CMS

Healthcare Financial Management, Feb, 2006

... CMS has outlined several changes for inpatient prospective payment system hospitals and skilled nursing facilities for FY05 and FY06. Most of the SNF FY06 wage index corrections involve the core-based statistical area and transition wage index values. However, several typographical errors to other entries are also highlighted for clarity. The transmittal also includes limited retroactive changes to the FY05 wage index values for certain hospitals meeting criteria specified in the FY06 inpatient PPS final rule. The changes became effective Jan. 9. (Transmittal 197)

... CMS has published the 2006 coding and payment changes for drug administration under the outpatient PPS. As of Jan. l, CMS has replaced some of the CPT codes used for drug administration services under the outpatient PPS in 2005 with more detailed CPT codes incorporating specific procedural concepts. To facilitate the transition to more specific CPT codes within the hospital environment and to help hospitals ensure continued correct coding concepts, drug administration services provided in 2006 under the outpatient PPS will be billed using a combination of CPT codes and C-codes. (Transmittal 785)

... CMS has rescinded demonstration transmittal 34, dated Dec. 16, 2005, and replaced it with a Dec. 30 transmittal (36). The transmittals address changes and guidelines on the 2006 oncology demonstration project. According to CMS, the new transmittal corrects the ICD code range (161.0-161.9) associated with head and neck cancer. The implementation of the new and revised material is Jan. 17. (Transmittal 36)

... CMS has updated the Medicare Claims Processing Manual, clarifying payment policy for evaluation and management visits by physicians and qualified NPPs in nursing facilities. The transmittal also elaborates on federally mandated visits, medically necessary visits, "incident to" services, prolonged services codes and other time-related services, split/shared E&M services, gang visits, and the SNF/NF discharge day management services. (Transmittal 792)

... CMS has changed the effective date to Jan. 1, 2006, for claims processing transmittal number 794 (dated Dec. 29, 2005) and has corrected the manual subsection 110.3, "Billing for Supplemental Payments for FQHCs Under Contract with Medicare Advantage (MA) Plans." The transmittal provides instructions on calculating and billing for the supplemental payments for federally qualified health centers under contract with MA plans. Until appropriate system changes are made, CMS said FQHCs should hold all claims for the new supplemental payment. CMS expects the necessary system changes to be installed by April 3, the implementation date of the transmittal. (Transmittal 794)

HFMA staff review CMS notices regularly for transmittals that affect healthcare financial managers, and post links to those transmittals on HFMA's web site. For links to these and other key transmittals, bookmark HFMA's Internet Guide to Medicare Coding and Billing (www.hfma.org/codebill).