1St Quarter 2005 Medicare B Update!
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Highlights In This Issue… A Physician’s Focus An Ongoing Focus of Medicare-Improving Quality of Health Care ............................ 3 Claims, Appeals, and Hearings Physician Education for the Revisions to the Health Professional Shortage Area (HPSA) Bonus Payment Processes and Implementation of the Physician Scarcity Area (PSA) Bonus Payments ........................................................................... 10 Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 10.3 and 11.0 ...................................................................................... 15 Temporary Change in Carrier Jurisdiction Pricing Rules for Purchased Diagnostic Services ........................................................................................................ 15 pdate HIPAA–The Health Insurance Portability and Accountability Act Remittance Advice Remark Code and Claim Adjustment Reason Code Update ....... 5 Fraud, Abuse, and Waste CMS Program Integrity Iniative .......................................................................... 57 U General Information Important News about Flu Shots for Medicare Beneficiaries ................................. 59 Connecticut Medical Review New, Revised, and Retired LMRPs/LCDs ........................................................... 81 Florida Medical Review New, Revised, and Retired LMRPs/LCDs ........................................................... 97 Features Connecticut and Florida Connecticut Only A Physician’s Focus ............ 3 Medical Review .................. 81 he Medicare B Update! About the Update! ............... 4 Tshould be shared with all Claims ................................. 6 Florida Only health care practitioners and Medical Review .................. 97 Coverage/Reimbursement .. 18 managerial members of the HIPAA and EMC .................. 54 provider/supplier staff. Publica- General Information ............ 57 Educational Resources ...... 93 Index ................................... 114 tions issued beginning in 1997 are available at no cost from our provider education Web sites: To receive quick, automatic notification when new publications and other http://www.connecticutmedicare.com items of interest are posted to our provider education Web sites, subscribe and http://www.floridamedicare.com. to our FCSO eNews mailing list. It’s very easy to do; go to http://www.connecticutmedicare.com or http://www.floridamedicare.com, click on the “Join our Electronic Mailing List FCSO eNews” bar and follow Routing Suggestions: the prompts. The FCSO eNews is sent at least every other week, more q frequently as required. Physician/Provider q Office Manager q Billing/Vendor q Nursing Staff q Other _________ A CMS Contracted Intermediary & Carrier _________ wedire2f A Newsletter for Connecticut and Florida Medicare Part B Providers pirst2urter2PHHS 22222olume2Q2xumer2I efvi2yp2gyxix Highlights In This Issue… ........................................... 1 Other Services Billing Requirements for Islet Cell Transplantation A Physician’s Focus for Beneficiaries in a NIH Clinical Trial............ 52 Medicare B An Ongoing Focus of Medicare-Improving Quality of Treatment of Obesity .............................................. 53 Health Care .......................................................3 HIPAA/EMC Update! About the Connecticut/Florida Medicare B Update! ... 4 Remittance Advice Remark and Claim Adjustment Advance Beneficiary Notices (ABNs) ..........................5 Reason Code Update ..................................... 56 Vol. 3, No. 1 Claims Revised American National Standards Institute X12N FirstQuarter 2005 2005 Healthcare Common Procedure Coding 837 Professional Health Care Claims System (HCPCS) Annual Update Reminder .......6 Companion Document ................................... 57 Publications Medicare Contractor Annual Update of the ICD-9-CM 6 Remittance Advice Remark and Claim Adjustment Staff HPSA Listing .............................................................. 7 Reason Code Update ..................................... 58 Terri Drury “Incident to” Services .................................................. 9 General Information Kimberly McCaw Revisions to the HPSA Bonus Payment Processes and Fraud, Waste, and Abuse Millie C. Pérez Implementation of the PSA Bonus Payments 10 CMS Program Integrity Initiative ............................. 60 Quarterly Update to Correct CCI Edits, Version 10.3 15 The Medicare B Update! Quarterly Update to Correct CCI Edits, Version 11.0 15 Important News about Flu Shots for Medicare Signature Requirements ......................................... 10 Beneficiaries .................................................. 62 is published quarterly by Type of Service Changes ........................................ 16 Flu Vaccine Issues ................................................... 60 the Medicare Invalid Diagnosis Code Editing – Second Phase .... 16 Update to Medicare Deductible, Coinsurance, and Communication and Temporary Change in Carrier Jursdictional Pricing Premium Rates for Calendar Year (CY) 2005 .. 63 Education department of Rules for Purchased Diagnostic Services ......... 16 Provider TeleTYpewriter Service Now Available ..... 65 First Coast Service Skilled Nursing Facility Consolidated Billing Options, Inc. (FCSO), to Coverage/Reimbursement Clinical Social Workers ......................................... 65 Medicare Physician Fee Schedule provide timely and useful October 2004 Quarterly Update of HCPCS ........... 66 information to Medicare 2004 FS for Clinical Psychologist and Clinical Social Claim Edits for Therapy Codes ............................. 68 Worker Services – Procedure 90818 ............... 18 Part B providers in Ambulance Services ............................................. 69 Connecticut and Florida. Full Replacement of CR 3415, Third Update to the Financial Services 2004 MPFSDB ............................................... 18 Unsolicited/Voluntary Refunds ................................. 71 Questions concerning this Third Update to the 2004 MPFSDB – Correction .... 20 Medicare Secondary Payer Third Update to the 2004 MPFSDB - Allowance publication or its contents Clarification of MSP Rules in Relation to a may be directed in writing to: Changes for Certain Procedures ..................... 21 Temporary Leave of Absence ......................... 72 Ambulance MSP Application to Former Spouses and Certain Correction to Ambulance FS Update for 2003 ......... 21 Medicare Part B Family Members Under the Federal Employees MCE-Publications Ambulatory Surgical Center Health Benefits ............................................... 72 ASC Payment Rates and Wage Index Values General Information P.O. Box 45270 Remain in Effect for Fiscal Year (FY) 2005 ..... 21 Guidance Regarding Elimination of SPR in Jacksonville, FL Chiropractic Old Format..................................................... 73 32232-5270 Revised Requirements for Chiropractic Billing of Medicare Replacement Drug Demonstration .......... 74 CPT codes, descriptors, Active/Corrective Treatment and Maintenance Implementation of New Medicare Redetermination Therapy ......................................................... 22 Notice ............................................................ 76 and other data only are Diagnostic Tests Use of Group Health Plan Payment System to Pay copyright 2004 Procedures A9522-A9523 ....................................... 23 Capitated Payments to Chronic Care Improve- American Medical Durable Medical Equipment ment Organizations Serving Medicare Fee-For- Association (or such 2004 Jurisdiction List .............................................. 24 Service Beneficiaries ...................................... 77 other date of publication Reasonable Charge Update for 2005 for Splints, Casts, Medicare-Approved Drug Discount Cards and Transi- of CPT). All Rights Dialysis Supplies, Dialysis Equipment, Thera- tional Assistance Program peutic Shoes, and Certain Intraocular Lenses . 32 Reserved. Applicable A Summary of New Initiatives of Interest to FARS/DFARS apply. No October Quarterly Update for 2004 DMEPOS Fee Physicians and Other Health Care Professionals 78 Schedule ....................................................... 33 fee schedules, basic units, A Summary for Physicians and Other Health relative values, or related Revised 2004 Update of the DMEPOS Fee Schedules - Care Professionals ............................................. 79 Correction ...................................................... 34 A Summary of New Initiative of Interest to listings are included in Drugs and Biologicals Physicians and Other Health Care Professionals 81 CPT. AMA does not J7190: Hemophilia Clotting Factors Billing CMS and FCSO Offer Help to Address Potential directly or indirectly Clarification .................................................... 35 Impacts Due to 2004 Hurricanes ...................... 83 practice medicine or Billing Instructions for ADVATE rAHF-PFM on dispense medical Medicare Claims ............................................ 36 Connecticut Medical Review services. AMA assumes Drug Pricing Update – Payment Limits for J1000 ... 37 Table of Contents ................................................... 84 Drug Pricing Update – Payment Limit forJ9045 and Advance Notice Statement ..................................... 84 no liability for data J9310 ............................................................ 38 New LCD Implementation ...................................... 85