decisionhealth Newsletters, Answer Books - 2006 Issue 10 (October)
Medicare_Claims_Processing_Manual / 341
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Article Overview
This article explains CMS changes to Medicare claims processing for purchased diagnostic tests and interpretations under the Medicare Physician Fee Schedule. It is relevant to Medicare contractors, laboratories, physicians, independent diagnostic testing facilities, and other suppliers that bill Part B claims, because it addresses jurisdiction, pricing locality, file updates, and related manual instructions for handling these services. The article also describes the creation and maintenance of a national abstract file, along with supporting changes in the Medicare Claims Processing Manual.
Why This Topic Matters
It affects how contractors and suppliers process, route, and price claims for purchased diagnostic services under Medicare. Understanding the update helps readers determine whether the full article applies to their billing, enrollment, and claims-processing responsibilities.
Article Sections
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Summary of Changes
Overview of the transmittal purpose, effective timing, and the general category of Medicare claims-processing changes being implemented.
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General Information
Background and policy context for the claims-processing update, including jurisdiction, supplier billing, file updates, and contractor responsibilities.
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Business Requirements
Administrative implementation requirements and references related to the update.
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Supporting Information and Possible Design Considerations
Operational guidance for contractors, including update retrieval, implementation planning, and system-related considerations.
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Schedule, Contacts, and Funding
Timing, contact, and implementation information for the transmittal.
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Chapter 1 - General Billing Requirements
Manual revisions addressing Medicare payment jurisdiction, place-of-service handling, and purchased-service billing topics.
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Payment Jurisdiction for Purchased Services
Revised guidance focused on purchased diagnostic services and the related claims-processing framework.
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Payment to Physician or Other Supplier for Purchased Diagnostic Tests - Claims Submitted to Carriers
Revised billing guidance for claims involving purchased diagnostic tests and carrier submission requirements.
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Payment to Supplier of Diagnostic Tests for Purchased Interpretations
Revised billing guidance for claims involving purchased interpretations and supplier submission requirements.
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Chapter 23 - Fee Schedule Administration and Coding Requirements
Manual changes related to fee schedule administration and coding processes for the updated file and pricing workflow.
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Abstract File for Purchased Diagnostic Tests/Interpretations
Description of the national abstract file, its update cycle, and contractor procedures for obtaining and using it.
What You Will Learn
- How CMS structured the national abstract file for purchased diagnostic services
- Which operational areas of Medicare claims processing were revised
- How the update affects carrier jurisdiction and pricing locality procedures
- What contractors must do to receive and install the annual and quarterly file updates
- Which manual sections were revised to reflect the new guidance
Who Should Read This
- Medicare contractors
- Part B carriers
- Laboratories
- Physicians
- Independent diagnostic testing facilities (IDTFs)
- Billing staff
- Revenue cycle and claims-processing teams
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