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MIR-2006-8AB, August 2006
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Critical Access Hospital (CAH) Claims
Note: This article was revised on July 18, 2006 to reflect more recent instructions issued to Medicare FIs. Please review the article to learn about these instructions, especially the highlighted language. |
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 was issued 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 code (00100-01999); and
- All CAH claims with Revenue codes 054X (Ambulance Services). The FISS is used by FIs to process your claims.
- However, the FISS system was NOT corrected by June 5 and will NOT be corrected until September 4, 2006.
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.
Until the appropriate corrections are made to Medicare’s systems, affected claims will be handled as follows:
- On CAH Method II claims with revenue code 0964 (Professional Fees, Anesthetist (CRNA)): FIs will change revenue code from 0964, used to bill CRNA services, to revenue code 0379 (Other Anesthesia). This will allow the correct reimbursement to be calculated. Once Medicare’s FISS system is changed, CRNA services can again be processed under 0964.
- All CAH claims with ambulance services (revenue codes 054): your FI will return these claims to you, asking that you remove the ambulance charges from the claim and submit a separate bill with just the ambulance charges for payment. Providers can resume billing both services on a single claim once the FISS system is modified on or about September 4, 2006.
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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.zip  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 Revised
Related Change Request (CR) #: N/A
Related CR Release Date: N/A
Effective Date: N/A
Related CR Transmittal #: N/A
Implementation Date: N/A
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