What's New from CMS

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.

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2013 - May | April | March | February | January

2012 - December | November | October | September | August | July | June | May | April | March | February | January

2011 - December | November | October | September | August | July | June | May | April | March | February | January

May

16 May 2013

• Quarterly Provider Update (QPU)
  (IOM Pub 100-09-Chapter 6 Section 50.2.4.3)
  The Quarterly Provider Update (QPU) is a listing of the regulations and program instructions issued by CMS that impact Medicare providers. The QPU is maintained by CMS and available to providers through the CMS Web site.
  Providers may elect to join a CMS electronic mailing list, to be notified periodically, of additions to the QPU. CMS publishes this update at the beginning of each quarter to inform the public about the following:
  
  • Regulations and major policies currently under development during this quarter.
  • Regulations and major policies completed or cancelled.
  • New/Revised manual instructions.
  
  The page may be found at: http://www.cms.gov/Regulations-and-Guidance/Regulations-and-Policies/QuarterlyProviderUpdates/index.html?redirect=/QuarterlyProviderUpdates/
  
  Visit the QPU What’s New page at https://www.cms.gov/QuarterlyProviderUpdates/02_Spotlight.asp
• Unsolicited/Voluntary Refund Checks – (Annual Reminder)
  (IOM 100-06, Chapter 5, section 410.10)
  NHIC, Corp. reminds you of the following statement from the IOM regarding unsolicited/voluntary refund checks:
  “The acceptance of a voluntary refund as repayment for the claims specified in no way affects or limits the rights of the Federal Government, or any of its agencies or agents, to pursue any appropriate criminal, civil, or administrative remedies arising from or relating to these or any other claims.”
  For more information, please view the above-mentioned at: http://www.cms.gov/manuals/downloads/fin106c05.pdf
• MM8255 – National Coverage Determination (NCD) for Transcatheter Aortic Valve Replacement (TAVR) – Implementation of Mandatory Reporting of Clinical Trial Number
• Revised: MM8182 – Standardizing the Standard - Operating Rules for Code Usage in Remittance Advice
• SE1303 – Information on the National Physician Payment Transparency Program: Open Payments
• Revised: MM8223 – Phase III Electronic Remittance Advice (ERA) Enrollment Operating Rules

09 May 2013

• Revised: SE1305 – Full Implementation of Edits on the Ordering/Referring Providers in Medicare Part B, DME, and Part A Home Health Agency (HHA) Claims (Change Requests 6417, 6421, 6696, and 6856)
• MM8286 – Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - July 2013 Update
• MM8223 – Phase III Electronic Remittance Advice (ERA) Enrollment Operating Rules
• MM8165 – Common Working File (CWF) Informational Unsolicited Response (IUR) or Reject for a New Patient Visit Billed by the Same Physician or Physician Group within the Past Three Years

02 May 2013

• MM8222 – Update to Chapter 15 of the Program Integrity Manual (PIM)

April

25 April 2013

• Revised: SE1305 – Full Implementation of Edits on the Ordering/Referring Providers in Medicare Part B, DME, and Part A Home Health Agency (HHA) Claims (Change Requests 6417, 6421, 6696, and 6856)
• MM8281 – Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP), and PC Print Update
• SE1249 – HIPAA Eligibility Transaction System (HETS) to Replace Common Working File (CWF) Medicare Beneficiary Health Insurance Eligibility Queries

22 April 2013

• New and Revised Sequestration Questions and Answers
  On April 8, 2013, the Centers for Medicare & Medicaid Services (CMS) issued a Q & A to explain the effect of the payment reduction for durable medical equipment (DME) capped rental claims. It has come to CMS’ attention that this Q & A requires additional clarification and issued the following Q & A as a replacement:
  Question: If a Durable Medical Equipment capped rental period started before April 1, 2013, are the rental payments for months after April 1, 2013, subject to the 2% reduction?
  Answer: Any claims for rental payments with a “FROM” date of service on or after April 1, 2013, will be subject to the 2% reduction, regardless of when the rental period began. For example, if a capped rental wheelchair was provided in February 2013, the monthly rental payment for May 2013 would be subject to the 2% sequestration reduction. The initial and subsequent monthly rental payments billed with a “FROM” date of service beginning on or prior to March 31, 2013 would not be affected by the 2% reduction.
  
  In addition, CMS issued the following new Qs & As as well as the revised Q & A above:
  
  Question: How long is the 2% reduction to Medicare fee-for-service claim payments in effect?
  Answer: The law specifies that the 2% reduction to Medicare fee-for-service payments resulting from the sequestration order that the President was required to issue on March 1, 2013, applies to all payments for services furnished in the one-year period after the reductions begin. For Medicare, the reductions begin on the first day of the first month after the order is issued, meaning they began on April 1, 2013. Accordingly, this sequestration order covers all payments for services with dates of service or dates of discharge (or a start date for rental equipment or multi-day supplies) April 1, 2013, through March 31, 2014.
  Question: Are drugs excluded from the 2% reduction?
  Answer: No. All fee-for-service Medicare claim payments are subject to the 2% reduction. There are no exemptions provided in the law for drugs or any other health care item or service provided under the fee-for-service program.

18 April 2013

• Revised: MM8153 – Recovery of Annual Wellness Visit (AWV) Overpayments
• MM8258 – Tax Identification Numbers of Foreign Owning and Managing Entities and Individuals

11 April 2013

• Revised: MM7631 – Revised and Clarified Place of Service (POS) Coding Instructions
• MM8265 – Claim Status Category and Claim Status Codes Update
• Revised: MM8056 – Payment Related to Prior Authorization for Power Mobility Devices (PMD)

09 April 2013

• Additional Question and Answer Related to Sequestration
  
  Question: If a Durable Medical Equipment capped rental period started before April 1, 2013, are the rental payments for months after April 1, 2013, subject to the 2% reduction?
  
  Answer: Any claims for rental payments with a “FROM” date of service on or after April 1, 2013, will be subject to the 2% reduction, regardless of when the rental period began. For example, if a capped rental wheelchair was provided in February 2013, the monthly rental payment for May 2013 would be subject to the 2% sequestration reduction. The initial monthly rental payment for February 2013 would not be affected by the 2% reduction.

04 April 2013

• Revised: MM7727 – Medicare Quality Reporting Incentive Programs Manual Update
• Revised: MM8169 – April Update to the CY 2013 Medicare Physician Fee Schedule Database (MPFSDB)
• We call your attention to the several important messages from CMS in the CMS e-News bulletin, dated 4/4/2013, on the topic of Claims, Pricer, and Code Updates.
• SE1308 – Physician Delegation of Tasks in Skilled Nursing Facilities (SNFs) and Nursing Facilities (NFs)
• MM8121 – Clarification of Detection of Duplicate Claims Section of the CMS Internet Only Manual

March

28 March 2013

• Revised: MM8197 – International Classification of Diseases (ICD)-10 Conversion from ICD-9 and Related Code Infrastructure of the Medicare Shared Systems as They Relate to CMS National Coverage Determinations (NCDs)
• Per Change Request (CR) 8226, the Implementation of the Award for Jurisdiction E Part A/Part B Medicare Administrative Contractor (JE A/B MAC) has been published.
• Revised: MM7441 – Magnetic Resonance Imaging (MRI) in Medicare Beneficiaries with Food and Drug Administration (FDA)-Approved Implanted Permanent Pacemakers (PMs) for Use in the MRI Environment
• Revised: MM7492 – Medicare Fee-For-Service (FFS) Claims Processing Guidance for Implementing International Classification of Diseases, 10th Edition (ICD-10)
• Revised: MM7818 – International Classification of Diseases, 10th Edition (ICD)-10 Conversion from (ICD-9) and Related Code Infrastructure of the Medicare Shared Systems as They Relate to CMS National Coverage Determinations (NCDs) (CR 1 of 3) (ICD-10)

27 March 2013

• Additional Questions and Answers Related to Sequestration
  (TDL 13276)
  
  Question: How is the 2% payment reduction under sequestration identified on the electronic remittance advice (ERA) and the standard paper remittance (SPR)?
  Answer: Claim adjustment reason code (CARC) 223 is used to report the sequestration reduction on the ERA and SPR.
  
  Question: What is the verbiage for CARC 223?
  Answer: “Adjustment code for mandated Federal, State or local law/regulation that is not already covered by another code and is mandated before a new code can be created.”
  
  Question: Will the 2% reduction be reported on the remittance advice in a separate field?
  Answer: For institutional Part A claims, the adjustment is reported on the remittance advice at the claim level. For Part B physician/practitioner, supplier, and institutional provider outpatient claims, the adjustment is reported at the line level.
  
  Question: How will the payments be calculated on the claims?
  Answer: The reduction is taken from the calculated payment amount, after the approved amount is determined and the deductible and coinsurance are applied.
  
  Example: A provider bills a service with an approved amount of $100.00, and $50.00 is applied to the deductible. A balance of $50.00 remains. We normally would pay 80% of the approved amount after the deductible is met, which is $40.00 ($50.00 x 80% = $40.00). The patient is responsible for the remaining 20% coinsurance amount of $10.00 ($50.00 - $40.00 = $10.00). However, due to the sequestration reduction, 2% of the $40.00 calculated payment amount is not paid, resulting in a payment of $39.20 instead of $40.00 ($40.00 x 2% = $0.80).
  
  Question: How are unassigned claims affected by the 2% reduction under sequestration?
  Answer: Though beneficiary payments toward deductibles and coinsurance are not subject to the 2% payment reduction, Medicare’s payment to beneficiaries for unassigned claims is subject to the 2% reduction. The non-participating physician who bills on an unassigned basis collects his/her full payment from the beneficiary, and Medicare reimburses the beneficiary the Medicare portion (e.g., 80% of the reduced fee schedule amount. NOTE: The “reduced fee schedule” refers to the fact that Medicare’s approved amount for claims from non-participating physicians/practitioners is 95% of the full fee schedule amount). This reimbursed amount to the beneficiary would be subject to the 2% sequester reduction just like payments to physicians on assigned claims. Both are claims payments, just to different parties. If the Limiting Charge applies to the service rendered, physicians/practitioners cannot collect more than the Limiting Charge amount from the beneficiary.
  
  Example: A non-participating provider bills an unassigned claim for a service with a Limiting Charge of $109.25. The beneficiary remains responsible to the provider for this full amount. However, sequestration affects how much Medicare reimburses the beneficiary. The non-participating fee schedule approved amount is $95.00, and $50.00 is applied to the deductible. A balance of $45.00 remains. Medicare normally would reimburse the beneficiary for 80% of the approved amount after the deductible is met, which is $36.00 ($45.00 x 80% = $36.00). However, due to the sequestration reduction, 2% of the $36.00 calculated payment amount is not paid to the beneficiary, resulting in a payment of $35.28 instead of $36.00 ($36.00 x 2% = $0.72).
  
  We encourage physicians, practitioners, and suppliers who bill unassigned claims to discuss with their Medicare patients the impact of the sequestration reductions to Medicare payments.
  
  Question: Is this reduction based on the date of service or date of receipt?
  Answer: In general, Medicare FFS claims with dates-of-service or dates-of-discharge on or after April 1, 2013, will incur a 2 percent reduction in Medicare payment. Claims for durable medical equipment (DME), prosthetics, orthotics, and supplies, including claims under the DME Competitive Bidding Program, will be reduced by 2 percent based upon whether the date-of-service, or the start date for rental equipment or multi-day supplies, is on or after April 1, 2013.

21 March 2013

• Revised: MM7260 – Modification to CWF, FISS, MCS and VMS to Return Submitted Information When There is a CWF Name and HIC Number Mismatch
• Revised: MM8147 – Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 19.1, Effective April 1, 2013
• Per Change Request (CR) 8227, the Implementation of the Award for Jurisdiction 6 Part A/Part B Medicare Administrative Contractor (J6 A/B MAC) has been published.
• CMS TDL-13261
  Sequestration Q & A for Posting to Contractor Web Sites--ACTION
  Question: Does the 2% payment reduction under sequestration apply to the payment rates reflected in Medicare fee-for-service fee schedules or does it only apply to the final payment amounts?
  Answer: Payment adjustments required under sequestration are applied to all claims after determining the Medicare payment including application of the current fee schedule, coinsurance, any applicable deductible, and any applicable Medicare Secondary Payment adjustments. All fee schedules, Pricers, etc., are unchanged by sequestration; it’s only the final payment amount that is reduced.
• Revised: MM8213 – Autologous Platelet-Rich Plasma (PRP) for Chronic Non-Healing Wounds
• Revised: MM8127 – Manual Updates to Clarify Inpatient Rehabilitation Facility (IRF) Claims Processing
• MM8212 – New Waived Tests
• MM8166 – Outpatient Therapy Functional Reporting Non-Compliance Alerts
• MM8203 – Clinical Laboratory Fee Schedule – Medicare Travel Allowance Fees for Collection of Specimens
• MM8247 – July 2013 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
• Mandatory Payment Reductions in the Medicare Fee-for-Service (FFS) Program – “Sequestration”
  TDL 13271
  As required by law, President Obama issued a sequestration order on March 1, 2013 requiring across-the-board reductions in Federal spending.
  In general, Medicare FFS claims with dates-of-service or dates-of-discharge on or after April 1, 2013, will incur a 2 percent reduction in Medicare payments. Therefore, to prevent making overpayments, interim and pass-through payments related to the Medicare cost report will be reduced by 2 percent. Beginning April 1, 2013 the 2 percent reduction will be applied to Periodic Interim Payments (PIP), Critical Access Hospital (CAH) and Cancer Hospital interim payments, and pass-through payments for Graduate Medical Education, Organ Acquisition, and Medicare Bad Debts.
  Questions about reimbursement should be directed to the J14 Medicare Administrative Contractor, NHIC, Corp:
  Part A - (877) 757-7783
  Part B - (866) 801-5304
  RHHI - (866) 289-0423
• Common Working File (CWF) Hosts April 2013 Release Dark Days
  TDL 13256
  For the upcoming April 2013 Release, CWF is expanding the Part B claim format and the CWF Hosts will be performing a history conversion. Due to the anticipated duration of this activity and to ensure the completion of the history conversion, weekly/monthly/quarterly processing, installation of the April 2013 Quarterly Release, and scheduled data center maintenance, there will be a CWF “Gray” day on Thursday, March 28, and two CWF “Dark” days on Friday, March 29 and Saturday, March 30, 2013. Below is a list of scheduled events for the release:
  • CWF Hosts will implement the Out of Service Area (OSA) drop for 03/25 through 03/29.
  • CWF Hosts will not perform any XREF or Health Insurance Correction Record (HICR) transactions from 03/25 through 03/30.
  • 03/28 will be considered a “Gray” day for the CWF Hosts. This means the CWF online Health Insurance Master Record (HIMR) inquiry will be available for all MACs. In addition, CWF Hosts will process In Sector Area (ISA) claims during the day on 03/28 and deliver response files back to the claims administration contractors in the old format for 03/28 night’s processing.
  • CWF Hosts will hold the claims received from claims administration contractors on 03/28 and 03/29.
  • 03/29 and 03/30 will be a “Dark” day for CWF Hosts with no onlines available, which means no access to the HIMR inquiry.
  • CWF Host will install the CWF April quarterly release on 03/29.
  • CWF Host will run the CWF SSM conversion and combine the held 03/28 and 03/29 claims administration contractor files on 03/30.
  • 04/01, the onlines are available for CWF Host under the new release.

15 March 2013

• Calendar Year (CY) 2013 Participation Enrollment and Medicare Participating Physicians and Suppliers Directory (MEDPARD)
  (per IOM and CR 8055)
  The 2013 MEDPARD Directories are posted on our web site at:
  http://www.medicarenhic.com/ne_prov/medpard.shtml and http://www.medicarenhic.com/bene/participating.shtml
  We encourage you to share this information with your specialty groups, associations, and patients.

14 March 2013

• Revised: SE0711 – Reminder – Medicare Now Provides Coverage for Eligible Medicare Beneficiaries of a One-Time Ultrasound Screening for Abdominal Aortic Aneurysms (AAA) When Referred for this Screening as a Result of the Initial Preventive Physical Examination (“Welcome to Medicare” Physical Exam)

12 March 2013

• The 2013 Primary Care Incentive Program Eligibility File has been published (TDL 13196).

07 March 2013

• SE1305 – Full Implementation of Edits on the Ordering/Referring Providers in Medicare Part B, DME, and Part A Home Health Agency (HHA) Claims (Change Requests 6417, 6421, 6696, and 6856)
• MM7824 – Reorganization of Chapter 13
• Revised: MM8010 – Update To Publication 100-04, Claims Processing Instructions For Chapter 12, Non-Physician Practitioners (NPPs)
• MM8169 – April Update to the CY 2013 Medicare Physician Fee Schedule Database (MPFSDB)
• MM8237 – April 2013 Update of the Ambulatory Surgical Center (ASC) Payment System

01 March 2013

• Change Request 8169 - April Update to the CY 2013 Medicare Physician Fee Schedule Database (MPFSDB)

February

28 February 2013

• Revised: MM8153 – Recovery of Annual Wellness Visit (AWV) Overpayments
• MM8211 – Healthcare Provider Taxonomy Codes (HPTC) Update, April 2013
• MM8155 – Update to Chapter 15 of the Program Integrity Manual (PIM)
• MM8204 – April Quarterly Update for 2013 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule
• MM8206 – Multiple Procedure Payment Reduction (MPPR) for Selected Therapy Services

26 February 2013

• Therapy Cap Manual Medical Review Instructions for 2012 and 2013 – ACTION
  TDL 13215
  Section 603 of the American Taxpayer Relief Act of 2012 (ATRA) contains a number of Medicare provisions affecting the outpatient therapy caps and mandatory manual medical review (MR) thresholds that became effective January 1, 2013.
  • Contractors shall continue to review therapy claims that did not go through the pre-approval process for dates of service October 1, 2012 through December 31, 2012.
  • Until CMS provides further instructions, all therapy claims that are suspended for manual medical review in 2013, above the $3,700 threshold, will be subject to prepayment medical review.

21 February 2013

• Change Request 7824—Reorganization of Chapter 13
• MM8199 – Change of Address for Percutaneous Transluminal Angioplasty (PTA) of the Carotid Artery Concurrent with Stenting Facility Approval and Recertification Letter Submission
• MM8056 – Payment Related to Prior Authorization for Power Mobility Devices (PMD)
• Revised: MM7900 – Expansion of Medicare Telehealth Services for Calendar Year (CY) 2013

14 February 2013

• Revised: MM7900 – Expansion of Medicare Telehealth Services for Calendar Year (CY) 2013
• Revised: MM8191 – Summary of Policies in the Calendar Year (CY) 2013 Medicare Physician Fee Schedule (MPFS) Final Rule and the Telehealth Originating Site Facility Fee Payment Amount
• MM8182 – Standardizing the Standard - Operating Rules for Code Usage in Remittance Advice

07 February 2013

• Per Change Request (CR) 8164, the 2013 Jurisdiction List for DMEPOS HCPCS Codes has been published.
• MM8164 – 2013 Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) Healthcare Common Procedure Coding System (HCPCS) Code Jurisdiction List
• Revised: MM8028 – Bariatric Surgery for the Treatment of Morbid Obesity National Coverage Determination, Addition of Laparoscopic Sleeve Gastrectomy (LSG)
• MM8162 – Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) Edits
• MM8161 – April 2013 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
• MM8143 – Emergency Update to the Calendar Year (CY) 2013 Medicare Physician Fee Schedule Database (MPFSDB)
• MM8046 – Modification of Payment Window Edit in the Common Working File (CWF) to Modify Diagnostic Service List
• MM8043 – Annual Update of HCPCS Codes Used for Home Health Consolidated Billing Enforcement
• MM7892 – Common Working File (CWF) Informational Unsolicited Response (IUR) or Reject for Place of Service Billed by Physician Office and either Ambulatory Surgical Center or Inpatient Hospital

January

31 January 2013

• MM8149 – Medicare Remit Easy Print (MREP) Enhancement

24 January 2013

• Revised: MM8168 – National Coverage Determination (NCD): Transcatheter Aortic Valve Replacement (TAVR) Coding Update/Policy Clarification
• MM8109 – International Classification of Diseases 10th Edition (ICD-10) Conversion from ICD-9 and Related Code Infrastructure of the Medicare Shared Systems as They Relate to the Centers for Medicare & Medicaid Services (CMS) National Coverage Determinations (NCDs)
• MM8127 – Manual Updates to Clarify Inpatient Rehabilitation Facility (IRF) Claims Processing
• MM8191 – Summary of Policies in the Calendar Year (CY) 2013 Medicare Physician Fee Schedule (MPFS) Final Rule and the Telehealth Originating Site Facility Fee Payment Amount

22 January 2013

• Please Join Us! The Centers for Medicare & Medicaid Services will be hosting several webinars for partners and providers on The Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program.

17 January 2013

• MM8168 – National Coverage Determination (NCD): Transcatheter Aortic Valve Replacement (TAVR) Coding Update/Policy Clarification
• Revised: MM8132 – Calendar Year (CY) 2013 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment
• Revised: MM8133 – Calendar Year (CY) 2013 Update for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule

11 January 2013

• Save The Date! The Centers for Medicare & Medicaid Services will be hosting several webinars for partners and providers on The Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program

10 January 2013

• MM8148 – January 2013 Update of the Ambulatory Surgery Center (ASC) Payment System

04 January 2013

• Extension of the 2013 Annual Participation Enrollment Program
  TDL 13149
  The Centers for Medicare & Medicaid Services (CMS) is extending the 2013 Annual Participation Enrollment Program. The participation enrollment period will now end February 15, 2013, instead of December 31, 2012.

03 January 2013

• Revised: MM8005 – Implementing the Claims-Based Data Collection Requirement for Outpatient Therapy Services — Section 3005(g) of the Middle Class Tax Relief and Jobs Creation Act (MCTRJCA) of 2012
• MM8154 – Remittance Advice Remark and Claims Adjustment Reason Code, Medicare Remit Easy Print, and PC Print Update
• MM7888 – New Healthcare Common Procedure Coding System (HCPCS) Code for External Ventricular Assist Devices or Any Ventricular Assist Device (VAD) For Which Payment Was Not Made Under Medicare Part A

December

27 December 2012

• MM8156 – Ambulance Inflation Factor for CY 2013 and Productivity Adjustment
• MM8146 – New Waived Tests
• Direction for Therapy Cap after December 31, 2012
  TDL 13136
  Any therapy pre-approval requests received on or after December 17, 2012 will not be approved or disapproved. Claims associated with these requests will be subject to prepayment or post payment review. This is necessary and appropriate to allow 10 business days to approve requests. Requests received on or after December 17, 2012 would otherwise extend past December 31, 2012 (where there are no exception requests since a new cap starts on January 1, 2013).
• MM8135 – Quarterly Update to the Correct Coding Initiative (CCI) Edits, Version 19.0, Effective January 1, 2013

20 December 2012

• Revised: MM7041 – Implementation of the PWK (Paperwork) Segment for X12N Version 5010
• MM8010 – Update To Publication 100-04, Claims Processing Instructions For Chapter 12, Non-Physician Practitioners (NPPs)
• Revised: MM7631 – Revised and Clarified Place of Service (POS) Coding Instructions
• Revised: MM7864 – Revision to Chapter 15 (Section 15.5.20) of the Medicare Program Integrity Manual (PIM)
• Revised: MM7785 – Revisions of the Financial Limitation for Outpatient Therapy Services – Section 3005 of the Middle Class Tax Relief and Job Creation Act of 2012
• Revised: MM8132 – Calendar Year (CY) 2013 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment
• SE1250 - Prescription Drug Monitoring Programs: A resource to Help Address Prescription Drug Abuse and Diversion
• MM7747 - Application of the Multiple Procedure Payment Reduction (MPPR) on Imaging Services to Physicians in the Same Group Practice

13 December 2012

• MM8005 – Implementing the Claims-Based Data Collection Requirement for Outpatient Therapy Services — Section 3005(g) of the Middle Class Tax Relief and Jobs Creation Act (MCTRJCA) of 2012
• Revised: MM7836 – Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Low Back Pain (CLBP)
• MM8133 – Calendar Year (CY) 2013 Update for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule
• MM8052 – Update to Medicare Deductible, Coinsurance, and Premium Rates for 2013
• SE1249 – HIPAA Eligibility Transaction System (HETS) to Replace Common Working File (CWF) Medicare Beneficiary Health Insurance Eligibility Queries
• Revised: SE1201 – Important Reminder for Providers and Suppliers Who Provide Services and Items Ordered or Referred by Other Providers and Suppliers
• MM7900 – Expansion of Medicare Telehealth Services for Calendar Year (CY) 2013
• MM8147 – Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 19.1, Effective April 1, 2013
• MM8006 – Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 18.3, Effective October 1, 2012
• Revised: SE1221 – Phase 2 of Ordering/Referring Requirement

06 December 2012

• MM7676 – Redesign of the Medicare Summary Notice (MSN) – Final Implementation – And Major Update to Chapter 21 of the Claims Process Manual
• MM8126 – 2013 Annual Update to the Therapy Code List
• Revised: MM7858 – Quarterly Update to the End Stage Renal Disease (ESRD) Prospective Payment System (PPS)
• MM8125 – New Place of Service (POS) Code for Place of Employment/Worksite
• MM8129 – Therapy Cap Values for Calendar Year (CY) 2013
• MM8132 – Calendar Year (CY) 2013 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment
• Revised: SE1126 – Further Details on the Revalidation of Provider Enrollment Information
• Revised: MM7350 – Implementation of Provider Enrollment Provisions in CMS-6028-FC

November

29 November 2012

• SE1244 – Medicare DMEPOS Competitive Bidding Program: Quick Reference Article
• SE1237 – Importance of Preparing/Maintaining Legible Medical Records

20 November 2012

• SE1248 – Special Report for Ambulatory Surgical Center (ASC) Quality Reporting
• MM7848 – Multiple Procedure Payment Reduction (MPPR) on the Technical Component (TC) of Diagnostic Cardiovascular and Ophthalmology Procedures
• MM8028 – Bariatric Surgery for the Treatment of Morbid Obesity National Coverage Determination, Addition of Laparoscopic Sleeve Gastrectomy (LSG)
• Use of Q6 Modifier for Locum Tenens by Providing Performing Provider NPI - Analysis only CR
  CR 8124

15 November 2012

• SE1247 – Hurricane Sandy and Medicare Disaster Related Claims
• SE1232 – Frequently Asked Questions (FAQs) on the 3-Day Payment Window for Services Provided to Outpatients Who Later Are Admitted as Inpatients
• MM7864 – Revision to Chapter 15 (Section 15.5.20) of the Medicare Program Integrity Manual (PIM)

14 November 2012

• To Our J14 Medical Community:
  (Change Request 8055)
  The Medicare Physician Fee Schedule Database (MPFSDB) and the Anesthesia files are available on our web site. Please go to http://www.medicarenhic.com/ne_prov/fee_sched.shtml to view the file for your Area. Any future updates released by CMS will be posted as soon as they are available.
  The Annual Participation Open Enrollment Period also has begun. To view the pertinent documents, please go to http://www.medicarenhic.com/ne_prov/fee_sched.shtml where you will find the CMS Announcement and the Medicare Participating Physician or Supplier Agreement (Form CMS 460). The mailing address is listed immediately below the forms on the same web page.
  Reminder: Any participating health professional who is not changing their participation status does not need to take any action during the Annual Open Enrollment Period.

8 November 2012

• MM8116 – January 2013 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
• MM8044 – Manual Updates to Clarify Skilled Nursing Facility (SNF) Claims Processing
• MM8100 – Effect of Beneficiary Agreements Not to Use Medicare Coverage and When Payment May be Made to a Beneficiary for Service of an Opt-Out Physician/Practitioner
• MM8107 – Editing Update for Annual Wellness Visit (AWV)
• Revised: SE1221 – Phase 2 of Ordering/Referring Requirement
• MM8007 – New Informational Unsolicited Response (IUR) Process to Identify Previously Paid Claims for Services Furnished to Incarcerated Medicare Beneficiaries
• MM8009 – New Informational Unsolicited Response (IUR) Process to Identify Previously Paid Claims for Services Furnished to Medicare Beneficiaries Classified as "Unlawfully Present" in the United States
• Calendar Year (CY) 2013 Participation Enrollment and Medicare Participating Physicians and Suppliers Directory (MEDPARD) Procedures
  CMS Change Request 8055
  We encourage you to visit the Medicare Learning Network® (MLN) (http://go.cms.gov/MLNGenInfo ) the place for official CMS Medicare Fee-For-Service provider educational information. There you can find one of our most popular products, MLN Matters national provider education articles. These articles help you understand new or changed Medicare policy and how those changes affect you. A full array of other educational products (including Web-based training courses, hard copy and downloadable publications, and CD-ROMs) are also available and can be accessed at: http://go.cms.gov/MLNProducts. You can also find other important physician Web sites by visiting the Physician Center Web page at: http://www.cms.gov/Center/Provider-Type/Physician-Center.html?redirect=/center/physician.asp.
  In addition to educational products, the MLN also offers providers and suppliers opportunities to learn more about the Medicare program through MLN National Provider Calls. These national conference calls, held by CMS for the Medicare Fee-For-Service provider and supplier community, educate and inform participants about new policies and/or changes to the Medicare program. Offered free of charge, continuing education credits may be awarded for participation in certain National Provider Calls. To learn more about MLN National Provider Calls including upcoming calls, registration information, and links to previous call materials, visit: http://www.cms.gov/Outreach-and-Education/Outreach/NPC/index.html.
• MM8086 – Termination of the Common Working File ELGB Provider Query
• Medical Identity Theft Web-Based Training Course for Providers
  TDL 13040
  The Medical Identity Theft Web-Based Training Course for Providers: Safeguarding Your Medical Identity, has been published on the CMS web site. You may link to it from our web site at: http://www.medicarenhic.com/ne_prov/rel_sites.shtml
• The CMS Announcement about Medicare Participation for Calendar Year 2013 and the CMS Medicare Participating Physician or Supplier Agreement for 2013 have been posted on our web site. The Participating Physician or Supplier Agreement is an interactive form that can be completed on line and printed. Mail this form to the address indicated on the web site. The Announcement contains valuable CMS information about Medicare Provider Participation in 2013. (Change Request 8055)
• SE1245 – Alert Concerning Impacts Arising from Having Non-Compliant Physical or Practice Address Information on File with Medicare
• MM7858 – Quarterly Update to the End Stage Renal Disease (ESRD) Prospective Payment System (PPS)
• MM7869 – Implementation of Changes to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) Consolidated Billing Requirements for Daptomycin and a Clarification of Outlier Services for Calendar Year 2013
• Administrative Relief for Areas Affected by Hurricane Sandy
  TDL 13058
  CMS has prepared this Q & A document for all providers, suppliers, and beneficiaries affected by Hurricane Sandy in the J14 area.

1 November 2012

• SE1246– Medicare Guidance Regarding Meningitis Outbreak
• MM8019 – General Update to Chapter 15 of the Program Integrity Manual (PIM) - Part IX

October

29 October 2012

• 2013 Fee Schedule / Open Enrollment Period
  (Change Request 8055; Internet Only Manual (IOM), Pub 100-04, Chapter 1, 30.3.12.1)
  NHIC, Corp. reminds our medical community that the upcoming Participation enrollment period documents and the upcoming Medicare Physician Fee Schedule (MPFS) and the Anesthesia Conversion Factor(s) will be published on the our web site after the physician fee schedule regulation is put on display. Once the rule is on display, you may go to http://www.medicarenhic.com/ne_prov/fee_sched.shtml for the related 2013 information.

18 October 2012

• SE1229 – A Physician’s Guide to Medicare Part D Medication Therapy Management (MTM) Programs
• Revised: MM7631 – Revised and Clarified Place of Service (POS) Coding Instructions
• SE1242 – 2012-2013 Seasonal Influenza (Flu) Resources for Health Care Professionals
• MM8051 – Reasonable Charge Update for 2013 for Splints, Casts, and Certain Intraocular Lenses

11 October 2012

• Revised: MM8047 – Influenza Vaccine Payment Allowances - Annual Update for 2012-2013 Season
• Revised: MM7631 – Revised and Clarified Place of Service (POS) Coding Instructions

04 October 2012

• Revised: MM8036 - Manual Medical Review of Therapy Services
• MM8049 – Annual Clotting Factor Furnishing Fee Update 2013
• MM8054 – New Waived Tests
• MM8047 – Influenza Vaccine Payment Allowances - Annual Update for 2012-2013 Season
• Revised: MM8017 – October Update to the Calendar Year (CY) 2012 Medicare Physician Fee Schedule Database (MPFSDB)
• Revised: MM7631 – Revised and Clarified Place of Service (POS) Coding Instructions

September

27 September 2012

• Revised: SE1011 – Edits on the Ordering/Referring Providers in Medicare Part B, DME and Part A HHA Claims (Change Requests 6417, 6421, 6696, and 6856)
• SE1221 – Phase 2 of Ordering/Referring Requirement
• Revised: SE1201 – Important Reminder for Providers and Suppliers Who Provide Services and Items Ordered or Referred by Other Providers and Suppliers
• MM7818 – International Classification of Diseases, 10th Edition (ICD)-10 Conversion from (ICD-9) and Related Code Infrastructure of the Medicare Shared Systems as They Relate to CMS National Coverage Determinations (NCDs) (CR 1 of 3) (ICD-10)
• Revised: MM7897 – National Coverage Determination (NCD) for Transcatheter Aortic Valve Replacement (TAVR)
• Revised: MM7806 – Extracorporeal Photopheresis (ICD-10)
• Rescinded: MM7819 – Coding Changes to Ultrasound Diagnostic Procedures for Transesophageal Doppler Monitoring
• SE1240 – Partial Code Freeze Prior to ICD-10 Implementation
• SE1239 – Updated ICD-10 Implementation Information

26 September 2012

• Change Request CR7819 has been rescinded.

20 September 2012

• Implementation of the Award for the Jurisdiction 5 Part A and Part B Medicare Administrative Contractor (J5 A/B MAC) Reprocurment Including a New Workload Number for the Remaining WPS Legacy Workload (CR 8059)
• SE1236-Documenting Medical Necessity for Major Joint Replacement (Hip and Knee)
• SE1234 – Important Information Concerning the Medicare Crossover Process and State Medicaid Agency Requirements for National Drug Codes (NDCs) Associated with Physician-Administered Part B Drugs
• MM8037 – 2013 Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Update
• Revised: MM7791 – Contractor and Common Working File (CWF) Additional Instructions Related to Change Request (CR) 7633 - Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse
• MM8045 – Claim Status Category and Claim Status Codes Update

13 September 2012

• Revised: MM7806 – Extracorporeal Photopheresis (ICD-10)

07 September 2012

• MM7890 – Ordering and Certifying Documentation - Maintenance Requirements
• MM8036 – Manual Medical Review of Therapy Services

06 September 2012

• Verify Your Zip Code - HPSA Reminder Notice
  Internet Only Manual, 100-4, Chapter 12, 90.4.1
  ZIP Code files for the automated payment of the HPSA bonus payment will be developed and updated annually. Effective for claims with dates of service on or after January 1, 2009, only services provided in areas that are designated as of December 31 of the prior year are eligible for the HPSA bonus payment. Physicians providing services in areas that were designated as of December 31 of the prior year but not on the automated file may use the AQ modifier. Only services provided in areas that were designated as of December 31 of the prior year but not on the automated file may use the modifier. Services provided in areas that are designated throughout the year will not be eligible for the HPSA bonus payment until the following year, provided they are still designated on December 31. Services provided in areas that are de-designated throughout the year will continue to be eligible for the HPSA bonus through the end of the calendar year.
  CMS will post on its Web site ZIP Codes that are eligible to automatically receive the bonus payment as well as information on how to determine when the modifier is needed to receive the bonus payment.
  All physicians are to verify their ZIP Code eligibility via the CMS Web site or the HRSA Website for the area where they provide physician services. For more information on HPSA, please go to the NHIC, Corp. HPSA page at http://www.medicarenhic.com/ne_prov/hpsa.shtml or to the CMS page at http://www.cms.gov/HPSAPSAPhysicianBonuses/. For more information on the HRSA (Health Resources and Service Administration), please go to http://www.hrsa.gov/index.html.
• MM7881 – Expiration of 2012 Therapy Cap Revisions and User-Controlled Mechanism to Identify Legislative Effective Dates
• MM7883 – 2013 Annual Update for the Health Professional Shortage Area (HPSA) Bonus Payments
• MM8021 – Healthcare Provider Taxonomy Codes (HPTC) Update, October 2012
• MM8032 – October 2012 Update of the Ambulatory Surgical Center Payment System (ASC)

August

30 August 2012

• Notice to Providers, Intern and Resident Information System (IRIS) Programs TDL 12492

  The Office of Financial Management will post two IRIS programs (Version 3.1 of IRISV3 and Version 1.1 of IRISEDV3) with updated files (medical school codes, residency type codes, and IRISV3 Operating Instructions as of August 2012) on the Centers for Medicare & Medicaid Services (CMS) website before August 31, 2012, for downloading by Medicare providers. The revised webpage address for downloading these programs is:
  www.cms.gov\Research-Statistics-Data-and-Systems/Computer-Data-and-Systems/IRIS

• SE1227 – Important Reminder About Medicare Secondary Payer Laws
• MM8017 – October Update to the Calendar Year (CY) 2012 Medicare Physician Fee Schedule Database (MPFSDB)
• Revised: SE1128 – Prohibition on Balance Billing Qualified Medicare Beneficiaries (QMBs)
• MM8029 – Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy Print (MREP) and PC Print Update

23 August 2012

• MM7879 - Physician Quality Reporting System and Electronic Prescribing (eRx) Incentive Program – Pub 100-22 Medicare Quality Reporting Incentive Programs Manual Update
• Revised: MM7884 – New Physician Specialty Code for Centralized Flu
• Revised: MM7897 – National Coverage Determination (NCD) for Transcatheter Aortic Valve Replacement (TAVR)

16 August 2012

• MM7897 – National Coverage Determination (NCD) for Transcatheter Aortic Valve Replacement (TAVR)
• MM7908 – Liver Transplantation for Patients with Malignancies
• Revised: MM7355 – Clarification of Medicare Conditional Payment Policy and Billing Procedures for Liability, No-Fault and Workers’ Compensation (WC) Medicare Secondary Payer (MSP) Claims
• MM7884 – New Physician Specialty Code for Centralized Flu
• MM7700 – Handling Form CMS-1500 Claims Where an ICD-9-CM “E” Code is Reported as the First Diagnosis on the Claim
• SE1230 – Addition of Digital Document Repository to Provider Enrollment Chain and Ownership System (PECOS)
• MM7836 – Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Low Back Pain (CLBP)

13 August 2012

• CMS Fraud Prevention Training Modules for Providers
  TDL 12472
  In June 2012, the Centers for Medicare & Medicaid Services produced two fraud prevention training modules that are currently available on the Medscape website (see below). These modules provide key information to health care practitioners and professionals on how they can assist CMS in preventing fraud and abuse, as well as highlight CMS’ efforts to fight fraud and abuse and explain how health care professionals can be part of these efforts.
  The first module, “Reducing Medicare and Medicaid Fraud and Abuse: Protecting Practices and Patients, can be found here: http://www.medscape.org/viewarticle/764496.
  The second module, “How CMS Is Fighting Fraud: Major Program Integrity Initiatives,” can be found here: http://www.medscape.org/viewarticle/764791.
  
  A total of 1.25 hours of continuing medical education (CME) credit can be earned for any Medscape user registered as a doctor or health care professional. Medscape accounts are free, and users do not have to be health care professionals to register for them. Registration is on the landing page of www.medscape.com.
  • Reducing Medicare and Medicaid Fraud and Abuse: Protecting Practices and Patients (requires Medscape user log in and password to access)
  • How CMS Is Fighting Fraud: Major Program Integrity Initiatives (requires Medscape user log in and password to access)
  Instructions for Accessing the Medscape Modules
  • Step 1: Access the Web site: www.medscape.org. Medscape accounts are free of charge.
  • Step 2: Registration is on the upper right hand corner of the home page of www.medscape.org next to the log in field.
  • Step 3: To access the modules, first enter your membership log in information.

09 August 2012

• MM7877 – Posting the Limiting Charge after Applying the e-Prescribing (eRx) Negative Adjustment
• MM7905 – Claim Status Category and Claim Status Codes Update
• MM7885 – October 2012 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files

July

26 July 2012

• MM7868 – New Waived Tests
• Revised: MM7499 – Reporting of Recoupment for Overpayment on the Remittance Advice (RA) with Patient Control Number

18 July 2012

• Revised: MM6823 – Pulmonary Rehabilitation (PR) Services
• Revised: MM7806 – Extracorporeal Photopheresis (ICD-10)

05 July 2012

• Revised: MM7854 – July 2012 Update of the Ambulatory Surgical Center (ASC) Payment System
• Revised: MM7499 – Reporting of Recoupment for Overpayment on the Remittance Advice (RA) with Patient Control Number
• SE1226 – Reminder of Importance of Correct Place-of-Service Coding on Medicare Part B Claims
• Revised: MM7856 – October Quarterly Update to 2012 Annual Update of HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement

June

28 June 2012

• Revised: MM7791 – Contractor and Common Working File (CWF) Additional Instructions Related to Change Request (CR) 7633 - Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse

21 June 2012

• Revised: SE1029 – 5010 Requirement for Ambulance Suppliers
• SE1221 – Phase 2 of Ordering and Referring Requirement
• Revised: SE1131 – Important Update Regarding 5010/D.0 Implementation – Action Needed Now
• Revised: SE1011 – Edits on the Ordering/Referring Providers in Medicare Part B, DME and Part A HHA Claims (Change Requests 6417, 6421, 6696, and 6856)
• Revised: SE1106 – Important Reminders about HIPAA 5010 & D.0 Implementation

14 June 2012

• MM7844 – July Update to the CY 2012 Medicare Physician Fee Schedule Database (MPFSDB)
• MM7806 – Extracorporeal Photopheresis (ICD-10)
• MM7821 – Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, Updated Manual Instructions
• SE1223 – Appeals for Denied Claims Submitted by an Ordering and Referring Opt-out Physician/Non-physician Practitioners Who Are Excluded by the Office of Inspector General (OIG)
• MM7856 – October Quarterly Update to 2012 Annual Update of HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement

04 June 2012

• MM7834 – Modifying the Timely Filing Exceptions on Retroactive Medicare Entitlement and Retroactive Medicare Entitlement Involving State Medicaid Agencies
• Revised: MM7355 – Clarification of Medicare Conditional Payment Policy and Billing Procedures for Liability, No-Fault and Workers' Compensation (WC) Medicare Secondary Payer (MSP) Claims
• MM7854 – July 2012 Update of the Ambulatory Surgical Center (ASC) Payment System

May

31 May 2012

• Unsolicited/Voluntary Refund Checks – (Annual Reminder)
  (IOM 100-06, Chapter 5, section 410.10)
  NHIC, Corp. reminds you of the following statement from the IOM regarding unsolicited/voluntary refund checks:
  “The acceptance of a voluntary refund as repayment for the claims specified in no way affects or limits the rights of the Federal Government, or any of its agencies or agents, to pursue any appropriate criminal, civil, or administrative remedies arising from or relating to these or any other claims.”
  For more information, please view the above-mentioned at: http://www.cms.gov/manuals/downloads/fin106c05.pdf
• Quarterly Provider Update (QPU)
  (IOM Pub 100-09-Chapter 6 Section 50.2.4.3)
  The Quarterly Provider Update (QPU) is a listing of the regulations and program instructions issued by CMS that impact Medicare providers. The QPU is maintained by CMS and available to providers through the CMS Web site.
  Providers may elect to join a CMS electronic mailing list, to be notified periodically, of additions to the QPU. CMS publishes this.
  Update at the beginning of each quarter to inform the public about the following:
  • Regulations and major policies currently under development during this quarter.
  • Regulations and major policies completed or cancelled.
  • New/Revised manual instructions
  The page may be found at: http://www.cms.gov/Regulations-and-Guidance/Regulations-and-Policies/QuarterlyProviderUpdates/index.html?redirect=/QuarterlyProviderUpdates/
  Visit the QPU What’s New page at https://www.cms.gov/QuarterlyProviderUpdates/02_Spotlight.asp
• Update Your Addresses! “Do Not Forward” (DNF) – Annual Reminder Notice
  (IOM Pub. 100-04 Chapter 1 Section 80.5.1)
  All providers must notify their Contractor (NHIC, Corp.) of any changes of address.
  To do this:
  1. Visit the CMS Enrollment website and download the Enrollment Form that pertains to you or your group or organization:
  http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/index.html?redirect=/MedicareProviderSupEnroll/02_EnrollmentApplications.asp
  2. Update the form with your new information and mail it to:
  NHIC, Corp.
  Provider Enrollment
  P.O. Box 3434
  Hingham, MA 02044
  NHIC, Corp. uses “return service requested” envelopes for certain mailings, and when an envelope is returned, we apply a Do Not Forward (DNF) flag to the provider’s Medicare Number. Once this happens, no additional checks will be generated until a properly completed change of address form is received and verified by NHIC, Corp. CMS requires corrections to all addresses before the contractor can remove the DNF flag and begin paying the provider or supplier again.
  Protect yourself from payment delays by submitting your changes timely.
• Certification of Mammography Facilities (Annual Reminder)
  (IOM 100-04, Chapter 18, section 20.1)
  NHIC, Corp. reminds providers that Medicare will reimburse only FDA-certified mammography centers for mammography services.
  We encourage you to inform your patients to use only centers that are certified.
  We provide a direct link on our web site to the listing for all of these facilities in each state at:
  http://www.medicarenhic.com/ne_prov/billing_info.shtml.
  Click on the “Mammography Centers – Certified” link.
  Please share this information with your patients.
• Revised: MM7610 - Screening for Sexually Transmitted Infections (STIs) and High Intensity Behavioral Counseling (HIBC) to Prevent STIs
• Revised: SE1216 – Examining the Difference between a National Provider Identifier (NPI) and a Provider Transaction Access Number (PTAN)

29 May 2012

• Rescinded: MM7819 – Coding Changes to Ultrasound Diagnostic Procedures for Transesophageal Doppler Monitoring

24 May 2012

• SE1216 – Examining the Difference between a National Provider Identifier (NPI) and a Provider Transaction Access Number (PTAN)
• SE1222 – Negative Pressure Wound Therapy Interpretive Guidelines
• MM7822 – July Quarterly Update for 2012 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule
• Revised: MM7499 – Reporting of Recoupment for Overpayment on the Remittance Advice (RA) with Patient Control Number
• MM7355 – Clarification of Medicare Conditional Payment Policy and Billing Procedures for Liability, No-Fault and Workers’ Compensation (WC) Medicare Secondary Payer (MSP) Claims
• MM7629 – Handling Misdirected Claims for Part B Items and Services
• Rescinded: MM7819 – Coding Changes to Ultrasound Diagnostic Procedures for Transesophageal Doppler Monitoring

10 May 2012

• Revised: MM7600 – New Physician Specialty Code for Sleep Medicine and Sports Medicine
• SE1219 – A Physician’s Guide to Medicare’s Home Health Certification, including the Face-to-Face Encounter
• MM7785 – Revisions of the Financial Limitation for Outpatient Therapy Services – Section 3005 of the Middle Class Tax Relief and Job Creation Act of 2012

03 May 2012

• MM7794 – New Influenza Virus Vaccine Code
• MM7791 – Contractor and Common Working File (CWF) Additional Instructions Related to Change Request (CR) 7633 - Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse
• MM7831 – Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes – July 2012 Update
• MM7260 – Modification to CWF, FISS, MCS and VMS to Return Submitted Information When There is a CWF Name and HIC Number Mismatch

April

26 April 2012

• MM7797 – General Update to Chapter 15 of the Program Integrity Manual (PIM) Part V
• Revised: MM7442 – Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Imaging Procedures
• 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)
• MM7793 – Claim Status Category and Claim Status Codes Update

12 April 2012

• MM7775 – Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), Medicare Remit Easy Print (MREP), and PC Print Update
• SE1217 – Guidance for Correct Claims Submission When Secondary Payers Are Involved
• MM7810 – July 2012 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
• MM7766 – Clinical Laboratory Fee Schedule – New Waived Tests
• MM7795 – New Waived Tests
• MM7778 – Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) Edits
• SE1218 – Redesigned Medicare Summary Notices
• SE1215 – Information for Medicare Fee-For-Service Providers About the Middle Class Tax Relief and Job Creation Act of 2012
• SE1211 – Information on the Centers for Medicare & Medicaid Services (CMS) Fraud Prevention: Automated Provider Screening and National Site Visit Initiatives
• Revised: MM7631 – Revised and Clarified Place of Service (POS) Coding Instructions
• Revised: MM7397 – Pharmacy Billing for Drugs Provided "Incident To" a Physician Service

05 April 2012

• MM7727 – Medicare Quality Reporting Incentive Programs Manual Update
• MM7745 – April Update to the Calendar Year (CY) 2012 Medicare Physician Fee Schedule Database (MPFSDB)
• Revised: MM7633 – Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse
• MM7679 – 2012 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Healthcare Common Procedure Coding System (HCPCS) Code Jurisdiction
• Revised: MM7636 – Intensive Behavioral Therapy (IBT) for Cardiovascular Disease (CVD)
• Revised: MM7637 – Screening for Depression in Adults
• Revised: MM7767 – Emergency March 2012 Update, Middle Class Tax Relief and Job Creation Act of 2012 (MCTRJCA) to the CY 2012 Medicare Physician Fee Schedule (MPFS) Database
• MM7802 – Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 18.2, Effective July 1, 2012

March

29 March 2012

• Delayed Paperwork (PWK) Implementation
  (TDL-12303)
  The Centers for Medicare & Medicaid Services (CMS) is delaying the implementation date of the PWK (Paperwork) Segment. The PWK was due to be implemented on April 1, 2012, via Change Requests 7041, 7306, and 7330. The delay is being initiated in order to address system concerns and impacts raised by Medicare Administrative Contractors (MACs). MACs will continue to work through their user acceptance testing of the PWK while the concerns and impacts are addressed. CMS will communicate the revised implementation date once determined.
  This PWK delay does not affect any current processes in place for the submission of additional documentation with your claims.
• MM7767 – Emergency March 2012 Update, Middle Class Tax Relief and Job Creation Act of 2012 (MCTRJCA) to the CY 2012 Medicare Physician Fee Schedule (MPFS) Database
• MM7754 – April 2012 Update of the Ambulatory Surgical Center (ASC) Payment System

22 March 2012

• Revised: MM7363 - Additional Provider and Supplier Enrollment Requirements for Fixed Wing and Helicopter Air Ambulance Operators

15 March 2012

• Revised: MM7678 – Use of Revised Remittance Advice Remark Code (RARC) N103 When Denying Services Furnished to Federally Incarcerated Beneficiaries
• Revised: MM7641 – Intensive Behavioral Therapy (IBT) for Obesity
• SE1208 – 855-O Medicare Enrollment Application Ordering and Referring Physicians or Other Eligible Professionals
• SE1209 – Provider Inquiry Screens Regarding Telehealth Services Eligibility Dates
• SE1212 – Important Information Concerning Medicare Outreach Efforts to Supplemental Payers Directing Their Payments to Incorrect Addresses
• MM7723 – Instructions for Processing Form CMS-855O Submissions
• The revised 2012 Medicare Physician Fee Schedules and Anesthesia Conversion Factors have been published. They are effective March 1, 2012. (TDL 12240)

13 March 2012

• The 2012 Medicare Participating Physicians/Suppliers Directories (MEDPARD) for J14 A/B MAC have been published. (per CR 7573)

08 March 2012

• The Centralized Billing for Flu and Pneumococcal Vaccination Annual Notice has been published. (IOM, 100-04, Chapter 18)
• Common Working File (CWF) Northeast, Pacific and South Hosts Dark Day on Saturday, March 24, 2012
  (TDL-12251)
  On Saturday, March 24, 2012, the CWF Northeast, Pacific and South Hosts will be conducting a history purge. Due to the anticipated duration of this activity and to ensure the completion of weekly processing and scheduled data center maintenance, there will be a CWF Dark Day at the CWF Northeast, Pacific and South Hosts only on that Saturday. This means there will be no access to the Health Insurance Master Record (HIMR) query, which is usually available until noon on Saturdays.
  All files received from satellites for Friday’s cycle (March 23, 2012) will be completed prior to bringing CWF production down. If, for any reason, satellite files are received late Saturday morning, they will be processed by CWF after the history purge has been completed.

01 March 2012

• Revised: MM7641 – Intensive Behavioral Therapy (IBT) for Obesity
• Revised: SE1204 – The Role of the Zone Program Integrity Contractors (ZPICs), Formerly the Program Safeguard Contractors (PSCs)
• SE1206 – 2012 Electronic Prescribing (eRx) Incentive Program: Future Payment Adjustments
• SE1207 – 2012 Physician Quality Reporting System Claims-Based Coding and Reporting Principles
• Revised: MM7671 – Summary of Policies in the Calendar Year (CY) 2012 Medicare Physician Fee Schedule (MPFS) Final Rule and the Telehealth Originating Site Facility Fee Payment Amount
• UPDATED 5010 837P and 837I Transaction Edits
  TDL – 12237
  Due to the urgency with which edit changes must be made, the Centers for Medicare & Medicaid Services (CMS) is updating the implementation date of certain 837P and 837I edits documented in Change Request 7719 (CR 7719).
  The following 5010 837P and 837I transaction edits are being implemented within the next 30 days:
  X222.124.2010BA.N3.005
  X222A1.017.2010BA.N4.005
  X223.218.2300.HI01-2.015 (DRG)
  X223.218.2300.HI01-2.010 (DRG)
  The following 5010 837P and 837I transaction edits are being implemented on July 1, 2012 (as originally scheduled in CR7719):
  X223.319.2310A.NM1.010
  X223.424.2400.SV202-2.025
  The edit spreadsheets for CR7719 and prior versions of the 837P and 837I edit spreadsheets can be found at the following link http://www.cms.gov/MFFS5010D0/20_TechnicalDocumentation.asp#TopOfPage

February

16 February 2012

• Revised: MM7688 – Immediate Recoupment for Fee for Service Claims Overpayments
• Revised: MM7681 – Advanced Diagnostic Imaging (ADI) Accreditation Enrollment Procedures. (Change Request (CR) 7681 Fully Rescinds and Replaces CR 7177)
• MM7610 – Screening for Sexually Transmitted Infections (STIs) and High Intensity Behavioral Counseling (HIBC) to Prevent STIs
• MM7641 – Intensive Behavioral Therapy (IBT) for Obesity
• SE1205 – Updating Beneficiary Information with the Coordination of Benefits Contractor

09 February 2012

• MM7631 – Revised and Clarified Place of Service (POS) Coding Instructions
• MM7694 – New Waived Tests
• MM7703 – Interaction of the Multiple Procedure Payment Reduction (MPPR) on Imaging Procedures and the Outpatient Prospective Payment System (OPPS) Cap on the Technical Component (TC) of Imaging Procedures

02 February 2012

• Revised: MM7670 – Claim Status Category and Claim Status Codes Update
• MM7734 – April 2012 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
• Revised: MM7363 – Additional Provider and Supplier Enrollment Requirements for Fixed Wing and Helicopter Air Ambulance Operators

January

26 January 2012

• SE1201 – Important Reminder for Providers and Suppliers Who Provide Services and Items Ordered or Referred by Other Providers and Suppliers
• MM7737 – Emergency Update to the CY 2012 Medicare Physician Fee Schedule Database (MPFSDB)

19 January 2012

• SE1202 – Health Professional Shortage Area (HPSA) Bonus Payment Policy Reminders
• MM7681 – Advanced Diagnostic Imaging (ADI) Accreditation Enrollment Procedures. (Change Request (CR) 7681 Fully Rescinds and Replaces CR 7177)
• MM7726 – Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 18.1, Effective April 1, 2012
• Revised: SE1138 – Non-Specific Procedure Code Description Requirement for HIPAA Version 5010 Claims
• Revised: SE1137 – Additional Health Insurance Portability and Accountability Act (HIPAA) 837 5010 Transitional Changes and Further Modifications to the Coordination of Benefits Agreement (COBA) National Crossover Process

12 January 2012

• Revised: MM7682 – January 2012 Update of the Ambulatory Surgery Center (ASC) Payment System
• Revised: MM7431 – Autologous Cellular Immunotherapy Treatment of Metastatic Prostate Cancer
• Revised: MM7436 – Recovery Audit Program: Medicare Administrative Contractor (MAC)-issued Demand Letters
• MM7678 – Use of Revised Remittance Advice Remark Code (RARC) N103 When Denying Services Furnished to Federally Incarcerated Beneficiaries
• Revised: MM7671 – Summary of Policies in the Calendar Year (CY) 2012 Medicare Physician Fee Schedule (MPFS) Final Rule and the Telehealth Originating Site Facility Fee Payment Amount

05 January 2012

• Quarterly Provider Update (QPU)
  (IOM Pub 100-09-Chapter 6 Section 50.2.4.3)
  The Quarterly Provider Update (QPU) is a listing of the regulations and program instructions issued by CMS that impact Medicare providers. The QPU is maintained by CMS and available to providers through the CMS Web site.
  Providers may elect to join a CMS electronic mailing list, to be notified periodically, of additions to the QPU. CMS publishes this Update at the beginning of each quarter to inform the public about the following:
  
  • Regulations and major policies currently under development during this quarter.
  • Regulations and major policies completed or cancelled.
  • New/Revised manual instructions
  The page may be found at: http://www.cms.hhs.gov/QuarterlyProviderUpdates/
  Visit the QPU What’s New page at https://www.cms.gov/QuarterlyProviderUpdates/02_Spotlight.asp

December

28 December 2011

• Revised: MM7567 – Update to Medicare Deductible, Coinsurance and Premium Rates for 2012
• MM7671 – Summary of Policies in the Calendar Year (CY) 2012 Medicare Physician Fee Schedule (MPFS) Final Rule and the Telehealth Originating Site Facility Fee Payment Amount
• Revised: MM7064 – End Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Consolidated Billing for Limited Part B Services
• SE1138 – Non-Specific Procedure Code Description Requirement for HIPAA Version 5010 Claims
• MM7683 – Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), Medicare Remit Easy Print (MREP), and PC Print Update
• Extension of the 2012 Annual Participation Enrollment Program
  TDL 12144
  NOTE: CMS is extending the 2012 Annual Participation Enrollment Program. The participation enrollment period will now end February 14, 2012, instead of December 31, 2011.
• MM7442 – Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Imaging Procedures
• Per TDL 12152, the link to the NOC code list being used for ASC X12 version 5010 837 Professional and Institutional transactions has been published.

21 December 2011

• SE1142 – Preventive Services Educational Resources for Health Care Professionals
• Revised: MM7397 – Pharmacy Billing for Drugs Provided "Incident To" a Physician Service

15 December 2011

• SE1141 – 2012 Electronic Prescribing (eRx) Payment Adjustment: Assessment and Application
• MM7633 – Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse
• MM7654 – Calendar Year (CY) 2012 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment
• MM7636 – Intensive Behavioral Therapy (IBT) for Cardiovascular Disease (CVD)
• Revised: MM7529 – Therapy Cap Values for Calendar Year (CY) 2012

08 December 2011

• Medicare’s Acceptance of Voluntary Refunds, Annual Notice
  (IOM, Publication 100-06, Chapter 5, Section 410-10) The acceptance of a voluntary refund as repayment for the claims specified in no way affects or limits the rights of the Federal Government, or any of its agencies or agents, to pursue any appropriate criminal, civil, or administrative remedies arising from or relating to these or any other claims.
• SE1137 – Additional Health Insurance Portability and Accountability Act (HIPAA) 837 5010 Transitional Changes and Further Modifications to the Coordination of Benefits Agreement (COBA) National Crossover Process
• MM7637 –Screening for Depression in Adults
• MM7628 – Reasonable Charge Update for 2012 for Splints, Casts, and Certain Intraocular Lenses

01 December 2011

• MM7504 – Expansion of Medicare Telehealth Services for CY 2012
• Revised: MM7489 – Instructions to Accept and Process All Ambulance Transportation Healthcare Common Procedure Coding System (HCPCS) Codes

November

29 November 2011

• MM7648 – 2012 Annual Update to the Therapy Code List
• MM7529 – Therapy Cap Values for Calendar Year (CY) 2012
• MM7567 – Update to Medicare Deductible, Coinsurance and Premium Rates for 2012
• Revised: MM7363 – Additional Provider and Supplier Enrollment Requirements for Fixed Wing and Helicopter Air Ambulance Operators

22 November 2011

• Change Request 7177 has been rescinded and is replaced by Change Request 7681.
• Attention Providers:
  (Per Change Request 7573)
  We encourage you to visit the Medicare Learning Network (http://www.cms.gov/MLNGenInfo/ )--the place for official CMS Medicare fee-for-service provider educational information. There you can find one of our most popular products, MLN Matters national provider education articles. These articles help you understand new or changed Medicare policy and how those changes affect you. A full array of other educational products (including Web-based training courses, hard copy and downloadable publications, and CD-ROMs) are also available and can be accessed at: http://www.cms.gov/MLNProducts/ . You can also find other important physician Web sites by visiting the Physician Center Web page at: http://www.cms.gov/center/physician.asp.
• To Our J14 Medical Community:
  (Change Requests 7573 and 7412)
  The Medicare Physician Fee Schedule Database (MPFSDB) and the Anesthesia files are available on our web site. Please go to http://www.medicarenhic.com/ne_prov/fee_sched.shtml to view the file for your Area and a short message from the Centers for Medicare & Medicaid Services (CMS).
  Any future updates released by CMS will be posted as soon as they are available.
  The Annual Participation Open Enrollment Period also has begun. To view the pertinent documents, please go to http://www.medicarenhic.com/ne_prov/fee_sched.shtml where you will find the CMS Announcement and the Medicare Participating Physician or Supplier Agreement (Form CMS 460). The mailing address is listed immediately below the forms on the same web page.
  Reminder: Any participating health professional who is not changing their participation status does not need to take any action during the Annual Open Enrollment Period.

17 November 2011

• Revised: MM7575 – Influenza Vaccine Payment Allowances - Annual Update for 2011-2012 Season
• Revised: MM7580 – New Influenza Virus Vaccine Code
• MM7599 – Annual Update of HCPCS Codes Used for Home Health Consolidated Billing Enforcement

09 November 2011

• Revised: SE1122 – Important Reminders about Advanced Diagnostic Imaging (ADI) Accreditation Requirements
• Revised: MM7431 – Autologous Cellular Immunotherapy Treatment of Metastatic Prostate Cancer
• Revised: MM7499 – Reporting of Recoupment for Overpayment on the Remittance Advice (RA) with Patient Control Number
• MM7621 – Changes to the Laboratory National Coverage Determination (NCD) Edit Software for January 2012
• MM7635 – CY 2012 Fee Schedule Update for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)
• 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)

03 November 2011

• MM7575 – Influenza Vaccine Payment Allowances - Annual Update for 2011-2012 Season
• MM7363 – Additional Provider and Supplier Enrollment Requirements for Fixed Wing and Helicopter Air Ambulance Operators
• MM7561 – Format Revisions to the Special Incentive Remittance Advice Used to Report Quarterly Incentive Payments for Health Professional Shortage Areas (HPSAs), the Primary Care Incentive Payment Program (PCIP), and the HPSA Surgical Incentive Payment Program (HSIP)
• MM7580 – New Influenza Virus Vaccine Code
• Revised: SE1126 – Further Details on the Revalidation of Provider Enrollment Information
• SE1134 – Medicare Payments for Diagnostic Radiology Services in Emergency Departments
• SE1136 – 2011-2012 Seasonal Influenza (Flu) Resources for Health Care Professionals
• MM7624 – January 2012 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
• Revised: MM7350 – Implementation of Provider Enrollment Provisions in CMS-6028-FC
• CMS Technical Direction Letter (TDL)-12038
  Hospital Routine Services Under Arrangement Requirement On August 18, 2011, the Centers for Medicare & Medicaid Services (CMS) issued the Fiscal Year (FY) 2012 Inpatient Prospective Payment System (IPPS) final rule. The final rule included a provision limiting the circumstances under which a hospital may furnish services “under arrangement.” Under the revised policy, only therapeutic and diagnostic services may be furnished outside of the hospital under arrangement; “routine services” (for example, bed, board, and nursing services) must be provided by the hospital. Under the policy, routine services that are furnished in the hospital to its inpatients are considered as being provided by the hospital. If services are provided outside of the hospital, the services are considered as being provided under arrangement.
  We recognize that hospitals may need more time to restructure existing arrangements and establish operational protocols necessary to comply with the requirement that only therapeutic and diagnostic services may be furnished outside of the hospital under arrangement and that “routine services” must be provided by the hospital. CMS expects that during FY 2012, hospitals will work towards ensuring compliance with the new requirements. CMS will continue to work with these hospitals to communicate the requirements of this provision and to provide continued guidance. Beginning with the FY 2013, all hospitals will need to be in full compliance with the modified under arrangement provisions.

October

27 October 2011

• SE1129 – Reminder—Beneficiary Cost-Sharing for Medicare-Covered Preventive Services Under the Affordable Care Act
• MM7566 – New Waived Tests
• MM7616 - Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 18.0, Effective January 1, 2012

20 October 2011

• 2012 Fee Schedule / Open Enrollment Period Postcards
  Per Change Request 7412, NHIC, Corp. calls your attention to the following notice regarding the mailing of the 2012 Fee Schedule / Open Enrollment Period CDs. For this year, we will be mailing postcards, as instructed by the IOM section below. Watch for them in your mailbox!
  Internet Only Manual (IOM) Pub. 100-04, Medicare Claims Processing Manual, Chapter 1, section 30.3.12.1:
  Until 2004, the Medicare contractors mailed each provider a hardcopy package which included enrollment materials, a paper copy of the Medicare Physician Fee Schedule (MPFS), an Announcement document, the Medicare Participating Physician or Supplier Agreement (Form CMS-460), and a variety of provider education material about the Medicare program. Beginning with the 2005 mailing, CMS directed Medicare contractors to begin using a CD for the participation mailing because it was less expensive than mailing the hardcopy materials.
  Beginning with the 2006 mailing, contractors placed the new Medicare fees on their Web sites and did not include the fees on the CDs due to frequent last minute changes to the MPFS. Removing the Medicare fees from the CD provided greater flexibility for updates late in the year due to legislative changes or CMS payment policy decisions.
  Since the fee schedules are no longer included on the CD, and the educational materials, as well as the Form CMS-460, are also posted on contractors’ Web sites, the value of the CD to the provider community has diminished. Beginning 2011, CMS is directing contactors to produce a postcard mailing, instead of a CD, for eligible physicians, practitioners and suppliers.
• Revised: MM7489 – Instructions to Accept and Process All Ambulance Transportation Healthcare Common Procedure Coding System (HCPCS) Codes
• 2012 Fee Schedule / Open Enrollment Period
  (Change Request 7412; Internet Only Manual (IOM) Chapter 1, 30.3.12.1)
  NHIC, Corp. reminds our medical community that the upcoming participation enrollment period documents and the upcoming Medicare Physician Fee Schedule (MPFS) and the Anesthesia Conversion Factor(s) will be published on the our web site after the physician fee schedule regulation is put on display. When the files are ready, you may go to http://www.medicarenhic.com/ne_prov/fee_sched.shtml for this information.
• Revised: SE1110 – Medicare Pilot Project for Electronic Submission of Medical Documentation (esMD) Data
• Revised: MM7558 – Updates to the Internet Only Manual Publication 100-04, Chapter 15 – Ambulance to include Medicare and Medicaid Extenders Act of 2010 (MMEA) Provisions
• SE1133 – Predictive Modeling Analysis of Medicare Claims
• 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)

06 October 2011

• SE1130 – Implementation of Pay.gov Application Fee Collection Process through PECOS
• SE1131 – Important Update Regarding 5010/D.0 Implementation – Action Needed Now
• MM7585 – Claim Status Category and Claim Status Codes Update
• Revised: MM7254 – Additional Fields for Additional Documentation Request (ADR) Letters
• MM7558 – Updates to the Internet Only Manual Publication 100-04, Chapter 15 – Ambulance to include Medicare and Medicaid Extenders Act of 2010 (MMEA) Provisions

September

29 September 2011

• MM7546 – Ambulance Inflation Factor for Calendar Year (CY) 2012
• SE1128 – Prohibition on Balance Billing Qualified Medicare Beneficiaries (QMBs)
• Revised: M7397 - Pharmacy Billing for Drugs Provided "Incident To" a Physician Service
• Revised: MM7441 – Magnetic Resonance Imaging (MRI) in Medicare Beneficiaries with Food and Drug Administration (FDA)-Approved Implanted Permanent Pacemakers (PMs) for Use in the MRI Environment
• MM7254 – Additional Fields for Additional Documentation Request (ADR) Letters

22 September 2011

• MM7405 – Clarification of Evaluation and Management (E/M) Payment Policy
• MM7514 – Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy Print (MREP) and PC Print Update
• Revised: MM7526 – Clinical Laboratory Fee Schedule - Medicare Travel Allowance Fees for Collection of Specimens
• Revised: MM7547 – October 2011 Update of the Ambulatory Surgery Center (ASC) Payment System
• Revised: SE1109 – Summary Information Regarding Medicare's Primary Care Incentive Payment Program (PCIP)

15 September 2011

• Revised: SE1101 – Overview of Medicare Policy Regarding Chiropractic Services
• SE1110 – Medicare Pilot Project for Electronic Submission of Medical Documentation (esMD)
• SE1123 – Contractor Entities at a Glance: Who May Contact You about Specific Centers for Medicare & Medicaid Services (CMS) Activities
• MM7492 – Medicare Fee-For-Service (FFS) Claims Processing Guidance for Implementing International Classification of Diseases, 10th Edition (ICD-10)
• Revised: MM7484 – Populating REF Segment - Other Claim Related Adjustment - for Healthcare Claim Payment/Advice or Transaction 835 Version 5010A1
• Revised: MM7507 – Changes to the Laboratory National Coverage Determination (NCD) Edit Software for October 2011
• Revised: MM7444 – October Quarterly Update to 2011 Annual Update of HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement

08 September 2011

• MM7441 – Magnetic Resonance Imaging (MRI) in Medicare Beneficiaries with Food and Drug Administration (FDA)-Approved Implanted Permanent Pacemakers (PMs) for Use in the MRI Environment
• MM7547 – October 2011 Update of the Ambulatory Surgery Center (ASC) Payment System
• MM7538 – Clarification to Chapter 26, Section 10.4 - Items 14-33 - Provider of Service or Supplier Information
• Revised: MM7097 – Eligible Physicians and Non-Physician Practitioners who need to Enroll in the Medicare Program for the Sole Purpose of Ordering and Referring Items and Services for Medicare Beneficiaries

01 September 2011

• Quarterly Provider Update (QPU)
  (IOM Pub 100-09-Chapter 6 Section 50.2.4.3) The Quarterly Provider Update (QPU) is a listing of the regulations and program instructions issued by CMS that impact Medicare providers. The QPU is maintained by CMS and available to providers through the CMS Web site.
  Providers may elect to join a CMS electronic mailing list, to be notified periodically, of additions to the QPU. CMS publishes this
  Update at the beginning of each quarter to inform the public about the following:
  • Regulations and major policies currently under development during this quarter.
  • Regulations and major policies completed or cancelled.
  • New/Revised manual instructions
  The page may be found at: http://www.cms.hhs.gov/QuarterlyProviderUpdates/
  Visit the QPU What’s New page at
  https://www.cms.gov/QuarterlyProviderUpdates/02_Spotlight.asp
• CR 7456, entitled Claim Status Category and Claim Status Codes Update, has been rescinded
• MM7526 – Clinical Laboratory Fee Schedule - Medicare Travel Allowance Fees for Collection of Specimens
• MM7552 – 2012 Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Update

August

25 August 2011

• MM7543 – Annual Clotting Factor Furnishing Fee Update 2012
• MM7528 – October Update to the Calendar Year (CY) 2011 Medicare Physician Fee Schedule Database (MPFSDB)
• Revised: MM7413 – Affordable Care Act - Section 3113 - Laboratory Demonstration for Certain Complex Diagnostic Tests – (CR 7413 Fully Rescinds and Replaces CR 7278)

18 August 2011

• Revised: MM7489 – Instructions to Accept and Process All Ambulance Transportation Healthcare Common Procedure Coding System (HCPCS) Codes
• Revised: MM7397 – Pharmacy Billing for Drugs Provided "Incident To" a Physician Service
• MM7517 – 2012 Annual Update for the Health Professional Shortage Area (HPSA) Bonus Payments
• 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)
• 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: MM7097 – Eligible Physicians and Non-Physician Practitioners who need to Enroll in the Medicare Program for the Sole Purpose of Ordering and Referring Items and Services for Medicare Beneficiaries
• MM7498 – Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS): Allowing Contract or Non-contract Suppliers to Maintain and Service the Enteral Nutrition Equipment That They Provided in the 15th Continuous Month of Rental
• MM7520 – Clarification of Payment for ESRD-Related Services Under the Monthly Capitation Payment
• MM7499 – Reporting of Recoupment for Overpayment on the Remittance Advice (RA) with Patient Control Number
• Revised: SE1011 – Edits on the Ordering/Referring Providers in Medicare Part B Claims (Change Requests 6417, 6421, and 6696)

11 August 2011

• Revised: MM7397 – Pharmacy Billing for Drugs Provided "Incident To" a Physician Service
• MM7489 – Instructions to Accept and Process All Ambulance Transportation Healthcare Common Procedure Coding System (HCPCS) Codes
• Revised: SE1126 – Further Details on the Revalidation of Provider Enrollment Information
• Change Request 7177 has been rescinded and is replaced by Change Request 7681.

04 August 2011

• SE1114 – NEW INFORMATION TO IMPROVE PATIENT SAFETY AT AMERICA'S HOSPITALS
• MM7516 – Affordable Care Act – Section 3113 – Laboratory Demonstration for Certain Complex Diagnostic Tests (This Article Fully Rescinds and Replaces MM7413)
• MM7436 – Recovery Audit Program: Medicare Administrative Contractor (MAC) issued Demand Letters.
• MM7497 – Independent Laboratory Billing of Automated Multi-Channel Chemistry (AMCC) Organ Disease Panel Laboratory Tests for Beneficiaries who are not Receiving Dialysis for Treatment of End Stage Renal Disease (ESRD)
• MM7488 – October 2011 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
• MM7484 – Populating REF Segment - Other Claim Related Adjustment - for Healthcare Claim Payment/Advice or Transaction 835 Version 5010A1
• MM7466 – Medicare Remit Easy Print (MREP) and PC Print User Guide Update for Implementation of Version 5010A1
• MM7511 – Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 17.3, effective October 1, 2011

July

28 July 2011

• MM7431 – Autologous Cellular Immunotherapy Treatment of Metastatic Prostate Cancer
• MM7513 – Additional Healthcare Common Procedure Coding System (HCPCS) Codes Subject to Clinical Laboratory Improvement Amendments (CLIA) Edits
• MM7507 – Changes to the Laboratory National Coverage Determination (NCD) Edit Software for October 2011

22 July 2011

• Common Working File Great Lakes and Northeast Hosts Dark Day on Saturday, July 23, 2011
  CMS Technical Direction Letter (TDL)-11410
  On Saturday, July 23, 2011, the Common Working File (CWF) Great Lakes and Northeast Hosts will be conducting a history purge. Due to the anticipated duration of this activity and to ensure the completion of weekly processing and scheduled data center maintenance, there will be a CWF dark day at the CWF Great Lakes and Northeast Hosts only on that Saturday. This means there will be no access to the Health Insurance Master Record (HIMR) query, which is usually available until noon on Saturdays.
  All files received from satellites for Friday's cycle (July 22, 2011) will be completed prior to bringing CWF production down. If, for any reason, satellite files are received late Saturday morning, they will be processed by CWF after the history purge has been completed.

21 July 2011

• Revised: MM7413 – Affordable Care Act - Section 3113 - Laboratory Demonstration for Certain Complex Diagnostic Tests – (CR 7413 Fully Rescinds and Replaces CR 7278)
• SE1101 – Overview of Medicare Policy Regarding Chiropractic Services

07 July 2011

• MM7454 – Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)
• SE1122 – Important Reminders about Advanced Diagnostic Imaging (ADI) Accreditation Requirements
• Revised: MM7175 - Specialty Code for Advanced Diagnostic Imaging Services
• Revised: MM7397 - Pharmacy Billing for Drugs Provided "Incident To" a Physician Service

June

30 June 2011

• Revised MM7306 – Modifications to the Implementation of the Paperwork (PWK) Segment for X12N Version 5010
• SE1120 – Electronic Prescribing (eRx) Incentive Program 2011 Updates

23 June 2011

• Certification of Mammography Facilities (Annual Reminder)
  IOM 100-04, Chapter 18, section 20.1
  NHIC, Corp. reminds providers that Medicare will reimburse only FDA-certified mammography centers for mammography services.
  We encourage you to inform your patients to use only centers that are certified.
  We provide a direct link on our web site to the listing for all of these facilities in each state at:
  http://www.medicarenhic.com/ne_prov/billing_info.shtml.
  Click on the “Mammography Centers – Certified” link.
  Please share this information with your patients.
• Unsolicited/Voluntary Refund Checks – (Annual Reminder)
  IOM 100-06, Chapter 5, section 410.10
  NHIC, Corp. reminds you of the following statement from the CMS Internet Only Manual (IOM) regarding unsolicited/voluntary refund checks:
  “The acceptance of a voluntary refund as repayment for the claims specified in no way affects or limits the rights of the Federal Government, or any of its agencies or agents, to pursue any appropriate criminal, civil, or administrative remedies arising from or relating to these or any other claims.” For more information, please view the above-mentioned at: http://www.cms.hhs.gov/manuals/downloads/fin106c05.pdf
• Update Your Addresses! “Do Not Forward” (DNF) – Annual Reminder Notice.
  (IOM Pub. 100-04 Chapter 1 Section 80.5.1)
  All providers must notify their Contractor (NHIC, Corp.) of any changes of address.
  To do this:
  1. Visit the CMS Enrollment website and download the Enrollment Form that pertains to you or your group or organization:
  http://www.cms.hhs.gov/MedicareProviderSupEnroll/02_EnrollmentApplications.asp#TopOfPage
  2. Update the form with your new information and mail it to:
        NHIC, Corp.
        Provider Enrollment
        P.O. Box 3434
        Hingham, MA 02044
  NHIC, Corp. uses “return service requested” envelopes for certain mailings, and when an envelope is returned, we apply a Do Not Forward (DNF) flag to the provider’s Medicare Number. Once this happens, no additional checks will be generated until a properly completed change of address form is received and verified by NHIC, Corp. CMS requires corrections to all addresses before the contractor can remove the DNF flag and begin paying the provider or supplier again.
  Protect yourself from payment delays by submitting your changes timely.
• MM7420 – Guidelines to Allow Contractors to Develop and Utilize Procedures for Accepting and Processing Reopenings via a Secure Internet Portal/Application
• Rescinded: MM7456 – Claim Status Category Code and Claim Status Code Update
• MM7435 – New Waived Tests
• Revised: SE1035 – Claims Modifiers for Use in the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program

16 June 2011

• Revised: MM6870 – Reporting of Recoupment for Overpayment on the Remittance Advice (RA)
• MM7416 – July Quarterly Update for 2011 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule

09 June 2011

• SE1113 – Foot Care Coverage Guidelines
• MM7303 – Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes – July 2011 Update
• Revised: MM7412 – Postcard Mailing for the Annual Participation Open Enrollment Period
• Revised: SE1119 – National Coverage Determination (NCD) for Percutaneous Transluminal Angioplasty (PTA) (20.7)
• MM7445 – July 2011 Update of the Ambulatory Surgical Center (ASC) Payment System
• MM7444 – October Quarterly Update to 2011 Annual Update of HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement
• MM7401 – Phase 3 of Manual Revisions to Reflect Payment Changes for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Items as a Result of the DMEPOS Competitive Bidding Program and the Deficit Reduction Act of 2005

May

26 May 2011

• MM7412 – Postcard Mailing for the Annual Participation Open Enrollment Period
• MM7397 – Pharmacy Billing for Drugs Provided "Incident To" a Physician Service
• MM7413 – Affordable Care Act - Section 3113 - Laboratory Demonstration for Certain Complex Diagnostic Tests – (CR 7413 Fully Rescinds and Replaces CR 7278)
• MM7430 – July Update to the CY 2011 Medicare Physician Fee Schedule Database (MPFSDB)

19 May 2011

• MM7399 – Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 17.2, effective July 1, 2011

12 May 2011

• MM7369 – Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy Print (MREP) Update
• Claims Reprocessing Questions & Answers
  TDL 11308
  The CMS Questions and Answers that offer additional information about the reprocessing of claims to comply with the Affordable Care Act are available. This document is located on our Fee Schedule page in the 2010 section.

6 May 2011

• JSM/TDL 11264
  CMS Message 201105-10
  Medicare Part B Average Sales Price - Payments for Wilate and Flulaval
  For the April 2011 Average Sales Price quarterly update, CMS is not publishing a payment limit for HCPCS code J7184 [Injection, Von Willebrand Factor Complex (Human), Wilate, Per 100 iu VWF:RCO] for claims with dates of service between Friday, April 1 and Thursday, June 30, 2011. A price for Wilate can be found on the “April 2011 ASP Not Otherwise Classified (NOC)” pricing file available on the CMS website. Additionally, as per updated CR #7234, CMS has updated the price for Q2036 (Flulaval vacc, 3 yrs & >, im) to $8.784 for the April 2011 ASP quarterly update. This updated price is effective for claims with dates of service on or after Friday, October 1, 2010. The revised price has been added to the October 2010 and January 2011 ASP pricing files. These pricing files can be found on the CMS website at http://www.CMS.gov/McrPartBDrugAvgSalesPrice.

5 May 2011

• MM7325 – Adjudication of Laboratory Tests that are Excluded from Clinical Laboratory Improvement Amendment (CLIA) Edits
• Revised: MM6786 – Screening for the Human Immunodeficiency Virus (HIV) Infection
• MM7411 – New K Codes for Suction Pumps and Wound Dressings
• SE1112 – Power Mobility Device Face-to-Face Examination Checklist

April

28 April 2011

• SE1111 – Medicare Electronic Health Record (EHR) Incentive Payment Process
• MM7349 – New Waived Tests
• Revised: MM6870 – Reporting of Recoupment for Overpayment on the Remittance Advice (RA)
• Revised: MM7234 – New HCPCS Q-codes for 2010-2011 Seasonal Influenza Vaccines
• Revised: MM7041 – Implementation of the PWK (Paperwork) Segment for X12N Version 5010

21 April 2011

• Revised: MM7175 – Specialty Code for Advanced Diagnostic Imaging Services

14 April 2011

• Change Request 7177 has been rescinded and is replaced by Change Request 7681.

07 April 2011

• Revised: MM6968 – Payment for Implantable Tissue Markers (Healthcare Common Procedure Coding System (HCPCS) Code A4648) and Implantable Radiation Dosimeters (HCPCS Code A4650)

March

31 March 2011

• MM7232 – Effective Date of Certified Provider or Supplier Agreement or Approval
• MM7357 – July 2011 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
• MM7343 – April 2011 Update of the Ambulatory Surgical Center (ASC) Payment System
• Revised: MM7266 – New Waived Tests
• MM7350 – Implementation of Provider Enrollment Provisions in CMS-6028-FC
• Revised: MM7278 – Affordable Care Act – Section 3113 – Laboratory Demonstration for Certain Complex Diagnostic Tests

24 March 2011

• MM7364 – 2011 Annual Update to the Therapy Code List
• SE1109 – Summary Information Regarding Medicare's Primary Care Incentive Payment Program (PCIP)
• MM7348 – Claim Status Category Code and Claim Status Code Update
• Revised: MM7319 – April Update to the Calendar Year (CY) 2011 Medicare Physician Fee Schedule Database (MPFSDB)
• Revised: MM7300 – Emergency Update to the CY 2011 Medicare Physician Fee Schedule Database
• MM7331 – Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 17.1, effective April 1, 2011

17 March 2011

• Change Request 7177 has been rescinded and is replaced by Change Request 7681.
• MM7296 – Magnetic Resonance Imaging (MRI) in Medicare Beneficiaries with Implanted Permanent Pacemakers (PMs) or Implantable Cardioverter Defibrillators (ICDs)
• Rescinded: MM7239 – Clinical Laboratory Fee Schedule – Medicare Travel Allowance Fees for Collection of Specimens

10 March 2011

• Revised: MM7012 – Waiver of Coinsurance and Deductible for Preventive Services, Section 4104 of The Affordable Care Act, Removal of Barriers to Preventive Services in Medicare
• Revised: MM7049 – Expansion of Medicare Telehealth Services for Calendar Year (CY) 2011
• SE1106 – Important Reminders about HIPAA 5010 & D.0 Implementation
• Revised: MM6870 – Reporting of Recoupment for Overpayment on the Remittance Advice (RA)
• SE1102 – Inappropriate Medicare Payments for Transforaminal Epidural Injection Services
• SE1104 – The Importance of Correctly Coding the Place of Service by Physicians and Their Billing Agents

03 March 2011

• Medicare NCCI - Medically Unlikely Edit (MUE) for FASLODEX (J9395)
  JSM/TDL-11174
  The Centers for Medicare & Medicaid Services has identified a Medicare claims processing issue with Healthcare Common Procedure Coding System (HCPCS) J9395 (Fulvestrant, 25 mg) (Faslodex) that began January 1, 2011. Payment for Faslodex is currently limited to a 250 mg dose but should be 500 mg, effective January 1, 2011, based on U.S. Food and Drug Administration (FDA) approved prescribing information. This will be corrected on April 1, 2011.
  Provider Action
  Providers may delay submission of their claims for a dosage greater than 250 mg until April 1, 2011, when the fix is in place to properly pay these claims. Alternatively, in this instance only, providers may submit their claims prior to April 1, 2011 by reporting J9395 on two lines of a claim utilizing modifier 59 with the code on one claim line, reporting ten units of service on each line, and be paid for the 500 mg dose of Faslodex.
  If providers have had claims denied due to this issue, they may resubmit their claims using the alternative identified above or request a reopening after April 1, 2011.
  Note: Due to NHIC system limitations, to have your claim paid, use modifier 76 in place of modifier 59.
• Revised: MM3834 – Smoking and Tobacco-Use Cessation Counseling
• Revised: MM7018 – Updates to the Medicare Claims Processing Manual (Publication 100-04, Chapter 15 (Ambulance)) to Correct Claims Billing Instructions as Well as to Update Fee Schedule Payment Rates Mandated by the Affordable Care Act of 2010
• Revised: MM6786 – Screening for the Human Immunodeficiency Virus (HIV) Infection
• MM7307 – Clarification to CR No. 6686 - Outpatient Mental Health Treatment Limitation
• Revised:MM7319 – April Update to the Calendar Year (CY) 2011 Medicare Physician Fee Schedule Database (MPFSDB)
• Revised: MM7060 – Incentive Payment Program for Primary Care Services, Section 5501(a) of The Affordable Care Act

February

24 February 2011

• SE1105 – Medicare Drug Screen Testing
• MM7313 – Clinical Laboratory Fee Schedule – Medicare Travel Allowance Fees for Collection of Specimens
• MM7128 – Payment Update and Common Working File (CWF) Editing for Influenza Virus Vaccine and Pneumococcal Vaccine (PPV) Codes
• MM7266 – New Waived Tests
• MM7277 – Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) Edits
• MM7267 – Primary Care Incentive Payment Program (PCIP) Eligibility for New Providers Enrolled in Medicare
• SE1107 – 2011 Electronic Prescribing (eRx) Incentive Program Update – Future Payment Adjustments
• Revised: MM7065 – Fractional Mileage Amounts Submitted on Ambulance Claims
• Revised: MM7079 – Annual Wellness Visit (AWV), Including Personalized Prevention Plan Services (PPPS)
• Revised: MM7299 – Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes – April 2011 Update
• Rescinded: MM7061 – Edit to Deny Payment to Physicians and Other Suppliers for the Technical Component (TC) of Pathology Services Furnished on Same Date as Inpatient and Outpatient Services and Implements New Messages, was rescinded on February 17, 2011.

10 February 2011

• MM7176 – Accreditation for Physicians and Non-Physician Practitioners Supplying the Technical Component (TC) of Advanced Diagnostic Imaging (ADI) Services
• MM7228 – Auto Denial of Claims Submitted With a GZ Modifier
• Revised MM7278 – Affordable Care Act – Section 3113 – Laboratory Demonstration for Certain Complex Diagnostic Tests
• MM7299 – Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes – April 2011 Update
• MM7319 – April Update to the Calendar Year (CY) 2011 Medicare Physician Fee Schedule Database (MPFSDB)
• Revised: MM7050 – Multiple Procedure Payment Reduction (MPPR) for Selected Therapy Services
• Revised: MM7079 – Annual Wellness Visit (AWV), Including Personalized Prevention Plan Services (PPPS)

03 February 2011

• MM7261 – Additional Healthcare Common Procedure Coding System (HCPCS) Codes Payable Under the Replacement Part, Accessories, and Supplies Pricing Logic Established By Change Requests (CRs) 5917 and 6573
• MM7306 – Modifications to the Implementation of the Paperwork (PWK) Segment for X12N Version 5010

January

27 January 2011

• MM7250 – Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy Print (MREP) Update
• MM7290 – Changes to the Laboratory National Coverage Determination (NCD) Edit Software for April 2011
• MM7257 – 2011 Durable Medical Equipment Prosthetics, Orthotics, and Supply (DMEPOS) Healthcare Common Procedure Coding System (HCPCS) Code Jurisdiction List
• Revised: MM7064 – End Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Consolidated Billing for Limited Part B Services
• Quarterly Provider Update (QPU) (IOM Pub 100-09-Chapter 6 Section 50.2.4.3)
  The Quarterly Provider Update (QPU) is a listing of the regulations and program instructions issued by CMS that impact Medicare providers. The QPU is maintained by CMS and available to providers through the CMS Web site.
  Providers may elect to join a CMS electronic mailing list, to be notified periodically, of additions to the QPU. CMS publishes this Update at the beginning of each quarter to inform the public about the following:
  
  • Regulations and major policies currently under development during this quarter.
  • Regulations and major policies completed or cancelled.
  • New/Revised manual instructions
  The page may be found at: http://www.cms.hhs.gov/QuarterlyProviderUpdates/
  Visit the QPU What’s New page at http://www.cms.hhs.gov/QuarterlyProviderUpdates/03_WhatsNew.asp
• MM7298 – April 2011 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
• MM7270 – Changes to the Time Limits for Filing Medicare Fee-For-Service Claims
• Revised: MM7248 – Calendar Year (CY) 2011 Update for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule

20 January 2011

• 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)

13 January 2011

• MM7275 - January 2011 Update of the Ambulatory Surgical Center (ASC) Payment System
• MM7264 - Summary of Policies in the CY 2011 Medicare Physician Fee Schedule (MPFS) and the Telehealth Originating Site Facility Fee Payment Amount
• MM7300 – Emergency Update to the CY 2011 Medicare Physician Fee Schedule Database
• Revised: SE1035 – Claims Modifiers for Use in the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program

06 January 2011

• MM6988 – Face Validity Assessment of Advance Beneficiary Notice (ABN) for Complex Medical Record Review
• Rescinded: MM7109 – Pharmacy Billing for Drugs Provided “Incident to” a Physician’s Service
• MM7262 – Medical Nutrition Therapy (MNT) Manual Correction
• Revised: MM6947 – Revisions to Claims Processing Instructions for Services Rendered in Place of Service Home
• MM7018 - Updates to the Medicare Claims Processing Manual (Publication 100-04, Chapter 15 Ambulance)) to Correct Claims Billing Instructions as Well as to Update Fee Schedule Payment Rates Mandated by the Affordable Care Act of 2010
• MM7249 – Payment for 510k Post-Approval Extension Studies Using 510k-Cleared Embolic Protection Devices during Carotid Artery Stenting (CAS) Procedures
• MM7218 - Medicare Remit Easy Print (MREP) Enhancement

04 January 2011

• Face-to-Face Encounter Home Health Certification Requirement
  (JSM/TDL-11111)
  Section 6407 of the Affordable Care Act of 2010 established a physician face-to-face encounter requirement for certification of eligibility for Medicare home health services. The law requires that the certifying physician must document that he or she, or a non-physician practitioner (NPP) working with the physician, has seen the patient.
  In the Home Health Prospective Payment System Rate Update for Calendar Year (CY) 2011, the Centers for Medicare & Medicaid Services (CMS) finalized its implementation approach for this law. Pursuant to 42 C.F.R. § 424.22(a)(1)(v) (75 Fed. Reg. 70464, November 17, 2010), the face-to-face encounter must occur within the 90 days prior to the start of care, or within the 30 days after the start of care. The regulation also states that the certifying physician must document the encounter as part of the certification itself or as a signed addendum to it. The documentation must include the date when the encounter occurred and a brief narrative which describes how the clinical findings of the encounter support the patient’s homebound status and need for skilled services. The rule requires such documentation be present on certifications for patients with starts of care on or after January 1, 2011.
  Although many home health agencies and physicians are aware of and are able to comply with this policy, CMS is concerned that some home health agencies and physicians may need additional time to establish operational protocols necessary to comply with this new law. As such, CMS expects that during the first quarter of CY 2011, home health agencies and physicians who order home health services will collaborate and establish internal processes to ensure compliance. Beginning with the second quarter of CY2011, home health agencies will have fully established such internal processes and CMS will expect appropriate documentation of the encounter.
  CMS will continue to address industry questions concerning the new requirement, and will update information on our Web site at http://www.cms.gov/center/hha.asp. We will also use other channels we have to communicate with providers to ensure information is widely distributed.
• Hospice Face-to-Face Encounter Requirement
  (JSM/TDL-11112)
  Section 3131(b) of the Affordable Care Act of 2010 requires a hospice physician or nurse practitioner (NP) to have a face-to-face encounter with every hospice patient prior to the patient’s 180th- day recertification, and each subsequent recertification. The provision applies to recertifications on and after January 1, 2011.
  In the Home Health Prospective Payment System Rate Update for Calendar Year (CY) 2011, the Centers for Medicare & Medicaid Services (CMS) finalized its implementation approach for this hospice provision. The final rule, codified at 42 C.F.R. 418.22(a)(4) (75 Fed. Reg. 70463, November 17, 2010) states that the encounter must occur no more than 30 calendar days prior to the start of the hospice patient’s third benefit period. The regulation requires that the hospice physician or nurse practitioner attest that the encounter occurred, and the recertifying physician must include a narrative which describes how the clinical findings of the encounter support the patient’s terminal prognosis of 6 months or less. Both the narrative and the attestation must be part of, or an addendum to, the recertification.
  Although many hospices are aware of and are able to comply with this policy, CMS is concerned that some hospices may need additional time to establish operational protocols necessary to comply with this new law. As such, CMS expects that during the first quarter of CY 2011, hospices will establish internal processes to ensure compliance. Beginning with the second quarter of CY 2011, hospices will have fully established such internal processes and CMS will expect appropriate documentation of the encounter.
  CMS will address industry questions concerning the new requirement on our Web site at http://www.cms.gov/center/hospice.asp. We will also use other channels we have to communicate with providers to ensure information is widely distributed.

05/16/2013