Medicare Information Resource , Issue 2006-6AB

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June 2006

MIR-2006-6AB

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	New Requirements for Low Vision Rehabilitation Demonstration Billing
H,S	H	Changes Conforming to CR3648 for Therapy Services
H	P	Nesiritide for Treatment of Heart Failure Patients
H,S	P	Cardiac Rehabilitation Programs
A	A	July Quarterly Update for 2006 DMEPOS Fee Schedule
H	C	Clarification on Billing Requirements for PTA Concurrent with the Placement of an FDA-Approved Carotid Stent
A	A,W	Additional Clarification of CR 3816 Business Requirements – Low Vision Rehabilitation Demonstration
H,S	P,E	Reporting of Diagnosis Code V06.6 on Influenza Virus and/or PPV Vaccine Claims and Acceptance of CPT Code 90660 for the Reporting of the Influenza Virus Vaccine
A	A	Correct Reporting of Diagnosis Codes on Screening Mammography Claims
A	A	Assignment of Physicians, Providers, and Suppliers to the MAC
A	A	Coverage of Prescription Niacin Products Under Part D for 2006
A	A	Medicare Provides Coverage for Many Preventive Services and Screenings
A	A	Full Replacement of CR4349, Hold on Medicare Payments – CR4349 Is Rescinded
A	A	Bariatric Surgery for Morbid Obesity
A	A	Announcing the Release of the Revised CMS-855 Medicare Enrollment Applications
A	A	Facilitating Your Medicare Enrollment
A	A	Quarterly Medicare Summary Notice (MSN) Printing Cycle
H	C	Payment for Carotid Artery Stenting (CAS) Post-Approval Extension Studies
A	A	Understanding the Remittance Advice
A	A	Fact Sheets for Specialty Providers Available in Print Format
A	A	Evaluation & Management Services Guide
A	A	New Preventive Services Web-Based Training Course Now Available
A	A	NPI Applications through the EFI Capability Starts Today
A	A	National Provider Identifier (NPI) Tip
A	A	Revised CMS-855 Medicare Provider Enrollment Applications


KEY	*Part A ONLY* Contents**
Part A	Title
A	Modify Common Working File (CWF) Edit 51#L
H	Revisions to Chapter 3, Section 140 of the Medicare Claims Processing Manual (Pub 100-4), the Inpatient Rehabilitation Facility Prospective Payment System
A	PPS Payment for Blood Clotting Factors Administered to Hemophilia Inpatients
H	Critical Access Hospital (CAH) Claims
A	Processing of OPPS Claims with Certain Drug Administration Code Pairs
A	Extension Due Date of Filing Hospital Cost Reports Due to the Submission of Occupational Mix Data
A	Proposed Rule for Inpatient Rehabilitation Facility Payment Policy

KEY	*Part B ONLY* Contents**
Part B	Title
A	Additional Requirements for the CAP for Part B Drugs and Biologicals
A	CAP for Part B Drugs - Coding, Testing, and Implementation
P,E	Competitive Acquisition Program (CAP) for Part B Drugs Physician Election
F	Additional $50 Payment for NTIOLs Furnished in Ambulatory Surgical Centers (ASCs)
P	Full Replacement for CR 4266, Revision for HPSA, and PSA Bonus Billing for Some Globally Billed Services - CR4266 Is Rescinded
A	Ambulatory Surgical Center (ASC) Claims Processing Manual Clarification
A	Medicare Remit Easy Print (MREP) Update
A	Options for Providers/Suppliers Affected by CR4376: Suppression of SPR to Providers and Suppliers Also Receiving ERA for 45 Days or More
P,B	Section 1011: Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens
A	New Version of MREP Available
A	Medicare Remit Easy Print (MREP) Software Reminder
E	Medicare's New Competitive Acquisition Program (CAP) for Outpatient Drugs and Biologicals
A	Options for Physicians/Suppliers Affected by Change Request (CR) 4376

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 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 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.