Submitted by Mark Yeh, MD (Alternate CAC Representative)

CMS contractor jurisdictions and updates:

In 2008, CMS created 15 jurisdictions and awarded carrier contractors for 5 year contracts.  California was grouped with Nevada, Hawaii, Guam, American Samoa, and Northern Mariana Islands in Jurisdiction 1.  This year, with the 5 year contracts expiring, CMS will reduce the number of Jurisdictions from 15 to 10.  Although California's current jurisdiction will remain unchanged in its make-up, it will be renamed Jurisdiction E.   In anticipation for the conversion to Jurisdiction E, contractor bids went out in 2012 and Noridian was awarded the new Jurisdiction E contract in September of 2012.  Our current Jurisdiction 1 contractor, Palmetto GBA, along with another competing contractor filed a protest to CMS and in January of 2013, the Jurisdiction E contract was re-awarded to Noridian.  Pametto GBA subsequently filed a second protest to the Federal courts and, at the time of the CAC meeting, final judgment was pending on this second protest.  

In the meantime, Noridian has already created a new website (www.noridianmedicare.com/je) for the transition from Palmetto GBA.  The transition dates to Jurisdiction E are 8/26/2013 for Part A and 9/16/2013 for Part B.  We were advised to check either the new Noridian website or the current Palmetto GBA website (www.palmettogba.com/medicare) for details of the transition process.  Palmetto GBA has pledged to make the transition process a smooth one if Noridian prevails as the new contractor without the hiccups that were experienced during the last carrier transition from NHIC to Palmetto GBA.  

Sequestration:

As a result of the so-called Sequestration, effective 4/1/2013, CMS will pay 2% less on all Medicare reimbursements.   Although a new fee schedule will not be formally issued, providers should expect 2% less than what is currently on the fee schedule from CMS.  Providers CANNOT collect the 2% difference from patients.  However, providers can continue to collect the regular co-payments from their patients who are Medicare beneficiaries.  The Sequestration only affects what the federal government pays out and does not affect direct payments from patients.  If a provider is out of network (i.e. has opted out of participation in Medicare), the provider can continue to bill the patient for the full payment without the 2% discount.  However, patients should be advised that their reimbursement from Medicare for seeing the out of network provider will be reduced by 2%.  

MRI of Patients with MRI compatible pacemakers:

To be paid for and not be audited by the Recovery Auditor, when performing an MRI on a patient with MRI compatible cardiac pacemaker that is approved by the FDA, it is necessary to include the following three items in the Medicare claim:

1) Appropriate MRI code

2) KX modifier

3) ICD-9 code V45.01 (cardiac pacemaker)

Inclusion of the KX modifier on the claim lines means that the provider attests that documentation is on file verifying that FDA-approved labeling requirements are met. For such claims without the KX modifier, Medicare will deny the claim.

Source:  MLN Matters® Number:  MM 7441.

PECOS (Provider Enrollment, Chain and Ownership System) advice:

Non-Medicare providers ordering laboratory or imaging studies on Medicare beneficiaries should fill out form 855 O.  This way, the non-Medicare provider will be recognized in the system so that laboratory or imaging studies ordered by the non-Medicare provider will get paid.

We were all reminded that studies ordered by providers not enrolled in PECOS that previously resulted in warning messages in Phase I of this program will now turn into denials in Phase II of the program beginning 5/1/2013.  

For further details, see:

MLN Matters® Number: SE1305

Related Change Request (CR) #: 6421, 6417, 6696, 6856.

We are pleased to inform you that a new release of myABR, launched on April 21, includes the historical detail of your self-entered CME and SAM credits, as well as the ability to enter Self-Assessment CME (SA-CME) credits. Your PQI history also will be available on myABR in early May.

You are required to complete 25 Self-Assessment CME (SA-CME) credits (not numbers of modules - SAMs) every three years, which may include other SA-CME activities as well as SAMs. For a SAM, you should use the number of CME credits attributed to it by its sponsor. Other SA-CME activities include Category 1 CME activities that use self-assessment tools to help you reflect on your practice and identify your individual needs. Thus, valid SA-CME activities include:

·  All Category 1 CME activities in "enduring materials" (including web-based and print) and "journal-based Category 1 CME" formats

·  Enduring and ABR-qualified live Self-Assessment Modules (SAMs)

For more information on SA-CME, please visit the Maintenance of Certification section of the ABR website (www.theabr.org) and click on the Part 2 section for your discipline:

Diagnostic Radiology: http://www.theabr.org/moc-dr-comp2

Radiation Oncology: http://www.theabr.org/moc-ro-comp2

This session will inform individual practitioners on the basics of Stage 1 of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. Learn if you are eligible, and if so, what you need to do to earn an incentive. This is the first in a series of 6 National Provider Calls on the Medicare and Medicaid EHR Incentive Programs. Other topics include: Stage 2, clinical quality measures, hardship exceptions, payment adjustments, and a discussion on certification by the Office of the National Coordinator for Health Information Technology.  

Target Audience: Professionals eligible for the Medicare and/or Medicaid EHR Incentive Programs. For more details:Eligibility Requirements for Professionals. 

Agenda:

• Are you eligible?

• How much are the incentives and how are they calculated?

• How do you get started?

• What are major milestones regarding participation and payment?

• How do you report on meaningful use?

• Where can you find helpful resources?

• Question and Answer Session

Registration information will be available soon on the CMS Upcoming National Provider Calls registration website.