CMS

Federal Register: CMS-R-131.
Published Date: February 23, 2007

The ABN has been used for the notification of Medicare beneficiaries under the statutory provisions of Section 1879 of the Social Security Act (“the Act”), the “limitation on liability” provision.

CMS has released a revision to the Advance Beneficiary Notice (ABN) form and is in the comment period. Previously the two versions of the ABN that were approved was the General Use ABN, form CMS-R-131-G, and CMS-R-131-L, specifically for physician-ordered laboratory tests. These two notices have now been combined into a single notice. CMS has also changed the official title to “Advance Beneficiary Notice of Noncoverage” in order to more clearly convey the purpose of the notice. Some revisions were incorporated into this single general notice to make it more consistent with the Home Health ABN (HHABN) and Skilled Nursing Facility ABN (SNFABN). The HHABN, was published in the Federal Register and subsequently received over 200 public comments and was approved by OMB in August 2006. The SNFABN was revised and consumer tested in 2006 and is currently scheduled to be released July 2007.

To view the announcement and requirements for submitting comments in the Federal Register, go to:

http://www.gpoaccess.gov/fr/advanced.html

On this page, under “Search by Issue Date, on the “Specific Date”: line, select “On” and enter “02/23/2007” in the date field. After “Search:” in the next line, enter “CMS-R-131”. The announcement should appear first if multiple items are found.

To obtain copies of the ABN and supporting documents, go to:

http://www.cms.hhs.gov/PaperworkReductionActof1995.

On the menu on the left side of this page, click on “PRA Listing”, then scroll down or search for “CMS-R-131”. Alternatively, you may email your request including your name, address, phone number, OMB control number (0938-0566) and CMS document identifier (CMS-R-131) to Paperwork@cms.hhs.gov, or call the Reports Clearance Office on (410) 786-1326.

[Note both sites may be down briefly. Please try multiple times if you encounter a problem.]

In order to be accepted, comments must be sent to:

CMS, Office of Strategic Operations and Regulatory Affairs,
Division of Regulations Development – C
Attention: Bonnie L. Harkless
Room C4-26-05,
7500 Security Blvd.
Baltimore, Maryland 21244-1850

These comments must be received by 5 p.m. on April 24, 2007.

  CMS

Invalid Managed Care Informational Unsolicited Responses (MCIURs) from CWF
Transmittal: CR: 5507 (PDF).
Effective Date: January 26, 2007
Implementation Date: April 26, 2007

Article SE0681 alerted providers that, in some instances, Medicare may be recovering certain overpayments due to system updates on beneficiary eligibility. When such overpayments are identified, Medicare systems generate a managed care informational unsolicited response (MCIUR), which triggers the overpayment recovery.

During the week of December 17, 2006, Medicare systems were updated with some incorrect Managed Care enrollment data, which caused the systems to create some incorrect MCIURs. Medicare files have now been corrected and CMS is working with Medicare contractors to stop the invalid overpayment recoveries from occurring. In addition, where action to recover the overpayments has already occurred, CMS has instructed contractors to reverse the action and reissue payment to providers.

  CMS

Reported on Claims Submitted to Carriers
Transmittal: CR: 5441 (PDF).
Effective Date: July 01, 2007

The Part B standard systems and the carrier claims processing systems will capture and process up to eight diagnosis codes on all claims (both paper and electronic). While the ANSI 837P 4010A allows a maximum of eight diagnosis codes to be reported for each claim, the Medicare Part B standard systems and the carrier claims processing systems have historically used only the first four diagnosis codes reported on the claim when processing the HIPAA format claims. Carriers have used a manual process to consider the remaining diagnosis codes in the Medicare payment determinations.

  CMS

Remittance Advice Remark Code (RARC)
      and Claim Adjustment Reason Code (CARC) Update
Transmittal: CR: 5507 (PDF).
Effective Date: April 01, 2007

Both code lists are updated three times a year, and are posted at http://wpc-edi.com/codes. The following lists summarize the latest changes:

  California: Medi-Cal

Cyanocobalamin Policy Effective Date Correction
Medi-Cal Update:  GM Bulletin 391.
Publication Date: February 2007

Revises an article published in the December 2006 Medi-Cal Update (and reported in the January 12, 2007 XIFIN e-Newsletter) which stated that the effective date of the diagnostic restriction policy for CPT-4 code 82607 (cyanocobalamin [vitamin B-12]) was January 01, 2007. The bulletin stated that the original policy was published in the May 2003 Medi-Cal Update and became effective June 01, 2003.

The May 2003 bulletin 343 only stated that effective for dates of service on or after June 01, 2003, the cyanocobalamin (vitamin B-12) test (CPT-4 code 82607) would be reimbursable only when an appropriate diagnosis on the claim documents medical necessity for the test. Reimbursement would be restricted to three tests per year for the same recipient by any provider, unless medical justification is entered in the Remarks area of the claim or submitted as an attachment. No specific coverage criteria was provided.

Code 82607 is reimbursable only when billed in conjunction with one or more of the following ICD-9-CM codes. Reimbursement is restricted to three tests per year for the same recipient by the same provider, unless medical justification is entered in the Remarks area/Reserved for Local Use field (Box 19) of the claim or submitted as an attachment.

Additionally, three of the ICD-9-CM codes have been updated to reflect the highest level of specificity currently available.

  California: Medi-Cal

Medi-Cal Update:  GM Bulletin 391.
Publication Date: February 2007

Effective for dates of service on or after March 01, 2007, providers may not submit the following non-specific diagnosis codes when billing for radiology or laboratory procedures:

  California: Medi-Cal

Medi-Cal Update:  GM Bulletin 390.
Publication Date: January 2007

Effective February 1, 2007, the number of daily units that may be reimbursed for CPT-4 code 87904 (infectious agent phenotype analysis by nucleic acid [DNA or RNA] with drug resistance tissue culture analysis, HIV 1; each additional drug tested) has been increased to 10 drug tests per day for the same patient, same provider and same date of service.