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.

Note: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material which is copyrighted by the American Medical Association (AMA). You are forbidden to download the files unless you read, agree to and abide by the provisions of the copyright statement. Read the copyright statement now (you will be linked back to here).

2012 - May | April | March | February | January

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

May

10 May 2012

• 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.

05/10/2012