CMS & Palmetto/J1MAC News

The following information has been received by ANCO.


****CMS NEWS****
MM6371 – Claims Processing Instructions for Diagnostic Tests Subject to the Anti-Markup Pricing Limitation
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6371.pdf

MM6362 – Reporting the National Provider Identifier (NPI) on Claims for Reference Laboratory and Purchased Diagnostic Services Performed Outside the Billing Jurisdiction
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6362.pdf

MM6370 – New Waived Tests
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6370.pdf

MM6139 – Implementation of New Provider Authentication Requirements for Medicare Contractor Provider Telephone and Written Inquiries
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6139.pdf

SE0902 – Important Information for Providers Serving Medicare Beneficiaries Enrolled in Private Fee-for-Service Plans
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0902.pdf

MM6397 – April Update to the 2009 Medicare Physician Fee Schedule Database (MPFSDB)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6397.pdf

MM6231 – Instructions for the Implementation of the Internet-Based Provider Enrollment, Chain and Ownership System (PECOS)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6231.pdf


****PALMETTO/J1MAC NEWS****
Claims Processing Instructions for Diagnostic Tests Subject to the
Anti-Markup Pricing Limitation
http://www.palmettogba.com/Palmetto/Providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~MLNs~All%20Part%20B%20MLNs~Claims%20Processing%20Instructions%20for%20Diagnostic%20Tests%20Subject%20to%20the%20Anti-Markup%20Pricing%20Limitation?opendocument

If the above link does not work in your e-mail program, please use the
temporary alternate link provided below.
http://www.palmettogba.com/Palmetto/Providers.nsf/docsCat/8525746A00550AA38525756F0064677F?opendocument

CR6371, Claims Processing Instructions for Diagnostic Tests Subject to the
Anti-Markup Pricing Limitation, clarifies changes finalized in the Calendar
Year (CY) 2009 Medicare Physician Fee Schedule (MPFS) final rule with
comment related to diagnostic tests and the revised anti-markup provisions
in section 414.50 of the Medicare regulations.

J1 Part B LCD Updates
http://www.palmettogba.com/Palmetto/Providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~J1%20Part%20B%20LCD%20Updates?opendocument

If the above link does not work in your e-mail program, please use the
temporary alternate link provided below.
http://www.palmettogba.com/Palmetto/Providers.nsf/docsCat/8525746A00550AA385257570007255CE?opendocument

These are the J1 Part B LCD Updates for March 5, 2009. Included are the
Blepharoplasty, Blepharoptosis and Brow Lift, Psychotherapy Services, Mohs
Micrographic Surgery and Injection of Spinal Canal LCDs.

New Waived Tests
http://www.palmettogba.com/Palmetto/Providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~MLNs~All%20Part%20B%20MLNs~New%20Waived%20Tests?opendocument

If the above link does not work in your e-mail program, please use the
temporary alternate link provided below.
http://www.palmettogba.com/Palmetto/Providers.nsf/docsCat/8525746A00550AA385257570006CFB16?opendocument

CR6370, New Waived Tests, alerts providers that the Centers for Medicare &
Medicaid Services (CMS) has listed the twelve latest tests approved by the
Food and Drug Administration (FDA) as waived tests under Clinical
Laboratory Improvement Amendments of 1988 (CLIA).

Reporting the National Provider Identifier (NPI) on Claims for Reference
Laboratory and Purchased Diagnostic Services Performed Outside the Billing
Jurisdiction
http://www.palmettogba.com/Palmetto/Providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~MLNs~All%20Part%20B%20MLNs~Reporting%20the%20National%20Provider%20Identifier%20(NPI)%20on%20Claims%20for%20Reference%20Laboratory%20and%20Purchased%20Diagnostic%20Services%20Performed%20Outside%20the%20Billing%20Jurisdiction?opendocument

If the above link does not work in your e-mail program, please use the
temporary alternate link provided below.
http://www.palmettogba.com/Palmetto/Providers.nsf/docsCat/8525746A00550AA3852575700047F26E?opendocument

CR6362 establishes an exception to the standard reporting of the national
provider identifier (NPI) on Medicare fee-for-service claims for reference
laboratory and purchased diagnostic services performed by a provider
outside billing jurisdiction.

Incorrect Provider Option Combinations
http://www.palmettogba.com/Palmetto/Providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~Incorrect%20Provider%20Option%20Combinations?opendocument

If the above link does not work in your e-mail program, please use the
temporary alternate link provided below.
http://www.palmettogba.com/Palmetto/Providers.nsf/docsCat/8525746A00550AA385257571005BFF57?opendocument

This article details incorrect provider option combinations that will be
rejected effective immediately.

National Provider Identifier (NPI) Development to Resume
http://www.palmettogba.com/Palmetto/Providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~National%20Provider%20Identifier%20(NPI)%20Development%20to%20Resume?opendocument

If the above link does not work in your e-mail program, please use the
temporary alternate link provided below.
http://www.palmettogba.com/Palmetto/Providers.nsf/docsCat/8525746A00550AA38525756A004F9B70?opendocument

For claims processed on and after April 1, 2009, Palmetto GBA will resume
development of claims when a one-to-one match for you National Provider
Identifier (NPI) and your Provider Transaction Access Number (PTAN) can not
be made.

Outpatient Therapy Caps with Exceptions in Calendar Year (CY) 2009
http://www.palmettogba.com/Palmetto/Providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20A~MLNs~All%20Part%20A%20MLNs~Outpatient%20Therapy%20Caps%20with%20Exceptions%20in%20Calendar%20Year%20(CY)%202009?opendocument

If the above link does not work in your e-mail program, please use the
temporary alternate link provided below.
http://www.palmettogba.com/Palmetto/Providers.nsf/docsCat/8525746A00550AA38525757100509630?opendocument

CR6321, Outpatient Therapy Caps with Exceptions in Calendar Year (CY) 2009,
describes the policy for outpatient therapy cap exceptions and updates the
dollar amount of the therapy caps for 2009.

Supporting Documentation and Coding Requirements for Postoperative Care:
CPT Modifier 55
http://www.palmettogba.com/Palmetto/Providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~Supporting%20Documentation%20and%20Coding%20Requirements%20for%20Postoperative%20Care%20CPT%20Modifier%2055?opendocument

If the above link does not work in your e-mail program, please use the
temporary alternate link provided below.
http://www.palmettogba.com/Palmetto/Providers.nsf/docsCat/8525746A00550AA38525757100506AF4?opendocument

This article details the necessary supporting documentation and coding
requirements for Postoperative Care: CPT Modifier 55