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Therapy Personnel Qualifications and Policies Effective January 1, 2008 Reference: Trans. 88, CR #5921, Pub. 100-02, MLN: MM5921
CR 5921, from which this article is taken, provides guidance for new regulations (See the Federal Register of November 27, 2007 for the discussion in the Medicare Physician Fee Schedule (MPFS) final rule of 2008.) that address outpatient therapy services, including personnel qualifications and the timing of recertification of plans of care for Part B services. This article summarizes these regulations.
Published Online: Tuesday, May 13, 2008

Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding News Reference: CMS List-Serv Message 051208
The Centers for Medicare & Medicaid Services (CMS) has published the first of several installments by adding a new chapter 36 to the existing Medicare Claims Processing Manual (Pub. 100-04) which provides instructions for Medicare contractors for the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program. This first installment contains instructions regarding the overall policy of the Medicare DMEPOS Competitive Bidding Program including, but not limited to, policy on grandfathered suppliers and items, and transfer of title of capped rental DME items, oxygen and oxygen equipment.
Published Online: Tuesday, May 13, 2008

Ambulance Fee Schedule - Conversion Factor File for CY 2009 Ambulance Inflation Factor Reference: Trans. 1499, CR #6000, Pub. 100-04, MLN: MM6000
Note: This article was revised on May 6, 2008, to correct the implementation date of the instruction. That date is October 6, 2008. All other information remains the same. This article is based on Change Request (CR) 6000 which revises the ambulance fee schedule file layout for Calendar Year (CY) 2009. Specifically, only the conversion factor field is being modified to: Remove the sign in the numeric field; and Expand the length of the Conversion Factor field. For claims with dates of service on or after January 1, 2009, Medicare contractor(s) will recognize the new Ambulance Fee Schedule file layout. For claims with dates of service prior to January 1, 2009, Medicare contractors will recognize the current layout.
Published Online: Tuesday, May 13, 2008

Reminder - CMS to Host National Provider Education Call on the DMEPOS Competitive Bidding Program - May 13, 2008 Reference: CMS List-Serv Message 050808
The Centers for Medicare & Medicaid Services (CMS) will host a national education conference call to address the implementation of the new Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding program scheduled to begin on July 1, 2008. This call is being conducted for Medicare fee-for-service DMEPOS suppliers, physicians, and other providers – all of which may be affected by the program. The call will give a general overview of the new program and address some of the exceptions and situations you may encounter as the program is implemented. A presentation will be made by the Competitive Bidding Implementation Contractor (CBIC) and CMS Subject Matter Experts will be available to answer questions. A PowerPoint presentation will be posted on the CMS Website prior to the call. Registration will close at 12:30 p.m. EDT on May 12, 2008, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
Published Online: Monday, May 12, 2008

CMS NPI Roundtable: Medicare Implementation Q&A Session Reference: CMS List-Serv Message 050808
A conference call titled CMS NPI Roundtable: Medicare Implementation Q&A Session will be held on May 19, 2008 from 2:00-3:30 p.m. EDT. In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation. If you cannot attend the call, replay information is available below. Registration will close at 2:00 p.m. EDT on May 18, 2008, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
Published Online: Monday, May 12, 2008

Incident to Policy Update Reference: Trans. 87, CR #5288, Pub. 100-02, MLN: MM5288
CR 5288, from which this article is taken, clarifies current Medicare policy regarding services provided as incident to the services of physicians or non-physician practitioners (NPP) in the office. Specifically, it updates information in the Medicare Benefit Policy Manual (Chapter 15 -- Covered Medical and Other Health Services, Sections.
Published Online: Monday, May 12, 2008

CMS Recruiting Registries as a New Way to Submit PQRI Data - Registry Self-Nominations Due to CMS by May 31, 2008 Reference: CMS List-Serv Message 050808
The Centers for Medicare & Medicaid Services (CMS) seeks self-nominations from clinical data registries interested in becoming a part of the submission process for the 2008 Physicians Quality Reporting Initiative (PQRI) Program. In April 2008, CMS announced new options for participating in the PQRI program, including the option for eligible professionals to submit quality measures data to CMS through a qualified, established clinical data registry. CMS is now accepting self-nominations from registries that wish to be considered a qualified, established clinical data registry to help eligible professionals qualify for PQRI incentive bonus payments. CMS is accepting self-nominations from registries through May 31, 2008. To learn more about how registries can apply, read CMS’ selection criteria and process online at http://www.cms.hhs.gov/PQRI/Downloads/2008PQRIRegistryRequirements.pdf on the CMS website.
Published Online: Monday, May 12, 2008

Upcoming Training for the Medicare Part B Drugs Competitive Acquisition Program (CAP) Reference: CMS List-Serv Message 051208
Noridian Administrative Services, the designated carrier for the CAP, offers interactive, online workshops about the CAP for Part B Drugs and Biologicals. These workshops train CAP vendors and elected physicians on a number of CAP topics and requirements such as billing for CAP claims, and NAS personnel are available to answer questions. Physicians and/or their staff are strongly encouraged to attend. Interested parties may view additional information about and register for these workshops at: https://www.noridianmedicare.com/cap_drug/train/workshops/index.html
Published Online: Monday, May 12, 2008

Clinical Laboratory Fee Schedule Fact Sheet Reference: CMS List-Serv Message 050808
The Clinical Laboratory Fee Schedule Fact Sheet, which provides general information about the Clinical Laboratory Fee Schedule, coverage of clinical laboratory services, and how payment rates are set, is now available in print format from the Centers for Medicare & Medicaid Services Medicare Learning Network. To place your order, visit http://www.cms.hhs.gov/mlngeninfo/, scroll down to "Related Links Inside CMS" and select "MLN Product Ordering Page."
Published Online: Friday, May 09, 2008

Clarification for Identifying Secondary Providers in Medicare Claims & More NPI Roundtable Information Reference: CMS List-Serv Message 050808
In accordance with the NPI final rule, when an identifier is reported on a paper or electronically submitted claim for ordering/referring /attending/operating/supervising/purchased service/other/service facility provider (in the x12N 837 claims transactions) or for prescriber (in the NCPDP 5.1 retail drug claim transaction), that identifier must be an NPI. For Medicare purposes, this requirement is effective May 23, 2008. If the entity to be identified as the ordering/referring/attending/operating/supervising/purchased service/other/service facility provider or prescriber does not furnish an NPI at the time of the order/referral/purchase or time of service, the billing provider must attempt to obtain that NPI in order to use it in the claim. The billing provider may use the NPI Registry or may need to contact the ordering/referring/ attending/operating/supervising/purchased service/other/service facility or presciber in order to obtain the NPI. While the Implementation guides for the X12N claims transactions permit the reporting of the Social Security Number (SSN) for some secondary providers if there is no NPI, we do not believe the billing provider will be successful in the obtaining the SSN. CMS will host a national NPI Roundtable Q&A session to address questions from the Medicare provider community prior to May 23rd. This Roundtable will be on May 19th from 2-3:30PM EDT.
Published Online: Friday, May 09, 2008

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