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Other CMS and OIG Issuances

Medicare Weekly Update, August 29, 2007

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CMS updates its National Coverage Determination for percutaneous transluminal angioplasty

CMS has posted an update to its National Coverage Determination for percutaneous transluminal angioplasty.

View the NCD.

CMS Frequently Asked Questions
CMS issued/updated the following FAQs last week (the questions are reprinted verbatim from the CMS Web site with only minor editorial clarifications):

• How are the NCCI edits arranged in the manual? (view)
• How often will the National Correct Coding Initiative (NCCI) edits be updated for Fiscal Intermediaries? (view)
• Will modifier -25 be used for all ER small laceration repairs, etc? (view)
• Can you explain the use of modifier -27? (view)
• How do you report more than one EKG performed in the same day? (view)
• Do the finger and toe modifiers apply to radiology CPT codes? (view)
• If an Inpatient Psychiatric Facility (IPF) must send a patient to another facility for care or treatment (e.g., dialysis), how does the IPF get reimbursed? (view)
• Will discounts offered by a hospital to all uninsured patients that are not based on individualized determinations of need, but, rather, are offered solely on the basis of the patient's uninsured status, affect Medicare payment for outlier or new technology cases? (view)
• What if the hospital wants to write off a Medicare patient's deductible and coinsurance regardless of their income level? Is that permissible? (view)
• Can a hospital be subject to criminal sanctions or penalties if it writes off a patient's bill? (view)
• Can a hospital write off a Medicare patient's bill but take aggressive collection action against a non-Medicare patient who doesn't pay his/her bill? (view)
• Are hospitals required to take low-income patients to court, or seize their homes, or send claims out to a collection agency when those patients don't pay their hospital bills? (view)
• Can a hospital be reimbursed by Medicare for a Medicare patient's unpaid deductibles or coinsurance? Are there special rules for this "bad debt" if the patient meets the hospital's indigency guidelines? (view)
• In cases where it is uncertain as to whether Medicare coverage may apply, is there any way to obtain a quick determination prior to proceeding, by telephone? (view)
• Does Medicare provide any special compensation to hospitals that treat a large number of uninsured patients - especially those hospitals that have to write off a large number of bills for the uninsured? (view)
• When may an Advanced Beneficiary Notice (ABN) be needed and issued to a beneficiary who is not in a state of emergency? (view)
• Are the C codes specifically for manufacturer use? (view)
• If the same procedure was done on the great toe of the right foot and on the great toe of the left foot, how would you code it? (view)
• Can hospitals use modifier -51? (view)
• Should modifier -52 (reduced services) be used for a procedure that is defined as bilateral by the HCPCS code, when the provider was only able to do one side? (view)
• What are the recertification rules for the Inpatient Psychiatric Facility Prospective Payment System? (view)
• Can a hospital waive collection of charges to an indigent, uninsured individual? (view)
• What if a hospital wants to discount charges to patients with large medical bills? (view)
• Does offering discounts to the uninsured/underinsured affect a hospital's cost to charge ratio or Medicare cost apportionment? (view)
• How is offering discounts to the uninsured/underinsured any different than a hospital giving a discount to Blue Cross or any other insurer? (view)
• Does the Medicare program's lesser of costs or charges (LCC) principle alter any of the given advice or prohibit hospitals from offering discounts to the uninsured or the underinsured? (view)
• Will Medicare pay a hospital's bad debts for non-Medicare patients who don't pay their bills? (view)

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