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Below you will find a listing of current Centers for Medicare & Medicaid Services (CMS) program information (transmittals, corrections/changes to existing Medicare guidelines, etc.) and general updates to this Web site.
Note: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material which is copyrighted by the American Medical Association (AMA). You are forbidden to download the files unless you read, agree to and abide by the provisions of the copyright statement. Read the copyright statement now (you will be linked back to here).
May |
April |
March |
February |
January
May
08 May 2008
- Ambulance Fee Schedule
- Conversion Factor File for CY 2009 Ambulance Inflation Factor (CR 6000)
- Effective March 19, 2008, CMS is maintaining its current non-coverage
determination for autologous platelet rich plasma (PRP) for the treatment of chronic,
non-healing cutaneous wounds, and is issuing a non-coverage determination for acute
surgical wounds when the autologous PRP is applied directly to the closed incision and for
dehiscent wounds. (CR 6043)
- In order to protect the privacy of Medicare beneficiaries and to comply with
the requirements of the Privacy Act of 1974 and the Health Insurance Portability and
Accountability Act, customer service staff at Medicare provider contact centers
(PCC) must properly authenticate the identity of providers/staff that call or write to
request beneficiary protected health information before disclosing it to the requestor. (SE0814)
- CMS will be conducting a National Provider Training Conference Call to give
Medicare Fee-for-Service providers an overview of the implementation of the DMEPOS Competitive Bidding Program. (JSM 08287)
01 May 2008
- CMS updated the sections of the Medicare Claims Processing Manual that
address prolonged services codes, in order to be consistent with changes/deletions
in codes and changes in typical/average time units in the American Medical Association Current
Terminology Procedural Terminology (CPT) coding system. (CR 5972)
- The revised ABN was released on March 3, 2008, and providers are authorized
to begin using the notice immediately. Beginning September 3, 2008, all providers,
practitioners, and suppliers paid under Part B, must use the revised ABN in place of the ABN-G
and ABN-L. The revised
instructions are available here and can also be accessed at www.cms.hhs.gov/bni, along with
the new form. (JSMTDL 08277)
- This article has again been revised: CMS issued a Decision Memorandum (DM)
that addressed Erythropoiesis Stimulating Agents (ESAs) use for cancer and related
neoplastic conditions. (CR 5818)
April
24 Apr 2008
18 Apr 2008
- This article provides guidance and resources, developed by professional societies, for determining the
most appropriate provisions of
allergen immunotherapy to Medicare beneficiaries. NOTE: NHIC, Corp. New England does not have a Local
Coverage Determination (LCD) on this topic. For the California LCD (Allergy Testing), please refer to the Active LCD Index at:
www.medicarenhic.com/cal_prov/policies.shtml. (SE0812)
17 Apr 2008
10 Apr 2008
-
Overview of New Medicare Competitive
Bidding Program for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) (SE0805)
-
Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program: Grandfathering, Repair and
Replacement, Mail Order Diabetic Supplies and Advanced Beneficiary Notices (ABNs) (SE0806)
-
Pre-Bidding Activities for the Medicare
Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (SE0811)
-
Delay of Enrollment Requirement for Audiologists (JSMTDL 08252)
03 Apr 2008
March
27 Mar 2008
20 Mar 2008
- The list of tests approved by the Food and Drug Administration (FDA) as waived tests under the Clinical Laboratory Improvement Amendments of 1988 (CLIA) has been updated. (CR 5913)
- CMS issued this to notify providers of the Medicare Claims Processing Manual update that clarifies the use of the JW modifier when processing all drugs except CAP drugs. (CR 5923)
- This article has been revised: CMS issued a Decision Memorandum (DM) that addressed Erythropoiesis Stimulating Agents (ESAs) use for cancer and related neoplastic conditions. (CR 5818)
- March is National Colorectal Cancer Awareness Month. The goal of this national health observance is to increase awareness that colorectal cancer is largely preventable, treatable and beatable. In conjunction with National Colorectal Cancer Awareness Month, the Centers for Medicare & Medicaid Services (CMS) remind health care professionals that Medicare provides coverage for certain colorectal cancer screenings. Colorectal cancer affects both men and women of all racial and ethnic groups, and is most often found in people aged 50 years or older. And the risk for developing colorectal cancer increases with age. (CMS Message 200803-08)
13 Mar 2008
- This article announces the latest update of Remittance Advice Remark Codes (RARCs) and Claim Adjustment Reason Codes (CARCs), effective April 1, 2008. (CR 5942)
- Payment for Inpatient Hospital Visits - General (Codes 99221 – 99239) (CR 5792)
- Those Medicare providers who were selected by the CMS to participate in the Medicare Contractor Provider Satisfaction Survey (MCPSS) are asked to please take the time to complete the survey or respond to the survey contractor, Westat, follow-up calls. The survey is designed so that it can be completed in 15 minutes and responses may be submitted via a secure website, mail, fax or over the telephone. Data collection ends in April. (SE0804)
- This article was revised: Payment Allowance Update for the Influenza Virus Vaccine CPT 90660 and further instruction regarding the Pneumococcal Vaccine CPT 90669 (CR 5910)
- This article was revised: Importance of Supplying Correct Provider Identification Information Required in Items 17, 17a, 24K, and 33 of the Form CMS-1500 (12-90), and the Electronic Equivalent (SE0529)
6 Mar 2008
February
28 Feb 2008
21 Feb 2008
14 Feb 2008
7 Feb 2008
- This article provides Medicare contractors with information about legislative changes to the 2008 MPFS, and about the extension of the Participation Open Enrollment period for 2008. (CR 5944)
- This article contains summaries of the policy changes in the 2008 Medicare Physician Fee Schedule and the telehealth originating site facility fee for 2008. (CR 5895)
- Revision to Instructions Relating to Compliance Standards for Independent Diagnostic Testing Facilities (IDTFs) (CR 5856)
- This article announces that Provider Legacy Identifiers are not to be reported on Medicare CMS-1500 or Form CMS-1450 claims received on or after May 23, 2008 (the date at which the NPI is required to be reported on claims). After that date, claims containing Legacy Identifiers will be returned as unprocessable. (CR 5858)
- This article announces that the 2008 Medicare Physician Fee Database (MPFSDB) includes two new CPT codes for smoking and tobacco use cessation counseling services; replacing the temporary HCPCS G codes (G0375 and G0376) currently in use for billing these services. (CR 5878)
- This article lists additional payable HCPCS “C” drug codes for Ambulatory Surgical Centers (ASCs). (CR 5885)
- In accordance with Transmittal 1388, Fee Schedule Update for 2008 for Durable Medical Equipment, Prosthetics, Orthotics and Supplies, DMEPOS fee schedule files were released to contractors to pay claims with dates of service on or after January 1, 2008. The Healthcare Common Procedure Coding System (HCPCS) code E0461 was inadvertently omitted from these files. Therefore, the January 2008 DMEPOS fee schedule files are being revised to add fee schedule amounts for HCPCS code E0461. (JSM 08165)
- This article has been updated: the 2007 Update of HCPCS Codes and Payments for Ambulatory Surgical Centers (CR 5211)
- This article has been revised: Ambulatory Surgical Center (ASC) Claims Processing Manual Clarification (CR 5026)
- This article "Revised Payment System for Ambulatory Surgical Centers (ASC) in Calendar Year (CY) 2008” was revised on January 31, 2008, to reflect that CMS issued a combined OPPS/ASC final rule on November 27, 2007. (SE0742)
January
31 Jan 2008
- This article clarifies instructions regarding the Coordination of Benefits Agreement (COBA) Medigap claim-based crossover process. (CR 5837)
- ATTENTION: FFS Medicare Physicians, Non-Physician Practitioners & Other Suppliers
MARCH 1ST IS A CRITICAL DATE!
Last week, CMS issued the January NPI message to all providers. (You can view the January NPI message online at http://www.cms.hhs.gov/NationalProvIdentStand/02_WhatsNew.asp on the CMS website.) This week begins a weekly messaging campaign for Medicare Fee-For-Service providers in order to raise the level of urgency as the March 1st implementation date approaches. (CMS Message 200801-23)
24 Jan 2008
- Outpatient Therapy Caps With Exceptions Start January 1, 2008. (CR 5871)
- This article notes the modification of the Reconsideration Request Form that is included with the model Medicare Redetermination Notice (for partly or fully unfavorable redeterminations.) (CR 5836)
- Effective for services on or after January 1, 2008, you must report the most recent hemoglobin or hematocrit levels. In addition, non-ESRD claims for the administration of ESAs must also contain one of three new Healthcare Common Procedure Coding System (HCPCS) modifiers. (CR 5699)
- This article notifies providers and suppliers that Medicare claims forms will be modified to accommodate the 8-digit clinical trail number for claims that Medicare receives on or after April 1, 2008. (CR 5790)
- CMS is creating new HCPCS modifiers for use when billing for patient care in clinical research studies. (CR 5805)
- This article reminds providers that it is the claim/bill submitter‘s responsibility to obtain the ordering, referring and attending, operating, other, service facility providers, or purchased service providers NPIs for claims. (CR 5890)
- This article has been revised: Effective April 1, 2008 contractors will deny claims for mammography services (rather than returning them as unprocessable) if the appropriate Food and Drug Administration (FDA) certification status is not listed on the FDA-created, CMS-supplied, Mammography Quality Standard Act (MQSA) data file. (CR 5577)
17 Jan 2008
- Effective January 18, 2008 the Medicare interest
rate for overpayments and underpayments has been changed to 12.125 percent. Historical Data available. (CR 5753)
- This article has been revised: Individuals Authorized Access to CMS Computer Services - Provider Community
(IACS-PC): THE SECOND IN A SERIES OF ARTICLES ON THE IACS (SE0753)
- Medicare Part B Drug Competitive Acquisition Program (CAP): Additional 2008 Physician Election
Period and Impact on Carriers An additional election period for the 2008 Medicare Part B Drug Competitive
Acquisition Program (CAP) will begin on January 15, 2008 and will conclude on February 15, 2008. The CAP is a voluntary program
that offers physicians the option to acquire many drugs they use in their practice from an approved CAP vendor, thus reducing
the time they spend buying and billing for drugs. For physicians who join during this additional election period, effective
dates of participation will be April 1, 2008 to December 31, 2008.
Physicians are instructed to submit their CAP election forms to their local carrier. As per Change Request (CR) 4064, local
carriers are required to forward a list to the CAP designated carrier of all physicians and practitioners who have elected to
participate in the CAP. This list is due on February 22, 2008. The designated carrier for the Competitive Acquisition Program
(CAP), Noridian Administrative Services (NAS), will hold an Ask the Contractor Teleconference (ATC) on January 23, 2008 at
2:00PM CST. Prospective CAP physicians will have an opportunity to learn more about the CAP and how to elect into the program
during the upcoming 2008 additional physician election. Additionally, NAS staff will be available to answer questions.
Call Number: (888) 830-6260 Passcode: 463742
A Joint Signature Memo (JSM) with instructions pertaining to posting information on the ATC and processing additional election
applications will be sent out soon. Participating CAP Physicians are required to use CAP-specific modifier codes and the dose
specific prescription order number on their claims. The following CRs pertain to the Part B Drug CAP and may be found on the
“Transmittals” page at www.cms.hhs.gov/transmittals:
2007: R1239CP, R1207CP, 1390CP
2006: R841CP, R839CP, R1034CP, R57MSP, R1088CP, R1076CP, R1055CP, R1313CP
2005: R777CP, R761CP, R715CP, R699CP
Additional information about the CAP is available at the following website:
www.cms.hhs.gov/CompetitiveAcquisforBios/01_overview.asp
The list of drugs supplied by the CAP vendor, including NDCs, is in the Downloads section at:
www.cms.hhs.gov/CompetitiveAcquisforBios/15_Approved_Vendor.asp
To view and download the billing instructions for Participating CAP Physicians, see “CAP Physician Billing Tips” in the
Downloads section of the “Information for Physicians” page:
www.cms.hhs.gov/CompetitiveAcquisforBios/02_infophys.asp (CMS Message 200801-12)
11 Jan 2008
- CMS is extending the temporary IVIG pre-administration-related services payment through calendar year (CY) 2008 to hospital
outpatient departments and physicians that administer IVIG. (CR 5713)
- CMS has released the January 2008 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and revisions to prior quarterly
pricing files. (CR 5852)
- CMS has revised the article on changes being made to submission instructions for completing boxes 32a and 32b of Form
CMS-1500. (CR 5749)
- In previous messages, the Centers for Medicare and Medicaid Services (CMS) indicated that the Medicare,
Medicaid and SCHIP Extension Act of 2007 replaced the scheduled 10.1 percent reduction in the Medicare Physician Fee
Schedule (MPFS) conversion factor with a 0.5 percent increase for dates of service beginning January 1 through June 30, 2008.
CMS has received a number of inquiries asking whether physicians need to take any special action to get paid at the rates
required by the statute. Physicians do not need to take any additional action in order for their MPFS claims to be paid
at the new rate that reflects the 0.5 percent increase in the conversion factor. Medicare contractors are able to
process claims for services paid under the MPFS that contain dates of service January 1 and after with the new 2008 rates. No
adjustments should be necessary. Your Medicare contractors have been instructed to process, beginning January 7, all claims
with dates of service January 1, 2008, and after, that contain MPFS services.
We are also taking this opportunity to reiterate two points made in earlier messages:
1. The new fees are expected to be posted on your local contractor’s website no later than January 11, 2008. The “Medicare
Physician Fee Schedule Look-Up” link on the CMS Website, which allows you to customize your search, will be updated with the
new 2008 fees during the week of January 21, 2008. However, the carrier specific public use files are available now on the CMS
Website for the new 2008 MPFS rates at the following link:
http://www.cms.hhs.gov/PhysicianFeeSched/PFSCSF/list.asp.
2. CMS extended the participation decision period an additional 45 days. The participation decision period now runs through
February 15, 2008, instead of ending on December 31, 2007. All participating status changes will be effective January 1, 2008.
Contractors will accept and process any participation elections or withdrawals, made during the extended enrollment period that
are received or post-marked on or before February 15, 2008.
Contractors will not automatically make adjustments for providers who change their participation status after January 1, 2008
(you should begin billing claims according to the participation decision that you have made). However, they will adjust claims
based on participation status changes that you bring to their attention. An official CMS change request and an MLNMatters
article will be forthcoming. (CMS Message 200801-11)
10 Jan 2008
- This article alerts affected physicians that the new HPSA bonus payment information for 2008 will be
available soon. The 2008 automated bonus payments applies to claims with dates of service on or after January 1, 2008 through
December 31, 2008. (CR 5698)
- CMS issued notification that changes are being made to submission instructions for completing boxes 32a and 32b of Form
CMS-1500. (CR 5749)
- The article discusses the update to Section 20 of Chapter 4 of the Medicare General Information,
Eligibility, and Entitlement Manual as it pertains to Physician Certification Statement requirements for all
ambulance providers. (CR 5833)
- This article provides that (effective September 10, 2007) no National Coverage Determination (NCD) for nebulized beta adrenergic agonist
therapy for lung diseases is appropriate. (CR 5820)
- Medicare Part B Drug Competitive Acquisition Program (CAP): Additional Physician Election Period and
“Ask-the-Contractor” Teleconference - The Centers for Medicare & Medicaid Services (CMS) will be conducting an
“Ask-the-Contractor” teleconference to discuss the additional 2008 CAP physician election period. The call will be hosted by
the CAP designated carrier, Noridian Administrative Services (NAS). All interested providers and contractor staff are invited
to participate.
Call Details:
| | Date: | Wednesday, January 23, 2008, 2:00PM CST |
| | Call: | (888) 830-6260 |
| | Passcode: | 463742 |
For security reasons, you will be required to give the passcode. A PowerPoint slide presentation to accompany the
“Ask-the-Contractor” teleconference will be posted on the NAS website at: www.noridianmedicare.com/cap_drug/train/act.html. The
slides will be available at least one day prior to the teleconference (Tuesday, January 22). CAP staff will be available to
respond to inquiries during a question and answer session after the presentation. (JSM 08109)
03 Jan 2008
- Legislative Change Affecting the 2008 Medicare Physician Fee Schedule (MPFS), and
Extension of the 2008 Participation Open Enrollment Period (JSM 08096)
- Handling Personally Identifiable Information (PII) on the Medicare
Summary Notice (MSN) (CR 5770)
- This article provides additional information and instructions for the
implementation of the CAP pertaining to CAP drug categories and fee schedule. (CR 5839)
- Update to Medicare Deductible, Coinsurance and Premium Rates for
2008 (CR 5830)
- Annual Update of Healthcare Common Procedure Codes System (HCPCS) Codes
Used for Home Health Consolidated
Billing Enforcement (CR 5829)
- Individuals Authorized Access to CMS Computer
Services - Provider Community (IACS-PC): THE SECOND IN A SERIES OF ARTICLES ON THE
IACS (SE0753)
- Individuals Authorized Access to CMS Computer
Services - Provider Community (IACS-PC): THE THIRD IN A SERIES OF ARTICLES ON THE
IACS-PC (SE0754)
- CMS publishes The Quarterly Provider Update on the
first business day of each quarter. It is a listing of all non-regulatory changes to
Medicare including Program Memoranda, manual changes, and any other instructions that
could affect providers.
- In December 2007, Westat, a survey research firm, began conducting the
2008 Medicare Contractor Provider Satisfaction Survey (MCPSS) for CMS. If you have
questions about the MCPSS and would like to speak to a study representative from Westat,
please call the MCPSS Provider Helpline 1-888-863-3561. You may also contact the
representative by e-mail at mcpss@westat.com. (JSM
08016)
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05/08/2008
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