Monday, November 16th, 2009
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.
Monday, November 2nd, 2009
Electronic data interchange (EDI) for claims submission is a great thing, but infallible? No. EDI relies on computers, and we all know how reliable computers can be. Let’s just say, the job of a medical biller isn’t done after she clicks the Submit button. To ensure claims are processed correctly and in a timely fashion you need to pay attention to your explanation of benefits (EOB) and communicate with your Medicare Administrative Contractor (MAC), but that’s not all.
An Oct. 8 post on TrailBlazer Health Enterprises’ Web site notifies Parts A and B providers that HCPCS Level II code J3420 is no longer covered as a self-administered drug, as indicated on the Self-Administered Drug Exclusions list, effective for service dates on or after Oct. 12.
| HCPCS Level II | Descriptor |
| J3420 | Injection, vitamin B-12 cyanocobalamin (Sytobex®, Redisol®, Rubramin PC®, Betalin 12®, Berubigen®, Cobex®, Cobal®, Crystal B12®, Cyano®, Cyanocobalamin®, Hydroxocobalamin®, Hydroxycobal®, Nutri-Twelve®) |
Monday, October 5th, 2009
The Office of Inspector General (OIG) released, Oct. 1, its annual Work Plan for fiscal year 2010. The Work Plan outlines activities the OIG intends to initiate or continue in its ongoing endeavor to right wrongs in Health and Human Services (HHS) programs and operations, such as Medicare. Read more »
Monday, August 3rd, 2009
The rapid increase of ultrasound services nationwide has Medicare watchdogs on the alert. Health care practitioners who submit Part B claims for technical and professional ultrasound services can expect added scrutiny. A recent Office of Inspector General (OIG) report provides insight as to what Medicare Administrative Contractors (MACs) will soon be on the lookout for when reviewing imaging service claims.
Thursday, July 2nd, 2009
The Office of Inspector General (OIG) is recommending the Centers for Medicare & Medicaid Services (CMS) do more to ensure Medicare Part B claims for chemotherapy administration services are appropriate.
This recommendation was prompted after the OIG was unable to determine whether Medicare appropriately paid for Part B services billed as chemotherapy administration from 2005 to 2007 because of “insufficient” data.
Monday, June 29th, 2009
Not sure if you should bill Part B or Part D for a drug regimen of aprepitant when used to alleviate chemotherapy induced nausea-vomiting (CINV)? You’re not alone. To answer an influx of questions pertaining to anti-emetic drugs, the Centers for Medicare & Medicaid Services (CMS) recently issued MLN Matters SE0910.
In MM SE0910, you will find guidance for billing aprepitant when used as a complete replacement for intravenous therapy or as a completion of a 48-hour regimen where IV aprepitant is given the day of chemotherapy and the oral medication is given days 2-3 of therapy.
Tuesday, April 28th, 2009
At the Obama administration’s request, the interim final rule on the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program went into effect April 18.
The rule—issued by the Centers for Medicare & Medicaid Services (CMS) on Jan. 16—implements provisions in section 154 of the 2008 Medicare Improvements for Patients and Providers Act (MIPPA) related to the program.
Specifically, this rule officially delays implementation of Round 1 of the DMEPOS Competitive Bidding Program until 2009 and Round 2 until 2011; requires CMS to conduct a second Round 1 competition this year; and mandates certain changes for both the Round 1 rebid and subsequent rounds of the program, including a process for feedback to suppliers regarding missing financial documentation and requiring contractors to disclose to CMS information regarding subcontracting relationships.
The Round 1 rebid includes the same items and services and will be conducted in the same areas as the 2007 Round 1 competition, with exceptions. Specifically, the Round 1 rebid excludes negative pressure wound therapy items and services, Puerto Rico, and Group 3 complex rehabilitative wheelchairs.
Suppliers previously awarded a competitive bidding contract will need to resubmit bids for consideration. However, suppliers need only submit financial documents from the past year, rather than the past three years.
The Round 1 rebid will occur in the following cities:
The Round 1 rebid will include the following categories of items and services:
CMS is expected to issue guidance on the timeline and bidding requirements related to the Round 1 rebid in the upcoming weeks. This rule does not have an immediate effect on the DMEPOS benefit for Medicare beneficiaries.
Friday, February 27th, 2009
Beginning Jan. 1, 2009, under the Outpatient Perspective Payment System (OPPS), payment allowance limits for specified covered outpatient drugs are paid at the average sales price (ASP) plus 4 percent.
Friday, January 16th, 2009
The Centers for Medicare & Medicaid Services (CMS) announced Jan. 7 it has awarded five Medicare Administrative Contractor (MAC) contracts for the combined administration of Part A and Part B Medicare fee-for-service (FFS) claims.
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