Medicare News Update, Issue 2006-03

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Issue 2006-03, March 2006

CPT five-digit codes, descriptions, and other data only are copyright 2004 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:

A	MM	Ambulance Fee Schedule Update for CY 2006
A	JSM	Announcement of Redesigned (NPI) Web Page
H		Billing Pegfilgrastim
H	MM	Blood Clotting Factor Payment Revision
H	MM	Calculation of IME Through IPPS Pricer – Revised
H, S	MM	Certified Swing-Bed Hospital Services
A	MM	Claims Status Category Code Update
A		Coordination of Benefits
O		CORF and ORF Issues - Teleconference
H	MM	Discharge or Death Prior to Room Assignment
A		Duplicate Claims Rejected with Reason Code 38200
A		EMS Listens
H, E		Frequent Hemodialysis Network Payments
A		Gap Billing Teleconference
A		Generic Notices for Expedited Reviews vs. Skilled Nursing Facility Advanced Beneficiary Notices (ABN)/Denial Letters
A	MM	HCPCS Codes for SNF Consolidated Billing
A	MM	Healthcare Provider Taxonomy Codes
A	MM	Hold on Medicare Payments
H		Inpatient PPS Teleconference
A		Instructions for Exiting CWF Inquiry
A		Interactive Voice Response Unit
S		Introduction to SNF Billing – Session 2 Teleconference
H	MM	January 2006 Hospital OPPS Changes
H		LCD and Article Revisions for March 2006
H		LCD Summary for Beta Glucocerebrosidase
A	MM	Long Descriptor for HCPCS Code Q4080
A	MM	Medicare Prescription Drug Coverage
A	MM	MSP Balancing Edit and ASCA Enforcement
A	MM	New 2006 Payment Under MPFS
S	MM	New SNF CB Web Site Address
H	MM	OPPS OCE V 7.0
A	MM	Payment of Vaccine Administration
H	MM	Percutaneous Transluminal Angioplasty – Revised
A		Provider Enrollment Functions
H	MM	QR Modifier Edit
A		Reason Code File Update
H	MM	Same-Day Transfer Claims Under IPF PPS
A	MM	Smoking and Tobacco-Use Cessation: CWF Inquiry
S	JSM	SNF Claims Receiving Reason Code W7062
A	MM	Systems Used by Medicare to Process Your Claims
A		The Appeals Process - Teleconference
A	MM	Therapy Caps – Revised
A	MM	Therapy Caps Exception Process
H	MM	Update of Radiopharmaceutical Imaging Agents - Revised
Key:	A-All Providers, H-Hospitals, S-Skilled Nursing Facilities (SNF), O-Comprehensive Outpatient Rehabilitation Facilities (CORF) and Outpatient Physical Therapy Providers, C-Community Mental Health Centers (CMHC), E-Renal Dialysis (ESRD) Providers, P-Hospice Providers, M-Home Health Providers, MM-Medlearn Matters, JSM-Joint Signature Memo

Telephone Directory

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 4:00 p.m.
Tuesday - Thursday 8:00 a.m. to 4:00 p.m.

Beneficiary Inquiries:
English and Spanish

1-800-MEDICARE (1-800-633-4227)

TTY for the Hearing-Impaired:

1 (877) 486-2048

Integrated Electronic Services (IES) Technical Help Desk:
Monday through Friday from 8:30 a.m. until 4:30 p.m.

1 (866) 889-7322

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

Medical Director:
Dr. Ted Triana

1(315) 442-4893

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.empiremedicare.com.