ACCC, CMA, & 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-12-15-2010.html. ANCO is an Institutional Member of ACCC. This edition features:

• ACCC Center for Provider Education Releases New Study on Use and Perceptions of Clinical Practice Guidlines

• How to You Manage Patients with Breast Cancer: Case Study Submissions Accepted

• Another Temporary SGR FIx: This Time for One Year

• US Oncological Review Available Free to ACCC Members

• December Update to ACCC's Part B-Drug Information Guide Available

• CMS Issues New J-code for Folotyn


****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:

• Medicare SGR cuts blocked for 2011: Work begins on long-term solution

• Urgent new and valuable benefit for CMA members: Medicare PQRI 2% bonus program

• CMA calls on DMHC to levy bigger finds, exercise greater oversight of health plans

• Important update on PECOS and ordering/referring

• Breast cancer detection program reopens enrollment


****PALMETTO/J1MAC NEWS****
Clinical Laboratory Fee Schedule - Medicare Travel Allowance Fees for
Collection of Specimens
This J1 A/B MAC MLN Matters article (CR7239) revises the payment of travel
allowances either on a per mileage basis (P9603) or on a flat rate basis
(P9604) for calendar year (CY) 2010. Note that Medicare Contractors will
not reprocess claims that were processed before the new rates were
implemented unless you bring such claims to their attention. Providers are
encouraged to review the information and to share with their staff
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8C4QN62343?opendocument&utm_source=J1BL&utm_campaign=J1BLs


Waiver of Coinsurance and Deductible for Preventive Services, Section 4104
of The Affordable Care Act, Removal of Barriers to Preventive Services in
Medicare
This J1 A/B MAC MLN Matters article (CR7012) implements the changes in
Section 4104 of The Affordable Care Act. The CR announces that (effective
for dates of service on or after January 1, 2011) Medicare will provide 100
percent payment for the initial preventive physical examination (IPPE) and
the annual wellness visit (AWV). It also provides 100 percent payment for
preventive services that are identified with a grade of A or B by the
United States Preventive Services Task Force (USPSTF) for any indication or
population and are appropriate for the individual. Essentially this means
Medicare will waive any coinsurance or copayments for the services
mentioned above. Providers are encouraged to review the information and to
share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8C4QRL0822?opendocument&utm_source=J1BL&utm_campaign=J1BLs


Common Working File (CWF) Unsolicited Response Adjustments for Certain
Claims Denied Due to an Open Medicare Secondary Payer (MSP) Group Health
Plan (GHP) Record Where the GHP Record was Subsequently Deleted or
Terminated
This J1 A/B MAC MLN Matters article (CR 6625a) was revised on December 6,
2010, to reflect a revision to CR 6625. The implementation date has been
changed to July 5, 2011. Also, the CR release date, transmittal number and
the Web address for accessing CR 6625 were revised. All other information
is the same. CR 6625 instructs Medicare contractors and shared system
maintainers (SSMs) to implement (effective April 1, 2011) an automated
process to reopen group health plan (GHP) Medicare Secondary Payer (MSP)
claims when related MSP data is deleted or terminated after claims were
processed subject to the beneficiary record on Medicare’s database.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~887QS92045?opendocument&utm_source=J1BL&utm_campaign=J1BLs


Palmetto GBA Launches Going Beyond Diagnosis Blog
Nationally insufficient documentation in medical records remains a leading
cause of Medicare claim denials. Palmetto GBA has developed an innovative
method for improving the quality of the information in medical records and
is sharing this process via the newly established Going Beyond Diagnosis
(GBD) blog. The GBD blog uses the International Classification of
Functioning Disability and Health (ICF) to help health care professionals
and organizations communicate with third-party payers.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8C5JMW3232?opendocument&utm_source=J1BL&utm_campaign=J1BLs


Physicians and Non-Physician Practitioners (NPPs) Excluded from
Deactivation in Medicare Due to Inactivity with Medicare
This special edition MLN Matters article (SE1034) is for certain physicians
and non-physician practitioners (NPPs) who have the unique enrollment
scenarios of enrolling for the sole purpose of ordering and referring items
and services for Medicare beneficiaries. These physicians and NPPs do not
and will not send claims to a Medicare contractor for the services they
furnish and shall be excluded from the 12-month non-billing deactivation
process. Providers are encouraged to review the information and to share
with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8C5LYD7527?opendocument&utm_source=J1BL&utm_campaign=J1BLs


Palmetto GBA Laboratory and Molecular Diagnostic Services Program
Palmetto GBA must determine reasonable and necessary services and apply
fair reimbursement to services that are not listed in the current Centers
for Medicare & Medicaid Services laboratory fee schedule. The vast numbers
of new diagnostic and molecular assays entering the market magnify these
issues. To address these vulnerabilities, Palmetto GBA has launched a
Laboratory and Molecular Diagnostic Services Program.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~88WHVW2123?opendocument&utm_source=J1BL&utm_campaign=J1BLs


Why do I need a remittance advice when I call the Provider Contact Center?
The Centers for Medicare & Medicaid Services (CMS) provides instructions
and requirements for Medicare contractors in the Internet-Only Manuals
(IOMs) about requests for information that is available on a remittance
advice (RA). Please be familiar with these before calling the Provider
Contact Center.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8C5N580648?opendocument&utm_source=J1BL&utm_campaign=J1BLs


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