Billing and Coverage
Last Modified: 10/3/2008
Some claims processed from October 1, 2006, through June 6, 2008, were for patients identified incorrectly as having Medicare as secondary. FCSO will reprocess affected claims.
Last Modified: 10/3/2008
Medicare Learning Network (MLN) Matters special edition article SE0833 is now available, which contains information on the 2009 competitive acquisition program (CAP) postponement. [PERL 200810-04]
Last Modified: 10/2/2008
Flu season is upon us. Begin now to take advantage of each office visit as an opportunity to encourage your patients to get a flu shot. It’s still their best defense against combating the flu this season. [PERL 200810-03]
Last Modified: 10/1/2008
Beginning January 5, 2009, Medicare will pay physicians at the facility rate for procedures furnished in ambulatory surgical centers (ASCs) that are excluded from the list of covered ASC procedures. [MM6052]
Last Modified: 10/1/2008
This outlines general information for providers detailing the International Classification of Diseases, 10th Edition (ICD-10) classification system. [SE0832]
Last Modified: 10/1/2008
This article provides clarification regarding Medicare payment of routine costs associated with clinical trials. [SE0822]
Last Modified: 9/30/2008
This article notifies providers about the annual update of the DMEPOS jurisdiction list which can assist the billing staff with determining where to submit their claims. [MM6062]
Last Modified: 9/26/2008
This manual update incorporates non-appeals related provisions published in the Federal Register on June 27, 2008. [MM6178]
Last Modified: 9/26/2008
The latest package of Correct Coding Initiative (CCI) edits will be effective October 1, 2008. Version 14.3 of the CCI edits will include all previous versions and updates from January 1, 1996 to the present. [MM6169]
Last Modified: 9/26/2008
This article was revised on September 24, 2008, to change the reference in the “Impact on Providers” section to data loop 2310A, instead of 2310B. All other information is the same. [MM6129]
Last Modified: 9/24/2008
CMS encourages Medicare providers to vaccinate their patients against the influenza virus. Providers may download the Medicare Part B Immunization Billing quick reference chart from the CMS Web site. [PERL 200809-19, 200809-43]
Last Modified: 9/23/2008
Effective October 1, 2008, if you owe overdue taxes to the Internal Revenue Service (IRS), your Medicare payment may be adjusted accordingly. [PERL 200808-26, 200809-34, 200809-41, 200809-43]
Last Modified: 9/23/2008
The standard Medicare Part B monthly premium will be $96.40 in 2009, the same as the Part B premium for 2008. This is the first year since 2000 that there was no increase in the standard premium over the prior year. [PERL 200809-41]
Last Modified: 9/23/2008
The new rules prohibit financial incentives that could encourage agents and brokers to maximize commissions by inappropriately moving, or churning, beneficiaries from one plan to another each year. [PERL 200809-41]
Last Modified: 9/23/2008
CMS has launched Ask Medicare, a new one-stop Web site to assist caregivers and beneficiaries with valuable health care information, services, and resources. [PERL 200809-41]
Last Modified: 9/23/2008
The RAC demonstration program has proven to be successful in returning dollars to the Medicare Trust Fund. This article provides tips to help you prepare for the RAC permanent program.
Last Modified: 9/22/2008
This guide provides information about payment for physician services in teaching settings, general documentation guidelines, and evaluation and management documentation guidelines. [PERL 200809-42]
Last Modified: 9/22/2008
CMS is providing a link where providers may find the capped and uncapped amounts for the technical component (TC) of most imaging services and the TC of global services at the outpatient prospective payment system rate. [PERL 200809-38]
Last Modified: 9/22/2008
Medicare Part B reimburses providers who accept the Medicare-approved payment amount for influenza, pneumococcal, and hepatitis B vaccines and their administration. All adults 65 and older should get influenza and pneumococcal shots. [PERL 200809-40]
Last Modified: 9/19/2008
Competitive acquisition program (CAP) drugs will not be available from an approved vendor for dates of service after December 31, 2008, and the 2009 CAP physician election period will not be held. [SE0833]
Last Modified: 9/19/2008
This article was revised on September 18, 2008, to make minor clarifying changes on page 2 and to delete some unnecessary language on pages 5 and 9. All other information remains the same. [MM6183]
Last Modified: 9/18/2008
Certain surgery and assistant-at-surgery claims processed from July 24, 2008, through September 12, 2008, were processed incorrectly. FCSO will adjust all affected claims.
Last Modified: 9/18/2008
This article informs providers, Medicare carriers, and A/B MACs of new waived tests approved by the Food and Drug Administration (FDA) under the Clinical Laboratory Improvement Amendments of 1988 (CLIA). [MM6179]
Last Modified: 9/17/2008
On or after September 16, 2008, the October 2008 average sales price (ASP) and ASP NOC files will be available for contractors to download, along with revisions to prior payment files, as CMS deems necessary. [MM6175]
Last Modified: 9/17/2008
CMS has revised the implementation date of change request 6185 to December 1, 2008. In addition, the transmittal numbers, CR release date, and the Web addresses for accessing CR 6185 were revised. All other information remains the same. [MM6185]
Last Modified: 9/15/2008
Revised September 9, 2008, to emphasize that the changes apply to claims received on or after August 18, 2008. The change request (CR) release date, transmittal number and Web address for accessing CR 5683 were also changed. [MM5683]
Last Modified: 9/12/2008
To decrease the volume of claims returned to providers, Medicare will assume that a diagnostic service is not purchased if there is no entry in either Block 20 on Form CMS-1500, or no PS1 segment on the 837P X12 4010A1 electronic format. [MM6122]
Last Modified: 9/12/2008
Earlier this year, CMS accepted bids for vendor contracts for the 2009-11 CAP. While CMS received several qualified bids, contractual issues with the successful bidders resulted in CMS postponing the 2009 program.[PERL 200809-15]
Last Modified: 9/11/2008
This article revises and clarifies payment of travel allowances that are based on either a per-mileage basis or flat-rate basis for calendar year 2008. The new rates are $1.035 per mile (code P9603) and $9.55 per flat-rate trip (code P9604). [MM6195]
Last Modified: 9/11/2008
Beginning March 1, 2009, Medicare contractors will accept only a properly executed revised advance beneficiary notice of noncoverage (CMS R-131) as a valid notification. [MM6136]
Last Modified: 9/11/2008
Influenza virus and pneumococcal vaccine claims submitted on roster bills do not require the reporting of the national provider identifier of the rendering provider in the 24J field of the Form CMS-1500 (08-05). [MM6079]
Last Modified: 9/8/2008
Effective 10/1/08, Vivitrol® naltrexone (J2315) has been added to the list of drugs available under the Competitive Acquisition Program (CAP). [PERL 200809-07]
Last Modified: 9/5/2008
E-prescribing enables licensed practitioners to transmit prescriptions via the Internet, instead of writing them on paper. Beginning in 2009, Medicare will provide incentive payments to eligible providers who e-prescribe. [PERL 200808-38 & 200809-05]
Last Modified: 9/5/2008
CMS study of possible alternative payment locality configurations is in the early stages of development. You are encouraged to submit comments on the options until October 20, 2008. [PERL 200809-06]
Last Modified: 9/4/2008
Article revised August 11, 2008, to reflect changes made to CR 6145. The transmittal number, release date, and Web address for accessing the NCD portion of CR 6145 were revised. All other information remains the same. [MM6145]
Last Modified: 9/4/2008
This article was revised on September 2, 2008, to revise the CR release date, transmittal number, and the Web address for accessing CR 6048. In addition, some language in item 3 on page 3 was clarified. [MM6048]
Last Modified: 9/4/2008
CMS has updated the Medicare benefits policy manual to incorporate guidance regarding the signature requirement for diagnostic tests. [MM6100]
Last Modified: 9/3/2008
An audio recording of this special forum will be accessible for downloading beginning September 10, 2008. [PERL 200808-34]
Last Modified: 9/3/2008
A self-paced training course is available to assist providers with the specific situations when Medicare requires additional information or documentation.
Last Modified: 8/29/2008
CMS was asked to reconsider the current noncoverage for fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging in the Medicare national coverage determinations for certain off-label uses. [MM6099]
Last Modified: 8/29/2008
The purpose of this Special Open Door Forum (ODF), scheduled September 3, 2008, is to provide guidance to DMEPOS providers on the MIPPA. [PERL 200808-34]
Last Modified: 8/28/2008
This article provides an overview of the October Update to the 2008 Medicare Physician Fee Schedule Database, scheduled for implementation on October 6, 2008. [MM6180]
Last Modified: 8/28/2008
According to the MCPSS, providers continue to be satisfied with services provided by Medicare fee-for-service (FFS) contractors, showing a relatively smooth transition to the new Medicare administrative contractors (MACs). [PERL 200808-30]
Last Modified: 8/25/2008
CMS' study of possible alternative payment for localities under the MPFS is in early stages of development. CMS encourages interested parties to submit comments on the options presented in the report, and suggestions for other options. [PERL 200808-25]
Last Modified: 8/25/2008
This article was revised on August 21, 2008, to clarify the “Provider Types Affected.” All other information remains the same. [MM6125]
Last Modified: 8/21/2008
CMS will be hosting a series of end-stage renal disease stakeholder meetings to provide an opportunity for interested stakeholders to provide vital input and recommendations on the program moving forward. [PERL 200808-24]
Last Modified: 8/19/2008
This specific code describes claims denied based on the non-compliance with the physician self-referral prohibition legislation or payer policy due to a financial interest, and the provider fails to meet one of the available exceptions. [MM6131]
Last Modified: 8/19/2008
Because of a systems error, Medicare may be denying CAP claims that contain the same beneficiary, date of service, and HCPCS drug code, but have different prescription order numbers. [MM6124]
Last Modified: 8/19/2008
This article announces that effective October 1, 2008, the list and payment amounts for drugs supplied under the CAP have been revised. [MM6158]
Last Modified: 8/19/2008
The remittance advice remark codes used in electronic and paper remittance advice, and the claim adjustment reason codes used in electronic and paper remittance advice and coordination-of-benefits claim transactions have been updated. [MM6109]
Last Modified: 8/19/2008
ICD-9 is now widely viewed as outdated with its limited ability to accommodate new procedures and diagnoses. ICD-9 contains only 17,000 codes and is expected to start running out of available codes next year. [PERL 200808-23]
Last Modified: 8/19/2008
The Centers for Medicare & Medicare Services (CMS) estimates that the average monthly premium beneficiaries will pay for standard Part D coverage in 2009 will be $28. [PERL 200808-22]
Last Modified: 8/18/2008
CMS reminds the Medicare providers of the requirements to correctly enroll in order to conduct mass immunization roster billing and centralized billing of Medicare for influenza and pneumococcal immunizations. [MM6121]
Last Modified: 8/15/2008
The Physician Group Practice (PGP) Demonstration improved the quality of care delivered to patients with congestive heart failure, coronary artery disease, and diabetes mellitus during the performance year two of the demonstration. [PERL 200808-19]
Last Modified: 8/14/2008
This guide provides information about evaluation & management services and is offered by CMS as a reference. [PERL 200808-18]
Last Modified: 8/14/2008
Effective March 1, 2009, when you contact Medicare through the IVR system, a CSR, or a written inquiry you will have to provide three data elements for authentication: 1) Your NPI; 2) Your PTAN, and 3) the last five-digits of your TIN. [MM6139]
Last Modified: 8/14/2008
CMS has awarded contracts for the 9th statement of work (SOW) for the 53 contractors participating in the Medicare QIO program. The 9th SOW focuses on improving the quality and safety of health care services to Medicare beneficiaries. [PERL 200808-17]
Last Modified: 8/14/2008
Organizations considering becoming co-sponsors for the two-day conference with CMS can access the notice in the Federal Register. All proposals must be submitted electronically. [PERL 200808-08, 200808-12]
Last Modified: 8/12/2008
This article is to remind the provider community that all Medicare beneficiaries must contact 1-800 Medicare (1-800-633-4227 TTY: 1-877-486-2048) for assistance.
Last Modified: 8/12/2008
An updated version of The Physician’s Guide to Medicare Coverage of Kidney Dialysis and Kidney Transplant Services booklet is available to download from the Centers for Medicare & Medicaid Services Medicare Learning Network. [PERL 200808-09]
Last Modified: 8/11/2008
CMS released the 2009 out-of-pocket (OOP) limits for Medigap plans K & L; the limits are $4,620 and $2,310, respectively. [PERL 200808-09]
Last Modified: 8/11/2008
Under this pilot in Arizona and Utah, a beneficiary may choose one of the selected commercial personal health record (PHR) tools, and Medicare will transfer up to two years of the individual’s claims data into the individual’s PHR. [PERL 200808-09]
Last Modified: 8/11/2008
The April 2008 version of the Rural Health Clinic Fact Sheet, which provides information about rural health clinic (RHC) services, is now available in print format. [PERL 200808-09]
Last Modified: 8/5/2008
These articles were recently revised to reflect current processes and provide the Web address which contains user reference guides. CMS will notify providers as internet applications become available. [SE0747, SE0753, SE0754]
Last Modified: 8/5/2008
Medicare helps beneficiaries with the cost of immunizations by providing coverage for pneumococcal, influenza and hepatitis B vaccines. Medicare covers the cost of these vaccines and their administration by recognized providers. [PERL 200808-03]
Last Modified: 8/5/2008
This article was revised to correctly state the payment policy regarding ER visits on the same day as critical care, to clarify reporting of services to neonates, infants, and children, and correct how to calculate critical care time. [MM5993]
Last Modified: 8/4/2008
This article serves as a reminder that the annual International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) update will be effective for dates of service on and after October 1, 2008. [MM6107]
Last Modified: 8/1/2008
Due to a preliminary injunction issued in San Diego, implementation of CR 5772 has been delayed. [JSM 08347]
Last Modified: 8/1/2008
Beginning in 2009, and during the next four years, Medicare will provide incentive payments to eligible professionals who are successful electronic prescribers. [PERL 200807-30]
Last Modified: 8/1/2008
This article alerts providers that effective for claims with dates of service on and after March 19, 2008, CMS revised its NCD limits and will expand the population eligible for home coverage of PT/INR monitoring. [MM6138]
Last Modified: 8/1/2008
This instruction was issued to highlight that the use of stamped signatures is prohibited. CMS has taken this step to ensure accurate application of Medicare’s program requirements throughout the nation. [SE0829]
Last Modified: 8/1/2008
These fact sheets are now available in print format from the Centers for Medicare & Medicaid Services Medicare Learning Network. [PERL 200807-31]
Last Modified: 7/31/2008
Qualified independent laboratories may continue to bill for the TC of certain physician pathology services provided to patients as part of a covered hospital inpatient stay or outpatient hospital service through December 31, 2009. [MM6042]
Last Modified: 7/31/2008
This special edition article explains Medicare’s guidelines for payment of Part B mental health services. [SE0816]
Last Modified: 7/24/2008
The HHS Office of the Inspector General has issued a policy statement regarding the waiving of retroactive beneficiary cost-sharing amounts attributable due to increased payment rates. [PERL 200807-28]
Last Modified: 7/22/2008
This article revises the action taken by change request 5757 to eliminate the negative impact on therapy professionals. [MM6128]
Last Modified: 7/22/2008
This article responds to questions concerning change request 5717, titled "Update to Audiology Policies." [MM6061]
Last Modified: 7/21/2008
Due to the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), legislation altered a number of Medicare policies. This article addresses five critical issues. [SE0826]
Last Modified: 7/21/2008
This article was rescinded on July 17, 2008, since CR 6088 was rescinded on the same date. [MM6088]
Last Modified: 7/21/2008
The special accreditation deadlines previously established for the second round of the program have been cancelled. The deadline of September 30, 2009, for which all DMEPOS suppliers must be accredited is still in effect. [PERL 200807-25]
Last Modified: 7/18/2008
Find out more about the Ombudsman Program, ZIP code files, and the important requirements of the "Grandfathered" supplier provision. [PERL 200806-19]
Last Modified: 7/17/2008
The moratorium that allows independent laboratories (ILs) to bill for the technical component (TC) of physician pathology services furnished to hospital patients has been reinstated. [JSM 08413, PERL 200807-23]
Last Modified: 7/17/2008
The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) delays implementation of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. [PERL 200807-21]
Last Modified: 7/16/2008
CR 6137 responds to a request by the manufacturer to reconsider and expand coverage to include Coverage with Evidence Development (CED) for intracranial stenting and angioplasty for patients in the IDE clinical trails. [MM6137]
Last Modified: 7/16/2008
Beginning with dates of service on or after July 1, 2008, ILs that qualify to bill for the TC of a physician pathology service furnished to a patient of a covered hospital may no longer bill their carrier for these services. [MM6088]
Last Modified: 7/15/2008
When submitting a written request for a redetermination, it's important to know what is considered an acceptable signature.
Last Modified: 7/15/2008
This article was revised to announce the availability of important information regarding the ordering of certain power mobility devices during the transition period just prior to implementation of the DMEPOS competitive bidding program. [MM6119]
Last Modified: 7/14/2008
CMS released a new report showing that $693.6 million in improper Medicare payments was returned to the Medicare Trust Funds between 2005 and March 2008. [PERL 200807-14]
Last Modified: 7/11/2008
The April 2008 version of the Rural Health Clinic Fact Sheet provides information about rural health clinic (RHC) services and is available to download. [PERL 200807-13]
Last Modified: 7/10/2008
The Medicare Guide to Rural Health Services Information for Providers, Suppliers, and Physicians contains rural health information pertaining to rural health facility types, coverage and payment policies, and rural provisions. [PERL 200807-08]
Last Modified: 7/9/2008
This April 2008 fact sheet provides information about the Rural Referral Center program requirements and is now available in print format. [PERL 200807-07]
