2004 Annual Coding File Update for Skilled Nursing Facility (SNF) Consolidated Billing
News about SNF consolidated billing 2004 coding file updates, which will be posted by CMS December 1, 2003.
2004 Coding & Reimbursement Update ~ Ohio & West Virginia
The 2004 Ohio & West Virginia Coding & Reimbursement Update is now available at palmettogba.com.(OH/WV)
2004 Drug and Biological Fee Schedule
The 2004 Drug and Biological Fee Schedule is now available. (OH/WV)
Appeals and Hearings Tips
Region C DMERC provides tips to expedite HO hearings. Information about helpful forms is also included.
Appeals Process
As a Medicare provider, you are responsible for documenting Medicare claims with all the information that is necessary for the carrier to make coverage and reimbursement determinations. Claims that are submitted with incomplete or inaccurate information will be rejected as unprocessable. Please read this Medicare Part B appeal information! (OH/WV)
Carrier Jurisdiction Changes ~ Zip Code Will Be Required for Services Rendered in an Office Setting - Revised
The Centers for Medicare & Medicaid Services (CMS) announces new information regarding submission of carrier jurisdiction services rendered in an office setting, effective April 1, 2004.
These instructions only apply to electronic claims using the ANSI X12N 837 format and paper claims. Services submitted in the National Standard Format (NSF) will not be required to make any changes in either the submission or processing of claims subject to jurisdictional pricing for services paid under the Medicare Physician Fee Schedule and Anesthesia services. (OH/WV)
Change of Information
Medicare providers are required to report changes of information using the CMS 855A Provider/Supplier Enrollment Application. Palmetto GBA has developed helpful hints to assist providers in completing the application.
Correct Coding Edits on the Internet and are Updated Quarterly
The Centers for Medicare & Medicaid Services (CMS) developed the National Correct Coding Initiative (NCCI) to promote national correct coding methodologies and eliminate improper coding. To assist providers in identifying CCI edits, CMS has posted Version 10.1, which is effective April 1, 2004, to its Web site. (OH/WV)
Correction to the January 2004 Annual Update of HCPCS Codes Subject to Home Health Consolidated Billing
This article informs providers that HCPCS codes A7525 and A7526 will not be added to home health consolidated billing enforcement.
Corrections to the Payment Rate and Copayment Amount for Oxaliplatin (Eloxatin) under the Hospital Outpatient Prospective Payment System (OPPS) – January 6, 2004 Federal Register
This article includes a correction to the payment rate and copayment amount for Oxaliplatin (Eloxatin) that was initially published in the January 6, 2004 Federal Register. For more information, click on the article title above.
Darbepoetin Alfa (Aranesp) and Epoetin Alfa (EPO, Epogen, Procrit) ~ Coverage and Coding Instructions and Documentation Required
Coverage and coding instructions and documentation required when Darbepoetin alfa or Epoetin alfa are administered in the treatment of anemia for ESRD patients on dialysis. (OH/WV)
Duplicate Claims Issue
Attention South Carolina Part A; Southeast and Southwest Home Health and Hospice providers. Please select the hyperlink text above to view important information concerning duplicate claims.
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)
Home Health Consolidated Billing Update ~ Effective January 1, 2004 - Revised
Effective for dates of service on or after January 1, 2004, the Centers for Medicare & Medicaid Services has advised that two HCPCS codes originally shown in the list of codes subject to Home Health Consolidated Billing requirements will not be included.
HCPCS codes A7525 (Tracheostomy mask, each) and A7526 (Tracheostomy tube collar/holder, each) are NOT to be included. All other information in this article remains the same. (OH/WV)
Intravenous Immune Globulin – New Benefit
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 provides a new benefit for intravenous immune globulin (IVIG) administered in the home setting effective for dates of service on or after January 1, 2004. This article details coverage criteria and claims processing information.
Laboratory National Coverage Determination (NCD) Edit Software Changes for April 5, 2004
Effective April 5, 20004, the Serum Iron Studies National Coverage Determination (NCD) will be updated in the Centers for Medicare & Medicaid Services' Laboratory NCD Edit Software. ICD-9 codes were added to the list of covered diagnoses. (OH/WV)
Network Service Vendor Agreement for Eligibility Inquiries - ANSI 270/271
The Network Service Agreement Packet must be completed prior for submitting ANSI 270 Eligibility Inquiries. All vendors must completed an updated Network Service Agreement Packet if you wish to have or continue this service.
North Carolina Part A Intermediary Open Draft LMRP Meeting - February 17, 2004
Registration information and instructions for the February 17, 2004, North Carolina Part A Open Draft LMRP Meeting are now available online.
Opt Out Providers Now Include Dentists, Podiatrists, & Optometrists
Dentists, podiatrists, and optometrists are now added to the list of providers who may opt out of the Medicare program. (OH/WV)
PC-ACE Pro32 Claim Submission Software
Special Notice to Paper Claim Submitters or UB-92 / NSF Electronic Claim Submitters: PC-ACE Pro32 Software is a new Windows-based, self-contained claims processing system for submission of ANSI 837 v4010A1 claim files for all Medicare lines of business. For more information about PC-ACE Pro32 Software, please access this article.
Region C Council Meeting Minutes, December 10, 2003
The minutes of the December 10, 2003 DMERC Region C Council meeting are now available online.
Region C Council Q&A, December 10, 2003
Answers to questions addressed at the December 10, 2003 DMERC Region C Council meeting are now available. Topic include rehab, orthotics and prosthetics, capped rental, durable medical equipment, enteral nutrition, respiratory equipment, EDI, and more.
Reminder: DMEPOS Coverage Parameters
DMEPOS suppliers should look to medical policy for guidelines on parameters such as dosages, quantity, number of units, etc., to avoid claim denials.
Rescinded 2004 Region C DMEPOS Fees
An important message regarding three 2004 Region C DMEPOS Fees that have been rescinded.
Revision to the Diagnosis Coding Instructions for Requests for Anticipated Payment (RAPs) and Claims to Conform with HIPAA Requirements
Transmittal 61 revises the diagnosis coding instructions for requests for anticipated payment (RAPs) and claims to conform with HIPAA requirements. For more information about this article, select the hyperlink text above.
Skilled Nursing Facility Therapy Claim Processing Problem
Due to a problem with the SNF NO PAY File, claims containing bill types 22x and 23x and specific HCPCS codes are being held until February 9, 2004.
Treatment of Certain Dental Claims as a Result of the Medicare Prescription Drug, Improvement, & Modernization Act of 2003
Amending claim submission procedures may be required for Medicare patients due to a change in new legislation. (OH/WV)
Treatment of Certain Dental Claims as a Result of the Medicare Prescription Drug, Improvement, & Modernization Act of 2003
Attention Dentists! Claim submission procedures must be amended for Medicare patients due to new legislation. (OH/WV, SC)
Ventricular Assist Devices (VADs) National Coverage Determination - Revised
The Centers for Medicare & Medicaid Services (CMS) is correcting the last section in the “Ventricular Assist Devises (VADs) National Coverage Determination” article published on our Web site on 12/22/2003 and in the December 2003 Medicare Advisory on page 20. They are making this correction so Medicare+Choice (M+C) providers can be appropriately paid for fee-for-services directly related to the implantation of a VAD for the expanded indication (destination therapy) as outlined in Pub. 100-03, Medicare National Coverage Determination (NCD) manual, section 20.9.
CPT codes published in the second bullet under “Billing Instructions for Providers Who Render Services to Medicare + Choice Beneficiaries” was changed and is shown in "red." (OH/WV)
02-0014-L-LONG ACTING SYNTHETIC ERYTHROPOIETINS
This SC Medicare Part B LMRP has been revised. HCPCS code for Darbepoetin Q0137 has been added. The revised effective date is 01/01/2004.
02-0020-L-DEBRIDEMENT OF ULCERS AND WOUNDS
This South Carolina Medicare Part B LMRP, 02-0020-L, Debridement of Ulcers and Wounds, has been revised. Wording was deleted to reflect Carriers Manual changes, and a 5th digit was added to 998.32 per 2004 ICD-9 code changes.
90-0014-L- EPOETIN ALFA (EPO) IN THE TREATMENT OF NON-ESRD ANEMIA
This South Carolina Medicare Part B LMRP has been updated to reflect revised wording for the Carriers Manual references.
90-0014-M-EPOETIN ALFA (EPO) FOR TREATMENT OF ANEMIA ASSOCIATED WITH CHRONIC RENAL FAILURE
This SC Medicare LMRP has been revised. HCPCS codes Q9920-Q9940 have been deleted. The revised effective date is 01/01/2004.
91-0038-L-LOW OSMOLALITY CONTRAST MEDIA
This South Carolina Medicare Part B LMRP has been revised. Codes A4644, A4645, A4646 were deleted. New code A9525 was added for 2004. The revised effective date is 01/01/2004.
99-0016-L-AREDIA (PAMIDRONATE DISODIUM, APD)
This SC Medicare Part B LMRP has been revised by adding a 4th digit added per 2004 ICD-9 updates. The revised effective date is 01/01/2004.
04-03-Inpatient rehabilitation
The North Carolina Part A intermediary announces the draft inpatient rehabilitation LMRP 04-03. The open draft LMRP meeting is scheduled for 02/17/2004 at 9 am at the Durham office.
04-05-Respiratory Therapy
The North Carolina Part A intermediary announces the draft Respiratory Therapy LMRP 04-05. The open draft LMRP meeting is scheduled for 02/17/2004 at 9 am at the Durham office.
04-06-Bariatric Surgery
The North Carolina Part A intermediary announces the draft Bariatric Surgery LMRP 04-06. The open draft LMRP meeting is scheduled for 02/17/2004 at 9 am at the Durham office.
04-07-Trastuzumab (Herceptin®)
The North Carolina Part A intermediary announces the draft Trastuzumab (Herceptin®) LMRP 04-07. The open draft LMRP meeting is scheduled for 02/17/2004 at 9 am at the Durham office.
00-08-0001-Erythropoetin Substitutes
The North Carolina Part A intermediary revised the erthropoetin substitutes LMRP 00-08-0001 by deleting HCPCS code C1774 from the CPT/HCPCS section of the policy.
01-13-Rituximab (Rituxan)
The North Carolina Part A Intermediary revised the Rituximab (Rituxan) local medical review policy LMRP 01-13 by adding ICD-9 codes 201.41-201.46 Hodgkin's disease; lymphocytic-histiocytic predominance and 201.48 Hodgkin's disease; lymphocytic-histiocytic predominance, lymph nodes of multiple sites to the diagnosis codes that support medical necessity. This revision is effective 02/06/2004.
97-11-M018-Transthoracic Echocardiography (TTE)
The North Carolina Medicare Part A intermediary revised the transthoracic echocardiography policy (TTE) LMRP 97-11-M018 by adding a number of ICD-9 diagnosis codes to support medical necessity for CPT codes 93320, 93321, and 93325. Consolidated ICD-9 codes supporting medical necessity for the CPT codes 93307 and 93308. This revision is effective 02/13/2004.
97-12-T023-Occupational Therapy Services
The North Carolina Part A intermediary revised the occupational therapy LMRP 97-12-T023 by adding non-physician practitioner (NPP) language to the policy.
98-10-T007-Speech-Language Pathology
The North Carolina Part A intermediary revised the Speech-Language pathology LMRP 98-10-T007 by adding non-physician practitioner (NPP) language to the policy.
99-10-D004-rG-CSF (Neupogen, Filgrastim)
The North Carolina Part A intermediary revised the rG-CSF LMRP 99-10-D004 by deleting language that myelodyslasia is not covered in the indications and limitations of coverage and/or medical necessity section of the policy. This revision is effective 02/06/2004.
Visit our Privacy Policy if you have any questions.
Copyright © 2003 Palmetto GBA. All Rights Reserved.
| 
