On June 25, 2010, President Obama signed into law the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010.” This law establishes a 2.2 percent update to the Medicare Physician Fee Schedule (MPFS) payment rates retroactive from June 1 through November 30, 2010. The Centers for Medicare...
The Continuing Extension Act of 2010, enacted on April 15, 2010, extended the zero percent update to the 2010 Medicare Physician Fee Schedule (MPFS) through May 31, 2010. On May 27, 2010, the Centers for Medicare...
CMS has posted on its website new, revised and invalid diagnosis codes that will go into effect Oct. 1, 2010. Beginning in October, you’ll have 122 new diagnosis codes. A large portion of the diagnosis codes are in the “V” code section, which describe a “supplementary classification of factors influencing health status and contact with health services,...
Effective for claims with dates of service on and after December 8, 2009, CMS will cover both standard FDA -approved HIV rapid screening tests for Medicare beneficiaries, subject to the criteria in the National Coverage Determination (NCD) Manual, sections 190.14 and 210.7, and the Medicare Claims Processing Manual (CPM), chapter 18, section 130. Note: This article was revised on May 21, 2010,...
The latest CCI edits, Version 16.2, is effective July 1, 2010, and includes all previous versions and updates from January 1, 1996, to the present. NEW Column 1 and Column 2 Code Pairs Column 1 Column 2 87070 88387 87070 88388 87071 88387 87071 88388 87073 88387 87073 88388 87075...
Listed below are the latest tests approved by the FDA as waived tests under CLIA. The tests are valid as soon as they are approved. The CPT codes for the following new tests MUST have the modifier QW to be recognized as a waived test. CPT Code Effective Date Description 82465QW, 83718QW, 84478QW, 80061QW, 82947QW, 82950QW, 82951QW, 82952QW December...
Physicians and non-physician practitioners (NPPs) who are currently enrolled in Medicare but do not have an enrollment record in the Provider Enrollment, Chain and Ownership System (PECOS) can expect to receive a one-time solicitation letter in the mail sometime soon. CMS has instructed its contractors to conduct a targeted outreach to ensure that all who are billing Medicare also are...
The Recovery Act of 2009 established CMS programs under Medicare and Medicaid to provide incentive payments for the “meaningful use” of certified Electronic Health Record (EHR) technology. These EHR incentive programs will provide incentive payments to eligible professionals and eligible hospitals as they demonstrate adoption, implementation, upgrading or meaningful use of...
CMS has launched the official website for the Medicare...
The searchable Medicare Coverage Database (MCD), contains all Medicare National Coverage Determinations (NCDs), National Coverage Analyses (NCAs) Local Coverage Determinations (LCDs), and local policy articles. NCAs include proposed NCD decisions. The database also includes several other types of national coverage policy-related documents, including Coding Analyses for Labs (CALs), Medicare...
This article, based on Change Request (CR) 6929, updates Form CMS-1500 information in the Medicare Claims Processing Manual by removing language allowing the use of legacy identifiers and making other technical corrections as a result of that change.
Effective January 1, 2011, all submitted EFT forms must be in the newest version, which is Form CMS-588 (05/10). CMS will accept the older version until the effective date. You will find the newest version on the CMS Website at: http://www.cms.gov/cmsforms/downloads/CMS588.pdf All applications for initial provider enrollment require that Form CMS-588, "Electronic Funds Transfer (EFT)...
This article is intended to assist all providers that will be affected by Medicare Administrative Contractor (MAC) implementations. CMS is providing this information to make you aware of what to expect as your FI or carrier transitions its work to a MAC. Knowing what to expect and preparing as outlined in this article will minimize disruption in your Medicare business. Please note that other...
In CR 6627, CMS inadvertently changed the billing instructions for reassigned services in a way that is not supported by CMS’s systems or Medicare policy. This CR corrects this error and reinstates the instructions in place prior to the implementation of CR 6627. Basically, language was added back to the Medicare Claims Processing Manual to show that although a supplier or provider may reassign...
This article is based on Change Request (CR) 6935, which announces availability of a new Medicare manual describing the Physician Quality Reporting Initiative (PQRI) and E-Prescribing (eRx) Incentive Programs. It is important to note that: The manual does not establish new requirements for the PQRI and eRx programs; and Changes to the programs are described in the annual MPFS...
This article is based on Change Request (CR) 6958 which updates the current instructions in the Medicare Claims Processing Manual, Chapter 29, to allow Medicare contractors to accept claim appeal requests via facsimile and/or via a secure Internet portal/application. Several Medicare contractors have requested authority from the CMS to utilize a secure Internet portal/application to receive...
On October 1, 2013, medical coding in U.S. health care settings will change from ICD-9-CM to ICD-10. The transition will require business and systems changes throughout the health care industry. Everyone who is covered by the Health Insurance Portability and Accountability Act (HIPAA) must make the transition, not just those who submit Medicare or Medicaid claims. The compliance dates are...
Change Request (CR) 6985, informs A/B MACs or carriers about additional new Healthcare Common Procedure Coding System (HCPCS) codes for 2010 that are subject to Clinical Laboratory Improvement Amendments (CLIA) edits. The HCPCS codes listed in the table, below, are new for 2009 and subject to CLIA edits, and require a facility to have either: A CLIA certificate of registration (...
The goal of the RAC Program is to identify improper payments made on claims of health care services provided to Medicare beneficiaries. The RACs review claims on a post-payment basis, and they can go back three years from the date the claim was paid. DCS, the Medicare Recovery Audit Contractor (RAC) for Region A, recently posted new CMS approved audit issues for RAC review. The new CMS...
In its "Semiannual Report to Congress," the Office of Inspector General (OIG), Department of Health & Human Services (HHS), announced expected recoveries of more than $3 billion for the first half of fiscal year (FY) 2010. Specifically, OIG's expected recoveries for October 2009 through March 2010 include about $667 million in audit receivables and $2.5 billion in...