Palmetto Issues July 2010 Medicare News Update

Medicare Physician Fee Schedule

  • The 'Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010' was signed into law on June 25, 2010. This law establishes a 2.2 percent update to the Medicare Physician Fee Schedule (MPFS) payment rates retroactive from June 1 through November 30, 2010.
  • Palmetto GBA is currently processing claims using the new 2.2 percent update rates. The new fees are posted on the Palmetto GBA Web site for each state. 

Medicare Contracting Reform: Updates

 Jurisdiction 15: OH, KY

  • CMS has awarded the J15 MAC to CIGNA.
  • Palmetto GBA teamed with another contractor to submit a proposal for Ohio and Kentucky. This proposal was not successful during the rebid process.
  • We will continue to share information with you through the Palmetto GBA Web site and listserv as more details become available regarding how these decisions will affect you.

 Online Provider Services

  • Beginning June 21, all providers that have EDI enrollment agreements on file with Palmetto GBA can register for this new online tool.
  • There is no charge for using this service!
  • Registration will allow you to access the following information through the Internet:

Beneficiary eligibility

Claim status and remittances online

Financial Information (payment floor and last three checks paid)

  • Only one Provider Administrator per EDI Enrollment Agreement/per PTAN performs the registration process. The Provider Administrator can then grant permission to additional users related to that PTAN. Billing services and clearinghouses should contact their provider clients to gain access to the system.

Signatures in Medical Records

This remains one of the top errors in reviews of medical records.  Recent CMS clarification: MLN Matters article MM6698.

  • Stamped signatures: not acceptable for medical review purposes
  • Medicare does not require orders for “clinical diagnostic tests” to be signed; however, if the orders are not signed, there must be signed documentation (electronic or handwritten signature) by the treating physician that he/she intended to order the clinical diagnostic test being performed
  • Palmetto GBA article, “Medicare Medical Records: Signature Requirements, Acceptable and Unacceptable Practices”
  • Palmetto GBA “job aid” (lists acceptable and unacceptable examples)

Patient Protection and Affordable Care Act (PPACA, or ACA)

Key provisions of this Act include:

  • Expansion of preventive services (details are still pending) (section 4104).
  • Continuation of the “exceptions” process for therapy caps (section 3103).  Reference: MLN Matters article SE0931.
  • Reductions in the technical components of certain diagnostic imaging procedures, when multiple procedures are performed (section 3135).  Reference: MLN Matters article MM6965.
  • Time limit for filing claims: changed to one year from the date of service.  Reference: MLN Matters article MM6960.

Make the Internet Work for You

  • Ohio home page:
  • West Virginia home page:
  • Register for the Palmetto GBA listserv.  You can customize your subscription by category (specialty and topic).  Be the first to know what’s new!
  • Use the MSP Lookup tool to determine whether Medicare should pay primary or secondary
  • The Denial Finder is a comprehensive resource for the most common denials for Ohio and West Virginia providers.  Search by remark code, procedure code, narrative explanation for denial, or narrative procedure!
  • The Modifier Lookup provides tips for correctly submitting and documenting all modifiers for Palmetto GBA
  • Use the E/M Tool for established patient services to input information and find the right CPT code supported by your documentation

Tips for Using Internet PECOS to Enroll or Change Your Enrollment Information

Enrolling or changing your enrollment information with Palmetto GBA can be quicker and easier using Internet PECOS, versus a paper CMS-855 application. These handy references contain helpful tips before you begin the Internet enrollment process:

  • When you’re ready to enroll or change your enrollment information using Internet PECOS, use this Web site:
  • Reminder: if you haven’t updated your enrollment records with Palmetto GBA since 2003, consider revalidating (this will ensure that you are in PECOS)

Ordered/Referred Services: Updates

  • Validity edits implemented for ordered/ referred services:
  • Providers eligible to order/refer
  • Valid ordering/referring NPI and enrolled in PECOS


  • At this time, Medicare contractors (including Palmetto GBA) will not implement changes that would automatically reject claims based on orders, certifications and referrals made by providers that have not yet had their applications approved by July 6, 2010.  
  • CMS issued an interim final regulation on May 5, 2010, implementing provisions of the Affordable Care Act that permit only a Medicare enrolled physician or eligible professional to certify or order home health services, durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), and certain items and services under Medicare Part B. The new law applies to orders, referrals and certifications made on or after July 1. The comment period for the regulation closed on July 6, after which the comments will be reviewed and considered before a final regulation is issued. The link to the proposed regulation (May 5 Federal Register) is (PDF, 96KB).
  • While the regulation was effective July 6, 2010, CMS will not implement automatic rejections of claims submitted by providers that have attempted to enroll in PECOS. 

 If you order/refer services:

  • Provide complete, valid information with your order/referral
  • Resources: CMS MLN Matters articles MM6417 and MM6421


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