CMS

In July 2006, the Form CMS-1500 (12-90) was revised by the National Uniform Claim Committee (NUCC) predominantly for the purpose of accommodating the National Provider Identifier. Since that time, the industry has been preparing for the implementation of the revised Form CMS-1500 (08-05). In September 2006, Medicare announced that it would implement the revised Form CMS-1500 (08-05) on January 01, 2007 with dual acceptability of both versions until March 31, 2007. Medicare further announced that beginning April 01, 2007, the only acceptable version of the form would be the Form CMS-1500 (08-05) and that the prior version, Form CMS-1500 (12-90), would be rejected.

The GPO has determined that the source files they received from the NUCC’s authorized forms designer were improperly formatted.

Given the circumstances, CMS has decided to extend the acceptance period of the Form CMS-1500 (12-90) version beyond the original April 1, 2007 deadline while this situation is resolved. Medicare contractors will be directed to continue to accept the Form CMS-1500 (12-90) until notified by CMS to cease. At present, CMS is targeting June 1, 2007 as that date.

  CMS

Correction to CR5404: New Waived Tests
Transmittal: 1197 (PDF).
Effective Date: March 09, 2007

Improvement Amendments of 1988 (CLIA), contained an incorrect CPT for the Gryphus Diagnostics BVBlue test. In both the table in the background section of the Recurring Update Notification attachment and in the waived test list attachment, CR 5404 listed the CPT code for the Gryphus Diagnostics BVBlue as CPT Code: 87899QW.

The CPT code 87899 is for infectious agent activity detection tests by immunoassay with direct optical observation; not otherwise specified. In contrast, the Gryphus Diagnostics BVBlue test is an enzyme activity test that detects sialidase activity in vaginal fluid specimens and is not an immunoassay test. The code in this table and in the waived test list attachment should have been 87999QW (Unlisted microbiology procedure). See the table below for the correct codes.

Note: All the other information in CR 5404 remains the same.

  CMS

Medicare Matters: MM: 5495 (PDF).
Effective Date: April 01, 2007

In order to lower the Medicare fee-for-service paid claims error rate, the Centers for Medicare & Medicaid Services (CMS) established units of service edits referred to below as Medically Unlikely Edits (MUEs). The National Correct Coding Initiative (NCCI) contractor develops and maintains MUEs

Key Points

• The upcoming release of the next version of the MUEs, which is version 1.1.
• Medicare carriers and A/B MACs will deny the entire claim line from non-institutional providers with units of service that exceed MUE criteria and pay the other services on the claims.
• FIs and A/B MACs will RTP claims from institutional providers with units of service that exceed MUE criteria.
• An appeal process will not be allowed for RTP’ed claims as a result of an MUE. Instead, providers should determine why the claim was returned, correct the error, and resubmit the corrected claim.
• Providers may appeal MUE criteria by forwarding a request the carrier or A/B MAC who, if they agree, will forward the appeal to the National Correct Coding Contractor.
• Excess charges due to units of service greater than the MUE may not be billed to the beneficiary (this is a “provider liability”), and this provision can neither be waived nor subject to an Advanced Beneficiary Notice (ABN).

  CMS

Version 13.1
Transmittal: 1201 (PDF).
Effective Date: April 01, 2007

These edits (Version 13.1), which include all previous versions and updates from January 1, 1996, will be effective on April 1, 2007.

  CMS

New FDA Waived Tests Under CLIA
Transmittal: 1195 (PDF).
Effective Date: April 01, 2007
Implementation Date: April 02, 2007

• CPT/HCPCS code, 82042QW, has been assigned for the albumin test performed using the Abaxis Piccolo Point of Care Chemistry Analyzer (Liver Panel Plus Reagent Disc){whole blood}.
• CPT/HCPCS code, 82150QW, has been assigned for the amylase test performed using the Abaxis Piccolo Point of Care Chemistry Analyzer (Liver Panel Plus Reagent Disc){whole blood}.
• CPT/HCPCS code, 82247QW, has been assigned for the total bilirubin test performed using the Abaxis Piccolo Point of Care Chemistry Analyzer (Liver Panel Plus Reagent Disc){whole blood}.
• CPT/HCPCS code, 82977QW, has been assigned for the gamma glutamlytransferase (GGT) test performed using the Abaxis Piccolo Point of Care Chemistry Analyzer (Liver Panel Plus Reagent Disc){whole blood}.
• CPT/HCPCS code, 84075QW, has been assigned for the alkaline phosphatase test performed using the Abaxis Piccolo Point of Care Chemistry Analyzer (Liver Panel Plus Reagent Disc){whole blood}.
• CPT/HCPCS code, 84157QW, has been assigned for the total protein test performed using the Abaxis Piccolo Point of Care Chemistry Analyzer (Liver Panel Plus Reagent Disc){whole blood}.
• CPT/HCPCS code, 84520QW, has been assigned for the urea (BUN) test performed using the Arkray SPOTCHEM EZ Chemistry Analyzer.

*The Current Procedural Terminology (CPT) codes for these new tests must have the modifier QW to be recognized as a waived test.

CMS

Laboratory National Coverage Determination (NCD) Edits
Transmittal:  1200.
Effective: Dates of Service on or After April 01, 2007

The new HCPCS code G0394 for Blood occult test (e.g., guaiac), feces, for single determination for colorectal neoplasm (i.e., patient was provided three cards or single triple card for consecutive collection) is added to the list of HCPCS codes for the Fecal Occult Blood Test NCD (190.34).

  NHIC — California

Error for “10” Units Corrected

The NHIC Medicare Claims Adjudication system was incorrectly processing claims for procedure codes 83898, 83901, 88180, 88185, 88271, 88275, 88305, 88312, 88313, 88342, 88358, 88360, 88361, 88365 and 88368 when ordered with “10 units” by processing the claims for “1 unit”, causing providers to have to appeal these claims in order to obtain the appropriate reimbursement. This system error was corrected by NHIC EDI on February 26, 2007. NHIC is unable to automatically correct the miss-paid claims, because of their inability to identify the claims which appear to be properly paid in their system. Accordingly, Providers who still have improperly paid claims may request a reopening to obtain payment on the remaining unpaid 9 units.