Medicare Information Resource , Issue 2007 07AB

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July 2007

MIR-2007 07AB

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
H	A	Bone Mass Measurement-Revised (CR#5521)
A	A	CMS Learn Resource Articles
A	A	Discarded Drugs and Biologicals and Claims with JW Modifier (CR#5520)
A	A	Discontinuance of the UPIN Registry (CR#5584)
A	A	Emergency Update to the 2007 MPFS-Revised (CR#5459)
A	A	Guidelines for Diabetes Self-Management Training–Revised (CR#5433)
A	A	July 2007 HCPCS Codes for Albuterol, Levalbuterol and Reclast (CR#5645)
A	A	July Quarterly Update for 2007 DMEPOS Fee Schedule-Revised (CR#5641)
H, S, E	A	Medicare Payments for Ambulance Transports (SE0724)
A	A	National Government Services, Inc. Medicare Monthly Review
A	A	Quarterly Update to Medicare Unlikely Edits-Revised (CR#5603)
H	A	Revised HCPCS Codes for Immune Globulin (CR#5635)
A	A	Stage 2 NPI Changes for Transaction 835 and SPR-Revised (CR#5081)
A	A	Stage 3 NPI Changes for Transaction 835 and SPR-Revised (CR#5452)

Key	Part A Only
Part A	Title
H, S	Clarification of SNF No-Payment Billing (CR# 5583)
H	Important Message from Medicare and Expedited Determination Procedures for Hospital Discharges (CR#5622)
A	July 2007 Integrated OCE Specifications (CR#5617)
H	July Update of Hospital OPPS: Summary (CR#5623)
H	Update to IPF PPS for Rate Year 2008 (CR#5619)

Key	Part B Only Content
Part B	Title
B	Carrier Jurisdiction for Ambulance Supplier Claims (CR#5203)
A	Clarification of Manual Instruction Regarding Scope of Portable X-Ray Benefit (CR#5536)
X	Foot Care Coverage Guidelines (SE0707)
A	Implementation of the Carrier Jurisdictional Pricing Rules for All Purchased Diagnostic Service Claims-Revised (CR#5543)
A	New Deadline for Required Submission of the CMS-1500 Form (08/05) (CR#5616)
A	Physician Quality Reporting Initiative Coding and Reporting Principles (CR#5640)
A	Proper Use of Modifier “59” (SE0715)
A	Quarterly Update to CCI Edits (CR#5604)
A	Transitioning of the Mandatory Medigap “Claim-Based” Crossover Process to the COB Contractor (CR#5601)

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.