Other Issuances: CMS posts quarterly updates to data files, OIG audits neulasta, and more
Medicare Weekly Update, July 6, 2010
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CMS updates OPPS addenda
CMS has posted a revised Addendum A and Addendum B under the OPPS, effective July 1.
CMS posts quarterly MUE update
CMS has released the quarterly files containing the published medically unlikely edits (MUE), effective July 1.
View the MUE file for practitioner services.
View the MUE file for facility outpatient services.
View the MUE file for DME supplier services.
CMS updates lab NCD manual
CMS has released the July update to the lab NCD manual.
CMS to address PECOS difficulties
On June 30, CMS issued a press release to announce that it will, for the time being, not implement changes that would automatically reject claims based on orders, certifications, and referrals made by providers that have not yet had their applications approved by July 6, 2010. CMS had issued an interim final regulation implementing provisions of the Affordable Care Act that permit only a Medicare-enrolled physician or eligible professional to certify or order home health services, durable medical equipment, prosthetics, orthotics, and supplies, and certain items and services under Medicare Part B. While more than 800,000 physicians and other health professionals have enrolled and have approved applications in the PECOS system, some providers have encountered problems.
OIG audits neulasta
On June 23, the OIG released two reports on carrier payments for neulasta made in calendar years 2004–2007. The OIG reports revealed overpayments of $1,600 in Virginia and $77,000 in West Virginia.
View the report on neulasta payments in Virginia.
View the report on neulasta payments in West Virginia.
CMS FAQ addresses improved ICD-9 processing
Why is the expansion of the number of ICD-9 diagnosis and procedure codes that CMS will accept and process being allowed on institutional claims?
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