Riverbend

ListServ Messages 07/04/2008

Riverbend GBA Listserv June 30, 2008

Riverbend GBA has been advised that the Remittance Advice of June 27, 2008 is not available to download. Please be aware that we are working to correct this issue, and will advise you via Listserv and Website Announcements as soon as information becomes available.

Riverbend GBA Remittance Advices are now available for downloading. Thank you for your patience while this issue was resolved and verified.

New Listserv Format from RGBA!

Reminder! Be sure to review to the end of this e-mail document for information that may affect your provider.

In recognition of the Independence Day holiday, RGBA, Inc. will be changing the payment cycle for the week ending July 4, 2008 as follows:

Monday Wednesday Friday

June 30, 2008 July 2, 2008 July 4, 2008

Payment Mailed Payment Mailed No Payment Cycle

Remittance Mailed for 6/30, 7/2

For the week ending July 11th, we will resume our normal payment cycles.

Information from The CMS.

The Medicare DMEPOS Competitive Bidding Program begins July 1, 2008.

If You Refer or Order DMEPOS for Medicare Beneficiaries:

Under this new program, beneficiaries who permanently reside in or travel to a designated competitive bidding area (CBA) are required to obtain competitive bid items from a contract supplier, unless an exception applies (e.g., grandfathered suppliers). You (e.g. physicians, practitioners, discharge planners, social workers, pharmacists, and home health agencies) will play a critical role in helping your Medicare patients select appropriate DMEPOS contract suppliers. The Medicare Learning Networks Tip Sheet for Referral Agents can help! Downloadable copies are available at www.cms.hhs.gov/DMEPOSCompetitiveBid. Click on the Provider Educational Products and Resources tab on the left then scroll down to the Downloads section.

Enteral Nutrition is Not a Grandfathered Competitively Bid Item:

Under the DMEPOS Competitive Bidding Program, enteral nutrition must be furnished by a contract supplier and cannot be provided by a non-contract grandfathered supplier. To ensure that there is no gap in service, this is important information for providers who order enteral nutrition for Medicare beneficiaries who permanently reside in or are visiting a CBA.

There is NO Application or Registration Required to Become a Grandfathered Supplier:

Suppliers servicing Medicare patients in a CBA need only notify their Medicare clients that they have elected to become a grandfathered supplier and receive a response that the Medicare beneficiary elects to continue services. For more details, see the “DMEPOS Grandfathered Suppliers� tip sheet on the CMS dedicated website at www.cms.hhs.gov/DMEPOSCompetitiveBid. Click on the Provider Educational Products and Resources� tab on the left then scroll down to the Downloads section.

New Frequently Asked Questions (FAQ) Now Posted on the CMS Website

Twenty six (26) new FAQs have recently been posted on the CMS DMEPOS Competitive Bidding provider website. See what’s new by going to www.cms.hhs.gov/DMEPOSCompetitiveBid . Click on the Provider Educational Products and Resources tab on the left then scroll down to Related Links Inside CMS.

New MLN Matters article on CMS Claims Processing Manual Revisions

The Centers for Medicare & Medicaid Services has issued Change Request (CR) 6007, Manual Revisions to Reflect Special Billing Instructions for DMEPOS Items as a Result of the DMEPOS Competitive Bidding Program and the corresponding MLN Matters article. The article is available at www.cms.hhs.gov/MLNMattersArticles/downloads/MM6007.pdf and will also be available on the Provider Educational Products and Resources� page of the CMS DMEPOS Competitive Bidding provider website soon.

Website Addition, Single Payment Amounts:

A new link to DMEPOS Competitive Bidding single payment amounts has been added to the dedicated website to allow easy access to the files that list the single payment amount for competitively bid items. Go to www.cms.hhs.gov/DMEPOSCompetitiveBid and click on the Single Payment Amounts tab on the left.

All the information that you need to know as a DMEPOS supplier or an enrolled Medicare provider who refers beneficiaries for DMEPOS is available on the CMS DMEPOS Competitive Bidding dedicated website located at www.cms.hhs.gov/DMEPOScompetitivebid.

If you would like to unsubscribe from a specific provider listserv, please go to https://list.nih.gov/cgi-bin/show_list_archives to unsubscribe or to leave the appropriate listserv. Please DO NOT respond to this email. This email is a service of CMS and routed through an electronic mail server to communicate Medicare policy and operational changes and/or updates. Responses to this email are not routed to CMS personnel. Inquiries may be sent by going to http://www.cms.hhs.gov/ContactCMS.Thank you.

CMS TO RATE NURSING HOME QUALITY NEW FIVE-STAR SYSTEM TO BE ADDED TO NURSING HOME COMPARE SITE

The Centers for Medicare & Medicaid Services announced it will soon launch a ground-breaking ranking system of America’s nursing homes, giving each a star rating.CMS is requesting comments on the system designed to provide patients and their families an easy to understand assessment of nursing home quality, making meaningful distinctions between high performing and low performing homes.

The ratings will be posted on the agencys Nursing Home Compare Web site by the end of this year. A sample screen shot of the proposed star ratings is available at www.cms.hhs.gov/PressContacts/10_PR_fivestar.asp. Medicare Compare can be found at www.medicare.gov.

More than three million Americans rely on services provided by a nursing home at some point during the year. The new five star rating system will provide a composite view of the quality and safety information currently on Nursing Home Compare to help beneficiaries, their families, and caregivers compare nursing homes more easily, said Kerry Weems, CMS acting administrator.

Through its consumer information Websites, CMS has begun to offer more and better information on the quality, patient satisfaction, and cost of care. This announcement, for example, closely follows the agencys first nationwide identification of chronically underperforming nursing homes. Facilities enrolled in the Special Focus Facility (SFF) initiative are placed under special scrutiny and undergo twice as many inspections as other homes. The SFF designation was recently added to the Nursing Home Compare Web site at www.medicare.gov/NHCompare.

Last year, CMS also initiated a star rating system for health and prescription drug plans that are available to Medicare beneficiaries.

This will be the first time that CMS will offer such a rating system for the fee for service, or traditional Medicare program. Currently, through the Compare Web site, CMS assists beneficiaries and their families in making nursing home choices by providing information on individual measures of quality of care, staffing, and survey inspection information.

Nursing Home Compares new rating system will also provide an incentive for nursing homes to strive toward earning a five star rating by providing an environment of better quality care, Weems said.

This new rating system is rooted in the tradition of the OBRA 87 nursing home reform law and quality improvement campaigns such as the Advancing Excellence in America’s Nursing Homes, a collaborative coalition of consumers, health care providers, labor, and nursing home professionals. CMS plans to work with other health care providers and consumers to make similar rating systems available for hospitals, home health agencies, and end-stage renal disease facilities in the future.

The agency is also considering adding new information to that already available on Nursing Home Compare such as whether a nursing home specializes in caring for patients with dementia, on ventilators, or in need of specialized rehabilitation services. Information on patient and family satisfaction with services at a facility may also be added to Nursing Home Compare. A Guide to Choosing a Nursing Home, a publication that includes information about the types of long-term care, local nursing home comparisons, and how to pay for nursing home care, can also be found on the site.

The five star rating system will begin to be published in December 2008. During June and July 2008 the agency is soliciting ideas, comments, and suggestions from the public, consumer groups, nursing homes, and many others. Comments may be sent to BetterCare@cms.hhs.gov.

Descriptive information about the quality rating system and its progress may be obtained on the CMS Hot Topics web page at http://www.cms.hhs.gov/SurveyCertificationGenInfo/02_HotTopics.asp. This web page also provided details about a national conference call called an open door forum that the agency had about the proposed five-star system on June 24, 2008.

While Nursing Home Compare is very informative, it is important to note that this should be just one of the tools that family members and caregivers use in the selection of a nursing home, Weems said.There is no substitute for visiting a nursing home in person and meeting with staff, residents, and other families.

Riverbend GBA Listserv of July 2, 2008

Special Open Door Forum

2008 Physician Quality Reporting Initiative Participation by the American College of Physicians Tuesday, July 15, 2008

3:30 PM – 5:00 PM Eastern Time

Conference Call Only

The Centers for Medicare and Medicaid Services (CMS), along with the American College of Physicians (ACP) will host a special open door forum to discuss participation in the 2008 Physician Quality Reporting Initiative (PQRI). This toll-free call will take place on Tuesday, July 15, 2008 from 3:30 pm 5:00 pm, ET. The purpose of this forum is to encourage PQRI participation and provide simple steps that physicians can use to collect and report quality data to be eligible for an incentive payment from CMS. Internists and/or a designated staff member, such as an office manager are encouraged to participate on the call.

Conference Leaders: Michael Rapp, MD (CMS) & Michael Barr, MD (ACP)

Conference Moderator: Natalie Highsmith (CMS)

We look forward to your participation.

Open Door Forum Participation Instructions:

Capacity is limited so dial in early. You may begin dialing into this forum as early as 1:30 PM ET.Dial in: 1.800.837.1935

Reference Conference ID:53531371

TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880 and for Internet Relay services click here http://www.consumer.att.com/relay/which/index.html. A Relay Communications Assistant will help.

An audio recording of this Special Door Forum will be posted to the Special Open Door Forum Website at http://www.cms.hhs.gov/OpenDoorForums/05_ODF_Special ODF.asp and will be available beginning

July 22, 2008.

For automatic emails of Open Door Forum schedule updates (E Mailing list subscriptions) and to view Frequently Asked Questions please visit our website at http://www.cms.hhs.gov/OpenDoorForums/

Thank you for your interest in CMS Open Door Forums.

The Centers for Medicare & Medicaid Services (CMS) has released the following MLN Matters article, SE0821 Reminder- Medicare Provides Coverage of Diabetes Screening Tests http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0821.pdf. This article reminds health care professionals that Medicare pays for diabetes screening tests for eligible beneficiaries and provides the correct procedure and diagnosis codes and modifier to use when filing claims for this screening service.

New, Revised information posted to The CMS Website:

New:

SE0824 Clarification of Medicare Bad Debt Policy Related to Accounts at a Collection Agency http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0824.pdf

MM6081 Private Contracting/Opting out of Medicare http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6081.pdf

MM6077 Update-Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) Rate Year 2009 http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6077.pdf

MM6098 Cardiac Computed Tomographic Angiography (CTA) http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6098.pdf

MM6001 Medicare Acute Care Episode (ACE) Demonstration. CR 6001 rescinds and fully replaces CR 5767 http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6001.pdf

Revised:

MM5792 Payment for Inpatient Hospital Visits - General (Codes 99221 thru 99239) http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5792.pdf

MM6084 Changes to the Laboratory National Coverage Determination (NCD) Edit Software for July 2008 http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6084.pdf

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Important Questions and Answers (Qs & As) from CMS Regarding the Holding of Claims Paid Under the Medicare Physician Fee Schedule (MPFS)

The Questions and Answers below apply to the recent decision by the Centers for Medicare and Medicare Services to hold claims paid under the Medicare physician fee schedule (MPFS) up to 10 business days that contain July 2008 dates of service.

Q1. Will claims containing services paid under the MPFS be held that contain both June and July dates of service?

A1. Yes, your local contractor will hold the entire claim for 10 business days.

Q2. Will claims be held that contain both services paid under the MPFS and services paid under a separate fee schedule?

A2. Yes, claims that contain both services paid and not paid under the MPFS will be held. For example, a claim with a July date containing an Evaluation and Management code and a drug code would be held.

Q3. Does the holding of claims paid under the MPFS also include anesthesia and purchased diagnostic services?

A3. Yes, contractors will hold all claims with dates of service July 1, 2008, and after that contain services paid under the MPFS, including anesthesia and purchased diagnostic services.

Supplier Directory Locator Tool Now Available

As of Tuesday, July 1, 2008, the Supplier Directory on www.medicare.gov has been updated to reflect the start of the DMEPOS Competitive Bidding program in certain areas of the country.

Users can begin their search on the Supplier Directory by entering their zip code. Product categories in that zip code that are competitive bid are identified, and special messaging will let users know if they have chosen an applicable product in a Competitive Bid Area (CBA) and why that is important to know. Search results for CBAs are organized by city of the zip code that was entered, and then by state. Users can sort by Supplier Name, and whether or not the supplier is participating. The address and phone number of the supplier is available.

Users are encouraged to check the site frequently as CMS will be making regular updates during the start of this program.

Clarification of Common Carrier and Local Storefront Suppliers Under the CMS DMEPOS Competitive Bidding Program

Common carrier, in its basic meaning, includes individuals or companies that transport goods or cargo (e.g., diabetic testing supplies) for compensation. This means that suppliers that pay a common carrier such as the U.S. Postal Service, Federal Express, United Parcel Service, or other shipping or courier service companies to transport diabetic testing supplies to Medicare beneficiaries' homes must be mail order contract suppliers under the DMEPOS Competitive Bidding Program, regardless of any contract arrangements suppliers may have with common carriers to deliver these items.

Diabetic supplies delivered by a common carrier to a Medicare beneficiarys home in a competitive bidding area must be furnished by a mail order contract supplier in order for Medicare to make payment unless the supplies are delivered by a local storefront using its own vehicles and W2 employees. This local storefront supplier must have its own local storefront that services the competitive bidding area, have its own location-specific National Supplier Clearinghouse (NSC) number for that storefront, bill for the diabetic supplies using that NSC number, and meet all of Medicare's supplier standards. It must also offer beneficiaries the choice of either obtaining the diabetic supplies from the supplier's storefront or having the items home delivered by the local storefront supplier using its own vehicles and W2 employees.

Reminder: Enteral Nutrition is Not a Grandfathered Competitively Bid Item

Under the DMEPOS Competitive Bidding Program, enteral nutrition must be furnished by a contract supplier and cannot be provided by a non-contract grandfathered supplier. To ensure that there is no gap in service, this is important information for providers who order enteral nutrition for Medicare beneficiaries who permanently reside in or are visiting a CBA.

National Provider Call for Referral Agents and Non-Contract Suppliers July 8, 2008

CMS will host a national audio call to address additional questions on the DMEPOS Competitive Bidding Program, which was implemented today, July 1, 2008. The call will be held on July 8, 2008 from 2:30 until 4:00 PM EDT. This call will not address contract supplier issues, but will instead focus on questions from non contract suppliers and referral agents (Medicare providers who order or refer DMEPOS in the 10 CBAs).

Please note, Participants will be able to submit questions through the online registration system at the time of sign up for the call.Registration details follow.

Conference call details:

Date: July 8, 2008

Conference Title: DMEPOS Competitive Bidding Program

Time: 2:30-4:00 p.m. EDT

In order to receive the call in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call in data. This registration is solely to reserve a phone line, NOT to allow participation. If you cannot attend the call, replay information is available below.

Registration will close at 2:30 p.m. EDT on July 7, 2008, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.

To register for the call participants need to go to: http://www2.eventsvc.com/palmettogba/070808

Fill in all required data.

Verify your time zone is displayed correctly the drop down box.

Click Register.

You will be taken to the Thank you for registering page and will receive a confirmation email shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.

For those of you who will be unable to attend, a replay option will be available shortly following the end of the call. This replay will be accessible from 4:30 p.m. EDT July 8 2008 until 11:59 p.m. EDT July 15 2008. The call in data for the replay is (800) 642 1687 and the passcode is 53825755.

Educational Products: New Skilled Nursing Facility/Nursing Facility Specialty Supplier Tip Sheet!

Within the next day, CMS will post a new tip sheet on SNF/NF Specialty Suppliers under the DMEPOS Competitive Bidding Program.

Below is a complete listing of provider Tip Sheets that can be accessed from our dedicated web page:

Tip Sheet for Skilled Nursing Facilities and Nursing Facilities: Specialty Contract Suppliers

Tip Sheet for Referral Agents

Tip Sheet for Grandfathered Suppliers

Tip Sheet for Mail Order Diabetic Testing Suppliers

Tip Sheet for Physicians and Other Treating Practitioners Who Are Enrolled Medicare DMEPOS Suppliers

Tip Sheet for Non Contract Suppliers

Go to www.cms.hhs.gov/DMEPOSCompetitiveBid to access all the latest information on the new program. Just click on the Provider Educational Products and Resources tab on the left then scroll down to the "Downloads" section for all MLN Matters articles, Tip Sheets, and links to beneficiary educational products as well.

Important Information from The CMS:

Expiration of Therapy Cap Exceptions

The exceptions to outpatient therapy caps expire on June 30, 2008. Outpatient therapy service providers should not submit claims with the KX modifier for services furnished on or after July 1, 2008. To the extent possible, CMS is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of outpatient physical therapy, occupational therapy and speech-language pathology claims for services furnished by physicians, non-physician practitioners, and therapists paid under the physician fee schedule, beginning July 1.

For physical therapy and speech language pathology services combined, the limit on incurred expenses is $1810. For occupational therapy services, the limit is $1810. Deductible and coinsurance amounts applied to therapy services count toward the amount accrued before a cap is reached. Therapy cap accruals began on January 1, 2008, and some patients may have reached the annual limits by June 30, 2008.

Providers may access the accrued amount or remaining amount of therapy services from the Medicare beneficiary eligibility inquiry and response transactions. Specifically:

For CWF users, the system returns the applied amount. See CR4115 at http://www.cms.hhs.gov/transmittals/downloads//R759CP.pdf

For users of the HETS 270/271, the system returns the “remaining� amount. See the page 18 of the 270/271 user guide at http://www.cms.hhs.gov/HETSHelp/Downloads/HETS%20270-71%20User%20Companion%20Guide.pdf

The Medicare contractors Interactive Voice Response units (IVR) return either the remaining or applied amounts based upon contractor programming. For those few contractors that do not provide this information on their IVRs, providers can call the contractors’ customer service representatives.

For additional information, Providers and Suppliers should also read the Medicare Claims Processing Manual, chapter 5, section 10. 2 at: http://www.cms.hhs.gov/manuals/downloads/clm104c05TXT.pdf

Patients Who Have Reached Their Limit(s) on Outpatient Therapy Services:

Note that patients who have reached their limit(s) on outpatient therapy services, other than those who reside in a Medicare certified part of a skilled nursing facility, may obtain medically necessary therapy services that exceed the caps if the services are furnished and billed by the outpatient department of a hospital. In other settings, outpatient therapy services in excess of the caps are not covered, and the therapy provider may charge for those services. An Advance

Beneficiary Notice is recommended, but not required for services that exceed therapy caps. An ABN is available at the following link: http://www.cms.hhs.gov/BNI/02_ABNGABNL.asp#TopOfPage (click on ABN CMS R 131 Form). In the box titled Reason Medicare will not pay the following language is suggested Medicare will not pay more than $1810 for expenses incurred for physical therapy and speech-language pathology services combined or for occupational services in 2008.

Patients may be referred to this website for further information:

http://www.medicare.gov/Publications/Pubs/pdf/10988.pdf which will be activated by July 3, 2008.

We will continue to be in communication with you with further information about payment of Medicare physician fee schedule claims. In addition, be on the alert for more information about other legislative provisions which may affect you.

Riverbend GBA Listserv July 1, 2008

The PowerPoint Presentation for the July 1, 2008 Special PQRI Open Door Forum (ODF) is now available on the CMS PQRI webpage at http://www.cms.hhs.gov/pqri/02_CMSSponsoredCalls.asp . To access the materials, click on the Special PQRI Open Door Forum 07/01/2008 link located in the Downloads section of the page.

Thank you.

Common Working File (CWF) Northeast Host Dark Day on Saturday, July 19, 2008.

On Saturday, July 19, 2008, the CWF Northeast Host 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 on that Saturday. This will mean there will be no access to the Health Insurance Master Record (HIMR), which is usually available until noon on Saturdays.

All files received from satellites for Friday’s cycle 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.

Information from The CSM.

Clarification of Mail Order in the Centers for Medicare & Medicaid Services (CMS) DMEPOS Competitive Bidding Program

The CMS has posted information on the Competitive Bidding Implementation Contractor (CBIC) website to clarify its policy with regard to mail order suppliers. This posting provides further guidance on common carriers and local storefront suppliers. Please visit the Suppliers FAQ section at http://www.dmecompetitivebid.comfor more information.

Riverbend GBA Listserv of July 1, 2008

Information from Riverbend GBA:

As instructed by CMS, Riverbend GBA initiated the HOOK process for the quarterly changes which applies the WW200 reason code. All claims being entered with a July 1, 2008 receipt date, regardless of the service dates, were moved into the SMHOOK location. This issue has now been resolved, and any claims inadvertently moved to SMHOOK today will be automatically moved tomorrow. This includes claims being entered into FISS via DDE.

The following is an important message regarding Quarterly updates to the Prospective Payment (PPS) Pricer from Riverbend GBA.

Riverbend GBA receives mandated software updates quarterly from The CMS regarding the Prospective Payment (PPS) Pricers that are necessary to properly adjudicate Medicare claims. This update process requires an installation and testing phase of the software by the Riverbend systems.

Claims that are received by Riverbend into FISS prior to the installation and testing phase completion will be placed in a temporary hold location with an assignment of SMHKXX, (the XX being representative of any set of letters or numbers and are specific to pricer software we may still be testing). The Current Hold locations and temporary suspend reason codes are:

Hold Location Reason Code Assigned

SMHOOK WW200 – This Reason Code will hold any claims (that come in with service dates in the new quarter until the releases are installed, effective the first Monday of the new quarter to insure the claims process correctly.)

SMHKIP 37150

SMHKSN 37148

SMHKOP OPPS1

SMHKLT 37167

SMHKHC HCP07

SMHKIR 37147 (Inpatient Rehab Facility)

SMHKPS 37181 (Inpatient Psychiatric Facility)

The claims will be held in this location until the software testing is completed, but no longer than 14 days from the date the changes were installed. At that time the claims will be released into FISS for processing. If The CMS anticipates the hold will surpass the normal 14 day payment process, specific instructions will be sent from The CMS and the affected providers will be notified via the Riverbend GBA Listserv.

The Riverbend Website at www.rgbagov.com has an available listing of claims currently placed in certain hold locations. The list includes; location ID, number of claims in each location, and the reason for the hold. Also listed is release information that is known to Riverbend.

July 1, 2008

To the extent possible, CMS is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, non-physician practitioners, and other providers of services paid under the Medicare physician fee schedule, beginning July 1. In this regard, CMS has instructed its contractors to hold these claims for the first 10 business days of July, for dates of service in July. This should have minimum impact on provider cash flow because, under current law, electronic claims are not paid any sooner than 14 days (29 days for paper claims) after the date of receipt. Meanwhile, all claims for services delivered on or before June 30 will be processed and paid under normal procedures.

After 10 business days, contractors will begin releasing claims into processing under the fee schedule which implements current law. This, of course, could result in claims being processed with the negative 10.6 percent update. If a new law is enacted which changes the negative 10.6 percent update, retroactive to July 1, CMS is prepared to automatically reprocess most of those claims which have already been processed.

Under the Medicare statute, Medicare pays the lower of submitted charges and the Medicare fee schedule amount. Claims with dates of service July 1 and later billed with a submitted charge at least at the level of the January 1 thru June 30, 2008, fee schedule will be automatically reprocessed, if Congress retroactively reinstates the update that was in effect for that time period. Any lesser amount will likely require providers to re-submit a revised claim.

To the extent possible, providers may hold claims in-house until it becomes clearer as to whether new legislation will be enacted or until cash flow becomes problematic. This will reduce the need for providers to reconcile two payments (i.e., the initial claim and the reprocessed claim), and it will simplify provider billings of beneficiary coinsurance and payment calculations for payers which are secondary to Medicare.

In addition, be on the alert for more information about other legislative provisions which may affect you