and PIN. An eTAR tab with options for Medical Services will be available. If you do not have access or only see options for Inquire only, please contact Medi-Cal at 1-800-541-5555 and follow the prompts for eTAR to request access.
The eTAR training team would like to extend an invitation to access the free learning tools available to all Medi-Cal providers. The eTAR Program Information webpage (www.medi-cal.ca.gov/go/etarhttp://www.medi-cal.ca.gov/go/etar) contains information useful to both new and experienced providers. Web based tutorials are available on this webpage to provide step-by-step instructions on how to submit eTARs and attachments, as well as update and inquire on previously submitted TARs This newly updated webpage also contains Medical and Pharmacy eTAR training dates, provider bulletins and helpful tips and pointers for both Medical and Pharmacy eTAR providers.
The following list contains the free Medi-Cal seminars where eTAR classes are taught. Parking fees may apply. For more information about training seminars, please visit the Medi-Cal Web site.
Fresno: April 13, 14, 15*
Fresno Convention Centerhttp://www.fresnoconventioncenter.com/index2.asp
800 M Street
Fresno, CA 93721
(559) 445-8100
Anaheim: June 2*, 3, 4
Anaheim Convention Centerhttp://www.anaheimconventioncenter.com/>\
800 West Katella Avenue
Anaheim, CA 92802
714-765-8950
An asterisk (*) indicates a Pharmacy eTAR class will also be held that day.
Regional representatives are available to provide one-on-one trainings to assist providers in learning how to use the eTAR application. To request free onsite training from a regional representative, please contact Medi-Cal at 1-800-541-5555.
****PALMETTO/J1MAC NEWS****
Ancillary Services Rejected Incorrectly
This Alert announces that some services have been rejected in error due to
the set up of various surgical services and related ancillary services.
Palmetto GBA is in the process of correcting this issue. 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 their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/848NKB3361?opendocument
Claim Status Category Code and Claim Status Code Update
This J1 A/B MAC MLN Matters article (CR6859) explains that the Claim Status
Codes and Claim Status Category Codes for use by Medicare contractors with
a specified Health Claim Status Request and Response were updated during
the January 2010 meeting of the National Code Maintenance Committee. Code
changes approved at that meeting were posted on the Internet on or about
March 1, 2010. At the January 2010 meeting, the committee also decided to
allow the industry six months for implementation of newly added or changed
codes. Included in the code lists are specific details, including the date
when a code was added, changed or deleted. Medicare contractors will
implement these changes on July 6, 2010. Providers are encouraged to review
the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/848PP66217?opendocument
J1 Provider Outreach and Education Event Calendar
Check out the updated Palmetto GBA J1 Provider Outreach and Education April
2010 Calendar on our Web site! Besides our Spring Workshop Tour, there are
other training opportunities in April that you might be interested in.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7TAL2C7131?opendocument
Sign up for the J1 Spring Workshop Tour Today
The J1 Spring Workshop Tour kicks off next Friday! If you have not already,
sign up today to reserve your seat at these educational events where our
ombudsmen present useful information on Medicare policy updates and tools
to your region.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84AP4L7644?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/2010/ACCConnect-4-7-2010.html. ANCO is an institutional member of ACCC. This edition features:
• Tuesday, April 13th, Conference Call: Healthcare Reform and Oncology
• New Education Program to Study Challenges in Treating Small-Population Cancers in the Community Setting
• Heard on ACCC's ListServ: Breast Center and Physicians' Time
• Healthcare Reform Establishes New Requirements for Tax-Exempt Hospitals
• Improving the Efficiency of Clinical Trials: Decreasing Times by 50%
• Medicare Will Cover PET Scans to Detect Bone Metastasis of Cancer Under CED Only
****ASH NEWS****
The American Society of Hematology's (ASH) Practice Update was published and is available online at http://www.hematology.org/Practice/Updates/. This edition features:
• Physician Payment Cuts Began April 1: CMS Holding Medicare Claims for the First 10 Days of April to Avoid Disruption
• Historic Health Reform Legislation Signed Into Law
• President Obama to Nominate Dr. Donald Berwick for CMS Administrator
• WinRho Box Warning Creates Reimbursement Implications
• 2010 PQRI & E-Prescribing Incentive Program National Provider Call With Q & A Session
• Patients Who Take a Proton-Pump Inhibitor With Medicine to Prevent Blood Clots Are Less Likely to Be Hospitalized for Bleeding Ulcers
Few Days Left to Register in Advance for Highlights of ASH® Latin America
****CMA NEWS****
The California Medical Association's (CMA) Alert was published and is available online at http://www.cmaalert.org. This edition features:
• Deep Medicare Cuts Took Efect April 1; CMS Orders Temporary Payment Hold
• Superior Court Judge Overturns Medical Board Furloughs; Appeals Court Temporarily Stays Ruling
• Field Poll: California's Don't Support Health Care Cuts
• Joint Commission Approves New Medical Staff Standard
• How Will Health Care Reform Affect Your Practice?
• Nominate an Outstanding Colleague for the CMA Foundation Leadership Awards
• Register Today for CMA's 36th Annual Legislative Leadership Conference
• First Issue of CMA's New Practice Management Bulletin Now Available
• Physician Billing Staff: Become a Certified Coder
****CMS NEWS****
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 3:30 p.m. – 5:00 p.m., EDT, on Thursday, April 15, 2010.
The PQRI is a 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: April 15, 2010
Conference Title: Physician Quality Reporting Initiative (PQRI) - National Provider Call
Time: 3:30 p.m. EDT
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 3:30 p.m. EDT on April 14, 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/041510
Fill in all required data.
Verify that your time zone is displayed correctly in the drop down box.
Click "Register".
You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.
For those of who will be unable to attend, a transcript of the call will be available at least one week after the call at http://www.cms.hhs.gov/pqri on the CMS website.
If you require services for the hearing impaired please send an email to: Medicare.TTT@PalmettoGBA.com.
The Centers for Medicare & Medicaid Services (CMS) has released a Special Edition MLN Matters article that provides guidance on the edits required to be identified in Part B claims from Medicare providers or suppliers who furnish items or services as a result of orders or referrals. Medicare providers and suppliers who order or refer items or services for Medicare beneficiaries must submit an enrollment application to Medicare by using Internet-based Provider Enrollment, Chain and Ownership System (PECOS), or by completing the paper enrollment application (CMS-855I). The article, SE1011, “Edits on the Ordering/Referring Providers in Medicare Part B Claims (Change Requests 6417, 6421, and 6696),” is available at http://www.cms.gov/MLNMattersArticles/downloads/SE1011.pdf on the CMS website.
The Centers for Medicare & Medicaid Services (CMS) changed its website address from www.cms.hhs.gov towww.cms.gov. Existing bookmarks and links from other websites will continue to work following this address change.
****DMHC/MediCal NEWS****
The eTAR application is an easy, effective, fast and free way to submit TARs. Providers that utilize the eTAR application are generally more successful when submitting TARs. Most Medi-Cal providers are activated to use eTAR. To verify access, go to www.medi-cal.ca.gov, select the Transactions tab and log in with your NPI and PIN. An eTAR tab with options for Medical Services will be available. If you do not have access or only see options for Inquire only, please contact Medi-Cal at 1-800-541-5555 and follow the prompts for eTAR to request access.
The eTAR training team would like to extend an invitation to access the free learning tools available to all Medi-Cal providers. The eTAR Program Information webpage (www.medi-cal.ca.gov/go/etarhttp://www.medi-cal.ca.gov/go/etar) contains information useful to both new and experienced providers. Web based tutorials are available on this webpage to provide step-by-step instructions on how to submit eTARs and attachments, as well as update and inquire on previously submitted TARs This newly updated webpage also contains Medical and Pharmacy eTAR training dates, provider bulletins and helpful tips and pointers for both Medical and Pharmacy eTAR providers.
The following list contains the free Medi-Cal seminars where eTAR classes are taught. Parking fees may apply. For more information about training seminars, please visit the Medi-Cal Web site.
Fresno: April 13, 14, 15*
Fresno Convention Centerhttp://www.fresnoconventioncenter.com/index2.asp
800 M Street
Fresno, CA 93721
(559) 445-8100
Anaheim: June 2*, 3, 4
Anaheim Convention Centerhttp://www.anaheimconventioncenter.com/>\
800 West Katella Avenue
Anaheim, CA 92802
714-765-8950
An asterisk (*) indicates a Pharmacy eTAR class will also be held that day.
Regional representatives are available to provide one-on-one trainings to assist providers in learning how to use the eTAR application. To request free onsite training from a regional representative, please contact Medi-Cal at 1-800-541-5555.
****PALMETTO/J1MAC NEWS****
Ancillary Services Rejected Incorrectly
This Alert announces that some services have been rejected in error due to
the set up of various surgical services and related ancillary services.
Palmetto GBA is in the process of correcting this issue. 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 their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/848NKB3361?opendocument
Claim Status Category Code and Claim Status Code Update
This J1 A/B MAC MLN Matters article (CR6859) explains that the Claim Status
Codes and Claim Status Category Codes for use by Medicare contractors with
a specified Health Claim Status Request and Response were updated during
the January 2010 meeting of the National Code Maintenance Committee. Code
changes approved at that meeting were posted on the Internet on or about
March 1, 2010. At the January 2010 meeting, the committee also decided to
allow the industry six months for implementation of newly added or changed
codes. Included in the code lists are specific details, including the date
when a code was added, changed or deleted. Medicare contractors will
implement these changes on July 6, 2010. Providers are encouraged to review
the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/848PP66217?opendocument
J1 Provider Outreach and Education Event Calendar
Check out the updated Palmetto GBA J1 Provider Outreach and Education April
2010 Calendar on our Web site! Besides our Spring Workshop Tour, there are
other training opportunities in April that you might be interested in.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7TAL2C7131?opendocument
Sign up for the J1 Spring Workshop Tour Today
The J1 Spring Workshop Tour kicks off next Friday! If you have not already,
sign up today to reserve your seat at these educational events where our
ombudsmen present useful information on Medicare policy updates and tools
to your region.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84AP4L7644?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, April 5, 2010
CMS & Palmetto/J1MAC News
The following information has been received by ANCO.
****CMS NEWS****
On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA), which amended the time period for filing Medicare fee-for-service (FFS) claims as one of many provisions aimed at curbing fraud, waste, and abuse in the Medicare program.
The time period for filing Medicare FFS claims is specified in Sections 1814(a), 1835(a)(1), and 1842(b)(3) of the Social Security Act and in the Code of Federal Regulations (CFR), 42 CFR Section 424.44. Section 6404 of the PPACA amended the timely filing requirements to reduce the maximum time period for submission of all Medicare FFS claims to one calendar year after the date of service.
Under the new law, claims for services furnished on or after January 1, 2010, must be filed within one calendar year after the date of service. In addition, Section 6404 mandates that claims for services furnished before January 1, 2010, must be filed no later than December 31, 2010. The following rules apply to claims with dates of service prior to January 1, 2010. Claims with dates of service before October 1, 2009, must follow the pre-PPACA timely filing rules. Claims with dates of service October 1, 2009, through December 31, 2009, must be submitted by December 31, 2010.
Section 6404 of the PPACA also permits the Secretary to make certain exceptions to the one-year filing deadline. At this time, no exceptions have been established. However, proposals for exceptions will be specified in future proposed rulemaking.
Please be on the alert for more information pertaining to the Patient Protection and Affordable Care Act.
Beginning with the April 2010 update, the Centers for Medicare and Medicaid Services (CMS) will now post the National Correct Coding Initiative (NCCI) Edit files in Excel 2007 and in text formats. Because Excel 2007 can support a larger number of rows, each code range will be contained in one file as opposed to multiple files. This should correct the incompatibility issues that some of our users experienced last quarter with the Excel 2003 files.
Please be aware that Excel 2003 and earlier versions of the software have a maximum row count of 65,536. Some of the NCCI Edit files exceed the maximum row count. If you do not have Excel 2007, please use the text format to import the data into an application that can support larger files.
For more information on NCCI edits and to download the files, visit the web page at
http://www.cms.hhs.gov/NationalCorrectCodInitEd/.
SE1011 – Edits on the Ordering/Referring Providers in Medicare Part B Claims (Change Requests 6417, 6421, and 6696)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE1011.pdf
MM6696 – Ordering/Referring Providers Who Are Not Enrolled in Medicare
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6696.pdf
MM6417 – Expansion of the Current Scope of Editing for Ordering/Referring Providers for claims processed by Medicare Carriers and Part B Medicare Administrative Contractors (MACs)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6417.pdf
****PALMETTO/J1MAC NEWS****
Change in Provider Enrollment Timeliness Standards for Certain Paper
Applications
This J1 A/B MAC MLN Matters article (CR6807) provides you with information
regarding the revised provider enrollment processing timeliness standards
for certain Medicare enrollment applications. These include CMS-855I
initial application, CMS-855B initial applications and Change Requests and
reassignments. Timeliness standards for Internet-based Provider Enrollment
Chain and Ownership System (PECOS) enrollment applications and Part A
providers are not affected by CR 6807. Providers are encouraged to review
the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/844NDE1516?opendocument
J1 Part B LCDs Updates
The notice period of the J1 Part B Local Coverage Determinations (LCDs),
Flow Cytometry L30692 and Physical Medicine and Rehabilitation Policy
L28290, begins on April 1, 2010. The revisions made during the comment
period will become effective on May 20, 2010.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/844PMG0324?opendocument
Timely Filing Requirements for Medicare Fee-For-Service Claims
On March 23, 2010, President Obama signed into law the Patient Protection
and Affordable Care Act (PPACA), which amended the time period for filing
Medicare fee-for-service (FFS) claims as one of many provisions aimed at
curbing fraud, waste, and abuse in the Medicare program. Under the new law,
claims for services furnished on or after January 1, 2010, must be filed
within one calendar year after the date of service. In addition, Section
6404 mandates that claims for services furnished before January 1, 2010,
must be filed no later than December 31, 2010.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/844LP34117?opendocument
Edits on the Ordering/Referring Providers in Medicare Part B Claims (Change
Requests 6417, 6421 and 6696)
This Special Edition MLN Matters article (SE1011) announces that if you
order or refer items or services for Medicare beneficiaries and you do not
have an enrollment record in the Provider Enrollment, Chain and Ownership
System (PECOS), you need to submit an enrollment application to Medicare.
You can do this using Internet-based PECOS or by completing the paper
enrollment application (CMS 855I). If you reassign your Medicare benefits
to a group or clinic, you will also need to complete the CMS 855R.
Providers are encouraged to review the information and to share with their
staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/845PP71455?opendocument
Ordering/Referring Providers Who Are Not Enrolled in Medicare
This J1 Part B MLN Matters article (CR6696) annouces that for the provider
education information related to CR 6696, see the MLN Matters® article
SE1011 on the CMS Web site. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/844RSC6007?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****
On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA), which amended the time period for filing Medicare fee-for-service (FFS) claims as one of many provisions aimed at curbing fraud, waste, and abuse in the Medicare program.
The time period for filing Medicare FFS claims is specified in Sections 1814(a), 1835(a)(1), and 1842(b)(3) of the Social Security Act and in the Code of Federal Regulations (CFR), 42 CFR Section 424.44. Section 6404 of the PPACA amended the timely filing requirements to reduce the maximum time period for submission of all Medicare FFS claims to one calendar year after the date of service.
Under the new law, claims for services furnished on or after January 1, 2010, must be filed within one calendar year after the date of service. In addition, Section 6404 mandates that claims for services furnished before January 1, 2010, must be filed no later than December 31, 2010. The following rules apply to claims with dates of service prior to January 1, 2010. Claims with dates of service before October 1, 2009, must follow the pre-PPACA timely filing rules. Claims with dates of service October 1, 2009, through December 31, 2009, must be submitted by December 31, 2010.
Section 6404 of the PPACA also permits the Secretary to make certain exceptions to the one-year filing deadline. At this time, no exceptions have been established. However, proposals for exceptions will be specified in future proposed rulemaking.
Please be on the alert for more information pertaining to the Patient Protection and Affordable Care Act.
Beginning with the April 2010 update, the Centers for Medicare and Medicaid Services (CMS) will now post the National Correct Coding Initiative (NCCI) Edit files in Excel 2007 and in text formats. Because Excel 2007 can support a larger number of rows, each code range will be contained in one file as opposed to multiple files. This should correct the incompatibility issues that some of our users experienced last quarter with the Excel 2003 files.
Please be aware that Excel 2003 and earlier versions of the software have a maximum row count of 65,536. Some of the NCCI Edit files exceed the maximum row count. If you do not have Excel 2007, please use the text format to import the data into an application that can support larger files.
For more information on NCCI edits and to download the files, visit the web page at
http://www.cms.hhs.gov/NationalCorrectCodInitEd/.
SE1011 – Edits on the Ordering/Referring Providers in Medicare Part B Claims (Change Requests 6417, 6421, and 6696)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE1011.pdf
MM6696 – Ordering/Referring Providers Who Are Not Enrolled in Medicare
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6696.pdf
MM6417 – Expansion of the Current Scope of Editing for Ordering/Referring Providers for claims processed by Medicare Carriers and Part B Medicare Administrative Contractors (MACs)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6417.pdf
****PALMETTO/J1MAC NEWS****
Change in Provider Enrollment Timeliness Standards for Certain Paper
Applications
This J1 A/B MAC MLN Matters article (CR6807) provides you with information
regarding the revised provider enrollment processing timeliness standards
for certain Medicare enrollment applications. These include CMS-855I
initial application, CMS-855B initial applications and Change Requests and
reassignments. Timeliness standards for Internet-based Provider Enrollment
Chain and Ownership System (PECOS) enrollment applications and Part A
providers are not affected by CR 6807. Providers are encouraged to review
the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/844NDE1516?opendocument
J1 Part B LCDs Updates
The notice period of the J1 Part B Local Coverage Determinations (LCDs),
Flow Cytometry L30692 and Physical Medicine and Rehabilitation Policy
L28290, begins on April 1, 2010. The revisions made during the comment
period will become effective on May 20, 2010.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/844PMG0324?opendocument
Timely Filing Requirements for Medicare Fee-For-Service Claims
On March 23, 2010, President Obama signed into law the Patient Protection
and Affordable Care Act (PPACA), which amended the time period for filing
Medicare fee-for-service (FFS) claims as one of many provisions aimed at
curbing fraud, waste, and abuse in the Medicare program. Under the new law,
claims for services furnished on or after January 1, 2010, must be filed
within one calendar year after the date of service. In addition, Section
6404 mandates that claims for services furnished before January 1, 2010,
must be filed no later than December 31, 2010.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/844LP34117?opendocument
Edits on the Ordering/Referring Providers in Medicare Part B Claims (Change
Requests 6417, 6421 and 6696)
This Special Edition MLN Matters article (SE1011) announces that if you
order or refer items or services for Medicare beneficiaries and you do not
have an enrollment record in the Provider Enrollment, Chain and Ownership
System (PECOS), you need to submit an enrollment application to Medicare.
You can do this using Internet-based PECOS or by completing the paper
enrollment application (CMS 855I). If you reassign your Medicare benefits
to a group or clinic, you will also need to complete the CMS 855R.
Providers are encouraged to review the information and to share with their
staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/845PP71455?opendocument
Ordering/Referring Providers Who Are Not Enrolled in Medicare
This J1 Part B MLN Matters article (CR6696) annouces that for the provider
education information related to CR 6696, see the MLN Matters® article
SE1011 on the CMS Web site. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/844RSC6007?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, April 1, 2010
CMS & Palmetto/J1MAC News
The following information has been received by ANCO.
****CMS NEWS****
MM6861 – Positron Emission Tomography (PET) (NaF-18) to Identify Bone Metastasis of Cancer
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6861.pdf
MM6859 – Claim Status Category Code and Claim Status Code Update
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6859.pdf
****PALMETTO/J1MAC NEWS****
April 2010 J1 A/B MAC Medicare Advisory
The April 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/83ZMG63263?opendocument
Holding of April 2010 Claims for Services Paid Under the 2010 Medicare
Physician Fee Schedule Update
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 (MPFS). As you are
aware, the Temporary Extension Act of 2010, enacted on March 2, 2010,
extended the zero percent (0%) update to the 2010 MPFS through March 31,
2010.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/83ZMJM2548?opendocument
Independent Diagnostic Testing Facilities: Availability of new 2010 Annual
Procedure Codes
This Alert explains that, per the Contractor Medical Director (CMD) review,
certain new services from the 2010 Annual Procedure Codes Update have been
generally approved as allowable procedures to be performed in Independent
Diagnostic Testing Facilities (IDTF), as long as all other certifications
and requirements have been accomplished. However, these services were not
added as approved in the system at that time. The system has been updated
and is now correct. In order to ensure accurate processing of relevant
claims already submitted, a mass adjustment will be performed on all
services denied incorrectly. Following this action, we will provide an
update on the number of claims adjusted per J1 environment. Providers are
encouraged to review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/83UNAS7187?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****
MM6861 – Positron Emission Tomography (PET) (NaF-18) to Identify Bone Metastasis of Cancer
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6861.pdf
MM6859 – Claim Status Category Code and Claim Status Code Update
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6859.pdf
****PALMETTO/J1MAC NEWS****
April 2010 J1 A/B MAC Medicare Advisory
The April 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/83ZMG63263?opendocument
Holding of April 2010 Claims for Services Paid Under the 2010 Medicare
Physician Fee Schedule Update
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 (MPFS). As you are
aware, the Temporary Extension Act of 2010, enacted on March 2, 2010,
extended the zero percent (0%) update to the 2010 MPFS through March 31,
2010.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/83ZMJM2548?opendocument
Independent Diagnostic Testing Facilities: Availability of new 2010 Annual
Procedure Codes
This Alert explains that, per the Contractor Medical Director (CMD) review,
certain new services from the 2010 Annual Procedure Codes Update have been
generally approved as allowable procedures to be performed in Independent
Diagnostic Testing Facilities (IDTF), as long as all other certifications
and requirements have been accomplished. However, these services were not
added as approved in the system at that time. The system has been updated
and is now correct. In order to ensure accurate processing of relevant
claims already submitted, a mass adjustment will be performed on all
services denied incorrectly. Following this action, we will provide an
update on the number of claims adjusted per J1 environment. Providers are
encouraged to review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/83UNAS7187?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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