by Jared Staheli
June 25th, 2015
Section 630 of the MMA, indefinitely extended by §2902 of the ACA, extended to IHS providers, suppliers, physicians and practitioners, independent ambulance suppliers, hospital based ambulance providers and clinical laboratory service suppliers the ability to bill for all Medicare Part B covered services and items which were not covered under BIPA. This includes all screening and preventive services covered by Medicare. This chapter contains the effective dates for services implemented under §630 of the MMA and §2902 of the ACA.
Beginning January 1, 2005, IHS providers and suppliers may bill Medicare for the following Medicare Part B services:
• Prosthetics and orthotics;
• Prosthetic devices;
• Surgical dressings, splints and casts;
• Therapeutic shoes;
• Drugs (A/B MAC and DME MAC drugs);
• Clinical laboratory services;
• Ambulance services; and
• Screening and preventive services not already covered.
Payment is made on the AIR for IHS providers. Payment is made on the appropriate fee schedule for IHS suppliers:
• The Medicare Physician Fee Schedule (MPFS);
• The Clinical Diagnostic Laboratory Fee Schedule;
• The Ambulance Fee Schedule;
• The DMEPOS Fee Schedule;
• The Anesthesia Fee Schedule; or
• DME MAC Drugs – based on the average sales price (ASP).
The nature of the provider or supplier, the location where the service is furnished and the service being rendered determines if the carrier, FI, Part A/B MAC, or regional DME MAC shall be billed. Most services that are paid under a fee schedule are billed to either the designated carrier or the (regional) DME MAC. Some fee schedule paid services are billed to the designated FI. For example, physical therapy may be billed to the designated carrier or Part A/B MAC by an independent practitioner, but is billed to the FI or Part A/B MAC when provided by a hospital outpatient department or by a hospital-based facility.
Refer to §80.3 of this chapter for more information on the claims processing jurisdiction for claims filed by IHS independent ambulance suppliers.
Refer to §80.7.1 of this chapter for more information on the claims processing jurisdiction for claims filed by freestanding facilities for clinical laboratory services.
Refer to §90.2.1 of this chapter for more information on the services billed to DME MAC.
Refer to §126.96.36.199 of this chapter for more information on the services billed to the FI.
Refer to Chapter 1, §10.1.9 of Pub. 100-04, Medicare Claims Processing Manual, for information on misdirected claims.