Medicare Information Resource , Issue 2006-7AB

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Medicare Information Resource

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July 2006

MIR-2006-7AB

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
H	A	Changes to the Laboratory NCD Edit Software for July 2006
A	P,N	CMS Announces Proposed Changes to Physician Fee Schedule Methodology
A	A	Collection of Fee-for-Service Payments Made During Periods of Managed Care Enrollment
A	A	Coverage for Home Use of Oxygen Included in Clinical Trials
A	A	Implementation of the Revised CMS-855 Medicare Enrollment Applications
A	A	July Quarterly Update for 2006 DMEPOS Fee Schedule
A	A	July Update to the 2006 Medicare Physician Fee Schedule Database
A	A	Medicare Policy Regarding Collection of Fee-for-Service Payments Made During Periods of Managed Care Enrollment
H	A	Medicare Posts Hospital Payment Information
A	A	Modifications to Online MSP Questionnaire
A		National Provider Identifier (NPI) Information
A	A	Open Door Forums
H	P	Pancreas Transplants Alone (PA)
H	P	Payment for PETS in CMS-Approved Clinical Trials and Coverage with Evidence Development - Use of QR and QV Modifiers
A	A	Prevention Awareness Continues
A	A	Quarterly Medicare Summary Notice (MSN) Printing Cycle
A	A	The National Provider Identifier (NPI) Countdown Has Begun

KEY	Part A Contents
Part A	Title
H,S	Benefits Exhaust and No-Payment Billing Instructions for Medicare FIs and SNFs
H	Billing and Payment of Certain Colorectal Cancer Screenings for Nonpatients on TOB 14X
H	Billing Clarification for J2505 Pegfilgrastim
A	Hospital OPPS Manual Revision: Clarification of Coding and Payment for Drug Administration
H	MMA - Method of Cost Settlement for Inpatient Services for Rural Hospitals Participating Under Demonstration Authorized by Section 410A of the Medicare Modernization Act
A	New Temporary “K” Code for Power Mobility Device (PMD) Batteries
A	Non-Outpatient Prospective Patient System Outpatient Code Editor (Non-OPPS OCE) Specifications Version 21.3
A	Outpatient Prospective Payment System Code Editor (OPPS OCE) Specifications Version 7.2
A	Redefined Type of Bill (TOB), 14X, for Nonpatient Laboratory Specimens
A	Use of the KX Modifier on Claims Submitted to the Fiscal Intermediary When Some Services Exceed the Therapy Caps

KEY	Part B Contents
Part B	Title
A	Beneficiary Fact Sheet for the CAP for Part B Drugs and Biologicals
P,N,E	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	Clinical Laboratory Improvement Amendments (CLIA) Brochure
A	Drug Administration Coding and Payment Policy – Update to Pub. 100-04 Medicare Claims Processing Manual
A	Extended Physician Election Process for the CAP for Part B Drugs and Biologicals
F,W	Information on Additional Payment for NTIOLs to ASCs
A	Medicare Remit Easy Print (MREP) Version 1.8
N	Payment for Evaluation and Management Services Provided During Global Period of Surgery
A	Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 12.2, Effective July 1, 2006
A	Remittance Advice Reminder
A	Update to the Healthcare Provider Taxonomy Codes (HPTC) Version 5.1

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.

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