Reason Code 37554

The problem has been fixed which caused claims to incorrectly receive reason code 37554 on IME claims. The system was not recognizing the facility as a teaching facility; therefore, the claims were returned. You may now resubmit those claims.

Incorrect Assignment of DRG 999

A recent problem was identified where the system was incorrectly assigning DRG 999 inpatient facility claims. Reimbursement was not being calculated correctly. If there were deductions, a negative reimbursement was calculated. If there was a zero reimbursement, claims suspended with reason code 39910. This happened on claims with discharge dates 04/01/08 and after. This problem has been corrected. The claims that suspended with reason code 39910 have been released. For those claims that finalized with an incorrect payment, you will need to submit an adjustment.

CR N/A, Pub. Provider Reimbursement Manual, Part 2, Provider Cost Reporting Forms and Instructions, Chapter 36, Form CMS-2552-96, Rev. 18, Filename: R18P236.pdf, R18P236f.zip, and R18P236s.zip Hospital and Hospital Health Care Complex Cost Report, (Form CMS-2552-96)

This transmittal updates Chapter 36, Hospital and Hospital Health Care Complex Cost Report, (Form CMS 2552-96) to reflect further clarification to existing instructions, corrections, and incorporates select Federal Register provisions. The effective date for instructional changes will vary due to various implementation dates.

Outpatient Hospital Services Workshops

Please join Highmark Medicare Services for an informative workshop on Outpatient Services presented in a hospital setting.  The workshop will enhance your knowledge about CERT data analysis, demonstrate appropriate billing and encourage Medicare compliance of billing and documentation requirements. This class meets the American Academy of Professional Coders’ guidelines for 3 Continuing Education Units.

SNF Rehab Webinar on May 14, 2008

Join us on May 14, 2008 at 1:00pm (EST) for our Webinar pertaining to SNF Rehab and the CERT program. An open telephone line and computer with a high speed internet connection are required to attend. Click the above link to enroll.

Outpatient Rehabilitation Therapy Services for MD/DC Providers

The purpose of this notice is to update the provider community of issues surrounding the service wide review for Outpatient Rehabilitation Therapy Services conducted by Highmark Medicare Services and to remind providers of the indications and limitations of coverage and/or medical necessity guidelines for Outpatient Rehabilitation Therapy Services.  This notice is also intended to assist in decreasing the claims error rate and to avoid provider denials of the above listed service.

Outpatient Rehabilitation Therapy Services for PA Providers

The purpose of this notice is to update the provider community of issues surrounding the service wide review for Outpatient Rehabilitation Therapy Services conducted by Highmark Medicare Services and to remind providers of the indications and limitations of coverage and/or medical necessity guidelines for Outpatient Rehabilitation Therapy Services.  This notice is also intended to assist in decreasing the claims error rate and to avoid provider denials of the above listed service.

Authentication Elements for IVR and Customer Service

Effective May 23, 2008, you will need both your NPI and Provider Transaction Access Number (PTAN) to use the IVR or speak with a Customer Service Representative. You may know your PTAN as your provider, Oscar, legacy or CMS certification number. For additional information refer to MLN Matters SE0814 – Provider Authentication by Medicare Provider Contact Centers.

May is National Osteoporosis Awareness and Prevention Month

In conjunction with National Osteoporosis Awareness and Prevention Month, the Centers for Medicare & Medicaid Services (CMS) reminds health care professionals that Medicare provides coverage of bone mass measurements for beneficiaries at clinical risk for osteoporosis.

April 2008 Medicare Part A Newsletter

The April 2008 Medicare Part A Newsletter is now available.

Provider Reimbursement Manual, Part 1, Rev. 437, Filename: R437PR1.pdf Inflation Factor

Sec. 905.6, Inflation Factor, provides for calendar year (CY) inflation factors to update previous years’ reasonable compensation ranges.

Provider Reimbursement Manual, Part 1, Rev. 436, Filename: R436PR1.pdf Pension Plan Revision

Since the PRM defines pension costs using ERISA terminology and the ERISA minimum and maximum cost limits, the GAAP terms have been replaced with the ERISA terms to prevent confusion with the pension costs determined for financial accounting purposes.

Provider Reimbursement Manual, Part 1, Chapter 3, Rev. 435, Filename: R435PR1.pdf Bad Debts, Charity, and Courtesy Allowances

This transmittal updates Chapter 3, Bad Debts, Charity, and Courtesy Allowances to reflect updated references from HCFA to CMS, correction of typos, and replace Fiscal Intermediary with Contractor.

J12 MAC Draft Local Coverage Determinations (LCDs)

As you are aware, Highmark Medicare Services has begun work as a MAC contractor for Jurisdiction J12. The schedule for all current business to move to the new MAC contract is on the J12 MAC Transition area of our website.

Reminder:  Draft LCDs were posted for comment on April 1, 2008. Please go to the J12 MAC Transition area of the website to send your comments before the close of the comment period on May 15, 2008.

Please view this bulletin for further information on how this affects our current Draft LCDs for Part A and Part B.

CMS to Host National Education Call on May 13th, 2008, 12:30 - 2:30 p.m. EST

The Centers for Medicare & Medicaid Services (CMS) will host a national education conference call to address the implementation of the new Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding program scheduled to begin on July 1, 2008.

Local Coverage Determinations (LCDs) Lunch and Learn - April 23, 2008

The audio file from the April 23, 2008 LCD lunch and learn is now available for download. Please click the link above for instructions.