Corporate Compliance

Transmittals and MLN Matters articles: CMS instructs on discarded drugs/biologicals, addresses self-administered drugs, and more

Medicare Insider, May 4, 2010

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CMS updates language on discarded drugs and biologicals

On April 30, CMS updated language in the Claims Processing Manual regarding discarded drugs and biologicals.

Effective date: July 30, 2010
Implementation date: July 30, 2010

View the transmittal.

CMS issued guidance on self-administered drugs

On April 30, CMS issued a transmittal to clarify what “administered” means in the context of self-administered drug determinations. The term “administered” refers only to the physical process by which the drug enters the patient’s body. It does not refer to whether the process is supervised by a medical professional (for example, to observe proper technique or side-effects of the drug). Injectable drugs, including intravenously administered drugs, are typically eligible for inclusion under the “incident to” benefit. With limited exceptions, other routes of administration including, but not limited to, oral drugs, suppositories, topical medications are considered to be usually self-administered by the patient.

Effective date: July 30, 2010
Implementation date: July 30, 2010

View the transmittal.

CMS updates lab NCDs

On April 30, CMS issued quarterly updates to its lab NCDs for July.

Effective date: July 1, 2010
Implementation date: July 6, 2010

View the transmittal.

CMS updates MAC business requirements regarding RACs

On April 30, CMS issued a transmittal adding A/B MACs to business requirements regarding the RAC program, including the requirement to reach a Joint Operating Agreement with each RAC operating in their jurisdication.

Effective date: June 1, 2010
Implementation date: June 1, 2010

View the transmittal.

CMS instructs on bypassing sex-related edits

On April 29, CMS issued a transmittal instructing institutional providers to report condition code 45 (Ambiguous Gender Category) on inpatient claims (per CR 6638) related to transgender or hermaphrodite beneficiaries. This claim level condition code should be appended by providers to bypass sex related edits and allow these claims to process. Claims related to transgender and hermaphrodite beneficiaries are being incorrectly returned to the provider (RTPed) for either a sex/diagnosis or sex/procedure conflict.

Effective date: October 1, 2010
Implementation date: October 4, 2010

View the transmittal.

CMS instructs on billing for tracheo-esophageal voice prosthesis

On April 29, CMS issued a transmittal on HCPCS code L8509, which describes a tracheo-esophageal voice prosthesis inserted by a licensed health care provider of any type. This type of prosthesis is inserted in a physician’s office or other outpatient setting. Therefore, claims for code L8509 should not be submitted to the DME MAC, but instead should be submitted to the A/B MAC or Part B carrier.

Effective date: October 1, 2010
Implementation date: October 4, 2010

View the transmittal.

CMS instructs on TOB for colorectal cancer screening

On April 28, CMS issued a transmittal to require the use of the 12X Type of Bill (TOB) in place of 13X TOB for the billing of colorectal screening services when provided to hospital inpatients under Part B or when Part A benefits have been exhausted. Appropriate TOBs for services other than hospital inpatients remain the same – 13X, 14X, 22X, 23X, 83X, and 85X.

Effective date: October 1, 2010
Implementation date: October 4, 2010

View the transmittal.

View a related MLN Matters article.

CMS to issue new MSN

On April 28, CMS issued a transmittal to implement a new Medicare Summary Notice (MSN) when payment to a provider is higher than expected under a prospective payment system (PPS). The new MSN will explain to the beneficiary the concept of the PPS and that the Medicare payment amounts are correct even though they may be higher than what the provider or supplier actually charged for those particular services.

Effective date: October 1, 2009
Implementation date: October 4, 2010

View the transmittal.

CMS implements FISS deactivation letters

On April 28, CMS issued a transmittal to ensure that providers/suppliers are notified that their Medicare billing privileges have been deactivated, FISS shall systematically generate a letter when a Part A deactivation occurs.

Effective date: October 1, 2010
Implementation date: October 4, 2010

View the transmittal.

CMS moves to integrate data repositories

On April 28, CMS issued two transmittal to continue integrating various Medicare claims data repositories, with the goal of streamlining data analysis by claims auditing contractors (e.g., ZPICs).

Effective date: October 1, 2010
Implementation date: October 4, 2010

View transmittal R681OTN.

View transmittal R685OTN.

CMS removes value codes requirement for therapy

On April 27, CMS issued a transmittal to remove the requirement for providers to report the total number of therapy visits using value code 50 – physical therapy, 51 – occupational therapy, 52 – speech therapy, and 53 – cardiac rehab.

Effective date: October 1, 2010
Implementation date: October 4, 2010

View the transmittal.

View a related MLN Matters article.



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