Medicare Compliance & Reimbursement

If some of your Medicare Part B claims are rolling in more slowly than usual, CMS has the reason why. On April 8, CMS announced that it discovered several claims processing errors that MACs are in the process of correcting, as follows:

Preventive services codes and surgical codes billed on the same date as a colonoscopy, flexible sigmoidoscopy, or barium enema "that were initiated as colorectal cancer screening services with dates of service on and after Jan. 1, 2011 were suspended due to deductible and coinsurance being erroneously applied," the announcement said. CMS began correcting this problem on April 4.

Outpatient claims for Hepatitis B vaccine codes 90740-90747 submitted on type of bill 13X for dates of service Jan. 1 or thereafter "are suspending if they are the only service on the claim," CMS noted. "Also, claims containing Hepatitis B vaccine services are not being paid when other services are billed on the same claim." MACs are holding claims impacted by this problem until CMS corrects the issue.

If you have any specific questions regarding claims for these services, contact your MAC's provider assistance department.

• Medicare is putting its money where its mouth is on hospital readmissions, and home care providers could stand to gain from the move. CMS is putting an additional $500 million into its Community-based Care Transitions Program, which aims to reduce rehospitalizations by improving care during a transition between care settings. The program began in 14 communities in 2009 and included home care and hospice participants.

CMS is accepting proposals for the Care Transitions funding now. "Today, community-based organizations and acute care hospitals that partner with community-based organizations can begin submitting applications for this funding," CMS instructs. "Applications are being accepted on a rolling basis. Awards will be made on an ongoing basis as funding permits."

CMS's new Innovation Center will use another $500 million to fund testing of different models to improve patient care for both hospital acquired conditions and improving care transitions, the agency adds.

The program, called the Partnership for Patients, could save Medicare $50 billion over the next 10 years, CMS predicts.

More information about the bids is at www.cms.gov/DemoProjectsEvalRpts/MD/itemdetail.asp?itemID=CMS1239313.

• Don't forget to include Type of Admission codes on your claims. "The Priority (Type) of Admission or Visit code is now required on all version 4010A1 institutional claims submitted or corrected via direct data entry, as well as on version 5010 institutional claims, regardless of how they are submitted," CMS explains in an e-mail message. Home care providers were confused when they started receiving returned claims with 11701 and 11801 error codes.

Tip: "Providers that are unsure which code to use are to use code 9 (Information not Available)," CMS instructs.

Outpatient claims were editing incorrectly with reason code 11701 and 11801, HHH MAC Palmetto GBA notes on its website. The new Type of Admission code requirement is for institutional claims only. But the issue is resolved and claims are no longer rejecting in error, Palmetto says.

CMS "directed contractors to temporarily inactivate the reason codes 11701 and 11801 for all Hard Copy and Direct Data Entry (DDE) claims," HHH MAC subcontractor National Government Services says in an e-mail to providers.

• CMS has added another specialty designation to your list, so when you submit claims you can identify the type of provider that performed a service. New specialty code 95 will apply to advanced diagnostic imaging (ADI) accreditation, effective July 1, 2011.

"Although CMS had previously designated this specialty code to the CAP drug vendor project, it will now be assigned to ADI accreditation," CMS said in Transmittal 2192. To read the entire transmittal, visit http://www.cms.gov/transmittals/downloads/R2192CP.pdf.

Competitive bidding for durable medical equipment may take a bit longer to come to your area, if it hasn't already arrived. CMS announced a six-month delay to Round 2 of DME competitive bidding at the Program Advisory and Oversight Committee (PAOC) meeting on April 4. Round 1 of bidding went into effect Jan. 1 in nine metro areas. Round 2 will expand the program to 91 metro areas.

Under the delay, contract winners will be announced in Spring 2013 and the prices and contracts would start in the Summer of 2013.