What's New from CMS for Jurisdiction 14 RHHI

This page contains announcements that were formerly on the What's New from CMS for Jurisdiction 14 Medicare Administrative Contractor (MAC) RHHI page. These announcements cover a variety of topics that are important to the provider/supplier community.

December

29 December 2010

• SE1035 – Claims Modifiers for Use in the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program
• MM7247 – Reporting of Service Units with HCPCS
• MM7248 – Calendar Year (CY) 2011 Update for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule
• MM7259 – Claim Status Category and Claim Status Code Update
• Revised: MM7046 – NPI Verification for Physician or Non-Physician Practitioner Providers for Critical Access Hospital (CAH) claims processed by Medicare Fiscal Intermediaries (FI) and Part A Medicare Administrative Contractors (A/B MAC)
• MM7256 - Implementation of Home Health Agency (HHA) Payment Safeguard Provisions

22 December 2010

• Revised: MM7234 – New HCPCS Q-codes for 2010-2011 Seasonal Influenza Vaccines
• Revised: MM7079 – Annual Wellness Visit (AWV), Including Personalized Prevention Plan Services (PPPS)
• MM7101 – Announcement of Medicare Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Payment Rate Increases
• SE1038 – Home Health Face-to-Face Encounter - A New Home Health Certification Requirement
• Signature on Requisitions for Clinical Diagnostic Laboratory Tests
  JSM/TDL-11097
  In the November 29, 2010, Medicare Physician Fee Schedule final rule, the Centers for Medicare & Medicaid Services (CMS) finalized its proposed policy to require a physician’s or qualified nonphysician practitioner’s (NPP) signature on requisitions for clinical diagnostic laboratory tests paid under the clinical laboratory fee schedule effective January 1, 2011. A requisition is the actual paperwork, such as a form, which is provided to a clinical diagnostic laboratory that identifies the test or tests to be performed for a patient.
  Although many physicians, NPPs, and clinical diagnostic laboratories may be aware of, and are able to comply with, this policy, CMS is concerned that some physicians, NPPs, and clinical diagnostic laboratories are not aware of, or do not understand, this policy. As such, CMS will focus in the first quarter of next year on developing educational and outreach materials to educate those affected by this policy. As they become available, we will post this information on our Web site at http://www.cms.hhs.gov/ClinicalLabFeeSched and use the other channels we have to communicate with providers to ensure this information is widely distributed. Once our first quarter educational campaign is fully underway, CMS will expect requisitions to be signed.
• Place of Service Indicator for HCPCS Codes G0339 and G0340
  JSM/TDL-11066
  The Pricing Indicator Code on the Alpha-Numeric HCPCS File has been changed from “00” to “13” for HCPCS codes G0339 and G0340. This change is effective for services furnished in CY 2006 – CY 2010.
  Place of Service Indicator for HCPCS Codes G0339 and G0340
  In calendar year (CY) 2006, the Status Code for Healthcare Common Procedure Coding System (HCPCS) codes G0339 (Image-guided robotic linear accelerator-based stereotactic radiosurgery, complete course of therapy in one session or first session of fractionated treatment) and G0340 (Image-guided robotic linear accelerator-based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, second through fifth sessions, maximum five sessions per course of treatment) changed in the Medicare Physician Fee Schedule (PFS) Relative Value File from “X” (Exclusion by law. These codes represent an item or service that is not within the definition of physicians’ services for physician fee schedule payment purposes. No relative value units (RVUs) are shown for these codes, and no payment may be made under the physician fee schedule. (Examples are ambulance services and clinical diagnostic laboratory services.)) to “C” (Carriers price the code. Carriers will establish RVUs and payment amounts for these services, generally on an individual case basis following review of documentation, such as an operative report.)
  While this change was accurately reflected in the annual published PFS Relative Value Files beginning in CY 2006, no corresponding change was made to the pricing indicator on the Alpha-Numeric HCPCS File. The Alpha-Numeric HCPCS File continued to show a HCPCS Pricing Indicator Code of “00” (Service not separately priced by part B) for HCPCS codes G0339 and G0340.
  Therefore, we are issuing this Joint Signature Memorandum/Technical Direction Letter (JSM/TDL) to update the Alpha-Numeric HCPCS File for CYs 2006-2010 to reflect a HCPCS Pricing Indicator Code of “13” (Price established by carriers).

16 December 2010

• MM7115 – Incentive Payment Program for Primary Care Services, Section 5501(a) of The Patient Protection and Affordable Care Act, Payment to a Critical Access Hospital (CAH) Paid Under the Optional Method
• Rescinded: MM7239 – Clinical Laboratory Fee Schedule – Medicare Travel Allowance Fees for Collection of Specimens
• MM7012 – Waiver of Coinsurance and Deductible for Preventive Services, Section 4104 of The Affordable Care Act, Removal of Barriers to Preventive Services in Medicare
• MM7042 – Ambulance Inflation Factor (AIF) for CY 2011 and Productivity Adjustment
• Revised: MM6625 – Common Working File (CWF) Unsolicited Response Adjustments for Certain Claims Denied Due to an Open Medicare Secondary Payer (MSP) Group Health Plan (GHP) Record Where the GHP Record was Subsequently Deleted or Terminated
• Revised: MM7234 – New HCPCS Q-codes for 2010-2011 Seasonal Influenza Vaccines
• Skilled Nursing Facility and Nursing Facility Reporting of Physician Consultation Services
  JSM/TDL 11080
  The Centers for Medicare & Medicaid Services (CMS) would like to remind skilled nursing facilities (SNFs) and nursing facilities (NFs) of the evaluation and management (E&M) services coding policy that has been in effect since January 1, 2010. If a physician or nonphysician practitioner is furnishing that practitioner’s first E&M service for a Medicare beneficiary in a SNF or NF during the patient’s facility stay, even if that service is provided prior to the federally mandated visit, the practitioner may bill the most appropriate E&M code that reflects the services the practitioner furnished, whether that code be an initial nursing facility care code (current procedural terminology [CPT] codes 99304 –99306) or a subsequent nursing facility care code (CPT codes 99307 –99310) if documentation and medical necessity do not meet the requirements for billing an initial nursing facility care code. Prior to January 1, 2010, this service may have been reported and paid using a CPT consultation code under the Medicare Physician Fee Schedule. The CMS Internet-Only Manual (IOM) Publication 100-04, Medicare Claim Processing Manual, Chapter 12, Section 30.6.13 will be updated to reflect this policy. Additional information on reporting physician consultation services can be found in MLN Matters article SE1010 and may be viewed at: http://www.cms.gov/MLNMattersArticles/downloads/SE1010.pdf.
• MM7237 – Implementation of Changes in End-Stage Renal Disease (ESRD) Payment for Calendar Year (CY) 2011
• MM7079 – Annual Wellness Visit (AWV), Including Personalized Prevention Plan Services (PPPS)
• Revised: MM7220 – Ventricular Assist Devices (VADs) as Destination Therapy
• Delay in Claim Editing for Ordering/Referring Providers
  (JSM/TDL 11051)
  The Centers for Medicare & Medicaid Services (CMS) previously announced that, beginning January 3, 2011, if certain Part B billed items and services require an ordering/referring provider and the ordering/referring provider is not on the claim, is not of a profession that is permitted to order/refer, or does not have an enrollment record in the Medicare Provider Enrollment, Chain and Ownership System (PECOS), the claim will not be paid. The automated edits will not be turned on effective January 3, 2011. We are working diligently to resolve enrollment backlogs and other system issues and will provide ample advanced notice to the provider and beneficiary communities before we begin any automatic nonpayment actions.

09 December 2010

• MM7125 – Billing Clarification for Positron Emission Tomography (NaF-18) PET for Identifying Bone Metastasis of Cancer in the Context of a Clinical Trial
• Revised: MM6991 – Calendar Year (CY) 2011 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment

02 December 2010

• MM7210 – Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 17.0, effective January 1, 2011
• MM7220 – Ventricular Assist Devices (VADs) as Destination Therapy
• MM7219 – Systems Changes Necessary to Implement “Technical Correction Related to Critical Access Hospital Services,” Section 3128 of the Affordable Care Act, Pub. L. 111-148
• MM7087 – National Modifier and Condition Code to Identify Items or Services Related to the 2010 Oil Spill in the Gulf of Mexico
• MM7234 – New HCPCS Q-codes for 2010-2011 Seasonal Influenza Vaccines
• MM7049 – Expansion of Medicare Telehealth Services for Calendar Year (CY) 2011
• MM7065 – Fractional Mileage Amounts Submitted on Ambulance Claims
• MM7225 – Reasonable Charge Update for 2011 for Splints, Casts, and Certain Intraocular Lenses
• MM7224 – Update to Medicare Deductible, Coinsurance and Premium Rates for 2011
• Revised: MM7120 – Influenza Vaccine Payment Allowances - Annual Update for 2010-2011 Season
• MM6991 – Calendar Year (CY) 2011 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment
• MM7068 – Instructions for PLB code reporting on Remittance Advice, a Crosswalk between the HIGLAS PLB codes and ASC X12 Transaction 835 PLB codes, and RAC Recoupment Reporting on Remittance Advice for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) claims
• Revised: MM6953 – Dermal Injections for Treatment of Facial Lipodystrophy Syndrome (LDS)
• Revised: SE1031 – 2010 - 2011 Seasonal Influenza (Flu) Resources for Health Care Professionals

November

23 November 2010

• MM7038 – Affordable Care Act Mandated Collection of Federally Qualified Health Center (FQHC) Data and Updates to Preventive Services Provided by FQHCs
• MM7050 – Multiple Procedure Payment Reduction (MPPR) for Selected Therapy Services
• MM7146 – Incentive Payment Program for Major Surgical Procedures Furnished in Health Professional Shortage Areas (HPSAs), Section 5501(b) of The Affordable Care Act, Payment to a Critical Access Hospital (CAH) Paid under the Optional Method
• MM7208 – Waiver of Coinsurance and Deductible for Preventive Services for Rural Health Clinics (RHCs), Section 4104 of the Affordable Care Act
• Revised: MM7064 – End Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Consolidated Billing for Limited Part B Services

18 November 2010

• SE1033 – Partial Code Freeze Prior to ICD-10 Implementation
• MM7107 – Outpatient Therapy Cap Values for CY 2011
• MM7202 – Implementation of Errata version 5010 of Health Insurance Portability and Accountability Act (HIPAA) transactions, and updates in 837I, 837P, and 835 flat files
• Revised: MM7041 – Implementation of the PWK (Paperwork) Segment for X12N Version 5010
• MM7181 – January 2011 Quarterly Update for the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program
• MM7005 – Payment for Certified Nurse-Midwife (CNM) Services
• MM7072 – Implementation of Edits for the Emergency Department (ED) Adjustment Policy under the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS)
• MM7156 – Additional Editing for Disaster Related Claims
• MM7163 – Update to Repetitive Billing Requirements for Institutional Claims
• MM7170 – Reporting of Modifiers and Revenue Codes on Claims for Therapy Services
• MM7141 – Expansion of Inpatient Prospective Payment System (IPPS) Transfer Policy to Include Critical Access Hospitals (CAHs) and Non-Participating Hospitals
• Revised: SE1027 – Recovery Audit Contractor (RAC) Demonstration High-Risk Medical Necessity Vulnerabilities for Inpatient Hospitals
• Revised: MM6452 – Method of Payment for Extended Stay Services Under the Frontier Extended Stay Clinic (FESC) Demonstration, Authorized by Section 434 of the Medicare Modernization Act (MMA) - CR6452 provides additional information to CR 6057

11 November 2010

• MM7178 – Medicare Remit Easy Print (MREP) Enhancement
• The Medicare Physician Fee Schedules, the Anesthesia Conversion Factors, and the Calendar Year (CY) 2011 Participation Enrollment form have been posted to the NHIC, Corp. web site. Please “Click Here” to view details. (IOM, Pub. 100-04, Chapter 1, 30.3.12.1)

04 November 2010

• MM7168 – Annual Clotting Factor Furnishing Fee Update 2011
• Revised: SE1028 – Recovery Audit Contractor (RAC) Demonstration High-Risk Diagnosis Related Group (DRG) Coding
• MM7145 – Accumulation of Informational Only claims with Condition Code 04 from Critical Access Hospitals (CAH) and Maryland Waiver Hospitals on the Provider Statistical and Reimbursement Report (PS&R)
• MM7204 – Changes to the Laboratory National Coverage Determination (NCD) Edit Software for January 2011
• MM7144 – National Uniform Billing Committee (NUBC) Point of Origin Code Updates
• MM7142 – Clarification of Payment Window for Outpatient Services Treated as Inpatient Services
• Revised: MM7044 – Implementation of the Interrupted Stay Policy under the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS)
• MM7161 – Air Ambulance Services
• MM7174 – Indian Health Service (IHS) Facilities and Tribal Provider’s Use of the Internet-based Provider Enrollment, Chain and Ownership System (PECOS)
• A new link has been posted on this web site entitled CMS Medicare Emergency Policies and Procedures. In the event of an emergency, CMS has prepared questions and answers to assist all providers at http://www.cms.gov/Emergency/. NHIC, Corp. strongly advises that you join our listserv to be kept informed of any local action or procedures. Please go to http://www.medicarenhic.com/ and view “Join Our Mailing List” on the left side of the page to select J14 A/B MAC. (CR 6837)
• Healthcare Provider Taxonomy Codes (HPTC) Update October 2010
  The HPTC set is maintained by the National Uniform Claim Committee (NUCC) for standardized classification of health care providers. The NUCC updates the code set twice a year with changes effective April 1 and October 1. The HPTC list is posted to the Washington Publishing Company (WPC) Web site at www.nucc.org/taxonomy. The PDF download of the codes is available from the NUCC site at http://nucc.org/index.php?option=com_content&task=view&id=14&Itemid=40.
  The changes to the code set include the addition of a new code and addition of definitions to existing codes. When reviewing the Health Care Provider Taxonomy code set online, revisions made since the last release can be identified by the color code; new items are green, modified items are orange, and inactive items are red.
  Reference: CMS CR7130

October

28 October 2010

• Revised: MM6953 – Dermal Injections for Treatment of Facial Lipodystrophy Syndrome (LDS)
• MM7120 – Influenza Vaccine Payment Allowances - Annual Update for 2010-2011 Season
• Revised: SE1031 – 2010 - 2011 Seasonal Influenza (Flu) Resources for Health Care Professionals

21 October 2010

• Revised: SE1024 – Recovery Audit Contractor (RAC) Demonstration High-Risk Vulnerabilities – No Documentation or Insufficient Documentation Submitted
• Revised: MM6856 – Expansion of the Current Scope of Editing for Attending Physician Providers for free-standing and provider-based Home Health Agency (HHA) claims processed by Medicare Regional Home Health Intermediaries (RHHIs)
• MM7137 – Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) for Myelodysplastic Syndrome (MDS)
• MM7133 – Counseling to Prevent Tobacco Use
• MM7100 – Revenue Codes Update
• MM7188 – January 2011 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
• MM7172 – Submission of Informational Only Claims by Maryland Waiver Hospitals and Critical Access Hospitals (CAHs) for Electronic Health Records (EHR) Purposes

14 October 2010

• SE1030 – Results of the 2010 Medicare Contractor Provider Satisfaction Survey (MCPSS)
• SE1031 – 2010 - 2011 Seasonal Influenza (Flu) Resources for Health Care Professionals
• Quarterly Provider Update (QPU) (IOM Pub 100-09-Chapter 6 Section 50.2.4.3) The Quarterly Provider Update (QPU) is a listing of the regulations and program instructions issued by CMS that impact Medicare providers. The QPU is maintained by CMS and available to providers through the CMS Web site.
  Providers may elect to join a CMS electronic mailing list, to be notified periodically, of additions to the QPU. CMS publishes this Update at the beginning of each quarter to inform the public about the following:
  • Regulations and major policies currently under development during this quarter.
  • Regulations and major policies completed or cancelled.
  • New/Revised manual instructions
  The page may be found at: http://www.cms.hhs.gov/QuarterlyProviderUpdates/
  Visit the QPU What’s New page at http://www.cms.hhs.gov/QuarterlyProviderUpdates/03_WhatsNew.asp

07 October 2010

• Revised: MM6856 – Expansion of the Current Scope of Editing for Attending Physician Providers for free-standing and provider-based Home Health Agency (HHA) claims processed by Medicare Regional Home Health Intermediaries (RHHIs)
• Revised: MM7134 – Fiscal Year (FY) 2011 Inpatient Prospective Payment System (IPPS), Long Term Care Hospital (LTCH) PPS, and Inpatient Psychiatric Facility (IPF) PPS Changes
• Revised: MM7117 – October 2010 Update of the Hospital Outpatient Prospective Payment System (OPPS)

September

30 September 2010

• MM7106 – Suspension of Automatic Denial of Institutional Claims Reporting Modifier –GA
• SE1027 – Recovery Audit Contractor (RAC) Demonstration High-Risk Medical Necessity Vulnerabilities for Inpatient Hospitals
• SE1028 – Recovery Audit Contractor (RAC) Demonstration High-Risk Diagnosis Related Group (DRG) Coding Vulnerabilities for Inpatient Hospitals
• MM6837 – Medicare Fee-For-Service Emergency Policies and Procedures: Questions and Answers (Qs & As) for All Types of Emergencies and Disasters – Rescission of CRs 5099, 6146, 6164, 6174, 6209, 6256, 6280, 6284, and 6378
• MM7113 – Intensive Cardiac Rehabilitation (ICR) Programs - Dr. Ornish’s Program for Reversing Heart Disease and the Pritikin Program
• MM7140 – Clarification on the Effective Date on the Procedure Status Indicator for Current Procedural Terminology (CPT) Code 80101
• MM7124 – 2010 Reminder For Roster Billing and Centralized Billing For Influenza and Pneumococcal Vaccinations
• MM7148 – Positron Emission Tomography (FDG PET) for Initial Treatment Strategy (PI) in Solid Tumors and Myeloma
• Issue Affecting the Crossing Over of End-Stage Renal Disease Facility Claims
  JSM/TDL 10416
  The Centers for Medicare & Medicaid Services (CMS) has notified us that its Coordination of Benefits Contractor (COBC) was unable to cross over several thousand End-Stage Renal Disease (ESRD) facility claims (type of bill [TOB] 72x) successfully during the period from July 5 through August 16, 2010. Unfortunately, the COBC’s translator and edit validation vendor had not made accommodations, prior to July 5, 2010, for the reporting of occurrence code 51, as prescribed by CMS change request 6782. The COBC thus rejected all 72x types of bills where occurrence code 51 qualifies the KT/V collection date with edit H51103, which means “51 is not a valid NUBC code.” Consequently, your local Medicare contractor would have issued a special provider notification letter to your facility specifying that Medicare did not cross over the listed claims due to H51103—“51 is not a valid National Uniform Billing Committee (NUBC) code.” This would be true even though your Medicare remittance advice indicated that Medicare transferred your patient’s claim to a given supplemental insurer.
  Due to the current configuration of the COBC translator and edit validator, the COBC is unable to re-run the affected claims through its HIPAA edit validation routine to facilitate the crossing over of the affected TOB 72x claims to your patients’ supplemental insurers. The COBC made changes on August 16, 2010, to accept the reporting of the KT/V collection date, as qualified by 51, on 837 institutional TOB 72x claims. Therefore, all claims that the Medicare contractors sent to the COBC as of August 16, 2010, will no longer be rejected with code H51103.
  The CMS has already notified all participating supplemental insurers and benefit programs of this issue. You are within your rights to now bill these insurers for any balances remaining following Medicare’s payment determination on your TOB 72x claims.

23 September 2010

• MM7159 – 2011 Annual Update of Healthcare Common Procedure Code System (HCPCS) Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Update
• MM7046 – Expansion of the Current Scope of Editing for Attending, Operating, or Other Physician or Non-Physician Practitioner Providers for Critical Access Hospital (CAH) claims processed by Medicare Fiscal Intermediaries (FI) and Part A Medicare Administrative Contractors (A/B MAC)
• MM7112 – October Update to the 2010 Medicare Physician Fee Schedule Database (MPFSDB)
• MM7117 – October 2010 Update of the Hospital Outpatient Prospective Payment System (OPPS)
• MM7134 – Fiscal Year (FY) 2011 Inpatient Prospective Payment System (IPPS), Long Term Care Hospital (LTCH) PPS, and Inpatient Psychiatric Facility (IPF) PPS Changes
• MM7139 – 2011 Annual Update for the Health Professional Shortage Area (HPSA) Bonus Payments
• MM7158 – Claim Status Category and Claim Status Codes Update
• SE1026 – Important News about Flu Shot Frequency for Medicare Beneficiaries
• Revised: MM6677 – Round One Rebid of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program - Phase 8A: Hospital Exception
• Revised: MM6776 – Billing and Processing for Healthy Control Group Volunteers in a Qualified Clinical Trial

16 September 2010

• MM7041 – Implementation of the PWK (Paperwork) Segment for X12N Version 5010
• MM7111 – October 2010 Integrated Outpatient Code Editor (I/OCE) Specifications Version 11.3
• Revised: MM6447 – Revisions and Re-issuance of Audiology Policies

02 September 2010

• Revised: MM6856 – Expansion of the Current Scope of Editing for Attending Physician Providers for free-standing and provider-based Home Health Agency (HHA) claims processed by Medicare Regional Home Health Intermediaries (RHHIs)
• MM7064 – End Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Consolidated Billing for Limited Part B Services

August

26 August 2010

• MM7034 – Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Pricer Update FY 2011
• MM7089 – Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy Print (MREP) Update
• Revised: SE1014 – Medicare Policy Regarding Pressure Reducing Support Surfaces
• MM6838 – Payment for Replacement of Oxygen Equipment in Bankruptcy Situations
• MM7095 – Discarded Drugs and Biologicals Policy at Contractor Discretion
• SE1025 – Consumer Assessment of Health Providers and Systems (CAHPS) Update for Home Health Agencies (HHA)

19 August 2010

• Holding of Claims Containing 90662
  JSM/TDL 10389
  The Centers for Medicare & Medicaid Services (CMS) is changing the status indicator for current procedural terminology (CPT) code 90662 from “E” to “L” in the October 2010 Integrated Outpatient Code Editor (IOCE). This affects claims with dates of service on and after December 23, 2009 and before October 1, 2010.CMS is instructing contractors to hold claims submitted during this period and to release them for processing after the implementation of the October 2010 IOCE. There is no action for providers to take on claims containing CPT code90662 that are held because the IOCE will be updated. If a provider is aware of claims that were processed in error before the claims hold began, the provider should request its contractor to adjust the claims.
• MM7034 – Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Pricer Update FY 2011
• MM7078 – Clarification of Billing Requirement for Ancillary Services Performed in the Ambulatory Surgical Center (ASC) by Entities Other Than ASCs
• MM7024 – Version 5010 Implementation—Changes to Present on Admission (POA) Indicator ‘1’ and the K3 Segment
• MM7076 – Inpatient Rehabilitation Facility (IRF) Annual Update: Prospective Payment System (PPS) Pricer Changes for Fiscal Year (FY) 2011
• Revised: MM7004 – 5010 Implementation--Processing Additional International Classification of Diseases, 9th Revision-Clinical Modification (ICD-9-CM) Diagnosis and Procedure Codes in Pricer, Grouper, and the Medicare Code Editor (MCE)

12 August 2010

• Revised:MM7006 – Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)
• Revised: MM6978 – Common Working File (CWF) Override Edit for Kidney Transplant Donor Claims When the Kidney Recipient is Deceased
• MM6625 – Common Working File (CWF) Unsolicited Response Adjustments for Certain Claims Denied Due to an Open Medicare Secondary Payer (MSP) Group Health Plan (GHP) Record Where the GHP Record was Subsequently Deleted or Terminated
• SE1022 – Medical Record Retention and Media Formats for Medical Records
• ALERT: Please read this important message from CMS: JSM 10382: Implementation of New Statutory Provision Pertaining to Medicare 3-Day Payment Window Policy - Outpatient Services Treated As Inpatient

5 August 2010

• MM7044 – Implementation of the Interrupted Stay Policy under the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS)
• MM6978 – Common Working File (CWF) Override Edit for Kidney Transplant Donor Claims When the Kidney Recipient is Deceased
• MM7004 – 5010 Implementation--Processing Additional International Classification of Diseases, 9th Revision-Clinical Modification (ICD-9-CM) Diagnosis and Procedure Codes in Pricer, Grouper, and the Medicare Code Editor (MCE)
• MM7014 – Home Health Agencies (HHAs) Providing Durable Medical Equipment (DME) in Competitive Bidding Areas
• MM7019 – Revised Instructions for Reporting Assessment Dates under the Inpatient Rehabilitation Facility (IRF), Skilled Nursing Facility (SNF), and Swing Bed (SB) Prospective Payment Systems (PPSs)
• MM7080 – Timely Claims Filing: Additional Instructions
• MM7058 – Definition of Ambulance Services

July

29 July 2010

• MM7070 – October Quarterly Update for 2010 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule
• MM7077 – Update to Hospice Payment Rates, Hospice Cap, Hospice Wage Index and the Hospice Pricer for Fiscal Year (FY) 2011
• Revised: SE0432 – Skilled Nursing Facility Consolidated Billing as It Relates to Certain Types of Exceptionally Intensive Outpatient Hospital Services
• Revised: MM6447 – Revisions and Re-issuance of Audiology Policies

22 July 2010

• MM7040 – Magnetic Resonance Angiography (MRA)
• Revised: SE1024 – Recovery Audit Contractor (RAC) Demonstration High-Risk Vulnerabilities – No Documentation or Insufficient Documentation Submitted
• MM7029 – Updates to the Inpatient Prospective Payment System (IPPS), Long Term Care Hospital (LTCH) PPS, Outpatient Prospective Payment System (OPPS), and Inpatient Rehabilitation Facility (IRF) PPS Changes due to the Affordable Care Act (ACA)
• MM7052 – Claim Status Category and Claim Status Code Update
• MM7057 – Changes to the Laboratory National Coverage Determination (NCD) Edit Software for October 2010

15 July 2010

• Medicare Mammography Services Claims Processing Issue
  JSM/TDL 10363
  The Centers for Medicare & Medicaid Services (CMS) identified a Medicare claims processing issue where adjustments submitted against original bills containing mammography services were incorrectly receiving Reason Code 36440 preventing the claims from finalizing. Claim adjustments receiving Reason Code 36440 were being held until the correction of this issue. This issue has been corrected and the held claims will now be released for processing. We apologize for any inconvenience you may experience related to this issue.
• SE1013 – Summary of Medicare Reporting and Payment of Services for Alcohol and/or Substance (Other than Tobacco) Abuse Structured Assessment and Brief Intervention (SBIRT) Services
• MM6905 – New Hospice Site of Service Code
• Revised: MM6945 – July Quarterly Update for 2010 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule
• SE1024 – Recovery Audit Contractor (RAC) Demonstration High-Risk Vulnerabilities – No Documentation or Insufficient Documentation Submitted
• MM7006 – Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)

08 July 2010

• SE1023 – Provisions in the Affordable Care Act of 2010 (ACA)
• MM6953 – Dermal Injections for Treatment of Facial Lipodystrophy Syndrome (LDS)
• Pricer Error in Sole Community Hospital (SCH), Medicare Dependent
  Hospital (MDH) and Certain Florida Hospitals’ Claims
  JSM/TDL-10356
  The Centers for Medicare & Medicaid Services (CMS) has discovered an error in the inpatient pricing of claims for Sole Community Hospitals, Medicare Dependent Hospitals and hospitals located in Florida, Core Based Statistical Area (CBSA) 23540. This affects claims with discharges on or after May 10, 2010. This error was corrected on July 1, 2010.

01 July 2010

• MM7007 – October 2010 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
• MM6974 – July Update to the 2010 Medicare Physician Fee Schedule Database (MPFSDB)
• Revised--MM6757 – Coding Patient Transfers under the Home Health Prospective Payment System (HH PPS)

June

24 June 2010

• MM6990 – Clarification of the Date of Service for Maintenance and Servicing Payments for Certain Oxygen Equipment after July 1, 2010
• MM7002 – October Quarterly Update to 2010 Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement
• SE1019 – ICD-10 Implementation Information
• REVISED: MM6698 – Signature Guidelines for Medical Review Purposes
• REVISED: MM6954 – Clinical Review Judgment
• SE1020 – Reminder to Inpatient Psychiatric Facilities (IPFs) to use Source of Admission Code D for Patient Transfers within the Same Facility

17 June 2010

• CR6987 - Clarification on Use of the SNFABN and Denial Letters
• MM6958 – Guidelines to Allow Contractors to Develop and Utilize Procedures for Accepting and Processing Appeals via Facsimile and/or via a Secure Internet Portal/Application
• MM6987 – Clarification on Use of the Skilled Nursing Facility Advance Beneficiary Notice (SNFABN) and Denial Letters
• Revised: MM6911 – Enhancements to Home Health (HH) Consolidated Billing Enforcement

14 June 2010

• The 2010 Medicare Physician Fee Schedule
  CMS Message 201006-15
  
  The Continuing Extension Act of 2010, enacted on April 15, 2010, extended the zero percent (0%) update to the 2010 Medicare Physician Fee Schedule (MPFS) through May 31, 2010.  At this time, Congress is debating the elimination of the negative update that took effect June 1, 2010.  The Centers for Medicare & Medicaid Services (CMS) is hopeful that Congressional action will be taken within the next several days to avert the negative update.
  
  To avoid disruption in the delivery of health care services to beneficiaries and payment of claims for physicians, non-physician practitioners, and other providers paid under the MPFS, CMS had instructed its contractors on May 27th to hold claims for services paid under the MPFS for the first 10 business days of June (i.e., through June 14, 2010).  This hold only affects MPFS claims with dates of service of June 1, 2010, and later.
  
  Given the possibility of Congressional action in the very near future, CMS is now directing its contractors to continue holding June 1 and later claims through Thursday, June 17, lifting the hold on Friday, June 18. 
  
  This action will facilitate accurate claims processing at the outset and minimize the need for claims reprocessing if Congressional action changes the negative update.  It also should minimize the provider and beneficiary burdens and costs associated with reprocessing claims.
  
  We understand that the delayed processing of Medicare claims may present cash flow problems for some Medicare providers.  However, we expect that the delay, if any, beyond the normal processing period will be only a few days.  Be on the alert for more information regarding the 2010 Medicare Physician Fee Schedule Update.   

10 June 2010

• SE1017 – Preparing for a Transition from an FI/Carrier to a Medicare Administrative Contractor (MAC) or from one Durable Medical Equipment (DME) MAC to another DME MAC
• Revised MM6996 – July 2010 Update of the Hospital Outpatient Prospective Payment System (OPPS)
• MM6447 – Revisions and Re-issuance of Audiology Policies
• MM6903 – Collagen Meniscus Implant
• MM6986 – Update-Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) Rate Year 2011
• MM6975 – Additional Instruction for Implementation of Health Insurance Portability and Accountability Act of 1996 (HIPAA) Version 5010 for Transaction 835 - Health Care Claim Payment/Advice and Updated Standard Paper Remit (SPR)
• Revised: MM6967 – July 2010 Integrated Outpatient Code Editor (I/OCE) Specifications Version 11.2
• Revised: SE0837 – Preparing for a Transition from an FI/Carrier to a Medicare Administrative Contractor (MAC) or from one Durable Medical Equipment (DME) MAC to another DME MAC
• MM6842 – One-Time Mailing of Solicitation Letter to Physicians and Non-Physician Practitioners Who Are Currently Enrolled In Medicare But Who Do Not Have Enrollment Records In The Provider Enrollment, Chain and Ownership System (PECOS)

3 June 2010

• Revised: MM6809 – Quarterly Healthcare Common Procedure Coding System (HCPCS) Code Changes – July 2010 Update
• Revised: MM6782 – Dialysis Adequacy, Infection and Vascular Access Reporting
• Revised: MM6711 – Discarded Drugs and Biologicals Updates

May

27 May 2010

• MM6967 – July 2010 Integrated Outpatient Code Editor (I/OCE) Specifications Version 11.2
• MM6823 – Pulmonary Rehabilitation (PR) Services
• Revised: MM6786 – Screening for the Human Immunodeficiency Virus (HIV) Infection
• Provisions of the Affordable Care Act & Supplemental Proposed Changes to the Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System & Supplemental Proposed Fiscal Year 2011 Rates
  CMS Message 201005-30
  CMS-1498-P2 which is titled "Medicare Program; Provisions of the Affordable Care Act and Supplemental Proposed Changes to the Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Supplemental Proposed Fiscal Year 2011 Rates" went on display at the Office of the Federal Register on May 21, 2010.
  This proposed rule is a supplement to the fiscal year (FY) 2011 hospital inpatient prospective payment systems (IPPS) and long-term care prospective payment system (LTCH PPS) proposed rule published in the May 4, 2010 Federal Register. This supplemental proposed rule would implement certain statutory provisions relating to Medicare payments to hospitals for inpatient services that are contained in the Patient Protection and Affordable Care Act (the Affordable Care Act) as amended by the Health Care and Education Reconciliation Act of 2010 (HCERA) (collectively known as the Affordable Care Act). It would also specify statutorily required changes to the amounts and factors used to determine the rates for Medicare acute care hospital inpatient services for operating costs and capital related costs, and for long term care hospital costs.
  To view the display copy of the regulation, impact files, data files and tables, go to:  (http://www.cms.gov/AcuteInpatientPPS/IPPS2010/list.asp.
• Payments Under the Skilled Nursing Facility Prospective Payment System (SNF PPS) For Fiscal Year (FY) 2011 – Update May 24, 2010
  CMS Message 201005-32
  ATTN:  Freestanding and Hospital-based SNFs and Rural Hospital Swing Beds
  Section 10325 of the Patient Protection and Affordable Care Act (ACA) includes a provision addressing Medicare payments for SNFs in FY 2011.   This section mandates a delay in the introduction of the Resource Utilization Groups, version 4 (RUG-IV) case mix classification system until FY 2012.  In addition, it requires that version 3.0 of the Minimum Data Set (MDS 3.0) Resident Assessment Instrument will be implemented as planned in FY 2011.  Finally, the section requires that certain specific components of RUG-IV, specifically, the concurrent therapy and look-back revisions, be applied in FY 2011.   While there is currently an existing grouper (the software program that uses assessment data to assign each SNF resident to the appropriate RUG) that utilizes the 53-group RUG-III system and the MDS 2.0, and a revised grouper that utilizes RUG-IV and the MDS 3.0, a grouper that incorporates the particular combination of features mandated by the statute does not currently exist.
  Accordingly, as we continue to build the payment infrastructure needed to incorporate the combination of features mandated by ACA, we will apply interim payment rates, effective October 1, 2010, that reflect not only the use of MDS 3.0, but also the new RUG-IV system in its entirety as finalized in the FY 2010 SNF PPS final rule (74 FR 40288, August 11, 2009).  Once the necessary infrastructure is in place, we will then retroactively adjust the rates to reflect a hybrid RUG-III (HR-III) system which incorporates RUG-IV’s specific revisions on concurrent therapy and the look-back period within the framework of the existing 53-group RUG-III system, along with the use of MDS 3.0. 
  This approach will allow CMS to make payments with the least disruption for providers and beneficiaries.   As we do every year, we will publish the specific payment rates for the upcoming fiscal year in the Federal Register, and provide additional guidance concerning implementation of the FY 2011 payments in the near future.  Finally, we note that there is legislation pending in Congress that would repeal section 10325 of the ACA, and thus eliminate the need to retroactively adjust payments.
• Updated Banking Transition
  CMS Message 201005-31
  The CMS recently awarded new banking contracts to U.S. Bank and JP Morgan Chase.  Medicare providers do not have to take any action.  However, providers should be aware that the Medicare payments may be made by a different bank than in the past because of these new banking contractors.
  The following Medicare claims processing contractors will remain with JP Morgan Chase:  Cahaba Government Benefit Administrators, Pinnacle Business Solutions, First Coast Service Options, Palmetto GBA (except for A/B MAC Jurisdiction 1) and Wisconsin Physician Service.  Providers that bill to these contractors will not experience any change.
  The following Medicare claims processing contractors will transition to JP Morgan Chase on August 2, 2010: Palmetto A/B MAC Jurisdiction 1 and  Trailblazer.
  The following contractors will transition to U.S. Bank on August 2, 2010, Noridian Administrative Services, CIGNA Government Services, Highmark Medicare Services, National Government Services, and NHIC.
• MM6809 –  Quarterly Healthcare Common Procedure Coding System (HCPCS) Code Changes – July 2010 Update
• MM6972 –  Extension for the Two Percent and Three Percent Add-On for the Ground Ambulance, Air Ambulance in Rural Areas and "Super Rural" Add-0n through December 31, 2010
• MM6850 –  Cardiac Rehabilitation and Intensive Cardiac Rehabilitation
• Revised: MM6973 –  Revised Payment Files for the 2010 Medicare Physician Fee Schedule Database (MPFSDB) and Retroactive Provisions under the Patient Protection and Affordable Care Act (Pub. L. 111-148) (the Affordable Care Act)
• MM6907 –  Internet Only Manual (IOM) Chapter 25 Revisions (Medicare Claims Processing Manual, Chapter 25 - Completing and Processing the Form CMS-1450 Data Set

20 May 2010

• MM6973 – Revised Payment Files for the 2010 Medicare Physician Fee Schedule Database (MPFSDB) and Retroactive Provisions under the Patient Protection and Affordable Care Act (Pub. L. 111-148) (the Affordable Care Act)
• MM6945 – July Quarterly Update for 2010 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule
• Important Message Regarding Medicare's Implementation of the Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act of 2010
  CMS Message 201005-24
  On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act.  One week later, on March 30, the President also signed into law the Health Care and Education Reconciliation Act of 2010.  These two new laws have a significant impact on the Medicare program and many of the provisions have effective dates prior to this point in time.  Over the past several weeks, the Centers for Medicare & Medicaid Services (CMS) has begun implementing various provisions of the new laws, including those with past effective dates.  In addition to implementing these legislative changes, the Medicare Physician Fee Schedule is being updated to include certain corrections, retroactive to January 1, 2010, as prescribed in recently published notices in the Federal Register.
  Once Medicare contractors have the new payment files in place, per the above, all claims going forward will be processed at the revised rates.  However, we continue to work on the best way to address the many claims that are paid at the rates that were in place before the current corrections and updates are made.   Please be on the alert for further information about how CMS will address past claims.  Until then, providers should NOT resubmit previously-processed claims affected by the payment changes, as it is likely that these resubmissions may be denied as duplicate claims.
• Additional Intern and Resident Information System Codes
  JSM/TDL 10278
  This message is to make you aware of recent updates to the Intern and Resident Information System (IRIS) software programs (IRISV3 and IRISEDV3) used by teaching hospitals and the provider community for collecting and reporting information on resident training in hospital and nonhospital settings: Four new IRIS residency type codes were added to the IRIS Residency Code Table. In addition, two new IRIS medical school codes were added to the IRIS Medical School Code Table. Providers may start using these codes in the IRISV3 program for cost reporting periods ending on or after December 31, 2009. You may download these programs by going to http://www.cms.gov/IRIS.
• SE1016 –  Re-Assignment of Certain Providers to Jurisdiction 1 and Jurisdiction 4 Medicare Administrative Contractors (MACs)
• MM6949 -  Ambulance Services - Updating the Medicare Benefit Policy Manual Chapter 10, Section 10.5 to Include Ambulance Transports with Joint Responses
• MM6954 - Clinical Review Judgment
• MM6786 – Screening for the Human Immunodeficiency Virus (HIV) Infection

13 May 2010

• Affordable Care Act – Provisions Impacting Outpatient Prospective Payment System (OPPS) Hospitals
  CMS Message 201005-14 (JSM/TDL 10261)
  On March 23, 2010, President Obama signed into law the Affordable Care Act (ACA). Section 3401(i) of the ACA imposes a 0.25 percentage point reduction to the OPPS market basket for Calendar Year (CY) 2010, effective for services furnished on or after January 1, 2010.
  The Centers for Medicare & Medicaid Services is working to expeditiously implement Section 3401(i) of ACA. Providers will begin seeing payments under this provision in the late May/early June time frame. Be on the alert for more information about this provision and its impact on past and future claims.
• MM6911 – Enhancements to Home Health (HH) Consolidated Billing Enforcement
• MM6964 – Changes to the Laboratory National Coverage Determination (NCD) Edit Software for July 2010
• MM6750- This article was rescinded on May 5, 2010, as the related CR 6750 was rescinded on that date.
• SE1014 – Medicare Policy Regarding Pressure Reducing Support Surfaces
• MM6821 – Requirements for Hospital Attestation and Billing of Fiscal Year (FY) 2007 and 2008 Informational Only Inpatient Claims for Medicare Advantage Beneficiaries
• MM6894 – Change in the Amount in Controversy (AIC) Requirement for Administrative Law Judge Hearings and Federal District Court Appeals
• Revised: MM6632 – FDG PET for Solid Tumors and Myeloma
• Per CR 6973, (Revised Payment Files for the 2010 Medicare Physician Fee Schedule Database (MPFSDB) and Retroactive Provisions under the Patient Protection and Affordable Care Act (Pub. L. 111-148) (the Affordable Care Act), the most recent revised Payment Files have been posted to our web site.
• JSM/TDL10259-Availability of the Final Federal Fiscal Year 2011 Wage Index Data Public Use Files and Deadline for Requesting Corrections to the Data
• MM6960 – Systems Changes Necessary to Implement the Patient Protection and Affordable Care Act (PPACA) Section 6404 - Maximum Period for Submission of Medicare Claims Reduced to Not More Than 12 Months

06 May 2010

• MM6955 – Temporary 3 Percent Rural Add-On for the Home Health Prospective Payment System (HH PPS)
• MM6760 – Use of 12X Type of Bill (TOB) for Billing Colorectal Screening Services
• MM6856 – Expansion of the Current Scope of Editing for Attending Physician Providers for free-standing and provider-based Home Health Agency (HHA) claims processed by Medicare Regional Home Health Intermediaries (RHHIs)
• MM6899 – Removal of the Provider Reporting Requirement for Total Number of Therapy Visits using Value Codes 50-53
• MM6897 – Remittance Advice Coding to Identify Claims Subject to the Limitation on Home Health Prospective Payment System (HH PPS) Outlier Payments
• MM6916 – Skilled Nursing Facility (SNF) Health Insurance Prospective Payment System (HIPPS) Coding Updates Effective October 1, 2010
• Revised: MM6867 – Update to List of ICD-9-CM Diagnosis Codes Not Requiring the Q0 Healthcare Common Procedure Coding System (HCPCS) Modifier for Automatic Implantable Cardiac Defibrillator (ICD) Services Provided in a Clinical Study
• MM6917 – Instructions Regarding the Processing of Inpatient Claims for Gender/Procedure Conflict
• MM6950 – Medicare Benefits Policy Manual Update – Determining Self-Administration of Drug or Biological
• MM6711 – Discarded Drugs and Biologicals Updates
• MM6901 – Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy Print (MREP) Update
• MM6910 – New Medicare Summary Notice (MSN) Message for Higher than Expected Prospective Payment System (PPS) Payments
• Revised: SE1008 – Medicare Coverage of Blood Glucose Monitors and Testing Supplies
• Revised: MM6955 – Temporary 3 Percent Rural Add-On for the Home Health Prospective Payment System (HH PPS)

April

29 April 2010

• Revised: MM6698 - Signature Guidelines for Medical Review Purposes
• Patient Protection and Affordable Care Act - Provisions Impacting Institutional Providers
  CMS Message 201004-31 (JSM/TDL-10242, JSM/TDL-10245, JSM/TDL -10247)
  
  On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA). PPACA Sections 3401 and 3137 contain a number of provisions affecting institutional providers. The 3401 sections discussed below are effective April 1, 2010, while Section 3137(a) has October 1, 2009, and April 1, 2010 effective dates. The Centers for Medicare & Medicaid Services is working to expeditiously implement these important provisions of PPACA. Providers will begin seeing payments under these provision in the late April/early May time frame. Be on the alert for more information about these provisions and their impact on past and future claims. What follows are brief descriptions of each provision:
  Inpatient Acute Hospitals (Section 3401(a))
  
  Section 3401(a) of PPACA imposes a 0.25 percentage point reduction to the Inpatient Prospective Payment System (IPPS) hospital's market basket for fiscal year (FY) 2010, effective for discharges on or after April 1, 2010. The reduction to the market basket will affect IPPS rates for discharges occurring on or after April 1, 2010, through September 30, 2010.
  
  Long-Term Care Hospitals (Section 3401(c))
  
  Section 3401(c) of PPACA imposes a 0.25 percentage point reduction to the Long Term Care Hospital's (LTCH) market basket for FY 2010, effective for discharges on or after April 1, 2010. The reduction to the market basket will affect LTCH rates for discharges occurring on or after April 1, 2010, through September 30, 2010.
  
  Inpatient Rehabilitation Facilities (Section 3401(d))
  
  Section 3401(d) of PPACA imposes a 0.25 percentage point reduction to the Inpatient Rehabilitation Facility market basket for FY 2010, effective for discharges on or after April 1, 2010. The reduction is also resulting in changes to the standard payment conversion factor, payment rates, and the outlier threshold amount.
  
  Extension of Section 508 Hospital Reclassifications (Sections 3137(a) and 10317)
  
  Sections 3137(a) and 10317 extend section 508 and special exception hospital reclassifications from October 1, 2009, through September 30, 2010. Effective April 1, 2010, section 3137(a) and 10317 also require removing section 508 and special exception wage data from the calculation of the reclassified wage index if doing so raises the reclassified wage index. All hospitals affected by sections 3137(a) and 10317 will be assigned an individual special wage index effective April 1, 2010. If the section 508 or special exception hospital's wage index applicable for the period beginning on October 1, 2009, and ending on March 31, 2010, is lower than for the period beginning on April 1, 2010, and ending on September 30, 2010, the hospital will be paid an additional amount that reflects the difference between the wage indices. The provision applies to both inpatient and outpatient hospital payments.
  
  Be on the alert for more information pertaining to the PPACA.

22 April 2010

• SE1008 – Medicare Coverage of Blood Glucose Monitors and Testing Supplies
• Revised: MM6777 – Billing and Processing Claims with Unlimited Occurrence Span Codes (OSCs)

15 April 2010

• MM6472 – Implementation of the Health Insurance Portability and Accountability Act (HIPAA) Version 005010 Medicare Administrative Contractors Requirements
• MM6896 – Update to the Medicare Claims Processing Manual (Publication 100-04, Chapter 15, Section 40)
• MM6870 – Reporting of Recoupment for Overpayment on the Remittance Advice (RA)
• Revised: SE0930 – Section 2902 of the Patient Protection and Affordable Care Act Permanently Extends Section 630 of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 for the Payment of Indian Health Services (IHS)
• Revised: SE0931 – Sections 3103 and 3104 of the Patient Protection and Affordable Care Act (PPACA) Extends Certain Payment Provisions Under the Medicare Program Related to Therapy Cap Exceptions and the Billing by Independent Laboratories for the Technical Component of Physician Pathology Services Furnished to Hospital Patients
• Correction of Wage Index for Core-Based Statistical Area 16700 Impacting End Stage Renal Disease Claims
  JSM/TDL 10230
  Medicare Adjustments for End Stage Renal Disease (ESRD) Claims with Core-Based Statistical Area (CBSA) 16700 Paid in Calendar Year (CY) 2010 with Dates of Service in CY 2009 The Centers for Medicare & Medicaid Services (CMS) has identified an incorrect wage index value in the 2010 ESRD Pricer for CBSA 16700. The 2010 ESRD Pricer contained the wage index factor of 0.9756 for claims with dates of service in CY 2009. The correct wage index value is 0.9731.
  Providers shall not attempt to resubmit affected claims as their fiscal intermediary or Medicare administrative contractor will be initiating adjustments with the sole purpose of correcting the payments. Providers should anticipate the initiation of these adjustments within the next 30 calendar days.
• MM6880 – Claims Submitted for Items or Services Furnished to Medicare Beneficiaries in State or Local Custody Under a Penal Authority and Examples of Application of Government Entity Exclusion. CR6880 rescinds and fully replaces CR 6544.
• MM6873 – Extension of Reasonable Cost Payment for Clinical Lab Tests Furnished by Hospitals with Fewer Than 50 Beds in Qualified Rural Areas
• MM6698 – Signature Guidelines for Medical Review Purposes

8 April 2010

• Extension of Ambulance Add-Ons for Ambulance Services
  (JSM/TDL 10217) (CMS Message 201004-10)
  On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA). PPACA Sections 3105 and 10311 impact certain ambulance payment provisions.  It should be noted that PPACA Section 3105 establishes the implementation date as April 1, 2010.  PPACA Section 10311 revises Section 3105 and changes the implementation date retroactive to January 1, 2010. 
  The PPACA extends increases in the ambulance fee schedule amounts for covered ground ambulance transports which originated in rural areas by 3 percent and for covered ground ambulance transports which originated in urban areas by 2 percent retroactive to January 1, 2010, through December 31, 2010.  The new law similarly extends the provision for air ambulance services provided in any area that was designated as a rural area for purposes of making payments under the ambulance fee schedule for services furnished on December 31, 2006.  Finally, the PPACA extends retroactive to January 1, 2010, and through December 31, 2010, Section 414 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 which established the super rural bonus.  
  The Centers for Medicare & Medicaid Services is working to expeditiously implement these three ambulance provisions of the PPACA.  Be on the alert for more information about these ambulance provisions and their impact on your past and future claims.  Further, be on the alert for more information pertaining to the Patient Protection and Affordable Care Act.

6 April 2010

• Banking Transition
  (JSM/TDL 10162)
  The CMS recently awarded new banking contracts to U.S. Bank and JP Morgan Chase. Medicare providers do not have to take any action. However, providers should be aware that the Medicare payments may be made by a different bank than in the past because of these new banking contractors. The following Medicare claims processing contractors will remain with JP Morgan Chase: Cahaba Government Benefit Administrators, Pinnacle Business Solutions, First Coast Service Options, Palmetto GBA (except for A/B MAC Jurisdiction 1) and Wisconsin Physician Service. Providers that bill to these contractors will not experience any change.
  The following Medicare claims processing contractors will transition to JP Morgan Chase on June 1, 2010: Palmetto A/B MAC Jurisdiction 1 and Trailblazer. The following contractors will transition to U.S. Bank on June 1, 2010, CIGNA Government Services, Highmark Medicare Services, National Government Services, NHIC and Noridian Administrative Services.

1 April 2010

• MM6852 – Clinical Laboratory Fee Schedule (CLFS) - Special Instructions for Specific Test Codes (CPT Code 80100, CPT Code 80101, CPT Code 80101QW, G0430, G0430QW, and G0431QW)
• MM6864 – Clinical Laboratory Fee Schedule (CLFS) - Medicare Travel Allowance Fees for Collection of Specimens
• MM6777 – Billing and Processing Claims with Unlimited Occurrence Span Codes (OSCs)
• MM6807 – Change in Provider Enrollment Timeliness Standards for Certain Paper Applications
• Revised: MM6775 – Outpatient Intravenous Insulin Treatment (Therapy)
• Revised: MM6782 – Dialysis Adequacy, Infection and Vascular Access Reporting
• Revised: MM6005 – Comprehensive Outpatient Rehabilitation Facility Manual
• MM6867: Update to List of ICD-9-CM Diagnosis Codes Not Requiring the Q0 Healthcare Common Procedure Coding System (HCPCS) Modifier for Automatic Implantable Cardiac Defibrillator (ICD) Services Provided in a Clinical Study
• MM6861 - Positron Emission Tomography (PET) (NaF-18) to Identify Bone Metastasis of Cancer
• MM6859 - Claim Status Category Code and Claim Status Code Update
• The Patient Protection and Affordable Care Act (PPACA)
  (JSM10207) (Message 201003-54)
  On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA). The Centers for Medicare & Medicaid Services (CMS) is working hard to expeditiously implement the new law. The law's Medicare fee-for-service provisions have varying effective dates and our first priority is to address provisions with the earliest effective dates. CMS is committed to assuring Medicare providers are well informed as early as possible. For that reason, CMS is urging you to be on the alert for notices and instructions from CMS and from your Medicare fiscal intermediary, carrier, or Medicare Administrative Contractor, on forthcoming policy and operational changes as we implement the PPACA.
• Timely Filing Requirements for Medicare Fee-For-Service Claims
  (JSM/TDL-10214) (Message 201004-02)
  On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA), which amended the time period for filing Medicare fee-for-service (FFS) claims as one of many provisions aimed at curbing fraud, waste, and abuse in the Medicare program.
  The time period for filing Medicare FFS claims is specified in Sections 1814(a), 1835(a)(1), and 1842(b)(3) of the Social Security Act and in the Code of Federal Regulations (CFR), 42 CFR Section 424.44. Section 6404 of the PPACA amended the timely filing requirements to reduce the maximum time period for submission of all Medicare FFS claims to one calendar year after the date of service.
  Under the new law, claims for services furnished on or after January 1, 2010, must be filed within one calendar year after the date of service. In addition, Section 6404 mandates that claims for services furnished before January 1, 2010, must be filed no later than December 31, 2010. The following rules apply to claims with dates of service prior to January 1, 2010. Claims with dates of service before October 1, 2009, must follow the pre-PPACA timely filing rules. Claims with dates of service October 1, 2009, through December 31, 2009, must be submitted by December 31, 2010.
  Section 6404 of the PPACA also permits the Secretary to make certain exceptions to the one-year filing deadline. At this time, no exceptions have been established. However, proposals for exceptions will be specified in future proposed rulemaking.
  Please be on the alert for more information pertaining to the Patient Protection and Affordable Care Act.
• Medicare Home Health Rural Add-on
  (Message 201004-04)
  On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA), which creates a 3% add-on to payments made for home health services to patients in rural areas. The add-on applies to episodes ending on or after April 1, 2010, through December 31, 2016. Similar to temporary rural add-on provisions in the past, claims that report a rural state code (code beginning with 999) as the Core Based Statistical Area (CBSA) code for the beneficiary’s residence will receive the additional 3% payment. The CBSA code is reported associated with value code 61 on home health claims.
  The Centers for Medicare & Medicaid Services is working to expeditiously implement the home health rural add-on provision, Section 3131(c), of the PPACA. Be on the alert for more information about this provision and its impact on past and future claims. Further, be on the alert for more information pertaining to the Patient Protection and Affordable Care Act.

March

29 March 2010

• Holding of April Claims for Services Paid Under the 2010 Medicare Physician Fee Schedule
  (CMS Message 201003-46)
  Information Regarding the Holding of April Claims for Services Paid Under the 2010 Medicare Physician Fee Schedule (3-26-2010)
  The Centers for Medicare & Medicaid Services (CMS) is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, non-physician practitioners, and other providers of services paid under the Medicare Physician Fee Schedule (MPFS). As you are aware, the Temporary Extension Act of 2010, enacted on March 2, 2010, extended the zero percent (0%) update to the 2010 MPFS through March 31, 2010.
  CMS believes Congress is working to avert the negative update that will take effect April 1. Consequently, CMS has instructed its contractors to hold claims containing services paid under the MPFS (including anesthesia services) for the first 10 business days of April. This hold will only affect claims with dates of service April 1, 2010, and forward. In addition, the hold should have minimum impact on provider cash flow because, under the current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt.
  Be on the alert for more information about the 2010 Medicare Physician Fee Schedule Update.

25 March 2010

• Reissued: Change Request 6712 - (CR6712) Medically Unlikely Edits. This CR provides updates and clarifications to MUE requirements established in 2006. For more information, the Centers for Medicare & Medicaid Services has issued the following transmittal at: http://www.cms.hhs.gov/transmittals/downloads/R617OTN.pdf

18 March 2010

• April 2010 Integrated Outpatient Code Editor (I/OCE) Specifications Version 11.0 (CR6882)
• Rescinded: Repeal of Section 20.10, Publication 100-03, National Coverage Determinations (NCD) Manual, Cardiac Rehabilitation Programs (CR6855)
• Revised: Point of Origin for Admission or Visit Codes Update to the UB-04 (CMS-1450) Manual Code List (CR6801)
• Medicare Home Health Claims Processing Issue Corrected
  (JSM/TDL 10181)
  The Centers for Medicare & Medicaid Services (CMS) identified a Medicare claims processing issue where home health adjustments and/or cancels that were performed for claims with a through date of January 1, 2010, or later were reflected as having an inaccurate reimbursement amount on the Home Health Payment Totals screen. This claims processing issue has been corrected and claims being held because of this issue were released on March 1, 2010. We apologize for any inconvenience you may experience related to this issue.
• DO NOT ENFORCE SUPERVISION REQUIREMENTS FOR THERAPEUTIC OUTPATIENT SERVICES IN CRITICAL ACCESS HOSPITALS FOR 2010
  (JSM/TDL-10187)
  The Centers for Medicare & Medicaid Services (CMS) will instruct all of its Medicare contractors not to evaluate or enforce the supervision requirements for therapeutic services provided to outpatients in Critical Access Hospitals (CAHs) for the duration of calendar year (CY) 2010. CMS will revisit the issue of supervision for therapeutic services provided to hospital outpatients in CAHs through the annual rulemaking cycle for CY 2011. CMS continues to expect CAHs to fulfill all other Medicare program requirements when providing services to Medicare beneficiaries and when billing Medicare for those services. While CMS is instructing contractors not to enforce the supervision requirements in CAHs for CY 2010, we continue to emphasize quality and safety for services provided to all patients in CAHs.

11 March 2010

• Quarterly Provider Update (QPU)
  (IOM Pub 100-09-Chapter 6 Section 50.2.4.3)
  The Quarterly Provider Update (QPU) is a listing of the regulations and program instructions issued by CMS that impact Medicare providers. The QPU is maintained by CMS and available to providers through the CMS Web site.
  Providers may elect to join a CMS electronic mailing list, to be notified periodically, of additions to the QPU. CMS publishes this Update at the beginning of each quarter to inform the public about the following:
     • Regulations and major policies currently under development during this quarter.
     • Regulations and major policies completed or cancelled.
     • New/Revised manual instructions
  The page may be found at: http://www.cms.hhs.gov/QuarterlyProviderUpdates/ Visit the QPU What’s New page at: http://www.cms.hhs.gov/QuarterlyProviderUpdates/03_WhatsNew.asp
• Repeal of Section 20.10, Publication 100-03, National Coverage Determinations (NCD) Manual, Cardiac Rehabilitation Programs (CR6855)
• Percutaneous Transluminal Angioplasty (PTA) of the Carotid Artery Concurrent with Stenting (CR6839)
• Additional ICD-9 Codes Analysis and Processing Direction (Institutional Claims Only) (CR6851)
• Accumulation of Claims with Condition Code 04 on the Provider Statistical and Reimbursement Report (PS and R) (CR6784)
• April 2010 Update of the Hospital Outpatient Prospective Payment System (OPPS) (CR6857)
• July 2010 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files (CR6805)
• Revised: Correction to Processing of Non-Covered Revenue Codes (CR6774)
• Revised: Billing for Services Related to Voluntary Uses of Advance Beneficiary Notices of Noncoverage (ABNs) (CR6563)

4 March 2010

• Critical Access Hospitals Method II Providers Notification
  JSM/TDL 10161
  Please be advised that effective April 1, 2010, claims submitted by a Critical Access Hospitals (CAH) Method II provider containing unlisted Healthcare Common Procedure Coding System (HCPCS) Codes for professional services (Revenue Codes 96x, 97x, or 98x) will be returned. The CAH Method II provider will need to determine a more specific HCPCS Code for unlisted procedures rendered by a physician before resubmitting the claim. Providers unable to determine a more specific HCPCS Code can contact the American Medical Association to request a code be assigned for the associated procedure.

February

25 February 2010

• Revised: Revision of Definition of Compendia as Authoritative Source for Use in the Determination of a Medically-Accepted Indication of Drugs/Biologicals Used Off-label in Anti-Cancer Chemotherapeutic Regimens (CR6806)
• Medicare Inpatient Skilled Nursing Facility No Payment Claim’s Processing Issue (JSM/TDL 10150)
  The Centers for Medicare & Medicaid Services (CMS) has identified a Medicare inpatient skilled nursing facility (SNF) claims processing issue where SNF 210 and 180 no payment bill types with condition code 21 were incorrectly processed with reason code 19904 since April 1, 2009. Providers should not attempt to resubmit affected claims as their fiscal intermediary (FI) or Medicare administrative contractor (MAC) will be initiating adjustments with the sole purpose of correcting the reason code rejection. Providers should anticipate the initiation of these adjustments within the next 30 calendar days.
• Reporting Inpatient Hospital Evaluation and Management (E/M) Services that Could be Described by Current Procedural Terminology (CPT) Consultation Codes
  (JSM/TDL-10152)
  This message is to clarify proper reporting in Calendar Year (CY) 2010 of initial E/M services provided by physicians (and other qualified nonphysicians when permitted) in the inpatient hospital setting that could be described by CPT Consultation Codes (99251-99255) that are no longer recognized for payment under the Medicare Physician Fee Schedule (MPFS). The Centers for Medicare & Medicaid Services (CMS) previously instructed physicians and other providers to use other applicable CPT E/M Codes to report the services that could be described by CPT Consultation Codes. The CMS also provided that, in the inpatient hospital setting, physicians (and qualified nonphysicians) who perform an initial E/M service may bill the initial hospital care CPT Codes (99221 – 99223). Since that instruction, CMS has received inquiries specifically as relates to reporting initial hospital care services for which the minimum key component work and/or medical necessity requirements for CPT Codes 99221–99233 are not documented. For instance, one element of inpatient consultation CPT Codes 99251 and 99252, respectively, require “a problem focused history” and “an expanded problem focused history.” In contrast, initial hospital care CPT Code 99221 requires “a detailed or comprehensive history.”
  
  First, CMS reminds providers that CPT Code 99221 may be reported for an E/M service if the requirements for billing that code, which are greater than CPT Consultation Codes 99251 and 99252, are met by the service furnished to the patient. The CMS has alerted Medicare Administrative Contractor Audit Staffs as well as Medicare Recovery Audit Contractors of its expectation that physicians may bill more E/M Codes for initial hospital care, in place of billing inpatient CPT Consultation Codes. The CMS has also alerted contractors to expect a different proportion of various initial hospital care CPT Codes under the new policy. The CMS expects its contractors to consider that these may be appropriate changes when making decisions about whether to pursue medical review and other types of claims review.
  
  Second, CMS notes that subsequent hospital care CPT Codes 99231 and 99232, respectively, require “a problem focused interval history” and “an expanded problem focused interval history” and could potentially meet the component work and medical necessity requirements to be reported for an E/M service that could be described by CPT Consultation Code 99251 or 99252. The CMS has instructed contractors to not find fault with providers who report a subsequent hospital care CPT Code, in cases where the medical record appropriately demonstrates that the work and medical necessity requirements are met for reporting a subsequent hospital care code (under the level selected), even though the reported code is for the provider's first E/M service to the inpatient during the hospital stay Finally, only in the case when an E/M service that could be described by CPT Code 99251 or 99252 is furnished and there is no other specific E/M code payable by Medicare that describes that service shall CPT Code 99499 (Unlisted evaluation and management service) be reported. Reporting 99499 requires submission of medical records and contractor manual medical review of the service prior to payment, and CMS expects reporting under these circumstances to be unusual.
  
  While CMS expects that the CPT Code reported accurately reflects the service provided, CMS has instructed contractors to not find fault with providers who report a subsequent hospital care CPT Code, in cases where the medical record appropriately demonstrates that the work and medical necessity requirements are met for reporting a subsequent hospital care code for an initial hospital E/M service.”
  
  “Reporting Hospice Services Provided by Physicians Under Part A that Could be Described by Current Procedural Terminology (CPT) Consultation Codes
  
  When hospices bill Part A for the services of physicians, they must use CPT Codes that are paid under the Medicare Physician Fee Schedule (MPFS). Since the CPT Consultation Codes are no longer recognized for payment under the MPFS, hospices shall follow the same guidelines for reporting E/M services as physicians billing Part B. Hospices shall use the most appropriate E/M Codes to bill for E/M services furnished by physicians that could be described by CPT Consultation Codes.”
• Questions and Answers on Reporting Physician Consultation Services (SE1010)
• Revised: Revisions to Consultation Services Payment Policy (CR6740)
• Revised: Implementation of Home Health Agency Program Safeguard Provisions (CR6750) Note: This article was rescinded on May 5, 2010, as the related CR 6750 was rescinded on that date.

18 February 2010

• Coding Patient Transfers under the Home Health Prospective Payment System (HH PPS) (CR6757)
• Rescinded: Compliance Standards for Consignment Closets and Stock and Bill Arrangements (CR6528)
• Revised: Dialysis Adequacy, Infection and Vascular Access Reporting (CR6782)
• Instructions on How to Process Negative Claim Adjustment Reason Code (CARC) Adjustment Amounts when Certain CARCs Appear on Medicare Secondary Payer Claims (CR6736)
• Point of Origin for Admission or Visit Codes Update to the UB-04 (CMS-1450) Manual Code List (CR6801)
• Maintenance and Servicing Payments for Certain Oxygen Equipment after July 1, 2010 (CR6792)
• Medicare Systems Edit Refinements Related to Hospice Services (CR6778)
• Interim Instructions for Processing Claims and Recouping Overpayments for Claims Submitted Under the Guidelines Established in Change Request 5917 (CR6762)
• Medicare Claims Crossover to Supplemental Payer Problem
  (JSM10139) (Message 201002-25)
  The Centers for Medicare & Medicaid Services (CMS) has identified a problem where claims were not automatically crossing over to supplemental payers even though the provider remittance advice indicated otherwise.  This problem began January 5, 2010.  Part A institutional claims and Part B professional claims, with the exception of supplier claims processed by Durable Medical Equipment Medicare Administrative Contractors (DME MACs), were impacted by this problem.  Claims processed by DME MACs were not impacted.  
  
  Part A Institutional Claims
  No action is required by Part A institutional providers.  As of February 2, 2010, CMS successfully implemented a systems fix to ensure that  all Part A institutional claims are now crossing over to supplemental payers as indicated on the remittance advice received by providers.  As part of the fix, CMS’ Medicare contractors were able to identify claims processed between January 5 and February 1, 2010, where the provider remittance advice indicated that the affected claims were crossed over to various supplemental payers but were not.   On February 2, 2010, the affected Medicare contractors began to send the affected claims to the Coordination of Benefits Contractor (COBC) to be crossed over to supplemental payers.  This effort is now largely completed.  Please allow until March 1, 2010, for supplemental payers to receive and process these claims before attempting to balance bill them for any remaining balances after Medicare.
  
  Part  B Professional Claims
  Action is required on behalf of Part B professional providers where a remittance advice with an issue date between January 5, 2010, and February 12, 2010, has two or more service lines for a beneficiary where both of the following apply:
  
  ·         One service line is 100 percent reimbursable (i.e., the approved amount and amount to be paid are equal,) AND   
  ·         One service line where part of or the entire Medicare approved amount is applied to the Part B deductible and/or carries co-insurance amounts. 
  
  CMS is not able to forward these beneficiary claims to supplemental payers even though the remittance advice may indicate otherwise.  Providers will need to identify these claims by reviewing their remittance advice with an issue date between January 5, 2010, and February 12, 2010, that contain the criteria noted above.  Once identified, providers will need to take action to balance bill the beneficiary’s supplemental payer.  As of February 12, 2010, this system problem was fixed and all claims are crossing over to supplemental payers as indicated on the provider remittance advice.  
  
  The CMS has already notified supplemental payers of these issues.  We regret any inconvenience you may experience related to this Medicare claim supplemental payer crossover problem.
• Implementation of a New Skilled Nursing Facility (SNF) Consolidated Billing (CB) Edit for Facility Services Billed by Ambulatory Surgical Centers (ASCs) (CR6702)
• Rescinded– Place of Service (POS) and Date of Service (DOS) Instructions for Interpretation of Diagnostic Tests (CR6375)
• Medicare Non-Covered Claims with Professional Component Claims Process Issue
  (JSM10144)
  The Centers for Medicare & Medicaid Services (CMS) has identified a Medicare claims processing issue where non-covered claims submitted with a professional component are incorrectly receiving Reason Code 31387 preventing the claims from finalizing. Non-covered claims containing professional component receiving Reason Code 31387 are being held and will be released on or about September 6, 2010, once this claims processing system issue is fixed. We apologize for any inconvenience you may experience related to this issue.”
• Medicare Mammography Services Claims Process Issue
  (JSM10143)
  The Centers for Medicare & Medicaid Services (CMS) has identified a Medicare claims processing issue where adjustments submitted against original bills containing mammography services are incorrectly receiving Reason Code 36440 preventing the claims from finalizing. Adjustments performed on claims containing mammography services receiving Reason Code 36440 are being held and will be released on approximately September 6, 2010, once this claims processing system issue is fixed. We apologize for any inconvenience you may experience related to this issue.”

11 February 2010

• Revision of Definition of Compendia as Authoritative Source for Use in the Determination of a Medically-Accepted Indication of Drugs/Biologicals Used Off-label in Anti-Cancer Chemotherapeutic Regimens (CR6806)
• Billing and Processing for Healthy Control Group Volunteers in a Qualified Clinical Trial (CR6776)
• Revised: Coverage of Inpatient Rehabilitation Services (CR6699)

4 February 2010

• Revision of Definition of Compendia as Authoritative Source for Use in the Determination of a Medically-Accepted Indication of Drugs/Biologicals Used Off-label in Anti-Cancer Chemotherapeutic Regimens (CR6806)
• April 2010 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files (CR6804)
• Correction to Processing of Non-Covered Revenue Codes (CR6774)
• Dialysis Adequacy, Infection and Vascular Access Reporting (CR6782)
• Associating Hospice Visits to the Level of Care (CR6791)
• Revised: Integrated Outpatient Code Editor (IOCE) PC (interactive and batch) Re-Write (CR6709)
• Payments to Institutional Providers with Multiple Service Delivery Locations (CR6300)
  Note: This was originally released on February 17, 2009 prior to the transition of J14 MAC.

2 February 2010

• Holding of Adjustments and Cancels Performed on Home Health Request for Anticipated Payments (RAPs) and Claims with a “Through” Date on or after January 1, 2010
  JSM/TDL 10131
  Medicare Home Health System Claims Process Issue
  This JSM has been revised. Please view the text posted for JSM 10181 on March 18th.

January

29 January 2010

• Revised: Holding of Outpatient Prospective Payment System Claims with Healthcare Common Procedure Coding System Code Q0139
  (JSM/TDL 10126)
  Medicare Outpatient Prospective Payment System Claims Process Issue
  The Centers for Medicare & Medicaid Services (CMS) has identified a Medicare claims processing issue where claims billed with dates of service January 1, 2010, or later with Healthcare Common Procedure Coding System (HCPCS) Code Q0139 (Injection, Ferumoxytol, for treatment of iron deficiency anemia 1 mg (for ESRD on dialysis)) are being paid based on the billed amount instead of the Medicare fee schedule. Claims containing HCPCS Q0139 are being held and will be released on approximately March 1, 2010, once this claims processing system issue is fixed. Any claims paid in error will be adjusted. End Stage Renal Disease (ESRD) claims (72x types of bills) are not impacted by this hold. We apologize for any inconvenience you may experience related to this issue.

28 January 2010

• Providers Randomly Selected to Participate in the Medicare Contractor Provider Satisfaction Survey (MCPSS) Urged to Respond (SE1005)
• Revised: Wrong Surgical or Other Invasive Procedure Performed on a Patient; Surgery or Other Invasive Procedure Performed on the Wrong Body Part; and Surgical or Other Invasive Procedure Performed on the Wrong Patient (CR6405)
• Holding of Outpatient Prospective Payment System Claims with Healthcare Common Procedure Coding System Code Q0139
  JSM/TDL 10126
  
  Medicare Outpatient Prospective Payment System Claims Process Issue
  
  The Centers for Medicare & Medicaid Services (CMS) has identified a Medicare claims processing issue where claims billed with dates of service January 1, 2010, or later with Healthcare Common Procedure Coding System (HCPCS) Code Q0139 (Injection, Ferumoxytol, for treatment of iron deficiency anemia 1 mg (for ESRD on dialysis)) are being paid based on the billed amount instead of the Medicare fee schedule. Claims containing HCPCS Q0139 are being held and will be released on approximately March 1, 2010, once this claims processing system issue is fixed. Any claims paid in error will be adjusted. We apologize for any inconvenience you may experience related to this issue.

25 January 2010

• Expiration of Increased Medicare Payments for Ground Ambulance Services and Air Ambulance Payment Improvements Provisions (JSM10125)
  
  Section 146(a) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) provided for an increase in the ambulance fee schedule amounts for covered ground ambulance transport. For transports that originated in urban areas, the increase was two (2) percent. For transports that originated in rural areas, the increase was three (3) percent. The increases were applicable only for claims with dates of service July 1, 2008, through December 31, 2009.
  
  Further, Section 146(b)(1) of MIPPA amended the designation of rural areas for air ambulance services. The statute specified that any area that was designated as a rural area as of December 31, 2006, for purposes of making payments under the ambulance fee schedule for air ambulance services should continue to be treated as a rural area for purposes of making air ambulance service payments under the ambulance fee schedule. This statute was also applicable only for claims with dates of service July 1, 2008, through December 31, 2009.
  
  As such, as of January 1, 2010, for ground and air ambulance claims received with dates of service on this date and beyond, Medicare will no longer be paying ground and air ambulance service providers based on these two expired provisions.

21 January 2010

• Expansion of Medicare Telehealth Services for Calendar Year (CY) 2010 (CR6705)
• Calendar Year (CY) 2010 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment (CR6657)
• Additional Information Regarding the Calendar Year (CY) 2010 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment (SE1001)
• Revised: Processing of Non-Covered International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Procedure Codes on Inpatient Hospital Claims (CR6547)
• Coverage of Inpatient Rehabilitation Services (CR6699)
• Revised: Billing for Services Related to Voluntary Uses of Advance Beneficiary Notices of Noncoverage (ABNs) (CR6563)
• Revised: Implementation of the Health Insurance Portability and Accountability Act (HIPAA) Version 5010 276/277 Claim Status Second Phase (CR6721)

14 January 2010

• Change Request 6712 - (CR6712) Medically Unlikely Edits
  This CR provides updates and clarifications to MUE requirements established in 2006. For more information, the Centers for Medicare & Medicaid Services has issued the following transmittal at http://www.cms.hhs.gov/transmittals/downloads/R617OTN.pdf.
• Implementation of Home Health Agency Program Safeguard Provisions (CR6750) Note: This article was rescinded on May 5, 2010, as the related CR 6750 was rescinded on that date.
• Revised: Emergency Update to the 2010 Medicare Physician Fee Schedule Database (MPFSDB) (CR6796)
• Revised: Pharmacogenomic Testing for Warfarin Response (CR6715)
• Revised: Additional Data Collection on Hospice Claims (CR6440)
• Revised: Positron Emission Tomography (PET) (FDG) for Cervical Cancer (CR6753)

7 January 2010

• Revised: Summary of Policies in the 2010 Medicare Physician Fee Schedule (MPFS) and the Telehealth Originating Site Facility Fee Payment Amount (CR6756)
• January 2010 Integrated Outpatient Code Editor (I/OCE) Specifications Version 11.0 (CR6761)

6 January 2010

• CR Rescinded and Reissued January 8, 2010: Pharmacogenomic Testing for Warfarin Response (CR6715)
• Coverage of Kidney Disease Patient Education Services (CR6557)

December

30 December 2009

• Expiration of Various Payment Provisions Under the Medicare Program (SE0931)
• Emergency Update to the 2010 Medicare Physician Fee Schedule Database (MPFSDB)(CR6796) This CR was rescinded and reissued. See postings on January 14th
• Summary of Policies in the 2010 Medicare Physician Fee Schedule (MPFS) and the Telehealth Originating Site Facility Fee Payment Amount (CR6756)
• Limitation on Home Health Prospective Payment System (HH PPS) Outlier Payments (CR6759)
• Revised: Tracking the Hospice Attending Physician’s National Provider Identifier (NPI) for Validating Hospice Part B Payments (CR6540)

28 December 2009

• Expiration of Moratorium that Allowed Independent Laboratories to Bill for the Technical Component of Physician Pathology Services Furnished to Hospital Patients and Expiration of Therapy Cap Exceptions
  (JSM/TDL-10110)
  
  1. Expiration of Moratorium that Allowed Independent Laboratories to Bill for the TC of Physician Pathology Services Furnished to Hospital Patients
  
  The Centers for Medicare & Medicaid Services (CMS) continues to work with Congress on significant legislation which affects the Medicare program. We believe this and other provisions may be extended as part of this legislation. We encourage you to monitor Congressional activity and stay apprised of the status of potential legislation. In the meantime, if such legislation is enacted, CMS will notify Medicare fee-for-service claims processing contractors to again process claims for those affected services. Providers may choose to hold their claims in the event legislation about this issue is enacted. However, current law mandates the following change:
  
  In the final physician fee schedule regulation published in the Federal Register on November 2, 1999, CMS stated that it would implement a policy to pay only the hospital for the technical component (TC) of physician pathology services furnished to hospital patients. At the request of the industry, to allow independent laboratories and hospitals sufficient time to negotiate arrangements, the implementation of this rule was administratively delayed. Subsequent legislation formalized a moratorium on the implementation of the rule.
  
  The most recent extension of the moratorium was established by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). Section 136 of the MIPPA expires on December 31, 2009, thus ending the moratorium. Therefore, independent laboratories may no longer bill Medicare for the TC of physician pathology services furnished to patients of a hospital, regardless of the beneficiary's hospitalization status (inpatient or outpatient) on the date that the service was performed. This prohibition is effective for claims with dates of service on and after January 1, 2010.
  
  We will continue to be in communication with you should there be further information regarding payment of claims impacted by the above guidance. In addition, be on the alert for more information about this and other legislative provisions which may affect you.”
  
  2. Expiration of Therapy Cap Exceptions Process
  
  The Centers for Medicare & Medicaid Services (CMS) continues to work with Congress on significant legislation which affects the Medicare program. We believe this and other provisions may be extended as part of this legislation. We encourage you to monitor Congressional activity and stay apprised of the status of potential legislation. In the meantime, if such legislation is enacted, CMS will notify Medicare fee-for-service claims processing contractors to again process claims for those affected services. Providers may choose to hold their claims in the event legislation about this issue is enacted. However, current law mandates the following change:
  
  The exceptions to outpatient therapy caps expire on December 31, 2009. Outpatient therapy service providers should not submit claims with the KX modifier for services furnished on or after January 1, 2010. The therapy caps are determined on a calendar year basis, so all patients will begin a new cap year on January 1, 2010. For physical therapy and speech language pathology services combined, the limit on incurred expenses is $1,860. For occupational therapy services, the limit is $1,860. Deductible and coinsurance amounts applied to therapy services count toward the amount accrued before a cap is reached.
  
  Note that patients who have reached their limit(s) on outpatient therapy services, other than those who reside in a Medicare-certified part of a skilled nursing facility, may obtain medically necessary therapy services that exceed the caps if the services are furnished and billed by the outpatient department of a hospital. In other settings, outpatient therapy services in excess of the caps are not covered, and the therapy provider may charge the beneficiary for those services. We will continue to be in communication with you should there be further information regarding payment of claims impacted by the above guidance. In addition, be on the alert for more information about this and other legislative provisions which may affect you.

24 December 2009

• Extension of JSM-09326 - Mass-Adjusting Calendar Year (CY) 2006-2008 Outpatient Prospective Payment System (OPPS) Claims Paid to Rural Sole Community Hospitals (SCHs), including Essential Access Community Hospitals (EACHs), for Blood and Blood Products
  JSM/TDL-10105
  The Centers for Medicare & Medicaid Services (CMS) has identified a claims processing error affecting rural sole community hospitals (SCHs), including essential access community hospitals (EACHs), paid under the hospital outpatient prospective payment system (OPPS). Due to this error, rural SCH claims submitted for blood and blood products under the OPPS during 2006, 2007, and 2008 did not receive the rural SCH adjustment of 7.1 percent and, therefore, were underpaid. This claims processing problem was corrected retroactively on October 5, 2009, for blood and blood products provided in rural SCHs, including EACHs, during 2006, 2007, or 2008. Hospitals may, if they choose, collect the higher copayments from beneficiaries, and if unsuccessful, obtain bad-debt reimbursement from Medicare following CMS’ long-standing policies for bad-debt reimbursement. If hospitals choose not to seek beneficiary reimbursement for the higher copayments, they may report the foregone income as non-reimburseable bad debt. Adjustments are in the process of being made to claims paid in error, with all adjustments to be completed no later than May 3, 2010. We regret any inconvenience you have experienced related to this problem.

23 December 2009

• 2010 Medicare Contractor Provider Satisfaction Survey (MCPSS)
  (JSM 10062) The Centers for Medicare & Medicaid Services is conducting the fifth administration of the Medicare Contractor Provider Satisfaction Survey (MCPSS). The survey is designed to collect quantifiable data on provider satisfaction with the performance of your Medicare contractor. The MCPSS will be sent to a random sample of approximately 30,000 Medicare fee-for-service providers and suppliers. CMS is listening and wants to hear from you about the services provided by your Medicare contractor. If you are selected to participate in the survey, please take a few minutes and complete this important survey. To learn more about the MCPSS, please visit http://www.cms.hhs.gov/mcpss or https://www.mcpsstudy.org.
  
  
• Quarterly Provider Update (QPU)
  (IOM Pub 100-09-Chapter 6 Section 50.2.4.3)
  The Quarterly Provider Update (QPU) is a listing of the regulations and program instructions issued by CMS that impact Medicare providers. The QPU is maintained by CMS and available to providers through the CMS Web site.
  Providers may elect to join a CMS electronic mailing list, to be notified periodically, of additions to the QPU. CMS publishes this Update at the beginning of each quarter to inform the public about the following:
  
  • Regulations and major policies currently under development during this quarter.
  • Regulations and major policies completed or cancelled.
  • New/Revised manual instructions
  The page may be found at: http://www.cms.hhs.gov/QuarterlyProviderUpdates/
  Visit the QPU What’s New page at http://www.cms.hhs.gov/QuarterlyProviderUpdates/03_WhatsNew.asp
  
  
• Place of Service and Date of Service Instructions for Interpretation of Diagnostic Tests -Change Request (CR) 6375, Transmittal 1873 sent via CI-6381, dated December 11, 2009, is rescinded and will be replaced with another CR in the future pending further policy clarification on date of service and place of service reporting for the interpretation of diagnostic tests that consistently addresses the full spectrum of clinical scenarios. (CR6375) (02/11/2009)
• Revised: January 2010 Update of the Hospital Outpatient Prospective Payment System (OPPS) (CR6751)
• Implementation of the Health Insurance Portability and Accountability Act (HIPAA) Version 5010 276/277 Claim Status Second Phase (CR6721)
• Revised: Positron Emission Tomography (PET) (FDG) for Cervical Cancer (CR6753)
• Revised: Instructions Regarding Processing Claims Rejecting for Gender/Procedure Conflict (CR6638)

17 December 2009

• January 2010 Update of the Hospital Outpatient Prospective Payment System (OPPS) (CR6751)
• Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy Print (MREP) Update (CR6742)
• Revised:Tracking the Hospice Attending Physician’s National Provider Identifier (NPI) for Validating Hospice Part B Payments (CR6540)
• Revised: Claim Status Category Code and Claim Status Code Update (CR6723)
• Revised: Revisions to Consultation Services Payment Policy (CR6740)

10 December 2009

• Tracking the Hospice Attending Physician’s National Provider Identifier (NPI) for Validating Hospice Part B Payments (CR6540)
• 2010 Annual Update to the Therapy Code List (CR6719)
• Home Health Prospective Payment System Rate Update for Calendar Year 2010 (CR6747)
• Requirements to Prevent the Misuse of Modifiers PA, PB, and PC on Incoming Claims (CR6718)

7 December 2009

• Re-Release of Fiscal Year 2010 Inpatient Prospective Payment System and Long Term Care Hospital Pricers
  JSM/TDL-10058
  
  The Centers for Medicare & Medicaid Services (CMS) has identified a claims processing error that incorrectly paid a new technology add-on payment for Spiration® IBV® claims that did not meet all conditions to qualify for the add-on payment for fiscal year 2010. This error has been corrected and contractors are adjusting claims that were inappropriately paid the add-on payment. We regret any inconvenience you may have experienced related to this problem.

3 December 2009

• Use of the “CR” Modifier and the “DR” Condition Code During the H1N1 Influenza Pandemic Emergency
  JSM/TDL 10047
  
  For claims where an admission or decision to retain a patient is made to meet the demands of the H1N1 pandemic emergency, that decision is indicated on claims sent to Medicare by using either the “CR” modifier or the “DR” condition code. These codes are only to be utilized by individual facilities designated as Critical Access Hospitals (CAH), Inpatient Rehabilitation Facilities (IRF), and Long Term Care Hospitals (LTCH) that have been granted an 1135 waiver under the current 1135 waiver authority dated October 27, 2009. The instructions that follow refer to claims for services between the date the waiver was granted to the facility and the date the waiver expires, is withdrawn, or is no longer required for the facility.
  
  The CR (catastrophe/disaster related) Modifier
  • Used for Part B items and services only but may be used in either institutional or non-institutional billing.
  • Required when an item or service is impacted by an emergency or disaster and Medicare payment for such item or service is conditioned on the presence of a “formal waiver”
  • May be required when either the contractor or CMS determine that such use is needed to efficiently and effectively process claims or to otherwise administer the Medicare fee-for-service program.
  
  The DR (disaster related) Condition Code
  • Used for institutional billing only (UB04/CMS-1450 or its electronic equivalent)
  • Required when a service is affected by an emergency or disaster and Medicare payment for such service is conditioned on the presence of a “formal waiver”
  • May be required when either the contractor or CMS determine that it is needed to efficiently and effectively process claims or to otherwise administer the Medicare fee-for-service program.
  • Used at the claim level when all of the services/items billed on the claim are related to the emergency/disaster.
  
  For more information on 1135 waivers, providers are encouraged to listen to the encore presentation on “Information Discussion from Department of Health and Human Services on H1N1” that was held on November 10, 2009. The encore presentation is available until May 10, 2009. To access the Encore Feature, dial (800) 642-1687 and enter Conference ID: 3H1N1.
  
  To learn more about these new billing instructions as well as the H1N1 pandemic emergency:
  • CR 6451 – www.cms.hhs.gov/transmittals/downloads/R1784CP.pdf.
  • H1N1 Questions & Answers – http://www.cms.hhs.gov/H1N1.
  • Official Government Web Site on Influenza vaccines and the H1N1 pandemic emergency – www.flu.gov.
  
  
  
• Revised: Therapy Cap Values for Calendar Year (CY) 2010 (CR6660)
  
  
• Annual Update of HCPCS Codes Used for Home Health (HH) Consolidated Billing Enforcement (CR6662)
  
  
• Ambulance Inflation Factor (AIF) for Calendar Year (CY) 2010 (CR6631)
  
  

2 December 2009

• Adjustment of Inpatient Skilled Nursing Facility Medicare Advantage Claims that Were Rejected Incorrectly
  JSM/TDL 10060
  
  The Centers for Medicare & Medicaid Services (CMS) recently discovered that inpatient Skilled Nursing Facility (SNF) Medicare Advantage (MA) claims submitted with Condition Code 04 were incorrectly rejecting with Reason Code 19904. Analysis determined that this error began with the implementation of the July 2009 User Release which was installed into production on September 3, 2009.
  System changes will be implemented into the Fiscal Intermediary Shared System (FISS) with user Change Request (CR) FS5493R2, to allow inpatient SNF claims submitted with Condition Code 04 to adjudicate and systematically bypass Reason Code 19904. User CR FS5493R2 will be installed into production on December 7, 2009. Once this change has been installed contractors shall adjust claims to correct the beneficiary’s spell of illness that meet the following criteria:
  • Bill Type = Inpatient SNF;
  • Receipt Date >= 9/3/09;
  • Condition Code = 04;
  • Rejected with reason code 19904.
  The adjustments shall be initiated no more than 30 days from the implementation of User CR FS5493R2.
  
  

November

24 November 2009

• Implementation of Changes in End Stage Renal Disease (ESRD) Payment for Calendar Year (CY) 2010 –MIPPA Section 153 (CR6679)
• Integrated Outpatient Code Editor (IOCE) PC (interactive and batch) Re-Write (CR6709)

19 November 2009

• Therapy Cap Values for Calendar Year (CY) 2010 (CR6660)
• Update to Medicare Deductible, Coinsurance, and Premium Rates for 2010 (CR6690)
• Ambulance Services (CR6707)
• Calendar Year (CY) 2010 Fee Schedule Update for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) (CR6720)
• Claim Status Category Code and Claim Status Code Update (CR6723)
• January 2010 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files (CR6708)
• Outpatient Mental Health Treatment Limitation (CR6686)
• Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program Round One Rebid Implementation--Phase 8B: Oxygen Modality (CR6692)

12 November 2009

• Mental Health Medically Unlikely Edit (MUE)
  JSM/TDL-10038
  
  The Centers for Medicare & Medicaid Services (CMS) has identified an incorrect Medically Unlikely Edit (MUE) of 3 units for hospital outpatient services described by Current Procedural Terminology (CPT) Code 90853 (Group psychotherapy (other than of a multiple-family group)). The proper MUE for this code is 5 units. This will be retroactively corrected in the January 1, 2010 Release. Your FI/MAC will hold hospital outpatient claims (Type of Bill (TOB) 13X) with 4 or 5 units of CPT Code 90853 on one line with dates of service on or after October 1, 2009.
  
  However, when providing 4 or 5 units of the service described by CPT Code 90853 between October 1, 2009, and January 1, 2010, you may choose to bill 3 units of CPT Code 90853 on one line, and 1 or 2 units of CPT Code 90853 on another line with Modifier -59 in order to receive payment for these services prior to the implementation of the corrected MUE on January 1, 2010. This is a time-limited instruction and applies only to services described by CPT Code 90853 provided between October 1, 2009, and January 1, 2010. In all other cases, the use of Modifier -59 is reserved only for services provided in distinct clinical circumstances. It is improper to use Modifier -59 to circumvent MUEs unless specifically instructed by your FI/MAC to do so.
  
  
• CR Rescinded and Reissued January 8, 2010: Processing of Non-Covered International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Procedure Codes on Inpatient Hospital Claims (CR6547)
  
  
• Continuation of Maintenance and Servicing Payments in CY 2010 for Certain Oxygen Equipment as a Result of the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 (CR6716)
  
  
• Further Clarification of Instructions on Using 837 Institutional Claim Adjustment Segments (CAS) for Medicare Secondary Payer (MSP) Part A Claims (SE0928)
  
  
• Announcement of Medicare Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Payment Rate Increases (CR6605)
  
  
• Ensuring the Denial of Claims for Ambulance Services Rendered to Beneficiaries in Part A Skilled Nursing Facility Stays (CR6700)
  
  
• Changes to the Laboratory National Coverage Determination (NCD) Edit Software for January 2010 (CR6717)
  
  

5 November 2009

• Reasonable Charge Update for 2010 for Splints, Casts, Dialysis Supplies, Dialysis Equipment, and Certain Intraocular Lenses (CR6691)
  
  
• Revised: Surgery for Diabetes National Coverage Determination (NCD) (CR6419)
  
  
• Billing for Services Related to Voluntary Uses of Advance Beneficiary Notices of Noncoverage (ABNs) (CR6563)
  
  
• Instructions Regarding Processing Claims Rejecting for Gender/Procedure Conflict (CR6638)
  
  

October

29 October 2009

• Coverage of Inpatient Rehabilitation Services (CR6699) This CR was rescinded and reissued. See postings on January 21st.
  
  
• Revised - FDG PET for Solid Tumors and Myeloma (CR6632)
  
  

22 October 2009

• FDG PET for Solid Tumors and Myeloma (CR6632)
  
  
• Magnetic Resonance Imaging (MRI) (CR6672)
  
  
• Annual Clotting Factor Furnishing Fee Update (CR6673)
  
  
• Revised: Implementation of Health Insurance Portability and Accountability Act of 1996 (HIPAA) version 5010 for Transaction 835 - Health Care Claim Payment/Advice (CR6589)
  
  
• Revised: Ensuring Only Clinical Trial Services Receive Fee-for-Service (FFS) Payment on Claims Billed for Managed Care Beneficiaries (CR6455)
  
  

19 October 2009

• Mass-Adjusting Calendar Year (CY) 2006-2008 Outpatient Prospective Payment System (OPPS) Claims Paid to Rural Sole Community Hospitals (SCHs), including Essential Access Community Hospitals (EACHs), for Blood and Blood Products JSM/TDL-09326
  
  The Centers for Medicare & Medicaid Services (CMS) has identified a claims processing error affecting rural sole community hospitals (SCHs), including essential access community hospitals (EACHs), paid under the hospital outpatient prospective payment system (OPPS). Due to this error, rural SCH claims submitted for blood and blood products under the OPPS during 2006, 2007, and 2008 did not receive the rural SCH adjustment of 7.1 percent and, therefore, were underpaid.
  
  This claims processing problem will be corrected retroactively on October 5, 2009, for blood and blood products provided in rural SCHs, including EACHs, during 2006, 2007, or 2008. Hospitals may, if they choose, collect the higher copayments from beneficiaries, and if unsuccessful, obtain bad-debt reimbursement from Medicare following CMS’s long-standing policies for bad debt reimbursement. If hospitals choose not to seek beneficiary reimbursement for the higher copayments, they may report the foregone income as non-reimbursable bad debt. At that time, adjustments will be made to claims paid in error with all adjustments completed no later than December 31, 2009 We regret the inconvenience you have experienced related to this problem.

15 October 2009

• Clarification of the Use of Modifiers When Billing “Wrong Surgery on a Patient” (SE0927)
  
  
• Revised: Fiscal Year (FY) 2010 Inpatient Prospective Payment System (IPPS), Long Term Care Hospital (LTCH) PPS, and Inpatient Psychiatric Facility (IPF) PPS Changes (CR6634)
  
  
• Revised: 2009 - 2010 Seasonal Influenza (Flu) Resources for Health Care Professionals (SE0926)
  
  

8 October 2009

• Activation of New Coordination of Benefits Agreement (COBA) Trading Partner Dispute Error Code Within the National Crossover Process (CR 6640)
  
  
• Comprehensive Outpatient Rehabilitation Facility Manual (CR 6005)
  
  
• Revised: Wrong Surgical or Other Invasive Procedure Performed on a Patient; Surgery or Other Invasive Procedure Performed on the Wrong Body Part; and Surgical or Other Invasive Procedure Performed on the Wrong Patient (CR 6405)
  
  
• Influenza Vaccine Payment Allowances - Annual Update for 2009-2010 Season (CR6608)

1 October 2009

• Billing for an Ambulance Transport with More than One Patient Onboard (CR6621)

September

24 September 2009

• Revised: Fiscal Year (FY) 2010 Inpatient Prospective Payment System (IPPS), Long Term Care Hospital (LTCH) PPS, and Inpatient Psychiatric Facility (IPF) PPS Changes (CR6634)
  
  
• 2009 - 2010 Seasonal Influenza (Flu) Resources for Health Care Professionals (SE0926)
  
  
• Implementation of Health Insurance Portability and Accountability Act of 1996 (HIPAA) version 5010 for Transaction 835 - Health Care Claim Payment/Advice (CR6589)
  
  
• Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy Print (MREP) Update (CR6604)
  
  
• Revised: Wrong Surgical or Other Invasive Procedure Performed on a Patient; Surgery or Other Invasive Procedure Performed on the Wrong Body Part; and Surgical or Other Invasive Procedure Performed on the Wrong Patient (CR6405)
  
  
• Revised: Processing of Osteoporosis Drugs under the Home Health Benefit (CR6512)

17 September 2009

• Announcing the Release of the Revised CMS-855 Medicare Enrollment Applications (SE0924)
  
  
• Revised: Medicare Fee-for-Services (MFFS) Billing for the Administration of the Influenza A (H1N1) Virus Vaccine (SE0920)
  
  
• Revised:Inpatient Rehabilitation Facility (IRF) Annual Update: Prospective Payment System (PPS) Pricer Changes for Fiscal Year (FY) 2010 (CR6607)
  
  
• Influenza Pandemic Emergency -- The Medicare Program Prepares (SE0836). Note: The Centers for Medicare & Medicaid Services rescinded this article on September 11, 2009.
  
  
• Revised: Claims Submitted for Items or Services Furnished to Medicare Beneficiaries in State or Local Custody under a Penal Authority and Examples of Application of Government Entity Exclusion (CR6544) This CR has been rescinded and replaced by CR 6880, posted on April 15th.

10 September 2009

• Claims Submitted for Items or Services Furnished to Medicare Beneficiaries in State or Local Custody under a Penal Authority and Examples of Application of Government Entity Exclusion(CR6544) This CR has been rescinded and replaced by CR 6880, posted on April 15th.
  
  
• 2010 Annual Update of HCPCS Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) for the Common Working File (CWF), A/B MACs, Medicare Carriers and Fiscal Intermediaries (FIs) (CR6619)
  
  
• Screening Computed Tomography Colonography (CTC) for Colorectal Cancer (CR6578)
  
  
• Implementation of the Health Insurance Portability and Accountability Act (HIPAA) Version 5010 Only in Jurisdiction 10 and Jurisdiction 14 Parts A and B (A/B) Medicare Administrative Contractors (MACs) (CR6595)
  
  
• Revised - October Update to the 2009 Medicare Physician Fee Schedule Database (MPFSDB) (CR6617)
  
  

3 September 2009

• Change Request 6617 will be implemented on October 5, 2009 with an effective date of January 1, 2009. Any disclosure information will be published on our Fee Schedule pages as soon as available.
  
  
• October Update to the 2009 Medicare Physician Fee Schedule Database (MPFSDB) (CR6617)
  
  
• Revised: Medicare Parts A and B Coverage and Prior Authorization (SE0916)
  
  
• Addition/Deletion of HCPCS Codes – October 2009 Quarterly Update (CR6594)
  
  
• October 2009 Integrated Outpatient Code Editor (I/OCE) Specifications Version 10.3 (CR6618)
  
  
• October 2009 Update of the Hospital Outpatient Prospective Payment System (OPPS) (CR6626)
  
  
• Claim Status Category Code and Claim Status Code Update (CR6609)
  
  
• H1N1 Code Effective Date Change
  
  JSM/TDL-09415
  
  (Removed 02/04/2010)
  
  
• Calendar Year (CY) 2009 Hospital Billing for Synvisc-One
  
  Synvisc-One was approved by the Food and Drug Administration (FDA) via a Premarket Approval (PMA) supplement on February 26, 2009. To ensure proper Medicare payment for Synvisc-One, the Centers for Medicare & Medicaid Services (CMS) instructs that for services provided from February 26, 2009, through December 31, 2009, hospitals shall bill for Synvisc-One using three (3) units of HCPCS code J7322 (Hyaluronan or derivative, Synvisc, for intra-articular injection, per dose). (JSM/TDL 09414)
  
  
• Compliance Standards for Consignment Closets and Stock and Bill Arrangements -Transmittal 300, sent via RO-6462 dated September 1, 2009 is rescinded. The Centers for Medicare & Medicaid Services (CMS) is rescinding this Change Request to consider other implementation options. (CR6528) (02/11/2009)
  
  
• Billing for the Administration of the Influenza A (H1N1) Virus Vaccine (SE0920)
  
  

August

20 August 2009

• Diabetes Self-Management Training (DSMT) Certified Diabetic Educator (CR6510)
  
  
• Compliance Standards for Consignment Closets and Stock and Bill Arrangements -Transmittal 300, sent via RO-6462 dated September 1, 2009 is rescinded. The Centers for Medicare & Medicaid Services (CMS) is rescinding this Change Request to consider other implementation options. (CR6528) (02/11/2009)
  
  
• 2010 Annual Update for the Health Professional Shortage Area (HPSA) Bonus Payments (CR6581)
  
  
• Reporting Non-Tax Withholding Due to Federal Payment Levy Program (FPLP) (CR6228)
  
  
• October 2009 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files (CR6585)
  
  
• Clinical Laboratory Fee Schedule – Medicare Travel Allowance Fees for Collection of Specimens (CR6524)
  
  
• Revised: Medicare Claims Processing Manual Clarifications for Skilled Nursing Facility (SNF) and Therapy Billing (CR6407)
  
  
• Update to the Hospice Payment Rates, Hospice Cap, Hospice Wage Index, and the Hospice Pricer for FY 2010 (CR6606)
  
  

13 August 2009

• The Use of the CR Modifier and DR Condition Code on Disaster/Emergency-Related Claims (CR6451)
  
  
• Revised:Appropriate Use of Modifier 50 and Add-On Codes for Facet Joint Injections Services (CR6518)
  
  
• Program Instructions Designating the Competitive Bidding Areas and Product Categories Included in the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program Round One Rebid in Calendar Year (CY) 2009 (CR6571)
  
  
• Marketing the Upcoming Health Insurance Portability and Accountability Act Version 5010 Conference Call to Billing Software Vendors and Clearinghouses
  
  JSM/TDL-09385
  
  The Centers for Medicare & Medicaid Services (CMS) will present the second in a series of National Education Training Conference Calls focused on Medicare’s Fee-for-Service (FFS) implementation of Health Insurance Portability and Accountability Act (HIPAA) Version 5010. The training presentation, geared to clearinghouses and billing software vendors, will cover Medicare FFS error handling transactions (TA1, 999, and 277CA), planned use of each transaction and applicable rules and exceptions for the Medicare FFS program. A Question & Answer (Q&A) session will follow the presentation that will give participants an opportunity to ask questions of CMS’ subject matter experts.
  
  Due to the nature of the content, only clearinghouse and billing software vendor staff are encouraged to participate in this important CMS training conference call.
  
  You must register for this call in advance, in order to receive the call-in information.
  
  Please note if your organization is planning to participate in this training call as a group, only one person needs to register to receive the call-in information. This registration is solely to reserve a telephone line, NOT to allow participation.
  
  Date: August 26, 2009
  Conference Title: Version 5010: Medicare FFS Error Handling Transactions
  Time: 2:00 – 3:30 p.m. ET
  
  Registration will close at 2:00 p.m. ET on August 25, 2009, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
  
  1. To register for the call, participants need to go to http://www2.eventsvc.com/palmettogba/082609.
  2. Fill in all required data.
  3. Verify your time zone is displayed correctly the drop down box.
  4. Click "Register".
  5. You will be taken to the “Thank you for registering” page and will receive a confirmation e-mail shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation e-mail, please check your spam/junk mail filter as it may have been directed there.
  6. A few days prior to the call (not before August 24th), check the Educational Resources page on CMS’ 5010 Web page at http://www.cms.hhs.gov/Versions5010andD0/40_Educational_Resources.asp to obtain a copy of the presentation that will be used during the call.
  
  

6 August 2009

• Revised: Payment for Co-surgeons in a Method II Critical Access Hospital (CAH) (CR6319)
  
  
• Telehealth Services in Indian Health Service (IHS) or Tribal Providers (CR6493)
  
  
• Revised: Section 148 of The Medicare Improvements for Patients and Providers Act (MIPPA) (CR6395)
  
  
• Guidance on Using Internet-based Provider Enrollment, Chain and Ownership System (PECOS) (SE0914)

July

31 July 2009

• Revised: Update-Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) Rate Year 2010 (CR6461)
  
  

30 July 2009

• 2009 Reminder for Roster Billing and Centralized Billing for Influenza and Pneumococcal Vaccinations (CR6539)
  
  
• Revised: Smoking and Tobacco Use Cessation Counseling Billing Code Update to Medicare (CR5878)
  
  
• Revised: Wrong Surgical or Other Invasive Procedure Performed on a Patient; Surgery or Other Invasive Procedure Performed on the Wrong Body Part; and Surgical or Other Invasive Procedure Performed on the Wrong Patient (CR6405)
  
  
• The Supplemental Security Income (SSI)/Medicare Beneficiary Data for Fiscal Year 2007 for Inpatient Prospective Payment System (IPPS) Hospitals, Inpatient Rehabilitation Facilities (IRFs), and Long Term Care Hospitals (LTCHs) (CR6530)
  
  
• Point of Origin Codes Update to the UB-04 (CMS-1450) Manual Code List (CR6478)
  
  
• Revised Processing of Osteoporosis Drugs Under the Home Health Benefit (CR6512)
  
  
• Quarterly Provider Update (QPU) - Reminder
  (IOM Pub 100-09-Chapter 6 Section 50.2.4.3)
  
  The Quarterly Provider Update (QPU) is a listing of the regulations and program instructions issued by CMS that impact Medicare providers. The QPU is maintained by CMS and available to providers through the CMS Web site.
  Providers may elect to join a CMS electronic mailing list, to be notified periodically, of additions to the QPU. CMS publishes this Update at the beginning of each quarter to inform the public about the following:
  • Regulations and major policies currently under development during this quarter.
  • Regulations and major policies completed or cancelled.
  • New/Revised manual instructions
  The page may be found at: http://www.cms.hhs.gov/QuarterlyProviderUpdates/
  Visit the QPU What’s New page at
  http://www.cms.hhs.gov/QuarterlyProviderUpdates/03_WhatsNew.asp

23 July 2009

• Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) (CR6520)
  
  
• Sleep Testing for Obstructive Sleep Apnea (OSA) (CR6534)
  
  
• Changes to the Laboratory National Coverage Determination (NCD) Edit Software for October 2009 (CR6548)
  
  

16 July 2009

• Revised: ESRD: Placement of a List of Diagnostic Tests that are Considered End Stage Renal Disease (ESRD) Related in Publication 100-04, Chapter 16 (CR6515)
  
  
• Take Action Now to Prepare for the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (SE0915)
  
  
• Revised: Clarification on Use of National Drug Codes (NDCs) in 837 I Billing (CR6330)
  
  
• Reprocessing of Rate Year (RY) 2010 Claims Paid Under the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) (JSM/TDL-09360)
  
  Rescinded July 21, 2009

9 July 2009

• Wrong Surgical or Other Invasive Procedure Performed on a Patient; Surgery or Other Invasive Procedure Performed on the Wrong Body Part; and Surgical or Other Invasive Procedure Performed on the Wrong Patient (CR6405)
  
  
• Review of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) (CR6468)
  
  
• Claim Status Category Code and Claim Status Code Update (CR6525)
  
  
• Method of Payment for Extended Stay Services Under the Frontier Extended Stay Clinic (FESC) Demonstration, Authorized by Section 434 of the Medicare Modernization Act (MMA) - CR6452 provides additional information to CR 6057 (CR6452)
  
  
• Instructions on utilizing 837 Institutional Claim Adjustment Segments (CAS) for Medicare Secondary Payer (MSP) Part A Claims. (This CR Rescinds and Fully Replaces CR 6275) (CR6426)
  
  
• Billing Routine Costs of Clinical Trials (Revised CR6431)
  
  

2 July 2009

• Revised: July 2009 Update of the Hospital Outpatient Prospective Payment System (OPPS) (CR6492)
  
  
• Review of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) (CR6468)
  
  

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03/10/2011