! In This Issue... ANSI Reason Codes The Most Frequent Claim Adjustment Reason Codes for 1st Quarter FY2000 ........................ 5 UPIN Directory Available on CD-ROM Free CD-ROM Containing the Complete National Listing of All UPIN Records ..................... 8 New CLIA Waived Tests Additional Tests Now Waived Under the Clinical Laboratory Improvement Amendments .... 11 pdate Questions and Answers Regarding the Prospective Payment System for Outpatient Rehabilitation Services Questions and Answers Prepared by HCFA for Inquiries Related to PPS for Outpatient Rehabilitation Services ..................................................................................... 14 Special Fraud Alert U OIG Alert Concerning Rental Arrangements for Space in Physician Offices ......................... 55 “Do Not Forward” Initiative Checks Will No Longer Be Forwarded To Locations Not On Medicare’s Provider Files ...... 57 Features lease share the Medicare B PUpdate! with appropriate members of your organization. From the Medical Director 3 Administrative 4 Routing Suggestions: Claims 6 ! Physician/Provider Coverage/Reimbursement 9 ! Office Manager Local and Focused Medical Review 16 Biller/Vendor Electronic Media Claims 54 ! General Information 55 ! Nursing Staff Educational Resources 64 ! Other __________ Index 80 __________ __________ __________ __________ __________ FIRST COAST __________ Medicare B Health Care Financing Administration SERVICE OPTIONS, INC. A Newsletter for Florida Medicare Part B Providers A HCFA Contracted Carrier & Intermediary May/June 2000 Volume 13, Number 3 TABLE OF CONTENTS From the Carrier Medical Director Electronic Media Claims A Physician’s Focus: File Your Medicare Claims Electronically ... 54 “The Medicare Coverage Process” .......... 3 Receive Your Medicare Remittance Medicare B Electronically ....................................... 54 Update! Administrative Advance Notice Requirement ..................... 4 General Information Vol. 13, No. 3 General Information About the Fraud and Abuse May/June 2000 OIG—Special Fraud Alert ......................... 55 Medicare B Update! .............................. 4 Publications General Information Staff “Do Not Forward” Initiative ........................ 57 Claims Bill Angel ANSI Reason Codes ................................... 5 New Website for Prompt Payment Interest Rate ....................................... 58 Shari Bailey Additional Development Request: “No Pauline Crutcher Indication of Name/Address of Role of Physicians in the Home Health PPS ............................... 58 Cynthia Moore Specific Performing Provider” ............... 6 Millie C. Pérez Claims Development Requests .................. 6 Consolidated Billing for SNFs ................... 60 Correct Coding Initiative ............................. 7 HCFA Announces New Medicare Hospital The Medicare B Health Professional Shortage Area (HPSA) Outpatient Payment System .............. 61 Update! is published Designations ........................................ 7 Services Provided in Religious Nonmedical bimonthly by the Procedure Code Modifiers .......................... 7 Health Care Institutions ..................... 62 Medicare Publications Submission of Medical Record Documen- Medicare Registration Department, to tation to Utilization Audit ...................... 8 Enrollment Tips From provide timely and UPIN Directory Available on CD-ROM ....... 8 Medicare Registration ......................... 62 useful information to News Regarding Supervising Medicare Part B Physicians of IDTFs ............................ 63 Coverage/Reimbursement providers in Florida. Medicare Secondary Payer Ambulance Settlement Agreement—INAMED ............. 63 Questions concerning Q0186: Paramedic Intercept— this publication or its New Definition for Rural ........................ 9 Educational Resources contents may be Fee Schedule Changes Medicare and The Millennium: directed in writing to: Corrections .................................................. 9 A New Dawning .................................. 64 Hematology/Oncology Medicare Part B Medifest 2000 Registration ....................... 65 Clarification of Liver Transplant Policy ....... 9 Publications Medifest Class Schedule 2000 ................. 66 Pancreas Transplants— P.O. Box 2078 Medifest Course Descriptions ................... 67 Revision to National Policy ................. 10 Jacksonville, FL Medicare 101 for Part B Providers ............ 69 Laboratory/Pathology 32231-0048 Medicare 101 Course Survey ................... 70 Revised Fees for Thin-Prep Pap Smears ... 11 Medical Specialty Seminar Schedule ....... 71 CPT five-digit codes, New CLIA Waived Tests ........................... 11 “Let’s Talk With Medicare” - descriptions, and Physical/Occupational Therapy Part B Session .................................... 72 other data only are Clarification on Physical Medicine CPT copyrighted by the “Let’s Talk With Medicare” - Coding Guidance ............................... 13 American Medical Part A Session .................................... 73 Questions and Answers Regarding the Association. All Quarterly Medicare Part A and Part B PPS for Outpatient Rehab Services ... 14 Rights Reserved. No Provider Education and Training fee schedules, basic Advisory Meeting ................................ 74 Local and Focused units, relative values Two New Computer Based Training or related listings are Medical Review Policies Courses Available ............................... 75 included in CPT. The List of Medicare Noncovered Services .. 16 Medicare Provider Website Replaces BBS .. 75 AMA does not E1399: Durable Medical Equipment, Order Form – Part B Materials for 2000 ... 76 directly or indirectly Miscellaneous—Billing Clarification .... 17 Order Form – Year 2000 Medifest and practice medicine or J7190: Hemophilia Clotting Factors .......... 17 Specialty Seminar Books .................... 77 dispense medical Q0136: Non-ESRD Epogen ...................... 19 Financial Services Physician/Supplier services. AMA 00001: IDTF .............................................. 22 Service Request Form ........................ 78 assumes no liability 20550: Injection of Tendon Sheath, for data contained or Index to Medicare B Update! .................... 80 not contained herein. Ligament, Trigger Points or Important Addresses and Ganglion Cyst ..................................... 38 Phone Numbers ................... Back Cover ICD-9-CM codes 33140: Transmyocardial Revascularization— and their descriptions Clarification ........................................ 39 Financial Services used in this 58340: Infertility ........................................ 40 Medicare Part B Financial Services publication are Ó 83735: Magnesium ................................... 42 Department .................................... Insert copyright 1998 PHPPROG: Psychiatric Partial Hospital- under the Uniform ization Program .................................. 44 Copyright 95004: Allergy Skin Tests ......................... 51 Convention. All 97010:Physical Medicine and rights reserved. Rehabilitation ....................................... 53 2 The Florida Medicare B Update! May/June 2000 FROM THE MEDICAL DIRECTOR A PHYSICIAN’S FOCUS “The Medicare Coverage Process” merican medicine is the most technologically advanced in the Aworld. New devices, drugs and procedures are becoming available at an unprecedented pace. The lay press is very attuned to new treatments and frequently publicizes them well before they become the standard of care. Patients see ads on TV or the Internet and come to the office requesting the latest thing. Many providers learn of new technological advances and are eager to incorporate them into their practice. How does a provider go about getting Medicare payment for these new drugs, devices or services? Typically, a new drug or device does not have a Current Procedural Terminologyä (CPT) or Health Care Financing Administration Common Procedure Coding System (HCPCS) code. Therefore, any billing for these services must carry an unlisted code. This means that the Medicare carrier will manually review the claim. The claim should include an invoice and a medical record that describes the clinical aspects of the service. If the service fits a Medicare benefit category and is medically necessary and reasonable, it will be added to the list of covered services. Should Medicare consider the service, device or drug not medically necessary or investigational, it would be added to the carrier’s list of noncovered services. As additional studies and information become available, the carrier may take the medication, device or service off of the noncovered list and publish a policy that would contain guidelines for coverage. Providers wishing to obtain coverage status for particular services should write to the Medical Policy Department of First Coast Service Options, Inc., at: Medicare Part B Medical Policy P.O. Box 2078 Jacksonville, FL 32231-0048 The letter should explain what service is being proposed, how it will benefit the patients, the place of service, the intended CPT codes and expected charges. It is also helpful to include two or three science-based articles from peer reviewed journals indicating significant patient benefit from the services. Letters of FDA approval and any information contained in any of the Compendia are useful. Letters of endorsement from recognized authorities supporting the clinical benefit of the service would also be considered. Several services have