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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