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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).
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September
July
2 July 2009
June
25 June 2009
- Revised: July 2009 Update to the Ambulatory Surgical Center (ASC) Payment System; Summary of Payment Policy Changes (CR6496)
- Crossover Claims Impacted by Common Working File (CWF)
Southeast Host Site Problem
JSM/TDL-09333
The Centers for Medicare & Medicaid Services (CMS) is alerting all providers, physicians, and suppliers to a problem that occurred during the timeframe of May 26-28, 2009, and would have negatively impacted their patients’ crossover claims. On the indicated dates, Medicare contractors that utilize the Common Working File (CWF) Southeast host site for paid claims authorization for their beneficiaries who primarily reside, or until recently resided, in Alabama, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee, the United States Virgin Islands, and Puerto Rico did not receive the customary confirmation from their host site that various claims were selected for crossover. The identified problem, which arose as part of the second CWF contractor transition, would have inhibited the crossing over of claims billed to Part A and Part B Medicare administrative contractors, carriers, fiscal intermediaries, and durable medical equipment Medicare administrative contractors roughly during the timeframe of May 22-25, 2009, inclusive.
The CMS regrets the negative impact that the aforementioned Southeast CWF host site transition problem has caused and recommends that individual providers, physicians, and suppliers take the following action: Examine your remittance advice or standard paper remittance advice to determine if your patients’ claims are identified as having been crossed over to your patients’ supplemental insurers. If you determine these claims were not crossed over, you are within your rights to submit claims to your patients’ insurers for supplemental payment using methodologies acceptable to those entities.
Questions concerning this broadcast may be directed to your local Medicare contractor’s Provider Relations Call Center.
11 June 2009
- New Waived Tests (CR6459)
- July Quarterly Update for 2009 for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) (CR6511)
- Manual Update to Include Billing Instructions for Professional Component (PC) and Technical Component (TC) in Regards to One Line Global Billing for Pathology Services. (CR6457)
- New Drug/Biological Health Care Procedure Code System (HCPCS) Codes for July 2009 Update (CR6477)
- Crossover Claims Impacted by Common Working File (CWF) Pacific Host Site Problem (JSM/TDL- 09321) Revised June 11, 2009
“The Centers for Medicare & Medicaid Services (CMS) is alerting all providers, physicians, and suppliers to a problem that occurred on May 4, 2009, and would have negatively impacted their patients’ crossover claims. On May 4, 2009, Medicare contractors that utilize the Common Working File (CWF) Pacific Host Site for paid claims authorization for their beneficiaries who primarily reside, or until recently resided, in Arizona, California, Hawaii, and Nevada did not receive the customary confirmation from their host site that various claims were selected for crossover. The identified problem inhibiting the crossing over of claims was limited to the CWF Pacific Host’s payment authorization process on May 4, 2009, and most likely would have impacted those claims billed to Part A and Part B Medicare Administrative Contractors (A/B MACs), carriers, fiscal intermediaries, and Durable Medical Equipment Medicare Administrative Contractors (DME MACs) around April 30 or May 1, 2009. The CMS volume estimates in terms of impacted claims are as follows: approximately 78,700 Part B physician claims; over 10,000 institutional claims; and an undetermined number of DME MAC claims (claims for durable medical equipment, prosthetics, orthotics, and medical supplies).
Providers, physicians, and suppliers should note that, as aforementioned, not all claims sent to the CWF Pacific Host Site on May 4, 2009, encountered crossover problems. Therefore, CMS’ recommendation to individual providers, physicians, and suppliers is as follows: Examine your electronic remittance advice or standard paper remittance advice to determine if your patients’ claims are identified as having been crossed over to your patients’ supplemental insurers. If you determine these claims were not crossed over, you are within your rights to submit claims to your patients’ insurers for supplemental payment using methodologies acceptable to those entities.”
04 June 2009
May
28 May 2009
21 May 2009
15 May 2009
14 May 2009
-
Requirements for Specialty Codes
This article is informational only and alerts providers that the Centers for
Medicare & Medicaid Services (CMS) is to revising the Medicare Claims Processing Manual,
Chapter 26, Section 10.8 in order to clarify the criteria CMS considers when reviewing
Medicare physician/non-physician practitioner specialty code requests. (CR6303)
-
Training Medicare Patients on Use of Home Glucose Monitors and Related Billing Information
This Special Edition article is being provided to help clarify the physician’s role
in prescribing and/or providing blood glucose self-testing equipment and supplies and diabetes
self-management training (DSMT) covered for Medicare Beneficiaries with diabetes. The article
reminds providers and suppliers about who may bill for DSMT and gives an overview of this benefit.
(SE0905)
-
Mandatory Claims Submission and its Enforcement
The Social Security Act (Section 1848(g)(4)) requires that claims be submitted for all
Medicare patients for services rendered on or after September 1, 1990. This requirement applies to
all physicians and suppliers who provide covered services to Medicare beneficiaries, and the
requirement to submit Medicare claims does not mean physicians or suppliers must accept assignment.
(SE0908)
-
Modification of the Common Working File (CWF) Copybook to Transmit “WC” Qualifier Alpha Codes to
Various Systems. (supplement to CR 5371)
This article is based on Change Request (CR) 6438 and is informational only for
providers. In order to prevent Medicare’s paying primarily for future medical expenses that
should be covered by workers’ compensation Medicare set-aside arrangements (WCMSA), a prior
instruction from Medicare, CR 5371, provided your Medicare contractors with instructions on
the creation of a new Medicare Secondary Payer (MSP) code in Medicare’s claims processing systems.
With the creation of the new MSP code, the Centers for Medicare & Medicaid Services (CMS) has the
capability to discontinue conditional payments for diagnosis codes related to WCMSA settlements.
(CR6438)
-
Processing and Payment of Physician and Non-Physician Practitioner Services Reassigned to Ambulatory
Surgical Centers (ASCs)
This article instructs Medicare Contractors to modify their systems to correctly accept,
process, and provide payment for physician and non-physician practitioner services reassigned to
Ambulatory Surgical Centers (ASCs). (CR6358)
-
Clarification about the Medical Privacy of Protected Health Information.
Note: This article was revised on May 11, 2009, to reflect updated
Web addresses for several products referenced in the article. (SE0726)
-
Medicare Claims Processing Manual Clarifications for Skilled Nursing Facility (SNF) and Therapy Billing
Note: This article was revised on May 11, 2009, to reflect a revised
CR6407 issued by the Centers for Medicare & Medicaid Services on May 8, 2009. The CR release date,
transmittal number, and the Web address for accessing CR 6407 were revised. All other information is
the same. (CR6407)
7 May 2009
-
Expansion of the Current Scope of Editing for Ordering/Referring Providers for claims
processed by Medicare Carriers and Part B Medicare Administrative Contractors (MACs)
This article announces that in order to comply with Social Security Act requirements,
the Centers for Medicare & Medicaid Services (CMS) is expanding claim editing to verify that the
ordering/referring provider on a claim is enrolled in Medicare and is eligible to order or refer
Medicare services. (CR6417)
-
Update to List of Medicare Telehealth Services
This article is based on Change Request (CR) 6458, which updates the list of Medicare
telehealth services to reflect the coding changes for ESRD-related services that took effect during
the 2009 Healthcare Procedural Coding System (HCPCS) update. (CR6458)
-
Ensuring Only Clinical Trial Services Receive Fee-for-Service (FFS) Payment on Claims Billed for
Managed Care Beneficiaries This article provides additional clarification about billing and processing claims for
outpatient clinical trial services to managed care enrollees.
For beneficiaries enrolled in a managed care plan, institutional providers, like hospitals, must not bill
outpatient clinical trial services and non-clinical trial services on the same claim. If covered outpatient
services unrelated to the clinical trial are rendered during the same day/stay for a Medicare managed care
patient, the provider must ONLY bill the clinical trial services to Medicare to be processed as though the
services were rendered to a Medicare fee-for-service (FFS) patient. (This allows the Medicare claims
processing system to pay for the services on a FFS basis and to not apply deductible when the patient is
found to be in a managed care plan.) Any outpatient services unrelated to the clinical trial should be
billed to the managed care plan. Hospitals should ensure that their billing staffs are aware of this change.
(CR6455)
-
Billing Routine Costs of Clinical Trials
Note: This article was revised on April 30, 2009, to reflect a revised CR 6431, issued by
the Centers for Medicare & Medicaid Services (CMS) on April 29, 2009. The sentence near the top of
page 3 of the article, which read “Institutional providers should also note that they must not bill
outpatient clinical trial services and non-clinical trial services on the same claim for Medicare
beneficiaries enrolled in managed care plans.” was deleted. A similar sentence was deleted from CR
6431. All other information is the same. (CR6431)
April
30 Apr 2009
-
An Introductory Overview of the HIPAA 5010
The implementation of HIPAA 5010 presents substantial changes in the content
of the data that you submit with your claims as well as the data available to you in response
to your electronic inquiries. The implementation will require changes to the software, systems,
and perhaps procedures that you use for billing Medicare and other payers. So it is extremely
important that you are aware of these HIPAA changes and plan for their implementation. (SE0904)
-
Surgery for Diabetes National
Coverage Determination (NCD)
Providers are advised that the Centers for Medicare & Medicaid Services (CMS) has
developed the following NCD entitled Surgery for Diabetes: Effective for services performed on
and after February 12, 2009, CMS determines that open and laparoscopic Roux-en-Y gastric bypass
(RYGBP), laparoscopic adjustable gastric banding (LAGB), and open and laparoscopic biliopancreatic
diversion with duodenal switch (BPD/DS) in Medicare beneficiaries who have type 2 diabetes mellitus
(T2DM) and a body mass index (BMI) < 35 are not reasonable and necessary under section 1862(a)(1)(A)
of the Social Security Act, and therefore are not covered by Medicare. (CR 6419)
Note: This article was revised on May 5, 2009 to reflect a revised CR 6419,
which was issued by the Centers for Medicare & Medicaid Services on May 4, 2009.
-
Clarification on Provider
Information Required on Medicare Claims for Routine Foot Care Services
Note: This article was rescinded on April 22, 2009. Some of the information
needs to be changed to provide better clarity on these services. (SE0907)
-
Adding a New
Specialty
Code for Hospice and Palliative Care
The Centers for Medicare & Medicaid Services (CMS) will add a new physician specialty
code to categorize Hospice and Palliative Care. This new physician specialty code is 17. Medicare
physicians self-designate their Medicare physician specialty on the Medicare enrollment application
(CMS-855I) when they enroll in the Medicare program. Medicare specialty codes describe the
specific/unique types of medicine that physicians practice. Specialty codes are used by CMS for
programmatic and claims processing purposes. (CR6311)
-
Important
Information Regarding the Centers for Medicare & Medicaid Services (CMS) National Claims Crossover Process
Physicians, providers, and suppliers should note that this special edition article is to
request that they allow sufficient time for the Medicare crossover process before attempting to balance
bill their patients’ supplemental insurers and payers for amounts remaining after Medicare’s payment
determination on their submitted claims. (SE0909)
-
Speech-Language
Pathology Private Practice Payment Policy
This article announces that Medicare will begin paying for appropriate claims submitted by
enrolled speech-language pathologists for services provided in private practice on or after July 1, 2009.
See the Background section of this article for additional important details. (CR6381)
23 Apr 2009
- Incorporation of Physician Fee Schedule Regulatory Changes into Chapter 10 of the Program Integrity Manual (PIM). Note: This article was revised on April 16, 2009, to reflect a revision made to CR 6310. Specifically, the Centers for Medicare & Medicaid Services modified two requirements of CR6310. The specific change in this article is in the last bullet point under “Timeframes for reporting changes of information” on page 3. That bullet point was changed to show that an overpayment may be assessed. Previously, it stated an overpayment will be assessed. The CR release date, transmittal number, and the Web address for accessing the CR have also been revised. All other information remains the same. (CR 6310)
16 Apr 2009
-
Clarification on Provider Information Required on Medicare Claims for Routine
Foot Care Services
This article is for informational purposes only for providers billing
Medicare contractors (carriers or Part A/B Medicare Administrative Contractors (MACs))
for routine foot care services. It is an overview of existing policy and no change
in policy is being conveyed. (SE0907)
-
Billing Routine Costs of Clinical Trials
This article alerts providers that they should continue to report the
International Classification of Diseases diagnosis code V70.7 (Examination of
participant in clinical trial) on clinical trial claims. It is no longer necessary
to make a distinction between a diagnostic and therapeutic clinical trial service
on the claim. (CR6431)
02 Apr 2009
-
Medicare Claims Processing Manual Clarifications for Skilled Nursing Facility (SNF) and Therapy Billing
This article provides clarifications and updates to the Medicare Claims Processing Manual,
Chapter 5 (Part B Outpatient Rehabilitation Billing), Section 20 (HCPCS Coding Requirements). These
clarifications indicate that effective January 1, 2009, the new Current Procedural Terminology (CPT)
code 95992 (Canalith repositioning procedure(s) (eg Epley maneuver, Semont maneuver), per Day) is bundled
under the Medicare Physician Fee Schedule (MPFS). (CR6407)
-
Instructions for Utilizing 837 Professional Claim Adjustment Segments (CAS) for Medicare Secondary Payer
(MSP) Part B Claims
(This CR rescinds and fully replaces CR6211) This article informs Medicare contractors about
the changes necessary to derive Medicare Secondary Payer (MSP) payment calculations from incoming 837
4010-A1 claims transactions. (CR6427)
-
J14 Part A and Part B Medicare Administrative Contractor (A/B MAC) New Workload Numbers for the States of
Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont
CMS needs to change the contractor workload numbers for the Part A and Part B workloads in the
States of Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont when that workload is transitioned
to the J14 A/B MAC. These changes need to be made because certain CMS applications need to individually
identify each workload. (CR6406)
- A new educational article has been published for
J14 Part A and Part B Medicare Administrative Contractor New Workload Numbers. (CR6406)
01 Apr 2009
- Provider Notification Instructions: Temporary Holding of all Diabetes Self
Management Training (DSMT) Claims (JSM/TDL-09228) - Note: JSM/TDL-09228 is rescinded and will
not be replaced at this time.
March
26 Mar 2009
-
2009 Physician Quality Reporting Initiative (PQRI) And The 2009 Electronic Prescribing (E-Prescribing)
Incentive Program
This article is based on Change Request (CR) 6394, which gives high-level overviews of the
2009 PQRI implementation and the new 2009 E-Prescribing Incentive Program implementation. Make sure that
your billing staffs are aware of the PQRI reporting changes and the E-Prescribing Incentive Program.
(CR6394)
-
Incorporation of Physician Fee Schedule Regulatory Changes into Chapter 10 of the Program Integrity Manual
(PIM)
This Change Request implements regulatory changes found in the CY 2009 Medicare
Physician Fee Schedule final rule with comment. (CR 6310)
-
April 2009 Update to the Ambulatory Surgical Center (ASC) Payment System; Summary of Payment Policy
Changes/Manual Revisions
This article is based on Change Request (CR) 6424 which describes changes to, and billing
instructions for, payment policies implemented in the April 2009 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 Healthcare Common Procedure Coding System (HCPCS) codes for
drugs and biologicals. Be sure your billing staff is aware of these changes. Be sure billing staff
know of these changes. (CR6424)
- Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Supplier Accreditation. Note: This article was revised on March 19, 2009, to change the Web links that were not working on pages 3 and 7. All other information is unchanged.(SE0903)
- New Common Working File (CWF) Medicare Secondary Payer (MSP) Type for Workers' Compensation Medicare Set-aside Arrangements (WCMSAs), to Stop Conditional Payments. Note: This article was revised on March 20, 2009, to reflect a revised transmittal related to CR 5371. The CR was changed to clarify some of the requirements. The CR release date, transmittal numbers (see above), and the Web address for accessing that transmittal were changed. All other information remains the same. (CR5371)
19 Mar 2009
-
Healthcare Provider Taxonomy Codes:
Healthcare Provider Taxonomy Codes (HPTC)
have been updated and are scheduled to be implemented with the April 2009 Release. The HPTC
list is available from the Washington Publishing Company (WPC) in two forms. The first form
is a free Adobe PDF download. The second form, available for purchase, is an electronic
representation of the code set that facilitates automatic loading. (CR 6382)
-
Heartsbreath Test for Heart Transplant Rejection
Note: This article was revised on March 12, 2009, to reflect a revised
transmittal related to CR 6366. The CR release date, transmittal number (see above), and the Web address
for accessing that transmittal were changed. All other information remains the same. (CR6366)
-
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Supplier Accreditation
DMEPOS (durable medical equipment, prosthetics, orthotics and supplies) providers and
suppliers enrolled in the Medicare Part B program are required to obtain accreditation by
September 30, 2009. (SE0903)
- Quarterly Update to
Correct Coding Initiative (CCI) Edits, Version 15.1, Effective April 1, 2009.
This article provides a reminder for physicians to take note of the quarterly updates
to Correct Coding Initiative (CCI) edits. The last quarterly release of the edit module was issued
in January 2009. (CR6388)
- Revision of the
Hospice Wage Index and the Hospice Pricer for FY 2009.
This article revises the Fiscal Year (FY) 2009 hospice wage index to include a full budget
neutrality adjustment factor (BNAF). (CR6418)
- April 2009
Integrated Outpatient Code Editor (I/OCE) Specifications Version 10.1.
This article describes changes to the Integrated Outpatient Code Editor. Be sure billing staffs
are aware of these changes. (CR6413)
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)
back to top
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
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
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29 Jan 2009
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
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
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November
26 Nov 2008
20 Nov 2008
13 Nov 2008
06 Nov 2008
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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
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