ASH & 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/5387.aspx. This edition features:

• SGR Fix Caught in Stalemate Between House and Senate

• ASH Urges CMS to Reconsider the Elimination of Consult Codes

• FDA Grants Accelerated Approval to Nilotinib for the Treatment of Adult Ph+ CML Patients

• FDA Announcement of Pfizer Voluntary Withdrawal of Cancer Treatment Mylotarg from US Market

• ASH Responds to NHI-JDA Joint Leadership Council with Translational and Clinical Research Priorities and Recommendations for Increased Efficiency

• ASH Recommends Hematologic Conditions Be Included in HHS Initiative on Multiple Chronic Conditions

• Medicare Releases Updates of the Quarterly Average Sales Price (ASP)


****PALMETTO/J1MAC NEWS****
Enhancements to Home Health (HH) Consolidated Billing Enforcement
This J1 A/B MAC MLN Matters article (CR6911a) was revised on June 14, 2010,
to reflect the revised CR 6911 that was issued on that date. In this
article, the CR release date and transmittal number were revised. Also,
the Web address for accessing CR 6911 was revised. The article announces
that 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. Make sure your
billing staff is aware of these changes. Non-routine supplies provided
during a HH episode of care are included in Medicare’s payment to the home
health agency (HHA) and subject to consolidated billing edits as described
in the Medicare Claims Processing Manual. If the date of service for a
non-routine supply HCPCS code that is subject to HH consolidated billing
falls within the dates of a HH episode, the line item was previously
rejected by Medicare systems. Providers are encouraged to review the
information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/86PPH33027?opendocument


J1 Part A and Part B LCDs Notice Periods Start June 24
Share with your staff - The notice period will begin on June 24, 2010, for
J1 Part A LCD, Cataract Surgery in Adults L30889 and J1 Part B LCDs,
Cataract Surgery in Adults L30691and Implantable Infusion Pump for
Treatment of Chronic Intractable Pain L28268.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/86PQ2X8804?opendocument


The Physician Quality Reporting Initiative (PQRI) and E-Prescribing (eRx)
Medicare Quality Reporting Incentive Programs Manual
This J1 A/B MAC MLN Matters article (CR6935) announces availability of a
new Medicare manual describing the Physician Quality Reporting Initiative
(PQRI) and E-Prescribing (eRx) Incentive Programs. It is important to note
that the manual does not establish new requirements for the PQRI and eRx
programs and changes to the programs are described in the annual MPFS
legislation. This new manual, entitled Physician Quality Reporting
Initiative (PQRI) and E-Prescribing (eRx) Medicare Quality Reporting
Incentive Programs Manual will be Publication 100-22 and will be available
on the Centers for Medicare & Medicaid Services (CMS) Web site. Providers
are encouraged to review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/86QKTM7767?opendocument


Correction to the Claims Processing Internet Only Manual (IOM) to Reinstate
Previous Instructions Regarding Payment Jurisdiction for Reassigned
Services
This J1 Part B MLN Matters article (CR6923) corrects instructions for
reassigned services in the Medicare Claims Processing Manual. CR 6923
reinstates Chapter 1, Section 10.1.1.3 regarding payment jurisdiction for
reassigned services. This section was deleted in error by CR 6627. This CR
also removes an outdated reference in Chapter 35, Section 40 to deleted
Chapter 1, Section 30.2.9.1, which was removed by CR 6733. In CR 6627, the
Centers for Medicare & Medicaid Services (CMS) inadvertently changed the
billing instructions for reassigned services in a way that is not supported
by CMS’s systems or Medicare policy. This CR corrects this error and
reinstates the instructions in place prior to the implementation of CR
6627. Providers are encouraged to review the information and to share with
their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/86QLBQ7311?opendocument


Signature Guidelines for Medical Review Purposes
This J1 A/B MAC MLN Matters article (CR6698b) was revised on June 16, 2010,
to include a table excerpt on pages six through seven from CR 6698 that
summarizes signature requirements. 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 e-prescribing. See the rest of this article for complete
details. 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/86RMPR2435?opendocument


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