Medicare and Medicaid Programs; Quarterly Listing of Program Issuances-Fourth Quarter, 1999 through First Quarter, 2002
Federal RegisterJun 28, 2002
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-9880-N]
Medicare and Medicaid Programs; Quarterly Listing of Program Issuances—Fourth Quarter, 1999 through First Quarter, 2002
AGENCY:
Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION:
Notice.
SUMMARY:
This notice lists CMS manual instructions, substantive and interpretive regulations, and other
Federal Register
notices that were published from October 1999, through March 2002, relating to the Medicare and Medicaid programs. This notice also identifies certain devices with investigational device exemption numbers approved by the Food and Drug Administration that potentially may be covered under Medicare, and provides information on national coverage determinations affecting specific medical and health care services under Medicare.
Section 1871(c) of the Social Security Act requires that we publish a list of Medicare issuances in the
Federal Register
at least every 3 months. Although we are not mandated to do so by statute, for the sake of completeness of the listing, we are also including all Medicaid issuances and Medicare and Medicaid substantive and interpretive regulations (proposed and final) published during this timeframe.
FOR FURTHER INFORMATION CONTACT:
It is possible that an interested party may have a specific information need and not be able to determine from the listed information whether the issuance or regulation would fulfill that need. Consequently, we are providing information contact persons to answer general questions concerning these items. Copies are not available through the contact persons.
Questions concerning Medicare items in Addendum III may be addressed to Karen Bowman, Office of Communications and Operations Support, Division of Regulations and Issuances, Centers for Medicare & Medicaid Services, C5-13-27, 7500 Security Boulevard, Baltimore, MD 21244-1850, (410) 786-5252.
Questions concerning Medicaid items in Addendum III may be addressed to Cindy Potter, Center for Medicaid State Operations, Policy Coordination and Planning Group, Centers for Medicare & Medicaid Services, S2-01-01, 7500 Security Boulevard, Baltimore, MD 21244-1850, (410) 786-6714.
Questions concerning Food and Drug Administration-approved investigational device exemptions may be addressed to Sharon Hippler, Office of Clinical Standards and Quality, Coverage and Analysis Group, Centers for Medicare & Medicaid Services, C4-11-04, 7500 Security Boulevard, Baltimore, MD 21244-1850, (410) 786-4633.
Questions concerning national coverage determinations should be directed to Kimberly Long, Office of Clinical Standards and Quality, Coverage and Analysis Group, Centers for Medicare & Medicaid Services, S3-11-15, 7500 Security Boulevard, Baltimore, MD 21244-1850, (410) 786-5702.
Questions concerning all other information may be addressed to Christopher McClintick, Office of Communications and Operations Support, Division of Regulations and Issuances, Centers for Medicare & Medicaid Services, C5-13-15, 7500 Security Boulevard, Baltimore, MD 21244-1850, (410) 786-4682.
SUPPLEMENTARY INFORMATION:
I. Program Issuances
The Centers for Medicare & Medicaid Services (CMS) is responsible for administering the Medicare and Medicaid programs. These programs pay for health care and related services for 39 million Medicare beneficiaries and 35 million Medicaid recipients. Administration of these programs involves (1) furnishing information to Medicare beneficiaries and Medicaid recipients, health care providers, and the public and (2) maintaining effective communications with regional offices, State governments, State Medicaid agencies, State survey agencies, various providers of health care, fiscal intermediaries and carriers that process claims and pay bills, and others. To implement the various statutes on which the programs are based, we issue regulations under the authority granted to the Secretary of the Department of Health and Human Services under sections 1102, 1871, 1902, and related provisions of the Social Security Act (the Act). We also issue various manuals, memoranda, and statements necessary to administer the programs efficiently.
Section 1871(c)(1) of the Act requires that we publish a list of all Medicare manual instructions, interpretive rules, statements of policy, and guidelines of general applicability not issued as regulations at least every 3 months in the
Federal Register
. We published our first notice June 9, 1988 (53 FR 21730). Although we are not mandated to do so by statute, for the sake of completeness of the listing of operational and policy statements, we are continuing our practice of including Medicare substantive and interpretive regulations (proposed and final) published during the 3-month time frame.
II. How To Use the Addenda
This notice is organized so that a reader may review the subjects of manual issuances, memoranda, substantive and interpretive regulations, and Food and Drug Administration-approved investigational device exemptions, and national coverage determinations published during the timeframe to determine whether any are of particular interest. We expect this notice to be used in concert with previously published notices. Those unfamiliar with a description of our Medicare manuals may wish to review Table I of our first three notices (53 FR 21730, 53 FR 36891, and 53 FR 50577) published in 1988, and the notice published March 31, 1993 (58 FR 16837). Those desiring information on the Medicare Coverage Issues Manual may wish to review the August 21, 1989 publication (54 FR 34555). Those interested in the procedures used in making national coverage determinations may review the April 27, 1999 publication (64 FR 22619). In this publication, the 1989 proposed rule affecting national coverage procedures and decisions (54 FR 4302) was withdrawn, and the procedures for national coverage determinations established.
To aid the reader, we have organized and divided this current listing into six addenda:
• Addendum I lists the publication dates of the most recent quarterly listings of program issuances.
• Addendum II identifies previous
Federal Register
documents that contain a description of all previously published CMS Medicare and Medicaid manuals and memoranda.
• Addendum III lists a unique CMS transmittal number for each instruction in our manuals or Program Memoranda and its subject matter. A transmittal may consist of a single instruction or many. Often, it is necessary to use information in a transmittal in conjunction with information currently in the manuals.
• Addendum IV lists all substantive and interpretive Medicare and Medicaid regulations and general notices published in the
Federal Register
during the quarters covered by this notice. For each item we list the—
• Date published;
•
Federal Register
citation;
• Parts of the Code of Federal Regulations (CFR) that have changed (if applicable);
• Agency file code number;
• Title of the regulation;
• Ending date of the comment period (if applicable); and
• Effective date (if applicable).
• Addendum V includes listings of the Food and Drug Administration-approved investigational device exemption numbers that have been approved or revised during the quarters covered by this notice. On September 19, 1995, we published a final rule (60 FR 48417) establishing in regulations at 42 CFR 405.201
et seq.
that certain devices with an investigational device exemption approved by the Food and Drug Administration and certain services related to those devices may be covered under Medicare. It is our practice to announce all investigational device exemption categorizations, using the investigational device exemption numbers the Food and Drug Administration assigns. The listings are organized according to the categories to which the device numbers are assigned (that is, Category A or Category B, and identified by the investigational device exemption number).
• Addendum VI includes completed national coverage determinations from June 28, 1999, the effective date of Medicare's new coverage process. Completed decisions are identified by title, a brief description, effective date, and section in the appropriate federal publication.
III. How To Obtain Listed Material
A. Manuals
Those wishing to subscribe to program manuals should contact either the Government Printing Office (GPO) or the National Technical Information Service (NTIS) at the following addresses:
Superintendent of Documents, Government Printing Office, ATTN: New Orders, P.O. Box 371954, Pittsburgh, PA 15250-7954, Telephone (202) 512-1800, Fax number (202) 512-2250 (for credit card orders); or
National Technical Information Service, Department of Commerce, 5825 Port Royal Road, Springfield, VA 22161, Telephone (703) 487-4630.
In addition, individual manual transmittals and Program Memoranda listed in this notice can be purchased from NTIS. Interested parties should identify the transmittal(s) they want. GPO or NTIS can give complete details on how to obtain the publications they sell. Additionally, most manuals are available at the following Internet address: http://www.hcfa.gov/pubforms/progman.htm.
B. Regulations and Notices
Regulations and notices are published in the daily
Federal Register
. Interested individuals may purchase individual copies or subscribe to the
Federal Register
by contacting the GPO at the address given above. When ordering individual copies, it is necessary to cite either the date of publication or the volume number and page number.
The
Federal Register
is also available on 24x microfiche and as an online database through
GPO Access.
The online database is updated by 6 a.m. each day the
Federal Register
is published. The database includes both text and graphics from Volume 59, Number 1 (January 2, 1994) forward. Free public access is available on a Wide Area Information Server (WAIS) through the Internet and via asynchronous dial-in. Internet users can access the database by using the World Wide Web; the Superintendent of Documents home page address is http://www.access.gpo.gov/nara/index.html, by using local WAIS client software, or by telnet to swais.access.gpo.gov, then log in as guest (no password required). Dial-in users should use communications software and modem to call (202) 512-1661; type swais, then log in as guest (no password required).
C. Rulings
We publish rulings on an infrequent basis. Interested individuals can obtain copies from the nearest CMS Regional Office or review them at the nearest regional depository library. We have, on occasion, published rulings in the
Federal Register
. Rulings, beginning with those released in 1995, are available online, through the CMS Home Page. The Internet address is
http://www.hcfa.gov/regs/rulings.htm.
D. CMS's Compact Disk-Read Only Memory (CD-ROM)
Our laws, regulations, and manuals are also available on CD-ROM and may be purchased from GPO or NTIS on a subscription or single copy basis. The Superintendent of Documents list ID is HCLRM, and the stock number is 717-139-00000-3. The following material is on the CD-ROM disk:
• Titles XI, XVIII, and XIX of the Act.
• CMS-related regulations.
• CMS manuals and monthly revisions.
• CMS program memoranda.
The titles of the Compilation of the Social Security Laws are current as of January 1, 1999. (Updated titles of the Social Security Laws are available on the Internet at
http://www.ssa.gov/OP_Home/ssact/comp-toc.htm.
) The remaining portions of CD-ROM are updated on a monthly basis.
Because of complaints about the unreadability of the Appendices (Interpretive Guidelines) in the State Operations Manual (SOM), as of March 1995, we deleted these appendices from CD-ROM. We intend to re-visit this issue in the near future and, with the aid of newer technology, we may again be able to include the appendices on CD-ROM.
Any cost report forms incorporated in the manuals are included on the CD-ROM disk as LOTUS files. LOTUS software is needed to view the reports once the files have been copied to a personal computer disk.
IV. How To Review Listed Material
Transmittals or Program Memoranda can be reviewed at a local Federal Depository Library (FDL). Under the FDL program, government publications are sent to approximately 1,400 designated libraries throughout the United States. Some FDLs may have arrangements to transfer material to a local library not designated as an FDL. Contact any library to locate the nearest FDL.
In addition, individuals may contact regional depository libraries that receive and retain at least one copy of most Federal Government publications, either in printed or microfilm form, for use by the general public. These libraries provide reference services and interlibrary loans; however, they are not sales outlets. Individuals may obtain information about the location of the nearest regional depository library from any library.
Superintendent of Documents numbers for each CMS publication are shown in Addendum III, along with the CMS publication and transmittal numbers. To help FDLs locate the materials, use the Superintendent of Documents number, plus the transmittal number. For example, to find the Intermediary Manual, Part 3—Claims Process, (HCFA Pub. 13-3) transmittal entitled “Mammography Screening,” use the Superintendent of Documents No. HE 22.8/6 and the transmittal number 1782.
(Catalog of Federal Domestic Assistance Program No. 93.773, Medicare—Hospital Insurance, Program No. 93.774, Medicare—Supplementary Medical Insurance Program, and Program No. 93.714, Medical Assistance Program)
Dated: June 20, 2002.
Jacquelyn Y. White,
Director, Office of Communications and Operations Support.
Addendum I
This addendum lists the publication dates of the most recent quarterly listings of program issuances.
June 4, 1998 (63 FR 30499)
August 11, 1998 (63 FR 42857)
September 16, 1998 (63 FR 49598)
December 9, 1998 (63 FR 67899)
May 11, 1999 (64 FR 25351)
November 2, 1999 (64 FR 59185)
December 7, 1999 (64 FR 68357)
January 10, 2000 (65 FR 1400)
May 30, 2000 (65 FR 34481)
Addendum II—Description of Manuals, Memoranda, and HCFA Rulings
An extensive descriptive listing of Medicare manuals and memoranda was published on June 9, 1988, at 53 FR 21730 and supplemented on September 22, 1988, at 53 FR 36891 and December 16, 1988, at 53 FR 50577. Also, a complete description of the Medicare Coverage Issues Manual was published on August 21, 1989, at 54 FR 34555. (Please note that in this publication the 1989 proposed rule referred to, concerning the criteria for national coverage determinations, was withdrawn (64 FR 22619)). A brief description of the various Medicaid manuals and memoranda that we maintain was published on October 16, 1992 (57 FR 47468).
Addendum III.—Medicare and Medicaid Manual Instructions
Transmittal No.
Manual/Subject/Publication No.
October 1999 through December 1999
Intermediary Manual
Part 3—Claims Process
(HCFA Pub. 13-3)
(Superintendent of Documents No. HE 22.8/6)
1782
•
Mammography Screening
1783
•
Clarification of Reimbursement for Transfers That Result in Same Day Hospice Discharge and Admission
1784
•
Bill Review for Partial Hospitalization Services Provided in Community Mental Health Centers
1785
•
Payment Calculation for Outpatient Claims
Medicare Secondary Payment Modules
1786
•
Pneumococcal Pneumonia, Influenza Virus and Hepatitis B Vaccines
1787
•
Review of Form HCFA—1450 for Inpatient and Outpatient Bills
Inpatient Part B Services
Outpatient Services
Calculating the Part B Payment
HCFA Common Procedure Coding System
Addition, Deletion, and Change of Local Codes
Reporting Hospital Outpatient Services Using HCFA Common Procedure
Coding System
Hospital Outpatient Partial Hospitalization Services
Carriers Manual
Part 3—Claims Process
(HCFA Pub. 14-3)
(Superintendent of Documents No. HE 22.8/7)
1650
•
Services Eligible for HPSA Bonus Payments
Post-Payment Review
1651
•
Identifying a Screening Mammography Claim
1652
•
Medicare Physician Fee Schedule Database 2000 File Layout
1653
•
Type of Service
1654
•
Cryosurgery of the Prostate Gland
1655
•
HCFA Common Procedure Coding System
1656
•
Coverage of Chiropractic Services
1657
•
Review of the Health Insurance Claim Form—HCFA-1500, Item 24
Program Memorandum
Intermediaries (HCFA Pub. 60A)
(Superintendent of Documents No. HE 22.8/6-5)
A-99-43
•
File Descriptions and Instructions for Retrieving the 2000 Physician,
Clinical Lab, Durable Medical Equipment, Prosthetics/Orthotics and
Supplies Fee
Schedule Payment Amounts through HCFA's Mainframe
Telecommunications Systems
A-99-44
•
Discharges to Swing Bed Units and other Post-Acute Care Providers
A-99-45
•
Requirements for Billing and Processing Claims for Services Subject to Line Item Data of Service Reporting
A-99-46
•
Implementation and Corrections to the Federal Register Notice Published August 5, 1999 for Home Health Agency Cost Limitation Effective October 1, 1999
A-99-47
•
Extended Repayment Schedules for Home Health Agencies Affected by the Interim Payment System
A-99-48
•
Renewal of Program Memorandum A-97-8—Instructions to Implement the New Medicare Summary Notice Combined with Program Memorandum AB-98-31
A-99-49
•
Proper Reporting and Acceptance of Non-covered Changes and Related Revenue Codes
A-99-50
•
Policy Clarification: Coding for Adequacy of Hemodialysis
A-99-51
•
FY 2000 Prospective Payment System Tax, Equity, and Fiscal Responsibility Act Hospital, and Other Bill Processing Changes
A-99-52
•
Home Health Agency Instructions for the Provision of Advance Beneficiary Notices And for Mandatory Claims Submission (Demand Bills)
A-99-53
•
Skilled Nursing Facility Election of Immediate Transition to 100% Federal Rate and Special Rules for Certain Skilled Nursing Facilities
A-99-54
•
Advance Beneficiary Notices Must Be Given To Beneficiaries and Demand Bills Must Be Submitted Promptly By Home Health Agencies
A-99-55
•
HAS BEEN RESCINDED AND WILL NOT BE RELEASED
A-99-56
•
Reopenings for Sole Community Hospital and Medicare Dependent Hospital Cost Reports Due to the Change to the Cost Report Instructions in Calculating the Hospital Specific Amount on Form HCFA-2552-96 and Form HCFA-2552-92
A-99-57
•
Hospital Outpatient Procedures: Billing for Contrast Material (Clarification)
A-99-58
•
Hospital Outpatient Procedures: Medicare Changes for Radiology and Other Diagnostic Coding Due to the 1999 HCFA Common Procedure Coding System Update; Revised Modifiers
A-99-59
•
New Composite Payment Rates Effective January 1, 2000, and Reopening of the Exception Process Under the End Stage Renal Disease Composite Rate System
A-99-60
•
Implementation of H.R. 3426, the Medicare, Medicaid, and the State Child Health Insurance Program Balanced Budget Refinement Act of 1999, P.L. 106-113, Section 303 (a) Which Revises the Per-Beneficiary Limitations on Home Health Agency Costs for Certain Home Health Agencies
A-99-61
•
Special Adjustment for Federal Skilled Nursing Facility Prospective Payment Rates and Special Payment Rules Applicable to Certain Skilled Nursing Facilities
A-99-62
•
Clarification of Allowable Medicaid Days in the Medicare Disproportionate Share Hospital Adjustment Calculation
Program Memorandum
Carriers
(HCFA Pub. 60B)
(Superintendent of Documents No. HE 22.8/6-5)
B-99-35
•
Enrollment of Independent Diagnostic Testing Facilities
B-99-36
•
Schedule for Completing the Calendar Year 2000 Update and Enrollment Process for the Medicare Physician Fee Schedule Database
B-99-37
•
Calendar Year 2000 Participation Enrollment and Medicare Participating Physicians and Suppliers Directory Procedures
B-99-38
•
Addition of Current Procedural Terminology Code 00300 to Use with G8 Monitored Anesthesia Care Modifier
B-99-39
•
Corrections to Calendar Year 2000 Medicare Physician Fee Schedule Database and Year 2000 Fact Sheet
B-99-40
•
Delay of Change to Form HCFA-1500 Instructions for Processing Physician Claims in Global Payment Systems (Change Request #457)
B-99-41
•
Instructions to Implement the New Medicare Summary Notice Program Memorandum B-98-4 and AB-98-31
B-99-42
•
Calculation of National Standard Format for Electronic Remittance Advice Amount Fields and Balancing of Data; and Clarification to Claim Field EAO 21 for Coordination of Benefits
B-99-43
•
Issues Related to Critical Care Policy
B-99-44
•
Medicare Enrollment of Physical Therapists in Private Practice and Occupational Therapists in Private Practice Effective on or after January 1, 1999
B-99-45
•
Emergency Changes to the 2000 Medicare Physician Fee Schedule Database
Program Memorandum
Intermediaries/Carriers
(HCFA Pub. 60A/B)
(Superintendent of Documents No. HE 22.8/6-5)
AB-99-72
•
Instructions for Implementing and Updating 2000 Payment Amounts for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
AB-99-73
•
2000 Payment Limit for Ambulance Services
AB-99-74
•
Clarification to Medicare Carrier Manual § 2130 Prosthetic Devices and Coverage Issues Manual § 60-9 Durable Medical Equipment Reference List—Coverage Intermittent Catheterization
AB-99-75
•
Interim Instructions for Processing Claims for Factor VIIa (Coagulation Factor, Recombinant)
AB-99-76
•
Education of Medicare Providers on the Adoption of Standard Electronic Health Care Transaction Formats in the United States
AB-99-77
•
Implementation of Edits for Prostate Cancer Screening
AB-99-78
•
Notice of New Interest Rate for Medicare Overpayments and Underpayments
AB-99-79
•
Collection of Comprehensive Encounter Data for Long-Term Care Demonstrations (Social Health Maintenance Organization, EverCare), Dual Eligible Demonstrations and Department of Defense Subvention Demonstration
AB-99-80
•
Clinical Diagnostic Laboratory Organ or Disease Panel Codes Billing Procedures for January 2000
AB-99-81
•
Calculation of Average Allowed Charges for Residual Items and Services Excluding Ambulance Services, Subject to the Reasonable Charge Payment Methodology
AB-99-82
•
Procedures for Reporting of Medicare Contractor
NON
-Medicare Secondary Payer Currently Not Collectible Debts
AB-99-83
•
Final Rule Revising and Updating Medicare Policies Concerning Ambulance Services
AB-99-84
•
Implementation of Calendar Year 2000 Clinical Diagnostic Laboratory Fee Schedule and Laboratory and Ambulance Costs Subject to Reasonable Charge Payment Methodology in 2000
AB-99-85
•
Clinical Diagnostic Laboratory Organ or Disease Panel Codes Claims Processing Procedures for April 2000
AB-99-86
•
Durable Medical Equipment Regional Carrier Operating Instructions for New National Coverage of the Continuous Subcutaneous Insulin Infusion Pump, Effective for Services Performed on or after April 1, 2000
AB-99-87
•
Clarification of Medicare Coverage of Abortion Services Instruction
AB-99-88
•
Program Memorandum on Statements of Intent to File Claims for Claims Filing Periods That End on December 31, 1999
AB-99-89
•
Start Date Options for Processing Year 2000 Services
AB-99-90
•
Clarification of Program Memorandum Transmittal No. AB-98-35 (Consolidated Billing for Skilled Nursing Facilities) and Revision to Transmittal No. AB-98-18 (Consolidated Billing for Skilled Nursing Facilities)
AB-99-91
•
Instructions for Implementing and Tracking the Medicare Fraud and Abuse Incentive Reward Program
AB-99-92
•
Temporary Conversion from Bundled Payments to Regular Medicare Payments for The Participating Centers of Excellence Demonstration Testing Beginning with Discharges after December 31, 1998
AB-99-93
•
Extension of the Limitation on Payment for Services to Individuals Entitled to Benefits On the Basis of End Stage Renal Disease Who Are Covered by Group Health Plans
AB-99-94
•
Reimbursement for Ambulance Services to Non-hospital-Based Dialysis Facilities
AB-99-95
•
Access to Eligibility Data by Eligibility Verification Vendors
AB-99-96
•
Data Collection for Program Integrity Y2K Contingency Planning
AB-99-97
•
HCFA Office of the Inspector General Hotline Referrals
AB-99-98
•
Extension of Medicare Benefits for Immunosuppressive Drugs
AB-99-99
•
Cervical or Vaginal Smear Tests (Pap Smears) Included in Calendar Year 2000 Clinical Diagnostic Laboratory Fee Schedule
AB-99-100
•
Model Acknowledgment Letters for Valid and Invalid Written Statements of Intent to Claim Medicare Benefits (As Referenced In PM Transmittal AB-99-88)
AB-99-101
•
Section 221 of the Balanced Budget Refinement Act of 1999 “Revision of Provisions Relating to Therapy Services”
Program Memorandum
State Survey Agencies
(HCFA Pub. 65)
(Superintendent of Documents No. HE 22.8/6-5)
99-2
•
Guideline and Exhibits Regarding Regulatory Requirements for Comprehensive Assessment and Use of the Outcome and Assessment Information Set
State Operations Manual
Provider Certification
(HCFA Pub. 7)
(Superintendent of Documents No. HE 22.8/12)
11
•
State Agency Identification of Potential Provider and Suppliers
Provider-Based Designation
Hospital Merger/Multiple Campus Criteria
Certification of Hospitals with Multiple Components as Single Hospital
12
•
Appendix A, Survey Procedures for Hospitals
13
•
Introduction
Definitions and Acronyms
Emphasis, Components and Applicability
Informal Dispute Resolution
Certification of Compliance and Noncompliance for Skilled Nursing
Facility and Nursing Facilities
Action When Facility is not in Substantial Compliance
Appeal of Certification of Noncompliance
Certification—Related Terms
Notice Requirements
Timing of Civil Money Penalties
Enforcement Action When Immediate Jeopardy Exists
Key Dates When Immediate Jeopardy Exists
Enforcement Action When Immediate Jeopardy Does Not Exist
Special Procedures for Recommending and Providing Notice of Category 1
Remedies and Denial of Payment for New Admissions
Key Dates When Immediate Jeopardy Does Not Exist
Response to the Plan of Correction
New Deficiencies Identified
Action When There is Substandard Quality of Care
Skilled Nursing Facility/Nursing Facility Readmission to Medicare or Medicaid Program After Termination
Enforcement Remedies for Skilled Nursing Facilities and Nursing Facilities
Life Safety Code Enforcement Guidelines for Skilled Nursing Facilities and Nursing Facilities
Denial of Payment for All New Medicare and Medicaid Admissions for Skilled Nursing Facilities and Nursing Facilities
Basis for Imposing Civil Money Penalties
Determining Amount of Civil Money Penalty
Effective Date of Civil Money Penalty
Duration of Civil Money Penalty
Appeal of Noncompliance Which Led to Imposition of Civil Money Penalty
Notice of Amount Due and Collectible
Continuation of Payment During Remediation
Sanctions for Inadequate State Survey Performance
Peer Review Organization Manual
(HCFA Pub. 19)
(Superintendent of Documents No. HE 22.8/8-15)
77
•
Introduction
Assistants at Cataract Surgery
Hospital and Medicare+Choice Organization Notices of Non-coverage
Hospital-Requested Higher-Weighted Diagnostic Related Group Assignments
Potential Concerns Identified During Project Data Collection
Referrals
78
•
Introduction
Quality Improvement Project Process
Selecting a Clinical Topic
Identifying Quality Indicators
Measuring Baseline Performance on Quality Indicators
Developing and Conducting Interventions
Remeasuring Performance on Quality Indicators
Documenting and Disseminating Results
National and Regional Projects
Local Projects
Medicare+Choice Organization Projects
Related Activities through Peer Review Organization, Carrier,
Intermediary, and End-Stage Renal Disease Network Cooperation
Information Collection
Publication Policy
Project Data Collection
79
•
Notice of Discharge and Medicare Appeal Rights Citations and Authority
Notice of Discharge and Medicare Appeal Rights
Medicare Enrollee Request for Peer Review Organization Immediate Review
80
•
Physician/Provider Meeting Activities Required by Statute
Physician/Provider Meeting Activities Required by Peer Review
Organization Contract
Peer Review Organization/Intermediary/Carrier Coordination Activities
Additional Peer Review Organization/Carrier Coordination Activities
Background
Confidentiality Requirements
Report Requirements
Publication Requirements
Hospital Manual
(HCFA Pub. 10)
(Superintendent of Documents No. HE 22.8/2)
745
•
Billing for Mammography Screening
746
•
Pneumococcal Pneumonia, Influenza Virus, and Hepatitis B Vaccines
747
•
HCFA Common Procedure Coding System
Reporting Outpatient Services Using HCFA Common Procedure Coding System
Billing for Hospital Outpatient Partial Hospitalization Services
Completion of Form HCFA—1450 for Inpatient and/or Outpatient Billing
Home Health Agency Manual
(HCFA Pub. 11)
Superintendent of Documents No. HE 22.8/5
291
•
Billing for Pneumococcal Pneumonia, Influenza Virus, and Hepatitis B Vaccines
Skilled Nursing Facility Manual
(HCFA Pub. 12)
Superintendent of Documents No. HE 22.8/3
361
•
Special Billing Instructions for Pneumococcal Pneumonia, Influenza Virus, and Hepatitis B Vaccines
Medicare Rural Health Clinic & Federally Qualified
Health Centers Manual
(HCFA Pub. 27)
Superintendent of Documents No. HE 22.8/19:985
34
•
Billing for Mammography Screening by Rural Health Clinics and Federally Qualified Health Centers
Medicare Renal Dialysis Facility Manual
(Non-Hospital Operated)
(HCFA Pub. 29)
Superintendent of Documents No. HE 22.8/13
87
•
Pneumococcal Pneumonia, Influenza Virus and Hepatitis B Vaccines
Hospice Manual
(HCFA Pub. 21)
Superintendent of Documents No. HE 22.8/18
56
•
Billing for Covered Medicare Services After Hospice Benefits are Exhausted
•
Clarification of Reimbursement for Transfers That Result in Same Day Hospice Discharge and Admission
57
•
Special Billing Instructions for Pneumococcal Pneumonia, Influenza Virus and Hepatitis B Vaccines
Outpatient Physical Therapy and Comprehensive
Outpatient Rehabilitation Facility Manual
(HCFA Pub. 9)
Superintendent of Documents No. HE 22.8/9
7
•
Billing Instructions for Partial Hospitalization Services Provided in Community Mental Health Centers
8
•
Pneumococcal Pneumonia, Influenza Virus, and Hepatitis B Vaccines
Coverage Issues Manual
(HCFA Pub. 6)
Superintendent of Documents No. HE 22.8/14
120
•
Infusion Pumps
121
•
Adult Liver Transplantation
Provider Reimbursement Manual—Part 1
(HCFA Pub. 15-1)
(Superintendent of Documents No. HE 22.8/4)
410
•
Dismissal for Lack of Board Jurisdiction
Provider Reimbursement Review Board Jurisdiction
411
•
Development of Skilled Nursing Facility Inpatient Routine Service Cost Limits
Provider Requests Regarding Applicability of Cost Limits
Requests Regarding New Provider Exemption
General Requirements
Intermediary Responsibilities Regarding Exceptions
Provider-Based Designation
Classification of Skilled Nursing Facilities for Cost Limit Application
412
•
Regional Medicare Swing-Bed Skilled Nursing Facility Rates
Provider Reimbursement Manual—Part 2
Provider Cost Reporting Forms and Instructions
Chapter 32—Form HCFA-1728-94
(HCFA Pub. 15-2-32)
(Superintendent of Documents No. HE 22.8/4)
8
•
Home Health Agency Cost Report
Provider Reimbursement Manual—Part 2
Provider Cost Reporting Forms and Instructions
Chapter 35—Form HCFA-2540-96
(HCFA Pub. 15-2-35)
(Superintendent of Documents No. HE 22.8/4)
6
•
Skilled Nursing Facility and Skilled Nursing Facility Complex Cost Report
7
•
Skilled Nursing Facility and Skilled Nursing Facility Complex Cost Report
Provider Reimbursement Manual—Part 2
Provider Cost Reporting Forms and Instructions
Chapter 36—Form HCFA-2552-96
(HCFA Pub. 15-2-36)
(Superintendent of Documents No. HE 22.8/4)
6
•
Hospital and Hospital Health Care Complex, Cost Reporting Form
Provider Reimbursement Manual—Part 2
Provider Cost Reporting Forms and Instructions
Chapter 37—Form HCFA-2540S-97
(HCFA Pub. 15-2-37)
(Superintendent of Documents No. HE 22.8/4)
2
•
Skilled Nursing Facility Cost Report
State Medicaid Manual—Part 4
Services
(HCFA Pub. 45-5)
Superintendent of Documents No. HE 22. 8/10
73
•
Personal Care Services
Medicare/Medicaid
Sanction—Reinstatement Report
(HCFA Pub. 69)
99-10
•
Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—September 1999
99-11
•
Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—October 1999
99-12
•
Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—November 1999
January 2000 through March 2000
Intermediary Manual
Part 3—Claims Process
(HCFA Pub. 13-3)
(Superintendent of Documents No. HE 22.8/6)
1788
•
Provider Electronic Billing File Record Formats
1789
•
HCFA Common Procedure Coding System for Hospital Outpatient Radiology Services and Other Diagnostic Procedures
1790
•
Oral Cancer Drugs
1791
•
Claims Processing Timeliness
Carriers Manual
Part 2—Program Administration
(HCFA Pub. 14-2)
(Superintendent of Documents No. HE 22.8/7-3)
140
•
Function Standards for Claims Processing Claims Operations
Carriers Manual
Part 3—Program Administration
(HCFA Pub. 14-3)
(Superintendent of Documents No. HE 22.8/7)
1658
•
Billing Requirement for Global Surgeries
1659
•
External Counterpulsation
1660
•
Clinical Psychologists Services
1661
•
National Emphysema Treatment Trial
Background
Coverage Summary
Beneficiaries Participating in the Study
Sites of Service
Format for Submitted Claims
Identifying National Emphysema Treatment Trial
Bypassing Existing Edits in Your System
Common Working File Processing of National Emphysema Treatment Trial
Dates of Service
Late Claim Submission
Termination of the Beneficiary's Participation
Coding
Payment
Managed Care
Responding to Billing Questions
Denied Claims
Participating Clinical Center
1662
•
Transmyocardial Revascularization
Medicare Coverage of Abortion Services
1663
•
Pancreas Transplants
Billing Instructions Pancreas Transplants
Program Memorandum
Intermediaries (HCFA Pub. 60A)
(Superintendent of Documents No. HE 22.8/6-5)
A-00-01
•
Consolidated Billing for Skilled Nursing Facility Patients When Receiving Outpatient Emergency Care in a Medicare-Participating Hospital or Critical Access Hospital
A-00-02
•
Installation of the Medicare Outpatient Code Editor Version 15.1
A-00-03
•
Implementation of H. R. 3426, the Medicare, Medicaid, and the State Child Health Insurance Program Balanced Budget Refinement Act of 1999, P.L 106-113, Section 301 (a) Which Provides an Adjustment to Defray the Cost Incurred by a Home Health Agency Attributable to Data Collection and Reporting Requirements Under the Outcome and Assessment Information Set
A-00-04
•
Provider Statistical and Reimbursement Report Unibill Record
A-00-05
•
Claims Processing Instructions for the National Institutes of Health National Emphysema Treatment Trial
A-00-06
•
Instructions for an End-Stage Renal Disease Facility to Retain Its Previously Approved Exception Payment Rate
A-00-07
•
Addition of Modifiers 25, 58, 78, and 79 to the List of Modifiers Approved for Hospital Outpatient Use and Correction to Program Memorandum A-99-41
A-00-08
•
Payment Safeguard Review of Skilled Nursing Facility Prospective Payment Bills—Updated Instructions
A-00-09
•
Hospital Outpatient Services Prospective Payment System Background
A-00-10
•
Discarding Program Memoranda on Surety Bonds
A-00-11
•
Medicare Home Health Benefit-Section 4615 of the Balanced Budget Act of 1997, Clarification That No Home Health Benefits Are Authorized Based Solely on Drawing Blood
A-00-12
•
Revision of Final Date to Accept Abbreviated Version of the UB-92 for Encounter Data Collection
A-00-13
•
Procedures for Financial Reporting of Medicare Letter of Credit Draws and Collections between the Hospital Insurance and Supplemental Medicare Insurance Trust Funds
A-00-14
•
Hospital Outpatient Radiology Services
A-00-15
•
Hospital Outpatient Procedures: Medicare Changes for Radiology and Other Diagnostic Coding Due to the 1998 HCFA Common Procedure Coding System Update: Changes Miscellaneous
A-00-16
•
The Balanced Budget Refinement Act Revision to PM Trasmittal No. A-99-51: FY 2000 Prospective Payment System and Excluded Hospital Bill Processing Changes—Wage Adjust 75th Percentile Cap of the Target Amounts or Excluded Hospitals and Units
Program Memorandum
Carriers
(HCFA Pub. 60B)
(Superintendent of Documents No. HE 22.8/6-5)
B-00-01
•
Paramedic Intercept Provisions of the Balanced Budget Act of 1997
B-00-02
•
Payment for Teleconsultations in Rural Health Professional Shortage Areas
B-00-03
•
Emergency Change to the 2000 Medicare Physician Fee Schedule Database
B-00-04
•
Fee-for Services Enrollment of Managed Care Organizations for the Indirect Payment Procedure
B-00-05
•
Adjustment to Remittance Advice Explanation of Medicare Benefits and Medicare Summary Notice Messages Generated by Carriers for Services Subject to the Facility/Non-Facility Payment Differential on the Medicare Physician Fee Schedule Database
B-00-06
•
Matrix to Complete Provider/Supplier Enrollment Application (Form HCFA-855 )
B-00-07
•
Change to Correct Coding Edits, Version 6.1, Effective April 1, 2000
B-00-08
•
Instruction for Usage of the Revised Oxygen Certificate of Medical Necessity Form 484.2 (11/99)
B-00-09
•
Clarification of Medicare Policies Concerning Ambulance Services
B-00-10
•
First Quarterly Update to the 2000 Medicare Physician Fee Schedule Database
B-00-11
•
Paramedic Intercept—New Definition for Rural
B-00-12
•
Notification Process for Changes to Health Professional Shortage Area Designations
B-00-13
•
Calculation of National Standard Format for Electronic Remittance Advice Amount Fields and Balancing of National Standard Format Data; and Clarification to Claim National Standard Format Field EAO 21 for Coordination of Benefits—Modification of Program Memorandum B-99-42 (CR1016) of December 1999
Program Memorandum
Intermediaries/Carriers
(HCFA Pub. 60A/B)
(Superintendent of Documents No. HE 22.8/6-5)
AB-00-01
•
Prospective Payment System for Outpatient Rehabilitation Services and Application of Financial Limitation
AB-00-02
•
Durable Medical Equipment Regional Carrier—Pre Discharge Delivery of Durable Medical Equipment Prosthetic, Orthotics & Supplies for Fitting and Training
AB-00-03
•
Notice of New Interest Rate for Medicare Overpayments and Underpayments
AB-00-04
•
April Quarterly Update for 2000 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Fee Schedule
AB-00-05
•
Operating Instructions for Expanded Coverage of the Electrical Osteogenic Stimulator for Fracture Healing. Effective for Services Performed on or after 4/1/2000
AB-00-06
•
Do not Forward Initiative
AB-00-07
•
Moratorium on Data Center Movements
AB-00-08
•
Payment for All Comprehensive Outpatient Rehabilitation Facility Services Under the Medicare Physician Fee Schedule
AB-00-09
•
Transmittal number AB-00-09 has been reserved for Y2k contingency planning and will have a limited distribution.
AB-00-10
•
Implementing Instructions for Services Provided in Religious Nonmedical Health Care Institutions
AB-00-11
•
Medicare Secondary Payer—Identification and Write Off/Adjustment of Medicare Secondary Payer Settlement Related Group Health Plan Based Accounts Receivable, and Write Off of Unsupportable
AB-00-12
•
Correction to Coordination of Benefits Contractor Numbers
AB-00-13
•
New Waived Tests—Effective Data Receipt
AB-00-14
•
Questions and Answers Regarding the Prospective Payment System for Outpatient Rehabilitation Services and Physical Medicine Current Procedural Terminology Coding Guidance
AB-00-15
•
Delay of Hyperbaric Oxygen Therapy Coverage Policy
AB-00-16
•
Instructions to All Medicare Contractors for Reporting Audited Year 2000 Costs on the Final Administrative Costs Proposals
AB-00-17
•
Clarification of Liver Transplant Policy
AB-00-18
•
Consolidated Billing for Skilled Nursing Facilities—The Balanced Budget Refinement Act of 1999
AB-00-19
•
Access to Eligibility Data by Eligibility Verification Vendors
AB-00-20
•
Guidance on April Release Implementation
State Operations Manual
Provider Certification
(HCFA Pub. 7)
(Superintendent of Documents No. HE 22.8/12)
14
•
Nurse Aid Training and Competency Evaluation Programs and Competency Evaluation Programs
Peer Review Organization Manual
(HCFA Pub. 19)
(Superintendent of Documents No. HE 22.8/8-15)
81
•
Peer Review Organization Responsibilities
•
Background
•
Statutory Authority for Memorandum of Agreement
•
Scope
•
Provider Memorandum of Agreement Specifications
•
Introduction
•
Intermediary/Carrier Memorandum of Agreement Specifications
Hospital Manual
(HCFA Pub. 10)
(Superintendent of Documents No. HE 22.8/2)
748
•
HCFA Common Procedure Coding System for Hospital Outpatient Radiology Services and Other Diagnostic Procedures
749
•
Oral Cancer Drugs
Oral Anti-Nausea Drugs as Full Therapeutic Replacements for Intravenous Dosage Forms as Part of a Cancer Chemotherapeutic Regimen
750
•
Claims Processing Timelines
Home Health Agency Manual
(HCFA Pub. 11)
Superintendent of Documents No. HE 22.8/5
292
•
Claims Processing Timeliness
Skilled Nursing Facility Manual (HCFA Pub. 12)Superintendent of Documents No. HE 22.8/3
362
•
Claims Processing Timeliness
Rural Health Clinic Manual & Federally Qualified Health Centers Manual (HCFA Pub. 27) Superintendent of Documents No. He 22.8/19:985
35
•
Claims Processing Timeliness
Renal Dialysis Facility Manual (Non-Hospital Operated) (HCFA Pub. 29) Superintendent of Documents No. 22. 8/13
88
•
Claims Processing Timeliness
Hospice Manual (HCFA Pub. 21) Superintendent of Documents No. HE 22. 8/18
58
•
Claims Processing Timeliness
Outpatient Physical Therapy and Comprehensive Outpatient Rehabilitation Facility Manual (HCFA Pub. 9) Superintendent of Documents No. HE 22. 8/9
9
•
Claims Processing Timeliness
Coverage Issues Manual (HCFA Pub. 6)Superintendent of Documents No. HE 22. 8/14
122
•
External Counterpulsation for Severe Angina
123
•
Osteogenic Stimulation
Provider Reimbursement Manual—Part 1 (HCFA Pub. 15-1)
(Superintendent of Documents No. HE 22.8/4)
413
•
Travel Expense
State Medicaid Manual
Part 2—State Organization and General Administration (HCFA Pub. 45-2) Superintendent of Documents No. HE 22. 8/10
92
•
Compliance with Disclosure of Information on Physician Incentive Plan Regulations
Medicare/Medicaid
Sanction—Reinstatement Report
(HCFA Pub. 69)
00-01
Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—December 1999
00-02
Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—January 2000
00-03
Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—February 2000
[April 2000 through June 2000]
Intermediary Manual
Part 2—Claims Process
(HCFA Pub. 13-2)
(Superintendent of Documents No. HE 22.8/6)
413
•
Assessment of Benefit Savings Attributable to Medical Review Activities
414
•
These Manual Changes Reflect Budget Performance Requirements implemented in Fiscal Year 2000 for the Beneficiary Telephone Customer Service
Intermediary Manual
Part 3—Claims Process
(HCFA Pub. 13-3)
(Superintendent of Documents No. HE 22.8/6)
1792
•
Payment for Blood Clotting Factor Administered to Hemophilia Inpatients
1793
•
Clarification of Reimbursement for Transfers That Result in Same Day Hospice Discharge and Admission
1794
•
Billing for Abortion Services
1795
•
Review of Form HCFA-1450 for Inpatient and Outpatient Bills
Review of Hospice Bills
1796
•
Provider Electronic Billing File and Record Formats
1797
•
Routine Services and Appliances
Pneumococcal Pneumonia, Influenza Virus and Hepatitis B Vaccines
1798
•
Limitation of Liability for Provider Claims Under Parts A and B of Medicare Program
Medical Review for Coverage of Skilled Nursing Facility Services
1799
•
Medicare Rural Hospital Flexibility Program
Requirements for Critical Access Hospital Services and Critical Access Hospital Long-Term Care Services
Payment for Services Furnished by a Critical Access Hospital Services
Carriers Manual
Part 2—Claims Process
(HCFA Pub. 14-2)
(Superintendent of Documents No. HE 22.8/7)
141
These Manual Changes Reflect Budget Performance Requirements Implemented in Fiscal Year 2000 for Beneficiary Telephone Customer Service
Carriers Manual
Part 3—Claims Process
(HCFA Pub. 14-3)
(Superintendent of Documents No. HE 22.8/7)
1664
•
Payment for Oral Anti-Emetic Drugs When Used as Full Replacement for Intravenous Anti-Emetic Drugs as Part of a Cancer Chemotherapeutic Regimen Claims Processing Jurisdiction
1665
•
Correction in Section G, to the Type of Service for 78267 and 78268
1666
•
Chiropractic Services
1667
•
Reasonableness and Necessity
Billing for Pneumococcal, Hepatitis B, and Influenza Virus Vaccines
Billing Requirements
Payment Requirements
Simplified Roster Bills
1668
•
Durable Medical Equipment, Prosthetic, and Orthotic Supplies: Contents have been moved to the Program Integrity Manual (Pub. 83)
Medical Review Program General Information: Contents have been moved to the Program Integrity Manual (Pub. 83)
Fraud and Abuse Background, Exhibits and Appendices: Contents have been moved to the Program Integrity Manual (Pub. 83)
1669
•
Durable Medical Equipment Regional Carrier Billing Procedures
Program Memorandum
Intermediaries (HCFA Pub. 60A)
(Superintendent of Documents No. HE 22.8/6-5)
A-00-17
•
Change to FY 2000 Hospital Prospective Payment System Policies as Required by the Medicare, Medicaid, and State Child Health Insurance Program Balanced Budget Refinement Act of 1999, P. L. 106-113
A-00-18
•
Fiscal Intermediary Community Mental Health Center Enrollment and Change of Ownership Site Visit Process and Coordination with National Site Visit Contractor
A-00-19
•
Implementation of Provider Enrollment, Chain and Ownership System
A-00-20
•
The Report of Benefit Savings
A-00-21
•
Revised Outpatient Code Editor Specifications for the Outpatient Prospective Payment System
A-00-22
•
Instructions For Reporting Additional Detailed Information of Form HCFA-750 Contractor Financial Report (Fiscal Intermediaries Only)
A-00-23
•
Hospital Outpatient Prospective Payment System Implementation Instructions
A-00-24
•
Upcoming Training on Home Health Prospective Payment System, Outpatient Prospective Payment System and Skilled Nursing Prospective Payment System Refinements and Consolidated Billing
A-00-25
•
Provider Statistical and Reimbursement Report
A-00-26
•
Payment of Skilled Nursing Facility Claims for Beneficiaries Disenrolling from Terminating Medicare+Choice Plans Who Have Not Met the 3-Day Stay Requirement
A-00-27
•
Permitting Reclassification of Certain Urban Hospitals as Rural Application Procedures
A-00-28
•
Clarification of Provider Cost Report Filing Requirements
A-00-29
•
Electronic Filing of Provider Cost Reports; Home Health Agencies and Skilled Nursing Facilities
A-00-30
•
Announcement of Medicare Rural Health Clinics and Federally Qualified Health Centers Payment Rate Increases and Policy Clarifications and Guidance for Services Furnished by Rural Health Clinics and Federally Qualified Health Centers
A-00-31
•
Reporting a Patient's Reason for Visit on a Part A Outpatient Claim
A-00-32
•
Effectuating Favorable Final Appellate Decisions That a Beneficiary is “Confined to Home”—Regional Home Health Intermediaries Only
A-00-33
•
Education and Outreach to Coordination of Benefits Trading Partners
A-00-34
•
Provider Statistical and Reimbursement Report
A-00-35
•
Revised Outpatient Code Editor Specifications for the Outpatient Prospective Payment System
A-00-36
•
Hospital Outpatient Prospective Payment System Implementation Instructions
A-00-37
•
Line Item Denials and the Reporting of Savings Generated by Claim Expansion and Line Item Processing
Program Memorandum
Carriers
(HCFA Pub. 60B)
(Superintendent of Documents No. HE 22.8/6-5)
B-00-14
•
Revisions to Durable Medical Equipment Regional Carrier Information Form (DIF) Immunosuppressive Drugs Durable Medical Equipment Regional Carrier Form (latest revision 7/25/95)
B-00-15
•
Change to Health Insurance Claim Form HCFA-1500 Instructions for Processing Physician Claims in Global Payment Systems
B-00-16
•
Provider Education Article: Role of Physicians in the Home Health Prospective Payment System
B-00-17
•
Emergency Changes to the 2000 Medicare Physician Fee Schedule Database
B-00-18
•
Emergency Changes to the 2000 Medicare Physician Fee Schedule Database
B-00-19
•
Durable Medical Equipment Regional Carrier Report on Expansion of Immunosuppressive Drugs
B-00-20
•
Collection and Submission of Data for the Provider Enrollment and Chain Ownership System
B-00-21
•
2000 Jurisdiction List
B-00-22
•
Durable Medical Equipment Regional Carriers and New Oral Anti-Cancer Drugs Approved for Use by Medicare
B-00-23
•
Business Requirements For Processing Physician Encounter Data In The HCFA Data Center
B-00-24
•
Issues Involving Certificates of Medical Necessity Certified Medical Necessity and Cover Letters for Certified Medical Necessity
B-00-25
•
New Temporary K Codes for Hydrogel Impregnated Gauze
B-00-26
•
Carrier Adjustments to be Made for Payment for HCFA Common Procedure Coding System Code 90669, Pneumococcal Conjugate Vaccine, Polyvalent, for Intramuscular Use
B-00-27
•
Durable Medical Equipment Regional Carriers Common Working File Changes for Codes J8999, E0784, E0781, A4230-4232, E0616, and E0749
B-00-28
•
Billing of Influenza (Flu) and Pneumococcal Pneumonia Vaccine Virus Claims for Authorized Centralized Billing Providers to be Processed Through One Designated Carrier
B-00-29
•
Correct Effective Date for Adjustment in Payment Amounts for New Technology Intraocular Lenses Furnished by Medicare-Approved Ambulatory Surgical Centers
B-00-30
•
Clarification of Billing for G0170 and G0171
B-00-31
•
Use of Common Procedural Terminology Code 33999 for Transmyocardial Revascularization
B-00-32
•
Common Procedural Terminology Codes 99214 and 99233
B-00-33
•
Changes to Correct Coding Edits, Version 6.2, Effective July 1, 2000
Program Memorandum
Intermediaries/Carriers
(HCFA Pub. 60A/B)
(Superintendent of Documents No. HE 22.8/6-5)
AB-00-21
•
Self-Administered Injectable Drugs and Biologicals
AB-00-22
•
“No Fee” Policy for Medicare Contractors' Provider Education and Training Activities Program Management and Medicare Integrity Program Funded Activities
AB-00-23
•
Medigap (Medicare Supplemental Insurance) Insurers Fraud Referrals
AB-00-24
•
Development and Dissemination of a Product Classification List for HCFA Common Procedure Coding System Code L0430
AB-00-25
•
Contractor Testing Requirements
AB-00-26
•
July Quarterly Update for 2000 Durable Medical Equipment, Prosthetics Orthotics, and Supplies
AB-00-27
•
Medicare Secondary Payer Government Performance and Results Act Goal for Fiscal Year 2000
AB-00-28
•
Update of Rates for Ambulatory Surgical Center Payments
AB-00-29
•
Comprehensive Error Rate Testing Program—Medicare Contractor Change Requirements and Medicare Part B/Durable Medical Equipment Regional Carrier Standard System Change Requirements
AB-00-30
•
Implementing Instructions for Services Provided in Religious Nonmedical Health Care Institutions
AB-00-31
•
Sending Common Working File Referrals for Initial Enrollment Questionnaire and Internal Revenue Services/Social Security Administration/Health Care Financing Administration Data Match Records to the Coordination of Benefits Contractor
AB-00-32
•
New Waived Tests
AB-00-33
•
Processing of Medicare+Choice Encounter Data at the Health Care Financing Administration Data Center
AB-00-34
•
Program Integrity Management Reporting System
AB-00-35
•
Further Guidance on April Release Implementation
AB-00-36
•
Transfer of Initial Medicare Secondary Payer Development Activities to the Coordination of Benefits Contractor
AB-00-37
•
Notice of New Interest Rate for Medicare Overpayments and Underpayments
AB-00-38
•
Consolidation of Program Memorandums for Outpatient Rehabilitation Therapy Services
AB-00-39
•
Consolidation of Program Memorandums for Outpatient Rehabilitation Therapy Services
AB-00-40
•
Written Statements of Intent to Claim Medicare Benefits; 60-Day Grace Period
AB-00-41
•
Procedures for the Benefit Integrity and Medical Review Units on Unsolicited Voluntary Refund Checks
AB-00-42
•
Claims Processing Instructions for the Medicare Coordinated Care Demonstration
AB-00-43
•
Program Memorandum on Written Statements of Intent to Claim Medicare Benefits
AB-00-44
•
Medicare Coverage of Non-Invasive Vascular Studies When Used to Monitor the Access Site of End-Stage Renal Disease Patients
AB-00-45
•
Award of Medicare+Choice Contract to Sterling Life Insurance Co., Inc. for Medicare+Choice Private Fee-for-Service Plan
AB-00-46
•
Health Care Financing Administration Policy for Disclosure of Individually Identifiable Information
AB-00-47
•
Release to Be Implemented June 5, 2000
AB-00-48
•
Model Acknowledgment Letters for Valid and Invalid Written Statements of Intent to Claim Medicare Benefits (As Referenced in PM Transmittal AB-99-88)
AB-00-49
•
Program Memorandum on Statements of Intent to File Claims for Claims Filing Periods that End on December 31, 1999
AB-00-50
•
Medicare Fraud Information Specialist Position
AB-00-51
•
Claims Processing Instructions for Claims Submitted With a Written Statement of Intent
AB-00-52
•
Assisted Suicide Funding Restriction Act of 1997 (P. L. 105-12)
AB-00-53
•
Suspension of National Coverage Policy on Electrostimulation for Wound Healing
AB-00-54
•
Modified Procedures for Sharing Health Care Financing Administration Data with the Department of Justice
AB-00-55
•
Hemodialysis Flow Study
AB-00-56
•
Memorandum of Understanding Between the Office of Inspector General and the Department of Justice—Sharing Fraud Referrals
AB-00-57
•
Contractor Updating of the International Classification of Diseases, Ninth Revision, Clinical Modification
AB-00-58
•
Guidance on Implementation of the Calendar Year 2000 Third Quarter Release
AB-00-59
•
Correction to July Quarterly Update for 2000 Durable Medical Equipment Prosthetics, Orthotics, and Supplies Fee Schedule
AB-00-60
•
Future Software Releases
AB-00-61
•
New Waived Tests
AB-00-62
•
Rescinding Change Requests Numbers 1001, 1108, 1116, and 1163
AB-00-63
•
Ocular Photodynamic Therapy
AB-00-64
•
Medicare Summary Notice Implementation at Seven Contractor Sites
AB-00-65
•
Business and System Requirements for the Home Health Prospective Payment System
State Operations Manual—Provider Certification
(HCFA Pub. 7)
Superintendent of Documents No. HE 22.8/12
16
•
Medicare/Medicaid Certification and Transmittal, Form HCFA-1539
Change in Size or Location of Participating Skilled Nursing Facility and/or Nursing Facility
Regional Office Verifying Continued Compliance with Exclusion Criteria by Currently Excluded Hospitals or Units
Change in Size or Location of Participating Skilled Nursing Facility and/or Nursing Facility
Change in Provider Location and/or Bed Complement—Other Than Distinct Part
17
•
Condition of Participation: Patients' Rights
Hospice Manual
(HCFA Pub. 10)
(Superintendent of Documents No. HE 22.8/2)
751
•
Payment for Blood Clotting Factor Administered to Hemophilia Inpatients
752
•
Billing for Mammography Screening
753
•
Billing for Abortion Services
754
•
Pneumococcal Pneumonia, Influenza Virus, and Hepatitis B Vaccines
755
•
Disclosure of Itemized Statement to an Individual for Any Item or Service Provided
756
•
Fraud and Abuse—General: Contents have been moved to the Program Integrity Manual (Pub. 83)
Focused Medical Review: Contents have been moved to the Program Integrity Manual (Pub. 83)
Billing for Part B Intermediary Outpatient Occupational Therapy Services: Contents have been moved to the Program Integrity Manual (Pub. 83)
Special Instructions for Billing Dysphagia: Contents have been moved to the Program Integrity Manual (Pub. 83)
757
•
Medicare Rural Hospital Flexibility Program
Requirements for Critical Access Hospital Services and Critical Access Hospital Long-term Care Services
Payment for Services Furnished by a Critical Access Hospital
Home Health Agency Manual
(HCFA Pub. 11)
Superintendent of Documents No. HE 22.8/5
293
•
Billing for Pneumococcal Pneumonia, Influenza Virus, and Hepatitis B Vaccines
294
•
Disclosure of Itemized Statement to an Individual for Any Item or Service Provided
295
•
Fraud and Abuse—General: Contents have been moved to the Program Integrity Manual (Pub. 83)
Billing for Part B—Outpatient Physical Therapy Services: Contents have been moved to the Program Integrity Manual (Pub. 83)
Focused Medical Review: Contents have been moved to the Program Integrity Manual (Pub. 83)
Skilled Nursing Facility Manual
(HCFA Pub. 12)
Superintendent of Documents No. HE 22.8/3
363
•
Special Billing Instructions for Pneumococcal Pneumonia, Influenza Virus and Hepatitis B Vaccines
364
•
Distinct Part of an Institution as a Skilled Nursing Facility
365
•
Disclosure of Itemized Statement to an Individual for Any Item or Service Provided
366
•
Fraud and Abuse—General: Contents have been moved to the Program Integrity Manual (Pub. 83)
Focused Medical Review: Contents have been moved to the Program Integrity Manual (Pub. 83)
Billing Part B Intermediary Outpatient Physical Therapy Bills: Contents have been moved to the Program Integrity Manual (Pub. 83)
Rural Health Clinic Manual & Federally Qualified
Health Centers Manual
(HCFA Pub. 27)
Superintendent of Documents No. He 22. 8/19:985
36
•
Disclosure of Itemized Statement to an Individual for Any Item or Service Provided
Renal Dialysis Facility Manual
(Non-Hospital Operated)
(HCFA Pub. 29)
Superintendent of Documents No. 22.8/13
89
•
Pneumococcal Pneumonia, Influenza Virus and Hepatitis B Vaccines
90
•
Disclosure of Itemized Statement to an Individual for Any Item or Service Provided
ESRD Network Organizations Manual
(HCFA Pub. 81)
Superintendent of Documents No. HE 22.9/4
10
•
Organizational Structure
Medical Review Board
Other Committees
Network Staff
Administrative Reports
Health Care Financing Administration Meeting
Cooperative Activities with State Survey Agencies and Peer Review Organizations
Annual Report Format
Hospice Manual
(HCFA Pub. 21)
Superintendent of Documents No. HE 22.8/18
59
•
Completion of the Uniform (Institutional Provider) Bill (HCFA-1450) for Hospice Bills
60
•
Special Billing Instructions for Pneumococcal Pneumonia, Influenza Virus and Hepatitis B Vaccines
61
•
Disclosure of Itemized Statement to an Individual for Any Item or Services Provided
62
•
Fraud and Abuse: Contents have been moved to the Program Integrity Manual (Pub. 83)
Focused Medical Review: Contents have been moved to the Program Integrity Manual (Pub. 83)
Outpatient Physical Therapy and Comprehensive
Outpatient Rehabilitation Facility Manual
(HCFA Pub. 9)
Superintendent of Documents No. HE 22.8/9
10
•
Pneumococcal Pneumonia, influenza Virus, and Hepatitis B Vaccines
11
•
Disclosure of Itemized Statement to an Individual for Any Item or Service Provided
12
•
Fraud and Abuse—General: Contents have been moved to the Program Integrity Manual (Pub. 83)
Medical Review of Comprehensive Outpatient Rehabilitation Facility Claims: Contents have been moved to the Program Integrity Manual (Pub. 83)
Focused Medical Review: Contents have been moved to the Program Integrity Manual (Pub. 83)
Intermediary Medical Review of Part B Outpatient Physical Therapy: Contents have been moved to the Program Integrity Manual (Pub. 83)
Coverage Issues Manual
(HCFA Pub. 6)
Superintendent of Documents No. HE 22.8/14
124
•
Pancreas Transplants
Provider Reimbursement Manual—Part 1
(HCFA Pub. 15-1)
(Superintendent of Documents No. HE 22.8/4)
414
•
Effective Date of Change in Bed Size and/or Bed Designation(s) of Participating Skilled Nursing Facility and/or Nursing Facility Requirements for Distinct Part Certification
Changes in Bed Size of Participating Skilled Nursing Facility and/or Nursing Facility
General Request Filing Requirements
Exceptions
Change in Designated Bed Location(s)
Cost Report Requirement after Change in Bed Size and/or Change in Designated Bed Location(s)
415
•
Historical Costs
Purchase of Facility as Ongoing Operation
Useful Life of Depreciable Assets
Salvage Value
Disposal of Assets
Gains or Loss on Disposal of Depreciable Assets (Excluding Involuntary Conversions)
Bona Fide Sale
Sale and Leaseback and Lease-Purchase Agreement
416
•
Right to Board Hearing
Individual Appeals
Group Appeals
Expedited Judicial Review
Request for Board Hearing or for Expedited Judicial Review
Provider Reimbursement Manual—Part 2
Provider Cost Reporting Forms and Instructions
Chapter 18—Form HCFA-2088-92
(HCFA Pub. 15-2-32)
(Superintendent of Documents No. HE 22.8/4)
9
•
Home Health Agency Cost Reporting Form HCFA-1728-94
State Medicaid Manual—Part 4/Services
(HCFA Pub. 45-6)
Superintendent of Documents No. HE 22.8/10
36
•
Updates ingredient prices used by States to establish upper limits for prescription drugs
Medicare Program Integrity Manual
(HCFA Pub. 83)
1
•
Medical Review and Benefit Integrity Programs
Sources to Identify Aberrancies, and Developing Fraud or Abuse Cases
Corrective Actions
Examples of Fraudulent Activities
Items and Services Having Special Durable Medical Equipment Regional
Carrier Review Considerations
Intermediary Medical Review Guidelines for Specific Services
Medical Review Reports
Program Memoranda
Medical Review Information Reported Electronically
Medicare/Medicaid
Sanction—Reinstatement Report
(HCFA Pub. 69)
00-04
•
Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded Reinstated—March 2000
00-05
•
Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—April 2000
00-06
•
Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—May 2000
[July through September 2000]
Intermediary Manual
Part 3—Claims Process
HCFA Pub. 13-3)
(Superintendent of Documents No. HE 22.8/6)
1800
•
Provider Electronic Billing File and Record Formats
1801
•
Prostate Cancer Screening Tests and Procedures
1802
•
Bill Review for Partial Hospitalization Services Provided in Community Mental Health Centers
1803
•
Information Regarding the Release of Medicare Eligibility Data
New Policy on Releasing Eligibility Data
Advise Your Providers and Network Service Vendors
Network Service Agreement
1804
•
Review of Form HCFA-1450 for Inpatient and Outpatient Bills
Outpatient Services
Hospital Outpatient Partial Hospitalization Services
Calculating the Part B Payment
Addition, Deletion and Change of Local Codes
Reporting Hospital Outpatient Services Using Health Care Financing Administration Common Procedure Coding System
1805
•
Stem Cell Transplantation
Allogeneic Stem Cell Transplantation
Autologous Stem Cell Transplantation
Acquisition Costs
1806
•
Pancreas Transplants
1807
•
Screening Pap Smears and Screening Pelvic Examinations
1808
•
Billing by Home Health Agencies Under Cost/Interim Payment System Reimbursement
Billing by Home Health Agencies Under the Home Health Prospective Payment System
When Bills Are Submitted
Billing for Nonvisit Charges
Durable Medical Equipment Furnished as a Home Health Benefit
More Than One Agency Furnished Home Health Services
Home Health Services Are Suspended or Terminated Then Reinstated
Preparation of a Home Health Billing Form in No-Payment Situations
Billing for Part B Medical and Other Health Services
Reimbursement of Home Health Agency Claims
Osteoporosis Injections as Home Health Agency Benefit
Completion of Form HCFA-1450 for Home Health Agency Billing Under Home Health Prospective Payment
Requests for Anticipated Payment
Home Health Prospective Payment System Claims
Home Health Prospective Payment System Claims When No Request for Anticipated Payment Was Submitted
Background on Home Health Prospective Payment System
Creation of Home Health Prospective Payment System
Regulatory Implementation of Home Health Prospective Payment System
Commonalities of the Cost Reimbursement and Home Health Prospective Payment System Environment
Effective Date and Scope of Home Health Prospective Payment System for Claims
Configuration of the Home Health Prospective Payment System Environment
New Software for the Home Health Prospective Payment System Environment
The Home Health Prospective Payment System Episodes
Effect of Election of Health Maintenance Organization and Eligibility Changes on Home Health Prospective Payment System Episodes
Split Percentage Payment of Episodes and Development of Episode Rates
Basis of Medicare Prospective Payment System and Case Mix
Coding of Home Health Prospective Payment System Episode Case-Mix Groups
On Home Health Prospective Payment System Claims: Research Group and Health Insurance Prospective Payment System Codes
Composition of Health Insurance Prospective Payment System Codes for Home Health Prospective Payment System
Significance of Health Insurance Prospective Payment Systems
Overview of the Provider Billing Process Under Home Health Prospective Payment
Overview—Grouper Links Assessment and Payment
Overview—Health Insurance Query Access System Shows Primary Home Health Agency
Overview—Request for Anticipated Payment: Submission and Processing Establishes Home Health Prospective Payment System Episode and Provides First Percentage Payment
Overview—Claim Submission and Processing Completes Home Health Prospective Payment System Payment, Closes Episode and Performs A-B Shift
Overview—Payment, Claim Adjustments and Cancellations
Definition of the Request for Anticipated Payment
Definition of Transfer Situation Under Home Health Prospective Payment System
Payment Effects
Payment When Death Occurs During a Home Health Prospective Payment System Episode
Adjustments of Episode Payment—Low Utilization Payment Adjustments
Adjustments of Episode Payment—Low Utilization Payment Adjustment
Adjustments of Episode Payment—Special Submission Case: “No-Request Anticipated Payment” Low Utilization Payment Adjustments
Adjustments of Episode Payment—Therapy Threshold
Adjustments of Episode Payment—Partial Episode Payment
Adjustments of Episode Payment—Significant Change in Condition
Adjustments of Episode Payment—Outlier Payments
Adjustments of Episode Payment—Exclusivity and Multiplicity of Adjustments
Seven Scenarios for Home Health Prospective Payment Adjustment
General Guidance on Line Item Billing Under Home Health Prospective Payment System
Acronym Table
Home Health Prospective Payment System Consolidated Billing and Primary Home Health Agency
New Common Working File Requirements for the Home Health Prospective Payment System
Creation of the Health Insurance Query System for Home Health Agencies And Hospices in the Common Working File—Replacement of Health Insurance Query System for Home Health Agencies
Health Insurance Query Access System Inquiry and Response
Timeliness and Limitations of Health Insurance Query System for Home Health Agency Responses
Inquiries to Regional Home Health Intermediaries Based on Health Insurance Query System for Home Health Agency Responses
National Home Health Prospective Payment Episode History File
Opening and Length of Home Health Prospective Payment System Episodes
Closing, Adjusting and Prioritizing Home Health Prospective Payment System
Episodes Based on Request for Anticipated Payment and Home Health Prospective Payment System
Episodes Based on Request for Anticipated Payment and Home Health Agency Claim Activity
Other Editing and Changes for Home Health Prospective Payment System Episodes
Priority Among Other Claim Types and Home Health Prospective Payment System
Consolidated Billing for Episodes
Medicare Secondary Payment and the Home Health Prospective Payment System Episode File
Chart Summarizing Effects of Request for Anticipated Payment/Claim Actions on the Home Health Prospective Payment System Episode File
Home Health Prospective Payment System Episode File Pricer Program
Outpatient Prospective Payment System Remittance Advice Instructions and 3753, Home Health Prospective Payment System Remittance Advice Instructions
1809
•
Under Arrangements
Outpatient Hospital Psychiatric Services
Partial Hospitalization Services
1810
•
Definition of Medicare Secondary Payer/Common Working File
Medicare Secondary Payer Maintenance Transaction Record Processing
Carriers Manual
Part 3—Claims Process
(HCFA Pub. 14-3)
(Superintendent of Documents No. HE 22.8/7)
1670
•
Echocardiography Services (Codes 93303—93350)
1671
•
Magnetic Resonance Angiography
Magnetic Resonance Angiography Coverage Summary
Coding Requirements
Payment Requirements and Methodology
Format for Submitting Medicare Carrier Claims
Claims Editing
1672
•
Claims Processing Jurisdiction
1673
•
Information Regarding the Release of Medicare Eligibility Data
New Policy on Releasing Eligibility Data
Advise Your Provider and Network Services Vendors
Network Service Agreement
1674
•
Stem Cell Transplantation
General
HCFA Common Procedure Coding System and Diagnosis Code
Non-Covered Conditions
Edits
Suggested Medicare Summary Notice/Explanation of Medicare Benefits and Regional Administrator Messages
1675
•
Screening Pap Smear and Pelvic Examination
Screening Pap Smears
Billing Requirements
Common Working File Edits
Medicare Summary Notices and Explanation of Your Medicare Benefits Message
Remittance Advice Notices
Screening Pelvic Examination
1676
•
HCFA Common Procedure Coding System and Payments Requirements
Calculating the Frequency
Common Working File Edits
Correct Coding Requirements
Diagnosis Coding Requirements
Denial Messages
1677
•
Definition of Medicare Secondary Payor/Common Working File Terms
Medicare Secondary Payor Maintenance Transaction Record Processing
1678
•
Medicare Physician Fee Schedule Database 2001 File Layout
Carriers Manual
Part 4—Professional Relations
(HCFA Pub. 14-4)
(Superintendent of Documents No. HE 22.8/7-4
22
•
Enrollment Procedures for General Application
Program Memorandum
Intermediaries (HCFA Pub. 60A)
(Superintendent of Documents No. HE 22.8/6-5)
A-00-38
•
Change in Hospice Payment Rates, Update to the Hospice Cap, Revised Hospice Wage Index and Hospice Pricer
A-00-39
•
Monitoring Process for Skilled Nursing Facility Exception Determinations
A-00-40
•
Further Information on the Use of Modifier -25 in Reporting Hospital Outpatient Services
A-00-41
•
Transition to the Home Health Prospective Payment System
A-00-42
•
Coding Information for Hospital Outpatient Prospective Payment System
A-00-43
•
Advance Beneficiary Notices for Services for Which Institutional Part B Claims Will be Processed by Fiscal Intermediaries
A-00-44
•
Outpatient Prospective Payment System Contingency Plans and Instructions
A-00-45
•
Interim Process for Certain “Inpatient Only” Code Changes
A-00-46
•
Skilled Nursing Facility Adjustment Billing: Adjustments to Health Insurance Prospective Payment System Codes Resulting From Minimum Data Set Corrections
A-00-47
•
Skilled Nursing Facility Annual Update: Prospective Payment System Pricer and Health Insurance Prospective Payment System Coding Changes
A-00-48
•
Drugs, Biologicals, Devices and New Technology HCFA Common Procedure Coding System Codes For Use Under the Hospital Outpatient Prospective Payment System
A-00-49
•
Payment of Skilled Nursing Facility Claims for Beneficiaries Disenrolling From Terminating Medicare+Choice Plans Who Have Not Met the 3-Day Hospital Stay Requirement
A-00-50
•
Department of Veterans Affairs Claims Adjudication Services Project: Systems Changes Needed
A-00-51
•
Q Codes For Use Under the Hospital Outpatient Prospective Payment System
A-00-52
•
Community Mental Health Centers Payment Instructions For Outpatient Prospective System Contingency Plans
A-00-53
•
Proper Billing of Units for Intrathecal Baclofen Under the Outpatient Prospective Payment System
A-00-54
•
The Supplemental Security Income Medicare Beneficiary Data for Fiscal Year 1999 for Prospective Payment System Hospitals
A-00-55
•
Provider Statistical and Reimbursement Report
A-00-56
•
Update of Rates for Ambulatory Surgical Center Payment
A-00-57
•
Payment of Skilled Nursing Facility Claims for Beneficiaries Disenrolling from Terminating Medicare+Choice Plans Who Have Not Met the 3-Day Stay Required
A-00-58
•
Destroy Outdated Stock of Medicare Summary Notices and Part A Explanation of Medicare Benefits Under the Hospital Outpatient Prospective Payment System
A-00-59
•
Home Health Prospective Payment System Phase in Plan, Contingency Plan, and Instructions
A-00-60
•
Standard Questions and Answers for Beneficiary Inquiries Related to the Hospital Outpatient Prospective Payment System
A-00-61
•
Update 1—Coding Information for Hospital Outpatient Prospective Payment System
A-00-62
•
File Descriptions and Instructions for Retrieving the 2001 Physician, Clinical Lab, Durable Medical Equipment, Prosthetics/Orthotics and Supplies Fee Schedule Payment Amounts Through Health Care Financing Administration's Mainframe Telecommunications Systems
A-00-63
•
Cost-to-Charge Ratios for Calculating Certain Payments Under the Hospital Outpatient Prospective Payment System
A-00-64
•
Terminating State Access to the Common Working File Eligibility Data
A-00-65
•
Release of Internal Revenue Service Data Elements on Eligibility Queries
A-00-66
•
Fiscal Year 2001 Prospective Payment System Hospital and Other Bill Processing Changes
A-00-67
•
Deactivation of Inactive Community Mental Health Center Medicare Numbers
A-00-68
•
Provider Statistical and Reimbursement Report
A-00-69
•
Background and Documentation for Correct Coding Initiative and Unit of Service Edits
A-00-70
•
Provider Statistical and Reimbursement Report
Program Memorandum
Carriers
(HCFA Pub. 60B)
(Superintendent of Documents No. HE 22.8/6-5)
B-00-34
•
This Transmittal Number Was Inadvertently Skipped and Will Not Be Used In the Future
B-00-35
•
Addition of Five “WW” Codes to Identify a New Source for Methotrexate
B-00-36
•
Returned Mail—Unique Physician Identification Number
B-00-37
•
Standard System Acceptance of Primary Payer Information at the Line Level
B-00-38
•
Addition of “WW” Codes to Identify a New Source for an Oral Anti-Cancer Drug in Dosages of 25mg and 100mg
B-00-39
•
Department of Veterans Affairs Claims Adjudication Services Project: Systems Changes Needed
B-00-40
•
Final Update to the 2000 Medicare Physician Fee Schedule Database
B-00-41
•
Changes to Correct Coding Edits, Version 6.3, Effective October 1, 2000
B-00-42
•
Analysis of Services Provided in Congregate Settings
B-00-43
•
New Temporary “K” Codes for Negative Pressure Wound Therapy Pumps
B-00-44
•
Site Visits and Enrollment of Independent Diagnostic Testing Facilities
B-00-45
•
Reporting of Carrier Pricing Methodology for Influenza and Pneumococcal Vaccinations to Health Care Financing Administration
B-00-46
•
Changes to Correct Coding Edits, Version 6.2, Effective September 5, 2000
B-00-47
•
Addition of Special Processing Number 39 (Centralized Billing of Flu and Pneumococcal Pneumonia Vaccine Claims) to the Common Working File
B-00-48
•
Claims Processing Instructions for the DME Prosthetic, Orthotics & Supplies Competitive Bidding Demonstration
B-00-49
•
Implementation of the Health Insurance Portability and Accountability Act Transaction Standards
Program Memorandum
Intermediaries/Carriers
(HCFA Pub. 60A/B)
(Superintendent of Documents No. HE 22.8/6-5)
AB-00-66
•
Coverage of Diabetes Outpatient Self-Management Training Services, Effective: July 1, 1998
AB-00-67
•
Implementation of § 4105 of the Balanced Budget Act Regarding Coverage of Diabetes Outpatient Self-Management Training Services
AB-00-68
•
Current Status of Medicare Program Memoranda Issued Before Calendar Year 2000
AB-00-69
•
Notice of New Interest Rate for Medicare Overpayments and Underpayments
AB-00-70
•
Program Safeguard Contractor for Corporate Integrity Agreements
AB-00-71
•
Claims Processing Instructions for the Medicare Coordinated Care Demonstration
AB-00-72
•
Medical Review Progressive Corrective Action
AB-00-73
•
Proper Billing of Outpatient Pathology Services Under the Outpatient Prospective Payment System
AB-00-74
•
Transfer of Initial Medicare Secondary Payer Development Activities to the Coordination of Benefits Contractor
AB-00-75
•
The Internal Control Certification Statement Required by the Budget and Performance Requirements for the Fiscal Year Ending September 30, 2000
AB-00-76
•
Modification of Medicare Policy for Erythropoietin
AB-00-77
•
New State Code for Maryland Provider Numbers
AB-00-78
•
Reasonable Charge Update for 2001 for Items and Services, Other than Ambulance Services, Still Subject to the Reasonable Change Payment Methodology
AB-00-79
•
Establishment of Contractor Numbers for Program Safeguard Contractors
AB-00-80
•
Instruction Implementation Reporting
AB-00-81
•
Self-Administered Injectable Drugs and Biologicals
AB-00-82
•
Update of Rates and Wage Index for Ambulatory Surgical Center Payments Effective October 1, 2000
AB-00-83
•
Verteporfin (Visudyne)
AB-00-84
•
Provider Toll-Free Telephone Inquiry Service
AB-00-85
•
Guidance on Implementation of the Calendar Year 2000 Fourth Quarter Release
AB-00-86
•
An Additional Source of Average Wholesale Price Data in Pricing Drugs and Biologicals Covered by the Medicare Program
AB-00-87
•
2001 Payment Limit for Ambulance Services
AB-00-88
•
Implementation of the Ambulance Fee Schedule
AB-00-89
•
Claims Processing Instructions for Carriers, Durable Medical Equipment Regional Carrier, Intermediaries and Regional Home Health Intermediaries for Claims Submitted for Medicare Beneficiaries Participating in Medicare Qualifying Clinical Trials
AB-00-90
•
Year 2001 Health Care Financing Common Procedure Coding System Annual Update Reminder
Program Memorandum
Medicaid State Agencies
(HCFA Pub. 17)
Superintendent of Documents No. HE 22.8/6-5
00-01
•
Current Status of Medicaid Program Memoranda and Action Transmittals Issued Before Calendar Year 2000
State Operations Manual—Provider Certification
(HCFA Pub. 7)
Superintendent of Documents No. HE 22.8/12
18
•
Religious Nonmedical Healthcare Institutions
Certification of Religious Nonmedical Healthcare Institutions
Interpretive Guidelines for Responsibilities of Medicare-Participating Religious Nonmedical Healthcare Institutions
19
•
Guidelines for Determining Immediate Jeopardy
20
•
Guidance to Surveyors—Long-Term Care Facilities
Peer Review Organization
(HCFA Pub. 19)
Superintendent of Documents No.HE 22.8/8-15
82
•
Disclosure of Quality Review Information to Complainants
Scope of Review
Complaints That Do Not Meet Statutory Requirements
Referrals
Review Process
Notice of Disclosure
Final Response to Complainants
Disclosure of Quality Review Information to Complainants
Request for Information Model Form
Final Response to Inquirer Model Notice (Concern Involved Practitioners)
Potential Quality Concern Model Notice
Hospice Manual
(HCFA Pub. 10)
(Superintendent of Documents No. HE 22.8/2)
758
•
Prostate Cancer Screening Tests and Procedures
759
•
Reporting Hospital Outpatient Services Using Health Care Financing Administration Common Procedure Coding System
Billing for Hospital Outpatient Partial Hospitalization Services
Completion of Form HCFA-1450 for Inpatient and/or Outpatient Billing
Addition, Deletion and Change of Local Codes
Reporting Hospital Outpatient Services Using Health Care Financing Administration Common Procedures Coding System
760
•
Screening Pap Smears and Screening Pelvic Examinations
761
•
Outpatient Hospital Psychiatric Services
Outpatient Partial Hospitalization Programs
Skilled Nursing Facility Manual
(HCFA Pub. 12)
Superintendent of Documents No. HE 22.8/3
367
•
Distinct Part of an Institution as a Skilled Nursing Facility
ESRD Network Organizations Manual
(HCFA Pub. 81)
Superintendent of Documents No. HE 22.9/4
11
•
End Stage Renal Disease Health Care Quality Improvement Program Responsibilities
Quality Improvement Projects
Background and Project Topics
Quality Improvement Program Frequency, Project Consultant, and Required Reporting
Project Idea
Quality Improvement Program Narrative Project Plan
Final Project Report
Identifying Additional Opportunities for Improvement
Quarterly Progress and Status Report
Clinical Performance Measures
Clinical Performance Measures—Network/National Sample
Clinical Performance Measures—Sampling Method
Clinical Performance Measures—Data Collection
Clinical Performance Measures—Data Validation
Clinical Performance Measures—Data Validating Reports
Health Care Financing Administration—Compiled Data Reports
Network Resources to Support the United States Renal Data System
End Stage Renal Disease Clinical Performance Measures
Annual Estimate of Patient Sample Per Network for United States Renal Data System Special Studies
End Stage Renal Disease Network—Project Idea Document Format
End Stage Renal Disease Network—Narrative Project Plan Format
End Stage Renal Disease Network—Final Project Report Format
Hospice Manual
(HCFA Pub. 21)
Superintendent of Documents No. HE 22.8/18
63
•
Reducing Barriers to Pneumococcal Vaccines
Outpatient Physical Therapy and Comprehensive
Outpatient Rehabilitation Facility Manual
(HCFA Pub. 9)
Superintendent of Documents No. HE 22.8/9
13
•
Billing Instructions for Partial Hospitalization Services Provided in Community Mental Health Centers
14
•
General
Partial Hospitalization Defined
Patient Eligibility Criteria
Documentation Requirements and Physician Supervision
Community Mental health Center Requirements
Outpatient Mental Health Treatment Limitation
Documentation Requirements and Physician Supervision
Coverage Issues Manual
(HCFA Pub. 6)
Superintendent of Documents No. HE 22.8/14
125
•
Stem Cell Transplantation
126
•
Routine Costs of Clinical Trials
Provider Reimbursement Manual—Part 1
(HCFA Pub. 15-1)
(Superintendent of Documents No. HE 22.8/4)
417
•
Special Treatment of Sole Community Hospitals Under Prospective Payment System
Provider Reimbursement Manual—Part 2
Provider Cost Reporting Forms and Instructions
Chapter 1—General—2088-92
(HCFA Pub. 15-2-1)
(Superintendent of Documents No. HE 22.8/4)
20
•
Electronic Submission of Hospital Cost Reports
Requirement To File Cost Report
Initial Cost Reporting Period
Cessation of Participation in Program
Cost Report Forms
Use of Substitute Cost Reporting Forms
Provider Reimbursement Manual—Part 2
Provider Cost Reporting Forms and Instructions
Chapter 35—Form HCFA-2540-96
(HCFA Pub. 15-2-35)
(Superintendent of Documents No. HE 22.8/4)
8
•
Skilled Nursing Facility & Complex Cost Report
Provider Reimbursement Manual—Part 2
Provider Cost Reporting Forms and Instructions
Chapter 38—Form HCFA-1984-99
(HCFA Pub. 15-2-38)
(Superintendent of Documents No. HE 22.8/4)
2
•
Hospice Cost Report
Medicare Program Integrity Manual
(HCFA Pub. 83)
2
•
Medical Review of Partial Hospitalization Claims
Medicare/Medicaid
Sanction—Reinstatement Report
(HCFA Pub. 69)
00-07
•
Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded Reinstated—June 2000
00-08
•
Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—July 2000
00-09
•
Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—August 2000
October through December 2000
Intermediary Manual
Part 3—Claims Process
(HCFA Pub. 13-3)
(Superintendent of Documents No. HE 22.8/6)
1811
•
Extracorporeal Immunoadsorption Using Protein A Columns
Hospital Outpatient Partial Hospitalization Services
1812
•
Dialysis for End-Stage Renal Disease—General
1813
•
Provider Electronic Billing File and Record Formats
1814
•
Claims Processing Timeliness
Beneficiary-Driven Demand Billing Under Home Health Prospective Payment System
Prospective Payment System Pricer Program
Home Health Agency Bills
Denials and Conditional Payments in Medicare Secondary Payer Situations
Provider Specific Payment Data
Provider Specific Payment Data Record Layout and Description
Intermediary Responsibilities
The Cancel Only Adjustment Code (Action Code 4)
1815
•
Payment for Blood Clotting Factor Administered to Hemophilia Inpatients
1816
•
Bill Review for Partial Hospitalization Services Provided In Community Mental Health Centers
Hospital Outpatient Partial Hospitalization Services
1817
•
Heart Transplants
1818
•
Oral Anti-Nausea Drugs as Full Therapeutic Replacements for Intravenous Dosage Forms As Part of a Cancer Chemotherapeutic Regimen
1819
•
Pneumococcal Pneumonia, Influenza Virus and Hepatitis B Vaccines
1820
•
Review of Form HCFA-1450 for Inpatient and Outpatient Bills
1821
•
Beneficiary-Driven Demand Billing Under Home Health Prospective Payment System
Carriers Manual
Part 3—Claims Process
(HCFA Pub. 14-3)
(Superintendent of Documents No. HE 22.8/7)
1679
•
Extracorporeal Immunoadsorption Using Protein A Columns
Coverage Summary
Coding and Payment
Denial Messages
1680
•
Beneficiaries Previously Enrolled in Managed Care Who Return to Traditional Fee For Service
1681
•
Type of Service
1682
•
Furnishing Medicare Physician Fee Schedule Database Pricing Files
Furnishing Physician Fee Schedule Data for Local and Carrier Price Codes
Furnishing Physician Fee Schedule Data for National Codes
Furnishing Fee Schedule (Excluding Physician Fee Schedule), Prevailing Charge and Conversion Factor Data to Palmetto GBA, Fiscal Intermediaries, State Agencies, Indian Health Services and United Mine Workers Health Maintenance Organization Processing Requirements
Specialty Code/Place of Service
1683
•
Durable Medical Equipment Regional Carrier Instructions for Denying Claims For Prescription Drugs Billed and/or Paid to Suppliers Not Licensed to Dispense Prescription Drugs
1684
•
Responsibility to Download and Implement Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Fee Schedules
1685
•
Home Use of Durable Medical Equipment
Evidence of Medical Necessity
Incurred Expenses for Durable Medical Equipment and Orthotic and Prosthetic Devices
Evidence of Medical Necessity Oxygen Claims
1686
•
Type of Service
1687
•
End-Stage Renal Disease Bill Processing Procedures
Home Dialysis Patients Options for Billing
1688
•
Durable Medical Equipment Regional Carrier Instructions for Denying Claims for Prescription Drugs Billed and/or Paid to Suppliers Not Licensed to Dispense Prescription Drugs
1689
•
Payment and Coding Requirements
Processing Claims to Ensure That Payment Conditions Are Met
Carriers Manual
Part 4—Professional Relations
(HCFA Pub. 14-4)
(Superintendent of Documents No. HE 22.8/7-4)
23
•
Registry Customer Information Control System
Program Memorandum
Intermediaries (HCFA Pub. 60A)
(Superintendent of Documents No. HE 22.8/6-5)
A-00-71
•
Medical Review of Home Health Services—For Regional Home Health Intermediaries
A-00-72
•
Technical Correction to Coding Information for Hospital Outpatient Prospective Payment System
A-00-73
•
Clarification of Modifier Usage in Reporting Outpatient Hospital Services
A-00-74
•
October Outpatient Code Editor
A-00-75
•
Corrections to Calculation of Inpatient Payment Amounts
A-00-76
•
Clarification of the Application of the Regulations at 42 Code of Federal Regulations 413.134(l) to Mergers and Consolidations Involving Non-Profit Providers
A-00-77
•
Change in Hospice Payment Rates, Update to the Hospice Cap, Revised Hospice Wage Index and Hospice Pricer
A-00-78
•
Provider Statistical and Reimbursement Report
A-00-79
•
Settlement Agreement Between the Health Care Financing Administration and National Medical Care, Inc. d/b/a Fresenius Medical Care North America for Payment of Medicare End-Stage Renal Disease Bad Debts
A-00-80
•
Notification to Outpatient Hospital Service Providers Concerning Deductible and Coinsurance Amounts on Electronic Remittance Advice Version 3051.4a
A-00-81
•
Resolution of Outpatient Prospective Payment System Implementation Issues
A-00-82
•
January 2001 Update: Coding Information for Hospital Outpatient Prospective Payment System
A-00-83
•
Business Requirements for Processing Outpatient Encounter Data in the Health Care Financing Administration Data Center
A-00-84
•
Medicare+Choice Inpatient Encounter Data—Migration of Data Processing to the Health Care Financing Administration Data Center
A-00-85
•
The Report of Benefit Savings
A-00-86
•
Changes to Fiscal Year 2000 Nursing and Allied Health Education Payment Policies as Required by the Medicare, Medicaid, and State Child Health Insurance Program Balanced Budget Refinement Act of 1999, P. L. 106-113
A-00-87
•
Off-Label Use of Oral Chemotherapy Drugs Methotrexate and Cyclophosphamide
A-00-88
•
Fee Schedule and Consolidated Billing for Skilled Nursing Facility Services
A-00-89
•
Implementation of Health Insurance Portability and Accountability Act Transaction Standards—Overview and Specific Instruction for Implementing the Inbound Claim
A-00-90
•
Policy Clarification: Coding for Adequacy of Hemodialysis
A-00-91
•
Inpatient Rehabilitation Facility Prospective Payment System
A-00-92
•
Corrections to Calculation of Federal Fiscal Year 2001 Inpatient Payment Amounts
A-00-93
•
Do Not Forward Initiative, Change Request 681, Transmittal No. AB-00-06, Dated February 2000
A-00-94
•
New End Stage Renal Disease Composite Payment Rates Effective January 1, 2001
A-00-95
•
Renewal of Program Memorandum A-97-8—Instructions to Implement the New Medicare Summary Notice Combined with Program Memorandum AB-98-31
A-00-96
•
Clarification of C-Code Reportable Under the Hospital Outpatient Prospective Payment System
A-00-97
•
Partial Implementation of Change Request 1119
A-00-98
•
Reporting of Outpatient Prospective Payment System and Home Health Prospective Payment System Data in Provider Remittance Advice Transactions
A-00-99
•
Medicare Contractor Use of the Regional Home Health Intermediary Outcomes and Assessment Information Set Verification Protocol for Review of Home Health Agency Prospective Payment Bills
A-00-100
•
Conversion to the UB-92 Version 6.0 and Continued Use of Version 5.0
A-00-101
•
Medicare Outpatient Code Editor Version 16.1
A-00-102
•
Hospital Outpatient Prospective Payment System Pass-Through Payment Corrections for Two Radiopharmaceuticals
Program Memorandum
Carriers
(HCFA Pub. 60B)
(Superintendent of Documents No. HE 22.8/6-5)
B-00-50
•
Home Health Prospective Payment System
B-00-51
•
Changes to Correct Coding Edits, Version 7.0, Effective January 1, 2001
B-00-52
•
Schedule for Completing the Calendar Year 2001 Fee Schedule Updates and the Participating Physician Enrollment Procedures
B-00-53
•
Calendar Year 2001 Participation Enrollment and Medicare-Participating Physicians and Suppliers Directory Procedures
B-00-54
•
Program Integrity Management Reporting System
B-00-55
•
Durable Medical Equipment Regional Carrier Common Working File to Add ICD-9 Diagnosis Code for Oral Anti-Cancer Drugs
B-00-56
•
Durable Medical Equipment Regional Carrier Common Working File Edit# 5211 Services after the Date of Death for Durable Medial Equipment Rental Items
B-00-57
•
Part B Outbound X12N 837 Coordination of Benefits Mapping
B-00-58
•
Durable Medical Equipment Regional Carriers—Change in Common Working File for Code K0009
B-00-59
•
Durable Medical Equipment Regional Carrier—Common Working File Revision for Oxygen Certificate of Medical Necessity
B-00-60
•
New Temporary “K” Codes for Augmentative and Alternative Communication Devices
B-00-61
•
Comprehensive Error Rate Testing Program Requirements for Medicare Contractor Operations
B-00-62
•
Promoting Influenza and Pneumococcal Vaccinations
B-00-63
•
Medicare Payment Allowance for Flu Vaccine
B-00-64
•
Program Integrity Sampling Module for Part B and Durable Medical Equipment Carriers
B-00-65
•
2001 Physician Fee Schedule for Payment Policies
B-00-66
•
Durable Medical Equipment Regional Carrier Operating Instructions for Coverage of the Ultrasonic Osteogenic Stimulators for Fracture Healing: Effective for Services Performed on or after 1/1/2001
B-00-67
•
Consolidated Billing for Skilled Nursing Facility Residents
B-00-68
•
X12N Professional Flat File
B-00-69
•
Blood Glucose Test Strips—Marketing to Medicare Beneficiaries
B-00-70
•
Changes to Correct Coding Edits, Version 7.1, Effective April 1, 2001
B-00-71
•
Addition of a Miscellaneous “WW” Code and National Drug Code for Oral Anti-Cancer Drugs
B-00-72
•
Instructions to Implement the New Medicare Summary Notice—Program Memorandum B-98-4 and PM AB-98-31
B-00-73
•
Correct Coding Initiative Edits Correction: Influenza (G0008), Pneumococcal (G0009), and Hepatitis B (G0010) Vaccine Codes
B-00-74
•
Claims Processing Instructions for Carriers To Make Available Claims and Medical Records for a Program Safeguard Contractor Task Order Request for Medical Record Review
B-00-75
•
Emergency Changes to the 2001 Medicare Physician Fee Schedule Database
B-00-76
•
Revised 2001 Anesthesia Conversion Factors
Program Memorandum
Intermediaries/Carriers
(HCFA Pub. 60A/B)
(Superintendent of Documents No. HE 22.8/6-5)
AB-00-91
•
Mammography Screening Payment Limit for Calendar Year 2001
AB-00-92
•
Sending Common Working File Referrals for Initial Enrollment Questionnaire and Internal Revenue Services/Social Social Security Administration/Health Care Financing Administration Data Match Records to the Coordination of Benefits Contractor
AB-00-93
•
Coordination With the Y2K Program Safeguard Contractor
AB-00-94
•
Urokinase (Abbokinas) Shortage
AB-00-95
•
Facility Requirements for Transplantation Centers
AB-00-96
•
Clarification of Fiscal Intermediary and Durable Medical Equipment Regional Carrier Responsibilities Concerning Home Dialysis Method Election and Claims Processing
AB-00-97
•
Notification to Providers and Suppliers of Transaction and Code Set Rule Promulgated In Accordance With the Health Insurance Portability and Accountability Act
AB-00-98
•
Medicare Deductible and Premium Rates for Calendar Year 2001
AB-00-99
•
Glucose Monitoring Note
AB-00-100
•
Mandatory Training on Ambulance Fee Schedule
AB-00-101
•
Notice of Interest Rate for Medicare Overpayments and Underpayments
AB-00-102
•
Clarification to Medicare Carriers Manual § 2130 Prosthetic Devices and Coverage Issues Manual § 60-9 Durable Medical Equipment Reference List—Coverage of Intermittent Catheterization
AB-00-103
•
Final Rule Revising and Updating Medicare Polices Concerning Ambulance Services
AB-00-104
•
Autologous Stem Cell Transplantation for Patients with Multiple Myeloma
AB-00-105
•
New Waived Test—November 9, 2000
AB-00-106
•
Establishment of Provider/Supplier Information and Education Resource Directory
AB-00-107
•
Transfer of Initial Medicare Secondary Payer Development Activities to the Coordination of Benefits Contractor
AB-00-108
•
Glucose Monitoring
AB-00-109
•
2001 Clinical Laboratory Fee Schedule an Laboratory Costs Subject to Reasonable Charge Payment Methodology
AB-00-110
•
Implementation of the New Payment Limit for Drugs and Biologicals
AB-00-111
•
Revised Claims Processing Instructions for Medicare Qualifying Clinical Trial Claims for Managed Care Enrollees
AB-00-112
•
Home Health Prospective Payment System/Consolidated Billing Edits and Systems Changes—Instructions for Standard Systems, Common Working File, and Contractors Part II
AB-00-113
•
Instructions for Implementing and Updating 2001 Payment Amounts for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
AB-00-114
•
Update of Codes and Payments for Ambulatory Surgical Centers
AB-00-115
•
Source of Average Wholesale Price Data in Pricing Drugs and Biologicals Covered by the Medicare Program
AB-00-116
•
Local Medical Review Policy Development and Format
AB-00-117
•
Payment of Drugs, Biologicals and Supplies in a Comprehensive Outpatient Rehabilitation Facility
AB-00-118
•
Delay Implementation of the Ambulance Fee Schedule
AB-00-119
•
Change in the Collection of Comprehensive Encounter Data for the Medicare Choices Demonstration, Long-Term Care Demonstrations (Social Health Maintenance Organization Evercare, Department of Defense Subvention Demonstration, and Dual Eligible Demonstrations
AB-00-120
•
Operating Instructions for Coverage of Non-Implantable Pelvic Floor Electrical Stimulators
AB-00-121
•
Medicare Intermediary Claims Processing Standard Systems Delay of Calendar Year 2001 Quarter Release
AB-00-122
•
Appeals of Medicare Part A/Part B Coverage Determinations
AB-00-123
•
Use of Beneficiary Question & Answers on www.hcfa.gov
AB-00-124
•
Payment for Method II Home Dialysis Supplies
AB-00-125
•
Accelerated Referral of Non-Medicare Secondary Payor Delinquent Debts (Active and Currently Not Collectible to Debt Collection Center for Cross Servicing and Treasury Offset Program)
AB-00-126
•
Use of the American Medical Associations' Physicians' Current Procedural Terminology, Fourth Edition Codes on Contractors' Web Sites
AB-00-127
•
Reimbursement for Ambulance Services to Nonhospital-Based Dialysis Facilities
AB-00-128
•
Extension of the Limitation on Payment for Services to Individuals Entitled to Benefits on the Basis of End-Stage Renal Disease Who Are Covered by Group Health Plan
AB-00-129
•
Coordination of Benefits Contractor Fact Sheet for Providers
AB-00-130
•
Intestinal Transplantation
AB-00-131
•
Clarification to Implementation of the Ambulance Fee Schedule
AB-00-132
•
Clarification Regarding Release of Medicare Eligibility Data
AB-00-133
•
Coordination With Provider Education Program Safeguard Contractor
AB-00-134
•
Cervical or Vaginal Smear Tests (Pap Smears) in Calendar Year 2001 Clinical Diagnostic Laboratory Fee Schedule
Program Memorandum
State Survey Agencies
(HCFA Pub. 65)
(Superintendent of Documents No. HE 22.8/6-5)
99-2
•
Guidelines and Exhibits Regarding Regulatory Requirements for Comprehensive Assessment and Use of the Outcome and Assessment Information Set
State Operations Manual
Provider Certification
(HCFA Pub. 7)
(Superintendent of Documents No. HE 22.8/12)
21
•
List of Appendices
Interpretive Guidelines and Survey Procedures—Hospital—Table of Contents
Interpretive Guidelines for Home Health Agencies
22
•
Minimum Data Set System
System Description
Administration Requirements
Validation and Editing Process
Correction of Errors in Minimum Data Set Records That Have Been Accepted by the Standard Minimum Data Set System at the State
23
•
Hospice—Citations and Description
Community Mental Health Centers—Citations and Description
Attestation Statement
Provider Agreement
Fiscal Intermediary Medicare Provider Billing Number Deactivation Letter Used by Fiscal Intermediary
Model Denial Letter for Community Mental Health Center Applicants—State Restrictions on Screening
Model Letter, Notice of Findings of Non-Compliance
Model Letter, Notice of Termination of Provider Agreement
Model Letter, Community Mental Health Center That Has Ceased Operating
Model Letter, Participation in Medicare as a Community Mental Health Center Providing Partial Hospitalization Services (Including Threshold and Service Requirements)
Model Letter, Notice of Failure to Meet Threshold and Service Requirements
Peer Review Organization Manual
(HCFA Pub. 19)
(Superintendent of Documents No. HE 22.8/8-15)
83
•
Introduction
Review Responsibilities to Handle Clinical Data Abstraction Center Referrals
Developing the Capacity to Estimate Local Payment Error Rates
Determining the Types of Errors and Developing the Interventions Necessary to Reduce or Eliminate Errors
Developing, Applying, and Assessing the Effect of Interventions
Collaborating With Provider and Practitioner Groups
Collaborating Efforts with Federal and State Agencies and Other Medicare Contractors
84
•
Review Process
Notice of Disclosure
Final Response to Complainants
Disclosure of Quality Review Information to Complainants
Request for Information Model Form
Final Response to Inquirer Model Notice (Concern Involved Practitioner)
Final Response to Inquirer Model Notice (Concern Involved Provider Facility)
Hospital Manual
(HCFA Pub. 10)
(Superintendent of Documents No. HE 22.8/2)
762
•
Extracorporeal Immunoadsorption Using Protein A Columns
763
•
Billing for Sodium Ferric Gluconate Complex in Sucrose Injection
764
•
Payment for Blood Clotting Factor Administered to Hemophilia Inpatients
765
•
Billing for Hospital Outpatient Partial Hospitalization Services
766
•
Heart Transplants
767
•
Completion of Form HCFA-1450 for Inpatient and/or Outpatient Billing
Renal Dialysis Facility Manual
(Non-Hospital Operated)
(HCFA Pub. 29)
(Superintendent of Documents No. 22.8/13)
91
•
Billing for Sodium Ferric Gluconate Complex in Sucrose Injection
ESRD Network Organizations Manual
(HCFA Pub. 81)
(Superintendent of Documents No. HE 22.9/4)
12
•
List of Commonly Used Acronyms, and Glossary Authority
Purpose of End-Stage Renal Disease Network Organizations
Requirements for End-Stage Renal Disease Network Organization
Responsibilities of End-Stage Renal Disease Network Organizations Goals
Network Organization's Role in Health Care Quality Improvement Program
Annual Report Format
Quarterly Progress and Status Report Format
Outpatient Physical Therapy and Comprehensive
Outpatient Rehabilitation Facility Manual
(HCFA Pub. 9)
(Superintendent of Documents No. HE 22.8/9)
15
•
Billing Instructions for Partial Hospitalization Services Provided in Community Mental Health Centers
Coverage Issues Manual
(HCFA Pub. 6)
(Superintendent of Documents No. HE 22.8/14)
127
•
Extracorporeal Immunoadsorption Using Protein A Columns
128
•
Air-Fluidized Beds
129
•
Hyperbaric Oxygen Therapy
130
•
Intravenous Iron Therapy
131
•
Osteogenic Stimulation
132
•
Durable Medical Equipment Reference List
Speech Generating Devices
133
•
Non-Implantable Pelvic Floor Electrical Stimulator
134
•
Artificial Hearts and Related Devices
Provider Reimbursement Manual—Part 1
(HCFA Pub. 15-1)
(Superintendent of Documents No. HE 22.8/4)
418
•
Requirements for Distinct Part Certification
419
•
Regional Medicare Swing-Bed Skilled Nursing Facility Rates
Provider Reimbursement Manual—Part 2
Provider Cost Reporting Forms and Instructions
Chapter 35—Form HCFA-2540-96
(HCFA Pub. 15-2-35)
(Superintendent of Documents No. HE 22.8/4)
9
•
Skilled Nursing Facility, and Skilled Nursing Facility Health Care Complex Cost Report, Form HCFA-2540-96
Provider Reimbursement Manual—Part 2
Provider Cost Reporting Forms and Instructions
Chapter 36—Form HCFA-2552-96
(HCFA Pub. 15-2-36)
(Superintendent of Documents No. HE 22.8/4)
7
•
Hospital and Hospital Health Care Complex Cost Report, Form HCFA-2552-96
Medicare Program Integrity Manual
(HCFA Pub. 83)
(Superintendent of Documents No. HE 22)
3
•
Types of Claims For Which Contractors Are Responsible
The Medicare Medical Review Program
National Coverage Policy and Local Medical Review Policy and Individual Claim Determinations
Individual Claim Determinations
Identification of Services for Which A Local Medical Review Policy is Needed
Coding Rules in Local Medical Review Policy
Local Medical Review Policy Notice Process
Manual Review Personnel and Levels of Review
The Contractor Advisory Committee
Medicare Fraud Information Specialist
Medicare Integrity Program—Provider Education and Training Activities
Contractor Medical Director
Office of Inspector General Referrals and Appropriate Fraud Information Database Entries
Introduction
Provider Tracking System
Evaluating Effectiveness of Corrective Actions
Verifying Potential Errors and Setting Priorities
Determining Whether the Problem is Widespread or Provider-Specific
Provider Education
Prepayment Review of Selected Claims
Automated and Manual Prepayment Review
Prepayment Edits
Development of Claims for Additional Documentation
Location of Postpay Reviews
Advance Determination of Medicare Coverage of Customized Durable Medical Equipment
Effectuating Favorable Final Appellate Decisions That A Beneficiary is “Confined to Home”
Contractor Advisory Committee Structure
Contractor Advisory Committee Process
The Medicare Fraud Program
Staffing of the Fraud Unit and Security Training
Durable Medical Equipment Fraud Functions
Identifying Potential Errors—Introduction
Data Analysis
Resources Needed for Data Analysis
Determine Indicators to Identify Norms and Deviations
Overview of Prepayment and Postpayment Review
Automated and Manual Prepayment Review
Categories of Medical Review Edits
Overpayment Assessment Procedures
Consent Settlement Offer Based on Potential Projected Overpayment
Certified Medical Necessity as the Written Order
Pick-up Slips
Incurred Expenses for Durable Medical Equipment and Orthotics and Prosthetic Devices
List of Medical Review Codes, Categories, and Conversion Factors for Fiscal Year 2000
Description of Carrier Advisory Committee
Consent of Settlement Documents
HCFA Forms 700 and 701
Medicare/Medicaid
Sanction—Reinstatement Report
(HCFA Pub. 69)
00-10
•
Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded Reinstated—September 2000
00-11
•
Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—October 2000
00-12
•
Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—November 2000
January 2001 through March 2001
Intermediary Manual
Part 1—Claims Process
(HCFA Pub. 13-1)
(Superintendent of Documents No. HE 22.8/6-3)
130
•
Principles of Reimbursement for Administrative Costs
Intermediary Manual
Part 2—Claims Process
(HCFA Pub. 13-2)
(Superintendent of Documents No. HE 22.8/6-3)
415
•
System Security Authority, Exhibits, and Appendices:
www.hcfa.gov/pubforms/pim/pimtoc.htm
416
•
Recovery of Overpayments Due to a Pattern of Furnishing Excessive or Noncovered Services
417
•
This Transmittal contains no updated information
Intermediary Manual
Part 3—Claims Process
(HCFA Pub. 13-3)
(Superintendent of Documents No. HE 22.8/6)
1822
•
No Legal Obligation To Pay For Or Provide Services
Review of Form HCFA-1450 For Inpatient And Outpatient Bills
Medicare Secondary Payor Maintenance Transaction Record Processing
Alphabetic Listing Of Data Elements
1823
•
Screening Pap Smears and Screening Pelvic Examinations
1824
•
Colorectal Screening
1825
•
Hospital Outpatient Partial Hospitalization Services
1826
•
Review of Form HCFA-1450 For Inpatient and Outpatients Bills
1827
•
Beneficiary-Driven Demand Billing Under Home Health Prospective Payment System
Carriers Manual
Part 2—Program Administration
(HCFA Pub. 14-1)
(Superintendent of Documents No. HE 22.8/7-2)
124
•
Principles of Reimbursement for Administrative Costs
Budget Preparation
Budget Preparation
Carriers Manual
Part 3—Program Administration
(HCFA Pub. 14-2)
(Superintendent of Documents No. HE 22.8/7)
142
•
System Security Authority, Exhibits, and Appendices:
www.hcfa.govpubforms/83_pim/pimtoc.htm
Carriers Manual
Part 3—Program Administration
(HCFA Pub. 14-3)
(Superintendent of Documents No. HE 22.8/7)
1690
•
Claims for Anesthesia Services Performed on and After January 1, 1992
Entities/Suppliers Whose Physicians' Services Are Paid for Under Fee Schedule
Method for Computing Fee Schedule Amounts
Payment Conditions for Anesthesiology Services
Assisted Suicide
Site-of-Service Payment Differential
Optometry Services
Allowable Adjustments
Evaluation and Management Service Codes—General
Payment for Office/Outpatient Visits
Consultations
Payment For Physician's Visits To Residents of Skilled Nursing Facilities and Nursing Facilities
Home Care and Domiciliary Care Visits
Prolonged Services
Home Services
Geographic Practice Cost Indices by Medicare Carrier and Locality
Determining Reasonable Charges for Services of Nurse Practitioners and Clinical Nurse Specialists
1691
•
No Legal Obligation To Pay For Or Provide Services
Medicare Secondary Payer General Provisions
Medicare Secondary Payer General Provisions Applicable To Individuals Covered By Group Health Plans and Large Group Health Plans
Limitation On Payment For Services To Individuals Eligible For Or Entitled To Benefits On Basis Of End Stage Renal Disease Who Are Covered By Group Health Plans
1692
•
Patient and Insured Information
Physician or Supplier Information
Place of Service Codes and Definitions Exhibits
1693
•
Physicians Billing for Purchased Diagnostic Tests (Other Than Clinical Diagnostic Laboratory Tests
1694
•
Screening Pap Smear Coverage and Payment Requirements
Screening Pelvic Examination Coverage and Payment Requirements
Diagnosis Coding
Billing Requirements
Calculating Frequency Limitations
Common Working File Edits
Medicare Summary Notices and Explanations of Your Part B Medicare Benefits
Remittance Advice Notices
1695
•
Coding Changes Became Effective for Hepatitis B Vaccines Through the Health Care Financing Administration Common Procedure Coding System
Annual Updates
1696
•
Evidence of Medical Necessity Oxygen Claims
1697
•
Covered Services and Health Care Financing Administration Common
Procedure Coding System Codes
Coverage Criteria
Determining Whether or Not the Beneficiary is at High Risk for Developing Colorectal Cancer
Determining Frequency Standards
Noncovered Services
Payment Requirements
Common Working File Edits
Medicare Summary Notices and Explanations of Your Part B Medicare Benefits
Remittance Advice Notices
Ambulatory Surgical Center Facility Fee
1698
•
Dual Eligibility/Entitlement Situations
Program Memorandum
Intermediaries (HCFA Pub. 60A)
(Superintendent of Documents No. HE 22.8/6-5)
A-01-01
•
January Outpatient Code Editor Specifications Version (V2.0)
A-01-02
•
Use of Telehealth In Delivery of Home Health Services
A-01-03
•
Temporary 2-Month Extension of Periodic Interim Payment for Home Health Providers
A-01-04
•
Change in Hospice Payment Rates As Required by the Benefits Improvement and Protection Act
A-01-05
•
Advance Beneficiary Notices Must Be Given To Beneficiaries and Demands Bills Must Be Submitted By Home Health Agencies
A-01-06
•
Restoration of Full Home Health Market Basket Update for Home Health Services for Fiscal Year 2001 and Temporary 10 Percent Payment Increase for Home Health Services Furnished in a Rural Area For 24 Months Under the Home Health Prospective Payment System
A-01-07
•
Application of Wage Index for Wichita, Kansas, Metropolitan Statistical Area Hospice Providers
A-01-08
•
Adjustments to the Federal Skilled Nursing Facility Prospective Payment System Rates for Fiscal Year 2001
A-01-09
•
Exemption of Critical Access Hospital Swing Beds From Skilled Nursing Facility Prospective Payment System
A-01-10
•
Technical Corrections to the January 2001 Update: Coding Information for Hospital Outpatient Prospective Payment System
A-01-11
•
Changes to Federal Fiscal Year 2001 Inpatient Hospital Payment As Required By the Benefits Improvement And Protection Act of 2000 (Public Law 106-554)
A-01-12
•
Provider Statistical and Reimbursement Report
A-01-13
•
Clarification of Allowable Medicaid Days in the Medicare Disproportionate Share Hospital Adjustment Calculation
A-01-14
•
Clarifications to Transmittal A-01-03, Change Request 1437, Temporary 2-Month Extension of Periodic Interim Payment for Home Health Providers
A-01-15
•
Implementation of Sections 111, 401, 403, and 405 of the Medicare, Medicaid, and State Child Health Insurance Program Benefits Improvement and Protection Act of 2000
A-01-16
•
Claims Guidance Related to Outpatient Code Editor Edit 27
A-01-17
•
Impact of the Benefits Improvement and Protection Act on Devices Eligible for Transitional Pass-Through Payments Under the Hospital Outpatient Prospective Payment System
A-01-18
•
Effective Dates for all Medicare Secondary Payer Sub-Modules Found in the Medicare Secondary Payer Pay Module
A-01-19
•
New Composite Payment Rates Effective April 1, 2001, through December 31, 2001, and the Application of Exceptions Under the End Stage Renal Disease Composite Rate System
A-01-20
•
Health Insurance Portability and Accountability Act Health Care Claim and Coordination of Benefits
A-01-21
•
Clarification of the Homebound Definition Under the Medicare Home Health Benefit
A-01-22
•
Extension of Due Date for Filing Provider Cost Reports
A-01-23
•
Modification to Home Health Prospective Payment System Date Matching Edit in Medicare Standard System Software
A-01-24
•
Further Guidance on Handling Outpatient Code Editor Error 13
A-01-25
•
New Processing and Reporting Requirements for Resolution of Outpatient Prospective Payment System Implementation Issues
A-01-26
•
Clarification of Exclusions to the Temporary 2-Month Extension of Periodic Interim Payments For Home Health Providers
A-01-27
•
Problems with Processing of Non-Outpatient Prospective Payment System Claims Through the Outpatient Code Editor
A-01-28
•
Addendum to Periodic Interim Payments For Home Health Providers
A-01-29
•
Medicare Review of Certification and Re-Certifications of Residents in Skilled Nursing Facilities
A-01-30
•
Advance Beneficiary Notices Must Be Given To Beneficiaries and Demand Bills Must Be Submitted By Home Health Agencies
A-01-31
•
Clinical Diagnostic Laboratory Tests Furnished by Critical Access Hospitals
A-01-32
•
Biweekly Interim Payments for Certain Hospital Outpatient Items and Services That Are Paid On A Cost Basis, and Direct Medical Education Payment, Not Included in the Hospital Outpatient Prospective Payment System
A-01-33
•
Fiscal Intermediary Community Mental Health Center Enrollment and Change of Ownership Site Visit Process and Coordination With National Community Mental Health Center Site Visit Contractor
A-01-34
•
Salary Equivalency Guidelines Update Factors
A-01-35
•
Medicare+Choice Inpatient Encounter Data-Migration of Data Processing to the Health Care Financing Administration Data Center
A-01-36
•
April Outpatient Code Editor Specifications Version (V2.1)
A-01-37
•
Change in the Standard Paper Remittance Advice for Home Health Agencies
A-01-38
•
Changes to Fiscal Year 2001 and Fiscal Year 2002 Graduate Medical Education Policies as Required by the Medicare, Medicaid, and State Child Health Insurance Program Balanced Budget Refinement Act of 1999, P.L. 106-113, and the Medicare, Medicaid, and State Child Health Insurance Program Benefits Improvement and Protection Act of 2000, P.L. 106-554
A-01-39
•
Postacute Care Transfer Policy
A-01-40
•
Additional Information on Transitional Pass-Through Devices and Drugs
A-01-41
•
Categories for Use in Coding Devices Eligible for Transitional Pass-Through Payments Under the Hospital Outpatient Prospective Payment System
A-01-42
•
Indian Health Service Hospital Payment Rates for Calendar Years 2000 and 2001
A-01-43
•
This Transmittal Has Been Rescinded
A-01-44
•
Standard Systems Changes Required to Incorporate Provider-Specific Payment-to-Cost Ratios into the Calculation of Interim Transitional Corridor Payment Outpatient Prospective Payment System
A-01-45
•
Clarification and HCFA Common Procedure Coding System Coding Update: Part B Fee Schedule and Consolidated Billing for Skilled Nursing Facility Services
A-01-46
•
Further Guidance on Handling the Outpatient Code Editor Edit 43
A-01-47
•
Implementation of Updates to the Federal Fiscal Year 2001 Inpatient Hospital Payments and Disproportionate Share Hospital Thresholds and Adjustments as Required by the Benefits Improvement and Protection Act of 2000 (Public Law 106-554)
Program Memorandum
Carriers
(HCFA Pub. 60B)
(Superintendent of Documents No. HE 22.8/6-5)
B-01-01
•
Use of Statistical Sampling for Overpayment Estimation When Performing Administrative Reviews of Part B Claims
B-01-02
•
Medicare Requirements for Payment for Medicare-Covered Drugs Administrative Reviews of Part B Claims
B-01-03
•
Request for Carriers to Include a Message on Paper Remittance Notices
B-01-04
•
New Temporary “K” Codes for Insulin Lispro
B-01-05
•
Matrix to Complete Provider/Supplier Enrollment Application (HCFA-855)
B-01-06
•
Health Insurance Portability and Accountability Act Health Care Claim and Coordination of Benefits
B-01-07
•
Apligraf (Graftskin)
B-01-08
•
Change in Effective Data For Five “WW” Codes For Methotrexate
B-01-09
•
Suspension of Recently Implemented Correct Coding Initiative Edits Bundling Evaluation and Management Codes and Ophthalmologic Codes Revision to Version 7.0
B-01-10
•
Systems Requirements for the Benefits Improvement and Protection Act of 2000 for Drugs and Biologicals Covered by Medicare, Section 114, Mandatory Submission of Assigned Claims for Drugs and Biologicals
B-01-11
•
Supplier Billing for Glucose Test Strips
B-01-12
•
Initial Viable Information Processing Systems Virtual Multiple Storage Changes Necessary to Allow for “Full Program Safeguard Contractor Implementation”
B-01-13
•
Explanation of Medicare Benefits, Medicare Summary Notice and Supplier Remittance Message Durable Medical Equipment Regional Carriers Must Use on Claims for Drugs and Related Equipment Supplied by a Supplier Not Licensed to Dispense the Drug
B-01-14
•
New Oral Anti-Cancer Drugs Approved for Use by Medicare
B-01-15
•
Durable Medical Equipment Regional Carrier System Requirements to Implement § 114 of the Benefits Improvement and Protection Act of 2000
B-01-16
•
Clarification of Medicare Policies Concerning Ambulance Services
B-01-17
•
Durable Medical Equipment Regional Carrier System Changes to Enforce Medicare Requirements for Payment for Medicare-Covered Drugs
B-01-18
•
Changes to Correct Coding Edits, Version 7.2, Effective July 1, 2001
B-01-19
•
Additional Information for Trail Blazer Health Enterprise for Centralized Billing of Flu and Pneumococcal Vaccinations
B-01-20
•
Two New “K” Codes for Heavy Duty Hospital Beds
B-01-21
•
Durable Medical Equipment Regional Carrier System Requirements to Implement § 114 of Benefits Improvement and Protection Act of 2000 (Additional Requirements for Change Request (CR) 1562, Transmittal B-01-15)
B-01-22
•
Initial Viable Information Processing System Medicare System Virtual Multiple Storage Changes Necessary to Allow for Full Program Safeguard Contractor Implementation
Program Memorandum
Intermediaries/Carriers
(HCFA Pub. 60A/B)
(Superintendent of Documents No. HE 22.8/6-5)
AB-01-01
•
Upcoming Train the Trainer Sessions on Skilled Nursing Facility Prospective Payment System and Consolidated Billing Updates
AB-01-02
•
Managing Medicare Appeals Workloads in Fiscal Year 2001
AB-01-03
•
April Quarterly Update for 2001 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Fee Schedule
AB-01-04
•
Implementation of the National Drug Code to Process Claims for Prescription Drugs and Biologicals and Request for Comments
AB-01-05
•
New Waived Tests—Effective Date of Receipt
AB-01-06
•
Replacement of Prosthetic Devices and Parts
AB-01-07
•
Contractor Testing Requirements
AB-01-08
•
Program Safeguard Contractor for Corporate Integrity Agreements
AB-01-09
•
Clarification of Physician Certification Requirements for Medicare Hospice
AB-01-10
•
Elimination of Time Limit for Coverage of Immunosuppressive Drugs Under Medicare
AB-01-11
•
Health Care Financing Administration Business Partner Systems Security Manual
AB-01-12
•
Charging Fees to Providers for Medicare Education and Training Activities Program Management
AB-01-13
•
Pap Test for Women Aged 65 and Older: Dispelling the Myths
AB-01-14
•
Notification to Beneficiaries About Cervical Cancer Month and the Benefit of Pap Tests
AB-01-15
•
Instructions to All Medicare Contractors for Reporting Audited Year 2000 Costs on the Final Administrative Costs Proposals
AB-01-16
•
Implementation of Benefits Improvement and Protection Act of 2000 Requirements for Drugs and Biologicals Covered by Medicare
AB-01-17
•
Medicare Coverage of Epoetin Alfa (Procrit) for Preoperative Use
AB-01-18
•
New Automatic Notice of Change to Medicare Secondary Payer Auxiliary File
AB-01-19
•
First Update to the 2001 Medicare Physician Fee Schedule Database
AB-01-20
•
Payment Revisions For Diagnostic and Screening Mammograms Performed With New Technologies—Effectuated By Benefits Improvement and Protection Act 2000
AB-01-21
•
Form HCFA-1522, Monthly Contractor Financial Report, Reconciliation
AB-01-22
•
2001 Payment Limit Update for Ambulance Services
AB-01-23
•
Medicare Summary Notices Programming Errors
AB-01-24
•
Medicare Secondary Payer: (1) Procedures for “Write-Off—Closed” of Medicare Secondary Payer Accounts Receivable; (2) Elimination of Automated/Systems “Write-Off—Closed” Actions for Medicare Secondary Payer Accounts Receivable; Zero Backend Tolerance for Medicare Secondary Payer Accounts Receivable (Reminder); and (3) Date for Establishment of Medicare Secondary Payer Accounts Receivable (Reminder)
AB-01-25
•
Clarification of Transmittal AB-00-107, Change Request 1163, and Transmittal AB-00-129, Change Request 1460, Regarding the Coordination of Benefits Contract of Benefits Contractor and Medicare Secondary Payer Prepay Work Activities for Customer Service, Medicare Secondary Payer and Standard Systems Contractor Staff
AB-01-26
•
Changes to the 2001 Payment Amounts for Durable Medical Equipment Prosthetics, Orthotics, and Supplies
AB-01-27
•
Notice of Interest Rate for Medicare Overpayments and Underpayments
AB-01-28
•
Current Status of Medicare Program Memoranda Issued Before Calendar Year 2001
AB-01-29
•
Free Electronic Billing Software
AB-01-30
•
Claims Processing Instructions for the Medicare Coordinated Care Demonstration—Correction and Enhancement
AB-01-31
•
Fraud Investigation Database
AB-01-32
•
Promoting Colorectal Cancer Screening as a Part of Colorectal Cancer Awareness Month
AB-01-33
•
Delay of Carrier and Intermediary Actions Required in Change Requests 1256 and 1323, Consolidated Billing for Skilled Nursing Facility Residents, and Fee Schedule for Part B Residents and Outpatients
AB-01-34
•
Health Care Financing Administration Office of the Inspector General Hotline Referrals
AB-01-35
•
Delay of Carrier and Intermediary Action Required in Change Request 1412, Transmittal AB-00-112, Dated November 16, 2000, Consolidated Billing for Home Health Agencies
AB-01-36
•
Extension of Moratorium on the Application of the Financial Limitation for Outpatient Rehabilitation Services
AB-01-37
•
Verteporfin
AB-01-38
•
Transmittal number AB-01-38, has been rescinded and will not be released
AB-01-39
•
Salary Equivalency Guidelines Update Factors
AB-01-40
•
Correction to Change Request 1500 (Transmittal AB-01-26)—Changes to the 2001 Payment Amounts for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
AB-01-41
•
Correction to April Quarterly Update for 2001 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Fee Schedule
AB-01-42
•
Changes to 2001 Clinical Laboratory Fee Schedule Required by the Benefits Improvement and Protection Act of 2000
AB-01-43
•
Revision to Carrier/Intermediary Provider Training for Skilled Nursing Facility Prospective Payment System and Consolidated Billing
AB-01-44
•
Binding Contractor Hearing Officers to Local and Regional Medical Review Policies
AB-01-45
•
Retention of HCFA Common Procedure Coding System Level III Codes
AB-01-46
•
New Waived Test—Effective Date of Receipt
AB-01-47
•
Independent Laboratory Billing for the Technical Component of Physician Pathology Services to Hospital Patients
AB-01-48
•
Remittance Advice and Medicare Summary Notice Messages for the Home Health Prospective Payment System
AB-01-49
•
Follow On Instructions to Health Care Financing Administration Business Partners Systems Security Requirements
Program Memorandum
Medicaid State Agencies
(HCFA Pub. 17)
Superintendent of Documents No. HE 22. 8/6-5
01-01
•
Current Status of Medicaid Program Memoranda and Action Transmittal Issued Before Calendar Year 2001
Medicare Regional Office Manual—Part 2
(HCFA Pub. 23-3)
Superintendent of Documents No. HE 22.8/8
330
•
Security Oversight Manual—
www.hcfa.gov/pubforms/progma.htm.
State Operations Manual
Provider Certification
(HCFA Pub. 7)
(Superintendent of Documents No. HE 22.8/12)
24
•
Psychiatric Hospitals
Conducting Initial Surveys and Scheduled Resurveys
25
•
Citations and Description
Organization of Home Health Agency
Characteristics Differentiating Branches From Subunits of Home Health Agency
Guidelines for Determining Parent, Branch, or Subunit
Processing Change from Branch to Subunit
Health Care Financing Administration Approval Necessary for Non-Parent Locations
Separate Entities
Operation of the Home Health Agencies
Consumer Awareness
Staff Awareness
Operation of Home Health Agencies Across State Lines
Surveying Health Maintenance Organization—Operated Home Health Agency
Guidelines for Determining Survey Frequency
Home Health Agency Survey Process for Determining Quality of Care Definitions
Home Health Functional Assessment Instrument
Outcome and Assessment Information Set Requirements
Clinical Laboratory Improvement Amendments
Standard Survey—Structure
Survey Tasks
Resident Assessment Protocols
26
•
Regional Office Assignment of Provider and Supplier Identification Numbers
Peer Review Organization Manual
(HCFA Pub. 19)
(Superintendent of Documents No. HE 22.8/8-15)
85
•
Statutory Background
Hospital Requirements
Hospital Penalties For Noncompliance
Regional Offices Responsibilities
State Agency Surveys
Peer Review Organization Review Responsibilities
Physician Review Outline
60-Day Peer Review Organization Review: Opportunity for Discussion (Sample Letter to Physician/Hospital),
86
Quality Review
Admission Review
Coverage Review
Discharge Review
Outlier Review
Limitation on Liability Determinations
Readmission Review
Circumvention of Prospective Payment System
Introduction
Review Setting
Using Screening Criteria
Providing Opportunity for Discussion
Profiling Case Review Results
Physician Reviewers
Health Care Practitioners Other Than Physicians
Conflict of Interest
When an Action Plan is Not Need
Additional Performance Improvement Activities
Denial and Reopening Time Frames
Hospice Manual
(HCFA Pub. 10)
(Superintendent of Documents No. HE 22.8/2)
768
•
Screening Pap Smears and Screening Pelvic Examinations
769
•
Billing for Colorectal Screening
770
•
Billing for Hospital Outpatient Partial Hospitalization Services
771
•
Completion of Form HCFA-1450 for Inpatient and /or Outpatient Billing
Coverage Issues Manual
(HCFA Pub. 6)
Superintendent of Documents No. HE 22. 8/14
135
•
Photodynamic Therapy
Photosensitive Drugs
Provider Reimbursement Manual—Part 1
(HCFA Pub. 15-1)
(Superintendent of Documents No. HE 22.8/4)
420
•
Travel Expenses
Provider Reimbursement Manual—Part 2
Chapter 31, Form HCFA-287-92
(HCFA Pub. 15-2-31)
(Superintendent of Documents No. HE 22.8/4)
4
•
Home Office Equity Capital—General Form HCFA-287-92 Worksheets
Provider Reimbursement Manual—Part 2
Chapter 18, Form HCFA-2088-92
(HCFA Pub. 15-2-18)
(Superintendent of Documents No. HE 22.8/4)
4
•
Outpatient Rehabilitation Provider Cost Reporting Form
Provider Reimbursement Manual—Part 2
Provider Cost Reporting Forms and Instructions
Chapter 35/Form HCFA-2540-96
(HCFA Pub. 15-2-35)
10
•
Skilled Nursing Facility and Skilled Nursing Facility Complex Cost Report
State Medicaid Manual—Part 4/Elegibility
(HCFA Pub. 45-3)
Superintendent of Documents No. HE 22.8/10
75
•
Medicaid Estate Recoveries
Medicare Program Integrity Manual
(HCFA Pub. 83)
4
•
Physician Assistant Rules Concerning Orders and Certificates of Medical Necessity
5
•
Advance Determination of Medicare Coverage of Customized Durable Medical Equipment
Definitions of Customized Durable Medical Equipment
Items Eligible for Advance Determination of Medicare Coverage
Instructions for Processing Advance Determination of Medical Coverage Requests
Affirmative Advance Determination of Medical Coverage Decisions
Negative Advance Determination of Medical Coverage Decisions
Durable Medical Equipment Regional Carrier Tracking
Business Partners Systems Security Manual
(HCFA Pub. 84)
1
•
Introduction
Information Technology Systems Security Roles and Responsibilities
Information Technology Systems Program Management
Health Care Financing Administration Core Security Requirements, and an overview the Contractor Assessment Security Tool
An Approach to Risk Assessment
An Approach to Business Continuity and Contingency Planning
An Approach to Fraud Control
Acronyms and Abbreviations
Glossary
Business Partners Security Oversight Manual
(HCFA Pub. 85)
1
•
Introduction
2
•
Information Technology Systems Security Roles and Responsibilities
Information Technology Systems Security Program Management
Audit Protocols and the Contractor Assessment Security Tool
Medicare/Medicaid
Sanction—Reinstatement Report
(HCFA Pub. 69)
01-01
•
Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—December 2000
02-01
•
Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—January 2001
03-01
•
Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—February 2001
April 2001 through June 2001
Intermediary manual
Part 1—Claims Process
(HCFA Pub. 13-1)
(Superintendent of Documents No. HE 22.8/6-3)
131
•
General
Instructions for Completing the HCFA-750A/B Contractor Financial Reports
Instructions for Completing the HCFA-751A/B Status of Accounts Receivable
Instructions for Completing the HCFA-C751A/B Status of Non-Medicare Secondary Payer Debt Currently Not Collectible
Instruction for Completing the HCFA-M751A/B Status of Medicare Secondary Payer Accounts Receivable
Instruction for Completing the HCFA-MC751 A/B Status of Medicare Secondary Payer Debt Currently Not Collectible
Provides Exhibits to be used to Prepare Contractor Financial Reports
Intermediary Manual
Part 2—Claims Process
(HCFA Pub. 13-2)
(Superintendent of Documents No. HE 22.8/6-3)
418
•
Beneficiary Services
Intermediary Manual
Part 3—Claims Process
(HCFA Pub. 13-3)
(Superintendent of Documents No. HE 22.8/6)
1828
•
Prospective Payment for Outpatient Rehabilitation Services and the Financial Limitation
1829
•
Overpayment for Provider Services—General
1830
•
Review of Form HCFA-1450 for Inpatient And Outpatient Bills
1831
•
Type of Bill
Body of Report
1832
•
Requirements for Critical Access Hospital Services and Critical Access
Hospital Long Term Care Service
Payment for Services Furnished by a Critical Access Hospital
Payment for Post-Hospital Skilled Nursing Facility Care Furnished by a Critical Access Hospital
1833
•
Provider Enrollment
1834
•
Dialysis for End Stage Renal Disease—General
1835
•
Cryosurgery of the Prostate Gland
1836
•
Diabetes Outpatient Self-Management Training Services
1837
•
Checking Reports
Body of Report
Quarterly Supplement to the Intermediary Workload Report—HCFA-1566A, Pages 1, 2, and 3
1838
•
Drugs and Biologicals
1839
•
Request for Anticipated Payment
Home Health Prospective Payment System Claims
Effective Date and Scope of Home Health Prospective Payment System for Claims
Split Percentage Payment of Episodes and Development of Episode Rates
Coding of Home Health Prospective Payment System Episode Case—Mix
Groups on Home Health Prospective Payment System Claims: Health Research Groups and Health Insurance Prospective Payment System Codes
Overview—Health Insurance Query System for Home Health Agency Inquiry System Shows Primary Home Health Agency
Overview—Request for Anticipated Payment Submission and Processing
Establishes Home Health Prospective Payment System Episode and Provides First Percentage Payment
Overview—Claim Submission and Processing Complete Home Health Prospective Payment System Payment Closes Episode and Performs A-B Shift
Definition of Transfer Situation Under Home Health Prospective Payment System Payment Effects
Payment When Death Occurs During a Home Health Prospective Payment System Episode
Adjustments of Episode Payment—“Special Submission Case: “No Resource Allocation Plan” Low Utilization Payment Adjustment
Adjustment of Episode Payment—“Significant Change in Condition
General Guidance on Line Item Billing under Home Health Prospective Payment System Home Health Prospective Payment System Consolidated Billing and Primary Home Health Agency
Creation of the Health Insurance Query System for Home Health Agencies and hospices in the Common Working File—Replacement of Health Insurance Query System for Home Health Agencies
Health Insurance Query System for Home Health Agencies Inquiry and Response
Timeliness and Limitations of Health Insurance Query System for Home Health Agencies Responses
Inquiries to Regional Home Health Intermediaries Based on Health Insurance Query System for Home Health Agencies Responses
National Home Health Prospective Payment Episode History File
Closing, Adjusting and Prioritizing Home Health Prospective Payment System Episodes Based on Resource Allocation Plan and Home Health Agencies Claim Activity
Other Editing and Changes for Home Health Prospective Payment System Episodes
Priority Among Other Claim Types and Home Health Prospective Payment System Consolidated Billing for Episodes
Version 3051.4A.01 Line Level Reporting Requirements for the Claim Payment in an Episode (More than 4 Visits)
Carriers Manual
Part 1—Program Administration
(HCFA Pub. 14-1)
(Superintendent of Documents No. HE 22.8/7-2)
125
•
General
Instructions for Completing the HCFA-750B Contractor Financial Reports
Instructions for Completing the HCFA-751B Status of Accounts Receivable
Instructions for Completing the HCFA-C751B Status of Non-Medicare Secondary Payer Debt Currently Not Collectible
Instructions for Completing the HCFA-C751B Status of Medicare Secondary Payer Accounts Receivable
Instructions for Completing the HCFA-M751B Status of Medicare Secondary Payer Accounts Receivable
Carriers Manual
Part 2—Program Administration
(HCFA Pub. 14-2)
(Superintendent of Documents No. HE 22.8/7)
143
•
Beneficiary Services
Carriers Manual
Part 3—Program Administration
(HCFA Pub. 14-3)
(Superintendent of Documents No. HE 22.8/7)
1699
•
Overpayments—General
1700
•
Billing for Pneumococcal, Hepatitis B, And Influenza Virus Vaccines
General Claims Processing Requirements
Billing Requirements
Simplified Roster Bills
1701
•
The Do Not Forward Initiative
1702
•
Durable Medical Equipment Regional Carrier Pre-Discharge Delivery of DME Prosthetic, & Supplies for Fitting and Training
1703
•
Correct Coding Initiative
1704
•
Coverage of Medical Devices under Medicare
Appeals Process for Investigational Device Exemption Categorization Decisions
Certain Devices with a Food and Drug Administration Investigational Device Exemption
Certain Devices with an Food & Drug Administration Investigational Device Exemption
Payment of Certain Investigational Devices
HCFA's Master File of Investigational Devices
Adjudicating the Claim Executive Office of Management & Budget Messages
Executive Office of Management & Budget Messages
1705
•
Professional Relations
Professional Relations for HCFA Common Procedure Coding System
1706
•
Dual Eligibility/Entitlement Situations
1707
•
Preoperative Services Paid Under the Physician Fee Schedule
1708
•
Payment for Intravenous Iron Replacement Therapy Drugs
Sodium Ferric Gluconate Complex in Sucrose Injection
Iron Sucrose Injection
Messages for Use with Denials
1709
•
Home Care And Domiciliary Care Visits
1710
•
Summary
Payment and Coding Requirements
Processing Claims to Ensure That Payment Conditions Are Met
1711
•
Simplified Roster Bills
1712
•
Review of Health Insurance Claim Form HCFA-1500
1713
•
Definition of Drug of Biologicals
1714
•
Billing Procedures and Modifiers for Certified Registered Nurse Anesthetist and Anesthesiologist in a Single Anesthesia Procedure
Exempt Certified Registered Nurse Anesthetist as Rural Hospitals
1715
•
Responsibility to Download and Implement DME Prosthetic, Orthotics & Supplies Fee Schedules
Carriers Manual
Part 4—Program Administration
(HCFA Pub. 14-4)
(Superintendent of Documents No. HE 22.8/7)
24
•
Provider Enrollment
Program Memorandum
Intermediaries (HCFA Pub. 60A)
(Superintendent of Documents No. HE 22.8/6-5)
A-01-48
•
Requirement for Line-Item Dates of Service for Ambulance Claims
A-01-49
•
Announcement of Medicare Rural Health Clinic and Federally Qualified Health Centers Payment Rate Increases, Changes to the Rural Health Clinic Benefit Made By the Medicare, Medicaid, and State Child Health Insurance Program Benefits Improvement and Protection Act (BIBA) of 2000 and Clarification Regarding Drugs Furnished by Rural Health Clinics Federally Qualified Health Center Manuals
A-01-50
•
Further Guidance Regarding Billing Under the Outpatient Prospective Payment System
A-01-51
•
Calculating Payment-to-Cost Ratios for Purposes of Determining Transitional Corridor Payment Under the Outpatient Prospective Payment System and Revising the Criteria Under Which a Provider May Request a Recalculation of Its Cost-to-Change Ratio
A-01-52
•
Medicare Payment for Ambulance Services Furnished by Certain Critical Access Hospitals
A-01-53
•
Discontinuing the Recognition and Financial Reporting of Accounts Receivables Due
A-01-54
•
Elimination of the Initial Request for Anticipated Payment Medicare Summary Notice Explanation of Medicare Benefits
A-01-55
•
Accelerated Referral of Non-Medicare Secondary Payor Active Delinquent Debts to the Debt Collection Center for Cross Servicing and Treasury Offset Program
A-01-56
•
Clarification to Health Insurance Prospective Payment System Coding and Billing Instructions
A-01-57
•
Health Insurance Portability Accountability Act of 1996 Administrative Simplification Implementation of Version 4010 of the Accredited Standards Committee X12N 835 (Payment/Remittance Advice) Transaction Standard Format
A-01-58
•
Clarification of Provider Cost Report Filing Requirements
A-01-59
•
Correction of Some Fiscal Year 2001 Hospice Wage Indices
A-01-60
•
Revised Processing and Reporting Requirement Timeframes for Resolution of Outpatient Prospective Payment System Implementation Issues
A-01-61
•
Processing of 1999 Bills Under the End Stage Renal Disease Composite Rate System
A-01-62
•
Extension of Due Date for Filling Provider Cost Reports
A-01-63
•
Further Guidance Regarding Health Insurance Portability and Accountability Act Health Care Claim and Coordination of Benefits
A-01-64
•
Providers Statistical and Reimbursement Report
A-01-65
•
HCFA Common Procedure Coding System Codes for Wheelchairs and Accessories
Instructions for Regional Home Health Intermediaries
A-01-66
•
July Outpatient Code Editor Specifications Version (V2.2)
A-01-67
•
July Medicare Outpatient Code Editor Version 16.2
A-01-68
•
Adjusting Clinical Diagnostic Laboratory Test Claims Furnished by Critical Access Hospitals
A-01-69
•
Inclusion of Medicare Paid Provider Message and Removal of the Ambulatory Payment Classification Code from Medicare Summary Notice
A-01-70
•
Frequently Asked Questions About Home Health Advance Bene
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