Displaying Part A Inpatient Rehabilitation Facility Articles 1 to 25 of 48

Topic	Date	Description
Pinnacle Business Solutions, Inc. Holiday	Wednesday, December 17, 2008	Pinnacle Business Solutions, Inc. will be closed on Thursday, December 25 and Friday, December 26, 2008 in observance of the Holiday Season. EDI Technical Support and Customer Service Representatives will not be available. The call center will open at our normal operating hours on Monday, December 29. We will be happy to serve you then.
Call Center Closing Times (Part A)	Tuesday, December 16, 2008	To better serve the provider community, the Centers for Medicare and Medicaid Services (CMS) is allowing Provider Contact Centers across the nation to conduct customer service training during normal business hours. The Medicare Program is very complex with continuous changes and this initiative will help prepare Provider Customer Service Representatives (CSR's) to give quality answers to substantive Medicare related questions or inquiries. Pinnacle Business Solutions, Inc. the Medicare Part A Intermediary for the State of Arkansas, will be participating in this program. We have developed a comprehensive training plan that includes closing our Provider Contact Center for up to eight hours each month. The following closure dates are scheduled for December 2008 and January 2009.
Influenza Pandemic Emergency - The Medicare Program Prepares	Tuesday, December 09, 2008	Note: This article was revised on December 8, 2008, to include a Web link to CR6209, which was recently issued by CMS. All other information remains the same. This article is informational only and is alerting providers that the Centers for Medicare & Medicaid Services (CMS) has begun preparing emergency policies and procedures that may be implemented in the event of a pandemic or national emergency.
Adding Certain Entities as Originating Sites for Payment of Telehealth Services--Section 149 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)	Monday, November 24, 2008	This article is based on Change Request (CR) 6215 which announces that the Centers for Medicare & Medicaid Services (CMS) is adding entities as originating sites for payment of telehealth services for dates of service on or after January 1, 2009.
Hurricane Updates	Wednesday, November 19, 2008	The employees of Pinnacle Medicare Services continue to extend their support and heartfelt concern to the victims of Hurricane Gustav. In an effort to assist our provider community/beneficiaries during this difficult time, all hurricane related updates will be posted in this section of our website.
Preparing for a Transition from an FI/Carrier to a Medicare Administrative Contractor (MAC)	Wednesday, November 12, 2008	This article is intended to assist all providers that will be affected by Medicare Administrative Contractor (MAC) implementations. The Centers for Medicare & Medicaid Services (CMS) is providing this information to make you aware of what to expect as your FI or carrier transitions its work to a MAC. Knowing what to expect and preparing as outlined in this article will minimize disruption in your Medicare business.
Update to the Initial Preventive Physical Examination (IPPE) Benefit	Wednesday, November 12, 2008	This article is based on Change Request (CR) 6223, which announces that, effective January 1, 2009, the Centers for Medicare & Medicaid Services (CMS) is expanding coverage for the IPPE benefit. This expanded coverage is subject to certain eligibility and other limitations that allow payment for an IPPE, no later than 12 months (rather than 6 months as previously required) after the date the individual’s first coverage period begins under Medicare Part B. However, this expanded coverage only applies if the IPPE is performed on or after January 1, 2009. The IPPE has been expanded to include measurement of an individual’s body mass index, and end-of-life planning as mandatory services (upon an individual’s consent). The screening electrocardiogram (EKG) is no longer a mandatory part of the IPPE, but it may be performed as an optional one-time service as a result of a referral arising out of the IPPE. Be sure your billing staff is aware of these changes.
New Hemophilia Clotting Factor and Healthcare Common Procedure Coding System (HCPCS) Code and Terminated Hemophilia Clotting Factor HCPCS Code	Friday, November 07, 2008	This article is based on Change Request (CR) 6268 which announces that, effective for inpatient claims with dates of discharge on or after January 1, 2009, Healthcare Common Procedure Coding System (HCPCS) code J7186 will be payable by Medicare. HCPCS code Q4096 will not be payable by Medicare for claims with dates of discharge on or after January 1, 2009.
Revision to the Reporting Requirements of Qualifying Hospital Stays on Inpatient Skilled Nursing Facility (SNF) and Swing Bed (SB) Claims	Friday, October 31, 2008	This article is based on Change Request (CR) 6233 which updates the requirement for reporting prior qualifying hospital stay dates on inpatient SNF and SB claims. Be sure billing staff are aware of these requirements.
New 2008 Medicare Physician Fee Schedule (MPFS) Payment Rates Effective for Dates of Service July 1, 2008, through December 31, 2008	Wednesday, October 29, 2008	This article is based on Change Request (CR) 6212, which announces the new 2008 MPFS payment rates effective for dates of service July 1, 2008, through December 31, 2008. Please note that Medicare contractors have already implemented the actions annotated in this article. The Centers for Medicare & Medicaid Services (CMS) directed Medicare contractors to revert back to the 0.5 percent payment rates that were previously in place until June 30, 2008, and to use those rates through December 31, 2008. In addition, carriers/Part B MACs are using the same rates as used for January 1 through June 30, 2008, to make payments, where appropriate, to Ambulatory Surgical Centers (ASCs) for services rendered from July 1 through December 31, 2008. This reflects a continuation of the payment policy for brachytherapy services at carrier/Part B MAC-priced amounts and the prospective rates for other ASC services. CMS also provided revised fees for selected mental health codes that had an increase in their fee schedule amounts. The effective date for the increase for the mental health codes was for dates of service on and after July 1, 2008. See the Background and Additional Information Sections of this article for further details regarding these changes.
National Provider Identifier (NPI) for Secondary Providers	Tuesday, October 21, 2008	Note: This article was revised on October 16, 2008, to reflect changes to CR 6093, which CMS revised on October 15, 2008, to include the FISS in the business requirements. The implementation date was changed to October 29, 2008. The CR release date, transmittal number, and the Web address for accessing CR6093 were also revised. All other information remains the same. This article is based on CR 6093 and outlines the need to use NPIs to identify secondary providers in Medicare claims beginning May 23, 2008.
The ICD-10 Clinical Modification/Procedure Coding System (CM/PCS) - The Next Generation of Coding	Tuesday, October 14, 2008	Note: This article was revised on October 9, 2008, to update the website addresses and other information in the "Additional Information" section of this article. All other information remains the same. This Special Edition article (SE0832) outlines general information for providers detailing the International Classification of Diseases, 10th Edition (ICD-10) classification system. Compared to the current ICD-9 classification system, ICD-10 offers more detailed information and the ability to expand specificity and clinical information in order to capture advancements in clinical medicine. Providers may want to become familiar with the new coding system. The system is not yet implemented in Medicare’s fee-for-service (FFS) claims processes so no action is needed at this time.
Non-acceptance of Legacy Provider Numbers on Incoming Medicare Claims	Monday, October 13, 2008	With the implementation of the National Provider Identifier (NPI) on May 23, 2008, Medicare ceased accepting legacy provider numbers, qualified by 1C and 1G within the secondary provider REF segments, on incoming Medicare American National Standards Institute (ANSI) X12N 837 4010A1 claims. Effective October 6, 2008, providers should note that, with one qualified exception, as highlighted below, Medicare will reject all incoming Medicare X12N 837 4010A1 claims that contain legacy identifiers. The following qualifiers within the secondary provider REF loops are acceptable: For 837 institutional claims, the Employer Identification Number (EIN)/Federal Tax ID, qualified by "EI" or "TJ," will be accepted; and For 837 professional claims, the provider’s EIN/Tax ID, qualified by "EI" or "TJ," or social security number, as qualified by "SY," will be accepted.
2009 Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) for the Common Working File (CWF), Medicare Administrative Contractors (MACs), Medicare Carriers and Fiscal Intermed	Monday, October 06, 2008	This article is based on Change Request (CR) 6220 which provides the 2009 annual update of Healthcare Common Procedure Coding System (HCPCS) Codes for Skilled Nursing Facility Consolidated Billing (SNF CB) and how the updates affect edits in Medicare claims processing systems. Physicians and providers are advised that, by the first week in December 2008, new code files will be posted at http://www.cms.hhs.gov/SNFConsolidatedBilling/ on the Centers for Medicare & Medicaid Services (CMS) website. Institutional providers note that this site will include new Excel® and PDF format files. 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 website in order to understand the Major Categories including additional exclusions not driven by HCPCS codes. See the Background and Additional Information Sections of this article for further details regarding these changes.
Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Pricer Update FY 2009	Thursday, September 25, 2008	This article is a reminder that the SNF PPS rates are updated annually.
Limitation on Recoupment (935) for Provider, Physicians and Suppliers Overpayments	Tuesday, September 23, 2008	Note: This article was revised on September 18, 2008, to make minor clarifying changes on page 2 and to delete some unnecessary language on pages 5 and 9. All other information remains the same. CR 6183, from which this article is taken, announces changes to the physician, provider, and supplier overpayment recoupment process, as required by Section 935 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) which amended Title XVIII of the Social Security Act to add to Section 1893 a new paragraph (f) addressing this process.
Limitation on Recoupment (935) for Provider, Physicians and Suppliers Overpayments	Tuesday, September 16, 2008	CR 6183, from which this article is taken, announces changes to the physician, provider, and supplier overpayment recoupment process, as required by Section 935 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) which amended Title XVIII of the Social Security Act to add to Section 1893 a new paragraph (f) addressing this process.
Implementation of New Provider Authentication Requirements for Medicare Contractor Provider Telephone and Written Inquiries	Friday, August 15, 2008	CR 6139, from which this article is taken, addresses the necessary provider authentication requirements to complete IVR transactions and calls with a Customer Service Representative (CSR). Effective March 1, 2009, when you call either the IVR system, or a CSR, the Centers for Medicare & Medicaid Services (CMS) will require you to provide three data elements for authentication: 1) Your National Provider Identifier (NPI); 2) Your Provider Transaction Access Number (PTAN), and 3) The last 5-digits of your tax identification number (TIN). Make sure that your staffs are aware of this requirement for provider authentication.
Upcoming Medicare Part A SNF Medicare Advanced Workshop	Thursday, August 07, 2008	Our Medicare Advanced Workshop serves as a supplement to the Welcome to Medicare Introductory Workshop. It is also perfect for those who are interested in additional training beyond basic Medicare as it provides a comprehensive overview of the Medicare program including claims submission, claims adjudication and how to read the remittance advice, appeals process, coverage criteria, billing requirements, common denials, overpayments, Medicare Secondary Payer, valuable web site resources, and much more. This is a full-day workshop and seating is limited. Lunch and light refreshments will be provided. WHO SHOULD ATTEND? We encourage all health care providers, practice/office managers, compliance officers, and billing personnel to attend. Online registration available.
Manual Revisions to Reflect Special Billing Instructions for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items as a Result of the DMEPOS Competitive Bidding Program	Tuesday, August 05, 2008	Note: This article is impacted by the Medicare Improvements for Patients and Providers Act of 2008, which was enacted on July 15, 2008. That legislation delays the implementation of the DMEPOS competitive bidding program until 2009 and makes other changes to the program. This article will be further revised and/or replaced as more details of the modified program are available. The Centers for Medicare & Medicaid Services (CMS) issued Change Request (CR) 6007 so suppliers are aware of the information provided in the new section 50 of chapter 36 of the Medicare Claims Processing Manual highlighted in the Key Points section of this CR and attached to CR6007.
Individuals Authorized Access to CMS Computer Services – Provider/Supplier Community (IACS-PC): THE FIRST IN A SERIES OF ARTICLES	Tuesday, August 05, 2008	Note: This article was revised on July 30, 2008, to reflect current processes and provide the Web address for the new IACS website which contains user reference guides. Please note that CMS will notify providers as internet applications become available, and provide clear instructions that specify which providers should register in IACS-PC. Do not register until you are notified by CMS or one of its contractors to do so and only if you meet the criteria in the notice. These articles will help providers to register for access to CMS online computer services when directed to do so by CMS. This article contains: 11 questions and answers to get you started and Overview of the registration process for IACS-PC defined provider/supplier organization users.
Individuals Authorized Access to CMS Computer Services – Provider/Supplier Community (IACS-PC): THE SECOND IN A SERIES OF ARTICLES ON THE IACS	Tuesday, August 05, 2008	Note: This article was revised on July 30, 2008, to reflect current processes and provide the Web address for the new IACS website which contains user reference guides. Please note that CMS will notify providers as internet applications become available, and provide clear instructions that specify which providers should register in IACS-PC. Do not register until you are notified by CMS or one of its contractors to do so and only if you meet the criteria in the notice. This article contains: 3 questions and answers about the registration process for provider organizations. (See NOTE below.) Links to the Quick Reference Guides for completing the registration process for provider organizations. (See NOTE below.) Note: For purposes of the IACS-PC, "Provider Organizations" include individual practitioners who will delegate IACS-PC work to staff as well as their staff using IACS-PC.
Individuals Authorized Access to CMS Computer Services – Provider/Supplier Community (IACS-PC): THE THIRD IN A SERIES OF ARTICLES ON THE IACS-PC	Tuesday, August 05, 2008	Note: This article was revised on July 30, 2008, to reflect current processes and provide the Web address for the new IACS website which contains user reference guides. Please note that CMS will notify providers as internet applications become available, and provide clear instructions that specify which providers should register in IACS-PC. Do not register until you are notified by CMS or one of its contractors to do so and only if you meet the criteria in the notice. This article describes the 3 steps providers must take to access a CMS Enterprise Provider Application including how to request a provider application role in IACS-PC (See step 2). CMS will notify providers as internet applications become available, and provide clear instructions that specify which providers should register in Individuals Authorized Access to CMS Computer Services – Provider/Supplier Community (IACS-PC). Do not register until you are notified by CMS or one of its contractors to do so and only if you meet the criteria in the notice.
Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)	Monday, August 04, 2008	This article is based on Change Request (CR) 6107 and reminds the Medicare contractors and providers that the annual ICD-9-CM update will be effective for dates of service on and after October 1, 2008 (for institutional providers, effective for discharges on or after October 1, 2008). You can see the new, revised, and discontinued ICD-9-CM diagnosis codes on the Centers for Medicare & Medicaid Services (CMS) website at http://www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/07_summarytables.asp#TopOfPage, or at the National Center for Health Statistics (NCHS) website at http://www.cdc.gov/nchs/icd9.htm in June of each year.
Clarification on the Correct Condition Code to Report on Provider Adjustment Requests to Indicate a Health Insurance Prospective Payment System (HIPPS) Code Change	Thursday, July 31, 2008	Note: This article was revised on July 28, 2008, to reflect that CR 6002 was revised on July 25, 2008. The CR release date, transmittal number, and the Web address for accessing CR 6002 have been changed in this article. All other information remains the same. CR 6002, from which this article is taken, announces that, as of January 1, 2009, you should no longer use the D4 condition code to report HIPPS code changes on SNF adjustment requests, but rather should begin to use Condition Code D2 – Change in Revenue Codes/HCPCS/HIPPS Rate Codes instead.
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