Medicare Information Resource , Issue 2007 04AB

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April 2007

MIR-2007 04AB

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.

In This Issue:

KEY		Part A & B Contents
Part A	Part B	Title
A	A	2007 Quarterly ASP Medicare Part B Drug Pricing File, Effective April 1, 2007, and Revisions to the January 2007 Part B Drug Pricing Files (CR# 5517)
A	A	Ambulance Fee Schedule – Medical Conditions List (CR# 5442)
A	A	Announcing a New Section of the CMS Pub. 100- Public Web Site Regarding Medicare Advantage Plans and Part D Plans (PE200703-22)
A	A	April Quarterly Update for 2007 DMEPOS Fee Schedule (CR# 5537)
A	A	April Update to the 2007 Medicare Physician Fee Schedule Database (MPFSDB) (CR#5528)
A	A	Changes to the Laboratory National Coverage Determination (NCD) Edit Software for April 2007 (CR#5514)
A	A	Colorectal Cancer Screening Data (PE200703-20)
A	A	Colorectal Cancer: Preventable, Treatable and Beatable (SE0710)
A	A	Differentiating Mass Adjustments from Other Types of Adjustments and Claims for Crossover Purposes and Revising the Detailed Error Report Special Provider Notification Letters (CR# 5472)
H	A	Extracorporeal Photopheresis (CR# 5464)
A	A	Flu Shot Reminder (PE200703-04)
A	A	Implementation of Revised Fee Schedule for HCPCS Codes for Power Mobility Devices (JSM-07308)
H, S	L	Laboratory Services Competitive Bidding Demonstration (PE200703-18)
A	A	Medically Unlikely Edits (MUE) (CR# 5495)
A	A	Medicare Guide to Rural Health Services Information (PE200703-09)
H	P	Medicare for Eligible Medicare Beneficiaries of a One-Time Ultrasound Screening for Abdominal Aortic Aneurysms (AAA) (SE0711)
A	A	National Nutrition Month® (PE200703-01)
A	A	NPI – Will You Be Ready (PE200703-19)
A	A	Participating Physician/Supplier Directory is Available (CR# 5307)
A	A	Reminder – Medicare Provides Coverage of Prostate Cancer Screening for Eligible Medicare Beneficiaries (SE0709)
A	A	Services Not Provided within the United States (CR# 5427)
A	A	Use of Nine-Digit Zip Codes to Determine the Correct Payment Locality (CR# 5208)

Key	Part A Only
Part A	Title
A	April 2007 Non-OPPS OCD Specifications Version 22.1 (CR# 5523)
H	April 207 OPPS OCE Specifications Version 8.1 (CR# 5522)
H	Billing for Islet Isolation Add-On in NIH Clinical Trial (CR# 5505)
H, E	ESRD Composite Payment Rates Update for 2007 (CR# 5535)
H, E	Hemophilia Clotting Factor for vonWillebrand Factor HCPCS Code (JSM-07291)

Key	Part B Only Content
Part B	Title
A	Common Errors to Avoid When Billing Medicare Carriers (SE0712)
A	Correction to CR5404, New Waived Tests (CR# 5482)
A	Extension for Acceptance of the CMS-1500 Claim Form (CR# 5568)
A	Incomplete or Invalid Claims Instructions for Implement the Revised HIC Form CMS-1500 (Version 8/05) (CR# 5391R)
A	New Waived Tests (CR# 5484)
A	PQRI Frequently Asked Questions (PE200703-13)
A	Program Overview: 2007 Physician Quality Reporting Initiative (CR# 5558)
A	Quarterly Update to CCI Edits, Version 13.1 (CR#5492)
A	Revised PQRI PowerPoint Presentation – Module One (PE200703-15)
A	Temporary Addition to ASCA Exception List for MSP (CR# 5488)

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

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

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 Information

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 Enrollment:	(866) 309-0486
Provider TDD:	(888) 897-7542

Provider Enrollment

Mail claims to:

National Government Services
Provider Enrollment
P.O. Box 69218
Harrisburg, PA 17106-9218

National Government Services
Provider Claims
P.O. Box 69201
Harrisburg, PA. 17106-9201

Part B Appeals & Correspondence

National Government 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

Provider Enrollment:	Mail Assigned Claims to:
National Government Services Reimbursement Dept. P.O. Box 1200 Crompond, NY 10517-1200	National Government Services, P.O. Box 100 Yorktown Heights, NY 10598

Unassigned Claims to:	Health Professional Shortage Area (HPSA) & EMC Audit:
National Government Services P.O. Box 355 Crompond, NY 10517	National Government 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	Part B Appeals & Correspondence
National Government Services MIR-Back Issues 800 2nd Avenue 3rd Floor New York, NY 10017	National Government Services P.O. Box 2280 Peekskill, NY 10566

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.NGSMedicare.com.