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MIR-2006-6AB, June 2006
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Critical Access Hospital (CAH) Claims
Provider Types Affected
Providers submitting claims to Medicare fiscal intermediaries (FIs) for critical access hospital (CAH) anesthesia and ambulance services provided to Medicare beneficiaries
Impact on Providers
This Special Edition article is based on recent instructions from the Centers for Medicare & Medicaid Services (CMS) to your FI to hold the following until errors with Medicare’s Fiscal Intermediary Shared System (FISS) are corrected on June 5, 2006:
- All CAH Method II claims that have Revenue Code 0964 (CRNA Professional Services) and anesthesia HCPCS codes (00100-01999); and
- All CAH claims with Revenue Code 054X (Ambulance Services).
The FISS is used by FIs to process your claims.
Background
Recently, CMS became aware of these two CAH claims processing issues:
- CAH Method II claims are reimbursing at an incorrect rate when the claims have both:
- Revenue Code 0964 (Certified Registered Nurse Anesthetist (CRNA) Professional Services); and
- Anesthesia Healthcare Common Procedure Coding System (HCPCS (00100-01999)); and
- All CAH claims with ambulance services (Revenue Codes 054X) are suspending because the line level coinsurance total does not match the claim level coinsurance.
This Special Edition article advises that your FI has been instructed to hold claims that fall into the above two categories until a FISS correction is released and installed by your FI no later than June 5, 2006.
Additional Information
If you have any questions, please contact your intermediary at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.pdf  on the CMS Web site.
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.
MLN Matters Number: SE0631
Related Change Request (CR) #: N/A
Effective Date: N/A
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