Palmetto GBA Information Dispatch for Wednesday, February 18, 2004

CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply.

30-Day Migration Deadline for HIPAA Compliance Palmetto GBA has issued important information regarding deadlines for submitting HIPAA-compliant claims. Click on this article for more information. Additional Guidelines for Implementing the National Council for Prescription Drug Program (NCPDP) Standards under HIPAA According to the HIPAA implementation guide (IG), Medicare systems must be able to receive the NCPDP HIPAA claim transaction with segments in any order. Effective July 1, 2004, the Medicare DMERCs will change their systems to comply with this requirement. Additional Rules for Critical Access Hospitals Established by the Medicare Prescription Drug Improvement and Modernization Act (MMA) of 2003, PL 108-173 Critical Access Hospital Providers: This article includes New Requirements for CAHs based on changes that have been established w/the MPDIMA of 2003, PL108-173. For information about this article, please select the hyperlink text above. Ambulatory Surgical Centers (ASC) Payment Changes for Fiscal Year 2004 Effective April 1, 2004, for services performed on or after April 1, 2004, the Centers for Medicare & Medicaid Services (CMS) have made revisions to the ASC payment group rates. (OH/WV) Announcing the New "Medlearn Matters…Information for Medicare Providers" Educational Resource The CMS introduces "Medlearn Matters...Information for Medicare Providers" as a new information resource for Medicare physicians, providers and suppliers. Consolidated Billing ~ Therapy Services Are Separately Payable To Physicians Physicians and other providers submitting services for patients in a skilled nursing facility should note changes in consolidated billing guidelines which will allow certain therapy services to be separately payable when provided by physicians. (OH/WV) Elimination of the 90-day Grace Period for Billing Discontinued ICD-9-CM Codes Effective October 1, 2004, the Centers for Medicare & Medicaid Services (CMS) will eliminate the 90 day grace period for discontinued ICD-9 codes. (OH/WV/SC) Elimination of the 90-day Grace Period for Billing Discontinued ICD-9-CM Codes; DMERC Effective for dates of service on and after October 1, 2004, no more 90-day grace periods will apply for the annual ICD-9-CM updates. Providers must bill using the diagnosis code that is valid for the date of service. (DMERC) Elimination of the 90-day Grace Period for Billing Discontinued ICD-9-CM Codes; Part B SC Effective for dates of service on and after October 1, 2004, no more 90-day grace periods will apply for the annual ICD-9-CM updates. Providers must bill using the diagnosis code that is valid for the date of service. Elimination of the 90-day Grace Period for HCPCS Codes Effective January 1, 2005, Medicare providers will no longer have a 90-day grace period to use discontinued HCPCS codes for services rendered in the first 90 days of the year. (OH/WV/SC) Elimination of the 90-day Grace Period for HCPCS Codes; DMERC CMS is eliminating the 90-day grace period for billing discontinued HCPCS codes effective January 1, 2005. (DMERC) Elimination of the 90-day Grace Period for HCPCS Codes; Part A SC CMS is eliminating the 90-day grace period for billing discontinued HCPCS codes effective January 1, 2005. (Part A SC) Elimination of the 90-day Grace Period for HCPCS Codes; Part B SC CMS is eliminating the 90-day grace period for billing discontinued HCPCS codes effective January 1, 2005. (Part B SC) Elimination of the 90-day Grace Period for HCPCS Codes; RHHI CMS is eliminating the 90-day grace period for billing discontinued HCPCS codes effective January 1, 2005. February 2004 Medicare Bulletin (Number 04-2) Attention North Carolina Part A Providers: The February 2004 Medicare Bulletin is now available online. HIPAA Vendor Listing for Ohio/West Virginia An updated HIPAA Vendor Listing for Ohio and West Virginia Medicare Part B is now available online. (OH/WV) Implementation of New Medicare Redetermination Notice; DMERC Due to changes to Medicare appeals procedures, DMERC suppliers will soon receive their first-level appeal decisions in a new format, called the Medicare Redetermination Notice. Implementation of New Medicare Redetermination Notice; NC Part A Due to changes to Medicare appeals procedures, Part A providers will soon receive their first-level appeal decisions in a new format, called the Medicare Redetermination Notice. Implementation of New Medicare Redetermination Notice; SC Part A Due to changes to Medicare appeals procedures, Part A SC providers will soon receive their first-level appeal decisions in a new format, called the Medicare Redetermination Notice. Implementation of New Medicare Redetermination Notice; SC Part B Due to changes to Medicare appeals procedures, Part B providers will soon receive their first-level appeal decisions in a new format, called the Medicare Redetermination Notice. Intravenous Immune Globulin Effective January 1, 2004, Medicare will allow IV Immune Globulin administered in the patient's home. (OH/WV/SC) Most Frequent RTP Reason Codes - February 2004 We are providing a list of the most frequently occurring FISS reason codes to help providers understand the reason codes seen most often. (NC Part A). New Temporary “K” HCPCS Codes for Wheelchair Cushions Effective July 1, 2004, 20 temporary HCPCS codes for wheelchair cushions will be established. PC-ACE Pro32 Patch Information - February 2004 A patch for Palmetto GBA's PC-ACE Pro32 software is available for download through the Palmetto GBA Web site. All users must install this patch. Click on this article title for additional information and download instructions. Physician/Supplier Guide to Medicare (Ohio/West Virginia) The Physician/Supplier Guide was updated to include E & M Documentation & Coding Tips.(OH/WV) Results of Service Specific Probe and Universal Reviews: Paid Dates 10/01/03 - 12/31/03 These tips, resulting from claims filing errors discovered during probe and universal reviews, were assembled by the Region C DMERC Medical Review department. Also included are review results for specific HCPCS codes. Simplifying Outpatient Observation Care Pathways Workshops You can now register for the Simplifying Outpatient Observation Care Pathways Workshop online. For more information about this workshop click on the hyperlink text above. South Carolina 2004 Medicare Physician Fee Schedule and Participation Enrollment Attention providers: An updated link to all of the 2004 South Carolina 2004 Medicare Physician Fee Schedule information is now available online. Special Rules for Critical Access Hospital (CAH) Outpatient Billing Attention Critical Access Hospital Provider: This article informs you of some key changes resulting from the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). To access this article select the hyperlink text above. Top 15 FISS Reason Codes for January 2004 In our continuing effort to offer as much information as possible on the processing of claims in FISS, we are providing a list of the top 15 reason codes by claim volume for hospitals, skilled nursing facilities (SNFs), and other providers (ESRD, RHC, CORF, ORF, etc.) produced/received in January 2004. (NC Part A) Update on Resend of 9/30/2003 FYE PS&Rs The preparation of the 9/30/2003 FYE PS&R report distribution resend is underway. Workshop Schedule Attention Providers: The 2004 Workshop Schedule through September 2004 is now available online. 98-0013-L-HELICOBACTER PYLORI BREATH TEST This SC Medicare Part B LMRP has been revised. Updates were made to reflect 5th digit ICD-9 changes. 98-0033-L-ANTI-EMETOGENIC THERAPY FOR CHEMOTHERAPY The SC Medicare Part B LMRP has been revised. Coverage was added for palonosetron HCI. 98-02-H004-Observation Bed/Room Services The North Carolina Part A intermediary revised the observation LMRP 98-02-H004 by adding CPT codes 99217 Observation care discharge day management, 99218 Initial observation care which requires detailed history and exam and medical decision making of straightforward or low complexity, 99219 Initial observation care which requires comprehensive history and exam and medical decision making of moderate complexity, and 99220 Initial observation care which requires comprehensive history and exam and medical decision making of high complexity to the CPT/HCPCS codes section of the policy. This revision is effective 02/20/2004. Visit our Privacy Policy if you have any questions. Copyright © 2004 Palmetto GBA. All Rights Reserved.

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