decisionhealth Newsletters, Answer Books - 2006 Issue 10 (October)
Medicare_Claims_Processing_Manual / 306
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Article Overview
This article covers a CMS Medicare Claims Processing Manual transmittal that updates the 2004 Medicare Physician Fee Schedule database and replaces an earlier change request. It is relevant to Medicare billing and claims-processing staff who track fee schedule file updates, payment-file revisions, and indicator changes tied to specific CPT/HCPCS entries and related administrative fields.
Why This Topic Matters
These transmittal updates affect how Medicare payment files and related claim-processing data are maintained, which can influence downstream contractor processing and provider billing administration. Readers reviewing fee schedule maintenance, CMS transmittals, or historical database updates will find the scope and affected identifiers useful.
Article Sections
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General Information
Background information on the update, its relationship to the earlier change request, and the cited policy basis. Also notes CMS provider education and distribution context.
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Business Requirements
Administrative implementation requirements and reference to the accompanying business requirements material.
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Supporting Information and Possible Design Considerations
Supplementary implementation and systems-planning categories, including other instructions, interfaces, dependencies, and testing considerations.
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Schedule, Contacts, and Funding
Effective and implementation dates, contractor contact information, and budget/funding notes for rollout.
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Attachment 1
Revised payment-file update items for the 2004 Medicare Physician Fee Schedule database, including selected CPT/HCPCS entries and associated administrative indicators.
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Attachment 2
File names for the revised payment files distributed with the update for different Medicare processing environments.
What You Will Learn
- The scope of a CMS transmittal that revises Medicare fee schedule database files
- How the update is organized across transmittal text and attachments
- What categories of CPT/HCPCS and administrative fields are referenced in the revised payment files
- Which implementation dates and administrative contacts are associated with the update
- How CMS presents carrier and intermediary file distribution information
Who Should Read This
- Medicare coders
- Billing and reimbursement staff
- Claims processing personnel
- Medicare contractors
- Provider education staff
- Revenue cycle professionals
Codes Discussed
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