Tuesday, May 25, 2010

ACCC, CMA, CMS, & 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-5-19-2010.html. ANCO is an Institutional Member of ACCC. This edition features:

• A Call to Action! Review and Comment on Proposed Changes to CoC Standards

• Overcome Burnout & Sour Attitudes: Keynoter Looks at Turn-Around Techniques

• CMS Issues Change on Payment Reduction to Certain Diagnostic Imaging Procedures

• Help ACCC Find Best Practices in Patient Transition Between the Hospital and Practice Setting

• Heard on ACCC's ListServ: Massage Therapy Reimbursement

• Nominees Sought for Two Congressional Healthcare Committees

• ACCC Secretary Receives AOSW Award


****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:

• Lawmakers Work on a Five Year Medicare Fix with California Geographic Payment Fix

• Physicians Can Now Claim Their Share of $350 Million UnitedHealth Settlement

• Governor's Proposed Budget Cuts Health Funding and Creates Administrative Hassles for Physicians

• CMA Tells Feds that Medical Loss Ratio Definition Must Prevent Subjective Insurer Manipulation

• Misleading Blue Shield Physician Ratings Go Public on June 1

• Don't Forget: FTC's Ref Flag Rules Take Effect June 1


****CMS NEWS****
The Centers for Medicare & Medicaid Services (CMS) has released MLN Matters Article #MM6960 to advise providers who submit claims to Medicare contractors that, as a result of the Affordable Care Act (ACA), claims with dates of service on or after January 1, 2010, received later than one calendar year beyond the date of service will be denied by Medicare. For more details, please read the article at http://www.cms.gov/MLNMattersArticles/downloads/MM6960.pdf on the CMS website.


****PALMETTO/J1MAC NEWS****
Online Provider Services Coming Soon
Online Provider Services is coming soon to PalmettoGBA.com/Medicare. It
will be available from the Self-service Tools menu on the Jurisdiction 1
Part A and Jurisdiction 1 Part B Web pages beginning 9 a.m. PST on May 19,
2010. Look for more information soon!
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/85JRAS5358?opendocument


PC-ACE Pro32 Training Modules for Institutional and Professional Claims
Submission
Palmetto GBA is pleased to announce the availability of new Web-based
PC-ACE Pro32 training modules for Part A and Part B providers. PC-ACE Pro32
is a complete, self-contained electronic processing system for healthcare
claims submission and management. This system does not integrate into
office systems, such as accounts receivable, inventory or billing. It
provides you with the ability to enter patient, claim, and procedure file
information, while creating summary reports of the claims you submit
electronically.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/857MGQ4785?opendocument


Northern California 2010 Revised Medicare Part B Fee Schedule
The Northern California 2010 Revised Medicare Part B Fee Schedule is now
available and is effective for services performed on or after January 1,
2010.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7ZDQMR7321?opendocument


Revised Payment Files for the 2010 Medicare Physician Fee Schedule Database
(MPFSDB) and Retroactive Provisions under the Patient Protection and
Affordable Care Act (Publication L. 111-148) (The Affordable Care Act)
This J1 A/B MAC MLN Matters article (CR6973) amends payment files that were
issued to contractors to take into account the 2010 Medicare Physician Fee
Schedule (MPFS) Final Rule correction notice that went on display at the
Federal Register on May 5, 2010, and retroactive provisions under the
Affordable Care Act. Providers are encouraged to review the information and
to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/85KKWH2865?opendocument


PC-ACE Pro32 Training Modules
Palmetto GBA is pleased to announce the availability of new Web-based
PC-ACE Pro32 training modules for Part A and Part B providers. PC-ACE Pro32
is a complete, self-contained electronic processing system for healthcare
claims submission and management. This system does not integrate into
office systems, such as accounts receivable, inventory or billing. It
provides you with the ability to enter patient, claim, and procedure file
information, while creating summary reports of the claims you submit
electronically.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/857MGQ4785?opendocument


Systems Changes Necessary to Implement the Patient Protection and
Affordable Care Act (PPACA) Section 6404 - Maximum Period for Submission of
Medicare Claims Reduced to Not More Than 12 Months
This J1 A/B MAC MLN Matters article (CR6960) announces that the Centers for
Medicare & Medicaid Services (CMS) is updating edit criteria related to the
timely filing limits for submitting claims for Medicare Fee-for-Service
(FFS) reimbursement. As a result of the PPACA, claims with dates of service
on or after January 1, 2010, received later than one calendar year beyond
the date of service will be denied by Medicare. Providers are encouraged to
review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/85LREN7223?opendocument


Spring Workshop Location Changed to Bishop, CA June 9
Palmetto GBA J1 Spring Workshop Tour scheduled for Tonopah, Nevada on June
9, 2010, will be moved to Bishop, California.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/85NKYJ4300?opendocument


Spring Workshop Tour Lake Tahoe Location Finalized June 8
The J1 Spring Workshop Tour scheduled for Lake Tahoe, Nevada on June 8,
2010, will be held at Harrah's Lake Tahoe, 18 U.S. Highway 50, Stateline,
NV 89449.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/85NRMU8025?opendocument


Updated: Certain Drugs Rejected Incorrectly
Certain HCPCS drug codes processed between February 10 through February 18,
2010, were rejected incorrectly for lack of invoice. A mass adjustment was
completed on March 25, 2010, to correct the issue.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/832KQT6638?opendocument


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Monday, May 17, 2010

Palmetto/J1MAC News

The following information has been received by ANCO.


****PALMETTO/J1MAC NEWS****
Certain Clinical Lab Services Rejected Incorrectly
This Alert announces that changes to the anti-markup payment limitation
editing (a.k.a., purchased service) were implemented on April 5, 2010. For
certain electronic claims that contained reference lab services and a
purchased service amount, the system was misreading pricing information in
Loop 2400, segment PS102 as blank. This caused services to reject when an
actual amount was present. A mass adjustment will be performed for any
electronic claim rejected with remittance advice remark code MA111
processed between April 5 and April 29. Please be sure to share with your
staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/857QVV7435?opendocument


Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC)
and Medicare Remit Easy Print (MREP) Update
This J1 A/B MAC MLN Matters article (CR6901) announces the latest update of
Remittance Advice Remark Codes (RARCs) and Claim Adjustment Reason Codes
(CARCs), effective July 1, 2010. The reason and remark code sets must be
used to report payment adjustments in remittance advice transactions. The
reason codes are also used in some coordination-of-benefits (COB)
transactions. The RARC list is maintained by the Centers for Medicare and
Medicaid Services (CMS), and used by all payers. Additions, deactivations
and modifications to it may be initiated by any health care organization.
The RARC and CARC lists are updated three times a year – March, July and
November. Providers are encouraged to review the information and to share
with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/85CKES1183?opendocument


Hold the Date: The CMS 2010 ICD-10/5010 National Provider Conference Call
The Centers for Medicare & Medicaid Services (CMS) will host a national
provider conference call on ‘ICD-10 Implementation in a 5010 Environment’
on Tuesday, June 15, 2010 from 12 p.m. to 2 p.m. EDT. The target audience
for this call includes: medical coders, physician office staff and provider
billing staff, health records staff, vendors, educators, system maintainers
and all Medicare fee-for-service (FFS) providers. Registration information
for this national provider conference call will be announced soon, so hold
the June 15th date now for this informative provider conference call.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/85DNW82261?opendocument


Change in the Amount in Controversy (AIC) Requirement for Administrative
Law Judge Hearings and Federal District Court Appeals
This J1 A/B MAC MLN Matters article (CR6894) notifies Medicare contractors
of the Amount in Controversy (AIC) required to sustain Administrative Law
Judge (ALJ) and Federal District Court appeal rights beginning January 1,
2010. The amount remaining in controversy requirement for ALJ hearing
requests made before January 1, 2010, is $120. The amount remaining in
controversy requirement for requests made on or after January 1, 2010, is
$130. For Federal District Court review, the amount remaining in
controversy goes from $1,220 for requests on or after January 1, 2009, to
$1,260 for requests on or after January 1, 2010. Providers are encouraged
to review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/85EJGY7540?opendocument


Enhancements to Home Health (HH) Consolidated Billing Enforcement
This J1 A/B MAC MLN Matters article (CR6911) announces that the Centers for
Medicare & Medicaid Services (CMS) is updating edit criteria related to the
consolidated billing provision of the Home Health Prospective Payment
System (HH PPS). It is also creating a new file of HH certification
information to assist suppliers and providers subject to HH consolidated
billing. Effective October 1, 2010, CMS is implementing new requirements to
modify this edit in order to restore the original intent to pay for
supplies delivered before the HH episode began. Such supplies may have been
ordered before the need for HH care had been identified, and are
appropriate for payment if all other payment conditions are met. The edit
will be changed to only reject services if the ‘from’ date on the supply
line item falls within a HH episode. Providers are encouraged to review the
information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/85CK9G6155?opendocument


Medicare Physician Fee Schedule: Implementation of the Patient Protection
and Affordable Care Act and Health Care and Education Reconciliation Act of
2010
The Medicare Physician Fee Schedule is being updated to include certain
corrections, retroactive to January 1, 2010, as prescribed in recently
published notices in the Federal Register. Once Palmetto GBA has the new
payment files in place, all claims going forward will be processed at the
revised rates. However, CMS will continue to work on the best way to
address the many claims that are paid at the rates that were in place
before the current corrections and updates are made. Please be on the alert
for further information about how CMS will address past claims. Until then,
providers should NOT resubmit previously-processed claims affected by the
payment changes, as it is likely that these resubmissions may be denied as
duplicate claims.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/85FJXG4223?opendocument


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Thursday, May 13, 2010

ASH, CMS, & Palmetto/J1MAC News

The following information has been received by ANCO.


****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/5197.aspx. This edition features:

• Physician Payment Cuts Scheduled to Begin June 1, Contact Congress Now to Stop the 21% Payment Cut

• ASH Adds MPD and MDS to the Consult-a-Colleague Program

• FDA Urges Doctors to Report Misleading Ads

• Medicare Proposes Rule for Inpatient Prospective Payment System for FY2011

• ASH Submits Comments to AHRQ on Comparative Effectiveness of Epoetin and Darbepoetin

• ASH Suggests Changes to the Electronic Health Record Incentive Program to Encourage Health Information Technology

• ASH Urges Appropriations Committees to Fully Fund Quality Measurement Incentives Included in Health Reform

• Maximum Period for Submission of Medicare Claims Reduced to Not More Than 12 Months

• Use of JW Modifier Necessary to Assure Payment of Discarded Drugs and Biologcals


****CMS NEWS****
MM6960 – Systems Changes Necessary to Implement the Patient Protection and Affordable Care Act (PPACA) Section 6404 - Maximum Period for Submission of Medicare Claims Reduced to Not More Than 12 Months
http://www.cms.gov/MLNMattersArticles/downloads/MM6960.pdf

MM6894 – Change in the Amount in Controversy (AIC) Requirement for Administrative Law Judge Hearings and Federal District Court Appeals
http://www.cms.gov/MLNMattersArticles/downloads/MM6894.pdf

MM6632 – FDG PET for Solid Tumors and Myeloma
http://www.cms.gov/MLNMattersArticles/downloads/MM6632.pdf


****PALMETTO/J1MAC NEWS****
PC-ACE Pro32 Training Modules for Institutional and Professional Claims Submission
Palmetto GBA is pleased to announce the availability of new Web-based
PC-ACE Pro32 training modules for Part A and Part B providers. PC-ACE Pro32
is a complete, self-contained electronic processing system for healthcare
claims submission and management. This system does not integrate into
office systems, such as accounts receivable, inventory or billing. It
provides you with the ability to enter patient, claim, and procedure file
information, while creating summary reports of the claims you submit
electronically.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/857MGQ4785?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, May 7, 2010

ACCC, CMA, CMS, & Palmetto/J1MAC News

The following information has been received by ANCO.


****ACCC NEWS****
The Association of Community Cancer Centers (ACCC) Connect was published and is available online at http://www.accc-cancer.org/mediaroom/newsletters/2010/ACCConnect-5-5-2010.html. ANCO is an Institutional Member of ACCC. This edition features:

• ACCC to Study In-Office Dispensing Pharmacies

• 13 ACCC-Member Cancer Programs Added to NCCCP

• FDA Conducting Safety Review of Commonly Used Prostate Cancer Drugs

• Heard on ACCC's ListServ: Shifts in Chemotherapy Reimbursement?

• Costs and Use of Diagnostic Imaging Rise Among Medicare Patients

• ACCC's CE Blackboard: New Multiple Myeloma CE Programs Available


****CMA NEWS****
The California Medical Association (CMA) Alert was published and is available online at http://www.calphys.org/html/news.asp. This edition features:

• Have You Checked Your Medical Board Profile Recently?

• Faulty Blue Shield Physician Ratings Go Public on June 1

• California Physicians Will Receive One-TIme Licensing Fee Credit

• FTC Red Flagg Rules Take Effect June 1

• Some Private Payors Changing Consultation Code Payment Policies

• CMA Foundation Announces Increased Funding for Medical Student-Run Clinics

• Deadline to Nominate a Colleague for the CMA Foundation Leadership Awards is June 30

• May Issue of CMA Practice Resources (CPR) Now Available

• Have You SIgned the Medicare Petition?


****CMS NEWS****
MM6911 – Enhancements to Home Health (HH) Consolidated Billing Enforcement
http://www.cms.gov/MLNMattersArticles/downloads/MM6911.pdf

MM6964 – Changes to the Laboratory National Coverage Determination (NCD) Edit Software for July 2010
http://www.cms.gov/MLNMattersArticles/downloads/MM6964.pdf

MM6950 – Medicare Benefits Policy Manual Update – Determining Self-Administration of Drug or Biological
http://www.cms.gov/MLNMattersArticles/downloads/MM6950.pdf

MM6711 – Discarded Drugs and Biologicals Updates
http://www.cms.gov/MLNMattersArticles/downloads/MM6711.pdf


The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host a national provider conference call on the 2010 Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (eRx). This toll-free call will take place from 1:30 p.m. – 3:00 p.m., EDT, on Wednesday, May 12, 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: May 12, 2010

Conference Title: Physician Quality Reporting Initiative (PQRI) - National Provider Call

Time: 1:30 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 1:30 p.m. EDT on Tuesday, May 11, 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/051210

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****
J1 Provider Outreach and Education Event Calendar
The Palmetto GBA J1 May 2010 Event Calendar is now available on our Web
site. If you are not able to register for our Spring Workshop Tour in your
area, check out the Event Calendar for another session located near you.
Remember, you can always attend our regular monthly Webinars and/or Ask the
Contractor Teleconferences (ACT) on popular Medicare topics.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7TAL2C7131?opendocument


2010 Physician Quality Reporting Initiative National Provider Call to be
held on May 12, 2010
The Centers for Medicare & Medicaid Services' (CMS) Provider Communications
Group will host a national provider conference call on the 2010 Physician
Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive
Program (eRx). This toll-free call will take place from 1:30 p.m. to 3
p.m., EDT, on Thursday, May 12, 2010.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/855L3Z1630?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, May 3, 2010

CMS & Palmetto/J1MAC News

The following information has been received by ANCO.


****CMS NEWS****
MM6760 – Use of 12X Type of Bill (TOB) for Billing Colorectal Screening Services
http://www.cms.gov/MLNMattersArticles/downloads/MM6760.pdf

MM6916 – Skilled Nursing Facility (SNF) Health Insurance Prospective Payment System (HIPPS) Coding Updates Effective October 1, 2010
http://www.cms.gov/MLNMattersArticles/downloads/MM6916.pdf


****PALMETTO/J1MAC NEWS****
J1 Part B Medical Review Progressive Corrective Action (PCA) Process
Curious about the Medical Review Progressive Corrective Action (PCA)
Process? This article explains what the process does and the important
procedures to follow.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84WQNH6286?opendocument


Underpayments - Third Notification for FY 2010
This article announces that Medicare Regulation 42 CFR §405.378 provides
for the assessment of interest at the higher of the current value of funds
rate of one percent for calendar year 2010 or the private consumer rate as
fixed by the Department of the Treasury. The Department of the Treasury has
notified the Department of Health and Human Services that the private
consumer rate has been changed to 10.875 percent effective April 23, 2010,
for Medicare overpayments and underpayments. Providers are encouraged to
review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84XLFW1866?opendocument


CMS-588 Electronic Funds Transfer (EFT) Registration Form
The Centers for Medicare & Medicaid Services (CMS) received approval from
the Office of Management and Budget to re-issue the EFT authorization
agreement. Providers and suppliers may begin using the revised EFT form
immediately, though Palmetto GBA shall continue to accept the previous
version of the EFT authorization agreement until January 1, 2011. This new
interactive form is now easier and simpler to use, with clarified
instructions.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84YLKM1010?opendocument


Drugs Administered Through An Implantable Infusion Pump
This Alert announces that the Implantable Infusion Pump for Treatment of
Chronic Intractable Pain LCD (L28268) and the associated article (A49293)
requires providers to submit an invoice for all drugs administered through
the pump. Drugs compounded by a pharmacy, should be submitted with HCPCS
code J3490. J3490 should be submitted one time with the total charge for
all drugs administered. Services submitted incorrectly will be rejected or
denied. Any services submitted incorrectly which resulted in an overpayment
may be recouped. Providers are encouraged to review this information and
the outlined articles, and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84YJZS6612?opendocument


Signature Guidelines for Medical Review Purposes
This J1 A/B MAC MLN Matters article (CR6698a) was revised and re-issued on
April 26, 2010, to include additional clarifying language from CR 6698.
This article clarifies for providers how Medicare claims review
contractors, review claims and medical documentation submitted by
providers. CR 6698 outlines the new rules for signatures and adds language
for Electronic prescribing (e-prescribing). These revised/new signature
requirements are applicable for reviews conducted on or after the
implementation date of April 16, 2010. Please note that all signature
requirements in CR 6698 are effective retroactively for Comprehensive Error
Rate Testing (CERT) for the November 2010 report period. Providers are
encouraged to review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84XPYG2484?opendocument


J1 Part B PPTN ID Request Form
The PPTN ID Request Form is a new online enrollment option for
Jurisidiction 1 Part B providers to request acces to the Professional
Provider Telecommunications Network (PPTN).
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84XMBT0432?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!