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


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