MLN Matters Articles From CMS

New:

SE0826 – Important Information on the New Medicare Law – The Medicare Improvements for Patients and Providers Act of 2008 

MM6115 – Hospice Discharge for Cause 

MM6116 – Revision of the Requirements for Denial of Payment for New Admissions (DPNA) for Skilled Nursing Facility (SNF) Billing 

Revised:

MM6080 – July 2008 Integrated Outpatient Code Editor (I/OCE) Specifications Version 9.2 

Rescinded:

SE0815 – Reminder that Exceptions to Therapy Caps are Restricted as of July 1, 2008 

Outpatient Hospital Services Workshop

Please join Highmark Medicare Services on July 25, 2008 (9:00am) at our offices in Camp Hill, PA for an informative workshop on Outpatient Hospital Services presented in a hospital setting. The topics that will be focused on will be billing diagnostic, rehabilitation and medication services. The workshop will enhance your knowledge about CERT data analysis, demonstrate appropriate billing and encourage Medicare compliance of billing and documentation requirements. This workshop meets the American Academy of Professional Coders' guidelines for 3 CEUs.

New 2008 Medicare Physician Fee Schedule Payment Rates Effective for Dates of Service July 1, 2008 through December 31, 2008 - UPDATE

The Medicare Improvements for Patients and Providers Act of 2008 was enacted on July 15, 2008.  As a result, the mid-year 2008 Medicare Physician Fee Schedule (MPFS) rate of -10.6 percent has been replaced with the January-June 2008 0.5 percent update, retroactive to July 1, 2008.    

Highmark Medicare Services has received the updated MPFS files and is currently validating those files in our test system. We expect to complete the validation within the next two business days. We will continue to update providers of the status of the files via our website and listserv.

CANCELLED - ACCREDITATION Deadlines FOR DMEPOS Competitive Bidding

The Medicare Improvements for Patients and Providers Act of 2008 was enacted on July 15, 2008. This new law has delayed the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program.

As a result of this delay, the special accreditation deadlines previously established for the second round of the program have been cancelled. Specifically, prior to enactment of this new law, suppliers must have been accredited or have applied for accreditation by July 21, 2008 to be eligible to submit a bid for the second round of competitive bidding and must have obtained accreditation by January 14, 2009 to be eligible for a second round contract. Both of these deadlines have been cancelled and no longer apply.

The deadline of September 30, 2009, that was previously established by which all DMEPOS suppliers must be accredited is still in effect.

Extension of Payment Rule for Brachytherapy and Therapeutic Radiopharmaceuticals

The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), enacted on July 15, 2008, extends the use of the cost to charge payment methodology for Brachytherapy and Therapeutic Radiopharmaceuticals through January 1, 2010.

This change is retroactive to July 1, 2008. Some claims have already been processed, however, using the Outpatient Prospective Payment System (OPPS) rates that were in effect until MIPAA enactment. To avoid a disruption in payment while the cost to charge payment methodology is re-implemented, impacted claims will continue to be paid based on the OPPS rates. Contractors will mass adjust all impacted OPPS claims with dates of service beginning July 1, 2008, as soon as the cost to charge payment methodology has been implemented. Reprocessing will be complete by September 30, 2008.

Reinstatement of the Moratorium That Allows Independent Laboratories to Bill for the TC of Physician Pathology Services Furnished to Hospital Patients

In the final physician fee schedule regulation published in the Federal Register on November 2, 1999, the Centers for Medicare & Medicaid Services (CMS) stated that it would implement a policy to pay only the hospital for the technical component (TC) of physician pathology services furnished to hospital patients.

Prior to this proposal, any independent laboratory could bill the carrier under the physician fee schedule for the TC of physician pathology services for hospital patients. At the request of the industry, to allow independent laboratories and hospitals sufficient time to negotiate arrangements, the implementation of this rule was administratively delayed. Subsequent legislation formalized a moratorium on the implementation of the rule. As such, during this time, the carriers and, more recently, Medicare Administrative Contractors (MAC) have continued to pay for the TC of physician pathology services when an independent laboratory furnishes this service to an inpatient or outpatient of a covered hospital.

The most recent extension of the moratorium, established by the Medicare, Medicaid, and SCHIP Extension Act (MMSEA), Section 104, expired on June 30, 2008. A new extension of the moratorium has been established by the Medicare Improvements for Patients and Providers Act of 2008, Section 136, retroactive to July 1, 2008.

A previous communication indicated that the moratorium had ended and that independent laboratories may no longer bill Medicare for the TC of physician pathology services furnished to patients of a covered hospital, regardless of the beneficiary's hospitalization status (inpatient or outpatient) on the date that the service was performed. This prohibition is rescinded and the moratorium will continue effective for claims with dates of service on and after July 1, 2008, but prior to January 1, 2010.

Delay of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program

The Medicare Improvements for Patients and Providers Act of 2008 was enacted on July 15, 2008. This new law has delayed the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. Items that had been included in the first round of the DMEPOS Competitive Bidding Program can be furnished by any enrolled DMEPOS supplier in accordance with existing Medicare rules. Payment for these items will be made under the fee schedule. Additional guidance regarding this new law will be forthcoming.

MLN Matters Articles from CMS

New:

MM6048 – Continuous Positive Airway Pressure (CPAP) Therapy for Obstructive Sleep Apnea (OSA) 

MM6114 – Update-Long Term Care Hospital (LTCH) Prospective Payment System (PPS) for Rate Year (RY) 2009 

MM6137 – Intracranial Percutaneous Transluminal Angioplasty (PTA) with Stenting

Revised:

MM6007 – Manual Revisions to Reflect Special Billing Instructions for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items as a Result of the DMEPOS Competitive Bidding Program 

Reinstatement of the Moratorium That Allows Independent Laboratories to Bill for the TC of Physician Pathology Services Furnished to Hospital Patients

The moratorium that allows independent laboratories to bill the carrier or A/B MAC for the TC of physician pathology services furnished to patients of a covered hospital, regardless of the beneficiary's hospitalization status has been reinstated by the Medicare Improvements for Patients and Providers Act of 2008.

Extension of Therapy Cap Exceptions

The Medicare Improvements for Patients and Providers Act of 2008 was enacted on July 15, 2008.

New 2008 Medicare Physician Fee Schedule Payment Rates Effective for Dates of Service July 1, 2008 through December 31, 2008

The Medicare Improvements for Patients and Providers Act of 2008 was enacted on July 15, 2008.  As a result, the mid-year 2008 Medicare Physician Fee Schedule (MPFS) rate of -10.6 percent has been replaced with the January-June 2008 0.5 percent update, retroactive to July 1, 2008.

Outpatient Hospital Services Workshop

Please join Highmark Medicare Services on July 22, 2008 at 9:00am at MT. Nittany Medical Center, Penn State PA for an informative workshop on Outpatient Hospital Services presented in a hospital setting. The topics that will be focused on will be billing diagnostic, rehabilitation and medication services. The workshop will enhance your knowledge about CERT data analysis, demonstrate appropriate billing and encourage Medicare compliance of billing and documentation requirements. This workshop meets the American Academy of Professional Coders' guidelines for 3 CEUs.

LCD/Article Updates

The August monthly Local Coverage Determination (LCD) release is being changed from August 13, 2008 to August 21, 2008.  

The following Part A MD/DC Local Coverage Determination (LCD) has been revised: 

• X-45D  -  Computed Tomographic Angiography of the Chest 

The following Part A MD/DC Billing and Coding Articles are retiring effective July 17, 2008: 

• I-4J  -  Coding Article for Hemophilia Clotting Factors (National Benefit)
• 96-05a1  -  Intravenous Immune Globulin 

The following Part A (PAFI) Local Coverage Determination (LCD) has been revised: 

• X-45D  -  Computed Tomographic Angiography of the Chest 

The following Part A (PAFI) Billing and Coding Article is retiring effective July 17, 2008: 

• I-4J  -  Coding Article for Hemophilia Clotting Factors (National Benefit)

Critical Access Hospital Fact Sheet

The Critical Access Hospital Fact Sheet  is now available in print format from the Centers for Medicare & Medicaid Services Medicare Learning Network.

This fact sheet provides information about eligible Critical Access Hospital (CAH) providers; CAH designation; CAH payments; reasonable cost payment principles that do not apply to CAHs; election of Standard Method or Optional (Elective) Payment Method; Medicare Rural Pass-Through funding for certain anesthesia services; Health Professional Shortage Area Incentive payments; Physician Scarcity Area Bonus payments; Medicare Prescription Drug, Improvement, and Modernization Act of 2003; and grants to states under the Medicare Rural Hospital Flexibility Program. To place your order, visit here, scroll down to "Related Links Inside CMS" and select "MLN Product Ordering Page."

NEW REPORT SHOWS CMS PILOT PROGRAM SAVING NEARLY $700 MILLION IN IMPROPER MEDICARE PAYMENTS

The Centers for Medicare & Medicaid Services (CMS) today released a new report offering fresh evidence that the recovery audit contractors (RACs) pilot program is successfully identifying improper payments. The findings will also help the agency improve the program as it is expanded nationwide within two years, officials say.

The evaluation report shows that $693.6 million in improper Medicare payments was returned to the Medicare Trust Funds between 2005 and March 2008. The funds returned to the Medicare Trust Funds occurred after taking into account the dollars repaid to health care providers, the money overturned on appeal and the costs of operating the RAC demonstration program.

Click here to view the entire Press Release. Click here to view the RAC Evaluation Report.