New This Month (July 2015)July 01, 2015
What's new? Article Payment Jurisdiction Among A/B MACs (B) for Services Paid Under the Physician Fee Schedule and Anesthesia Services (Rev. 3086) Article Payment Jurisdiction for Services Subject to the Anti-Markup Payment Limitation Article Claims Processing Requirements for Deported Beneficiaries (Rev. 943, Issued: 05-05-06) Article Implementation of Payment Policy for Deported Medicare Beneficiaries (Rev. 943, Issued: 05-05-06) Article Provider Assignment to FIs and MACs (Rev. 1707; Issued: 03-27-09) Article FI Service to HHAs and Hospices (Rev. 1, 10-01-03) Article Provider Change of Ownership (CHOW) (Rev. 861, Issued: 02-17-06) Article CMS No Longer Accepts Provider Requests to Change Their FI (Rev. 2876, Issued: 02-07-14) Article Provider Participation (Rev. 1, 10-01-03) Article Content and Terms of Provider Participation Agreements (Rev. 1, 10-01-03) Article Provider Charges to Beneficiaries (Rev. 2921, Issued: 04-04-14) Article Charges to Hold a Bed During SNF Absence (Rev. 1522, Issued: 05-30-08) Article Provider Refunds to Beneficiaries (Rev. 1, 10-01-03) Article Provider Treatment of Beneficiaries (Rev. 1, 10-01-03) Article Assignment of Provider’s Right to Payment (Rev. 1, 10-01-03) Article Exceptions to Assignment of Provider’s Right to Payment – Claims Submitted to A/B MACs (Rev. 1931, Issued: 03-12-10) Article Background and Purpose of Reassignment Rules - Claims Submitted to B/MACs (Rev. 1931, Issued: 03-12-10) Article Reassignments by Nonphysician Suppliers - Claims Submitted to FIs (Rev. 1, 10-01-03) Article Effect of Payment to Ineligible Recipient (Rev. 1, 10-01-03) Article Payment to Agent - Claims Submitted to Carriers (Rev. 1, 10-01-03) Article Payment to Bank (Rev. 213, 06-25-04) Article Payment to Employer of Physician - Carrier Claims Only (Rev. 1, 10-01-03) Article Payment for Services Provided Under a Contractual Arrangement - Carrier Claims Only (Rev. 472, Issued: 02-11-05) Article University-Affiliated Medical Faculty Practice Plans - Claims Submitted to Carriers (Rev. 1, 10-01-03) Article Indirect Payment Procedure (IPP) - Payment to Entities that Provide Coverage Complementary to Medicare Part B (Rev. 2896, Issued: 03-07-14) Article Payment to Physician or Other Supplier for Diagnostic Tests Subject to the Anti-Markup Payment Limitation - Claims Submitted to A/B MACs (B) (Rev. 3089, Issued: 10-21-14) Article Payment Under Reciprocal Billing Arrangements - Claims Submitted to Carriers (Rev. 1486, Issued: 04-04-08) Article Physician Payment Under Locum Tenens Arrangements - Claims Submitted to Carriers (Rev. 1486, Issued: 04-04-08) Article Establishing That a Person or Entity Qualifies to Receive Payment on Basis of Reassignment - for Carrier Processed Claims (Rev. 1, 10-01-03) Article Billing Procedures for Entities Qualified to Receive Payment on Basis of Reassignment - for A/B MAC (B) Processed Claims (Rev. 3086, Issued: 10-03-14) Article Correcting Unacceptable Payment Arrangements (Rev. 1931, Issued: 03-12-10 Article Questionable Payment Arrangements (Rev. 1, 10-01-03) Article Sanctions for Prohibited Payment Arrangement (Rev. 1, 10-01-03) Article Prohibition of Assignments by Beneficiaries Article Two-Midnight Rule- CMS Fact Sheet Article Physician/Practitioner/Supplier Participation Agreement and Assignment - Carrier Claims (Rev. 1035, Issued: 08-18-06) Article Mandatory Assignment on Carrier Claims (Rev. 2487, Issued: 06-08-12) Article Processing Claims for Services of Participating Physicians or Suppliers by Carriers (Rev. 1, 10-01-03) Article Nature and Effect of Assignment on Carrier Claims (Rev. 643, Issued: 08-12-05) Article Dentists: Prescriptions and Referring to other providers with Medicare Article Transfer of Claims Material Between Carrier and Intermediary (FI) (Rev. 2474, Issued: 05-18-12) Article A DME MAC receives a Paper Claim with Items or Services that are in Another DME MAC's Payment Jurisdiction (Rev. 2474, Issued: 05-18-12) Article FI Jurisdiction of Requests for Payment (Rev. 1, 10-01-03) Article FI Payment for Emergency and Foreign Hospital Services (Rev. 1, 10-01-03) Article Payments Under Part B for Services Furnished by Suppliers of Services to Patients of a Provider (Rev. 1, 10-01-03) Article Claims Submitted for Items or Services Furnished to Medicare Beneficiaries in State or Local Custody Under a Penal Authority (Rev. 1944, Issued: 04-09-10) Article Carrier Claims Processing - Reporting of Pricing Localities for Clinical Laboratory Services (Rev. 85, 02-06-04) Article Medicare Carrier or RRB-Named Carrier to Welfare Carrier (Rev. 2474, Issued: 05-18-12) Article Protests Concerning Transfer of Requests for Payment to Carrier (Rev. 2474, Issued: 05-18-12) Article Carrier Claims Processing - Jurisdiction of Laboratory Claims (Rev. 3071, 12-22-14) Article Carrier Claims Processing - Examples of Reference Laboratory Jurisdiction Rules (Rev. 85, 02-06-04) Article Specimen Collection Fee (Rev. 1, 10-01-03) Article Independent Laboratory Specimen Drawing (Rev. 3071, 12-22-14) Article Specimen Drawing for Dialysis Patients (Rev. 3056, 12-01-14) Article Coding Requirements for Specimen Collection (Rev. 3056, 12-01-14) Article Clinical Laboratory Improvement Amendments (CLIA) Requirements - Background (Rev. 3014, Effective: Upon Implementation of ICD-10) Article Verifying CLIA Certification (Rev. 865, 07-03-06) Article CLIA Numbers (Rev. 1, 10-01-03) Article CLIA Categories and Subcategories (Rev. 1, 10-01-03) Article Certificate for Provider-Performed Microscopy Procedures (Rev. 865, 07-03-06) Article Certificate of Waiver (Rev. 1652, 01-05-09) - CLIA Article HCPCS Subject To and Excluded From CLIA Edits (Rev. 865, 07-03-06) Article CLIA Number Submitted on Claims from Independent Labs (Rev. 3014, Effective: Upon Implementation of ICD-10) Article Anatomic Pathology Services (Rev. 1, 10-01-03) Article Technical Component (TC) of Physician Pathology Services to Hospital Patients (Rev. 2714, 06-25-13) Article National Minimum Payment Amounts for Cervical or Vaginal Smear Clinical Laboratory Tests (Rev. 1, 10-01-03) Article Laboratory Tests Utilizing Automated Equipment (Rev. 1, 10-01-03) Article Automated Test Listing (Rev. 1, 10-01-03) Article Organ or Disease Oriented Panels (Rev. 1451, 07-07-08) Article Claims Processing Requirements for Panel and Profile Tests (Rev. 372, 04-04-05) Article History Display (Rev. 372, 04-04-05) Article CPT Codes Subject to and Not Subject to the Clinical Laboratory Fee Schedule (Rev. 1, 10-01-03) Article Procedures Not Subject to Fee Schedule When Billed With Blood Products (Rev. 1, 10-01-03) Article Not Otherwise Classified Clinical Laboratory Tests (Rev. 1, 10-01-03) Article Billing for Hemophilia Clotting Factors (Rev. 1564, 01-05-09) Article Clotting Factor Furnishing Fee (Rev. 3055, 01-05-15) Article Intravenous Immune Globulin (Rev. 3085, Effective: Upon Implementation of ICD-10) Article Pharmacy Supplying Fee and Inhalation Drug Dispensing Fee (Rev. 754, 01-03-06) Article Reporting of Hematocrit and/or Hemoglobin Levels (Rev. 1412, 04-07-08) Article Required Modifiers for ESAs Administered to Non-ESRD Patients (Rev. 1412, 04-07-08) Article Hospitals Billing for Epoetin Alfa (EPO) and Darbepoetin Alfa (Aranesp) for Non-ESRD Patients (Rev. 1412, 04-07-08) Article Requirement for Providing Route of Administration Codes for Erythropoiesis Stimulating Agents (ESAs) (Rev. 1212; 06-29-07) Article Claims Processing Rules for ESAs Administered to Cancer Patients for Anti-Anemia Therapy (Rev. 3085, Effective: Upon Implementation of ICD-10) Article Claims Processing Rules for Hospital Outpatient Billing and Payment - Drugs, Biologicals, and Radiopharmaceuticals (Rev. 2903, 04-07-14) Article Claims Processing Rules for Hospital Outpatient Billing and Payment - HCPCS Codes Replacements (Rev. 2903, 04-07-14) Article Hospital Outpatient Payment Under OPPS for New, Unclassified Drugs and Biologicals After FDA Approval But Before Assignment of a Product-Specific Drug or Biological HCPCS Code (Rev. 3085) Article Hospital Billing For Take-Home Drugs (Rev. 3085, Effective: Upon Implementation of ICD-10) Article The Competitive Acquisition Program (CAP) for Drugs and Biologicals Not Paid on a Cost or Prospective Payment Basis (Rev. 3085, Effective: Upon Implementation of ICD-10) Article Payment Jurisdiction for Reassigned Services (Rev. 1987) Article Application of Local Medical Review Policies (Rev. 866, 07-03-06) - Competitive Acquisition Program Article Exceptions to Jurisdictional Payment (Rev. 1, 10-01-03) Article Claims Processing Instructions for the Designated Carrier (Rev. 866, 07-03-06) - Competitive Acquisition Program Article Creation of Internal Vendor Provider Files (Rev. 866, 07-03-06) - Competitive Acquisition Program Article Suppliers of Durable Medical Equipment, Prosthetics, Orthotics, Supplies, Parental and Enteral Nutrition (PEN) (Rev. 2487) Article Supplier of Portable X-Ray, EKG, or Similar Portable Services (Rev. 1, 10-01-03) Article Background (Rev. 1, 10-01-03) - Laboratory Services Article Ambulance Services Submitted to Carriers (Rev. 1, 10-01-03) Article Definitions (Rev. 85, 02-06-04) - Laboratory Services Article General Explanation of Payment (Rev. 2581, 04-01-13) - Laboratory Services Article Calculation of Payment Rates - Clinical Laboratory Test Fee Schedules (Rev. 1, 10-01-03) Article Initial Development of Laboratory Fee Schedules (Rev. 1, 10-01-03) Article Annual Fee Schedule Updates (Rev. 2106, 01-03-11) - Laboratory Services Article Mandatory Assignment for Laboratory Tests (Rev. 1, 10-01-03) Article Rural Health Clinics (Rev. 1, 10-01-03) - Laboratory Services Article Deductible and Coinsurance Application for Laboratory Tests (Rev. 2581, 04-01-13) Article Independent Laboratories (Rev. 1, 10-01-03) Article Method of Payment for Clinical Laboratory Tests - Place of Service Variation (Rev. 2971, 07-07-14) Article Payment for Review of Laboratory Test Results by Physician (Rev. 1, 10-01-03) Article Laboratories Billing for Referred Tests (Rev. 85, 02-06-04) Article Claims Information and Claims Forms and Formats (Rev. 85, 02-06-04) - Billing for Clinical Laboratory Tests Article Paper Claim Submission to A/B MACs (B) (Rev. 3089, 01-01-15) - Billing for Clinical Laboratory Tests Article Cases Involving Referral Laboratory Services (Rev. 1, 10-01-03) Article Electronic Claim Submission to A/B MACs (B) (Rev. 3089, 01-01-15) - Billing for Clinical Laboratory Tests Article Railroad Retirement Beneficiary Carrier (Rev. 142, 04-16-04) Article Payment Limit for Purchased Services (Rev. 16, 10-31-03) - Billing for Clinical Laboratory Tests Article Welfare Carriers (Rev. 1, 10-01-03) Article Hospital Billing Under Part B (Rev. 3014, Effective: Upon Implementation of ICD-10) Article Critical Access Hospital (CAH) Outpatient Laboratory Service (Rev. 2971, 07-07-14) Article Special Skilled Nursing Facility (SNF) Billing Exceptions for Laboratory Tests (Rev. 1, 10-01-03) Article Disposition of Misdirected Claims to the B/MAC/Carrier/DME MAC (Rev. 2474, Issued: 05-18-12) Article Which Contractor to Bill for Laboratory Services Furnished to a Medicare Beneficiary in a Skilled Nursing Facility (SNF) (Rev. 1, 10-01-03) Article Rural Health Clinic (RHC) Billing (Rev. 1, 10-01-03) Article A Local B/MAC/Carrier Receives a Claim for Services that are in Another Local B/MAC/Carrier’s Payment Jurisdiction (Rev. 2474, Issued: 05-18-12) Article Billing for End Stage Renal Disease (ESRD) Related Laboratory Tests (Rev. 2487, 06-19-12) Article Automated Multi-Channel Chemistry (AMCC) Tests for ESRD Beneficiaries (Rev. 3116, 04-06-15) Article A Local B/MAC/Carrier Receives a Claim for Services that are in A DME MAC’s Payment Jurisdiction (Rev. 2474, Issued: 05-18-12) Article A DME MAC Receives a Claim for Services that are in A Local B/MAC/Carrier’s Payment Jurisdiction (Rev. 2474, Issued: 05-18-12) Article A Local B/MAC/Carrier Receives a Claim for an RRB Beneficiary (Rev. 2474, Issued: 05-18-12) Article A Local B/MAC/Carrier/DME MAC Receives a Claim for a UMWA Beneficiary (Rev. 2474, Issued: 05-18-12) Article Claims Processing for Separately Billable Tests for ESRD Beneficiaries (Rev. 1655, 02-02-09) Article Separately Billable ESRD Laboratory Tests Furnished by Hospital-Based Facilities (Rev. 1655, 02-02-09) Article Skilled Nursing Facility (SNF) Consolidated Billing (CB) Editing and Separately Billed ESRD Laboratory Test Furnished to Patients of Renal Dialysis Facilities (Rev. 1769, 07-31-09) Article Billing for Noncovered Clinical Laboratory Tests (Rev. 1, 10-01-03) Article Date of Service (DOS) for Clinical Laboratory and Pathology Specimens (Rev. 1515, 01-05-09) Article Carrier Claims Processing - Referring Laboratories (Rev. 85, 02-06-04) Article Carrier Claims Processing - Physicians (Rev. 1, 10-01-03) Article Carrier Claims Processing - Assignment Required (Rev. 1, 10-01-03) Article Carrier Claims Processing - Hospital-Leased Laboratories (Rev. 1, 10-01-03) Article Carrier Claims Processing - Hospital Laboratory Services Furnished to Nonhospital Patients (Rev. 3014, Effective: Upon Implementation of ICD-10) Article SOAP notes (subjective, objective, assessment, plan) Article DMEPOS - Repair Labor Billing and Payment Policy Article Exceptions to Average Sales Price (ASP) Payment Methodology (Rev. 2437, 01-01-13) Medicare Pub 100-04 Drugs and Biologicals Article Single Drug Pricer (SDP) (Rev. 397, 01-03-05) Article Calculation of the Payment Allowance Limit for DMERC Drugs (Rev. 397, 01-03-05) Article Calculation of the AWP (Rev. 397, 01-03-05) Medicare Pub 100-04 Drugs and Biologicals Article Carrier Distribution of Limit Amounts (Rev. 1, 10-01-03) Medicare Pub 100-04 Drugs and Biologicals Article Discarded Drugs and Biologicals (Rev. 1962, 07-30-10) Article Discarded Erythropoietin Stimulating Agents for Home Dialysis (Rev. 1581; 12-01-08) Article Assignment Required for Drugs and Biologicals (Rev. 1, 10-01-03) Article DMEPOS Suppliers Require a License to Dispense Drugs (Rev. 1, 10-01-03) Article Prescription Drugs Billed by Suppliers Not Licensed to Dispense Them (Rev. 1, 10-01-03) Article Claims Processing Requirements - General (Rev. 3085, Implementation: Upon Implementation of ICD- 10) Article Billing Drugs Electronically - NCPDP (Rev. 3085, Implementation: Upon Implementation of ICD-10) Article Reporting Modifiers in the Compound Drug Segment (Rev. 1, 10-01-03) Article HCPCS Service Coding for Oral Cancer Drugs (Rev. 1, 10-01-03) Article HCPCS and NDC Reporting for Prodrugs (Rev. 136, 04-09-04) Article Oral Anti-Emetic Drugs Used as Full Replacement for Intravenous Anti-Emetic Drugs as Part of a Cancer Chemotherapeutic Regimen (Rev. 2931, 07-07-14) Article HCPCS Codes for Oral Anti-Emetic Drugs (Rev. 3085, Effective: Upon Implementation of ICD-10) Article Claims Processing Jurisdiction for Oral Anti-Emetic Drugs (Rev. 2931, 07-07-14) Article Billing and Payment Instructions for A/B MACs (A) (Rev. 3085, Effective: Upon Implementation of ICD-10) Article Billing for Immunosuppressive Drugs (Rev. 1448; 07-07-08) Article Requirements for Billing A/B MAC (A) for Immunosuppressive Drugs (Rev. 3085, Effective: Upon Implementation of ICD-10) Article Policy for Alcohol Screening and Behavioral Counseling Interventions (Rev. 2433, 10-14-11) Article Institutional Billing Requirements for Alcohol Screening and Behavioral Counseling Interventions (Rev. 2433, 10-14-11) Article Professional Billing Requirements for Alcohol Screening and Behavioral Counseling Interventions (Rev. 2433, 10-14-11, Article Claim Adjustment Reason Codes, Remittance Advice Remark Codes, Group Codes, and Medicare Summary Notice Messages for Alcohol Screening and Behavioral Counseling Interventions (Rev. 2433, 10-14-11) Article Screening for Depression in Adults (Rev. 2431,10-14-11) Article Professional Billing Requirements for Screening for Depression in Adults (Rev. 2431, 10-14-11) Article Institutional Billing Requirements for Screening for Depression in Adults (Rev. 2431, 10-14-11) Article CARCs, RARCs, Group Codes, and MSN Messages for Screening for Depression in Adults (Rev. 2431, 10-14-11) Article Dental Documentation with ICD-10 Article Intensive Behavioral Therapy for Obesity (Effective November 29, 2011) (Rev. 2421, 11-29-11) Article Policy for Intensive Behavioral Therapy for Obesity (Rev. 3232, 01-05-15) Article Institutional Billing Requirements for Policy for Intensive Behavioral Therapy for Obesity (Rev. 3232, 01-05-15) Article Professional Billing Requirements for Policy for Intensive Behavioral Therapy for Obesity (Rev. 3232, 01-05-15) Article Claim Adjustment Reason Codes (CARCs), Remittance Advice Remark Codes (RARCs), Group Codes, and Medicare Summary Notice (MSN) Messages for Policy for Intensive Behavioral Therapy (Rev. 3232, 01-05-15) Article Screening for Hepatitis C Virus (HCV) (Rev. 3215, 06-02-14) Article Institutional Billing Requirements for Screening for Hepatitis C Virus (HCV) (Rev. 3215, 01-05-15) Article Professional Billing Requirements for Screening for Hepatitis C Virus (HCV) (Rev. 3215, 01-05-15) Article Claim Adjustment Reason Codes (CARCs), Remittance Advice Remark Codes (RARCs), Group Codes, and Medicare Summary Notice (MSN) Messages for Screening for Hepatitis C Virus (HCV) (Rev. 3215, 01-05-15) Article Payment Rules for Drugs and Biologicals (Rev. 2437, 01-01-13) Article Payment Allowance Limit for Drugs and Biologicals Not Paid on a Cost or Prospective Payment Basis (Rev. 131, 03-26-04) Article MMA Drug Pricing – Average Sales Price (Rev. 1513, 06-23-08) Article Average Sales Price (ASP) Payment Methodology (Rev. 1513, 06-23-08) Medicare Pub 100-04 Drugs and Biologicals Article When to Report 70332 For TMJ Imaging Procedures Article Healthcare Common Procedure Coding System (HCPCS) Coding for the IPPE (Rev. 2159, 04-04-11) Article A/B Medicare Administrative Contractor (MAC) and Contractor Billing Requirements for the IPPE (Rev. 2159, 04-04-11) Article A/B MAC and Fiscal Intermediary (FI) Billing Requirements for the IPPE (Rev. 2159, 04-04-11) Article Coinsurance and Deductible for the IPPE (Rev. 2159, 04-04-11) Article Medicare Summary Notices (MSNs) for the IPPE (Rev. 1615, 01-05-09) Article Remittance Advice Remark Codes for the IPPE (Rev. 1615, 01-05-09) Article Claims Adjustment Reason Codes for the IPPE (Rev. 1615, 01-05-09) Article Advanced Beneficiary Notice (ABN) as Applied to the IPPE (Rev. 1615, 01-05-09) Article HCPCS Coding for Diabetes Screening (Rev. 457, 04-04-05) Article Carrier Billing Requirements for Diabetes Screening (Rev. 457, 04-04-05) Article Modifier Requirements for Pre-diabetes (Rev. 457, 04-04-05) Article Fiscal Intermediary (FI) Billing Requirements for Diabetes Screening (Rev. 457, 04-04-05) Article HCPCS Coding for Cardiovascular Disease Screening for Diabetes Screening (Rev. 408, 01-03-05) Article Carrier Billing Requirements for Diabetes Screening (Rev. 408, 01-03-05) Article Fiscal Intermediary (FI) Billing Requirements for Diabetes Screening (Rev. 408, 01-03-05) Article Diagnosis Code Reporting for Diabetes Screening (Rev. 408, 01-03-05) Article Ultrasound Screening for Abdominal Aortic Aneurysm (AAA) (Rev. 3096, 11-18-14) Article Definitions for Ultrasound Screening for Abdominal Aortic Aneurysm (AAA) (Rev. 3096, 11-18-14) Article Coverage for Ultrasound Screening for Abdominal Aortic Aneurysm (Rev. 3096, 11-18-14) Article Payment for Ultrasound Screening for Abdominal Aortic Aneurysm (Rev. 1113, 01-02-07) Article HCPCS Code for Ultrasound Screening for Abdominal Aortic Aneurysm (Rev. 1113, 01-02-07) Article Advance Beneficiary Notice for Ultrasound Screening for Abdominal Aortic Aneurysm (Rev. 1113, 01-02-07) Article Coding and Payment of DSMT Services (Rev. 1255, 07-02-07) Article Special Processing Instructions for Billing Frequency Requirements of DSMT Services (Rev. 1255, 07-02-07) Article Advance Beneficiary Notice (ABN) Requirements of DSMT Services (Rev. 1255, 07-02-07) Article Healthcare Common Procedure Coding System (HCPCS) for HIV Screening Tests (Rev. 2199, 07-06-10) Article Billing Requirements for HIV Screening Tests (Rev. 2199, 07-06-10) Article Payment Method for HIV Screening Tests (Rev. 2199, 07-06-10) Article Diagnosis Code Reporting for HIV Screening Tests (Rev. 2199, 07-06-10) Article Medicare Summary Notice (MSN) and Claim Adjustment Reason Codes (CARCs) for HIV Screening Tests (Rev. 2199, 07-06-10) Article Annual Wellness Visit (AWV) (Rev. 2159, 04-04-11) Article Healthcare Common Procedure Coding System (HCPCS) Coding for the AWV (Rev. 2159, 04-04-11) Article A/B Medicare Administrative Contractor (MAC) and Carrier Billing Requirements for the AWV (Rev. 2159, 04-04-11) Article A/B MAC and Fiscal Intermediary (FI) Billing Requirements for the AWV (Rev. 2159, 04-04-11) Article Medicare Summary Notices (MSNs), Remittance Advice Remark Codes (RARCs), Claims Adjustment Reason Codes (CARCs), and Advance Beneficiary Notices (ABNs) for the AWV (Rev. 2159, 04-04-11) Article Counseling to Prevent Tobacco Use (Rev. 2058, 01-03-11) Article Healthcare Common Procedure Coding System (HCPCS) and Diagnosis Coding for Counseling to Prevent Tobacco Use (Rev. 2058, 01-03-11) Article Carrier Billing Requirements for Counseling to Prevent Tobacco Use (Rev. 2058, 01-03-11) Article
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