CMS

Clinical Laboratory Improvement Amendments

New Waived Tests

CMS released a list of new CLIA waived tests. The implementation date for these is April 5, 2004.

Reference:  Change Request 3061; Transmittal 102; Pub. 100-04.

Coordination of Benefits Agreement (COBA)

CMS issued CR 3109 on the implementation of a new initiative known as the Coordination of Benefits Agreement (COBA) consolidated crossover process, which changes the existing Medicare claims crossover process. The Coordination of Benefits Contractor (COBC) will assign unique five-digit COBA IDs to Medigap and Medicaid insurers that do not provide eligibility files to the COBC. Effective October 4, 2004 all Part B providers must cease including the Carrier issued Medigap or Medicaid ID on incoming claims and replace them with the claim-based COBA ID.

Reference:  MM3109, Medlearn Matters, Related Change Request 3109.

Elimination of Grace Period for Discontinued Codes

CMS issued Transmittal 94 (published February 6, 2004) on the elimination of the 90-day grace period for discontinued ICD-9-CM diagnosis codes effective October 1, 2004.

CMS issued Transmittal 89 (published February 6, 2004) on the elimination of the 90-day grace period for discontinued CPT and HCPCS codes effective January 1, 2005.

Claims with discontinued codes will be returned as unproccessable after the respective policy effective dates noted above.

Reference:  MM3094, Medlearn Matters, Related Change Request 3094.

HIPAA

Modified HIPAA Contingency Plan

CMS has issued CR 2981 on modifying the Health Insurance Portability and Accountability Act (HIPAA) contingency plan, effective July 1, 2004. Medicare will continue to allow submission of non-compliant electronic claims. However, the payment of electronic claims that are not HIPAA compliant will take thirteen additional days.

Reference:  MM2981, Medlearn Matters, Related Change Request 2981.

View the  Change Request 2981, Transmittal 114; Pub. 100-04.

NCD

Laboratory National Coverage Determination - Update

CMS published their April update for NCDs. The only lab procedure updated is the Serum Iron Studies, CPT codes:

82728   Ferritin
83540   Iron
83550   IBC
84466   Transferin

The following diagnosis codes are added to the list of ICD-9 codes covered by Medicare:

• 403.01,  Hypertensive renal disease, malignant, with renal failure
• 403.11,  Hypertensive renal disease, benign, with renal failure
• 403.91,  Hypertensive renal disease, unspecified, with renal failure
• 404.02,  Hypertensive heart and renal disease, malignant, with renal failure
• 404.03,  Hypertensive heart and renal disease, malignant, with heart and renal failure
• 404.12,  Hypertensive heart and renal disease, benign, with renal failure
• 404.13,  Hypertensive heart and renal disease, benign, with heart and renal failure
• 404.92,  Hypertensive heart and renal disease, unspecified, with renal failure
• 404.93,  Hypertensive heart and renal disease, unspecified, with heart and renal failure

Reference:  NCD Index.

Remittance Advice Remark Codes

26 Feb 2004

The Remittance Advice Remark Code and Claim Adjustment Reason Codes are updated.

View the  Remark Reason Codes 02/04, Change Request 3122; Transmittal 93; Publication 100-04.

California - NHIC Medicare

Apolipoproteins

Apolipoproteins (82172) was denied last year as medically unnecessary. NHIC revised their policy and will now go back and automatically re-pay everything denied 2/26/03-5/31/03, per Michele Kelly at NHIC.

Duplicate Billing Denials

NHIC issues its largest volume of denials for duplicate billings. The handling of these services is expensive to both providers and the Medicare program. NHIC strongly discourages providers from configuring their systems to automatically rebill outstanding claims after 30 days. Electronic claims are settled after 14 days while paper claims are settled after 28 days. NHIC recommends providers build edits into their systems to avoid duplicate submissions. NHIC encourages providers to stay current with posting every claim from their remittance advice(s) into their system, including denials. If a procedure is performed multiple times on the same day, use ICD-9-CM codes, modifiers and documentation to identify different sites, sessions or specimens.

Reference:  "Duplicate Billing" on the NHIC website for California providers, posted January 22, 2004.

New Medical Director for CA

26 Feb 2004

National Heritage Insurance Company (NHIC) announced the acceptance by Bruce Quinn, MD/PhD, MBA of the position as NHIC California Carrier Medical Director (CMD).

Reference:  New Medical Director.

California Medi-Cal

FPACT HPV Testing

Human Papilloma Virus (HPV) Reimbursement Update

Effective for dates of service on or after April 1, 2004, the following CPT-4 Human Papilloma Virus (HPV) procedure codes are no longer reimbursable:

New York - EMPIRE Medicare Service

Local Coverage Determination

New York Empire published the following policy in Notice Period and will have an effective date of April 19, 2004.

Reference:  Local Coverage Determination, EMPIRE Medicare Service.

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