Program_Memos / 2002 / AB-02-064

Why This Topic Matters

The memorandum affects whether and how home INR monitoring services are covered, reported, and paid under Medicare. It also identifies the claim-processing and administrative references that contractors and providers needed when implementing the policy change.

Article Sections

1. Coverage

   Summarizes the Medicare coverage update for home INR monitoring and the broad patient and service requirements associated with the policy.

2. Intermediary Billing Instructions

   Describes intermediary-facing billing information, including applicable code sets, bill types, revenue codes, diagnosis coding, and payment pathways.

3. Carrier Billing Instructions

   Presents carrier-facing billing guidance for the related HCPCS services and associated service classifications.

4. Carrier Claims Requirements

   Outlines claim submission, payment, and processing considerations for the service under Medicare claims administration.

5. Carrier Payment Requirements

   Summarizes payment methodology and related Medicare claims payment considerations for the service.

6. Claims Editing

   Notes claims-processing edit considerations and local review options for contractors implementing the policy.

7. Remittance Advice Notice

   Identifies guidance for remittance advice reporting when claims are denied under specific circumstances.

8. Medicare Summary Notice (MSN) Messages

   Lists patient notice language used when claims are denied for timing-related reasons.

9. Provider Notification

   Describes how contractors were instructed to communicate the coverage change to providers and other stakeholders.