MEDICARE AND PRIVATE PAYER'S  FOCUS ON PAY-FOR-PERFORMANCE INCLUDES ELECTRONIC MEDICAL RECORDS. ARE YOU READY? 

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CMS 2006 Demonstration Project Important Updates

• http://www.cms.hhs.gov/MedlearnMattersArticles/downloads/SE0589.pdf
• http://www.cms.hhs.gov/MedlearnMattersArticles/downloads/SE0588.pdf "
  

We also have these .pdf's here:

Coding Guidelines: SE0588
Demo Project Instructions: SE0589

CMS Correction to Demonstration Project Guidelines

CMS has issued Transmittal 36 to correct information recently released in Transmittal 34 pertaining to the implementation of the 2006 Oncology Demonstration Project.  Please note this new Transmittal recinds and replaces the earlier Transmittal 34.



Helpful Forms for the Demonstration Project

Demo Project Form Version 2 - Marty Neltner/MOASC

Demo Project by DX version 2 - Bobbi Buell, courtesy of Caring4Cancer website

Emergency Update to the Medicare Physician Fee Schedule

CMS released Transmittal 798 (CR 4268). Summary of Changes: Payment files were issued to carriers based upon the November 21, 2005, Medicare Physician Fee Schedule Final Rule. This change request amends those payment files and includes G0332 (new G-code for intravenous infusion of immunoglobulin) and new G-codes for the 2006 Oncology Demonstration Project.

• CMS has issued an article on the new waived tests approved by the FDA under CLIA. (CR 4136)

• CMS publishes The Quarterly Provider Update on the first business day of each quarter. It is a listing of all non-regulatory changes to Medicare including Program Memoranda, manual changes, and any other instructions that could affect providers.
• Effective January 1, 2006, Medicare will no longer handle Telephone Redeterminations. All Redetermination requests must be submitted in writing to NHIC. Additional information is available.
• In continuous efforts to provide opportunities to discuss issues involving the Medicare Prescription Drug Coverage - Part D program with providers, the Centers for Medicare and Medicaid Services will be hosting a weekly Provider Part D conference call. The Thursday, December 29, 2005 conference call scheduled for 2pm EST has been cancelled. The next scheduled call will be Tuesday, Jan 3, 2006 at 2pm EST. To participate on Tuesday, dial the conference phone number 1-800-619-2457 and reference the password "Part D".

• The following ten Local Coverage Determinations (LCDs) have been updated due to the 2006 annual HCPCS update: Bariatric Surgery; Cardiovascular Nuclear Medicine: Myocardial Perfusion Imaging and Cardiac Blood Pool Studies; Category III CPT Codes; Diabetes Mellitus Therapy Using Hepatic Activation or PIVIT Therapy; Echocardiography, Transthoracic and Transesophageal; Electrodiagnostic Studies; Erythropoietin Analogs for the Treatment of Anemia Unrelated to Dialysis Therapy; Intensity Modulated Radiation Therapy; Intravenous Immune Globulin (IVIg); and Lumbar MRI. These can all be accessed on our policy index on  the CMS website.

National Heritage Insurance - Northern California - 31140

National Heritage Insurance - Southern California - 31146

• Effective January 1, 2006, the following 17 LCDs will be retired: Amylase; Clinical Use of  Hepatitis C Virus (HCV) Molecular Tests; Cytogenetic Studies; Gonadotropin: Follicle Stimulating Hormone and Luteinizing Hormone; Implantable Loop Recorder; Intracoronary  Brachytherapy with Stent; Kyphoplasty; Level 3 Sleep Study: Home Unattended; Percutaneous Vertebroplasty: Pulmonary Services - Pulse Oximetry; Sedimentation Rate, Erythrocyte; Non-Automated and Sedimentation Rate, Erythrocyte; Automated; Syphillis Testing; Troponin; Vision Rehabilitation for Low Vision Patients; Vitamin B-12 Injections; Vitamin K Injections (Aqua MEPHYTON, Phytonadione); and Water-Induced Thermotherapy (WIT) for Benign Prostatic Hypertrophy.
• The following four Draft Local Coverage Determinations will be presented at the January CAC Meeting: External Counterpulsation (ECP) - (revision); Foot Care - Comprehensive; Removal of Skin Lesions; and Pulmonary Function Testing - (revision). These can be accessed from the Draft Local Coverage Determination (LCD) Index.
• The December minutes from the Medicare Advisory Forum meeting have been posted.
• The Questions and Answers from the Webinar on the 1500 Claim Form has been posted.
• The CERT Newsletter for December been posted.
• The allowance limits for Medicare Part B Drugs for effective January 1, 2006 have been posted.
• NHIC will be hosting a one hour Ask the Contractor Teleconference (ACT) on January 24th at 10:00 AM PST/1:00 PM EST on the subject of Physical Therapy and Occupational Therapy Services.

Congress Fails to Pass Budget By End of Session;
Medicare Physician Payment Cuts Will Take Effect Jan. 1
courtesy of the CMS AlertThe Voice of 35,000 California Physicians • December 30, 2005

Last week, the U.S. House of Representatives passed a federal budget package that would have stopped the 4.4 percent Medicare cut and frozen physician payments at 2005 rates.

However, last Wednesday, the Senate passed an ammended budget package that had to go back to the House for final approval. Unfortunately, most members of the House had gone back to their home districts for the holidays and House leaders were unable to take action on the Medicare physician payment issue before January 1. Because Congress did not complete its work, the Centers for Medicare and Medicaid Services (CMS) are obligated by law to implement the scheduled 4.4 percent rate cut on January 1.

CMA and AMA will be aggressively pushing Congress to act as soon as possible to stop the 2006 payment cuts and institute the freeze as proposed in the budget reconciliation bill. We will also be strongly urging that the payment adjustment be retroactive to January 1 so that physicians do not experience a rate cut.

At this time, the House is scheduled to return on January 31, and the Senate is set to reconvene on January 18. These dates may change since Congress has numerous urgent issues to address, including the physician payment issue.

Read More on the CMS website >>