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Cal Rad Update

First Annual State of Radiology in California

 

We invite you to complete a brief survey that will provide some important information on the elements of radiology practice in California. It is our hope that this will be an annual survey with an expanding profile of information on radiology groups and trends. This information will only be tabulated in the aggregate and individual responses will be kept confidential.


As an incentive to encourage your response all respondents will be entered into a drawing. We will draw two lucky winners for an IPAD and a Visa Gift Card of $100. CRS members may only reply once, and the survey must be completed by Friday, January 28, 2011 in order to be eligible. Thanks for your help in allowing us to develop this data. It will be shared with all of our members.

Click here to view the survey.


We Need Your Help in Blocking the Upcoming Medi-Cal Cuts to Radiology

 

We have previously informed you of the cuts to radiology that were part of this year's state budget agreement. You have yet to see the actual impact since they have not been implemented, but will be retroactive to 10/1/10. The reductions are dramatic for MRI, CT and PET and the CRS will be seeking injunctive relief to block the cuts. Click here to view the letter for more detailed information. Prior legal challenges to these budget driven cuts have been successful and we need to raise funds to allow us to proceed. Please review the letter, contact us with any questions, and contribute as soon as possible.


 

Updates from Medicare and Palmetto

 

Important Update on PECOS & Ordering/Referring

At this time CMS has not turned on the automated edits that would deny claims for services that were ordered or referred by a physician or other eligible professional simply for lack of an approved file in PECOS. CMS is working diligently to resolve backlog and other systems issues and will provide ample advance notice to the provider and beneficiary communities before CMS begins any such automatic denials.  While there are some rumors that the edits will be turned on in January, we want to reiterate that CMS has not announced any date (January 3 or otherwise) as to when ordering/referring edits will be turned on.

 

Physicians or other eligible professionals not currently enrolled in PECOS should take the initiative to enroll sooner rather than later. There are three ways to verify that you have an enrollment record in PECOS:

  • Check the Ordering Referring Report on the CMS website, available here. If you are listed on that report, you have a current enrollment record in PECOS.
  • Use Internet-based PECOS to look for your PECOS enrollment record, available here. If no record is displayed, you do not have an enrollment record in PECOS.
  • Contact your designated Medicare enrollment contractor and ask if you have an enrollment record in PECOS.  Visit www.cms.gov/MedicareProviderSupEnroll for the "Medicare Fee-For-Service Contact Information" list (in the "Downloads" section).

If you are not yet in PECOS, the best way to submit your application is through Internet-based PECOS.  For more information, click here.


Important Information on the Timely Claims Filing Requirement
The Centers for Medicare & Medicaid Services (CMS) would like to remind Medicare Fee-For-Service physicians, providers and suppliers submitting claims to Medicare for payment, as a result of the Patient Protection and Affordable Care Act (PPACA), effective immediately, all claims for services furnished on or after Jan 1, 2010, must be filed with your Medicare contractor no later than one calendar year (12 months) from the date of service - or Medicare will deny them.

 

If you have Medicare Fee-For-Service claims with service dates from Oct 1, 2009, through Dec 31, 2009, those claims MUST be filed by Dec 31, 2010, or Medicare will deny them. Claims with service dates from Jan 1, 2009, to Oct 1, 2009, keep their original Dec 31, 2010 deadline for filing.

 

In general, the start date for determining the 1-year timely filing period is the date of service or "From" date on the claim.  For institutional claims that include span dates of service (i.e., a "From" and "Through" date on the claim), the "Through" date on the claim is used for determining the date of service for claims filing timeliness.  For claims submitted by physicians and other suppliers that include span dates of service, the line item "From" date is used for determining the date of service for claims filing timeliness.

 

Information on MRA of the neck

J1 Part A Medical Review has completed service specific probe reviews on Magnetic Resonance Angiography (MRA) in Hawaii and California. To avoid your claims being denied in the future, please click here to review the article before filing.

Every Woman Counts Program Reverses Prior Mammography Screening Reductions

 

The California Department of Public Health (CDPH) has  announced that after closing enrollment in January 2010 due to funding shortages, the Cancer Detection Programs: Every Woman Counts (CDP: EWC) will reopen enrollment December 1, 2010 to eligible women age 40 and older for breast cancer screening and diagnostic services.  The EWC webpage currently indicates that new enrollments will begin on December 1, 2010 for women age 40 and older seeking breast cancer screening and diagnostic services. 

 

The CRS had joined with a number of breast cancer advocacy groups including the Komen Foundation and the ACS in successfully reversing these prior limitations on access to mammography screening. The major problem now is reimbursement of digital mammography at analog rates and an EWC reimbursement that is tied to Medi-Cal rates which are being reduced.