Medicare Information Resource , Issue 2007-2XAB

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Medicare Information Resource

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February 2007

MIR-2007-2AB

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.

Effective January 1, 2007, National Government Services assumed the Medicare
business operations of its affiliate, Empire Medicare Services.

http://www.NGSMedicare.com

In This Issue:

KEY		Part A & B Contents
Part A	Part B	Title
A	A	2007 Physician Fee Schedule Payment Policies
A	A	2007 Update of HCPCS Codes for ASC
A	A	Annual Medicare Contractor Provider Satisfaction Survey
A	A	Emergency Update to the 2007 Medicare Physician Fee Schedule (MPFS) Database
A	A	Flu Shot Reminder
A	A	Implementation of Revised Fee Schedule Amounts for New Healthcare Common Procedure Coding System (HCPCS) Codes for Power Mobility Devices (PMDs)
H	P, S	Intracranial Percutaneous Transluminal Angioplasty with Stenting
A	A	Legislative Change to the Update Factor for the 2007 MPFS and Extension of the Participating Enrollment Period
A	A	Medicare Fee-for-Service Implementation of the National Provider Identifier (NPI)
A	A	Medicare Fee-for-Services and Medicare Advantage Eligibility System Issues
A	A	Medicare Physician Fee Schedule Fact Sheet
A	A	New HHS National Clearinghouse for Long-Term Care Information Web Site
A	A	NPI: Get It, Share It, Use It
H, S, O	H, P	Outpatient Therapy Cap Exception Process for 2007
H, S, O	H, P	Outpatient Therapy Cap Exceptions Clarification
A	A	Overview of Medicare Preventive Services Now Available
A	A	Payment Allowance for Influenza Vaccine and Pneumococcal Vaccine When Payment Is Based on 95 Percent of the Average Wholesale Price (AWP)
H	P	Preadministration-Related Services Associated with IVIG Administration
A	A	Revisions to Procedures to Establish Good Cause and Qualified Independent Contractor (QIC) Jurisdictions
A	A	Rules of Behavior Governing Medicare Eligibility Inquiries
H, S, O	H, P	Therapy Caps Exception Process

Key	Part A Content
Part A	Title
H	Acute Inpatient Prospective Payment System Fact Sheet
H, S	Claims Submission Instructions for Institutional Providers Billing Vaccine Claims in Cases Where a National Provider Identifier (NPI) Is Not Available
H	Correction of Instructions for Calculating IRF Compliance Percentage Threshold
H	Inpatient Rehabilitation Facility (IRF) Teaching Adjustment
H, S	Reporting Taxonomy Codes to Identify Provider Subparts on Institutional Claims
S	Skilled Nursing Facility (SNF) Consolidated Billing (CB) Common Working File (CWF) Edit Bypass Instructions for Hospital Emergency Room Services Spanning Multiple Service Dates
A	Instructions for Full Recovery Audit Contractor Inpatient Denials
A	January 2007 Non-Outpatient Prospective Payment System (Non-OPPS) Outpatient Code Editor (OCE) Specifications Version 22.1
H	January 2007 Outpatient Prospective Payment System (OPPS) Outpatient Code Editor (OCE) Specifications Version 8.0
H	January 2007 Update of the Hospital Outpatient Prospective Payment System (OPPS):Summary of Payment Policy Changes and OPPS PRICER Logic Changes and Instructions for Updating the Outpatient Provider Specific File (OPSF)

Key	Part B Content
Part B	Title
A	2007 CAP Physician Election Period
A	Additional Instructions for the Coordination of Medicare Secondary Payer (MSP) Claims
A	Assignment of Dedicated Medicare Secondary Payer Modifier Introduced in Change Request (CR) 5332 (Transmittal 1088)
C, P	Cardiac Output Monitoring by Thoracic Electrical Bioimpedance (TEB)
A	Elimination of CMS-1491 and CMS-1491U Forms
A	Enhance the Multi-Carrier System (MCS) to Avoid Duplicate Payments When a Full Claim Adjustment Is Performed
A	Instructions for the Coordination of Medicare Secondary Payer (MSP) Claims for the Competitive Acquisition Program (CAP)
N	Private Contracting- Definition of Physician/Practitioner
L, P	Tax Relief and Health Care Act of 2006 Changes to Independent Laboratory Billing for the Technical Component (TC) of Physician Pathology Services

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 4:00 p.m.
Tuesday - Thursday 8:00 a.m. to 4:00 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

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
Part B Telephone Reopenings	(866) 620-1190
Provider 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
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
Part B Telephone Reopenings	(888) 399-7719


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

New Help Desk Number Effective February 26, 2007
NGS Medicare EDI Help Desk	1 (877) 273-4334
Monday-Wednesday, Friday 8:00 -11:30 a.m. (EST) 12:00 Noon - 4:00 p.m.
Thursday 8:00 - 11:30 a.m. (EST) 12:00 Noon - 3:00 p.m.
EDI Part A Web Address NGS.EDI.A@Anthem.com
EDI Part B Web Address NGS.EDI.B@Anthem.com

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.