Medicare Compliance & Reimbursement
Don't Forget About Pending OPPS Changes
The bulk of the changes to hospital outpatient prospective payment system billing procedures and payment policies will affect facility claims for drugs and biologicals.
Effective Oct. 1, 2005, the Centers for Medicare and Medicaid Services will grant "pass-through" status to C9225 (Injection, fluocinolone acetonide intravitreal implant, per 0.59 mg) and C9226 (Injection, ziconotide for intrathecal infusion, per 5 mcg), the agency announced in a Sept. 2 Medlearn Matters article. Other changes under the October OPPS update include:
• The pass-through status effective date for J8501 (Aprepitant, oral, 5 mg) is April 4, 2005, not April 6.
• Effective May 31, 2005, you can bill for galsulfase using code C9224 (Injection, galsulfase, per 5 mg).
• When hospitals use a surgically implanted device for which they incur no cost, they should report a charge of zero for the device and submit a token charge ($1.00) to their fiscal intermediary.
For more information, go to http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM4035.pdf.
Medicare Compliance & Reimbursement
- Special report:
Disaster Relief--Katrina, Aftermath Spur CMS To Loosen Guidelines
Unprecedented beneficiary blight lightens some procedure rules.
Many physicians and other medical professionals are donating their [...] - Rehab:
'Roadmap' Could Lead To Greater Rehab Riches
Quintet of system strategies highlight federal improvement plan.
The Centers for Medicare and Medicaid Services plans [...] - Physicians:
'Prior Determination' System Premieres
Carriers have 45 days to decide on pricey items, but may respond more quickly.
When patients [...] - Medicare Demonstration:
Providers, Get Ready For Pay System Overhaul
CMS wants your help to develop and test major health care system improvements.
The feds have [...] - Hospitals:
CMS Wants Hospitals Up To Snuff On Quality Standards
Agency says incentive payments will be harder to qualify for.
How well a hospital provides prevention [...] - Medigap:
No Money For 'None' Or 'Other' Medigap Claims
C11 denials frequently befuddle physicians.
Medicare Remittance Notices are often confusing and fail to provide enough [...] - Hospitals:
Don't Forget About Pending OPPS Changes
Pass-through payments possible for certain codes.
The bulk of the changes to hospital outpatient prospective payment [...] - Pharmaceuticals:
Initial Post-Infusion IV Push Needs Subsequent Code
AMA adds category for hormonal agents to drug administration codes.
Physicians that are struggling to come [...] - Medicaid:
Commission Recommendations Rile NGA
Proposals affect drug reimbursement, eligibility and tax treatment of MCOs.
The controversial Commission on Medicaid Reform [...] - Enforcement Watch:
States May Be Overcharging For Medical Staff
Enhanced-rate payments not possible on certain overhead costs.
Providers in states that charge the government more [...] - Medicare Part D:
Seniors Slowly Coming Around On PDP
Attitudes shift as PDP enrollment approaches.
Do more seniors believe that the upcoming Medicare prescription drug [...] - Bill Watch
The following bills were introduced in the House: H.R. 3654. A bill to amend title [...]
