CMS

Medicare Matters:  MM4313 (PDF).
Publication Date: February 01, 2006
Effective Date: January 01, 2006

Congress has passed the Deficit Reduction Act (DRA) of 2005, which, among other things, changes the update to the 2006 conversion factor for services paid under the Medicare Physician Fee Schedule (MPFS). The DRA replaces the previously announced -4.4 percent reduction with a zero-percent increase for services paid under the MPFS. The change is effective retroactive for service on or after January 01, 2006.

Claims processed with the -4.4 percent rates will be reprocessed with the new rates and adjustments will be made. Medicare contractors will complete the necessary adjustments no later than July 01, 2006. In the event your claims are not adjusted by your carrier/FI/RHHI, contact them to bring the issue to their attention and they will make the adjustments.

  CMS

Medicare Matters:  MM4284 (PDF).
Effective Date: January 01, 2006
Implementation Date: March 13, 2006

Medicare carriers, DMERCs, FIs, and RHHIs will not pay paper claims prior to the 29th day after receipt of the claim.

  CMS

Medicare Matters:  CR 4349 (PDF).
Publication Date: February 10, 2006
Effective Date: September 22, 2006

A brief hold will be placed on Medicare payments for all claims for the last nine days of the Federal fiscal year, i.e., September 22, 2006 - September 30, 2006. Claims held as a result of this one-time policy will be paid on October 2, 2006. No interest or late penalty will be paid to an entity or individual for any delay in a payment by reason of this one-time hold on payments.

  CMS

Medicare Matters:  CR 4023 (PDF).
Publication Date: November 29, 2005 (Revised)
Implementation Date: April 03, 2006

Effective January 03, 2006, Medicare will begin accepting the NPI on the 837 and 276 4010A1 transactions with certain restrictions. With the scheduled implementation of the National Provider Identifier (NPI) in 2007, CMS has begun the process of making the necessary system changes to accommodate the NPI.

Providers should ensure the following when submitting EDI transactions to Medicare:

• If NM108 has a qualifier of XX, there must be a corresponding 10 digit numeric number in NM109 as well as an REF01 submitted in the same loop with a 1C (Medicare Provider Number) or 1G (Provider UPIN Number) qualifier.
• If qualifier XX is submitted in NM108 of the 2010AA or 2010AB loop, there must be a REF01 submitted in the same loop with an EI (EIN) or SY (SSN) qualifier.
• In 276 transactions, a qualifier XX or FI should only occur once.

  NHIC

Published Date: January 19, 2006

Medicare Secondary Payer (MSP) voluntary refund checks submitted by providers to NHIC are included with all other checks received at NHIC. As such, research is required to identify those checks as MSP voluntary refunds. In order to improve the timeliness for application of the monies returned and provide improved service to the provider community, please use the following guidelines when sending MSP voluntary refunds to NHIC:

• Include the words "MSP" on the refund checks.
• Include the words "MSP" on the envelope containing the check.
• Mail the MSP refund check as follows

For Southern California providers:
Medicare Administration - MSP Refund
National Heritage Insurance Company
P.O. Box 515301
Los Angeles, CA 90051-6601

For Northern California providers:
Medicare Administration - MSP Refund
National Heritage Insurance Company
P.O. Box 951
Marysville, CA 95901-0951

For New England providers:
Medicare Government Accounting
National Heritage Insurance Company
P.O. Box 9103
Hingham, MA 02044-9103

Reference:  MSP Refunds

  California — Medi-Cal

Medi-Cal Update  Bulletin 379.
Publication Date: February 2006
Effective Date: October 01, 2005

Providers are reminded to use ICD-9 code V26.31 when billing a combination of the following codes up to a maximum quantity of 25 or up to a maximum reimbursement of $180 per day per recipient.

Claims that were billed or denied for a quantity greater than one for the preceding codes and were cut back will automatically be reprocessed retroactive to dates of service on or after October 1, 2001. No action is necessary on the part of the provider.