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Medicare Bulletin - April 2014

1. BIE lt m IE m gt T Ro T 0A I O m Specific Coding and Pricing Issues As part of this update fee schedules for the following codes will be added to the DMEPOS fee schedule file effective January 1 2014 e A4387 Ostomy Pouch Closed With Barrier Attached With Built In Convexity I Piece Each and e L3031 Foot Insert Plate Removable Addition to Lower Extremity Orthotic High Strength Lightweight Material All Hybrid Lamination Prepreg Composite Each CMS is adjusting the fee schedule amounts for shoe modification codes A5503 through A5507 as part of this update in order to reflect more current allowed service data Section 1833 0 2 C of the Act required that the payment amounts for shoe modification codes A5503 through A5507 be established in a manner that prevented a net increase in expenditures when substituting these items for therapeutic shoe insert codes A5512 or A5513 To establish the fee schedule amounts for the shoe modification codes the base fees for codes A5512 and A5513 were weighted based on the approximated total allowed services for each code for items furnished during the second quarter of CY2004 For 2014 CMS is updating the weighted average insert fees used to establish the fee schedule amounts for the shoe modification codes with more current allowed service data for each insert code The base fees for A5512 and A5513 will be weighted based on the appr
2. How do I use the Forms tab to submit a redetermination request To submit a redetermination request click on the Forms tab to access the Secure Forms page In the Go To page field select the Secure Forms option This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 04 APRIL 2014 17 You have O unread message s and O alerts to Go To page Select Form a Secure Forms Welcome to secure forms You can now submit forms to CGS Administrators securely through myCGS You may attach up to five POF attachments to each form Each attachment can be up to 5MB in size The forms and attachments are automatically entered into our workflow This makes form processing more efficient and cost effective To begin please select an answer to the questions from the drop down selections below Based upon the answer given for each of the questions the available form s will appear at the bottom of this box At this time only Appeals forms are available Select a Topic Appeals Select a Type First level appeal on a Medicare Claim To verify you are within timely filing requirements for this Appeal please use our Appeals Calculator Is your appeal late over
3. article is intended for physicians providers including home health agencies and suppliers that submit claims to Medicare administrative contractors MACs including home health amp hospice Medicare administrative contractors HH amp H MACs and durable medical equipment Medicare administrative contractors DME MACs for services to Medicare beneficiaries What You Need to Know This article based on CR 8597 provides the removal of language that was erroneously included in CR 8404 and in the Medicare Claims Processing Manual Chapter 30 Sections 50 3 and 50 6 2 It also provides clarified manual instructions regarding home health agency issuance of the Advance Beneficiary Notice of Noncoverage ABN to dual eligible beneficiaries Background The ABN is an Office of Management and Budget OMB approved written notice issued by providers and suppliers for items and services provided under Medicare Part B including hospital outpatient services and care provided under Part A by home health agencies HHAs hospices and religious non medical healthcare institutes only Key Points of CR 8597 e With the exception of Durable Medical Equipment Prosthetic Orthotics amp Supplies DMEPOS suppliers providers and suppliers who are not enrolled in Medicare cannot issue the ABN to beneficiaries DMEPOS suppliers not enrolled as Medicare suppliers are required by statute to provide ABN notification prior to furnishing any items or service
4. MACs for services to Medicare beneficiaries Provider Action Needed This article is based on CR 8485 which informs MACs about changes necessary to create a new process that insures refunded principal and associated interest amounts can be reported separately on remittance advices and that claim identifiers are used to identify the appropriate claim for which those amounts apply Make sure that your billing staffs are aware of these changes Background CMS was advised that the current practice of reporting principal and interest amounts for all related claims on the Remittance Advice RA as one lump sum amount was creating problems for the provider community since it was not conducive to the proper posting of payments CR 8485 instructs the MACs on how to report refunded principal and interest amounts separately and how to use claim identifiers to indicate the appropriate claim for those amounts Providers should see these changes appear on RAs created after CR 8485 is implemented on July 7 2014 Step by step instructions on how refunds with interest on previously recouped money are handled including step s required by providers as well as an example of reporting for the new Refund PLB Codes are found in Attachment 1 to this CR Additional Information The official instruction CR 8485 issued to your MAC regarding this change is available at http www cms hhs gov Regulations and Guidance Guidance Transmittals Downloads R1342OTN pdf
5. Updated Payment Rate for Q4127 Effective July 1 2013 through September 30 2013 The payment rate for Q4127 was incorrect in the July 2013 OPPS Pricer The corrected payment rate is listed in Table 5 below and it has been installed in the April 2014 OPPS Pricer effective for services furnished on July 1 2013 through September 30 2013 MACs will adjust claims that were previously processed incorrectly if you bring such claims to the attention of your MAC Table 5 Updated Payment Rates for Certain HCPCS Codes Effective July 1 2013 through September 30 2013 Corrected Minimum HCPCS Code Sins Indicator APC Short Descriptor Corrected Payment Rate Unadjusted Copayment Q4127 1449 Talymed 13 78 2 76 This newsletter should be shared with all health care practitioners and managerial members of the provider supplier staff Newsletters are available at no cost from our website at http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 04 RETURN TO VAN lO CONTENTS APRIL 2014 BIE lt m IE m gt T Ro T WY I O m f Updated Payment Rates for Certain HCPCS Codes Effective October 1 2013 through December 1 2013 The payment rates for three HCPCS codes were incorrect in the October 2013 OPPS Pricer The corrected payment rates are listed in Table 6 below and they have been installed in the April 2014 OPPS Pricer effective for
6. You are accessing a US Government information system The Centers for Medicare amp Medicaid Services CMS maintains ownership and responsibilty for this computer system and has allowed CGS to provide the services of this system Users of this system must adhere to CMS information security polices standards and procedures Your usage of this system may be monitored recorded and audited Your use of this information system established your consent to any and al monitoring and recording of your activities Unauthorized user is prohibited and subject to criminal and civil penalbes Refer to the Terms of Use CGS is pleased to offer you claim status Claims e remits Remittance beneficiary eligibility Eligibility and Financial Tools online Just click on the tems in the grey navigation bar to access the features of Online Provider Services What is the Forms tab in myCGS The Forms tab in myCGS allows users the ability to submit a redetermination request 1st appeal level using the myCGS portal Additional features via the Forms tab will be available in the near future What do I need to know about using the Forms tab Only those myCGS users who have been assigned rights by their Provider Administrator will have access to the Forms tab If you do not have access to the Forms tab but believe you should talk with the myCGS Provider Administrator for your agency organization and they can update your security
7. lodine I 131 tositumomab therapeutic per treatment dose will change from SI K Paid under OPPS This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 04 APRIL 2014 SE lt m IE m gt T Ro T WY I O m 7 separate APC payment to SI E Not paid by Medicare when submitted on outpatient claims any outpatient bill type Effective January 1 2014 the status indicator for HCPCS code J1446 Injection TBO Filgrastim 5 micrograms will change from SI E not paid by Medicare when submitted on outpatient claims any outpatient bill type to SI K Paid under OPPS separate APC payment Effective January 1 2014 the status indicator for HCPCS code J7178 Injection human fibrinogen concentrate 1 mg will change from SI N Paid under OPPS payment is packaged into payment for other services Therefore there is no separate APC payment to SI K Paid under OPPS separate APC payment Effective January 1 2014 the status indicator for HCPCS code Q0181 Unspecified oral dosage form FDA approved prescription anti emetic for use as will change from SI E not paid by Medicare when submitted on outpatient claims any outpatient bill type to SI N Paid
8. 120 days for a redetermination or over 365 days for a reopening No zj aR lt m IE m gt T Ro T 0A I O m Redetermination 1 Level Appeal EA J15 A 1000 Currently the only level of appeal that can be submitted via the myCGS portal is the first level of appeal the redetermination To determine if your appeal request is still timely click on the Appeals Calculator link If your appeal is untimely you cannot submit your redetermination request via the myCGS portal Click on the Redetermination 1st Level Appeal link to access the online Redetermination Form What information do need to submit a redetermination request using myCGS The myCGS Redetermination Form is separated into sections Beneficiary Information Provider Information and Attachments Basic information such as the beneficiary s claim number HICN dates of service being appealed the Document Control Number DCN of the claim being appealed and an explanation about why you are appealing the claim It is also important to indicate whether your appeal request is related to an overpayment such as the Comprehensive Error Rate Testing CERT program a recovery audit RA findings or a Zone Program Integrity Contractor ZPIC review Fields that contain a red asterisk indicate that information is required myCGS amp also allows documentation supporting the appeal request to be attached directly to the redetermination reque
9. CMS will provide at least 90 days advanced notice of the new termination date The questions and answers from the February 4 2014 myCGS Introduction to a World of Information Using a Web Portal Ask the Contractor Teleconference ACT are available at http www cgsmedicare com hhh education faqs act act_qa020414 html Based on the Medicare Learning Network MLN Matters article MM8620 CWF Editing for Vaccines Furnished to Hospice Correction hittp www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles Downloads MM8620 pdf the following Web pages have been updated to remove the information indicating that a beneficiary who is receiving hospice care must receive preventive vaccines from their hospice provider Election of the Medicare Hospice Benefit While Receiving Home Health Services During an MA Plan Enrollment Period http www cgsmedicare com hhh education materials Election_Med_Hospice_Benefit html Top Claim Submission Errors for Home Health Providers Error C7010 http www cgsmedicare com hhh education materials C7010 html The Adjustments Cancels Web page at hitp www cgsmedicare com hhh education materials Adjustments_Cancels html has been updated to include information about the Document Control Number DCN being required in Form Locator FL 64 of the UB 04 or in the DCN field on FISS Page 01 The Reopenings Web page at
10. Certification with a copy of the check to the following address J15 HHH Correspondence CGS PO Box 20014 Nashville TN 37202 Credit Balance Reports Certification Adjustment Submitted e If you have or will be submitting an adjustment please send the CMS 838 to the following address J15 HHH Correspondence CGS PO Box 20014 Nashville TN 37202 BIE lt m IE m gt T Ro T 0A I O m If you have any Credit Balance related questions or are unable to access our website at http www cgsmedicare com hhh financial CMS 588 html to obtain a paper copy of the CMS 838 form please contact the Medicare Credit Balance telephone line at 1 866 590 6703 For Home Health and Hospice Providers MLN Connects Provider e News The MLN Connects Provider e News contains a week s worth of Medicare related messages issued by the Centers of Medicare amp Medicaid Services CMS These messages ensure planned coordinated messages are delivered timely about Medicare related topics The following provides access to the weekly messages Please share with appropriate staff If you wish to receive the ListServ directly from CMS please contact CMS at LearnResource L cms hhs gov e February 20 2014 http go usa gov Bfxh e February 27 2014 hiip go usa gov BJwz e March 6 2014 hitp go usa govw KgZY e March 13 2014 http go usa gov K83W This newsletter should be shared wit
11. Coding Used Assessment Dates OASIS Version Date on OASIS on RAP on Claim Start of Care 9 28 2014 9 30 2014 OASIS C_ 11 26 2014 ICD 9 CM ICD 9 CM ICD 10 CM Resumption of Care Recertification 9 28 2014 9 25 2014 OASIS C 11 26 2014 ICD 9 CM ICD 9 CM ICD 10 CM Start of Care 9 28 2014 10 2 2014 OASIS C1 11 26 2014 ICD 10 CM ICD 9 CM ICD 10 CM Resumption of Care Recertification 10 2 2014 9 28 2014 OASIS C_ 11 30 2014 ICD 9 CM ICD 10 CM ICD 10 CM Additional Information To find additional information about ICD 10 visit http www cms gov Medicare Coding ICD10 index html on the CMS website The ICD 10 related implementation date is now October 1 2014 as announced in final rule CMS 0040 F issued on August 24 2012 This final rule is available at http www cms gov Medicare Coding ICD10 Statute_Regulations html on CMS website If you have any questions please contact a CGS Customer Service Representative by calling the CGS Provider Contact Center at 1 877 299 4500 and choose Option 1 This newsletter should be shared with all health care practitioners and managerial members of the provider supplier staff Newsletters are available at no cost from our website at http www cgsmedicare com 2014 Copyright CGS Administrators LLC RETURN TO VAN i CONTENTS APRIL 2014 MEDICARE BULLETIN GR 2014 04 BIE lt m IE m gt T Ro T 0A I O m 13 For Hospice P
12. Neurostimulator Pulse Generator which was discontinued effective 12 31 2005 The payment amount is based on the explosion of code E0756 into four codes for different types of neurostimulator pulse generator systems which were not materially utilized in the This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at http www cgsmedicare com 2014 Copyright CGS Administrators LLC TABLE OF CONTENTS MEDICARE BULLETIN GR 2014 04 APRIL 2014 BIE lt m IE m gt T Ro T 0A I O m 28 Medicare program As such payment for code L8679 will revert back to the fee schedule amounts previously established for code E0756 Diabetic Testing Supplies The fee schedule amounts for non mail order diabetic testing supplies without KL modifier for codes A4233 A4234 A4235 A4236 A4253 A4256 A4258 A4259 are not updated by the covered item update for CY 2014 In accordance with Section 636 a of the American Taxpayer Relief Act of 2012 the fee schedule amounts for these codes were adjusted in CY 2013 so that they are equal to the single payment amounts for mail order Diabetic Testing Supplies DTS established in implementing the national mail order Competitive Bidding Program CBP under Section 1847 of the Act The non mail order payment amounts on the fee schedule file will be update
13. about HETS please contact the MCARE Help Desk at 1 866 324 7315 For Home Health and Hospice Providers SE1402 Updated Mobile Applications Apps for Open Payments The Centers for Medicare amp Medicaid Services CMS has issued the following Special Edition Medicare Learning Network MLN Matters article This MLN Matters article and other CMS articles can be found on the CMS website at http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles 2014 MLN Matters Articles html BIE lt m IE m gt T Ro T 0A I O m MLN Matters Number SE1402 Related Change Request CR N A Related CR Release Date N A Effective Date N A Related CR Transmittal N A Implementation Date N A Provider Types Affected This MLN Matters Special Edition SE is intended for physicians providers and suppliers submitting claims to Medicare administrative contractors MACs for services to Medicare beneficiaries What You Need to Know CMS is issuing this article to alert the provider community of updates to the mobile applications apps Open Payments Mobile for Industry and Open Payments Mobile for Physicians implemented as a result of user feedback to CMS See the Background and Key Points sections of this article for details Also a part of SE1402 is new technical documentation The Open Payments QR Code Reader How To Guide Included are the technical in
14. are used to identify a device that is furnished without cost or with a full or partial credit Also effective January 1 2014 for claims with APCs that require implantable devices and have significant device offsets greater than 40 percent the amount of the device credit will be specified in the amount portion for value code FD Credit Received from the Manufacturer for a Replaced Medical Device and will be deducted from the APC payment from the applicable procedure The OPPS payment deduction for the applicable APCs referenced above will be limited to the total amount of the device offset when the FD value code appears on a claim The offset amounts for the above referenced APCs along with the offsets for other APCs are available under the Annual Policy Files link on the left column at http www cms gov HospitalOutpatientPPS on the CMS OPPS website CMS is updating the Medicare Claims Processing Manual Chapter 4 Sections 61 3 1 through 61 3 4 and adding Sections 61 3 5 through 61 3 6 to Chapter 4 of that manual to reflect these changes to the reporting guidelines for no cost full credit and partial credit devices and these revised and added sections are included as an attachment to CR 8653 Those added sections are as follows This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TAB
15. factor to yield a CY 2014 maintenance and servicing fee of 68 73 for oxygen concentrators and transfilling equipment Additional Information The official instruction CR 8531 issued to your MAC regarding this change may be viewed at http Awww cms gov Regulations and Guidance Guidance Transmittals Downloads R2836CP pdf on the CMS website If you have any questions please contact a CGS Customer Service Representative by calling the CGS Provider Contact Center at 1 877 299 4500 and choose Option 1 For Home Health and Hospice Providers MM8582 Revised Claim Status Category and Claim Status Codes Update The Centers for Medicare amp Medicaid Services CMS has issued a revision to the following Medicare Learning Network MLN Matters article This MLN Matters article and other CMS articles can be found on the CMS website at http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles 2014 MLN Matters Articles html MLN Matters Number MM8582 Revised Related Change Request CR CR 8582 Related CR Release Date February 24 2014 Effective Date April 1 2014 Related CR Transmittal R2884CP Implementation Date April 7 2014 Note This article was revised on February 27 2014 to reflect an updated Change Request CR The CR corrects the date when the Claim Status Category Codes and Claim Status Codes will be posted which is March 1 2014 All other information remains th
16. gt T Ro T 0A I O m include agency specific information on secondary insurance claims or a blank line for the beneficiary to insert secondary insurance information Agencies can pre print language in the Additional Information section of the notice Some States have specific rules established regarding HHA completion of liability notices in situations where dual eligibles need to accept liability for Medicare noncovered care that will be covered by Medicaid Medicaid has the authority to make this assertion under Title XIX of the Act where Medicaid is recognized as the payer of last resort meaning other Federal programs like Medicare Title XVIII must pay in accordance with their own policies before Medicaid picks up any remaining charges In the past some States directed HHAs to select the third checkbox on the HHABN to indicate the choice to bill Medicare On the ABN the first check box under the Options section indicates the choice to bill Medicare and is similar to the third checkbox on the outgoing HHABN Note If there has been a State directive to submit a Medicare claim for a denial HHAs must mark the first check box when issuing the ABN HHAs serving dual eligibles should comply with existing HHABN State policy within their jurisdiction as applicable to the ABN unless the State instructs otherwise The appropriate option selection for dual eligibles will vary depending on the State s Medicaid di
17. identifier designating the company initiating the funds transfer This must be a 1 followed by the payer s Tax Identification Number TIN TRNO4 Reference Identification O This data element is required when information beyond the Originating Company Identifier in TRNO3 is necessary for the payee to identify the source of the payment Segment Segment Terminator M The TRN data segment in the addenda record must end with Terminator either a tilde or a backslash This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at E T hae iiad 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 04 APRIL 2014 oT Additional Information The official instruction CR 8619 issued to your MAC regarding this change is available at http Awww cms gov Regulations and Guidance Guidance Transmittals Downloads R13510TN pdf on the CMS website If you have any questions please contact a CGS Customer Service Representative by calling the CGS Provider Contact Center at 1 877 299 4500 and choose Option 1 For Home Health and Hospice Providers MM8620 CWF Editing for Vaccines Furnished at Hospice Correction The Centers for Medicare amp Medicaid Services CMS has issued the following Medicare Learning Network MLN Matters article This MLN Matters article and other CMS a
18. instructs providers and clearinghouses on how to volunteer to be chosen for ICD 10 End to End testing with Medicare in July 2014 Potential testers must complete the volunteer form on the MAC website by March 24 2014 Background The International Classification of Disease Tenth Revision ICD 10 must be implemented by October 1 2014 While system changes to implement this project have been completed and tested in previous releases the industry has requested the opportunity to test with CMS CR 8602 will allow for a small subset of Medicare claims submitters to test with MACs and the Common Electronic Data Interchange CEDI contractor to demonstrate that CMS systems are ready for the ICD 10 implementation This additional testing effort will further ensure a successful transition to ICD 10 To facilitate this testing CR 8602 requires MACs to do the following BIE lt m IE m gt T Ro T 0A I O m Conduct a limited end to end testing with submitters in July 2014 Test claims will be submitted July 21 25 2014 Each MAC and CEDI with assistance from DME MACs will select 32 submitters to participate in the end to end testing The Railroad Retirement Board RRB contractor will select 16 submitters Testers will be selected randomly from a list of volunteers At least five but not more than ten of the testers will be a clearinghouse and submitters should be a mix of provider types By March 7 2014 th
19. intermediaries RHHIs home health and hospices MACs HHH MACs and durable medical equipment MACs DME MACs for services provided to Medicare beneficiaries Provider Action Needed CR 8611 from which this article is taken instructs Medicare contractors to obtain the most recent HPTC set and use it to update their internal HPTC tables and or reference files This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at http www cgsmedicare com 2014 Copyright CGS Administrators LLC TABLE OF CONTENTS MEDICARE BULLETIN GR 2014 04 APRIL 2014 BIE lt m IE m gt T Ro T 0A I O m 34 Background The Health Insurance Portability and Accountability Act of 1996 HIPAA requires that covered entities use the standards adopted under this law for electronically transmitting certain health care transactions including health care claims The standards include implementation guides which dictate when and how data must be sent including specifying the code sets which must be used Both the current Accredited Standards Committee ASC X 12 837 institutional and professional Technical Report Type 3 TR3s require that the National Uniform Claim Committee NUCC HPTC set be used to identify provider specialty information on a health care claim However the standards do not m
20. is required based on the claim Through date On Requests for Anticipated Payment RAPs Medicare billing instructions require that the From and Through dates are the same So if the episode begins in September 2014 the From and Through dates on the RAP would report the same date in September These RAPs would report ICD 9 CM diagnosis codes using codes matching the OASIS assessment BIE lt m IE m gt T Ro T 0A I O m If the HH episode spans into October 2014 the corresponding final claim for the episode will be required to report ICD 10 CM codes HH claims cannot be split into periods before and after October 1 2014 so these claims will have claim Through dates of October 1 2014 or later The HIPPS code on the final claim must match the HIPPS code that was reported on the RAP The HIPPS code on the RAP was based on the ICD 9 CM codes matching the OASIS assessment CR 7492 stated that CMS will Allow HHAs to use the payment group code derived from ICD 9 CM codes on claims which span 10 1 but require those claims to be submitted using ICD 10 CM codes This means that HHAs do not have to re group the episode based on the ICD 10 CM codes But this could result in some inconsistency between the HIPPS code and the ICD 10 CM codes on the claim CMS will alert medical reviewers at our MACs to ensure that the ICD 10 CM codes on these claims are not used in making determinat
21. services furnished on October 1 2013 through December 31 2013 MACs will adjust claims that were previously processed incorrectly if you bring such claims to the attention of your MAC Table 6 Updated Payment Rates for Certain HCPCS Codes Effective October 1 2013 through December 31 2013 Corrected Minimum HCPCS Code Status Indicator APC Short Descriptor Corrected Payment Rate Unadjusted Copayment A9600 K 0701 Sr89 strontium 1 196 47 239 29 J2323 K 9126 Natalizumab injection 12 99 2 60 Q4127 G 1449 Talymed 13 78 2 76 g Reassignment of Skin Substitute Products that are New for CY 2014 from the Low Cost Group to the High Cost Group In the CY 2014 OPPS ASC final rule CMS finalized a policy to package payment for skin substitute products into the associated skin substitute application procedure You can review the CY 2014 OPPS ASC final rule at http www gpo gov idsys pkg FR 2013 12 10 pdf 2013 28737 pdf on the Internet For packaging purposes CMS created two groups of application procedures application procedures that use high cost skin substitute products billed using Current Procedural Terminology CPT codes 15271 15278 and application procedures that use low cost skin substitute products billed using HCPCS codes C5271 C5278 Assignment of skin substitute products to the high cost or low cost groups depended upon a comparison of the July 2013 payment rate for the skin subs
22. under OPPS payment is packaged into payment for other services Therefore there is no separate APC payment These codes are listed in Table 3 below along with the effective date for the revised status indicator Table 3 Drugs and Biologicals with Revised Status Indicators HCPCS Code Long Descriptor APC Status Indicator Effective Date A9545 lodine 131 tositumomab therapeutic per treatment dose E 4 1 2014 J1446 Injection TBO Filgrastim 5 micrograms 1477 K 1 1 2014 J7178 Injection human fibrinogen concentrate 1 mg 1478 K 1 1 2014 Q0181 Unspecified oral dosage form FDA approved prescription N 1 1 2014 anti emetic for use as d Updated Payment Rate for Q4127 Effective April 1 2013 through June 30 2013 The payment rate for Q4127 was incorrect in the April 2013 OPPS Pricer The corrected payment rate is listed in Table 4 below and it has been installed in the April 2014 OPPS Pricer effective for services furnished on April 1 2013 through June 30 2013 MACs will adjust claims that were previously processed incorrectly if you bring such claims to the attention of your MAC Table 4 Updated Payment Rates for Certain HCPCS Codes Effective April 1 2013 through June 30 2013 Corrected Minimum Unadjusted Copayment HCPCS Code Status Indicator APC Short Descriptor Corrected Payment Rate Q4127 G 1449 Talymed 13 78 2 76 e
23. urged to contact their financial institutions directly in order to understand the form in which payment information will be transmitted or reported on a per payment basis as a result of CR 8629 We suggest that providers should subsequently take steps to assure that the payment information that is changed as a result of CR 8629 can be accommodated by your accounting processes and systems Background In support of Health Insurance Portability amp Accountability Act of 1996 HIPAA Operating Rules for health care EFT and remittance advice transactions adopted by HHS NACHA The Electronic Payments Association has adopted its own operating rules that apply to ACH transactions that are health care payments from health plans to providers NACHA manages the development administration and governance of the ACH Network used by all types of financial networks and represents more than 10 000 financial institutions A new NACHA standard for electronic healthcare claim payments went into effect on September 20 2013 impacting all originators and receivers of EFT used to pay healthcare claims This Healthcare EFT standard stems from the Affordable Care Act which requires that healthcare payers must pay healthcare claim payments electronically using HIPAA standards if requested by the healthcare provider BIE lt m IE m gt T Ro T 0A I O m The standard designated for these claim payments is the Healthcare EFT Standard whi
24. used by providers physicians and other suppliers to receive individual beneficiary eligibility information under the Medicare program including information found on the CWF MSP auxiliary file Although most MSP information from the MSP record is currently included on the HETS 271 response transaction International Classification of Diseases ICD Clinical Modification CM diagnosis codes are not included CMS believes it would be beneficial for CWF to This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at http www cgsmedicare com 2014 Copyright CGS Administrators LLC TABLE OF CONTENTS MEDICARE BULLETIN GR 2014 04 APRIL 2014 21 include ICD CM diagnosis codes as derived from MSP no fault liability and workers compensation MSP auxiliary records on the interface file that it sends to MBD Through a separate Medicare Advantage Prescription Drug CR CMS will ensure that the MBD table information that is exchanged with HETS will be modified to include ICD diagnosis codes Thereafter the diagnosis codes will be included in the HETS 271 response transaction that CMS makes available to providers physicians and suppliers Since the HETS 271 response transaction can only accommodate up to 8 diagnosis codes CR 8456 instructs CWF to send up to 25 iterations of diagnosis codes associated with MS
25. would need to report ICD 9 CM diagnosis codes even though ICD 10 CM codes were used on the OASIS assessment Since RAPs are not subject to medical review and are replaced in Medicare claims history by the final claim there is no need to account for adverse impacts in these situations The ICD 9 CM codes are simply required in order for the RAP to be processed The corresponding final claim for the episode will report ICD 10 CM codes matching the OASIS assessment Recertification Episodes Beginning in the First Days of October 2014 In the case of recertification episodes the M0090 date can be up to 5 days earlier than the episode start date So a recertification episode starting on October 2 2014 could have an M0090 date of September 28 2014 ICD 9 CM codes are used on the OASIS assessment and will be used to determine the HIPPS code But in this case both the RAP and claim will require ICD 10 CM codes since the Through date on both will be after October 1 2014 The coding used to support the payment of the HIPPS code will be the ICD 9 CM codes which are stored in the OASIS system In these cases also CMS will alert medical reviewers at our MACs and researchers using CMS data files to prevent adverse impacts The following table summarizes the above scenarios RAP From Claim Diagnosis Diagnosis Diagnosis Type of OASIS Through OASIS M0090 Date Through Coding Used Coding Used
26. 0 Payment 20Amounts on the Internet CY2014 Fee Schedule Update Factor For CY 2014 the update factor of 1 0 percent is applied to the applicable CY 2013 DMEPOS fee schedule amounts In accordance with the statutory Sections 1834 a 14 and 1886 b 3 B xi II of the Act the DMEPOS fee schedule amounts are to be updated for 2014 by the percentage increase in the consumer price index for all urban consumers United States city average or CPI U for the 12 month period ending with June of 2013 adjusted by the change in the economy wide productivity equal to the 10 year moving average of changes in annual economy wide private non farm business Multi Factor Productivity MFP The MFP adjustment is 0 8 percent and the CPI U percentage increase is 1 8 percent Thus the 1 8 percentage increase in the CPI U is reduced by the 0 8 percentage increase in the MFP resulting in a net increase of 1 0 percent for the update factor 2014 Update to the Labor Payment Rates The 2014 fees for HCPCS labor payment codes K0739 L4205 and L7520 are increased 1 8 percent effective for claims with dates of service from January 1 2014 through December 31 2014 and those rates are as follows STATE K0739 L4205 L7520 STATE K0739 L4205 L7520 AK 27 40 31 22 36 73 NC 14 55 21 68 29 43 AL 14 55 21 68 29 43 ND 18 13 31 16 36 73 This newsletter should be shared with all health care practitioners and manageria
27. 13 through March 3 2014 since testing does not support future dated claims Test claims will receive the 277CA or 999 acknowledgement as appropriate to confirm that the claim was accepted or rejected in the system Testing will not confirm claim payment or produce remittance advice e MACs and CEDI will be staffed to handle increased call volume during this week Make sure that your billing staff is aware of these upcoming ICD 10 testing periods Background CMS is in the process of implementing ICD 10 All covered entities have to be fully compliant on October 1 2014 I lt m ne m gt E ar Ro I O w O m CR 8465 instructs all Medicare MACs and the DME MACs CEDI contractor to implement an ICD 10 testing week with trading partners The concept of trading partner testing was originally designed to validate the trading partners ability to meet technical compliance and performance processing standards during the HIPAA 5010 implementation The ICD 10 testing week has been created to generate awareness and interest and to instill confidence in the provider community that CMS and the MACs are ready and prepared for the ICD 10 implementation This testing week will give trading partners access to the MACs and CEDI for testing with real time help desk support The event will be conducted virtually and will be posted on each MAC and the CEDI website as well as the CMS website The testing week will be M
28. 5010 html on the CGS website CMS plans to offer a second week of acknowledgement testing in early May 2014 End to End Testing In late July 2014 CMS will offer end to end testing to a small sample group of providers BIE lt m IE m gt T Ro T 0A I O m End to end testing includes the submission of test claims to CMS with ICD 10 codes and the provider s receipt of a Remittance Advice RA that explains the adjudication of the claims The goal of this testing is to demonstrate that e Providers or submitters are able to successfully submit claims containing ICD 10 codes to the Medicare FFS claims systems e CMS software changes made to support ICD 10 result in appropriately adjudicated claims based on the pricing data used for testing purposes and e Accurate RAs are produced The sample will be selected from providers suppliers and other submitters who volunteer to participate Information about the volunteer registration will be available in March 2014 Over 500 volunteer submitters will be selected nationwide to participate in the end to end testing The small sample group of participants will be selected to represent a broad cross section of provider types claims types and submitter types Additional details about the end to end testing process will be disseminated at a later date in a separate MLN Matters article If you have any questions please contact a CGS Customer Service Rep
29. APRIL 2014 gt WWW CGSMEDICARE COM Medicare Bulletin Jurisdiction 15 Reaching Out to the Medicare Community CELERIAN GROUP COMPANY 2014 Copyright CGS Administrators LLC O lt m JE m gt L Ro ag O N U O m Medicare Bulletin z Jurisdiction 15 TE HOME HEALTH PROVIDERS MM8506 Pub 100 03 Chapter 1 m Language only Update l aaa 25 2 MM8597 Correction CR Advance Beneficiary MM8531 Revised Calendar Year CY 2014 Notice of Noncoverage ABN Form CMS R 131 3 Update for Durable Medical Equipment Prosthetics L MM8653 April 2014 Update of the Hospital Orthotics and Supplies DMEPOS Fee Schedule 26 Ro Outpatient Prospective Payment System OPPS 4 MM8582 Revised Claim Status Category 4p SE1410 Revised Special Instructions for the and Claim Status Codes UPCate sccaasestdaetienacine 31 International Classification of Diseases Clinical MM8602 International Classification of Diseases Op Modification 10th Edition ICD 10 CM Coding Tenth Revision ICD 10 Limited End to End Testing U on Home Health Episodes that Span October 1 40t 11 with Submitters 32 O MM8611 Healthcare Provider Taxonomy m HOSPICE PROVIDERS Codes HPTC Update April 2014 oo 34 MM8619 Implementation of Health Insurance Change Request 8358 Frequently Asked Portability amp Accountability Act HIPAA Standards Questions FAQS 14 and Operating Rules for Healt
30. C set is available for view or for download from the Washington Publishing Company WPC at htip www wpc edi com codes on the Internet CR 8611 implements the NUCC HPTC code set that is effective on April 1 2014 and instructs Medicare contractors to obtain the most recent HPTC set and use it to update their internal HPTC tables and or reference files When reviewing the HPTC set online revisions made since the last release can be identified by the color code e New items are green e Modified items are orange and e Inactive items are red Additional Information The official instruction CR 8611 issued to your carriers Fls A B MACs RHHIs HHH MACs and DME MACs regarding this change may be viewed at hitp www cms gov Regulations and Guidance Guidance Transmittals Downloads R2888CP pdf on the CMS website If you have any questions please contact a CGS Customer Service Representative by calling the CGS Provider Contact Center at 1 877 299 4500 and choose Option 1 This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 04 APRIL 2014 35 For Home Health and Hospice Providers MM8619 Implementation of Health Insurance Portability amp Accountability Act HIPAA S
31. For Home Health Providers SE1410 Revised Special Instructions for the International Classification of Diseases Clinical Modification 10th Edition ICD 10 CM Coding on Home Health Episodes that Span October 1 2014 The Centers for Medicare amp Medicaid Services CMS issued the following Special Edition Medicare Learning Network MLN Matters on February 24 2014 CMS then revised the article on February 27 and March 4 2014 The following article reflects both revisions This MLN Matters article and other CMS articles can be found on the CMS website at http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles 2014 MLN Matters Articles html MLN Matters Number SE1410 Revised Related Change Request CR N A Related CR Release Date N A Effective Date N A Related CR Transmittal N A Implementation Date N A Note This article was revised on February 27 2014 to correct an entry in the table on page 4 The last row and third column of the table should have indicated OASIS C All other information is unchanged BIE lt m IE m gt T Ro T 0A I O m Note This article was revised on March 4 2014 to remove references to the General Equivalence Mappings These changes are on page 3 and in the table on page 4 All other information is unchanged Provider Types Affected This MLN Matters article is intended for physicians provider
32. LE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 04 APRIL 2014 5 61 3 5 Reporting and Charging Requirements When a Device is Furnished Without Cost to the Hospital or When the Hospital Receives a Full or Partial Credit for the Replacement Device Beginning January 1 2014 Effective January 1 2014 when a hospital furnishes a new replacement device received without cost or with a credit of 50 percent or more of the cost of a new replacement from a manufacturer due to warranty recall or field action the hospital must report the amount of the device credit in the amount portion for value code FD Credit Received from the Manufacturer for a Replaced Medical Device Also effective January 1 2014 hospitals must report one of the following condition codes when the value code FD is present on the claim e 49 Product Replacement within Product Lifecycle Replacement of a product earlier than the anticipated lifecycle due to an indication that the product is not functioning properly 50 Product Replacement for Known Recall of a Product Manufacturer or FDA has identified the product for recall and therefore replacement 61 3 6 Medicare Payment Adjustment Beginning January 1 2014 Rev 1657 Issued 12 31 08 Effective 01 01 14 Implementation 01 05 09 Effective January 1 2014 Medicare payment is reduced by the amount of the device credit for specifie
33. Number MM8653 Related Change Request CR CR 8653 Related CR Release Date February 28 2014 Effective Date April 1 2014 Related CR Transmittal R2894CP Implementation Date April 7 2014 Provider Types Affected This MLN Matters Article is intended for providers and suppliers who submit claims to Part A Medicare Administrative Contractors A MACs and Home Health and Hospice HH amp H MACs for services provided to Medicare beneficiaries This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at http www cgsmedicare com 2014 Copyright CGS Administrators LLC TABLE OF CONTENTS MEDICARE BULLETIN GR 2014 04 APRIL 2014 BIE lt m IE m gt T Ro T 0A I O m Provider Action Needed This article is based on Change Request CR 8653 which describes changes to and billing instructions for various payment policies implemented in the April 2014 OPPS update The April 2014 Integrated Outpatient Code Editor I OCE and OPPS Pricer will reflect the Healthcare Common Procedure Coding System HCPCS Ambulatory Payment Classification APC HCPCS Modifier and Revenue Code additions changes and deletions identified in CR 8653 Be sure your billing staff are aware of these changes Background Change Request CR 8653 describes changes to and billing instructions for v
34. P no fault liability and workers compensation records for inclusion on the HETS 271 response transaction Additional Information The official instruction CR 8456 issued to your MAC regarding this change may be viewed at http www cms gov Regulations and Guidance Guidance Transmittals Downloads R13560TN pdf on the CMS website If you have any questions please contact a CGS Customer Service Representative by calling the CGS Provider Contact Center at 1 877 299 4500 and choose Option 1 BIE lt m IE m gt T Ro T 0A I O m For Home Health and Hospice Providers MM8465 Revised International Classification of Diseases 10th Revision ICD 10 Testing with Providers through the Common Edits and Enhancements Module CEM and Common Electronic Data Interchange CEDI The Centers for Medicare amp Medicaid Services CMS has issued a revision to the following Medicare Learning Network MLN Matters article This MLN Matters article and other CMS articles can be found on the CMS website at http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles 2014 MLN Matters Articles html MLN Matters Number MM8465 Related Change Request CR CR 8465 Related CR Release Date February 26 2014 Effective Date December 3 2013 Related CR Transmittal R13530TN Implementation Date March 3 2014 Note This article was revised on February 27 2014 to ref
35. SV file including address phone number etc The prior app version included only vendor physician name in the CSV file This enhancement will simplify the data review process Streamlined Add Payment process The steps to Add Payment are streamlined to allow the user to enter contact information for the vendor or physician while staying within the Add Payment menu The prior app version required the user to first enter contact information for the vendor or physician separately and then go to the Add Payment menu Easy payment duplication A new button available on the View Payment screen allows payment data to be easily duplicated in case a physician or vendor has multiple occurrences of the same payment The only data field that needs to be re entered is the date Vendors Physicians sorted alphabetically In Manage Vendors Physicians vendors or physicians are now listed alphabetically The prior app version listed vendors and physicians in the order in which they were entered Email print QR code added A Share button is available to email or print a QR code that is generated within the app for sharing at a later time Payment QR code warning added After a payment QR code is scanned a red warning message appears to remind the user to manually add the vendor or physician name to the payment data conveyed in the QR code Additional data elements added in Ad
36. about the testing to their websites Additional Information The official instruction CR 8602 issued to your MAC regarding this change may be viewed at http Awww cms gov Regulations and Guidance Guidance Transmittals Downloads R1352OTN pdf on the CMS website If you have any questions please contact a CGS Customer Service Representative by calling the CGS Provider Contact Center at 1 877 299 4500 and choose Option 1 For Home Health and Hospice Providers MM8611 Healthcare Provider Taxonomy Codes HPTC Update April 2014 The Centers for Medicare amp Medicaid Services CMS has issued the following Medicare Learning Network MLN Matters article This MLN Matters article and other CMS articles can be found on the CMS website at http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles 2014 MLN Matters Articles html MLN Matters Number MM8611 Related Change Request CR CR 8611 Related CR Release Date February 28 2014 Effective Date April 1 2014 Related CR Transmittal R2888CP Implementation Date July 7 2014 Contractors with the capability to do so will implement April 1 2014 Provider Types Affected This MLN Matters article is intended for physicians other providers and suppliers submitting claims to Medicare claims administration contractors fiscal intermediaries Fls carriers A B Medicare administrative contractors A B MACs regional home health
37. and clearinghouses that use Medicare s Common Working File CWF queries to obtain their patient s Medicare health insurance eligibility information from Medicare contractors carriers fiscal intermediaries Fls regional home health intermediaries RHHIs durable medical equipment Medicare administrative contractors DME MACs and or Part A B Medicare administrative contractors A B MACs Provider Action Needed If you currently use CWF queries to obtain Medicare health insurance eligibility information for Medicare fee for service patients you should immediately begin transitioning to the Medicare Health Insurance Portability and Accountability Act HIPAA Eligibility Transaction System HETS What You Need to Know This article describes upcoming changes to Medicare beneficiary health insurance eligibility inquiry services that CMS will implement in the coming months In April 2013 access to CWF eligibility query functions implemented in the Multi Carrier System MCS and ViPS Medicare System VMS also referred to as PPTN and VPIQ was terminated CMS intends to terminate access to the other CWF eligibility queries implemented in the Fiscal Intermediary Standard System FISS Direct Data Entry DDE often referred to the HIQA HIQH ELGA and ELGH screens and HUQA Change Request 8248 creates the ability for CMS to terminate these queries While termination was originally scheduled for April 2014 CMS is delaying the date CMS will
38. and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 04 APRIL 2014 25 For Home Health and Hospice Providers MM8531 Revised Calendar Year CY 2014 Update for Durable Medical Equipment Prosthetics Orthotics and Supplies DMEPOS Fee Schedule The Centers for Medicare amp Medicaid Services CMS has issued a revision to the following Medicare Learning Network MLN Matters article This MLN Matters article and other CMS articles can be found on the CMS website at http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles 2013 MLN Matters Articles html MLN Matters Number MM8531 Revised Related Change Request CR CR 8531 Related CR Release Date December 13 2013 Effective Date January 1 2014 Related CR Transmittal R2836CP Implementation Date January 6 2014 Note This article was revised on March 6 2014 to provide updates regarding HCPCS codes changes that were effective January 1 2014 The changes are on page 2 bold All other information remains unchanged BIE lt m IE m gt T Ro T 0A I O m Provider Types Affected This MLN Matters article is intended for providers and suppliers submitting claims to Medicare administrative contra
39. andate the reporting of provider specialty information via a HPTC be on every claim nor for every provider to be identified by specialty The standard implementation guides state that this information is e Required when the payer s adjudication is known to be impacted by the provider taxonomy code and If not required by this implementation guide do not send Note Medicare does not use HPTCs to adjudicate its claims and would not expect to see these codes on a Medicare claim However currently it validates any HPTC that a provider happens to supply against the NUCC HPTC set BIE lt m IE m gt T Ro T 0A I O m The Transactions and Code Sets Final Rule published on August 17 2000 establishes that the maintainer of the code set determines its effective date See http aspe hhs gov admnsimp final txfin00 htm on the Internet This rule also mandates that covered entities must use the nonmedical data code set specified in the standard implementation guide that is valid at the time the transaction is initiated For implementation purposes Medicare generally uses the date the transaction is received for validating a particular nonmedical data code set required in a standard transaction The HTPC set is maintained by the NUCC for standardized classification of health care providers and the NUCC updates the code set twice a year with changes effective April 1 and October 1 The HPT
40. arch 3 through March 7 2014 Testing Week Information Your MAC will announce and actively promote the testing week via ListServ messages and will post the testing week announcement on their website Your MAC will host a registration site for the testing week or provide an e mail address for the trading partners to provide registration information The registration site or e mail address information will be available and publicized to trading partners at least four weeks prior to the testing week During the testing week EDI help desk support will be available at a minimum from 9 00 a m to 4 00 p m local contractor time with enough support to handle any increased call volume Providers and suppliers participating during the testing week will receive electronic acknowledgement confirming that the submitted test claims were accepted or rejected On or before March 18 2014 your contractor will report the following to CMS Number of trading partners conducting testing during the testing week Percent of trading partners that conducted testing during the testing week versus number of trading partners supported by contract Percent of test claims accepted versus rejected Report of any significant issues found during testing This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at o htt
41. arious payment policies implemented in the April 2014 OPPS update The April 2014 I OCE and OPPS Pricer will reflect the HCPCS APC HCPCS Modifier Status Indicators SIs and Revenue Code additions changes and deletions identified CR 8653 The April 2014 revisions to I OCE data files instructions and specifications are provided in the April 2014 I OCE CR8658 Upon release of CR8658 a related MLN Matters article can be found at http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles Downloads MM8658 pdf on the Centers for Medicare amp Medicaid Services CMS website BIE lt m IE m gt T Ro T 0A I O m The key changes in the April 2014 update to the hospital OPPS are summarized in the following sections Changes to Device Edits for April 2014 The most current list of device edits can be found under Device and Procedure Edits at http www cms gov Medicare Medicare Fee for Service Payment HospitalOutpatientPPS on the Centers for Medicare amp Medicaid Services CMS website Failure to pass these edits will result in claims being returned to the provider No Cost Full Credit and Partial Credit Devices Effective January 1 2014 CMS will no longer recognize the modifier FB Item provided without cost to provider supplier or practitioner or credit received for replaced device or the modifier FC Partial credit received for replaced device which
42. ay not be used in the X12 276 277 to report claim status The National Code Maintenance Committee meets at the beginning of each X12 trimester meeting February June and October and makes decisions about additions modifications and retirement of existing codes The codes sets are available at http www wpc edi com reference codelists healthcare claim status category codes and http www wpc edi com reference codelists healthcare claim status codes on the Internet All code changes approved during the January 2014 committee meeting shall be posted on these sites on or about March 1 2014 Included in the code lists are specific details including the date when a code was added changed or deleted These code changes are to be used in the editing of all X12 276 transactions processed on or after the date of implementation and are to be reflected in X12 277 transactions issued on and after the date of implementation of CR 8582 BIE lt m IE m gt T Ro T 0A I O m Additional Information The official instruction CR 8582 issued to your MAC regarding this change may be viewed at http www cms hhs gov Regulations and Guidance Guidance Transmittals Downloads R2884CP pdf on the CMS website If you have any questions please contact a CGS Customer Service Representative by calling the CGS Provider Contact Center at 1 877 299 4500 and choose Option 1 For Home Health and Hospice Providers MM8602 In
43. ces to Medicare beneficiaries What You Need to Know This article is based on CR 8629 which informs MACs that they must comply with NACHA Operating Rules that are applicable to initiators of health care payments CR 8629 requires MACs to modify or change data elements currently inputted into payment information that is transmitted through the ACH EFT Network with electronic health care payments The overarching goal of the requirements of CR 8629 are to assure that providers receiving health care payments via EFT will receive a trace number that facilitates automatic reassociation of the EFT health care payment with its associated remittance advice Physicians other providers and suppliers should be aware that consequently the payment information that a provider receives or that is transmitted from a provider s financial institution regarding the health care EFT payment may change as per these requirements Specifically the Company Entry Description and the TRN Segment that is This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 04 APRIL 2014 39 reported or transmitted to a provider from its financial institution may change in terms of content or length Providers are
44. ch is a NACHA CCD transaction that includes the ASC X12 835 TRN data segment in the addenda record The Healthcare EFT Standard requires the following Company Entry Description of HCCLAIMPMT to identify the payment as healthcare e Company Name should be the health plan or third party administrator paying the claim e An addenda record must be included with a Record Type Code of 7 and an Addenda Type Code equal to 05 and e Payment Related Information in the addenda record must contain the ASC X12 835 TRN Re association Trace Number data segment that is included on the electronic remittance advice Healthcare providers will utilize the data within the addenda record to match the payment to the electronic remittance advice which is sent to the provider separate from the payment As a result specific addenda formatting requirements must be followed for healthcare EFT payments See Healthcare EFT Standard Format in the Medicare IOM for more information Example TRN 1 12345 1512345678 9999999 TRN TRN01 TRNO2 TRNO3 TRNO4 Segment Terminator data element separator The following table explains this example Mandatory Element Element Name or Optional Data Content TRN Reassociation Trace Number M ASC X12 835 segment identifier This is always TRN This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider
45. collect information from the selected test volunteers to request the HICNs NPIs and Provider Transaction Access Numbers PTANSs the testers will use during the testing The forms for this information must This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at http www cgsmedicare com 2014 Copyright CGS Administrators LLC TABLE OF CONTENTS MEDICARE BULLETIN GR 2014 04 APRIL 2014 33 be completed and returned to the MAC CEDI by May 2 2014 If these forms are not returned by May 2 the tester may lose the opportunity to test CEDI will instruct suppliers to submit claims with ICD 10 codes with Dates of Service DOS 10 1 2014 through 10 15 2014 They may also submit claims with ICD 9 codes with DOS before 10 1 2014 MACs will instruct testers to submit test claims with ICD 10 codes with DOS on or after 10 1 2014 They may also submit test claims with ICD 9 codes with DOS before 10 1 2014 MACs and CEDI will be prepared to support increased call volume from testers during the testing window and up to 2 weeks following the receipt of the Electronic Remittance Advices ERAs from testing MACs and CEDI will provide information to the testers on who to contact for testing questions There may be separate contacts for front end questions and remittance questions e MACs will post an announcement
46. ctors MACs for DMEPOS items or services paid under the DMEPOS fee schedule What You Need to Know The CMS issued CR 8531 to advise providers of the Calendar Year CY 2014 annual update for the Medicare DMEPOS fee schedule The instructions include information on the data files update factors and other information related to the update of the DMEPOS fee schedule Make sure your staffs are aware of these updates Background and Key Points of CR 8531 The DMEPOS fee schedules are updated on an annual basis in accordance with statute and regulations The update process for the DMEPOS fee schedule is located in the Medicare Claims Processing Manual Chapter 23 Section 60 which is available at http www cms gov Regulations and Guidance Guidance Manuals downloads clm104c23 pdf on the CMS website Payment on a fee schedule basis is required for Durable Medical Equipment DME prosthetic devices orthotics prosthetics and surgical dressings by Section1834 a h and i of the Social Security Act the Act Also payment on a fee schedule basis is a regulatory requirement at 42 CFR Section 414 102 for Parenteral and Enteral Nutrition PEN and splints casts and certain intraocular lenses Fee Schedule Files The DMEPOS fee schedule file will also be available for providers and suppliers as well as State Medicaid Agencies managed care organizations and other interested parties at http www cms gov Medicare Medicare Fee for Servic
47. d Claim Submission Guidelines Booklet ICN 906764 Downloadable and hard copy at htip www cms gov Outreach and Education Medicare Learning Network MLN MLNProducts Downloads MedicareC laimSubmissionGuidelines ICN906764 pdf In September 2012 the Centers for Medicare amp Medicaid Services CMS announced the availability of a new electronic mailing list for those who refer Medicare beneficiaries for Durable Medical Equipment Prosthetics Orthotics and Supplies DMEPOS Referral agents play a critical role in providing information and services to Medicare beneficiaries To ensure you give Medicare patients the most current DMEPOS Competitive Bidding Program information CMS strongly encourages you to review the information sent from this new electronic mailing list In addition please share the information you receive from the mailing list and the link to the mailing list for referral agents https public govdelivery com accounts USCMS subscriber new pop t amp topic_id USCMS _7814 subscriber Web page with others who refer Medicare beneficiaries for DMEPOS Thank you for signing up Are you ready to transition to ICD 10 on October 1 2014 In this MLN Connects video at http Awww youtube com watch v kCV6aFIA Sc amp feature youtu be on ICD This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no c
48. d Payment gt Travel amp Lodging When nature of payment in Add Payment is Travel amp Lodging the following additional data elements can be entered city state and country of travel note that these new data elements are required for reporting purposes but remember the apps are not used for reporting data only for tracking it Tablet support e Both apps are optimized for viewing on tablet devices Changes that Apply to Just One App Open Payments Mobile for Physicians Manage Companies added e Within Manage Vendors a new data field allows users to assign vendors to companies when entering new vendor information e Company information is needed for the Reports Statistics functionality to illustrate all payments by company name This newsletter should be shared with all health care practitioners and managerial members of the provider supplier staff Newsletters are available at no cost from our website at http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 04 APRIL 2014 RETURN TO SVAN EO CONTENTS BIE lt m IE m gt T Ro T O 78 I O m 48 The updated Frequently Asked Questions at hitp www cms gov Regulations and Guidance Legislation National Physician Payment Transparency Program Downloads Mobile App FAQs 5bAugust 2013 5d pdf about the mobile apps contain all the d
49. d each time the single payment amounts are updated which can happen no less often than every three years as CBP contracts are recompeted The national CBP for mail order diabetic supplies is effective July 1 2013 to June 30 2016 The program instructions reviewing these changes are Transmittal 2709 Change Request CR 8325 dated May 17 2013 and Transmittal 2661 Change Request CR 8204 dated February 22 2013 You may review the MLN Matters Articles for these CRs at http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles downloads MM8325 pdf and http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles downloads MM8204 pdf on the CMS website BIE lt m IE m gt T Ro T 0A I O m Although for payment purposes the single payment amounts replace the fee schedule amounts for mail order DTS KL modifier the fee schedule amounts remain on the DMEPOS fee schedule file as reference data such as for establishing bid limits for future rounds of competitive bidding programs The mail order DTS fee schedule amounts shall be updated annually by the covered item update adjusted for Multi Factor Productivity MFP which results in update of 1 0 percent for CY 2014 The single payment amount public use file for the national mail order competitive bidding program is available at http www dmecompetitivebid com palmetto cbicrd2 nsf DocsCat Single 2
50. d later returns to respite care from July 15 to July 18 and completes the month on routine home care the provider must report two separate line items for the respite periods and two occurrence span code M2 as follows Revenue Line items e Revenue code 0655 with line item date of service 07 01 XX for respite period July 1 through July 5 and line item units reported as 5 e Revenue code 0651 with line item date of service 07 06 XX for routine home care July 6 through July 14 and line item units reported as 9 e Revenue code 0655 with line item date of service 07 15 XX for respite period July 15 through 17th and line item units reported as 3 e Revenue code 0651 with line item date of service 07 18 XX for routine home care on date of discharge from respite through July 31 and line item units reported as 14 Occurrence Span Codes e M2 0701XX 0705XX e M2 0715XX 0717XX Additional Information The official instruction CR 8569 issued to your MAC regarding this change may be viewed at http Awww cms gov Regulations and Guidance Guidance Transmittals Downloads R2867CP pdf on the CMS website If you have any questions please contact a CGS Customer Service Representative by calling the CGS Provider Contact Center at 1 877 299 4500 and choose Option 1 This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost fr
51. d procedure codes reported with value code FD The payment deduction is limited to the full device offset when the FD value code appears on a claim Payment is only reduced for procedure codes that map to the APCs on the list of APCs subject to the adjustment that are reported with value code FD and that are present on claims with specified device HCPCS codes The OPPS Pricer deducts the lesser of the device credit or the full unadjusted device offset amount from the Medicare payment for a procedure code in an APC subject to the adjustment when billed with value code FD on the claim This deduction is made from the Medicare payment after the multiple procedure discounting and terminated procedure discounting factors are applied units of service are accounted for and after the APC payment has been wage adjusted When two or more procedures assigned to APCs subject to the adjustment are reported with value code FD the OPPS Pricer will apportion the device credit to the applicable line on the claim for each procedure assigned to an APC subject to the adjustment When value code FD is reported on a claim where multiple APCs would be subject to the adjustment the OPPS Pricer apportions the device credit to each of those lines The percentage of the device credit apportioned to each applicable line is based on the percentage that the unadjusted payment of each applicable line represents relative to the total unadjusted payme
52. d to the HCPCS for OTS orthotics In addition as part of the review to determine which HCPCS codes for prefabricated orthotics describe OTS orthotics it was determined that HCPCS codes for prefabricated orthotics describe items that are furnished OTS and items that require expertise in customizing the orthotic to fit the individual patient Therefore it was necessary to explode these codes into two sets of codes One set is the existing codes revised effective January 1 2014 to only describe devices customized to fit a specific patient by an individual with expertise and a second set of new codes describing the OTS items Also as shown in the table that follows for CY 2014 the fee schedule amounts for existing codes will be applied to the corresponding new codes added for the items furnished OTS The cross walking of fee schedule amounts for a single code that is exploded into two codes for distinct complete items is in accordance with the instructions found in the Medicare Claims Processing Manual Chapter 23 Section 60 3 1 which is available at http www cms gov Regulations and Guidance Guidance Manuals downloads clm104c23 pdf on the CMS website Prefabricated Orthotic Codes Split into Two Codes Effective January 1 2014 Fee from Crosswalk to New Off The Shelf and Fee from Crosswalk to New Off The Shelf and Existing Code Revised Custom Fitted Orthotic Codes Existin
53. dard requires the following BIE lt m IE m gt T Ro T 0A I O m Company Entry Description of HCCLAIMPMT to identify the payment as healthcare e Company Name should be the health plan or third party administrator paying the claim e An addenda record must be included with a Record Type Code of 7 and an Addenda Type Code equal to 05 and e Payment Related Information in the addenda record must contain the ASC X12 835 TRN Re association Trace Number data segment that is included on the electronic remittance advice Healthcare providers will use the data within the addenda record to match the payment to the electronic remittance advice which is sent to the provider separate from the payment As a result specific addenda formatting requirements must be followed for healthcare EFT payments The TRN data segment must contain the following data elements separated by an asterisk Example TRN 1 12345 1512345678 9999999 TRN TRNO1 TRNO2 TRNO3 TRNO4 Segment Terminator data element separator Mandatory Element Element Name or Optional Data Content TRN Re association Trace Number M ASC X12 835 segment identifier This is always TRN TRNO1 Trace Type Code M Trace Type Code is always a 1 TRNO2 Re association Information M This data element must contain the EFT trace number TRNO3 Origination Company ID M A unique
54. determination request myCGS will show Secure Form Confirmation along with the Submission ID number so you can continue to monitor your redetermination request For more information about the Forms tab and submitting redeterminations using myCGS go to Chapter 6 Messaging Forms Tab of the myCGS User Manual http www cgsmedicare com mycgs manual html and select the appropriate link for your line of business Part B or Home Health amp Hospice BIE lt m IE m gt T Ro T 0A I O m For Home Health and Hospice Providers Medicare Credit Balance Quarterly Reminder This is to remind you to submit the Quarterly Medicare Credit Balance Report The next report is due in our office postmarked by April 30 2014 for the quarter ending March 31 2014 A Medicare credit balance is an amount determined to be refundable to the Medicare program for an improper or excess payment made to a provider because of patient billing or claims processing errors Each provider must submit a quarterly Medicare Credit Balance Report CMS 838 and certification for each individual PTAN which is available at http www cms gov Medicare CMS Forms CMS Forms downloads CMS838 pdf The report must be postmarked by the date indicated above If the report is received with a postmark date later than the date indicated above we are required to withhold 100 percent of all payments being sent to your facility This withholding will re
55. e Google Play app store or iOSApple app store look for your available updates and select the Open Payments apps to download the updates If you have not yet downloaded the apps search for Open Payments in the applicable app store and you ll be prompted to download the newly updated versions In response to user feedback the table below describes the enhancements made to the apps since their initial launch in July 2013 All changes are intuitive and will add elements of ease expected by app users Enhancement Topic Details What It Does Changes that Apply to Both Apps Open Payments Mobile for Industry and Open Payments Mobile for Physicians Streamlined e A number of infrequently used menu options e g Program Information and Change Welcome screen Password moved from the Welcome screen and now appear in a hidden menu options e To access the menu swipe to the right at the Welcome screen Reports Statistics e Anew Reports Statistics button accessible on the Welcome screen allows the user to create a chart bar and pie showing their transfer of value data sorted by physician within Open Payments Mobile for Industry or vendor within Open Payments Mobile for Physicians e This new chart creation capability will streamline data review CSV exporting e When payment data is exported via CSV format all profile data for the associated vendor physician is included in the C
56. e MACs and CEDI will post a volunteer form to their website to collect volunteer information with which to select volunteers The form will provide information to verify that volunteers are ready to test meet the requirements to test and collect needed data about the tester how they submit claims what type of claims will be tested etc Volunteers must submit the completed forms to the MACs and CEDI by March 24 2014 By April 14 2014 the MACs and CEDI for the DME MACs will notify the volunteers that they have been selected to test and provide them with the information needed for the testing such as How to submit test claims for example what test indicators should be set What dates of service may be used for testing How many claims may be submitted for testing Test claims volume is limited to a total of 50 claims for the entire testing week submitted in no more than three files Request for National Provider Identifiers NPIs and Health Insurance Claim Numbers HICNs that will be used in testing no more than 5 NPls and 10 HICNs per submitter Notice that if more than 50 claims are submitted they may not be processed Notice that claims submitted with NPIs or HICNs not previously submitted for testing likely will not be completed and Notice of potential Protected Health Information PHI on test remittances not submitted and instructions to report PHI found to the MAC MACs and CEDI for the DME MACs will
57. e Payment DMEPOSFeeSched on the CMS website Healthcare Common Procedure Coding System HCPCS Codes Added Deleted The following new codes are effective January 1 2014 e A7047 in the inexpensive routinely purchased IN payment category This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 04 APRIL 2014 26 e E0766 in the frequently serviced FS payment category and E1352 The following new codes are in the prosthetics and orthotics PO payment category L5969 L8679 L0455 L0457 L0467 L0469 L0641 L0643 L0648 L0651 L1812 L1833 L1848 L3678 L3809 L3916 L3918 L3924 L3930 L4361 L4387 and L4397 The following code is deleted from the HCPCS effective January 1 2014 and therefore is removed from the DMEPOS fee schedule files L0430 The following codes are deleted from the DMEPOS fee schedule files as of January 1 2014 A4611 A4612 A4613 E0457 E0459 L8685 L8686 L8687 and L8688 For gap filling purposes the 2013 deflation factors by payment category are listed in the following table Factor Category 0 469 Oxygen 0 472 Capped Rental 0 473 Prosthetics and Orthotics 0 600 Surgical Dressings 0 653 Parental and Enteral Nutrition
58. e contractors A B MACs hospice and home health HH amp H MACs and durable medical equipment MACs DME MACs for services provided to Medicare beneficiaries Provider Action Needed CMS issued CR 8506 as an informational alert to providers that language only changes updates to the Medicare National Coverage Determinations NCD Manual Pub 100 03 were made The changes were made to comply with Conversion from ICD 9 to ICD 10 Conversion from ASC X12 Version 4010 to Version 5010 Conversion of former contractor types to MACs and PSN Other miscellaneous editorial and formatting updates provided for better clarity correctness and consistency Note The edits made to the NCD Manual are technical editorial only and in no way alter existing NCD policies Background These edits to Pub 100 03 are part of a CMS wide initiative to update its manuals and bring them in line with recently released instructions regarding the above noted subject matter Additional Information The official instruction CR 8506 issued to your MAC regarding this change may be viewed at http Awww cms gov Regulations and Guidance Guidance Transmittals downloads R159NCD pdf on the CMS website If you have any questions please contact a CGS Customer Service Representative by calling the CGS Provider Contact Center at 1 877 299 4500 and choose Option 1 This newsletter should be shared with all health care practitioners
59. e same Provider Types Affected This MLN Matters article is intended for physicians other providers and suppliers submitting claims to Medicare administrative contractors MACs including durable medical equipment Medicare administrative contractors DME MACs and home health amp hospice MACs for services to Medicare beneficiaries Provider Action Needed This article is based on CR 8582 which informs Medicare contractors about the changes to Claim Status Category Codes and Claim Status Codes Make sure that your billing personnel are aware of these changes This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 04 APRIL 2014 BIE lt m IE m gt T Ro T 0A I O m 31 Background The Health Insurance Portability and Accountability Act HIPAA requires all health care benefit payers to use only Claim Status Category Codes and Claim Status Codes approved by the national Code Maintenance Committee in the X12 276 277 Health Care Claim Status Request and Response format adopted as the standard for national use e g previous HIPAA named versions included 004010X093A1 These codes explain the status of submitted claim s Proprietary codes m
60. ective and implementation dates All other information remains the same Provider Types Affected This MLN Matters article is intended for physicians providers and suppliers submitting claims to Medicare administrative contractors MACs including home health amp hospice HH amp H MACs and durable medical equipment Medicare administrative contractors DME MACs for services to Medicare beneficiaries Provider Action Needed This article is based on CR 8456 which informs Medicare contractors about changes to the Medicare Beneficiary Database MBD File to include Diagnosis Codes on the Health Insurance Portability and Accountability Act Eligibility Transaction System HETS 270 271 transactions The HETS 271 response transaction will include as much Medicare Secondary Payer MSP information as possible to assist providers physicians and suppliers to identify which diagnosis codes are relevant to given MSP no fault liability and workers compensation cases The diagnosis codes that the provider community will access via the HETS 270 271 process will assist providers physicians and other suppliers to better determine when Medicare is the secondary payer in association with their patients current liability no fault or workers compensation incidents that may prompt beneficiaries to seek medical services Please ensure that your billing staffs are aware of these changes Background The HETS 270 271 process is
61. edicare Part D Fact Sheet ICN 908764 downloadable and hard copy at http www cms gov Outreach and Education Medicare Learning Network MLN MLNProducts Downloads Vaccines Part D Factsheet ICN908764 pdf NEW Hospice Related Services Part B Podcast ICN 908995 downloadable only at http www cms gov Outreach and Education Medicare Learning Network MLN MLNProducts MLN Multimedia Items ICN908995 podcast html REVISED Contractor Entities At A Glance Who May Contact You About Specific Centers for Medicare amp Medicaid Services CMS Activities Educational Tool ICN 906983 downloadable at http www cms gov Outreach and Education Medicare Learning Network MLN MLNProducts Downloads ContractorEntityGuide ICN906983 pdf REVISED Quick Reference Information Medicare Immunization Billing Educational Tool ICN 006799 downloadable at http www cms gov Outreach and Education Medicare Learning Network MLN MLNProducts Downloads gr_immun_bill pdf REVISED Medical Privacy of Protected Health Information Fact Sheet ICN 006942 downloadable at http www cms gov Outreach and Education Medicare Learning Network MLN MLNProducts Downloads SE0726FactSheet pdf REVISED General Equivalence Mappings Frequently Asked Questions Booklet ICN 901743 hard copy only at http Awww cms gov Medicare Coding ICD10 Downloads GEMs CrosswalksBasicFAQ pdf REVISED Medicare Enrollment an
62. er Service Representative by calling the CGS Provider Contact Center at 1 877 299 4500 and choose Option 1 For Home Health and Hospice Providers News Flash Messages from the Centers for Medicare amp Medicaid Services CMS e Looking for the latest new and revised MLN Matters articles Subscribe to the MLN Matters electronic mailing list For more information about MLN Matters and how to register for this service go to http www cms gov Outreach and Education Medicare Learning Network MLN MLNProducts downloads What_Is_MLNMatters pdf and start receiving updates immediately Generally Medicare Part B covers one flu vaccination and its administration per flu season for beneficiaries without co pay or deductible Now is the perfect time to vaccinate beneficiaries Health care providers are encouraged to get a flu vaccine to help protect themselves from the flu and to keep from spreading it to their family co workers and patients Note The flu vaccine is not a Part D covered drug For more information visit MLN Matters Article MM8433 Influenza Vaccine Payment Allowances Annual Update for 2013 2014 Season hitp www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles Downloads MM8433 pdf MLN Matters Article SE1336 2013 2014 Influenza Flu Resources for Health Care Professionals http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles D
63. er that allows providers to re associate the EFT health care payment with its associate electronic remittance advice Make sure that your billing staffs are aware of these changes Note that CR 8619 requires MACs to modify or change data elements currently inputted into payment information that is transmitted through the ACH EFT Network with electronic health care payments Physicians other providers and suppliers should be aware that consequently the payment information that a provider receives or that is transmitted from a provider s financial institution regarding the health care EFT payment may change as per these requirements Specifically the Company Entry Description and the TRN Segment that is reported or transmitted to a provider from its financial institution may change in terms of content or length Providers are urged to contact their financial institutions directly in order to understand the form in which payment information will be transmitted or reported on a per payment basis as a result of CR 8619 We suggest that providers should subsequently take steps to assure that the payment information that is changed as a result of related CR 8629 see the related article at http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles Downloads MM8629 pdf can be accommodated by your accounting processes and systems This newsletter should be shared with all health care practitioners and ma
64. er to furnish vaccines to hospice beneficiaries Key Points e Your MAC will allow professional claims for vaccines Influenza PPV and Hepatitis B and vaccine administration containing modifier GW when the date of service falls within a hospice election e Your MAC will adjust vaccine claims with dates of service on or after October 1 2013 which were previously rejected due to a hospice election if you bring such claims to your MAC s attention This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at http www cgsmedicare com 2014 Copyright CGS Administrators LLC TABLE OF CONTENTS MEDICARE BULLETIN GR 2014 04 APRIL 2014 38 Note from CGS Once this CR is implemented April 7 2014 providers may submit a reopening request to CGS to adjust and pay rejected claims with dates of service on or after October 1 2013 which are processed through April 6 2014 Providers must submit the HHH Reopening Adjustment Request Form https www cgsmedicare com hhh appeals pdf hhh_reopening_form pdf and include a hardcopy UB 04 adjustment claim XX7 For information about submitting a reopening refer to the Clerical Reopenings section of the Reopenings Web page at hitps www cgsmedicare com hhh appeals Reopenings html Additional Information The official instruction CR 8620
65. es html MLN Matters Number MM8569 Related Change Request CR CR 8569 Related CR Release Date February 5 2014 Effective Date July 1 2014 Related CR Transmittal R2867CP Implementation Date July 7 2014 Provider Types Affected This MLN Matters article is intended for providers submitting claims to Medicare Administrative Contractors MACs for services to Medicare beneficiaries Provider Action Needed This article based on CR 8569 instructs MACs to implement system edits to prevent payment of respite care for more than 5 days at a time for any hospice claim submitted on or after July 1 2014 This instruction will enforce the current policy that limits payment of respite care to no more than 5 consecutive days Make sure your billing staffs are aware of this update Background The Code of Federal Regulations CFR 42 Part 418 302 states that payment for inpatient respite care is subject to the requirement that it may not be provided consecutively for more than 5 days at a time Payment for the sixth and any subsequent day of respite care is made at the appropriate home care rate In an effort to prevent potential overpayments in the Medicare Hospice benefit CR 8569 implements new edits This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cg
66. etails about these enhancements link to the document above or visit the Apps for Tracking Assistance page on the Open Payments website QR Code Technical Guide Available for Apps Also now available to support use of the Open Payments apps is a how to guide that explains the technical details associated with how to create Quick Response QR codes usable in the apps The Open Payments QR Code Reader How To Guide includes detailed highly technical instructions for creating or importing contact information using a QR code reader and generating a QR code to transfer profile or payment information to other user s devices Additional Information If you have any questions please contact a CGS Customer Service Representative by calling the CGS Provider Contact Center at 1 877 299 4500 and choose Option 1 To review The Open Payments Mobile Application Quick Response QR Code Reader Documentation A How To Guide to Create Java Script Object Notation JSON QR Code referenced in this SE1402 see http www cms gov Regulations and Guidance Legislation National Physician Payment Transparency Program Downloads Open Payments QR Code Reader How To Guide 5bDecember 2013 5d pdf on the CMS website BIE lt m IE m gt T Ro T 0A I O m To review the series of SE articles leading up to SE1402 see the following 1 MLN Matters SE1303 Information on the National Physician Payment T
67. fication of Diseases 10th Edition Clinical Modification ICD 10 CM codes located at http cems hhs gov Medicare Coding ICD10 ICD 10 MS DRG Conversion Project html on the CMS website On this web page you can also find current versions of the ICD 10 CM MS DRG Grouper Medicare Code Editor available from National Technical Information Service and MS DRG Definitions Manual that will allow you to analyze any payment impact from the conversion of the MS DRGs from ICD 9 CM to ICD 10 CM codes and to compare the same version in both ICD 9 CM and ICD 10 CM and A pilot version of the October 2013 Integrated Outpatient Code Editor IOCE that utilizes ICD 10 CM located at http www cms gov Medicare Coding OutpatientCodeEdit Downloads ICD 10 IOCE Code Lists pdf on the CMS website The final version of the IOCE that utilizes ICD 10 CM is scheduled for release in August 2014 Crosswalks for Local Coverage Determinations LCDs will be available in April 2014 If you will not be able to complete the necessary systems changes to submit claims with ICD 10 codes by October 1 2014 you should investigate downloading the free billing software that CMS offers from their MACs The software has been updated to support ICD 10 codes and requires an internet connection This billing software only works for submitting fee for service claims to Medicare Alternatively many MACs offer provider internet portals and some MACs offer a subset of these
68. for Open Payments 47 with Providers through the Common Edits SE1409 Revised Medicare Fee For Service FFS and Enhancements Module CEM and FFS gt International Classification of Diseases 10th Common Electronic Data Interchange CEDI 22 Edition ICD 10 Testing Approach 50 MM8485 Reporting Principal and Interest Amounts When Refunding Previously Recouped Money on the Remittance Advice RA 24 Bold italicized material is excerpted from the American Medical Association Current Procedural Terminology CPT codes Descriptions and other data only are copyrighted 2009 American Medical Association All rights reserved Applicable FARS DFARS apply MEDICARE BULLETIN GR 2014 04 APRIL 2014 2 For Home Health Providers MM8597 Correction CR Advance Beneficiary Notice of Noncoverage ABN Form CMS R 131 The Centers for Medicare amp Medicaid Services CMS has issued the following Medicare Learning Network MLN Matters article This MLN Matters article and other CMS articles can be found on the CMS website at http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles 2014 MLN Matters Articles html MLN Matters Number MM8597 Related Change Request CR CR 8597 Related CR Release Date February 14 2014 Effective Date May 15 2014 Related CR Transmittal R2878CP Implementation Date May 15 2014 Provider Types Affected This MLN Matters
69. g Code Revised Custom Fitted Orthotic Codes L0454 L0455 and L0454 L1810 11812 and L1810 L0456 L0457 and L0456 L1832 L1833 and L1832 L0466 L0467 and L0466 L1847 L1848 and L1847 L0468 L0469 and L0468 L3807 L3809 and L3807 L0626 L0641 and L0626 L3915 L3916 and L3915 L0627 L0642 and L0627 L3917 L3918 and L3917 L0630 L0643 and L0630 L3923 L3924 and L3923 L0631 L0648 and L0631 L3929 L3930 and L3929 L0633 L0649 and L0633 L4360 L4361 and L4360 L0637 L0650 and L0637 L4386 L4387 and L4386 L0639 L0651 and L0639 L4396 L4397 and L4396 Further information on the development of new OTS orthotic codes can be found at http www cms gov Medicare Medicare Fee for Service Payment DMEPOSFeeSched OTS_Orthotics html on the CMS website Neurostimulator Devices HCPCS codes L8685 L8686 L8687 and L8688 are not included on the 2014 DMEPOS fee schedule file They were removed from the file to reflect the change in the coverage indicators for these codes to invalid for Medicare I effective January 1 2014 However code L8679 Implantable Neurostimulator Pulse Generator Any Type is added to the HCPCS and DMEPOS fee schedule file effective January 1 2014 for billing Medicare claims previously submitted under L8685 L8686 L8687 and L8688 The fee schedule amounts for code L8679 are based on the established Medicare fee schedule amounts for all types of pulse generators under the previous HCPCS code E0756 Implantable
70. h Care Electronic MM8569 Enforcement of the 5 Day Payment Limit for Funds Transfers erenn 36 Respite Care under the Hospice Medicare Benefit 14 MM8620 CWF Editing for Vaccines Furnished at Hospice Correction 38 HOME HEALTH amp MM8629 Implementation of National Automated Clearinghouse Association NACHA Operating HOSPICE PROVIDERS Rules for Health Care Electronic Funds Transiter EIT isois 39 CGS Website Updates 16 f N News Flash Messages from the Centers Introducing the myCGS Web Portal Submitting for Medicare amp Medicaid Services CMS 41 Redeterminations through Forms Tab aaa 17 f Provide Your Feedback on the Home Health Medicare Credit Balance Quarterly Reminder 19 amp Hospice Website Redesign ts 43 MUN Connects M ErOVIQE BNO WS sasscaaettinsayaesetian a Provider Contact Center PCC Availability 43 PING ae Revie a Nadiiying tie Pally Commen Quarterly Provider Update ooo eee 44 Working File CWF to Medicare Beneficiary Database MBD File to Include Diagnosis Codes SE1249 Revised HIPAA Eligibility Transaction on the Health Insurance Portability and Accountability System HETS to Replace Common Working Act Eligibility Transaction System HETS 270 271 File CWF Medicare Beneficiary Health Transactions 21 Insurance Eligibility Queries ooo lees 45 MM8465 Revised International Classification E1402 Updated Mobile Applications Apps of Diseases 10th Revision ICD 10 Testing
71. h all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 04 APRIL 2014 20 For Home Health and Hospice Providers MM8456 Revised Modifying the Daily Common Working File CWF to Medicare Beneficiary Database MBD File to Include Diagnosis Codes on the Health Insurance Portability and Accountability Act Eligibility Transaction System HETS 270 271 Transactions The Centers for Medicare amp Medicaid Services CMS has issued the following Medicare Learning Network MLN Matters article on February 11 2014 A revision to this article was then issued on March 7 2014 The following reflects the revised article This MLN Matters article and other CMS articles can be found on the CMS website at http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles 2014 MLN Matters Articles html MLN Matters Number MM8456 Revised Related Change Request CR CR 8456 Related CR Release Date March 6 2014 Effective Date October 1 2014 Related CR Transmittal R13560TN Implementation Date October 6 2014 BIE lt m IE m gt T Ro T 0A I O m Note This article was revised on March 7 2014 to reflect a revised Change Request CR The revise CR changes the eff
72. http www cgsmedicare com hhh appeals Reopenings htm has been updated to specify that adjustments require the necessary adjustment coding condition code Document Control Number DCN and remarks as required documentation for Clerical and Ordering Referring Denial Reopenings This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 04 APRIL 2014 BIE lt m IE m gt T Ro T 0A I O m 16 For Home Health and Hospice Providers Introducing the myCGS Web Portal Submitting Redeterminations through Forms Tab This article is the third in a series of articles previously published in the CGS Medicare Bulletin to introduce the myCGS Web portal to all providers that submit claims to CGS The information below provides a general overview of the Forms tab in myCGS which allows CGS providers to submit redetermination requests the first appeal level and monitor the status of these requests using the myCGS Web portal ces Home Claims Remittance Eligibility Financial Tools Messages Forms Support User Provider You have O unread message s and 0 alerts ga aR lt m IE m gt T Ro T 0A I O m Welcome
73. icle and other CMS articles can be found on the CMS website at http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles 2014 MLN Matters Articles html MLN Matters Number SE1409 Revised Related Change Request CR N A Related CR Release Date N A Effective Date October 1 2014 Related CR Transmittal N A Implementation Date N A Note This article was revised on February 27 2014 to add information about the second week of acknowledgement testing and to provide more details about end to end testing BIE lt m IE m gt T Ro T 0A I O m Provider Types Affected This article is intended for all physicians providers and suppliers submitting claims to Medicare Administrative Contractors MACs including Home Health amp Hospice MACs HH amp H MACs and Durable Medical Equipment MACs DME MACs for services provided to Medicare beneficiaries Provider Action Needed For dates of service on and after October 1 2014 entities covered under the Health Insurance Portability and Accountability Act HIPAA are required to use the ICD 10 code sets in standard transactions adopted under HIPAA The HIPAA standard health care claim transactions are among those for which ICD 10 codes must be used for dates of service on and after October 1 2014 Be sure you are ready This MLN Matters Special Edition article is intended to convey the testing approach
74. ilable You can review the CY 2014 OPPS ASC final rule at http www gpo gov fdsys pkg FR 2013 12 10 pdf 2013 28737 pdf on the Internet In cases where adjustments to payment rates are necessary based on the most recent ASP submissions CMS will incorporate changes to the payment rates in the April 2014 release of the OPPS Pricer The updated payment rates effective April 1 2014 will be included in the April 2014 update of the OPPS Addendum A and Addendum B which will be posted at hitp www cms gov Medicare Medicare Fee for Service Payment HospitalOutpatientPPS Addendum A and Addendum B Updates html on the CMS website b Drugs and Biologicals with OPPS Pass Through Status Effective April 1 2014 Two drugs and biologicals have been granted OPPS pass through status effective April 1 2014 These items along with their descriptors and APC assignments are identified in Table 2 below Table 2 Drugs and Biologicals with OPPS Pass Through Status Effective April 1 2014 HCPCS Code Short Descriptor Long descriptor APC Status Indicator c9021 Injection obinutuzumab 10 mg Injection obinutuzumab 1476 G Q4121 Theraskin per square centimeter Theraskin 1479 G Note The HCPCS code identified with an indicates that this is a new code effective April 1 2014 c Revised Status Indicator for HCPCS Codes A9545 J1446 J7178 and Q0181 Effective April 1 2014 the status indicator for HCPCS code A9545
75. ion HETS HETS allows Medicare providers and their agents to submit and receive X12N 270 271 eligibility request and response files over a secure connection Many Medicare providers and their agents are already receiving eligibility information from HETS For more information about HETS and how to obtain access to the system refer to the CMS HETS Help Web page at http www cms gov Research Statistics Data and Systems CMS Information Technology HETSHelp HowtoGetConnectedHETS270271 html on the CMS website BIE lt m IE m gt T Ro T 0A I O m Frequently Asked Questions Are Medicare providers that currently use CWF to obtain beneficiary eligibility information required to switch to HETS No but it is recommended Providers may also choose to use a Medicare Contractor s IVR or Internet portal What are the minimum data elements required in order to complete an eligibility search in HETS HETS applies search logic that uses a combination of four data elements Health Insurance Claim Number HICN Medicare Beneficiary s Date of Birth Medicare Beneficiary s Full Last Name including Suffix if applicable and Medicare Beneficiary s Full First Name The Date of Birth and First Name are optional but at least one must be present Does HETS return the same eligibility information that is currently provided by the CWF eligibility queries Changes are currently underway in HETS to return psychiat
76. ions CMS will also alert researchers using CMS data files of this inconsistency The coding used to support the payment of the HIPPS code will be the ICD 9 CM codes that were used on the RAP and which are stored in the OASIS system These same procedures will apply to resumption of care assessments M0100 03 and to recertification M0100 04 and follow up M0100 05 assessments when the episode start date and the M0090 date on those assessments are both before October 1 2014 but the episode ends in October 2014 see table on next page Episodes Starting Before October 1 2014 with OASIS Completion Dates in October 2014 There may be cases where the episode start of care date is before October 1 2014 and due to the 5 day completion window the M0090 date is in October 2014 For example an initial episode with a start of care date of September 28 2014 could have an M0090 date of October 2 2014 In these cases ICD 10 CM codes will be used on the OASIS and to determine the HIPPS code This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 04 APRIL 2014 12 The RAP for this example would have From and Through dates of September 28 2014 As a result these RAPs
77. issued to your MAC regarding this change is available at http www cms gov Regulations and Guidance Guidance Transmittals Downloads R1339OTN pdf on the CMS website If you have any questions please contact a CGS Customer Service Representative by calling the CGS Provider Contact Center at 1 877 299 4500 and choose Option 1 For Home Health and Hospice Providers MM8629 Implementation of National Automated Clearinghouse Association NACHA Operating Rules for Health Care Electronic Funds Transfers EFT BIE lt m IE m gt T Ro T 0A I O m The Centers for Medicare amp Medicaid Services CMS has issued the following Medicare Learning Network MLN Matters article This MLN Matters article and other CMS articles can be found on the CMS website at http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles 2014 MLN Matters Articles html MLN Matters Number MM8629 Related Change Request CR CR 8629 Related CR Release Date February 21 2014 Effective Date July 1 2014 Related CR Transmittal R13490TN Implementation Date July 7 2014 Provider Types Affected This MLN Matters article is intended for physicians other providers and suppliers submitting claims to Medicare administrative contractors MACs including home health amp hospice MACs HH amp H MACs and durable medical equipment Medicare administrative contractors DME MACs for servi
78. l members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 04 APRIL 2014 29 STATE K0739 L4205 L7520 STATE K0739 L4205 L7520 AR 14 55 21 68 29 43 NE 14 55 21 66 41 04 AZ 17 99 21 66 36 21 NH 15 62 21 66 29 43 CA 22 32 35 59 41 48 NJ 19 63 21 66 29 43 CO 14 55 21 68 29 43 NM 14 55 21 68 29 43 CT 24 30 22 16 29 43 NV 23 18 21 66 40 12 DC 14 55 21 66 29 43 NY 26 79 21 68 29 43 DE 26 79 21 66 29 43 OH 14 55 21 66 29 43 FL 14 55 21 68 29 43 OK 14 55 21 68 29 43 GA 14 55 21 68 29 43 OR 14 55 21 66 42 32 HI 17 99 31 22 36 73 PA 15 62 22 30 29 43 IA 14 55 21 66 35 23 PR 14 55 21 68 29 43 ID 14 55 21 66 29 43 RI 17 34 22 32 29 43 IL 14 55 21 66 29 43 SC 14 55 21 68 29 43 IN 14 55 21 66 29 43 SD 16 26 21 66 39 35 KS 14 55 21 66 36 73 TN 14 55 21 68 29 43 KY 14 55 27 16 37 64 TX 14 55 21 68 29 43 LA 14 55 21 68 29 43 UT 14 59 21 66 45 83 MA 24 30 21 66 29 43 VA 14 55 21 66 29 43 MD 14 55 21 66 29 43 VI 14 55 21 68 29 43 ME 24 30 21 66 29 43 VT 15 62 21 66 29 43 MI 14 55 21 66 29 43 WA 23 18 31 77 37 74 MN 14 55 21 66 29 43 WI 14 55 21 66 29 43 MO 14 55 21 66 29 43 WV 14 55 21 66 29 43 MS 14 55 21 68 29 43 WY 20 28 28 89 41 04 MT 14 55 21 66 36 73 2014 National Monthly Pay
79. lect a revised CR that provides additional information to providers suppliers and clearinghouses about how claims will be submitted for testing page 2 in bold The transmittal number CR release date and link to the CR were also changed All other information remains the same Provider Types Affected This MLN Matters article is intended for Medicare providers and suppliers submitting claims to Medicare contractors A B Medicare administrative contractors A B MACs home health and hospice MACs HHH MACs and the durable medical equipment MACs DME MACs for services to Medicare beneficiaries What Providers Need to Know This article is based on CR 8465 which announces plans for front end ICD 10 testing between MACs and their trading partners This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 04 APRIL 2014 22 For dates of service of October 1 2014 and after providers are required to submit ICD 10 codes on their claims MACs must provide the opportunity for providers and suppliers to submit test claims through the CEM or the CEDI on the designated testing days e Test claims with ICD 10 codes must be submitted with current dates of service i e October 1 20
80. lumn at http www cms gov Medicare Medicare Fee for Service Payment HospitalOutpatientPPS index htm on the CMS OPPS website Coverage Determinations The fact that a drug device procedure or service is assigned a HCPCS code anda payment rate under the OPPS does not imply coverage by the Medicare program but indicates only how the product procedure or service may be paid if covered by the program MACs determine whether a drug device procedure or other service meets all program requirements for coverage For example MACs determine that it is reasonable and necessary to treat the beneficiary s condition and whether it is excluded from payment Additional Information The official instruction CR 8653 issued to your MAC regarding these changes is available at http www cms gov Regulations and Guidance Guidance Transmittals Downloads R2894CP pdf on the CMS website If you have any questions please contact a CGS Customer Service Representative by calling the CGS Provider Contact Center at 1 877 299 4500 and choose Option 1 This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 04 APRIL 2014 BIE lt m IE m gt T Ro T O WY I O m 10
81. main in effect until the reporting requirements are met If no credit balance exists for your facility during a quarter a signed Medicare Credit Balance Report certification is still required Please include your Medicare provider number on the certification form Refer to the Medicare Credit Balance Report CMS 838 form for complete instructions However for additional assistance in completing the form refer to the Tips on Completing a Credit Balance Report Form CMS 838 Web page at https www cgsmedicare com hhh financial 838_form_tips html on the CGS website To ensure timely receipt and processing please send to the appropriate address listed below Credit Balance Reports CMS 838 Certification with Checks If you are sending a check with the CMS 838 to repay the credit balance amount please send the check payable to Medicare Fund with either a copy of This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at http www cgsmedicare com 2014 Copyright CGS Administrators LLC TABLE OF CONTENTS MEDICARE BULLETIN GR 2014 04 APRIL 2014 19 the CMS 838 or a letter indicating that the check is associated with the CMS 838 to the following address CGS J15 Home Health and Hospice PO Box 957124 St Louis MO 63195 7124 In addition send the original CMS 838
82. mation available for three of these nine products Table 7 below shows the 3 new products and their low high cost status based on the comparison of the price per square centimeter for each product to the 32 square centimeter threshold for CY 2014 Table 7 Updated Payment Rates for Certain HCPCS Codes Effective April 1 2014 HCPCS Code Long Descriptor Status Indicator Low High Cost Status Q4143 Repriza Per Square Centimeter N Low Q4147 Architect Extracellular Matrix Per Square Centimeter N High Q4148 Neox 1k Per Square Centimeter N High This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at http www cgsmedicare com 2014 Copyright CGS Administrators LLC TABLE OF CONTENTS MEDICARE BULLETIN GR 2014 04 APRIL 2014 SIE lt m IE m gt L Ro T O WY w O m h Billing Guidance for the Topical Application of Mitomycin During or Following Ophthalmic Surgery Hospital outpatient departments should only bill HCPCS code J7315 Mitomycin ophthalmic 0 2 mg or HCPCS code J3490 unclassified drugs for the topical application of mitomycin during or following ophthalmic surgery J7315 may be reported only if the hospital uses mitomycin with the trade name Mitosol Any other topical mitomycin should be reported with J3490 Hospital outpatient departme
83. ment Amounts for Stationary Oxygen Equipment CR8531 implements the 2014 national monthly payment amount for stationary oxygen equipment HCPCS codes E0424 E0439 E1390 and E1391 effective for claims with dates of service on or after January 1 2014 As required by statute the payment amount must be adjusted on an annual basis as necessary to ensure budget neutrality of the new payment class for Oxygen Generating Portable Equipment OGPE The updated 2014 monthly payment amount of 178 24 includes the 1 percent update factor for the 2014 DMEPOS fee schedule Please note that when updating the stationary oxygen equipment fees corresponding updates are made to the fee schedule amounts for HCPCS codes E1405 and E1406 for oxygen and water vapor enriching systems Since 1989 the fees for codes E1405 and E1406 have been established based on a combination of the Medicare payment amounts for stationary oxygen equipment and nebulizer codes E0585 and E0570 respectively 2014 Maintenance and Servicing Payment Amount for Certain Oxygen Equipment CR 8531 also updates the 2014 payment amount for maintenance and servicing for certain oxygen equipment You can read more about payment for claims for maintenance and servicing for oxygen equipment in MLN Matters Articles MM6792 at http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles downloads MM6792 pdf and MM6990 at http www cms gov Outreach and Education Medica
84. nagerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at oO http www cgsmedicare com 2014 Copyright CGS Administrators LLC TABLE OF CONTENTS MEDICARE BULLETIN GR 2014 04 APRIL 2014 36 Background The regulation adopting the Health Care EFT standards is available at https www federalregister gov articles 2012 01 10 2012 132 administrative simplification adoption of standards for health care electronic funds transfers efts on the Internet The regulation adopting the EFT amp ERA Operating Rules can be found at https www federalregister gov articles 2012 08 10 2012 19557 administrative simplification adoption of operating rules for health care electronic funds transfers h 4 on the Internet A new National Automated Clearinghouse Association NACHA standard for electronic healthcare claim payments went into effect on September 20 2013 impacting all originators and receivers of electronic funds transfers EFT used to pay healthcare claims This Healthcare EFT standard stems from the Affordable Care Act which requires that healthcare payers must pay healthcare claim payments electronically using HIPAA standards if requested by the healthcare provider The standard designated for these claim payments is the Healthcare EFT Standard which is a NACHA CCD transaction that includes the ASC X12 835 TRN data segment in the addenda record The Healthcare EFT Stan
85. nt for all applicable lines Note The tables of APCs and devices to which the offset reductions apply and the full and partial offset amounts are available at http www cms gov Medicare Medicare Fee for Service Payment HospitalOutpatientPPS index html on the CMS website New Services New services listed in Table 1 below are assigned for payment under the OPPS effective April 1 2014 Table 1 New Services Payable under OPPS Effective April 1 2014 Effective Minimum Unadjusted HCPCS date SI APC Short Descriptor Long descriptor Payment Copayment C9739 4 01 2014 T 0162 Cystoscopy Cystourethroscopy with 2 007 32 401 47 prostatic imp 1 3 insertion of transprostatic implant 1 to 3 implants This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at http www cgsmedicare com 2014 Copyright CGS Administrators LLC TABLE OF CONTENTS MEDICARE BULLETIN GR 2014 04 APRIL 2014 BIE lt m IE m gt T Ro T 0A I O m Table 1 New Services Payable under OPPS Effective April 1 2014 Effective Minimum Unadjusted HCPCS date SI APC Short Descriptor Long descriptor Payment Copayment C9740 4 01 2014 T 1564 Cystoimpl4or Cystourethroscopy wi
86. nts are not permitted to bill HCPCS code J9280 Injection mitomycin 5 mg for the topical application of mitomycin New HCPCS Code Effective April 1 2014 One new HCPCS code has been created for reporting services supplies and accessories used in the home under the Medicare intravenous immune globulin IVIG demonstration This code is listed in Table 8 below and it is effective for services furnished on or after April 1 2014 Table 8 New HCPCS Codes Effective April 1 2014 Status Indicator HCPCS Code Long Descriptor Short Descriptor Effective 4 1 14 Q2052 Services supplies and accessories used in the home under the Ivig demo N Medicare intravenous immune globulin ivig demonstration services supplies Changes to OPPS Pricer Logic Effective January 1 2014 for claims with APCs which require implantable devices and have significant device offsets greater than 40 percent a device offset cap will be applied to the applicable procedure line based on the credit amount listed in the FD Credit Received from the Manufacturer for a Replaced Medical Device value code The credit amount in value code FD which reduces the post wage adjusted APC line payment for the applicable procedure will be capped by the device offset amount for that APC The offset amounts for the above referenced APCs along with the offsets for other APCs is available under the Annual Policy Files link on the left co
87. o cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 04 APRIL 2014 44 For Home Health and Hospice Providers SE1249 Revised HIPAA Eligibility Transaction System HETS to Replace Common Working File CWF Medicare Beneficiary Health Insurance Eligibility Queries The Centers for Medicare amp Medicaid Services CMS has issued a revision to the following Special Edition Medicare Learning Network MLN Matters article This MLN Matters article and other CMS articles can be found on the CMS website at http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles 2012 MLN Matters Articles htm MLN Matters Number SE1249 Revised Related Change Request CR N A Related CR Release Date N A Effective Date N A Related CR Transmittal N A Implementation Date N A Note This article was revised on February 10 2014 to update certain language to reflect the current status of this change see bolded language on page 2 Also clarifications have been made to the last question in the Frequently Asked Questions section on page 3 All other information is unchanged BIE lt m IE m gt T Ro T 0A I O m Provider Types Affected This MLN Matters Special Edition Article is intended for health care providers suppliers and their billing agents software vendors
88. o included in the update The purpose of the Quarterly Provider Update is to BIE lt m IE m gt T Ro T 0A I O m e Inform providers about new developments in the Medicare program e Assist providers in understanding CMS programs and complying with Medicare regulations and instructions e Ensure that providers have time to react and prepare for new requirements e Announce new or changing Medicare requirements on a predictable schedule and e Communicate the specific days that CMS business will be published in the Federal Register To receive notification when regulations and program instructions are added throughout the quarter go to https www cms gov Regulations and Guidance Regulations and Policies QuarterlyProviderUpdates CMS Quarterly Provider Updates Email Updates htm to sign up for the Quarterly Provider Update electronic mailing list We encourage you to bookmark the Quarterly Provider Update website at https www cms gov Regulations and Guidance Regulations and Policies QuarterlyProviderUpdates index html and visit it often for this valuable information If you have any questions please contact a CGS Customer Service Representative by calling the CGS Provider Contact Center at 1 877 299 4500 and choose Option 1 This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at n
89. om our website at http www cgsmedicare com 2014 Copyright CGS Administrators LLC TABLE OF CONTENTS MEDICARE BULLETIN GR 2014 04 APRIL 2014 BIE lt m IE m gt T Ro T 0A I O m 15 For Home Health and Hospice Providers CGS Website Updates CGS has recently made updates to their website giving providers additional resources to assist with billing Medicare covered services appropriately Please review the following updates e Hospice Medicare Billing Codes Sheet Quick Resource Tool This quick resource tool available at http www cgsmedicare com hhh education materials pdf Hospice _Medicare_Billing Codes_Sheet pdf has been updated to include the most recent coding information for billing hospice claims Updates were made to include billing information provided in Change Request 8358 which is required for dates of service April 1 2014 optional beginning January 1 2014 The Beneficiary Eligibility Information FAQs Web page at http www cgsmedicare com hhh education faqs Beneficiary Eligibility_Info_FAQs html and the Checking Beneficiary Eligibility Web page at http www cgsmedicare com hhh claims checking_bene_eligibility ntm have been updated to include information about the revised SE1249 Medicare Learning Network MLN Matters article indicating that provider access to ELGA ELGH which was originally scheduled to be terminated April 7 2014 has been delayed
90. on the CMS website This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 04 APRIL 2014 BIE lt m IE m gt T Ro T 0A I O m 24 If you have any questions please contact a CGS Customer Service Representative by calling the CGS Provider Contact Center at 1 877 299 4500 and choose Option 1 For Home Health and Hospice Providers MM8506 Pub 100 03 Chapter 1 Language only Update The Centers for Medicare amp Medicaid Services CMS has issued the following Medicare Learning Network MLN Matters article This MLN Matters article and other CMS articles can be found on the CMS website at htto www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles 2014 MLN Matters Articles html MLN Matters Number MM8506 Related Change Request CR CR 8506 Related CR Release Date February 5 2014 Effective Date October 1 2014 Related CR Transmittal R159NCD Implementation Date October 1 2014 Provider Types Affected BIE lt m IE m gt T Ro T 0A I O m This MLN Matters article is intended for physicians providers and suppliers submitting claims to A B Medicare administrativ
91. ost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 04 APRIL 2014 BIE lt m IE m gt T Ro T 0A I O m 42 10 Coding Basics Sue Bowman from the American Health Information Management Association AHIMA provides a basic introduction to ICD 10 coding including Similarities and differences ICD 10 code structure and Coding process and examples To receive notification of upcoming MLN Connects videos and calls and the latest Medicare program information on ICD 10 subscribe to the weekly MLN Connects Provider eNews at https public dc2 govdelivery com accounts USCMS subscriber new pop t amp topic_id USCMS_7819 MLN Matters Articles Index Have you ever tried to search MLN Matters articles for information regarding a certain issue but you did not know what year it was published To assist you next time in your search try the CMS article indexes that are published at http www cms gov outreach and education medicare learning network min MLNMattersArticles on the CMS website These indexes resemble the index in the back of a book and contain keywords found in the articles including HCPCS codes and modifiers These are published every month Just search ona keyword s and you will find articles that contained those word s Then just click on one of the related article numbers and it will open
92. ownloads SE1336 pdf HealthMap Vaccine Finder http vaccine healthmap org a free online service where users can search for locations offering flu and other adult vaccines While some providers may offer flu vaccines those that don t can help their patients locate flu vaccines within their local community This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 04 APRIL 2014 zie O lt m IE m gt T Ro T 0A I O m 41 Free Resources http www cdc gov flu freeresources can be downloaded from the CDC website including prescription style tear pads that allow you to give a customized flu shot reminder to patients at high risk for complications from the flu On the CDC order form under Programs select Immunizations and Vaccines Influenza Flu for a list of flu related resources Products from the Medicare Learning Network MLN NEW Information on the National Physician Payment Transparency Program Open Payments Podcast ICN 908961 downloadable only at http www cms gov Outreach and Education Medicare Learning Network MLN MLNProducts MLN Multimedia Items ICN908961 Podcast html NEW Vaccine Payments Under M
93. oximated total allowed services for each code for items furnished during the Calendar Year 2012 The fee schedule amounts for shoe modification codes A5503 through A5507 are being revised to reflect this change effective January 1 2014 Off the Shelf Orthotics Section 1847 a 2 C of the Act mandates implementation of competitive bidding programs throughout the United States for awarding contracts for furnishing Off The Shelf OTS orthotics which require minimal self adjustment for appropriate use and do not require expertise in trimming bending molding assembling or customizing to fit the individual Regulations at 42 CFR 414 402 define the term minimal self adjustment to mean an adjustment that the beneficiary caretaker for the beneficiary or supplier of the device can perform and that does not require the services of a certified orthotist This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 04 APRIL 2014 21 an individual who is certified by the American Board for Certification in Orthotics and Prosthetics Inc or by the Board for Orthotist Prosthetist Certificationor an individual who has specialized training As shown in the following table 22 new codes are adde
94. p www cgsmedicare com 2014 Copyright CGS Administrators LLC TABLE OF CONTENTS MEDICARE BULLETIN GR 2014 04 APRIL 2014 23 Additional Information The official instruction CR 8465 issued to your MAC regarding this change may be viewed at http www cms gov Regulations and Guidance Guidance Transmittals Downloads R13530TN pdf on the CMS website If you have any questions please contact a CGS Customer Service Representative by calling the CGS Provider Contact Center at 1 877 299 4500 and choose Option 1 For Home Health and Hospice Providers MM8485 Reporting Principal and Interest Amounts When Refunding Previously Recouped Money on the Remittance Advice RA The Centers for Medicare amp Medicaid Services CMS has issued the following Medicare Learning Network MLN Matters article This MLN Matters article and other CMS articles can be found on the CMS website at htto www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles 2014 MLN Matters Articles html MLN Matters Number MM8485 Related Change Request CR CR 8485 Related CR Release Date February 6 2014 Effective Date July 1 2014 Related CR Transmittal R13420TN Implementation Date July 7 2014 Provider Types Affected This MLN Matters article is intended for physicians and other providers submitting claims to Medicare administrative contractors MACs including home health amp hospice HH amp H
95. portals that you can register for to ensure that you have the flexibility to submit professional claims this way as a contingency This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at http www cgsmedicare com 2014 Copyright CGS Administrators LLC TABLE OF CONTENTS MEDICARE BULLETIN GR 2014 04 APRIL 2014 51 Acknowledgement Testing Crosswalks for Local Coverage Determinations LCDs will be available in April 2014 If you will not be able to complete the necessary systems changes to submit claims with ICD 10 codes by October 1 2014 you should investigate downloading the free billing software that CMS offers from their MACs The software has been updated to support ICD 10 codes and requires an internet connection This billing software only works for submitting fee for service claims to Medicare Alternatively many MACs offer provider internet portals and some MACs offer a subset of these portals that you can register for to ensure that you have the flexibility to submit professional claims this way as a contingency were accepted or rejected For more information about acknowledgement testing refer to the information on your MAC s website Note from CGS For more information about the ICD 10 testing week refer to the ICD 10 CM PCS Web page at https www cgsmedicare com hhh claims
96. provide at least 90 days advanced notice of the new termination date This will not affect the use of DDE to submit claims or to correct claims and will not impact access to beneficiary eligibility information from Medicare Contractor s Interactive Voice Response IVR units and or Internet portals This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 04 APRIL 2014 45 Background In 2005 CMS began offering HETS in a real time environment to Medicare health care providers suppliers and their billing agents software vendors and clearinghouses HETS is Medicare s Health Care Eligibility Benefit Inquiry and Response electronic transaction ASCX12 270 271 Version 5010 adopted under HIPAA HETS replaces the CWF queries and is to be used for the business of Medicare such as preparing an accurate Medicare claim or determining eligibility for specific services Key Points General Information CMS plans to discontinue access to the CWF queries through the shared systems Medicare providers and their agents that currently access the CWF queries through the shared system screens will need to modify their business processes to use HETS to access Medicare beneficiary eligibility informat
97. ransparency Program Open Payments is available at http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles Downloads SE1303 pdf on the CMS website 2 MLN Matters SE1329 Mobile Apps for the Open Payments program Physician Payments Sunshine Act is available at http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles Downloads SE1329 pdf on the CMS website 3 MLN Matters SE1330 Open Payments An Overview for Physicians and Teaching Hospitals may be found at http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles downloads SE1330 pdf on the CMS website This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 04 APRIL 2014 49 For Home Health and Hospice Provides SE1409 Revised Medicare Fee For Service FFS International Classification of Diseases 10th Edition ICD 10 Testing Approach The Centers for Medicare amp Medicaid Services CMS issued the following Special Edition Medicare Learning Network MLN Matters article on February 19 2014 A revision to this article was then issued on February 27 2014 This MLN Matters art
98. re Learning Network MLN MLNMattersArticles downloads MM6990 pdf on the CMS website This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at http www cgsmedicare com 2014 Copyright CGS Administrators LLC TABLE OF CONTENTS MEDICARE BULLETIN GR 2014 04 APRIL 2014 BIE lt m IE m gt T Ro T 0A I O m 30 To summarize payment for maintenance and servicing of certain oxygen equipment can occur every 6 months beginning 6 months after the end of the 36th month of continuous use or end of the supplier s or manufacturer s warranty whichever is later for either HCPCS code E1390 E1391 E0433 or K0738 billed with the MS modifier Payment cannot occur more than once per beneficiary regardless of the combination of oxygen concentrator equipment and or transfilling equipment used by the beneficiary for any 6 month period Per 42 CFR 414 210 5 iii the 2010 maintenance and servicing fee for certain oxygen equipment was based on 10 percent of the average price of an oxygen concentrator For CY 2011 and subsequent years the maintenance and servicing fee is adjusted by the covered item update for DME as set forth in Section1834 a 14 of the Act Thus the 2013 maintenance and servicing fee is adjusted by the 1 percent MFP adjusted covered item update
99. rective If the HHA s State Medicaid office does NOT want a claim filed with Medicare prior to filing a claim with Medicaid the HHA should direct the beneficiary to choose Option 2 When Option 2 is chosen based on State guidance but the HHA is aware that the State sometimes asks for a Medicare claim submission at a later time the HHA must add a statement in the Additional Information box such as Medicaid will pay for these services Sometimes Medicaid asks us to file a claim with Medicare We will file a claim with Medicare if requested by your Medicaid plan Additional Information The official instruction CR 8597 issued to your MAC regarding this change may be viewed at http Awww cms gov Regulations and Guidance Guidance Transmittals Downloads R2878CP pdf on the CMS website If you have any questions please contact a CGS Customer Service Representative by calling the CGS Provider Contact Center at 1 877 299 4500 and choose Option 1 For Home Health Providers MM8653 April 2014 Update of the Hospital Outpatient Prospective Payment System OPPS The Centers for Medicare amp Medicaid Services CMS has issued the following Medicare Learning Network MLN Matters article This MLN Matters article and other CMS articles can be found on the CMS website at http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles 2014 MLN Matters Articles htm MLN Matters
100. resentative by calling the CGS Provider Contact Center at 1 877 299 4500 and choose Option 1 This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 04 APRIL 2014 52
101. ric information to authorized providers and to return Hospice period information in the same format as CWF When these changes are made HETS will return all of the information provided by the CWF eligibility queries that is needed to process Medicare claims These changes will be in place before the termination date for the FISS DDE CWF query access HETS returns additional information that CWF does not return For example HETS returns e Part D plan number address and enrollment dates and e Medicare Advantage Organization name address website and phone number This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 04 APRIL 2014 46 The HETS 270 271 Companion Guide provides specific details about the eligibility information that is returned in the HETS 271 response The guide is available at http www cms gov Research Statistics Data and Systems CMS Information Technology HETSHelp Downloads HETS270271CompanionGuide5010 pdf on the CMS website Additional Information If you use a software vendor or clearinghouse to access Medicare beneficiary health insurance eligibility information you should direct questions to your vendor or clearinghouse If you have any questions
102. rmation claim and deductible information and general information For information about the IVR access the IVR User Guide at http www cgsmedicare com hhh help pdf IVR_User_Guide pdf on the CGS website In addition This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at O http www cgsmedicare com 2014 Copyright CGS Administrators LLC TABLE OF CONTENTS MEDICARE BULLETIN GR 2014 04 APRIL 2014 43 CGS Internet portal myCGS is available to access eligibility information through the Internet For additional information go to http www cgsmedicare com hhh index html and click the myCGS button on the left side of the Web page For your reference access the Home Health amp Hospice 2014 Holiday Training Closure Schedule at https Awww cgsmedicare com hhh help pdf Holiday_Schedule pdf for a complete list of PCC closures For Home Health and Hospice Providers Quarterly Provider Update The Quarterly Provider Update is a comprehensive resource published by the Centers for Medicare amp Medicaid Services CMS on the first business day of each quarter It is a listing of all nonregulatory changes to Medicare including transmittals manual changes and any other instructions that could affect providers Regulations and instructions published in the previous quarter are als
103. roviders Change Request 8358 Frequently Asked Questions FAQs Through a cooperative effort the Home Health amp Hospice HH amp H Medicare Administrative Contractors MACs have developed an extensive list of FAQs to assist hospice providers in implementing data reporting changes mandated by Change Request CR 8358 http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles Downloads MM8358 pdf Answers to the most common questions can be answered by this document including when drugs must be reported and how they are reported on a claim The FAQs can be accessed from the CGS Frequently Asked Questions Web page at http www cgsmedicare com hhh education faqs index html below the Hospice Billing header and is labeled Change Request 8358 Providers should review this document before calling the CGS Provider Contact Center with any questions related to CR 8358 BIE lt m IE m gt T Ro T 0A I O m For Hospice Providers MM8569 Enforcement of the 5 Day Payment Limit for Respite Care under the Hospice Medicare Benefit The Centers for Medicare amp Medicaid Services CMS has issued the following Medicare Learning Network MLN Matters article This MLN Matters article and other CMS articles can be found on the CMS website at http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles 2014 MLN Matters Articl
104. rticles can be found on the CMS website at http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles 2014 MLN Matters Articles html BIE lt m IE m gt T Ro T 0A I O m MLN Matters Number MM8620 Related Change Request CR CR 8620 Related CR Release Date February 6 2014 Effective Date October 1 2013 Related CR Transmittal R13390TN Implementation Date April 7 2014 Provider Types Affected This MLN Matters article is intended as an update for non hospice providers furnishing vaccines to hospice beneficiaries and submitting claims to Medicare Administrative Contractors MACs Provider Action Needed CMS issued CR 8620 to alert providers that any provider may furnish vaccines to hospice beneficiaries Be sure your billing staffs are aware of this change Background When CR 8098 Transmittal 1298 was published effective October 1 2013 it denied claims for vaccines furnished to hospice patients that were provided by anyone other than the patient s hospice provider This was to enforce the statement in the Medicare Claims Processing Manual chapter 18 section 10 2 4 that vaccines may be covered when furnished by the hospice CMS has determined that this enforcement is too restrictive since the manual does not say only when furnished by the hospice CR 8620 removes the changes made to Medicare systems in CR 8098 in order to allow any provid
105. s suppliers and other covered entities who submit claims to Medicare administrative contractors MACs for services provided to Medicare beneficiaries in home health HH care settings Provider Action Needed This MLN Matters Special Edition SE 1410 alerts providers that on October 1 2014 all Medicare claims submissions of diagnosis codes will change from the International Classification of Diseases 9th Edition Clinical Modification ICD 9 CM to the 10th Edition ICD 10 CM All entities covered by the Health Insurance Portability and Accountability Act HIPAA must make this transition requiring systems changes throughout the entire health care industry Background In 2011CMS issued CR 7492 which provided information on reporting guidelines and claims submissions requirements for ICD 10 CM Particularly CR 7492 provided instructions regarding claims with service dates that span the ICD 10 effective date Recently CMS issued an updated article SE1408 at http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles Downloads SE1408 pdf which provides special billing instructions for home health agencies HHAs to apply to HH claims where the episode begins in August or September 2014 and ends in October 2014 MLN Matters article SE1408 also provides details for coding other types of claims for services that span the ICD 10 implementation date of October 1 2014 This article provides further detail
106. s regarding HH claims for episodes that span he October 1 date Key Points of This Article Three factors affect how ICD 10 CM must be used on these episodes for services that span the October 1 date This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at http www cgsmedicare com 2014 Copyright CGS Administrators LLC TABLE OF CONTENTS MEDICARE BULLETIN GR 2014 04 APRIL 2014 11 1 The claim From date episode start date 2 The Outcome and Assessment Information Set OASIS assessment completion date OASIS item M0090 date and 3 The claim Through date Episodes Starting Before October 1 2014 with OASIS Completion Dates Before October 1 2014 In the case of initial HH episodes the OASIS assessment must be completed within 5 days of the start of care The assessment completion date M0090 date determines whether the HH Grouper software that determines the payment group for the episode will apply ICD 9 CM or ICD 10 CM codes to the episode In the case where the episode start of care date is before October 1 2014 and the M0090 date is also before October 1 2014 ICD 9 CM codes will be used on the OASIS and to determine the payment group code the Health Insurance Prospective Payment System HIPPS code For HH claims type of bill 032x ICD 10 CM reporting
107. s to Medicare beneficiaries An example of an approved customization of the ABN which can be used by providers of laboratory services Sample Lab ABN is now available for download at http www cms gov Medicare Medicare General Information BNI ABN html When issuing ABNSs to dual eligibles or beneficiaries having a secondary insurer HHAs are permitted to direct the beneficiary to select a particular option box on the notice to facilitate coverage by another payer This is an exception to the usual ABN issuance guidelines prohibiting the notifier from selecting one of the options for the beneficiary When a Medicare claim denial is necessary to facilitate payment by Medicaid or a secondary insurer HHAs should instruct beneficiaries to select Option 1 on the ABN HHAs may add a statement in the Additional Information section to help a dual eligible better understand the payment situation such as We will submit a claim for this care with your other insurance or Your Medical Assistance plan will pay for this care HHAs may also use the Additional Information on the ABN to This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 04 APRIL 2014 BIE lt m IE m
108. sensitive testing methodology Alpha testing is performed by each FFS claims processing system maintainer for 4 weeks e Beta testing is performed by a separate Integration Contractor for 8 weeks and e Acceptance testing is performed by each MAC for 4 weeks to ensure that local coverage requirements are met and the systems are functioning as expected CMS began installing and testing system changes to support ICD 10 in 2011 As of October 1 2013 all Medicare FFS claims processing systems were ready for ICD 10 implementation CMS continues to test its CD 10 software changes with each quarterly release Provider Initiated Beta Testing Tools To help you prepare for ICD 10 CMS recommends that you leverage the variety of Beta versions of its software that include ICD 10 codes as well as National Coverage Determination NCD code crosswalks to test the readiness of your own systems The following testing tools are available for download BIE lt m IE m gt T Ro T 0A I O m NCDs converted from International Classification of Diseases 9th Edition ICD 9 to ICD 10 located at http www cms gov Medicare Coverage CoverageGenInfo ICD10 html on the CMS website The ICD 10 Medicare Severity Diagnosis Related Groups MS DRGs conversion project along with payment logic and software replicating the current MS DRGs which used the General Equivalence Mappings to convert ICD 9 codes to International Classi
109. smedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 04 APRIL 2014 14 to prevent payment of respite care for more than 5 days at a time for any hospice claim submitted on or after July 1 2014 Since respite care is payable only for periods of respite up to 5 consecutive days claims reporting respite periods greater than 5 consecutive days will be Returned to the Provider RTP Days of respite care beyond 5 days must be billed at the appropriate home care rate for payment consideration When a MAC RTPs a claim it will include an external narrative on the RTP reason code stating that respite care exceeding 5 consecutive days must be billed as routine home care and are not to be included in the M2 occurrence span code For example If the patient enters a respite period on July 1 and is returned to routine home care on July 6 the units of respite reported on the line item would be 5 representing July 1 through July 5 July 6 is reported as a day of routine home care regardless of the time of day entering respite or returning to routine home care When there is more than one respite period in the billing period the provider must include the M2 occurrence span code for all periods of respite The individual respite periods reported shall not exceed 5 days including consecutive respite periods For example If the patient enters a respite period on July 1 and is returned to routine home care on July 6 an
110. st This eliminates the need to copy and mail documentation with your appeal request myCGS will accommodate up to 5 attachments of 5 MB each which should accommodate all medical documentation required for a patient s claim Attachments must be in a PDF format and at least one attachment is required How do know if my Redetermination request was successfully received Once all required information is entered simply click the Submit button to submit your redetermination request to CGS You will receive a message in your myCGS inbox You can access the message by either clicking on the Messages tab or clicking the link displayed in the Message bar This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 04 APRIL 2014 18 ces Mome Chins emits atty rnd oso rors Soper Admin User Provider You have 3 unread message s and O alerts Go To page Select Form MESSAGE INBOX ARCHIVED MESSAGES Chick on the subject inks to view messages Bold links indicate new unread messages In Message inbox No items found 1 myCGS amp will confirm receipt of your redetermination request by indicating Secure Form Received Once a tracking number has been assigned to your re
111. structions for creating or importing contact information using a QR code reader and generating a QR code to transfer profile or payment information to other user devices Background In July 2013 CMS released two mobile apps Open Payments Mobile for Industry and Open Payments Mobile for Physicians Below are enhancements to the original Open Payments mobile apps The changes to the apps include the following e Streamlining the menu on the Welcome screen e Adding the ability to export all profile data associated with a payment into CSV format and e Developing a new function to view reports of payments in bar and pie charts The apps are intended to support reporting under the Open Payments program For more details refer to http www cms gov Regulations and Guidance Legislation This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 04 APRIL 2014 47 National Physician Payment Transparency Program index html on the CMS website For help with the apps contact the CMS helpdesk at OpenPayments cms hhs gov Key Points of SE1402 If you already downloaded the apps you will need to run an update to take advantage of the new app functionality To do so visit either th
112. supplier staff Newsletters are available at no cost from our website at http www cgsmedicare com 2014 Copyright CGS Administrators LLC TABLE OF CONTENTS MEDICARE BULLETIN GR 2014 04 APRIL 2014 40 Mandatory Element Element Name or Optional Data Content TRNO1 Trace Type Code M Trace Type Code is always a 1 TRNO2 Reassociation Information M This data element must contain the EFT trace number TRNO3 Origination Company ID M A unique identifier designating the company initiating the funds transfer This must be a 1 followed by the payer s Tax Identification Number TIN TRNO4 Reference Identification O This data element is required when information beyond the Originating Company Identifier in TRNO3 is necessary for the payee to identify the source of the payment Segment Segment Terminator M The TRN data segment in the addenda record must end with Terminator either a tilde or a backslash Additional Information For information on the NACHA Operating Rules that apply to health care payments particularly with regard to requirements for originators see htips healthcare nacha org healthcarerules The official instruction CR 8629 issued to your MAC regarding this change may be viewed at http www cms gov Regulations and Guidance Guidance Transmittals Downloads R13490TN pdf on the CMS website If you have any questions please contact a CGS Custom
113. tandards and Operating Rules for Health Care Electronic Funds Transfers The Centers for Medicare amp Medicaid Services CMS has issued the following Medicare Learning Network MLN Matters article This MLN Matters article and other CMS articles can be found on the CMS website at http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles 2014 MLN Matters Articles html MLN Matters Number MM8619 Related Change Request CR CR 8619 Related CR Release Date February 21 2014 Effective Date July 1 2014 Related CR Transmittal R13510TN Implementation Date July 7 2014 Provider Types Affected BIE lt m IE m gt T Ro T 0A I O m This MLN Matters article is intended for physicians providers and suppliers submitting claims to Medicare administrative contractors MACs including durable medical equipment Medicare administrative contractors DME MACs and home health and hospice HH amp H MACs for services to Medicare beneficiaries What You Need to Know This article is based on CR 8619 which informs Medicare contractors that Section 1104 of the Affordable Care Act mandates the adoption of a standard for the Health Care Electronic Funds Transfers EFT HIPAA transaction and operating rules for the Health Care EFT and Remittance Advice Transaction The main intent of these standards and operating rules is to assure health plans transmit a trace numb
114. ternational Classification of Diseases Tenth Revision ICD 10 Limited End to End Testing with Submitters The Centers for Medicare amp Medicaid Services CMS has issued the following Medicare Learning Network MLN Matters article This MLN Matters article and other CMS articles can be found on the CMS website at http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles 2014 MLN Matters Articles html MLN Matters Number MM8602 Related Change Request CR CR 8602 Related CR Release Date February 21 2014 Effective Date July 7 2014 Related CR Transmittal R13520TN Implementation Date July 7 2014 Provider Types Affected This MLN Matters article is intended for physicians other providers and suppliers who submit claims to Medicare claims administration contractors durable medical equipment Medicare administrative contractors DME MACs A B Medicare administrative contractors A B MACs and or home health and hospices HH amp H MACs for services provided to Medicare beneficiaries This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 04 APRIL 2014 32 What You Need to Know This article is based on CR 8602 which
115. th 4 750 00 950 00 more insertion of transprostatic implant 4 or more implants Extended Assessment and Management EAM Composite APC 8009 Effective January 1 2014 CMS will provide payment for all qualifying extended assessment and management encounters through newly created composite APC 8009 Extended Assessment and Management EAM Composite Any clinic visit Level 4 or Level 5 Type A Emergency Department ED visit or Level 5 Type B ED visit furnished by a hospital in conjunction with observation services of eight or more hours will qualify for payment through APC 8009 Effective January 1 2014 CMS will no longer provide payment for extended assessment and management encounters through APCs 8002 Level Extended Assessment and Management Composite and 8003 Level Extended Assessment and Management Composite CMS is updating the Medicare Claims Processing Manual Pub 100 04 Chapter 4 Sections 10 2 1 and 290 5 to reflect these changes to the EAM Composite APC reporting guidelines These updated sections are included as an attachment to CR 8653 Billing for Drugs Biologicals and Radiopharmaceuticals a Drugs and Biologicals with Payments Based on Average Sales Price ASP Effective April 1 2014 In the Calendar Year CY 2014 OPPS ASC final rule with comment period CMS stated that payments for drugs and biologicals based on ASPs will be updated on a quarterly basis as later quarter ASP submissions become ava
116. that document Give it a try BIE lt m IE m gt T Ro T 0A I O m For Home Health and Hospice Providers Provide Your Feedback on the Home Health amp Hospice Website Redesign CGS launched the redesign of the Home Health amp Hospice website on March 3 2014 Tell us what you think by taking a few moments to complete the Foresee survey This survey measures your satisfaction with the CGS website therefore your participation is important to us The survey gives you the opportunity to tell us your likes and dislikes and what improvements you would like to see to the redesigned HH amp H section of the CGS website For Home Health and Hospice Providers Provider Contact Center PCC Availability Medicare is a continuously changing program and it is important that we provide correct and accurate answers to your questions To better serve the provider community the Centers for Medicare amp Medicaid Services CMS allows the provider contact centers the opportunity to offer training to our customer service representatives CSRs Listed below are the dates and time the home health and hospice PCC at 1 877 299 4500 Option 1 will be closed for training CSR Training Date Time Tuesday April 8 2014 Tuesday April 22 2014 8 00 a m 10 00 a m Central Time The Interactive Voice Response IVR 1 877 220 6289 is available for assistance in obtaining patient eligibility info
117. that the Centers for Medicare amp Medicaid Services CMS is taking for ICD 10 implementation Background The implementation of International Classification of Diseases 10th Edition ICD 10 represents a significant code set change that impacts the entire health care community As the ICD 10 implementation date of October 1 2014 approaches CMS is taking a comprehensive four pronged approach to preparedness and testing to ensure that CMS as well as the Medicare Fee For Service FFS provider community is ready When you is used in this publication we are referring to the FFS provider community The four pronged approach includes e CMS internal testing of its claims processing systems e Provider initiated Beta testing tools Acknowledgement testing and End to end testing Each approach is discussed in more detail below This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at http www cgsmedicare com 2014 Copyright CGS Administrators LLC TABLE OF CONTENTS MEDICARE BULLETIN GR 2014 04 APRIL 2014 50 CMS Internal Testing of Its Claims Processing Systems CMS has a very mature and rigorous testing program for its Medicare FFS claims processing systems that supports the implementation of four quarterly releases per year Each release is supported by a three tiered and time
118. titute product to 32 which is the weighted average payment per unit for all skin substitute products using the skin substitute utilization from the CY 2012 claims data and the July 2013 payment rate for each product Skin substitute products with a July 2013 payment rate that was above 32 per square centimeter are paid through the high cost group and those with a July 2013 payment rate that was at or below 32 per square centimeter are paid through the low cost group for CY 2014 As a reminder for CY 2015 CMS will follow the usual policy with regard to the specific quarterly ASP data sets used for proposed and final rule making in that CMS will use April 2014 ASP data to establish the proposed rule low high cost threshold and CMS will use July 2014 ASP data to establish the final low high cost threshold for CY 2015 CMS also finalized a policy that for any new skin substitute products approved for payment during CY 2014 CMS will use the 32 per square centimeter threshold to determine mapping to the high or low cost skin substitute group Any new skin substitute products without pricing information were assigned to the low cost category until pricing information becomes available There were nine new skin substitute products that were effective January 1 2014 and that were assigned to the low cost payment group because pricing information was not available for these products at the time of the January 2014 update There is now pricing infor

Medicare Bulletin - April 2014

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