Medicare Compliance & Reimbursement

MRIs Are Now Billable for Patients with Pacemakers, CMS Says

Not all coverage news coming out of CMS is bad news. The agency's July 7 announcement proves that, reporting that CMS will expand coverage of MRIs for patients with implanted pacemakers when used according to FDA-approved labeling. The latest national coverage determination "provides access to the MRI environment for patients with FDA-approved pacemakers," CMS announced in its latest news release.

Currently, the only approved pacemaker that is FDAapproved for use with MRIs is the RevoMRI SureScan Pacing System, which was approved on Feb. 8. "This swift action by CMS provides patients who need a pacemaker with greater access to MRI exams," CMS administrator Donald Berwick said in the July 7 announcement.

To read the final decision memorandum, visit www.cms.gov/medicare-coverage-database/details/nca-decisionmemo.aspx?&NcaName=Magnetic%20Resonance%20Imaging%20(MRI)%20(3rd%20Recon)&bc=ACAAAAAAIAAA&NCAId=252&.

If you missed the first 5010 form testing day in June, never fear -- CMS has announced a new period when you can test your 5010 form, but instead of a day, it's a whole week. Between Aug. 22 and Aug. 26, CMS will allow you an opportunity to submit a 5010 form to your MAC to determine whether your submission will be successful. In addition, the MACs will offer "the added benefit of realtime help desk support and direct and immediate access to MACs," CMS noted in a July 12 news release.

Reminder: If your practice is not 5010-form compliant by Jan. 1, 2012, you'll face denied claims, because that's when CMS starts requiring the new HIPAA 5010 forms. Many CMS open door forums have focused on the fact that the new 5010 forms will be better equipped to handle ICD-10 codes than current claim forms, but keep in mind that your system will need to be able to process both the old ICD-9 code set and new ICD-10 code set simultaneously. This will allow for claims processing, reporting, and analysis until all healthcare entities and services are converted to ICD-10. The period of time needed for maintaining both ICD-9 and ICD-10 will depend on the needs of your individual practice. For more information on the 5010 transition, visit www.CMS.gov/Versions5010andD0.