NHIC What's New

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).

October

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)

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)

August

27 Aug 2008

Reporting Withholding Due to IRS Federal Payment Levy Program (FPLP) on the Remittance Advice. This article was revised on August 21, 2008, to clarify the “Provider Types Affected”. All other information remains the same. (CR6125)
October Update to the 2008 Medicare Physician Fee Schedule Database (MPFSDB). Payment files were issued to contractors based upon the 2008 Medicare Physician Fee Schedule Final Rule. Implementation date is October 6, 2008. This article provides the changes for the payment files. (CR6180)

21 Aug 2008

The latest update of Remittance Advice Remark Codes (RARC) used in electronic and paper remittance advice, and Claim Adjustment Reason Codes (CARC) used in electronic and paper remittance advice and coordination of benefits (COB) claim transactions. These changes will be effective October 1, 2008. (CR6109)
This article is based on Change Request (CR) 6158, which provides notice that there will be a Part B CAP Quarterly Drug List Update effective October 1, 2008. When available, the October 2008 list of drugs supplied under the CAP will be posted at the CMS website.
Reporting Withholding Due to IRS Federal Payment Levy Program (FPLP) on the Remittance Advice. This article informs you that your Medicare payments could be reduced if the Internal Revenue Service (IRS) needs to collect overdue taxes that you owe. (CR6125)
CMS instructs FIs, A/B MACs, RHHIs, and DME MACs (effective January 1, 2009) to use the new Claim Adjustment Reason Code (CARC) #213 when denying claims based on non-compliance with the physician self-referral prohibition. Make sure that your billing staffs are aware of this new CARC code. (CR6131)
CR6124, Effective with claims processed on or after January 5, 2009, revises Medicare systems to allow individual Competitive Acquisition Program (CAP) claims with different prescription order numbers to not be denied as duplicate claims though they are for the same patient, contain the same date of service, and contain the same Healthcare Common Procedure Coding System (HCPCS) drug code. This will also apply to an individual CAP claim that contains multiple lines that appear to be duplicates except for different prescription order numbers. (CR6124)
This article reminds the Medicare physician community of the requirements to correctly enroll in order to conduct Mass Immunization Roster Billing and Centralized Billing of Medicare for influenza and pneumococcal immunizations. (CR6121)
Medicare Contractor Interactive Voice Response (IVR) Systems, effective January 1, 2009- This article was revised on August 13, 2008, to change the title to more accurately reflect the Change Request requirements. Additionally, changes were made to further clarify the authentication requirements. In particular, the note on page 2 was changed to show that you will only be allowed three attempts to correctly provide your NPI, PTAN, AND last 5-digits of your TIN. (CR 6139)

14 Aug 2008

This article indicates a new requirement for Ordering/Referring Information on Ambulatory Surgical Center (ASC) Claims for Diagnostic Services. (CR 6129)
This article indicates implementation of new provider authentication requirements for Medicare Contractor Interactive Voice Response (IVR) Systems, effective January 1, 2009. (CR 6139)
This article for Screening DNA Stool Test for Colorectal Cancer was revised on August 11, 2008, to reflect changes made to the transmittal number, release date, and Web address for accessing the NCD. (CR6145)

07 Aug 2008

This article reminds the Medicare contractors and providers that the annual ICD-9-CM update will be effective for dates of service on and after October 1, 2008. (CR 6107)
Medicare Cost Report (MCR) data play a central role in the development of the input price indexes (market baskets) used to update PPS payments. Similarly, they are essential in evaluating Medicare payment adequacy. It is crucial that Medicare providers fill out these reports with complete and valid data. (CR 6132)
This document is directed to individual eligible professionals who reported 2007 PQRI quality measures data to Medicare and will access their reports personally. (SE0830)
Here are the steps for organizations to access their 2007 Physician Quality Reporting Initiative (PQRI) feedback reports. (SE0831)
This article has again been revised: the definition of critical care services how to correctly bill for these services, and the revision to the Medicare Claims Processing Manual Chapter 12, Section 30.6.12. (Critical Care Visits and Neonatal Intensive Care (Codes 99291 - 99292)). (CR 5993)
This article has been revised: Individuals Authorized Access to CMS Computer Services (IACS) - Provider/Supplier Community (IACS-PC);THE FIRST IN A SERIES OF ARTICLES (SE0747)
This article has been revised: Individuals Authorized Access to CMS Computer Services - Provider Community (IACS-PC): THE SECOND IN A SERIES OF ARTICLES ON THE IACS (SE0753)
This article has been revised: Individuals Authorized Access to CMS Computer Services – Provider/Supplier Community (IACS-PC): THE THIRD IN A SERIES OF ARTICLES ON THE IACS-PC (SE0754)

July

31 July 2008

Qualifying independent laboratories may continue to bill Medicare directly for the TC of certain physician pathology services provided to patients as part of a covered hospital inpatient stay or outpatient hospital service, through December 31, 2009 regardless of the beneficiary’s hospitalization status. (CR 6042)
Prothrombin Time (PT/INR) monitoring for home anticoagulation management. (CR 6138)
This article is informational only and reminds providers that the Centers for Medicare & Medicaid Services (CMS) no longer issues, updates, or uses the Unique Physician Identification Number (UPIN) in claims processing. (CR 6036)
CMS will not expand the colorectal cancer screening benefit to include coverage of PreGen-Plus™, a commercially available screening DNA stool test; because the FDA determines that this test requires pre-market review and approval. (CR 6145)
This 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. (CR 5683)
This special edition article is being provided to explain Medicare’s guidelines for payment of Part B mental health services. (SE0816)
This notice is to provide guidance to providers/suppliers and Medicare contractors on the use of stamped signatures. Note that stamped signatures are not acceptable on any medical record. (SE0829)
This article has been revised: Effective for claims with dates of service on and after March 13, 2008, Medicare will allow for coverage of Continuous Positive Airway Pressure (CPAP) therapy based upon a positive diagnosis of Obstructive Sleep Apnea (OSA) by home sleep testing (HST). (CR 6048).
April 2008 update to the Medicare Code Editor (MCE) and Grouper. (CR 5876)

24 July 2008

Revision to Skilled Nursing Facility (SNF) Common Working File (CWF) Editing (CR 6128)
This article alerts Audiologists who are not currently enrolled to the fact that they are required to obtain their NPI and use it on claims for services they render on or after October 1, 2008. (CR 6061)
Important Information on the New Medicare Law – The Medicare Improvements for Patients and Providers Act of 2008
This article contains a compilation of messages that were issued on July 16, 2008.(SE0826)
This article has been rescinded: SE0815 – Reminder that Exceptions to Therapy Caps are Restricted as of July 1, 2008
Effective July 24, 2008 the Medicare interest rate for overpayments and underpayments has been changed to 11.125 percent. Historical Data available (CR 5751)
The Medicare Improvements for Patients and Providers Act of 2008 was enacted on July 15, 2008. This new law has delayed the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. As a result of this delay, the special accreditation deadlines previously established for the second round of the program have been cancelled. Specifically, prior to enactment of this new law, suppliers must have been accredited or have applied for accreditation by July 21, 2008 to be eligible to submit a bid for the second round of competitive bidding and must have obtained accreditation by January 14, 2009 to be eligible for a second round contract. Both of these deadlines have been cancelled and no longer apply. The deadline of September 30, 2009, that was previously established by which all DMEPOS suppliers must be accredited is still in effect. (CMS Message 200807-25)

18 July 2008

Change Request (CR) 6088 is being rescinded and will be replaced in the near future with another CR.

17 July 2008

Reinstatement of Moratorium That Allowed Independent Laboratories to Bill for the Technical Component of Physician Pathology Services (JSM/TDL 08413)
Extension of Therapy Cap Exceptions (JSM/TDL- 08411)
This article has been revised: the definition of critical care services, how to correctly bill for these services, and the revision to the Medicare Claims Processing Manual Chapter 12, Section 30.6.12. (Critical Care Visits and Neonatal Intensive Care (Codes 99291 - 99292)). (CR 5993)
New 2008 Medicare Physician Fee Schedule Payment Rates Effective for Dates of Service July 1, 2008 through December 31, 2008. (JSMTDL 08410)
CMS has reviewed the evidence and on May 12, 2008 posted a final decision memorandum following reconsideration of its National Coverage Determination (NCD) on PTA with intracranial stent placement at section 20.7.B.5 of the Medicare NCD Manual. CMS reaffirms its existing NCD with no changes, and will continue to cover PTA and stenting of intracranial arteries for the treatment of cerebral artery stenosis > 50 percent in patients with intracranial atherosclerotic disease when furnished in accordance with the Food and Drug Administration (FDA) approved protocols governing Category B Investigational Device Exemption (IDE) clinical trials. CMS will continue its national non-coverage for all other indications for PTA with or without stenting to treat obstructive lesions of the vertebral and cerebral arteries. (CR 6137)

10 July 2008

CMS publishes The Quarterly Provider Update on the first business day of each quarter. It is a listing of all non-regulatory changes to Medicare including Program Memoranda, manual changes, and any other instructions that could affect providers.
This article has been revised: CMS is taking steps to encourage physicians and other eligible professionals to participate in the Physician Quality Reporting Initiative (PQRI), a program designed to improve the quality of care provided to Medicare beneficiaries. This article announces the establishment of alternative reporting periods and alternative criteria for satisfactorily reporting quality measures for the 2008 PQRI. (CR 6104)
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 Continuous Positive Airway Pressure (CPAP) therapy based upon a positive diagnosis of Obstructive Sleep Apnea (OSA) by home sleep testing (HST). (CR 6048).

03 July 2008

Medicare contractors may continue to accept the 2006 Version of the CMS 855 for all providers and suppliers, except specialty hospitals, through September 2008; specialty hospitals are required to use the revised application immediately. The Centers for Medicare & Medicaid Services (CMS) has placed the revised enrollment applications on the CMS’ Provider Enrollment Web site at http://www.cms.hhs.gov/MedicareProviderSupEnroll. Please download and begin to submit the revised version of the Medicare enrollment applications. (JSM/TDL 08378)
This article notifies providers of the update by the Centers for Medicare & Medicaid Services (CMS) to Medicare Benefit Policy Manual about Private Contracting/Opting out of Medicare. (CR 6081). For the complete instructions, refer to Change Request 6081.
This article announces that CMS, upon review of the available evidence, has determined that the coverage of cardiac computed tomographic angiography (CTA) to diagnosis coronary artery disease (CAD) will remain at local Medicare contractor discretion, and no national coverage determination (NCD) is appropriate at this time. (CR 6098)
This article has been revised: Payment for Inpatient Hospital Visits - General (Codes 99221 – 99239) (CR 5792)
Changes to the Laboratory National Coverage Determination (NCD) Edit Software for July 2008 (CR 6084)
The exceptions to outpatient therapy caps expired on June 30, 2008. Outpatient therapy service providers should not submit claims with the KX modifier for services furnished on or after July 1, 2008. Additional Information. (JSMTDL 08387)
To the extent possible, 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 Fee-For-Service (FFS) providers of services paid under the Medicare physician fee schedule, beginning July 1. In this regard, CMS has instructed its contractors to hold these claims for the first 10 business days of July, for dates of service in July. Additional information. (CMS Message 200806-24)
These Questions and Answers apply to the recent decision by the Centers for Medicare & Medicare Services to hold claims paid under the Medicare physician fee schedule (MPFS) up to 10 business days that contain July 2008 dates of service. (JSMTDL 08389/CMS Message 200807-04)

June

26 June 2008

This article clarifies information on what elements are needed during a screening pelvic examination. (CR 6085)
This article reminds providers of the periodic updates to the Claim Status Codes and Claim Status Category Codes. (CR 6090)
This article informs Medicare contractors of new waived tests approved by the Food and Drug Administration (FDA) under Clinical Laboratory Improvement Amendments of 1988 (CLIA). (CR 6060)
This article provides the October quarterly update to the 2008 Healthcare Common Procedure Coding System (HCPCS) codes for Skilled Nursing Facility (SNF) consolidated billing (CB) enforcement. (CR 6111)
CMS is taking steps to encourage physicians and other eligible professionals to participate in the Physician Quality Reporting Initiative (PQRI), a program designed to improve the quality of care provided to Medicare beneficiaries. This article announces the establishment of alternative reporting periods and alternative criteria for satisfactorily reporting quality measures for the 2008 PQRI. (CR 6104)
This article describes changes to, and billing instructions for, payment policies implemented in the July 2008 ASC update. (CR 6095)

19 June 2008

This article serves as a reminder to health care professionals and their staff that Medicare pays for diabetes screening tests. To ensure proper reimbursement for these screening tests the correct procedure and diagnosis codes and modifier (when appropriate) must be used when filing claims. (SE0821)
This article informs Medicare providers that CMS wants providers to know that since Medicare Claims Processing Contracting reform is on-going, some of the Contractor/Carrier numbers included in the 2008 annual Ambulance Fee Schedule Public Use File (PUF) posted to the CMS website may be outdated. To ensure that the Contractor/Carrier numbers contained in the file are as accurate as possible, a quarterly update to the PUF file, containing new Contractor/Carrier numbers, will be posted to the CMS website. Change Request 6091 Instruction. (CR 6091)
Inappropriate Denials of Claims for Percutaneous Transluminal Angioplasty (PTA) of Carotid Arteries Concurrent with Stenting Based on Facility Recertification Due Dates (CR 6046)
This article has been revised: Chapter 36 (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program) has been added to the Medicare Claims Processing Manual. (CR 5978)
This article is the second installment of, and adds information to, Chapter 36 DMEPOS Competitive Bidding Program in the Medicare Claims Processing Manual. (CR 6119)
This article was revised on 6/11: Important Exceptions and Special Circumstances that Occur under the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. (SE0807)

12 June 2008

This article provides National Provider Identifier (NPI) instructions for institutional providers and suppliers billing for self-referred mammography services. (CR 6023)
This article has been revised: the quarterly update to the July 2008 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) fee schedules. (CR 6022)
This article explains the definition of critical care services, how to correctly bill for these services, and notes the revision to the Medicare Claims Processing Manual Chapter 12, Section 30.6.12. (Critical Care Visits and Neonatal Intensive Care (Codes 99291 - 99292)). (CR 5993)
This article instructs Medicare contractors to download and implement the July 2008 Average Sales Price (ASP) drug pricing file for Medicare Part B drugs; and if released by CMS, also the revised files. (CR 6049)
This article announces the changes that will be included in the July 2008 quarterly release of the edit module for clinical diagnostic laboratory services. (CR 6084)
The July Update to the 2008 Medicare Physician Fee Schedule Database is posted on the Fee Schedule page. (CR 6087)
This article has been revised: Effective July 1, 2008 there is an Update to the 2008 Medicare Physician Fee Schedule Database (MPFSDB). (CR 6087)
These articles have been revised again:
- Overview of New Medicare Competitive Bidding Program for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) (SE0805)
- Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program: Grandfathering, Repair and Replacement, Mail Order Diabetic Supplies and Advanced Beneficiary Notices (ABNs) (SE0806)

05 June 2008

This article has been rescinded: clarification of current Medicare policy regarding services provided as incident to the services of physicians or nonphysician practitioners (NPP) in the office. (CR 5288)
Effective July 1, 2008 there is an Update to the 2008 Medicare Physician Fee Schedule Database (MPFSDB). (CR 6087)
The Food and Drug Administration (FDA) has approved (effective July 1, 2008) waived tests under the Clinical Laboratory Improvement Amendments of 1988 (CLIA). (CR 6021)
This article provides notice that there will be a Part B CAP Quarterly Drug List Update effective July 1, 2008. (CR 6053)
This article alerts providers that the CMS revised the date of service policy for clinical laboratory tests and added the technical component of physician pathology service effective January 1, 2009. (CR 6018)
This article provides notice of updates and additions to language in the Medicare Claims Processing Manual relating to the ASP drug pricing and payment methodology. (CR 5798)
Chapter 36 (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program) has been added to the Medicare Claims Processing Manual. (CR 5978)
On or after July 1, 2008, the exceptions to therapy caps are restricted to those medically necessary services billed by the outpatient departments of hospitals. Use of the KX modifier will not be effective on or after July 1, 2008. (SE0815)
This article has been rescinded: Additional Information on Reporting a National Provider Identifier (NPI) for Ordering/Referring and Attending/Operating/Other/Service facility for Medicare Claims. (CR 5890)
This article has been revised again: Important Exceptions and Special Circumstances that Occur under the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. (SE0807)
This article clarifies payment of travel allowances, either on a per mileage basis (P9603) or on a flat rate basis (P9604) for Calendar Year (CY) 2008. (CR 5996)

May

29 May 2008

This article provides the quarterly update to the July 2008 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) fee schedules. (CR 6022)
This article provides a reminder for physicians to take note of the quarterly updates to Correct Coding Initiative (CCI) edits. (CR 6045)
These articles have been revised:
- Important Exceptions and Special Circumstances that Occur under the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. (SE0807)
- Overview of New Medicare Competitive Bidding Program for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) (SE0805)
- Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program: Grandfathering, Repair and Replacement, Mail Order Diabetic Supplies and Advanced Beneficiary Notices (ABNs) (SE0806)

22 May 2008

Currently, the Medicare Claims Processing Manual does not have claims processing instructions for IDTFs and this notifies providers of the availability of this information in that manual. (New Chapter 35). No changes in policy are conveyed. (CR 5815)
This article has been revised again: effective for services on or after January 1, 2008, you must report the most recent hemoglobin or hematocrit levels. In addition, non-ESRD claims for the administration of ESAs must also contain one of three new Healthcare Common Procedure Coding System (HCPCS) modifiers. (CR 5699)

15 May 2008

This article summarizes the new regulations that address outpatient therapy services, including personnel qualifications and the timing of recertification of plans of care for Part B services. (CR 5921)
This notification provides updates to the lists of Healthcare Common Procedure Coding System (HCPCS) codes that are subject to the consolidated billing provision of the SNF Prospective Payment System (PPS). (CR 6009)
This "One Time Notice" describes the CMS approach for assigning providers to MACs and discusses the process of moving providers to MACs. (CR 5979)
This article was revised: Ambulance Fee Schedule - Conversion Factor File for CY 2009 Ambulance Inflation Factor (CR 6000)

08 May 2008

Ambulance Fee Schedule - Conversion Factor File for CY 2009 Ambulance Inflation Factor (CR 6000)
Effective March 19, 2008, CMS is maintaining its current non-coverage determination for autologous platelet rich plasma (PRP) for the treatment of chronic, non-healing cutaneous wounds, and is issuing a non-coverage determination for acute surgical wounds when the autologous PRP is applied directly to the closed incision and for dehiscent wounds. (CR 6043)
In order to protect the privacy of Medicare beneficiaries and to comply with the requirements of the Privacy Act of 1974 and the Health Insurance Portability and Accountability Act, customer service staff at Medicare provider contact centers (PCC) must properly authenticate the identity of providers/staff that call or write to request beneficiary protected health information before disclosing it to the requestor. (SE0814/JSM 08285)
CMS will be conducting a National Provider Training Conference Call to give Medicare Fee-for-Service providers an overview of the implementation of the DMEPOS Competitive Bidding Program. (JSM 08287)

01 May 2008

CMS updated the sections of the Medicare Claims Processing Manual that address prolonged services codes, in order to be consistent with changes/deletions in codes and changes in typical/average time units in the American Medical Association Current Terminology Procedural Terminology (CPT) coding system. (CR 5972)
The revised ABN was released on March 3, 2008, and providers are authorized to begin using the notice immediately. Beginning September 3, 2008, all providers, practitioners, and suppliers paid under Part B, must use the revised ABN in place of the ABN-G and ABN-L. The revised instructions are available here and can also be accessed at www.cms.hhs.gov/bni, along with the new form. (JSMTDL 08277)
This article has again been revised: CMS issued a Decision Memorandum (DM) that addressed Erythropoiesis Stimulating Agents (ESAs) use for cancer and related neoplastic conditions. (CR 5818)

10/09/2008