ASH, CMS, & Palmetto/J1MAC News

The following information has been received by ANCO.


****ASH NEWS****
The American Society of Hematology (ASH) Practice Update was published and is available online at http://www.hematology.org/policy/practice/07232009.cfm#1. This edition features:

Health Reform Legislation Continues to Develop – Physician Payment Issues Controversial

CMS Proposes 2010 Payment and Policy Changes for Physicians

CMS Proposes Hospital Outpatient Prospective Payment System (HOPPS) 2010 Rule

ASH Meets With CMS About Bone Marrow Transplant

ICD-9-CM Medicare Contractor Annual Update Released

ASH State-of-the-Art Symposium Advance Registration Closing Soon


****CMS NEWS****
The Centers for Medicare & Medicaid Services (CMS) is not providing an updated Codes.ini file with the implementation of the July 2009 release (CR6453). Due to the timing of when the Codes Committee meets, the list of updated Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs) will not be available until after the implementation of the July 2009 release. Therefore, CMS will provide an updated list of CARCs and RARCs via the Codes.ini file with the implementation of the October 2009 release.


CMS has launched its website for agency-wide information and education on Versions 5010, D.0 and 3.0. As you may already know, Version 5010 is the new version of the X12 standards for HIPAA transactions; version D.0 is the new version of the National Council for Prescription Drug Program (NCPDP) standards for pharmacy and supplier transactions; and version 3.0 is a new NCPDP standard for Medicaid pharmacy subrogation.

On this website, you can view background information on the new standards, regulatory information, the latest outreach messages from CMS, educational resources, resources specific to D.0 and 3.0, as well as implementation information for the Medicare Fee-For-Service systems. CMS plans to add additional information as it becomes available so bookmark the site today!
http://www.cms.hhs.gov/Versions5010andD0

You can also view the presentation, transcript and listen to the audiofile from the June 9thnational provider conference call on Versions 5010 and D.0 on the Educational Resources page or at http://www.cms.hhs.gov/Versions5010andD0/Downloads/6-9-2009_National_Provider_Call.pdf on the CMS website.


A new video explaining the MLN and its benefits to Fee-For-Service healthcare providers, is now available for download on the CMS website. This video, approximately seven minutes in length, is suitable for self instruction or for use during provider education events. National associations and organizations may want to consider posting this video to their websites to educate their membership on the products and services of the MLN.

To access the video, click on this hyperlink: MLN Video - Quick and Basic Information about the MLN and its Benefits to Providers [ZIP, 44.1MB]. Please note the large file size; download speeds will vary based on your Internet connection.


MM6520 – Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6520.pdf


****PALMETTO/J1MAC NEWS****
Coding and Reporting Principles for the Physician Quality Reporting
Initiative (PQRI) and the Electronic Prescribing (E-Prescribing) Incentive
Programs,
To read CR 6514, Coding and Reporting Principles for the Physician Quality
Reporting Initiative (PQRI) and the Electronic Prescribing (E-Prescribing)
Incentive Programs, open the PDF document below.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7TZMYK4572?opendocument

Billing Requirements for Provider Information
Providers are reminded that billing and rendering provider NPI information
submitted on the claim must correspond appropriately.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7U5QEG0772?opendocument

Interest Payment on Clean Claims Not Paid Timely
The interest payment on clean claims not paid timely as determined by the
Treasury Department has been updated.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7U5R8G5086?opendocument

Medicare Contractor Annual Update of the International Classification of
Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)
CR 6520 announces the Medicare Contractor Annual Update of the
International Classification of Diseases, Ninth Revision, Clinical
Modification (ICD-9-CM).
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7U5PGN4647?opendocument

Part B LCD Update
Please review the following Part B local coverage determinations, which
have been revised.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7U6QLC5666?opendocument

J1 Provider Contact Center to be Closed for Training Friday, July 24
The J1 Provider Contact Center will be closed for training from 11 a.m. to
3 p.m. Friday, July 24, 2009 PST.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7U7JPU1353?opendocument

Modifiers - General Information
Not sure which modifier to use to file your claim? Here's a primer on the
most used - and misued - modifiers. Modifiers assure that the carrier will
give consideration to the special circumstances that might affect payment.
Omitting modifiers might result in payment denials or rejections. Using the
correct modifier with the initial filing will eliminate the need for
appeals and processing delays.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7U6QVQ8370?opendocument

Redeterminations: What information should I send with the request?
Need to know what information to send with your redetermination request?
Read this article to find out how to send redetermination requests in a
timely manner.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7U7K7E7756?opendocument