Medicare Compliance & Reimbursement

Be prepared to re-enroll in Medicare if you enrolled prior to 2002. It's official: If you enrolled in Medicare before the Centers for Medicare & Medicaid Services (CMS) started using the Provider Enrollment, Chain and Ownership System (PECOS), then you can't simply make changes to your enrollment information.

If you do, your carrier will send your 855 enrollment form back to you and request a whole new application, according to Transmittal 173 (CR 5338). Your carrier also will return the application if it lacks a signature, if you sent it more than 30 days prior to the effective date or if you sent in a new application while you were still entitled to appeal the denial of a previous application.

Other news from recent CMS transmittals: 

If you provide long-distance medicine to patients who can't visit in person, you'll receive a pay hike for 2007. The "telehealth originating facility fee" (code Q3014) for 2007 is $22.94, up from $20 originally, according to Transmittal 258 (CR 5443). The transmittal also explains that carriers will apply the 25-percent reduction for multiple imaging scans on the same body region first -- and then apply the outpatient-imaging cap, where applicable. You'll have some new codes to cope with this year if you're taking part in the physician voluntary reporting program (PVRP) to get extra feedback on whether you meet quality measures. Transmittal 259 (CR 5409) lists dozens of potential new PVRP codes, including whether the physician documented alarm symptoms, ordered a barium swallow test, screened the patient for risk of falling or gave the patient aspirin in the emergency room. 

Brace yourself: Carriers should automatically deny any claims where a code has more units on a single day than the Medically Unlikely Edits (MUEs) allow, CMS says. The MUEs will include a code, the maximum daily units, and the effective date, according to Transmittal 178 (CR 5402).

There's good news for practices supplying intravenous immune globulin (IVIG) to patients. In the face of shortages and high costs for IVIG, CMS will continue to pay an extra "pre-administration" payment once per day for patients receiving IVIG. You must bill G0332 on the same claim form as the IVIG product (J1566-J1567), according to Transmittal 1140 (CR 5428). 

Know your rights: Medicare contractors have 60 days to make a decision about your claim during Medical Review. After that time, they must either send you a notification of their decision or enter the decision and reason codes into one of the shared computer systems, according to Transmittal 179 (CR 5252). 

Stay up to date: CMS issued the new quarterly average sales price (ASP) payment amounts for Part B drugs in Transmittal 1129 (CR 5413). 

Medicare won't cover infrared therapy for diabetic neuropathy, according to Transmittal [...]