Washington Report –January, 2007 

Bill Finerfrock and Paige BagbyCapitol Associates

 NPI, Where is the Industry New Year, New Congress – Old Problems What’s in a Name? First 100 Hours Raising Minimum Wage Linked to Small Business Tax Changes Prescription Drug Price Negotiations More Medicare Cuts on the Horizon? What He Said, What He Meant Medicare Listserve open to Billing Companies CIGNA cited by OIG for Inappropriate Payments CMS Issues HIPAA Security Guidance for Remote Use of and Access to Electronic Protected Health Information Medicare Proposes Expanded Coverage Of Angioplasty Of The Carotid Artery Concurrent With Stenting  CMS Program Transmittals released in January  Back to top NPI, Where is the Industry On January 24th, the National Committee on Vital and Health Statistics (NCVHS) Subcommittee on Standards And Security conducted a hearing to assess the readiness of various segments of the health care industry to comply with the May 23rd start date for use of the National Provider Identifier (NPI). Witnesses representing providers, healthcare business partners and payers were all asked to present testimony on the respective state of readiness for their segment of the healthcare community to use the NPI.  HBMA was asked to present testimony on the state of the billing industry to submit claims using the

NPI and our assessment on the relative readiness of the provider community we deal with.  We were also asked to identify any problems we see with the healthcare provider community complying with the May 23rd deadline. The organizations invited to present testimony were: Panel 1 – ProvidersAmerican Medical AssociationFederation of American HospitalsMedical Group Management AssociationAmerican Dental Association National Minority Quality Forum

Panel 2 – Business PartnersHealthcare Data ExchangeEDIfecsHealthcare Billing and Management         AssociationGateway EDI 

Panel 3 – PayersAmericas Health Insurance PlansCenters for Medicare and Medicaid ServicesBlue Cross/Blue Shield Association

 Panel 4 – Pharmacy National Association of Chain Drug StoresNational Community Pharmacists Association

Panel 5 – Proposal Presentation WEDI

 

 HBMA’s testimony was presented by Bob Burleigh, Past-President of HBMA.  Bob is also a member of HBMA’s Government Relations Committee. HBMA expressed confidence that billing companies and the physicians and providers for whom they work are well on their way to being fully compliant with the NPI requirements.  This confidence was based upon the results of a member survey HBMA conducted in late November 2006.   More than 130 member companies responded to the on-line survey.  This represents slightly more than 20% of the HBMA membership.  Respondents ranged from companies that bill for fewer than 10 physicians (11%) to companies that bill for more than 200 physicians (18%) According to the survey, more than 75% of HBMA member companies have sought and received NPIs for all or nearly all of their physicians and providers.  Only one HBMA member company reported that it had not yet obtained NPIs for any of their physicians.  HBMA believes that the high level of NPI enrollment by HBMA physicians is a direct result of the Association’s various member education programs and reminders throughout the year.   But as optimistic as HBMA is about the ability of physicians and providers who use billing companies to be ready, concern was expressed that many physicians

are still unaware of the importance of obtaining an NPI. Anecdotal information was presented from individual billing company reports of meetings they’ve attended at which physicians were either unaware of the need to obtain an NPI or mistakenly believed that they did not need an NPI.   HBMA also expressed its collective frustration over the fact that HHS has yet to issue the public dissemination notice that is necessary in order to make the NPI database publicly available.  The notice, which was originally supposed to be issued in the Spring of 2006, has not been released by HHS and as a consequence, there is no public database providers, billing companies or other entities that need to have access to the database can go to and get NPIs.  This is extremely significant for physicians who rely on referrals.  Medicare policy requires that when a physician to whom a patient has been referred submits a claim for the services provided, the physician must not only put his/her personal NPI on the claim form, but also that of the physician from whom the referral came.  Beginning May 23rd, if the claim does not have both NPIs, it will be rejected. As a consequence of the failure of HHS to make the database available, and the impediments this has caused in making sure that all providers, payers and billing companies are ready to go on the 23rd of May, HBMA was joined by other witnesses in recommending that CMS adopt a contingency plan to allow claims to be submitted and processed after May 23rd using the provider’s legacy number.  The duration of the delay in full implementation would be dependent upon HHS’ release of the dissemination notice.  While witnesses offered different timelines for the contingency plan, virtually all were in agreement that a contingency plan was critical; otherwise the system could come to a crashing halt on May 23rd. The lone dissenting voice for some type of delay or contingency plan was the witness representing the Workgroup on Electronic Data Interchange (WEDI).  While WEDI acknowledged all of the problems identified by the other witnesses with meeting the May 23rd effective date, the organization took the position that all claims should still be required to include the provider’s NPI as a condition for payment.  The reaction of the audience and several Commission members to the seeming disregard by WEDI for the problems this might cause was swift and very vocal.  It appeared that WEDI’s principle argument for holding to the May 23rd date is the belief that changing the date will make it difficult to force compliance with the NPI requirements. NCVHS is an Advisory Committee to the Secretary of Health and Human Services.  It has representation from payers, providers, academicians, lawyers and members of the general public.  According to the Committee’s Charter, “The National Committee on Vital and Health Statistics is the Department's statutory public advisory body on health data, statistics and national health information policy. This Committee shall serve as a national forum on health data and information systems. It is intended to serve as a forum for the collaboration of interested parties to accelerate the evolution of public and private health

information systems toward more uniform, shared data standards, operating within a framework protecting privacy and security.” Based upon the findings from the hearing, NCVHS will write a letter to the Secretary of HHS assessing where it believes the industry is in terms of NPI compliance and making any recommendations the Committee feels are necessary in order to ensure there are no disruptions in the marketplace.   In terms of process, the Standards and Security Subcommittee will prepare a draft letter that it will submit to the Full NCVHS for consideration. The Full Committee is scheduled to meet in mid-February and will consider the letter at that time.  Presuming the letter is approved by the Full Committee, it would most likely be transmitted to the Secretary in late February.   It is not clear what actions the Committee will recommend to the Secretary; however, if the Committee recommendations reflect the views of a majority of the witnesses, then some delay in the effective date should be forthcoming.  Even if the Committee recommends a delay, the Secretary is not obligated to follow the Committee’s recommendation. Back to top New Year, New Congress – Old Problems The elections this past November resulted in major changes in the political landscape in Washington, DC.  The election of a Democrat controlled House ended 12 years of Republican control for that chamber and resulted in the election of the first woman as Speaker of the House.   New Chairmen/women have assumed control of all Congressional Committees and this will affect the type of legislation we will see passed by the House and Senate in 2007 and 2008.   Whether the legislation adopted by a Democrat Congress will be signed by the President remains to be seen.  President Bush has been reluctant to use his veto pen during the first six years of this administration, however, that was largely due to the fact that both houses of Congress were controlled by his party during most of that time.  Now that Congress is controlled by Democrats, the likelihood that he will veto bills during the last two is quite high.   Here are the new Democrat Chairs of the key House and Senate Committees (and Subcommittees) that deal with Health policy matters.   Senate Finance                         -           Chair, Senator Max Baucus (D-MT)Senate Health, Education,         -           Chair, Senator Ted Kennedy (D-MA)  Labor & PensionsHouse Energy & Commerce     -           Chair, Representative John Dingell (D-MI)

  Health Subcommittee              -           Chair, Representative Frank Pallone (D-NY)House Ways & Means             -           Chair, Representative Charlie Rangel (D-NY)  Health Subcommittee              -           Chair, Representative Pete Stark (D-CA) Other than Representative Pallone, all of these Representatives and Senators are seasoned veterans on their respective Committees or Subcommittees.  Baucus, Kennedy, Dingell and Stark previously served as Chairs of their respective Committees or Subcommittees during previous Congress in which the Democrats were in control.  Representative Rangel had been the ranking Democrat on the Ways & Means Committee for several years. Among the new Chairs, Representative Pallone is the least experienced Member.  His elevation to the Chairmanship of the Energy & Commerce Health Subcommittee was made possible by the decision of former Representative Sherrod Brown (D-OH) to seek election to the U.S. Senate.  Brown was successful in defeating GOP incumbent Mike DeWine (R-OH) in the November election and has moved offices to the Senate side of the Capitol.  That departure created a vacancy at the top of the Health Subcommittee and Speaker Pelosi chose Pallone as the new Subcommittee chair. One of the most familiar returning Chairs is Pete Stark.  Representative Stark is familiar to all in the health world as he is the author of the “Stark Rules” governing various business relationships between and among healthcare providers.  It is expected that the new Democrat majority will want to revisit and perhaps try to update the Stark rules to close what some view as “loopholes” in the current requirements.  Representative Stark is also well-known in Washington for his sometimes terse relationship with organized medicine.   In addition to different types of legislation coming out of the Committees, we can also expect numerous “oversight” hearings.  CMS officials will probably be spending so much time before the Committees explaining their actions, they will want to rent a long-term parking space near the Capitol.  If nothing else, Committee hearings should be lively! Back to top What’s in a Name? One of the first actions the Democrat leadership took upon assuming the leadership of the House was to change the name of one of the Committees.  For several decades when Democrats controlled the House, there was a Committee call the Education and Labor Committee.  When Republicans assumed control of the House in 1993, the name of the Committee was changed to Education and Workforce.  At the time, it was believed that this was a political shot across the

bow of organized labor that their influence in the House was not as great as it once was.   In an example of “turn about is fair play” the new Democrat majority has switched the name of the Committee back to Education and Labor and signaled to the outside world that organized labor is once again, an influential voice in the United States House of Representatives. No word on whether there will be changes in the rules governing the sandboxes at the Congressional child care center.   Back to top First 100 Hours During the campaign, Democrat candidates asserted that if they were elected to the majority, they would move to pass a spate of legislation during the “first 100 hours” of the new Congress.  The legislative packaged ranged from cutting interest rates on student loans, raising the minimum wage and authorizing CMS to negotiate with drug companies are part of the Medicare Part D prescription drug program.   Democrats were elected and House and Senate leaders have met their commitment to pass the promised legislation (H.R. 1 through H.R. 6 and S. 1 through S. 6).  Although each house has passed the legislation necessary to fulfill the commitment, none of those bills have been reconciled (i.e. different versions passed by House and Senate) and it will likely be some time before a unified bill is ready for transmittal to the President.   Democrats should be congratulated for meeting their self-imposed deadlines for passing the bills.   Back to top Raising Minimum Wage Linked to Small Business Tax Changes Raising the minimum wage received overwhelming support in both the House and Senate.  The bill passed the House by a vote of 315 - 116 and the Senate, by a vote of 94 – 3.  However, despite the broad bi-partisan support for raising the minimum wage, getting a bill to the President is not certain.  The bill passed by the Senate was linked to certain tax breaks for small businesses and other tax and policy changes.   The bill, as passed by the House, was a short, rather simple bill that raised the minimum wage on the following schedule:  $5.85 an hour, beginning on the 60th

day after the date of enactment of the bill; $6.55 an hour, beginning 12 months after that 60th day; and, $7.25 an hour, beginning 24 months after that 60th day.  

 Although the bill was short and sweet when passed by the House, by the time the bill made it’s way to the Senate floor, it had grown dramatically in size and scope.   Examples of legislative changes included in the Senate version, not included in the House version are:

* Extension of Increased Expensing For Small Businesses* Clarification of Cash Accounting Rules For Small Business* Extension and Modification Of Combined Work Opportunity Tax Credit and Welfare-To-Work            Credit* Treatment of Bank Director Shares* Special Rule For Banks Required To Change From The Reserve Method Of Accounting On Becoming            S Corporation* Treatment of the Sale Of Interest In A Qualified Subchapter S Subsidiary* Elimination of All Earnings And Profits Attributable To Pre-1983 Years For Certain Corporations* Expansion of Qualifying Beneficiaries of An Electing Small Business Trust Due to the differences in the two versions of the bill, a House-Senate Conference Committee will be required to resolve the differences.  Senior House Members have expressed some skepticism over several of the Senate passed tax provisions.  It is not clear whether any of the Senate provisions are “deal breakers” for the House.  According to news reports, the House Leadership has repeatedly said that want to pass a minimum wage bill without the tax provisions.  Some House Leaders have even threatened to challenge the bill as passed by the Senate on Constitutional grounds arguing that the Constitution requires that all bills dealing with the raising or spending of money must “originate” in the House.   Back to top Prescription Drug Price Negotiations Democrats have long believed that a major flaw in the Medicare Part D, prescription drug program has been the inability of the government to negotiate prices with the pharmaceutical industry.  Proponents of negotiation argue that given the size of the Medicare program and the size of the drug benefit, the government should be able to use its market power to negotiate better drug prices for seniors then seniors will get under an open market system.  The analogy is made to the VA which typically is able to get some of the best prices for prescription drugs due to the fact that it negotiates as a system 

 As part of their 100 Hour initiative, Democrat House and Senate candidates promised to pass legislation authorizing the federal government to negotiate drug prices as part of the Medicare Part D prescription drug program.  That legislation, H.R. 4, was introduced and passed by the House by a vote of 255 – 170. The bill would require the Secretary of HHS to  “negotiate with pharmaceutical manufacturers the prices (including discounts, rebates, and other price concessions) that may be charged to PDP sponsors and MA organizations for covered Part D drugs for Part D eligible individuals who are enrolled under a prescription drug plan or under an MA-PD plan.” The Bush Administration has indicated that even though Congress would authorize the Secretary to negotiate with Drug Companies, there’s no requirement that would force the Secretary to engage in those negotiations.   Back to top More Medicare Cuts on the Horizon? According to a report in the New York Times, President Bush will ask Congress to cut more than $70 billion in spending from the Medicare and Medicaid programs over the next five years. The President will announce his proposals as part of his budget for Fiscal Year 2008.  The budget documents will be released to the public on February 5th.  Capitol Associates will prepare a separate budget analysis for the HBMA membership. Although most elected officials are not commenting on news reports, but rather want to wait and see the budget document, there is no question that should President Bush seriously push for cuts of this magnitude, he will encounter serious opposition from Congress – both Democrats and Republicans.   During the last session of Congress, President Bush proposed more modest proposals for reducing Medicare and Medicaid spending and encountered strong opposition to those reductions.  President Bush was unable to get a majority of Republicans to support his “modest” proposals, it is hard to imagine a Democrat Controlled Congress supporting even deeper cuts.   Previous attempts to control Medicare spending have met with Congressional resistance particularly because they relied upon cuts in provider payments.  For example, in years past, Hospitals have been denied a full inflationary update.  Changes of this nature can often save a significant amount of money to the Medicare program over time, but the hospitals never recoup these “savings”.   

Taken together, Medicare and Medicaid cover more than one in four Americans. Federal spending for the two programs totaled $554 billion last year.  Cutting approximately $15 Billion per year for the next 5 years would represent a cut of approximately 2.7% per year in overall program expenditures.  In theory, if you can simply slow the projected growth in the program, you could achieve a “savings” of this magnitude merely by bending the trend line so that benefit costs do not rise as rapidly.  They could still rise, just not as swiftly as current projections.   In addition to trying to slow the growth in spending, you can achieve governmental savings by shifting more of the cost of the program to the beneficiary.  According to the NY Times article, “…some Medicare beneficiaries would shoulder added costs. The president’s budget would require more people to pay the higher premiums.”  The Times story asserts that, “Most of the proposed savings, however, would come from health care providers.”  HBMA will provide an analysis of the Presidents Budget proposal after it is released. Back to top What He Said, What He Meant Washington is a town with many professional sports franchises.  In football, you have the pride and tradition of the Redskins, in baseball, the young Nationals about to start their third season and the Capitals Hockey team and Wizards basketball teams are in mid-season form. But there’s another sport in Washington that you won’t see on ESPN but for which there is a long and infamous tradition – the battle of the political pundit. For some reason, long ago, it was decided that most Americans were either not smart enough or not well-read enough to understand what politicians were telling us.  We could not trust our own ears to keep us informed, we needed a political pundit to interpret the words of the politicians so we knew what they were really saying.   I remember years ago sitting with my parents and watching President Johnson give a speech to the nation about Vietnam that lasted 20 minutes.  This was then followed by an hour long program where the pundits explained what I had just heard.  And because this was in the pre-cable days, it wasn’t like I could switch over to the garden channel, the cooking channel or some other more entertaining program.   The game of political punditry continues to this day and it is safe to say that the “super bowl” for political pundits is the State-of-the Union address. 

 Per the constitution, the President shall periodically (it does not actually require an annual report) present to Congress information on the state of the Union and recommend legislative proposals for their consideration.  So when George W. Bush stood before a joint session of Congress on January 24th, he was continuing in the proud tradition of his predecessors.  The speech lasted slightly more than 45 minutes (including applause) but the “analysis” of the speech lasted for days. Here’s what one pundit had to say about the President’s health proposals:             “I've found myself wondering what on earth President Bush and his advisers            were thinking in proposing their new plan for the uninsured in his State of the             Union address. Other, that is, than finding a way to anger Democrats and             Republicans alike.”  Now I don’t know whether what the President proposed will work at reducing the number of uninsured or not.  But clearly this reporter/pundit has decided it won’t work, can’t work and could only have been proposed in some perverse attempt by the President to unify Democrats and Republicans.   I prefer – at least initially – to take the politicians statements at face value, and believe they are sincere in their beliefs.  In my mind, time, analysis and testing may prove something a success or failure but in the land of punditry, we must provide instant analysis and classify something as a success or failure within 48 hours of it being proposed.        Here’s what the President proposed: 

“And so tonight, I propose two new initiatives to help more Americans afford their own insurance. First, I propose a standard tax deduction for health insurance that will be like the standard tax deduction for dependents. Families with health insurance will pay no income or payroll taxes on $15,000 of their income. Single Americans with health insurance will pay no income or payroll taxes on $7,500 of their income. With this reform, more than 100 million men, women, and children who are now covered by employer-provided insurance will benefit from lower tax bills. At the same time, this reform will level the playing field for those who do not get health insurance through their job. For Americans who now purchase health insurance on their own, this proposal would mean a substantial tax savings -- $4,500 for a family of four making $60,000 a year. And for the millions of other Americans who have no health insurance at all, this deduction would help put a basic private health

insurance plan within their reach. Changing the tax code is a vital and necessary step to making health care affordable for more Americans.”

 The President went on to say,  

“There are many other ways that Congress can help. We need to expand Health Savings Accounts. We need to help small businesses through Association Health Plans. We need to reduce costs and medical errors with better information technology. We will encourage price transparency. And to protect good doctors from junk lawsuits, we must pass medical liability reform. In all we do, we must remember that the best health care decisions are made not by government and insurance companies, but by patients and their doctors.”

            While I’m not optimistic that the new Congress will heed his call for expanding Health Savings Accounts; approve Association Health Plans legislation; or, pass medical liability reform, we will monitor the progress on those issues and report to the HBMA membership as developments warrant.   There is no question that health care will be on the agenda for the 110th Congress.  Several proposals to establish a national health insurance program have already been introduced in the House and Senate and individual states have moved to address health issues in recent months.   Stay tuned and keep a close eye on action not only in Washington, but your individual state Capitols as well.   Back to top Medicare Listserve open to Billing Companies The Centers for Medicare & Medicaid Services has created a new listserv for clearinghouses, software vendors, and billing companies involved with submitting electronic transactions to, or receiving transactions from, Medicare fee-for-service (FFS) contractors.  Messages sent on the listserv will inform subscribers when new CMS instructions are released that affect changes to electronic billing software or services.  If you are a billing company involved in Medicare FFS billing, please consider joining the CMS Mailing Lists.  You can go to the website at http://www.cms.hhs.gov/apps/mailinglists/  and sign up for the CLEARINGHOUSE listserv located in the “Available Mailing Lists” menu. Back to top CIGNA cited by OIG for Inappropriate Payments 

The Office of Inspector General (OIG) for the Department of Health and Human Services recently released a report on their analysis of costs CIGNA submitted to the Centers for Medicare and Medicaid Services (CMS) for pension costs associated with individuals employed by CIGNA to handle Medicare Part B and CME claims.   To review the entire report, go to: http://oig.hhs.gov/oas/reports/region7/70600209.pdf According to the OIG report, “CIGNA administers Medicare Part B and Durable Medical Equipment operations under cost reimbursement contracts with the Centers for Medicare & Medicaid Services and claims reimbursement for its Medicare employees' pension costs.  Regulations and the Medicare contracts provide guidance for claiming pension costs.” OIG found that between 1991 and 2004, CIGNA claimed $3,103,925 of inappropriate pension costs because it did not claim pension costs in accordance with the Medicare contracts.  Consequently, OIG recommended that CIGNA revise its claims by $3,103,925 and that CIGNA claim future pension costs in accordance with the Medicare contracts.  CIGNA agreed to claim future pension costs in accordance with the Medicare contracts and reimburse the government for the inappropriately claimed pension costs.  Back to top CMS Issues HIPAA Security Guidance for Remote Use of and Access to Electronic Protected Health InformationCMS has prepared guidance to provide HIPAA covered entities with general information on the risks and possible mitigation strategies for remote use of and access to Electronic Protected Health Information (EPHI).This guidance document sets forth CMS' minimal compliance expectations for covered entities seeking to safeguard EPHI that is accessed, stored or transported offsite.  According to the CMS release, “this document does not seek to provide a comprehensive list of risks and mitigation strategies but rather a general list of suggestions for organizations that require remote use of sensitive health information.”To view this document, go to:http://www.cms.hhs.gov/SecurityStandard/Downloads/SecurityGuidanceforRemoteUseFinal122806.pdfBack to top Medicare Proposes Expanded Coverage Of Angioplasty Of The Carotid Artery Concurrent With Stenting  The following was released by CMS on February 2, 2007. 

 The Centers for Medicare & Medicaid Services (CMS) announced today that it is proposing to expand its coverage policy for carotid artery stenting (CAS). A proposed National Coverage Determination (NCD) posted today includes a coverage expansion that reflects the latest evidence on the effective use of stenting, a procedure that reduces the occurrence of stroke in the Medicare population. Stroke is the third leading cause of death in the United States and the leading cause of serious, long-term disability. Approximately 70 percent of all strokes occur in people age 65 and older. Under Medicare’s current policy, patients with no symptoms of carotid artery stenosis (narrowing of the arteries) and who are at high risk for CEA are only covered when CAS procedures are performed in FDA Category B Investigational Device Exemption (IDE) trials, FDA-approved post approval studies, or in accordance with the Medicare clinical trial policy. Medicare is proposing to expand coverage for CAS to this group of patients who have greater than 80 percent carotid artery stenosis. Medicare is also proposing to modify coverage for patients who are 80 years of age and older. After a thorough review of the available evidence, significant concerns regarding the safety of CAS when performed in this older patient population have emerged. This proposed decision allows for coverage of patients age 80 and above only when CAS procedures are performed in Category B Investigational Device Exemption (IDE) trials, FDA-approved post approval studies, or in accordance with the clinical trial policy. The proposed decision memorandum published today by CMS is on its web site, www.cms.hhs.gov. The posting of this proposed decision memorandum marks the beginning of a 30-day public comment period. Those wanting to submit comments should visit the tracking sheet for this analysis at: http://www.cms.hhs.gov/mcd/viewtrackingsheet.asp?id=194. Back to top CMS Program Transmittals released in January  The following program transmittals were issued by the Centers for Medicare and Medicaid Services between January 1, 2007 and January 31, 2007.   CMS uses transmittals to communicate new or changed policies or procedures that will be incorporated into the CMS Online Manual System. The cover or transmittal page summarizes and specifies the changes.  Transmittal Number Subject Effective Date

R1179CP

Differentiating Mass Adjustments From Other Types of Adjustments and Claims for Crossover Purposes and Revising the Detailed Error Report Special Provider Notification Letters

07/02/2007

R1180CPOutpatient Clinical Laboratory Tests Furnished by Hospitals With Fewer Than 50 Beds in Qualified Rural Areas

07/02/2007

R1172CP

Payment of Same Day Transfer Claims Under the Long Term Care Hospital Prospective Payment System (LTCH PPS)

07/02/2007

R1171CP Revisions to the Medicare Physician Fee Schedule (MPFS) Disclosure Format 07/02/2007

R1173CP Timeliness Standards for Processing Other-Than-Clean Claims 07/02/2007

R1175CP Part C and D Plan Type Display on the Common Working File (CWF) 07/02/2007

R1177CP

DME - Changes in Maintenance and Servicing Due to Deficit Reduction Act Legislation for Capped Rentals and Oxygen Equipment

07/02/2007

R1169CPRevision of Editing to Ensure Demand Bills Remain Identifiable in Claims History After Processing

07/02/2007

R1170CPInpatient Psychiatric Facility Prospective Payment System (IPF PPS) for Oncology Treatment Payment Adjustment

07/02/2007

R116FM Chapter 7, Internal Control Requirements Update 01/29/2007

R1166CPCorrection to the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) Pricer

04/02/2007

R1163CPRemittance Advice Remark Code (RARC) and Claim Adjustment Reason Code (CARC) Update

04/02/2007

R1164CP Coding Change for Lumbar Artificial Disc Replacement (LADR) 03/03/2007

R262OTN Invalid Managed Care Informational 04/26/2007

Unsolicited Responses (MCIURs) from CWF

R1168CPDirect Billing and Payment for Non- Physician Practitioner Services Furnished to Hospital Inpatients and Outpatients

04/26/2007

R1167CP

Use of 9-Digit ZIP codes for Determining the Correct Payment Locality for Services Paid Under the Medicare Physician Fee Schedule (MPFS) and Anesthesia Service

10/01/2007

R185PI

Updating Financial Reporting Requirements for Workload and Cost Associated With the Return of Demand Bills.

02/26/2007

R186PI

Durable Medical Equipment Medicare Administrative Contractors (DME MACs) Adoption or Rejection of Local Coverage Determinations (LCDs) Recommended by Durable Medical Equipment Program Safeguard Contractors (DME PSCs).

N/A

R187PIImplementation of New Compliance Standards for Independent Diagnostic Testing Facilities (IDTFs).

02/26/2007

R188PI

Accrediation Quality Standards for Suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)

04/02/2007

R24SOMA

Sunset of the Policies for Provider Nominations for an Intermediary and the Provider Requests for a Change of Intermediary

01/26/2007

R65BP Inpatient Hospital Therapeutic Services 04/07/2007

R1165CP

Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) Edits

04/02/2007

R184PI Revisions for MACs and PSCs 02/26/2007

R114FM Reporting Requirements for Crossover Claims Transmitted to the Coordination

02/26/2007

of Benefits Contractor (COBC) under the Coordination of Benefits Agreement (COBA) Process

R115FM

Clarification of the Protocol for Estimating Allowance for Uncollectible Accounts Form CMS-H/M751A/B, Status of Accounts Receivable

04/02/2007

R1161CPAdditional Changes to the 2007 Medicare Physician Fee Schedule Database

02/26/2007

R183PI

Update the MCS System to Validate National Provider Identifiers (NPIs) in Place of Unique Physician Identification Numbers (UPINs

N/A

R1160CPColorectal Cancer Screening Flexible Sigmoidoscopy and Colonoscopy Coinsurance Payment Chang

07/02/2007

R261OTN Institutional Value Code Changes 07/02/2007

R1157CPProcessing All Diagnosis Codes Reported on Claims Submitted to Carriers (Final Phase)

07/02/2007

R1158CP Guidelines for Payment of Diabetes Self-Management Training (DSMT) 07/02/2007

R23SOMA Federal Minimum Qualifications Standards 02/20/2007

R64BP Guidelines for Payment of Diabetes Self-Management Training (DSMT 07/02/2007

R260OTN

Enhance MCS to Avoid Duplicate Payments When a Full Claim Adjustment is Performed. This CR rescinds and fully replaces CR 3878.

04/02/2007

R1155CP

January 2007 Outpatient Prospective Payment System (OPPS) Outpatient Code Editor (OCE) Specifications Version 8.0

01/02/2007

R1156CP Revised Medicare Zip Code File to Download 02/05/2007

R1153CP Claim Status Category Code and Claim Status Code Update 04/02/2007

R182PI Medicaid State Agencies 03/01/2007

R1154CP Healthcare Provider Taxonomy Codes (HPTC) Update 04/02/2007

R113FMNotice of New Interest Rate for Medicare Overpayments and Underpayments-2nd Qtr. FY 2007

01/19/2007

R1151CP

Skilled Nursing Facility (SNF) Consolidated Billing (CB) Common Working File (CWF) Edit Bypass Instructons for Hospital Emergency Room Services Spanning Multiple Service Dates

04/02/2007

R1152CP Emergency Update to the 2007 Medicare Physician Fee Schedule Database 01/02/2007

R52DEMO Chiropractic Demonstration 2007 Rate Change 01/02/2007

R1150CP

January 2007 Non-Outpatient Prospective Payment System (Non-OPPS) Outpatient Code Editor (OCE) Specifications Version 22.1

01/02/2007

R64NCD Intracranial Percutaneous Transluminal Angioplasty (PTA) with Stenting 02/05/2007

R1147CP Intracranial Percutaneous Transluminal Angioplasty (PTA) With Stenting 02/05/2007

R1148CP

Tax Relief and Health Care Act of 2006 Changes to Independent Laboratory Billing for the Technical Component (TC) of Physician Pathology Services

02/05/2007

R1149CP Revision of Chapter 31 Eligibility Rules of Behavior 04/02/2007

R259OTN Additional Codes for Physician Voluntary Reporting Program (PVRP) 01/02/2007

JA0003 CMS 270/271 (Eligibility) Extranet Transactions N/A

SE0703

Assignment of Dedicated Medicare Secondary Payer Modifier Introduced in Change Request (CR) 5332 (Transmittal 1088)

N/A

SE0702Annual Medicare Contractor Provider Satisfaction Survey: Make Your Voice Heard!

N/A

SE0680The New HHS National Clearinghouse for Long-Term Care Information Website