ASH & Palmetto/J1MAC News

The following information has been received by ANCO.


****ASH NEWS****
The American Society of Hematology's Practice Update was published and is available online at http://www.hematology.org/Practice/Practice-Updates/6224.aspx. This edition features:

• Congress Passes a One Year Extension of Medicare Physician Payment Rates

• ASH Submits COmments to CMS Regarding Accountable Care Organizations and the Medicare Shared Savings Program

• CMS Provides Resources to Aid Version 5010 and ICD-10 Transitions

• CMS to Host National Provider Call on PQRS and eRx.


****PALMETTO/J1MAC NEWS****
Edits on the Ordering/Referring Providers in Medicare Part B Claims (Change
Requests 6417, 6421 and 6696)
This special edition MLN Matters article (SE1011a) was revised on November
26, 2010, to include the following statement: The Centers for Medicare &
Medicaid Services (CMS) previously announced that, beginning January 3,
2011, if certain Part B billed items and services require an
ordering/referring provider and the ordering/referring provider is not in
the claim, is not of a profession that is permitted to order/refer or does
not have an enrollment record in the Medicare Provider Enrollment, Chain
and Ownership System (PECOS), the claim will not be paid. The automated
edits will not be turned on effective January 3, 2011. We are working
diligently to resolve enrollment backlogs and other system issues and will
provide ample advanced notice to the provider and beneficiary communities
before we begin any automatic non-payment actions. Providers are encouraged
to review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~845PP71455?opendocument&utm_source=J1BL&utm_campaign=J1BLs


E/M Service: Similar Services from Multiple Providers in the Same Group
Physicians in the same group practice who are in the same specialty must
bill and be paid as though they were a single physician. When more than one
E/M service is provided to the same patient on the same date by more than
one physician in the same specialty in the same group, only one E/M service
may be reported unless the E/M services are for unrelated problems.
Physicians in the same group practice but who are in different specialties
or subspecialties may bill and be paid without regard to their membership
in the same group.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BSM6J0300?opendocument&utm_source=J1BL&utm_campaign=J1BLs


2010 Physician Quality Reporting System & Electronic Prescribing Incentive
Program National Provider Call
The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications
Group will host a national provider conference call on the 2010 Physician
Quality Reporting System and Electronic Prescribing Incentive Program
(eRx). This toll-free call will take place from 2:30 p.m. to 4 p.m. ET, on
Monday, December 13, 2010.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BVLJY6786?opendocument&utm_source=J1BL&utm_campaign=J1BLs


Billing Clarification for Positron Emission Tomography (NaF-18) PET for
Identifying Bone Metastasis of Cancer in the Context of a Clinical Trial
This J1 A/B MAC MLN Matters article (CR7125) was issued to clarify a
requirement in CR 6861 regarding how these claims should be billed.
Specifically, CR 7125 amends instructions for claims submitted for the
professional (PC), technical (TC) or global components. This article
explains the specific claims handling instructions for claims submitted for
each of these components. Providers are encouraged to review the
information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BXN968142?opendocument&utm_source=J1BL&utm_campaign=J1BLs


Open Draft LCD Meetings January 2011
Share with your staff - Palmetto GBA J1 A/B Medicare Administrative
Contractor (MAC) has scheduled Open Draft Local Coverage Determination
(LCD) meetings in California, Nevada and Hawaii for January 2011. The
general public is invited to submit information related to the proposed
LCDs for Palmetto GBA's consideration.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~7YDPHY0633?opendocument&utm_source=J1BL&utm_campaign=J1BLs


Calendar Year (CY) 2011 Annual Update for Clinical Laboratory Fee Schedule
and Laboratory Services Subject to Reasonable Charge Payment
This J1 A/B MAC MLN Matters article (CR 6991a) was revised on December 1,
2010, to correct the annual update percentage shown on Page 2 for
laboratory tests paid on a reasonable charge basis.
This article provides instructions for the CY 2011 clinical laboratory fee
schedule, mapping for new codes for clinical laboratory tests and updates
for laboratory costs subject to the reasonable charge payment. Providers
are encouraged to review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BRJ3V0164?opendocument&utm_source=J1BL&utm_campaign=J1BLs


J1 Part B LCDs Revised
The following J1 Part B LCDs have been revised: Anorectal Manometry, Anal
Electromyography, and Biofeedback Training for Perineal Muscles and
Anorectal or Urethral Sphincters L28236; Bladder Tumor Markers DL31302;
Interferons L28273; and Intravenous Immune Globulin L28275.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/8BXNYB2881?opendocument


ANSI v5010: New 999 and 277CA Response Reports
New 999 and 277CA reports will be generated with the transition to ANSI
v5010.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BPRZH0661?opendocument&utm_source=J1BL&utm_campaign=J1BLs


ANSI v5010: New Reports For Electronic Claim Submitters
This posting includes information on new reports coming with the ANSI v5010
transition.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BNNAA4332?opendocument&utm_source=J1BL&utm_campaign=J1BLs


J1 PCC to Close for Training
The J1 Provider Contact Center (PCC) will be closed for training on Friday,
December 17, 2010, from 11 a.m. to 3 p.m. PT. The PCC will reopen on
Friday, December 17, 2010, at 3 p.m. PT. Please share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/8BYKQP4772?opendocument


Recovery Audit Contractor (RAC) Demonstration High-Risk Vulnerabilities for
Physicians
This special edition MLN Matters article (SE1036) is the fourth in a series
of articles that will disseminate information on Recovery Audit Contractor
(RAC) demonstration high dollar improper payment vulnerabilities. The
purpose of this article is to provide education to physicians on two
vulnerabilities in an effort to prevent these same problems from occurring
in the future. With the expansion of the RAC Program nationally, it is
essential that physicians understand the lessons learned from the
demonstration and implement appropriate corrective actions. Providers are
encouraged to review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BYN7K8430?opendocument&utm_source=J1BL&utm_campaign=J1BLs


ANSI v5010: New 999 and 277CA Response Reports
New 999 and 277CA reports will be generated with the transition to ANSI
v5010.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BPRZH0661?opendocument&utm_source=J1BL&utm_campaign=J1BLs


ANSI v5010: New Electronic Claim Format Requirements for ANSI 837 v5010
This article is the second in a series regarding implementation of version
5010 as the new standard for all ANSI ASC X12N electronic transactions.
This article outlines the changes to the ANSI 837 Electronic Claim format
from v4010A1 to v5010.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8AKJ8B6236?opendocument&utm_source=J1BL&utm_campaign=J1BLs


ANSI v5010: New Reports For Electronic Claim Submitters
This posting includes information on new reports coming with the ANSI v5010
transition.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BNNAA4332?opendocument&utm_source=J1BL&utm_campaign=J1BLs


ANSI v5010: Is Your Practice or Facility Ready for the ANSI Version 5010
Transition
This article is the first in a series regarding implementation of version
5010 as the new standard for all ANSI ASC X12N electronic transactions.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~89SQG51700?opendocument&utm_source=J1BL&utm_campaign=J1BLs


ANSI v5010: CMS-1500 to ANSI 837 v5010 Crosswalk
This article is the third in a series regarding implementation of version
5010 as the new standard for all ANSI ASC X12N electronic transactions.
This article includes a crosswalk from the CMS-1500 claim form to the ANSI
837 v5010 electronic claim format.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8ANJA28028?opendocument&utm_source=J1BL&utm_campaign=J1BLs


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