CMS
Published Date: August 5, 2004
Effective Date: January 1, 2005

The 2005 physician fee schedule was published in the Federal Register on August 5th. As a result of the changes to the relative value units and the 1.5 % fee schedule update for 2005, the Pathology fee schedule increased by 4%. The actual impact for providers depends upon their test mix.

Reference:  Federal Register: Medicare Program;  Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2005.

CMS
Publish Date: July 23, 2004
Effective Date: October 1, 2004

The Correct Coding Initiative (CCI) Edits update will be implemented on October 1, 2004. CMS implemented National CCI Edits in 1996 for the purpose of identifying and eliminating incompatible code pairs. The October 1 update has the following changes:

• No Comprehensive/Compound code pairs were deleted from the list
• No new Mutually Exclusive code pairs were added to the list
• No Mutually Exclusive code pairs were deleted from the list
• No Mutually Exclusive code pairs were modified from the list
• No Comprehensive/Compound code pairs were deleted from the list
• 7 Comprehensive/Compound code pairs were modified from the list
• 164 new radiology Comprehensive/Compound code pairs were added to the list

The following Comprehensive/Compound code pairs were modified:

California - NHIC
Publication Date August 05, 2004

In last month's newsletter an article appeared regarding a coverage change made by NHIC for CRP (CPT 86141). NHIC had announced that effective immediately they would begin to cover the previously denied service. As additional information, please note that when the coverage decision was changed, NHIC changed it without regard to date of service. Additionally, NHIC has indicated that there will be no automatic retro adjustment for this service. Accordingly, labs must resubmit claims for any CRPs denied prior to the coverage change in order to obtain payment.

Reference:  California Providers, Updates.

California - NHIC
Publish Date: August 12, 2004

If you discover that an overpayment of Medicare funds has occurred, you are expected to notify the program and take appropriate actions to remedy the situation.

The protocol to make a refund to NHIC is as follows:

1. Fill out the "Voluntary Refund Form" completely for each claim, or

2. Submit a copy of the Remittance Advice (RA) or Medicare Summary Notice (MSN) with the claim highlighted and notated with the exact amount of the refund and the reason for the refund, or

3. Submit a spreadsheet listing the following information for each claim:

• Claim Internal Control Number (ICN) from the Medicare RA/MSN

• Patient HIC Number from the Medicare RA/MSN

• Patient’s Name as shown exactly on the Medicare RA/MSN

• Date of Service

• Procedure Code

• Refund Reason

• Refund Amount

In addition:

• Make checks payable to: NHIC-Medicare

• Submit the refund to:

• For Southern California: Medicare Cash Accounting, P.O. Box 515301, Los Angeles, CA 90051-6601

• For Northern California: Medicare Cash Accounting, P.O. Box 391, Marysville CA 95901

Reference:  Medicare NHIC  Making Refunds.

California - Medi-Cal
Publish Date: September 2004
Effective Date: October 18, 2004

The 2004 updates to the Current Procedural Terminology – 4th Edition (CPT-4) and Healthcare Common Procedure Coding System (HCPCS) National Level II and local Level III codes will become effective October 18, 2004 for Medi-Cal. Some of the policy changes follow:

PATHOLOGY/LABORATORY
Deleted and Replacement CPT-4 Codes
The following are deleted CPT-4 codes and their 2004 replacement codes. The policy of the deleted codes applies to the replacement codes.

California - Medi-Cal
Publication Date: September 15, 2004

California Medi-Cal Contracting: Request for Application Time Schedule

Illinois - WPS
2005 ICD-9-CM Coverage – Policy Revisions
Publication Date September 2004
Effective Date: October 1, 2004

Effective for claims submitted with dates of service on or after October 1, 2004, Wisconsin Physician Services (WPS) will cover the new 2005 ICD-9-CM codes for Diagnostic Pap Smears.

New York - Medicaid
Publication Date: September 2004
Effective Date: October 6, 2004

Medicaid New York has published their compliance deadline. After October 6, 2004, Medicaid will only accept and process electronic transactions and claims submitted in a HIPAA-compliant format. Electronic transactions and claims submitted in a non-HIPAA compliant format will be rejected.

New York State - Medicaid
Publish Date: September 2004
Effective Date: September 1, 2004

Enrolled laboratories will be eligible for Medicaid reimbursement for travel expenses associated with in-home phlebotomy services, i.e., blood draws, provided under circumstances outlined in the Medicare Update.

Tenessee - CIGNA
Effective Date October 01, 2004

Cigna – Medicare Tennessee will retire LMRPs:

85651  Sedimentation Rate, Erythrocyte; Non-automated
85652  Sedimentation Rate, Erythrocyte; Automated

Reference:  Part B Medicare Newsletter.