DHCS/MediCal & Palmetto/J1MAC News

The following information has been received by ANCO.


****DHCS/MediCal NEWS****
The December Medi-Cal Bulletin has just been made available to providers. It spells out the action being taken by them to resolve the Zometa denials & payment methodology.


****PALMETTO/J1MAC NEWS****
2011 Medicare Physician Fee Schedule: Update
On December 15, 2010, President Obama signed into law the Medicare and
Medicaid Extenders Act of 2010 (MMEA). Section 101 of the MMEA prevents a
payment cut for physicians that would have taken effect on January 1, 2011.
While the physician fee schedule update will be zero percent, other changes
to the relative value units (RVUs) used to calculate the fee schedule rates
must be budget neutral. To make those changes budget neutral, the
conversion factor must be adjusted for 2011. CMS is currently developing
the 2011 Medicare Physician Fee Schedule (MPFS) to implement the zero
percent update, and we expect all 2011 claims to be processed timely, in
compliance with the new legislation. The 2011 fees schedules will be posted
on this Web site as soon as they are finalized.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CKSB42356?opendocument&utm_source=J1BL&utm_campaign=J1BLs


Claim Status Category and Claim Status Code Update
This J1 A/B MAC MLN Matters article, based on Change Request (CR) 7259,
explains that the claim status codes and claim status category codes for
use by Medicare contractors with the Health Claim Status Request and
Response ASC X12N 276/277, along with the 277 Health Care Claim
Acknowledgement, were updated during the January 2011 meeting of the
National Code Maintenance Committee, where code changes were also approved.
Included in the code lists are specific details, including the date when a
code was added, changed or deleted. Medicare contractors will implement
these changes on April 4, 2011. All providers should ensure that their
billing staffs are aware of the updated codes and the timeframe for
implementations.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CKHLF1313?opendocument&utm_source=J1BL&utm_campaign=J1BLs


Electronic Health Records Incentives Registration Starts January 3, 2011
Beginning January 3, 2011, registration will be available for eligible
health care professionals and eligible hospitals who wish to participate in
the Medicare EHR incentive program. Eligible professionals and eligible
hospitals must register in order to participate in the Medicare and
Medicaid EHR incentive programs. This article provides key dates you should
know if you plan to participate in this incentive program.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CKK7M6807?opendocument&utm_source=J1BL&utm_campaign=J1BLs


Expansion of the Current Scope of Editing for Ordering/Referring Providers
for claims processed by Medicare Carriers and Part B Medicare
Administrative Contractors (MACs)
This J1 Part B MLN Matters article (CR 6417d) was revised on December 17,
2010, to reflect the changes in the release of revised Change Request (CR)
6417 on December 16, 2010. The CR was revised to show the implementation
date for phase two is being delayed and will not begin on January 3, 2011.
A placeholder date of July 5, 2011, has been stated in revised CR 6417.
This placeholder date is being issued to give the Centers for Medicare &
Medicaid Services (CMS) more flexibility to determine the appropriate date
for nonpayment of claims that fail the ordering/referring provider edits.
CR 6417 requires Medicare implementation of system edits to assure that
Part B providers and suppliers bill for ordered or referred items or
services only when those items or services are ordered or referred by
physicians and non-physician practitioners who are eligible to order/refer
such services. Physicians and non-physician practitioners who order or
refer must be enrolled in the Medicare Provider Enrollment, Chain and
Ownership System (PECOS) and must be of the type/specialty eligible to
order/refer services for Medicare beneficiaries. Please share with your
staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~84HMMV6711?opendocument&utm_source=J1BL&utm_campaign=J1BLs


2011 Electronic Prescribing (eRx) Incentive Program Update
In November 2010, the Centers for Medicare & Medicaid Services announced
that, beginning in 2012, eligible professionals who are not successful
electronic prescribers may be subject to a payment adjustment on their
Medicare Part B Physician Fee Schedule (PFS) covered professional services.
Section 132 of the Medicare Improvements for Patients and Providers Act of
2008 (MIPPA) authorizes CMS to apply this payment adjustment whether or not
the eligible professional is planning to participate in the eRx Incentive
Program.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CKJ3Q1816?opendocument&utm_source=J1BL&utm_campaign=J1BLs


Physician Quality Reporting System: Town Hall Meeting on February 9, 2011
The Centers for Medicare & Medicaid Services (CMS) will host a Town Hall
Meeting to discuss the Physician Quality Reporting System. The meeting will
be held on February 9, 2011, from 10 a.m. until 4 p.m. in Baltimore,
Maryland and via teleconference. The purpose of the Town Hall Meeting is
to solicit input from participating stakeholders on key components of the
design of the Physician Quality Reporting System and individual quality
measures and measures groups being considered for possible inclusion in the
2012 Physician Quality Reporting System.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CKFEP0785?opendocument&utm_source=J1BL&utm_campaign=J1BLs


Electronic Health Records Incentive Programs: Important Information About
Provider Registration
Registration begins January 3, 201; are you ready? The new CMS Electronic
Health Records (EHR) Web page can help. This new Web page is updated,
reorganized and more user-friendly. Be sure to check it out and register
soon.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CKLVS6122?opendocument&utm_source=J1BL&utm_campaign=J1BLs


Home Health Face-to-Face Encounter Certification Requirement
Section 6407 of the Affordable Care Act of 2010 established a physician
face-to-face encounter requirement for certification of eligibility for
Medicare home health services. The certifying physician must document that
he or she, or a non-physician practitioner (NPP) working with the
physician, has seen the patient.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CKS325738?opendocument&utm_source=J1BL&utm_campaign=J1BLs


Hospice Face-to-Face Encounter Requirement
Effective January 1, 2011, Section 3131(b) of the Affordable Care Act of
2010 requires a hospice physician or nurse practitioner (NP) to have a
face-to-face encounter with every hospice patient prior to the patient’s
180th-day recertification and each subsequent recertification.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CKSJ67267?opendocument&utm_source=J1BL&utm_campaign=J1BLs


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