Corporate Compliance

Transmittals/MLN Matters articles: CMS addresses ordering/referring providers, ABN validity assessments, and more

Medicare Update for Physician Services, January 6, 2011

CMS corrects manual omission for HCPCS units of service

On December 17, CMS issued a transmittal to incorporate a table of therapy CPT codes indicating maximum unit limitations that was inadvertently deleted from the manual.

Effective date: March 21, 2011
Implementation date: March 21, 2011

View the transmittal.

View a related MLN Matters article.

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 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.

View a related MLN Matters article.

CMS implements annual wellness visit benefit

On December 3, CMS issued two transmittals to implement expanded coverage of preventive services under the Patient Protection and Affordable Care Act. Subject to certain eligibility and other limitations, Medicare will cover an annual wellness visit, including personalized prevention plan services, for an individual who is no longer within 12 months after the effective date of his or her first Medicare Part B coverage period, and has not received either an initial preventive physical examination or an annual wellness visit providing PPPS within the past 12 months. Medicare coinsurance and Part B deductibles do not apply.

Effective date: January 1, 2011
Implementation date: April 4, 2011

View the Benefit Policy Manual transmittal.

View the Claims Processing Manual transmittal.

View a related MLN Matters article.

CMS implements primary care incentive payments

On December 3, CMS implemented the 10% primary care incentive bonus mandated by the Patient Protection and Affordable Care Act.

Effective date: April 1, 2011
Implementation date: April 4, 2011

View the transmittal.

View a related MLN Matters article.

CMS posts special article on physician vulnerabilities under the RAC program

On December 2, CMS issued the latest in a series of RAC program special MLN Matters articles. The current article aims to provide education to physicians on two vulnerabilities uncovered by the RAC demonstration program - services billed with excessive units and duplicate claims.

View the special edition MLN Matters article.

CMS posts preventive services guidance

CMS recently communicated a previously sensitive transmittal to implement changes under the Patient Protection and Affordable Care Act (PPACA) related to preventive services. Provisions of PPACA waive the coinsurance/copayment and deductible for the initial preventive physical examination, the annual wellness visit, and Medicare-covered preventive services recommended by the United States Preventive Services Task Force with a grade of A or B for any indication or population and that are appropriate for the individual. PPACA also waives the deductible for planned colorectal cancer screening tests that become diagnostic.

Effective date: January 1, 2011
Implementation date: January 3, 2011

View the transmittal.

View a related MLN Matters article.

CMS instructs on ESRD home dialysis payment

CMS recently communicated a previously sensitive transmittal related to home dialysis. Effective January 1, 2011, the ESRD monthly capitation payment (MCP) physician (or practitioner) must furnish at least one face-to-face patient visit per month for the home dialysis MCP service.

Effective date: January 1, 2011
Implementation date: January 3, 2011

View the transmittal.

View a related MLN Matters article.

CMS implements HPSA incentive payments under PPACA

CMS recently communicated a previously sensitive transmittal to implement health professional shortage area (HPSA) incentive payments for major surgical procedures, as mandated by the Patient Protection and Affordable Care Act.

Effective date: January 1, 2011, and April 4, 2011
Implementation date: This change request will be implemented over two releases – the January 3, 2011, release will implement the claim identification of the incentive and the April 4, 2011, release is for full implementation of the instructions.

View the transmittal.

View a related MLN Matters article.

CMS replaces transmittals

CMS replaced several transmittals previously outlined in Medicare Update for Physician Services.

MLN Matters article

CMS released an MLN Matters article related to a transmittal previously outlined in Medicare Update for Physician Services.

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