Corporate Compliance

Transmittals/MLN Marrters articls: CMS alerts providers about HIPAA 5010 transition, clarifies incident to policy, and more

Medicare Update for Physician Services, January 5, 2012

CMS alerts providers about HIPAA 5010 transition

On December 1, CMS posted a Special Edition MLN Matters article alerting providers that supplemental payers are transitioning to HIPAA 5010 or National Council for Prescription Drug Programs (NCPDP) D.0 under the National Crossover Process.

View the Special Edition MLN Matters article
CMS clarifies incident to policy

On December 15, CMS issued a change request that clarifies policy with respect to restrictions on pharmacy billing for drugs provided incident to a physician service. It also clarifies policy for the local determination of payment limits for drugs that are not nationally determined.

Effective Date: January 1, 2013
Implementation Date: January 1, 2013

View the transmittal


CMS finalizes three-day window payment policy regarding wholly owned and wholly operated entities

On December 21, CMS rescinded Transmittal 2297, dated September 2, 2011, and replaced it with Transmittal 2373. The new transmittal:

  • Removes sensitive and controversial instructions
  • Finalizes CMS payment modifier PD (Diagnostic or related nondiagnostic item or service provided in a wholly owned or wholly operated entity to a patient who is admitted as an inpatient within 3 days),
  • Finalizes CMS policy with a compliance date of July 1, 2012, as reflected in calendar year 2012 Medicare physician fee schedule final rule (76 FR 73279) published on November 1, 2011. 
Effective Date: January 1, 2012
Implementation Date: January 3, 2012 

View the transmittal

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