Part B Insider (Multispecialty) Coding Alert

Published on Sun Nov 05, 2006 PDF

Carriers must look at all diagnosis codes on a claim

The Centers for Medicare & Medicaid Services (CMS) has appropriate controls in place to make sure its Comprehensive Error Rate Testing (CERT) program is coming up with accurate data, the HHS Office of Inspector General cheered. CMS has taken steps to reduce the CERT error rate, and followed up on the recommendations in last year's OIG report.

In other news:

- CMS is requiring carriers and other contractors to process all diagnosis codes included on a claim, not just the first diagnosis code, by April 1, 2007, according to Transmittal 1095, dated Oct. 27.

- You can obtain a new print copy of the updated -Guidelines for Teaching Physicians, Interns, and Residents Fact Sheet- from the CMS Medicare Learning Network. Go to www.cms.hhs.gov/mlngeninfo, scroll down to -Related Links Inside CMS,- and select -MLN Product Ordering Page.-

- You should start reporting your physician's national provider identifier (NPI) on claims for any services your physician purchased outside your carrier's jurisdiction by May 23, CMS instructs in Transmittal 243, dated Oct. 23.

- If you-re taking part in the Competitive Acquisition Program (CAP) for Part B drugs, you can still obtain the drugs separately from approved providers and bill the primary plan outside the CAP program, if your patient has Medicare Secondary coverage, according to Transmittal 1088, dated Oct. 27.

- Some Health Professional Shortage Areas (HPSAs) no longer meet the requirements for an HPSA but haven't had their status revoked because the Department of Health & Human Services hasn't updated the list since 2002, the Government Accountability Office reported (GAO-07-84). Also, most of the rural health clinics located in HPSA areas received HPSA scores too low to participate in some federal programs for shortage areas.

- Medicare has updated the place of service (POS) codes to add a new code for prison/correctional facility, POS 09, according to MLN Matters article MM4316.

- The new interest rate for Medicare overpayments and underpayments will be 12.375 percent, according to Transmittal 108, dated Oct. 12.

- Mental health copays may be more than double in some settings than in others, the HHS Office of Inspector General says in a new report (OEI-04-05-00180). Also, carriers may be incorrectly applying the limitation on Alzheimer's disease-related services.

- CMS has shifted local provider education and training funding from medical review (MR) to provider outreach and education (POE), so it revised the chapter on provider training to provide more guidance on education in Transmittal 163, dated Sept. 29.