The following information has been received by ANCO.
****ACCC NEWS****
The Association of Community Cancer Center's (ACCC) This Week At ACCC was published and is available online at http://www.accc-cancer.org/mediaroom/newsletters/2009/media_ACCCNEWSLETTER_6-1-2009.html. ANCO is an Institutional Member of ACCC. This edition features:
ACCC Launches New Cancer Care Patient Navigation Website
ACCC's E-Newsletter to Change Its Name
7 Million More Americans Projected to Become Uninsured by 2010
FDA Grants Full Approval to Sprycel for CML
Q&A on ACCC's Listserve: RN vs. Pharmacist Mixing Chemo
Houston, We Have a Free Meeting June 10
ACCC's National Oncology Economics Conference: Updated Agenda
****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 Fends off Trial Lawyers' Attack on MICRA; Appeals Court Upholds Constitutionality of Landmark Law
CMA Calls Health Cuts Ill-Advised and Fiscally Reckless
CMA Legislative Victory: Legislature Orders Audit of Medi-Cal TAR Process
Physicians Have Opportunity to Verify Accuracy of California Physician Performance Initiative Demographic Data Online
Medical Board Backlog Leads to Licensing Delays
New Congressional Health Reform Proposals Expected in June
Webinar: How the Stimulus Bill Impacts Your HIPAA Obligations
Have 10 Minutes? You Can Help the CMA Foundation Promote Appropriate Antibiotic Use
June 30 Is the Deadline to Nominate a Colleague for the CMAF Leadership Awards
****PALMETTO/J1MAC NEWS****
Billing Routine Cost of Clinical Trials (Revised)
Change request 6431, which addresses billing routine costs of clinical
trials has been revised.
http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7RRNCY0074?opendocument
Monday, June 1, 2009
Friday, May 29, 2009
ASH & Palmetto/J1MAC News
The following information has been received by ANCO.
****ASH NEWS***
The American Society of Hematology's (ASH) Practice Update was published today and is available online at http://www.hematology.org/policy/practice/05282009.cfm#1. This edition features:
Update on Health Reform: ASH Comments on Senate Finance Committee Health-Care Reform Proposals
Medicare Average Sales Price Updates Available
ABMS Approves New Standards for Maintenance of Certification® Program; ASH Expresses Concerns
Top Level Positions Filled at FDA, CDC
IOM Releases a Report on Conflict of Interest in Medical Research, Education, and Practice; ASH’s Established Policies Are Already in Compliance
ASH Grassroots Network on Facebook
ASH Participates in June American Medical Association House of Delegates Meeting
****PALMETTO/J1MAC NEWS****
Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 15.2,
Effective July 1, 2009
This article is based on Change Request (CR) 6469, which reminds physicians
to take note of the quarterly updates to Correct Coding Initiative (CCI)
edits.
http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7SGKY83150?opendocument
****ASH NEWS***
The American Society of Hematology's (ASH) Practice Update was published today and is available online at http://www.hematology.org/policy/practice/05282009.cfm#1. This edition features:
Update on Health Reform: ASH Comments on Senate Finance Committee Health-Care Reform Proposals
Medicare Average Sales Price Updates Available
ABMS Approves New Standards for Maintenance of Certification® Program; ASH Expresses Concerns
Top Level Positions Filled at FDA, CDC
IOM Releases a Report on Conflict of Interest in Medical Research, Education, and Practice; ASH’s Established Policies Are Already in Compliance
ASH Grassroots Network on Facebook
ASH Participates in June American Medical Association House of Delegates Meeting
****PALMETTO/J1MAC NEWS****
Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 15.2,
Effective July 1, 2009
This article is based on Change Request (CR) 6469, which reminds physicians
to take note of the quarterly updates to Correct Coding Initiative (CCI)
edits.
http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7SGKY83150?opendocument
Thursday, May 28, 2009
CMS & Palmetto/J1MAC News
The following information has been received by ANCO.
****CMS NEWS****
MM6469 – Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 15.2, Effective July 1, 2009
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6469.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
MM6431 – Billing Routine Costs of Clinical Trials
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6431.pdf
What’s New with 2009 Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing (E-Prescribing) Incentive Programs
1. Article Regarding Implementation Advice for 2009 PQRI and E-Prescribing Incentive Programs Now Available
2. Three Physician Quality Reporting Initiative Help Desk Resources Now Available for Eligible Professionals
CMS Announces Availability of a New Educational Resource Article on the 2009 PQRI and E-Prescribing Program
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that a new educational resource has been posted to the PQRI webpage on the CMS website. An article titled: Physician Quality
Reporting Initiative (PQRI) & E-Prescribing: Implementation Advice for the Office Manager outlines step-by-step how to get started in reporting 2009 PQRI measures.
The article is available at http://www.cms.hhs.gov/PQRI/31_PQRIToolKit.asp on the CMS website as a downloadable document and is accessible by scrolling down to the Downloads section and selecting the “2009 PQRI and E-Prescribing Implementation Advice” link.
Three Physician Quality Reporting Initiative Help Desk Resources are Now Available for Eligible Professionals
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce three PQRI Help Desk Resources to assist eligible professionals with their questions on the Physician Quality Reporting Initiative.
1. Provider Call Center Directory
· Remittance Advice Notices
· Incentive payment distribution status
· Adjustments made to incentive payment due to sanctions/overpayments
For contact information, see the “Provider Center Toll-free Numbers Directory” by clicking the link under the “Related Links Inside CMS” section below and scrolling down to the “Downloads” section.
2. External User Services (EUS) – 7:00 AM – 7:00 PM EST
· Registering/creating an IACS account
· Accessing an IACS account
· Changing an IACS account
· Approving users into an organization
Phone: 1-866-484-8049
TTY: 1-866-523-4759
3. QualityNet Help Desk – 7:00 AM – 7:00 PM CST
· General CMS PQRI & ERX Information
· PQRI Portal Password Issues
· PQRI feedback report availability and access
Phone: 1-866-288-8912
All publicly available information on the CMS Physician Quality Reporting Initiative can be found at http://www.cms.hhs.gov/PQRI, on the CMS website.
All publicly available information on the CMS Electronic Prescribing Incentive Program can be found at http://www.cms.hhs.gov/ERxIncentive on the CMS website.
****PALMETTO/J1MAC NEWS****
Requesting a Redetermination of an Overpayment for Multiple Beneficiaries
and/or Multiple Claims
Palmetto GBA recently has been receiving individual redetermination
requests for overpayments containing multiple beneficiaries and/or multiple
claims with only one Accounts Receivable (AR)/Financial Control Number
(FCN). If you receive a demand letter for an overpayment with multiple
beneficiaries/claims and wish to appeal, please submit the redetermination
request as one bulk request, not individual requests for each claim or
beneficiary.
http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7SES446030?opendocument
Weekly Part B ACT Call May 28 on EDI and Schedule Change Starting June 2
The next weekly J1 Part B Ask the Contractor Teleconference (ACT) call will
be held on Thursday, May 28 at 2 p.m. PST. The subject will be Electronic
Data Interchange (EDI). Starting June 2, the weekly ACT calls will be
rescheduled to Tuesdays at 12:30 p.m. PST.
http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7S3T650154?opendocument
****CMS NEWS****
MM6469 – Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 15.2, Effective July 1, 2009
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6469.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
MM6431 – Billing Routine Costs of Clinical Trials
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6431.pdf
What’s New with 2009 Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing (E-Prescribing) Incentive Programs
1. Article Regarding Implementation Advice for 2009 PQRI and E-Prescribing Incentive Programs Now Available
2. Three Physician Quality Reporting Initiative Help Desk Resources Now Available for Eligible Professionals
CMS Announces Availability of a New Educational Resource Article on the 2009 PQRI and E-Prescribing Program
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that a new educational resource has been posted to the PQRI webpage on the CMS website. An article titled: Physician Quality
Reporting Initiative (PQRI) & E-Prescribing: Implementation Advice for the Office Manager outlines step-by-step how to get started in reporting 2009 PQRI measures.
The article is available at http://www.cms.hhs.gov/PQRI/31_PQRIToolKit.asp on the CMS website as a downloadable document and is accessible by scrolling down to the Downloads section and selecting the “2009 PQRI and E-Prescribing Implementation Advice” link.
Three Physician Quality Reporting Initiative Help Desk Resources are Now Available for Eligible Professionals
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce three PQRI Help Desk Resources to assist eligible professionals with their questions on the Physician Quality Reporting Initiative.
1. Provider Call Center Directory
· Remittance Advice Notices
· Incentive payment distribution status
· Adjustments made to incentive payment due to sanctions/overpayments
For contact information, see the “Provider Center Toll-free Numbers Directory” by clicking the link under the “Related Links Inside CMS” section below and scrolling down to the “Downloads” section.
2. External User Services (EUS) – 7:00 AM – 7:00 PM EST
· Registering/creating an IACS account
· Accessing an IACS account
· Changing an IACS account
· Approving users into an organization
Phone: 1-866-484-8049
TTY: 1-866-523-4759
3. QualityNet Help Desk – 7:00 AM – 7:00 PM CST
· General CMS PQRI & ERX Information
· PQRI Portal Password Issues
· PQRI feedback report availability and access
Phone: 1-866-288-8912
All publicly available information on the CMS Physician Quality Reporting Initiative can be found at http://www.cms.hhs.gov/PQRI, on the CMS website.
All publicly available information on the CMS Electronic Prescribing Incentive Program can be found at http://www.cms.hhs.gov/ERxIncentive on the CMS website.
****PALMETTO/J1MAC NEWS****
Requesting a Redetermination of an Overpayment for Multiple Beneficiaries
and/or Multiple Claims
Palmetto GBA recently has been receiving individual redetermination
requests for overpayments containing multiple beneficiaries and/or multiple
claims with only one Accounts Receivable (AR)/Financial Control Number
(FCN). If you receive a demand letter for an overpayment with multiple
beneficiaries/claims and wish to appeal, please submit the redetermination
request as one bulk request, not individual requests for each claim or
beneficiary.
http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7SES446030?opendocument
Weekly Part B ACT Call May 28 on EDI and Schedule Change Starting June 2
The next weekly J1 Part B Ask the Contractor Teleconference (ACT) call will
be held on Thursday, May 28 at 2 p.m. PST. The subject will be Electronic
Data Interchange (EDI). Starting June 2, the weekly ACT calls will be
rescheduled to Tuesdays at 12:30 p.m. PST.
http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7S3T650154?opendocument
5th Annual Oncology Congress (September 24-26; San Francisco)
The most up-to-date information on the 5th Annual Oncology Congress taking place in San Francisco from September 24-26th is available at http://www.oncologycongress.com.
ANCO members can use registration code ANCO09 at https://reed.eventready.com/index.cfm?fuseaction=reg.page&event_id=1368 to activate a special discounted registration rate of $100.
ANCO members can use registration code ANCO09 at https://reed.eventready.com/index.cfm?fuseaction=reg.page&event_id=1368 to activate a special discounted registration rate of $100.
Wednesday, May 27, 2009
ACCC, ASCO, & Palmetto/J1MAC News
The following information has been received by ANCO.
****ACCC NEWS****
The Association of Community Cancer Centers (ACCC) This Week At ACCC was published and is available online at http://www.accc-cancer.org/mediaroom/newsletters/2009/media_ACCCNEWSLETTER_5-26-2009.html. ANCO is an Institutional Member of ACCC. This edition features:
Patient Navigation: Dr. Harold P. Freeman Provides Insight
CMS Will Share Data with Hospitals on New Imaging Efficiency Measures
ACCC Public Policy: Webinar on Hospital/Physician Clinical Integration
Q&A on ACCC's Listserve: Physician Supervision in Infusion Suite
Houston, We Have a Free Meeting June 10
ACCC's National Oncology Economics Conference: Updated Agenda
****ASCO NEWS****
The American Society of Clinical Oncology's (ASCO) ASCO Express was published today. ANCO is a state/regional affiliate of ASCO. This edition features:
Abstracts from the 2009 Annual Meeting Now Available on ASCO.org
Register for a Best of ASCO® Meeting
Best of ASCO® International – Coming to a City Near You
Submit an Abstract for the 2009 Breast Cancer Symposium
Registration and Housing Now Open for the 2009 Breast Cancer Symposium
Registration and Housing Now Open for the 2009 ASCO Electronic Health Records Symposium
ASCO Launches Four New Lung Cancer Treatment Plan and Summary Templates
NIH Seeks Comments on Online Presentation of Clinical Trials Data
NCI Expands TARGET Initiative to Include Pediatric Cancers
Senate Finance Committee Releases Health Care Reform Policy Options
Read the JCO Original Report, "Prostate-specific Antigen Progression Predicts Overall Survival in Patients With Metastatic Prostate Cancer"
Read the JOP Special Series on the Cancer Quality Alliance Proceedings
****PALMETTO/J1MAC NEWS****
J1 A/B MAC June Medicare Advisory
The June 2009 J1 A/B MAC Medicare Advisory is now available to be viewed on
the Palmetto GBA Web site. It contains the latest updates and useful
information regarding Medicare. Please share this information with your
staff.
http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7SEPPG2004?opendocument
Palmetto GBA J1 A/B MAC Web Updates Notice
Palmetto GBA has updated the J1 Part A and Part B CERT Introduction page.
http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7S3J2U7382?opendocument
Weekly Part B ACT Call May 28 on EDI and Schedule Change Starting June 2
The next weekly J1 Part B Ask the Contractor Teleconference (ACT) call will
be held on Thursday, May 28 at 2 p.m. PST. The subject will be Electronic
Data Interchange (EDI). Starting June 2, the weekly ACT calls will be
rescheduled to Tuesdays at 12:30 p.m. PST.
http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7S3T650154?opendocument
****ACCC NEWS****
The Association of Community Cancer Centers (ACCC) This Week At ACCC was published and is available online at http://www.accc-cancer.org/mediaroom/newsletters/2009/media_ACCCNEWSLETTER_5-26-2009.html. ANCO is an Institutional Member of ACCC. This edition features:
Patient Navigation: Dr. Harold P. Freeman Provides Insight
CMS Will Share Data with Hospitals on New Imaging Efficiency Measures
ACCC Public Policy: Webinar on Hospital/Physician Clinical Integration
Q&A on ACCC's Listserve: Physician Supervision in Infusion Suite
Houston, We Have a Free Meeting June 10
ACCC's National Oncology Economics Conference: Updated Agenda
****ASCO NEWS****
The American Society of Clinical Oncology's (ASCO) ASCO Express was published today. ANCO is a state/regional affiliate of ASCO. This edition features:
Abstracts from the 2009 Annual Meeting Now Available on ASCO.org
Register for a Best of ASCO® Meeting
Best of ASCO® International – Coming to a City Near You
Submit an Abstract for the 2009 Breast Cancer Symposium
Registration and Housing Now Open for the 2009 Breast Cancer Symposium
Registration and Housing Now Open for the 2009 ASCO Electronic Health Records Symposium
ASCO Launches Four New Lung Cancer Treatment Plan and Summary Templates
NIH Seeks Comments on Online Presentation of Clinical Trials Data
NCI Expands TARGET Initiative to Include Pediatric Cancers
Senate Finance Committee Releases Health Care Reform Policy Options
Read the JCO Original Report, "Prostate-specific Antigen Progression Predicts Overall Survival in Patients With Metastatic Prostate Cancer"
Read the JOP Special Series on the Cancer Quality Alliance Proceedings
****PALMETTO/J1MAC NEWS****
J1 A/B MAC June Medicare Advisory
The June 2009 J1 A/B MAC Medicare Advisory is now available to be viewed on
the Palmetto GBA Web site. It contains the latest updates and useful
information regarding Medicare. Please share this information with your
staff.
http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7SEPPG2004?opendocument
Palmetto GBA J1 A/B MAC Web Updates Notice
Palmetto GBA has updated the J1 Part A and Part B CERT Introduction page.
http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7S3J2U7382?opendocument
Weekly Part B ACT Call May 28 on EDI and Schedule Change Starting June 2
The next weekly J1 Part B Ask the Contractor Teleconference (ACT) call will
be held on Thursday, May 28 at 2 p.m. PST. The subject will be Electronic
Data Interchange (EDI). Starting June 2, the weekly ACT calls will be
rescheduled to Tuesdays at 12:30 p.m. PST.
http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7S3T650154?opendocument
Tuesday, May 26, 2009
Palmetto/J1MAC News
The following information has been received by ANCO.
****PALMETTO/J1MAC NEWS****
July 2009 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing
Files and Revisions to Prior Quarterly Pricing Files
This MLN article, Change Request (CR) 6471, instructs Medicare Contractors
to download and implement the July 2009 ASP drug pricing file to determine
the payment limit for claims for separately payable Medicare Part B drugs
processed or reprocessed on or after July 6, 2009 with dates of service
July 1, 2009, through September 30, 2009.
http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7S9LVX6631?opendocument
Erythropoietin Stimulating Agents (ESAs) for the Treatment of Anemia Unrelated to Dialysis Therapy Rounding Error
States Applicable to Alert:
American Samoa, Guam, Hawaii, Nevada, Northern Mariana Islands, Northern
California and Southern California
Background Information:
From April 1, 2009 through May 9, 2009, there was an error in the EDI system, which may have caused claims submitted with a Hematocrit (HCT) and/or Hemoglobin (HGB) level, to process incorrectly. The system may have been erroneously rounding the levels to the nearest whole number. Claims with .4 or below were rounded down and claims with .5 or higher were rounded up. If the levels were rounded to high (i.e. if the HBG was rounded to 10.0 or the HCT was rounded to 30.0) then the service may have been denied in error.
Applies To Procedure Code(s):
J0881
J0885
Modifier(s):
EA
Remark /Reason Codes:
50 - These are non-covered services because this is not deemed a "medical necessity" by the payer.
N386 - This decision was based on a National Coverage Determination (NCD). An NCD provides a coverage determination as to whether a particular item or service is covered. A copy of this policy is available at http://www.cms.hhs.gov/mcd/search.asp. If you do not have web access, you may contact the contractor to request a copy of the NCD.
MAC Action:
Services brought to our attention by affected providers will be adjusted.
Provider Action:
If you feel that you have claims that meet this criteria please contact the Telephone Reopening Line at 1-866-669-5543 to have your claims reopened. You may also request your Reopenings in writing.
****PALMETTO/J1MAC NEWS****
July 2009 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing
Files and Revisions to Prior Quarterly Pricing Files
This MLN article, Change Request (CR) 6471, instructs Medicare Contractors
to download and implement the July 2009 ASP drug pricing file to determine
the payment limit for claims for separately payable Medicare Part B drugs
processed or reprocessed on or after July 6, 2009 with dates of service
July 1, 2009, through September 30, 2009.
http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7S9LVX6631?opendocument
Erythropoietin Stimulating Agents (ESAs) for the Treatment of Anemia Unrelated to Dialysis Therapy Rounding Error
States Applicable to Alert:
American Samoa, Guam, Hawaii, Nevada, Northern Mariana Islands, Northern
California and Southern California
Background Information:
From April 1, 2009 through May 9, 2009, there was an error in the EDI system, which may have caused claims submitted with a Hematocrit (HCT) and/or Hemoglobin (HGB) level, to process incorrectly. The system may have been erroneously rounding the levels to the nearest whole number. Claims with .4 or below were rounded down and claims with .5 or higher were rounded up. If the levels were rounded to high (i.e. if the HBG was rounded to 10.0 or the HCT was rounded to 30.0) then the service may have been denied in error.
Applies To Procedure Code(s):
J0881
J0885
Modifier(s):
EA
Remark /Reason Codes:
50 - These are non-covered services because this is not deemed a "medical necessity" by the payer.
N386 - This decision was based on a National Coverage Determination (NCD). An NCD provides a coverage determination as to whether a particular item or service is covered. A copy of this policy is available at http://www.cms.hhs.gov/mcd/search.asp. If you do not have web access, you may contact the contractor to request a copy of the NCD.
MAC Action:
Services brought to our attention by affected providers will be adjusted.
Provider Action:
If you feel that you have claims that meet this criteria please contact the Telephone Reopening Line at 1-866-669-5543 to have your claims reopened. You may also request your Reopenings in writing.
Thursday, May 21, 2009
CMS & Palmetto/J1MAC News
The following information has been received by ANCO.
****CMS NEWS****
MM6440 – Additional Data Collection on Hospice Claims
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6440.pdf
MM6471 – July 2009 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/MM6471.pdf
Revised:
SE0832 – The ICD-10 Clinical Modification/Procedure Coding System (CM/PCS)—The Next Generation of Coding
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0832.pdf
****PALMETTO/J1MAC NEWS****
The Comprehensive Error Rate Testing (CERT) Fact Sheet
The J1 Comprehensive Error Rate Testing (CERT) Fact Sheet is now available
at Palmetto GBA Web site.
http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7S7RXH5804?opendocument
****CMS NEWS****
MM6440 – Additional Data Collection on Hospice Claims
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6440.pdf
MM6471 – July 2009 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/MM6471.pdf
Revised:
SE0832 – The ICD-10 Clinical Modification/Procedure Coding System (CM/PCS)—The Next Generation of Coding
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0832.pdf
****PALMETTO/J1MAC NEWS****
The Comprehensive Error Rate Testing (CERT) Fact Sheet
The J1 Comprehensive Error Rate Testing (CERT) Fact Sheet is now available
at Palmetto GBA Web site.
http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7S7RXH5804?opendocument
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