Archived News 1

This page was last updated: April 15, 2007

Archived News....

Click here to view Archived News (November 2005 - April 2006)

5/19/06

Medicare issues changes to coverage for Bariatric Surgery for Morbid Obesity ...

http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5013.pdf

5/22/06

The revised Medicare Physician Guide: A Resource for Residents, Practicing Physicians, and Other Health Care Professionals (previously titled Medicare Resident & New Physician Guide: Helping Health Care Professionals Navigate Medicare) is now available in downloadable format on the MLN Publication Page located at www.cms.hhs.gov/MLNProducts/MPUB/list.asp on the Centers for Medicare & Medicaid Services website. The guide will be available in print format in approximately six weeks.

5/18/06

New Preventive Services Web-Based Training Course Now Available at CMS ....

http://cms.meridianksi.com/kc/main/kc_frame.asp?kc_ident=kc0001&loc=1

DON'T FORGET! A brief hold will be placed on Medicare payments for ALL claims (e.g., initial claims, adjustment claims, and Medicare Secondary Payer (MSP) claims) for the last 9 days of the Federal fiscal year, i.e., September 22, 2006-September 30, 2006.

Archived News

Aetna Changes Modifier 25 Policy

http://www.aetna.com/provider/aetna_changes_modifier.html

"Aetna and representatives from several state medical societies reached an agreement whereby Aetna will reimburse physicians separately for specific procedures billed with an Evaluation and Management (E&M) code appended with Modifier 25. All other policies will still apply and may impact the ultimate payment of the codes. These policies can be found on our secure provider website. Once logged in, registered users should select “Doing Business with Aetna,” “Policy Information,” then “Payment and Coding Policies” to view these policies.

Physicians do not need to resubmit claims, and no further action is needed on their part.

Aetna will reprocess previously denied claims with dates of service dating back to July 1, 2004 for specific procedures billed with an E&M code appended with Modifier 25.

As a permanent solution, Aetna is updating its IT systems so when these specific procedure codes are billed with an E&M code appended with Modifier 25, both codes will be paid.

To expedite payment until the system fixes are complete, physicians may append Modifier 59 to the specific procedures billed with an E&M code. This will speed up payment. Physicians can continue to use Modifier 25, but it will take Aetna a little longer to reprocess those claims.

We believe that health care professionals will see this as further evidence of Aetna's commitment to a collaborative relationship with the medical community."

Aetna - Denials for codes 76082, 76083, 78478, and 78480

During the period of April 17, 2006, through July 14, 2006, physicians may submit and/or resubmit claims related to:

*CAD Mammography Services (CPT Codes 76082 and 76083) provided to Aetna members between January 1, 2004 and March 31, 2005; and/or

* Myocardial Perfusion Testing Services (CPT Codes 78478 and 78480) provided to Aetna members between January 1, 2004 and May 12, 2005.

Cervical cancer vaccine possible as a routine pediatric vaccination. Chicago Tribune, May 30, 2006

With the Food and Drug Administration's anticipated approval of a cervical cancer vaccine in early June, Gardasil soon may become a routine vaccination in pediatricians' offices. (CPT code 90649)

http://www.chicagotribune.com/features/lifestyle/health/chi-0605280408may28,1,4315039.story?coll=chi-health-hed

Merck says shingles vaccine approved

AP/Yahoo, May 26, 2006

A new vaccine that could put the pox on shingles for many adult sufferers of the often painful infection caused by the chickenpox virus has received federal approval, health officials said.

http://news.yahoo.com/s/ap/20060526/ap_on_he_me/shingles_vaccine

5/30/06

The Centers for Medicare & Medicaid Services (CMS) has clarified the documentation requirements and policy requirements for the use of CPT modifier -25 used with E/M services..... Different diagnoses are not required for reporting the E/M service on the same date as the procedure or other service with a global fee period.

http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5025.pdf

Physicians and providers need to follow new pneumococcal pneumonia and influenza vaccine and administration billing rules effective October 2, 2006.

Diagnosis coding:

When providing both vaccines, report diagnosis code V06.6.

For PPV only, report diagnosis code V03.82.

For influenza only, report diagnosis code V04.81.

View MM5037 here.

Massachusetts Senate OK's licensing of drug reps

Boston Globe, June 1, 2006

A proposal passed by the state Senate could make Massachusetts the first state in the nation to license drug company sales representatives and would prohibit them from providing entertainment, gifts, payments, or travel to doctors, healthcare facilities, or public officials.

Read rest of story...

CMS Quarterly Updates Effective July 1, 2006:

MM5064 - Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 12.2

http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5064.pdf

MM5102 - July Update to the 2006 Medicare Physician Fee Schedule Database

http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5102.pdf

MM5108 - Changes to the Laboratory National Coverage Determination (NCD) Edit Software for July 2006

http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5108.pdf

Scroll down to find the latest news...

6.30.06

Aetna's Coverage Policies for Gardasil and Zostavax:

Gardasil (90649) - http://www.aetna.com/cpb/data/CPBA0726.html Zostavax (90736) - http://www.aetna.com/cpb/data/CPBA0115.html

July 18, 2006

CMS LAUNCHES COMPREHENSIVE EFFORT TO COMBAT MEDICAID FRAUD AND ABUSE.

http://www.cms.hhs.gov/apps/media/

press/release.asp?Counter=1900

The Medicare Physician Guide: A Resource for Residents, Practicing Physicians, and Other Health Care Professionals is now available in print format free of charge from the Medicare Learning Network. Click here to order a copy either in manual format or CD-ROM.

7/11/06

The American College of Radiology's position on "Split Interpretations"

http://www.acr.org/s_acr/doc.asp?CID=2600&DID=24277

2007 ICD-9 Codes now available!

New, Revised, and Deleted Codes Effective 10.01.06:

http://www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/07_summarytables.asp#TopOfPage

June 21, 2006

CMS ANNOUNCES PROPOSED CHANGES TO PHYSICIAN FEE SCHEDULE

CMS announced proposed changes to the Medicare Physician Fee Schedule that will substantially increase the reimbursement for E/M services. View the press release:

http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1887

8/8/06

CMS PROPOSES POLICY, PAYMENT CHANGES FOR PHYSICIANS' SERVICES IN 2007

Read the press release:

http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1939

HealthLeaders News - Aug 9, 2006

Physicians brace for Medicare payment cuts

The Centers for Medicare and Medicaid Services on Tuesday proposed a payment cut of 5.1 percent for all physician-related services reimbursed under Medicare for 2007. CMS said the reduction is necessary because spending on physician services has increased faster than expected, but the American Medical Association is calling on Congress to stop next year’s payment cut....

Read full story:

http://www.healthleadersmedia.com/physician_leaders/view_physician_leaders_content.cfm?content_id=82312

CMS NEWS - 8/23/06

NPI: Get It. Share It. Use It.

August 23rd marks 9 months remaining until the National Provider Identifier (NPI) compliance date. Over 1 million NPIs have been issued so far --- do you have your NPI yet? At this 9-month mark, the Centers for Medicare & Medicaid Services (CMS) would like to announce the following:

CMS NPI Roundtable – September 26, 2006

CMS will host a national NPI Roundtable, open to all health care professionals, on Tuesday, September 26th from 2:00-3:30PM ET. To participate, you may call 1-877-203-0044, pass code 4795739

CMS will address common questions related to Medicare’s guidance on Subparts. While CMS will only address questions from a Medicare perspective, this information may be helpful to all providers. Medicare providers, who have questions, should select the appropriate email below and send in questions by Friday, September 8th. Questions received after this date will not be considered.

Medicare providers who bill a Fiscal Intermediary should send questions to: NPIQuestionsfromFIBillers@cms.hhs.gov

Medicare providers who bill a Carrier should send questions to: NPIQuestionsfromCarrierBillers@cms.hhs.gov

Medicare providers who bill a Durable Medical Equipment Regional Carrier (DMERC) should send questions to: NPIQuestionsfromDMERCBillers@cms.hhs.gov

Think You Don’t Need an NPI? Think Again.

Even those providers who do not bill for services may need to disclose their NPIs to those providers who do (e.g., physicians who order lab tests or refer patients for diagnostic testing must be identified on the lab’s or testing facility’s claims).

Even if you plan to retire in April, but know that some of your claims will not be submitted until after the May 23rd compliance date, you still need an NPI. Without the NPI, those claims may be adversely affected, with payment delayed or possibly even denied.

Reminder to Supply Legacy Identifiers on NPI Application

CMS continues to urge providers to include legacy identifiers on their NPI applications. This will help all health plans, including Medicare, to get ready for May 23, 2007. If reporting a Medicaid legacy number, include the associated State name. If providers have already been assigned NPIs, CMS asks them to consider going back into the NPPES and updating their information with their legacy identifiers if they did not include those identifiers when they applied for NPIs. This information is critical for health plans and health care clearinghouses in the development of crosswalks to aid in the transition to the NPI.

New NPI Slogans and Partnership with WEDI

Recently, CMS and the Workgroup for Electronic Data Interchange (WEDI) agreed to common NPI slogans for use in outreach campaigns. These slogans appear at the beginning and end of this listserv message, and will continue to appear on our messages and products. A recent WEDI press release, found at http://www.wedi.org/npioi/public/articles/dis_viewArticle.cfm?ID=537, discusses the slogans and partnership in more detail.

Special Information for Medicare Providers

Designation of Subparts

CMS reminds Medicare providers to visit Medicare’s Subparts Expectation Paper (located at http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/Medsubparts01252006.pdf on the CMS NPI web page) for more suggestions on how to determine their subparts. Remember, no health plan, not even Medicare, can instruct a provider on how to enumerate subparts. This is a business decision that the organization provider must make considering its unique business operations.

Medicare Provider Enrollment and NPIs

CMS requires that providers and suppliers obtain their NPIs prior to enrolling in Medicare or updating their Medicare enrollment information. Providers and suppliers must enter their NPIs on the CMS-855 Medicare provider enrollment applications and submit a copy of their NPI notifications with each CMS-855 application that they submit.

Required Use of NPI on Medicare Paper Claim Forms

Medicare will require the NPI on its paper claim forms. To learn more visit a recent MLN Matters article on this topic at http://www.cms.hhs.gov/MLNMattersArticles/downloads/mm4023.pdf on the CMS website.

Medicare DME Suppliers and NPIs

CMS issued a special communication regarding DME suppliers and the NPI which can be viewed at http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/npi_dme_comm.pdf on the CMS website.

Medicare to Require Taxonomy Codes on Institutional Claims

Effective January 1, 2007, institutional Medicare providers (e.g., hospitals, HHAs, SNFs) who submit claims for their primary facility and its subparts must report a taxonomy code on all claims submitted to their Fiscal Intermediary. To learn more, visit a recent MLN Matters article at http://www.cms.hhs.gov/MLNMattersArticles/downloads/mm5243.pdf on the CMS website.

Use of NPI on Medicare Claims on October 1st

Beginning October 1st, Medicare can accept claims that only have an NPI on them, however, to facilitate further testing, Medicare strongly encourages its providers to submit both legacy identifiers and their NPI on claims.

As always, more information and education on the NPI can be found at the CMS NPI page HYPERLINK "http://www.cms.hhs.gov/NationalProvIdentStand" http://www.cms.hhs.gov/NationalProvIdentStand on the CMS website. Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203.

Getting an NPI is free - not having one can be costly.

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Tell your associates to sign-up for CMS' Fee-for-Service provider listservs! Go to http://www.cms.hhs.gov/apps/mailinglists/default.asp?audience=3 to subscribe.

For more information about CMS provider listservs, go to http://www.cms.hhs.gov/MLNProducts/downloads/MailingLists_FactSheet.pdf

8/18/06

The Medicare Resident, Practicing Physician, and Other Health Care Professional Training Program Facilitator’s Kit, which includes everything facilitators, trainers, educators, and physicians need to prepare for and present a Medicare training course, is now available. To order your free Facilitator's Kit, visit the Medicare Learning Network at http://www.cms.hhs.gov/mlngeninfo/ on the Centers for Medicare & Medicaid Services website. Select "MLN Product Ordering Page" under the “Related Links Inside CMS” Section to place your order.

8/9/06

CMS Abandons Additional Contiguous Body Part Reimbursement Reduction

CMS announced that it will not, as previously planned, seek an additional 25% technical reimbursement cut for imaging on contiguous body parts in the same session, as part of the Medicare Physician Fee Schedule (MPFS) proposed rule for 2007, but will maintain the current 25% cut imposed on January 1, 2006.....

http://www.acr.org/s_acr/doc.asp?CID=2601&DID=24462

REMINDER:

The current CMS-1500 form will be discontinued as of 4/02/07.

For additional information see: MM 5060

For immediate release

September 7, 2006

Most Americans alarmed by impending Medicare cuts that will harm seniors' access to care.

Congressional action needed now to avert Medicare physician payment cuts

http://www.ama-assn.org/ama/pub/category/16792.html

9/5/06 - MEDICARE PROVIDER FEEDBACK TOWN HALL MEETING

September 20, 2006

2:00 - 4:00 PM EST

The Centers for Medicare & Medicaid Services (CMS) would like to request your participation in a Town Hall meeting on September 20, 2006, from 2:00 PM to 4:00 PM (Eastern Standard Time). The meeting will be held in the auditorium at the Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244 and by teleconference. The purpose of the meeting is to solicit the opinions of individual Medicare FFS physicians, providers and suppliers. The meeting will provide the Agency with an open and public venue to interact with individual Medicare providers and suppliers and obtain their feedback on a variety of Medicare policy and operational issues. All providers and suppliers that participate in the Medicare program, including physicians, hospitals, home health agencies, and other third-party billers, are invited to attend this meeting.

The agenda items for the meeting are available in the August 25, 2006 Federal Register Notice announcing the meeting. CMS will also hold a question and answer session that offers meeting participants an opportunity to provide feedback, as well as make suggestions regarding how this process can be improved.

Meeting Registration Details - Registration for the meeting will open on August 25, 2006. Individuals interested in attending the meeting and providing feedback, either in person or by teleconference, must complete the on-line registration located at http://registration.mshow.com/cms2/. The on-line registration system will capture contact information and practice characteristics, such as names, email addresses, and provider/supplier types. Registered participants may be contacted for follow-up meetings to solicit additional opinions and clarify any issues that may arise during the September 20 Town Hall meeting.

The on-line registration system will generate a confirmation page to indicate the completion of your registration. Please print this page as your registration receipt. We encourage you to complete your registration as soon as possible. Registration after 5:00 p.m. on September 18, 2006 will delay confirmation and you may not be permitted entrance to the building.

Those participating by teleconference should dial: 1-877-357-7851 and enter the Conference ID: 2323964.

Special Accommodations: Individuals requiring sign language interpretation or other special accommodations must contact Colette Shatto by email at MFG@cms.hhs.gov.

For questions or additional information about the Medicare Provider Feedback Town Hall Meeting, please send an email to MFG@cms.hhs.gov.

9/5/06

NEW!! NPI Training Package

CMS has developed a Training package on NPI that will assist providers with self-education, as well as education of staff. This package is also useful to national and local medical societies for group presentations and training. The entire package will consist of five modules: General Information, Electronic File Interchange (EFI), Subparts, Data Dissemination and Medicare Implementation. Each Module consists of a PowerPoint presentation (with speaker's notes) and is designed to stand alone or can be combined with other Modules for a training session tailored to the particular audience. Modules will be posted to the CMS NPI web page as completed.

Modules currently available include:

Module 1: General Information

Module 2: Electronic File Interchange (EFI)

Module 3: Subparts

To view these Modules, visit http://www.cms.hhs.gov/NationalProvIdentStand/04_education.aspon the CMS NPI web page and find the "NPI Training Package" under the "Downloads.”

ACOG’s Coding Department has posted the new, expanded and revised ICD-9-CM codes that become effective October 1, 2006 that are of interest to obstetrician-gynecologists.

http://www.acog.org/departments/dept_notice.cfm?recno=6&bulletin=3952