By now, you’ve probably heard about the biggest change the 2010 Medicare Physician Fee Schedule (MPFS) final rule has brought about—the elimination of consultation codes. Because this news has received so much fanfare, you may have overlooked other important policy changes. The following is a summary of additional significant policy changes taking place in 2010 of which you should be aware. Read more »
Monday, November 16th, 2009
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:
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.
Monday, June 1st, 2009
A provision in the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 will soon change the policy of who is considered a critical access hospital (CAH) outpatient when outpatient clinical diagnostic laboratory services are provided.
Tuesday, May 26th, 2009
It seems the new date of service (DOS) for the technical component (TC) of pathology, mandated by the 2007 Medicare Physician Fee Schedule (MPFS) final rule and implemented May 23, 2008, has caused some confusion. Does the DOS requirement apply to pathology tests when the TC and professional component (PC) are performed by the same lab and billed globally? Enquiring minds want to know!
To clarify, the Centers for Medicare & Medicaid Services (CMS) recently updated Pub. 100-04, Medicare Claims Processing Manual, chapters 1 and 16.
Monday, April 13th, 2009
Practioners and suppliers no longer need to differentiate between diagnostic and therapeutic clinical trial services on claims processed after July 10, according to the Centers for Medicare & Medicaid Services (CMS). For proper reimbursement, however, they need to follow recently changed Medicare Claims Processing Manual instructions to the letter.
The Centers for Medicare & Medicaid Services (CMS) has updated the list of HCPCS codes subject to or excluded from Clinical Laboratory Improvement Amendments (CLIA) edits for 2009.
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