ANCO Online ListServ

CMA & Palmetto/J1MAC News

2011-01-26T06:43:00.000-08:00

The following information has been received by ANCO.

****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:

• CMAs long-running court battle over MediCal provider cuts heads to Supreme Court

• House of Representatives votes to repeal health care reform; Senate unlikely to act

• CMA introduces new biweekly column on state politics

• Webinar: How to enroll in the federal EHR incentive programs

****PALMETTO/J1MAC NEWS****
Reminder: Physician Quality Reporting System: Town Hall Meeting February 9,
2011
CMS will host a Town Hall meeting on February 9, 2011, to discuss the
Physician Quality Reporting System (formerly Physician Quality Reporting
Initiative). The purpose is to solicit input from participating
stakeholders on individual quality measures and measures groups being
considered for possible inclusion in the proposed set of quality measures
for use in the 2012 Physician Quality Reporting System and key components
of its design. Interested parties are invited to participate, either onsite
at CMS headquarters in Baltimore, Maryland, or via teleconference. The
meeting is open to the public; however, attendance is limited to space and
teleconference lines available.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8DALEV0751?opendocument&utm_source=J1BL&utm_campaign=J1BLs

Rescheduled: National Provider Call on 2011 Physician Quality Reporting
System & eRx Incentive Program
For those who registered to participate in January 18 national provider
call, please be aware that the call is being rescheduled to January 27,
2011, 1:30 p.m. to 3 p.m. ET. Due to inclement weather conditions in the
Washington, DC/Baltimore metropolitan area, some of the presenters for this
call have been prevented from attending.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8DAN7J8527?opendocument&utm_source=J1BL&utm_campaign=J1BLs

J1 PCC Closing Schedule: January 28, 2011
Share with your staff - The J1 Provider Contact Center (PCC) will be closed
for training on Friday, January 28, 2011, from 11 a.m. to 3 p.m. PT.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/8D4TRF1003?opendocument

Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC)
and Medicare Remit Easy Print (MREP) Update
This J1 A/B MAC MLN Matters article (CR 7250) announces the latest update
of Remittance Advice Remark Codes (RARCs) and Claim Adjustment Reason Codes
(CARCs), effective April 1, 2011. The reason and remark code sets must be
used to report payment adjustments in remittance advice transactions. The
RARC list is maintained by the Centers for Medicare & Medicaid Services
(CMS) and used by all payers. Providers are encouraged to review the
information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8DBNQY6144?opendocument&utm_source=J1BL&utm_campaign=J1BLs

February 2011 J1 A/B MAC Medicare Advisory
The February 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~8DERNB8217?opendocument&utm_source=J1BL&utm_campaign=J1BLs

J1 Provider Outreach and Education Event Calendar
J1 Part A providers, join us for a free Webinar on Medicare Secondary Payer
(MSP) Conditional Payment Billing on January 26, 2011. J1 Part B providers,
check out the free Webinar on ICD-10 and HIPAA5010 on January 26. Also,
mark your calendar to attend an Ask the Contractor Teleconference (ACT) on
2011 Medicare Updates on January 27, 2011.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~7TAL2C7131?opendocument&utm_source=J1BL&utm_campaign=J1BLs

Have Your Remittance Advice On Hand When You Call the Provider Contact
Center (PCC)
Share with your staff - The Centers for Medicare & Medicaid Services (CMS)
Internet-Only Manuals (IOMs) provide instructions and requirements for
Medicare Contractors on how to handle provider requests for information
that is already available on a Remittance Advice (RA). Please review the
enclosed article and make sure you have your RA on hand when calling the
Provider Contact Center.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8DEL7R2754?opendocument&utm_source=J1BL&utm_campaign=J1BLs

Notice of New Interest Rate for Medicare Overpayments and Underpayments:
Second Notification for FY 2011
The Department of the Treasury has notified the Department of Health and
Human Services that the private consumer rate has been changed to 11.25
percent effective January 24, 2011, for Medicare overpayments and
underpayments.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8DFGLY2184?opendocument&utm_source=J1BL&utm_campaign=J1BLs

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ACCC, ASH, CMA, & Palmetto/J1MAC News

2011-01-14T07:12:00.000-08:00

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/2011/ACCConnect-1-12-2011.html. ANCO is an Institutional Member of ACCC. This edition features:

• Exceptional Times--Exceptional Meeting: ACCC's 37th Annual National Meeting

• Are You Getting the Most from ACCC's New Reimbursement and Patient Assistance Programs Guide?

• Shortage of Chemo Drugs Raising Concerns

• How do You Manage Patients with Advanced Prostate Cancer? Case Study Submissions Accepted

• ACCC's Part B--Drug Information Guide January Update 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/6323.aspx. This edition features:

• Congres Reconvenes: House Republications Plan to Repeal Health Reform

• Medicare Updates Physician Payment Rates for 2011

• Medicare Releases Revisions to the January 2011 Average Sales Price (ASP)

• ASH Comments on Proposed Rule for Medicaid RAC Program

• Problems Accessing Melphalan (Alkeran) Reported

• ASH Submits Comments to FDA Regading Approval Pathway for Biosimilar and Interchangeable Biological Products

• CMS Updates for Physicians (EHR, eRx)

****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:

• Governor Brown's proposed budget would dramatically cut health and human services

• CMS launches website for physicians to enroll in EHR program

• Medicare releases new fee schedule for 2011

• Free webinars on HIPAA version 5010 help physicians prepare for January 1st, 2012 deadline

****PALMETTO/J1MAC NEWS****
CMS Launches the 2011 Medicare Contractor Provider Satisfaction Survey
(MCPSS)
It’s that time again. It's time for you to let your voice be heard! The
Centers for Medicare & Medicaid Services (CMS) has launched its annual
Medicare Contractor Provider Satisfaction Survey (MCPSS). This survey
offers Medicare FFS providers and suppliers an opportunity to give CMS
feedback on their interactions with Medicare FFS contractors related to
seven key business functions: provider inquiries, provider outreach and
education, claims processing, appeals, provider enrollment, medical review,
and provider audit and reimbursement.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CUGBA1237?opendocument&utm_source=J1BL&utm_campaign=J1BLs

J1 Part B LCD Retired
The J1 Part B Local Coverage Determination (LCD), Intracoronary
Brachytherapy (L28274), was retired on January 1, 2011.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/8CUMCS1367?opendocument

CMS Expands Healthcare Provider Directory: First Phase of Physician Compare
Web Site
The Centers for Medicare & Medicaid Services (CMS) enhanced the online
Physician Directory tool with new information about physicians and other
health care workers in their communities and the services those
professionals provide. The new feature, called Physician Compare, expands
and updates CMS’ Healthcare Provider Directory, which has helped millions
of beneficiaries find Medicare-participating doctors online for over a
decade.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CUG7Y8568?opendocument&utm_source=J1BL&utm_campaign=J1BLs

Physician Quality Reporting System Town Hall Meeting: February 9
The Centers for Medicare & Medicaid Services (CMS) will host a Town Hall
Meeting on February 9, 2011, 10 a.m. to 4 p.m. ET
to discuss the Physician Quality Reporting System. The purpose of the Town
Hall Meeting is to solicit input from participating stakeholders on
individual quality measures and measures groups being considered for
possible inclusion in the proposed set of quality measures for use in the
2012 Physician Quality Reporting System and key components of the design of
the Physician Quality Reporting System.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CUFZE4528?opendocument&utm_source=J1BL&utm_campaign=J1BLs

National Provider Teleconference: Preparing for ICD-10 Implementation in
2011
The Centers for Medicare & Medicaid Services (CMS) will host a national
provider teleconference on 'Preparing for ICD-10 Implementation in 2011' on
January 12, 2011. Subject matter experts will review basic information on
the transition to ICD-10 and discuss implementation planning and
preparation strategies for this year. A question and answer session will
follow the presentations.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CUGVD3253?opendocument&utm_source=J1BL&utm_campaign=J1BLs

Correction to Article: G0101 and G0182 - Incorrect Adjustments Impacting
Part B Providers in Northern California, Southern California, Ohio and West
Virginia
An error was discovered in the article, ‘G0101 and G0182 - Incorrect
Adjustments Impacting Part B Providers in Northern California, Southern
California, Ohio and West Virginia’, which was published to the J1 Web site
and sent out on listserv on January 6, 2011. The ‘G0101’ code in the title
is incorrect; the correct code is ‘G0181’. The article title has been
corrected on the Web site.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/8CVLNU2451?opendocument

Share with your staff - The 2011 J1 Mammography Fee Schedule has been
updated on our Web site.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~7ZFTY68431?opendocument&utm_source=J1BL&utm_campaign=J1BLs

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Palmetto/J1MAC News

2011-01-07T07:56:00.000-08:00

The following information has been received by ANCO.

****PALMETTO/J1MAC NEWS****
2011 Revised Medicare Part B Fee Schedule: Northern California
The Northern California 2011 Revised Medicare Part B Fee Schedule is now
available and is effective for services performed on or after January 1,
2011.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8B8PAG2626?opendocument&utm_source=J1BL&utm_campaign=J1BLs

CMS Quarterly Provider Update
The Quarterly Provider Update is a comprehensive resource published by the
Centers for Medicare & Medicaid Services (CMS) on the first business day of
each quarter. It is a listing of all non-regulatory changes to Medicare
including program memoranda, manual changes and any other instructions that
could affect providers. Regulations and instructions published in the
previous quarter are also included in the update.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~7GLTKN5010?opendocument&utm_source=J1BL&utm_campaign=J1BLs

CMS Quarterly Provider Update
The Quarterly Provider Update is a comprehensive resource published by the
Centers for Medicare & Medicaid Services (CMS) on the first business day of
each quarter. It is a listing of all non-regulatory changes to Medicare
including program memoranda, manual changes and any other instructions that
could affect providers. Regulations and instructions published in the
previous quarter are also included in the update.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~7GLTKN5010?opendocument&utm_source=J1BL&utm_campaign=J1BLs

PC-ACE Pro32 version 2.26 Update File
PC-ACE Pro32 software has been updated to version 2.26 with several CMS
Medicare mandates and enhancements. All PC-ACE Pro32 users must download
and install the attached software update file immediately.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CTME56017?opendocument&utm_source=J1BL&utm_campaign=J1BLs

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

Registration Now Open for Medicare and Medicaid Electronic Health Record
(EHR) Incentive Program
The Centers for Medicare & Medicaid Services (CMS) encourages eligible
professionals, eligible hospitals and critical access hospitals to register
for the Medicare and/or Medicaid EHR Incentive Program(s) as soon as
possible. You can register before you have a certified EHR. Register even
if you do not have an enrollment record in the Provider Enrollment, Chain
and Ownership System (PECOS).
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CTGUS3370?opendocument&utm_source=J1BL&utm_campaign=J1BLs

Medicare Fee-for-Service Implementation of HIPAA Version 5010 and D.0
Transactions: Fourteenth National Education Call
The Centers for Medicare & Medicaid Services (CMS) will host its fourteenth
national education call regarding Medicare fee-for-service (FFS)
implementation of HIPAA Version 5010 and D.0 transaction standards on
January 19, 2011. This session will focus on the errata impact to HIPAA
transactions and the Medicare FFS companion guides. Subject matter experts
will review how Medicare FFS is implementing the errata, review the
Medicare FFS companion guide and provide information to help the audience
through the transition to implementation. The presentation will be followed
by a Q&A session.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CTH6G2176?opendocument&utm_source=J1BL&utm_campaign=J1BLs

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Palmetto/J1MAC News

2011-01-02T20:55:00.000-08:00

The following information has been received by ANCO.

****PALMETTO/J1MAC NEWS****
ANSI v5010: ANSI 837 v5010 Testing Procedures
The ANSI 837 v5010 Testing Procedures document includes testing
instructions for J1 Part A, J1 Part B, NC Part A , LA Part A, MS Part A and
Railroad Medicare to ensure your new ANSI-formatted electronic claims
software meets format and quality standards. These instructions are
applicable to ANSI v5010 testing from January 1, 2011 through April 3,
2011. Additional testing will need to be performed once the errata is
installed on April 4, 2011. Updated ANSI 837 v5010 testing instructions
will be published at that time. No one will be placed in ANSI v5010
production until successful errata testing is completed.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CMP5M6351?opendocument&utm_source=J1BL&utm_campaign=J1BLs

Get Ready for Version 5010
In January, the health care industry will have less than a year left to
prepare for the Version 5010 transaction set change on January 1, 2012. To
assist with compliance, the Centers for Medicare & Medicaid Services (CMS)
is supporting an education effort, Get Ready 5010, that will kick off with
a series of free Webinars scheduled from January 11 through 13, 2011.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8CMKB31537?opendocument&utm_source=J1BL&utm_campaign=J1BLs

J1 Open Draft LCD Meeting: California, January 18, 2011
Share with your staff - Palmetto GBA J1 A/B MAC will host an Open Draft
Local Coverage Determination (LCD) meeting in California, January 18, 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~7TKQ3P7107?opendocument&utm_source=J1BL&utm_campaign=J1BLs

Multiple Procedure Payment Reduction (MPPR) for Selected Therapy Services
This J1 A/B MLN Matters article (CR 7050a) was revised on December 22,
2010, to reflect changes made to CR 7050 on December 21, 2010. The CR 7050
was revised based on policy changes required by the Physician Payment and
Therapy Relief Act of 2010, which changed the multiple payment procedure
reduction for therapy services in the office setting or a non-institutional
setting to 20 percent, instead of 25 percent. The CR release date,
transmittal number and Web address for accessing CR 7050 were also revised.
This article announces that Medicare is applying a new multiple procedure
payment reduction (MPPR) to the practice expense (PE) component of payment
of select therapy services paid under the MPFS. Providers are encouraged to
review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BGSDE5876?opendocument&utm_source=J1BL&utm_campaign=J1BLs

J1 Part B LCD (DL31628) Comment Period January 13 through March 7, 2011
The comment period for J1 Part B Local Coverage Determination (LCD),
Molecular Profiling for Unknown Primary Cancers (UPC) DL31628, will begin
on January 13 and end on March 7, 2011.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/8CLTWT8785?opendocument

CMS Quarterly Provider Update
The Quarterly Provider Update is a comprehensive resource published by the
Centers for Medicare & Medicaid Services (CMS) on the first business day of
each quarter. It is a listing of all non-regulatory changes to Medicare
including program memoranda, manual changes and any other instructions that
could affect providers. Regulations and instructions published in the
previous quarter are also included in the update.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~7GLTKN5010?opendocument&utm_source=J1BL&utm_campaign=J1BLs

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DHCS/MediCal & Palmetto/J1MAC News

2010-12-31T07:04:00.000-08:00

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!

ASH & Palmetto/J1MAC News

2010-12-27T08:06:00.000-08:00

The following information has been received by ANCO.

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

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

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

• CMS to Host Town Hall Meeting to Discuss PQRS

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

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

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

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

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

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

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

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

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

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

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Palmetto/J1MAC News

2010-12-22T06:32:00.000-08:00

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

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ACCC, CMA, & Palmetto/J1MAC News

2010-12-16T07:04:00.000-08:00

ASH & Palmetto/J1MAC News

2010-12-12T07:32:00.000-08:00

The following information has been received by ANCO.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Palmetto/J1MAC News

2010-12-06T07:55:00.000-08:00

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

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ACCC, CMA & Palmetto/J1MAC News

2010-12-02T06:57:00.000-08:00

ASH & Palmetto/J1MAC News

2010-11-27T09:23:00.000-08:00

The following information has been received by ANCO.

****ASH NEWS****
The American Society of Hematology's (ASH) Practice Update was published and is available online at http://www.hematology.org/Practice/Practice-Updates/5997.aspx. This edition features:

• Senate Passes Legislation to Avert Medicare Payment Cuts; Urge Your Representative to Support Stopping the Scheduled 23% Medicare Physician Payment Cut

• Final 2011 Physician Fee Schedule Rule Includes Significant Cuts

• ASH Annual Meeting: Policy & Practice Events You Will Want to Attend

****PALMETTO/J1MAC NEWS****
December 2010 J1 A/B MAC Medicare Advisory
The December 2010 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~8BGKUY1013?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 3, 2010, from 11 a.m. to 3 p.m. PT. The PCC will reopen on
Friday, December 3, 2010, at 3 p.m. PT. Please share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BFVR90761?opendocument&utm_source=J1BL&utm_campaign=J1BLs

Online Provider Services (OPS) Claims Status Enhancements
Palmetto GBA has enhanced the claims status feature of Online Provider
Services (OPS). OPS now displays the processed date and check number, if
applicable, when returning claims status for a beneficiary. OPS is our
secure Web portal that allows providers to access information regarding
claim status, beneficiary eligibility, amount approved-to-pay, and to view
duplicate remittance notices. All providers that have an EDI Enrollment
Agreement on file may register to use this tool. If you haven’t already
registered, please consider doing so. Access the introductory article to
learn more: click on the “Introducing Online Provider Services” graphic on
the top of any of our main state Web pages. One important consideration:
only one Provider Administrator per EDI Enrollment Agreement/per PTAN
performs the registration process. The Provider Administrator can then
grant permission to additional users related to that PTAN. Billing services
and clearinghouses should contact their provider clients to gain access to
the system.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BGSRZ1171?opendocument&utm_source=J1BL&utm_campaign=J1BLs

J1 Part B LCDs Revised
Multiple J1 Part B LCDs have been revised. To view these LCDs, go to the
'LCDs and NCDs' Web page under the Medical Policies section of the J1 Part
B Web site. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BFVB65821?opendocument&utm_source=J1BL&utm_campaign=J1BLs

Multiple Procedure Payment Reduction (MPPR) on the Technical Component (TC)
of Certain Diagnostic Imaging Procedures
This J1 A/B MAC MLN Matters article (CR 6993) announces that Medicare is
changing the multiple procedure payment reduction (MPPR) on the technical
component (TC) of certain diagnostic imaging procedures. You should make
sure that your billing staffs are aware of these changes.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BGLDH4824?opendocument&utm_source=J1BL&utm_campaign=J1BLs

Thirteenth National Education Call on Medicare Fee-For-Service (FFS)
Implementation of HIPAA Version 5010 and D.0 Transactions
The Centers for Medicare & Medicaid Services (CMS) will host its 13th
national education call regarding Medicare FFS implementation of HIPAA
Version 5010 and D.0 transaction standards on December 8, 2010. This
session will focus on provider outreach and education activities and
transition specific testing protocols. Subject matter experts will review
Medicare FFS communications, outreach and education strategy, as well as
provide information to help the audience through the transition to
implementation. The presentation will be followed by a Q&A session.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BHMS75816?opendocument&utm_source=J1BL&utm_campaign=J1BLs

Multiple Procedure Payment Reduction (MPPR) for Selected Therapy Services
This J1 A/B MLN Matters article (CR7050) announces that Medicare is
applying a new multiple procedure payment reduction (MPPR) to the practice
expense (PE) component of payment of select therapy services paid under the
MPFS. Providers are encouraged to review the information and to share with
their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BGSDE5876?opendocument&utm_source=J1BL&utm_campaign=J1BLs

Online Provider Services (OPS) Claims Status Enhancements
Palmetto GBA has enhanced the claims status feature of Online Provider
Services (OPS). OPS now displays the processed date and check number, if
applicable, when returning claims status for a beneficiary. OPS is our
secure Web portal that allows providers to access information regarding
claim status, beneficiary eligibility, amount approved-to-pay and to view
duplicate remittance notices. All providers that have an EDI Enrollment
Agreement on file may register to use this tool. If you haven’t already
registered, please consider doing so. Access the introductory article to
learn more by selecting the 'Introducing Online Provider Services' graphic
on the top of any of our main contract home pages. Please Note: Only one
Provider Administrator per EDI Enrollment Agreement/per PTAN performs the
registration process. The Provider Administrator can then grant permission
to additional users related to that PTAN. Billing services and
clearinghouses should contact their provider clients to gain access to the
system.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/8BGSRZ1171?opendocument

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Palmetto/J1MAC News

2010-11-23T07:40:00.000-08:00

The following information has been received by ANCO.

****PALMETTO/J1MAC NEWS****
2009 PQRI and eRx Incentive Program Feedback Reports
After beginning the release of the 2009 PQRI feedback reports, the Centers
for Medicare & Medicaid Services (CMS) temporarily halted production of the
files to investigate some conflicting field information in the reports. The
2009 PQRI and eRx Incentive Program feedback reports will soon be made
available on the PQRI portal. CMS anticipates that the Taxpayer
Identification Number (Tax ID Number or TIN) level reports, which include
the National Provider Identifier (NPI) level reports, will be available the
week of November 22, 2010, on the PQRI Portal. Individual NPI reports will
be made available shortly afterward.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BBGD64145?opendocument&utm_source=J1BL&utm_campaign=J1BLs

PC-ACE Pro32 Training Modules
Palmetto GBA is pleased to announce the availability of new Web-based
PC-ACE Pro32 training modules for Part A and Part B providers. PC-ACE Pro32
is a complete, self-contained electronic processing system for health care
claims submission and management. This system does not integrate into
office systems, such as accounts receivable, inventory or billing. It
provides you with the ability to enter patient, claim and procedure file
information while creating summary reports of the claims you submit
electronically.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~857MGQ4785?opendocument&utm_source=J1BL&utm_campaign=J1BLs

November 25 through 26 Medicare Payments
Palmetto GBA will not issue Medicare payments on November 25 through 26
because of the Thanksgiving holiday. Payments will be issued as usual on
November 24 and will resume on November 29.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BBQYG0836?opendocument&utm_source=J1BL&utm_campaign=J1BLs

Provider Education for Handling National Provider Identifier (NPI) Issues
Related to Deceased Providers Who Had an NPI
This J1 Part B MLN Matters article (CR6984) explains how claims should be
submitted by representatives of deceased providers who had obtained an NPI
prior to death. A claim submitted after May 23, 2007, for a deceased
provider who had an NPI will be rejected by Medicare because the provider’s
NPI was deactivated in the Medicare claims processing system due to the
provider’s death. When a deceased provider’s claim is rejected by a
Medicare Contractor because of the absence of an NPI, the claim submitter
is expected to contact the Medicare Contractor to discuss payment of the
claim and the provider’s death. Providers are encouraged to review the
information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BATB38107?opendocument&utm_source=J1BL&utm_campaign=J1BLs

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ACCC, CMA & Palmetto/J1MAC News

2010-11-19T07:04:00.000-08:00

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-11-17-2010.html. ANCO is an Institutional Member of ACCC. This edition features:

• Update on Commission of Cancer Program Standards Revision

• Conference Call: November 19 to Discuss Final 2011 HOPPS Rule and Physician Fee Schedule.

• FDA Approves Eisai's Halaven Injection for Treatment of Metastatic Breast Cancer

• Heard on ACCC's ListServ: Staffing Guidlines

• New Certifications: Oncology and Women's Health EHR

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

• CMA Stops Proposed Medicare Geographic Payment Cuts

• CMA Launches Campaign to Stop Medicare Cuts

• Two CMA Physicians Elected to State Assembly

• Time To Declare Medicare Participation for 2011

• CMA Publishes Guide to Obtaining Federal Funding for EHRs

• Webinar: EHRs--Meaningful Use

****PALMETTO/J1MAC NEWS****
2010 E-Prescribing Incentive Program Measurement Code Reporting Update
All eligible professionals (EPs) are encouraged to follow the current 2010
E-Prescribing (eRx) incentive program requirements. EPs should check the
measure specifications at the beginning of each year because they may
change. The correct measurement code to bill in 2010 for calculations of
the 2010 eRx incentive payment is HCPCS code G8553. The 2009 eRx
measurement codes have been accepted for processing by the Medicare claims
systems. However, in October, a temporary change occurred that led to the
rejection of 2009 eRx codes. EPs cannot resubmit claims that may have been
rejected with the 2009 eRx measurement codes. Submissions reported using a
qualified registry or a qualified electronic health record will not be
affected by this situation.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8B5QF80168?opendocument

Time Limit Denials
The time limit for filing claims to Medicare has changed. The changes
apply to Medicare primary and secondary claims. Claims with dates of
service October 1, 2008 through December 31, 2009, must be filed no later
than December 31, 2010. Services performed on or after January 1, 2010,
must be filed within one year from the date of service. Please review your
billing records carefully to ensure that your claims are filed on time.
Review this article for more information.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~7RJJMU2314?opendocument

Important Timely Filing Requirement Information: Reminder
If you are a Medicare fee-for-service (FFS) physician, provider or supplier
submitting claims to Medicare for payment, this is very important
information you need to know. Effective immediately, any Medicare FFS claim
with a date of service on or after January 1, 2010, must be received by
your Medicare contractor no later than one calendar year (12 months) from
the claim’s date of service, or Medicare will deny the claim.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8B8HVB4453?opendocument

Implementation of ERRATA Version 5010 of Health Insurance Portability and
Accountability Act (HIPAA) Transactions and Updates in 837I, 837P and 835
Flat Files
This J1 A/B MAC MLN Matters (CR7202) alerts and updates providers about the
administrative simplification provisions of Health Insurance Portability
and Accountability Act (HIPAA) Regulations that the Secretary of the
Department of Health and Human Services (DHHS) is required to adopt
regarding standard electronic transactions and code sets. Currently, CMS is
in the process of implementing an ERRATA version of 5010 of the HIPAA
transactions as well as the updates to the 837I, 837P and 835 flat files.
Be sure that you will be compliant with this next HIPAA standard by January
1, 2012. Providers are encouraged to review the information and to share
with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8B8Q943537?opendocument

Implementation of the PWK (Paperwork) Segment for X12N Version 5010
This J1 A/B MAC MLN Matters article (CR7041a) was revised on November 12,
2010, to reflect a revised CR 7041 issued on November 10, 2010. The
effective and implementation dates have been changed. In addition, the CR
transmittal number, release date and the Web address for accessing CR 7041
were revised. All other information is the same. The article announces the
implementation of the PWK (paperwork) segment for X12N Version 5010. The
PWK segment provides the ‘linkage’ between electronic claims and additional
documentation which is needed for claims adjudication. Providers are
encouraged to review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~896S543018?opendocument

Outpatient Therapy Cap Values for CY 2011
This J1 A/B MAC MLN Matters article (CR7107) describes the Centers for
Medicare & Medicaid Services (CMS) policy for outpatient therapy caps for
Calendar Year (CY) 2011. Therapy caps for 2011 will be $1,870. The
exceptions process will continue unchanged for the time frame directed by
Congress. Providers are encouraged to review the information and to share
with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8B8Q420673?opendocument

2011 Medicare Part B Fee Schedule: Northern California
The Northern California 2011 Medicare Part B Fee Schedule is now available
and is effective for services performed on or after January 1, 2011. As you
know, Medicare payment rates under the Medicare Physician Fee Schedule
(MPFS) are set according to statutory criteria. The following 2011 MPFS
payment rates are reflective of the 2011 Physician Fee Schedule Final Rule
that was put on display at the Office of the Federal Register on November
2, 2010, and are based on current law which provides a negative update for
2011. However, the Centers for Medicare & Medicaid Services will quickly
work to update MPFS payment rates in the event Congress passes legislation
to prevent the negative update from going into effect on January 1, 2011.
We encourage physicians and other affected practitioners to consider the
possibility of this legislation as you evaluate decisions related to your
annual participation election. Please be on the alert for more information
about the 2011 physician update as it becomes available.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8B8PAG2626?opendocument

2009 Electronic Prescribing (eRx) Incentive Program: Payments
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce
that incentive payments for the 2009 Electronic Prescribing (eRx) Incentive
Program were made to eligible professionals who met the criteria for
successful reporting. This article includes information about how to
identify eRx payments on your paper or electronic remittance advice.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8B8JHW8618?opendocument

Implementation of HIPAA Version 5010 & D.0 Transactions Call
The Centers for Medicare & Medicaid Services (CMS) will host its 12th
national education call regarding Medicare fee-for-service (FFS)
implementation of HIPAA Version 5010 and D.0 transaction standards on
Wednesday, November 17, focusing on Coordination of Benefits (COB). Subject
matter experts will review Medicare FFS specific changes, including those
arising from the adoption of the HIPAA 5010 Errata, as well as general
information to help the audience prepare for the transition. The
presentation will be followed by a Q&A session. The target audience for
this call includes vendors, clearinghouses and providers who will need to
make Medicare FFS specific changes in compliance with HIPAA version 5010
requirements.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8B9HRR3770?opendocument

Registration for ONC Personal Health Records Roundtable Now Open
Online registration is now open for the roundtable on 'Personal Health
Records - Understanding the Evolving Landscape.' This free day-long public
roundtable, hosted by the Office of the National Coordinator for Health
Information Technology (ONC), will be held on Friday, December 3, 2010, at
the FTC Conference Center in Washington, D.C. Register to attend in person
or via Webcast by visiting the Health IT Web site.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8B9HWY8427?opendocument

Partial Code Freeze Prior to ICD-10 Implementation
This special edition article (SE1033) addresses the ICD-9-CM Coordination &
Maintenance (C&M) Committee meeting held on September 15, 2010. In that
meeting, the committee had finalized the decision to implement a partial
freeze for ICD-9-CM, ICD-10-CM and ICD-10-PCS codes prior to implementation
of ICD-10 on October 1, 2013. Providers are encouraged to review the
information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8B8S664065?opendocument

November 17 Grandfathering Notification Deadline for DMEPOS Bidding Program
- Message From CMS
Once the Durable Medical Equipment, Prosthetics, Orthotics and Supplies
(DMEPOS) competitive bidding program becomes effective on January 1, 2011,
beneficiaries with Original Medicare who obtain competitively bid items in
competitive bidding areas (CBAs) must obtain these items from a contract
supplier for Medicare to pay, unless an exception applies. All non-contract
suppliers that furnish competitively bid rented durable medical equipment
(DME) or oxygen and oxygen equipment to beneficiaries in CBAs must decide
if they will elect to become grandfathered suppliers, notify beneficiaries
of their grandfathering decisions, and fulfill other requirements.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8BAFZU5742?opendocument

J1 PCC to Close in Observance of Thanksgiving Holiday
The J1 Provider Contact Center (PCC) will be closed in observance of the
Thanksgiving holiday on Thursday, November 25, 2010, and Friday, November
26, 2010. The PCC will reopen on Monday, November 29, 2010, at 7 a.m. PT.
Please share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8B9QQN4104?opendocument&utm_source=J1BL&utm_campaign=J1BLs

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Palmetto/J1MAC News

2010-11-12T07:13:00.000-08:00

The following information has been received by ANCO.

****PALMETTO/J1MAC NEWS****
Medicare Remit Easy Print (MREP) Enhancement
This J1 A/B MAC MLN Matters article (CR7178) announces the following list
of enhancements to the Medicare Remit Easy Print (MREP): 1) The MREP Demo
function has been updated to reflect current functionalities; and 2) A
report can be run now for Medicare Secondary Payer (MSP) Claims to
distinguish the Medicare secondary payments from the primary payments.
Providers using the MREP software need to obtain the new version in January
and install it to begin benefiting from these enhancements. Providers are
encouraged to review the information and to share it with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8AZKQ52465?opendocument

The Comprehensive Error Rate Testing (CERT) Fact Sheet (PDF, 321 KB)
The updated CERT Fact Sheet is now available on the J1 Web sites. Review
these facts before you submit to reduce claim submission errors and more.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~7S7RXH5804?opendocument

J1 PCC to Close on November 11 for Veteran's Day
The J1 PCC will be closed on Thursday, November 11, 2010, in observance of
Veteran’s Day. The call center will reopen on Friday, November 12, 2010, at
7 a.m. PT. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/8AWQNX5670?opendocument

Denials: Top Reasons and Procedures
Find denial reasons in plain language and tips for resolving them in the
Palmetto GBA Denial Resolution tool. Top denial reasons include services
for hospice patients; bundled services; Medicare is the secondary payer;
and bundled payment for pre- and post-operative visits.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~7RHRDT1707?opendocument

Medicare Improves Access to Preventive Services for 2011
The Centers for Medicare & Medicaid Services (CMS) issued a final rule with
comment period that will implement key provisions in the Affordable Care
Act of 2010. These provisions expand preventive services for Medicare
beneficiaries, improve payments for primary care services and promote
access to health care services in rural areas. The new policies will apply
to payments under the Medicare Physician Fee Schedule (MPFS) for services
furnished on or after January 1, 2011.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8AWFU81003?opendocument

2009 Physician Quality Reporting Initiative (PQRI) Incentive Payment Update
Incentive payments for the 2009 Physician Quality Reporting Initiative
(PQRI) will begin this fall for eligible professionals who met the criteria
for successful reporting. Carriers and Medicare Administrative Contractors
(MACs) have begun processing and distributing 2009 PQRI incentive payments
on October 25, 2010. Distribution of 2009 PQRI incentive payments is
scheduled to be completed by November 12, 2010. These incentive payments
are paid as a lump sum to the Taxpayer Identification Number (TIN) under
which the professional’s claims were submitted.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8AWHFL0213?opendocument

American Recovery and Reinvestment Act of 2009 Electronic Health Record
(EHR) Incentive Program: Healthcare Common Procedure Coding System (HCPCS)
Modifier for the EHR Incentive Program
This J1 Part B MLN Matters article (CR7035) announces that the Centers for
Medicare & Medicaid Services has developed a new Electronic Health Record
Health Professional Shortage Area Modifier AZ, which will allow eligible
professionals to report claims rendered in a dental HPSA when the ZIP code
does not fully fall within that dental HPSA. Providers are encouraged to
review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8B2NKZ4542?opendocument

Palmetto GBA 1099/B Notice Request Form
The Palmetto GBA 1099/B Notice Request Form is now available online. Please
review and complete the form before submission.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8B2Q328780?opendocument

J1 Part B LCDs Revised
Multiple J1 Part B LCDs have been revised. To view these LCDs, go to the
'LCDs and NCDs' Web page under the Medical Policies section of the J1 Part
B Web site. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/8B2SH65375?opendocument

Specialty Code for Advanced Diagnostic Imaging Services
This J1 A/B MAC MLN Matters article (CR7175a) was revised on November 4,
2010, to remove unnecessary language that had inadvertently referred to the
specialty code as a ‘DMEPOS’ code. All other information is the same. This
article announces that, effective April 1, 2011, the Centers for Medicare &
Medicaid Services (CMS) will establish a new specialty code (specialty code
95) for Advanced Diagnostic Imaging (ADI) Accreditation. Providers are
encouraged to review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8AVQJ41352?opendocument

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ACCC, CMA, & Palmetto/J1MAC News

2010-11-05T08:59:00.000-07:00

Palmetto/J1MAC News

2010-10-28T07:33:00.000-07:00

The following information has been received by ANCO.

****PALMETTO/J1MAC NEWS****
Partial Code Freeze Prior to ICD-10 Implementation
At the ICD-9-CM Coordination & Maintenance Committee Meeting (September 15,
2010), it was announced that the committee had finalized the decision to
implement a partial freeze for both ICD-9-CM codes, ICD-10-CM and
ICD-10-PCS codes prior to implementation of ICD-10 on October 1, 2013.
Please share this information with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8AKKPG3004?opendocument

November 2010 J1 A/B MAC Medicare Advisory
The November 2010 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~8AGR4T0470?opendocument

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

Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) for
Myelodysplastic Syndrome (MDS)
This J1 A/B MAC MLN Matters article (CR7137) announces (through a National
Coverage Determination (NCD)) that, effective for claims with dates of
service on and after August 4, 2010, Medicare will cover the use of
Allogeneic HSCT for treatment of MDS under Section 1862(a)(1)(E) of The
Social Security Act (the Act) only if provided in the context of a
Medicare-approved clinical study meeting specific criteria under Coverage
with Evidence Development (CED). Providers are encouraged to review the
information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8AKPVF7648?opendocument

Counseling to Prevent Tobacco Use
This J1 A/B MAC MLN Matters article (CR7133) announces that the Centers for
Medicare & Medicaid Services (CMS) will cover counseling to prevent tobacco
use for outpatient and hospitalized beneficiaries. Effective for claims
with dates of service on and after August 25, 2010, CMS will cover tobacco
cessation counseling for outpatient and hospitalized Medicare
beneficiaries: 1) Who use tobacco, regardless of whether they have signs or
symptoms of tobacco-related disease; 2) Who are competent and alert at the
time that counseling is provided; and 3) Whose counseling is furnished by a
qualified physician or other Medicare-recognized practitioner. These
individuals who do not have signs or symptoms of tobacco-related disease
will be covered under Medicare Part B when the above conditions of coverage
are met, subject to certain frequency and other limitations. Providers are
encouraged to review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8AKQ361051?opendocument

J1 Part B LCDs Revised
Multiple J1 Part B LCDs have been revised. To view these LCDs, go to the
'LCDs and NCDs' Web page under the 'Medical Policies' section of the J1
Part B Web site. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/8ALN4Y2234?opendocument

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ACCC, CMA & Palmetto/J1MAC News

2010-10-26T07:05:00.000-07:00

Palmetto/J1MAC News

2010-10-14T07:07:00.000-07:00

The following information has been received by ANCO.

****PALMETTO/J1MAC NEWS****
Annual PPTN Recertification For J1 Part B Underway
Palmetto GBA has started our annual security recertification invoice
process for Jurisdiction 1 Part B PPTN access. J1 Part B PPTN users will
receive via mail a PPTN recertification notice and invoice. Please respond
promptly so that your PPTN access is not terminated.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~89ZQMR2112?opendocument

PC-ACE Pro32 version 2.24 Update File
PC-ACE Pro32 software has been updated to version 2.24 with several CMS
Medicare mandates and enhancements. All PC-ACE Pro32 users must download
and install the attached software update file immediately.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~89ZQTX2544?opendocument

2010 - 2011 Seasonal Influenza (Flu) Resources for Health Care
Professionals
This special edition article (SE1031) announces that 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. No
deductible or co-payment/co-insurance applies. All adults 65 and older
should get seasonal flu vaccine. People with Medicare who are under 65 but
have chronic illness, including heart disease, lung disease, diabetes or
end-stage renal disease should get a seasonal flu shot. Providers are
encouraged to review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8A5NMV3805?opendocument

Results of the 2010 Medicare Contractor Provider Satisfaction Survey
(MCPSS)
This special edition article (SE1030) is informational only and provides a
summary of the findings from the annual MCPSS by the Centers for Medicare &
Medicaid Services (CMS). The MCPSS offers Medicare fee-for-service (FFS)
providers an opportunity to give CMS feedback on their satisfaction,
attitudes, perceptions and opinions about the services provided by their
respective contractor. The MCPSS elicits information from a sample of
hospitals, physicians, skilled nursing facilities (SNFs), home health
agencies, clinical laboratories, and other providers and suppliers.
Providers are encouraged to review the information and to share with their
staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8A5LMV8717?opendocument

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ACCC, CMA, & Palmetto/J1MAC News

2010-10-08T07:13:00.000-07:00

The following information has been received by ANCO.

****ACCC NEWS****
The Association of Community Cancer Center's (ACCC) has announced the new Part B Drug Information Guide. Visit http://www.accc-cancer.org/druginfo/ for more information.

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-10-6-2010.html. ANCO is an Institutional Member of ACCC. This edition features:

• ACCC's Successful St. Louis Meeting

• Voice Your Support for the Prostate Act

• Heard on ACCC's ListServ: Physician Supervision Requirements in Radiation Oncology

• 2009 Electronic Prescribing (eRx) Incentive Program Update

• Physician Compare Website: Find Out the Details

****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:

• San Jose Physician James G. Hinsdale, M.D., Elected CMA President

• First Wave of Certified EHRs Announced

• 2010 State Legislative Wrap Up

• Highlights from CMA's 2010 House of Delegates

• Last Call: Act Now on $350M UnitedHealth Settlement

****PALMETTO/J1MAC NEWS****
CMS Quarterly Provider Update
The Quarterly Provider Update is a comprehensive resource published by the
Centers for Medicare & Medicaid Services (CMS) on the first business day of
each quarter. It is a listing of all non-regulatory changes to Medicare
including Program Memoranda, manual changes, and any other instructions
that could affect providers. Regulations and instructions published in the
previous quarter are also included in the Update.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~7GLTKN5010?opendocument

Correction to Article: Submitting Claims for Compounded Medication for
Implantable Infusion Pumps
An error was discovered in the article, ‘Submitting Claims for Compounded
Medication for Implantable Infusion Pumps’, which was published to the J1
Web site and the October 2010 J1 Advisory. In the table under the Fentanyl
drug, the amount should be 0.0072 dollars per mcg, rather than 0.072
dollars per mcg. The article with the correct amount will be posted on the
J1 Web site immediately and will be published in the November 2010 J1
Advisory. We apologize for the inconvenience. Please be sure to share with
your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/89RQDS0382?opendocument

Overpayment Refund Form: Medicare Part A and B
A new Overpayment Refund form will be in use. For more information, please
view the article link Provider Medicare Voluntary Refunds: Immediate Offset
Requests Terminated.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~7JBHHJ3014?opendocument

Provider Medicare Voluntary Refunds: Immediate Offset Requests Terminated
The J1 Immediate Offset Request Form has been updated and placed on the J1
Part B Web site. Providers are encouraged to review the information and to
share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~89DRTZ7213?opendocument

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

New Medicare Self-Referral Disclosure Protocol
Section 6409(a) of the Affordable Care Act (ACA) ACA requires the secretary
of the Department of Health and Human Services, in cooperation with the
inspector general of the Department of Health and Human Services, to
establish a Medicare self-referral disclosure protocol (SRDP) that sets
forth a process to enable providers of services and suppliers to
self-disclose actual or potential violations of Section 1877 of the Social
Security Act (the Act). The SRDP requires health care providers of services
or suppliers to submit all information necessary for CMS, on behalf of the
secretary, to analyze the actual or potential violation of Section 1877 of
the Act. Section 6409(b) of the ACA, gives the secretary of HHS the
authority to reduce the amount due and owing for violations of Section
1877.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~89TMHJ1123?opendocument

Clarification on the Effective Date on the Procedure Status Indicator for
Current Procedural Terminology (CPT) Code 80101
This J1 A/B MAC MLN Matters article (CR7140) clarifies that the effective
date for the change of the procedure status indicator to ‘I’ for Current
Procedure Terminology (CPT) Code 80101 has been set to January 1, 2010, for
all claims and CR 7140 supercedes all other CRs in relation to this issue.
Providers are encouraged to review the information and to share with their
staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~89WRXT6724?opendocument

Medicare Fee-For-Service Emergency Policies and Procedures: Questions and
Answers (Qs & As) for All Types of Emergencies and Disasters - Rescission
of CRs 5099, 6146, 6164, 6174, 6209, 6256, 6280, 6284 and 6378
This J1 A/B MAC MLN Matters article (CR6837) is informational only and
advises providers on where to find information regarding Medicare policies
related to emergency guidance for the duration of the emergency, such as
the H1N1 pandemic. As part of its preparedness efforts for an influenza
pandemic, the Centers for Medicare & Medicaid Services (CMS) developed
certain emergency guidance and procedures that may be implemented for the
Medicare fee-for-service (FFS) program in the event of a pandemic or
disaster. Providers are encouraged to review the information and to share
with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~89WRQU7814?opendocument

October is National Breast Cancer Awareness Month
The Centers for Medicare & Medicaid Services (CMS) is asking the provider
community to keep their patients with Medicare healthy by encouraging them
to take advantage of Medicare-covered screening mammograms and other
preventive services covered by Medicare.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~89XH971028?opendocument

J1 PCC to Close October 11 in Observance of Columbus Day
The J1 PCC will be closed in observance of Columbus Day on Monday, October
11, 2010. The call center will reopen on Tuesday, October 12, 2010, at 7
a.m. PDT. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/89YLU36474?opendocument

IDTF Table for CPT Codes 77072-78816
The revised IDTF Table for CPT Codes 77072-78816 is now available on the J1
Web site. The CPT Codes 78261, 78262 and 78264 were added to the table.
Providers are encouraged to review the information and to share with their
staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~855P3Q7108?opendocument

CMS Town Hall Meeting on the Physician Compare Web Site
CMS will host a town hall meeting on the Physician Compare Web site.
Section 10331 of the Patient Protection and Affordable Care Act of 2010
requires CMS to establish a Physician Compare Web site containing
information on physicians enrolled in Medicare and other eligible
professionals who participate in the Physician Quality Reporting Initiative
by January 1, 2011. This meeting will be held on October 27, 2010, from 1
p.m. to 5 p.m. EDT in the main auditorium of the central building of the
Centers for Medicare & Medicaid Services or via teleconference. The meeting
is open to the public; however, attendance is limited to space and
teleconference lines available.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~89YDPF8307?opendocument

CMS Medicare Quarterly Provider Compliance Newsletter: First Edition
Released
The Medicare Learning Network (MLN) has developed a new educational tool,
the Medicare Quarterly Provider Compliance Newsletter, to advise
physicians, suppliers and other fee-for-service (FFS) providers about how
to avoid common billing errors and other erroneous activities when dealing
with the Medicare program.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~89YDPB2738?opendocument

Special Open Door Forum: Physician Quality Reporting Initiative (PQRI) and
Electronic Prescribing (eRx) Incentive Program Updates
The Centers for Medicare & Medicaid Services (CMS) will host a special open
door forum on the 2010 PQRI and Electronic Prescribing eRx Incentive
Program updates on October 19, 2010 from 2 p.m. to 3 p.m. EDT. During this
special open door forum, CMS will discuss: 2009 PQRI and eRx Incentive
Program payment distribution and provide instructions for understanding
these payments; an overview of the 2009 Feedback Report user guides for
PQRI and the eRx Incentive Program; changes to the electronic remittance
advice for eligible professionals receiving PQRI and eRx incentive payments
in 2010; and participation in the 2010 eRX Incentive Program.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~89ZJ6G5867?opendocument

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Palmetto/J1MAC News

2010-09-30T07:05:00.000-07:00

The following information has been received by ANCO.

****PALMETTO/J1MAC NEWS****
October 2010 J1 A/B MAC Medicare Advisory
The October 2010 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~89JPXZ8868?opendocument

Claim Status Category and Claim Status Codes Update
This J1 A/B MAC MLN Matters article (CR7158) explains that the Claim Status
Codes and Claim Status Category Codes for use by Medicare Contractors, as
well as several additional items, will be posted to the Washington
Publishing Company Web site on or about November 1, 2010. 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
January 3, 2011. Providers are encouraged to review the information and to
share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~89KQCJ6463?opendocument

J1 Open Draft LCD Meeting: California, October 19, 2010
Share with your staff - Palmetto GBA J1 A/B MAC will host an Open Draft
Local Coverage Determination (LCD) meeting in California, October 19, 2010.
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~7TKQ3P7107?opendocument

October Update to the 2010 Medicare Physician Fee Schedule Database
(MPFSDB)
This J1 A/B MAC MLN Matters article (CR7112) amends payment files issued to
Medicare Contractors based upon the 2010 Medicare Physician Fee Schedule
Final Rule. Medicare Contractors will not search their files to either
retract payment for claims already paid or to retroactively pay claims that
were processed prior to implementation of CR 7112. However, Contractors
will adjust claims brought 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~89KQA55235?opendocument

Eligible Physicians and Non-Physician Practitioners who need to Enroll in
the Medicare Program for the Sole Purpose of Ordering and Referring Items
and Services for Medicare Beneficiaries
This J1 Part B MLN Matters article (CR7097) announces that physicians and
non-physician practitioners will need to enroll in the Medicare program so
they can order and refer items and services for Medicare beneficiaries. The
enrollment requirement is specified in the article. Providers are
encouraged to review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~89KQ6F6732?opendocument

J1 Part B Accepts Redetermination Reqeusts via Fax October 1
Share with your staff - Effective October 1, 2010, Palmetto GBA will begin
accepting Part B redetermination requests via fax. No special preparation
is necessary for redetermination requests submitted via fax. All currently
required elements are necessary to be present for faxed requests. You may
fax your J1 Part B Redetermination requests to (803) 462-3914.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~89LRFJ3001?opendocument

2011 Annual Update for the Health Professional Shortage Area (HPSA) Bonus
Payments
This J1 A/B MAC MLN Matters article (CR7139) alerts providers that the
annual HPSA bonus payment 2011 file will be made available by the Centers
for Medicare & Medicaid Services (CMS) to your Medicare Contractor on
November 15, 2010. This file will be used for Health Professional Shortage
Area (HPSA) bonus payments on applicable claims with dates of service on or
after January 1, 2011, through December 31, 2011. Providers are encouraged
to review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~89KQME0048?opendocument

National Correct Coding Initiative (NCCI) Tool
The National Correct Coding Initiative (NCCI) packages, or 'bundles,'
reimbursement for some services under Medicare. NCCI identifies code pairs
that are never reimbursed separately and code pairs that can only be
reimbursed separately in certain circumstances (identified by the
appropriate modifier). Please use the NCCI tool to determine if the service
you are submitting is bundled with another service.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~89QGRF8716?opendocument

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ASH, CMA, & Palmetto/J1MAC News

2010-09-24T07:51:00.000-07:00

The following information has been received by ANCO.

****ASH NEWS****
The American Society of Hematology's (ASH) Practice Update was published and is available online at http://www.hematology.org/Practice/Practice-Updates/5774.aspx. This edition features:

• Health Reform Law Passes SIx-Month Milestone: Initial Reforms Begin to Take Effect

• Register for ASH Webinar Series on Thrombosis

• ASH Comments on Proposed HIPAA Modifications: Recommends Flexibility During Implementation

• AHRQ Technology Assessment on Off-Label Cancer Treatment Incorporates ASH Comments to Address Concerns

• CMS Introduces Webpage Dedicated to ICD-9/10 Transition in a CMS Version 5010 Environment

• CMS Publishes October 2010 ASP and NOC Pricing FIles and Crosswalks

• Register for the 52nd ASH Annual Meeting by November 4

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

• CMA Files Lawsuit Against Blue Shield for Bogus Physician Rating System

• There's Still Time to Claim Your Share of the $350M UnitedHealth Settlement

• CMA Advocacy Results in Changes to UnitedHealthcare Coverage Determination Guideline

• CMA Receives Grant for Electronic Health Records Support

• Federal EHR Incentives: Do You Qualify?

• CMA Tells IOM That Medicare Rates Must Reflect Regional Costs

****PALMETTO/J1MAC NEWS****
PECOS Dark Days
Due to scheduled maintenance, the Internet-based Provider Enrollment, Chain
and Ownership System (PECOS) will be unavailable from Wednesday, September
29, 2010, through Sunday, October 3, 2010. Internet-based PECOS allows
physicians, non-physician practitioners, providers and other suppliers to
enroll or make a change to their existing Medicare enrollment information
over the Internet.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~89CLB68565?opendocument

2011 Annual Update of Healthcare Common Procedure Code System (HCPCS) Codes
for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Update
This J1 A/B MAC MLN Matters article (CR7159) provides the 2011 annual
update of Healthcare Common Procedure Coding System (HCPCS) Codes for
Skilled Nursing Facility Consolidated Billing (SNF CB) and how the updates
affect edits in Medicare claims processing systems. Physicians and
providers are advised that, by the first week in December 2010, new code
files will be posted on the Centers for Medicare & Medicaid Services (CMS)
Web site. Note that this site will include new Excel and PDF format files.
It is important and necessary for the provider community to view the
‘General Explanation of the Major Categories’ PDF file located at the
bottom of each year’s FI/A/B MAC update listed on the CMS Web site in order
to understand the Major Categories, including additional exclusions not
driven by HCPCS codes. Providers are encouraged to review the information
and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~89BNAE2184?opendocument

Tenth National Education Call on Medicare Fee-for-Service (FFS)
Implementation of HIPAA Version 5010 and D.0 Transactions
The Centers for Medicare & Medicaid Services (CMS) will host its tenth
national education call on September 29, 2010, regarding implementation of
HIPAA Version 5010 and D.0 transaction standards for Medicare
Fee-for-Service (FFS). This session will focus on the TA1, 999 and 277CA
transactions. Subject matter experts will review Medicare FFS specific
changes as well as general information to help the audience prepare for the
transition. The presentation will be followed by a question and answer
session.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~89DFW21218?opendocument

Update to the Healthcare Provider Taxonomy Codes (HPTC) - January 1, 2011
In this article, the Centers for Medicare and Medicaid Services (CMS) has
released the summary of changes reflected in the Health Care Provider
Taxonomy Code (HPTC) list. A/B MACs will update their HPTC tables with this
new version effective on January 1, 2011. Providers are encouraged to
review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~89GLU94224?opendocument

Provider Medicare Voluntary Refunds: Immediate Offset Requests Terminated
This article announces that, as of October 1, 2010, Palmetto GBA will no
longer allow providers to request 'immediate offset' as a payment method
relating to voluntary/self-disclosed Medicare overpayments. Providers must
submit a check made payable to Palmetto GBA or Medicare with the
overpayment refund form. If the check payee is addressed differently, the
check will be returned to the provider. Overpayment refund forms received
without check payment will be processed under established collection
procedures mandated by the Centers for Medicare & Medicaid Services (CMS).
Providers are encouraged to review the information and to share with their
staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~89DRTZ7213?opendocument

Further Instruction for Implementation of Health Insurance Portability and
Accountability Act of 1996 (HIPAA) version 5010 for Transaction 835 -
Health Care Claim Payment/Advice and Updated Standard Paper Remit (SPR)
Change Request (CR) 7032 provides additional instructions to clarify
instructions previously sent or not implemented correctly, and to set up a
process to follow when corrective actions must be developed and implemented
for Out Of Balance situations. This announces that the Centers for Medicare
& Medicaid Services (CMS) is in the process of implementing the next
version of the HIPAA Transaction 835 standard – referred to as 835v5010 in
this document. The Secretary of the Department of Health and Human Services
(DHHS) has adopted ASC X12 version 5010 and NCPDP version D.0 as the next
HIPAA standard for HIPAA covered transactions. The final rule was published
on January 16, 2009. Providers are encouraged to review the information and
to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~89HJL77718?opendocument

J1PCC to Close on September 24
The J1PCC will be closed for training on Friday, September 24, 2010, from
11 a.m. to 3 p.m. (PDT). The Call Center will re-open at 3 p.m. PDT.
Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/89JR771328?opendocument

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Palmetto/J1MAC News

2010-09-16T07:43:00.000-07:00

The following information has been received by ANCO.

****PALMETTO/J1MAC NEWS****
Don’t Delay - Send In Your CERT Documentation Immediately!
If you have received a request from the CERT Review Contractor to submit
documentation, please be advised that the deadline is quickly approaching.
Time is running out so please respond by submitting the requested
documentation to the CERT Review Contractor by Tuesday, September 21. You
should forward the documentation to the designated contact information
provided in the letter from the CERT Review Contractor. We urge you to
respond and share this information with the appropriate staff within your
organization.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~894PHR3517?opendocument

Open Draft LCD Meetings October 2010
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 October 2010. 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

Workshop: Issues Related to Accountable Care Organizations
On October 5, 2010, the Federal Trade Commission (FTC) will co-host a
workshop on several issues associated with Accountable Care Organizations
(ACOs), organizations authorized by the new Affordable Care Act that seek
to deliver high-quality and efficient health care services to consumers.
The workshop, which will be held at CMS Headquarters in Baltimore,
Maryland, is free and open to the public.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~895ELV5346?opendocument

CMS Makes Information about Physician Fee Schedule Payment Rates More
Accessible
CMS has updated and enhanced the Medicare Physician Fee Schedule Lookup to
allow the user to: download search results into a CSV file, modify search
criteria without starting over, search on all available types of
information at the same time (Pricing Information, Payment Policy
Indicators, Relative Value Units and Geographical Practice Cost Index), and
sort and view results table columns in ascending or descending order.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~896HMB1802?opendocument

CMS to Host Listening Session Regarding Confidential Feedback Reports and
the Implementation of a Value-Based Payment Modifier for Physicians
CMS will host a listening session on September 24 as part of the transition
to a value-based purchasing program for services of physicians and certain
other professionals, as well as other related provisions under the Patient
Protection and Affordable Care Act (ACA). The ACA contains provisions that
continue and expand the Physician Feedback Program and also require
implementation of a value-based payment modifier to the Fee-for-Service
physician fee schedule. The purpose of the listening session is to solicit
comments on approaches being considered as CMS implements these provisions.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~896HNZ5433?opendocument

Implementation of the PWK (Paperwork) Segment for X12N Version 5010
This J1 A/B MAC MLN Matters article (CR7041) announces the implementation
of the PWK (paperwork) segment for X12N Version 5010. The PWK segment
provides the ‘linkage’ between electronic claims and additional
documentation which is needed for claims adjudication. Although the PWK
segment allows for an electronic submission of additional documentation,
this preliminary implementation will only allow for submission of
additional documentation via mail and fax. Providers are encouraged to
review the information and share it with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~896S543018?opendocument

J1 A/B MAC Palmetto GBA Assigned ICD-9-CM Codes for National Coverage
Determinations
The HCPCS Codes and the associated ICD-9 Codes for Stem Cell
Transplantation National Coverage Determination (NCDs) have been added to
the list of J1 A/B MAC Palmetto GBA Assigned ICD-9-CM Codes for National
Coverage Determinations. Providers are encouraged to review the information
and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~7RCMMD8585?opendocument

J1 Part B LCDs Revised
Share with your staff - Multiple J1 Part B LCDs have been revised. To view
these LCDs, go to the ‘LCDs and NCDs’ Web page under the Medical Policies
section of the J1 Part B Web site.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~899NK26615?opendocument

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ASH, ACCC, CMA, & Palmetto/J1MAC News

2010-09-10T08:17:00.000-07:00

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-9-8-2010.html. ANCO is an Institutional Member of ACCC. This edition features:

• Two New Educational Offerings on ACCC's CE Blackboard

• Meet Us in St. Louis!

• ACCC Submits Comments to CMS on 2011 Proposed Hospital Outpatient Prospective Payment System Rule

• Heard on ACCC's ListServ: Referrals/Pre-authorizations for Outpatient Chemotherapy

• CMS Offers National Provider Call on ICD-10 Implementation in a 5010 Environment

• For Women with BRCA Mutations, Prophylactic Surgery Reduces Cancer Risk

****ASH NEWS****
The American Society of Hematology (ASH) Practice Update was published and is available online at http://www.hematology.org/Practice/Practice-Updates/5709.aspx. This edition features:

• Earn CME Credits from Blood

• CMS Offers Incentive Payments for Participation in HIT and Quality Initiatives

• CMS to Host Conference Call on ICD-10 Implementation

• CMS Releases Quarterly Update to Correct Coding Initiative Edits

• Legislative & Judicial Action Concerning Embryonic Stem Cell Research

• Register for ASH Webinar Series on Thrombosis

• Register for the 52nd ASH Annual Meeting by November 4

****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:

• CME Certification Forms Are In the Mail

• Modesto Physician Appointed to California Medical Board

• Applications Now Available for California's New Preexisting Condition Insurance Plan

• More Health Reform Provisions Take Effect September 23

• CMA Comments on the 2011 Medicare Physician Payment Rule

• Blue Shield Pulls Out of Healthy Families in 15 Counties

• Blue Cross Extends Healthy Families Continuity of Care Plan for Physicians in Most Counties

• Legislature Passes Bill Banning Rescissions

• Bill Protecting Kids' Access to Vaccines Goes to Governor's Desk

****PALMETTO/J1MAC NEWS****
J1 Part B LCDs Revised
Share with your staff - The following J1 Part B Local Coverage
Determinations (LCDs) have been revised: Botulinum Toxin Types A and B
Policy L28242 and Implantable Infusion Pump for Treatment of Chronic
Intractable Pain L28268.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~88VPX33722?opendocument

J1 Part B Self-Administered Drugs Exclusion List 2010
Share with your staff - Revision history has been added to the J1 Part B
2010 Self-Administered Drugs Exclusion List. For specific revisions, check
out the Version links at the end of the PDF attachment.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~7QWPBL3352?opendocument

Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 16.3,
effective October 1, 2010
This J1 Part B MLN Matters article (CR7081) 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 July 2010. Providers are encouraged to review the information and
to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~88VQ9Z0600?opendocument

J1 Provider Outreach and Education Event Calendar
MACtoberfest, Palmetto GBA J1's largest educational and networking event of
the year, is coming soon! Space is limited for this popoular event, so
secure your spot and register today. Also check out our new multi-month
Event Calendar on the J1 Part A or Part B Web site.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~7TAL2C7131?opendocument

J1 Part B LCDs: Revised
The following J1 Part B Local Coverage Determinations (LCDs) have been
revised: Botulinum Toxin Types A and B Policy L28242 and Magnetic Resonance
Angiography (MRA) of the Head and Neck, Chest, Abdomen and Pelvis, Lower
Extremities L28277.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~88MK8T3077?opendocument

Outpatient Services: Incorrect Denials
This article announces that Palmetto GBA began denying certain procedure
codes in July 2009 that were performed in outpatient hospital settings. In
May 2010, it was determined that the Hospital OPPS 'inpatient-only' list
did not apply to Medicare Part B and that these claims were denied in
error. Palmetto GBA has corrected its claims processing system to reflect
this change and it is currently adjusting claims that were denied based on
this list. Providers are encouraged to review the information and to share
with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~88WQSS0201?opendocument

Revisions to Claims Processing Instructions for Services Rendered in Place
of Service Home
This J1 Part B MLN Matters article (CR6947a) was revised on September 1,
2010, to reflect a revised CR 6947, which was re-issued on August 31, 2010.
The article was revised to show a new CR release date, transmittal number
and Web address for accessing CR 6947. This article announces a requirement
that Contractors now enter the address of where services were performed,
including the ZIP Code, on claims for anesthesia services and every service
payable under the Medicare Physician Fee Schedule (MPFS) for services
provided in all places of service, including Home. This change will be
effective for claims that are submitted on the 5010 version of the ANSI
X12N 837P electronic form that are processed by Medicare on or after
January 1, 2011, and on the paper Form CMS 1500 with dates of service on or
after January 1, 2011. Providers are encouraged to review the information
and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~886Q3Y1574?opendocument

Final Reminder: ICD-10 Implementation in a 5010 Environment Follow-Up
National Provider Call
The Centers for Medicare & Medicaid Services (CMS) will host a follow-up
national provider conference call on 'ICD-10 Implementation in a 5010
Environment.' Subject matter experts will review basic information on both
ICD-10 and 5010 and explain how they are interrelated. A question and
answer session will follow the presentations. This event will be held on
Monday, September 13, 2010, from 12 p.m. to 1:30 p.m.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~894ETW2046?opendocument

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Palmetto/J1MAC News

2010-09-02T07:58:00.000-07:00

The following information has been received by ANCO.

****PALMETTO/J1MAC NEWS****
2010 MACtoberfest Online Registration Now Open
The 2010 MACtoberfest online registration is now open. Space is limited for
this popular event; so secure your spot today! To register and view
registration details, click on the MACtoberfest database link enclosed.
http://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~867R3X8418?opendocument

IDTF Table for CPT Codes 51725-70555
The revised IDTF Table for CPT Codes 51725-70555 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~855NCQ1375?opendocument

IDTF Table for CPT Codes 71010-73223
The revised IDTF Table for CPT Codes 71010-73223 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~855NLU3185?opendocument

IDTF Table for CPT Codes 73500-74775
The revised IDTF Table for CPT Codes 73500-74775 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~855NQH0567?opendocument

IDTF Table for CPT Codes 75557-76380
The revised IDTF Table for CPT Codes 75557-76380 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~855NVD7641?opendocument

IDTF Table for CPT Codes 76506-77059
The revised IDTF Table for CPT Codes 76506-77059 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~855NXN3616?opendocument

IDTF Table for CPT Codes 77072-78876
The revised IDTF Table for CPT Codes 77072-78876 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~855P3Q7108?opendocument

IDTF Table for CPT Codes 91000-93770
The revised IDTF Table for CPT Codes 91000-93770 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~855P5Y7260?opendocument

IDTF Table for CPT Codes A9500-Q9967
The revised IDTF Table for CPT Codes A9500-Q9967 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~855PBP5623?opendocument

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ACCC, ASH, CMA & Palmetto/J1MAC News

2010-08-27T08:12:00.000-07:00

Palmetto/J1MAC News

2010-08-24T08:01:00.000-07:00

The following information has been received by ANCO.

****PALMETTO/J1MAC NEWS****
Diagnostic Lab Billing and Coding Guidelines
In this article, the Comprehensive Error Rate Testing (CERT) Contractor
reported an increase in errors for complete blood counts (CBC) and
urinalysis (UA) laboratory services. Data indicates two types of errors:
code selection errors and standard protocol use in place of
patient-specific physician orders. Only lab services ordered by the
physician should be provided and billed. A physician’s written order must
match the performed service. Providers may not perform additional lab
services based on internal standard or implied protocols. Providers are
encouraged to review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/88FQ5L2055?opendocument

Payment for Implantable Tissue Markers (Healthcare Common Procedure Coding
System (HCPCS) Code A4648) and Implantable Radiation Dosimeters (HCPCS Code
A4650)
This J1 Part B MLN Matters article (CR6968) clarifies that the Healthcare
Common Procedure Coding System (HCPCS) codes for implantable tissue markers
and for implantable radiation dosimeters are separately billable and
payable for physicians when used with certain CPT Codes. Providers are
encouraged to review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/88GLQQ5588?opendocument

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ACCC, CMA, & Palmetto/J1MAC News

2010-08-16T07:54:00.000-07:00

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-8-11-2010.html. ANCO is an Institutional Member of ACCC. This edition features:

• Archived Webinar Now Available: Guide to Best Practices in a Comprehensive Prostate Cancer Program II

• Only a Limited Number of Hotel Rooms Remain: St. Louis Conference Hotel is Filling Up

• Expanded Enrollment for 340B Opens

• Podcast Available: Highlights of ACCC's 2010 Survey--Cancer Care Trends in Community Cancer Centers

• Nominations Open for ACCC's 2011 David King Community Clinical Scientist Award

• Heard on ACCC's ListServ: Supporting a Gynecologic Oncology Specialist

• National Coalition of Oncology Nurse Naviators (NCONN) to Host October Meeting

****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:

• 2011 Medicare fee schedule dramatically shifts funding from urban states to rural states

• Sacramento pediatrician receives physician humanitarian award

• Most major health plans will not delegate time access requirements

• U.S. Senate extends Medicaid assistance to states; California budget talks continue

• Rosy predictions for Medicare solvency are unrealistic, says Medicare actuary

• Medicare auditor identifies 131,000 overpaid claims

• CMA webinar: Health Care Reform 2010

****PALMETTO/J1MAC NEWS****
2010 MACtoberfest in Palm Springs, California October 27-29
Pack your bags and join us in the desert of Palm Springs, California from
October 27 to 29 to find your directions in the vast world of Medicare.
Registration opens soon. Look out for more details by clicking on the
MACtoberfest event icon from the J1 Part A or Part B home page in the next
few days.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/867R3X8418?opendocument

Implementation of New Statutory Provision Pertaining to Medicare Three-Day
Payment Window - Outpatient Services Treated as Inpatient
This article serves as notification of the implementation of the three-day
(or one-day) payment window provision under Section 102 of Publication L
111-192 of the 'Preservation of Access to Care for Medicare Beneficiaries
and Pension Relief Act of 2010'. It includes general instructions on
appropriate billing for compliance with the law. CMS will provide
conforming updates to the Medicare regulations and the Medicare Claims
Processing Manual (Publication 100-4) in the near future. Providers are
encouraged to review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/886QRF3304?opendocument

Timely Claims Filing: Additional Instructions
This J1 A/B MAC MLN Matters article (CR7080) expands the Medicare
Fee-for-Service (FFS) reimbursement instructions outlined in change request
(CR) 6960 that specified the basic timely filing standards established for
FFS reimbursement. Those basic standards are a result of Section 6404 of
the Patient Protection and Affordable Care Act of 2010 (ACA) that states
that claims with dates of service on or after January 1, 2010, received
later than one calendar year beyond the date of service will be denied by
Medicare. CR 7080 lists the standards for dates of service used to
determine the timely filing of claims. Providers are encouraged to review
the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/886RHS0688?opendocument

Correction: 'Customer Service Representative (CSR) Conference Call' Article
There was a typo in a J1 article that was published in the Friday, August
6, 2010, listserv. The PCC closure time indicated in the article, Customer
Service Representative (CSR) Conference Call, was published as 7:30 a.m. to
11:30 p.m. on August 20. This is incorrect. The correct PCC closure time on
August 20 is from 7:30 a.m. to 11:30 a.m. This has been corrected in the
article that was published on the J1 Web site. We apologize for the
inconvenience.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/887KWU0785?opendocument

Revisions to Claims Processing Instructions for Services Rendered in Place
of Service Home
This J1 Part B MLN Matters article (CR6947) announces a requirement that
Contractors now enter the address of where services were performed,
including the ZIP code, on claims for anesthesia services and every service
payable under the Medicare Physician Fee Schedule (MPFS) for services
provided in all places of service, including Home. This change will be
effective for claims that are submitted on the 5010 version of the ANSI
X12N 837P electronic form that are processed by Medicare on or after
January 1, 2011, and on the paper Form CMS 1500 with dates of service on or
after January 1, 2011. Providers are encouraged to review the information
and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/886Q3Y1574?opendocument

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 (CR6625) instructs Medicare Contractors
and shared system maintainers (SSM) 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. Providers are encouraged to review the information and to share
with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/887QS92045?opendocument

Medical Record Retention and Media Formats for Medical Records
This Special Edition (SE1022) is an informational article. This article
provides guidance for physicians, suppliers and providers on record
retention timeframes. State laws generally governs how long medical records
are to be retained. However, the Health Insurance Portability and
Accountability Act (HIPAA) of 1996 (HIPAA) administrative simplification
rules require a covered entity, such as a physician billing Medicare, to
retain required documentation for six years from the date of its creation
or the date when it last was in effect, whichever is later. Providers are
encouraged to review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/889N558127?opendocument

Medicare Contractor Annual Update of the International Classification of
Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)
This J1 A/B MAC MLN Matters article (CR7006a) was revised on August 4,
2010, to reflect the revised CR 7006. In this article, the CR release date
and transmittal number were changed and the Web address for accessing CR
7006 was also changed. The article reminds the Medicare Contractors and
providers that the annual ICD-9-CM update will be effective for dates of
service on and after October 1, 2010, (for institutional providers,
effective for discharges on or after October 1, 2010). Providers are
encouraged to review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/887QZX2140?opendocument

J1 Alert: Audit 122
This Alert announces that, per Change Request 1252, effective March 2001,
Cancer Screening NCD coverage was implemented for CPT Codes G0102 and
G0103. Incorrect denials for these codes occurred from June 28, 2010, to
July 13, 2010. A mass adjustment was performed and the system has been
updated to allow these services for dates of service (DOS) on or after
March 1, 2001. Providers are encouraged to review the information and to
share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/889KFA3685?opendocument

J1 Alert: Super Rural Bonus ZIP Codes for Ambulance
This Alert announces that Change Request 6972 reinstated the 22.6 percent
bonus on super rural ZIP Codes performed by ambulance suppliers from
December 31, 2009, until December 31, 2010. Palmetto GBA will identify
claims that processed with dates of service (DOS) on or after July 7, 2010,
with January 1, 2010, DOS and after, which have been paid incorrectly.
Providers are encouraged to review the information and to share with their
staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/889KMR3508?opendocument

Electronic Prescribing (eRx) Incentive Program 2010 Updates
This Special Edition article (SE1021) alerts providers that it is not too
late to start participating in the electronic prescribing (eRx) Incentive
Program to potentially qualify to receive a full-year incentive payment.
Eligible professionals may begin reporting eRx at any time throughout the
2010 program year of January 1, 2010, through December 31, 2010, to be
incentive eligible. Providers are encouraged to review the information and
to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/889MWH4827?opendocument

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Palmetto/J1MAC News

2010-08-09T07:47:00.000-07:00

The following information has been received by ANCO.

****PALMETTO/J1MAC NEWS****
Change Request 6654: Notice of New Interest Rate for Medicare Overpayments
& Underpayments - Fourth Notification for FY 2010
This article announces that a Medicare regulation provides for the
assessment of interest at the higher of the current value of funds rate of
one percent for calendar year 2010 or the private consumer rate as fixed by
the Department of the Treasury. The Department of the Treasury has notified
the Department of Health and Human Services that the private consumer rate
has been changed to 11 percent effective July 21, 2010, for Medicare
overpayments and underpayments. Providers are encouraged to review the
information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/882NZ98575?opendocument

J1 Provider Outreach and Education Event Calendar
J1 Event Calendar is now loaded with August events hosted by Palmetto GBA
J1 Provider Outreach and Education. Look out for more details about our
upcoming MACtoberfest, the Palmetto GBA J1's largest educational and
networking event of the year, on our J1 Part A and Part B home page soon.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7TAL2C7131?opendocument

Customer Service Representative (CSR) Conference Call
The Palmetto GBA J1 Provider Contact Center will be closed on Friday,
August 20, 2010, from 7:30 a.m. to 11:30 p.m. (PST) for training. During
the training, The Centers for Medicare & Medicaid Services’ (CMS) Division
of Contractor Provider Communications will host an All Customer Service
Representative (CSR) Conference Call. The call will provide all provider
contract center CSRs with an opportunity to learn about current CMS
initiatives and exchange ideas across contact centers as well as between
CMS and the front line of provider customer service. Please be sure to
share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/883LBV8108?opendocument

Medicare & Medicaid EHR Incentive Program Question and Answer Session
The Centers for Medicare & Medicaid Services (CMS) invites you to join us
for the fourth in a series of national provider calls addressing the
specifics of the Medicare and Medicaid EHR incentive programs. Have
questions? Join this free session to have an opportunity to ask a question
and hear answers by our panel of experts on the Medicare and Medicaid EHR
incentive programs. This event will be held on August 12, 2010, from 2 p.m.
to 3:30 p.m. ET.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/883HYQ8221?opendocument

2010 PQRI & E-Prescribing Incentive Program: National Provider Call with
Question & Answer Session
The Centers for Medicare & Medicaid Services (CMS) Provider Communications
Group will host a national provider conference call on the 2010 Physician
Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive
Program (eRx). This toll-free call will take place from 3 p.m. to 4:30 p.m.
EDT, on Tuesday, August 17, 2010.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/883HNN2764?opendocument

Medicare & Medicaid EHR Incentive Program Specifics for Eligible
Professionals Conference Call
The Centers for Medicare & Medicaid Services (CMS) invites you to join us
for a national provider call addressing the specifics of the Medicare and
Medicaid EHR incentive programs for eligible professionals. If you are an
individual practitioner, this free session will help you learn the details
of the programs that specifically pertain to you - eligibility, payment,
what you need to register, timeline and meaningful use reporting. This
event will be held on August 10, 2010, from 2 p.m. to 3:30 p.m. ET.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/883JQG0736?opendocument

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Palmetto/J1MAC News

2010-08-05T07:30:00.000-07:00

The following information has been received by ANCO.

****PALMETTO/J1MAC NEWS****
Medicare Physicians and Non-Physician Practitioners: Protecting Your
Privacy, Protecting Your Medicare Enrollment Record
This article references a CMS document that provides tips on how you can
protect your Medicare enrollment information that is stored on the
Internet, how to ensure your Medicare enrollment information is current and
lists advantages of using Internet-based PECOS to enroll in Medicare or
update your Medicare enrollment information. Please be sure to share with
your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/87TQ2U0811?opendocument

Skilled Nursing Facility Consolidated Billing as It Relates to Certain
Types of Exceptionally Intensive Outpatient Hospital Services
This Special Edition article (SE0432) was revised on July 22, 2010, to
include ‘ambulatory surgical centers’ in the last sentence in the top
paragraph of page 3. This article describes Skilled Nursing Facility (SNF)
Consolidated Billing (CB) as it relates to certain types of exceptionally
intensive outpatient hospital services, such as Magnetic Resonance Imaging
(MRI) services, Computerized Axial Tomography (CT) Scans and Radiation
Therapy. Providers are encouraged to review the information and to share
with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/87UR266534?opendocument

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ACCC, CMA, & Palmetto/J1MAC News

2010-07-30T07:47:00.000-07:00

Palmetto/J1MAC News

2010-07-26T08:09:00.001-07:00

The following information has been received by ANCO.

****PALMETTO/J1MAC NEWS****
Magnetic Resonance Angiography (MRA)
This J1 A/B MAC MLN Matters article (CR7040) announces that, effective for
claims with dates of services on or after June 3, 2010, Medicare
Contractors will have the discretion to cover or not cover all indications
of MRA (and magnetic resonance imaging (MRI)) that are not specifically
nationally covered or nationally non-covered. Existing national coverage
for both MRI and MRA will be maintained. Providers are encouraged to review
the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/87LKR34723?opendocument

August 2010 J1 A/B MAC Medicare Advisory
The August 2010 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/vMasterDID/87MRBX3556?opendocument

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ACCC, CMA, & Palmetto/J1MAC News

2010-07-19T08:53:00.000-07:00

ASH & Palmetto/J1MAC News

2010-07-13T08:41:00.000-07:00

Palmetto/J1MAC News

2010-07-06T07:09:00.001-07:00

The following information has been received by ANCO.

****PALMETTO/J1MAC NEWS****
CMS Quarterly Provider Update
The Quarterly Provider Update is a comprehensive resource published by the
Centers for Medicare & Medicaid Services (CMS) on the first business day of
each quarter. It is a listing of all non-regulatory changes to Medicare
including Program Memoranda, manual changes and any other instructions that
could affect providers. Regulations and instructions published in the
previous quarter are also included in the Update.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/86XG7Y7538?opendocument

CMS to Review PECOS Enrollment Process - Medicare Working with Ordering and
Referring Providers and Suppliers to Streamline Enrollment Process
As part of those efforts, CMS will, for the time being, not implement
changes that would automatically reject claims based on orders,
certifications and referrals made by providers that have not yet had their
applications approved by July 6, 2010. While more than 800,000 physicians
and other health professionals have enrolled and have approved applications
in the PECOS system, some providers have encountered problems. CMS is
continuing to update and streamline the process, and more providers have
been enrolled in the past few days.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/86XJ6S3468?opendocument

J1 Provider Outreach and Education Event Calendar
J1 Event Calendar is now loaded with July events hosted by Palmetto GBA J1
Provider Outreach and Education. Look out for more details about our
upcoming MACtoberfest, the Palmetto GBA J1's largest educational and
networking event of the year, on our J1 Part A or Part B home page soon.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7TAL2C7131?opendocument

July Update to the 2010 Medicare Physician Fee Schedule Database (MPFSDB)
This J1 A/B MAC MLN Matters article (CR6974) amends payment files that were
issued to Medicare contractors based on the 2010 Medicare Physician Fee
Schedule (MPFS) Final Rule. This article provides corrections and effective
for dates of service on or after January 1, 2010, to those files. Providers
are encouraged to review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/86YLPS0778?opendocument

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ACCC, CMA, & Palmetto/J1MAC News

2010-07-02T06:29:00.001-07:00

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-6-30-2010.html. ANCO is an Institutional Member of ACCC. This edition features:

• President Obama Signs Physician-Fix Legislation

• CMS Posts Proposed 2011 Physician Fee Schedule

• Last Chance to Review and Comment on Proposed Changes to CoC Standards

• Heard on ACCC's ListServ: Drop in Radiation Therapy Numbers

• July 2010 Average Sales Price (ASP) Files Are Now Available

• Study Finds Poor Physician Adherence to Cervical Cancer Screening Guidelines

****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:

• State Facing Pertussis Epidemic: CDPH Urges Physicians to Vaccinate Patients Against Whooping Cough

• CMA Objects to Proposed Regulations Requiring Physician Participation in Lethal Injections

• President Signs Six-Month Medicare Patch

• Highlights from AMA's Annual Meeting

• CMA Publishes Payor Contract Amendment Action Guide

• The 2010 California Physician's Legal Handbook is Here

• Remember: PECOS Enrollment Deadline is July 6, 2010

• Physicians Must Now Comply With MBC Signage Regs

• July Issue of CMA Practice Resources (CPR) Now Available

****PALMETTO/J1MAC NEWS****
Clinical Review Judgment
This J1 A/B MAC MLN Matters article (CR6954a) was revised on June 16, 2010,
to include an additional reference to Chapter 3 of the Medicare Program
Integrity Manual on page 2. This article adds Section 3.14 (Clinical Review
Judgment) to the Medicare Program Integrity Manual, clarifying existing
language regarding clinical review judgments. It also requires that
Medicare claim review Contractors instruct their clinical review staffs to
use clinical review judgment when making complex review determinations
about a claim. Providers are encouraged to review the information and to
share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/86RLFN7537?opendocument

CMS to Expand Medicare Preventive Services and Improve Access to Primary
Care in 2011
The Centers for Medicare & Medicaid Services (CMS) today issued a proposed
rule that would implement key provisions in the Affordable Care Act of 2010
that expand preventive services for Medicare beneficiaries, improve
payments for primary care services, and promote access to health care
services in rural areas. The proposed policies would apply to payments
under the Medicare Physician Fee Schedule for services furnished on or
after January 1, 2011.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/86UKWZ8612?opendocument

Filing Requirements for Providers Responding to Additional Documentation
Requests (ADR)
Share with your staff - When responding to a medical record request or
Additional Documentation Requests (ADR) from Palmetto GBA, please make sure
the medical record is sent within 30 days from the date on the ADR letter.
For more detailed requirements for ADR submission, please read the article
link enclosed.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7RAKLH0083?opendocument

How to Attend Webinars via WebEx
Share with your staff - The WebEx Tech Support phone number has been
changed. Please call (800) 508-8758 with the event number if you need any
technical assistance to attend our Webinars via WebEx.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/83FQXB5711?opendocument

J1 PCC Closed In Observance of Independence Day July 5
The J1 Provider Contact Center (PCC) will be closed in observance of
Independence Day on Monday, July 5, 2010.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/86URDM1328?opendocument

July 2010 J1 A/B MAC Medicare Advisory
The July 2010 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/vMasterDID/86USJG3150?opendocument

Opportunity for Nonparticipating Physicians/Practitioners to Become
Participating
In consideration of the recent enactment of the Preservation of Access to
Care for Medicare Beneficiaries and Pension Relief Act of 2010, which
established a 2.2 percent update to the Medicare Physician Fee Schedule
(MPFS), the Centers for Medicare & Medicare Services (CMS) is offering
physicians and other practitioners, whose current participation status is
non-participating, the opportunity to become participating (PAR). This
opportunity is being offered only to those physicians/practitioners whose
current PAR status is non-participating. This opportunity is available
through July 16, 2010.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/86UMR82114?opendocument

The President Signs the Preservation of Access to Care for Medicare
Beneficiaries and Pension Relief Act of 2010 - 2.2 Percent Medicare
Physician Fee Schedule Update for June 1, 2010, Through November 30, 2010
This article announces that on June 25, 2010, President Obama signed into
law the 'Preservation of Access to Care for Medicare Beneficiaries and
Pension Relief Act of 2010'. This law establishes a 2.2 percent update to
the Medicare Physician Fee Schedule (MPFS) payment rates retroactive from
June 1 through November 30, 2010. The Centers for Medicare & Medicaid
Services (CMS) has directed Medicare claims administration contractors to
discontinue processing claims at the negative update rates and to
temporarily hold all claims for services rendered June 1, 2010, and later,
until the new 2.2 percent update rates are tested and loaded into the
Medicare contractors' claims processing systems. Providers are encouraged
to review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/86RL3M6255?opendocument

Guidelines to Allow Contractors to Develop and Utilize Procedures for
Accepting and Processing Appeals via Facsimile and/or via a Secure Internet
Portal, Application
This J1 A/B MAC MLN Matters article (CR6958) updates the current
instructions in the Medicare Claims Processing Manual, Chapter 29, to allow
Medicare contractors to accept claim appeal requests via facsimile and/or
via a secure Internet portal, application. CR 6958 provides guidance to
Medicare Contractors who have already modified or currently wish to modify
their procedures to allow for receipt and/or processing of redetermination
requests via facsimile and/or via a secure Internet portal/application. At
this time, Medicare contractors are not required to accept appeals via
facsimile or via secure Internet portal/application. Medicare contractors
wishing to utilize a secure Internet portal/application must seek approval
from the Centers for Medicare & Medicaid Services (CMS) prior to
implementation of that portal/application. Providers are encouraged to
review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/86VP8N6611?opendocument

October Quarterly Update to 2010 Annual Update of Healthcare Common
Procedure Coding System (HCPCS) Codes Used for Skilled Nursing Facility
(SNF) Consolidated Billing (CB) Enforcement
This J1 Part A MLN Matters article (CR7002) provides the October quarterly
update to the 2010 Healthcare Common Procedure Coding System (HCPCS) codes
for Skilled Nursing Facility (SNF) consolidated billing (CB). Providers are
encouraged to review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/86WQBX5053?opendocument

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ASH & Palmetto/J1MAC News

2010-06-27T08:01:00.000-07:00

The following information has been received by ANCO.

****ASH NEWS****
The American Society of Hematology's (ASH) Practice Update was published and is available online at http://www.hematology.org/Practice/Practice-Updates/5387.aspx. This edition features:

• SGR Fix Caught in Stalemate Between House and Senate

• ASH Urges CMS to Reconsider the Elimination of Consult Codes

• FDA Grants Accelerated Approval to Nilotinib for the Treatment of Adult Ph+ CML Patients

• FDA Announcement of Pfizer Voluntary Withdrawal of Cancer Treatment Mylotarg from US Market

• ASH Responds to NHI-JDA Joint Leadership Council with Translational and Clinical Research Priorities and Recommendations for Increased Efficiency

• ASH Recommends Hematologic Conditions Be Included in HHS Initiative on Multiple Chronic Conditions

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

****PALMETTO/J1MAC NEWS****
Enhancements to Home Health (HH) Consolidated Billing Enforcement
This J1 A/B MAC MLN Matters article (CR6911a) was revised on June 14, 2010,
to reflect the revised CR 6911 that was issued on that date. In this
article, the CR release date and transmittal number were revised. Also,
the Web address for accessing CR 6911 was revised. The article announces
that CMS is updating edit criteria related to the consolidated billing
provision of the Home Health Prospective Payment System (HH PPS). It is
also creating a new file of HH certification information to assist
suppliers and providers subject to HH consolidated billing. Make sure your
billing staff is aware of these changes. Non-routine supplies provided
during a HH episode of care are included in Medicare’s payment to the home
health agency (HHA) and subject to consolidated billing edits as described
in the Medicare Claims Processing Manual. If the date of service for a
non-routine supply HCPCS code that is subject to HH consolidated billing
falls within the dates of a HH episode, the line item was previously
rejected by Medicare systems. Providers are encouraged to review the
information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/86PPH33027?opendocument

J1 Part A and Part B LCDs Notice Periods Start June 24
Share with your staff - The notice period will begin on June 24, 2010, for
J1 Part A LCD, Cataract Surgery in Adults L30889 and J1 Part B LCDs,
Cataract Surgery in Adults L30691and Implantable Infusion Pump for
Treatment of Chronic Intractable Pain L28268.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/86PQ2X8804?opendocument

The Physician Quality Reporting Initiative (PQRI) and E-Prescribing (eRx)
Medicare Quality Reporting Incentive Programs Manual
This J1 A/B MAC MLN Matters article (CR6935) announces availability of a
new Medicare manual describing the Physician Quality Reporting Initiative
(PQRI) and E-Prescribing (eRx) Incentive Programs. It is important to note
that the manual does not establish new requirements for the PQRI and eRx
programs and changes to the programs are described in the annual MPFS
legislation. This new manual, entitled Physician Quality Reporting
Initiative (PQRI) and E-Prescribing (eRx) Medicare Quality Reporting
Incentive Programs Manual will be Publication 100-22 and will be available
on the Centers for Medicare & Medicaid Services (CMS) Web site. Providers
are encouraged to review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/86QKTM7767?opendocument

Correction to the Claims Processing Internet Only Manual (IOM) to Reinstate
Previous Instructions Regarding Payment Jurisdiction for Reassigned
Services
This J1 Part B MLN Matters article (CR6923) corrects instructions for
reassigned services in the Medicare Claims Processing Manual. CR 6923
reinstates Chapter 1, Section 10.1.1.3 regarding payment jurisdiction for
reassigned services. This section was deleted in error by CR 6627. This CR
also removes an outdated reference in Chapter 35, Section 40 to deleted
Chapter 1, Section 30.2.9.1, which was removed by CR 6733. In CR 6627, the
Centers for Medicare & Medicaid Services (CMS) inadvertently changed the
billing instructions for reassigned services in a way that is not supported
by CMS’s systems or Medicare policy. This CR corrects this error and
reinstates the instructions in place prior to the implementation of CR
6627. Providers are encouraged to review the information and to share with
their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/86QLBQ7311?opendocument

Signature Guidelines for Medical Review Purposes
This J1 A/B MAC MLN Matters article (CR6698b) was revised on June 16, 2010,
to include a table excerpt on pages six through seven from CR 6698 that
summarizes signature requirements. This article clarifies for providers how
Medicare claims review contractors review claims and medical documentation
submitted by providers. CR 6698 outlines the new rules for signatures and
adds language for e-prescribing. See the rest of this article for complete
details. These revised/new signature requirements are applicable for
reviews conducted on or after the implementation date of April 16, 2010.
Please note that all signature requirements in CR 6698 are effective
retroactively for Comprehensive Error Rate Testing (CERT) for the November
2010 report period. Providers are encouraged to review the information and
to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/86RMPR2435?opendocument

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Palmetto/J1MAC News

2010-06-24T07:20:00.001-07:00

The following information has been received by ANCO.

****PALMETTO/J1MAC NEWS****
J1 Part A and Part B LCDs Comment Periods Start
The comment period of the J1 Part A Local Coverage Determination (LCD),
Ambulance Services DL31250, will begin on July 8, 2010 and end on August
30, 2010. The comment period of the following J1 Part B LCDs will begin on
July 9, 2010 and end on August 30, 2010: Bladder Tumor Markers DL31302 and
Posterior Tibial Nerve Stimulation (PTNS) for Urinary Control DL31287.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/86HM4Z6685?opendocument

One-Time Mailing of Solicitation Letter to Physicians and Non-Physician
Practitioners Who Are Currently Enrolled In Medicare But Who Do Not Have
Enrollment Records In The Provider Enrollment, Chain and Ownership System
(PECOS)
This J1 A/B MAC MLN Matters article (CR6842) advises you that your Medicare
contractor will be mailing the letter shown in the attachment to CR 6842 if
you do not have a record in PECOS. The letter will request that you take
the steps to establish such a record and will explain how to do so. It is
important that you maintain your enrollment information to ensure you are
eligible for future Medicare initiatives and incentives. The letter will
explain that Medicare records indicate you do not have an enrollment record
in PECOS because you enrolled in Medicare prior to implementation of PECOS
and you have not submitted any updates or changes to your Medicare
enrollment information in the past six (or more) years. Providers are
encouraged to review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/86HQZQ7533?opendocument

J1 Open Draft LCD Meeting: California, July 13, 2010
Palmetto GBA J1 A/B MAC will host an Open Draft Local Coverage
Determination (LCD) meeting for both Part A and Part B in California, from
9 a.m. to 11 a.m. PST on July 13, 2010. The general public is invited to
submit information related to the proposed LCDs for Palmetto GBA's
consideration. To register, please visit our Workshops database. If you
will not be able to come to the meeting, please call (866) 628-8620 with
Conference ID 403971 to particpate.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7TKQ3P7107?opendocument

J1 Part A and Part B LCDs Comment Periods Start
The comment period of the J1 Part A Local Coverage Determination (LCD),
Ambulance Services DL31250, will begin on July 8, 2010 and end on August
30, 2010. The comment period of the following J1 Part B LCDs will begin on
July 9, 2010 and end on August 30, 2010: Bladder Tumor Markers DL31302 and
Posterior Tibial Nerve Stimulation (PTNS) for Urinary Control DL31287.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/86HM4Z6685?opendocument

J1 PCC Closed for Training June 25
The J1 Provider Contact Center (PCC) will be closed for training on Friday,
June 25, 2010, from 11 a.m. to 3 p.m. PST.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/86NLDQ5271?opendocument

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ACCC, CMA, & Palmetto/J1MAC News

2010-06-18T06:31:00.000-07:00

ASH & Palmetto/J1MAC News

2010-06-13T08:05:00.000-07:00

Palmetto/J1MAC News

2010-06-10T09:03:00.000-07:00

The following information has been received by ANCO.

****PALMETTO/J1MAC NEWS****
J1 Part B LCDs Update
Share with your staff - The following J1 Part B LCDs have been revised: In
Vitro Chemosensitivity & Chemoresistance Assays L30697 and Physical
Medicine and Rehabilitation Policy L28290.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/868ST27336?opendocument

Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 16.2,
effective July 1, 2010
This J1 Part B MLN Matters article (CR6930) 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 April 2010. Providers are encouraged to review the information
and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/863MSV2227?opendocument

Updated Form CMS 1500 Information
This J1 Part B MLN Matters article (CR6929) updates Form CMS 1500
information in the Medicare Claims Processing Manual by removing language
allowing the use of legacy identifiers and making other technical
corrections as a result of that change. As part of this update, providers
are reminded that they are responsible for purchasing their own CMS 1500
forms. Forms can be obtained from printers or printed in-house as long as
the forms follow the specifications approved by the Centers for Medicare &
Medicaid Services (CMS) as developed by the American Medical Association
(AMA). Providers are encouraged to review the information and to share with
their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/864MT86566?opendocument

Get ready for 2010 MACtoberfest October 27-29
Save the date for MACtoberfest, our largest educational and networking
event of the year! Join us October 27-29 in California and receive
Continuing Education Unit (CEU) credits for all the sessions you complete.
Look out for more details on our J1 Part A or Part B Web sites in the next
few weeks.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/867R3X8418?opendocument

J1 PCC Closed for Training Friday, June 11
The J1 Provider Contact Center (PCC) will be closed for training from 11
a.m. to 3 p.m. PST on Friday, June 11, 2010.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/867RFC3500?opendocument

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ACCC, CMA, & Palmetto/J1MAC News

2010-06-03T07:28:00.000-07:00

ASH & Palmetto/J1MAC News

2010-06-01T07:49:00.000-07:00

ACCC, CMA, CMS, & Palmetto/J1MAC News

2010-05-25T07:33:00.000-07:00

Palmetto/J1MAC News

2010-05-17T07:10:00.000-07:00

The following information has been received by ANCO.

****PALMETTO/J1MAC NEWS****
Certain Clinical Lab Services Rejected Incorrectly
This Alert announces that changes to the anti-markup payment limitation
editing (a.k.a., purchased service) were implemented on April 5, 2010. For
certain electronic claims that contained reference lab services and a
purchased service amount, the system was misreading pricing information in
Loop 2400, segment PS102 as blank. This caused services to reject when an
actual amount was present. A mass adjustment will be performed for any
electronic claim rejected with remittance advice remark code MA111
processed between April 5 and April 29. Please be sure to share with your
staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/857QVV7435?opendocument

Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC)
and Medicare Remit Easy Print (MREP) Update
This J1 A/B MAC MLN Matters article (CR6901) announces the latest update of
Remittance Advice Remark Codes (RARCs) and Claim Adjustment Reason Codes
(CARCs), effective July 1, 2010. The reason and remark code sets must be
used to report payment adjustments in remittance advice transactions. The
reason codes are also used in some coordination-of-benefits (COB)
transactions. The RARC list is maintained by the Centers for Medicare and
Medicaid Services (CMS), and used by all payers. Additions, deactivations
and modifications to it may be initiated by any health care organization.
The RARC and CARC lists are updated three times a year – March, July and
November. Providers are encouraged to review the information and to share
with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/85CKES1183?opendocument

Hold the Date: The CMS 2010 ICD-10/5010 National Provider Conference Call
The Centers for Medicare & Medicaid Services (CMS) will host a national
provider conference call on ‘ICD-10 Implementation in a 5010 Environment’
on Tuesday, June 15, 2010 from 12 p.m. to 2 p.m. EDT. The target audience
for this call includes: medical coders, physician office staff and provider
billing staff, health records staff, vendors, educators, system maintainers
and all Medicare fee-for-service (FFS) providers. Registration information
for this national provider conference call will be announced soon, so hold
the June 15th date now for this informative provider conference call.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/85DNW82261?opendocument

Change in the Amount in Controversy (AIC) Requirement for Administrative
Law Judge Hearings and Federal District Court Appeals
This J1 A/B MAC MLN Matters article (CR6894) notifies Medicare contractors
of the Amount in Controversy (AIC) required to sustain Administrative Law
Judge (ALJ) and Federal District Court appeal rights beginning January 1,
2010. The amount remaining in controversy requirement for ALJ hearing
requests made before January 1, 2010, is $120. The amount remaining in
controversy requirement for requests made on or after January 1, 2010, is
$130. For Federal District Court review, the amount remaining in
controversy goes from $1,220 for requests on or after January 1, 2009, to
$1,260 for requests on or after January 1, 2010. Providers are encouraged
to review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/85EJGY7540?opendocument

Enhancements to Home Health (HH) Consolidated Billing Enforcement
This J1 A/B MAC MLN Matters article (CR6911) announces that the Centers for
Medicare & Medicaid Services (CMS) is updating edit criteria related to the
consolidated billing provision of the Home Health Prospective Payment
System (HH PPS). It is also creating a new file of HH certification
information to assist suppliers and providers subject to HH consolidated
billing. Effective October 1, 2010, CMS is implementing new requirements to
modify this edit in order to restore the original intent to pay for
supplies delivered before the HH episode began. Such supplies may have been
ordered before the need for HH care had been identified, and are
appropriate for payment if all other payment conditions are met. The edit
will be changed to only reject services if the ‘from’ date on the supply
line item falls within a HH episode. Providers are encouraged to review the
information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/85CK9G6155?opendocument

Medicare Physician Fee Schedule: Implementation of the Patient Protection
and Affordable Care Act and Health Care and Education Reconciliation Act of
2010
The Medicare Physician Fee Schedule is being updated to include certain
corrections, retroactive to January 1, 2010, as prescribed in recently
published notices in the Federal Register. Once Palmetto GBA has the new
payment files in place, all claims going forward will be processed at the
revised rates. However, CMS will continue to work on the best way to
address the many claims that are paid at the rates that were in place
before the current corrections and updates are made. Please be on the alert
for further information about how CMS will address past claims. Until then,
providers should NOT resubmit previously-processed claims affected by the
payment changes, as it is likely that these resubmissions may be denied as
duplicate claims.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/85FJXG4223?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!

ASH, CMS, & Palmetto/J1MAC News

2010-05-13T07:20:00.000-07:00

ACCC, CMA, CMS, & Palmetto/J1MAC News

2010-05-07T06:55:00.000-07:00

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-5-5-2010.html. ANCO is an Institutional Member of ACCC. This edition features:

• ACCC to Study In-Office Dispensing Pharmacies

• 13 ACCC-Member Cancer Programs Added to NCCCP

• FDA Conducting Safety Review of Commonly Used Prostate Cancer Drugs

• Heard on ACCC's ListServ: Shifts in Chemotherapy Reimbursement?

• Costs and Use of Diagnostic Imaging Rise Among Medicare Patients

• ACCC's CE Blackboard: New Multiple Myeloma CE Programs Available

****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:

• Have You Checked Your Medical Board Profile Recently?

• Faulty Blue Shield Physician Ratings Go Public on June 1

• California Physicians Will Receive One-TIme Licensing Fee Credit

• FTC Red Flagg Rules Take Effect June 1

• Some Private Payors Changing Consultation Code Payment Policies

• CMA Foundation Announces Increased Funding for Medical Student-Run Clinics

• Deadline to Nominate a Colleague for the CMA Foundation Leadership Awards is June 30

• May Issue of CMA Practice Resources (CPR) Now Available

• Have You SIgned the Medicare Petition?

****CMS NEWS****
MM6911 – Enhancements to Home Health (HH) Consolidated Billing Enforcement
http://www.cms.gov/MLNMattersArticles/downloads/MM6911.pdf

MM6964 – Changes to the Laboratory National Coverage Determination (NCD) Edit Software for July 2010
http://www.cms.gov/MLNMattersArticles/downloads/MM6964.pdf

MM6950 – Medicare Benefits Policy Manual Update – Determining Self-Administration of Drug or Biological
http://www.cms.gov/MLNMattersArticles/downloads/MM6950.pdf

MM6711 – Discarded Drugs and Biologicals Updates
http://www.cms.gov/MLNMattersArticles/downloads/MM6711.pdf

The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host a national provider conference call on the 2010 Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (eRx). This toll-free call will take place from 1:30 p.m. – 3:00 p.m., EDT, on Wednesday, May 12, 2010.

The PQRI is voluntary quality reporting program that provides an incentive payment to identified individual eligible professionals (EPs), and beginning with the 2010 PQRI, group practices who satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-For-Service (FFS) beneficiaries.

The PQRI was first implemented in 2007 as a result of section 101 of the Tax Relief and Health Care Act of 2006 (TRHCA), and further expanded as a result of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), and the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). The eRx Incentive Program is an incentive program for eligible professionals initially implemented in 2009 as a result of section 132(b) of the MIPPA. The eRx Incentive Program promotes the adoption and use of eRx systems by individual eligible professionals (and beginning with the 2010 eRx Incentive Program, group practices).

Following a few program announcements and updates, the lines will be opened to allow participants to ask questions of CMS PQRI and eRx subject matter experts.

Educational products are available on the PQRI dedicated web page located at http://www.cms.hhs.gov/PQRI , on the CMS website, in the Educational Resources section, as well as educational products are available on the eRx dedicated web page located at http://www.cms.hhs.gov/ERxIncentive on the CMS website. Feel free to download the resources prior to the call so that you may ask questions of the CMS presenters.

Conference call details:

Date: May 12, 2010

Conference Title: Physician Quality Reporting Initiative (PQRI) - National Provider Call

Time: 1:30 p.m. EDT

In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation.

Registration will close at 1:30 p.m. EDT on Tuesday, May 11, 2010, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.

To register for the call participants need to go to:
http://www.eventsvc.com/palmettogba/051210

Fill in all required data.

Verify that your time zone is displayed correctly in the drop down box.

Click "Register".

You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.

For those of who will be unable to attend, a transcript of the call will be available at least one week after the call at http://www.cms.hhs.gov/pqri on the CMS website.

If you require services for the hearing impaired please send an email to:Medicare.TTT@PalmettoGBA.com.

****PALMETTO/J1MAC NEWS****
J1 Provider Outreach and Education Event Calendar
The Palmetto GBA J1 May 2010 Event Calendar is now available on our Web
site. If you are not able to register for our Spring Workshop Tour in your
area, check out the Event Calendar for another session located near you.
Remember, you can always attend our regular monthly Webinars and/or Ask the
Contractor Teleconferences (ACT) on popular Medicare topics.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7TAL2C7131?opendocument

2010 Physician Quality Reporting Initiative National Provider Call to be
held on May 12, 2010
The Centers for Medicare & Medicaid Services' (CMS) Provider Communications
Group will host a national provider conference call on the 2010 Physician
Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive
Program (eRx). This toll-free call will take place from 1:30 p.m. to 3
p.m., EDT, on Thursday, May 12, 2010.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/855L3Z1630?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!

CMS & Palmetto/J1MAC News

2010-05-03T07:47:00.000-07:00

The following information has been received by ANCO.

****CMS NEWS****
MM6760 – Use of 12X Type of Bill (TOB) for Billing Colorectal Screening Services
http://www.cms.gov/MLNMattersArticles/downloads/MM6760.pdf

MM6916 – Skilled Nursing Facility (SNF) Health Insurance Prospective Payment System (HIPPS) Coding Updates Effective October 1, 2010
http://www.cms.gov/MLNMattersArticles/downloads/MM6916.pdf

****PALMETTO/J1MAC NEWS****
J1 Part B Medical Review Progressive Corrective Action (PCA) Process
Curious about the Medical Review Progressive Corrective Action (PCA)
Process? This article explains what the process does and the important
procedures to follow.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84WQNH6286?opendocument

Underpayments - Third Notification for FY 2010
This article announces that Medicare Regulation 42 CFR §405.378 provides
for the assessment of interest at the higher of the current value of funds
rate of one percent for calendar year 2010 or the private consumer rate as
fixed by the Department of the Treasury. The Department of the Treasury has
notified the Department of Health and Human Services that the private
consumer rate has been changed to 10.875 percent effective April 23, 2010,
for Medicare overpayments and underpayments. Providers are encouraged to
review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84XLFW1866?opendocument

CMS-588 Electronic Funds Transfer (EFT) Registration Form
The Centers for Medicare & Medicaid Services (CMS) received approval from
the Office of Management and Budget to re-issue the EFT authorization
agreement. Providers and suppliers may begin using the revised EFT form
immediately, though Palmetto GBA shall continue to accept the previous
version of the EFT authorization agreement until January 1, 2011. This new
interactive form is now easier and simpler to use, with clarified
instructions.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84YLKM1010?opendocument

Drugs Administered Through An Implantable Infusion Pump
This Alert announces that the Implantable Infusion Pump for Treatment of
Chronic Intractable Pain LCD (L28268) and the associated article (A49293)
requires providers to submit an invoice for all drugs administered through
the pump. Drugs compounded by a pharmacy, should be submitted with HCPCS
code J3490. J3490 should be submitted one time with the total charge for
all drugs administered. Services submitted incorrectly will be rejected or
denied. Any services submitted incorrectly which resulted in an overpayment
may be recouped. Providers are encouraged to review this information and
the outlined articles, and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84YJZS6612?opendocument

Signature Guidelines for Medical Review Purposes
This J1 A/B MAC MLN Matters article (CR6698a) was revised and re-issued on
April 26, 2010, to include additional clarifying language from CR 6698.
This article clarifies for providers how Medicare claims review
contractors, review claims and medical documentation submitted by
providers. CR 6698 outlines the new rules for signatures and adds language
for Electronic prescribing (e-prescribing). These revised/new signature
requirements are applicable for reviews conducted on or after the
implementation date of April 16, 2010. Please note that all signature
requirements in CR 6698 are effective retroactively for Comprehensive Error
Rate Testing (CERT) for the November 2010 report period. Providers are
encouraged to review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84XPYG2484?opendocument

J1 Part B PPTN ID Request Form
The PPTN ID Request Form is a new online enrollment option for
Jurisidiction 1 Part B providers to request acces to the Professional
Provider Telecommunications Network (PPTN).
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84XMBT0432?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!

ASH & Palmetto/J1MAC News

2010-04-29T07:39:00.000-07:00

The following information has been received by ANCO.

All ANCO Online LIstServ postings are archived at the ANCO Online ListSev blog available online at http://anco-online.blogspot.com/.

****ASH NEWS****
The American Society of Hematology's (ASH) Practice Update was published and is available online at http://www.hematology.org/Practice/Practice-Updates/5120.aspx. This edition features:

• Please Complete a Brief Survey on Consult Code Elimination

• Congress Passes Another Short-Term Extension of the 2009 Medicare Physician Payment Rates to Restore 21 Percent Cut

• FDA Provides New Data About Revised USP Unit for Heparin

• Medicare to Host Conference Calls About the Recovery Audit Contracts (RAC) Program

• FDA Announces Drug Shortage of Mustargen

****CMS NEWS****
MM6698 – Signature Guidelines for Medical Review Purposes
http://www.cms.gov/MLNMattersArticles/downloads/MM6698.pdf

****PALMETTO/J1MAC NEWS****
May 2010 J1 A/B MAC Medicare Advisory
The May 2010 J1 A/B MAC MedicAre Advisory is now available on the Web site.
Providers are encouraged to review the information and to share with their
staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84RL2A3307?opendocument

Medicare Providers: What You Need to Know About Signatures & Documentation
In the past year, Palmetto GBA has seen an escalating number of errors
assessed by the Comprehensive Error Rate Testing (CERT) Review Contractor
due to signature problems on practitioners’ medical records, x-ray reports
and laboratory/radiology orders. The discovery of CERT errors may lead to
increased scrutiny of future services billed to Medicare. Your support and
understanding of this important issue are essential to ensuring the
accuracy of Medicare claims. We encourage you to share this information
with your staff in support of our efforts to assure that claims and
supporting documentation are properly indicated on claims submissions or
redetermination requests.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84VQSL3077?opendocument

ACCC, CMA, & Palmetto/J1MAC News

2010-04-22T08:02:00.000-07:00

CMS & Palmetto/J1MAC News

2010-04-19T07:44:00.000-07:00

The following information has been received by ANCO.

****CMS NEWS****
On April 15, 2010, President Obama signed into law the “Continuing Extension Act of 2010.” This law extends through May 31, 2010, the zero percent update to the MPFS that was in effect for claims with dates of service January 1, 2010, through March 31, 2010. The law is retroactive to April 1, 2010. Consequently, effective immediately, claims with dates of service April 1 and later which were being held by Medicare contractors are being released for processing and payment. Please keep in mind that the statutory payment floors still apply and, therefore, clean electronic claims cannot be paid before 14 calendar days after the date they are received by Medicare contractors (29 calendar days for clean paper claims).

Please watch your listservs and your contractor’s website for more information.

****PALMETTO/J1MAC NEWS****
On April 15, 2010, President Obama signed into law the "Continuing Extension Act of 2010." This law extends through May 31, 2010, the zero percent update to the MPFS that was in effect for claims with dates of service January 1, 2010 through March 31, 2010. The law is retroactive to April 1, 2010. Consequently, effective immediately, claims with dates of service April 1 and later, which were being held by Medicare contractors, are being released for processing and payment. Please keep in mind that the statutory payment floors still apply and, therefore, clean electronic claims cannot be paid before 14 calendar days after the date they are received by Medicare contractors (29 calendar days for clean paper claims).

Given the uncertainty regarding MPFS claims with dates of service June 1, 2010, and later, please watch your listservs and your contractor's website for more information.

J1 Part B LCDs Updates
The following J1 Part B Local Coverage Determinations (LCDs) have been
revised: Flow Cytometry L30692, In Vitro Chemosensitivity & Chemoresistance
Assays L30697 and CT Colonography (Virtual Colonoscopy) L28250.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84HR646420?opendocument

PC-ACE Pro32 version 2.20 Update File
PC-ACE Pro32 software has been updated to version 2.20 with several CMS
Medicare mandates and enhancements. All PC-ACE Pro32 users must download
and install the attached software update file immediately.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84FRCM4526?opendocument

Medicare Medical Records: Signature Requirements Acceptable and
Unacceptable Practices
While CMS guidelines mandate the presence of signatures specifically for
all 'medical review' purposes, modifiers, etc., records pertaining to any
procedures billed to Medicare are potentially subject to review by not only
Palmetto GBA, but other CMS contractors. Because of this, we are alerting
you to the importance of these signature requirements and if changes are
needed, we suggest you take immediate action. The contents of this article
are applicable to Medicare claims with dates of service on or after March
1, 2010, processed by or medical record submitted to Palmetto GBA for
Medical Review purposes on or after April 16, 2010.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84HT746343?opendocument

The Continuing Extension Act of 2010 Extends Zero Percent Medicare
Physician Fee Schedule (MPFS) Update
On April 15, 2010, President Obama signed into law the 'Continuing
Extension Act of 2010.' This law extends through May 31, 2010, the zero
percent update to the MPFS that was in effect for claims with dates of
service January 1, 2010 through March 31, 2010. The law is retroactive to
April 1, 2010. Consequently, effective immediately, claims with dates of
service April 1 and later, which were being held by Medicare contractors,
are being released for processing and payment. Please keep in mind that the
statutory payment floors still apply and, therefore, clean electronic
claims cannot be paid before 14 calendar days after the date they are
received by Medicare contractors (29 calendar days for clean paper claims).
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84KMXM0885?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!

CMS & Palmetto/J1MAC News

2010-04-15T07:56:00.000-07:00

The following information has been received by ANCO.

****CMS NEWS****
The Centers for Medicare & Medicaid Services (CMS) has called a public meeting of the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) on Wednesday, April 21, 2010. The Committee generally provides advice and recommendations concerning the adequacy of scientific evidence needed to determine whether certain medical items and services can be covered under the Medicare statute. This meeting will examine currently available evidence on the use of Radiation Therapy for Localized Prostate Cancer. This meeting is open to the public in accordance with the Federal Advisory Committee Act (5 U.S.C. App. 2, section 10(a)).
CMS is hosting a webinar for this meeting. Webinar participants will be able to view presentations and will be connected to live audio. However, live video will not be streamed. Attendance is limited and requires registration. Registration will be closed at 5pm eastern time on April 19, 2010. Participants should be advised that the webinar is a listening only session; that is, no questions or interactions will be permitted and all lines will be muted.
Date: Wednesday, April 21, 2010
Time: 7:50am -8:00am, Eastern (Webinar Login)
8:00am-4:30pm, Eastern (Live MEDCAC Meeting)
Please register by going to this link (there is no cost to register):
https://webinar.cms.hhs.gov/_a7/medcacprostate421/event/registration.html
You will be required to develop a password. Passwords must be 8-32 characters, and contain at least one capital letter and one number.

MM6472 – Implementation of the Health Insurance Portability and Accountability Act (HIPAA) Version 005010 Medicare Administrative Contractors Requirements
http://www.cms.gov/MLNMattersArticles/downloads/MM6472.pdf

MM6896 – Update to the Medicare Claims Processing Manual (Publication 100-04, Chapter 15, Section 40)
http://www.cms.gov/MLNMattersArticles/downloads/MM6896.pdf

MM6870 – Reporting of Recoupment for Overpayment on the Remittance Advice (RA)
http://www.cms.gov/MLNMattersArticles/downloads/MM6870.pdf

SE1011 – Edits on the Ordering/Referring Providers in Medicare Part B Claims (Change Requests 6417, 6421, and 6696)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE1011.pdf

MM6696 – Ordering/Referring Providers Who Are Not Enrolled in Medicare
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6696.pdf

SE0931 – Sections 3103 and 3104 of the Patient Protection and Affordable Care Act (PPACA) Extends Certain Payment Provisions Under the Medicare Program Related to Therapy Cap Exceptions and the Billing by Independent Laboratories for the Technical Component of Physician Pathology Services Furnished to Hospital Patients
http://www.cms.gov/MLNMattersArticles/downloads/SE0931.pdf

MM6417 – Expansion of the Current Scope of Editing for Ordering/Referring Providers for claims processed by Medicare Carriers and Part B Medicare Administrative Contractors (MACs)
http://www.cms.gov/MLNMattersArticles/downloads/MM6417.pdf

MM6698 – Signature Guidelines for Medical Review Purposes
http://www.cms.gov/MLNMattersArticles/downloads/MM6698.pdf

The Centers for Medicare & Medicaid Services (CMS) will be hosting its fifth national provider call regarding the implementation of HIPAA Version 5010. There will be a brief presentation given by CMS followed by a Q&A session with CMS subject matter experts. Please note that this call is geared towards vendors, clearinghouses, and providers who are performing their own development of 5010.

Subject: Medicare Fee-For-Service Implementation of HIPAA version 5010 For Eligibility Inquiry and Response, 270/271 Transaction

Agenda:
· General Overview
· Medicare Specific Changes
o Service Type Codes
o Patient Matching Rules
o Error Handling
o Response Changes
· Timelines and Deadlines
· What you need to do to prepare
· 270/271 Errata
· Q & A

Conference call details:

Date: April 28, 2010
Conference Title: HIPAA Version 5010 national provider call: CMS’ discussion of Eligibility Inquiry and Response, 270/271 Transaction

Time: 2:00 p.m. – 3:30 p.m. ET

In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation.

Registration will close at 2:00 p.m. ET on April 27, 2010, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.

1. To register for the call participants need to go to: http://www.eventsvc.com/palmettogba/042810
2. Fill in all required data.
3. Verify your time zone is displayed correctly the drop down box.
4. Click "Register".
5. You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.

The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host a national provider conference call on the 2010 Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (eRx). This toll-free call will take place from 3:30 p.m. – 5:00 p.m., EDT, on Thursday, April 15, 2010.

The PQRI is voluntary quality reporting program that provides an incentive payment to identified individual eligible professionals (EPs), and beginning with the 2010 PQRI, group practices who satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-For-Service (FFS) beneficiaries.

The PQRI was first implemented in 2007 as a result of section 101 of the Tax Relief and Health Care Act of 2006 (TRHCA), and further expanded as a result of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), and the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).

The eRx Incentive Program is an incentive program for eligible professionals initially implemented in 2009 as a result of section 132(b) of the MIPPA. The eRx Incentive Program promotes the adoption and use of eRx systems by individual eligible professionals (and beginning with the 2010 eRx Incentive Program, group practices).

Following a few program announcements and updates, the lines will be opened to allow participants to ask questions of CMS PQRI and eRx subject matter experts.

Educational products are available on the PQRI dedicated web page located at http://www.cms.hhs.gov/PQRI , on the CMS website, in the Educational Resources section, as well as educational products are available on the eRx dedicated web page located at http://www.cms.hhs.gov/ERxIncentive on the CMS website. Feel free to download the resources prior to the call so that you may ask questions of the CMS presenters.

Conference call details:

Date: April 15, 2010

Conference Title: Physician Quality Reporting Initiative (PQRI) - National Provider Call

Time: 3:30 p.m. EDT

In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation. Registration will close at 3:30 p.m. EDT on April 14, 2010, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.

To register for the call participants need to go to: http://www.eventsvc.com/palmettogba/041510

Fill in all required data.

Verify that your time zone is displayed correctly in the drop down box.

Click "Register".

You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.

For those of who will be unable to attend, a transcript of the call will be available at least one week after the call at http://www.cms.hhs.gov/pqri on the CMS website.

If you require services for the hearing impaired please send an email to: Medicare.TTT@PalmettoGBA.com.

****PALMETTO/J1MAC NEWS****
Potential Overpayment on Services Submitted with Inpatient/Outpatient Place
of Service
This Alert announces that auditing is set up in our system to deny services
for Global and TC components when billed in specified inpatient or
outpatient settings and pathological lab services in inpatient or
outpatient settings. Claims with dates of service on or after March 30,
2009, could have been incorrectly paid and should have been denied as Part
A charges. A mass adjustment is being performed to recover the
overpayments. Providers are encouraged to review the information and to
share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84CRMB1010?opendocument

Sections 3103 and 3104 of the Patient Protection and Affordable Care Act
(PPACA) Extends Certain Payment Provisions Under the Medicare Program
Related to Therapy Cap Exceptions and the Billing by Independent
Laboratories for the Technical Component of Physician Pathology Services
Furnished to Hospital Patients
This special edition article is being re-issued by the Centers for Medicare
& Medicaid Services (CMS) to notify affected providers that a number of
Medicare payment provisions, such as the Therapy Cap Exceptions Process and
Allowing Independent Laboratories to Bill for the Technical Component of
Physician Pathology Services Furnished to Hospital Patients, have been
extended as a result of the Patient Protection and Affordable Care Act
(PPACA). Previously, these provisions were to sunset as of December 31,
2009.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84CRYQ1687?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!

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

2010-04-09T06:52:00.000-07:00

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-4-7-2010.html. ANCO is an institutional member of ACCC. This edition features:

• Tuesday, April 13th, Conference Call: Healthcare Reform and Oncology

• New Education Program to Study Challenges in Treating Small-Population Cancers in the Community Setting

• Heard on ACCC's ListServ: Breast Center and Physicians' Time

• Healthcare Reform Establishes New Requirements for Tax-Exempt Hospitals

• Improving the Efficiency of Clinical Trials: Decreasing Times by 50%

• Medicare Will Cover PET Scans to Detect Bone Metastasis of Cancer Under CED Only

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

• Physician Payment Cuts Began April 1: CMS Holding Medicare Claims for the First 10 Days of April to Avoid Disruption
• Historic Health Reform Legislation Signed Into Law

• President Obama to Nominate Dr. Donald Berwick for CMS Administrator

• WinRho Box Warning Creates Reimbursement Implications

• 2010 PQRI & E-Prescribing Incentive Program National Provider Call With Q & A Session

• Patients Who Take a Proton-Pump Inhibitor With Medicine to Prevent Blood Clots Are Less Likely to Be Hospitalized for Bleeding Ulcers

Few Days Left to Register in Advance for Highlights of ASH® Latin America

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

• Deep Medicare Cuts Took Efect April 1; CMS Orders Temporary Payment Hold

• Superior Court Judge Overturns Medical Board Furloughs; Appeals Court Temporarily Stays Ruling

• Field Poll: California's Don't Support Health Care Cuts

• Joint Commission Approves New Medical Staff Standard

• How Will Health Care Reform Affect Your Practice?

• Nominate an Outstanding Colleague for the CMA Foundation Leadership Awards

• Register Today for CMA's 36th Annual Legislative Leadership Conference

• First Issue of CMA's New Practice Management Bulletin Now Available

• Physician Billing Staff: Become a Certified Coder

****CMS NEWS****
The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host a national provider conference call on the 2010 Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (eRx). This toll-free call will take place from 3:30 p.m. – 5:00 p.m., EDT, on Thursday, April 15, 2010.

The PQRI is a voluntary quality reporting program that provides an incentive payment to identified individual eligible professionals (EPs), and beginning with the 2010 PQRI, group practices who satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-For-Service (FFS) beneficiaries.

The PQRI was first implemented in 2007 as a result of section 101 of the Tax Relief and Health Care Act of 2006 (TRHCA), and further expanded as a result of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), and the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).

The eRx Incentive Program is an incentive program for eligible professionals initially implemented in 2009 as a result of section 132(b) of the MIPPA. The eRx Incentive Program promotes the adoption and use of eRx systems by individual eligible professionals (and beginning with the 2010 eRx Incentive Program, group practices).

Following a few program announcements and updates, the lines will be opened to allow participants to ask questions of CMS PQRI and eRx subject matter experts.

Educational products are available on the PQRI dedicated web page located at http://www.cms.hhs.gov/PQRI , on the CMS website, in the Educational Resources section, as well as educational products are available on the eRx dedicated web page located at http://www.cms.hhs.gov/ERxIncentive on the CMS website. Feel free to download the resources prior to the call so that you may ask questions of the CMS presenters.

Conference call details:

Date: April 15, 2010

Conference Title: Physician Quality Reporting Initiative (PQRI) - National Provider Call

Time: 3:30 p.m. EDT

In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation. Registration will close at 3:30 p.m. EDT on April 14, 2010, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.

To register for the call participants need to go to:
http://www.eventsvc.com/palmettogba/041510

Fill in all required data.

Verify that your time zone is displayed correctly in the drop down box.

Click "Register".

You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.

For those of who will be unable to attend, a transcript of the call will be available at least one week after the call at http://www.cms.hhs.gov/pqri on the CMS website.

If you require services for the hearing impaired please send an email to: Medicare.TTT@PalmettoGBA.com.

The Centers for Medicare & Medicaid Services (CMS) has released a Special Edition MLN Matters article that provides guidance on the edits required to be identified in Part B claims from Medicare providers or suppliers who furnish items or services as a result of orders or referrals. Medicare providers and suppliers who order or refer items or services for Medicare beneficiaries must submit an enrollment application to Medicare by using Internet-based Provider Enrollment, Chain and Ownership System (PECOS), or by completing the paper enrollment application (CMS-855I). The article, SE1011, “Edits on the Ordering/Referring Providers in Medicare Part B Claims (Change Requests 6417, 6421, and 6696),” is available at http://www.cms.gov/MLNMattersArticles/downloads/SE1011.pdf on the CMS website.

The Centers for Medicare & Medicaid Services (CMS) changed its website address from www.cms.hhs.gov towww.cms.gov. Existing bookmarks and links from other websites will continue to work following this address change.

****DMHC/MediCal NEWS****
The eTAR application is an easy, effective, fast and free way to submit TARs. Providers that utilize the eTAR application are generally more successful when submitting TARs. Most Medi-Cal providers are activated to use eTAR. To verify access, go to www.medi-cal.ca.gov, select the Transactions tab and log in with your NPI and PIN. An eTAR tab with options for Medical Services will be available. If you do not have access or only see options for Inquire only, please contact Medi-Cal at 1-800-541-5555 and follow the prompts for eTAR to request access.

The eTAR training team would like to extend an invitation to access the free learning tools available to all Medi-Cal providers. The eTAR Program Information webpage (www.medi-cal.ca.gov/go/etarhttp://www.medi-cal.ca.gov/go/etar) contains information useful to both new and experienced providers. Web based tutorials are available on this webpage to provide step-by-step instructions on how to submit eTARs and attachments, as well as update and inquire on previously submitted TARs This newly updated webpage also contains Medical and Pharmacy eTAR training dates, provider bulletins and helpful tips and pointers for both Medical and Pharmacy eTAR providers.

The following list contains the free Medi-Cal seminars where eTAR classes are taught. Parking fees may apply. For more information about training seminars, please visit the Medi-Cal Web site.

Fresno: April 13, 14, 15*
Fresno Convention Centerhttp://www.fresnoconventioncenter.com/index2.asp
800 M Street
Fresno, CA 93721
(559) 445-8100

Anaheim: June 2*, 3, 4
Anaheim Convention Centerhttp://www.anaheimconventioncenter.com/>\
800 West Katella Avenue
Anaheim, CA 92802
714-765-8950

An asterisk (*) indicates a Pharmacy eTAR class will also be held that day.

Regional representatives are available to provide one-on-one trainings to assist providers in learning how to use the eTAR application. To request free onsite training from a regional representative, please contact Medi-Cal at 1-800-541-5555.

****PALMETTO/J1MAC NEWS****
Ancillary Services Rejected Incorrectly
This Alert announces that some services have been rejected in error due to
the set up of various surgical services and related ancillary services.
Palmetto GBA is in the process of correcting this issue. When the issue is
resolved, a mass adjustment will be performed for any services rejected
incorrectly. Providers are encouraged to review the information and to
share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/848NKB3361?opendocument

Claim Status Category Code and Claim Status Code Update
This J1 A/B MAC MLN Matters article (CR6859) explains that the Claim Status
Codes and Claim Status Category Codes for use by Medicare contractors with
a specified Health Claim Status Request and Response were updated during
the January 2010 meeting of the National Code Maintenance Committee. Code
changes approved at that meeting were posted on the Internet on or about
March 1, 2010. At the January 2010 meeting, the committee also decided to
allow the industry six months for implementation of newly added or changed
codes. 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 July 6, 2010. Providers are encouraged to review
the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/848PP66217?opendocument

J1 Provider Outreach and Education Event Calendar
Check out the updated Palmetto GBA J1 Provider Outreach and Education April
2010 Calendar on our Web site! Besides our Spring Workshop Tour, there are
other training opportunities in April that you might be interested in.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7TAL2C7131?opendocument

Sign up for the J1 Spring Workshop Tour Today
The J1 Spring Workshop Tour kicks off next Friday! If you have not already,
sign up today to reserve your seat at these educational events where our
ombudsmen present useful information on Medicare policy updates and tools
to your region.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/84AP4L7644?opendocument

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CMS & Palmetto/J1MAC News

2010-04-05T10:52:00.000-07:00

The following information has been received by ANCO.

****CMS NEWS****
On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA), which amended the time period for filing Medicare fee-for-service (FFS) claims as one of many provisions aimed at curbing fraud, waste, and abuse in the Medicare program.

The time period for filing Medicare FFS claims is specified in Sections 1814(a), 1835(a)(1), and 1842(b)(3) of the Social Security Act and in the Code of Federal Regulations (CFR), 42 CFR Section 424.44. Section 6404 of the PPACA amended the timely filing requirements to reduce the maximum time period for submission of all Medicare FFS claims to one calendar year after the date of service.

Under the new law, claims for services furnished on or after January 1, 2010, must be filed within one calendar year after the date of service. In addition, Section 6404 mandates that claims for services furnished before January 1, 2010, must be filed no later than December 31, 2010. The following rules apply to claims with dates of service prior to January 1, 2010. Claims with dates of service before October 1, 2009, must follow the pre-PPACA timely filing rules. Claims with dates of service October 1, 2009, through December 31, 2009, must be submitted by December 31, 2010.

Section 6404 of the PPACA also permits the Secretary to make certain exceptions to the one-year filing deadline. At this time, no exceptions have been established. However, proposals for exceptions will be specified in future proposed rulemaking.

Please be on the alert for more information pertaining to the Patient Protection and Affordable Care Act.

Beginning with the April 2010 update, the Centers for Medicare and Medicaid Services (CMS) will now post the National Correct Coding Initiative (NCCI) Edit files in Excel 2007 and in text formats. Because Excel 2007 can support a larger number of rows, each code range will be contained in one file as opposed to multiple files. This should correct the incompatibility issues that some of our users experienced last quarter with the Excel 2003 files.

Please be aware that Excel 2003 and earlier versions of the software have a maximum row count of 65,536. Some of the NCCI Edit files exceed the maximum row count. If you do not have Excel 2007, please use the text format to import the data into an application that can support larger files.

For more information on NCCI edits and to download the files, visit the web page at
http://www.cms.hhs.gov/NationalCorrectCodInitEd/.

SE1011 – Edits on the Ordering/Referring Providers in Medicare Part B Claims (Change Requests 6417, 6421, and 6696)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE1011.pdf

MM6696 – Ordering/Referring Providers Who Are Not Enrolled in Medicare
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6696.pdf

MM6417 – Expansion of the Current Scope of Editing for Ordering/Referring Providers for claims processed by Medicare Carriers and Part B Medicare Administrative Contractors (MACs)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6417.pdf

****PALMETTO/J1MAC NEWS****
Change in Provider Enrollment Timeliness Standards for Certain Paper
Applications
This J1 A/B MAC MLN Matters article (CR6807) provides you with information
regarding the revised provider enrollment processing timeliness standards
for certain Medicare enrollment applications. These include CMS-855I
initial application, CMS-855B initial applications and Change Requests and
reassignments. Timeliness standards for Internet-based Provider Enrollment
Chain and Ownership System (PECOS) enrollment applications and Part A
providers are not affected by CR 6807. Providers are encouraged to review
the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/844NDE1516?opendocument

J1 Part B LCDs Updates
The notice period of the J1 Part B Local Coverage Determinations (LCDs),
Flow Cytometry L30692 and Physical Medicine and Rehabilitation Policy
L28290, begins on April 1, 2010. The revisions made during the comment
period will become effective on May 20, 2010.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/844PMG0324?opendocument

Timely Filing Requirements for Medicare Fee-For-Service Claims
On March 23, 2010, President Obama signed into law the Patient Protection
and Affordable Care Act (PPACA), which amended the time period for filing
Medicare fee-for-service (FFS) claims as one of many provisions aimed at
curbing fraud, waste, and abuse in the Medicare program. Under the new law,
claims for services furnished on or after January 1, 2010, must be filed
within one calendar year after the date of service. In addition, Section
6404 mandates that claims for services furnished before January 1, 2010,
must be filed no later than December 31, 2010.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/844LP34117?opendocument

Edits on the Ordering/Referring Providers in Medicare Part B Claims (Change
Requests 6417, 6421 and 6696)
This Special Edition MLN Matters article (SE1011) announces that if you
order or refer items or services for Medicare beneficiaries and you do not
have an enrollment record in the Provider Enrollment, Chain and Ownership
System (PECOS), you need to submit an enrollment application to Medicare.
You can do this using Internet-based PECOS or by completing the paper
enrollment application (CMS 855I). If you reassign your Medicare benefits
to a group or clinic, you will also need to complete the CMS 855R.
Providers are encouraged to review the information and to share with their
staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/845PP71455?opendocument

Ordering/Referring Providers Who Are Not Enrolled in Medicare
This J1 Part B MLN Matters article (CR6696) annouces that for the provider
education information related to CR 6696, see the MLN Matters® article
SE1011 on the CMS Web site. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/844RSC6007?opendocument

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CMS & Palmetto/J1MAC News

2010-04-01T07:42:00.000-07:00

The following information has been received by ANCO.

****CMS NEWS****
MM6861 – Positron Emission Tomography (PET) (NaF-18) to Identify Bone Metastasis of Cancer
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6861.pdf

MM6859 – Claim Status Category Code and Claim Status Code Update
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6859.pdf

****PALMETTO/J1MAC NEWS****
April 2010 J1 A/B MAC Medicare Advisory
The April 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/83ZMG63263?opendocument

Holding of April 2010 Claims for Services Paid Under the 2010 Medicare
Physician Fee Schedule Update
The Centers for Medicare & Medicaid Services (CMS) is working with
Congress, health care providers, and the beneficiary community to avoid
disruption in the delivery of health care services and payment of claims
for physicians, non-physician practitioners, and other providers of
services paid under the Medicare Physician Fee Schedule (MPFS). As you are
aware, the Temporary Extension Act of 2010, enacted on March 2, 2010,
extended the zero percent (0%) update to the 2010 MPFS through March 31,
2010.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/83ZMJM2548?opendocument

Independent Diagnostic Testing Facilities: Availability of new 2010 Annual
Procedure Codes
This Alert explains that, per the Contractor Medical Director (CMD) review,
certain new services from the 2010 Annual Procedure Codes Update have been
generally approved as allowable procedures to be performed in Independent
Diagnostic Testing Facilities (IDTF), as long as all other certifications
and requirements have been accomplished. However, these services were not
added as approved in the system at that time. The system has been updated
and is now correct. In order to ensure accurate processing of relevant
claims already submitted, a mass adjustment will be performed on all
services denied incorrectly. Following this action, we will provide an
update on the number of claims adjusted per J1 environment. Providers are
encouraged to review the information and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/83UNAS7187?opendocument

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ACCC, ASH, CMS, & Palmetto/J1MAC News

2010-03-29T08:35:00.000-07:00

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-3-25-2010.html. ANCO is an Institutional Member of ACCC. This edition features:

• ACCC Annual Meeting Presentations and Summary Now Online

• Heard on ACCC's ListServ: Billing for Social Work Services

• ACCC Submits Comments to CMS About Radiation Therapy for Localized Prostate Cancer

• Two New Online CE Programs: New Treatment Strategies

• April ASP Drug Pricing Files Posted

****ASH NEWS****
The American Society of Hematology's (ASH) Practice Update was published and is available online at http://www.hematology.org/Practice/Practice-Updates/5059.aspx. This edition features:

• Historic Health-Care Reform Signed into Law

• Physician Payment Cuts Scheduled to Begin April 1; Contact Congress Now to Stop the 21% Cut

• Clinical Trials Coverage Provision Included in Final Health Reform Bill

• FDA Launches New Safety Program for ESAs March 24; ASH Clarifying Requirements for Hematologists Who Treat Anemia not Caused by Cancer

• President Obama Announces New Fraud Control Initiatives

• ASH Comments on Proposed Rule for Electronic Health Record Incentive Program

• Medicare Requires Physicians to Update Enrollment Information in PECOS to Receive Payment

• Highmark's Update Policy on ESAs is Now Active

• FDA "Black Box" Warning on Blood Thinner Plavix

• Medicare Releases Updates on Hospital Outpatient Prospective Payment System (OPPS)

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

****CMS NEWS****
The Centers for Medicare & Medicaid Services (CMS) is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, non-physician practitioners, and other providers of services paid under the Medicare Physician Fee Schedule (MPFS). As you are aware, the Temporary Extension Act of 2010, enacted on March 2, 2010, extended the zero percent (0%) update to the 2010 MPFS through March 31, 2010.

CMS believes Congress is working to avert the negative update that will take effect April 1. Consequently, CMS has instructed its contractors to hold claims containing services paid under the MPFS (including anesthesia services) for the first 10 business days of April. This hold will only affect claims with dates of service April 1, 2010, and forward. In addition, the hold should have minimum impact on provider cash flow because, under the current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt.
Be on the alert for more information about the 2010 Medicare Physician Fee Schedule Update.

MM6852 – Clinical Laboratory Fee Schedule (CLFS) - Special Instructions for Specific Test Codes (CPT Code 80100, CPT Code 80101, CPT Code 80101QW, G0430, G0430QW, and G0431QW)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6852.pdf

MM6864 – Clinical Laboratory Fee Schedule (CLFS) - Medicare Travel Allowance Fees for Collection of Specimens
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6864.pdf

MM6777 – Billing and Processing Claims with Unlimited Occurrence Span Codes (OSCs)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6777.pdf

MM6807 – Change in Provider Enrollment Timeliness Standards for Certain Paper Applications
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6807.pdf

MM6683 – Validating the Billing of End Stage Renal Disease (ESRD) 50/50 Rule Modifier
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6683.pdf

****PALMETTO/J1MAC NEWS****
Clinical Laboratory Fee Schedule (CLFS) - Medicare Travel Allowance Fees
for Collection of Specimens
This J1 A/B MAC MLN Matters article (CR6864) updates the Medicare travel
allowance fees for collection of specimens for CY 2010. The Centers for
Medicare & Medicaid Services (CMS) will issue annual updated travel
allowance amounts via a recurring update CR. The travel allowance, which is
intended to cover the estimated travel costs of collecting a specimen is
made only if a specimen collection fee is also payable. The travel codes
allow for such payment either on a per mileage basis or on a flat rate per
trip basis. Providers are encouraged to review the information and to share
with staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/83VLP93873?opendocument

Evaluation and Management (E/M) Services Review Checklist and Scoresheet
Tool (for Established Patients)
Palmetto GBA is pleased to announce the creation of the online Evaluation
and Management (E/M) Checklist and Scoresheet Tool created to improve the
accuracy of procedure code selection based on the services you provide.
This tool can be used for services provided to established patients and is
based on the Current Procedural Terminology (CPT). This revolutionary
online tool has the potential to dramatically improve your accuracy in the
selection of the correct E/M procedure code. The E/M tool will guide you
to the appropriate CPT procedure code based on the data you enter. The
scoresheet is designed to help you determine the appropriate level of care
procedure code to submit, in an effort to reduce billing errors.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/83WNBR2836?opendocument

J1 Open Draft LCD Meeting: California, April 13, 2010
Palmetto GBA J1 A/B MAC will host an Open Draft Local Coverage
Determination (LCD) meeting for both Part A and Part B in California, from
9 a.m. to 11 a.m. PST on April 13, 2010. The general public is invited to
submit information related to the proposed LCDs for Palmetto GBA's
consideration. To register, please visit our Workshops database. If you
will not be able to come to the meeting, please call (866) 628-8620 with
Conference ID 403971 to particpate.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7TKQ3P7107?opendocument

Clinical Laboratory Fee Schedule (CLFS) - Medicare Travel Allowance Fees
for Collection of Specimens
This J1 A/B MAC MLN Matters article (CR6864) updates the Medicare travel
allowance fees for collection of specimens for CY 2010. The Centers for
Medicare & Medicaid Services (CMS) will issue annual updated travel
allowance amounts via a recurring update CR. The travel allowance, which is
intended to cover the estimated travel costs of collecting a specimen is
made only if a specimen collection fee is also payable. The travel codes
allow for such payment either on a per mileage basis or on a flat rate per
trip basis. Providers are encouraged to review the information and to share
with staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/83VLP93873?opendocument

Clinical Laboratory Fee Schedule (CLFS) - Special Instructions for Specific
Test Codes (CPT Code 80100, CPT Code 80101, CPT Code 80101QW, G0430,
G0430QW and G0431QW)
This J1 A/B MAC MLN Matters article (CR6852) provides special instructions
for the proper use of specified CPT codes as of April 1, 2010. During CY
2009, effective for January 1, 2010, two new G codes were established, and
it had come to CMS’ attention that some providers were incorrectly using
certain CPT codes. Therefore, CMS created two new G codes to operate in
place of and alongside these existing codes. Providers are encouraged to
review the information and to share with staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/83VMBA6011?opendocument

J1 Part B Draft LCD Update
The comment period of the J1 Part B Draft Local Coverage Determination
(LCD), Implantable Infusion Pump for Treatment of Intractable Pain
(DL28268), will begin on April 8 and end on June 1, 2010.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/83VN9V1837?opendocument

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CMA, CMS, & Palmetto/J1MAC News

2010-03-24T07:12:00.000-07:00

The following information has been received by ANCO.

****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:

• Health Reform Takes Important Steps to Cover Uninsured, But Falls Short of Ensuring Access to Doctors

• CMA Submits Comments on Meaningful Use Definition

• CMA President Named to Board of Health Information Exchange Organization

• State Approves Regulations to Expand Scope of Practice for Nonphysicians

• Appeals Court Hears Oral Arguments in Lawsuit Challenging San Francisco's Ban on Sale of Tobacco in Pharmacies

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

• CMA Launches Free Practice Management Newsletter: Subscribe Today

• There's Still Time to Register for CMA's 13th Annual Health Care Leadership Academy

****CMS NEWS****
The Centers for Medicare and Medicaid Services (CMS) has posted the April 2010 ASP and NOC pricing files and crosswalks. The ASP pricing files for January 2010, October 2009, July 2009, and April 2009 have also been updated. All are available for download at http://www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/ (see left menu for year-specific links).

The Centers for Medicare & Medicaid Services (CMS) will be hosting its fourth national provider call regarding the implementation of HIPAA Version 5010. There will be a brief presentation given by CMS followed by a Q&A session with CMS subject matter experts. Please note that this call is geared towards vendors, clearinghouses, and providers who are performing their own development of 5010.

Conference call details:

Date: March 24, 2010

Conference Title: HIPAA Version 5010 Fourth National Provider Call

Discussion topics:
· General overview of 5010
· Additional changes to Medicare Fee For Service (FFS)
· Timelines and deadlines
· What you need to do to prepare
· CMS’s approach for new error handling transactions: 999 and 277CA
· Hot Topics:
1. Billing provider address change - P.O. Boxes no longer permitted
2. Discussions on handling Transaction Errata

Time: 2:00 p.m. – 3:30 p.m. ET

In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation.

Registration will close at 2:00 p.m. ET on March 23, 2010, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.

1. To register for the call participants need to go to:
http://www.eventsvc.com/palmettogba/032410
2. Fill in all required data.
3. Verify your time zone is displayed correctly the drop down box.
4. Click "Register".
5. You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.

****PALMETTO/J1 MAC NEWS****
Medicare Remit EasyPrint (MREP) Software for J1 Part B
Medicare Remit EasyPrint (MREP) version 2.7 is available for download.
Please note that the Remittance Advice Remark Codes (RARCs) and Claim
Adjustment Reason Codes (CARCs) must be downloaded from the Washington
Publishing Company (WPC) Web site to be used in conjunction with the
updated MREP Software. You can save time and money by taking advantage of
FREE MREP software now available to view and print the ANSI 835!
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7HVMA20718?opendocument

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CMS & PALMETTO/J1MAC News

2010-03-19T07:36:00.000-07:00

The following information has been received by ANCO.

****CMS NEWS****
The revised Clinical Laboratory Fee Schedule Fact Sheet (January 2010), which provides general information about the Clinical Laboratory Fee Schedule, coverage of clinical laboratory services, and how payment rates are set, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/clinical_lab_fee_schedule_fact_sheet.pdf . If you are unable to open the fact sheet, please copy and paste the URL into your Internet browser.

The Centers for Medicare & Medicaid Services (CMS) will be hosting its fourth national provider call regarding the implementation of HIPAA Version 5010. There will be a brief presentation given by CMS followed by a Q&A session with CMS subject matter experts. Please note that this call is geared towards vendors, clearinghouses, and providers who are performing their own development of 5010.

Conference call details:

Date: March 24, 2010

Conference Title: HIPAA Version 5010 Fourth National Provider Call

Discussion topics:
· General overview of 5010
· Additional changes to Medicare Fee For Service (FFS)
· Timelines and deadlines
· What you need to do to prepare
· CMS’s approach for new error handling transactions: 999 and 277CA
· Hot Topics:
1. Billing provider address change - P.O. Boxes no longer permitted
2. Discussions on handling Transaction Errata

Time: 2:00 p.m. – 3:30 p.m. ET

In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation.

Registration will close at 2:00 p.m. ET on March 23, 2010, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.

1. To register for the call participants need to go to: http://www.eventsvc.com/palmettogba/032410

2. Fill in all required data.

3. Verify your time zone is displayed correctly the drop down box.
4. Click "Register".
5. You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the following updated 2010 Physician Quality Reporting Initiative (PQRI) educational products to the PQRI webpage at www.cms.hhs.gov/PQRI on the CMS website.
2010 PQRI – Educational Resource Documents - Several new educational resource documents for 2010 PQRI are now available on the "Educational Resources" link of the PQRI website and include the following:
· 2010 PQRI Electronic Health Record (EHR) Reporting Made Simple
· 2010 PQRI Tip Sheet: Satisfactorily Reporting 2010 PQRI Measures
· 2010 PQRI Program Tip Sheet: PQRI Made Simple – Reporting the Preventive Care Measures Group
· 2010 PQRI Fact Sheet: What's New for the 2010 PQRI

2010 EHR-Based Reporting Documents - Several documents related to EHR-based reporting for 2010 PQRI have been updated and are now available on the "Alternative Reporting Mechanisms" page of the PQRI website, which include the following:
· 2010 EHR Measure Specifications
· Updated 2010 EHR Measure Specification Release Notes
· Updated 2010 EHR Downloadable Resource Table
· Updated EHR Data Submission Specifications Utilizing QRDA Release Notes
· Updated EHR Data Submission Specifications Utilizing QRDA Header Errors and Edits
· Updated EHR Data Submission Specifications Utilizing QRDA Body Errors and Edits

2010 PQRI Measures Documents - Several documents related to reporting PQRI measures for 2010 have been updated and are now available on the "Measures Codes"page of the PQRI website, which include the following:
· 2010 Getting Started with Reporting of PQRI Measures Groups
· 2010 PQRI Implementation Guide
· 2010 PQRI QDC Categories
· 2010 PQRI Single Source Master Code Table
· 2010 PQRI Measures Specifications – Release Notes

Qualified Registries for 2010 PQRI and eRx Reporting - An updated list of registries that have become "qualified" to submit quality data to CMS on behalf of their eligible professionals for 2010 PQRI and eRx reporting is now available on the "Alternative Reporting Mechanisms" page of the PQRI website.

Qualified Electronic Health Record (EHR) Vendors for the 2010 PQRI and Electronic Prescribing Incentive Programs - An updated list of EHR vendors and their programs that have been "qualified" to submit quality data to CMS by eligible professionals for 2010 PQRI reporting is now available on the "Alternative Reporting Mechanisms" page of the PQRI website.

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the following updated 2010 Electronic Prescribing Incentive (eRx) Program educational products to the eRx webpage at www.cms.hhs.gov/ERxIncentive on the CMS website.

2010 eRx – Educational Resource Documents - Several new educational resource documents for 2010 eRx are now available on the “Educational Resources” link of the eRx website and include the following:
· 2010 eRx Incentive Program Fact Sheet: What’s New for the 2010 eRx Incentive Program
· 2010 eRx Incentive Program Made Simple Fact Sheet

2010 EHR-Based Reporting Documents - Several documents related to EHR-based reporting for 2010 eRx have been updated and are now available on the "Alternative Reporting Mechanism" page of the eRx website, which include the following:
· 2010 EHR Downloadable Resource
· Qualified Registries for 2010 PQRI and eRx Reporting
· Qualified Electronic Health Record (EHR) Vendors for the 2010 PQRI and Electronic Prescribing Incentive Programs

****PALMETTO/J1MAC NEWS****
Correction Notice: Feature Article on March 2010 J1 Advisory Cover Page
Contains Incorrect Page Number
The monthly feature article for the March 2010 J1 Medicare Advisory,
‘Billing for Services Related to Voluntary Uses of Advance Beneficiary
Notices of Non-Coverage (ABN),’ was printed with an incorrect page number
on the cover page. The featured article is continued on page 79 rather than
page 75. The Web version of the advisory has been corrected and published
to the J1 Web site. We apologize for any confusion this has caused. Please
be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/83CL628122?opendocument

2010 Palmetto GBA J1 Spring Workshop Tour Kicks off April 16
The 2010 Palmetto GBA J1 Spring Workshop Tour is coming soon to a location
near you! The three-month training and education series kicks off on
Friday, April 16. To register or find out more about the workshops, please
log into your Palmetto GBA Workshops database account and register for the
session you wish to attend.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/83LR9V7466?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!

ASH, CMS & Palmetto/J1MAC News

2010-03-14T09:19:00.000-07:00

The following information has been received by ANCO.

****ASH NEWS****
The American Society of Hematology's (ASH) Practice Update was published and is available online at http://www.hematology.org/Practice/Practice-Updates/5027.aspx. This edition features:

• Senate Passes Seven Month Extension of Current Medicare Physician Payment; Contact the House of Representatives Now to Stop the 21 Percent Cut

• Congressional Negotiations Continue on Health Reform Legislation; Complex Policy Issues and Procedural Tactics in Play

• Information on How the New ESA REMS Program Will Affect MDS Patients

• March is DVT Awareness Month: ASH Recommendations Unveiled to Respond to Public Health Crisis in DVT and PE

• Medicare Publishes New Physician Resources Concerning the Consultation Code Elimination and Physician Payment

****CMS NEWS****
MM6805 – July 2010 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6805.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

****PALMETTO/J1MAC NEWS****
A More User-Friendly J1 Learning and Education Section
A more user-friendly J1 Learning and Education section is on the way! As
one of our continual efforts to improve our Web site, the structure and the
content of this section will be revised. Look out for the new version in
the next few days.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/83EQ2J8711?opendocument

Portable X-Ray Services
This article announces that selected HCPCS codes should be used as a guide
when submitting claims for the set-up and transportation of portable x-ray
equipment to the patient. The transportation charge is not payable unless
the portable x-ray equipment used was actually transported to the location
where the x-ray was taken. Suppliers should not bill for a transport fee
when the x-ray equipment is stored in a facility for use as needed. If the
x-ray is not covered, the transportation and set up will also be
non-covered. Suppliers are encouraged to review the information and to
share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/83CSCX8671?opendocument

Billing for Services Related to Voluntary Uses of Advance Beneficiary
Notices of Non-Coverage (ABNs)
This J1 A/B MAC MLN Matters article (CR6563b) was revised on February 22,
2010, to reflect a revised CR6563, which was issued on February 19, 2010.
The article was revised to reflect a new CR release date, transmittal
number and Web address for accessing CR 6563. 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. Providers are encouraged to review the
information and to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/83FSJ46884?opendocument

Services Denied for Provider Not Eligible/Deactivated: Liability for
Charges
This article announces that, effective April 1, 2010, when a Medicare
provider has been deactivated for non-billing or when other circumstances
result in your Medicare billing privileges being revoked, the
responsibility for charges denied with message code PR-B7 will change from
patient responsibility to contractual obligation. This also includes
denials for Independent Diagnostic Testing Facilities (IDTF) when the
submitted service does not meet the IDTF's qualifications. These services
will be specified on the Medicare remittance notice with message code
CO-B7. You may not bill the patient for services that are denied as
contractual obligation. Providers are encouraged to review the information
and to share with their staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/839M9W6114?opendocument

Unavailability of Internet-Based PECOS Monday, March 29 through Monday,
April 5
Due to scheduled maintenance, Internet-based Provider Enrollment, Chain and
Ownership System (PECOS) will be unavailable from Monday, March 29, 2010
through Monday, April 5, 2010. Internet-based PECOS allows physicians,
non-physician practitioners, providers and other suppliers (except
suppliers of durable medical equipment, prosthetics, orthotics and supplies
(DMEPOS)) to enroll or make a change to their existing Medicare enrollment
information over the Internet.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/83GNS66826?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!

CMA, CMS & Palmetto/J1MAC News

2010-03-11T07:11:00.000-08:00

The following information has been received by ANCO.

****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:

• Physicians: Are You Compliant with Recent HIPAA Changes?

• CMA Publishes Timely Access Guide for Physicians

• Court Upholds Governor's Furloughs of Medical Board Staff and Shifting of Agency's FUnds to Other State Programs

• Congress Stops SGR Cuts through March 31; CMA Fighting for Permanent Repeal

• Health Reform Update

• CMA's Council of Legislation Convenes to Set Legislative Priorities for 2010

• Reminder: Blue Cross Health Families Continuity of Care Plan Ends 3/31

• Tomorrow is Early Bird Deadline for CMA's 13th Annual Health Care Leadership Academy

• Registration Now Open for CMA's Legislative Leadership Conference

• Patient Cough and Cold Kits Now Available from the CMA Foundation

****CMS NEWS****
As part of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, the Centers for Medicare & Medicaid Services (CMS) administers the Electronic Health Record (EHR) incentive programs under Medicare and Medicaid. CMS prepared a proposed rule on the EHR incentive programs for public comment. This proposed rule includes the definition of meaningful use and other requirements to qualify for incentive payments. The comment period for this proposed rule closes on March 15, 2010. CMS welcomes your comments which may be submitted through http://www.regulations.gov. For additional information on the proposed rule, visit http://www.cms.hhs.gov/Recovery/11_HealthIT.asp on the web. Here you will find fact sheets, presentation materials summarizing the proposed rule, and links to the proposed rule itself.

The Basic Introduction to ICD-10-CM National Provider Conference Call will be conducted on Tuesday, March 23, 2010 from
1:00 p.m. – 2:30 p.m. Eastern Daylight Time. This conference call will provide an overview of ICD-10-CM/PCS requirements and a basic introduction to ICD-10-CM. The following topics will be discussed:
· Requirement to report ICD-10-CM/PCS codes for services provided on or after October 1, 2013.
· ICD-9-CM codes will not be accepted after October 1, 2013 (there will not be a grace period).
· Benefits of ICD-10-CM.
· Key similarities and differences between ICD-9-CM and ICD-10-CM.
· General structure and characteristics of ICD-10-CM.
· New features in ICD-10-CM.
· Setting the record straight about common ICD-10-CM myths and misperceptions.
· Impact of ICD-10-CM on medical record documentation.

Registration information and discussion materials for this conference call can be accessed at
http://www.cms.hhs.gov/ICD10/07_CMS_Sponsored_Calls.asp .

The Medicare Physician Fee Schedule Fact Sheet (March 2010) has been revised to include information about the two month zero percent (0%) update to the 2010 Medicare Physician Fee Schedule (MPFS) effective for dates of service January 1, 2010 through March 31, 2010. This fact sheet, which also provides information about MPFS payment rates and the MPFS payment rates formula, is available in downloadable format from the Centers for Medicare & Medicaid ServicesMedicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/MedcrePhysFeeSchedfctsht.pdf

****PALMETTO/J1MAC NEWS****
Questions and Answers on Reporting Physician Consultation Services
This J1 Special Edition article (SE1010) alerts providers that effective
January 1, 2010, various CPT consultation codes are no longer recognized
for Medicare Part B payment. Effective for services furnished on or after
January 1, 2010, providers should report each E/M service, including visits
that could be described by CPT consultation codes, with an E/M code payable
under the Medicare Physician Fee Schedule (MPFS) that represents where the
visit occurs and that identifies the complexity of the visit performed.
Providers are encouraged to review the information and to share with their
staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/837MM68711?opendocument

Electronic Funds Transfer (EFT) Authorization Agreement Processing
This article announces that Medicare contractors shall not process more
than one Electronic Funds Transfers (EFT) request for a provider or
supplier within a three-month period, unless there is an unusual and
compelling reason to do so. Medicare contractors shall apply this policy
immediately for providers and suppliers who have submitted more than one
EFT change request within the preceding three months. Please be sure to
share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/839NHG2671?opendocument

Basic Introduction to ICD-10-CM National Provider Conference Call
CMS will conduct the 'Basic Introduction to ICD-10-CM National Provider
Conference Call' on Tuesday, March 23, 2010 from 1 p.m. to 2:30 p.m. EDT.
This conference call will provide an overview of ICD-10-CM/PCS requirements
and a basic introduction to ICD-10-CM.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/83DNM36051?opendocument

Open Draft LCD Meetings April 2010
Palmetto GBA J1 A/B Medicare Administrative Contractor (MAC) has scheduled
Open Draft Local Coverage Determination (LCD) meetings in California,
Nevada and Hawaii for April 2010. 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/vMasterDID/7YDPHY0633?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!