ASH & Palmetto/J1MAC News

The following information has been received by ANCO.


****ASH NEWS****
The American Society of Hematology's (AS) Practice Update was published and is available online at http://www.hematology.org/Advocacy/Testimony/2010/6287.aspx. This edition features:

• Stopgap Funding Bill Omits CMS Funding Increase Needed to Implement Health Reform

• CMS Releases 2011 Electronic Prescribing (eRx) Incentive Program Update

• CMS to Host Town Hall Meeting to Discuss PQRS

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


****PALMETTO/J1MAC NEWS****
Place of Service Indicator for HCPCS Codes G0339 and G0340
The Pricing Indicator Code on the Alpha-Numeric HCPCS File has been changed
from '00' to '13' for HCPCS codes G0339 and G0340. This change is effective
for services furnished in CY 2006 – CY 2010. While this change was
accurately reflected in the annual published PFS Relative Value Files
beginning in CY 2006, no corresponding change was made to the pricing
indicator on the Alpha-Numeric HCPCS File. The Alpha-Numeric HCPCS File is
being updated to reflect the correct pricing indicator code.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CCQT65222?opendocument&utm_source=J1BL&utm_campaign=J1BLs


January 2011 J1 A/B MAC Medicare Advisory
The January 2011 J1 A/B MAC Medicare Advisory is now available on the J1
Web site. Providers are encouraged to review the information and to share
with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CCH5W2540?opendocument&utm_source=J1BL&utm_campaign=J1BLs


CERT Appeals: Providing Documentation
When services are denied or down-coded by the CERT Review Contractor and an
overpayment is identified, providers are entitled to file a Part B
redetermination request to Palmetto GBA. We are seeing a growing number of
appeals for which the medical records sent by providers and third-party
medical billing companies are missing key components of the documentation
necessary to conduct the review. Prior to filing an appeal, we suggest you
follow the steps listed in this article.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CBPRW2370?opendocument&utm_source=J1BL&utm_campaign=J1BLs


J1 Part B LCDs Revised
The following J1 Part B LCDs have been revised: Cardiac Catheterization,
Diagnostic L28244, Injections- Tendon, Ligament, Ganglion Cyst, Tunnel
Syndromes and Morton’s Neuroma L28271, and Intensity Modulated Radiation
Therapy (IMRT) L28272.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/8CBSNU2143?opendocument


A New Home Health Certification Requirement: Home Health Face-to-Face
Encounter
A new Medicare home health law goes into effect on January 1, 2011, that
affirms the role of the physician as the person who orders home health care
based on personal examination of the patient. Effective in January, a
physician who certifies a patient as eligible for Medicare home health
services must see the patient. The law also allows the requirement to be
satisfied if a non-physician practitioner (NPP) sees the patient, when the
NPP is working for, or in collaboration with, the physician.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CCP295540?opendocument&utm_source=J1BL&utm_campaign=J1BLs


Signatures Required on Requisitions for Clinical Diagnostic Laboratory
Tests: Effective January 1, 2011
Effective January 1, 2011, a physician’s or qualified non-physician
practitioner’s (NPP’s) signature is required on all requisitions for
clinical diagnostic laboratory tests paid under the clinical laboratory fee
schedule. This is a change from previous Medicare guidelines and is
included in the November 29, 2010, Medicare Physician Fee Schedule final
rule. CMS guidelines regarding signatures on requisitions for clinical
diagnostic laboratory tests will be updated soon. Updated information will
be posted on the CMS Web site.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CCRRD7180?opendocument&utm_source=J1BL&utm_campaign=J1BLs


J1 PCC Closed in Observance of the Holidays December 23-24 and December 31,
2010
The J1 Provider Contact Center (PCC) will be closed in observance of the
holidays on December 23, December 24 and December 31, 2010. The PCC will
reopen on Monday, December 27, 2010, at 7 a.m. PT after Christmas and
reopen on Monday, January 3, 2011, at 7 a.m. PT after New Year's Day.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CDNZ38731?opendocument&utm_source=J1BL&utm_campaign=J1BLs


Palmetto GBA Launches Going Beyond Diagnosis Blog
Palmetto GBA launched the Going Beyond Diagnosis blog! Claims denied for
insufficient documentation in medical records? Use the ICF to communicate
treatment plans efficiently. Visit the blog to collaborate with our Medical
Affairs area and share your experiences with the ICF.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8C5JMW3232?opendocument&utm_source=J1BL&utm_campaign=J1BLs


Signatures on Requisitions for Clinical Diagnostic Laboratory Tests
In the November 29, 2010 Medicare Physician Fee Schedule final rule, the
Centers for Medicare & Medicaid Services (CMS) finalized its proposed
policy to require a physician's or qualified non-physician practitioner's
(NPP) signature on requisitions for clinical diagnostic laboratory tests
paid under the clinical laboratory fee schedule effective January 1, 2011.
A requisition is the actual paperwork, such as a form, which is provided to
a clinical diagnostic laboratory that identifies the test or tests to be
performed for a patient. Although many physicians, NPPs and clinical
diagnostic laboratories may be aware of, and are able to comply with, this
policy, CMS is concerned that some physicians, NPPs and clinical diagnostic
laboratories are not aware of, or do not understand, this policy. As such,
CMS will focus in the first calendar quarter of 2011 on developing
educational and outreach materials to educate those affected by this
policy. As it becomes available, CMS will post this information on the CMS
Web site and use the other channels available to communicate with providers
to ensure this information is widely distributed. Once the first quarter of
2011 educational campaign is fully underway, CMS will expect requisitions
to be signed.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CCRRD7180?opendocument&utm_source=J1BL&utm_campaign=J1BLs


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