CMS & Palmetto/J1MAC News

The following information has been received by ANCO.


****CMS NEWS****
The latest Claim Adjustment Reason Codes and Remittance Advice Remark Codes are available in the Codes.ini file for the MREP software. You can access this file in the Zipped folder for “Medicare Remit Easy Print - Version 2.7” at http://www.cms.hhs.gov/AccesstoDataApplication/02_MedicareRemitEasyPrint.asp on the CMS website.


MM6733 – Payment to Physician or Other Supplier for Diagnostic Tests Subject to the Anti-Markup Payment Limitation
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6733.pdf

MM6563 – Billing for Services Related to Voluntary Uses of Advance Beneficiary Notices of Noncoverage (ABNs)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6563.pdf

MM6547 – Processing of Non-Covered International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Procedure Codes on Inpatient Hospital Claims
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6547.pdf

MM6721 – Implementation of the Health Insurance Portability and Accountability Act (HIPAA) Version 5010 276/277 Claim Status Second Phase
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6721.pdf


****PALMETTO/J1MAC NEWS****
Payment to Physician or Other Supplier for Diagnostic Tests Subject to the
Anti-Markup Payment Limitation
This J1 Part B MLN Matters article (CR6733) alerts providers that the
Centers for Medicare & Medicaid Services (CMS) is revising the section of
the Medicare Claims Processing Manual to implement changes to 42 CFR
section 414.50 that were made in the CY 2009 PFS final rule (73 FR 69799,
November 19, 2008). These changes include two alternative methods for
determining when not to apply the anti-markup payment limitation. Please be
sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7ZWSUB0567?opendocument


Billing for Services Related to Voluntary Uses of Advance Beneficiary
Notices of Non-coverage (ABN)
This J1 Part A MLN Matters article (CR6563a) was revised on January 16,
2010, to reflect a revised CR6563, which was issued on January 15, 2010.
The article was revised to reflect a new CR release date, transmittal
number and Web address for accessing CR 6563. All other information remains
the same. This article announces recent instructions for the use of
modifiers in association with Advance Beneficiary Notices (ABN).
Specifically, effective April 1, 2010, two HCPCS level-2 modifiers have
been updated to distinguish between voluntary, and required, uses of
liability notices. Please be sure to share with your staff.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7ZWT6V2758?opendocument


Medicare Appeals: The Importance of Getting It to the Right Place at the
Right Time
How to make sure your Medicare appeal requests get to the right place at
the right time? J1 Part B shares this article from the Qualified
Independent Contractor (QIC) Part B North on the driving factor that caused
a high rate of dismissal decisions and clarifies the correct request
procedure and timelines.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7ZQLL81672?opendocument


Pricing for Lupron Injections
Share with your staff - J1 Part B alerts providers that some claims
processed from January 4 through January 19, 2010, were paid at the
submitted charge amount instead of the allowed amount. All claims paid in
error will be adjusted when the system is corrected.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7ZWNXY3046?opendocument


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