Medicare Compliance & Reimbursement

Starting Jan. 1, 2004, patients will have a better sense of what's going on if claims get denied because of a local medical review policy or a national coverage determination. In an Aug. 1 program memorandum (AB-03-112; http://cms.hhs.gov/manuals/pm_trans/AB03112.pdf), the Centers for Medicare & Medicaid Services orders contractors to be sure that they tell beneficiaries the specific LMPR or NCD numbers associated with any claims denials for Part A services. In other recent program memoranda, CMS: adjusts mileage payment policies for rural ground ambulance services (AB-03-110; http://cms.hhs.gov/manuals/pm_trans/AB03110.pdf); lays out claims processing instructions for incomplete screening colonoscopies (AB-03-114; http://cms.hhs.gov/manuals/pm_trans/AB03114.pdf); corrects policies resulting in improper denials of durable medical equipment claims during inpatient stays (B-03-055; http://cms.hhs.gov/manuals/pm_trans/B03055.pdf); establishes edits to ensure accurate coding and payment for claims governed by inpatient prospective payment system transfer/discharge policies (A-03-065; http://cms.hhs.gov/manuals/pm_trans/A03065.pdf); sets policies on payment denials for Medicare services provided to alien beneficiaries who aren't lawfully present in the U.S. (AB-03-115; http://cms.hhs.gov/manuals/pm_trans/AB03115.pdf); provides guidelines and instructions on the National Council for Prescription Drug Program transaction format (B-03-056; http://cms.hhs.gov/manuals/pm_trans/B03056.pdf and B-03-057; http://cms.hhs.gov/manuals/pm_trans/B03057.pdf); and establishes procedures relating to Health Insurance Portability and Accountability Act transactions rule testing (AB-03-111; http://cms.hhs.gov/manuals/pm_trans/AB03111.pdf).