Transmittals and MLN Matters articles: CMS requires ABN assessment for complex medical review, clarifies "incident to" drug billing, and more
Medicare Weekly Update, December 14, 2010
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CMS posts special article on ordering/referring providers\
CMS has released a special edition MLN Matters article related to providers enrolling in Medicare for the sole purpose of ordering and referring items/services for beneficiaries. CMS is excluding these practitioners from the deactivation process.
CMS requires ABN assessment as part of complex medical review
On December 10, CMS issued a transmittal to require that medical reviewers request all a mandatory advance beneficiary notices of noncoverage (ABN) for claims undergoing complex medical record review. Face validity assessment of the ABN shall be done if the claim is determined not to be reasonable and necessary.
Effective date: January 12, 2011
Implementation date: January 12, 2011
CMS clarifies “incident to” drug billing
On December 10, CMS issued a transmittal to clarify policy regarding restrictions on pharmacy billing for drugs provided incident to a physician service. The transmittal also clarifies policy for the local determination of payment limits for drugs that are not nationally determined.
Effective date: March 14, 2011
Implementation date: March 14, 2011
CMS posts ESRD changes
On December 10, CMS issued a transmittal to implement 2011 updates under the ESRD PPS.
Effective date: January 1, 2011
Implementation date: January 3, 2011
CMS targets DMEPOS provided during inpatient stay
On December 10, CMS issued a transmittal to implement edit changes regarding durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) provided during an inpatient stay. Medicare does not allow separate payment for DMEPOS during an inpatient stay, so is modifying an edit to catch these claims going forward; the edit will change from an alert code to a rejection.
Effective date: April 1, 2011
Implementation date: April 4, 2011
CMS replaces transmittal
CMS rescinded and replaced the following transmittal, previously outlined in Medicare Weekly Update.
MLN Matters articles
CMS posted the following MLN Matters articles related to transmittals previously outlined in Medicare Weekly Update.
- Billing Clarification for Positron Emission Tomography (NaF-18) PET for Identifying Bone Metastasis of Cancer in the Context of a Clinical Trial
- Incentive Payment Program for Primary Care Services, Section 5501(a) of The Patient Protection and Affordable Care Act, Payment to a Critical Access Hospital (CAH) Paid Under the Optional Method
- Clinical Laboratory Fee Schedule – Medicare Travel Allowance Fees for Collection of Specimens
- Waiver of Coinsurance and Deductible for Preventive Services, Section 4104 of The Affordable Care Act, Removal of Barriers to Preventive Services in Medicare
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