Content Section
Note: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material which is copyrighted by the American Medical Association (AMA). You are forbidden to download the files unless you read, agree to and abide by the provisions of the copyright statement. Read the copyright statement now (you will be linked back to here).
|
 |
National
Government Services, Inc.
Medicare Monthly Review Part A and B |
|
A
Combined Part A and Part B Newsletter |
MLN Matters. . .Information
for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
|
MMR-2007 11A, November 2007
MLN Matters Number: MM5723 |
Related Change Request (CR) #: 5723 |
Related CR Release Date: September 21, 2007 |
Effective Date: October 1, 2007 |
Related CR Transmittal #: R1342CP |
Implementation Date: October 1, 2007 |
October 2007 Integrated Outpatient Code Editor (I/OCE) Specifications Version 8.3
Provider Types Affected
All providers who submit institutional outpatient claims (including non-OPPS hospitals) to Medicare Administrative Contractors (A/B MAC), fiscal intermediaries (FI), or Regional Home Health Intermediaries (RHHI) for services provided to Medicare beneficiaries
Impact on Providers
This article is based on Change Request (CR) 5723 and notifies providers that the I/OCE Specifications Version 8.3, is effective October 1, 2007. Claims with dates of service prior to July 1, 2007 are routed through the nonintegrated versions of the OCE software that coincide with the versions in effect for the date of service on the claim.
Background
This article is based on Change Request (CR) 5723 and informs providers that the I/OCE routes all institutional outpatient claims (including non-outpatient prospective payment system hospital claims) through a single integrated OCE eliminating the need to update, install, and maintain two separate OCE software packages on a quarterly basis. This integration does not change the current logic that is applied to outpatient bill types that already pass through the outpatient prospective payment system (OPPS) OCE software. It expands the software usage to include non-OPPS hospitals.
There are numerous changes/additions/deletions to diagnosis codes, Ambulatory Payment Classification (APC) codes, and Health Care Common Procedure Codes (HCPCS) in the October, 2007, the changes will not be detailed in this article. Instead, please see CR5723 for those details. CR5723 is available at http://www.cms.hhs.gov/Transmittals/downloads/R1342CP.pdf  on the Centers for Medicare & Medicaid Services (CMS) Web site.
The key changes for the October 2007 I/OCE are as follows: (Some I/OCE modifications in the release may also be retroactively added to prior releases. If so, the retroactive date will appear in the 'Effective Date' column.)
| Effective Date |
Modification |
01/01/06 |
Modify the program logic to return edit 47 for codes that have SI changed from Q to N, if there is no other service on the claim (e.g., if G0378 is the only code reported on a claim). |
10/1/07 |
Modify the program to exclude bill type 12x from edits 71 and 77. |
7/1/07 |
Modify the program to assign ASC group numbers only on claims from Non-OPPS hospitals (OPPS flag = 2) with bill type 83X, and only in the PC program/ interface. |
Make HCPCS/APC/SI changes as specified by CMS |
Implement version 13.2 of the NCCI file, removing all code pairs which include Anesthesia (00100-01999), E/M (92002-92014, 99201-99499), or MH (90804-90911). |
10/1/07 |
Update the valid diagnosis code lists with ICD-9-CM changes |
10/1/07 |
Update diagnosis/age and diagnosis/sex conflict edits with MCE changes |
4/1/07* |
Remove codes 0599, 0709, 0749, 0759, 0779, 0789 & 0799 from the list of valid revenue codes |
10/1/07 |
Remove code 0719 from the list of valid revenue codes. |
Readers should also read through the specifications attached to CR5723 and note the highlighted sections, which also indicate change from the prior release of the software.
Additional Information
For complete details regarding CR5723, please see the official instruction (CR5723) issued to your Medicare A/B MAC, RHHI, or FI. That instruction may be viewed by going to http://www.cms.hhs.gov/Transmittals/downloads/R1342CP.pdf on the CMS Web site.
If you have questions, please contact your Medicare A/B MAC, RHHI, or FI 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.
National Provider Identifier (NPI) News – During this testing and implementation phase for the NPI, providers should pay close attention to information from health plans and clearinghouses to understand how claims are being processed and what providers should be doing to assure no disruption in payment. Providers should also ensure that the information they are submitting on a claim is what is being transmitted to each health plan by the billing vendors or clearinghouses who may be submitting the claims on their behalf. Additional information can be found at http://www.cms.hhs.gov/NationalProvIdentStand/  on the CMS Web site.
Additional Information Provided by National Government Services
*Terminated Revenue codes 0599, 0709, 0759, 0779, 0789 & 0799?
The October 2007 Integrated Outpatient Code Editor (IOCE) has terminated Revenue Codes 0599, 0709, 0759, 0779, 0789 & 0799 effective with service dates on and after 040107. The correct effective date should be October 1, 2007 for the deletion of these revenue codes. The January 2008 IOCE will make this correction to allow these codes thru September 30, 2007 and not assign OCE Edit W7041. In the interim, providers may bill using the “0” general classification for dates of service between April 1, 2007 and Sept. 30, 2007
| 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. |
|
: Links with this graphic go to an external site outside of Empire Medicare Services and will open in a new window. 
: You must have the Adobe Acrobat Reader (version 4.0 or higher) to view the PDF files. If you do not already have this software, you can Download it here (This software is free!). 
: PDF file links externally and will open in a new window. You must have the Adobe Acrobat Reader (version 4.0 or higher) to view the PDF files. If you do not already have this software, you can Download it here (This software is free!).
: You must have WinZip to view the files. If you do not already have this software, you may download an evaluation version from: http://www.winzip.com. 
