The following information is provided by OTN/Onmark, McKesson Specialty Companies, and ANCO Corporate Member.
CMS Releases Q-4 2008 Drug Payment Limits under ASP+6%
On September 16, 2008 CMS posted the Q-4 2008 ASP+6% Drug Payment Limit Files on the drug pages of the CMS Web site, Medicare Part B Drugs Average Sales Price (ASP) Information Resource. As you will see below, there are a number of significant changes to drugs widely administered in oncology offices and HOPD's:
Drug J-Code Q-3 '07 ASP+6% Q-4 '08 ASP+6% % Change
Carboplatin per 50mg J9045 $ 5.23 $ 9.61 + 83.7%
Bleomycin per 15iu J9040 $ 31.52 $ 34.83 + 10.5%
Etoposide per 100mg J9182 $ 4.43 $ 4.84 + 9.3%
Goserelin Acetate Impl. per 3.6mg J9202 $ 177.16 $ 189.45 + 6.9%
Vincristine Sulfate per 1mg J9370 $ 6.47 $ 6.80 + 5.1%
Irinotecan per 20mg J9206 $ 74.75 $ 37.00 - 50.5%
Pamidronate disodium per 30mg J2430 $ 38.21 $ 29.24 - 23.5%
Paclitaxel per 30mg J9265 $ 14.41 $ 11.04 - 23.4%
Granesitron HCL per 100mcg J1626 $ 5.35 $ 4.33 - 19.1%
Amifostine (Ethyol) per 500mg J0207 $ 511.32 $ 424.03 - 17.1%
For the third quarter now the rates reflected in the drug reimbursement files take into account the calculation methodology change mandated MMSEA-2007 for drugs within the multisource/generic category. The data used for the Q-4 2008 ASP+6% reimbursement files is based on the Q-2 2008 sales data submitted to CMS by drug manufacturers on July 31. Reimbursement allowables on NOC drugs were also updated.
The changes are effective October 1 and will remain in effect until either a correction or the next scheduled update by CMS. The next scheduled update will be in December and effective January 1, 2009.
We strongly encourage you to review the entire ASP+6% Drug Payment Limit file which will be available on the OTN Website.
Tuesday, September 23, 2008
List Serv Palmetto/J1MAC Website Update
The following updates have been posted to the Palmetto/J1MAC website.
CCI Edit Changes: Column I and Column II Codes
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~CCI%20Edit%20Changes:%20Column%20I%20and%20Column%20II%20Codes?opendocument
There is an important change that affects codes bundled with CCI edits.
Effective for date of service on and after July 1, 2008, if documentation
in the patient's medical record supports the use of CPT modifier 59 for
your code pair (containing a Column I and Column II code), CPT modifier
must be submitted with the Column II code only. Previously, Palmetto GBA
accepted claims for Column I/Column II code pairs when either code was
submitted with CPT modifier 59.
Applies to:
Jurisdiction 1//J1 Part B: General
----------
Telephone Claim Correction Checklist
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~Appeals~Telephone%20Claim%20Correction%20Checklist?opendocument
Do you need assistance to correct a simple error made on a claim? Please
see the checklist in this article for the type of issues that can be
corrected by telephone instead of filing a Redetermination (1st level of
appeal). Please contact us at 1-866-669-5543, Monday-Friday, anytime
between 7:00 a.m.-3:00 p.m. PST. Be prepared to provide the provider's
identifier and the patient's Medicare number, last name and first initial.
We can handle three qualified requests per call.
Applies to:
Jurisdiction 1//J1 Part B: General
CCI Edit Changes: Column I and Column II Codes
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~CCI%20Edit%20Changes:%20Column%20I%20and%20Column%20II%20Codes?opendocument
There is an important change that affects codes bundled with CCI edits.
Effective for date of service on and after July 1, 2008, if documentation
in the patient's medical record supports the use of CPT modifier 59 for
your code pair (containing a Column I and Column II code), CPT modifier
must be submitted with the Column II code only. Previously, Palmetto GBA
accepted claims for Column I/Column II code pairs when either code was
submitted with CPT modifier 59.
Applies to:
Jurisdiction 1//J1 Part B: General
----------
Telephone Claim Correction Checklist
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~Appeals~Telephone%20Claim%20Correction%20Checklist?opendocument
Do you need assistance to correct a simple error made on a claim? Please
see the checklist in this article for the type of issues that can be
corrected by telephone instead of filing a Redetermination (1st level of
appeal). Please contact us at 1-866-669-5543, Monday-Friday, anytime
between 7:00 a.m.-3:00 p.m. PST. Be prepared to provide the provider's
identifier and the patient's Medicare number, last name and first initial.
We can handle three qualified requests per call.
Applies to:
Jurisdiction 1//J1 Part B: General
Thursday, September 18, 2008
CMS/Medicare Website Updates
Dear ANCO Online ListServ Subscriber:
The following updates have been posted to the CMS/Medicare website.
MM6175 - October 2008 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/MM6175.pdf
The following updates have been posted to the CMS/Medicare website.
MM6175 - October 2008 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/MM6175.pdf
Palmetto/J1MAC Website Updates
Dear ANCO Online ListServ Subscriber:
The following updates have been posted to the Palmetto/J1MAC website.
J1 Part B LCD Update
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~J1%20Part%20B%20LCD%20Update?opendocument
Click on the link to view the J1 A/B MAC Part B LCDs that have been
revised.
Applies to:
Jurisdiction 1//J1 Part B: General
----------
The following updates have been posted to the Palmetto/J1MAC website.
J1 Part B LCD Update
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~J1%20Part%20B%20LCD%20Update?opendocument
Click on the link to view the J1 A/B MAC Part B LCDs that have been
revised.
Applies to:
Jurisdiction 1//J1 Part B: General
----------
CMS/Medicare: New Fact Sheets on Reporting Changes to Medicare Enrollment
Dear ANCO Online ListServ Subscriber:
The following information is provided by CMS/Medicare.
The Centers for Medicare & Medicaid Services (CMS) has posted three new Fact Sheets on the Medicare Provider Enrollment page at http://www.cms.hhs.gov/MedicareProviderSupEnroll/, on the CMS website.
These Fact Sheets list the types of changes that enrolled physicians, non-physician practitioners, and group practices are required to report to Medicare within specific times of occurrence. Non-reporting of changes may adversely affect claims processing, claims payment amounts, and the eligibility of the physician, non-physician practitioner, or group practice to participate in Medicare. The Fact Sheets indicate the Medicare provider enrollment forms that must be used to report the changes, and include information on where to go for assistance.
Links to each Fact Sheet are provided below:
Reporting Responsibilities for Individual Physicians Enrolled in the Medicare Program
http://www.cms.hhs.gov/MedicareProviderSupEnroll/Downloads/PhysicianReportingResponsibilities.pdf
Reporting Responsibilities for Individual Non-Physician Practitioners Enrolled in the Medicare Program
http://www.cms.hhs.gov/MedicareProviderSupEnroll/Downloads/Non-PhysicianReportingResponsibilities.pdf
Reporting Responsibilities for Physician Group Practices Enrolled in the Medicare Program
http://www.cms.hhs.gov/MedicareProviderSupEnroll/Downloads/GroupPracticeReportingResponsibilities.pdf
The following information is provided by CMS/Medicare.
The Centers for Medicare & Medicaid Services (CMS) has posted three new Fact Sheets on the Medicare Provider Enrollment page at http://www.cms.hhs.gov/MedicareProviderSupEnroll/, on the CMS website.
These Fact Sheets list the types of changes that enrolled physicians, non-physician practitioners, and group practices are required to report to Medicare within specific times of occurrence. Non-reporting of changes may adversely affect claims processing, claims payment amounts, and the eligibility of the physician, non-physician practitioner, or group practice to participate in Medicare. The Fact Sheets indicate the Medicare provider enrollment forms that must be used to report the changes, and include information on where to go for assistance.
Links to each Fact Sheet are provided below:
Reporting Responsibilities for Individual Physicians Enrolled in the Medicare Program
http://www.cms.hhs.gov/MedicareProviderSupEnroll/Downloads/PhysicianReportingResponsibilities.pdf
Reporting Responsibilities for Individual Non-Physician Practitioners Enrolled in the Medicare Program
http://www.cms.hhs.gov/MedicareProviderSupEnroll/Downloads/Non-PhysicianReportingResponsibilities.pdf
Reporting Responsibilities for Physician Group Practices Enrolled in the Medicare Program
http://www.cms.hhs.gov/MedicareProviderSupEnroll/Downloads/GroupPracticeReportingResponsibilities.pdf
Palmetto/J1MAC Website Updates
Dear ANCO Online ListServ Subscriber:
The following updates have been posted to the Palmetto/J1MAC website.
National Provider Identifier (NPI) for Secondary Providers
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~NPI~National%20Provider%20Identifier%20(NPI)%20for%20Secondary%20Providers?opendocument
This article is based on CR 6093 and outlines the need to use NPIs to
identify secondary providers in Medicare claims beginning May 23, 2008.
Some Medicare claims also need to identify one or more secondary providers.
A secondary provider could be a health care provider who ordered services
for a Medicare patient or who referred a Medicare patient to another health
care provider (ordering/referring providers); an attending, operating,
supervising, purchased service, other, or service facility provider; or a
prescriber (the latter only in retail pharmacy drug claims).
Applies to:
Jurisdiction 1//J1 Part B: General
----------
New Waived Tests
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~New%20Waived%20Tests?opendocument
Change Request 6179, from which this article is taken, informs providers of
new waived tests approved by the Food and Drug Administration (FDA) under
the Clinical Laboratory Improvement Amendments of 1988 (CLIA). Make sure
that your billing staffs are aware of these newly waived tests.
Applies to:
Jurisdiction 1//J1 Part B: General
----------
Reminder Notice: 2008 PQRI National Provider Conference Call with Question
& Answer Session
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Current%20News~Reminder%20Notice:%202008%20PQRI%20National%20Provider%20Conference%20Call%20with%20Question%20Answer%20Session?opendocument
The Centers for Medicare & Medicaid Services' (CMS) Provider Communications
Group will host the seventh in a series of national provider conference
calls on the 2008 Physician Quality Reporting Initiative (PQRI). This
toll-free call will take place from 3:30 p.m. - 5:00 p.m., EDT, on
Thursday, September 18, 2008.
Applies to:
Part B - Ohio / West Virginia//General - Part B
Part B - South Carolina//General - Part B
Railroad Medicare (RRB)//General - Railroad Medicare
Jurisdiction 1//J1 Part B: General
----------
The following updates have been posted to the Palmetto/J1MAC website.
National Provider Identifier (NPI) for Secondary Providers
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Resources~NPI~National%20Provider%20Identifier%20(NPI)%20for%20Secondary%20Providers?opendocument
This article is based on CR 6093 and outlines the need to use NPIs to
identify secondary providers in Medicare claims beginning May 23, 2008.
Some Medicare claims also need to identify one or more secondary providers.
A secondary provider could be a health care provider who ordered services
for a Medicare patient or who referred a Medicare patient to another health
care provider (ordering/referring providers); an attending, operating,
supervising, purchased service, other, or service facility provider; or a
prescriber (the latter only in retail pharmacy drug claims).
Applies to:
Jurisdiction 1//J1 Part B: General
----------
New Waived Tests
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~New%20Waived%20Tests?opendocument
Change Request 6179, from which this article is taken, informs providers of
new waived tests approved by the Food and Drug Administration (FDA) under
the Clinical Laboratory Improvement Amendments of 1988 (CLIA). Make sure
that your billing staffs are aware of these newly waived tests.
Applies to:
Jurisdiction 1//J1 Part B: General
----------
Reminder Notice: 2008 PQRI National Provider Conference Call with Question
& Answer Session
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Current%20News~Reminder%20Notice:%202008%20PQRI%20National%20Provider%20Conference%20Call%20with%20Question%20Answer%20Session?opendocument
The Centers for Medicare & Medicaid Services' (CMS) Provider Communications
Group will host the seventh in a series of national provider conference
calls on the 2008 Physician Quality Reporting Initiative (PQRI). This
toll-free call will take place from 3:30 p.m. - 5:00 p.m., EDT, on
Thursday, September 18, 2008.
Applies to:
Part B - Ohio / West Virginia//General - Part B
Part B - South Carolina//General - Part B
Railroad Medicare (RRB)//General - Railroad Medicare
Jurisdiction 1//J1 Part B: General
----------
10th Annual UCSF/UCDavis Thoracic Oncology Conference
Dear ANCO Online ListServ Subscriber:
The 10th Annual UCSF/UC Davis Thoracic Oncology Conference takes place on November 8, 2008 at the InterContinental Hotel, San Francisco. UCSF and UC Davis are Institutional Members of ANCO.
For additional information, please visit https://www.cme.ucsf.edu/cme/CourseDetail.aspx?coursenumber=MSU09004.
The 10th Annual UCSF/UC Davis Thoracic Oncology Conference takes place on November 8, 2008 at the InterContinental Hotel, San Francisco. UCSF and UC Davis are Institutional Members of ANCO.
For additional information, please visit https://www.cme.ucsf.edu/cme/CourseDetail.aspx?coursenumber=MSU09004.
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