Medicare Information Resource , Issue 2006-12AB

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December 2006

MIR-2006-12AB

CPT five-digit codes, descriptions, and other data only are copyright 2006 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

H, S, E	A	Ambulance Inflation Factor for CY 2007
A	A	Annual Update of HCPCS Codes Used for Home Health Consolidated Billing
A	A	Application Update to Medicare Deductible, Coinsurance, and Premium Rates for 2007
H, S, E	A	Changes to the Laboratory NCD Edit Software for January 2007
A	A	CWF Duplicate Claim Edit for the Technical Component of Radiology and Pathology Laboratory Services Provided to Hospital Inpatients
A	A	CWF Southwest Host Dark Day on Saturday, December 2, 2006
A	A	Flu Season Is Here!
A	A	Hospice Payment System Fact Sheet
H	C, P	Implementation of an Ultrasound Screening for Abdominal Aortic Aneurysms (AAA)
A	A	Implementation of Revised Fee Schedule Amounts for New HCPCS Codes for Power Mobility Devices
H, S	A	Information Regarding Fix to Correct NPI Information within the 837 Institutional Crossover Claim Files
H	A	Laboratory Competitive Bidding
A	A	MMA-Reopenings and Revisions of Claim Determinations and Decisions
A	A	NPI: Get It, Share It, Use It
A	A	Returning Paper Claims Received from Clearinghouses
S	A	Skilled Nursing Facility PPS Fact Sheet


KEY
Part A	Title
H	Clarification on Billing for Cryosurgery of the Prostate Gland
H	Critical Access Hospital (CAH) Annual Election of Method II for Outpatient Services
H	FY 2007 Inpatient PPS, Long-Term Care Hospital and Inpatient Psychiatric Facility PPS Changes – Correction
H	Hospital Outpatient Prospective Payment System Fact Sheet
H, E	Line-Item Billing Requirement for End Stage Renal Disease (ESRD) Claims
A	MMA- Sunset of the Provider Nomination Provision and the Policy to Assign Providers the Local Fiscal Intermediary (FI)
H	New Edits to Enforce Proper Transfer Coding and Payment in Inpatient Rehabilitation Facility PPS
A	Notification and Testing of an Integrated Outpatient Code Editor for the July 2007 Release
H, S, O	Outpatient Therapy Cap Exceptions Clarifications
H	Reporting and Payment of No-Cost and Reduced-Cost Devices Furnished by OPPS Hospitals
H, S	Reporting of Taxonomy Codes to Identify Provider Subparts on Institutional Claims
H	Revenue Code 068X on Critical Access Hospital Claims
A	Uniform Billing (UB-04) Implementation – UB-92 Replacement
H	Update to CR5304 Article Published in November 2006 MIR About CPT Code 90736
P	Update to the Hospice Payment Rates, Hospice Cap, Hospice Wage Index and the Hospice Pricer for FT 2007

KEY
Part B	Title
A	Cap Billing: Do Not Bill a Prescription Order Number More Than Once
B	Carrier Jurisdiction for Ambulance Supplier Claims
A	MMA- Competitive Acquisition Program (CAP) for Part B Drug - Appeals
A	Multiple Procedure Reduction on the Technical Component (TC) of Certain Diagnostic Imaging Procedures and Cap on the TC of Imaging Procedures
A	Processing All Diagnosis Codes Reported on Claims Submitted to Carriers
P	Reporting the NPI on Physician Claims for Clinical Diagnostic Services Purchased Outside of the Local Carrier’s Jurisdiction

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 4:00 p.m.
Tuesday - Thursday 8:00 a.m. to 4:00 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
Part B Telephone Reopenings	(866) 620-1190
Provider Enrollment:	(866) 309-0486
Provider 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
Part B Telephone Reopenings	(888) 399-7719


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.