For more information or questions,
February 06, 2012Determining Eligibility for the Medicare Health Professional Shortage Area Physician Bonus PaymentPhysicians who may be eligible for the Medicare Health Professional Shortage Area (HPSA) bonus payment should be aware of the following information and educational resources regarding determining eligibility, in order to minimize errors during the post-payment review process.
Information on the HPSA bonus, including the list of zip codes eligible for automatic payment, can be found at on the CMS website at http://www.CMS.gov/HPSApsaPhysicianBonuses/01_overview.asp. Two MLN Matters articles are available which go into further detail:
o “2012 Annual Update for the HPSA Bonus Payments” (MM7517) is available at http://www.CMS.gov/HPSApsaPhysicianBonuses/01_overview.asp., and
o “HPSA Bonus Payment Policy Reminders” (SE1202) is available at http://www.CMS.gov/MLNMattersArticles/downloads/SE1202.pdf.
Websites to help determine existing designations and eligibility for the Medicare HPSA physician bonus include:
o http://HPSAfind.HRSA.gov/HPSAsearch.aspx – to identify designations within a state,
o http://www.FFIEC.gov/geocode/default.aspx – to identify census tracts by entering an address), and
o http://DataWarehouse.HRSA.gov/geoadvisor/ShortageDesignationAdvisor.aspx – to see if an area is listed as being in an eligible area.
February 06, 2012National Provider Call: Claims-Based Reporting for the Physician Quality Reporting System & Electronic PrescribingNational Provider Call: Claims-Based Reporting for the Physician Quality Reporting System & Electronic Prescribing
Tue Feb 21; 1:30-3pm ET
The Centers for Medicare & Medicaid Services (CMS) will host a National Provider Call on the Physician Quality Reporting System & Electronic Prescribing Incentive Program. Subject matter experts will provide an overview on claims-based reporting for both programs, followed by a question and answer session.
Target Audience: All Medicare Fee-For-Service Providers, Medical Coders, Physician Office Staff, Provider Billing Staff, Electronic Health Records Staff, and Vendors
Agenda:
Opening Remarks
Program Announcements
Overview of claims-based reporting for the Physician Quality Reporting System
Overview of claims-based reporting for the eRx Incentive Program
Question & Answer Session
Registration Information: n order to receive the call-in information, you must register for the call. Registration will close at 12pm on the day of the call or when available space has been filled; no exceptions will be made, so please register early. For more details, including instructions on registering for the call, please visit http://www.eventsvc.com/blhtechnologies.
Presentation: The presentation for this call will be posted at least one day in advance http://www.CMS.gov/PQRS/04_CMSSponsoredCalls.asp in the “Downloads” section of the page.
February 06, 2012CMS NEWS: Three demonstration projects to begin aim to strengthen Medicare by eliminating fraud, waste, and abuseCMS NEWS: Three demonstration projects to begin aim to strengthen Medicare by eliminating fraud, waste, and abuse
FOR IMMEDIATE RELEASE
February 3, 2012
CMS announces the Prior Authorization of Power Mobility Devices (PMDs) Demonstration and
the Recovery Audit Prepayment Review Demonstration
On November 15, 2011 Centers for Medicare and Medicare (CMS) announced three demonstration projects that aim to strengthen Medicare by eliminating fraud, waste, and abuse. Reductions in improper payments will help ensure the sustainability of the Medicare Trust Funds and protect beneficiaries who depend upon the Medicare program.
CMS is pleased to announce that the Prior Authorization of Power Mobility Devices (PMDs) Demonstration and the Recovery Audit Prepayment Review Demonstration which were delayed from their initial January 1, 2012 start date are expected to move forward on or after June 1, 2012. For additional information on these demonstrations please visit http://go.cms.gov/cert-demos
These demonstrations will begin after receipt of a paperwork reduction act (PRA) Office of Management and Budget (OMB) control number. The CMS posted a PRA notification from these demonstrations on February 3, 2012 at http://www.cms.gov/PaperworkReductionActof1995/PRAL/list.asp
The CMS significantly revised the Prior Authorization of PMDs demonstration in response to provider and supplier concerns. For more information on the adopted changes please visit http://go.cms.gov/PAdemo
The Part A to Part B Rebilling Demonstration began on January 1, 2012.
Click here to view Federal Register notice: https://s3.amazonaws.com/public-inspection.federalregister.gov/2012-02821.pdf
February 06, 2012CMS Provider Education Resources - 2/3/2012CMS Provider Education Resources - 2/3/2012
General Information
February 03, 2012
CMS asks that TrailBlazer share the following information received from CMS' Provider Education Resources Listservs.
The links contained in the attached PDF document may direct you to sites other than TrailBlazer.
Below is a summary of the messages included in the attachment.
• Only One Electronic Remittance Advice Recipient per NPI/Legacy ID beginning Sunday, April 1st.
• Physician Self-Referral Prohibition: Additional Information on Exception Process for Physician-Owned Hospitals.
• Envelope Control/Reference Number Matching for Version 5010 Claim Transitions.
• National Provider Call: Claims-Based Reporting for the Physician Quality Reporting System & Electronic Prescribing, Tuesday.
• Two Important Electronic Health Record (EHR) Incentive Program Messages.
• Two Affordable Care Act Messages.
• Extension of Licensure Deadline for the Round 2 and National Mail-Order Competitions of the DMEPOS Competitive Bidding Program.
TrailBlazer Note:
CMS released Technical Direction Letter (TDL) 12148, dated December 22, 2011, which includes updated instructions for the ASC X12 Version 5010 transition. As stated in TDL 12148, TrailBlazer will not reject compliant ASC X12 Version 4010A1 transactions prior to April 1, 2012. The exact date and time 4010A1 transactions will be rejected will be published at a later date.
Stay informed - Improve office efficiency and claims reimbursement by staying current on Medicare billing and policy changes by sharing this listserv with others in your organization. To register and subscribe to listservs or to view current listserv subscriptions, click Manage subscriptions under Listserv Notifications on the Medicare home page.
February 06, 2012CMS Announces Prior Authorization of Power Mobility Devices Demonstration and Recovery Audit Prepayment Review DemonstrationOn Tue Nov 15, 2011, the Centers for Medicare & Medicare (CMS) announced three demonstration projects that aim to strengthen Medicare by eliminating fraud, waste, and abuse. Reductions in improper payments will help ensure the sustainability of the Medicare Trust Funds and protect beneficiaries who depend upon the Medicare program.
CMS is pleased to announce that the Prior Authorization of Power Mobility Devices (PMDs) Demonstration and the Recovery Audit Prepayment Review Demonstration – which were delayed from their initial Sun Jan 1 start-date – are expected to move forward on or after Fri June 1, 2012. For additional information on these demonstrations, please visit http://go.CMS.gov/cert-demos.
These demonstrations will begin after receipt of a Paperwork Reduction Act (PRA) Office of Management and Budget control number. CMS posted a PRA notification for these demonstrations on Fri Feb 3 at http://www.CMS.gov/PaperworkReductionActof1995/PRAL/list.asp.
CMS significantly revised the Prior Authorization of PMDs demonstration in response to provider and supplier concerns. For more information on the adopted changes please visit http://go.CMS.gov/PAdemo.
The Part A to Part B Rebilling Demonstration began on Sun Jan 1, 2012.
To view the relevant Federal Register notice, visit https://s3.amazonaws.com/public-inspection.federalregister.gov/2012-02821.pdf
February 06, 2012CMS NEWS: Health reform law saves $2.1 billion for 3.6 million Americans with MedicareCMS NEWS: Health reform law saves $2.1 billion for 3.6 million Americans with Medicare
FOR IMMEDIATE RELEASE Contact: CMS Public Affairs
Thursday, February 2, 2012 (202) 690-6145
Health reform law saves $2.1 billion for 3.6 million Americans with Medicare
New data show average American with Medicare to save nearly $4,200 through 2021 thanks to health reform
3.6 million people with Medicare saved $2.1 billion on their prescription drugs in 2011 thanks to the Affordable Care Act according to data issued today by the Department of Health and Human Services (HHS). Savings for people with Medicare will increase over time. According to a new report issued today from HHS, the average person with Medicare will save nearly $4,200 by 2021 because of the new law.
“The Affordable Care Act is already saving money for millions of Americans with Medicare,” said HHS Secretary Kathleen Sebelius. “As we move forward, we will close the donut hole completely and save even more money for everyone with Medicare.”
The Affordable Care Act provides a 50 percent discount on brand-name prescription drugs and this year, a 14% discount on generics. Last year, it provided a seven percent discount on covered generic medications for people who hit the prescription drug coverage gap known as the donut hole last year, with 2,814,646 beneficiaries receiving $32.1 million in savings on generics.
In 2011, the 3.6 million Americans who hit the donut hole saved an average of $604 on the cost of their prescription drugs.
Data also show that women especially benefitted from the law’s provision with 2.05 million women saving $1.2 billion on their prescription drugs.
By 2020, the donut hole will be closed completely. The new report released today by the Department of Health and Human Services finds that this provision and other features of the health reform law will generate substantial savings for people with Medicare. Typical Medicare beneficiaries will save an average of nearly $4,200 from 2011 to 2021. People with high prescription drug costs could save as much as $16,000.
The savings are a product of provisions in the Affordable Care Act and other cost trends that:
• • Decrease prescription drug costs for seniors
• • Make preventive services like mammograms free for everyone in Medicare
• • Reduce growth in Part B premiums (for physician services)
• •
These announcements come one day after HHS announced that in 2012, Medicare Advantage premiums have fallen by seven percent on average and enrollment has risen by about 10 percent since last year. For more details on that announcement, visit http://www.hhs.gov/news/press/2012pres/02/20120201a.html
For state-by-state savings figures for today’s donut hole announcement, visit: http://www.cms.gov/Plan-Payment/
For more information about donut hole savings, visit http://www.cms.gov/apps/media/fact_sheets.asp
For the report regarding savings those with Medicare will see over time, visit http://www.aspe.hhs.gov/_/index.cfm
###
February 03, 2012CMS Announces Prior Authorization of Power Mobility Devices Demonstration and Recovery Audit Prepayment Review DemonstrationCMS Announces Prior Authorization of Power Mobility Devices Demonstration and Recovery Audit Prepayment Review Demonstration
On Tue Nov 15, 2011, the Centers for Medicare & Medicare (CMS) announced three demonstration projects that aim to strengthen Medicare by eliminating fraud, waste, and abuse. Reductions in improper payments will help ensure the sustainability of the Medicare Trust Funds and protect beneficiaries who depend upon the Medicare program.
CMS is pleased to announce that the Prior Authorization of Power Mobility Devices (PMDs) Demonstration and the Recovery Audit Prepayment Review Demonstration – which were delayed from their initial Sun Jan 1 start-date – are expected to move forward on or after Fri June 1, 2012. For additional information on these demonstrations, please visit http://go.CMS.gov/cert-demos.
These demonstrations will begin after receipt of a Paperwork Reduction Act (PRA) Office of Management and Budget control number. CMS posted a PRA notification for these demonstrations on Fri Feb 3 at http://www.CMS.gov/PaperworkReductionActof1995/PRAL/list.asp.
CMS significantly revised the Prior Authorization of PMDs demonstration in response to provider and supplier concerns. For more information on the adopted changes please visit http://go.CMS.gov/PAdemo.
The Part A to Part B Rebilling Demonstration began on Sun Jan 1, 2012.
To view the relevant Federal Register notice, visit https://s3.amazonaws.com/public-inspection.federalregister.gov/2012-02821.pdf
February 03, 2012CMS NEWS: Three demonstration projects to begin aim to strengthen Medicare by eliminating fraud, waste, and abuseCMS NEWS: Three demonstration projects to begin aim to strengthen Medicare by eliminating fraud, waste, and abuse
FOR IMMEDIATE RELEASE
February 3, 2012
CMS announces the Prior Authorization of Power Mobility Devices (PMDs) Demonstration and
the Recovery Audit Prepayment Review Demonstration
On November 15, 2011 Centers for Medicare and Medicare (CMS) announced three demonstration projects that aim to strengthen Medicare by eliminating fraud, waste, and abuse. Reductions in improper payments will help ensure the sustainability of the Medicare Trust Funds and protect beneficiaries who depend upon the Medicare program.
CMS is pleased to announce that the Prior Authorization of Power Mobility Devices (PMDs) Demonstration and the Recovery Audit Prepayment Review Demonstration which were delayed from their initial January 1, 2012 start date are expected to move forward on or after June 1, 2012. For additional information on these demonstrations please visit http://go.cms.gov/cert-demos
These demonstrations will begin after receipt of a paperwork reduction act (PRA) Office of Management and Budget (OMB) control number. The CMS posted a PRA notification from these demonstrations on February 3, 2012 at http://www.cms.gov/PaperworkReductionActof1995/PRAL/list.asp
The CMS significantly revised the Prior Authorization of PMDs demonstration in response to provider and supplier concerns. For more information on the adopted changes please visit http://go.cms.gov/PAdemo
The Part A to Part B Rebilling Demonstration began on January 1, 2012.
Click here to view Federal Register notice: https://s3.amazonaws.com/public-inspection.federalregister.gov/2012-02821.pdf
February 02, 2012One Year Milestone for the Medicare and Medicaid EHR Incentive Programs Marked on Tue Jan 3 One Year Milestone for the Medicare and Medicaid EHR Incentive Programs Marked on Tue Jan 3
Tue Jan 3 was the one-year anniversary of the start of registration for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. Over the past year, there has been a tremendous amount of interest in the incentive programs as providers across the country have implemented EHRs. Year-one highlights include:
43 states have started their Medicaid EHR Incentive Programs
More than 176,000 people have registered for the Medicare and/or Medicaid EHR Incentive Programs
More $2.5 billion has been paid in incentive payments to eligible professionals (EPs) and eligible hospitals and critical access hospitals (CAHs) across the country
CMS has created useful resources for participants in the Medicare and Medicaid EHR Incentive Programs, including:
1. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals – This interactive guide walks EPs through every aspect of the Medicare program, and provides helpful resources and tips along the way.
2. Updated User Guides – CMS has updated the registration and attestation user guides, which direct EPs and eligible hospitals through the CMS registration and attestation system. There are five guides that can be downloaded from the Educational Materials page of the EHR website.
3. Provider Testimonial Videos – These videos, which can be found on the CMS YouTube channel, highlight providers’ experiences participating in the EHR Incentive Programs.
A Look Ahead
As we move into 2012 and the second participation year of the Medicare and Medicaid EHR Incentive Programs, CMS is hopeful that providers will begin or continue their participation in the programs, and take advantage of these incentives for meaningful use of EHRs.
If you are considering registering for the programs, but have not done so yet, take a look at the CMS EHR website and use our eligibility tool to find out if you can participate.
Remember that 2012 is the last year in which EPs can receive a full incentive payment in the Medicare EHR Incentive Program; beginning in 2013, EPs will receive a smaller overall total payment.
Want more information about the EHR Incentive Programs? Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.
February 02, 2012National Provider Call: Claims-Based Reporting for the Physician Quality Reporting System & Electronic PrescribingNational Provider Call: Claims-Based Reporting for the Physician Quality Reporting System & Electronic Prescribing
Tue Feb 21; 1:30-3pm ET
The Centers for Medicare & Medicaid Services (CMS) will host a National Provider Call on the Physician Quality Reporting System & Electronic Prescribing Incentive Program. Subject matter experts will provide an overview on claims-based reporting for both programs, followed by a question and answer session.
Target Audience: All Medicare Fee-For-Service Providers, Medical Coders, Physician Office Staff, Provider Billing Staff, Electronic Health Records Staff, and Vendors
Agenda:
Opening Remarks
Program Announcements
Overview of claims-based reporting for the Physician Quality Reporting System
Overview of claims-based reporting for the eRx Incentive Program
Question & Answer Session
Registration Information: n order to receive the call-in information, you must register for the call. Registration will close at 12pm on the day of the call or when available space has been filled; no exceptions will be made, so please register early. For more details, including instructions on registering for the call, please visit http://www.eventsvc.com/blhtechnologies.
Presentation: The presentation for this call will be posted at least one day in advance http://www.CMS.gov/PQRS/04_CMSSponsoredCalls.asp in the “Downloads” section of the page.
February 9, 2009 - The Provider Specific data for the FY 2009 IRF PPS PC Pricer has been updated and is ready to be downloaded from the page,
located here, under the Downloads section. If you use the IRF PPS PC Pricer, please go to the page above and download the latest version of the IRF PC Pricer, posted 02/05/2009.
February 9, 2009 - Understanding the Remittance Advice: A Guide for Medicare Providers, Physicians, Suppliers, and Billers (October 2008) is now available to download from the CMS Medicare Learning Network (MLN). This publication is designed to help fee-for-service Medicare providers understand the remittance advice (RA), its applicable uses, and how to interpret RA fields and codes communicated by Medicare contractors. To view, download and print this guide, please go to the CMS Medicare Learning Network (MLN) at
this location. Print copies will be available in approximately 4 to 6 weeks.
February 9, 2009 - The Hospital Outpatient Prospective Payment System Fact Sheet (January 2009), which provides general information about the Hospital Outpatient Prospective Payment System, ambulatory payment classifications, and how payment rates are set, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at
this location . If you are unable to access the hyperlink in this message, please copy and paste the URL into your Internet browser.
January 1, 2009 - The PARA Newsletter for January 2009 is now available.
Click here for a list of upcoming events, recent updates to the PARA Data Editor, and more.
November 3, 2008 - The Centers for Medicare & Medicaid Services (CMS) has announced the scheduled release of modifications to the HCPCS code set. These changes have been posted to the HCPCS website at
this Web page. All changes are effective January 1, 2009, unless otherwise indicated in the effective date column.
October 31, 2008 - In a final rule establishing Medicare payment and policy changes for services in HOPDs and ambulatory surgical centers (ASCs) for calendar year (CY) 2009, the Centers for Medicare & Medicaid Services (CMS) reiterates its commitment to implementing Value Based Purchasing (VBP) initiatives across the continuum of beneficiaries' care and transforming Medicare from a passive payer to a prudent purchaser of health care.
Click here for Fact Sheets posted on the CMS Web site.
August 15, 2008 - The Department of Health and Human Services (HHS) has announced a long-awaited proposed regulation that would replace the ICD-9-CM code sets now used to report health care diagnoses and procedures with greatly expanded ICD-10 code sets, effective October 1, 2011.
Click here to read the HHS press release issued.
July 31, 2008 - A final acute care inpatient prospective payment (IPPS) rule that went on display at the Office of the Federal Register for publication August 19, 2008 updates Medicare payments to hospitals for fiscal year (FY) 2009 and provides additional incentives for hospitals to improve the quality of care provided to people with Medicare. As part of these quality of care incentives, the rule includes payment provisions to reduce never events that occur in hospitals.
Click here for a CMS press release with more information on the final rule.
July 21, 2008 - The
PDE Filters tab now allows you to isolate procedures with a common default HCPCS / CPT® code but different current or expected prices. The new filter is labeled
Same CPT w/Different Prices.
July 18, 2008 - On July 15, as expected, President Bush vetoed the Medicare bill containing the physician payment cut restoration--and both the House and Senate overrode the veto within hours of his action. The House vote was 383 to 41; in the Senate it was 70 to 26. In his veto message, Bush said he objected to the bill because it would get its funding from a reduction in federal payments to Medicare Advantage. Click
here to view an HFMA article regarding this decision.
July 15, 2008 - The
PDE Pricing tab offers PDE users a mechanism for running their own custom pricing iterations. Select the iteration parameters from the available options, and create a new iteration in real time.
July 1, 2008 - July 2008 OPPS updates are ready. Utilize the PARA Data Editor to review the latest CMS updates and how they affect your CDM. We have analyzed all CMS July updates and compiled this information in both a report and a specific filter to view only what impacts your CDM. To access your information please log in to the PDE and click on the July 2008 Filter.
July 1, 2008 - The PARA Calculator has been updated with the July 2008 changes to Physicians and Outpatient CCI Edits. The purpose of the CCI edits is to ensure the most comprehensive groups of codes are billed rather than the component parts. Additionally, CCI edits check for mutually exclusive code pairs.
March 21, 2008 - Change Request (CR) 5980 provides information on the April 2008 Physicians Fee Schedule quarterly update. Payment files were issued to contractors based upon the 2008 Medicare Physician Fee Schedule Final Rule. This change request amends those payment files and includes new/revised codes for the Physician Quality Reporting Initiative. Click
here for a PDF file of this CR.
January 8, 2008 - PARA introduces
myMedicalCosts.com, a free, convenient and rapid method for Consumers to gather healthcare pricing, quality indicators and Patient satisfaction comments on Providers using both public and private sources. Using the MMC Web site, Consumers will request a service and receive bids from Providers, and PARA will facilitate the required transfer of information between Consumers and Providers.
January 1, 2008 - The PARA Calculator has been updated with the January 2008 changes to Physicians (Version 14.0) and Outpatient (Version 13.3) CCI Edits. The purpose of the CCI edits is to ensure the most comprehensive groups of codes are billed rather than the component parts. Additionally, CCI edits check for mutually exclusive code pairs. Click
here for a PDF file of MLN Matters article MM5824 with more details.
September 6, 2007 - Medicare Learning Network (MLN) Matters article MM 5499 has been posted to the Centers for Medicare & Medicaid Services (CMS) website. It was revised on September 6, 2007, to clarify the timeframes for reporting the POA indicators that must be submitted for every diagnosis on inpatient acute care hospital claims. Click
here for a PDF file of this article.
September 25, 2007 - PARA presented a Webinar today discussing Pricing Transparency and their latest web based tool, "Quote A Price", designed to allow hospitals to quickly provide accurate and timely Patient pricing and co-payments. Click
here to view a broadcast of the Webinar.
To register for our next Webinar "Providing Patient Quotations and Co-Payments", please click
here.
October 2007 - The 2008 CPT code changes are now available. For more information, speak with your account representative.
August 18, 2007 - In a significant policy change, Bush administration officials say that Medicare will no longer pay the extra costs of treating preventable errors, injuries and infections that occur in hospitals, a move they say could save lives and millions of dollars. Click
here to view a Wall Street Journal article regarding this decision.
July 1, 2007 - July 2007 OPPS updates are ready. Utilize the PARA Data Editor to review the latest CMS updates and how they affect your CDM. We have analyzed all CMS July updates and compiled this information in both a report and a specific filter to view only what impacts your CDM. To access your information please log in to the PDE and click on the July 2007 Filter.
June 20, 2007 - The Centers for Medicare & Medicaid Services (CMS) has made available the Medicare Part B Drug and Biological Average Sales Price (ASP) Payment Amounts for July 1, 2007 to September 30, 2007 on the CMS
Website. The files are located in the "Downloads" section of this web page.
June 4, 2007 - The CMS Quarterly Provider Update (QPU) was updated from 5/25/2007 thru 5/30/2007 to include recently published regulations and instructions. To view these documents, visit the QPU
What’s New page. To view released instructions and regulations grouped by the quarter in which they were released visit the
QPU home page.
May 18, 2007 - Medicare Learning Network (MLN) Matters article MM 5601 has been posted to the Centers for Medicare & Medicaid Services (CMS) website. It is entitled Transitioning the Mandatory Medigap ("Claim-Based") Crossover Process to the Coordination of Benefits Contractor (COBC). Click
here for a PDF file of this article.
May 18, 2007 - CMS continues to identify and implement payment and coding changes as necessary to ensure more accurate payments under Section 1847A, using their internal process for modifying the HCPCS code set and adjusting the NDC to HCPCS crosswalk. A full list of the July 2007 quarterly updates to the HCPCS is available at the
HCPCS quarterly update page.
May 10, 2007 - The CMS Quarterly Provider Update (QPU) was updated from 5/3/2007 thru 5/8/2007 to include recently published regulations and instructions. To view these documents, visit the QPU
What’s New page. To view released instructions and regulations grouped by the quarter in which they were released visit the
QPU home page.
March 21, 2007 - Change Request (CR) 5544 provides information on the April 2007 Update of the Hospital Outpatient Prospective Payment System (OPPS). It describes changes to, and billing instructions for, payment policies found in the April 2007 OPPS update. The April 2007 OPPS OCE and OPPS PRICER reflects the HCPCS, APC, HCPCS Modifier, and Revenue Code additions, changes, and deletions identified in this notification. Click
here for a PDF file of this CR.
April 27, 2007 - The CMS Quarterly Provider Update (QPU) was updated from 4/18/2007 thru 4/20/2007 to include recently published instructions. To view these documents, visit the QPU
What’s New page. To view released instructions and regulations grouped by the quarter in which they were released visit the
QPU home page.
February 26, 2007 - Change Request (CR) 5528 provides information on the April 2007 Physicians Fee Schedule quarterly update. Payment files were issued to carriers based upon the December 1, 2006, Medicare Physician Fee Schedule Final Rule. This change request amends those payment files. Click
here for a PDF file of this CR.
April 1, 2007 - The PARA Calculator has been updated with the April 2007 changes to Addendum A and Addendum B. The quarterly updates of Addendum A and Addendum B reflect the OPPS Pricer changes that are part of the quarterly OPPS recurring update notification transmittals.
January 24, 2007 - Medicare Learning Network (MLN) Matters article MM 5498 has been posted to the Centers for Medicare & Medicaid Services (CMS) website. This article describes additional changes to the 2007 Medicare Physician Fee Schedule Database. Click
here for a PDF file of this article.
March 21, 2007 - Change Request (CR) 5544 provides information on the April 2007 Update of the Hospital Outpatient Prospective Payment System (OPPS). It describes changes to, and billing instructions for, various payment policies implemented in the April 2007 OPPS update. The April 2007 OPPS Outpatient Code Editor (OCE) and OPPS PRICER will reflect the Healthcare Common Procedure Coding System (HCPCS), Ambulatory Payment Classification (APC), HCPCS Modifier, and Revenue Code additions, changes, and deletions identified in this notification. Click
here for a PDF file of this CR.
December 22, 2006 - CMS has extended the payment for Preadministration-Related Services associated with Intravenous Immune Globulin (IVIG) Administration through 2007. To achieve correct reimbursement the IVIG preadministration HCPCS code G0332 is billed once per day and must be billed on the same claim form as the IVIG product (J1566 and/or J1567), have the same date of service as the IVIG product and a drug administration service. Click
here for a PDF file of MLN Matters article MM5428, which provides complete details.
December 15, 2006 - Change Request (CR) 5413 instructs Medicare contractors to download the January 2007 Average Sales Price (ASP) drug pricing file for Medicare Part B drugs as well as the revised January 2006, April 2006, July 2006, and October 2006 files. Click
here for a PDF file of this CR.
December 20, 2006 - Change Request (CR) 5211 updates the 2007 HCPCS codes and Ambulatory Surgical Centers (ASC) payment rates, effective for services furnished on or after January 1, 2007. Click
here for a PDF file of this CR.
2007 CPT / HCPCS codes – The 2007 codes have been issued in their final form. Click
here for a PDF file analyzing the changes.
California Medi-Cal November 2006 Code Update – Medi-Cal is changing a number of codes. Click
here for a PDF file of the old to new mapping.
December 8, 2006 - Change Request (CR) 5417, provides specific information regarding the annual update for the 2007 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule. Be sure billing staff are aware of this update. Click
here for a PDF file of this CR.
December 8, 2006 - Change Request (CR) 5362 contains important information regarding the 2007 annual updates to the clinical laboratory fee schedule, mapping for new codes for clinical laboratory tests and laboratory costs related to services subject to reasonable charge payments. It is important that affected laboratories understand these changes to ensure correct and accurate payments from Medicare. Click
here for a PDF file of this CR.
December 12, 2006 – PARA introduces a new method for our clients to receive sensitive data. If we need to convey Charge Description Master, pricing, or other proprietary information to you, we will send you a link in an email. That link will allow you to log in to our Web site and establish a secure connection to a Web page containing a link to the file. Click
here to access a Word document with instructions and more information on the Secure File Download application.
Market data – Having recently processed 55 million claims with 280 million HCPCS codes, PARA now has the most current market data for any Hospital paid under OPPS during 2005 for any date and any HCPCS code. Click
here to email Violet in our Sales Department and receive a Market Analysis.