ANCO Online ListServ

ACCC, ASCO, ASH, & Palmetto/J1MAC News

2009-07-08T16:27:00.000-07:00

The following information has been received by ANCO.

****ACCC NEWS****
Looming Crises in Cancer Care:
26th National Oncology Economics Conference
Association of Community Cancer Centers
September 22-25; Minneapolis, MN

How Will the Proposed Rules from CMS Affect Your Bottom Line & Your Service Line?

Just last week the Centers for Medicare & Medicaid Services (CMS) released its proposed 2010 Hospital Outpatient Department Rule and Physician Fee Schedule. Will reduction in payments be steep and excessive? Will changes affect the way you deliver care? What's new in "physician supervision" and quality reporting requirements?

The 26th National Oncology Economics Conference in Minneapolis, Minnesota, September 22-25, 2009, is designed to answer these questions. . . and offers a roadmap to surmount the coming challenges that 2010 holds for both cancer programs and practices.

View the meeting announcement/registration form at http://www.accc-cancer.org/meetings/pdf/meetings_noec2009_brochure.pdf

****ASCO NEWS****
The American Society of Clinical Oncology (ASCO) invites you to participate in the ASCO Study of Collaborative Practice Arrangements, funded by Susan G. Komen for the Cure®. Oncology Metrics, llc, has been commissioned by ASCO and is conducting a survey to inform the study. This study builds on the ASCO report published in the March 2007 Journal of Oncology Practice that projected a significant shortage of medical oncologists in the United States by 2020.

The study aims to address the workforce shortage by exploring collaborative practice models between oncologists and non-physician practitioners (NPPs). It will examine the impact of these models on practice efficiency and quality of care, and explore the satisfaction of physicians, NPPs and their patients with collaborative practice models. With the anticipated shortage of oncologists in coming years, identifying and sharing best practice models for greater efficiency in oncology practices is crucial for our profession, and both providers and patients will benefit.

During the first phase of this project, a brief survey will be administered to collect data about your practice and the services provided by NPPs in your office, as well as the oncologist/NPP collaboration style. If your practice does not employ NPPs, please answer the survey with that information. This survey should take your practice administrator or lead physician 20-30 minutes to complete.

All practices completing the full survey will receive an electronic summary of the survey results. In addition, in appreciation of your time, the first 25 participants completing the full survey will receive a $25 American Express gift card; the next 100 participants will receive a $10 gift card. Please be sure to include your email address as requested at the end of the survey.

Forty practices (representing a diversity of practice models) will then be invited to participate in a detailed analysis of the collaborative practice models being used today. Oncology practices that are selected to participate will receive a modest honorarium.

The individually-identified data collected from this survey will be kept strictly confidential. All reports resulting from this survey will use de-identified information to guard the confidentiality of all participants. Oncology Metrics will create analytical reports including aggregated data from this survey, but will only publish in a manner that obscures data sources, ensuring that readers will be unable to make any supported inference of data to any individual practice.

All survey responses must be submitted electronically. To complete the survey, go to
https://www.surveymonkey.com/s.aspx?sm=mUFMdcthVymqtS9m8JUc1Q_3d_3d

Individuals and practices may receive more than one invitation to participate in this survey; please submit only one survey per practice.

Through your participation, you will be making a lasting contribution to assure high quality care remains available to future oncology patients. If you have questions, please contact Elaine Towle at etowle@oncomet.com or (603) 887-8433.

****ASH NEWS****
Register Now for the 51st ASH Annual Meeting

The American Society of Hematology (ASH) welcomes you to the vibrant, charming city of New Orleans for our 51st annual meeting. Since Hurricane Katrina, major improvements and renovations have been made throughout the city, and there has never been a better time to experience this national treasure. As the largest hematology meeting in the world, this event offers many invaluable benefits, including the opportunity to:

• Grow professionally: This year’s Education Program will offer nearly 30 sessions covering the breadth of hematology, including a number of other intriguing, less traditional topics such as nanotechnology, complementary medicine, and emergency preparedness. The Scientific Program will include 17 sessions on a wide range of topics presented by each of ASH’s scientific committees. The meeting is also a valuable source of continuing medical education (CME) for physicians.

• Learn from the best: At the Meet-the-Expert Sessions, more than 40 speakers from all over the world will facilitate small-group discussions on advances in hematologic malignancies, bleeding disorders, sickle cell disease, transplantation, and many other topics, which will allow participants to present their questions directly to foremost experts in these areas and gain new insights and perspectives.

• Keep abreast of the hottest research: Abstracts selected for oral and poster presentations feature the latest research in the field and are chosen through blind scoring and a peer-review selection process as the most outstanding among the thousands submitted for the annual meeting. Simultaneous Sessions will take place Sunday through Tuesday, including a newly added Monday evening session. Late-breaking abstracts will be presented on Tuesday.

• Further your career: The annual meeting provides a variety of high-quality educational, career-development, and networking opportunities to meet the unique needs and interests of undergraduates, medical and graduate students, residents, and fellows. Trainees are invited to participate in these activities to make the most of the experience.

Review the 2009 schedule and program at http://www.hematology.org/meetings/2009/program/index.cfm

****PALMETTO/J1MAC NEWS****
J1 Provider Contact Center to be Closed for Training Friday, July 10, 2009
The J1 Provider Contact Center will be closed for training on Friday, July
10, from 11 a.m. PST to 3 p.m. PST. The call center will reopen at 3 p.m.
PST.
http://www.palmettogba.com/Palmetto/Providers.nsf/vMasterDID/7TQN6H3171?opendocument

News and Fact Sheet:CMS Proposed Payment, Policy Changes For Physicians'
Services To Medicare Beneficiaries in 2010
The Centers for Medicare & Medicaid Services (CMS) announced today proposed
changes to policies and payment rates for services to be furnished during
calendar year 2010 by over one million physicians and nonphysician
practitioners who are paid under the Medicare Physician Fee Schedule
(MPFS).
http://www.palmettogba.com/Palmetto/Providers.nsf/vMasterDID/7TQL237108?opendocument

Part B LCD Updates
There have been updates to several Part B LCDs.
http://www.palmettogba.com/Palmetto/Providers.nsf/vMasterDID/7TQMQM1435?opendocument

J1 Open Draft LCD Meeting: California, July 21
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, July
21, 2009. 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/7TKQ3P7107?opendocument

ANCO's ASCO/ONS Highlights 2009

2009-07-06T17:14:00.000-07:00

ANCO's ASCO/ONS Highlights 2009 will take place on Saturday, August 29th, at The Claremont Resort in Oakland.

Please download the meeting announcement and registration form at http://www.anco-online.org/ASCOHL2009.html.

The registration deadline for ANCO's ASCO/ONS Highlights 2009 is Friday, August 21st and space is limited so please send your registration as soon as possible.

CMS & Palmetto/J1MAC News

2009-07-03T07:19:00.000-07:00

The following information has been received by ANCO.

****CMS NEWS****
New:
MM6525 – Claim Status Category Code and Claim Status Code Update
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6525.pdf

If you downloaded the National Correct Coding Initiative (NCCI) Edits for Physicians (version number 15.2, effective 7/1/09 – 9/30/09) yesterday or today, please download the files again. Incorrect files were posted for the NCCI Edits for Physicians. The files have been corrected, and can be found at http://www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/list.asp on the CMS website.

MM6431 – Billing Routine Costs of Clinical Trials
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6431.pdf

****PALMETTO/J1MAC NEWS***
J1 Open Draft LCD Meeting: Nevada July 16
Palmetto GBA J1 A/B MAC will host an Open Draft Local Coverage
Determination (LCD) meeting for both Part A and Part B in Nevada, July 16,
2009. 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/7TKHPT7557?opendocument

ASCO & CMS News

2009-07-01T17:14:00.000-07:00

The following information has been received by ANCO.

****CMS NEWS****
The Centers for Medicare & Medicaid Services (CMS) announced today proposed changes to policies and payment rates for services to be furnished during calendar year (CY 2010) by over 1 million physicians and nonphysician practitioners who are paid under the Medicare Physician Fee Schedule (MPFS). The MPFS sets payment rates for more than 7,000 types of services in physician offices, hospitals, and other settings.

CMS is making several proposals to refine Medicare payments to physicians, which are expected to increase payment rates for primary care services. The proposals include an update to the practice expense component of physician fees. For 2010, CMS is proposing to include data about physicians’ practice costs from a new survey, the Physician Practice Information Survey (PPIS), designed and conducted by the American Medical Association.

CMS will accept comments on the proposed rule until August 31, and will respond to all comments in a final rule to be issued by November 1, 2009. Unless otherwise specified, the new payment rates and policies will apply to services furnished to Medicare beneficiaries on or after January 1, 2010.

To read the entire CMS Press Release issued today (6/30), please click here:
http://www.cms.hhs.gov/apps/media/press_releases.asp

To read the CMS Fact Sheet on the Physician Fee Proposed rule also issued today (6/30), click here:
http://www.cms.hhs.gov/apps/media/fact_sheets.asp

For more information on the proposed rule, which went on display at 11:15 a.m. (approx.) today (7/1) and be published on Monday, July 13. The 60-day comment period will close on Monday, August 31. Click here:
http://www.federalregister.gov/OFRUpload/OFRData/2009-15835_PI.pdf . More information will be posted shortly at: http://www.cms.hhs.gov/PhysicianFeeSched/PFSFRN/list.asp .

****ASCO NEWS****
CMS just released its proposed physician fee schedule for 2010, and our preliminary review is deeply concerning. An initial analysis of the fee schedule indicates that there could be reductions in overall payments to medical oncologists in the range of 6 percent, with steeper cuts in payments to radiation oncologists upwards of 10 percent.

As you know, AMA conducted a Physician Practice Information (PPI) survey in conjunction with more than 30 medical specialties in order to collect updated data on physician practice expenses per hour. AMA provided this data to CMS earlier this year as the agency developed its physician fee schedule for the coming year.

ASCO had concerns about participating in the survey but ultimately encouraged practices to participate, as the AMA survey is the only mechanism recognized by CMS for calculating the expense of services that oncology practices provide to patients.

According to the AMA, only 50 oncology practices provided data on practice expenses. This is substantially lower than the 245 responses yielded by the 2002 ASCO survey that Gallup conducted and that currently forms the basis for our practice expense payments.

We are certain that your practice expenses have not dropped since 2005, given the high level of the care and treatment that oncologists currently provide people with cancer. In fact, we believe that expenses have more likely increased substantially for many practices. ASCO is prepared to protest this proposed reduction in fee schedule payments in the strongest terms possible. We are already in direct communication with CMS and leaders in Congress to express how critical it is to provide the resources that practices require in order to ensure that all cancer patients receive the care they need.

ASCO will complete a thorough analysis of all provisions in the fee schedule affecting oncology and will provide more detailed information as soon as possible. Contact ASCO's Cancer Policy & Clinical Affairs Department at 571-483-1670 or publicpolicy@asco.org with any immediate questions that you have.

Palmetto/J1MAC & Corporate Member News

2009-07-01T06:36:00.000-07:00

The following information has been received by ANCO.

****PALMETTO/J1MAC NEWS****
ACT Call: Recovery Audit Contractor (RAC) - July 14, 2009
Palmetto GBA will offer a J1 Part B ACT call on Tuesday, July 14, at 12:30
p.m. PST. The call will focus on the Recovery Audit Contractor (RAC)
appeals process and recoupment.
http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7T2KU95544?opendocument

Understanding the Rules and Using the Tools Webinar To Be Held July 15 and
16
Did you miss the Understanding the Rules and Using the Tools Spring
workshop series? Here’s your chance to catch up: Palmetto GBA J1 Part B
Providers and Billers, join us for a free Understanding the Rules and Using
the Tools Webinar on July 15 and 16!
http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7THSGR3582?opendocument

CMS recently issued updated instructions for contractors to follow when
contacting providers on EFT who have failed to respond with a completed EFT
application as requested. To comply with these new instructions, we have
taken the listing of those that are on EFT and compared to our database of
ones that completed and returned the EFT applications as requested. Providers
who have not returned a new completed EFT application are being mailed a
letter indicating that they must respond to us by July 24th or their provider
number will be placed on DNF. If they fail to respond 90 days after the DNF
has been placed, their number will be deactivated. The letters were mailed
late last week.

****CORPORATE MEMBER NEWS****
Onmark, along with GlaxoSmithKline, invite oncologists in your practice to earn $100 by completing a brief web-based survey about Radioimmunotherapty (RIT).

Visit http://www.surveymonkey.com/s.aspx?sm=ztITVvz9_2fTn_2bD70_2fiJxCLA_3d_3d%20 to participate now.

In order to process the $100 honoraria, survey respondents must fax a completed W9 form to (650) 745-1278. A limited number of responses will be accepted, so please complete this survey at your earliest convenience.

ACCC, ASCO, ASH, & NCCN News

2009-06-30T08:23:00.000-07:00

The following information has been received by ANCO.

****ACCC NEWS****
How Will You Solve Today's Inpatient and Outpatient Challenges?

Pressing issues confront oncology today: declining revenues and reimbursements, the high cost of new technology, implementation of electronic medical records, and shortages in the oncology workforce.

The Association of Community Cancer Centers (ACCC) is here to help programs and practices confront the looming crises in cancer care. Learn how to:

Enhance your cancer service line
Implement cost-saving strategies
Determine which EMR system best fits your needs
Create innovative physician employment arrangements
Assess if 340B-status is right for your hospital
Negotiate with third-party payers
Evaluate productivity metrics
Improve charge capture. . . and much more!

Join us at ACCC's 26th National Oncology Economics Conference in Minneapolis, Minnesota, September 22-25, 2009. This is the one national meeting designed to benefit ALL members of your cancer care team.

ACCC members who register for the meeting at the full rate ($550 or higher) may register a second person, member or non-member, at the 2nd Registrant discount rate, as long as he or she is a cancer care provider.

Learn More and Register at http://www.accc-cancer.org/meetings/meetings_noec2009.asp!

Patient Navigation Pre-conference— Sept. 22
Enhance your patient navigation services.

Oncology Pharmacy Pre-conference— Sept. 22
For the oncology pharmacy team AND physicians who seek to establish an in-house pharmacy or hire a part-time consultant pharmacist.

****ASCO NEWS****
Register and Reserve Housing for the 2009 Breast Cancer Symposium
The theme of the Symposium, "Integrating Emerging Science into Clinical Practice," emphasizes the growing focus on translational research in oncology. The deadline to receive housing and early registration rates is Sept. 9.

Register and Reserve Housing for the 2009 ASCO Electronic Health Records Symposium
With the American Recovery and Reinvestment Act (ARRA) signed into law, now is the time to implement electronic health records (EHR) into your practice. The 2009 ASCO EHR Symposium, "Harnessing the EHR, From Incentives to Sustainability" can prepare you with the knowledge and tools for success. Join us Oct. 6-7 in San Francisco. The deadline to receive housing and early registration rates is Sept. 9.

We want to alert you to an exciting new ASCO program opportunity. Through financial support by Susan G. Komen for the Cure®, ASCO is offering hematology/oncology practices in the United States the chance to participate in the pilot test of a new breast cancer registry. The Breast Cancer Registry Pilot will use a web-enabled application that is based on the ASCO Breast Cancer Treatment Plan and Summary template (www.asco.org/treatmentsummary).

The three main goals of the Breast Cancer Registry Pilot are to:
Implement and evaluate a new way for data submission to a database for quality monitoring and improvement.
Evaluate the burden, value, usefulness, and effectiveness of the Breast Cancer Registry Pilot methodology to oncology practices.
Assess patients' perspectives regarding treatment and survivorship discussions using the treatment plan and summary reports generated by the web-based registry.

ASCO is currently recruiting 20 diverse outpatient hematology/oncology practices to participate in the Breast Cancer Registry Pilot data entry and evaluation research study. Practices will receive a $20,000 stipend for their participation. The pilot period will begin in early Fall 2009 and be completed by year-end, 2010.

Help ASCO start a registry and learn to incorporate a treatment plan and summary in your patient care. Ultimately, ASCO seeks to provide a registry for national quality monitoring and quality improvement. We encourage you to share this exciting opportunity with other members in your state, attached is a flier for your own distribution.

If you would like more information or you think your practice may be interested in participating, visit www.asco.org/bcr. Applications are due by June 30th. Accepted practices will be notified in July.

Selections of participants will be made by ASCO in its sole discretion, and all selections shall be final. If your practice is selected, you will be notified in July, 2009. Participation will be subject to written registry and study participation agreements. For more information, e-mail Ginger Norris at ginger.norris@asco.org or Charmaine Cummings at charmaine.cummings@asco.org.

****ASH NEWS****
New PQRI Resources Available
The Centers for Medicare and Medicaid Services (CMS) has released a new document directed at office managers outlining the steps providers should take to participate in the 2009 Physician Quality Reporting Initiative (PQRI) and E-Prescribing programs. Thedocument is available from CMS. More resources to help hematologists be successfully reimbursed for PQRI and E-Prescribing participation are available on the ASH Web site.

****NCCN NEWS***
The National Comprehensive Cancer Network (NCCN) is reaching out to oncology professionals to determine how useful the NCCN Clinical Practice Guidelines in Oncology™ are to you in informing your treatment decisions. Your responses will help us to make the NCCN Guidelines even more accessible to you. Please take a few minutes to give us your perspective by completing this short survey.

Click here (https://www.surveymonkey.com/s.aspx?sm=VffEQquxjmW2KnWkwVU08w_3d_3d) to access the NCCN Clinical Practice Guidelines in Oncology™ User Survey.

CMS, DHHS/MediCal, & Palmetto/J1MAC News

2009-06-30T08:18:00.000-07:00

The following information has been received by ANCO.

****CMS NEWS****
The Centers for Medicare & Medicaid Services (CMS) has posted the July 2009 ASP pricing files and crosswalks, which are available for download at http://www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/01a1_2009aspfiles.asp

SE0910 – Clarification for Billing Part B versus Part D for the Anti-emetic Aprepitant (Emend®)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0910.pdf

The written and audio transcripts of the ICD-10-CM/PCS Implementation and General Equivalence Mappings (Crosswalks) National Provider Conference Call, which was conducted by the Centers for Medicare & Medicaid Services on May 19, 2009, are now available in the Downloads Section at http://www.cms.hhs.gov/ICD10/06a_2009_CMS_Sponsored_Calls.asp .

The Centers for Medicare & Medicaid Services (CMS) must announce that the 2007 Physician Quality Reporting Initiative (PQRI) feedback reports that have been posted since July 2008 on www.qualitynet.org/pqri will be archived effective June 30, 2009 and will no longer be available to eligible professionals (EPs) who participated in the 2007 PQRI.

Archiving is required to create server space for new feedback reports related to the 2008 PQRI and the 2007 PQRI re-run participation. Only those EPs who previously did not qualify by submitting at least one quality data code successfully, but are newly qualified following the back-end system analysis and re-run of 2007 PQRI data, will receive a 2007 PQRI re-run feedback report.

All eligible professionals who successfully submitted at least one quality data code for the 2008 PQRI will receive a feedback report. These reports should be available in October 2009.

The 2008 PQRI incentive payment will be distributed by the Carrier and/or A/B MAC in October 2009. The 2007 PQRI re-run incentive payments will be distributed by the Carrier and/or A/BMAC in November 2009.

Additional information about the 2007 PQRI feedback reports can be found in the “2007 PQRI Program” section page at http://www.cms.hhs.gov/pqri on the CMS website.

It is not too late to start participating in the 2009 Physician Quality Reporting Initiative (PQRI) and potentially qualify to receive incentive payments. A new half-year reporting period begins on July 1. If you have not yet started, you can begin by reporting either:

· Three individual 2009 PQRI measures for at least 80% of applicable Medicare Part B FFS patients seen between July 1, 2009 and December 31, 2009 through a qualified 2009 PQRI registry. To qualify for a half-year incentive (some registries may allow an eligible professional to submit data to them from the start of 2009 thus being able to report for the entire year); or

· A measures group through claims or a qualified 2009 PQRI registry.; depending on the sample method selected for a measures group, you could qualify for:
o A half-year incentive by reporting the measures group on 80% of applicable Medicare Part B FFS patients seen between July 1, 2009 and December 31, 2009 or
o A full-year incentive by reporting the measures group on 30-consecutive patients.

A list of qualified registries for the 2009 PQRI can be found on the CMS PQRI “Reporting” section page at http://www.cms.hhs.gov/PQRI on the CMS website.

Eligible professionals do not need to sign-up or pre-register to participate in the 2009 PQRI. Submission of quality data codes for individual PQRI measures to CMS through a qualified registry or for a measures group through claims or a qualified registry will indicate intent to participate.

Although there is no requirement to register prior to submitting the data, there are some preparatory steps that professionals should take prior to undertaking PQRI reporting. CMS has created a tip sheet titled, “Satisfactorily Reporting 2009 PQRI Measures,” that provides information about how to get started with PQRI reporting. To access this tip sheet and all available educational resources on the 2009 PQRI please visit http://www.cms.hhs.gov/PQRI/ on the CMS website. Eligible professionals are encouraged to visit the PQRI webpage often for the latest information and downloads on PQRI.

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the availability of Qualified Registries for 2009 Physician Quality Reporting Initiative (PQRI) Reporting.

A list of qualified registries can be accessed under the “Reporting” section page on the CMS website at http://www.cms.hhs.gov/PQRI. Each of the registries listed has gone through a vetting process. CMS believes that it is highly likely each of these registries will be successful in their data submission for the PQRI program.

Eligible professionals who wish to participate in the 2009 PQRI using one of the registry-based options may contact the registries for additional details on participation options.

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.

A new website is now available from the Centers for Medicare & Medicaid Services (CMS) concerning Health Information Technology as provided for in the American Recovery and Reinvestment Act of 2009. On this website, you can find information pertaining to the Medicare and Medicaid incentives for electronic health records adoption and important links to related websites at the Department of Health and Human Services.

Posted now are:
· A CMS fact sheet and questions/answers pertaining to the incentive programs
· Link to press release pertaining to the process of defining meaningful use (Comments are due June 26, 2009.)
· Resources on Health IT and privacy & security (HIPAA)

Bookmark http://www.cms.hhs.gov/Recovery/11_HealthIT.asp today to find the latest on Health Information Technology.

****DHHS/MediCal NEWS****
Medi-Cal is receiving increased volumes of claims with NDCs. Please keep in mind 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 Level I, II or III code, will be denied. As a result, Medi-Cal would like to note the findings related to claim denials. Below are common questions/errors, based on claim reporting and provider contact, to be shared with your membership.

Medi-Cal has seen an increase in denied claims resulting from, but not limited to, the following issues:

Providers report they are unaware that NDCs are required
Provider's software is not ready yet
Provider didn't think NDC was required for this particular code
Provider was unaware of correct NDC format
Resources

The Medi-Cal Web site has a page devoted to NDC Reporting Requirements that contains reporting requirements details, frequently asked questions (FAQs), definitions, claim examples/formats, NDC presentation and information on Section 340B of the Public Health Service Act. Click here to access: http://files.medi-cal.ca.gov/pubsdoco/ndc/ndc.asp

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 .

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.

Additional information has been posted to the Medi-Cal Web site this week regarding Optional Benefits Reductions. A new link has been added to the home page (http://www.medi-cal.ca.gov/), Newsroom, section entitled: Medi-Cal Beneficiary Optional Benefits Reduction Notice. The link connects users to the DHCS Web page and beneficiary notices provided in the thirteen threshold languages.

In addition, the applicable provider manual sections have been refreshed and pages updated to reflect the most current information. The provider manuals can be accessed from the following link: http://files.medi-cal.ca.gov/pubsdoco/manuals_menu.asp.

****PALMETTO/J1MAC NEWS****
July 2009 J1 A/B MAC Medicare Advisory
The July 2009 J1 A/B MAC Medicare Advisory is now available 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/7TCRHU0154?opendocument

MammaPrint Test – Breast Cancer Prognosis Draft LCD J1B-09-0002
Palmetto GBA Part B has developed a new Local Coverage Determination (LCD)
for a new diagnostic test. The Draft LCD MammaPrint Test – Breast Cancer
Prognosis which will be open for comment on July 16, 2009.
http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7TANRA2065?opendocument

Part B LCD Update
The following J1 Part B LCDs have been revised.
http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7TANL83761?opendocument

Part B LCD Update
The following J1 Part B LCDs will begin their notice period on June 25,
2009.The revisions made during the comment period will become effective
August 10, 2009.
http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7TAN6V8370?opendocument

Advance Payments to Providers of Part B Services: Updated Summary of the
Requirements
The requirements for advance payment for Part B providers who are
experiencing financial hardship due to claims that are unable to process
within established time limits have been updated.
http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7TBQYM3512?opendocument

Erythropoietin Stimulating Agents (ESAs) for the Treatment of Anemia
Unrelated to Dialysis Therapy: Rounding Error Revised
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. Previously, you were
told these claims could be corrected via a telephone reopening. However,
due to the complex nature of these services, the reopening should be
requested in writing.
http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7SAL6P2226?opendocument

Fraud Alert: Be Aware of Fraudulent Requests for Provider Enrollment
Information by Fax or Mail
Fraud Alert: Please be aware of a recent scam that asks providers to
complete an enrollment application within 48 hours or risk payment
interruption.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7SXNUX1831?opendocument

CMS & Palmetto/J1MAC News

2009-06-10T07:39:00.000-07:00

The following information has been received by ANCO.

****CMS NEWS****
MM6459 – New Waived Tests
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6459.pdf

MM6503 – October Quarterly Update to 2009 Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6503.pdf

MM6523 – Revised Billing Instructions for Occurrence Span Code 74 for Skilled Nursing Facility (SNF) No Payment Claims
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6523.pdf

MM6477 – New Drug/Biological Health Care Procedure Code System (HCPCS) Codes for July 2009 Update
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6477.pdf

****PALMETTO/JMAC NEWS****
New Drug/Biological Health Care Procedure Code System (HCPCS) Codes for
July 2009 Update
MM6477 contains the July 2009 update to the New Drug/Biological Health Care
Procedure Code System (HCPCS) Codes.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7SUL9Z2777?opendocument

New Waived Tests
CR6459, New Waived Tests, alerts providers that the Centers for Medicare &
Medicaid Services (CMS) has listed the twelve latest tests approved by the
Food and Drug Administration (FDA) as waived tests under Clinical
Laboratory Improvement Amendments of 1988 (CLIA).
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7SUHY58206?opendocument

CMS News

2009-06-09T17:01:00.000-07:00

The following information has been received by ANCO.

****CMS NEWS****
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the posting of five frequently asked questions (FAQs) related to the re-run of 2007 Physician Quality Reporting Initiative (PQRI) data. The FAQs below, as well as, all PQRI FAQs can be accessed under “Related Links Inside CMS” section at http://www.cms.hhs.gov/PQRI on the CMS website.

We will be updating the FAQ section, so please continue to check it often.

FAQ # 9537
Q. What is the reason for the re-run of 2007 Physician Quality Reporting Initiative (PQRI) feedback reports and incentive payments?

A. CMS investigated reported issues following delivery of the 2007 Physician Quality Reporting Initiative (PQRI) feedback reports and incentive payments and determined that several unanticipated technical issues could be corrected by conducting back-end system analytics and re-running the data. Reports are anticipated to be available in the fall of 2009.
Reference: http://www.cms.hhs.gov/PQRI

FAQ # 9540
Q. When will the re-run of the 2007 Physician Quality Reporting Initiative (PQRI) feedback report and incentive payment be available? How will my practice receive this information?

A. 2007 Physician Quality Reporting Initiative (PQRI) reports are anticipated to be available in the fall of 2009 and will be available to the Tax Identification Number (TIN). These reports will be available only for those eligible professionals (EPs) who have qualified due to the back-end system analysis and re-running the data. For those EPs who already received an incentive, the re-run will not apply, thus those EPs will not receive an additional feedback report. Feedback reports will be available via the PQRI Reports Delivery System (RDS). An Individuals Authorized Access to the CMS Computer Services (IACS) user name and password will be required to access the report.
Reference: http://www.cms.hhs.gov/PQRI

FAQ #9541
Q. Will eligible professionals (EPs), using their individual national provider identifier (NPI), receive an additional incentive when the 2007 Physician Quality Reporting Initiative (PQRI) data is re-run in the fall of 2009?

A. No. Only those eligible professionals (EPs) who previously did not receive a bonus but are bonus eligible following the back-end system analysis and re-run of the 2007 Physician Quality Reporting Initiative (PQRI) data will potentially receive the 2007 re-run incentive.
Reference: http://www.cms.hhs.gov/PQRI

FAQ# 9542
Q. Will there be a 2007 Physician Quality Reporting Initiative (PQRI) re-run for the Medicare Care Management Performance (MCMP) and Physician Group Practice (PGP) demonstration projects?

A. No. Incentive payments to eligible Medicare Care Management Performance (MCMP) and Physician Group Practice (PGP) demonstration project participants have been issued and are a separate incentive program from the Physician Quality Reporting Initiative.
Reference: http://www.cms.hhs.gov/PQRI

FAQ #9543
Q. Will there be a 2007 Physician Quality Reporting Initiative (PQRI) re-run for Medicare Advantage participants?

A. Yes. Those Medicare Advantage eligible professionals (EPs) who previously did not receive a bonus but are bonus eligible following the back-end system analysis and re-run of the 2007 Physician Quality Reporting Initiative (PQRI) data will potentially receive the 2007 re-run incentive.
Reference: http://www.cms.hhs.gov/PQRI
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.

The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host a national provider conference call on the 2009 Physician Quality Reporting Initiative (PQRI). This toll-free call will take place from 2:30 p.m. – 4:30 p.m., EDT, on Wednesday, June 17, 2009.

The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) made the PQRI program permanent, but only authorized incentive payments through 2010. Eligible professionals who meet the criteria for satisfactory submission of quality measures data for services furnished during the reporting period, January 1, 2009 - December 31, 2009, will earn an incentive payment of 2.0 percent of their total allowed charges for Physician Fee Schedule (PFS) covered professional services furnished during that same period. The 2009 PQRI consists of 153 quality measures and 7 measures groups.

The topics covered on this national provider call will include:

How to access the PQRI help desk;
Review of the incentive payments and feedback reports timeline; and
An update on the upcoming decisions registries for 2009.

Following this presentation, the lines will be opened to allow participants to ask questions of CMS PQRI 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, section. Feel free to download the resources prior to the call so that you may ask questions of the CMS presenters.

Conference call details:

Date: June 17, 2009

Conference Title: 2009 Physician Quality Reporting Initiative-National Provider Call

Time: 2:30 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. If you cannot attend the call, replay information is available below.

Registration will close at 2:30 p.m. EDT on June 16, 2009, 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://www2.eventsvc.com/palmettogba/061709

Fill in all required data.

Verify your time zone is displayed correctly 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 you 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.

ACCC, ASCO, & Palmetto/J1MAC News

2009-06-09T06:33:00.001-07:00

Managing Payer Contract Negotiations in Oncology

2009-06-09T06:32:00.000-07:00

US Oncology Physician Services, an ANCO Corporate Member, is hosting a webcast on June 17th entitled Managing Payer Contract Negotiations. Please www.opspharmacist.com/opes for more information and to register.

Palmetto/J1MAC News

2009-06-08T06:55:00.001-07:00

The following information has been received by ANCO.

****PALMETTO/J1MAC NEWS****
ICD-9-CM Diagnosis Code 0600 Update

Share with your staff - The ICD-9-CM diagnosis code 0600 ‘Sylvatic’ was
incorrectly end dated in our system. Providers are asked to contact the
Palmetto GBA Provider Contact Center (PCC) at (866) 931-3901 and ask for
the claims to be reprocessed.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7Q3JV82052?opendocument

CMS to Host First National Medicare Fee-For-Service (FFS) Provider
Education Call on HIPAA Version 5010 - June 9, 2009

CMS will host a national education conference call to address Medicare's
FFS implementation of HIPAA Version 5010. This call is being conducted for
all Medicare fee-for-service providers. The call will give a general
overview of Medicare's transition to HIPAA Version 5010 and address some of
the exceptions and situations you may encounter as the new version is
implemented.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7SNR6V1562?opendocument

CMS & Palmetto/J1MAC News

2009-06-04T07:22:00.000-07:00

The following information has been received by ANCO.

****CMS NEWS****
The Second in Series: General Equivalence Mappings – ICD-9-CM to and from ICD-10-CM and ICD-10-PCS Fact Sheet (May 2009), which provides basic information about the General Equivalence Mappings (GEM) including possible users of the GEMs, why the GEMs are needed, and how the GEMs files are formatted as well as Reimbursement Mappings information, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/ICD-10Mappingfctsht.pdf .

****PALMETTO/J1MAC NEWS****
Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC),
and Medicare Remit Easy Print (MREP) Update
CR6453, Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code
(RARC), and Medicare Remit Easy Print (MREP) Update, announces the latest
coding updates which are effective starting July 1, 2009.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7SMPH26470?opendocument

Weekly Part B ACT Call on Claims Wednesday, June 10
The next weekly ACT call will be held on Wednesday, June 10 at 12:30 p.m.
PST. The subject will be Claims. Future ACT calls will be held every
Tuesday at 12:30 p.m. PST unless otherwise announced.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7S3T650154?opendocument

CMS & Palmetto/J1MAC News

2009-06-03T17:18:00.000-07:00

The following information has been received by ANCO.

****CMS NEWS****
MM6453 – Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy Print (MREP) Update
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6453.pdf

MM6484 – July Update to the 2009 Medicare Physician Fee Schedule Database (MPFSDB)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6484.pdf

MM6431 – Billing Routine Costs of Clinical Trials
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6431.pdf

MM5584 – Discontinuance of the Unique Physician Identification Number (UPIN) Registry
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5584.pdf

The Centers for Medicare & Medicaid Services (CMS) will host a national education conference call to address Medicare’s FFS implementation of HIPAA Version 5010. This call is being conducted for all Medicare fee-for-service providers. The call will give a general overview of Medicare’s transition to HIPAA Version 5010 and address some of the exceptions and situations you may encounter as the new version is implemented. A presentation will be given and Subject Matter Experts will be available to answer questions specific to Medicare. A PowerPoint presentation will be posted on the CMS 5010 Web page prior to the call. The CMS 5010 Web address is http://www.cms.hhs.gov/ElectronicBillingEDITrans/18_5010D0.asp

Conference call details:
Date: June 9, 2009
Conference Title: Medicare audio conference call: HIPAA Version 5010 – What you need to know!
Time: 2:30 – 4:00 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. If you cannot attend the call, there will be an audio version available for downloading on the 5010 Web page.

Registration will close at 2:30 p.m. ET on June 8, 2009, 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://www2.eventsvc.com/palmettogba/060909

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/J1MAC NEWS****
Extended Hours for Palmetto GBA Railroad Medicare
Share with your staff - Palmetto GBA J1 A/B MAC is posting this article on
behalf of Palmetto GBA Railroad Medicare: Palmetto GBA Railroad Medicare
has expanded its telephone hours to better serve health care providers in
all geographic time zones.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7SLP4P1211?opendocument

July Update to the 2009 Medicare Physician Fee Schedule Database
CR6484, July Update to the 2009 Medicare Physician Fee Schedule Database,
amends payment files that were issued to Medicare contractors based on the
2009 MPFS Final Rule.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7SMQCN2708?opendocument

ACCC, CMA, & Palmetto/J1MAC News

2009-06-01T18:24:00.000-07:00

ASH & Palmetto/J1MAC News

2009-05-29T07:18:00.000-07:00

The following information has been received by ANCO.

****ASH NEWS***
The American Society of Hematology's (ASH) Practice Update was published 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

CMS & Palmetto/J1MAC News

2009-05-28T07:16:00.001-07:00

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

5th Annual Oncology Congress (September 24-26; San Francisco)

2009-05-28T07:14:00.000-07:00

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.

ACCC, ASCO, & Palmetto/J1MAC News

2009-05-27T07:08:00.000-07:00

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

Palmetto/J1MAC News

2009-05-26T06:59:00.000-07:00

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.

CMS & Palmetto/J1MAC News

2009-05-21T07:42:00.000-07:00

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 & Palmetto/J1MAC News

2009-05-20T07:18:00.000-07:00

The following information has been received by ANCO.

****CMS NEWS****
MM6480 – July 2009 Integrated Outpatient Code Editor (I/OCE) Specifications Version 10.2
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6480.pdf

MM6481 – Changes to the Laboratory National Coverage Determination (NCD) Edit Software for July 2009
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6481.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****
2009 Physician Quality Reporting Initiative (PQRI) and Electronic
Prescribing Incentive Program (E-Prescribing) National Provider Call
PowerPoint Presentation is Available
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce
that the PowerPoint presentation that will be used during the May 20, 2009,
PQRI and E-Prescribing National Provider call is available on the CMS Web
site.
http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7S7QSH6057?opendocument

June 4, 2009: POE-AG Agenda
The agenda for the Palmetto GBA J1 Provider Outreach and Education Advisory
Group meeting on June 4, 2009, is now available at our Web site.
http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7S3SZT6621?opendocument

Palmetto GBA J1 A/B MAC Contract Provider To Be closed Monday, May 25,
2009, For Memorial Day
Palmetto GBA's offices and the Provider Contact Centers (PCCs) will be
closed Monday, May 25, 2009, in observance of Memorial Day.
http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7S7KDU2146?opendocument

Weekly J1 Part B Ask the Contractor Teleconference (ACT) Calls Reinstated
Starting May 21
Palmetto GBA will reinstate the weekly J1 Part B Ask the Contractor
Teleconference (ACT) calls every Thursday starting May 21 through July 2009
to address the latest concerns within the provider community.
http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7S3T650154?opendocument

CMS News

2009-05-19T17:43:00.000-07:00

The following information has been received by ANCO.

****CMS NEWS****
Background materials for the May 20, 2009 Special Open Door Forum: Outpatient Imaging Efficiency Measures are available for review at http://www.QualityNet.org and http://www.ImagingMeasures.com.

Centers for Medicare & Medicaid Services
Special Open Door Forum:
Outpatient Imaging Efficiency Measures
Wednesday, May 20, 2009
2:00PM – 4:00PM Eastern Time (ET)
Conference Call Only

Featuring:
John Cooper, M.D. (CMS),
Mark Zezza, Ph.D. (The Lewin Group),
Thomas G. Dehn, M.D., FACR (National Imaging Associates, Inc.),
Joan DaVanzo, Ph.D. (Dobson | DaVanzo & Associates, LLC).

The Centers for Medicare & Medicaid Services (CMS) will hold a Special Open Door Forum (ODF) to discuss the development and implementation of facility-level hospital Outpatient Imaging Efficiency measures. The CMS has contracted with The Lewin Group, to develop a set of imaging efficiency measures. National Imaging Associates, and Dobson & DaVanzo are subcontracted by Lewin to support this effort.

During this Special ODF, CMS staff will discuss:

· Each of the four outpatient imaging efficiency measures currently required under the Hospital Outpatient Quality Data Reporting Program
(HOP QDRP) for CY2010 payment determination;
· Highlight some frequently asked questions;
· New Outpatient Imaging Efficiency measures under development.

Afterwards, there will be an opportunity for the public to ask questions.

To make the call as informative as possible, we recommend that participants:
· Visit the QualityNet (http://www.QualityNet.org) and Choose “Imaging Efficiency Measures” under “Hospital – Outpatient” and also http://www.ImagingMeasures.com ;
· Pre-submit any questions you wish to have addressed on the call to Imaging.Measures@lewin.com. Please type “Question for National Open Door Forum” in your Subject line. The most frequently asked questions received by 5 pm ET on Thursday, May 14, 2009, will be addressed on the call. Submitted questions not selected for the call will be answered individually via e-mail reply.

We look forward to your participation.

Special Open Door Forum Participation Instructions:

Dial: 1-800-837-1935 Conference ID 94281978

Note: TTY Communications Relay Services are available for the Hearing Impaired.

For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will A Relay Communications Assistant will help.

An audio recording of this Special Forum will be posted to the Special Open Door Forum website at http://www.cms.hhs.gov/OpenDoorForums/05_ODF_SpecialODF.asp and will be accessible for downloading beginning May 29, 2009.

For automatic emails of Open Door Forum schedule updates (E-Mailing list subscriptions) and to view Frequently Asked Questions please visit our website at http://www.cms.hhs.gov/opendoorforums/ .

Thank you for your interest in CMS Open Door Forums.

2009 Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (E-Prescribing) National Provider Call PowerPoint Presentation is now available

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that the PowerPoint presentation that will be used during the May 20th, 2009 PQRI and E-Prescribing National Provider call is now available on the CMS website.

This presentation provides an update on the Quality Data Code (QDC) Error Report; tips for satisfactorily reporting a Measures Group in the 2009 PQRI; and frequently asked questions on E-Prescribing.

To access the presentation, go to http://www.cms.hhs.gov/PQRI/04_CMSSponsoredCalls.asp., scroll down to the Downloads section and select the “National Provider Call - May 20, 2009” link.

ACCC & CMS News

2009-05-19T06:59:00.000-07:00

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_5-18-2009.html. ANCO is an Institutional Member of ACCC. This edition features:

Many Disagree with Medicare's "No" Decision for Virtual Colonoscopy

ACCC Public Policy Update: Two CMS May 20 Teleconferences

Health Plan Paperwork/Interactions Taking Much Physician and Nurse Time

New FTC "Red Flags" Rule on Identity Theft Applies to Many Providers

Q&A on ACCC's Listserve: Use of Nurse Practitioners

Houston, We Have a Free Meeting June 10

A Compelling Value This September in Minneapolis: Updated Agenda

US Oncology Launches Audio Reimbursement Education for Practices

****CMS NEWS****
Centers for Medicare & Medicaid Services
Special Open Door Forum:
Medicare Imaging Demonstration Project
Wednesday, May 27, 2009
9:30 am – 11:30 am ET

The Centers for Medicare and Medicaid Services (CMS) is holding a Special Open Door Forum (ODF) in order to solicit stakeholder input for the design and development of the Appropriate Use of Imaging Services Demonstration. This Special ODF will be a “listening session” in which CMS hopes to gather information from stakeholders about issues that will affect Demonstration design and implementation.

This demonstration was authorized by Section 135(b) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) for the purpose of collecting data regarding physician use of advanced diagnostic imaging services. For purposes of this demonstration, advanced diagnostic imaging services are defined as diagnostic magnetic resonance imaging, computed tomography, and nuclear medicine (including positron emission tomography).

CMS is interested in holding this Special ODF to gather input related to the design and implementation of this provision. CMS will not be able to respond to comments at this Forum but intends to consider the information we obtain as input develop this demonstration.

CMS is especially interested in information and feedback in the following topic areas:
1. Demonstration Framework:
a. Given that prior authorization is excluded from the demonstration by legislative mandate, how can we best design the demonstration to test both point of order (POO) and point of service (POS) systems?

b. How could CMS assess the impact of POO and POS systems through randomized designs or other comparative models?

c. What will motivate physician participation in the demonstration? How should physicians be recruited? What is the role of economic and non-economic incentives in encouraging participation?

2. Point of Order (POO) and Point of Service Systems (POS):
a. What are the major characteristics of POO and POS? How are they similar and how are they different in their assessments of appropriateness? How are these systems currently used by providers and payers?

b. What data are captured by the systems and what is the comparability in data elements across systems? Are there distinctions in how appropriateness of individual procedures is assessed between these two systems?

c. Does use of POO versus POS systems vary systematically by type of service, service setting, type of physician, and/or geography? How common is the use of these systems by specialists, primary care physicians and performing physicians?

d. How do ordering and performing physicians interface with the POO or POS systems? Do individual physicians or group practices use of more than one system?

3. Imaging Procedures:
a. Specific procedures being considered for inclusion in the demonstration are likely to be high in volume, high in growth, exhibit geographic variation, and have consensus around clinical guidelines. Are there other criteria we should consider when selecting procedures for inclusion in the demonstration?

b. What procedures that have the characteristics described above have been incorporated into POO and POS?

c. Should the demonstration focus on applying a decision support system for only specific types of imaging procedure use (e.g., MRI for Lumbar Spine, rather than all MRIs)? Might a focus on only specific types of procedures cause confusion for physicians or increase burden on physicians?

For a more information, please see the demonstration website: http://www.cms.hhs.gov/DemoProjectsEvalRpts/MD/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=3&sortOrder=descending&itemID=CMS1222075&intNumPerPage=10

We ask that all interested parties who wish to present their positions or comments prepare to speak for no more than 2 minutes. Telephone participants will also be given an opportunity to speak and will be under the same time limitation.

CMS requests that interested parties prepare their comments or input in written form and submit this information toImagingDemo135b@cms.hhs.gov . We also request that you bring a hard copy of your written material for collection at the Special ODF.

We look forward to your participation.

There are two ways to participate, by phone or "in-person".

1. To participate by phone:
Dial: 1-800-837-1935 & Reference Conference ID: 90111467
Persons participating by phone are not required to RSVP.
Note: TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.

2. To participate "in-person" at the CMS Baltimore Site, RSVP is required.
Please RSVP by 2pmET Thursday, May 21, 2009 to: SpecialODF@cms.hhs.gov . Please use “Medicare Imaging Demonstration” in the subject line, send your name along with the name of your organization, your contact information, and indicate whether or not you plan to speak.

Please plan to arrive no later than 9:00 AM to account for time required to pass through security. Visitors are subject to a vehicle search and an examination of all parcels (including purses) brought into the complex. Visitors all must have a valid Government-issued photo identification card or badge.

ADDRESS:
CMS Single Site Building
Auditorium
7500 Security Boulevard
Baltimore, MD 21244

An audio recording and transcript of this Special Forum will be posted to the Special Open Door Forum website at http://www.cms.hhs.gov/OpenDoorForums/05_ODF_SpecialODF.asp and will be accessible for downloading beginning June 8, 2009.

For automatic emails of Open Door Forum schedule updates, E-Mailing list subscriptions and to view Frequently Asked Questions please visit our website at http://www.cms.hhs.gov/opendoorforums/ .

Thank you for your interest in CMS Open Door Forums.

CMA & Palmetto/J1MAC News

2009-05-18T07:10:00.000-07:00

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:

New Medicare Enrollment Rules Could Have Costly Consequences for Physicians

Are You Looking for Your IMQ CME Certification Form?

CMA Launches Language Access Project with Physician Survey

Governor Proposes Major Cuts to Health Care

CMA Supports Senate Move to Expand Health Care Coverage,

Says Access to Care Must Be Protected

CMA Bill Would Bring Fairness and Transparency to Peer Review System

Webinar: How the Stimulus Bill Impacts Your HIPAA Obligations

****PALMETTO/J1MAC NEWS****
Palmetto GBA has updated the J1 Part B Fee Schedules introduction page to
better serve our Web users.

Palmetto GBA J1 Part B Web Updates Notice
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7S3J2U7382?opendocument