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MIR-2007 06A, June 2007
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Update of HCPCS Codes for Hemophilia Clotting Factors (MM5466)
Provider Types Affected
Providers who submit claims to Medicare fiscal intermediaries (FI) and Part A/B Medicare Administrative Contractors (A/B MAC) for hemophilia clotting factors
Provider Action Needed
Impact to You
Discontinue the use of HCPCS code J7188, injection, vonWillebrand factor complex, human, ristocetin cofactor, per IU, effective for discharges after December 31, 2006.
What You Need to Know
Providers are to use the new HCPCS code, J7187, injection, vonWillebrand factor complex, human, ristocetin cofactor, per IU, effective with dates of discharge January 1, 2007. However, Medicare systems will not be ready to process J7187 until October 1, 2007. Claims submitted with J1787 prior to the October 1, 2007 implementation date will be returned to the provider (RTP).
What You Need to Do
Be sure billing staff are aware of this change and of how to handle related claims until Medicare systems are updated on October 1, 2007. The background section of this article provides instructions for handling this issue until October 1, 2007.
Background
Effective for dates of discharge on or after January 1, 2007, providers should use the new HCPCS code of J7187 for appropriate hemophilia clotting factors. However, as mentioned, Medicare systems will not be ready to process the J7187 code until October 1, 2007. Thus, for claims submitted from January 1, 2007 through September 30, 2007, (and for dates of discharge on or after January 1, 2007), hospitals should take the following steps:
- For claims for hospital inpatient care, omit the J7187 code from the claim.
- Once payment has been received for the inpatient claim, immediately submit an adjustment request (type of bill 117), including the J7187 code on the adjustment.
- Once Medicare systems are ready to process the J1787 code, the adjustment will process automatically.
With the exception of the adjustment requests just mentioned, Medicare will return claims containing J7187 with dates of discharge on or after January 1, 2007, which are received prior to the October 1, 2007 implementation date.
Providers should note that this does not impact payment of outpatient claims, or skilled nursing facility claims. However, claims paid under the inpatient psychiatric facility (IPF) prospective payment system will also need to omit J7187 as noted above and IPF providers should follow the above instructions.
Additional Information
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.
CR5466 is the official instruction issued to your Medicare A/B MAC or FI on this issue. That instruction may be viewed by going to http://www.cms.hhs.gov/Transmittals/downloads/R1234CP.pdf  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
MLN Matters Number: MM5466
Pub. 100-4, Transmittal# R1234CP, CR# 5466
Related CR Release Date: April 27, 2007
Effective Date: January 1, 2007
Implementation Date: October 2, 2007
Medicare Disproportionate Share Hospital Fact Sheet Available
The revised (March 2007) Medicare Disproportionate Share Hospital Fact Sheet, which provides information about methods to qualify for the Medicare Disproportionate Share Hospital (DSH) adjustment and Medicare DSH payment adjustment formulas, is now available on the CMS Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/2007mdsh.pdf .
| 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. |
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