Medicare and Medicaid Programs; Quarterly Listing of Program Issuances-July 2003 Through September 2003

Federal RegisterDec 24, 2003

Ask Donna

What actually matters in this document.

Text

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-9019-N]

Medicare and Medicaid Programs; Quarterly Listing of Program Issuances—July 2003 Through September 2003

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 July 2003 through September 2003, relating to the Medicare and Medicaid programs. This notice provides information on national coverage determinations affecting specific medical and health care services under Medicare. Additionally, this notice identifies certain devices with investigational device exemption numbers approved by the Food and Drug Administration that potentially may be covered under Medicare. Finally, this notice also includes listings of all approval numbers from the Office of Management and Budget for collections of information in CMS regulations.

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, and to foster more open and transparent collaboration efforts, we are also including all Medicaid issuances and Medicare and Medicaid substantive and interpretive regulations (proposed and final) published during this 3-month time frame.

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. (

See

Section III of this notice for how to obtain listed material.)

Questions concerning items in Addendum III may be addressed to Karen Bowman, Office of Strategic Operations and Regulatory Affairs, Centers for Medicare & Medicaid Services, C5-16-03, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-5252.

Questions concerning national coverage determinations in Addendum V may be addressed to Patricia Brocato-Simons, Office of Clinical Standards and Quality, Centers for Medicare & Medicaid Services, C1-09-06, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-0261.

Questions concerning Investigational Device Exemptions items in Addendum VI may be addressed to Sharon Hippler, Office of Clinical Standards and Quality, Centers for Medicare & Medicaid Services, C5-13-27, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-4633.

Questions concerning approval numbers for collections of information in Addendum VII may be addressed to Dawn Willinghan, Office of Strategic Operations and Regulatory Affairs, Regulations Development and Issuances Group, Centers for Medicare & Medicaid Services, C5-09-26, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-6141.

Questions concerning all other information may be addressed to Gwendolyn Johnson, Office of Strategic Operations and Regulatory Affairs, Regulations Development and Issuances Group, Centers for Medicare & Medicaid Services, C5-12-26, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-6954.

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 the two 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, all Medicare contractors 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, and to foster more open and transparent collaboration, we are continuing our practice of including Medicare substantive and interpretive regulations (proposed and final) published during the respective 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, national coverage determinations (NCDs), and Food and Drug Administration (FDA)-approved investigational device exemptions (IDEs) published during the subject quarter 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 National Coverage Determination Manual (NCDM, formerly the Medicare Coverage Issues Manual (CIM)) may wish to review the August 21, 1989, publication (54 FR 34555). Those interested in the revised process used in making NCDs under the Medicare program may review the September 26, 2003, publication (68 FR 55634).

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 or multiple instruction(s). 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 quarter 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; and

• Title of the regulation.

• Addendum V includes completed NCDs, or reconsiderations of completed NCDs, from the quarter covered by this notice. Completed decisions are identified by the section of the NCDM (or CIM) in which the decision appears, the title, the date the publication was issued, and the effective date of the decision.

• Addendum VI includes listings of the FDA-approved IDE categorizations, using the IDE numbers the FDA 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 IDE number.

• Addendum VII includes listings of all approval numbers from the Office of Management and Budget (OMB) for collections of information in CMS regulations in title 42; title 45, subchapter C; and title 20 of the CFR.

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, PO 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://cms.hhs.gov/manuals/default.asp

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.gpoaccess.gov/fr/index.html

, by using local WAIS client software, or by telnet to

swais.gpoaccess.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://cms.hhs.gov/rulings

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 Hospice Manual, (CMS Pub. 21) transmittal entitled “Payment of Amounts Owed Medicare,” use the Superintendent of Documents No. HE 22.8/18 and the transmittal number 69.

(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: December 2, 2003.

Jacquelyn Y. White,

Director, Office of Strategic Operations and Regulatory Affairs.

Addendum I

This addendum lists the publication dates of the most recent quarterly listings of program issuances.

November 2, 1999 (64 FR 59185)

December 7, 1999 (64 FR 68357)

January 10, 2000 (65 FR 1400)

May 30, 2000 (65 FR 34481)

June 28, 2002 (67 FR 43762)

September 27, 2002 (67 FR 61130)

December 27, 2002 (67 FR 79109)

March 28, 2003 (68 FR 15196)

June 27, 2003 (68 FR 38359)

September 26, 2003 (69 FR 55618)

Addendum II—Description of Manuals, Memoranda, and CMS 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 former CIM (now the NCDM) was published on August 21, 1989, at 54 FR 34555. A brief description of the various Medicaid manuals and memoranda that we maintain was published on October 16, 1992, at 57 FR 47468.

Addendum III.—Medicare and Medicaid Manual Instructions

[July 2003 through September 2003]

Transmittal No.

Manual/Subject/Publication No.

Intermediary Manual

Part 3—Audits, Reimbursement Program Administration

(CMS-Pub. 13-3)

(Superintendent of Documents No. HE 22.8/6)

1892

•

Frequency of Billing

Provider Education

1893

•

Release Software

1894

•

Review of Form CMS-1450 (previously Form HCFA-1450) for Inpatient and

Outpatient Bills

1895

•

Diabetes Outpatient Self-Management Training Services

1896

•

Mammography Screening

Diagnostic Mammography

Diagnostic and Screening Mammography Performed With New Technologies

Mammography Billing Charts for Billing for Computer Aided Detection Devices

Common Working File Application of Age and Frequency Edits

Hospital Outpatient Partial Hospitalization Services

1897

•

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

Definitions

Retroactive Implementation

Processing Claims

Determining the 30-Month Coordination Period During Which Medicare May Be Secondary Payer

Effect of Dual Entitlement

Subsequent Periods of End-Stage Renal Disease Eligibility or Entitlement

Amount of Secondary Medicare Payments Where Group Health Payments in Part for Items and Services

Limitation on Right of Provider or Facility to Charge a Beneficiary

Responsibility of Provider/Providers of Service and Renal Dialysis Facilities

Action When Group Health Payments Erroneously Pay Primary Benefits

Referral to Regional Offices of Cases Involving Taking Into Account Medicare Eligibility or Entitlement and Benefit Differentiation During Coordination Period

Claimant's Right To Take Legal Action Against a Group Health Plan

Medical Services Furnished to End-Stage Renal Disease Beneficiaries by Source Outside Group Health Plan Managed Care Plan

Limitations on Payment for Services to Aged Beneficiaries Who are Covered by a Group Health Plan on the Basis of Current Employment Status

Definitions

Individuals Subject to Limitation on Payment, General

Individuals Not Subject to Limitation on Payment, General

Identification of Cases by Providers of Services

Identification of Cases and Action Where There Is Indication of Possible Group Health Plan Coverage

Action by Provider Where Medicare Is Secondary to Group Health Plan

Limitation on Right of Provider or Facility to Charge a Beneficiary

Employer Plan Denies Claim for Primary Benefit

Referral of Cases to Regional Offices

Recovery of Mistaken Primary Medicare Payments

Advice to Providers, Physicians, and Beneficiaries

Mistaken Group Health Plan Primary Payments

Claimant's Right to Take Legal Action Against a Group Health Plan

Special Rules for Services Furnished by Source Outside Group Health Plan

Managed Care Health Plan

Medicare as Secondary Payer for Disabled Individuals

1898

•

Payment for Services Furnished by a Critical Access Hospital

Carriers Manual

Part 3—Program Administration

(CMS Pub. 14-3) (Superintendent of Documents No. HE 22.8/7)

1808

•

Mandatory Assignment and Participation Program

Participation Program

Limiting Charge

1809

•

Durable Medical Equipment Regional Carriers—Billing Procedures Related to Advance Beneficiary Notice Upgrades

Providing Upgrades of Durable Medical Equipment Prosthetic, Orthotics, and Supplies Without Any Extra Charge

1810

•

Payment for Physician Services Furnished to Dialysis Inpatients

Dialysis Services (Codes 90935-90999)

1811

•

Release Software

Contractor Testing Requirements

1812

•

Definitions of Lines 1 through 115

Checking Reports

Exhibits

1813

•

Data Element Requirements

Payment to Physician for Purchased Diagnostic Tests

Area Carriers—Physician's Services

Payment Jurisdiction for Services Paid Under the Physician Fee Schedule and Anesthesia Services

Claims Processing Instructions for Payment Jurisdiction for Claims Received On or After April 1, 2004

Payment Jurisdiction for Purchased Services

Jurisdiction for Shipboard Services

Exceptions to Jurisdictional Payment

Exhibit 10

Items 14-33 Physician or Supplier Information

1814

•

Screening Mammography Examinations

Identifying a Screening Mammography Claim and a Diagnostic Mammography Claim

Adjudicating the Claim

Diagnostic and Screening Mammograms Performed With New Technologies

1815

•

Repairs, Maintenance, Replacement, and Delivery

1816

•

Correct Coding Initiative

1817

•

Medicare Secondary Payment General Provisions

Third Party Payer Pays Charges in Full

Physician, Supplier, or Beneficiary Bills Medicare for Primary Benefits

Multiple Insurers

Third Party Payer Pays Primary Benefits When Not Required

Right of Physician or Supplier to Charge Beneficiary

General

Definitions

Current Employment Status

Employer-Sponsored Managed Care Health Plan

Nonconforming Group Health Plan

Recovery of Mistaken Primary Medicare Payments

Advice to Physicians/Suppliers and Beneficiaries

Mistaken Group Health Plan Primary Payments

Claimant's Right to Take Legal Action Against a Group Health Plan

Special Rules for Services Furnished by Source Outside Group Health Plan

Managed Care Health Plan

Medicare Secondary Payer Provisions for Working Aged Individuals

Individual Not Subject to Medicare Secondary Payer Provision

Exception for Small Employers in Multi-Employer and Multiple Employer Group Health Plan

Dually Entitled Individuals

General

Individuals Not Subject to Medicare Secondary Payer Provision

Items and Services Furnished On or After January 1, 1987 and Before August 10, 1993 (Date of Enactment of Omnibus Budget Reconciliation Act of 1993)

1818

•

Filing the Request for Payment

1819

•

Special Requirements for Claims for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies

1820

•

Medicare Physician Fee Schedule Database 2004 File Layout

Maintenance Process for the Medicare Physician Fee Schedule Database

Carriers Manual

Part 4—Professional Relations

(CMS Pub. 14-4)

(Superintendent of Documents No. HE 22.8/7-4)

•

Provider of Services or Supplier Information

Program Memorandum Intermediaries

(CMS Pub. 60A)

(Superintendent of Documents No. HE 22.8/6-5)

A-03-057

•

Medicare Program-Update to the Hospice Payment Rates, Hospice Cap, Hospice Wage Index and the Hospice for Fiscal Year 2004

A-03-058

•

Change in Methodology for Determining Payment for Outliers Under the Acute Care Hospital Inpatient and Long-Term Care Hospital Prospective Payment System

A-03-059

•

Addition of Patient Status Code 43, Deletion of Patient Status Codes 71 and 72, and Information on New Patient Status Code 65

A-03-060

•

Medicare Program—Update to the Prospective Payment System for Home Health Agencies for Fiscal Year 2004

A-03-061

•

Tentative Settlement Requirements for Cost Reports from Home Health Agencies and Skilled Nursing Facilities That Have No Reimbursement Impact

A-03-062

•

Department of Veterans Affairs Claims Adjudication Services Project System Changes Needed

A-03-063

•

Installation of Version 30 of the Provider Statistical and Reimbursement Reporting System

A-03-064

•

X12N 837 Institutional Health Care Claim Companion Document

A-03-065

•

New Common Working File Edits to Ensure Accurate Coding and Payments for Discharge and/or Transfer Policies Under the Inpatient Prospective Payment System

A-03-066

•

Hospital Outpatient Prospective Payment System Implementation Instructions

A-03-067

•

The Supplemental Security Income Medicare Beneficiary Data for Fiscal Year 2002 for Inpatient Prospective Payment System Hospitals

A-03-068

•

Informing Beneficiaries About Which Local Medical Review Policy and/or National Coverage Determination Is Associated With Their Claim Denial

A-03-069

•

October Outpatient Code Editor Specification Version (V4.3)

A-03-070

•

Inclusion of the State of New York in Demonstration for Settlement of Payments for Home Health Services to Dual Eligibles and Instructions for Processing Fiscal Year 2000 Claims Under the Demonstration. Regional Home Health Intermediaries Only.

A-03-071

•

Retroactive Correction of Provider Statistical and Reimbursement System Report Data Related to Mammography and Outpatient Therapy Services

A-03-072

•

Instructions for Provider Credit Balance Reporting Related Activities

A-03-073

•

Fiscal Year 2004 Inpatient Prospective Payment System, Long Term Care Hospital, and Other Billing Changes

A-03-074

•

Inpatient Rehabilitation Facility Annual Update: Prospective Payment System Pricer Changes for Fiscal Year 2004

A-03-075

•

Medicare Part A Skilled Nursing Facility Prospective Payment System Update

A-03-076

•

October 2003 Update of the Hospital Outpatient Prospective Payment System

A-03-077

•

October Medicare Outpatient Code Editor Specification Version 19.0 for Bills From Hospitals That Are Not Paid Under the Outpatient Prospective Payment System

A-03-078

•

Reimbursement for Automated Multi-Channel Chemistry Tests for End-Stage Renal Disease Beneficiaries

A-03-079

•

Installation of Version 31 of the Provider Statistical and Reimbursement Reporting System

A-03-080

•

End-Stage Renal Disease Reimbursement for Automated Multi-Channel Chemistry Test

A-03-081

•

Conflicting Policies With Provider Reimbursement Manual 15-1, Section 2771

A-03-082

•

Clarification for Billing Under the 2300 Provider Number by Hospital-Based Renal Dialysis Facilities

Program Memorandum

Carriers

(CMS Pub. 60B)

(Superintendent of Documents No. HE 22.8/6-5)

B-03-050

•

Multiple Primary Payers on Part B Claims-Revision to Change Request 2050

B-03-051

•

Therapy Modifier Bypass for Ambulance Claims

B-03-052

•

Addition of Temporary “Q” Codes for Drugs Used in Infusion Pumps

B-03-053

•

Healthcare Provider Taxonomy Codes Crosswalk

B-03-054

•

Establishing and Maintaining Provider and Supplier Enrollment Data in Provider kEnrollment, Chain and Ownership System as Needed for Use By the Railroad Medicare Carrier to Pay Claims

B-03-055

•

Common Working File crossover Editing for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Claims During an Inpatient Stay

B-03-056

•

Durable Medical Equipment Regional Carriers—Additional Instructions for Health Insurance Portability and Accountability Act Implementatyion on National Drug Codes and the National Council of Prescription Drug Programs

B-03-057

•

Additional Guidelines for Implementing the National Council for Prescription Drug Program Format

B-03-058

•

Procedures for the Reconciliation of Total Funds Expended for Multi-Carriers Systems Medicare Contractors Used in the Preparation of Form CMS-1522, Monthly Contractor Financial Report

B-03-059

•

Minimum Number of Pricing Files That Must Be Maintained Online for Medicare Single Drug Pricer

B-03-060

•

Expansion of Beneficiary History and Claims in Process Files in the Voucher Insurance Plan Viable Medicare System. Phase 2—Adjudication Claims in Process File Expansion

B-03-061

•

Durable Medical Equipment Regional Carriers National Council of Prescription of Drug Programs Crosswalk Requirements

B-03-062

•

Procedures for Non-Medicare Secondary Payer Overpayments With Original Balance Less than $10

B-03-063

•

Healthcare Provider Taxonomy Codes Crosswalk

B-03-064

•

Clarification—ICD-9 Coding

B-03-065

•

Changes to Code List for Therapy Services

B-03-066

•

Durable Medical Equipment Regional Carriers—Eliminate Combined Working File Edit for Cancer Diagnosis for National Drug Codes

B-03-067

•

National Council for Prescription Drug Programs Batch Transmittal Standard 1.1 Billing Request Companion Document

B-03-068

•

2004 Annual Update for Skilled Nursing Facility Consolidated Billing for the Common Working File and Medicare Carriers

B-03-069

•

Schedule for Completing the Calendar Year 2004 Fee Schedule Updates and the Participating Physician Enrollment Procedures

Program Memorandum

Intermediaries/Carriers

(CMS Pub. 60A/B)

(Superintendent of Documents No. HE 22.8/6-5)

AB-03-094

•

October 2003 Quarterly Updates for Skilled Nursing Facility Consolidated Billing

AB-03-095

•

Remittance Advice Remark and Reason Code Update

AB-03-096

•

Quarterly Update of Healthcare Common Procedure Coding System Codes Used for Home Health Consolidated Billing Enforcement

AB-03-097

•

Delay in Implementation of Outpatient Therapy Caps to September 1, 2003

AB-03-098

•

Medicare Summary Notice Implementation for Contractors Using Arkansas Part A Standard System and HCFA Part B Standard System

AB-03-099

•

Instructions for Fiscal Intermediary Standard System and Multi-Carriers System Healthcare Integrated General Ledger Accounting System Changes

AB-03-100

•

October Quarterly Update for 2003 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Fee Schedule

AB-03-101

•

Clarification for CR 2562: Collection of Fee-for-Service Payments Made During Periods of Managed Care Enrollment

AB-03-102

•

Clarifications Regarding Coverage of Hyperbaric Oxygen Therapy for the Treatment of Diabetic Wounds of the Lower Extremities

AB-03-103

•

Medicare Secondary Payer Debt Referral and Write-Off Closed Instructions

AB-03-104

•

Changes to the Laboratory National Coverage Determination Edit Software for October 1, 2003

AB-03-105

•

Harkin Grantees: Complaint Tracking System and Aggregate Reports

AB-03-106

•

Third Clarification of Medicare Policy Regarding the Implementation of the Ambulance Fee Schedule

AB-03-107

•

Federal Bankruptcy/State Insurer Liquidation Actions and Medicare Secondary Payer Debt

AB-03-108

•

Medicare Secondary Payer—(1) Use of Inter-Contractor Notices and the Common Working File for the Development of the Medicare Secondary Payer Conditional Payment Amount for Liability, No-Fault, Worker's Compensation, and Federal Tort Claims Act Cases; (2) Reminder Regarding Termination Updates to the Common Working File; (3) Reminder Regarding Savings Information to Non-Lead Contractors

AB-03-109

•

Discontinue Use of the Healthcare Integrity and Protection Data Bank for Provider Enrollment Only

AB-03-110

•

Adjustment to the Rural Mileage Payment Rate for Ground Ambulance Services

AB-03-111

•

Shared System Maintainer Hours for Resolution of Problems Detected During Health Insurance Portability and Accountability Act Transaction Release Testing

AB-03-112

•

Transmittal AB-03-112 Has Been Rescinded

AB-03-113

•

Update of Codes in the Program Integrity Management Reporting System and the Contractor Administrative Cost and Financial Management System

AB-03-114

•

Claims Processing and Payment of Incomplete Screening Colonoscopies

AB-03-115

•

Payment Denial for Medicare Services Furnished to Alien Beneficiaries Who Are Not Lawfully Present in the United States

AB-03-116

•

Update of Rates and Wage Index for Ambulatory Surgical Center Payment Effective October 1, 2003

AB-03-117

•

Contractor Guidance for Connection to the Medicare Data Communication Network for Real-time Eligibility Inquiries (270/271) Via a Route Other Than Insurance Value-Added Network Services

AB-03-118

•

Cease Further Work on the Eligibility File-Based Standard Trading Partner Agreement for the Purpose of Coordination of Benefits

AB-03-119

•

Final Update to the 2003 Medicare Physician Fee Schedule Database

AB-03-120

•

Medicare Secondary Payer—(1) Copy of Recovery Demand Packages Resulting From a Data Match or Non-Data Match Group Health Plan Recovery Action to Insurers/Third Party Administrators of Employers; (2) Documentation Required When an Insurer/Third Party Administrator Wishes to Resolve a Debt on Behalf of Its Client, an Employer Debtor

AB-03-121

•

Requirement to Cross Claims Over to Multiple Supplemental Insurers

AB-03-122

•

Notice of Interest Rate for Medicare Overpayments and Underpayments

AB-03-123

•

Scheduled Release for October Updates to Software Programs and Pricing/Coding Files

AB-03-124

•

Standard System Automation of the Notice of Change to Medicare Secondary Payer Auxiliary File Process

AB-03-125

•

Consolidation of Claims Cross-Over Process

AB-03-126

•

Change in Type of Service for L04080

AB-03-127

•

Payment for Fecal Leukocyte Examination Under Clinical Laboratory Improvement Amendments of 1988 Certificate for Provider-Performed Microscopy Procedures During Calendar Year 2003

AB-03-128

•

Clarification to Transmittal AB-03-044 (CR 2611), Addition of New Temporary “K” Codes

AB-03-129

•

Addition of Three New International Classifications of Diseases, Ninth Revision, Clinical Modification Diagnosis Codes To Be Effective as Part of the October 1, 2003, International Classification of Diseases, Clinical Update

AB-03-130

•

Levocarnitine for Use in the Treatment of Carnitine Deficiency in End-Stage Renal Disease Patients

AB-03-131

•

Update to Health Care Claims Status Category Codes and Health Care Claim Status Codes for Use With the Health Care Claim Status Request and Response ASCX12N 276/277

AB-03-132

•

Provider Education Article: Guidelines for Medicare Part B Laboratory Testing

AB-03-133

•

Managing Medicare Appeals Workloads in Fiscal Year 2004

AB-03-134

•

Modifier and Condition Code for Providers to Use When Billing for Implantable Automatic Defibrillators for Beneficiaries in Medicare+Choice Plan

AB-03-135

•

Darbepoetin Alfa (Trade Name Aranesp) and Epoetin Alfa (Trade Name Epogen) for Treatment of Anemia in End-Stage Renal Disease Patients on Dialysis

AB-03-136

•

Correction to Quarterly Update of Health Care Common Procedure Coding System Codes Used for Home Health Consolidated Billing Enforcement

AB-03-137

•

Update of Home Care Common Procedure Coding System Codes and Payment for Ambulatory Surgical Centers and File Names, Descriptions and Instructions for Retrieving the 2004 Ambulatory Surgical Center Home Health Care Common Procedure Coding System Additions, Deletions, and Master Listing

AB-03-138

•

Modification of Medicare Policy for Erythropoietin

AB-03-139

•

Appeals Quality Improvement and Data Analysis Activities

AB-03-140

•

2004 Healthcare Common Procedure Coding System Annual Update Reminder

AB-03-141

•

CMS Companion Document for the Accredited Standards Committee X12N276/277 Health Care Claim Status Request and Response

AB-03-142

•

The Coordination of Benefits Contractor Will Post the Lead Medicare Contractor in the Group Name Field on the Common Working File and Expansion of Lead Contractor Viewing in the Electronic Correspondence Referral System

AB-03-143

•

Implementation of Certain Initial Determination and Appeal Provisions Within Section 521 of the Medicare, Medicaid and State Child Health Insurance Program Benefits Improvement and Protection Act of 2000

AB-03-144

•

Establishing a Uniform Process for the Preparation and Mailing of Case Files From the Contractor to the Office of Hearings and Appeals of the Social Security Administration

AB-03-145

•

Instructions for Contractors Other Than the Religious Nonmedical Health Care Institution Specialty Intermediary Regarding Claims For Beneficiaries With Religious Nonmedical Health Care Institution Elections

AB-03-146

•

Reminder Notice of the Implementation of the Ambulance Transition Schedule

AB-03-147

•

Core Elements and Required Statements for a Valid Privacy Authorization

State Operations Manual

(CMS Pub. 7)

(Superintendent of Documents No. HE 22.8/12)

•

Regional Offices Assignment of Provider and Supplier Identification Number

Hospice Manual

(CMS Pub. 10)

(Superintendent of Documents No. HE 22.8/2)

806

•

Hospital Manual, Credit Balance Reporting Requirements—General Provisions

Payment of Amounts Owed Medicare

Medicare Credit Balance Reporting Certification Page

807

•

Payment for Services Furnished by a Critical Access Hospital

Home Health Agency Manual

(CMS Pub. 11)

(Superintendent of Documents No. HE 33.8/5)

305

•

Diabetes Outpatient Self-Management Training

306

•

Home Health Agency Manual, Credit Balance Reporting Requirements—General Provisions

Completing the Centers for Medicare & Medicaid Services—838

Payment of Amounts Owed Medicare

Medicare Credit Balance Report Certification Page

Skilled Nursing Facility Manual

(CMS Pub. 12)

(Superintendent of Documents No. HE 22.8/3)

377

•

Credit Balance Reporting Requirements—General Provisions

Payment of Amounts Owed Medicare

Medicare Credit Balance Report Certification Page

Coverage Issues Manual

(CMS Pub. 6)

(Superintendent of Documents No. HE 22.8/14)

173

•

Implantable Automatic Defibrillators

Peer Review Organization (CMS Pub. 19)

(Superintendent of Documents No. 22.8/8-15)

•

Case Review and Health Care Quality Improvement Program—has been moved to Corresponding Internet-Only Manual chapter in Pub. 100-10, Medicare Quality Improvement Organizations Manual, which can be found at