Non-HHA PS&R Summary Reports available for paid claims through 05/31/2008

CWF July 4, 2008 Holiday Schedule

Any files received will be processed the following morning, July 5, 2008 and returned that day.

MLN Matters Articles from CMS

New:

SE0824 – Clarification of Medicare Bad Debt Policy Related to Accounts at a Collection Agency 

MM6098 – Cardiac Computed Tomographic Angiography (CTA) 

MM6001 – Medicare Acute Care Episode (ACE) Demonstration. CR 6001 rescinds and fully replaces CR 5767 

Revised:

CMS HOLDING OF JULY CLAIMS

“The following Questions and Answers apply to the recent decision by the Centers for Medicare & Medicare Services to hold claims paid under the Medicare physician fee schedule (MPFS) up to 10 business days that contain July 2008 dates of service. 

Q1.   Will claims containing services paid under the MPFS be held that contain both June and July dates of service?
A1.   Yes, your local contractor will hold the entire claim for 10 business days.

Q2.   Will claims be held that contain both services paid under the MPFS and services paid under a separate fee schedule?
A2.   Yes, claims that contain both services paid and not paid under the MPFS will be held. For example, a claim with a July date containing an Evaluation and Management code and a drug code would be held.                                                                                                                 

Q3.   Does the holding of claims paid under the MPFS also include anesthesia and purchased diagnostic services?
A3.   Yes, contractors will hold all claims with dates of service July 1, 2008, and after that contain services paid under the MPFS, including anesthesia and purchased diagnostic services.”

Expiration of Therapy Cap Exceptions

The exceptions to outpatient therapy caps expire on June 30, 2008.  Outpatient therapy service providers should not submit claims with the KX modifier for services furnished on or after July 1, 2008.   To the extent possible, CMS is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of outpatient physical therapy, occupational therapy and speech-language pathology claims for services furnished by physicians, non-physician practitioners, and therapists paid under the physician fee schedule, beginning July 1. 

Credit Balance Reports due July 31, 2008

This notice is a reminder that the Medicare credit balance report for the quarter ending June 30, 2008 are due by July 31, 2008. The quarterly report is to include all new Medicare credit balances not reported on a previous quarterly report.

Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding News

The CMS has posted information on the Competitive Bidding Implementation Contractor (CBIC) website to clarify its policy with regard to mail order suppliers. This posting provides further guidance on common carriers and local storefront suppliers. Please visit the Supplier’s FAQ section by clicking link above for more information."

Common Working File (CWF) Northeast Host Dark Day on Saturday, July 19, 2008

On Saturday, July 19, 2008, the CWF Northeast Host will be conducting a history purge.

Due to the anticipated duration of this activity and to ensure the completion of weekly processing and scheduled data center maintenance, there will be a CWF dark day on that Saturday. This will mean there will be no access to the Health Insurance Master Record (HIMR), which is usually available until noon on Saturdays.

All files received from satellites for Friday’s cycle will be completed prior to bringing CWF production down. If for any reason satellite files are received late Saturday morning, they will be processed by CWF after the history purge has been completed.

Local Coverage Determinations (LCDs) Updates

The following MAC J12 Local Coverage Determinations (LCDs) have been revised: 

• L27529 - Scanning Computerized Ophthalmic Diagnostic Imaging
• L27497 - Fluorescein and Indocyanine Green Angiography
• L27507 - Ophthalmic A and B Scans

The Medicare DMEPOS Competitive Bidding Program begins July 1, 2008.

All the information that you need to know as a DMEPOS supplier or an enrolled Medicare provider who refers beneficiaries for DMEPOS is available on the CMS DMEPOS Competitive Bidding dedicated website.Please visit the Announcement and Communication link for the most recent news.

Hold Claims Paid Under the Medicare Physician Fee Schedule (MPFS)

To the extent possible, CMS is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, non-physician practitioners, and other providers of services paid under the Medicare physician fee schedule, beginning July 1. Click the link above to read the article in its entirety.

FISS DDE Screen Changes Effective September 2, 2008

On September 2, 2008, four Medicare-A Online System screens will be updated. These screen updates will allow for an expanded dollar amount of several fields.

FISS DDE Screen Changes Effective July 7, 2008

July Fourth Holiday - EDI Availability

Highmark Medicare Services will be observing the July 4th holiday on July 4, 2008. Our business doors will be closed and the EDI Services help desk will not be available. However, you may continue utilizing EDI Services.

On July 4, 2008, EDI platforms are available for claims submission, claim status inquiries, and report retrieval including Electronic Remittance Advice (ERA). Medicare checks and ERA will generate as normal on this day.

The Fiscal Intermediary Standard System (FISS) will also be available, therefore, all Direct Data Entry (DDE) functions (online, claim entry or the HIQA transaction for beneficiary eligibility) will be available.

Quick Reference Guide for Medicare Part A Appeals

Effective August 1, 2008, Highmark Medicare Services will not routinely request additional inpatient documentation from providers who failed to submit all the necessary medical records.  The redetermination will be performed based on the medical record documentation that you submitted with your appeal request.  Providers, physicians and other suppliers are responsible for providing all the information the contractor requires to adjudicate the claim(s) at issue.

MLN Matters Articles from CMS

New:

MM6090 – Claim Status Category Code and Claim Status Code Update 

MM6094 – July 2008 Update of the Hospital Outpatient Prospective Payment System (OPPS) 

MM6085 – Screening Pelvic Examination 

MM6111 – October Quarterly Update to 2008 Annual Update of HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement 

Provider Contact Center

Reminder: Our Call Center will not be closed for training on Monday, June 30th.