Medicare Information Resource , Issue 2006-10AB

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Medicare Information Resource

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October 2006

MIR-2006-10AB

CPT five-digit codes, descriptions, and other data only are copyright 2005 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS clauses apply.

In This Issue:

KEY		Part A & B Contents
Part A	Part B	Title
A	A	2006-2007 Influenza (Flu) Season Resources for Health Care Professionals
H	C	Billing Requirements for Percutaneous Transluminal Angioplasty (PTA) Concurrent with the Placement of an FDA-Approved Carotid Stent
H, S	A	Change to Laboratory National Coverage Determination (NCD) Edit Software for October 2006
A	A	Collection of Fee-for-Service Payments Made During Periods of Managed Care Enrollment (Previously CR2801 Program Transmittal AB-03-101) - Manualization
A	A	Flu Shot Reminder
A	A	Immunization: Promoting Prevention for a Healthier Life
A	A	Important National Provider Identifier (NPI) Information
H, S	A	Laboratory Competitive Bidding Demonstration
A	A	Modification of National Provider Identifier (NPI) Editing Requirements in CR4023 and an Attachment to CR4320
A	A	National Provider Identifier (NPI) – Will You Be Ready?
A	A	National Recovery Contractor for New Medicare Secondary Payer (MSP) Recovery Claims
A	A	New HCPCS Codes and Fees Schedule Amounts for Power Mobility Devices (PMD)
A	A	NPI Roundtable Encore Presentation
A	A	October 2006 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing File, Effective October 1, 2006, and Revisions to April 2006 and July 2006 Quarterly ASP Medicare Part B Drug Pricing Files
A	A	October Quarterly 2006 DMEPOS Fee Schedule
A	A	Online Availability of NPI Application/Update Form (CMS-10114)
A	A	Overview of Medicare Preventive Services Video
A	A	Stage 2 Requirements for Use and Editing of NPI Numbers Received in Electronic Data Interchange Transactions, via Direct Data Entry Screens or Paper Claims Forms


Key	Part A ONLY Contents
Part A	Title
H	Delaware - Common Working File (CWF) Edit E61#8 Update
H, E	Change in Healthcare Common Procedure Coding System (HCPCS) Codes for Renal Dialysis Facilities and Hospitals Billing for End Stage Renal Disease (ESRD) Related Epoetin Alfa (EPO), Effective January 1, 2007
H, E	Clarification of Billing for Separately Billable ESRD Drugs
S	Mass Adjustment of 22X & 32X Bill Types Containing HCPCS Codes G0008, G0009, and G0010 with Dates of Services July 1, 2006 and Greater
H	MMA-Medicare Telehealth Services
H	October 2006 OPPS Outpatient Code Editor Version 7.3
H, S	Reporting Taxonomy Codes to Identify Provider Subparts on Institutional Claims
H, E	Revisions to Epoetin (EPO) and Aranesp Monitoring Policy
H	Update to Inpatient Psychiatric Facility (IPF) Inpatient Prospective Payment System (IPPS) for Rate Year 2007


Key	Part B ONLY Contents
Part B	Title
A	Additional Requirements Necessary to Implement the Revised Health Insurance Claim Form CMS-1500
A	Competitive Acquisition Program (CAP) Creation of Automated Tables for Provider Information, Expansion of CAP Fee Schedule File Layout, and Additional Instructions for Claims Received from Railroad Retirement Board Beneficiaries
A	Medicare Part B Drug Competitive Acquisition Program (CAP) Additions to Approved CAP Vendor’s Drug List Effective October 1, 2006: Information on Price File Updates
L	MMA-Independent Laboratory Billing for Technical Component (TC) of Physician Pathology Services
A	Quarterly Update to Correct Coding Initiative (CCI) Edits Version 12.3, Effective October 1, 2006
A	Revised CMS-1500 Claim Form

Part A Contact Information

Automated IVR Inquiries 1 (877) 567-7205
Monday - Friday 6:00 a.m. to 6:00 p.m.
Saturdays 9:00 a.m. to 2:00 p.m.

These hours represent minimum availability. System access is generally available until 10:00 p.m. on weekdays and 6:00 p.m. on weekends.

Provider Inquiries : 1 (888) 855-4356
Monday & Friday 9:00 a.m. to 4:30 p.m.
Tuesday - Thursday 8:00 a.m. to 4:30 p.m.

You will be able to transfer to a provider representative only during these hours.Please have your provider number, the HIC number and service dates available when you call.

The Provider Inquiries TTY number for the Hearing Impaired is: 1 (877) 425--2370
Monday & Friday 9:00 a.m. to 4:30 p.m.
Tuesday - Thursday 8:00 a.m. to 4:30 p.m.

Beneficiary Inquiries:
English and Spanish 1-800-MEDICARE
(1-800-633-4227)
TTY for the Hearing-Impaired: 1 (877) 486-2048

Integrated Electronic Services (IES)
Technical Help Desk: 1 (866) 889-7322
Monday - Friday from 8:30 a.m. until 4:30 p.m.

Medicare Fraud Hotline:
To report fraud and abuse in the Medicare and Medicaid programs: 1(800) HHS-TIPS/1(800) 447-8477

The Hotline TTY Number for the Hearing-Impaired is: 1(877) 623-6190
Medical Director: Dr. Ted Triana 1(315) 442-4893

Part B New Jersey Contact Information

Beneficiary TDD:	(800) 992-0165
Beneficiary Telephone Inquiries & ARU:	(800) 633-4227
DMERC:	(866) 419-9458
EMC:	(866) 488-0546
Fax-on-Demand (FOD):	(888) 281-8586
Part B Provider IVR:	(877) 567-9235
Part B Provider Customer Service:	(888) 855-4346
Provider Enrollment:	(866) 309-0486
Provider TTY/TDD:	(888) 897-7542

Provider Enrollment Mail claims to :

Empire Medicare Services
Provider Enrollment
P.O. Box 69218
Harrisburg, PA 17106-9218

Empire Medicare Services
Provider Claims
P.O. Box 69201
Harrisburg, PA. 17106-9201

Part B Appeals & Correspondence
Empire Medicare Services
P.O. Box 69202
Harrisburg, PA 17106-9202

Part B New York Contact Information

Part B Provider Telephone Inquiries (STAR) Claim Status and information, eligibility deductible, pricing and seminar information:	(877) 869-6504
Claim Entry (MTCE):	(631) 244-5300
Claim Entry (MTCE) Information:	(212) 476-7934
DMERC:	(866) 419-9458
EMC Technical Support Help Desk:	(866) 889-7322
Fax-on-Demand (FOD):	(866) 709-1905
General Provider Enrollment Information:	(866) 837-0241
Health Professional Shortage Area (HPSA) and EMC Audit:	(315) 442-4600
IES Technical Help Desk:	(866) 889-7322
Provider TTY/TDD:	(866) 786-7155


Provider Enrollment Empire Medicare Services Reimbursement Dept. P.O. Box 1200 Crompond, NY 10517-1200	Mail Assigned Claims to: Empire Medicare Services P.O. Box 100 Yorktown Heights, NY 10598


Unassigned Claims to: Empire Medicare Services P.O. Box 355 Crompond, NY 10517	Health Professional Shortage Area (HPSA) & EMC Audit Empire Medicare Services P.O. Box 4716 Syracuse, NY 13221-4716

UPIN Directories (CD/ROM version)
Quality Assurance and Coordination Dept.
P.O. Box 1201
Crompond, NY 10517

Back Issue Requests
Empire Medicare Services,
MNB-Back Issues
800 2nd Avenue
3rd Floor
New York, NY 10017

Part B Appeals & Correspondence
Empire Medicare Services
P.O. Box 2280
Peekskill, NY 10566

Part A Key: A-All Providers, C-Community Mental Health Centers (CMHC), E-Renal Dialysis (ESRD) Providers, H-Hospitals, M-Home Health Providers, O-Comprehensive Outpatient Rehabilitation Facilities (CORF) and Outpatient Physical Therapy Providers, P-Hospice Providers, S-Skilled Nursing Facilities (SNF), NA-Not Applicable

Part B Key: A-All Providers, B-Ambulance, C-Cardiovascular, D-DMEPOS, E-Drugs & Biologicals, F-ASC, G-Anesthesia, H-Physical & Occupational Therapy, I-Beneficiaries, J-Insurers, K-Home Health Care, L-Laboratory, M-Medicine, N-Non-Physician Practitioner, O-Nuclear Medicine, P-Physicians, R-Radiology, S-Surgery, U-Urology, V-Chiropractor, W-Ophthalmology, X-Podiatry, Q-Oncology, NA-Not Applicable

This bulletin should be shared with all health care practitioners and managerial members of the provider staff. Bulletins are available at no cost from our Web site at www.empiremedicare.com.