12 Mar 2009

• April Update to the 2009 Medicare Physician Fee Schedule Database (MPFSDB)   This article amends payment files that were issued to contractors based upon the 2009 Medicare Physician Fee Schedule (MPFS) Final Rule. Physical therapists should pay particular attention to the "Background Section" regarding the billing of Canalith repositioning procedures. (CR6397)
• Instructions for the Implementation of the Internet-Based Provider Enrollment, Chain and Ownership System (PECOS)   This article alerts providers to the fact that the information about Internet-based PECOS applications provided in previously issued Change Request (CR) 5954 is now incorporated into Centers for Medicare & Medicaid Services (CMS) Medicare Program Integrity Manual Chapter 10-Medicare Provider/Supplier Enrollment, which is available at http://www.cms.hhs.gov/manuals/downloads/pim83c10.pdf on the CMS website. CMS emphasizes that none of the material in CR 5954 is changing in any way; the material is simply being shifted to chapter 10. (CR6231)
• Implementation of New Provider Authentication Requirements for Medicare Contractor Provider Telephone and Written Inquiries   Note: This article was revised on March 5, 2009, to reflect the revised CR 6139, which CMS re-issued on March 4, 2009. (The effective and implementation dates for providers were previously changed to April 6, 2009 by Transmittal R23COM on February 10.)  In this revision of the article, the CR release date, transmittal number, and the Web address of the CR have been changed. All other information remains the same. (CR6139)
• Outpatient Therapy Caps with Exceptions in Calendar Year (CY) 2009   Note: This article was revised on March 10, 2009, to clarify the Advance Beneficiary Notice (ABN) language on page 2. All other information remains the same. (CR6321)
• Disclosure of Physician Ownership in Hospitals   Change Request (CR) 6036, from which this article is taken, announces that:
  • Physician-owned hospitals are required to disclose to their patients the names of the physician owners and the names of immediate family members of the physician who have an ownership or investment interest in the hospital; and
  • Physicians are required to disclose to their patients at the time of referral if they (or their immediate family members) have an ownership or investment interest in the hospitals to which they refer patients for treatment.
  Hospitals that fail to disclose this information to patients may lose their provider agreements to participate in the Medicare program, and physicians who fail to disclose this information to patients may lose their hospital medical staff memberships.
  You should make sure that you have appropriate hospital physician-ownership disclosure procedures in place and that you are providing appropriate disclosures to your patients. (CR6306)
• Updates to the Medicare Claims Processing Manual (Publication 100-04), Chapter 15, Ambulance Services   This article implements significant changes to the Internet Only Manual Publication 100-04, Chapter 15. Most of the changes in CR 6347 have already been communicated via prior change requests and related MLN Matters articles. The key purpose of CR 6347 is to eliminate references to the reasonable charge payment methodology and the transition to the Ambulance Fee Schedule, which took place from April 2002 until December 2006, in the actual Medicare manual. Please make sure your staff is familiar with these changes. (CR6347)
• Preparing for a Transition from an FI/Carrier to a Medicare Administrative Contractor (MAC)   Note: This article was revised on March 11, 2009, to add definitions of an outgoing and incoming contractor and the article is re-issued to remind affected providers of upcoming Medicare contractor transitions. (SE0837)

05 Mar 2009

• Claims Processing Instructions for Diagnostic Tests Subject to the Anti-Markup Pricing Limitation   This article clarifies changes finalized in the Calendar Year (CY) 2009 Medicare Physician Fee Schedule (MPFS) final rule with comment related to diagnostic tests and the revised anti-markup provisions in section 414.50 of the Medicare regulations. Although this article provides instructions to your carrier or MAC that describe how to apply the anti-markup payment limitation, it also provides instructions for determining when the anti-markup payment limitation applies and when it does not apply. (Note that the anti-markup payment limitation applies to tests formerly referred to as “purchased diagnostic tests”.)   (CR 6371)
• New Waived Tests   This article alerts providers that the Centers for Medicare & Medicaid Services (CMS) has listed the twelve latest tests approved by the Food and Drug Administration (FDA) as waived tests under Clinical Laboratory Improvement Amendments of 1988 (CLIA). The tests newly added to the waived tests are in the table on page 2 of this article. Be sure your billing staffs are aware of these changes.  (CR 6370)
• Outpatient Therapy Caps with Exceptions in Calendar Year (CY) 2009    This article describes the Centers for Medicare & Medicaid Services (CMS) policy for outpatient therapy cap exceptions for 2009 and updates the dollar amount of the therapy caps for 2009. Be sure billing staff is aware of the updates.  (CR 6321)
• Reporting the National Provider Identifier (NPI) on Claims for Reference Laboratory and Purchased Diagnostic Services Performed Outside the Billing Jurisdiction   This article establishes an exception to the standard reporting of the national provider identifier (NPI) on Medicare fee-for-service claims for reference laboratory and purchased diagnostic services performed by a provider located outside the jurisdiction of your Medicare contractor. When you bill for either of these services (reference laboratory services listed on the Clinical Laboratory Fee Schedule, or purchased diagnostic services) and the services were performed by a provider located in another Medicare contractor’s jurisdiction, you must report your own NPI on the Medicare claim as the performing provider and annotate the claim with the performing provider’s name, address and ZIP code. Be sure to record the performing provider’s NPI in the clinical records for auditing purposes. You should make sure that your billing staff has been made aware of this NPI documentation requirement.  (CR6362)
• Implementation of New Provider Authentication Requirements for Medicare Contractor Provider Telephone and Written Inquiries
  Note:  This article was revised on February 26, 2009, to reflect the revised CR 6139, which CMS re-issued on February 25, 2009. (The effective and implementation dates for providers were previously changed to April 6, 2009 by Transmittal R23COM on February 10.) In this revision of the article, the CR release date, transmittal number, and the Web address of the CR have been changed. All other information remains the same.  (CR6139)
• Important Information for Providers Serving Medicare Beneficiaries Enrolled in Private Fee-for-Service Plans
  Note:  This article was revised on February 26, 2009, to add some clarifying information. Specifically, a note has been added to the top of page 3 to explain the difference between deemed providers and non-contracted providers. Also, language has been added to show that appeals of medical necessity determinations must first go through the plan’s appeals process. Finally, language has been added to show that a plan’s terms and conditions should be posted on their website and the address of that site should be available on the beneficiary’s membership card. All other information remains the same.   (SE0902)

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February

26 Feb 2009

• Changes to the Laboratory National Coverage Determination (NCD) Edit Software for April 2009   This article announces the changes that will be included in the April 2009 release of Medicare’s edit module for clinical diagnostic laboratory National Coverage Determinations (NCDs). The last quarterly release of the edit module was issued in January 2009. (CR6383)
• Remittance Advice Remark Code (RARC) and Claim Adjustment Reason Code (CARC) Update   This article announces the latest update of Remittance Advice Remark Codes (RARCs) and Claim Adjustment Reason Codes. (CR6336)
• Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) Edits . The Centers for Medicare & Medicaid Services (CMS) is issuing CR6356 to identify HCPCS code changes, including modifiers for 2009 that are both subject to CLIA edits and excluded from CLIA edits. Be sure billing staff is aware of the changes. (CR6356)
• Adding a New Specialty Code for Speech Language Pathologists (SLP) - CR 6292, from which this article is taken, announces that the Centers for Medicare & Medicaid Services (CMS) has developed a new specialty code to categorize speech pathology services. This new code (specialty code 15) is effective July 1, 2009.
  Providers and suppliers use CMS specialty codes to ensure that their claims are processed and paid correctly. Section 143 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) amends the Social Security Act to permit Speech Language Pathologists (SLP) to apply for enrollment as suppliers in Medicare beginning July 1, 2009. This will allow SLPs in private practice to bill Medicare directly for their services. (CR6292)
• April 2009 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files  This article informs Medicare contractors that on or after December 16, 2008, the January 2009 Average Sales Price (ASP) file will be available for download along with revisions to prior ASP payment files, if CMS determines that revisions to these prior files are necessary. In addition, on or after March 16, 2009, the April 2009 ASP NOC files will be available for retrieval from the Centers for Medicare & Medicaid Services (CMS) ASP webpage along with revisions to prior ASP NOC files, if CMS determines that revisions to these prior files are necessary. (CR 6380)
• Updates to the Internet Only Manual Publication 100-02, Chapter 10 (of the Medicare Benefit Policy Manual)   This article alerts providers that the Centers for Medicare & Medicaid Services (CMS) is issuing CR6318 to highlight the revisions to the Medicare Benefit Policy Manual, Chapter10 - Ambulance Services. The article is informational in nature, since CR 6318 revises that manual to incorporate information previously released via Transmittal AB-02-130 and updates to the Medicare Claims Processing Manual, Chapter 15, which is available at http://www.cms.hhs.gov/manuals/downloads/clm104c15.pdf on the CMS website. (CR6318)
• Individuals Authorized Access to CMS Computer Services (IACS) - Provider/Supplier Community: THE FIRST IN A SERIES OF ARTICLES. (SE0747)
  Note:   This article was revised on February 20, 2009, to reflect current terminology and processes as reflected on the IACS website. Please note that CMS will notify providers as internet applications become available, and provide clear instructions that specify which providers should register in IACS to access those applications. For example, MLN Matters articles SE0830 and SE0831 inform physicians how to register in IACS to access their Physician Quality Reporting Initiative (PQRI) feedback reports. Do not register until you are notified to do so by CMS or one of its contractors and only if you meet the criteria in the notice.
• Individuals Authorized Access to CMS Computer Services (IACS) – Provider/Supplier Community: THE SECOND IN A SERIES OF ARTICLES ON IACS. (SE0753)
  Note:   This article was revised on February 20, 2009, to reflect current terminology and processes as reflected on the IACS website. Please note that CMS will notify providers as internet applications become available, and provide clear instructions that specify which providers should register in IACS to access those applications. For example, MLN Matters articles SE0830 and SE0831 inform physicians how to register in IACS to access their Physician Quality Reporting Initiative (PQRI) feedback reports. Do not register until you are notified to do so by CMS or one of its contractors and only if you meet the criteria in the notice.
• Individuals Authorized Access to CMS Computer Services (IACS) – Provider/Supplier Community: THE THIRD IN A SERIES OF ARTICLES ON IACS. (SE0754)
  Note:   This article was revised on February 20, 2009, to reflect current terminology and processes as reflected on the IACS website. Please note that CMS will notify providers as internet applications become available, and provide clear instructions that specify which providers should register in IACS to access those applications. For example, MLN Matters articles SE0830 and SE0831 inform physicians how to register in IACS to access their Physician Quality Reporting Initiative (PQRI) feedback reports. Do not register until you are notified to do so by CMS or one of its contractors and only if you meet the criteria in the notice.
• Payment for Repair, Maintenance and Servicing of Oxygen Equipment as a Result of the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008.   This article alerts providers that the Centers for Medicare & Medicaid Services (CMS) is providing instructions regarding repair, maintenance, and servicing of oxygen equipment resulting from implementation of Section 144(b) of the MIPPA. The 36-month cap noted in MIPPA applies to stationary and portable oxygen equipment furnished on or after January 1, 2006. Therefore, the 36-month cap may end as early as January 1, 2009, for beneficiaries using oxygen equipment on a continuous basis since January 1, 2006. (CR6296)

19 Feb 2009

• Clarification of Date of Service (DOS) of Ambulance Services   Providers of ambulance services should note the clarifications made by CR 6372, as noted in this article. Specifically, this change request clarifies the proper date of service to use on claims, especially in situations where the beneficiary dies. (CR6372)
• Shipboard Services Billed to the Carrier and Services Not Provided Within the United States  Change Request (CR) 6327 rescinds and fully replaces CR 6217. This article clarifies payment for shipboard services billed to Medicare contractors and services not provided within the United States. (CR6327)
• Heartsbreath Test for Heart Transplant Rejection   This article alerts providers that the Centers for Medicare & Medicaid Services (CMS) determined that the Heartsbreath Test is not reasonable and necessary under section 1862(a)(1)(A) of the Social Security Act, and is non-covered for dates of service on or after December 8, 2008. (CR6366)
• Implementation of New Provider Authentication Requirements for Medicare Contractor Provider Telephone and Written Inquiries  This article was revised on February 11, 2009, to reflect the revised CR 6139, which CMS re-issued on February 10, 2009. The effective and implementation dates for providers have been changed to April 6, 2009. Also, the CR release date, transmittal number, and the Web address of the CR have been changed. All other information remains the same. (CR6139)

12 Feb 2009

• Medicare Part B Drug Competitive Acquisition Program (CAP) Postponed for 2009. Note: This article was revised on February 6, 2009, to reflect the fact that the CAP for 2009 is postponed and the impact of that postponement. (SE0833).
• Physician Signature Requirements for Diagnostic Tests.  (CR6100)
  Note: This article was revised on February 6, 2009, to remove a parenthetical statement from the first paragraph of page 2 of this article. All other information remains the same.
• Shipboard Services Billed to the Carrier and Services Not Provided Within the United States. (CR6217)
  Note: This article was rescinded and the CR was replaced by CR6327.
• Implementation of an Ambulatory Surgical Center (ASC) Healthcare Common Procedure Coding System (HCPCS) Payment Indicator File.   This article provides Medicare contractors with instructions for implementing an Ambulatory Surgical Center (ASC) Healthcare Common Procedure Coding System (HCPCS) payment indicator file. (CR6184)
• Standard System Change to Allow Claims Processing Contractors Flexibility with 9-Digit ZIP Codes   This article is informational and makes revisions to Medicare systems to allow Medicare contractors to add new and valid 4-digit ZIP code extensions to the file they use for jurisdictional pricing, thus enabling claims requiring use of the 9-digit ZIP code to process faster when new ZIP codes are established. (CR6293)
• Change in the Amount in Controversy Requirement for Administrative Law Judge Hearings and Federal District Court Appeals.   This article notifies Medicare contractors of the Amount in Controversy (AIC) required to sustain Administrative Law Judge (ALJ) and Federal District Court appeal rights beginning January 1, 2009. (CR6295)

05 Feb 2009

• Important Information for Providers Serving Medicare Beneficiaries Enrolled in Private Fee-for-Service Plans. (SE0902)
• Skilled Nursing Facility Consolidated Billing As It Relates to Ambulance Services (SE0433)
  Note: This article was revised on January 29, 2009, to add the note at the end of page 4 regarding transportation between a skilled nursing facility (SNF) and a physician’s office. All other information remains the same.
• Preparing for a Transition from an FI/Carrier to a Medicare Administrative Contractor (MAC). (SE0837)

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29 Jan 2009

• Shipboard Services Billed to the Carrier and Services Not Provided Within the United States.   This article announces that CMS wants providers to know that the Medicare Claims Processing Manual and the Medicare Benefit Policy Manual are being revised. (CR6217)
• A revison has been made to Change Request (CR) 6138 Prothrombin Time (PT/INR) Monitoring for Home Anticoagulation Management.   This article is superceded by MM6313 as CR6313 replaced CR6138, on which this article had )been based. (CR6138)

22 Jan 2009

• New Common Working File (CWF) Medicare Secondary Payer (MSP) Type for Workers' Compensation Medicare Set-aside Arrangements (WCMSAs), to Stop Conditional Payments   In order to prevent Medicare’s paying primarily for future medical expenses that should be covered by workers’ compensation Medicare set-aside arrangements (WCMSA), CR 5371, from which this article is taken, provides your Medicare contractors with instructions on the creation of a new MSP code in Medicare’s claims processing systems. With the creation of the new MSP code, the Centers for Medicare & Medicaid Services (CMS) will have the capability to discontinue conditional payments for diagnosis codes related to such settlements. (CR5371)
• January 2009 Update of the Ambulatory Surgical Center (ASC) Payment System   This article is a recurring update that describes changes to and billing instructions for various payment policies implemented in the January 2009 ASC update. Make sure billing staff are aware of the changes.(CR6323)
• Reporting Withholding Due to IRS Federal Payment Levy Program (FPLP) on the Remittance Advice   This article was revised on January 8, 2009, to add information regarding requirements for provider representatives who contact the IRS and to make other minor clarifications.(CR6125)
• Skilled Nursing Facility Consolidated Billing As It Relates to Ambulance Services    This article was revised on January 7, 2009, to add language on page 4 to discuss Medicare’s noncoverage of transportation by any means other than ambulance. All other information remains the same.(SE0433)
• Expansion of Medicare Telehealth Services   In the calendar year 2009 physician fee schedule final rule with comment period (CMS-1403-FC), the Centers for Medicare & Medicaid Services (CMS) added three codes to the list of Medicare distant site health services for follow-up inpatient telehealth consultations. This article highlights the related policy instructions. Be sure your billing staff is aware of these changes.(CR6130)

15 Jan 2009

• End Stage Renal Dialysis (ESRD) Medicare Claims Processing Manual Clarification   This article clarifies existing policies related to laboratory billing procedures for laboratory services furnished to hospital-based and independent dialysis facility patients. Be sure billing staff is aware of these clarifications.(CR6245)
• Clarification of Medicare Payment for Routine Costs in a Clinical Trial   This Special Edition article was revised and provides clarification regarding Medicare payment of routine costs associated with clinical trials. Be sure your billing staff is aware of this information.(SE0822)
• Summary of Policies in the 2009 Medicare Physician Fee Schedule (MPFS) and the Telehealth Originating Site Facility Fee Payment Amount   This article provides a summary of the policies in the 2009 MPFS and announces the telehealth originating site facility fee payment amount. Be sure billing staff are aware of these Medicare changes.(CR6349)
• Correction to Prothrombin Time (PT/INR) Monitoring for Home Anticoagulation Management   This article is based on Change Request (CR) 6313, which corrects CR 6138 (Prothrombin Time (PT/INR) Monitoring for Home Anticoagulation Management, released on July 25, 2008) by adding particular ICD-9-CM codes (451.11, 451.19, 451.2, 451.80-451.84, 451.89, 453.40-453.49 and 415.12) that CR 6138 omitted. It contains no other changes; however its content is repeated in this article for your convenience as a reference document. (CR6313)
• This article Prothrombin Time (PT/INR) Monitoring for Home Anticoagulation Management  has been rescinded and replace by CR6313.

08 Jan 2009

• Providers Urged to Participate in Annual Medicare Contractor Satisfaction Survey (MCPSS)   CMS is sending the 2009 survey, designed to be completed in about 20 minutes, to approximately 30,000 randomly selected providers, including physicians and other health care practitioners, suppliers and institutional facilities that serve Medicare beneficiaries across the country. CMS will begin to notify providers selected to participate in the survey in December 2008. Providers are urged to submit their responses via a secure website, mail, fax, or over the telephone.(SE0843)
• Claim Status Category Code and Claim Status Code Update   Reminders to providers of the periodic updates to the Claim Status Codes and Claim Status Category Codes that Medicare contractors use with the Health Care Claim Status Request (ASC X12N 276), and the Health Care Claim Response (ASC X12N 277). (CR6328)
• Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 15.0, Effective January 1, 2009   This article provides a reminder for physicians to take note of the quarterly updates to Correct Coding Initiative (CCI) edits.(CR6290)
• Signature and Date Stamps for DME Supplies-Certificates of Medical Necessity (CMNs) and DME MAC Information Forms (DIFs)   This article is based on Change Request (CR) 6261 and alerts providers that the Centers for Medicare & Medicaid Services (CMS) has issued instructions regarding signature requirements for CMNs and DIFs. Signature and date stamps are not acceptable for use on CMNs and DIFs. Be sure your billing staffs are aware of this change. Your Medicare contractors will accept only hand written, facsimiles of original written and electronic signatures and dates on medical record documentation for medical review purposes on CMNs and DIFs. (CR6261)
• Adjustment for Medicare Mental Health Services   This article identifies the CPT “Psychiatry” procedure codes that represent mental health services that have already been increased in payment by 5% effective for these “specified services” provided on or after July 1, 2008 through December 31, 2009. Be sure your billing staff is aware of this list of CPT codes that represent “specified services”. (CR6208)

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December

31 Dec 2008

• Changes in Payment for Oxygen Equipment   This article alerts providers that the Centers for Medicare & Medicaid Services (CMS) terminates all Round I supplier contracts awarded under the DMEPOS Competitive Bidding Program, as a result of Section 154 of the MIPPA which delays the Program. Therefore, in the 10 areas where competitive bidding was initiated, Medicare will resume paying for DMEPOS items, retroactive to June 30, 2008, in accordance with the standard payment rules and fee schedule amounts. This article also provides guidance on the changes in payment for oxygen and oxygen equipment as a result of section 144(b) of the MIPPA of 2008, as well as, additional claims processing and payment instructions for DMEPOS items. (CR 6297)
• New Waived Tests   This article alerts providers that the Centers for Medicare & Medicaid Services (CMS) has listed the latest tests approved by the Food and Drug Administration as waived tests under Clinical Laboratory Improvement Amendments of 1988 (CLIA). The tests newly added to the waived tests are in the table on page 2 of this article. Be sure your billing staffs are aware of these changes. (CR6287)

24 Dec 2008

• Calendar Year (CY) 2009 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment   is based on Change Request (CR) 6070 which provides instructions for the Calendar Year (CY) 2009 clinical laboratory fee schedule, mapping for new codes for clinical laboratory tests, and updates for laboratory costs subject to the reasonable charge payment. (CR6070)
• January 2009 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files   CR 6288, from which this article is taken, instructs Medicare contractors to download and implement the January 2009 Average Sales Price (ASP) drug pricing file for Medicare Part B drugs; and if released by the Centers for Medicare & Medicaid Services (CMS), also the revised October 2008, July 2008, April 2008, and January 2008 files. (CR6288)
• Annual Clotting Factor Furnishing Fee Update   CR 6277, from which this article is taken, announces that for calendar year 2009, the blood clotting furnishing factor of $0.164 per international unit (I.U.) is added to the payment limit for a blood clotting factor that is not included on the Average Sales Price (ASP) or Not Otherwise Classified (NOC) files. (CR6277)

18 Dec 2008

• Changes to the Laboratory National Coverage Determination (NCD) Edit Software for January 2009   This article announces the changes that will be included in the January 2009 release of the edit module for clinical diagnostic laboratory National Coverage Determinations (NCDs). The last quarterly release of the edit module was issued in October 2008. (CR6304)
• Thermal Intradiscal Procedures   Effective for services performed on or after September 29, 2008, the Centers for Medicare & Medicaid Services (CMS) has concluded that the evidence does not demonstrate that TIPs improve health outcomes; and has therefore determined that TIPs are not reasonable and necessary for the treatment of low back pain. Effective September 29, 2008, TIPs are non-covered for Medicare beneficiaries.(CR6291)
• Improved Access to Ambulance Services Payment Rates for Effective Dates of Service July 1, 2008, through December 31, 2009   This article announces an increase in payment for ground ambulance transports. Effective July 1, 2008 through December 31, 2009, the ambulance fee schedule amounts for covered ground ambulance transports which originate in rural areas are increased by three (3) percent, and for covered ground ambulance transports which originate non-rural areas, they are increased by two (2) percent.(CR6206)
• Instructions for Utilizing 837 Professional Claim Adjustment (CAS) Segments for Medicare Secondary Payer (MSP) Part B Claims   This article informs Medicare contractors about the changes necessary to derive Medicare Secondary Payer (MSP) payment calculations from incoming 837 4010-A1 claims transactions. (CR6211)
  Note:  This article was rescinded on March 27, 2009, when the related CR 6211 was rescinded. CR 6211 was replaced by CR 6427, which may be found at http://www.cms.hhs.gov/transmittals/downloads/R67MSP.pdf on the CMS website. The related MLN matters article may be found at http://www.cms.hhs.gov/MLNMattersArticles/downloads/mm6427.pdf on the CMS website.
• CMS has rescinded CR 6187 as of December 12, 2008.

11 Dec 2008

• Health Professional Shortage Area (HPSA) Bonus Payment Policy Changes   This article is based on Change Request (CR) 6106 and informs providers who are serving Medicare beneficiaries in areas that were eligible on December 31 of the prior year for the HPSA bonus but not on the automated ZIP code list to use the AQ modifier to receive the HPSA bonus payment. Make sure billing staff are aware of the clarified criteria for proper use of the AQ modifier. (CR6106)
• 2008 Jurisdiction List for Durable Medical Equipment Prosthetics, Orthotics, and Supply (DMEPOS) Healthcare Common Procedure Coding System (HCPCS) Codes   CR 6062 was revised to reflect a revised 2008 jurisdiction list to clarify that HCPCS code A4559 (coupling gel) may only be billed to the local carrier. The CR release date, transmittal number, and Web address for accessing CR 6062 were also revised. All other information remains the same.
• Influenza Pandemic Emergency -- Policies Concerning the Medicare Program    This article was revised on December 8, 2008, to include a Web link to CR6209, which was recently issued by CMS. All other information remains the same.(SE0836)
• Fee Schedule Update for 2009 for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)   This article was revised on December 3, 2008 to clarify language in the second paragraph of page 5. The revised language more completely explains the rationale for the revised 2009 monthly national payment rate for stationary oxygen equipment. All other information remains the same.(CR6270)

04 Dec 2008

• Influenza Pandemic Emergency -- The Medicare Program Prepares   This article was revised on November 26, 2008, to include Web revised links to recently-reissued CR6174, CR 6146, and CR 6164, all of which were recently revised by CMS. All other information remains the same. (SE0836)

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November

26 Nov 2008

• Update to Medicare Deductible, Coinsurance and Premium Rates for 2009   This article was revised on November 18, 2008, to reflect changes made to CR6258, which was re-issued on November 17. The CR transmittal number and release date were revised and the Web address for accessing CR6258 was changed. All other information remains the same. (CR6258)
• Remittance Advice Remark Code (RARC) and Claim Adjustment Reason Code (CARC) Update   This article is based on Change Request (CR) 6229 which updates Remittance Advice Remark Codes (RARCs) and Claim Adjustment Reason Codes (CARCs). If you use the Medicare Remit Easy Print software, note that Medicare will update that software as a result of implementing CR6229. Be sure billing staff are aware of these updates. (CR6229)
• Steps for Eligible Professionals to Access Their Physician Quality Reporting Initiative (PQRI) Feedback Reports   This article was revised on November 25, 2008. This document is directed to individual eligible professionals who reported PQRI quality measures data to Medicare and will access their reports. If you are enrolled in Medicare as a sole proprietorship business, this is your only option for accessing PQRI Feedback Reports via the Internet.
  Eligible professionals described above cannot have staff or others register to access your PQRI Feedback Reports. (SE0830)
• Steps for IACS Defined "Organizations" to Access Their Physician Quality Reporting Initiative (PQRI) Feedback Reports   This article was revised on November 25, 2008, to provide clarification of some of the steps involved in registering to access the reports and to clarify who should register as "Organizations". It is directed to group practices that are corporations or limited liability companies in which at least one eligible professional reported PQRI quality measures data to Medicare. (SE0831)

20 Nov 2008

• Compendia as Authoritative Sources for Use in the Determination of a "Medically Accepted Indication" of Drugs and Biologicals Used Off-Label in an Anti-Cancer Chemotherapeutic Regimen   This article updates the list of compendia recognized as authoritative sources of information for the determination of drugs and biologicals used off-label in anti-cancer chemotherapeutic regimens.(CR6191)
• Medicare Payments for Part B Mental Health Services   This article was revised on November 14, 2008, to show that the "Reasonable Expectation of Improvement" discussion on page 9 only applies to mental health services furnished under partial hospitalization programs.(SE0816)
• Fee Schedule Update for 2009 for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)   This article alerts providers that the Centers for Medicare & Medicaid Services (CMS) has issued instructions for implementing and/or updating the DMEPOS fee schedule payment amounts on a semiannual basis (January and July), with quarterly updates as necessary (April and October). Be sure your billing staffs are aware of these changes. (CR6270)

13 Nov 2008

• Update to the Initial Preventive Physical Examination (IPPE) Benefit   Effective January 1, 2009, the Centers for Medicare & Medicaid Services (CMS) is expanding coverage for the IPPE benefit. (CR6223)
• Preparing for a Transition from an FI/Carrier to a Medicare Administrative Contractor (MAC)   This article is intended to assist all providers that will be affected by Medicare Administrative Contractor (MAC) implementations. The Centers for Medicare & Medicaid Services (CMS) is providing this information to make you aware of what to expect as your FI or carrier transitions its work to a MAC. Knowing what to expect and preparing as outlined in this article will minimize disruption in your Medicare business. (SE0837)
• Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes Used for Home Health Consolidated Billing Enforcement   This article updates the lists of Healthcare Common Procedure Codes System (HCPCS) codes subject to the consolidated billing provision of the Home Health Prospective Payment System (HH PPS). (CR6262)
• Influenza Vaccine and the Pneumococcal Vaccine Payment Allowances Based on 95 Percent of the Average Wholesale Price (AWP)   This article was revised on November 7, 2008, to reflect the correct payment amount for CPT code 90669. The correct amount is $78.803. All other information remains the same. (CR6153)
• Update to Medicare Deductible, Coinsurance and Premium Rates for 2009   This article provides the Medicare rates for deductible, coinsurance and premium payment amounts for calendar year (CY) 2009. (CR6258)

06 Nov 2008

• Reporting National Provider Identifiers (NPI) on claims for Out-of-Jurisdiction Purchased Mammography Preventive Screening and Diagnostic Services   This article provides billing instructions for using the NPI on paper, or electronically-submitted, Medicare claims for purchased mammography screening and diagnostic services when the service is performed outside of the carrier’s or A/B MAC’s claims processing jurisdiction. In this situation, billing providers should report their own NPI as the performing provider and also provide the name, address, and zip code of the performing physician/supplier. (CR6237)
• 2009 Annual Update to the Therapy Code List   This article alerts providers to updates to Medicare’s therapy code list with two “sometimes” therapy codes for CY 2009. Note that these codes always represent therapy services and require the use of a therapy modifier when performed by therapists. (CR6254)
• Influenza Vaccine and the Pneumococcal Vaccine Payment Allowances Based on 95 Percent of the Average Wholesale Price (AWP).  This article provides the updated payment allowances, effective as of September 1, 2008, for influenza and pneumococcal vaccines when payment is based on 95 percent of the average wholesale price (AWP). (CR6153)
• 2008 - 2009 Influenza (Flu) Season Resources for Health Care Professionals   Keep this Special Edition MLN Matters article and refer to it throughout the 2008 - 2009 flu season. Don’t forget to immunize yourself and your staff – Get the Flu Shot – Not the Flu! (SE0838)

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October

30 Oct 2008

• New 2008 Medicare Physician Fee Schedule (MPFS) Payment Rates Effective for Dates of Service July 1, 2008, through December 31, 2008 Provider Types-This article announces the new 2008 MPFS payment rates effective for dates of service July 1, 2008, through December 31, 2008. Please note that Medicare contractors have already implemented the actions annotated in this article. (CR6212)
• Influenza Pandemic Emergency -- The Medicare Program Prepares - This article has been revised and is informational only. This article is alerting providers that the Centers for Medicare & Medicaid Services (CMS) has begun preparing emergency policies and procedures that may be implemented in the event of a pandemic or national emergency. (SE0836)

23 Oct 2008

• Influenza Pandemic Emergency -- The Medicare Program Prepares   This article is informational only and is alerting providers that the Centers for Medicare & Medicaid Services (CMS) has begun preparing emergency policies and procedures that may be implemented in the event of a pandemic or national emergency. (SE0836) /JSMTDL 09027
• Medicare Payment for Air Ambulance Services Under Section 146(b)(1) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)   This article is based on Change Request (CR) 6214, which alerts providers to the fact that any area that was designated as a rural area as of December 31, 2006, for purposes of making payments under the ambulance fee schedule for air ambulance services, will be treated as a rural area for purposes of making payments under the ambulance fee schedule for air ambulance services furnished during the period July 1, 2008, through December 31, 2009. (CR6214)
• Continuous Positive Airway Pressure (CPAP) Therapy for Obstructive Sleep Apnea (OSA)   This article was revised on October 16, 2008. Providers need to be aware that effective for claims with dates of service on and after March 13, 2008, Medicare will allow for coverage of CPAP therapy based upon a positive diagnosis of OSA by home sleep testing (HST), subject to the requirements of CR6048. (CR6048)
• National Provider Identifier (NPI) for Secondary Providers   This article was revised on October 19, 2008 and is based on CR 6093 and outlines the need to use NPIs to identify secondary providers in Medicare claims beginning May 23, 2008.(CR6093)
• Influenza Pandemic Emergency -- Policies Concerning the Medicare Program   This article was rescinded on October 20, 2008. It was replaced by a Special Edition (SE) article SE0836.(CR6164)
• Laboratory National Coverage Determination (NCD) Edit Software for October 2008   This article was revised on October 21, 2008, to correct the reference to the NCD from 190.18 to 190.19 on the bottom of page 3. A code for Gamma Glutamyl Transferase was corrected to 571.42 on page 5. It also corrected two codes on page 6 for FOBT, by adding a zero to correct the ICD-9-CM codes to 209.40 and 209.50. All other information remains the same.(CR6213)
• CMS has requested we republish this article Reasonable Charge Update for 2008 for Splints, Casts, Dialysis Supplies, Dialysis Equipment, and Certain Intraocular Lenses   This article was revised on November 7, 2007 to change the title to the chart showing the payment limits. That chart should have read “2008” and not “2007”. All other information is unchanged. (CR5740)

16 Oct 2008

• Non-acceptance of Legacy Provider Numbers on Incoming Medicare Claims - Effective October 6, 2008, providers should note that, with one qualified exception, Medicare will reject all incoming Medicare X12N 837 4010A1 claims that contain legacy identifiers.(SE0835)
• The ICD-10 Clinical Modification/Procedure Coding System (CM/PCS)—The Next Generation of Coding   Note: This article was revised on October 9, 2008, to update the website addresses and other information in the “Additional Information” section of this article. All other information remains the same. (SE0832)
• Claims Jurisdiction and Enrollment Procedures for Suppliers of Certain Prosthetics, Durable Medical Equipment (DME) and Replacement Parts, Accessories and Supplies - This article alerts suppliers, including manufacturers, enrolled with the National Supplier Clearinghouse (NSC) as a Durable Medical Equipment Prosthetic, Orthotics, and Supplies (DMEPOS) supplier, that they may now enroll with and bill the Medicare carrier or A/B MAC for replacement parts, accessories and supplies for prosthetic implants and surgically implanted DME items that are not required to be billed to the Medicare fiscal intermediary. (CR5917)

9 Oct 2008

• Reasonable Charge Update for 2009 for Splints, Casts, Dialysis Supplies, Dialysis Equipment, and Certain Intraocular Lenses    This announces the calculation of reasonable charges for payment of claims for splints, casts, dialysis supplies, dialysis equipment, and intraocular lenses furnished in calendar year 2009. (CR6221)
• October 2008 Update to the Ambulatory Surgical Center (ASC) Payment System; Summary of Payment Policy Changes    This article describes changes to, and billing instructions for, payment policies implemented in the October 2008 ASC update. This update provides updated payment rates for selected separately payable drugs and biologicals and provides rates and descriptors for newly created Level II HCPCS codes for drugs and biologicals. Be sure billing staff is aware of these changes. (CR 6205)
• Competitive Acquisition Program (CAP) for Part B Drugs and Biologicals Vendor Identification Number, Physician Election, and Iron Dextran Payment Update    This article updates instructions regarding Vendor Identification Number (VIN) Q103 in CAP claims processing and other related processes. The CR also updates procedures pertaining to CAP physician election and addresses the procedure for paying CAP claims for Iron dextran products. (CR 6210)
• Ambulance Inflation Factor (AIF) for CY 2009    This article provides the Ambulance Inflation Factor (AIF) for Calendar Year (CY) 2009. The AIF for CY 2009 is 5.0 percent. (CR 6113)
• 2009 Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) for the Common Working File (CWF), Medicare Administrative Contractors (MACs), Medicare Carriers and Fiscal Intermediaries (FIs)    This provides the 2009 annual update of Healthcare Common Procedure Coding System (HCPCS) Codes for Skilled Nursing Facility Consolidated Billing (SNF CB) and how the updates affect edits in Medicare claims processing systems. (CR 6220)
• Laboratory National Coverage Determination (NCD) Edit Software for October 2008    This article announces the changes that will be included in the October 2008 release of the edit module for clinical diagnostic laboratory National Coverage Determinations (NCDs). The last quarterly release of the edit module was issued in July 2008. CR 6213 incorporates all changes from July 2008 to the present and has no other changes. (CR 6213)
• Influenza Pandemic Emergency -- Policies Concerning the Medicare Program    This article is informational only and alerts providers that the Centers for Medicare & Medicaid Services (CMS) has emergency policies and procedures that may be used in the event of a pandemic or national emergency. In the event of a pandemic or other national emergency as described in the Background section of this article, CMS will issue one or more communications, known as Joint Signature Memoranda (JSM) to Medicare contractors intended to specify which policies and procedures are being implemented and other relevant information. While CMS will be prepared to implement CR6164 on October 27, 2008, actual operation would not occur until an emergency. (CR 6164)
• The ICD-10 Clinical Modification/Procedure Coding System (CM/PCS)—The Next Generation of Coding This article was revised on October 3, 2008, to include a link to the ICD-10 Notice of Proposed Rulemaking. The link is in the “Additional Information” section of this article. All other information remains the same. (SE0832)

2 Oct 2008

• Physician Payment Amounts When Physicians Furnish Excluded Procedures in Ambulatory Surgical Centers (ASCs). Effective for dates of service on or after January 1, 2008, Medicare will pay physicians at the facility rate for furnishing procedures in ASCs that are excluded from the list of covered ASC procedures. CMS is implementing his policy beginning January 5, 2009. In essence, the fee paid on all physician services performed in ASCs (place of service code of 24) will be the lower facility fee and not the non-facility fee. (CR6052)
• Clarification of Medicare Payment for Routine Costs in a Clinical Trial - The Centers for Medicare & Medicaid Services (CMS) reminds providers that the policies for payment of the routine costs of the clinical trial are outlined in chapter 16, section 40 of the Medicare Benefit Policy Manual (SE0822)
• This Special Edition article outlines general information for providers detailing the International Classification of Diseases, 10th Edition (ICD-10) classification system. Compared to the current ICD-9 classification system, ICD-10 offers more detailed information and the ability to expand specificity and clinical information in order to capture advancements in clinical medicine. Providers may want to become familiar with the new coding system.
  The system is not yet implemented in Medicare’s fee-for-service (FFS) claims processes so no action is needed at this time. (SE0832)
• This article is informational and is based on Change Request (CR) 6062 that notifies providers that the spreadsheet containing an updated list of the HCPCS codes for DME MAC and Part B local carrier or A/B MAC jurisdictions is updated annually to reflect codes that have been added or discontinued (deleted) each year. The spreadsheet is helpful to billing staff by showing the appropriate Medicare contractor to be billed for HCPCS appearing on the spreadsheet. The spreadsheet for the 2008 Jurisdiction List is attached to CR6062 at http://www.cms.hhs.gov/Transmittals/downloads/R1605CP.pdf on the CMS website. (CR6062)

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September

25 Sept 2008

• THIS IS A REMINDER: Beginning October 1, 2008 Your Medicare Payments Could Be Reduced If The Internal Revenue Service (IRS) Needs To Collect Overdue Taxes That You Owe
  The Taxpayer Relief Act of 1997, Section 1024, authorizes the IRS to reduce certain federal payments, including Medicare payments, to allow collection of overdue taxes. Should you owe such taxes and your payments are reduced, your remittance advice will reflect a provider level adjustment code (PLB) of "WU" in the PLB03-1 data field.  For more information, please see MLN Matters Article #MM6125 available at:  http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6125.pdf
• Flu Shot Reminder
  Flu Season Is Coming! It’s not too early to start vaccinating as soon as you receive vaccine. Encourage your patients to get a flu shot as it is still their best defense against the influenza virus. (Medicare provides coverage of the flu vaccine without any out-of-pocket costs to the Medicare patient. No deductible or copayment/coinsurance applies.) And don’t forget, health care workers also need to protect themselves. Get Your Flu Shot. – Not the Flu.
  Remember - Influenza vaccine plus its administration are covered Part B benefits. Note that influenza vaccine is NOT a Part D covered drug.
  For information about Medicare's coverage of the influenza virus vaccine and its administration as well as related educational resources for health care professions and their staff, please go to http://www.cms.hhs.gov/MLNProducts/Downloads/flu_products.pdf on the CMS website. To order, free of charge, a quick reference chart on Medicare Part B Immunization Billing, go to http://cms.meridianksi.com/kc/main/kc_frame.asp?kc_ident=kc0001&loc=5 on the CMS website. CMS Message 200809-34
• Limitation on Recoupment (935) for Provider, Physicians and Suppliers Overpayments - This article was revised on September 18, 2008, to make minor clarifying changes on page 2 and to delete some unnecessary language on pages 5 and 9. All other information remains the same. (CR6183)
• The Competitive Acquisition Program (CAP) is Postponed For 2009- Earlier this year, CMS accepted bids for vendor contracts for the 2009-11 CAP. While CMS received several qualified bids, contractual issues with the successful bidders resulted in CMS postponing the 2009 program. As a result, CAP drugs will not be available from an Approved CAP Vendor for dates of service after December 31, 2008, and the 2009 CAP physician election period scheduled for October 1 to November 15, 2008 will not be held. CAP drugs will not be available from an approved CAP vendor for dates of service after December 31, 2008. (SE0833)
• New Requirement for Ordering/Referring Information on Ambulatory Surgical Center (ASC) Claims for Diagnostic Services. Note: This article was revised on September 24, 2008, to change the reference in the “Impact on Providers” section to data loop 2310A, instead of 2310B. All other information is the same. (CR6129)
• Incorporation of Recent Regulatory Revisions into Chapter 10 of the Program Integrity Manual (PIM)- This article is based on Change Request (CR) 6178 which incorporates recent regulatory changes into the Medicare Program Integrity Manual (Chapter 10 (Healthcare Provider/Supplier Enrollment)). (CR6178)
• This article is a reminder for physicians to take note of the quarterly updates to Correct Coding Initiative (CCI) edits. (CR6169)

18 Sept 2008

• Limitation on Recoupment (935) for Provider, Physicians and Suppliers Overpayments- this article announces changes to the physician, provider, and supplier overpayment recoupment process, as required by Section 935 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) which amended Title XVIII of the Social Security Act to add to Section 1893 a new paragraph (f) addressing this process. (CR6183)
• October 2008 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files- This article instructs Medicare contractors to download and implement the October 2008 Average Sales Price (ASP) drug pricing file for Medicare Part B drugs; and if released by the Centers for Medicare & Medicaid Services (CMS), also the revised July 2008, April 2008, January 2008, and October 2007 files. (CR6175)
• Medicare Coverage of Artificial Hearts- This article was revised on September 11, 2008, to reflect changes made to CR6185. The CR was changed to revise the implementation date to December 1, 2008. In addition, the transmittal numbers, CR release date, and the Web addresses for accessing CR6185 were revised. All other information remains the same. (CR6185)
• This informs providers, Medicare carriers, and A/B MACs of new waived tests approved by the Food and Drug Administration (FDA) under the Clinical Laboratory Improvement Amendments of 1988 (CLIA.) (CR6179)
• This article is based on CR 6093 and outlines the need to use NPIs to identify secondary providers in Medicare claims beginning May 23, 2008. (CR6093)

11 Sept 2008

• Medicare has issued a national coverage determination (NCD) (effective on May 1, 2008), that establishes limited coverage for artificial hearts when implanted in patients enrolled in Medicare-approved clinical studies meeting all of the Coverage with Evidence Development (CED) criteria. (CR6185)
• Pneumococcal Pneumonia, Influenza Virus, and Hepatitis B Vaccines - This article notifies providers that the Centers for Medicare & Medicaid Services (CMS) revised Form CMS-1500 to accommodate the reporting of the National Provider Identifier (NPI). The current Form CMS 1500 (08-05) does not require reporting the NPI for influenza virus and pneumococcal vaccine claims submitted as roster bills. Therefore your Medicare contractor should NOT return claims as unprocessable to the supplier/provider of service when the rendering provider does not enter his/her NPI into 24J of Form CMS-1500 for influenza virus and pneumococcal vaccine claims submitted as roster bills. (CR6079)
• Revised Form CMS-R-131 Advance Beneficiary Notice of Noncoverage- CR 6136, This article announces that, effective March 3, 2008, the Centers for Medicare & Medicaid Services (CMS) implemented use of the revised Advance Beneficiary Notice of Noncoverage (ABN); which combines the general Advance Beneficiary Notice (ABN-G) and laboratory Advance Beneficiary Notice (ABN-L) into a single form, with form number (CMS R-131).
  You should be aware that beginning March 3, 2008 and prior to March 1, 2009, your contractors will accept either the current ABN-G and ABN-L or the revised ABN as valid notification. However, beginning March 1, 2009, Medicare contractors will accept only a properly executed revised ABN (CMS R-131) as valid notification. (CR6136)
• Clinical Laboratory Fee Schedule—Medicare Travel Allowance Fees for Collection of Specimens- This article is based on Change Request (CR) 6195, which revises and clarifies payment of travel allowances that are based on either a per mileage basis (P9603) or on a flat rate basis (P9604) for calendar year (CY) 2008. The new rates are $1.035 per mile (P9603) and $9.55 per flat-rate trip (P9604). (CR6195)
• Beneficiary Submitted Claims: This article updates the procedures for processing claims submitted by Medicare beneficiaries to carriers and/or A/B MACs and serves as a reminder to providers and suppliers that they are required by law to submit claims to Medicare for services they render to Medicare beneficiaries. These updates do not apply to beneficiary claims submitted to Durable Medical Equipment (DME) MACs. (CR 5683)
• Indicator for the Technical Component of Purchased Diagnostic Services:This article is based on Change Request (CR) 6122 which provides instructions to your carrier or AB MAC on how to process claims for diagnostic services when there is no entry (either an indication in Block 20 of the CMS-1500 form or a claim or line level PS1 segment on the 837P X12 4010A1 electronic format) on the claim to indicate that whether the diagnostic services were purchased. (CR6122)

4 Sept 2008

• The Centers for Medicare & Medicaid Services (CMS) is continuing its national non-coverage policy for the off-label indications of fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) imaging for chronic osteomyelitis, infection of hip arthroplasty, and fever of unknown origin. (CR6099)
• This article for Physician Signature Requirements for Diagnostic Tests, updates the Medicare Benefit Policy Manual, Chapter 15 (Covered Medical and Other Health Services), Section 80 (Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests) Subsection 80.6.1 (Definitions); to incorporate language previously contained in Section 15021 of the Medicare Carriers Manual, but inadvertently omitted when the Medicare Benefit Policy Manual was published. (CR6100)
• 2009 Annual Update for the Health Professional Shortage Area (HPSA) Bonus Payments: this article provides your carriers, FIs, and A/B MACs with the names of the test and final files for the Health Professional Shortage Area (HPSA) bonus payments for 2009 and alerts providers that the 2009 file will be posted to the Centers for Medicare & Medicaid Services (CMS) website when it is available.(CR6150)
• Continuous Positive Airway Pressure (CPAP) Therapy for Obstructive Sleep Apnea (OSA). This article was revised on September 2, 2008, to reflect changes to CR 6048, which CMS revised on August 28, 2008. The CR release date, transmittal number, and the Web address for accessing CR6048 were revised. In addition, some language in item 3 on page 3 was clarified. All other information remains the same. (CR6048)

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07/02/2009