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AAPC Nov. 21, 2007
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Issue #89

Top Stories

2008 PQRI Q&A Calls Start November 28

More MAC Contracts Awarded by CMS

CMS Sets Part B Flu Vaccine Prices at 95 Percent AWP

New POS Addresses Temporary Lodging

CMS Updates NPI Requirement

New Rules for Obtaining COB for Unauthorized DMEPOS Items

Test Yourself - Earn 0.5 CEUs

Renée  Dustman

Renée Dustman
EdgeBlast Editor

Top News

2008 PQRI Q&A Calls Start November 28

Get answers about the 2008 Physician Quality Reporting Initiative (PQRI) in the first of a series of conference calls on the initiative Nov. 28, 3–5 p.m. EST.

Participation in the call, which will include a discussion of the 119 PQRI measures available for selection in 2008, is by registration only. Registration closes Nov. 27, 3 p.m. EST or before, if full.

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More MAC Contracts Awarded by CMS

Highmark Medicare Services Inc. and Palmetto GBA are the fourth and fifth carriers to be named by the Centers of Medicare and Medicaid Services (CMS) as Medicare Administrative Contractors (MACs). Both carriers signed contracts with CMS to administer Part A and Part B Medicare claims payment. Together, the two contracts are the largest in terms of claims volume that CMS will award. Highmark Medicare Services Inc. expects to process approximately 131 million claims annually, accounting for more than 11 percent of the National Medicare fee-for-service workload.

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CMS Sets Part B Flu Vaccine Prices at 95 Percent AWP

CMS has set Part B payment allowance limits for influenza and pneumococcal vaccines at 95 percent of average wholesale price (AWP) except when the vaccine is provided in a hospital outpatient department, where reimbursement will be based on reasonable cost. Be sure to check with contracted payers to learn how it affects your coding and reporting.

Fee rates for the codes are outlined in Transmittal 1357, dated Oct. 26, 2007. For more information, check the following link: http://www.cms.hhs.gov/transmittals/downloads/R1357CP.pdf

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New POS Addresses Temporary Lodging

If your clinicians are providing care to tourists and you haven't been able to find a Place of Service code that really applies, try the new POS code 16 Temporary Lodging, which CMS has released effective April 1, 2008. The new place of service is defined by CMS as "A short-term accommodation such as a hotel, camp ground, hostel, cruise ship or resort where the patient receives care, and which is not identified by any other POS code." The November 2 transmittal can be found at http://www.cms.hhs.gov/transmittals/downloads/R1366CP.pdf

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CMS Updates NPI Requirement

Providers and suppliers are no longer required to submit a copy of their NPI notification from the National Plan and Provider Enumeration System (NPPES) to the Medicare contractor unless instructed to do so. CMS clarifies this update to the Division of Provider and Supplier Enrollment (DPSE) policy in a recent transmittal. The new policy also states that for providers that obtain an NPI via Electronic File Interchange (EFI), Medicare contractors may accept a copy of the NPI Registry Details Page in lieu of a copy of the provider’s NPI Notification. To read the complete transmittal on which this report is based, go to http://www.cms.hhs.gov/transmittals/downloads/R227PI.pdf.

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New Rules for Obtaining COB for Unauthorized DMEPOS Items

Effective May 23, 2008, all suppliers and providers must submit a National Provider Identifier (NPI) for an ordering/referring provider. In Transmittal 1368, the CMS instructs suppliers billing for durable medical equipment prosthetic and orthotic supplies (DMEPOS) without a physician’s order to use their own name and NPI in the Ordering/Referring Provider Name fields of the claim form. Suppliers should also use modifier EY (no physician or other licensed health care provider order for this item of service).

The EY modifier allows DMEPOS suppliers to submit claims to Medicare for items without prescription in order to obtain a Medicare denial, which in turn they can send to a secondary insurer for coordination of benefit (COB) purposes.

If a physician’s order has been obtained for some but not all DMEPOS items, suppliers must submit separate claims for the items dispensed with and without a physician’s order.

The November 2 transmittal can be found at http://www.cms.hhs.gov/transmittals/downloads/R1368CP.pdf

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Test Yourself - Earn 0.5 CEUs

By answering the following questions, you can earn 0.5 continuing education units to apply toward your annual AAPC CEU renewal every two years. Simply answer the questions and list this as one of your itemized CEUs on your CEU form. If you are chosen for verification, we will then ask you to send in a copy of your work.  Please put the number of each EdgeBlast included in your submission. The number is available at the top of the page.

Answers to the questions are not always found directly (word for word) in the EdgeBlast in which they appear. While often related to the EdgeBlast content, they require additional resources such as your ICD-9-CM, CPT® and HCPCS Level II manuals.

1. CMS intends to implement a new three-tiered numbering scheme for MACs with year-end as the earliest cutover date. What will the top tier identify?

Answer:

2. List the 2007 CPT® codes for the influenza virus and pneumococcal vaccines.

Answer:

3. Which POS code should you use on a claim for services provided on or after April 1, 2008 to a Medicare patient who is traveling cross-country in his RV?

Answer:

4. Every provider that submits an enrollment application must furnish its NPI(s) in the applicable section(s) of which CMS form?

Answer:

5. Suppliers billing for durable medical equipment prosthetic and orthotic supplies (DMEPOS) items without prescription should use which modifier to secure a Medicare denial for coordination of benefit (COB) purposes?

Answer:

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