Medicare Compliance & Reimbursement

CMS to Update LCDs With ICD-10 Codes by April 10

If your practice has been clamoring to find out which ICD-10 codes will be linked to each type of procedure code, the Centers for Medicare & Medicaid Services has pledged to get you that information by April. MLN Matters article MM8348, issued Sept. 6, says “All ICD-10 local coverage decisions (LCDs) and associated ICD-10 articles will be published on the Medicare Coverage Database no later than April 10, 2014. All other LCDs and articles (i.e., those LCDs and articles that do not contain ICD-10 information, or articles not attached to an LCD) will be published no later than Sept. 4, 2014).

Since the ICD-10 implementation date is Oct. 1, 2014, this should give you almost six months to nail down the LCD transition, which will help guide you in determining the crosswalk of which diagnosis codes are linked to which procedures.

To read the complete MLN Matters article on this topic, visit www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8348.pdf.

CMS Gives Vaccine Prices a Shot in the Arm

Good news for physicians who administer flu shots — CMS seems inclined to give practices a break with some of its recent updates to the seasonal influenza vaccines pricing, which CMS announced on Sept. 13. CMS boosted payment for one code this season and reduced pay for another, according to MLN Matters article MM8433.

The Part B payment changes related to flu vaccines are as follows and went into effect on August 1:

• 90655 — Influenza virus vaccine, trivalent, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use — $17.243 (up from $16.456 last year)
• 90656 — Influenza virus vaccine, trivalent, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use — $12.398 (exactly the same as last year)
• 90657 — Influenza virus vaccine ,trivalent, split virus, when administered to children 6-35 months of age, for intramuscular use — $6.022 (down from $6.023 last year)
• 90685 — Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use — $23.228 (new code this year so comparison values aren’t available)
• 90686 — Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to individuals 3 years of age and older, for intramuscular use — $19.409 (new code this year so comparison values aren’t available).

For more on CMS’s flu shot pricing, visit www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM8433.pdf

Nix This Home Health Claim Type Next Month

Don’t forget that you can no longer use type of bill 33x as of Oct. 1, reminds Home Health & Hospice Medicare Administrative Contractor NGS. “Claims submitted with TOB 033x will be rejected and returned,” NGS warns on its website.

Claims rejected for this reason will return with two error codes, NGS says: CSCC A7 (Acknowledgement/Rejected for Invalid Information) and CSC 228 (Type of bill for UB claim). CMS announced the change in May.

MAC Makes Changes To Extended Repayment Plans

Don’t be surprised to see changes if you need to request an Extended Repayment Schedule. Changes to the ERS process took effect Sept. 3, HHH Medicare Administrative Contractor Palmetto GBA notes on its website.

For example: While your MAC or CMS evaluates your ERS request, Medicare now will recoup 30 percent on the overpayment for which the request was submitted. That’s down from 100 percent, Palmetto points out. “The 30 percent recoupment will be applied to the outstanding overpayment in addition to the required monthly payment submissions by the provider while the plan is under review,” the MAC explains.

See other ERS changes, including adjustments to the hardship definition, at http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/fin106c04.pdf