A September 2011 “Medicare Claim Submission Guidelines” fact sheet is now available on the Centers for Medicare & Medicaid Services (CMS) website.
This Medicare Learning Network® (MLN) fact sheet offers providers and suppliers up-to-date guidance on how to:
- Apply for a national provider identifier (NPI) and enroll in the Medicare program
- File Medicare claims
- Opt out of Medicare and arrange private contracts with Medicare beneficiaries
Download the fact sheet to refresh your memory or to learn new factoids, such as:
Did you know: Chiropractors may not opt out of Medicare and provide services under private contract? This is because the opt-out law does not include chiropractors in the definition of “physician.” The same holds true for physical and occupational therapists.
October 14th, 2011
The April edition of the Centers for Medicare & Medicaid Services’ (CMS’) freely distributed Medicare Quarterly Provider Compliance Newsletter tackles a variety of payment issues that affect inpatient rehabilitation facilities, physicians, non-physician practitioners (NPPs), radiology suppliers, and inpatient and outpatient hospitals. Billing staff should be on the lookout for the claims errors highlighted in this publication, and take steps to prevent them.
The general format of the newsletter describes each problem identified by Medicare claims processing contractors, recovery audit contractors (RACs), program safeguard contractors, zone program integrity contractors (ZPICs), and other governmental organizations, such as the Office of Inspector General (OIG). It then explains the issues that may occur as a result of the error, the steps CMS has taken to make providers aware of the problem, and guidance on what providers need to do to avoid repeating the error or improper activity. The newsletter also refers providers to other documents for more detailed information.
Among the common billing errors identified in this edition is that for oxaliplatin. Contractors and auditors continue to find many outpatient hospitals incorrectly calculating the number of service units billed for this anti-cancer chemotherapeutic agent for the treatment of colorectal cancer.
CMS restates that, for outpatient services furnished on or after Jan. 1, 2006, hospitals should use HCPCS Level II code J9263 Injection Oxaliplatin 0.5 mg to report administration of this drug. The confusion, CMS says, may come from previous policy that instructed hospitals to use HCPCS Level II code C9205 Injection, Oxaliplatin, per 5 mg. The major difference between doses (0.5 mg and 5 mg) often results in hospitals billing too many units. Refer to the newsletter for examples on how this drug should be billed and links to additional Medicare guidance.
Speaking of billing too many units, another issue identified in the newsletter is that for physicians, NPPs, and outpatient hospitals billing excessive units of untimed codes. CMS instructs these providers to use untimed codes to bill for services not defined by specific timeframes; but no matter how long the evaluation or service takes, bill only one unit of an untimed code for a patient, per date of service (some exceptions apply).
Another RAC finding highlighted in the April newsletter involves the technical component (TC) of radiology provided by suppliers, physicians, and NPPs. CMS reminds these providers that the TC of radiology services in a Patient Perspective System (PPS) hospital setting cannot be billed separately to Part B. Medicare reimburses the hospital, and radiology suppliers should bill the hospital, not the Medicare contractor.
The newsletter also regularly includes a brief synopsis of a variety of Special Edition (SE) articles regarding OIG findings. In this edition, CMS highlights the following:
SE1102 Inappropriate Medicare Payments for Transforaminal Epidural Injection Services
SE1103 Capped Rental DME: Enforcement of Payment Requirements for Beneficiary-owned Capped Rental DME
SE1104 The Importance of Correctly Coding the Place of Service by Physicians and their Billing Agents
Read the newsletter for complete details.
June 10th, 2011
The Centers for Medicare & Medicaid Services (CMS) posted on its website April 18 two new provider education publications pertaining to Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS).
On the CMS Outreach and Education > MLN General Information > Spotlight webpage, in the Downloads section, you can view, download or print the following new resources:
- Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Quality Standards is designed to provide education on DMEPOS quality standards for Medicare deemed Accreditation Organizations (AOs) for DMEPOS suppliers.
- The Basics of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Accreditation is a fact sheet designed to provide education on the DMEPOS accreditation requirements, the types of providers who are exempt, and the process for becoming accredited.
April 29th, 2011
The Centers for Medicare & Medicaid Services (CMS) has updated its Medicare Learning Network (MLN) payment system fact sheet for the Clinical Laboratory Fee Schedule (CLFS). In this fact sheet you will find background information and coverage of clinical laboratory services and payment rates updated for 2011.
April 1st, 2011
Try the NEW Guided Pathways (December 2008) Medicare Learning Network (MLN) products. These three booklets incorporate existing Medicare Learning Network (MLN) products and other Centers for Medicare & Medicaid Services (CMS) resources into well organized sections to help Medicare fee-for-service (FFS) providers and suppliers find information to understand and navigate the Medicare program. The three Guided Pathways booklets guide learners to resources that provide a fundamental overview of Medicare, as well as detailed FFS policies and requirements.
January 20th, 2009