Provider Reimbursement Manual

NEW/REVISED MATERIAL--EFFECTIVE DATE:

This transmittal updates Chapter 36, Hospital and Hospital Health Care Complex Cost Report, (Form CMS-2552-96). This transmittal also reflects further clarification to existing instructions and incorporates select Federal Register provisions. The effective date for instructional changes will vary due to various implementation dates. This manual is available on the CMS site in an electronic version and as a paper manual.

Martin Luther King Jr. Day Holiday Schedule

Highmark Medicare Services will be observing the Martin Luther King Jr. Day Holiday on Monday, January 19, 2009. Our business doors will be closed and the EDI Services Help Desk will not be available. However, you may continue utilizing EDI services.

Lunch and Learn- Sleep Studies January 13, 2009 12:00 PM (EST)

Please join us for lunch and get the Medicare education you need! Lunch and Learn teleconferences cover a single educational topic in less than 30 minutes. These power paced sessions are uniquely tailored to fit your busy schedule. We will be discussing Sleep Studies on January 13, 2009 at noon. The handout material is now available.

CMS Reissues Attachment D to Chapter 8 of the OASIS Implementation Manual

"Attachment D" to Chapter 8 of the "Outcome and Assessment Information Set (OASIS) Implementation Manual" has been reissued to promote accurate selection and assignment of the patient's diagnosis on the current OASIS (OASIS B1 [1/2008).

Medicare Billing Information for Rural Providers, Suppliers, and Physicians

The publication titled Medicare Billing Information for Rural Providers, Suppliers, and Physicians (revised October 2008), which consists of charts that provide Medicare billing information for Rural Health Clinics, Federally Qualified Health Centers, Skilled Nursing Facilities, Home Health Agencies, Critical Access Hospitals, and Swing Beds, is now available in print format from the Centers for Medicare & Medicaid Services Medicare Learning Network. To place your order, visit here, scroll down to "Related Links Inside CMS" and select "MLN Product Ordering Page."

Martin Luther King Jr. Day Holiday Schedule

Highmark Medicare Services will be observing the Martin Luther King Jr. Day Holiday on Monday, January 19, 2009. Our business doors will be closed and the EDI Services Help Desk will not be available. However, you may continue utilizing EDI services.

Summary of Policies in the 2009 Medicare Physician Fee Schedule (MPFS)

MLN Matters article MM6349 provides a summary of the policies in the 2009 MPFS and announces the telehealth originating site facility fee payment amount.

Medicare Billing Information for Rural Providers, Suppliers, and Physicians

The publication titled Medicare Billing Information for Rural Providers, Suppliers, and Physicians (revised October 2008), which consists of charts that provide Medicare billing information for Rural Health Clinics, Federally Qualified Health Centers, Skilled Nursing Facilities, Home Health Agencies, Critical Access Hospitals, and Swing Beds, is now available in print format from the Centers for Medicare & Medicaid Services Medicare Learning Network. To place your order, visit here, scroll down to "Related Links Inside CMS" and select "MLN Product Ordering Page."

Lunch and Learn - New vs. Established Patients and Office and Other Outpatient Consultation Codes

Please join us for our upcoming Lunch and Learn teleconferences. Our January 9, 2009 Lunch and Learn will focus on the distinction between a new versus an established patient and January 16, 2009 we will review the Office or Other Outpatient Consultation codes 99244 and 99245, and how to bill for them appropriately.

MLN Matters Articles from CMS

New:

MM6351 - Emergency Update to the 2009 Medicare Physician Fee Schedule Database (MPFSDB) 

MM6282 -  Incorporation of Recent Regulatory Revisions Pertinent to Suppliers of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) 

MM6328 – Claim Status Category Code and Claim Status Code Update 

MM6261 – Signature and Date Stamps for DME Supplies-Certificates of Medical Necessity (CMNs) and DME MAC Information Forms (DIFs) 

MM6290 – Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 15.0, Effective January 1, 2009 

Revised:

MM6070 -  Calendar Year (CY) 2009 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment