Displaying Part A Inpatient Rehabilitation Facility Articles 1 to 25 of 39

Topic	Date	Description
Call Center Closing Times (Part A)	Monday, November 17, 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 Rhode Island, 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. Using Provider Contact Center call distribution data to determine the least possible impact for our customers, we have selected the following dates in November 2008 and December 2008.
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 Medicare Deductible, Coinsurance and Premium Rates for 2009	Wednesday, November 12, 2008	This article is based on Change Request (CR) 6258, which provides the Medicare rates for deductible, coinsurance and premium payment amounts for calendar year (CY) 2009.
Application of the Hospital Outpatient Quality Data Reporting Program under the Hospital Outpatient Prospective Payment System (OPPS)	Friday, November 07, 2008	This article is based on Change Request (CR) 6072 regarding application of the Hospital Outpatient Quality Data Reporting Program to services paid under the Hospital OPPS, effective for services rendered on or after January 1, 2009. Effective for OPPS services furnished on or after January 1, 2009, ‘subsection (d) hospitals’ that have failed to submit timely outpatient hospital quality data as required in the Social Security Act (Section 1833(t)(17)(A)) will receive payment under the OPPS that reflects a two percent deduction from the annual OPPS update for failure to submit quality data in a timely manner or for failure to submit quality data that passes validation edits. Hospitals that are not required to submit quality data (i.e. that are not ‘subsection (d) hospitals’) will receive the full update. Similarly, the reduction will not apply to subpart (d) hospitals that are not paid under the OPPS (e.g. Indian Health service hospitals). See the Background and Additional Information Sections of this article for further details regarding 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.
Influenza Pandemic Emergency - The Medicare Program Prepares	Friday, October 31, 2008	Note: This article was revised on October 28, 2008, to include a link to recently-issued CR 6174. 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.
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.
Fiscal Year (FY) 2009 Inpatient Prospective Payment System (IPPS), Long Term Care Hospital (LTCH) PPS, and Inpatient Psychiatric Facility (IPF) PPS Changes	Wednesday, October 08, 2008	This article is based on Change Request (CR) 6189 which outlines changes for IPPS hospitals for FY 2009. The policy changes for FY 2009 appeared in the Federal Register on August 19, 2008, and the final IPPS rates will be available on the Centers for Medicare & Medicaid Services (CMS) website prior to October 1, 2008. CR 6189 also addresses changes to Medicare Severity Diagnosis Related Groups (MS-DRGs) and ICD-9-CM coding that affects LTCH PPS, and IPF PPS. The LTCH PPS rate changes occurred on July 1, 2008.
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.
Smoking and Tobacco Use Cessation Counseling Billing Update for Comprehensive Outpatient Rehabilitation Facilities (CORFs) and Outpatient Physical Therapy Providers (OPTs)	Tuesday, September 16, 2008	CR 6163, from which this article is taken, updates CR 5878 (Smoking and Tobacco Use Cessation Counseling Billing Code Update to Medicare), released February 1, 2008, to remove outpatient physical therapy provider (OPT) bill type 74X and comprehensive outpatient rehabilitation facility (CORF) bill type 75X from the list of applicable bill types for smoking and tobacco cessation counseling (effective July 1, 2008). In addition, CR 6163 also announces that the applicable revenue codes for CORF billing are being updated to remove 029X (Durable Medical Equipment) because CORFs do not bill DME; and lists the revenue codes for which CORFs can bill on 75X bill types. Make sure that your billing staffs are aware (effective July 1, 2008) that smoking and tobacco use cessation counseling is not billable by OPT or CORF providers, and are also aware of the current, applicable CORF revenue codes for 75X bill types.
Inpatient Rehabilitation Facility (IRF) Annual Update: Prospective Payment System (PPS) Pricer Changes for FY 2009	Wednesday, September 10, 2008	This article is based on Change Request (CR) 6166 which provides updated rates used to correctly pay IRF PPS claims for FY 2009. Be sure billing staff are aware of these changes.
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.
Fiscal Year (FY) 2006 Supplemental Security Income (SSI) Data	Tuesday, August 12, 2008	This article is based on Change Request (CR) 6126, which states that, as of May 5, 2008, hospitals (this includes acute care hospitals paid under the inpatient prospective payment system and inpatient rehabilitation facilities (IRF)) may elect to use either its FY 2005 or FY 2006 SSI ratio from the files published on the Centers for Medicare & Medicaid Services (CMS) website to file its cost report that would otherwise be submitted with the FY 2006 SSI ratio.
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.
New Hemophilia Clotting Factor and HCPCS Code	Thursday, July 31, 2008	Note: This article was revised on July 28, 2008, to reflect changes made to CR 6006, which CMS revised on July 25, 2008. The CR release date, transmittal number, and the Web address for accessing CR 6006 were revised. All other information remains the same. This article is based on Change Request (CR) 6006 which announces that Healthcare Common Procedure Coding System (HCPCS) code Q4096 (INJECTION, VON WILLEBRAND FACTOR COMPLEX, HUMAN, RISTOCETIN COFACTOR (NOT OTHERWISE SPECIFIED), PER I.U. VWF:RCO VWF complex, NOS) will be payable for Medicare effective for claims with dates of service on or after April 1, 2008. Appropriate systems changes for editing hemophilia clotting factors on inpatient claims will not be made by Medicare’s Fiscal Intermediary Shared System (FISS) until January 5, 2009 release. This CR does not impact outpatient hospital claims or on any SNF claims as payment is made under different methodologies. Q4096 is payable in those settings effective April 1, 2008. Providers need to be aware of the instructions in the rest of this article in order to properly submit inpatient claims with Q4096 for discharges on or after April 1, 2008 through January 5, 2009.
Important Information on the New Medicare Law – The Medicare Improvements for Patients and Providers Act of 2008	Tuesday, July 22, 2008	This article contains a compilation of messages that were issued on July 16, 2008. The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) was enacted on July 15, 2008. This legislation alters a number of Medicare policies, which have been the subject of a number of change requests (CRs) and MLN Matters articles published in recent months. The Centers for Medicare & Medicaid Services (CMS) is in the process of revising these previously issued CRs and MLN Matters articles as a result of this legislation. However, CMS feels it is important that physicians, providers and suppliers be aware of five critical issues immediately. These five issues are: New 2008 Medicare Physician Fee Schedule (MPFS) payment rates effective for dates of service July 1, 2008 through December 31, 2008; Extension of the exceptions process for the therapy caps; A delay in the Medicare durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) competitive bidding program; Reinstatement of the moratorium that allows independent laboratories to bill for the technical component (TC) of physician pathology services furnished to hospital patients; and Extension of the payment rule for Brachytherapy and Therapeutic Radiopharmaceuticals. Be sure your billing staff is aware of these changes.
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