Updates

Below you will find a listing of current Medicare changes and updates to the website pertinent to the state of California.

For National CMS program information updates (transmittals, corrections/changes to existing Medicare guidelines) refer to What's New.

Note: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material which is copyrighted by the American Medical Association (AMA). You are forbidden to download the files unless you read, agree to and abide by the provisions of the copyright statement. Read the copyright statement now (you will be linked back to here).

May | April | March | February | January

May

08 May 2008

• Two revised educational articles have been posted: ICD-9-CM Coding on Claims and Item 24E of the CMS-1500 Claim Form.
• The Educational Tools and Questions & Answers from the webinar on Bundled Services is now available.
• The Ophthalmology/Optometry Billing Guide has been revised.

01 May 2008

• The Draft LCD Open Meeting scheduled for July has been cancelled.
• The latest issue of the CERT newsletter has been posted.

April

24 Apr 2008

• Two new educational articles have been posted: Use of an 8-Digit Registry Number on Clinical Trial Claims and Care Plan Oversight Documentation Requirements.
• Registration is now being accepted for the May 21 webinar: National and Local Coverage Determinations and the Use of the New Advanced Beneficiary Notice of Noncoverage.
• The Questions & Answers from the previous webinar are now available: Care Plan Oversight and Skilled Nursing Facility Consolidated Billing.

17 Apr 2008

• The Questions and Answers from the Provider Enrollment Webinar have been posted.
• The listings of Opt-Out Providers have been updated.
• The Medicare Secondary Payer Billing Guide has been updated.
• The minutes from the March meeting of the Provider Outreach & Education Advisory Group (POE-AG) have been posted.

10 Apr 2008

• Two new educational articles are now available: Radiopharmaceutical Imaging Agents - Billing Proper Quantities and The Reopening Process.
• The Questions and Answers from the National Provider Identifier ACT have been posted.

03 Apr 2008

• Three new educational articles are now available: Provider Revalidation, ASC Billing Tip - Diagnostic Services, and Part-Time Physician Involvement in Diagnostic Clinics
• The Ambulatory Surgery Center Billing Guide has been updated to include all the 2008 changes.
• The April update to the Physician Fee Schedules and the Updates to the Indicators have been posted.
• The Allowance Limits for Medicare Part B Drugs for April and revised ones for the past two quarters are now available.
• The Medicare Participating Physicians/Suppliers Directory of Rural Health Clinics is now available.

March

27 Mar 2008

• A new Provider Enrollment Form Interactive Tool has been added: Form 855R. There are already tools available for Form 855B and Form 855I.
• Registration is now available for a Webinar on April 23 on the topic of Bundled Services.
• The Related Web Sites page has been reorganized for convenience.
• This local Coverage Determination (LCD) has been revised: Independent Diagnostic Testing Facilities (IDTF). The CPT code 77057, was added, as it was inadvertently missing. This LCD can be accessed from the Active Index link on the LCD Indices page.

20 Mar 2008

• Two new educational articles have been added: Correct Use of Modifiers for Foot Care Services and Proper Reimbursement for PT/OT Services Rendered in the Outpatient Hospital Setting
• The Questions & Answers from the 2008 Updates Webinar have been added.
• Registration is now being accepted for a Webinar on Consolidated Billing/Care Plan Oversight to be held on March 28.

17 Mar 2008

• The 2008 Medicare Participating Physicians/Suppliers Directory (MEDPARD) is now available. (CR 5944)

13 Mar 2008

• The 2008 Medicare Workshop Guide is now available.
• Two new educational articles have been added: Modifier 22, and Evaluation and Management Services Updates
• The following LCDs was revised: Independent Diagnostic Testing Facilities (IDTF) - Revised - Updated LCD regarding annual HCPCS/CPT changes. Per CR 5856 added information to the Documentation Requirements Section regarding the IDTF's responsibility in maintaining documentation of the beneficiaries' written clinical complaint, and that any changed in ownership, location, general supervision, and adverse legal action must be reported to the contractor. It can be accessed from the Active Index on the LCD Indices page.

6 Mar 2008

• The Claim Form CMS-1500 Instructions online learning module has been updated.
• Registration is now being accepted for two webinars: Skilled Nursing Facility Consolidated Billing/Care Plan Oversight and Provider Enrollment Application Process.
• The Introduction to Medicare Billing Guide has been revised.
• New/Revised educational articles: Appeals Process for 2008, Appeals Reminder, Change in the Amount of Controversy Requirement for Federal District Court Appeals, Review of Immunization Administration Code, CLIA Edits - HCPCS Codes Subject to and Excluded from Edits, and Top 10 Duplicate Claim Submitters by Specialty.
• The Draft LCD Open Meeting scheduled for April has been cancelled.
• There is still time to register for the 2008 Medicare Workshops. Registration is free, and the following topics will be discussed: Medicare Updates, Error Reduction, and Electronic Data Interchange.

February

28 Feb 2008

• Check out the two new web pages: Forms (listing of all forms in one place), and Medicare Secondary Payer & Overpayments.
• New/Revised Educational Articles added: Rejection of X12 276 Claim Status Requests That Lack National Provider Identifiers (NPIs);  NHIC, Corp. Evaluation & Management (E/M) Coding Requirements;  Independent Laboratories Billing the Technical Component of Physician Pathology Services;  Modifier 25 Update; and Correct Reporting of Diagnosis Codes on Screening Mammography Claims - Billing Instructions  
• The Preventive Services Billing Guide has been updated.

21 Feb 2008

• The March 2008 issue of the Medicare B Resource newsletter is now available.
• New/Revised Educational Articles added: Diagnostic Radiology - Duplicate Claim Denials, Outpatient Therapy Cap and Exception Process 2008 – Contractor Instruction, Colorectal Cancer Screening – New Code, and 2007 Current Procedural Terminology (CPT) Mammography Codes
• The 1500 Claim Form Instructions Billing Guide has been updated.

14 Feb 2008

• New/Revised Educational Articles have been posted: NPI Compliance Claim Statistics - Week Ending February 1, 2008, Interim Procedures to Allow for Timely Processing of Mammography Claims with Mammography Quality Standards Act (MQSA) Certification Updates, Common Reasons for Down Coding E/M Services, Beneficiary Signature Requirements, Incomplete/Mismatched Beneficiary Information, Item 24E of the CMS-1500 Claim Form, Mandatory Electronic Claims Submission, Provider Signature Requirements, Dermatology Billing Reminders – Removal of Skin Lesions, 2008 Therapy Codes that also Qualify for an Automatic Exception to the Therapy Cap, Off-Label Medications - Coverage
• On Feb 29, 2008 there will be an Ask the Contractor Teleconference (ACT) on the topic: NPI - The latest news
• The Educational Online module for Provider Enrollment Form Completion has been revised
• Questions & Answers from the Provider Enrollment Webinar is now available
• Revised billing guides have been posted: Preventive Services Billing Guide, Preventive Services Reference Sheet
• The Individual Enrollment (Form 855I) Interactive Form Tool has been revised
• The following LCD was updated (active index): Physical Therapy - Updated LCD with current Change Request, CR 5871, issued January 17, 2008, effective January 1, 2008, Outpatient Therapy Caps without KX Modifier Exceptions Start January 1, 2008;
• Insurance Verification Reminder
  Around the first of the year, it is not unusual for NHIC, Corp. to see an increase in claims that deny with the following reason code:
  
  CO109 – Claim not covered by this payer/contractor.  You must send the claim to the correct payer/contractor.
  
  The last quarter of the year is open enrollment for Medicare beneficiaries.  This is when patients have the option to elect other health care coverage such as a Medicare Advantage (Health Maintenance Organization) plan.  You should always verify the patient’s eligibility with Medicare, especially during the beginning of the year following open enrollment.
  
  As a reminder, you can call NHIC, Corp. at 866-502-6054 for SCA and 877-591-1587 for NCA to access patient eligibility information 24 hours a day using the speech Interactive Voice Response (IVR) system.  Information for multiple patients can be accessed during a single telephone call as well.  For more information on Medicare eligibility and using the speech IVR please see the following article “Focus on....Medicare Eligibility”:
  http://www.medicarenhic.com/cal_prov/articles/medicareelig_1207.pdf

07 Feb 2008

• New/revised Educational Articles have been posted: Medical Necessity Denials - Local Coverage Determinations;  Item 11 of CMS-1500 Claim Form - Required for Claim Submission;  Competitive Acquisition Program - Billing Part B Drugs; and  Independent Diagnostic Testing Facilities (IDTFs) - Revision to Instructions Relating to Compliance Standards
• The revised ASC Fee Schedule files have been posted.
• The Educational Online module for the CMS-1500 Claim Form has been revised.
• This Local Coverage Determination (LCD) has been revised: Category III. It can be accessed from the Active Index on the LCD Indices page.
• Information on upcoming Ask the Contractor Teleconferences (ACT) have been posted.

January

31 Jan 2008

• Four new Educational Articles have been posted: Erythropoiesis Stimulating Agents (ESA) Coverage and Claims Requirements;  Foot Care Services - Billing Reminders;  Physical Therapist Duplicate Claim Denials;   and  NPI Compliance Claim Statistics.
• The Questions & Answers from the Non-Physician Practitioners ACT have been posted.
• The CBSA Localities for some of the ASC Fee Schedules have been revised.
• Check out the new PDF comprehensive Newsletter Index. It will search all newsletters at one time
• We have added a new page for Self-Service Tools. These tools provide an efficient method of making information available for Medicare Providers and Suppliers.
  • Claim Filing Calculator – use this tool to determine when a claim must be filed.
  • Global Surgery Period Calculator – assists in determining when the global period ends for a major surgical procedure with a 90-day global period.  The global surgery period begins the date following the surgical date.
  • Redetermination Request Calculator - A redetermination request must be made within 120 days. This tool helps you determine when that request must be made from the date of the MSN/SPR.

24 Jan 2008

• New or revised Educational Articles: Ambulance Transports and Medicare Payments - Revision;  Duplicate Claim Submissions and the Carrier Bulletin Board System (CABBS);   Proper Billing of Technical & Professional Components ;   Top 10 Duplicate Claim Submitters by Specialty;   Unprocessable or Rejected Claims; and Billing Reminders for “Incident To” Services.
• Registration is now being accepted for the February 26 Webinar on 2008 Medicare Updates.
• The payable list of drug codes in Ambulatory Surgical Centers (ASC) have been posted.

17 Jan 2008

• The minutes from the December meeting of the Provider Outreach & Education Advisory Group (POE-AG) have been posted.
• The Questions & Answers from the Evaluation & Management Services webinar have been posted.
• The fee schedules for Clinical Psychologists and Licensed Clinical Social Workers have been added.
• Physician Scarcity Area (PSA) Bonus

  The Physician Scarcity Area (PSA) Bonus is payable for dates of service January 1, 2005 through December 31, 2007.    The Medicare, Medicaid, and State Children’s Health Insurance Program (SCHIP) Extension Act of 2007 amended §1833(u)(1) of the Social Security Act and has extended payment of that bonus through June 30, 2008. Additional information available.

• Three new educational articles have been added: Medical Review Post Payment Service Specific Widespread Probe Results for Therapeutic Activities; Correct Physician Coding for NDO Plicator Technology, and Medical Review Post Payment Service Specific Widespread Probe Results for Colonoscopy.
• The following Local Coverage Determination (LCD) was revised due to a recent FDA warning (November 2007) regarding the usage of ESAs, and the CMS NCD, dated July 30, 2007: Erythropoietin Stimulating Agents (ESAs) for the Treatment of Anemia Unrelated to Dialysis Therapy.
Several sections of the LCD were updated, and several editorial comments were changed for clarity. The LCD can be accessed from the Active Index on the LCD page of the website.

10 Jan 2008

• Registration is now being accepted for the 2008 Medicare Workshops.
• The listings of Opt-Out Providers have been updated.
• The Physician Fee Schedules are now available in PDF and CSV format.
• Two new educational articles have been published: Cranial Laser Release Treatment and Routine Billing of Blood Glucose Labs by Institutions or Home Health.
• The following LCDs have 2008 CPT\HCPCS code changes. These changes are effective January 1, 2008. The LCDs will be updated on the CMS Web site by Jan 31, 2008.
  • Category III CPT Codes - (Codes invalid as of 1/1/08 - 0054T, 0055T, 0065T, 0133T, 0135T, 0153T, 0154T; New codes, effective 1/1/08 - 0178T, 0179T, 0180T, 0181T, 0182T, 0183T, 0184T, 0185T, 0186T, 0187T)
  • Diabetes Mellitus Therapy PIVIT - (New code 90776)
  • Gonadotropin Releasing Hormone Analogs - Revised - (New code J9226)
  • Independent Diagnostic Testing Facilities (IDTF) - (Multiple codes were deleted and added. Please see LCD for full list of effective codes)
  • IVIg - (Codes invalid as of 1/1/08 - Q4087, Q4088, Q4091, Q4092; New codes, effective 1/1/08 - J1561, J1568, J1569, J1572)
  • Lumbar MRI - (Codes invalid as of 1/1/08, Q9952; New code effective 1/1/08 - A9579)
• Please Note: The LCD “Incontinence Therapy using Micro-ablation Devices” will not be finalized. NHIC, Corp has decided not to pursue this issue at this time.
• Due to technical difficulties, LCD "Ophthalmic Examination for Patients with Diabetes" did not post to the CMS web site as planned. Therefore the 45 day notice period has not started. The LCD will post to the CMS web site on January 16, 2008, and then will begin the 45 day notice period. The LCD will become effective March 2, 2008. We apologize for any inconvenience this may have caused.

03 Jan 2008

• The revised 2008 Physician Fee Schedules, ambulance fees, and anesthesia conversion factors are now available.
• The Ambulatory Surgical Center (ASC) fee schedules are also now available.
• New educational articles have been posted: Centralized Billing for Flu and Pneumococcal Vaccinations, New CLIA Waived Tests, and Physician Quality Reporting Initiative Reporting Codes And The Proper Use of Modifiers.
• The following LCD was revised: Bone Mass Measurement - (added ICD-9-cm code range 733.10-733.19) This can be accessed from the Active LCD Index on the CMS website: Northern California, Southern California.
• The following Draft LCD will be presented at the January 16, 2008, Contractor Advisory Committee Meeting: Peripheral Injections (Steroid, Anesthetic, Neurolytic) -- Diagnostic and Therapeutic. It can be accessed from the Draft LCD Index on the CMS Website: Northern California, Southern California.

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05/08/2008