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MIR-2007-3AB, March 2007
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) for Oncology Treatment Payment Adjustment
Provider Types Affected
Inpatient Psychiatric Facilities (IPF) submitting claims to Medicare Fiscal Intermediaries (FI) or Part A/B Medicare Administrative Contractors (A/B MAC) for oncology treatment services provided to Medicare beneficiaries.
Provider Action Needed
This article is based on Change Request (CR) 5470 which states that an oncology adjustment factor should be applied when the oncology procedure code appears in either the principal procedure code field or any of the other procedure code fields. However, the adjustment may not have been applied to some claims. Be sure your billing staff is aware of this issue and takes appropriate action as noted in this article.
Background
Currently, the Inpatient Psychiatric Facility (IPF) Prospective Payment System (PPS) Pricer program receives only the “other” procedure codes from Medicare’s Fiscal Intermediary Standard System (FISS). Therefore, if a radiation or chemotherapy procedure code appears in the principal procedure code field, the claim will not receive the “Oncology Treatment” payment adjustment.
The IPF PPS provides a comorbidity adjustment of 1.07 for Oncology Treatment, and in order to receive this adjustment, a claim must have:
- An ICD-9-CM code in the range from 1400 through 2399, and
- A procedure code 99.25 (chemotherapy) or 92.21 through 92.29 (radiation).
CR 5470 states that the FISS will pass the IPF PPS Pricer all procedure codes, including the principal procedure code and allow this capability back to January 1, 2005 (the implementation date of the IPF PPS).
The oncology adjustment factor should be applied when the oncology procedure code appears in either the principal procedure code field or any of the other procedure code fields.
If an IPF believes that they are entitled to a comorbidity adjustment for Oncology Treatment, the IPF should resubmit their claim after July 1, 2007, so that they may be reimbursed accurately. Timely filing rules will not apply to claims resubmitted by IPFs as a result of this issue.
Additional Information
The official instruction, CR5470, issued to FIs and A/B MACs regarding this change may be viewed at http://www.cms.hhs.gov/Transmittals/downloads/R1170CP.pdf  on the CMS Web site.
If you have any questions, please contact your FI or A/B MAC at their toll-free number, which may be found on the CMS Web site at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip. 
Flu Shot Reminder
It’s Not Too Late to Give and Get a Flu Shot!
The peak of flu season typically occurs between late December and March; however, flu season can last until May. Protect yourself, your patients, and your family and friends by getting and giving the flu shot. Each office visit presents an opportunity for you to talk with your patients about the importance of getting an annual flu shot and a lifetime pneumococcal vaccination. Remember - influenza and pneumococcal vaccination and their administration are covered Part B benefits. Note that influenza and pneumococcal vaccines are NOT Part D covered drugs. For more information about Medicare’s coverage of adult immunizations and educational resources, go to CMS’s Web site: http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0667.pdf.
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: MM5470
Pub. 100-4, Transmittal# R1170CP, CR# 5470
Related CR Release Date: February 2, 2007
Effective Date: January 1, 2005
Implementation Date: July 2, 2007
Additional Information Provided by National Government Services
Providers should resubmit a debit claim with a bill type of 117, and condition code D9. In remarks providers must note that the claim is an adjustment for the “oncology comorbidity payment.”
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