Updates from the Medicare Learning Network ®
§ "Medicare Quarterly Provider Compliance Newsletter [Volume 2, Issue 2]" Released § "Important Reminder for Providers and Suppliers Who Provide Services and Items Ordered or Referred by Other Providers and Suppliers" MLN Matters Article Released § "Additional HIPAA 837 5010 Transitional Changes and Further Modifications to COBA National Crossover Process" MLN Matters Article Revised § "Non-Specific Procedure Code Description Requirement for HIPAA Version 5010 Claims" MLN Matters Article Revised § "Medicare Physician Fee Schedule" Fact Sheet Revised § "Ambulatory Surgical Center Fee Schedule" Fact Sheet Revised § "Hospital Value-Based Purchasing Program" Fact Sheet Available in Hardcopy >From the MLN: "Medicare Quarterly Provider Compliance Newsletter [Volume 2, >Issue 2]" Released The new "Medicare Quarterly Provider Compliance Newsletter [Volume 2, Issue 2]<http://www.cms.gov/MLNProducts/Downloads/MedQtrlyComp_Newsletter_ICN907703.pdf>" (ICN 907703) has been released in downloadable format. This educational tool is designed to provide education on how to avoid common billing errors and other erroneous activities when dealing with the Medicare Program, and highlights the top issues of the particular quarter. Please visit http://www.CMS.gov/MLNProducts/downloads/MedQtrlyCompNL_Archive.pdf<http://www.cms.gov/MLNProducts/downloads/MedQtrlyCompNL_Archive.pdf> to download, print, and search an archive of previously-issued newsletters. >From the MLN: "Important Reminder for Providers and Suppliers Who Provide >Services and Items Ordered or Referred by Other Providers and Suppliers" MLN >Matters Article Released MLN Matters Special Edition Article #SE1201, "Important Reminder for Providers and Suppliers Who Provide Services and Items Ordered or Referred by Other Providers and Suppliers<http://www.cms.gov/MLNMattersArticles/Downloads/SE1201.pdf>," has been released in downloadable format. This article is designed to provide education on policy that says Medicare will only pay for specific items or services that are ordered or referred by providers or suppliers who are enrolled in Medicare and authorized to do so. It includes information about what providers should know before submitting a claim and limitations to the policy. >From the MLN: "Additional HIPAA 837 5010 Transitional Changes and Further >Modifications to COBA National Crossover Process" MLN Matters Article Revised MLN Matters Special Edition Article #SE1137, "Additional Health Insurance Portability and Accountability Act (HIPAA) 837 5010 Transitional Changes and Further Modifications to the Coordination of Benefits Agreement (COBA) National Crossover Process<http://www.cms.gov/MLNMattersArticles/Downloads/SE1137.pdf>," has been revised and is available in downloadable format. This article is designed to provide education on the HIPAA 5010 COBA National Crossover Process for supplemental payers, and includes important information and examples to assist providers with the transition. The article was revised to add a section to clarify the crossover impact for providers who are permitted to submit claims using the CMS 1500 or UB04 hardcopy formats. >From the MLN: "Non-Specific Procedure Code Description Requirement for HIPAA >Version 5010 Claims" MLN Matters Article Revised MLN Matters Special Edition Article #SE1138, "Non-Specific Procedure Code Description Requirement for HIPAA Version 5010 Claims<http://www.cms.gov/MLNMattersArticles/Downloads/SE1138.pdf>," has been revised and is available in downloadable format. This article is designed to provide education on the requirements for non-specific procedure codes for HIPAA 5010 claims, as established in Change Request 7392. It includes guidance to help providers comply with the requirements and submit HIPAA-compliant claims for all non-specific procedure codes. The article was revised to clarify that claims will not be rejected if 'Not Otherwise Classified' is submitted as the code description. >From the MLN: "Medicare Physician Fee Schedule" Fact Sheet Revised The "Medicare Physician Fee Schedule<http://www.cms.gov/MLNProducts/downloads/MedcrePhysFeeSchedfctsht.pdf>" fact sheet (ICN 006814) has been revised and is now available in downloadable format. It includes information on physician services, therapy services, Medicare Physician Fee Schedule (PFS) payment rates, and the Medicare PFS rates formula. >From the MLN: "Ambulatory Surgical Center Fee Schedule" Fact Sheet Revised The "Ambulatory Surgical Center Fee Schedule<http://www.cms.gov/MLNProducts/downloads/AmbSurgCtrFeepymtfctsht508-09.pdf>" fact sheet (ICN 006819) has been revised and is now available in downloadable format. It includes information on the definition of an Ambulatory Surgical Center Fee Schedule (ASC), ASC payment, how payment rates are determined, and healthcare quality. >From the MLN: "Hospital Value-Based Purchasing Program" Fact Sheet Available >in Hardcopy The "Hospital Value-Based Purchasing Program<http://www.cms.gov/MLNProducts/downloads/Hospital_VBPurchasing_Fact_Sheet_ICN907664.pdf>" fact sheet (ICN 907664) is now available in hardcopy. This fact sheet is designed to provide education on the Hospital Value-Based Purchasing Program, and includes information on how Medicare will make incentive payments to hospitals in FY2013 based on performance and scoring of Clinical Process of Care Measures and Patient Experience of Care Dimensions. To order hardcopies of this fact sheet, visit http://www.CMS.gov/MLNProducts<http://www.cms.gov/MLNProducts> and click on 'MLN Product Ordering Page' under 'Related Links Inside CMS' at the bottom of the webpage. ________________________________ Flu Season is Here! While seasonal flu outbreaks can happen as early as October, flu activity usually peaks in January. Remind your patients that annual vaccination is recommended for optimal protection. Medicare pays for the seasonal flu vaccine and its administration for seniors and others with Medicare with no co-pay or deductible. Healthcare workers, who may spread the flu to high risk patients, should get vaccinated too. Don't forget to immunize yourself and your staff. Protect your patients. Protect your family. Protect yourself. Get the Flu Vaccine-Not the Flu. Remember - The flu vaccine plus its administration are covered Part B benefits. CMS has posted the 2011-2012 seasonal flu vaccine payment limits at http://www.CMS.gov/McrPartBDrugAvgSalesPrice/10_VaccinesPricing.asp. Note that the flu vaccine is NOT a Part D-covered drug. For more information on coverage and billing of the flu vaccine and its administration, as well as related educational provider resources, visit http://www.CMS.gov/MLNProducts/35_PreventiveServices.asp and http://www.cms.gov/immunizations. ________________________________ Note: If you have problems accessing any hyperlink in this message, please copy and paste the URL into your Internet browser. If you know someone who would like to subscribe to a Medicare Fee-For-Service (FFS) provider listserv, go to (http://www.cms.gov/prospmedicarefeesvcpmtgen/downloads/Provider_Listservs.pdf). If you would like to unsubscribe from a specific provider listserv, please go to (https://list.nih.gov/cgi-bin/wa.exe?INDEX) to unsubscribe or to leave the appropriate listserv. Please DO NOT respond to this email. This email is a service of CMS and routed through an electronic mail server to communicate Medicare policy and operational changes and/or updates. Responses to this email are not routed to CMS personnel. Inquiries may be sent by going to (http://www.cms.gov/ContactCMS). Thank you.
