Medicare Compliance & Reimbursement

Starting Oct. 1, if you don't include an ICD-9-CM diagnosis code on your Part B claims, you probably won't get paid. It's all part of complying with the Health Insurance Portability and Accountability Act transactions and code sets standards, the Centers for Medicare & Medicaid Services explains in a June 6 program memorandum (B-03-045; http://cms.hhs.gov/manuals/pm_trans/B03045.pdf). The only exceptions to the rule - which otherwise applies to all professional claims - are claims submitted by ambulance suppliers. CMS offers more information on the new policy in a provider education article included in a July 11 program memo (B-03-046; http://cms.hhs.gov/manuals/pm_trans/B03046.pdf). In other recent program memoranda, CMS: counsels contractors on screening complaints alleging fraud and abuse (AB-03-083; http://cms.hhs.gov/manuals/pm_trans/AB03083.pdf); instructs contractors to alert beneficiaries to the outpatient therapy cap (AB-03-085; http://cms.hhs.gov/manuals/pm_trans/AB03085.pdf); updates coordination of benefits processing procedures (A-03-047; http://cms.hhs.gov/manuals/pm_trans/A03047.pdf); lays out contractor budgeting rules for Medicare secondary payer matters (AB-03-082; http://cms.hhs.gov/manuals/pm_trans/AB03082.pdf); updates outpatient code editor software (A-03-048; http://cms.hhs.gov/manuals/pm_trans/A03050.pdf and A-03-050; http://cms.hhs.gov/manuals/pm_trans/A03050.pdf); orders fiscal intermediaries to use the "SuperOp" system (A-03-049; http://cms.hhs.gov/manuals/pm_trans/A03049.pdf); amends certain policies relating to the Provider Enrollment Chain Ownership System (B-03-044; http://cms.hhs.gov/manuals/pm_trans/B030 44.pdf); and announces changes to the national coverage determination edit software (AB-03-084; http://cms.hhs.gov/manuals/pm_trans/AB03084. pdf).