Transmittals and MLN Matters Articles
Medicare Update for Physician Services, July 2, 2009
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Billing routine costs of clinical trials
Transmittal 1743 originally issued on May 22, 2009, was rescinded and replaced on June 26, 2009 with Transmittal 1761 to change the effective and implementation dates to September 28, 2009. The transmittal was summarized in last month’s edition of MUPS and has been reprinted here for your convenience.
“Practitioners billing for services associated with clinical trials should report ICD-9 code V70.7 (Examination of participant in clinical trial) on their claim. HCPCS modifier -Q1 indicates a routine clinical service provided in a research study. It is no longer necessary to make a distinction between a diagnostic and therapeutic clinical trial service on the claim.”
Effective date: For claims processed after September 28, 2009 with dates of service on or after January 1, 2008
Implementation date: September 28, 2009
Provider enrollment deactivations and revocations
CMS released a transmittal updating the Program Integrity Manual with instructions related to provider enrollment deactivations and revocations, with additional clarification on the revocation provisions regarding address changes.
Effective date: July 27, 2009
Implementation date: July 27, 2009
Expanded editing for ordering/referring providers
Medicare requires claims for services based on an order or referral from another practitioner contain the ordering or referring practitioner’s National Provider Identification number. Only certain practitioners can refer or order services. Contractors are required to expand their current editing process for the ordering/referring information reported on claims in two phases.
Effective date: October 1, 2009
Implementation date: October 5, 2009
Reassigning benefits to ASCs and revoked or deceased practitioners
CMS issued a transmittal stating that practitioners may reassign their benefits to Ambulatory Surgical Centers (ASCs). When practitioners reassign their benefits to a solo practitioner who dies or has their billing privileges revoked, then the practice is no longer eligible to receive Medicare payments after the date of death or effective date of revocation. At that point, all reassignments are automatically terminated.
Effective date: January 1, 2008
Implementation date: October 5, 2009
No coverage for Never Events
CMS will not cover a procedure, or any of the services related to it, if the practitioner performs a different procedure altogether or erroneously performs a procedure on the wrong body part or wrong patient. Following discharge from the hospital, any medically necessary services can be covered even if they are related to the surgical error. Three National Coverage Determinations have been developed. Facilities and practitioners have new modifiers to indicate these situations.
Effective date: January 15, 2009
Implementation date: July 6, 2009 for B-MACs and Carriers; October 5, 2009 for MACs, FIs, and FISS.
Withholding of Medicare payments due to Federal Payment Levy Program (FPLP)
Transmittal 380 originally issued on October 3, 2008, has been reissued as Transmittal 503 to reflect the single change which is the implementation date for Healthcare Integrated General Ledger Accounting System (HIGLAS). The transmittal was summarized in a previous issue of MUPS which is reprinted here for your convenience.
“Medicare payments can be withheld when it is determined that a tax levy exists. Now, thanks to Section 189(a) and Section 189(b) of the Medicare Improvements for Patients and Providers Act of 2008, non-tax debt offsets can also be levied against Medicare providers to repay unpaid debts owed to other federal agencies. Examples of non-tax debts include education loans, alimony, and child support.”
Effective date: January 1, 2009
Implementation date: January 5, 2009 for FISS and MCS; October 5, 2009 for HIGLAS
Update to claim status categories and claim status codes
On June 12, CMS released a transmittal announcing the standard code sets for the claim status category codes and that the claim status codes have been revised and are posted at www.wpc-edi.com/content/view/180/223/.
The claim status category codes indicate the general category of the claim status (accepted, rejected, additional information requested, etc.) which is then further detailed in the claim status codes. The claim status codes communicate information about whether the claims have been received, pended, or paid.
Effective date: July 1, 2009
Implementation date: July 6, 2009
How to bill for aprepitant
CMS released a Special Edition MLN Matters article to help clarify when the drug aprepitant, which is used to alleviate chemotherapy induced nausea/vomiting, should be billed to Medicare Part B or Medicare Part D.
Effective date: N/A
Implementation date: N/A
SNF Consolidated Billing edits modified
CMS modified the edits that allow only certain services to be excluded from Consolidated Billing rules (and therefore, separately payable) when a Skilled Nursing Facility (SNF) resident is in a Part A covered stay.
Effective date: January 1, 2009
Implementation date: October 5, 2009
New waived tests
CMS added new clinical lab tests newly approved by the Food and Drug Administration to the list of waived tests under the Clinical Laboratory Improvement Amendments (CLIA).
Effective date: July 1, 2009
Implementation date: July 6, 2009
‘Interpretive Guidelines for Hospitals’ affect physicians
A revision to Appendix A of the State Operations and Provider Certification Manual, a manual not frequently referred to in MUPS, was released entitled, “Interpretive Guidelines for Hospitals.” Don’t let the name fool you. It contains guidance for physicians making entries into patients’ medical records in the hospital setting.
Effective date: June 5, 2009
Implementation date: June 5, 2009
PC/TC date of service
A companion MLN Matters article was released by CMS on a transmittal summarized in a previous issue of MUPS “Date of service for PC and TC of pathology services”.
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