National Government Services, Inc. Medicare Monthly Review Part A and B
A Combined Part A and Part B Newsletter

MMR-2007 12A, December 2007

Correction to Calculation of Coinsurance for Indian Health Service Critical Access Hospitals (IHS CAHs)

Provider Types Affected
Indian Health Service Critical Access Hospitals (IHS CAH) that bill Medicare fiscal intermediaries (FI) or Medicare Administrative Contractors (A/B MAC) for services provided to Medicare beneficiaries

Provider Action Needed
Impact to You - Change Request (CR) 5769 corrects the calculation of Medicare Part B coinsurance for IHS CAHs.

What You Need to Know - The calculation of coinsurance for IHS CAHs for services paid on the facility-specific per visit rate is to be based solely on billed charges, not on the payment amount for the particular IHS CAH. On April 7, 2008, Medicare systems will be corrected to calculate coinsurance for IHS CAHs accordingly. FIs or MACs will not search their claims histories to find and correct claims processed by Medicare since April 1, 2007 through April 6, 2008, but will correct any claims that you bring to their attention.

What You Need to Do - Make certain that your billing staffs are aware of this change.

Background
The change directed in CR5769 corrects an error in the Medicare system that calculates Part B coinsurance for IHS CAHs on claims processed since April 1, 2007.

Additional Information
For complete details regarding this Change Request (CR), please see the official instruction (CR5769) issued to your Medicare A/B MAC or FI. That instruction may be viewed by going to http://www.cms.hhs.gov/transmittals/downloads/R1362CP.pdf on the CMS Web site.

If you have questions, please contact your Medicare A/B MAC 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.