Corporate Compliance

Transmittals and MLN Matters articles: CMS requires ABN assessment for complex medical review, clarifies "incident to" drug billing, and more

Medicare Insider, 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.

View the MLN Matters article.

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

View the transmittal.

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

View the transmittal.

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

View the transmittal.

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

View the transmittal.

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CMS rescinded and replaced the following transmittal, previously outlined in Medicare Weekly Update.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.



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