Provider Types Affected
Physicians, providers, and suppliers who submit claims to Medicare contractors (carriers, fiscal intermediaries (FI), regional home health intermediaries (RHHI), Part A/B Medicare Administrative Contractors (A/B MAC), and DME Medicare Administrative Contractors (DME MAC)) for pulmonary rehabilitation services to Medicare beneficiaries

Impact on Providers
The Centers for Medicare & Medicaid Services (CMS) issued CR 5834 detailing the decision regarding a national coverage determination (NCD) for Pulmonary Rehabilitation Services.

• Effective with dates of service on and after September 25, 2007, Medicare contractors will continue to process claims for pulmonary rehabilitation services using their local coverage determination (LCD) process or case-by-case adjudication.
• No changes to process or policy are made with CR5834.

Background
Currently, CMS does not cover pulmonary rehabilitation as a single entity. However, there is a limited benefit for some pulmonary rehabilitation services provided in a comprehensive outpatient rehabilitation facility (CORF). Also, certain components of pulmonary rehabilitation may fall under other existing benefit categories and may be provided independently outside of a CORF. On November 15, 2006, CMS received a request for a national coverage determination that would address components of pulmonary rehabilitation services in the hospital outpatient, physician office, and CORF settings. CR5834 communicates the findings resulting from that request. To see the complete analysis, visit http://www.cms.hhs.gov/mcd/viewnca.asp?where=index&nca_id=199 on the CMS Web site.

Additional Information
You may see the official instruction (CR5834) issued to your Medicare carrier, A/B MAC, FI, DME MAC or RHHI by going to http://www.cms.hhs.gov/Transmittals/downloads/R78NCD.pdf on the CMS Web site. The actual revision to the National Coverage Determination manual containing this NCD is attached to CR5834.

If you have questions, please contact your Medicare A/B MAC, carrier, FI, DME MAC or RHHI at their toll-free number which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip on the CMS Web site.

News Flash - It's seasonal flu time again! If you have Medicare patients who haven’t yet received their flu shot, you can help them reduce their risk of contracting the seasonal flu and potential complications by recommending an annual influenza and a one-time pneumococcal vaccination. Medicare provides coverage for flu and pneumococcal vaccines and their administration. – And don’t forget to immunize yourself and your staff. Protect yourself, your patients, and your family and friends. Get Your Flu Shot – Not the Flu! Remember - Influenza vaccination is a covered Part B benefit but the influenza vaccine is NOT a Part D covered drug. Health care professionals and their staff can learn more about Medicare’s coverage of adult immunizations and related provider education resources, by reviewing Special Edition MLN Matters article SE0748 at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0748.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.

News Flash - A new preventive services brochure entitled Cancer Screenings, ICN# 006434, is now available on the Centers for Medicare & Medicaid Services (CMS) Medicare Learning Network (MLN). This tri-fold brochure provides health care professionals with an overview of Medicare’s coverage of the following screening services: mammography, colorectal, prostate, Pap test, and pelvic exam. The brochure is available at http://www.cms.hhs.gov/MLNProducts/downloads/Cancer_Screening.pdf on the CMS Web site.

Posted: 12/27/2007