Friday, January 29, 2010

ACCC, ASH, CMA, CMS, & Palmetto/J1MAC News

The following information has been received by ANCO.


****ACCC NEWS****
The Association of Community Cancer Centers (ACCC) Connect was published and is available online at http://www.accc-cancer.org/mediaroom/newsletters/2010/ACCConnect-1-27-2010.html. ANCO is an Institutional Member of ACCC. This edition features:

• Cancer Care Trends Survey to be Released at ACCC's 36th Annual National Meeting in Baltimore, MD

• New Continuing Education Activity on Therapy for Advanced/Metastatic NSCLC

• Heard on ACCC's ListServ: Leaving Ports Accessed for Multiple Day Chemotherapy

• The Downside of Diagnostic Imaging

• FDA Revises Safety Information for Bortezomib

• Seeking Your Thoughts on ACCC's Meeting Topics

• Spanish Translations of NCD Patient Publications Now Available


****ASH NEWS****
The American Society of Hematology (ASH) Practice Update was published and is available online at http://www.hematology.org/Practice/Practice-Updates/4844.aspx. This edition features:

• President Obama Expected to Renew Call for Health Reform in State of the Union Address

• Medicare Physician Payment "Fix" Has Unclear Future

• ASH Urges Inclusion of Clinical Trials Coverage Provision in Final Health Reform Bill

• CMS Releases a Revised Medicare Physician Fee Schedule Fact Sheet

• 2009 ASH Quick Reference: The Evaluation and Management of Heparin-Induced Thrombocytopenia

• Earn CME Through Blood Articles


****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:

• Fate of Health Reform Uncertain

• CMA CEO Alfred Gilchrist Steps Down

• CMA Updates Medicare Consultation Code Billing Guide

• DMHC Finalizes Timely Access Regulations

• New Orders for H1N1 Vaccine Now Being Accepted

• Pharmacy Board Proposes Patient Centric Prescription Labeling Regulations

• CMA's 2010 Model Medical Staff Bylaws Now Available

• Register Today for the 2010 California Health Care Leadership Academy


****CMS NEWS****
The revised Medicare Physician Fee Schedule Fact Sheet (January 2010), which provides general information about the Medicare Physician Fee Schedule (MPFS) including MPFS payment rates and the MPFS payment rates formula, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/MedcrePhysFeeSchedfctsht.pdf .


****PALMETTO/J1MAC NEWS****
Presentation is Available for Part B ACT on January 26, 2010
The presentation of the J1 Part B Ask the Contractor Teleconference (ACT)
on January 26, 2010, is now available on our Web site.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/822STK5306?opendocument


Clarification of CMS Change Request 6417 Requirements: Expansion of Current
Scope
We are issuing this Alert to clarify Change Request 6417, which was issued
by CMS to expand editing on claims submitted to Medicare involving
ordering/referring medical providers. It explains some of these changes to
the provider community and assist ordering/referring or other affected
providers in interpreting more effectively any relevant remittance advice
messages. The Alert is designed to proactively address any issues you may
be experiencing and to help providers with determining if the errors are
related to enrollment or a claim submission error. Please be sure to share
with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/823LAX7865?opendocument


J1 PCC Closed for Training January 29
The Palmetto GBA J1 Provider Contact Center (PCC) will be closed for
training on Friday, January 29, 2010, from 11 a.m. until 3 p.m. PST.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/823MNE6536?opendocument


Notice of New Interest Rate for Medicare Overpayments & Underpayments:
Change Request 6652
This article is for Change Request 6652, Notice of New Interest Rate for
Medicare Overpayments & Underpayments. This article will be published
quarterly to let providers know that interest rates will be updated
quarterly and an article will be published to announce those changes.
Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/823SA92151?opendocument


The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!

Monday, January 25, 2010

CMS & Palmetto/J1MAC News

The following information has been received by ANCO.


****CMS NEWS****
The latest Claim Adjustment Reason Codes and Remittance Advice Remark Codes are available in the Codes.ini file for the MREP software. You can access this file in the Zipped folder for “Medicare Remit Easy Print - Version 2.7” at http://www.cms.hhs.gov/AccesstoDataApplication/02_MedicareRemitEasyPrint.asp on the CMS website.


MM6733 – Payment to Physician or Other Supplier for Diagnostic Tests Subject to the Anti-Markup Payment Limitation
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6733.pdf

MM6563 – Billing for Services Related to Voluntary Uses of Advance Beneficiary Notices of Noncoverage (ABNs)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6563.pdf

MM6547 – Processing of Non-Covered International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Procedure Codes on Inpatient Hospital Claims
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6547.pdf

MM6721 – Implementation of the Health Insurance Portability and Accountability Act (HIPAA) Version 5010 276/277 Claim Status Second Phase
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6721.pdf


****PALMETTO/J1MAC NEWS****
Payment to Physician or Other Supplier for Diagnostic Tests Subject to the
Anti-Markup Payment Limitation
This J1 Part B MLN Matters article (CR6733) alerts providers that the
Centers for Medicare & Medicaid Services (CMS) is revising the section of
the Medicare Claims Processing Manual to implement changes to 42 CFR
section 414.50 that were made in the CY 2009 PFS final rule (73 FR 69799,
November 19, 2008). These changes include two alternative methods for
determining when not to apply the anti-markup payment limitation. Please be
sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7ZWSUB0567?opendocument


Billing for Services Related to Voluntary Uses of Advance Beneficiary
Notices of Non-coverage (ABN)
This J1 Part A MLN Matters article (CR6563a) was revised on January 16,
2010, to reflect a revised CR6563, which was issued on January 15, 2010.
The article was revised to reflect a new CR release date, transmittal
number and Web address for accessing CR 6563. All other information remains
the same. This article announces recent instructions for the use of
modifiers in association with Advance Beneficiary Notices (ABN).
Specifically, effective April 1, 2010, two HCPCS level-2 modifiers have
been updated to distinguish between voluntary, and required, uses of
liability notices. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7ZWT6V2758?opendocument


Medicare Appeals: The Importance of Getting It to the Right Place at the
Right Time
How to make sure your Medicare appeal requests get to the right place at
the right time? J1 Part B shares this article from the Qualified
Independent Contractor (QIC) Part B North on the driving factor that caused
a high rate of dismissal decisions and clarifies the correct request
procedure and timelines.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7ZQLL81672?opendocument


Pricing for Lupron Injections
Share with your staff - J1 Part B alerts providers that some claims
processed from January 4 through January 19, 2010, were paid at the
submitted charge amount instead of the allowed amount. All claims paid in
error will be adjusted when the system is corrected.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7ZWNXY3046?opendocument


The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!

Wednesday, January 20, 2010

Palmetto/J1MAC News

The following information has been received by ANCO.


****PALMETTO/J1MAC NEWS****
2010 Fee Schedule Revisions for 52 CPT Codes
Share with your staff - CMS corrected the Part A Medicare Physician Fee
Schedule allowances for 52 CPT codes, in addition to the changes made in
the 2010 Anesthesia Conversion Factor practices expense. Although all Part
A fee schedules were released and republished, rates for these codes impact
the Supplemental and Skilled Nursing Facility (SNF) fee schedules only.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7ZPSVV2365?opendocument


2010 J1 Abstract Fee Schedule (XLS, 143 KB)
This is the 2010 J1 Abstract Fee Schedule. Please be sure to share with
your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7ZFSWF4440?opendocument


2010 J1 Mammography Fee Schedule (XLS, 20 KB)
This is the 2010 J1 Mammography Fee Schedule. Please be sure to share with
your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7ZFTY68431?opendocument


2010 J1 Supplemental Fee Schedule (XLS, 9 MB)
This is the 2010 J1 Supplemental Fee Schedule. Please be sure to share with
your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7ZFU553584?opendocument


January 2010 J1 A/B MAC Medicare Advisory
The January 2010 J1 A/B MAC Medicare Advisory is available on the Web site.
Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7Z8K9G3785?opendocument


The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!

Monday, January 18, 2010

ACCC, ASH, CMA, CMS, & 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-1-13-2010.html. ANCO is an Institutional Member of ACCC. This edition features:

• Join Us for Great Learning & Networking Opportunities at ACCC's 36th Annual National Meeting in Baltimore, MD

• ACCC to Co-Host Educational Briefing on Capitol Hill

• Who Will Care for Tomorrow's Cancer Patients? ACCC Looks for Answers

• Heard on ACCC's ListServ: Are Tumor Boards for Education or for Active Treatment Planning

• New HCPCS Code for Taxotere (docetaxel) Injection Concentrate (J9171)

• NIH Conference: Enhancing Use and Quality of Colorectal Cancer Screening


****ASH NEWS****
The American Society of Hematology's (ASH) Practice Update was published and available online at http://www.hematology.org/Practice/Practice-Updates/4801.aspx. This edition features:

• ASH Continues Efforts to Restore Payment for Medicare Consult Codes to Support Hematologists

• Congressional Negotiations Begin on Final Health Reform Bill

• ASH Supports BCR-ABL Testing for Chronic Myeloid Leukemia to MedCAC

• 2010 Physician Quality Reporting Initiative Program Continues Financial Incentive for Physician Participation

• 2009 ASH Quick Reference: The Evaluation and Management of Heparin-Induce Thrombocytopenia

• Federal Regulations Proposed to Define "Meaningful Use" and Set Standard for Electronic Health Record Incentive Program

• Last Chance to Register for Highlights of ASH


****CMA NEWS****
The California Medical Association's (CMA) Alert was published and is available online at http://www.calphys.org/html/news.asp. This edition features:

• Congress at the Brink of Health Reform

• CMA Sends Delegation to DC to Lobby for Health Reform Improvements

• CMA Polling Members on Health Reform

• Federal Officials Announce Meaningful Use Criteria

• Consultation Code Issue Frustates Physicians: CMA Publishes Billing Guide

• Questions About the New Consultation Code Rules? Sign Up for CMA's Webinar: How to Bill Medicare in 2010

• Governor Schwarzenegger Releases Proposed 2010-2011 Budget

• CMS Temporarily Extends California's Family PACT Waiver

• Blue Cross Extends Health Families Continuity of Care Plan, Again

• CMA's 36th Annual Legislative Conference is April 27


****CMS NEWS****
The revised Medicare Physician Guide: A Resource for Residents, Practicing Physicians, and Other Health Care Professionals (Oct 2009), which offers general information about the Medicare Program, how to become a Medicare provider or supplier, Medicare payment policies, Medicare reimbursement, evaluation and management services, protecting the Medicare Trust Fund, inquiries, overpayments, and fee-for-service appeals, is now available in CD-ROM format from the Centers for Medicare & Medicaid Services Medicare Learning Network. To place your order, visit http://www.cms.hhs.gov/MLNGenInfo/ , scroll down to “Related Links Inside CMS” and select “MLN Product Ordering Page.”


MM6818 – Correction to CR 6728 on Correct Coding Initiative (CCI) Edits, Version 16.0, Effective January 1, 2010
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6818.pdf


MM6796 – Emergency Update to the 2010 Medicare Physician Fee Schedule Database (MPFSDB)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6796.pdf


MM6715 – Pharmacogenomic Testing for Warfarin Response
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6715.pdf


MM6440 – Additional Data Collection on Hospice Claims
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6440.pdf


MM6753 – Positron Emission Tomography (PET) (FDG) for Cervical Cancer
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6753.pdf


MM6705 – Expansion of Medicare Telehealth Services for Calendar Year (CY) 2010
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6705.pdf


MM6657 – Calendar Year (CY) 2010 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6657.pdf


SE1001 – Additional Information Regarding the Calendar Year (CY) 2010 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE1001.pdf


MM6547 – Processing of Non-Covered International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Procedure Codes on Inpatient Hospital Claims
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6547.pdf


The Centers for Medicare & Medicaid Services (CMS) is hosting a Listening Session on the 2011 Physician Quality Reporting Initiative (PQRI). The purpose of this listening session is to discuss and solicit feedback on the individual quality measures and measures groups being considered for possible inclusion in the proposed set of quality measures for use in the 2011 PQRI program and key components of the design of the PQRI program, such as possible reporting mechanisms, reporting periods, criteria for satisfactory reporting, the group practice reporting option, and public reporting of 2011 PQRI data.

The listening session will be held on February 2, 2010 from 10 a.m. to 4:30 p.m. (EST) in the main auditorium of the Central Building of the Centers for Medicare & Medicaid Services, located at 7500 Security Boulevard, Baltimore, MD 21244–1850.

There is still time to register to participate in this event! Although we are no longer accepting registrations for participation via teleconference, there is still space to participate in person. In order to participate in the meeting, you must complete the online registration at http://www.usqualitymeasures.org on the internet, by no later than 5 p.m. EST on January 27, 2010.

A summary of the measures and measures groups suggestions received and other background materials for the listening session will be posted on the PQRI section of the CMS Web site at www.cms.hhs.gov/PQRI on the CMS website, in the coming weeks.

For more information, please see the Federal Register meeting notice posted at http://edocket.access.gpo.gov/2009/pdf/E9-30122.pdf on the Internet.


The Medicare Learning Network (MLN) has produced two QUICK REFERENCE CHARTS, which provide information on frequently used Centers for Medicare & Medicaid Services (CMS) web pages.
· The Quick Reference: All Medicare Providers (DEC2009) chart includes a list of CMS web pages that ALL Medicare providers use most frequently.
· The Quick Reference: New Medicare Provider (DEC2009) chart includes a list of CMS web pages that NEW Medicare providers use most frequently.

These charts can be bookmarked and viewed online or they can be printed and used as ready references. Both charts can be located at http://www.cms.hhs.gov/MLNProducts/MPUB/list.asp on the MLN Publications page. Use search key word “quick” to locate these publications.


The World of Medicare WBT is designed for health care professionals who want to understand the fundamentals of the Medicare Program. After completing this course, participants should be able to differentiate between Medicare Part A, Part B, Part C, and Part D, identify Medicare beneficiary health insurance options, eligibility, and enrollment, as well as recognizing how Medigap and Medicaid work with the Medicare Program.

This WBT course offers continuing education credits. Please see the course description for details.This training can be accessed by visiting http://www.cms.hhs.gov/MLNgeninfo/ and scrolling to the “Related Links Inside CMS” page section. Within these links, select Web Based Training (WBT) Modules and then World of Medicare (January 2010) from the list provided.


****PALMETTO/J1MAC NEWS****
ACT Call: New Year, Fresh Start - January 26, 2010
Please join us on January 26, 2010, for an Ask the Contractor
Teleconference (ACT): New Year, Fresh Start! This hour long ACT call is
designed to be a Medicare refresher course, covering a variety of topics
including the call inquiry process, filing an appeal and reading your
remittance advice.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7ZMN764584?opendocument


J1 A/B MAC Palmetto GBA Assigned ICD-9-CM Codes for National Coverage
Determinations
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7RCMMD8585?opendocument


J1 PCC Closed January 18, 2010 (MLK Day)
Share with your staff - The J1 Provider Contact Center (PCC) will be closed
on Monday, January 18, 2010, in observance of Martin Luther King Day.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7ZNNW21210?opendocument


Correction to CR 6728 on Correct Coding Initiative (CCI) Edits, Version
16.0, Effective January 1, 2010
This J1 Part B MLN Matters article (CR6818) informs physicians that the
latest package of Correct Coding Initiative (CCI) edits, Version 16.0,
effective January 1, 2010, is being corrected to replace the files in CR
6728, which was released on November 20, 2009. Please be sure to share with
your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7ZPLU75368?opendocument


Emergency Update to the 2010 Medicare Physician Fee Schedule Database
(MPFSDB)
This J1 A/B MAC MLN Matters article (CR6796a) was revised on January 8,
2010, to reflect a new Change Request (CR) 6796 that was released on
January 6, 2010. The transmittal number (see above), CR Release Date and
Web address for accessing CR 6796 has been changed. The files associated
with CR 6796 include a legislative change to the CY 2010 conversion factor
update and changes as a result of technical corrections to the malpractice
relative value units. This article also amends payment files that were
issued to Medicare contractors based on the 2010 Medicare Physician Fee
Schedule (MPFS) Final Rule. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7ZPN448006?opendocument


Medically Unlikely Edits (MUE): Change Request 6712
These instructions are for Change Request 6712, Medically Unlikely Edits
(MUE). The instructions are being posted because there will not be an MLN
Matters article that addresses this subject matter. Please be sure to share
with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7ZNTJ54702?opendocument


The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!

Thursday, January 7, 2010

CMS & Palmetto/J1MAC News

The following information has been received by ANCO.


****CMS NEWS****
Revised--Special Edition MLN Matters Article #SE0929 - 2010 Annual Participation Enrollment Program Extension
This article was revised on December 22, 2009, to show that the 2010 Annual Participation Enrollment Program has been extended through March 17, 2010. Due to recent revisions that were made to the 2010 Medicare Physician Fee Schedule (MPFS), CMS has extended the 2010 Annual Participation Enrollment Program end date from December 31, 2009, to March 17, 2010 – therefore, the enrollment period now runs from November 13, 2009, through March 17, 2010. The effective date for any Participation status change during the extension, however, remains January 1, 2010; and will be in force for the entire year. For more information, please view the article located at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0929.pdf on the CMS website.


QRI and eRx measures-related documents. The updated documents are now available on the CMS PQRI webpage at http://www.cms.hhs.gov/PQRI and the CMS eRx webpage at http://www.cms.hhs.gov/ERxincentive respectively on the CMS website.

2010 Measures Groups Specification Update

Version 3.0 of the Measures Groups Specifications Manual released in November 2009 for 2010 PQRI has been revised. Version 3.1 of the 2010 PQRI Measures Groups Specifications Manual and Release Notes reflects a change to the denial remark code note for several Measures Groups. Correct G-codes specific to each Measures Group have been replaced within this document. For further details, the updated “2010 PQRI Measures Groups Specifications Manual and Release Notes” is now available on the CMS PQRI webpage at http://www.cms.hhs.gov/pqri, on the CMS website. Click on the “Measures Codes” section page on the left.

2010 Measure Specifications Update

Version 4.0 of the Measure Specifications Manual and Release Notes, which was released in November 2009 for PQRI 2010, has been updated.
· Two updates were made to Version 4.1 of the Measure Specifications Manual
o Measure #193: Additional information was added to the note for Numerator Coding option CPT II 4256F
o Measure #94: CPT 92567 was added to the Denominator Coding
· Version 4.1 of the Release Notes was updated in several areas:
o Two temporary measure numbers have been replaced with final measure numbers
o Measure #21 and Measure #22: A CPT code that was listed as being deleted from the Denominator Coding was revised to reflect the correct code
o Measure #48: CPT codes listed as being added and deleted from the Denominator Coding have been updated to reflect they were only added to the measure.

The updated version of the “2010 PQRI Measure Specifications Manual for Claims and Registry Reporting of Individual Measures and Release Notes” is now available on the CMS PQRI webpage at http://www.cms.hhs.gov/pqri, on the CMS website. Click on the “Measures Codes” section page on the left.

Final 2010 EHR Measures Specifications

The final “2010 EHR Measures Specifications” and “2010 EHR Measures Specifications - Release Notes” have been modified and are now available on the CMS PQRI website. Please note, changes were made to this document, as some encounter codes were identified as non-covered services under the Medicare Physician Fee Schedule and will not be counted in the denominator population for PQRI reporting calculations. To access these final documents, please visit the CMS PQRI webpage at http://www.cms.hhs.gov/pqri, on the CMS website. Click on the “Alternative Reporting Mechanisms” section page on the left.

2010 PQRI Single Source Code Master Update

The “2010 PQRI Single Source Code Master” document released in November 2009 for PQRI 2010 has been revised to add CPT 92567 to the Denominator Coding for Measure #94. The updated document is now available on the CMS PQRI webpage at http://www.cms.hhs.gov/pqri, on the CMS website. Click on the “Measures Codes” section page on the left.

2010 eRx Measure Specifications Update

Version 1.0 of the 2010 eRx Release Notes released in November for 2010 eRx has also been revised. The updated Version 1.1 of the eRx Release Notes now correctly reflects a change in the Denominator Updates section of the document. To access this updated document, please see the “2010 eRx Measures Specifications and Release Notes”, which available on the CMS Electronic Prescribing Incentive Program (eRx) webpage at http://www.cms.hhs.gov/ERxincentive, on the CMS website. Click on the “E-Prescribing Measure” section page on the left.


The revised Understanding the Remittance Advice (RA) for Professional Providers Web-Based Training (WBT), has been made available by the Centers for Medicare & Medicaid Services (CMS) Medicare Learning Network (MLN). Available for Continuing Education credit, this course provides instructions to help fee-for-service Medicare providers and their billing staffs interpret the RA received from Medicare and reconcile it against submitted claims. It additionally provides guidance on how to read Electronic Remittance Advices (ERAs) and Standard Paper Remittance Advices (SPRs), as well as information for balancing an RA. This course also presents an overview of software that Medicare provides free to providers in order to view ERAs. This training can be accessed by visiting http://www.cms.hhs.gov/MLNgeninfo/ and scrolling to the “Related Links Inside CMS” page section. Within these links, select Web Based Training (WBT) Modules and then Understanding the Remittance Advice for Professional Providers from the list of training courses provided.


CMS and ONC Issue Regulations Proposing a Definition of ‘Meaningful Use’ and Setting Standards for Electronic Health Record Incentive Program

Public Encouraged to Comment on New Regulations

The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) encourage public comment on two regulations issued today that lay a foundation for improving quality, efficiency and safety through meaningful use of certified electronic health record (EHR) technology. The regulations will help implement the EHR incentive programs enacted under the American Recovery and Reinvestment Act of 2009 (Recovery Act).

A proposed rule issued by CMS outlines proposed provisions governing the EHR incentive programs, including defining the central concept of “meaningful use” of EHR technology. An interim final regulation (IFR) issued by ONC sets initial standards, implementation specifications, and certification criteria for EHR technology. Both regulations are open to public comment.

“Widespread adoption of electronic health records holds great promise for improving health care quality, efficiency, and patient safety,” said, National Coordinator for Health Information Technology David Blumenthal, M.D., M.P.P. “The Recovery Act’s financial incentives demonstrate Congress’ and the Administration’s commitment to help providers adopt and make meaningful use of EHR technology so they can give better care and their patients’ experience of care will improve. Over time, we believe the EHR incentive program under Medicare and Medicaid will accelerate and facilitate health information technology adoption by more individual providers and organizations throughout the health care system.”

“These regulations are closely linked,” said Charlene Frizzera, CMS Acting Administrator. “CMS’s proposed regulation would define and specify how to demonstrate ‘meaningful use’ of EHR technology, which is a prerequisite for receiving the Medicare incentive payments. Our rule also outlines the proposed payment methodologies for the Medicare and Medicaid EHR incentive programs. ONC’s regulation sets forth the standards and specifications that will enhance the interoperability, functionality, utility and security of health information technology.”

CMS and ONC worked closely to develop the two rules and received input from hundreds of technical subject matters experts, health care providers, and other key stakeholders. Numerous public meetings to solicit public comment were held by three Federal advisory committees: the National Committee on Vital and Health Statistics (NCVHS), the Health IT Policy Committee (HITPC), and the Health IT Standards Committee (HITSC). HITSC presented its final recommendations to the National Coordinator in August 2009. These recommendations, along with all other input were considered to help inform the development of the regulations announced today.

The IFR issued by ONC describes the standards that must be met by certified EHR technology to exchange healthcare information among providers and between providers and patients. This initial set of standards begins to define a common language to ensure accurate and secure health information exchange across different EHR systems. The IFR describes standard formats for clinical summaries and prescriptions; standard terms to describe clinical problems, procedures, laboratory tests, medications and allergies; and standards for the secure transportation of this information using the Internet.

The IFR calls for the industry to standardize the way in which EHR information is exchanged between organizations, and sets forth criteria required for an EHR technology to be certified. These standards will support meaningful use and data exchange among providers who must use certified EHR technology to qualify for the Medicare and Medicaid incentives.

Under the statute, HHS is required to adopt an initial set of standards for EHR technology by Dec. 31, 2009. The IFR will go into effect 30 days after publication, with an opportunity for public comment and refinement over the next 60 days. A final rule will be issued in 2010. “We strongly encourage stakeholders to provide comments on these standards and specifications,” Dr. Blumenthal said.

The Recovery Act established programs to provide incentive payments to eligible professionals and eligible hospitals participating in Medicare and Medicaid that adopt and make “meaningful use” of certified EHR technology. Incentive payments may begin as soon as October 2010 to eligible hospitals. Incentive payments to other eligible providers may begin in January 2011.

The proposed rule would define the term "meaningful EHR user" as an eligible professional or eligible hospital that, during the specified reporting period, demonstrates meaningful use of certified EHR technology in a form and manner consistent with certain objectives and measures presented in the regulation. These objectives and measures would include use of certified EHR technology in a manner that improves quality, safety, and efficiency of health care delivery, reduces health care disparities, engages patients and families, improves care coordination, improves population and public health, and ensures adequate privacy and security protections for personal health information.

The proposed rule would define meaningful use for the Medicare EHR incentive programs. It proposes one definition that would apply to eligible professionals participating in the Medicare fee-for-service and the Medicare Advantage EHR incentive programs as well as a proposed definition that would apply to eligible hospitals and critical access hospitals. These definitions also would serve as the minimum standard for eligible professionals and eligible hospitals participating in the Medicaid EHR incentive program. The rule proposes that states could request CMS approval to implement additional meaningful use measures, as appropriate, but could not request approval of fewer or less rigorous meaningful use measures than required by the rule.

This rule proposes a phased approach to implement the proposed requirements for demonstrating meaningful use. This approach would initially establish reasonable criteria for meaningful use based on currently available technological capabilities and providers’ practice experience. CMS will establish stricter and more extensive criteria for demonstrating meaningful use over time, as anticipated developments in technology and providers’ capabilities occur.

CMS provides a 60-day comment period on the proposed rule. “The definition and requirements for demonstrating meaningful use of EHR technology are proposals. CMS welcomes and will give serious consideration to comments that improve our proposal while achieving the goals Congress established for the EHR incentive programs,” Frizzera said.

The CMS proposed rule and fact sheets may be viewed at http://www.cms.hhs.gov/Recovery/11_HealthIT.asp

ONC’s interim final rule may be viewed at http://healthit.hhs.gov/standardsandcertification. In early 2010 ONC intends to issue a notice of proposed rulemaking related to the certification of health information technology

Additional Website resources:

The Recovery Act Health IT Page is: http://www.cms.hhs.gov/Recovery/11_HealthIT.asp.

DIRECT Link to CMS Regulation: http://www.federalregister.gov/OFRUpload/OFRData/2009-31217_PI.pdf.

A copy of the ONC Regulation is available at: http://healthit.hhs.gov/standardsandcertification.

The HHS Press Release is available at: https://www.cms.hhs.gov/apps/media/press_releases.asp.

The CMS Fact Sheets are available at: https://www.cms.hhs.gov/apps/media/fact_sheets.asp.


The written and audio transcript summaries of the ICD-10-CM/PCS Medicare Severity - Diagnosis Related Group Conversion Project National Provider Conference Call, which was conducted by the Centers for Medicare & Medicaid Services on November 19, 2009, are now available in the Downloads Section at http://www.cms.hhs.gov/ICD10/06a_2009_CMS_Sponsored_Calls.asp .


****PALMETTO/J1MAC NEWS****
2010 Coding Update
The 2010 Coding Update contains a wealth of information that will be
helpful to your office. Some of the articles in this publication include:
Additions, Deletions and Changes for HCPCS, CDT, and CPT codes and
modifiers; Proper use of modifiers and more.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7Z9Q8Q1420?opendocument


J1 A/B MAC Palmetto GBA Assigned ICD-9-CM Codes for National Coverage
Determinations
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7RCMMD8585?opendocument


Emergency Update to the 2010 Medicare Physician Fee Schedule Database
(MPFSDB)
This J1 A/B MAC MLN Matters article (CR6796) is associated with CR 6796
include a legislative change to the CY 2010 conversion factor update and
changes as a result of technical corrections to the malpractice relative
value units. The conversion factor for CY 2010 is $36.0846. This article
amends payment files that were issued to Medicare contractors based on the
2010 Medicare Physician Fee Schedule (MPFS) Final Rule. Please be sure to
share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7ZDQVL0370?opendocument


Expiration of Various Payment Provisions Under the Medicare Program
The Centers for Medicare and Medicaid issued special edition MLN Matters
Article SE0931 to notify affected providers that a number of Medicare
payment provisions will no longer be in effect when the provisions sunset
as of December 31, 2009.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7Z9PW37844?opendocument


Summary of Policies in the 2010 Medicare Physician Fee Schedule (MPFS) and
the Telehealth Originating Site Facility Fee Payment Amount
This J1 A/B MAC MLN Matters article (CR6756) was revised on December 30,
2009, to reflect a revised CR 6756, which was issued on December 29, 2009.
The CR release date, transmittal number (see above), and the Web address
for accessing CR 6756 were changed. This article provides a summary of the
policies in the 2010 MPFS and announces the telehealth originating site
facility fee payment amount. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7ZDQM75774?opendocument


Expiration of Therapy Cap Exceptions Process
In this article, the exceptions to outpatient therapy caps expired on
December 31, 2009. Outpatient therapy service providers should not submit
claims with the specified modifier for services furnished on or after
January 1, 2010. The therapy caps are determined on a calendar year basis,
so all patients will begin a new cap year on January 1, 2010. Please be
sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7ZEKMK2570?opendocument


J1 A/B MAC Palmetto GBA Assigned ICD-9-CM Codes for National Coverage
Determinations
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7RCMMD8585?opendocument


Northern California 2010 Revised Medicare Part B Fee Schedule
The Northern California 2010 Revised Medicare Part B Fee Schedule is now
available and is effective for services performed on or after January 1,
2010.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7ZDQMR7321?opendocument


Tracking the Hospice Attending Physician’s National Provider Identifier
(NPI) for Validating Hospice Part B Payments
This J1 Part A/B MAC MLN Matters article (CR6540b) is a revision and is
meant to ensure that the hospice reported data in the Notice of Election
(NOE) and claims for the attending physician which may be a Nurse
Practitioner (NP) meet the definition of attending physician/NP in the Code
of Federal Regulations (CFR), while also reporting the hospice physician
responsible for certifying the terminal illness. Please be sure to share
with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7ZELZX0570?opendocument


The ANCO Online ListServ has moved and is now sent directly from the ANCO office computer. Please contact ListServ@anco-online.org if you wish to update or unsubscribe your e-mail address. Thanks!