Medicare_Claims_Processing_Manual / Change Request 5699

Why This Topic Matters

It helps readers understand which Medicare claims are affected by the 2008 reporting changes and how CMS updated claims-processing instructions across multiple billing scenarios. The article is especially important for organizations that submit ESA or anti-anemia drug claims and need to align internal workflows with CMS manual revisions.

Article Sections

1. Summary of Changes

   Overview of the change request, effective and implementation dates, and the general categories of claims affected. Includes the scope of the manual updates and the high-level purpose of the instructions.

2. Changes in Manual Instructions

   List of Medicare Claims Processing Manual chapters and sections revised or added by the transmittal. Identifies where the updated guidance appears in the manual.

3. Funding

   Administrative and contractor funding statements for fiscal intermediaries, carriers, and MACs. Covers implementation responsibility and contract-related guidance.

4. Attachments

   References to business requirements and manual instruction attachments that support the change request. Provides the structure of the supplemental materials included with the transmittal.

5. Attachment - Business Requirements

   Background, policy context, and the business requirements table for the reporting changes. Covers implementation scope across claim types and system components.

6. General Information

   Background and policy rationale for the reporting changes. Explains the CMS and legislative context for the update.

7. Business Requirements Table

   Detailed requirements for claims processing systems, including edits, claim-return conditions, data transmission, and storage support. Also covers responsibility assignments across system types and contractors.

8. Provider Education Table

   Provider education distribution requirements and references to related educational material. Describes contractor posting and communication expectations.

9. Supporting Information

   Supplemental notes and cross-references supporting the business requirements. Includes implementation-related clarifications and data-handling notes.

10. Contacts

    CMS contact information for pre-implementation and post-implementation inquiries. Identifies the offices and roles associated with the change request.

11. Funding

    Repeat funding language for contractors and MACs in the supporting sections. Reiterates budget and technical direction statements.

12. Manual Instruction Updates

    Updated Medicare Claims Processing Manual sections for hospital outpatient, drugs and biologicals, CAP processing, and claim form items. Focuses on the revised instructions that implement the change request.

13. Chapter 17 - Drugs and Biologicals

    Table of contents and chapter sections addressing reporting of laboratory values, required modifiers, hospital billing, and related drug claims processing. Includes both general rules and specific claim-form reporting instructions.

14. Reporting of Hematocrit and/or Hemoglobin Levels

    Instructions for reporting laboratory values on claims for selected drug administrations and for handling missing information. Covers institutional and professional claim formats at a high level.

15. Required Modifiers for ESAs Administered to Non-ESRD Patients

    Instructions for the modifiers associated with non-ESRD ESA claims and related billing presentation. Addresses how the manual describes modifier reporting at a general level.

16. Hospitals Billing for Epoetin Alfa and Darbepoetin Alfa for Non-ESRD Patients

    Hospital billing guidance for selected drugs in non-ESRD settings. Covers applicable bill types, revenue codes, and related outpatient payment context.

17. The Competitive Acquisition Program for Drugs and Biologicals Not Paid on a Cost or Prospective Payment Basis

    Background on the CAP program and its relation to Part B drugs and biologicals. Includes broad program structure, vendor participation, and claim-processing context.

18. Claims Processing Instructions for CAP Claims for the Local Carriers

    Carrier instructions for CAP claim handling and exclusions. Describes how local processing fits into the broader CAP framework.

19. Items 14-33 - Provider of Service or Supplier Information

    Detailed Form CMS-1500 instructions for provider/supplier data elements and supporting claim information. Includes general reporting guidance across multiple item fields and claim scenarios.