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CMS Transmittals and MLN Matters Articles

Medicare Weekly Update, May 1, 2007

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Inpatient Psychiatric Facility Prospective Payment System discharge date when benefits exhaust

On April 27, CMS issued a transmittal clarifying that as of October 1, 2007, an inpatient psychiatric facility patient is considered to be discharged at the point at which their benefits exhaust.

Effective Date: December 3, 2007
Implementation Date: December 3, 2007

View this transmittal.

Medicare National Provider Identifier implementation contingency plan

On April 24, CMS issued a transmittal announcing a Medicare National Provider Identifier (NPI) implementation contingency plan. Under the contingency plan, providers who act in good faith (i.e., they are working toward being able to accept and send NPIs on electronic transactions) to comply with the NPI implementation requirements may continue to use their legacy numbers. However, beginning May, 2007, Medicare will start evaluating the number of submitted claims containing an NPI on a monthly basis. Once Medicare determines that a sufficient number of submitted claims contain an NPI, "primary providers" (billing, pay-to, and rendering providers), will have two months to discontinue the use of legacy numbers.

Effective Date: May 23, 2007
Implementation Date: May 23, 2007

CMS will also hold a roundtable to discuss the contingency plan on May 10, 2007, from 2 p.m. to 3:30 p.m. EST. However, in order to participate in the call, all interested listeners must first register for the session. Registration will close May 9 at 2 p.m. EST, or when space has been filled. Click here to register.  

View this transmittal.
View the relating MLN Matters article.

New instructions for payment of astigmatism-correcting intraocular lenses

On April 27, CMS issued a transmittal operationalizing an administrator ruling regarding astigmatism-correcting intraocular lenses (IOL) following cataract surgeries. Effective January 22, 2007, Medicare will allow beneficiaries to pay additional charges for insertion of these lenses. When a beneficiary requests insertion of an astigmatism-correcting IOL following removal of a cataract and that procedure is performed, the beneficiary is responsible for payment of facility charges for services and supplies attributable to the astigmatism-correcting IOL. However, while an advanced beneficiary notice is not required, prior to performing the procedure, the facility must inform the beneficiary that Medicare will not make payment for services related to the astigmatism-correcting functionality of the IOL. CMS is encouraging facilities to issue a notice of exclusion from Medicare benefits for this purpose.

Effective Date: January 22, 2007
Implementation Date: May 29, 2007

View this transmittal.

Bariatric surgery billing requirements

On April 27, CMS issued a transmittal operationalizing the national coverage determination for bariatric surgeries.

Effective Date: February 21, 2006
Implementation Date: May 29, 2007

View this transmittal.

Update of HCPCS codes for hemophilia clotting factors

On April 27, CMS issued a transmittal clarifying coding requirements applicable to inpatient psychiatric facilities that furnish hemophilia clotting factor.

Effective Date: January 1, 2007
Implementation Date: October 2, 2007

View this transmittal.

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