! Highlights In This Issue... Modifier SG— Ambulatory Surgical Center (ASC) Facility Service ..................................................................................................................................... 8 Payment Allowance for Injectable Drugs ................................................................................................................................... 23 New and Revised Local and Focused Medical Review Policies ................................................................................................................................... 29 pdate Administration Simplification Compliance Act (ASCA)—Questions and Answers ................................................................................................................................... 61 Changes to the Standard Paper Remittance Advice U ................................................................................................................................... 69 Medicare Education and Outreach— Calendar of Upcoming Events ................................................................................................................................... 74 Features he Medicare B Update! A Physician’s Focus ..................................... 3 Tshould be shared with all Adminstrative ............................................... 4 health care practitioners and managerial members of the Claims ......................................................... 5 provider/supplier staff. Issues Coverage/Reimbursement ........................... 6 published beginning in 1997 are available at no cost from Local and Focused our provider Web site, Medical Review Policies ............................. 29 www.floridamedicare.com. Electronic Media Claims ............................ 61 General Information .................................... 64 • Physician/Provider Educational Resources .............................. 74 • Office Manager Index to Medicare B Update! ...................... 81 • Billing/Vendor • Nursing Staff • Other _________ _________ A CMS Contracted Carrier & Intermediary _________ Medicare B A Newsletter for Florida Medicare Part B Providers Third Quarter 2002 Volume 15, Number 3 TABLE OF CONTENTS A Physician’s Focus Focused Medical Review Comprehensive Data Analysis Findings ................... 60 Medicare B “Medicare by the Numbers” ...................................... 3 Update! Adminstrative Electronic Media Claims About the Medicare B Update! .................................. 4 CMS Issues Model Plan to Extend Deadline for Vol. 15, No. 3 Advance Beneficiary Notice ...................................... 5 Compliance with Electronic Transactions Rule . 61 Third Quarter 2002 Administration Simplification Compliance Act Claims (ASCA)—Questions and Answers .................. 61 Publications Correct Coding Initiative ............................................ 5 Health Insurance Portability and Accountability Act Staff Health Professional Shortage Area (HIPAA)—New Testing Timeline ...................... 63 Betty Alix Designation Changes ...................................... 6 Bill Angel General Information Shari Bailey Coverage/Reimbursement Fraud and Abuse James Griffith Medicare Physician Fee Schedule Payment to Supplier of Diagnostic Tests for Millie C. Pérez Correction—First Update to the 2002 Medicare Purchased Interpretations .............................. 64 Physician Fee Schedule Database ................... 6 Four “Rights” Can’t Go Wrong ................................ 65 The Medicare B Update! Add-On Procedures ................................................. 7 Inappropriate Billing of Diagnostic Tests ................... 65 is published quarterly by “Once-in-a-Lifetime” Procedures ................................ 7 Medicare Fraud Alert: Inappropriate Billing of Free the Medicare Publications Ambulatory Surgical Center Samples or Items .......................................... 66 Department of First Coast Modifier SG— Ambulatory Surgical Center (ASC) Financial Services Service Options, Inc., to Facility Service ............................................... 8 Notice of Interest Rate for Medicare Overpayments provide timely and useful The List of Procedures Approved in an Ambulatory and Underpayments ...................................... 66 information to Medicare Surgical Center ............................................... 8 Medicare Registration Part B providers in Florida. Anesthesia Electronic Medicare Provider/Supplier Anesthesiologist Billings Services With Student Enrollment Forms ......................................... 67 Questions concerning this Nurse Anesthetist ......................................... 13 Home Health Consolidated Billing publication or its contents Durable Medical Equipment, Prosthetics, Payment for Therapy Services Wrongly Denied ........ 67 may be directed in writing to: Orthotics, and Supplies (DMEPOS) Correction of Remark Code Message ...................... 67 2002 Jurisdiction List ............................................. 13 SNF Consolidated Billing Medicare Part B KX: New Permanent Modifier for “Specific Required Notification of Updates to Coding Files on CMS Web Publications Documentation on File” .................................. 21 Site for Skilled Nursing Facility (SNF) Consoli- P.O. Box 2078 Elimination of CMN Requirement for CPAP Device ... 22 dated Billing (CB) .......................................... 68 Jacksonville, FL Evaluation & Management General Information 32231-0048 Payment to Hospice Members Enrolled in Managed Coverage and Billing for the Diagnosis and Treatment of CPT codes, descriptors Care Organizations (MCOs) ........................... 68 Peripheral Neuropathy with Loss of Protective and other data only are Sensation in People with Diabetes .................. 22 Beneficiaries Previously Enrolled in Managed Care copyright 2001 American Injectable Drugs Who Transition to Traditional Fee for Service Medical Association (or Medicare Payment Allowance for Injectable Drugs .... 23 (FFS) ........................................................... 69 such other date of Laboratory/Pathology Changes to the Standard Paper Remittance (SPR) publication of CPT). All Policies Related to Processing Claims for Clinical Advice Notice ................................................ 69 Rights Reserved. Diagnostic Laboratory Services ....................... 24 Sample SPR Format ............................................. 71 Applicable FARS/DFARS Travel Allowance for Collection of Specimens ............ 25 The Patient Friendly Advisory apply. No fee schedules, New CLIA Waived Tests ......................................... 26 Easy-to-Access Help Available at Medicare.gov ....... 73 basic units, relative values Medical Nutrition Therapy or related listings are Correct Payment for Medical Nutrition Therapy (MNT) Educational Resources included in CPT. AMA Services Rendered by Registered Dietitians or Medicare Education and Outreach— does not directly or Nutrition Professionals ................................... 28 Calendar of Upcoming Events ......................... 74 indirectly practice medicine or dispense National Coverage Decision Medicare Part B Resource Manual Order Form ........ 76 medical services. AMA Non-Contact Normothermic Wound Therapy (NNWT) 28 Medicare Part B Individual Module Order Form ......... 77 Order Form – 2002 Part B Materials ........................ 78 assumes no liability for Local and Focused Medical Review Procedure-to-Diagnosis Relationship Booklet data contained or not contained herein. Policies No Longer Available ........................................ 78 Index to Medicare B Update! ................................... 81 Local Medical Review Policies ICD-9-CM codes and their Important Addresses, Phone Numbers, Delay in Implementation of Pulmonary Rehabilitation descriptions used in this and Web sites ............................................... 83 Services Policy ............................................. 29 publication are copy- Billing for Noncovered Investigational/Experimental right 2000 under the Services ....................................................... 30 Uniform Copyright NCSVCS: The List of Medicare Noncovered Services 30 Convention. All rights J0635: Vitamin D Analogs in Chronic Renal Disease 30 reserved. J1561: Intravenous Immune Globulin ....................... 33 Third party Web sites: J9999: Antineoplastic Drugs–Additions to Policy ...... 37 This document contains 00001: Independent Diagnostic Testing Facility (IDTF) 37 references to sites 31231: Diagnostic Nasal Endoscopy ....................... 53 operated by third parties. 66821: Yag Laser Capsulotomy .............................. 53 Such references are 84100: Serum Phosphorus ..................................... 54 provided for your 84436: Thyroid Function Tests ................................ 54 convenience only. FCSO 85651: Sedimentation Rate, Erythrocyte ................. 55 does not control such sites, 90800: Psychiatric Services ................................... 57 and is not responsible for 92502: Special Otorhinolaryngologic Services— their content. The Correction to Policy ....................................... 59 inclusion of these 94010: Spirometry; ................................................ 59 references within this 94240: Functional Residual Capacity or document does not suggest Residual Volume .......................................... 59 any endorsement of the 97399: Noncoverage of PulseMetric