Meeting Reminder

• The Most Adanced Diagnostic and Clinical Information in Cancer Prevention, Early Detection, Diagnosis, Treatment and Rehabilitation that will have an Impact on your Practice

• Therapeutic Approaches in Breast, Lung, Gastrointestinal, Gynecologic, Head & Neck, Skin, Central Nervous System, Urologic, Bone and Hemotologic Malignancies.

• Radiation Oncology, Supportive Care and Survivorship Sessions.

• Multidisciplinary Faculty of 140+ Oncology Thought Leaders with Representation from 17 of the Top 20 Cancer Centers.

• Capacity Controlled to Cultivate Learning from te Experienceof our Colleagues

Go to www.OncologyCongress.com and register for the full conference package.
Enter the Priority Code: MOASC for $100 off registration price.

 

Patient Assistance Programs Highlighted in Oncology Issues

The September/October Oncology Issues features an in-depth look at a model oncology patient assistance program. Sarasota Memorial Health Care System, a community not-for-profit hospital located in Southwest, Fla., faced a growing challenge of how to effectively case manage its uninsured and underinsured cancer patients. Expenses were mounting. The hospital’s Pharmacy Department was concerned over the ever-increasing costs of drugs and suggested that the fiscal responsibility for caring for these uninsured and underinsured patients was becoming too burdensome for the hospital.The solution: An Oncology Patient Assistance Program. Read more.

Encore Presentation of the 9/26 NPI Roundtable Now Available

The National Provider Identifier (NPI) Roundtable that occurred on September 26^th drew a record-breaking number of participants -the likes of which CMS had not previously seen during the HIPAA Roundtable series.  As a result, this overwhelming response exceeded logistical expectations and therefore many callers were unable to join the call.  An encore presentation is now available for access at your convenience, 24 hours/day, until midnight on Wednesday, October 4^th (including the weekend).  Interested participants can access the encore with the following information:

Encore Dial In #:    (800) 642-1687

Conference ID #:    4795739

A transcript of this call will also be available shortly at http://www.cms.hhs.gov/NationalProvIdentStand/ on the CMS website.

Medicare/Medicaid Relationship Brochure

The updated Medicare/Medicaid Relationship Brochure is now available in downloadable format on the Centers for Medicare & Medicaid Services MLN Publications

Page located on the CMS website at http://www.cms.hhs.gov/MLNProducts/downloads/Relationship_Brochure.pdf

The brochure discusses the relationship between Medicare beneficiaries who have limited income and resources might be getting help paying for their out-of-pocket medical and prescription expenses from their State Medicaid Program. For such persons who are eligible for full Medicaid coverage, the Medicaid program supplements Medicare coverage by providing services and supplies that is available under their State's Medicaid Program.  Hard copies of the brochure will be available for ordering through the Medicare Learning Networkin approximately six weeks.

Leslie Norwalk Named CMS Acting Administrator

Leslie Norwalk has been named Acting Administrator for the Centers for Medicare & Medicaid Services (CMS) following the resignation of Mark McClellan, MD, PhD. Norwalk will oversee the government's health programs, which include Medicare, Medicaid, and the State Children's Health Insurance Program.

Norwalk has served as CMS Deputy Administrator for the last five years and is considered a national leader on Medicare issues. In addition, Herb Kuhn has been appointed CMS Deputy Administrator. While Norwalk's leadership is only temporary until President Bush nominates a permanent replacement, it is likely that she will serve for at least several months and up to two years.

The next enrollment period for the prescription drug benefit is set to begin November 15. Overseeing the enrollment will be one of Norwalk's first duties as Acting Administrator.

House Passes National Institutes of Health Reform Act of 2006

On September 26, the U.S. House of Representatives passed H.R. 4146, "The National Institutes of Health Reform Act of 2006," to revise and extend the authorities of the National Institutes of Health (NIH).

The legislation, which passed the House by a vote of 414 to 2:

• Creates a new, comprehensive electronic reporting system to catalogue all of the research activities of the NIH in a standardized format.
• Establishes a formal strategic planning process for the entire research portfolio of the agency that transcends the research planning activities of individual institutes and centers. 
• Establishes a "common fund" to provide a permanent funding mechanism for trans-NIH research projects
• Sets up a formal, public process to review the structural and organizational design of the Agency every seven years. 
• Limits the overall size of the NIH to 27 institutes and centers.
• Authorizes the Director to award grants for demonstration projects for biomedical research bridging the biological, behavioral, and social sciences with the physical, chemical, mathematical, and computational sciences. 

The reforms outlined in the bill provide NIH with the flexibility necessary to facilitate and encourage translational research while maintaining a strong emphasis on investigator-initiated research projects. ASCO sent a letter last week to the Chairman of the House Energy and Commerce Committee, endorsing the legislation. It is unclear whether the Senate will take up this legislation. 

September

29 September 2006

• Important NPI Update:Get It. Share It. Use It. (JSM 06701)

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28 September 2006

• Important NPI Claims Processing Information - As noted in previous announcements by the agency and our contractors, CMS plans to begin testing the new software that has been developed to use the National Provider Identifier (NPI) in the existing Medicare fee-for-service claims processing systems. (CMS Message 200609-15)
• The Medicare Physician Fee Schedule for Fiscal Year 2007 will be posted shortly after the final Federal Register rule is put on display. (CR 5214)
• CMS has provided information on the 2006 - 2007 Influenza (Flu) Season resources for health care professionals. (SE0667)
• Effective January 1, 2007, HCPCS code G0107 for screening Fecal Occult Blood Tests (FOBT) is being terminated and replaced by CPT code 82270. (CR 5292)
• CMS announces Part D Low Income Subsidy (LIS) Redetermination Information. (SE0668)
• NPI REMINDER: The compliance date, May 23, 2007, is only 8 months away.  It’s every provider’s responsibility to make sure that an NPI is obtained if the provider is required to do so. (CMS Message 200609-13)
• This article has been revised: notice of the updated payment allowance limits effective October 1, 2006, and revisions to the January 2006, April 2006, and July 2006 quarterly drug pricing files. (CR 5270)
• NPI: Get It. Share It. Use It. Encore Presentation of the 9/26 NPI Roundtable Now Available
  
  The National Provider Identifier (NPI) Roundtable that occurred on September 26th drew a record-breaking number of participants -the likes of which CMS had not previously seen during the HIPAA Roundtable series. As a result, this overwhelming response exceeded logistical expectations and therefore many callers were unable to join the call. An encore presentation is now available for access at your convenience, 24 hours/day, until midnight on Wednesday, October 4th (including the weekend). Interested participants can access the encore with the following information:
  
  Encore Dial In #: (800) 642-1687
  
  Conference ID #: 4795739
  
  A transcript of this call will also be available shortly at www.cms.hhs.gov/NationalProvIdentStand/ on the CMS website.
  
  Getting an NPI is free - not having one can be costly.(CMS Message 200609-14)

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22 September 2006

• Implementation of New Healthcare Common Procedure Coding System (HCPCS) Codes and Fee Schedule Amounts for Power Mobility Devices (PMDs) (JSM06688)
• The Centers for Medicare & Medicaid Services (CMS) has awarded a contract for a national Medicare Secondary Payer Recovery Contractor (MSPRC) to Chickasaw Nation Industries, Inc. – Administration Services, LLC (CNI). This contract will be implemented on October 2, 2006. (JSM 06686)
• September is the perfect time to start talking with your patients about getting the flu shot. Medicare provides coverage for the flu vaccine and its administration. Influenza vaccination is a covered Part B benefit. Note that influenza vaccine is NOT a Part D covered drug. Please encourage your Medicare patients to take advantage of this vital benefit. And don’t forget – health care professionals and their staff benefit from the flu vaccine also. Protect yourself, your patients, and your family and friends. Get your flu shot! (CMS Message 200609-11)

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21 September 2006

• This article provides notice of the updated payment allowance limits effective October 1, 2006, and revisions to the January 2006, April 2006, and July 2006 quarterly drug pricing files. (CR 5270)
• This article notes the quarterly update to Correct Coding Initiative (CCI) edits, version 12.3, effective October 1, 2006. (CR 5258)
• This article announces the changes that will be included in the October 2006 release of the National Coverage Determination (NCD) edit module for clinical diagnostic laboratory services. (CR 5293)
• This article is to alert individual Medicare Fee-for-Service (FFS) providers and suppliers that a town hall meeting soliciting their opinions is scheduled. CMS recognizes and values the importance of medical associations, individual provider and supplier perspectives and looks forward to providing this town hall meeting as a feedback venue. (SE0666)
• This article has been revised: CMS is implementing the revised Form CMS-1500, which accommodates the reporting of the National Provider Identifier (NPI). The Form CMS-1500 (08-05) version will be effective January 1, 2007, but will not be mandated for use until April 2, 2007, and some additional requirements have been added. (CR 5060)
• CMS has revised the article on additional information and instructions for the implementation of the CAP pertaining to CAP drug categories and fee schedule. (CR 5079)
• The Medicare Learning Network is pleased to announce the availability of An Overview of Medicare Preventive Services for Physicians, Providers, Suppliers, and Other Health Care Professionals video program and 2006 - 2007 Influenza (Flu) Season Educational Products and Resources online PDF document. (CMS Message 200609-08)
• Immunization: Promoting Prevention for a Healthier Life
  September 24 -30 is National Adult Immunization Awareness Week. This annual heath observance provides an excellent reminder for you to talk with your Medicare patients about vaccine-preventable diseases and ensure that they are protected against influenza and pneumonia, which together are the fifth leading cause of death among adults 65 and older in the U.S. These vaccines are safe and effective, and there are no out-of-pocket costs for your Medicare patients. CMS needs your help to ensure that Medicare beneficiaries take full advantage of these preventive benefits. For information about National Adult Immunization Awareness Week, go to http://www.cdc.gov/nip/events/naiaw/default.htm. For information about Medicare’s coverage of adult immunizations and educational resources, go to (http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0667.pdf ). (CMS Message 200609-10)

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14 September 2006

• The Centers for Medicare & Medicaid Services (CMS) would like to request your participation in a Town Hall meeting on September 20, 2006, from 2:00 PM to 4:00 PM (Eastern Standard Time).(JSM 06667/CMS Message 200609-05)
• NPI News: Information about the NPPES downtime, change in online availability of NPI application/update form, and CMS NPI Roundtable. (CMS Message 200609-06)
• Independent laboratories may not bill for the technical component (TC) of physician pathology services furnished to a patient of a hospital after December 31, 2006. (CR 5210)
• Information has been posted on the October quarterly update for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule. (CR 5255)

07 September 2006

• CMS has posted an article to inform physicians participating in the CAP program that, effective October 1, 2006, drugs are being added to the CAP drug table. (SE0658)
• CMS has updated the list of CLIA Waived Tests. (CR 5231)
• September is Prostate Cancer Awareness Month! Please join with the Centers for Medicare & Medicaid Services (CMS) in promoting awareness of prostate cancer and the prostate cancer screening benefit covered by Medicare. (CMS Message 200609-03)

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August

31 August 2006

• Section 302(b) of the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA) requires CMS to conduct a demonstration project on the application of competitive acquisition for payment of most clinical laboratory services that would otherwise be payable under the Medicare Part B fee schedule. (CR 5205)
• CMS has recently released information on some physician self-referral exceptions related to software or services provided by vendors to providers for use in electronic health prescribing, and for use in electronic health record creation and transmission. These instructions are effective October 10, 2006.
• CMS NPI Roundtable – September 26, 2006
  CMS will host a national NPI Roundtable, open to all health care professionals, on Tuesday, September 26^th from 2:00-3:30PM ET.  To participate, you may call 1-877-203-0044, pass code 4795739 CMS will address common questions related to Medicare’s guidance on Subparts.  While CMS will only address questions from a Medicare perspective, this information may be helpful to all providers. Medicare providers, who have questions, should select the appropriate email below and send in questions by Friday, September 8^th.  Questions received after this date will not be considered. 
  
  

  Medicare providers who bill a Fiscal Intermediary should send questions to:  NPIQuestionsfromFIBillers@cms.hhs.gov

  Medicare providers who bill a Carrier should send questions to: NPIQuestionsfromCarrierBillers@cms.hhs.gov

  Medicare providers who bill a Durable Medical Equipment Regional Carrier (DMERC) should send questions to:  NPIQuestionsfromDMERCBillers@cms.hhs.gov

  Revised Date for Acceptance of NPIs on Paper Claims
  As mentioned in a previous announcement, Medicare will require the use of the NPI on paper claims.  As such, CMS is implementing use of the revised CMS-1500 form to accommodate use of the NPI.  Transition to the new form will begin on January 2, 2007.  For more details, and to learn more about the revised form, visit http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5060.pdf on the CMS website.  (CMS Message 200608-13)
• This message is a reminder for all providers and physicians who bill Medicare contractors for their services. A brief hold will be placed on Medicare payments for all claims during the last 9 days of the Federal fiscal year (September 22 through September 30, 2006).  These payment delays are mandated by section 5203 of the Deficit Reduction Act of 2005.  No interest will be accrued and no late penalties will be paid to an entity or individual by reason of this one-time hold on payments.  All claims held during this time will be paid on October 2, 2006.
  This policy only applies to claims subject to payment.  It does not apply to full denials, no-pay claims, and other non-claim payments such as periodic interim payments, home health requests for anticipated payments, and cost report settlements.
  Please note that payments will not be staggered and no advance payments will be allowed during this 9-day hold.
  For more information, please view the MLN Matters Article at  http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5047.pdf (CMS Message 200608-12)
• CMS has revised the article on the clarification of billing requirements for Percutaneous Transluminal Angioplasty (PTA) concurrent with the placement of an FDA-approved carotid stent. (CR 5022)
• CMS has revised this article for a second time: Collection of fee-for-service payments made during periods of managed care enrollment. (CR 5105)
• CMS has revised the article on the changes to the CMS-1500 (12-90) claim form. The intent of the new form is to best accommodate the NPI with minimal changes to the current claim form. (CR 4293)
• CMS has revised the article on Stage 2 requirements for use and editing of National Provider Identifier (NPI) numbers. (CR 4023)
• CMS Announces Outreach Conferences for Section 1011 (of the Medicare Modernization Act of 2003): Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens (SE0662)
• This article corrects certain business requirements that relate to edits for National Provider Identifiers (NPIs) and provider legacy identifiers when reported on claims, particularly for referring/ordering or other secondary providers, effective October 1, 2006 and later. (CR 5229)

 

ION Meetings For Physicians Only

October 13 - 15 - National/Business Meeting - Gaylord Texan, Dallas, TX