|
|
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).
September |
August |
July |
June |
May |
April |
March
September
02 September 2010
August
26 August 2010
19 August 2010
12 August 2010
5 August 2010
July
29 July 2010
22 July 2010
15 July 2010
08 July 2010
01 July 2010
June
24 June 2010
17 June 2010
14 June 2010
- The 2010 Medicare Physician Fee Schedule
CMS Message 201006-15
The Continuing Extension Act of 2010, enacted on April 15, 2010, extended the zero percent (0%) update to the 2010 Medicare Physician Fee Schedule (MPFS) through May 31, 2010. At this time, Congress is debating the elimination of the negative update that took effect June 1, 2010. The Centers for Medicare & Medicaid Services (CMS) is hopeful that Congressional action will be taken within the next several days to avert the negative update.
To avoid disruption in the delivery of health care services to beneficiaries and payment of claims for physicians, non-physician practitioners, and other providers paid under the MPFS, CMS had instructed its contractors on May 27th to hold claims for services paid under the MPFS for the first 10 business days of June (i.e., through June 14, 2010). This hold only affects MPFS claims with dates of service of June 1, 2010, and later.
Given the possibility of Congressional action in the very near future, CMS is now directing its contractors to continue holding June 1 and later claims through Thursday, June 17, lifting the hold on Friday, June 18.
This action will facilitate accurate claims processing at the outset and minimize the need for claims reprocessing if Congressional action changes the negative update. It also should minimize the provider and beneficiary burdens and costs associated with reprocessing claims.
We understand that the delayed processing of Medicare claims may present cash flow problems for some Medicare providers. However, we expect that the delay, if any, beyond the normal processing period will be only a few days. Be on the alert for more information regarding the 2010 Medicare Physician Fee Schedule Update.
10 June 2010
3 June 2010
May
27 May 2010
- MM6823 – Pulmonary Rehabilitation (PR) Services
- Revised: MM6786 – Screening for the Human Immunodeficiency Virus (HIV) Infection
- Updated Banking Transition
CMS Message 201005-31
The CMS recently awarded new banking contracts to U.S. Bank and JP Morgan Chase. Medicare providers do not have to take any action. However, providers should be aware that the Medicare payments may be made by a different bank than in the past because of these new banking contractors.
The following Medicare claims processing contractors will remain with JP Morgan Chase: Cahaba Government Benefit Administrators, Pinnacle Business Solutions, First Coast Service Options, Palmetto GBA (except for A/B MAC Jurisdiction 1) and Wisconsin Physician Service. Providers that bill to these contractors will not experience any change.
The following Medicare claims processing contractors will transition to JP Morgan Chase on August 2, 2010: Palmetto A/B MAC Jurisdiction 1 and Trailblazer.
The following contractors will transition to U.S. Bank on August 2, 2010, Noridian Administrative Services, CIGNA Government Services, Highmark Medicare Services, National Government Services, and NHIC.
- MM6809 – Quarterly Healthcare Common Procedure Coding System (HCPCS) Code Changes – July 2010 Update
- MM6972 – Extension for the Two Percent and Three Percent Add-On for the Ground Ambulance, Air Ambulance in Rural Areas and "Super Rural" Add-0n through December 31, 2010
- MM6850 – Cardiac Rehabilitation and Intensive Cardiac Rehabilitation
- Revised: MM6973 – Revised Payment Files for the 2010 Medicare Physician Fee Schedule Database (MPFSDB) and Retroactive Provisions under the Patient Protection and Affordable Care Act (Pub. L. 111-148) (the Affordable Care Act)
- MM6930 – Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 16.2, effective July 1, 2010
20 May 2010
- MM6973 – Revised Payment Files for the 2010 Medicare Physician Fee Schedule Database (MPFSDB) and Retroactive Provisions under the Patient Protection and Affordable Care Act (Pub. L. 111-148) (the Affordable Care Act)
- MM6945 – July Quarterly Update for 2010 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule
- Important Message Regarding Medicare's Implementation of the Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act of 2010
CMS Message 201005-24
On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act. One week later, on March 30, the President also signed into law the Health Care and Education Reconciliation Act of 2010. These two new laws have a significant impact on the Medicare program and many of the provisions have effective dates prior to this point in time. Over the past several weeks, the Centers for Medicare & Medicaid Services (CMS) has begun implementing various provisions of the new laws, including those with past effective dates. In addition to implementing these legislative changes, the Medicare Physician Fee Schedule is being updated to include certain corrections, retroactive to January 1, 2010, as prescribed in recently published notices in the Federal Register.
Once Medicare contractors have the new payment files in place, per the above, all claims going forward will be processed at the revised rates. However, we continue to work on the best way to address the many claims that are paid at the rates that were in place before the current corrections and updates are made. Please be on the alert for further information about how CMS will address past claims. Until then, providers should NOT resubmit previously-processed claims affected by the payment changes, as it is likely that these resubmissions may be denied as duplicate claims.
- Additional Intern and Resident Information System Codes
JSM/TDL 10278
This message is to make you aware of recent updates to the Intern and Resident Information System (IRIS) software programs (IRISV3 and IRISEDV3) used by teaching hospitals and the provider community for collecting and reporting information on resident training in hospital and nonhospital settings:
Four new IRIS residency type codes were added to the IRIS Residency Code Table. In addition, two new IRIS medical school codes were added to the IRIS Medical School Code Table. Providers may start using these codes in the IRISV3 program for cost reporting periods ending on or after December 31, 2009. You may download these programs by going to http://www.cms.gov/IRIS.
- SE1016 – Re-Assignment of Certain Providers to Jurisdiction 1 and Jurisdiction 4 Medicare Administrative Contractors (MACs)
- MM6949 - Ambulance Services - Updating the Medicare Benefit Policy Manual Chapter 10, Section 10.5 to Include Ambulance Transports with Joint Responses
- MM6954 - Clinical Review Judgment
- MM6786 – Screening for the Human Immunodeficiency Virus (HIV) Infection
- MM6914 – Addition of Repair Codes to the List of Healthcare Common Procedure Coding System (HCPCS) Codes Payable Under the Instructions Provided in Change Requests (CRs) 6573 and 5917
13 May 2010
06 May 2010
April
29 April 2010
22 April 2010
15 April 2010
8 April 2010
- SE1011 – Edits on the Ordering/Referring Providers in Medicare Part B Claims (Change Requests 6417, 6421, and 6696)
- MM6696 – Ordering/Referring Providers Who Are Not Enrolled in Medicare
- Revised: MM6417 – Expansion of the Current Scope of Editing for Ordering/Referring Providers for claims processed by Medicare Carriers and Part B Medicare Administrative Contractors (MACs)
- Revised: MM6421 – Expansion of the Current Scope of Editing for Ordering/Referring Providers for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers' Claims Processed by Durable Medical Equipment Medicare Administrative Contractors (DME MACs)
- Extension of Ambulance Add-Ons for Ambulance Services
(JSM/TDL 10217) (CMS Message 201004-10)
On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA). PPACA Sections 3105 and 10311 impact certain ambulance payment provisions. It should be noted that PPACA Section 3105 establishes the implementation date as April 1, 2010. PPACA Section 10311 revises Section 3105 and changes the implementation date retroactive to January 1, 2010.
The PPACA extends increases in the ambulance fee schedule amounts for covered ground ambulance transports which originated in rural areas by 3 percent and for covered ground ambulance transports which originated in urban areas by 2 percent retroactive to January 1, 2010, through December 31, 2010. The new law similarly extends the provision for air ambulance services provided in any area that was designated as a rural area for purposes of making payments under the ambulance fee schedule for services furnished on December 31, 2006. Finally, the PPACA extends retroactive to January 1, 2010, and through December 31, 2010, Section 414 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 which established the super rural bonus.
The Centers for Medicare & Medicaid Services is working to expeditiously implement these three ambulance provisions of the PPACA. Be on the alert for more information about these ambulance provisions and their impact on your past and future claims. Further, be on the alert for more information pertaining to the Patient Protection and Affordable Care Act.
6 April 2010
- Banking Transition
(JSM/TDL 10162)
The CMS recently awarded new banking contracts to U.S. Bank and JP Morgan Chase. Medicare providers do not have to take any action. However, providers should be aware that the Medicare payments may be made by a different bank than in the past because of these new banking contractors.
The following Medicare claims processing contractors will remain with JP Morgan Chase: Cahaba Government Benefit Administrators, Pinnacle Business Solutions, First Coast Service Options, Palmetto GBA (except for A/B MAC Jurisdiction 1) and Wisconsin Physician Service. Providers that bill to these contractors will not experience any change.
The following Medicare claims processing contractors will transition to JP Morgan Chase on June 1, 2010: Palmetto A/B MAC Jurisdiction 1 and Trailblazer.
The following contractors will transition to U.S. Bank on June 1, 2010, CIGNA Government Services, Highmark Medicare Services, National Government Services, NHIC and Noridian Administrative Services.
1 April 2010
- MM6852 – Clinical Laboratory Fee Schedule (CLFS) - Special Instructions for Specific Test Codes (CPT Code 80100, CPT Code 80101, CPT Code 80101QW, G0430, G0430QW, and G0431QW)
- MM6864 – Clinical Laboratory Fee Schedule (CLFS) - Medicare Travel Allowance Fees for Collection of Specimens
- MM6807 – Change in Provider Enrollment Timeliness Standards for Certain Paper Applications
- Revised: MM6775 – Outpatient Intravenous Insulin Treatment (Therapy)
- Revised: MM6005 – Comprehensive Outpatient Rehabilitation Facility Manual
- Revised: MM6683 – Validating the Billing of End Stage Renal Disease (ESRD) 50/50 Rule Modifier
- MM6867: Update to List of ICD-9-CM Diagnosis Codes Not Requiring the Q0 Healthcare Common Procedure Coding System (HCPCS) Modifier for Automatic Implantable Cardiac Defibrillator (ICD) Services Provided in a Clinical Study
- MM6861 - Positron Emission Tomography (PET) (NaF-18) to Identify Bone Metastasis of Cancer
- MM6859 - Claim Status Category Code and Claim Status Code Update
- The Patient Protection and Affordable Care Act (PPACA)
(JSM10207) (Message 201003-54)
On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA). The Centers for Medicare & Medicaid Services (CMS) is working hard to expeditiously implement the new law. The law's Medicare fee-for-service provisions have varying effective dates and our first priority is to address provisions with the earliest effective dates. CMS is committed to assuring Medicare providers are well informed as early as possible. For that reason, CMS is urging you to be on the alert for notices and instructions from CMS and from your Medicare fiscal intermediary, carrier, or Medicare Administrative Contractor, on forthcoming policy and operational changes as we implement the PPACA.
- Timely Filing Requirements for Medicare Fee-For-Service Claims
(JSM/TDL-10214) (Message 201004-02)
On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA), which amended the time period for filing Medicare fee-for-service (FFS) claims as one of many provisions aimed at curbing fraud, waste, and abuse in the Medicare program.
The time period for filing Medicare FFS claims is specified in Sections 1814(a), 1835(a)(1), and 1842(b)(3) of the Social Security Act and in the Code of Federal Regulations (CFR), 42 CFR Section 424.44. Section 6404 of the PPACA amended the timely filing requirements to reduce the maximum time period for submission of all Medicare FFS claims to one calendar year after the date of service.
Under the new law, claims for services furnished on or after January 1, 2010, must be filed within one calendar year after the date of service. In addition, Section 6404 mandates that claims for services furnished before January 1, 2010, must be filed no later than December 31, 2010. The following rules apply to claims with dates of service prior to January 1, 2010. Claims with dates of service before October 1, 2009, must follow the pre-PPACA timely filing rules. Claims with dates of service October 1, 2009, through December 31, 2009, must be submitted by December 31, 2010.
Section 6404 of the PPACA also permits the Secretary to make certain exceptions to the one-year filing deadline. At this time, no exceptions have been established. However, proposals for exceptions will be specified in future proposed rulemaking.
Please be on the alert for more information pertaining to the Patient Protection and Affordable Care Act.
March
29 March 2010
- Holding of April Claims for Services Paid Under the 2010 Medicare Physician Fee Schedule
(CMS Message 201003-46)
Information Regarding the Holding of April Claims for Services Paid Under the
2010 Medicare Physician Fee Schedule (3-26-2010)
The Centers for Medicare & Medicaid Services (CMS) is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, non-physician practitioners, and other providers of services paid under the Medicare Physician Fee Schedule (MPFS). As you are aware, the Temporary Extension Act of 2010, enacted on March 2, 2010, extended the zero percent (0%) update to the 2010 MPFS through March 31, 2010.
CMS believes Congress is working to avert the negative update that will take effect April 1. Consequently, CMS has instructed its contractors to hold claims containing services paid under the MPFS (including anesthesia services) for the first 10 business days of April. This hold will only affect claims with dates of service April 1, 2010, and forward. In addition, the hold should have minimum impact on provider cash flow because, under the current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt.
Be on the alert for more information about the 2010 Medicare Physician Fee Schedule Update.
25 March 2010
- Reissued: Change Request 6712 - (CR6712) Medically Unlikely Edits.
This CR provides updates and clarifications to MUE requirements established in 2006. For more information, the Centers for Medicare & Medicaid Services has issued the following transmittal at: http://www.cms.hhs.gov/transmittals/downloads/R617OTN.pdf
- Healthcare Provider Taxonomy Codes (HPTC) Update April 2010
The HPTC set is maintained by the National Uniform Claim Committee (NUCC) for standardized classification of health care providers. The NUCC updates the code set twice a year with changes effective April 1 and October 1. The HPTC list is posted to the NUCC Web site at www.nucc.org/taxonomy. The PDF download of the codes is available from the NUCC site at www.nucc.org/index.php?option=com_content&task=view&id=91&Itemid=53.
The changes to the code set include the addition of a new code and addition of definitions to existing codes. When reviewing the Health Care Provider Taxonomy code set online, revisions made since the last release can be identified by the color code; new items are green, modified items are orange, and inactive items are red.
Reference: CMS CR6840 www.cms.hhs.gov/transmittals/downloads/R1896CP.pdf
18 March 2010
11 March 2010
09/02/2010
|
|
