ASH, CMS, DHCS/MediCal, & Palmetto/J1MAC News & Employment Opportunity

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/policy/practice/03122009.cfm. It features:

Bone Marrow Failure Disease Research and Treatment Act Introduced in House

President Obama Lifts Limits on Federally Funded Stem Cell Research

President Obama Signs Omnibus Budget Legislation

Health-Care Reform Debate Begins to Take Shape in Washington

President Obama to Nominate Former New York City Health Commissioner as FDA Commissioner

FTC Commissioner Thinks Obama Administration Will Help Stop Agreements to Delay Generics

RAC Protests Resolved

March is DVT Awareness Month

ASH PQRI and E-Prescribing Webinar: Rescheduling in Process

IOM Cancer Care Workshop Presentation Slides Available


****CMS NEWS
MM6347 – Updates to the Medicare Claims Processing Manual (Publication 100-04), Chapter 15, Ambulance Services
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6347.pdf


*****DHCS/MediCal NEWS*****
IMPORTANT National Drug Code (NDC) Reporting Requirements - Reminder
The implementation date is fast approaching! Providers are reminded that, claims with dates of service on or after April 1, 2009 that do not meet the NDC reporting requirements to include a valid NDC with a HCPCS code, will be denied. For more information on NDC reporting, including FAQs, please visit the NDC page on the Medi-Cal Web site at http://files.medi-cal.ca.gov/pubsdoco/ndc/ndc.asp

In order to comply with the DRA, providers must bill for physician-adminstered drugs using the appropriate CPT-4, HCPCS Level II, or local HCPCS Level III codes and, in addition, must include the NDC on the claim form. Providers have been encouraged, for dates of service on or after September 1, 2008, to include the NDC code on the claim, but claims without an NDC code have still been paid. Unfortunately, we are seeing minimal voluntary submissions of NDC and now is the time for providers to practice how they are going to comply.

Resources
The ASC X12N Version 4010A1 Companion Guides have been updated and are available on the Medi-Cal Web site at http://files.medi-cal.ca.gov/pubsdoco/hipaa/hipaaspecs_home.asp . These guides will enable technical staff or software vendors to update your software to include the NDC requirements on the 837 electronic transactions. Additionally, the Part 2 provider bulletins (General Medicine, Obstetrics and Outpatient) include NDC information, physician-administered drug definitions, billing descriptions and examples for CMS 1500 and UB-04 paper claim forms, as well as both 837 Institutional and Professional electronic formats, and Section 340B information. These bulletins can be viewed on the Medi-Cal Web site at http://files.medi-cal.ca.gov/pubsdoco/Bulletins_menu.asp . Finally, the CMS 1500 and UB-04 claim form tutorials on the Medi-Cal Web site have been updated to include instructions on how to bill HCPCS and NDCs and can be viewed at http://files.medi-cal.ca.gov/pubsdoco/eo/elearning.asp .

Provider Workshops
There will be additional overviews presented at the Medi-Cal seminar, to address the NDC reporting requirements, in Long Beach on 3/24 and 3/25. The locations of the sessions and how to pre-register can be found on the Medi-Cal Web site http://files.medi-cal.ca.gov/pubsdoco/eo/training.asp

Should you have any questions or need additional information, please call the Telephone Service Center (TSC) at 1-800-541-5555 and choose the appropriate prompt or visit the Medi-Cal Web site at the address listed above.


Fiscal Year 2008–09 March Payment Hold Updated March 13, 2009
Pursuant to Chapter 4, Statutes of 2009 (SBx 3 8), reimbursement to Medi-Cal institutional providers except for small and rural hospitals, designated public hospitals, and local education agencies, will be held for a period of four weeks effective March 26 (the fourth warrant release date of March) and released four weeks later beginning April 23, 2009. The hold is necessary to address the State’s cash flow issues. A total of one check write in March will be held as a result of the March Payment Hold. Payments to Medi-Cal non-institutional providers will not be held. Please note, the list below is limited to providers whose claims are processed by the Medi-Cal fiscal intermediary.

Beginning the week of March 23, 2009 providers whose held amount is $5,000 or more will receive a Value of Claims (VOC) Letter from the Department of Health Care Services. The letter will specify the amount of their claims payments $5,000 and above being suppressed as a result of the March hold. The purpose of these letters is to assist providers in working with their fiduciary institutions during this payment hold.

Please note that if the State’s cash flow does not improve, there is a possibility that claim payments in the first three weeks of April could be held, under an April hold, for up to four weeks and paid in the following month one week at a time. If the April hold is implemented, the same criteria (types of providers held) applied to the March hold will be applied to the April hold. If an April hold is implemented, the Department will continue to provide weekly VOC letters to providers meeting the $5,000 dollars held threshold.

To ensure implementation of this proposal, the Department of Health Care Services will hold reimbursement on the following Medi-Cal institutional providers.

Medi-Cal Institutional Providers
Adult Day Health Care Centers (ADHC)
Assistive Device and Sick Room Supply Dealers
Blood Banks
Clinical Laboratories
Fabricating Optical Laboratory/Prison Industry Authority (PIA)
Home Health Agencies (HHA)
Community Hospital Outpatient Departments
Community Hospital Inpatient (with the exception of Designated Public Hospitals)
Long Term Care (LTC) facilities
Ground Medical Transportation
Genetic Disease Testing
Public Law 95 – 210 RHC/Federally Qualified Health Center (RHC/FQHC)
Air Ambulance Transportation Services
Certified Hospice Service per Assembly Bill 4249
Free Clinics
Community Clinics
Chronic Dialysis Clinics
Multispecialty Clinics
Surgical Clinics
Exempt from Licensure Clinics
Rehabilitation Clinics
County Clinics not associated with a hospital
Birthing Center Services: Primary Care Clinics
Clinics otherwise undesignated
Alternative Birth Centers: Specialty Clinics
Home and Community Based Services (HCBS) Nursing Facilities
County Hospital Inpatient (with the exception of Designated Public Hospitals)
County Hospital Outpatient
Pediatric Subacute Care: LTC (distinct and freestanding) LTC accommodation codes 83 – 90 and 91 – 98
Institutions for Mental Disease: Mental Health Inpatient
Multipurpose Senior Services Program (MSSP)
Indian Health Services
Residential Care Facilities for the Elderly
The following providers are exempt from the March payment hold.
Local Educational Agencies
Small and Rural Hospitals
Designated Public Hospitals – Inpatient Payments


****PALMETTO/J1MAC NEWS****
New Dates and Revised Times to the 2009 Understanding the Rules and Using
the Tools workshop series
http://www.palmettogba.com/palmetto/Providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~New%20Dates%20and%20Revised%20Times%20to%20the%202009%20Understanding%20the%20Rules%20and%20Using%20the%20Tools%20workshop%20series?opendocument

If the above link does not work in your e-mail program, please use the
temporary alternate link provided below.
http://www.palmettogba.com/palmetto/Providers.nsf/docsCat/8525746A00550AA385257577006137E3?opendocument

Palmetto GBA has added new dates and times for our 2009 Understanding the
Rules and Using the Tools workshop series.


April Update to the 2009 Medicare Physician Fee Schedule Database
http://www.palmettogba.com/palmetto/Providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20A~MLNs~All%20Part%20A%20MLNs~April%20Update%20to%20the%202009%20Medicare%20Physician%20Fee%20Schedule%20Database?opendocument

If the above link does not work in your e-mail program, please use the
temporary alternate link provided below.
http://www.palmettogba.com/palmetto/Providers.nsf/docsCat/8525746A00550AA385257578006953D6?opendocument

CR6397, April Update to the 2009 Medicare Physician Fee Schedule Database,
amends payment files that were issued to contractors based upon the 2009
Medicare Physician Fee Schedule (MPFS) Final Rule.


Healthcare Provider Taxonomy Codes (HPTC) Update April 2009
http://www.palmettogba.com/palmetto/Providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20A~MLNs~All%20Part%20A%20MLNs~Healthcare%20Provider%20Taxonomy%20Codes%20(HPTC)%20Update%20April%202009?opendocument

If the above link does not work in your e-mail program, please use the
temporary alternate link provided below.
http://www.palmettogba.com/palmetto/Providers.nsf/docsCat/8525746A00550AA3852575780071AB6F?opendocument

CR 6382, Healthcare Provider Taxonomy Codes (HPTC) Update April 2009,
includes information on changes to HPTC codes and information on the
requirements of The Health Insurance Portability and Accountability Act.

Updates to the Medicare Claims Processing Manual (Publication 100-04),
Chapter 15, Ambulance Services
http://www.palmettogba.com/palmetto/Providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20A~MLNs~All%20Part%20A%20MLNs~Updates%20to%20the%20Medicare%20Claims%20Processing%20Manual%20(Publication%20100-04)%20Chapter%2015%20Ambulance%20Services?opendocument

If the above link does not work in your e-mail program, please use the
temporary alternate link provided below.
http://www.palmettogba.com/palmetto/Providers.nsf/docsCat/8525746A00550AA385257578006A5BD7?opendocument

CR6347, Updates to the Medicare Claims Processing Manual (Publication
100-04), Chapter 15, Ambulance Services, implements significant changes to
the Internet-Only Manual Publication 100-04, Chapter 15.


****Empllyment Opportunity****
Oncologists Needed for Medical Director Positions with West Coast Biotech. No Industry Experience Required.

Several Oncologists are needed to fill Medical Director level positions with a West Coast biotech company. Candidates will fill medical director positions overseeing clinical trials ranging from phase one to phase four.

Previous Industry experience is not required.
This is a full time position and offers a full relocation package.

Candidates will be accepted even if they are fresh out of school. Candidates must be board eligible Oncologists or Hematologists. I am also accepting candidates out of industry, academia, or private practice. Similar positions are also available for Orthopedic Surgeons, Endocrinologists, and Rheumatologists.

Please contact me at 760-525-9739 or jaketanner82@gmail.com .