Every Woman counts (EWC) Program Announces Changes to Mammography Screening Guidelines
The EWC program has notified providers on 12/1/09 of several changes to their coverage of mammography screening under their Cancer Detection Program. The CRS was aware of one of those changes but is strongly opposed to the second change.
The first change effective 1/1/10 the EWC program will reimburse digital screening mammography at the same rate that Medi-Cal currently reimburses for analog screening mammography. The radiology provider is free to accept this lower payment for the higher level of service if they wish to do so, i.e. it is voluntary. This was the imperfect solution contained in AB 356 ( Nava) that takes effect 1/1/0 to the problem of the gradual disappearance of analog mammography equipment but an EWC program that did not contain enough funds to pay for the higher cost of digital mammography.
The second change is to the age eligibility for breast cancer screening from age 40 to age 50 ala the recent recommendation from the US Preventive Services Task Force. That report has been met with significant criticism from all quarters and is not being implemented by Medicare or Medicaid programs. EWC is doing so after consulting with the Breast and Cervical Cancer Advisory Council and indicates this change is driven by a lack of adequate funding sources. The EWC indicates that if a women age 40 to 49 is screened prior to 1/1/10 and has an abnormal result they will receive follow-up services for a final diagnosis. They also indicate that they will suspend all new enrollments in EWC until July 1, 2010.
The CRS has indicated their opposition to the age change for screening and will be participating in a press conference next week with Assemblyman Nava and the Susan Komen Foundation to demand that this policy be rescinded. The solution for the EWC program is adequate funding and not elimination of essential screening services for their patient population. We will keep you informed of development on these EWC policy changes.
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Important Advisory on Medicare Part B Payments
Effective December 11, 2009, Palmetto GBA Jurisdiction 1 Medicare Administrative Contractor (MAC) will be transitioning our Part B financial accounting system from the Multi-Carrier System (MCS) to the Healthcare Integrated General Ledger Accounting System (HIGLAS). This transition involves only our financial accounting system. We will continue to use MCS for all of our claims processing activities.
Implementation of HIGLAS will enable the Centers for Medicare & Medicaid Services (CMS) to track Medicare payments and to accurately pay claims for over 40 million Medicare beneficiaries. The transition will also provide CMS with enhanced oversight of contractors' accounting systems and access to more accurate, timely and consistent data for decision-making and for performance evaluations.
A HIGLAS education letter containing the following information from Palmetto GBA was mailed to all J1 Part B providers in November, 2009.
Introduction to HIGLAS
Updated information regarding our HIGLAS implementation is available from the HIGLAS link in the Self Service Tools and Top Links section on the Palmetto GBA J1 Part B home page. This same information will be issued in our e-mail update and published in our monthly advisory.
Temporary Waiver of the Claims Processing Payment Floor
CMS has approved Palmetto GBA's waiver request to reduce the payment floor for both paper and Electronic Data Interchange (EDI) claims. Beginning December 9, 2009, the payment floor will be reduced to zero for both EDI and paper claims, and payments will be released for claims that have already been approved for payment.
This temporary reduction of the payment floor will result in payments being issued early (checks and Electronic Funds Transfers (EFTs)). This may give the appearance that your cash revenues have increased when in fact payments for some of your claims may have simply been made earlier than normal. Providers are encouraged to monitor their payments and make adjustments as necessary to prevent cash flow problems during the transition period.
HIGLAS Transition Activities
On December 9, 2009, Palmetto GBA J1B will run our last MCS payment cycle and begin the HIGLAS transition (See Palmetto GBA J1B HIGLAS transition timeline below). Waiver of the payment floor will result in claim payments (checks and EFTs) being issued earlier than normal. Online systems will go down at 10 p.m. EST.
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Providers are encouraged to continue submitting claims as normal
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Following our transition to HIGLAS, Palmetto GBA J1 Part B will resume normal scheduled payments
HIGLAS Payments and Remittance Advices
Palmetto GBA J1B will not be issuing payments from December 10 through December 15, 2009. Electronic Remittance Advices (ERAs) and paper RAs will not be available. Palmetto GBA J1B will resume normal payment cycles and issuance of payments on December 16, 2009, at which time providers will be able to retrieve their ERAs.
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