Medicare Information Resource , Issue 2007 06AB

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June 2007

MIR-2007 06AB

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	Article Revisions Due to NPI Contingency Plan (CRs 5089, 4023, 5081, 5229, 5378, 5568, 5289, 5508, 5243, 5334, 5391, 5060, 4239, SE0528, SE0659)
H	W	Astigmatism-Correcting Intraocular Lenses (CR#5527)
H	P	Clarification of Bariatric Surgery Billing (CR#5477)
A	A	Healthy Vision (PE200705-06)
H, S	A	Invalid SNF informational Unsolicited Responses from Medicare’s CWF System (CR#5587)
A	A	Medicare Fee-for-Service NPI Contingency Plan (CR#5595 Revised)
A	A	Modification to the Model Medicare Redetermination Notice (CR#5554)
A	A	NPI: The NPI Compliance Deadline Is Here! (PE200705-30)
A	A	Part B Paid Claims that Overlap Non-pay SNF Claims (PE200705-02)
A	A	Payment and Coding for Drugs and Biologicals (PE200705-23)
A	A	Provider Authentication Requirement for Telephone and Written Inquiries During NPI Contingency Plan (SE0721)
H, E	P	Requirements for Route of Administration Code for ESA (CR# 5480)

Key	Part A Only
Part A	Title
M	CMS Proposes Payment Changes for Home Health Services (PE200704-37)
P	Correction of Hospice Cap for FYs 2003 and 2004 (CR#5596)
H	Graduate Medical Education Payments to Teaching Hospitals (PE200705-03)
A	Implementation of the UB-04 Fact Sheet (Related to PE200704-31)
H	Inpatient Psychiatric Facility PPS Fact Sheet (PE200705-16, PE200705-24)
H	Payment for Extended Stay Services Under Frontier Extended Stay Clinic Demonstration (CR#5454)
H	Policy and Payment Changes for LTCHs for Rate Year 2008 (PE200705-04)
H	Policy and Payment Changes for LTCHs for Rate Year 2008 Correction (PE200705-21)
H	Present on Admission Indicator (CR#5499)
H, S	Proposed Increase in Payments to Nursing Homes for 2008 (PE200705-01)
H	Proposed Payment and Policy Changes for IRFs in FY 2008 (PE200705-08)
H	Proposed Payment Reform for Inpatient Hospital Services in 2008 (PE200705-22)
A	Uniform billing (UB-04) Implementation (CR#5072-Revised)
H	Update of HCPCS Codes for Hemophilia Clotting Factors (CR#5466)
H	Use of Benefits Exhaust Day as Discharge Date for IPF PPS (CR# 5474)

Key	Part B Only Content
Part B	Title
A	Competitive Acquisition Program Educational Materials Available during Additional Physician Election Period (PE200705-27)
A	Physician Quality Reporting Initiative Information Available
D	Pre Bidding Activities for DMEPOS Competitive Bidding Program (SE0714)
D	Web Cast Available for DMEPOS Competitive Bidding Program Suppliers (PE200704-37)

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.