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Issue 2006-04, April 2006
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Modification of Roster Billing for Mass Immunizers Billing for Inpatient Part B Services (Type of Bills 12X and 22X)
Note: CR4242 rescinds and replaces CR3735.
Provider Types Affected
Providers billing Medicare fiscal intermediaries (FIs) for mass immunization services
Provider Action Needed
Impact to You
This article is based on Change Request (CR) 4242, which replaces CR3735 (Transmittal 542, dated April 29, 2005).
What You Need to Know
CR3735 incorrectly instructed providers to include the discharge date on the roster billing for mass immunizers. CR4242 removes this requirement and adds instructions to report the following additional (HIPAA required) data elements on the roster when billing for inpatient Part B services (TOBs 12x and 22x) effective October 1, 2005: admission date, admission type, admission diagnosis, patient’s status code, and admission source code.
What You Need to Do
See the Background section of this article for further details regarding this change.
Background
Change Request (CR) 4242 replaces CR3735 (Transmittal 542, dated April 29, 2005) and removes the requirement for reporting the discharge date on roster billing for mass immunizers billing for inpatient Part B services.
Medlearn Matters Number: MM4242 Related Change Request Number: 4242
Because the current roster billing process for mass immunizers billing inpatient Part B services utilizing TOBs 12x (hospitals) and 22x (Skilled Nursing Facilities) does not require the reporting of additional data elements that are mandated by the Health Insurance Portability and Accountability Act (HIPAA), CR 4242:
- Updates the roster billing to include these HIPAA-mandated data elements; and
- Instructs your FI to inform providers that mass immunize to report the following additional data elements on the roster when billing for inpatient Part B services (TOBs 12x and 22x) effective October 1, 2005:
- Admission date
- Admission type
- Admission diagnosis
- Patient’s status code
- Admission source code.
Implementation
The implementation date for this instruction is July 3, 2006.
Additional Information
For complete details, please see the official instruction issued to your intermediary regarding this change. That instruction may be viewed at http://www.cms.hhs.gov/Transmittals/downloads/R829CP.pdf  on the CMS Web site.
If you have any questions, please contact your intermediary at their toll-free number, which may be found at http://www.cms.hhs.gov/apps/contacts/  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.
Medlearn Matters Number: MM4242
Related Change Request (CR) #: 4242
Related CR Release Date: February 2, 2006
Effective Date: October 1, 2005
Related CR Transmittal #: R829CP
Implementation Date: July 3, 2006
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