What's New for Jurisdiction 14 Part A

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.

2012 - May | April | March | February | January

2011 - December | November | October | September | August | July | June | May | April | March | February | January

May

10 May 2012

• SE1219 – A Physician’s Guide to Medicare’s Home Health Certification, including the Face-to-Face Encounter
• Revised: MM7701 – Allowing Physician Assistants to Perform Skilled Nursing Facility (SNF) Level of Care Certifications and Recertification’s
• MM7771 – New Fiscal Intermediary Shared System (FISS) edit to review Medicare Outpatient Prospective Payment System (OPPS) Payments Exceeding Charges
• MM7785 – Revisions of the Financial Limitation for Outpatient Therapy Services – Section 3005 of the Middle Class Tax Relief and Job Creation Act of 2012

03 May 2012

• MM7794 – New Influenza Virus Vaccine Code
• MM7792 – New Occurrence Code to Report Date of Death
• MM7762 – Hospital Dialysis Services for Patients with and without End Stage Renal Disease (ESRD)
• MM7764 – Anesthesiologist Services with a Modifier GC in a Method II Critical Access Hospital (CAH)
• MM7791 – Contractor and Common Working File (CWF) Additional Instructions Related to Change Request (CR) 7633 - Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse
• MM7815 – Fiscal Intermediary Standard System (FISS) update for Clinical Laboratory Fee Schedule Upload to Include Kansas Payment Locality Structure
• MM7816 – Temporary Directions to Accommodate Organ Donor Complications Billing on 837I Claims
• Revised: MM7692 – Revised Editing for Hepatitis B Administration Code G0010
• MM7755 – Ensuring Hospice Certifying Physician Identifiers Are Fully Processed
• MM7831 – Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes – July 2012 Update
• MM7260 – Modification to CWF, FISS, MCS and VMS to Return Submitted Information When There is a CWF Name and HIC Number Mismatch
• MM7798 – Update to the Fiscal Intermediary Shared Systems (FISS) Processing for the End Stage Renal Disease (ESRD) Quality Incentive Program (QIP) for Children's Hospitals

April

26 April 2012

• MM7797 – General Update to Chapter 15 of the Program Integrity Manual (PIM) Part V
• MM7793 – Claim Status Category and Claim Status Codes Update
• Revised: MM7473 – Correction to Processing of Hospice Discharge Claims

12 April 2012

• MM7775 – Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), Medicare Remit Easy Print (MREP), and PC Print Update
• SE1217 – Guidance for Correct Claims Submission When Secondary Payers Are Involved
• MM7810 – July 2012 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
• SE1218 – Redesigned Medicare Summary Notices
• SE1215 – Information for Medicare Fee-For-Service Providers About the Middle Class Tax Relief and Job Creation Act of 2012
• SE1211 – Information on the Centers for Medicare & Medicaid Services (CMS) Fraud Prevention: Automated Provider Screening and National Site Visit Initiatives
• Revised: MM7397 – Pharmacy Billing for Drugs Provided "Incident To" a Physician Service

05 April 2012

• MM7745 – April Update to the Calendar Year (CY) 2012 Medicare Physician Fee Schedule Database (MPFSDB)
• Revised: MM7767 – Emergency March 2012 Update, Middle Class Tax Relief and Job Creation Act of 2012 (MCTRJCA) to the CY 2012 Medicare Physician Fee Schedule (MPFS) Database
• Revised: MM7633 – Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse
• Revised: MM7636 – Intensive Behavioral Therapy (IBT) for Cardiovascular Disease (CVD)
• Revised: MM7637 – Screening for Depression in Adults
• Revised: MM7523 – Billing for Donor Post-Kidney Transplant Complication Services

March

29 March 2012

• Common Working File Great Western, Mid Atlantic and Southwest Hosts Dark Day on Saturday, April 21, 2012
  (TDL-12295)
  On Saturday, April 21, 2012, the Common Working File (CWF) Great Western, Mid-Atlantic and Southwest Hosts will be conducting a history purge. Due to the anticipated duration of this activity and to ensure the completion of weekly processing and scheduled data center maintenance, there will be a CWF Dark Day at the CWF Great Western, Mid-Atlantic and Southwest Hosts only on that Saturday. This means there will be no access to the Health Insurance Master Record (HIMR) query, which is usually available until noon on Saturdays.
  All files received from satellites for Friday’s cycle (April 20, 2012) will be completed prior to bringing CWF production down. If, for any reason, satellite files are received late Saturday morning, they will be processed by CWF after the history purge has been completed.
• Delayed Paperwork (PWK) Implementation
  (TDL-12303)
  The Centers for Medicare & Medicaid Services (CMS) is delaying the implementation date of the PWK (Paperwork) Segment. The PWK was due to be implemented on April 1, 2012, via Change Requests 7041, 7306, and 7330. The delay is being initiated in order to address system concerns and impacts raised by Medicare Administrative Contractors (MACs). MACs will continue to work through their user acceptance testing of the PWK while the concerns and impacts are addressed. CMS will communicate the revised implementation date once determined.
  This PWK delay does not affect any current processes in place for the submission of additional documentation with your claims.
• SE1213 – Questionable Billing By Suppliers of Lower Limb Prostheses
• MM7767 – Emergency March 2012 Update, Middle Class Tax Relief and Job Creation Act of 2012 (MCTRJCA) to the CY 2012 Medicare Physician Fee Schedule (MPFS) Database
• Version 5010 Edit Spreadsheet Changes for 837I
  (TDL-12281)
  Effective April 2, 2012 the Centers for Medicare & Medicaid Services (CMS) is updating specific 5010 837I (Institutional) transaction edits. The below these edits are being modified and will appear in future 5010 Edit Spreadsheets
  Complete listings of 837I edits are available on the CMS Web site at www.cms.gov/ElectronicBillingEDITrans/
  Deactivate Edits:
  X223.218.2300.HI01-2.010 (DRG)
  X223.389.2330B.DTP.030
  
  Added Edits:
  X222.124.2010BA.N3.005
  X222A1.017.2010BA.N4.005
  X223.218.2300.HI01-2.015 (DRG)
  

22 March 2012

• Rebilling Inpatient Hospital Denials for Services that Could Have Been Billed as Outpatient for Providers Participating in the Three-Year Demonstration Project
  (TDL-12228)
  
  The Centers for Medicare & Medicaid Services (CMS) is currently conducting a three-year demonstration on rebilling for a small number of voluntary hospital participants. This demonstration allows only those participants the ability to rebill for all medically necessary services that could have been provided in an outpatient setting except observation services, regardless of timely filing restrictions, for 90 percent of the allowable payment.
  
  Unless a provider is a participant in the rebilling demonstration, current CMS payment policy allows providers to rebill only a small number of ancillary services within the timely filing guidelines. All fiscal intermediaries (FIs)/carriers/A/B Medicare Administrative Contractors (MACs) shall follow current CMS payment policies.
  
  Please Note: The following Technical Direction Letters (TDLs) were only applicable to claims adjustments initiated by the Recovery Auditors during the Recovery Audit Demonstration. CMS has officially rescinded TDL-07165 and TDL-08168.
  • On February 21, 2012, CMS issued TDL-12228 addressing guidance for participating providers rebilling ancillary services for inpatient claims denied due to lack of medical necessity during the Recovery Audit Demonstration.
  • On December 28, 2006, the CMS issued TDL-07165 with guidance regarding rebilling for ancillary services for inpatient claims denied due to lack of medical necessity during the Recovery Audit Demonstration.
  • This guidance was expanded in TDL-08168, issued on February 7, 2008, to include rebilling for all services provided on the inpatient bill that could have been billed as outpatient.
  
  For additional information on what can or cannot be billed on a type of bill 12X or 13X bill type, see the CMS Internet Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, Chapter 4, Sections 120 and 240
• Revised: MM7363 - Additional Provider and Supplier Enrollment Requirements for Fixed Wing and Helicopter Air Ambulance Operators
• MM7751 – April 2012 Integrated Outpatient Code Editor (I/OCE) Specifications Version 13.1

15 March 2012

• SE1209 – Provider Inquiry Screens Regarding Telehealth Services Eligibility Dates
• Revised: MM7678 – Use of Revised Remittance Advice Remark Code (RARC) N103 When Denying Services Furnished to Federally Incarcerated Beneficiaries
• Revised: MM7641 – Intensive Behavioral Therapy (IBT) for Obesity
• MM7748 – April 2012 Update of the Hospital Outpatient Prospective Payment System (OPPS)
• The revised 2012 Medicare Physician Fee Schedules and Anesthesia Conversion Factors have been published. They are effective March 1, 2012. (TDL 12240)

13 March 2012

• The 2012 Medicare Participating Physicians/Suppliers Directories (MEDPARD) for J14 A/B MAC have been published. (per CR 7573)

08 March 2012

• The Centralized Billing for Flu and Pneumococcal Vaccination Annual Notice has been published. (IOM, 100-04, Chapter 18)
• Common Working File (CWF) Northeast, Pacific and South Hosts Dark Day on Saturday, March 24, 2012
  (TDL-12251)
  On Saturday, March 24, 2012, the CWF Northeast, Pacific and South Hosts will be conducting a history purge. Due to the anticipated duration of this activity and to ensure the completion of weekly processing and scheduled data center maintenance, there will be a CWF Dark Day at the CWF Northeast, Pacific and South Hosts only on that Saturday. This means there will be no access to the Health Insurance Master Record (HIMR) query, which is usually available until noon on Saturdays.
  All files received from satellites for Friday’s cycle (March 23, 2012) will be completed prior to bringing CWF production down. If, for any reason, satellite files are received late Saturday morning, they will be processed by CWF after the history purge has been completed.

01 March 2012

• Revised: SE1204 – The Role of the Zone Program Integrity Contractors (ZPICs), Formerly the Program Safeguard Contractors (PSCs)
• Revised: MM7641 – Intensive Behavioral Therapy (IBT) for Obesity
• Revised: MM7672 – January 2012 Update of the Hospital Outpatient Prospective Payment System (OPPS)
• SE1210 – Recovery Auditors Findings Resulting from Medical Necessity Reviews of Renal and Urinary Tract Disorders
• MM7578 – Fiscal Intermediary Shared System (FISS) and Common Working File (CWF) System Enhancement for Storing Line Level Rendering Physicians/Practitioners National Provider Identifier (NPI) Information
• Revised: MM7671 – Summary of Policies in the Calendar Year (CY) 2012 Medicare Physician Fee Schedule (MPFS) Final Rule and the Telehealth Originating Site Facility Fee Payment Amount
• UPDATED 5010 837P and 837I Transaction Edits
  TDL – 12237
  Due to the urgency with which edit changes must be made, the Centers for Medicare & Medicaid Services (CMS) is updating the implementation date of certain 837P and 837I edits documented in Change Request 7719 (CR 7719).
  The following 5010 837P and 837I transaction edits are being implemented within the next 30 days:
  X222.124.2010BA.N3.005
  X222A1.017.2010BA.N4.005
  X223.218.2300.HI01-2.015 (DRG)
  X223.218.2300.HI01-2.010 (DRG)
  The following 5010 837P and 837I transaction edits are being implemented on July 1, 2012 (as originally scheduled in CR7719):
  X223.319.2310A.NM1.010
  X223.424.2400.SV202-2.025
  The edit spreadsheets for CR7719 and prior versions of the 837P and 837I edit spreadsheets can be found at the following link http://www.cms.gov/MFFS5010D0/20_TechnicalDocumentation.asp#TopOfPage

February

16 February 2012

• Revised: MM7688 – Immediate Recoupment for Fee for Service Claims Overpayments
• MM7610 – Screening for Sexually Transmitted Infections (STIs) and High Intensity Behavioral Counseling (HIBC) to Prevent STIs
• MM7641 – Intensive Behavioral Therapy (IBT) for Obesity
• SE1205 – Updating Beneficiary Information with the Coordination of Benefits Contractor

09 February 2012

• MM7706 – Update to Pub 100-04, "Medicare Claims Processing Manual," Chapter 3: Inpatient Hospital Billing
• Revised MM7717 – Clarification for Skilled Nursing Facility (SNF) and Swing Bed (SB) Part A Billing Updating System Requirements for Assessment Date Reporting and Removal of the Occurrence Code 16 Reporting Requirement
• MM7704 – International Classification of Diseases - 10th Edition (ICD-10), Inclusion of Type of Bill 33X
• Revised: MM7677 – New Hospice Condition Code for Out of Service Area Discharges
• Revised: MM7687 – Update to Abortion Condition Codes Associated With Reason Code 32809

06 February 2012

• (TDL-12207) Common Working File (CWF) Great Lakes, Keystone and Southeast Hosts Dark Day on Saturday, February 18, 2012
  On Saturday, February 18, 2012, the CWF Great Lakes, Keystone and Southeast Hosts will be conducting a history purge. Due to the anticipated duration of this activity and to ensure the completion of weekly processing and scheduled data center maintenance, there will be a CWF Dark Day at the CWF Great Lakes, Keystone and Southeast Hosts only on that Saturday. This means there will be no access to the Health Insurance Master Record (HIMR) query, which is usually available until noon on Saturdays.
  All files received from satellites for Friday’s cycle (February 17, 2012) will be completed prior to bringing CWF production down. If, for any reason, satellite files are received late Saturday morning, they will be processed by CWF after the history purge has been completed.

02 February 2012

• MM7674 – Inpatient Rehabilitation Facility (IRF) No-Pay Billing for Medicare Advantage (MA) Patients Update
• Revised: MM7686 – Medicare System Update to Include a Rendering Provider Field to Allow Correct Physician National Provider Identifier (NPI) Reporting for the Primary Care Incentive Program (PCIP) for Critical Access Hospitals (CAHs) Reimbursed Under the Optional Method
• MM7684 – Multiple Procedure Payment Reduction (MPPR) for Physician Services for Certain Diagnostic Imaging Procedures in Critical Access Hospitals (CAH)
• MM7680 – Update to the Fiscal Year (FY) 2012 List of Codes Exempt from Reporting Present on Admission (POA)
• MM7692 – Revised Editing for Hepatitis B Administration Code G0010
• MM7717 – Clarification for Skilled Nursing Facility (SNF) and Swing Bed (SB) Part A Billing Updating System Requirements for Assessment Date Reporting and Removal of the Occurrence Code 16 Reporting Requirement
• Revised: MM7363 – Additional Provider and Supplier Enrollment Requirements for Fixed Wing and Helicopter Air Ambulance Operators
• MM7675 – Revisions to the Hospice Medicare Summary Notice (MSN)
• MM7734 – April 2012 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
• Revised: MM7670 – Claim Status Category and Claim Status Codes Update
• MM7677 – New Hospice Condition Code for Out of Service Area Discharges
• Revised: MM7685 – Instructions to Teaching Hospitals for Reporting the Internal Revenue Service (IRS) Refund of Medical Resident FICA Taxes
• MM7687 – Update to Abortion Condition Codes Associated With Reason Code 32809
• Revised: MM7533 – Announcement of Medicare Rural Health Clinic (RHC) and Federally Qualified Health Centers (FQHC) Payment Rate Increases

January

26 January 2012

• SE1201 – Important Reminder for Providers and Suppliers Who Provide Services and Items Ordered or Referred by Other Providers and Suppliers
• Revised: MM7557 – Fiscal Intermediary Standards System (FISS) Claims Processing Updates For Ambulance Services
• MM7737 – Emergency Update to the CY 2012 Medicare Physician Fee Schedule Database (MPFSDB)

19 January 2012

• SE1202 – Health Professional Shortage Area (HPSA) Bonus Payment Policy Reminders
• Revised: MM7672 – January 2012 Update of the Hospital Outpatient Prospective Payment System (OPPS)
• Revised: SE1137 – Additional Health Insurance Portability and Accountability Act (HIPAA) 837 5010 Transitional Changes and Further Modifications to the Coordination of Benefits Agreement (COBA) National Crossover Process
• Revised: MM7557 – Fiscal Intermediary Standards System (FISS) Claims Processing Updates For Ambulance Services
• Revised: SE1138 – Non-Specific Procedure Code Description Requirement for HIPAA Version 5010 Claims
• MM7701 – Allowing Physician Assistants to Perform Skilled Nursing Facility (SNF) Level of Care Certifications and Recertifications

12 January 2012

• Revised: MM7436 – Recovery Audit Program: Medicare Administrative Contractor (MAC)-issued Demand Letters
• MM7502 – Bundling of Payments for Services Provided to Outpatients Who Later Are Admitted as Inpatients: 3-Day Payment Window Policy and the Impact on Wholly Owned or Wholly Operated Physician Offices
• MM7672 – January 2012 Update of the Hospital Outpatient Prospective Payment System (OPPS)
• Revised: MM7671 – Summary of Policies in the Calendar Year (CY) 2012 Medicare Physician Fee Schedule (MPFS) Final Rule and the Telehealth Originating Site Facility Fee Payment Amount
• Revised: MM7431 – Autologous Cellular Immunotherapy Treatment of Metastatic Prostate Cancer
• Revised: MM7685 – Instructions to Teaching Hospitals for Reporting the Internal Revenue Service (IRS) Refund of Medical Resident FICA Taxes
• MM7678 – Use of Revised Remittance Advice Remark Code (RARC) N103 When Denying Services Furnished to Federally Incarcerated Beneficiaries

05 January 2012

• 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 https://www.cms.gov/QuarterlyProviderUpdates/02_Spotlight.asp
• MM7685 – Instructions to Teaching Hospitals for Reporting the Internal Revenue Service (IRS) Refund of Medical Resident FICA Taxes

December

28 December 2011

• MM7668 – January 2012 Integrated Outpatient Code Editor (I/OCE) Specifications Version 13.0
• Revised: MM7567 – Update to Medicare Deductible, Coinsurance and Premium Rates for 2012
• MM7671 – Summary of Policies in the Calendar Year (CY) 2012 Medicare Physician Fee Schedule (MPFS) Final Rule and the Telehealth Originating Site Facility Fee Payment Amount
• SE1138 – Non-Specific Procedure Code Description Requirement for HIPAA Version 5010 Claims
• MM7683 – Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), Medicare Remit Easy Print (MREP), and PC Print Update
• MM7660 – Additional Instructions Regarding Demand Bills Under the Home Health Prospective Payment System
• Revised: MM7064 – End Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Consolidated Billing for Limited Part B Services
• Extension of the 2012 Annual Participation Enrollment Program
  TDL 12144
  NOTE: CMS is extending the 2012 Annual Participation Enrollment Program. The participation enrollment period will now end February 14, 2012, instead of December 31, 2011.
• Per TDL 12152, the link to the NOC code list being used for ASC X12 version 5010 837 Professional and Institutional transactions has been published.

21 December 2011

• SE1142 – Preventive Services Educational Resources for Health Care Professionals
• MM7666 – Off-Cycle Release of the Inpatient Prospective Payment System (IPPS) Fiscal Year (FY) 2012 Pricer
• Revised: MM7397 – Pharmacy Billing for Drugs Provided "Incident To" a Physician Service

15 December 2011

• MM7636 – Intensive Behavioral Therapy (IBT) for Cardiovascular Disease (CVD)
• MM7633 – Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse.
• MM7654 – Calendar Year (CY) 2012 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment.
• Revised: MM7529 – Therapy Cap Values for Calendar Year (CY) 2012

08 December 2011

• Medicare’s Acceptance of Voluntary Refunds, Annual Notice
  (IOM, Publication 100-06, Chapter 5, Section 410-10) The acceptance of a voluntary refund as repayment for the claims specified in no way affects or limits the rights of the Federal Government, or any of its agencies or agents, to pursue any appropriate criminal, civil, or administrative remedies arising from or relating to these or any other claims.
• SE1137 – Additional Health Insurance Portability and Accountability Act (HIPAA) 837 5010 Transitional Changes and Further Modifications to the Coordination of Benefits Agreement (COBA) National Crossover Process
• MM7657 – Home Health Prospective Payment System Rate (HH PPS) Update for Calendar Year (CY) 2012
• MM7637 –Screening for Depression in Adults
• MM7628 – Reasonable Charge Update for 2012 for Splints, Casts, and Certain Intraocular Lenses

01 December 2011

• MM7504 – Expansion of Medicare Telehealth Services for CY 2012
• Revised: MM7489 – Instructions to Accept and Process All Ambulance Transportation Healthcare Common Procedure Coding System (HCPCS) Codes
• Revised: MM7593 – Clarification and Revisions for Claims Submitted for End Stage Renal Disease (ESRD) Patients

November

29 November 2011

• MM7648 – 2012 Annual Update to the Therapy Code List
• Revised: MM7617 – Implementation of Changes in End Stage Renal Disease (ESRD) Payment for Calendar Year (CY) 2012
• MM7529 – Therapy Cap Values for Calendar Year (CY) 2012
• MM7567 – Update to Medicare Deductible, Coinsurance and Premium Rates for 2012
• Revised: MM7363 – Additional Provider and Supplier Enrollment Requirements for Fixed Wing and Helicopter Air Ambulance Operators
• MM7626 – Recoupment of Incorrect Payments Made Under the End Stage Renal Disease (ESRD) Prospective Payment System (PPS) for the Low-Volume Payment Adjustment

22 November 2011

• SE1135 – Guidance on Completing the CMS-855A Enrollment Form
• To Our J14 Medical Community:
  (Change Requests 7573 and 7412)
  The Medicare Physician Fee Schedule Database (MPFSDB) and the Anesthesia files are available on our web site. Please go to http://www.medicarenhic.com/ne_prov/fee_sched.shtml to view the file for your Area and a short message from the Centers for Medicare & Medicaid Services (CMS).
  Any future updates released by CMS will be posted as soon as they are available.
  The Annual Participation Open Enrollment Period also has begun. To view the pertinent documents, please go to http://www.medicarenhic.com/ne_prov/fee_sched.shtml where you will find the CMS Announcement and the Medicare Participating Physician or Supplier Agreement (Form CMS 460). The mailing address is listed immediately below the forms on the same web page.
  Reminder: Any participating health professional who is not changing their participation status does not need to take any action during the Annual Open Enrollment Period.

17 November 2011

• Revised: MM7575 – Influenza Vaccine Payment Allowances - Annual Update for 2011-2012 Season
• Revised: MM7580 – New Influenza Virus Vaccine Code
• MM7599 – Annual Update of HCPCS Codes Used for Home Health Consolidated Billing Enforcement
• MM7533 – Announcement of Medicare Rural Health Clinic (RHC) and Federally Qualified Health Centers (FQHC) Payment Rate Increases

09 November 2011

• Revised: MM7523 – Billing for Donor Post-Kidney Transplant Complication Services
• Revised: SE1117 – Correct Provider Billing of Admission Date and Statement Covers Period
• MM7635 – CY 2012 Fee Schedule Update for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)
• Revised: MM7499 – Reporting of Recoupment for Overpayment on the Remittance Advice (RA) with Patient Control Number
• MM7621 – Changes to the Laboratory National Coverage Determination (NCD) Edit Software for January 2012
• MM7617 – Implementation of Changes in End Stage Renal Disease (ESRD) Payment for Calendar Year (CY) 2012
• MM7471 – Implementation of Changes to the End Stage Renal Disease (ESRD) Prospective Payment System (PPS) Outlier Payment Policy and Changes to the ESRD PPS Consolidated Billing (CB) Requirements for Laboratory Services Furnished in a Hospital Emergency Room or Department
• Revised: MM7431 – Autologous Cellular Immunotherapy Treatment of Metastatic Prostate Cancer
• MM7593 – Clarification and Revisions for Claims Submitted for End Stage Renal Disease (ESRD) Patients

03 November 2011

• MM7564 – Claim Adjustment Reason Code (CARC) Used for Therapy Claims Subject to the Multiple Procedure Payment Reduction (MPPR)
• MM7556 – Discontinuation of Hospice Late Charge Claims
• MM7363 – Additional Provider and Supplier Enrollment Requirements for Fixed Wing and Helicopter Air Ambulance Operators
• MM7575 – Influenza Vaccine Payment Allowances - Annual Update for 2011-2012 Season
• MM7580 – New Influenza Virus Vaccine Code
• Revised: SE1126 – Further Details on the Revalidation of Provider Enrollment Information
• Revised: MM7350 – Implementation of Provider Enrollment Provisions in CMS-6028-FC
• SE1136 – 2011-2012 Seasonal Influenza (Flu) Resources for Health Care Professionals
• MM7624 – January 2012 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
• MM7553 – Diagnosis Code Update for Add-on Payments for Blood Clotting Factor Administered to Hemophilia Inpatients
• MM7587 – Payment for Multiple Surgeries in a Method II Critical Access Hospital (CAH)
• MM7557 – Fiscal Intermediary Standards System (FISS) Claims Processing Updates For Ambulance Services
• CMS Technical Direction Letter (TDL)-12038
  Hospital Routine Services Under Arrangement Requirement On August 18, 2011, the Centers for Medicare & Medicaid Services (CMS) issued the Fiscal Year (FY) 2012 Inpatient Prospective Payment System (IPPS) final rule. The final rule included a provision limiting the circumstances under which a hospital may furnish services “under arrangement.” Under the revised policy, only therapeutic and diagnostic services may be furnished outside of the hospital under arrangement; “routine services” (for example, bed, board, and nursing services) must be provided by the hospital. Under the policy, routine services that are furnished in the hospital to its inpatients are considered as being provided by the hospital. If services are provided outside of the hospital, the services are considered as being provided under arrangement.
  We recognize that hospitals may need more time to restructure existing arrangements and establish operational protocols necessary to comply with the requirement that only therapeutic and diagnostic services may be furnished outside of the hospital under arrangement and that “routine services” must be provided by the hospital. CMS expects that during FY 2012, hospitals will work towards ensuring compliance with the new requirements. CMS will continue to work with these hospitals to communicate the requirements of this provision and to provide continued guidance. Beginning with the FY 2013, all hospitals will need to be in full compliance with the modified under arrangement provisions.

October

27 October 2011

• SE1129 – Reminder—Beneficiary Cost-Sharing for Medicare-Covered Preventive Services Under the Affordable Care Act

20 October 2011

• Revised: MM7489 – Instructions to Accept and Process All Ambulance Transportation Healthcare Common Procedure Coding System (HCPCS) Codes
• MM7478 – Hospice Claims Processing Procedures When Required Face-to-Face Encounters Do Not Occur Timely
• MM7459 – Calendar Year 2012 and After Payments to Home Health Agencies That Do Not Submit Required Quality Data
• Revised: SE1110 – Medicare Pilot Project for Electronic Submission of Medical Documentation (esMD) Data
• Revised: MM7558 – Updates to the Internet Only Manual Publication 100-04, Chapter 15 – Ambulance to include Medicare and Medicaid Extenders Act of 2010 (MMEA) Provisions
• SE1133 – Predictive Modeling Analysis of Medicare Claims

06 October 2011

• SE1130 – Implementation of Pay.gov Application Fee Collection Process through PECOS
• SE1131 – Important Update Regarding 5010/D.0 Implementation – Action Needed Now
• MM7585 – Claim Status Category and Claim Status Codes Update
• Revised: MM7254 – Additional Fields for Additional Documentation Request (ADR) Letters
• MM7558 – Updates to the Internet Only Manual Publication 100-04, Chapter 15 – Ambulance to include Medicare and Medicaid Extenders Act of 2010 (MMEA) Provisions
• MM7506 – Fiscal Year (FY) 2012 Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) Changes

September

29 September 2011

• SE1128 – Prohibition on Balance Billing Qualified Medicare Beneficiaries (QMBs)
• Revised: M7397 - Pharmacy Billing for Drugs Provided "Incident To" a Physician Service
• MM7254 – Additional Fields for Additional Documentation Request (ADR) Letters
• MM7546 – Ambulance Inflation Factor for Calendar Year (CY) 2012
• Revised: MM7441 – Magnetic Resonance Imaging (MRI) in Medicare Beneficiaries with Food and Drug Administration (FDA)-Approved Implanted Permanent Pacemakers (PMs) for Use in the MRI Environment
• Revised: MM7460 – Implementation of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) 153c End Stage Renal Disease (ESRD) Quality Incentive Program (QIP) and Other Requirements for ESRD Claims

22 September 2011

• MM7405 – Clarification of Evaluation and Management (E/M) Payment Policy
• MM7514 – Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy Print (MREP) and PC Print Update
• Revised: MM7526 – Clinical Laboratory Fee Schedule - Medicare Travel Allowance Fees for Collection of Specimens

15 September 2011

• Revised: MM7507 – Changes to the Laboratory National Coverage Determination (NCD) Edit Software for October 2011
• SE1110 – Medicare Pilot Project for Electronic Submission of Medical Documentation (esMD)
• SE1123 – Contractor Entities at a Glance: Who May Contact You about Specific Centers for Medicare & Medicaid Services (CMS) Activities
• MM7492 – Medicare Fee-For-Service (FFS) Claims Processing Guidance for Implementing International Classification of Diseases, 10th Edition (ICD-10)
• Revised: MM7484 – Populating REF Segment - Other Claim Related Adjustment - for Healthcare Claim Payment/Advice or Transaction 835 Version 5010A1
• Revised: MM7510 – Inpatient Rehabilitation Facility (IRF) Annual Update: Prospective Payment System (PPS) Pricer Changes for Fiscal Year (FY) 2012
• Revised: MM7444 – October Quarterly Update to 2011 Annual Update of HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement

08 September 2011

• MM7522 – Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Pricer Update Fiscal Year (FY) 2012
• MM7508 – Fiscal Year (FY) 2012 Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) Prospective Payment System (PPS) Changes
• MM7545 – October 2011 Update of the Hospital Outpatient Prospective Payment System (OPPS)
• MM7441 – Magnetic Resonance Imaging (MRI) in Medicare Beneficiaries with Food and Drug Administration (FDA)-Approved Implanted Permanent Pacemakers (PMs) for Use in the MRI Environment
• MM7460 – Implementation of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) 153c End Stage Renal Disease (ESRD) Quality Incentive Program (QIP) and Other Requirements for ESRD Claims
• Cost Report Filing Extensions (TDL-11452)
  Medicare Cost Report Filing Update
  The Centers for Medicare & Medicaid Services (CMS) has provided additional instructions on filing the new Medicare Hospital Cost Report (Form CMS 2552-10), the new Medicare Skilled Nursing Facility Cost Report (Form CMS 2540-10), and the new Medicare Independent Renal Dialysis Facility Cost Report (Form CMS 265-11) including additional cost report filing extensions.
  Form CMS 2552-10
  All providers with full 12 months or greater cost reporting periods, which begin on or after May 1, 2010 (and end on or after April 30, 2011), shall file on the Form CMS 2552-10 subject to the following filing extension schedule:
  

  Cost Reporting FYE	Current Due Date	Revised Due Date	Extension
  04/30/2011	09/30/2011	11/30/2011	60 days
  05/31/2011	10/31/2011	11/30/2011	30 days
  06/30/2011	11/30/2011	01/31/2012	60 days
  07/31/2011	12/31/2011	01/31/2012	30 days
  08/31/2011	01/31/2012	02/29/2012	30 days
  09/30/2011	02/29/2012	03/31/2012	30 days
  10/31/2011	03/31/2012	03/31/2012	None
  11/30/2011	04/30/2012	04/30/2012	None

  
  Hospitals with hospital-based end-stage renal disease (ESRD) facilities and/or departments are subject to the same filing extension schedule as indicated above. Hospitals with hospital-based ESRDs shall submit their cost reports, using the current Form CMS 2552-10 with the existing Worksheet I series. The cost reports of hospitals with hospital-based ESRDs that claim Medicare bad debts shall not be settled until a revised Worksheet I series is published incorporating the new bad debt calculation.
  All providers with less than a 12-month cost reporting period, beginning on or after May 1, 2010, but ending prior to April 30, 2011, must file on Form CMS 2552-96, and will be final settled on Form CMS 2552-96. These cost reports are due the latter of 30 days from the date of this notification or five months following the close of the cost reporting period. This includes hospitals with hospital-based ESRDs.
  Form CMS 2540-10
  Form CMS 2540-10 is effective for cost reporting periods beginning on or after December 1, 2010. Providers shall continue to file on the Form CMS 2540-96 for any short period cost reports beginning on or after December 1, 2010, and ending November 30, 2011. No filing extensions are granted at this time.
  Form CMS 265-11
  Form CMS 265-11 is effective for cost reporting periods that overlap or begin on or after January 1, 2011, and are subject to the following filing extension schedule:
  

  Cost Reporting FYE	Current Due Date	Revised Due Date	Extension
  01/31/2011	06/30/2011	11/30/2011	150 days
  02/28/2011	07/31/2011	11/30/2011	120 days
  03/31/2011	08/31/2011	11/30/2011	90 days
  04/30/2011	09/30/2011	11/30/2011	60 days
  05/31/2011	10/31/2011	11/30/2011	30 days
  06/30/2011	11/30/2011	11/30/2011	None

01 September 2011

• MM7526 – Clinical Laboratory Fee Schedule - Medicare Travel Allowance Fees for Collection of Specimens
• 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
  https://www.cms.gov/QuarterlyProviderUpdates/02_Spotlight.asp
• MM7552 – 2012 Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Update
• CR 7456, entitled Claim Status Category and Claim Status Codes Update, has been rescinded

August

25 August 2011

• MM7543 – Annual Clotting Factor Furnishing Fee Update 2012
• MM7528 – October Update to the Calendar Year (CY) 2011 Medicare Physician Fee Schedule Database (MPFSDB)
• Revised: MM7413 – Affordable Care Act - Section 3113 - Laboratory Demonstration for Certain Complex Diagnostic Tests – (CR 7413 Fully Rescinds and Replaces CR 7278)
• MM7541 – October 2011 Integrated Outpatient Code Editor (I/OCE) Specifications Version 12.3

18 August 2011

• Revised: MM7489 – Instructions to Accept and Process All Ambulance Transportation Healthcare Common Procedure Coding System (HCPCS) Codes
• Revised: MM7397 – Pharmacy Billing for Drugs Provided "Incident To" a Physician Service
• MM7510 – Inpatient Rehabilitation Facility (IRF) Annual Update: Prospective Payment System (PPS) Pricer Changes for Fiscal Year (FY) 2012
• MM7499 – Reporting of Recoupment for Overpayment on the Remittance Advice (RA) with Patient Control Number
• MM7517 – 2012 Annual Update for the Health Professional Shortage Area (HPSA) Bonus Payments
• MM7520 – Clarification of Payment for ESRD-Related Services Under the Monthly Capitation Payment

12 August 2011

• Common Working File (CWF) South and Southeast Hosts
  Dark Day on Saturday, August 13, 2011
  (TDL-11433)
  On Saturday, August 13, 2011, the CWF South and Southeast Hosts will be conducting a history purge. Due to the anticipated duration of this activity and to ensure the completion of weekly processing and scheduled data center maintenance, there will be a CWF dark day at the CWF South and Southeast Hosts only on that Saturday. This means there will be no access to the Health Insurance Master Record (HIMR) query, which is usually available until noon on Saturdays.
  
  All files received from satellites for Friday’s cycle (August 12, 2011) will be completed prior to bringing CWF production down. If, for any reason, satellite files are received late Saturday morning, they will be processed by CWF after the history purge has been completed.

11 August 2011

• MM7489 – Instructions to Accept and Process All Ambulance Transportation Healthcare Common Procedure Coding System (HCPCS) Codes
• Revised: MM7397 – Pharmacy Billing for Drugs Provided "Incident To" a Physician Service
• Revised: SE1126 – Further Details on the Revalidation of Provider Enrollment Information

04 August 2011

• MM7465 – Anesthesiologist Services in a Method II Critical Access Hospital (CAH)
• MM7457 – Addition of Medical Severity Diagnosis Related Group (MS-DRG) 265 to the List Subject to Inpatient Prospective Payment System (IPPS) Replaced Devices Offered Without Cost or With a Credit Policy
• MM7476 – Quarterly Update to the End-Stage Renal Disease Prospective Payment System
• MM7466 – Medicare Remit Easy Print (MREP) and PC Print User Guide Update for Implementation of Version 5010A1
• MM7488 – October 2011 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
• MM7484 – Populating REF Segment - Other Claim Related Adjustment - for Healthcare Claim Payment/Advice or Transaction 835 Version 5010A1
• MM7516 – Affordable Care Act – Section 3113 – Laboratory Demonstration for Certain Complex Diagnostic Tests (This Article Fully Rescinds and Replaces MM7413)
• MM7460 – Implementation of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) 153c End Stage Renal Disease (ESRD) Quality Incentive Program (QIP) and Other Requirements for ESRD Claims
• MM7505 – Method of Cost Settlement for Inpatient Services for Rural Hospitals Participating Under Demonstration Authorized by Section 410A of the Medicare Modernization Act. Sections 3123 and 10313 of the Affordable Care Act authorized an expansion of the demonstration and an extension for an additional 5-year period. This Change Request (CR) gives instructions for this additional 5-year period. This CR is an extension of CR5020 for this additional 5-year period.
• MM7518 – Update to Hospice Payment Rates, Hospice Cap, Hospice Wage Index and the Hospice Pricer for FY 2012
• MM7436 – Recovery Audit Program: Medicare Administrative Contractor (MAC) issued Demand Letters.
• SE1114 – NEW INFORMATION TO IMPROVE PATIENT SAFETY AT AMERICA'S HOSPITALS

July

28 July 2011

• MM7431 – Autologous Cellular Immunotherapy Treatment of Metastatic Prostate Cancer
• MM7507 – Changes to the Laboratory National Coverage Determination (NCD) Edit Software for October 2011

22 July 2011

• Common Working File Great Lakes and Northeast Hosts Dark Day on Saturday, July 23, 2011
  CMS Technical Direction Letter (TDL)-11410
  On Saturday, July 23, 2011, the Common Working File (CWF) Great Lakes and Northeast Hosts will be conducting a history purge. Due to the anticipated duration of this activity and to ensure the completion of weekly processing and scheduled data center maintenance, there will be a CWF dark day at the CWF Great Lakes and Northeast Hosts only on that Saturday. This means there will be no access to the Health Insurance Master Record (HIMR) query, which is usually available until noon on Saturdays.
  All files received from satellites for Friday's cycle (July 22, 2011) will be completed prior to bringing CWF production down. If, for any reason, satellite files are received late Saturday morning, they will be processed by CWF after the history purge has been completed.

21 July 2011

• Revised: MM7413 – Affordable Care Act - Section 3113 - Laboratory Demonstration for Certain Complex Diagnostic Tests – (CR 7413 Fully Rescinds and Replaces CR 7278)

07 July 2011

• Change Fiscal Intermediary Shared System Reason Code Edit Statuses for Change Requests 7142 and 7304
  TDL 11364
  The Centers for Medicare & Medicaid Services is deactivating four reason codes under Change Request 7142; 38041, 38069, 38108, and 38109. Contractors are immediately releasing any claims held for these reason codes.
• MM7454 – Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)
• Revised: MM7128 – Payment Update and Common Working File (CWF) Editing for Influenza Virus Vaccine and Pneumococcal Vaccine (PPV) Codes
• Revised: MM7397 - Pharmacy Billing for Drugs Provided "Incident To" a Physician Service

June

30 June 2011

• Revised: MM7306 – Modifications to the Implementation of the Paperwork (PWK) Segment for X12N Version 5010

23 June 2011

• Certification of Mammography Facilities (Annual Reminder)
  IOM 100-04, Chapter 18, section 20.1
  NHIC, Corp. reminds providers that Medicare will reimburse only FDA-certified mammography centers for mammography services.
  We encourage you to inform your patients to use only centers that are certified.
  We provide a direct link on our web site to the listing for all of these facilities in each state at:
  http://www.medicarenhic.com/ne_prov/billing_info.shtml.
  Click on the “Mammography Centers – Certified” link.
  Please share this information with your patients.
• Unsolicited/Voluntary Refund Checks – (Annual Reminder)
  IOM 100-06, Chapter 5, section 410.10
  NHIC, Corp. reminds you of the following statement from the CMS Internet Only Manual (IOM) regarding unsolicited/voluntary refund checks:
  “The acceptance of a voluntary refund as repayment for the claims specified in no way affects or limits the rights of the Federal Government, or any of its agencies or agents, to pursue any appropriate criminal, civil, or administrative remedies arising from or relating to these or any other claims.” For more information, please view the above-mentioned at: http://www.cms.hhs.gov/manuals/downloads/fin106c05.pdf
• Update Your Addresses! “Do Not Forward” (DNF) – Annual Reminder Notice.
  (IOM Pub. 100-04 Chapter 1 Section 80.5.1)
  All providers must notify their Contractor (NHIC, Corp.) of any changes of address.
  To do this:
  1. Visit the CMS Enrollment website and download the Enrollment Form that pertains to you or your group or organization:
  http://www.cms.hhs.gov/MedicareProviderSupEnroll/02_EnrollmentApplications.asp#TopOfPage
  2. Update the form with your new information and mail it to:
        NHIC, Corp.
        Provider Enrollment
        P.O. Box 3434
        Hingham, MA 02044
  NHIC, Corp. uses “return service requested” envelopes for certain mailings, and when an envelope is returned, we apply a Do Not Forward (DNF) flag to the provider’s Medicare Number. Once this happens, no additional checks will be generated until a properly completed change of address form is received and verified by NHIC, Corp. CMS requires corrections to all addresses before the contractor can remove the DNF flag and begin paying the provider or supplier again.
  Protect yourself from payment delays by submitting your changes timely.
• MM7420 – Guidelines to Allow Contractors to Develop and Utilize Procedures for Accepting and Processing Reopenings via a Secure Internet Portal/Application
• Rescinded: MM7456 – Claim Status Category Code and Claim Status Code Update
• Revised: MM7339 – Manual Clarifications for Skilled Nursing Facility (SNF) Part A Billing
• SE1117 – Correct Provider Billing of Admission Date and Statement Covers Period
• SE1121 – Recovery Audit Program Diagnosis Related Group (DRG) Coding Vulnerabilities for Inpatient Hospitals
• Revised: SE1035 – Claims Modifiers for Use in the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program

16 June 2011

• MM7416 – July Quarterly Update for 2011 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule
• Revised: MM6870 – Reporting of Recoupment for Overpayment on the Remittance Advice (RA)

09 June 2011

• MM7404 – Critical Access Hospital (CAH) Optional Method Election for Outpatient Services
• Revised: SE1119 – National Coverage Determination (NCD) for Percutaneous Transluminal Angioplasty (PTA) (20.7)
• MM7303 – Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes – July 2011 Update
• MM7338 – Revisions to the "Medicare Claims Processing Manual" - Chapter 10 (Home Health Agency Billing)
• MM7401 – Phase 3 of Manual Revisions to Reflect Payment Changes for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Items as a Result of the DMEPOS Competitive Bidding Program and the Deficit Reduction Act of 2005
• MM7443 – July 2011 Update of the Hospital Outpatient Prospective Payment System (OPPS)
• MM7444 – October Quarterly Update to 2011 Annual Update of HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement

02 June 2011

• MM7367 – Update-Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) Rate Year 2012
• MM7379 – Pass-through Payment for Certified Registered Nurse Anesthetist Services

May

26 May 2011

• MM7397 – Pharmacy Billing for Drugs Provided "Incident To" a Physician Service
• MM7430 – July Update to the CY 2011 Medicare Physician Fee Schedule Database (MPFSDB)
• MM7413 – Affordable Care Act - Section 3113 - Laboratory Demonstration for Certain Complex Diagnostic Tests – (CR 7413 Fully Rescinds and Replaces CR 7278)
• MM7425 – October 2011 Quarterly Update for the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program
• MM7439 – July 2011 Integrated Outpatient Code Editor (I/OCE) Specifications Version 12.2

19 May 2011

• MM7399 – Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 17.2, effective July 1, 2011
• MM7142 – Revised: Clarification of Payment Window for Outpatient Services Treated as Inpatient Services

12 May 2011

• MM7395 – Corrections to Home Health Prospective Payment System (HH PPS) Outlier Limitation
• MM7361 – Section 1833 (a)(1)(F) of the Social Security Act - Payment of Licensed Clinical Social Worker (LCSW) in a Method II Critical Access Hospital (CAH)
• MM7369 – Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy Print (MREP) Update
• Revised: MM7374 – Manual Changes for Therapy Services in Home Health, Publication 100-02, Chapter 7
• Claims Reprocessing Questions & Answers
  TDL 11308
  The CMS Questions and Answers that offer additional information about the reprocessing of claims to comply with the Affordable Care Act are available. This document is located on our Fee Schedule page in the 2010 section.

5 May 2011

• MM7213 – Implementation of New Reasonable Useful Lifetime (RUL) Policy for Stationary and Portable Oxygen Equipment
• Revised: MM6786 – Screening for the Human Immunodeficiency Virus (HIV) Infection
• MM7411 – New K Codes for Suction Pumps and Wound Dressings
• MM7396 – Home Health Requests for Anticipated Payment and Timely Claims Filing
• MM7366 – End Stage Renal Disease (ESRD) Transition Budget Neutrality Adjustment - Correction

April

28 April 2011

• SE1111 – Medicare Electronic Health Record (EHR) Incentive Payment Process
• MM7374 – Manual Changes for Therapy Services in Home Health, Publication 100-02, Chapter 7
• Physician Certification and Recertification of Services Manual Changes
  (CR7377)
  This manual update includes a face-to-face encounter requirement for home health and hospice certifications.
  The Centers for Medicare & Medicaid Services (CMS) is including the following clarifications to the CMS Internet-Only Manual (IOM) Publication 100-01, Medicare General Information, Eligibility, and Entitlement Manual, Chapter 4, Physician Certification and Recertification of Services:
  Due to new provisions mandated by passage of the Affordable Care Act, there are new statutory requirements regarding face-to-face encounters for certifications applicable to the home health and hospice programs that must be updated in Chapter 4.
  Sections 6407 and 3132 of the Affordable Care Act require these face-to-face encounters with a physician for home health and hospice certifications. Details of the policy are provided in the above-mentioned chapter.
  For complete details on this update, see the official instruction, Change Request (CR) 7377, which may viewed at http://www.cms.gov/transmittals/downloads/R68GI.pdf on the CMS Web site.
• MM7385 – Updates to Internet Only Manual (IOM) Pub. 100-04, Medicare Claims Processing Manual, Chapter 3: Inpatient Hospital Billing
• MM7388 – End Stage Renal Disease (ESRD) Low Volume Adjustment and Establishing Quarterly Updates to the ESRD Prospective Payment System (PPS)
• Revised: MM7041 – Implementation of the PWK (Paperwork) Segment for X12N Version 5010
• Revised: MM6870 – Reporting of Recoupment for Overpayment on the Remittance Advice (RA)
• Revised: MM7234 – New HCPCS Q-codes for 2010-2011 Seasonal Influenza Vaccines

25 April 2011

• Temporary Deactivation of Fiscal Intermediary Shared System (FISS) Edits 34919 and 34931 – CORRECTION
  (TDL 11142)
  Provider Notification
  The Centers for Medicare & Medicaid Services is temporarily deactivating Present on Admission (POA) reason codes 34919 and 34931, pending system changes by the Fiscal Intermediary Shared System (FISS) Maintainer. Contractors are immediately releasing any claims held for these reason codes. Providers may PF9 any claims that have been returned to them for reason codes 34919 and 34931 for reprocessing.

07 April 2011

• MM7345 – July Quarterly Update to 2011 Annual Update of HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement

March

31 March 2011

• MM7232 – Effective Date of Certified Provider or Supplier Agreement or Approval
• MM7339 – Manual Clarifications for Skilled Nursing Facility (SNF) Part A Billing
• MM7357 – July 2011 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
• Revised: MM7208 – Waiver of Coinsurance and Deductible for Preventive Services for Rural Health Clinics (RHCs), Section 4104 of the Affordable Care Act
• Revised: MM7278 – Affordable Care Act – Section 3113 – Laboratory Demonstration for Certain Complex Diagnostic Tests
• MM7350 – Implementation of Provider Enrollment Provisions in CMS-6028-FC

24 March 2011

• MM7364 – 2011 Annual Update to the Therapy Code List
• MM7348 – Claim Status Category Code and Claim Status Code Update
• MM7342 – April 2011 Update of the Hospital Outpatient Prospective Payment System (OPPS)
• Revised: MM7319 – April Update to the Calendar Year (CY) 2011 Medicare Physician Fee Schedule Database (MPFSDB)
• Revised: MM7300 – Emergency Update to the CY 2011 Medicare Physician Fee Schedule Database
• Revised: MM7337 – Hospice Benefit Policy Manual Update: New Certification Requirements and Revised Conditions of Participation

17 March 2011

• MM7296 – Magnetic Resonance Imaging (MRI) in Medicare Beneficiaries with Implanted Permanent Pacemakers (PMs) or Implantable Cardioverter Defibrillators (ICDs)
• MM7344 – April 2011 Integrated Outpatient Code Editor (I/OCE) Specifications Version 12.1
• Rescinded: MM7239 – Clinical Laboratory Fee Schedule – Medicare Travel Allowance Fees for Collection of Specimens

10 March 2011

• MM7337 – Hospice Benefit Policy Manual Update: New Certification Requirements and Revised Conditions of Participation
• Revised: MM7012 – Waiver of Coinsurance and Deductible for Preventive Services, Section 4104 of The Affordable Care Act, Removal of Barriers to Preventive Services in Medicare
• Revised: MM7049 – Expansion of Medicare Telehealth Services for Calendar Year (CY) 2011
• SE1106 – Important Reminders about HIPAA 5010 & D.0 Implementation
• Revised: 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
• Revised: MM6870 – Reporting of Recoupment for Overpayment on the Remittance Advice (RA)

03 March 2011

• Revised:MM7319 – April Update to the Calendar Year (CY) 2011 Medicare Physician Fee Schedule Database (MPFSDB)
• Revised: MM3834 – Smoking and Tobacco-Use Cessation Counseling
• Revised: MM6786 – Screening for the Human Immunodeficiency Virus (HIV) Infection
• Revised: MM7018 – Updates to the Medicare Claims Processing Manual (Publication 100-04, Chapter 15 (Ambulance)) to Correct Claims Billing Instructions as Well as to Update Fee Schedule Payment Rates Mandated by the Affordable Care Act of 2010
• MM7307 – Clarification to CR No. 6686 - Outpatient Mental Health Treatment Limitation

February

25 February 2011

• CMS has issued the following message: Institutional billing codes are available from the NUBC (www.nubc.org) via the NUBC’s official UB-04 Data Specifications Manual. (JSM\TDL 11166)

24 February 2011

• SE1105 – Medicare Drug Screen Testing
• MM7313 – Clinical Laboratory Fee Schedule – Medicare Travel Allowance Fees for Collection of Specimens
• MM7128 – Payment Update and Common Working File (CWF) Editing for Influenza Virus Vaccine and Pneumococcal Vaccine (PPV) Codes
• MM7271 – January 2011 Update of the Hospital Outpatient Prospective Payment System (OPPS)
• Revised: MM7072 – Implementation of Edits for the Emergency Department (ED) Adjustment Policy under the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS)
• Revised: MM7065 – Fractional Mileage Amounts Submitted on Ambulance Claims
• Revised: MM7079 – Annual Wellness Visit (AWV), Including Personalized Prevention Plan Services (PPPS)
• Revised: MM7299 – Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes – April 2011 Update
• MM7315 – Correction to Chapter 5, Section 20.2 of the Internet-Only Claims Processing Manual

17 February 2011

• Revised: MM7182 – New Home Health Claims Reporting Requirements for G Codes Related to Therapy and Skilled Nursing Services
• CR7329- Clarifications for Home Health Face-to-Face Encounter Provisions

10 February 2011

• MM7228 – Auto Denial of Claims Submitted With a GZ Modifier
• Revised MM7278 – Affordable Care Act – Section 3113 – Laboratory Demonstration for Certain Complex Diagnostic Tests
• MM7319 – April Update to the Calendar Year (CY) 2011 Medicare Physician Fee Schedule Database (MPFSDB)
• Revised: MM7208 – Waiver of Coinsurance and Deductible for Preventive Services for Rural Health Clinics (RHCs), Section 4104 of the Affordable Care Act
• Revised: MM7079 – Annual Wellness Visit (AWV), Including Personalized Prevention Plan Services (PPPS)
• MM7299 – Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes – April 2011 Update
• Revised: MM7050 – Multiple Procedure Payment Reduction (MPPR) for Selected Therapy Services
• Revised: MM7294 – Medicare and Medicaid Extenders Act of 2010 (MMEA) Extension of Reasonable Cost Payment for Clinical Lab Tests Furnished by Hospitals with Fewer Than 50 Beds in Qualified Rural Areas
• HCPCS Codes G0438 and G0439 Added to Primary Care
  Exception (JSM/TDL – 11135)
  Healthcare Common Procedure Coding System (HCPCS) code G0438 (Annual wellness visit, including personal prevention plan services, first visit) and HCPCS code G0439 (Annual wellness visit, including personal prevention plan services, subsequent visit) have been added to the Primary Care Exception (PCE) under the Medicare Physician Fee Schedule (MPFS) teaching physician payment policy. Section 4103 of the Affordable Care Act provided coverage for annual wellness visits, effective January 1, 2011. Please refer to Change Request 7079 for more details regarding the annual wellness visit service.

09 February 2011

• Handling Present on Admission (POA) Reason Codes 17801, 34919, 34929 & 34931 and Reason Code 31608 Pending Installation of Fixes to the Fiscal Intermediary Shared System (FISS) - ACTION
  (JSM/TDL 11154)
  The Centers for Medicare & Medicaid Services (CMS) is aware that providers have been experiencing problems related to Reason Codes 17801, 31608, 34919, 34929, and 34931. CMS has been working to enable impacted claims to be processed as quickly as possible. We have previously advised you that CMS has temporarily deactivated reason codes 34919 and 34931, pending system changes by the Fiscal Intermediary Shared System Maintainer. NHIC, Corp. has released claims held for these reason codes. Providers may resubmit any claims that have been returned to them for reason codes 34919 and 34931 for reprocessing.
  In addition, systems fixes have been installed and tested for reason codes 31608 and 34929. NHIC, Corp. has released claims held for these reason codes. Providers may resubmit any claims that have been returned to them for reason code 31608 or 34929 for reprocessing.
  A fix for reason code 17801 will be installed on February 7, 2011. Providers may immediately resubmit any claims that have been returned to them for reason code 17801 so that they may be paid as soon as possible after the fix has been installed and verified. Such claims will be suspended pending the installation of the fix. As soon as NHIC, Corp. has verified the fix, they will release any claims that are being held for that reason code.

08 February 2011

• End Stage Renal Disease Claims
  CMS Message 201102-14 (JSM/TDL-11162)
  The Centers for Medicare and Medicaid Services (CMS) has identified a problem with 2011 End Stage Renal Disease (ESRD) home dialysis claims. Payment for home dialysis claims for Continuous Ambulatory Peritoneal Dialysis (CAPD) and Continuous Cycling Peritoneal Dialysis (CCPD) are not being correctly adjusted for the daily rate resulting in overpayments for these claims. CMS will hold these claims to prevent the overpayments and reduce the number of necessary adjustments to claims. The claims will be released for processing on or before February 21, 2011. Contractors will be instructed to adjust claims that were paid incorrectly within 30 days. Hemodialysis claims are not impacted and will not be held. CMS regrets any inconvenience this may cause ESRD facilities.

03 February 2011

• MM7280 – Update to the Fiscal Intermediary Shared System (FISS) End of Present on Admission (POA) Indicator Logic for Version 5010 837I Electronic Health Care Claim Submissions
• Clarification of Existing Policy Regarding Items and Services Included Under the End-Stage Renal Disease Composite Payment Rate (CR7312)
  This change request provides clarification to the existing policy regarding items and services included under the End-Stage Renal Disease (ESRD) composite rate located in the Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-02, Medicare Benefit Policy Manual, Chapter 11, Section 30. (348 KB) Please read CR 7312 in its entirety on the CMS Web site at: http://www.cms.gov/transmittals/downloads/R136BP.pdf.
• MM7306 – Modifications to the Implementation of the Paperwork (PWK) Segment for X12N Version 5010
• MM7294 – Medicare and Medicaid Extenders Act of 2010 (MMEA) Extension of Reasonable Cost Payment for Clinical Lab Tests Furnished by Hospitals with Fewer Than 50 Beds in Qualified Rural Areas
• Corrections to Payments for Certain Home Health Prospective Payment System Claims (JSM11149)
  The calendar year 2011 update to the Home Health Prospective Payment System (HH PPS) Pricer program was installed in Medicare systems effective January 3, 2011. The wage index file in this Pricer update contained wage index values for certain Core-Based Statistical Areas (CBSAs) with effective dates of April 1, 2010. All wage index values for the HH PPS are effective on a calendar year basis, so any April 1 wage index values are in error. As a result, any HH PPS claims paid on or after January 3, 2011, with one of the affected CBSAs and with dates of service between April 1, 2010, and December 31, 2010, were paid incorrectly.
  The Centers for Medicare & Medicaid Services (CMS) released a revised HH PPS Pricer program on January 20, 2011 that will be loaded into production on February 7 to correct this problem. Within six weeks of implementation, NHIC Corp. will adjust any paid claims paid in error as a result of this issue using the following criteria:
  • Original claims or adjustments with types of bill 32x or 33x,
  • Statement Covers “Through” dates on or after April 1, 2010, through December 31, 2010,
  • Claim receipt dates on or after January 3, 2011, through the installation date of the corrected Pricer, and
  • Value code 61 amounts indicating CBSAs which have an effective date of April 1, 2010
  No provider action is necessary.

January

27 January 2011

• 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
• MM7250 – Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy Print (MREP) Update
• MM7290 – Changes to the Laboratory National Coverage Determination (NCD) Edit Software for April 2011
• Revised: MM7064 – End Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Consolidated Billing for Limited Part B Services
• SE1037 – Guidance on Hospital Inpatient Admission Decisions
• MM7116 – Elimination of Lump Sum Purchase Payment for Standard Power Wheelchairs Furnished on or after January 1, 2011 due to the Affordable Care Act
• MM7207 – Certified Registered Nurse Anesthetist (CRNA) Services in a Method II Critical Access Hospital (CAH) Without a CRNA Pass-Through Exemption
• MM7284 – Revision of the ICD-9 CM Codes Recognized for a Co-morbidity Payment Adjustment under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS)
• MM7298 – April 2011 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
• MM7169 – Improved Processing of Oxygen Services on Home Health Claims
• MM7235 – Home Oxygen Use to Treat Cluster Headache (CH)
• MM7244 – Off-Cycle Release of the Inpatient Prospective Payment System (IPPS) Pricer to Accept Diagnosis Codes and to Pass a Low-Volume Payment Amount
• MM7270 – Changes to the Time Limits for Filing Medicare Fee-For-Service Claims
• Revised: MM7248 – Calendar Year (CY) 2011 Update for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule
• Attention Institutional Providers:
  Information for Institutional Providers Regarding the Billing of CPT Code 90662
  (CMS Message 201101-43)
  Medicare institutional providers should not submit claims with CPT code 90662 with dates of service on or after Friday, October 1, 2010, via roster billing; current editing prevents CPT code 90662 to be billed on roster claims. Medicare systems are unable to hold roster claims submitted by institutional providers until system changes are implemented on Tuesday, July 5, 2011. Medicare institutional providers may submit their roster claims on an individual claim basis or hold their roster claims until Tuesday, July 5, 2011, and then submit as a roster bill at that time.

25 January 2011

• Temporary Deactivation of Fiscal Intermediary Shared System (FISS)
  Edits 34919 and 34931
  JSM 11142
  The Centers for Medicare & Medicaid Services is temporarily deactivating Present on Admission (POA) reason codes 34919 and 34931, pending system changes by the Fiscal Intermediary Shared System (FISS) Maintainer. Contractors are immediately releasing any claims held for these reason codes. Providers may PF9 any claims that have been returned to them for reason codes 34919 and 34931 for reprocessing.

13 January 2011

• MM7264 - Summary of Policies in the CY 2011 Medicare Physician Fee Schedule (MPFS) and the Telehealth Originating Site Facility Fee Payment Amount
• MM7300 – Emergency Update to the CY 2011 Medicare Physician Fee Schedule Database
• Revised: SE1035 – Claims Modifiers for Use in the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program

06 January 2011

• SE1039 – Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Billing Guide
• MM7253 – Home Health Prospective Payment System Rate (HH PPS) Update for Calendar Year (CY) 2011
• MM7249 – Payment for 510k Post-Approval Extension Studies Using 510k-Cleared Embolic Protection Devices during Carotid Artery Stenting (CAS) Procedures
• MM6988 – Face Validity Assessment of Advance Beneficiary Notice (ABN) for Complex Medical Record Review
• Rescinded: MM7109 – Pharmacy Billing for Drugs Provided “Incident to” a Physician’s Service
• MM7252 – January 2011 Integrated Outpatient Code Editor (I/OCE) Specifications Version 12.0
• MM7262 – Medical Nutrition Therapy (MNT) Manual Correction
• MM7182 – New Home Health Claims Reporting Requirements for G Codes Related to Therapy and Skilled Nursing Services
• Revised: MM7101 – Announcement of Medicare Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Payment Rate Increases
• MM7018 - Updates to the Medicare Claims Processing Manual (Publication 100-04, Chapter 15 Ambulance)) to Correct Claims Billing Instructions as Well as to Update Fee Schedule Payment Rates Mandated by the Affordable Care Act of 2010

04 January 2011

• Face-to-Face Encounter Home Health Certification Requirement
  (JSM/TDL-11111)
  Section 6407 of the Affordable Care Act of 2010 established a physician face-to-face encounter requirement for certification of eligibility for Medicare home health services. The law requires that the certifying physician must document that he or she, or a non-physician practitioner (NPP) working with the physician, has seen the patient.
  In the Home Health Prospective Payment System Rate Update for Calendar Year (CY) 2011, the Centers for Medicare & Medicaid Services (CMS) finalized its implementation approach for this law. Pursuant to 42 C.F.R. § 424.22(a)(1)(v) (75 Fed. Reg. 70464, November 17, 2010), the face-to-face encounter must occur within the 90 days prior to the start of care, or within the 30 days after the start of care. The regulation also states that the certifying physician must document the encounter as part of the certification itself or as a signed addendum to it. The documentation must include the date when the encounter occurred and a brief narrative which describes how the clinical findings of the encounter support the patient’s homebound status and need for skilled services. The rule requires such documentation be present on certifications for patients with starts of care on or after January 1, 2011.
  Although many home health agencies and physicians are aware of and are able to comply with this policy, CMS is concerned that some home health agencies and physicians may need additional time to establish operational protocols necessary to comply with this new law. As such, CMS expects that during the first quarter of CY 2011, home health agencies and physicians who order home health services will collaborate and establish internal processes to ensure compliance. Beginning with the second quarter of CY2011, home health agencies will have fully established such internal processes and CMS will expect appropriate documentation of the encounter.
  CMS will continue to address industry questions concerning the new requirement, and will update information on our Web site at http://www.cms.gov/center/hha.asp. We will also use other channels we have to communicate with providers to ensure information is widely distributed.
• Hospice Face-to-Face Encounter Requirement
  (JSM/TDL-11112)
  Section 3131(b) of the Affordable Care Act of 2010 requires a hospice physician or nurse practitioner (NP) to have a face-to-face encounter with every hospice patient prior to the patient’s 180th- day recertification, and each subsequent recertification. The provision applies to recertifications on and after January 1, 2011.
  In the Home Health Prospective Payment System Rate Update for Calendar Year (CY) 2011, the Centers for Medicare & Medicaid Services (CMS) finalized its implementation approach for this hospice provision. The final rule, codified at 42 C.F.R. 418.22(a)(4) (75 Fed. Reg. 70463, November 17, 2010) states that the encounter must occur no more than 30 calendar days prior to the start of the hospice patient’s third benefit period. The regulation requires that the hospice physician or nurse practitioner attest that the encounter occurred, and the recertifying physician must include a narrative which describes how the clinical findings of the encounter support the patient’s terminal prognosis of 6 months or less. Both the narrative and the attestation must be part of, or an addendum to, the recertification.
  Although many hospices are aware of and are able to comply with this policy, CMS is concerned that some hospices may need additional time to establish operational protocols necessary to comply with this new law. As such, CMS expects that during the first quarter of CY 2011, hospices will establish internal processes to ensure compliance. Beginning with the second quarter of CY 2011, hospices will have fully established such internal processes and CMS will expect appropriate documentation of the encounter.
  CMS will address industry questions concerning the new requirement on our Web site at http://www.cms.gov/center/hospice.asp. We will also use other channels we have to communicate with providers to ensure information is widely distributed.

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05/10/2012