Know when you need an NPI and when you don't. Providers wanting to brush up on vaccination billing procedures before the season starts can consult two new transmittals from the Centers for Medicare & Medicaid Services. The agency outlines the difference between mass immunization roster billers and centralized billers, among other specifics, in Aug. 15 Transmit-tal No. 366 (CR 6121). Reminder: Beneficiaries do not need to have a physician's order or supervision to receive a Medicare-covered vaccination, points out the transmittal at
http://www.cms.hhs.gov/transmittals/downloads/R366OTN.pdf. A related MLN Matters article is at
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6121.pdf. And CMS spells out vaccination billing changes to the Medicare Claims Processing Manual in a 56-page Sept. 5 transmittal. For example: Roster bills do not require a National Provider Identifier (NPI), CMS says in Transmittal No. 1586 (CR 6079), at www.cms.hhs. gov/transmittals/downloads/R1586CP.pdf. Meanwhile, the Visiting Nurse Associa-tions of America is helping the public find places to get flu vaccinations. Interested persons can search for a flu clinic near them at www.vnaa.org. Last year, VNAA member agencies conducted over 4,500 flu clinics, the trade group notes. • If you're still waiting on payment for DME items in the 10 former competitive bidding areas, you may soon see relief. CMS has issued the formal instructions telling DME MACs to pay for former bid items under fee-for-service rules. "Restore all standard fee-for-service (FFS) edits and payment files that were in effect for DMEPOS claims as of June 30, 2008," CMS instructs the carriers in Sept. 5 Transmittal No. 375 (CR 6203). Contractors should reprocess denied and underpaid claims by Sept. 30, CMS says. Don't overlook: Home health agencies will have to resubmit claims that were denied due to competitive bidding, CMS instructs. The payment date for held claims is less clear. "Contractors shall process all previously-held DMEPOS Competitive Bidding Program claims under standard FFS rules and shall complete such processing as soon as possible," CMS says. Not over yet: CMS directs carriers to hold onto their bidding programming even though they're disabling it. That will "permit the resumption of the DMEPOS Competitive Bidding Program with a minimum of additional reprogramming, upon notification," the agency notes. The transmittal is online at
http://www.cms.hhs.gov/transmittals/downloads/R375OTN.pdf. • There's yet another HH PPS Pricer problem, although this one affects your bookkeeping more than your reimbursement. Affected claims process with the correct reimbursement, but "the Fiscal Intermediary Stan-dard System (FISS) does not show the new Health Insurance Prospective Payment System (HIPPS) code assigned by Pricer," RHHI Cahaba GBA says in a Sept. 9 message to providers. The problem af-fects claims with dates of service Jan. 1 or later. • The topic of home care is proving important to some politicians this election year. On Sept. 9, [...]
