LCD/Article Update

The following Part B Billing and Coding Article has been revised:

• R-10G - Intensity Modulated Radiation Therapy (IMRT)

MLN Matters Articles from CMS

New:

MM5288 - Incident to Policy Update

MM6043 - Blood-Derived Products for Chronic, Non-Healing Wounds

SEO814 - Provider Authentication by Medicare Provider Contact Centers

MM5972 - Prolonged Services (Codes 99354 - 99359)

Revised:

MM6000 - Ambulance Fee Schedule - Conversion Factor File for CY 2009 Ambulance Inflation Factor

Clinical Laboratory Fee Schedule Fact Sheet

The Clinical Laboratory Fee Schedule Fact Sheet, which provides general information about the Clinical Laboratory Fee Schedule, coverage of clinical laboratory services, and how payment rates are set, is now available in print format from the Centers for Medicare & Medicaid Services Medicare Learning Network. To place your order, click link above.

REMINDER: CMS will Host NPI National Roundtable on May 14, 2008

Registration is still open for the Roundtable to be held on May 14th from 2-3:30PM EDT. For more information, visit here. For registration details, click link above.

Still not sure what an NPI is and how you can get it, share it and use it? More information and education on the NPI can be found through the CMS NPI page.  Providers can apply for an NPI online here or can call the NPI enumerator to request a paper application at 1-800-465-3203.

CMS will Host NPI National Roundtable Q&A Session on May 19, 2008

CMS will host a national NPI Roundtable Q&A session to address questions from the Medicare provider community prior to May 23rd. For more information, visit here.  For registration details, click link above.

Additional Guidance and Clarification for Identifying Secondary Providers in Medicare Claims

In accordance with the NPI final rule, when an identifier is reported on a paper or electronically submitted claim for ordering/referring/attending/operating/ supervising/purchased service/other/service facility provider (in the x12N 837 claims transactions) or for prescriber (in the NCPDP 5.1 retail drug claim transaction), that identifier must be an NPI. For more information, click link above.

CMS to Host National Education Call on May 13th, 2008 from 12:30 - 2:00 p.m. EDT

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.

This call is being conducted for Medicare fee-for-service DMEPOS suppliers, physicians, and other providers – all of which may be affected by the program. The call will give a general overview of the new program and address some of the exceptions and situations you may encounter as the program is implemented. A presentation will be made by the Competitive Bidding Implementation Contractor (CBIC) and CMS Subject Matter Experts will be available to answer questions. A PowerPoint presentation will be posted on the CMS Website prior to the call.

In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation. If you cannot attend the call, replay information is available below.

Registration will close at 12:30 p.m. EDT on May 12, 2008, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time. To register for the call participants need to click link above.

For those of you who will be unable to attend, a replay option will be available shortly following the end of the call. This replay will be accessible from 2:30 p.m. EDT 5/13/2008 until 11:59 p.m. EDT 5/17/2008. The call in data for the replay is (800) 642-1687 and the passcode is 45744159.

CMS recommends the review of three MLN Matters articles prior to the call. There is a substantial amount of program information and how it will impact DMEPOS suppliers, physicians and other providers:

MLN Matters Special Edition # SE0805 "Overview of New Medicare Competitive Bidding Program for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS). 

MLN Matters Special Edition Article #SE0806 "Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program: Grandfathering, Repair and Replacement, Mail Order Diabetic Supplies and Advanced Beneficiary Notices (ABNs). 

MLN Matters Special Edition Article # SE0807"Important Exceptions and Special Circumstances that Occur Under the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program

CMS Recruiting Registries as a New Way to Submit PQRI Data - Registry Self-Nominations Due to CMS by May 31, 2008

The Centers for Medicare & Medicaid Services (CMS) seeks self-nominations from clinical data registries interested in becoming a part of the submission process for the 2008 Physicians Quality Reporting Initiative (PQRI) Program. In April 2008, CMS announced new options for participating in the PQRI program, including the option for eligible professionals to submit quality measures data to CMS through a qualified, established clinical data registry.

CMS is now accepting self-nominations from registries that wish to be considered a qualified, established clinical data registry to help eligible professionals qualify for PQRI incentive bonus payments.

Interested registries should visit the CMS PQRI website for information about:

• How a registry can nominate itself for consideration as a PQRI-participating registry; and
• The criteria CMS will use to determine whether a registry qualifies for inclusion in the list of qualified, established clinical data registries under the 2008 PQRI Program.

CMS is accepting self-nominations from registries through May 31, 2008. To learn more about how registries can apply, read CMS’ selection criteria and process online on the CMS website. (Refer to the document, "2008 PQRI Registry Requirements for Submission under New Options.")

For general information about the PQRI program, visit CMS’ PQRI webpage on the CMS website.

New Physician Office Training - Philadelphia Location

Highmark Medicare Services will be hosting a Medicare Basics Seminar on June 26th. This Seminar is designed for practitioners and office staff new to Medicare billing. Attending may also be helpful to those needing a refresher course on Medicare billing.

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 PIN, provider or legacy 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.

Lunch and Learn - Medicare Secondary Payer Basics

Join us for a Lunch and Learn teleconference on May 13, at 12:00 pm (EDT). This Lunch and Learn will cover MSP concepts and desciption of the types of insurances that would be primary to Medicare.