CMS

Healthcare Financial Management, March, 2006

... CMS is repealing section 20.25 of the National Coverage Determinations Manual (100.3), effective for cardiac catheterization services performed in other than a hospital setting on or after Jan. 12. In the absence of an NCD on cardiac catheterization in other than a hospital setting, coverage is determined by the local Medicare contractor. (Transmittal 46)

... The Annual Update to the Therapy Code List describes changes to, and billing instructions for, payment policies for rehabilitation therapy services, including physical therapy, occupational therapy, and speech-language pathology. This instruction updates the list of codes that describe therapy services and their associated policies. (Transmittal 805)

... Effective Feb. 21, physicians are allowed to bill and receive their Health Professional Shortage Area and Physician Scarcity Area bonuses when the place of service is "home." (Transmittal 813)

... This transmittal updates the Claim Status Codes and Claim Status Category Codes for use by Medicare contractors with the Health Care Claim Status Request and Response ASC X12N 276/277. Contractors are to use codes with the "new as of 4/06" designation and prior dates, and inform affected providers of the new codes. (Transmittal 814)

... Transmittal 646 (CR 3940), dated Aug. 12, 2005, is rescinded and replaced by this transmittal to include instructions for adding a Transitional Outpatient Payments Indicator field in the Outpatient Provider Specific File. CR 3940, issued on Aug. 12, 2005, included instructions for updating the Inpatient Provider Specific File and the OPSF. (Transmittal 817)

... The revenue codes that both rural health clinics and federally qualified health centers use when billing for RHC/FOHC services have been changed. Currently, FQHCs and RHCs bill most of their services, except for those subject to the Medicare outpatient mental health treatment limitation, under revenue code 0520 and 0521, respectively. Occasionally, RHCs use revenue code 0522 to bill when RHC services are provided in the beneficiary's home. CMS requested a redefinition of revenue codes 0521 and 0522 to include FQHC services as well as RHC services. CMS also requested the addition of revenue codes 0524, 0525, 0527, and 0528 to provide the agency with information needed to improve administration of the RHC and FQHC programs. (Transmittal 820)

... On June 30, 2005, CMS issued an amendment to correct technical errors in the interim final rule entitled =Medicare Program: Changes to the Medicare Claims Appeal Procedures (42 CFR Parts 401 and 405), which CMS issued on March 8, 2005. Among the corrections was one clarifying that a determination regarding the untimely submission of a claim is not an initial determination. Thus, a claim that is denied because it was not timely filed is not subject to appeal. (Transmittal 830)

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).