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National
Government Services, Inc.
Medicare Monthly Review Part A and B |
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A
Combined Part A and Part B Newsletter |
MLN Matters. . .Information
for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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MMR-2007 09AB, September 2007
2008 Annual Update of HCPCS Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) for the Common Working File (CWF), Medicare Carriers and Fiscal Intermediaries (FI)
Provider Types Affected
Physicians, providers, and suppliers submitting claims to Medicare contractors (carriers, durable medical equipment Medicare Administrative Contractors (DME MAC), Part A/B Medicare Administrative Contractors (Part A/B MAC) and fiscal intermediaries (FI)) for services provided to Medicare beneficiaries in SNFs
Provider Action Needed
Impact to You
This article is based on Change Request (CR) 5696, which provides the 2008 annual update of HCPCS Codes for SNF CB and how the updates affect edits in Medicare claims processing systems.
What You Need to Know
CR5696 provides updates to HCPCS codes that will be used to revise CWF edits to allow carriers and FIs to make appropriate payments in accordance with policy for SNF CB in the Medicare Claims Processing Manual, Chapter 6, Section 110.4.1 for carriers and Chapter 6, Section 20.6 for FIs.
What You Need to
See the Background and Additional Information sections of this article for further details regarding this update.
Background
Medicare’s claims processing systems currently have edits in place for claims received for beneficiaries in a Part A covered SNF stay as well as for beneficiaries in a noncovered stay. Changes to Healthcare Common Procedure Coding System (HCPCS) codes and Medicare Physician Fee Schedule designations are used to revise these edits to allow carriers, A/B MACs, DME MACs, and FIs to make appropriate payments in accordance with policy for SNF CB contained in the Medicare Claims Processing Manual. These edits only allow services that are excluded from CB to be separately paid by Medicare contractors.
Physicians and providers are advised that, by the first week in December 2007, new code files will be posted at http://www.cms.hhs.gov/SNFConsolidatedBilling/  on the CMS Web site. Institutional providers note that this site will include new Excel® and PDF format files.
Note: It is important and necessary for the provider community to view the “General Explanation of the Major Categories” PDF file located at the bottom of each year’s FI update listed at http://www.cms.hhs.gov/SNFConsolidatedBilling/ on the CMS Web site in order to understand the Major Categories including additional exclusions not driven by HCPCS codes.
Additional Information
The official instruction, CR5696, issued to your Medicare contractor regarding this change can be found at http://www.cms.hhs.gov/Transmittals/downloads/R1317CP.pdf  on the CMS Web site.
If you have questions, please contact your Medicare contractor at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip  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: MM5696
Related Change Request (CR) #: 5696
Related CR Release Date: August 17, 2007
Effective Date: January 1, 2008
Related CR Transmittal #: R1317CP
Implementation Date: January 7, 2008
News Flash – The May 2007 version of the Quick Reference Information: Medicare Preventive Services laminated chart is now available to order or download from the Medicare Learning Network. To order, go to the “MLN Product Ordering Page” located at http://cms.meridianksi.com/kc/main/kc_frame.asp?kc_ident=kc0001&loc=5 or to view online, go to http://www.cms.hhs.gov/MLNProducts/downloads/MPS_QuickReferenceChart_1.pdf on the CMS Web site.
| 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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