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Below you will find a listing of current Medicare changes and updates to the website pertinent
to the Jurisdiction 14 Part A Medicare Administrative Contractor (MAC).
Please join the
Jurisdiction 14 Part A Listserve to ensure that you receive
notification of updates.
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March
September
02 September 2010
August
26 August 2010
19 August 2010
12 August 2010
5 August 2010
July
29 July 2010
22 July 2010
15 July 2010
08 July 2010
01 July 2010
June
24 June 2010
17 June 2010
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
3 June 2010
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
06 May 2010
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
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
- Introduction and Implementation of Healthcare Integrated General Ledger Accounting System (HIGLAS)
J14 MAC Part A Rhode Island Providers (excluding Home Health and Hospice)
Effective April 16, NHIC, Corp., will be transitioning our Part A financial accounting system from the Fiscal Intermediary Standard System (FISS) to the Healthcare Integrated General Ledger Accounting System (HIGLAS). This transition involves only our financial accounting system. We will continue to use the Fiscal Intermediary Standard System (FISS) for all claims processing activity.
Implementation of HIGLAS will enable the Centers for Medicare & Medicaid Services (CMS) to track Medicare payments and to accurately pay claims for over 40 million Medicare beneficiaries. The transition will also provide CMS with enhanced oversight of contractors’ accounting systems, as well as access to more accurate, timely, and consistent data for decision-making and for performance evaluations.
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.
- This MLN article MM6547 is being reissued as a reminder that effective for discharges on or after April 1, 2010, hospitals must submit non-covered procedures performed in the same inpatient stay with covered procedures on a separate claim. Please review MM6547 for additional information.
- 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.
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
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.
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09/02/2010
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