Archive for the ‘CMS’ Category

Highmark Medicare Services recently announced that Medicare Physician Fee Schedule (MPFS) amounts are currently unavailable on its Web site because the Center for Medicare and Medicaid Services (CMS) is expected to issue a correction.

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To ensure proper reimbursement, billing staff will need to update their standard knowledge of Advance Beneficiary Notice (ABN) modifiers. A Medicare policy revision due to take effect in 2010 changes modifier usage when reporting certain types of liability notices for non-covered services to a Medicare payer. Read more »

Medicare rural health centers (RHCs) and federally qualified health centers (FQHCs) can expect to see payment updates in 2010 thanks to an increase in the Medicare Economic Index (MEI), according to the Centers for Medicare & Medicaid Services (CMS). Read more »

The Centers for Medicare & Medicaid Services (CMS) has made a few important changes to the National Coverage Determination (NCD) edit software for clinical diagnostic laboratory services worth noting. In particular, a change to the effective date of coverage for three NCD ICD-9-CM diagnosis code lists will allow clinics to recoup any lost payments due to erroneous denials.

The effective date for three NCDs was “inadvertently” changed from Oct. 1, 2007 to July 1, 2009 with the July 1 quarterly release. The January 2010 quarterly release of the edit module for clinical diagnostic laboratory services corrects this mistake.

The affected ICD-9 code lists are those in the following NCDs:

• Prothrombin Time (PT) (190.17)
• Serum Iron Studies (190.18)
• Gamma Glutamyl Transferase (190.32)

The effective date for the ICD-9 codes listed in these NCDs will be revised from July 1, 2009 to Oct. 1, 2007, effective Jan. 1, 2010.

The January 2010 quarterly update also relocates ICD-9 codes 453-50 – 453.52 from the Serum Iron Studies NCD to the Gamma Glutamyl Transferase NCD, effective Jan. 1, 2010.

Medicare instructs contractors in Transmittal 1847, issued Nov. 6, not to search their files to retroactively pay claims but to adjust claims brought to their attention. A provider education article is available on the CMS Web site, and includes a list of affected ICD-9 codes.

National Government Services (NGS) will be merging four regions (Connecticut, Upstate New York, Queens County, and Downstate New York) into a single claims processing environment beginning Dec. 12. According to NGS, the Centers for Medicare & Medicaid Services (CMS) has approved a “Dark Day” on Dec. 14 to allow NGS to execute the merge. This will affect all providers who submit claims to the jurisdiction 13 (J13) Part B Medicare Administrative Contractor (MAC).

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The Centers for Medicare & Medicaid Services (CMS) has initiated a national coverage analysis (NCA) for the use of allogeneic hematopoietic stem cell transplantation (HSCT) for Medicare patients with myelodysplastic syndrome (MDS).

MDS refers to a heterogeneous group of acquired bone marrow disorders characterized by dysplastic growth of hematopoietic progenitors and a hypercellular bone marrow with peripheral cytopenia. Medicare patients age 65 and older represent 80 percent of the total population receiving an MDS diagnosis. One potential therapy for MDS is allogeneic HSCT.

This analysis is in response to an NCA request letter industry stakeholders composed and sent to CMS.

Currently, allogeneic HSCT for MDS is neither a covered or non-covered indication under the national coverage determination (NCD) for Stem Cell Transplantation (110.8.1). As it is not in either of these two categories, it may be covered at local contractor discretion. National Government Services (NGS), jurisdiction 13 Part A/Part B Medicare Administrative Contractor (A/B MAC), recently developed a local coverage determination (LCD) for stem cell transplantation that includes MDS and myelofibrosis with myeloid metaplasia.

CMS is seeking public comment on this topic and says it is particularly interested in any additional recent clinical studies and other scientific information related to the outcomes of this treatment. “If the evidence is determined to be inadequate for coverage, we are especially interested in what types of studies are needed,” CMS states in the tracking sheet.

Public comment may be submitted until Dec. 10. The proposed decision memo is due out May 10, 2010 and the NCA is expected to be completed by Aug. 8, 2010.

The Associated Press reports that for three years, the Centers for Medicare & Medicaid Services (CMS) repeatedly ignored internal watchdog warnings about swindlers stealing millions of dollars by scamming several programs, documents show. CMS received roughly 30 warnings from inspectors over three years during the Bush and Obama administrations but didn’t respond to half of them, even after repeated letters, according to records provided to The Associated Press by U.S. Sen. Charles Grassley’s office.

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End-stage renal disease (ESRD) facilities concerned about a proposed ESRD prospective payment system (PPS) that would replace the current payment system and methodologies still have time to stand up and be heard. The Centers for Medicare & Medicaid Services (CMS) has extended the comment period out by 30 days.

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Recovery Audit Contractors (RAC) HealthDataInsights (HDI) and CGI Federal have added to their list of new issues eligible for review as per the Centers for Medicare & Medicaid Services (CMS).

The RAC program, mandated by the Tax Relief and Health Care Act of 2006, is being implemented in 2010 to detect and correct past improper Medicare payments.

Tip: Don’t wait until Jan. 1, 2010 to review these new issues and correct any problems your outpatient hospital or physician practice may uncover. Read more »

The Centers for Medicare & Medicaid Services (CMS) began accepting bids for the Round One Rebid of the Medicare Competitive Bidding Program for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) on Oct. 21. Qualified DME suppliers in nine areas have until Dec. 21 to submit bids.

Registration to participate in the Round One Rebid is nearing an end. Suppliers that wish to submit bids must be registered by Nov. 4, 9 p.m. EST.

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