Medicare Compliance & Reimbursement

Effective Oct. 1, you'll have a host of lab codes that you'll be able to report as "CLIA-waived," thanks to a Sept. 12 CMS transmittal on the matter.

According to Transmittal 1594, CMS will now consider 21 additional tests CLIA-waived. You'll have to append modifier QW (CLIA-waived test) to these codes, which include the following, among others:

• 83520 -- Immunoassay, analyte, quantitative; not otherwise specified

• 87880 -- Infectious agent detection by immunoas say  with direct optical observation; Streptococcus, group A

• 89300 -- Semen analysis; presence and/or motility of sperm including Huhner test (post coital)

To read the full list of newly-approved CLIA-waived tests, visit the CMS Web site at http://www.cms.hhs.gov/transmittals/downloads/R1594CP.pdf

• Providers who would like to brush up on vaccination billing procedures before the season starts can consult two new transmittals from the Centers for Medicare & Medicaid Services.

The agency outlines the difference between mass immunization roster billers and centralized billers, among other specifics, in Aug. 15 Transmittal No. 366 (CR 6121).

Reminder: Beneficiaries do not need to have a physician's order or supervision to receive a Medicare-covered vaccination, points out the transmittal, which you can find at http://www.cms.hhs.gov/transmittals/downloads/R366OTN.pdf. And CMS spells out vaccination billing changes to the Medicare Claims Processing Manual in a Sept. 5 transmittal.

For example: Roster bills do not require a National Provider Identifier (NPI), CMS says in Transmittal No. 1586 (CR 6079), located at http://www.cms.hhs.gov/transmittals/downloads/R1586CP.pdf.

• Most coders and billers are eager to slash their denials and increase reimbursement. One quick way to ensure that you've filed your claims properly is to fill out the all-important CMS-1500 form accurately.

To confirm that practices are completing their CMS-1500 claim forms correctly, CMS has instituted a Web-based training course that offers information "that will allow you to file Medicare Part B claims accurately and reduce your chances of receiving unprocessable rejections," according to a Sept. 9 alert from CMS.

To access the Web-based training seminar, visit www.cms.hhs.gov/mlngeninfo, click "Related links inside CMS," and click on "Web-based training modules."

Best bet: Keep a CMS-1500 form handy during the training so you can refer to it often. You can find them at http://www.cms.hhs.gov/cmsforms/downloads/CMS1500805.pdf.

• If you're enjoying the opportunity to obtain drugs for Medicare beneficiaries under the CAP program, CMS has some bad news for you.

CMS has elected to halt the Competitive Acquisition Program (CAP) effective Dec. 31, according to a Sept. 10 CMS announcement.

CMS has reviewed bids for the 2009 CAP program, but "contractual issues with the successful bidders resulted in CMS postponing the 2009 program," the Sept. 10 announcement says. "As a result, CAP physician election for participating in the CAP in 2009 will not be held, and CAP drugs will not be available from an approved CAP vendor for dates of service after Dec. 31, 2009."

CMS plans to assess feedback from participating physicians and vendors so the agency can "consider implementing changes to the CAP before proceeding with another bid solicitation."

If you'd like to submit comments to CMS on the CAP program, go online to http://www.cms.hhs.gov/Competitive AcquisforBios.