Medicare News Update, Issue 2006-04

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Issue 2006-04, April 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		Additional Information about CR# 4324 and CR# 4270
A		American Hospital Association Clearinghouse for Coding Questions
A	MM	Appeals: Administrative Law Judge; Departmental Appeals Board; U.S. District Court Review
A	MM	April 2006 ASP for Medicare Drug Pricing File
A	MM	April 2006 Non-OPPS OCE Specifications Version 21.2
H	MM	April 2006 OPPS OCE Specifications Version 7.1
A	MM	April Quarterly Update for 2006 DMEPOS Fee Schedule
A	JSM	Change in Provider Call Center Hours
A	MM	Changes to Chapter 29 - Appeals of Claims Decisions - Revised
H	MM	Changes to Laboratory NCD Edit Software
A	MM	CMS Seeks Provider Input on Fee-for-Service Contractors
A	MM	Colorectal Cancer: Preventable, Treatable, Beatable
H		Correction - Local Coverage Determination (LCD) Summary
A	MM	Denial of Claims Not Timely Filed
A	MM	Drug Coverage Materials for Health Care Professionals
A		EMS Educational Tools
H, S, O		Further Instruction on CR 4364: Therapy Cap Exceptions
A	MM	HIGLAS and 835 IG Code Mapping and SPR Changes
H	MM	Hospital Billing for Take-Home Drugs
A		Improved Local Coverage Determination (LCD) Search
H		LCD and Article Revisions for April 2006
H		LCD Summary – Swallow Evaluation
H, S	MM	Mammography Facility Certification File
A		Medicare Credit Balance Reporting
H	MM	Modification of Roster Billing for Mass Immunizers
A	MM	New Name for Medicare Provider Education Articles
A	MM	NPI – Policy on Subpart Designation
A	MM	NPI Numbers Received in EDI Transactions
H	MM	OPPS Hospital Emergency Room Services Exceeding 24 Hours
H, S, O		Outpatient Therapy HCPCS Code 97542 Revised Definition
S		Patient Status Required on SNF OPT Bill Type 23X
A	MM	Payment for Power Mobility Device (PMD) Claims
H	MM	Payment of Same-Day Transfer Claims IPF PPS - Revised
A		PC-ACE Pro32 April 2006 Release
A	MM	Prescription Drug Coverage: Understanding Costs to Beneficiaries
A	MM	Provider Enrollment in the Medicare Program
A	MM	RARC and CARC Update
A		Reason Code File Update
A	JSM	Redesigned National Provider Identifier (NPI) Web Page
A	MM	Remittance Advice Remarks and Claim Adjustment Codes
H, E	MM	Repeat Tests for AMCC for ESRD Beneficiaries
A	JSM	Streamlined Drug Coverage Materials
H	MM	Supplying and Inhalation Drug Dispensing Fee Revisions
H, S, O	MM	Therapy Cap Exception Process –Revised
H, S, O	MM	Therapy Code List Update
H	MM	TOPs for Sole Community and Small Rural Hospitals for 2006
H, S, O	MM	Ultrasound Stimulation for Nonunion Fracture Healing
A		Upcoming Change to Provider Bulletin Format
A		Upcoming Medicare Training
H, E	MM	Update to ESRD Composite Payment Rates
A		What’s Preventing Your Electronic Claim from Being Accepted
A		ZIP Code Inquiry

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.