Meeting Reminders - NEW 06/10/07

“PREPARING FOR MEDICARE’S PHYSICIAN QUALITY REPORTING INITIATIVE (PQRI)"

Choose From:  June 12, 13, or 14 at 12:00 noon Pacific Daylight Time
Call in number:  1-866-222-5350
Access Code:  6724228

PLEASE RSVP to MOASC Administration at (909) 985-9061 ext. 1 or via e-mail at moasc@moasc.org.

Overview:  A voluntary Pay-for-Reporting project that may allow physicians and other healthcare providers to earn 1.5 percent of their Medicare allowable for many services for dates of service between July 1 and December 31, 2007

Presented by Lash Group Healthcare Consultants and AstraZeneca Cancer Support Network.

Medicare Releases Final Quality Initiative Details - NEW 06/10/07

The Centers for Medicare & Medicaid Services (CMS) this week released the final specifications for its Physicians Quality Reporting Initiative (PQRI), which starts July 1. The specifications contain descriptions and clinical recommendation statements for each of the 74 performance measures and include instructions on how to code each measure’s numerator and denominator. (182 pages)

2007 Physician Quality Reporting Initiative (PQRI) National Provider Conference Call with Question & Answer Session - NEW 06/10/07

The Centers for Medicare & Medicaid Services' (CMS) Provider Communications Group will host the fourth in a series of national provider conference calls on the 2007 Physician Quality Reporting Initiative (PQRI). This toll-free call will take place from 3:00 p.m. - 5:00 p.m., EDT, on Wednesday, June 13th, 2007. Materials for the call will be posted to the PQRI webpage at, http://www.cms.hhs.gov/PQRI.In order to receive the call-in information, you must register for the call. To register for the call participants need to go to the Registration page.

Clarification on Billing for Drug Waste - NEW 06/10/07

CR 5520, from which this article is taken, revises the Medicare Claims Processing Manual, Chapter 17, Sections 40 and 100.2.9 to include language that references payment for administering (and discarding) both single use vials and single use packages. Specifically, the change is to clarify that Medicare will cover the amount of a single use vial or single use package of a drug or biological that was discarded along with the amount of that single use vial/package that was administered to the Medicare patient.
Read the MedLearn Matters MM5520 >>
Read the CMS Transmittal >>

CMS Discontinues UPIN Assignment - NEW 06/10/07

The CMS will discontinue assigning Unique Physician Identification Numbers (UPIN) on June 29, 2007, but CMS will maintain its UPIN public "look-up" functionality and Registry website (http://www.upinregistry.com) through September 30, 2007. (CR 5584)

Immune Globulin Coding Update - NEW 06/10/07

CMS will be implementing HCPCS coding changes for Immune Globulin. (CR 5635)

Old CMS-1500 Forms Will Not Be Accepted After July 1 - NEW 06/10/07

The Centers for Medicare and Medicaid Services (CMS) yesterday told carriers to stop accepting the old CMS-1500 forms on July 2.

As reported earlier this year in CMA Alert, CMS announced it would continue accepting the old CMS-1500 claim forms past the original April 1 deadline because of formatting errors in some of the new forms being distributed by the Government Printing Office and other vendors. The form was  updated to accommodate the mandated National Provider Identifiers (NPIs).

NPI Look-Up Tool Available Soon - NEW 06/10/07

So, you’ve gotten your National Provider Identifier (NPI), right? Did you know you will also have to include the NPIs of referring physicians and health care facilities on your claim forms?

The Centers for Medicare & Medicaid Services (CMS) finally announced that  physicians and other covered entities will soon be able to look up NPIs by simply entering the provider or facility name into an online database. This online lookup will be available on June 28, 30-days after CMS’s official NPI data dissemination policy was published in the Federal Register.

The online lookup will return NPIs and relevant demographic information, but it will not disclose social security numbers, dates of birth, or IRS taxpayer identification numbers, according to CMS.

CMA-Sponsored Bill Introduced Into U.S. Congress Would Bring Equity to Geographic Payment Formula - NEW 06/10/07

Rep. Sam Farr (D-Carmel) last week introduced a CMA-sponsored bill to fix the inequitable and outdated Medicare geographic payment formula. The bill, which has bipartisan support from key members of the California congressional delegation, would allow currently underpaid counties to be reimbursed based on more accurate geographic practice costs.
Read More>> (Article and content copyright CMA. Used with permission)

Survey Results Confirms Blue Cross’s Widespread Failure to Adequately Notify Physicians of Fee Schedule Changes - NEW 06/10/07

CMA would like to thank all of you who completed the Blue Cross fee schedule survey last week. The survey results clearly demonstrate that Blue Cross has failed to provide physicians with timely access to the proposed fee schedule, leaving many physicians unable to assess the financial impact that the fee schedule changes will have on their practices. CMA has urged the Department of Managed Health Care to delay implementation of this new fee schedule, which is scheduled to take effect June 1.

Ninety-two percent of the 174 practices that responded said that Blue Cross failed to provide them with enough information to calculate their new reimbursement rates, and 75 percent of practices that requested additional information did not receive a satisfactory response in a timely manner.

CMA has provided DMHC with the survey results and urged them to take immediate action.

UPDATE: Responding to complaints from hundreds of CMA physicians, the Department of Managed Health Care (DMHC) has forced Blue Cross to delay implementation of its new fee schedule and take appropriate measures to notify doctors of the rate changes.

(Article and content copyright CMA. Used with permission)