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
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!
Friday, December 31, 2010
Monday, December 27, 2010
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
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!
****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
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, December 22, 2010
Palmetto/J1MAC News
The following information has been received by ANCO.
****PALMETTO/J1MAC NEWS****
Timely Claims Filing Requirement: Important Information
Effective immediately, the Centers for Medicare & Medicaid Services (CMS)
would like to remind Medicare fee-for-service physicians, providers and
suppliers, who are submitting claims to Medicare for payment, all claims
for services furnished on or after January 1, 2010, must be filed with your
Medicare contractor no later than one calendar year (12 months) from the
date of service or Medicare will deny them. This is a result of the Patient
Protection and Affordable Care Act (PPACA).
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8C5UT62660?opendocument&utm_source=J1BL&utm_campaign=J1BLs
J1 Provider Contact Center (PCC) Training and Holiday Closure Schedule for
Fiscal Year 2011
The J1 PCC Training and Holiday Closure Schedule for Fiscal Year 2011 is
now available on our Web site.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8C5QKU5678?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Skilled Nursing Facility and Nursing Facility Reporting of Physician
Consultation Services
If a physician or non-physician practitioner is furnishing that
practitioner’s first E/M service for a Medicare beneficiary in a SNF or NF
during the patient’s facility stay, even if that service is provided prior
to the federally mandated visit, the practitioner may bill the most
appropriate E/M code that reflects the services the practitioner furnished,
whether that code be an initial nursing facility care code or a subsequent
nursing facility care code if documentation and medical necessity do not
meet the requirements for billing an initial nursing facility care code.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8C5SMM5368?opendocument&utm_source=J1BL&utm_campaign=J1BLs
J1 PCC to Close in Observance of the Holidays
The J1 Provider Contact Center (PCC) will be closed in observance of the
Christmas holiday on Thursday, December 23, 2010, and Friday, December 24,
2010. The PCC will reopen on Monday, December 27, 2010, at 7 a.m. PT. The
PCC will also be closed on Friday, December 31, 2010, in observance of New
Year's Day and will reopen on Monday, January 3, 2011, at 7 a.m. PT. Please
share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/8C6KTX6101?opendocument
2011 Coding Update
The 2011 Coding Update contains a wealth of information that will be
helpful to your office. This publication includes information on 2011
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/ls/J1B~8C8LMQ2367?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Incorrect Adjustments Impacting Part B Providers in Northern California,
Southern California, Ohio and West Virginia
This article announces that Palmetto GBA recently completed adjustments for
claims that originally processed from September 2, 2008, to October 28,
2010, with HCPCS codes G0181 and G0182. These adjustments incorrectly
canceled the original payment. The adjustments will appear on remittance
advices dated December 14, 2010, through December 20, 2010. The adjusted
claims will have the remark code CO-151, which states: 'Payment adjusted
because the payer deems the information submitted does not support this
many/frequency of services'. Providers will also receive demand letters for
these adjusted claims. Providers are encouraged to review the information
and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8C8SVY1100?opendocument&utm_source=J1BL&utm_campaign=J1BLs
President Obama Signs the Medicare and Medicaid Extenders Act of 2010
On Wednesday, December 15, 2010, President Obama signed into law the
Medicare and Medicaid Extenders Act of 2010 (MMEA). This new law prevents a
scheduled payment cut for physicians who treat Medicare patients from
taking effect. The Centers for Medicare & Medicaid Services (CMS) is
pleased that this law has addressed key issues for beneficiaries and
providers, and we are actively engaged in implementing these changes.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CBLM37813?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Incorrect Adjustments Impacting Part B Providers in Northern California,
Southern California, Ohio and West Virginia
Palmetto GBA has identified a problem with adjustments to some claims for
Care Plan Oversight (HCPCS codes G0181 and G0182). This issue impacts Part
B providers in northern California, southern California, Ohio and West
Virginia only for claims processed from September 2, 2008, through October
28,2010. If you received an overpayment letter for these services issued
during this timef rame, you do not need to take any action. Palmetto GBA
will send corrected notices to all affected providers.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CBMDT3161?opendocument&utm_source=J1BL&utm_campaign=J1BLs
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!
****PALMETTO/J1MAC NEWS****
Timely Claims Filing Requirement: Important Information
Effective immediately, the Centers for Medicare & Medicaid Services (CMS)
would like to remind Medicare fee-for-service physicians, providers and
suppliers, who are submitting claims to Medicare for payment, all claims
for services furnished on or after January 1, 2010, must be filed with your
Medicare contractor no later than one calendar year (12 months) from the
date of service or Medicare will deny them. This is a result of the Patient
Protection and Affordable Care Act (PPACA).
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8C5UT62660?opendocument&utm_source=J1BL&utm_campaign=J1BLs
J1 Provider Contact Center (PCC) Training and Holiday Closure Schedule for
Fiscal Year 2011
The J1 PCC Training and Holiday Closure Schedule for Fiscal Year 2011 is
now available on our Web site.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8C5QKU5678?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Skilled Nursing Facility and Nursing Facility Reporting of Physician
Consultation Services
If a physician or non-physician practitioner is furnishing that
practitioner’s first E/M service for a Medicare beneficiary in a SNF or NF
during the patient’s facility stay, even if that service is provided prior
to the federally mandated visit, the practitioner may bill the most
appropriate E/M code that reflects the services the practitioner furnished,
whether that code be an initial nursing facility care code or a subsequent
nursing facility care code if documentation and medical necessity do not
meet the requirements for billing an initial nursing facility care code.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8C5SMM5368?opendocument&utm_source=J1BL&utm_campaign=J1BLs
J1 PCC to Close in Observance of the Holidays
The J1 Provider Contact Center (PCC) will be closed in observance of the
Christmas holiday on Thursday, December 23, 2010, and Friday, December 24,
2010. The PCC will reopen on Monday, December 27, 2010, at 7 a.m. PT. The
PCC will also be closed on Friday, December 31, 2010, in observance of New
Year's Day and will reopen on Monday, January 3, 2011, at 7 a.m. PT. Please
share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/8C6KTX6101?opendocument
2011 Coding Update
The 2011 Coding Update contains a wealth of information that will be
helpful to your office. This publication includes information on 2011
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/ls/J1B~8C8LMQ2367?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Incorrect Adjustments Impacting Part B Providers in Northern California,
Southern California, Ohio and West Virginia
This article announces that Palmetto GBA recently completed adjustments for
claims that originally processed from September 2, 2008, to October 28,
2010, with HCPCS codes G0181 and G0182. These adjustments incorrectly
canceled the original payment. The adjustments will appear on remittance
advices dated December 14, 2010, through December 20, 2010. The adjusted
claims will have the remark code CO-151, which states: 'Payment adjusted
because the payer deems the information submitted does not support this
many/frequency of services'. Providers will also receive demand letters for
these adjusted claims. Providers are encouraged to review the information
and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8C8SVY1100?opendocument&utm_source=J1BL&utm_campaign=J1BLs
President Obama Signs the Medicare and Medicaid Extenders Act of 2010
On Wednesday, December 15, 2010, President Obama signed into law the
Medicare and Medicaid Extenders Act of 2010 (MMEA). This new law prevents a
scheduled payment cut for physicians who treat Medicare patients from
taking effect. The Centers for Medicare & Medicaid Services (CMS) is
pleased that this law has addressed key issues for beneficiaries and
providers, and we are actively engaged in implementing these changes.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CBLM37813?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Incorrect Adjustments Impacting Part B Providers in Northern California,
Southern California, Ohio and West Virginia
Palmetto GBA has identified a problem with adjustments to some claims for
Care Plan Oversight (HCPCS codes G0181 and G0182). This issue impacts Part
B providers in northern California, southern California, Ohio and West
Virginia only for claims processed from September 2, 2008, through October
28,2010. If you received an overpayment letter for these services issued
during this timef rame, you do not need to take any action. Palmetto GBA
will send corrected notices to all affected providers.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CBMDT3161?opendocument&utm_source=J1BL&utm_campaign=J1BLs
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, December 16, 2010
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
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!
****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
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!
Sunday, December 12, 2010
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
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!
****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
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, December 6, 2010
Palmetto/J1MAC News
The following information has been received by ANCO.
****PALMETTO/J1MAC NEWS****
The 'Physician Payment and Therapy Relief Act of 2010' Extends 2.2 Percent
Medicare Physician Fee Schedule Update
On November 30, 2010, President Obama signed into law 'The Physician
Payment and Therapy Relief Act of 2010.' This law extends through December
31, 2010, the 2.2 percent update to the Medicare Physician Fee Schedule
(MPFS) that has been in effect for Medicare Physician Fee Schedule (MPFS)
claims with dates of service of June 1, 2010, through November 30, 2010.
Payments for 2010 services under the MPFS will continue without delay.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BQRY48715?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Update to Medicare Deductible, Coinsurance and Premium Rates for 2011
This J1 A/B MAC MLN Matters article (CR7224) provides the Medicare rates
for deductible, coinsurance and premium payment amounts for Calendar Year
(CY) 2011. A beneficiary is responsible for an inpatient hospital
deductible amount, which is deducted from the amount payable by the
Medicare program to the hospital for inpatient hospital services furnished
in a spell of illness. Providers are encouraged to review the information
and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BPSYJ3265?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 6991) 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. Please share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BRJ3V0164?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Important Information on the Timely Claims Filing Requirement
Effective immediately, all claims for services furnished on or after
January 1, 2010, must be filed with your Medicare contractor no later than
one calendar year (12 months) from the date of service, or Medicare will
deny those claims. If you have Medicare fee-for-service claims with service
dates from October 1, 2009, through December 31, 2009, those claims must be
filed by December 31, 2010, or Medicare will deny those claims. Claims with
service dates from January 1, 2009, to October 1, 2009, keep their original
December 31, 2010 deadline for filing.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BRLA36358?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Information Regarding the Billing of New Q HCPCS Codes for 2010-2011
Seasonal Influenza Vaccines for Medicare Fee-for-Service Providers
Physicians, other practitioners and suppliers may submit their claims with
the new influenza Q HCPCS codes on an individual basis or via the roster
billing process. CMS has instructed Medicare contractors to hold all claims
containing the influenza Q HCPCS codes with dates of service on or after
October 1, 2010, until their systems are able to accept them for
processing. The Medicare contractors’ systems will be ready to process
claims containing the Q HCPCS codes no later than February 7, 2011.
Physicians, other practitioners and suppliers also have the option to hold
their claims containing the new influenza Q HCPCS codes until February 7,
2011.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BRJJC5038?opendocument&utm_source=J1BL&utm_campaign=J1BLs
2010 - 2011 Seasonal Influenza (Flu) Resources for Health Care
Professionals
This special edition article (SE1031b) was revised on November 29, 2010, to
include a reference to MLN Matters article MM7234 (New HCPCS Q-codes for
2010–2011 Seasonal Influenza Vaccines). In this article, the Centers for
Medicare & Medicaid Services (CMS) reminds health care professionals that
Medicare Part B reimburses health care providers for seasonal flu vaccines
and their administration. Medicare provides coverage of the seasonal flu
vaccine without any out-of-pocket costs to the Medicare patient. Providers
are encouraged to review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8A5NMV3805?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Claim Editing for Ordering/Referring Providers
Note: Please disregard the listserv message for this article that was sent
on December 2, 2010. The statement 'CMS previously announced' was
inadvertently omitted from the December 2 listserv. We apologize for the
inconvenience. Although the article on the J1 Web site is correct, the
listserv was inaccurate and will be replaced with the following message:
This article announces that automated edits for ordering/referring
providers will not be turned on effective January 3, 2011. 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: 1) Not
in the claim; 2) Is not of a profession that is permitted to order/refer;
or 3) Does not have an enrollment record in the Medicare Provider
Enrollment, Chain and Ownership System (PECOS), the claim will not be paid.
Providers are encouraged to review the information and to share with their
staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BQKQL6582?opendocument&utm_source=J1BL&utm_campaign=J1BLs
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!
****PALMETTO/J1MAC NEWS****
The 'Physician Payment and Therapy Relief Act of 2010' Extends 2.2 Percent
Medicare Physician Fee Schedule Update
On November 30, 2010, President Obama signed into law 'The Physician
Payment and Therapy Relief Act of 2010.' This law extends through December
31, 2010, the 2.2 percent update to the Medicare Physician Fee Schedule
(MPFS) that has been in effect for Medicare Physician Fee Schedule (MPFS)
claims with dates of service of June 1, 2010, through November 30, 2010.
Payments for 2010 services under the MPFS will continue without delay.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BQRY48715?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Update to Medicare Deductible, Coinsurance and Premium Rates for 2011
This J1 A/B MAC MLN Matters article (CR7224) provides the Medicare rates
for deductible, coinsurance and premium payment amounts for Calendar Year
(CY) 2011. A beneficiary is responsible for an inpatient hospital
deductible amount, which is deducted from the amount payable by the
Medicare program to the hospital for inpatient hospital services furnished
in a spell of illness. Providers are encouraged to review the information
and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BPSYJ3265?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 6991) 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. Please share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BRJ3V0164?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Important Information on the Timely Claims Filing Requirement
Effective immediately, all claims for services furnished on or after
January 1, 2010, must be filed with your Medicare contractor no later than
one calendar year (12 months) from the date of service, or Medicare will
deny those claims. If you have Medicare fee-for-service claims with service
dates from October 1, 2009, through December 31, 2009, those claims must be
filed by December 31, 2010, or Medicare will deny those claims. Claims with
service dates from January 1, 2009, to October 1, 2009, keep their original
December 31, 2010 deadline for filing.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BRLA36358?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Information Regarding the Billing of New Q HCPCS Codes for 2010-2011
Seasonal Influenza Vaccines for Medicare Fee-for-Service Providers
Physicians, other practitioners and suppliers may submit their claims with
the new influenza Q HCPCS codes on an individual basis or via the roster
billing process. CMS has instructed Medicare contractors to hold all claims
containing the influenza Q HCPCS codes with dates of service on or after
October 1, 2010, until their systems are able to accept them for
processing. The Medicare contractors’ systems will be ready to process
claims containing the Q HCPCS codes no later than February 7, 2011.
Physicians, other practitioners and suppliers also have the option to hold
their claims containing the new influenza Q HCPCS codes until February 7,
2011.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BRJJC5038?opendocument&utm_source=J1BL&utm_campaign=J1BLs
2010 - 2011 Seasonal Influenza (Flu) Resources for Health Care
Professionals
This special edition article (SE1031b) was revised on November 29, 2010, to
include a reference to MLN Matters article MM7234 (New HCPCS Q-codes for
2010–2011 Seasonal Influenza Vaccines). In this article, the Centers for
Medicare & Medicaid Services (CMS) reminds health care professionals that
Medicare Part B reimburses health care providers for seasonal flu vaccines
and their administration. Medicare provides coverage of the seasonal flu
vaccine without any out-of-pocket costs to the Medicare patient. Providers
are encouraged to review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8A5NMV3805?opendocument&utm_source=J1BL&utm_campaign=J1BLs
Claim Editing for Ordering/Referring Providers
Note: Please disregard the listserv message for this article that was sent
on December 2, 2010. The statement 'CMS previously announced' was
inadvertently omitted from the December 2 listserv. We apologize for the
inconvenience. Although the article on the J1 Web site is correct, the
listserv was inaccurate and will be replaced with the following message:
This article announces that automated edits for ordering/referring
providers will not be turned on effective January 3, 2011. 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: 1) Not
in the claim; 2) Is not of a profession that is permitted to order/refer;
or 3) Does not have an enrollment record in the Medicare Provider
Enrollment, Chain and Ownership System (PECOS), the claim will not be paid.
Providers are encouraged to review the information and to share with their
staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BQKQL6582?opendocument&utm_source=J1BL&utm_campaign=J1BLs
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, December 2, 2010
ACCC, CMA & 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-12-1-2010.html. ANCO is an Institutional Member of ACCC. This edition features:
• ACCC Releases New Study on Care Transition
• New CME/CE Activity Launched: Strategies for Managing Patients with Breast Cancer
• FDA Approves AMGENS. Xgeve for the Prevention of Skeletal-Related Events in Patients with Bone Metastases from Solid Tumors
• Heard on ACCC's ListServ: ICD-9s by Tumor Site
****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:
• Congress postpones Medicare cuts until January
• New timely access regulations to take effect January 17
• CMA continues court challenge of state taking physician license fees from medical board
• CalHIPSO tops nation in signups of doctors getting EHRs
• Webinar: EHRs--Meaningful Use
****PALMETTO/J1MAC NEWS****
Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 17.0,
Effective January 1, 2011
This J1 A/B MAC MLN Matters article (CR 7210) provides a reminder for
physicians to take note of the quarterly updates to Correct Coding
Initiative (CCI) edits. The last quarterly release of the edit module was
issued in October 2010. Please share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BNQMF8435?opendocument&utm_source=J1BL&utm_campaign=J1BLs
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!
****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-12-1-2010.html. ANCO is an Institutional Member of ACCC. This edition features:
• ACCC Releases New Study on Care Transition
• New CME/CE Activity Launched: Strategies for Managing Patients with Breast Cancer
• FDA Approves AMGENS. Xgeve for the Prevention of Skeletal-Related Events in Patients with Bone Metastases from Solid Tumors
• Heard on ACCC's ListServ: ICD-9s by Tumor Site
****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:
• Congress postpones Medicare cuts until January
• New timely access regulations to take effect January 17
• CMA continues court challenge of state taking physician license fees from medical board
• CalHIPSO tops nation in signups of doctors getting EHRs
• Webinar: EHRs--Meaningful Use
****PALMETTO/J1MAC NEWS****
Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 17.0,
Effective January 1, 2011
This J1 A/B MAC MLN Matters article (CR 7210) provides a reminder for
physicians to take note of the quarterly updates to Correct Coding
Initiative (CCI) edits. The last quarterly release of the edit module was
issued in October 2010. Please share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BNQMF8435?opendocument&utm_source=J1BL&utm_campaign=J1BLs
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!
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