Medicare Compliance & Reimbursement

Brace yourself, rehab providers. The Centers for Medicare & Medicaid Services is gearing up to implement the much dreaded - and oft delayed - therapy cap. In a May 2 program memorandum (AB-03-057; http://cms.hhs.gov/manuals/pm_trans/AB03057.pdf), CMS declares that Medicare claims processors should begin applying the cap starting July 1. The cap applies to occupational therapy and physical therapy (including speech-language pathology). In other recent program memoranda, CMS:
lists diagnosis codes for pap smear and pelvic exam services (AB-03-054; http://cms.hhs.gov/manuals/pm_trans/AB03054.pdf);
declares that therapy services rendered by physicians are excluded from home health consolidated billing (B-03-037; http://cms.hhs.gov/manuals/pm_trans/B03037.pdf0;
outlines its policies on end stage renal disease reimbursement for automated multi-channel chemistry tests (A-03-033; http://cms.hhs.gov/manuals/pm_trans/A03033.pdf);
identifies proper revenue codes for medical devices that have been granted pass-through status under the outpatient prospective payment system (A-03-035; http://cms.hhs.gov/manuals/pm_trans/A03035.pdf);
lays out claims processing instructions for oral anti-cancer drugs (B-03-038; http://cms.hhs.gov/manuals/pm_trans/B03038.pdf);
lists the latest waived tests under the Clinical Laboratory Improvement Amendments (AB-03-056; http://cms.hhs.gov/manuals/pm_trans/AB03056.pdf);
clarifies timely-filing rules for certain PPS claims (A-03-034; http://cms.hhs.gov/manuals/pm_trans/A03034.pdf);
offers guidance to contractors on managing Medicare appeal workload backlogs (AB-03-052; http://cms.hhs.gov/manuals/pm_trans/AB03052.pdf);
updates fiscal intermediary reporting requirements for the Program Integrity Management Reporting System (A-03-038; http://cms.hhs.gov/manuals/pm_trans/A03038.pdf);
continues the long process of getting the Health Care Financing Administration-to-CMS name change worked out in its computer systems (AB-03-059; http://cms.hhs.gov/manuals/pm_trans/AB03059.pdf);
alerts contractors to some Health Insurance Portability and Accountability Act transaction release testing (AB-03-055; http://cms.hhs.gov/manuals/pm_trans/AB03055.pdf);
announces the availability of online screens for laboratory national coverage determinations (AB-03-053; http://cms.hhs.gov/manuals/pm_trans/AB03053.pdf);
alerts contractors to changes in the ambulatory surgical center HCPCS master listing (AB-03-032; http://cms.hhs.gov/manuals/pm_trans/AB03032.pdf);
announces the latest update to the provider statistical and reimbursement reporting system (A-03-036; http://cms.hhs.gov/manuals/pm_trans/A03036.pdf);
lays out instructions relating to the Provider Enrollment Chain Ownership System (B-03-032; http://cms.hhs.gov/manuals/pm_trans/B03032.pdf; B-03-033; http://cms.hhs.gov/manuals/pm_trans/B03033.pdf; B-03-034; http://cms.hhs.gov/manuals/pm_trans/B03034.pdf; and B-03-035; http://cms.hhs.gov/manuals/pm_trans/B03035.pdf);
outlines policies for handling situations where contractors make fee-for-service payments during periods of managed care enrollment (AB-03-058; http://cms.hhs.gov/manuals/pm_trans/AB03058.pdf);
describes changes to certain flat files (AB-03-060; http://cms.hhs.gov/manuals/pm_trans/AB03060.pdf) and the beneficiary history and claims-in-process files (B-03-036; http://cms.hhs.gov/manuals/pm_trans/B03036.pdf); and
updates policy on the Contractor Reporting of Operational and Workload Data system (B-03-031; http://cms.hhs.gov/manuals/pm_trans/B03031.pdf and A-03-037; http://cms.hhs.gov/manuals/pm_trans/A03037.pdf).