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ListServ Message 02/08/2008
February 4, 2008
Information posted by The CMS.
New:
MM5912 January 2008 Update of the Hospital Outpatient Prospective Payment System (OPPS) http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5912.pdf
MM5837 Clarification Regarding the Coordination of Benefits Agreement (COBA) Medigap Claim based Crossover Process http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5837.pdf
Revised:
MM5745 Billing Instructions Regarding Payment for Hospice Care Based on Location Where Care is Furnished http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5745.pdf
MM5245 Instructions for Reporting Hospice Services in Greater Line Item Detail
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5245.pdf
MM5211 2007 Update of HCPCS Codes and Payments for Ambulatory Surgical Centers (ASCs) http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5211.pdf
MM5026 Ambulatory Surgical Center (ASC) Claims Processing Manual Clarification
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5026.pdf
MM5837 Clarification Regarding the Coordination of Benefits Agreement (COBA) Medigap Claim based Crossover Process http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5837.pdf
SE0663 Notifying Medicare Patients about Lifetime Reserve Days (LRDs) http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0663.pdf
SE0742 Revised Payment System for Ambulatory Surgical Centers (ASC) in Calendar Year (CY) 2008 http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0742.pdf
February 5, 2008
In accordance with Transmittal 1388, Fee Schedule Update for 2008 for Durable Medical Equipment, Prosthetics, Orthotics and Supplies, DMEPOS fee schedule files were released to contractors to pay claims with dates of service on or after January 1, 2008. The Healthcare Common Procedure Coding System (HCPCS) code E0461 was inadvertently omitted from these files. Therefore, the January 2008 DMEPOS fee schedule files are being revised to add fee schedule amounts for HCPCS code E0461.
As a result of the addition, a revised January 2008 DMEPOS Fee Schedule file will be released to the Statistical Analysis Durable Medical Equipment Regional Carrier (SADMERC), DME MACs, local Part B carriers, and A/B MACs via CMS’ mainframe telecommunications system on February 5, 2008. A revised 2008 DMEPOS Fee Schedule file will also be released to FIs, regional home health intermediaries, A/B MACs, Railroad Retirement Board (RRB), Indian Health Service, and United Mine Workers on February 5, 2008.
Important Information from The CMS.
The NPI is here. The NPI is now. Are you using it?
ATTENTION: Fee For Service (FFS) Medicare Physicians, Non Physician Practitioners & Other Suppliers
Effective March 1, 2008, when required for Medicare claim submission, all 837P and CMS-1500 claims must have an NPI or NPI/legacy pair in the required primary provider fields. Failure to include an NPI will cause the claim to reject.
Visit the CMS NPI web page at http://www.cms.hhs.gov/NationalProvIdentStand/02_WhatsNew.asp for more details.
Registration Closes Today for CMS National NPI Roundtable on 2/6/2008
CMS will host a national NPI Roundtable on Wednesday, February 6th from 2:30 4PM ET. This call will focus on the status of the Medicare implementation of the NPI, and will address questions from participants regarding the Medicare policy affecting Part B claims, which becomes effective March 1st. Registration details are available at http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/listservwording2-6-08npicall.pdf on the CMS website.
Need More Information?
Not sure what an NPI is and how you can get it, share it and use it? As always, more information and education on the NPI can be found through the CMS NPI page
www.cms.hhs.gov/NationalProvIdentStand on the CMS website. Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203. Having trouble viewing any of the URLs in this message? If so, try to cut and paste any URL in this message into your web browser to view the intended information.
Note: All current and past CMS NPI communications are available by clicking CMS Communications in the left column of the www.cms.hhs.gov/NationalProvIdentStand CMS webpage.
Information from The CMS.
February is American Heart Month Since 1999, the rate of deaths from coronary heart disease and stroke in American has declined. While much progress has been achieved in reducing the death rate, heart disease and stroke still remain the number 1 and number 3 causes of death in the U.S., and a major cause of disability and reduced quality of life. Found more often among people aged 65 or older, heart disease is largely preventable. The Centers for Medicare & Medicaid Services (CMS) is taking this opportunity to remind health care professionals that Medicare beneficiaries are covered for certain cardiovascular screening blood tests. This screening can help beneficiaries learn if they have an increased risk of heart disease and stroke.
Medicare provides coverage of the following cardiovascular screening blood tests for the early detection of cardiovascular disease or abnormalities associated with an elevated risk of heart disease and stroke:
Total Cholesterol Test
Cholesterol Test for High density Lipoproteins
Triglycerides Test
Coverage of cardiovascular screening blood tests is provided as a Medicare Part B benefit. The beneficiary will pay nothing for the blood tests (there is no coinsurance or copayment and no deductible for this benefit).
IMPORTANT NOTE: The cardiovascular screening benefit covered by Medicare is a stand alone billable service separate from the Initial Preventive Physical Examination or Welcome to Medicare Visit and does not have to be obtained within the first six months of a beneficiary’s Medicare Part B coverage.
Spread the Word
CMS needs your help getting the word out about the cardiovascular screening benefit covered by Medicare. Talk with your patients about their risk factors for cardiovascular disease and how they can help lessen their risk through lifestyle modifications such as diet, physical activity, better control of cholesterol, and smoking cessation or if necessary with medication. Encourage your Medicare patients not previously diagnosed with cardiovascular disease to take full advantage of the cardiovascular screening blood tests covered by Medicare. It could save their lives!
For More Information
CMS has developed a variety of educational products and resources to help health care professionals and their staff learn more about coverage, coding, billing, and reimbursement for preventive services and screenings covered by Medicare.
The MLN Preventive Services Educational Products Web Page provides descriptions and ordering information for MLN preventive services educational products and resources for health care
ofessionals and their staff. http://www.cms.hhs.gov/MLNProducts/35_PreventiveServices.asp
Expanded Benefits Brochure This tri-fold brochure provides health care professionals with an overview of Medicare’s coverage of the initial preventive physical exam (IPPE), ultrasound screening for abdominal aortic aneurysms, and cardiovascular screening blood tests. http://www.cms.hhs.gov/MLNProducts/downloads/Expanded_Benefits.pdf To order copies of the brochure, go to the Medicare Learning Network Product Ordering System located at: http://cms.meridianksi.com/kc/main/kc_frame.asp?kc_ident=kc0001&loc=5
The CMS website provides additional information about cardiovascular screening benefit at http://www.cms.hhs.gov/CardiovasDiseaseScreening/
For information to share with your Medicare patients, visit http://www.medicare.gov
For information about American Heart Month, please visit the American Heart Association’s website at http://www.americanheart.org/presenter.jhtml?identifier=1200000 and the Centers for Disease Control and Prevention’s website at ttp://www.cdc.gov/DHDSP/announcements/american_heart_month.htm on the Web.
Thank you.
Riverbend GBA has the following Webinars available for registration. Click on the word “More” below to register for that particular Webinar Event.
February 6, 2008
Information posted by The CMS.
Subscriber’s Note: See Article MM5944 for an update to the 2008 Medicare Physician Fee Schedule!!
New:
MM5944 EMERGENCY Legislative Change Affecting the 2008 Medicare Physician Fee Schedule (MPFS), and Extension of the 2008 Participation Open Enrollment Period http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5944.pdf
MM5895 Summary of Policies in the 2008 Medicare Physician Fee Schedule (MPFS) and the Telehealth Originating Site Facility Fee Payment Amount http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5895.pdf
MM5896 Announcement of Medicare Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Payment Rate Increases http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5896.pdf
MM5880 Modification of Payment Window Edits in the Medicare’s Common Working File (CWF) to Look at Line Item Dates of Service (LIDOS) on Outpatient Claims http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5880.pdf
MM5856 Revision to Instructions Relating to Compliance Standards for Independent Diagnostic Testing Facilities (IDTFs) http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5856.pdf
MM5858 Medicare Fee for Service Legacy Provider IDs Prohibited on Form CMS-1500 Claims after NPI Required Date http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5858.pdf
MM5882 New Value Code to Report Patient Prior Payments http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5882.pdf
MM5877 Correction to Low Utilization Payment Adjustment Add-on Payments under the Refined Home Health Prospective Payment System (HH PPS) http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5877.pdf
MM5816 Support Income Tax Reporting http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5816.pdf
MM5878 Smoking and Tobacco Use Cessation Counseling Billing Code Update to Medicare http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5878.pdf
MM5885 Additional Payable Healthcare Common Procedure Coding System (HCPCS) “C” Drug codes in Ambulatory Surgical Centers (ASCs) http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5885.pdf
February 7, 2008
Riverbend GBA continues to enhance our Web site to help you, our providers of service, access or link to documents or “Tools” for claims submission and processing.
The latest addition to our “Tools” menu is the Fee Schedules link. The information indicated below is now accessible from the RGBA Web site at www.rgbagov.com, or you can link directly to that page at: http://www.rgbagov.com/Tools/
Fee Schedules
The following offsite links are fee schedules published by The Centers for Medicare and Medicaid Services (CMS).
Drug Average Sales Price (ASP) Pricing File
Clinical Lab Fee Schedule
Durable Medical Equipment, Prosthetics/Orthotics and Supplies Fee Schedule Medicare Physician
Fee Schedules
Ambulance Fee Schedules
This enhancement will allow Riverbend GBA to publish the annual pricing information much more quickly, plus, it also allows our providers quarterly access to the fee schedule files.
You Are Cordially Invited To Attend
the 2008 2nd Quarter
Ask the Contractor Teleconference (ACT)
February 20, 2008
2:00 P.M. EST
Dial In Number: 1-877-852-6573
Hosted by:
Riverbend Government Benefits Administrator, Inc.
All providers are welcome and are encouraged to join the call.
Representatives from all areas of RGBA will be available.
The Ask The Contractor Teleconference is scheduled for 90 minute. If you have questions for Riverbend that you would like answered during this call, you are encouraged to e-mail those to us as soon as possible to ensure any necessary research is completed by the scheduled date. Please send your questions to: education@rgbagov.com .
Once the call is completed, there will be a replay for 30 days. The replay can be accessed by calling 888.203.1112, and entering replay pass code 3422025.
February 7, 2008
In our continuing effort to keep you informed regarding NPI, Riverbend is offering the following information. Consistent with Publication 100-8, Chapter 10, and Section 4.21 of the Program Integrity Manual each Medicare enrollment application submitted must contain all the National Provider Identifiers (NPIs) needed to establish a correct association between the existing Medicare legacy identifier (i.e., Online Survey Certification and Reporting System (OSCAR) number or the Centers for Medicare & Medicaid Service Certification Number (CCN).
To ensure that information is entered into the Provider Enrollment, Chain and Ownership System (PECOS) consistently and that contractors, such as Riverbend, are establishing the NPI/CCN combination designated by a provider, each contractor must obtain the NPI-to-legacy number combination for each practice location or department if not sent with the initial Medicare enrollment application.
Through this process CMS has determined some NPI matches on the crosswalk were forced or matched from a claim record and not matched through PECOS. In an attempt to ensure all NPI crosswalk matches are validated through PECOS, CMS is mandating a re-verification of the NPI crosswalk. Once the re-verification has occurred providers could experience rejected claims. Unless NPI and CCN combination(s) are consistent and identify the same entity, claims will not process correctly.
As a result, providers whose claims are not rejecting due to an invalid NPI match may experience claims rejecting once the corrected crosswalk is installed. If you experience this problem you will need to submit an 855A to Riverbend.
February 8, 2008
Information from The CMS.
Subscriber’s Note: Article SE0555 was rescinded on August 9, 2007. This article ‘slipped through the cracks’ and was not delivered, on time, to providers and Medicare Contractors. I apologize for any inconvenience. Also, March has been given as the month when CMS will end sending listserv notices via the NIH listservs. I’ll try to keep everyone informed as things develop.
Paul
New:
MM5902 Emergency Update to the 2008 Medicare Physician Fee Schedule Database (MPFSDB) http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5902.pdf
MM5937 Extension of the Dates of Service Eligible for the Physician Scarcity Area (PSA) Bonus Payment http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5937.pdf
Rescinded:
SE0555 Medicare’s Implementation of the National Provider Identifier (NPI): The Second in the Series of Special Edition MLN Matters Articles on NPI-Related Activities http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0555.pdf
Information from The CMS.
New Medicare Learning Network (MLN) Products are now available on the topic of Individuals Authorized Access to CMS Computer Services - Provider Community (IACS-PC).
As we have previously mentioned,CMS will soon be offering the Provider Enrollment, Chain and Ownership System (PECOS) and Provider Statistical and Reimbursement Report (PS&R) online. These new online enterprise applications will allow Medicare fee-for-service providers to access, update, and submit enrollment and cost report information over the Internet. Providers and/or appropriate staff must register for access through a new CMS security system known as the Individuals Authorized Access to CMS Computer Services - Provider Community (IACS-PC). CMS urges FFS providers to read the series of MLN Matters articles on this subject and act now. They can be accessed at the following urls:
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0747.pdf
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0753.pdf
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0754.pdf
There is another product available on the Medicare Learning Network website that contains Steps to Accessing CMS Enterprise Applications for Provider Organizations. The fact sheet/chart can be accessedat the following url: http://www.cms.hhs.gov/MLNProducts/downloads/IACSchart.pdf
February Flu Shot Reminder
It’s Not Too Late to Give and Get the Flu Shot!
In the U.S., the peak of flu season typically occurs anywhere from late December through March; however, flu season can last as late as May. Each office visit presents an opportunity for you to talk with your patients about the importance of getting an annual flu shot and a one time pneumococcal vaccination. Protect yourself, your patients, and your family and friends by getting and giving the flu shot. Don’t Get the Flu. Don’t Give the Flu. Get Vaccinated!
Remember Influenza and pneumococcal vaccinations and their administration are covered Part B benefits. Note that influenza and pneumococcal vaccines are NOT Part D covered drugs. You and your staff can learn more about Medicare’s coverage of adult immunizations and related provider education resources, by reviewing Special Edition MLN Matters article SE0748 http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0748.pdf on the CMS website.
End of Listserv Message.
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