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


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