2004 MLN Matters Articles

HIPAA Privacy Act

Thu, 10 Nov 2005 09:51:00 EST

Transmittal #: R7GI
Subject: HIPAA Privacy Act
MM Article #: N/A
MM Article Release Date: N/A

Additional Instructions Related to the "Redistribution of Unused Resident Positions," Section 422 of the Medicare Modernization Act of 2003 (MMA), P.L. 108-173, for Purposes of Graduate Medical Education (GME) Payments

Thu, 10 Nov 2005 09:53:00 EST

Transmittal #: R92OTN
Subject: Additional Instructions Related to the "Redistribution of Unused Resident Positions," Section 422 of the Medicare Modernization Act of 2003 (MMA), P.L. 108-173, for Purposes of Graduate Medical Education (GME) Payments
MM Article #: N/A
MM Article Release Date: N/A

PET Scans and Related Claims Processing

Thu, 10 Nov 2005 09:54:00 EST

Transmittal #: R223CP
Subject: PET Scans and Related Claims Processing
MM Article #: N/A
MM Article Release Date: N/A

SNF CB Requirements for DMEPOS

Thu, 10 Nov 2005 09:56:00 EST

Transmittal #: R222CP
Subject: SNF CB Requirements for DMEPOS
MM Article #: N/A
MM Article Release Date: N/A

Chapter 11

Thu, 10 Nov 2005 09:58:00 EST

Transmittal #: R56MCM
Subject: Chapter 11
MM Article #: N/A
MM Article Release Date: N/A

Local Medical Review Policy/ Local Coverage Determination Medicare Summary Notice (MSN) Message Revision

Thu, 10 Nov 2005 09:59:00 EST

Transmittal #: R79PI
Subject: Local Medical Review Policy/ Local Coverage Determination Medicare Summary Notice (MSN) Message Revision
MM Article #: N/A
MM Article Release Date: N/A

This transmittal is rescinded and replaced with Transmittal 50, dated July 30, 2004.

Thu, 10 Nov 2005 10:00:00 EST

Transmittal #: R48FM
Subject: This transmittal is rescinded and replaced with Transmittal 50, dated July 30, 2004.
MM Article #: N/A
MM Article Release Date: N/A

Correction to January 2005 Annual Update of HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement

Thu, 10 Nov 2005 10:33:00 EST

Transmittal #: R421CP
Subject: Correction to January 2005 Annual Update of HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement
MM Article #: MM3613
MM Article Release Date: 01/06/2005

Update to FY 2005 Wage Index for Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS) Hospitals

Thu, 10 Nov 2005 10:34:00 EST

Transmittal #: R422CP
Subject: Update to FY 2005 Wage Index for Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS) Hospitals
MM Article #: MM3672
MM Article Release Date: 01/26/2005

January 2005 Update of the Hospital Outpatient Prospective Payment System (OPPS): Summary of Payment Policy Changes

Thu, 10 Nov 2005 10:35:00 EST

Transmittal #: R419CP
Subject: January 2005 Update of the Hospital Outpatient Prospective Payment System (OPPS): Summary of Payment Policy Changes
MM Article #: N/A
MM Article Release Date: N/A

January 2005 Update of the Hospital Outpatient Prospective Payment System (OPPS): Summary of Payment Policy Changes

Thu, 10 Nov 2005 10:36:00 EST

Transmittal #: R423CP
Subject: January 2005 Update of the Hospital Outpatient Prospective Payment System (OPPS): Summary of Payment Policy Changes
MM Article #: MM3632
MM Article Release Date: 01/12/2005

Elimination of Regulations for Written Statement of Intent (SOI)

Thu, 10 Nov 2005 10:40:00 EST

Transmittal #: R211CP
Subject: Elimination of Regulations for Written Statement of Intent (SOI)
MM Article #: MM3310
MM Article Release Date: 06/24/2004

Reporting Medicare Secondary Payer (MSP) Information on the Health Insurance Portability and Accountability Act of 1996 (HIPAA) X12N 837 Created Via Free Billing Software

Thu, 10 Nov 2005 11:06:00 EST

Transmittal #: R84OTN
Subject: Reporting Medicare Secondary Payer (MSP) Information on the Health Insurance Portability and Accountability Act of 1996 (HIPAA) X12N 837 Created Via Free Billing Software
MM Article #: MM3284
MM Article Release Date: 06/07/2004

Initial Preventive Physical Examination (IPPE)-(Note: This is a full replacement of CR 3413, transmittal 294, dated September 3, 2004. CR 3413 is rescinded.)

Thu, 10 Nov 2005 11:08:00 EST

Transmittal #: R417CP
Subject: Initial Preventive Physical Examination (IPPE)-(Note: This is a full replacement of CR 3413, transmittal 294, dated September 3, 2004. CR 3413 is rescinded.)
MM Article #: MM3638
MM Article Release Date: 12/27/2004

Interest Payment on Clean Non-PIP Claims Not Paid Timely

Thu, 10 Nov 2005 11:09:00 EST

Transmittal #: R416CP
Subject: Interest Payment on Clean Non-PIP Claims Not Paid Timely
MM Article #: N/A
MM Article Release Date: N/A

Chemotherapy Demonstration Project

Thu, 10 Nov 2005 11:09:00 EST

Transmittal #: R14DEMO
Subject: Chemotherapy Demonstration Project
MM Article #: MM3670
MM Article Release Date: 01/06/2005

Temporary Change in Carrier Jurisdictional Pricing Rules for Purchased Diagnostic Services

Thu, 10 Nov 2005 11:10:00 EST

Transmittal #: R415CP
Subject: Temporary Change in Carrier Jurisdictional Pricing Rules for Purchased Diagnostic Services
MM Article #: MM3630
MM Article Release Date: 04/01/2005

Business Partners Systems Security Manual

Thu, 10 Nov 2005 11:43:00 EST

Transmittal #: R5SSS
Subject: Business Partners Systems Security Manual
MM Article #: N/A
MM Article Release Date: N/A

January Update to the Medicare Outpatient Code Editor (OCE) Version 20.1 for Bills From Hospitals That Are Not Paid Under The Outpatient Prospective Payment System (Non-OPPS)

Thu, 10 Nov 2005 11:45:00 EST

Transmittal #: R402CP
Subject: January Update to the Medicare Outpatient Code Editor (OCE) Version 20.1 for Bills From Hospitals That Are Not Paid Under The Outpatient Prospective Payment System (Non-OPPS)
MM Article #: MM3621
MM Article Release Date: 01/06/2005

January 2005 Update of the Hospital Outpatient Prospective Payment System (OPPS):Changes to Coding and Payment for Drug Administration

Thu, 10 Nov 2005 11:46:00 EST

Transmittal #: R404CP
Subject: January 2005 Update of the Hospital Outpatient Prospective Payment System (OPPS):Changes to Coding and Payment for Drug Administration
MM Article #: MM3610
MM Article Release Date: 12/21/2004

January 2005 Update of the Hospital Outpatient Prospective Payment System (OPPS): Billing for Devices that do not have Transitional Pass-Through Status, and that are not Classified as New Technology Ambulatory Payment Classification (APC) Groups

Thu, 10 Nov 2005 11:47:00 EST

Transmittal #: R403CP
Subject: January 2005 Update of the Hospital Outpatient Prospective Payment System (OPPS): Billing for Devices that do not have Transitional Pass-Through Status, and that are not Classified as New Technology Ambulatory Payment Classification (APC) Groups
MM Article #: MM3606
MM Article Release Date: 12/23/2004

New Dispensing/Supply Fee Codes for Oral Anti-Cancer, Oral Ant-Emetic, Immunosuppressive, and Inhalation Drugs

Thu, 10 Nov 2005 11:47:00 EST

Transmittal #: R396CP
Subject: New Dispensing/Supply Fee Codes for Oral Anti-Cancer, Oral Ant-Emetic, Immunosuppressive, and Inhalation Drugs
MM Article #: MM3620
MM Article Release Date: 12/29/2004

DMERC/Local Carriers/SADMERC - Drug Pricing Limits as of January 1, 2005

Thu, 10 Nov 2005 11:49:00 EST

Transmittal #: R397CP
Subject: DMERC/Local Carriers/SADMERC - Drug Pricing Limits as of January 1, 2005
MM Article #: MM3232
MM Article Release Date: 12/21/2004

Diabetes Screening Tests

Thu, 10 Nov 2005 11:51:00 EST

Transmittal #: R409CP
Subject: Diabetes Screening Tests
MM Article #: N/A
MM Article Release Date: N/A

Update to Health Care Claims Status Category Codes and Health Care Claim Status Codes for Use with the Health Care Claim Status Request and Response ASC X12N 276/277

Thu, 10 Nov 2005 11:52:00 EST

Transmittal #: R406CP
Subject: Update to Health Care Claims Status Category Codes and Health Care Claim Status Codes for Use with the Health Care Claim Status Request and Response ASC X12N 276/277
MM Article #: MM3566
MM Article Release Date: 12/23/2004

Shared System Maintainer Hours for Resolution of Problems Detected as a Result of Implementation of Change Request 2525 and Change Request 2527

Thu, 10 Nov 2005 11:54:00 EST

Transmittal #: R133OTN
Subject: Shared System Maintainer Hours for Resolution of Problems Detected as a Result of Implementation of Change Request 2525 and Change Request 2527
MM Article #: N/A
MM Article Release Date: N/A

Scheduled Release for January Updates to Software Programs and Pricing/Coding Files

Thu, 10 Nov 2005 11:56:00 EST

Transmittal #: R14GI
Subject: Scheduled Release for January Updates to Software Programs and Pricing/Coding Files
MM Article #: N/A
MM Article Release Date: N/A

Medicare Coordinated Care Demonstration (MCCD)-Override of Certain Medicare Secondary Payer Edit Codes

Thu, 10 Nov 2005 11:57:00 EST

Transmittal #: R11DEMO
Subject: Medicare Coordinated Care Demonstration (MCCD)-Override of Certain Medicare Secondary Payer Edit Codes
MM Article #: N/A
MM Article Release Date: N/A

Incorrect Reporting of MTUS Indicator When Drugs are Billed Using an NDC Code

Thu, 10 Nov 2005 11:58:00 EST

Transmittal #: R400CP
Subject: Incorrect Reporting of MTUS Indicator When Drugs are Billed Using an NDC Code
MM Article #: N/A
MM Article Release Date: N/A

Section 2231, Regional Medicare Swing-Bed Rates

Thu, 10 Nov 2005 11:59:00 EST

Transmittal #: R427PR1
Subject: Section 2231, Regional Medicare Swing-Bed Rates
MM Article #: N/A
MM Article Release Date: N/A

Development of a Coordination of Benefits Agreement (COBA) Auxiliary File and Modification of the Health Insurance Portability and Accountability Act (HIPAA) 837 Coordination of Benefits (COB) Flat File and National Council for Prescription Drug Programs (NCPDP) File

Thu, 10 Nov 2005 12:01:00 EST

Transmittal #: R130OTN
Subject: Development of a Coordination of Benefits Agreement (COBA) Auxiliary File and Modification of the Health Insurance Portability and Accountability Act (HIPAA) 837 Coordination of Benefits (COB) Flat File and National Council for Prescription Drug Programs (NCPDP) File
MM Article #: N/A
MM Article Release Date: N/A

Cardiovascular Disease Screening

Thu, 10 Nov 2005 12:02:00 EST

Transmittal #: R408CP
Subject: Cardiovascular Disease Screening
MM Article #: MM3411
MM Article Release Date: 12/21/2004

Hospital Billing for Repetitive Services

Thu, 10 Nov 2005 12:03:00 EST

Transmittal #: R407CP
Subject: Hospital Billing for Repetitive Services
MM Article #: MM3633
MM Article Release Date: 12/27/2004

Emergency Change to Carrier Instructions for the End Stage Renal Disease (ESRD) 50/50 Rule Implementation

Thu, 10 Nov 2005 12:05:00 EST

Transmittal #: R405CP
Subject: Emergency Change to Carrier Instructions for the End Stage Renal Disease (ESRD) 50/50 Rule Implementation
MM Article #: MM3609
MM Article Release Date: 12/21/2004

New Location Code ICC, Status Code AR and Modified Intent Letter for Unfiled Cost Reports Only

Thu, 10 Nov 2005 12:12:00 EST

Transmittal #: R61FM
Subject: New Location Code ICC, Status Code AR and Modified Intent Letter for Unfiled Cost Reports Only
MM Article #: N/A
MM Article Release Date: N/A

Medicare Secondary Payer (MSP) Debt Referral Instructions and Debt Collection Improvement Act of 1996 (DCIA) Activities

Thu, 10 Nov 2005 13:54:00 EST

Transmittal #: R22MSP
Subject: Medicare Secondary Payer (MSP) Debt Referral Instructions and Debt Collection Improvement Act of 1996 (DCIA) Activities
MM Article #: N/A
MM Article Release Date: N/A

Hospice Pre-Election Evaluation and Counseling Services

Thu, 10 Nov 2005 13:56:00 EST

Transmittal #: R386CP
Subject: Hospice Pre-Election Evaluation and Counseling Services
MM Article #: MM3585
MM Article Release Date: 03/28/2005

Surveys, Contracting Strategy, Grievances and Appeals

Thu, 10 Nov 2005 13:56:00 EST

Transmittal #: R64MCM
Subject: Surveys, Contracting Strategy, Grievances and Appeals
MM Article #: N/A
MM Article Release Date: N/A

January 2005 Update of the Hospital Outpatient Prospective Payment System (OPPS): Summary of OPPS Outpatient Code Editor (OCE) Data Changes and OPPS PRICER Logic Changes; Changes to Payment for Diagnostic Mammography

Thu, 10 Nov 2005 13:58:00 EST

Transmittal #: R385CP
Subject: January 2005 Update of the Hospital Outpatient Prospective Payment System (OPPS): Summary of OPPS Outpatient Code Editor (OCE) Data Changes and OPPS PRICER Logic Changes; Changes to Payment for Diagnostic Mammography
MM Article #: MM3586
MM Article Release Date: 01/04/2005

This instruction is to inform the fiscal intermediaries that the January 2005 Outpatient Prospective Payment System Outpatient Code Editor (OPPS OCE) Specifications have been updated with new additions, changes, and deletions

Thu, 10 Nov 2005 13:58:00 EST

Transmittal #: R387CP
Subject: This instruction is to inform the fiscal intermediaries that the January 2005 Outpatient Prospective Payment System Outpatient Code Editor (OPPS OCE) Specifications have been updated with new additions, changes, and deletions
MM Article #: MM3583
MM Article Release Date: 12/07/2004

2005 Part B Deductible Update to the Back Page of Medicare Summary Notices

Thu, 10 Nov 2005 14:00:00 EST

Transmittal #: R401CP
Subject: 2005 Part B Deductible Update to the Back Page of Medicare Summary Notices
MM Article #: N/A
MM Article Release Date: N/A

Expansion of the Existing Interrupted Stay Policy Under Long Term Care Hospital (LTCH) Prospective Payment System

Thu, 10 Nov 2005 14:00:00 EST

Transmittal #: R399CP
Subject: Expansion of the Existing Interrupted Stay Policy Under Long Term Care Hospital (LTCH) Prospective Payment System
MM Article #: MM3279
MM Article Release Date: 12/29/2004

Ambulance Fee Schedule - Medical Conditions List

Thu, 10 Nov 2005 14:01:00 EST

Transmittal #: R395CP
Subject: Ambulance Fee Schedule - Medical Conditions List
MM Article #: MM3619
MM Article Release Date: 01/10/2005

New Dispensing/Supply Fee Codes for Oral Anti-Cancer, Oral Ant-Emetic, Immunosuppressive, and Inhalation Drugs

Thu, 10 Nov 2005 14:02:00 EST

Transmittal #: R394CP
Subject: New Dispensing/Supply Fee Codes for Oral Anti-Cancer, Oral Ant-Emetic, Immunosuppressive, and Inhalation Drugs
MM Article #: N/A
MM Article Release Date: N/A

2005 Part B Deductible Update to the Back Page of Medicare Summary Notices

Thu, 10 Nov 2005 14:03:00 EST

Transmittal #: R393CP
Subject: 2005 Part B Deductible Update to the Back Page of Medicare Summary Notices
MM Article #: N/A
MM Article Release Date: N/A

Chemotherapy Demonstration Project

Thu, 10 Nov 2005 14:07:00 EST

Transmittal #: R12DEMO
Subject: Chemotherapy Demonstration Project
MM Article #: N/A
MM Article Release Date: N/A

Revision of Program Integrity Manual (PIM), Section 3.11.1.4

Thu, 10 Nov 2005 14:08:00 EST

Transmittal #: R91PI
Subject: Revision of Program Integrity Manual (PIM), Section 3.11.1.4
MM Article #: N/A
MM Article Release Date: N/A

Prepayment Review of Claims for MR Purposes

Thu, 10 Nov 2005 14:12:00 EST

Transmittal #: R90PI
Subject: Prepayment Review of Claims for MR Purposes
MM Article #: N/A
MM Article Release Date: N/A

Inpatient Psychiatric Facility Prospective Payment System (IPF PPS)

Thu, 10 Nov 2005 14:17:00 EST

Transmittal #: R384CP
Subject: Inpatient Psychiatric Facility Prospective Payment System (IPF PPS)
MM Article #: MM3541
MM Article Release Date: 12/07/2004

Instructions Applicable to the Audit of Hospitals that are Part of an Affiliated Group in Relation to the "Redistribution of Unused Resident Positions," Section 422 of the Medicare Modernization Act of 2003 (MMA), P.L. 108-173, for Purposes of Graduate Medical Education (GME) Payments

Thu, 10 Nov 2005 14:18:00 EST

Transmittal #: R127OTN
Subject: Instructions Applicable to the Audit of Hospitals that are Part of an Affiliated Group in Relation to the "Redistribution of Unused Resident Positions," Section 422 of the Medicare Modernization Act of 2003 (MMA), P.L. 108-173, for Purposes of Graduate Medical Education (GME) Payments
MM Article #: N/A
MM Article Release Date: N/A

Annual Update of HCPCS Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB)

Thu, 10 Nov 2005 14:20:00 EST

Transmittal #: R360CP
Subject: Annual Update of HCPCS Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB)
MM Article #: MM3542
MM Article Release Date: 11/29/2004

Hospice Pre-Election Evaluation and Counseling Services

Thu, 10 Nov 2005 14:21:00 EST

Transmittal #: R28BP
Subject: Hospice Pre-Election Evaluation and Counseling Services
MM Article #: MM3585
MM Article Release Date: 03/28/2005

2005 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment

Thu, 10 Nov 2005 14:22:00 EST

Transmittal #: R363CP
Subject: 2005 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment
MM Article #: MM3526
MM Article Release Date: 11/16/2004

2005 Drug Administration Coding Revisions

Thu, 10 Nov 2005 14:22:00 EST

Transmittal #: R129OTN
Subject: 2005 Drug Administration Coding Revisions
MM Article #: MM3631
MM Article Release Date: 01/06/2005

Promoting Medicare's Preventive Benefits and Services on an Annual Basis

Thu, 10 Nov 2005 14:23:00 EST

Transmittal #: R128OTN
Subject: Promoting Medicare's Preventive Benefits and Services on an Annual Basis
MM Article #: N/A
MM Article Release Date: N/A

Update to the Prospective Payment System (PPS) for Home Health Agencies for Calendar Year (CY) 2005

Thu, 10 Nov 2005 14:25:00 EST

Transmittal #: R362CP
Subject: Update to the Prospective Payment System (PPS) for Home Health Agencies for Calendar Year (CY) 2005
MM Article #: MM3556
MM Article Release Date: 11/19/2004

Payment for Referred Laboratory Automated Multi-Channel Chemistry (AMCC) Tests

Thu, 10 Nov 2005 14:25:00 EST

Transmittal #: R372CP
Subject: Payment for Referred Laboratory Automated Multi-Channel Chemistry (AMCC) Tests
MM Article #: MM3483
MM Article Release Date: 01/10/2005

Fee Schedule Update for 2005 for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)

Thu, 10 Nov 2005 14:26:00 EST

Transmittal #: R369CP
Subject: Fee Schedule Update for 2005 for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)
MM Article #: N/A
MM Article Release Date: N/A

Updated Billing Instructions for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)

Thu, 10 Nov 2005 14:27:00 EST

Transmittal #: R371CP
Subject: Updated Billing Instructions for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)
MM Article #: MM3487
MM Article Release Date: 12/10/2004

Clarification to IOM Chapter 17, Section 80.4 regarding claims for Blood Clotting Factors

Thu, 10 Nov 2005 14:28:00 EST

Transmittal #: R374CP
Subject: Clarification to IOM Chapter 17, Section 80.4 regarding claims for Blood Clotting Factors
MM Article #: N/A
MM Article Release Date: N/A

New ESRD Composite Payment Rates Effective January 1, 2005

Thu, 10 Nov 2005 14:30:00 EST

Transmittal #: R27BP
Subject: New ESRD Composite Payment Rates Effective January 1, 2005
MM Article #: MM3554
MM Article Release Date: 12/07/2004

Updating Financial Reporting Requirements for Medical Review and Local Provider Education and Training

Thu, 10 Nov 2005 14:30:00 EST

Transmittal #: R89PI
Subject: Updating Financial Reporting Requirements for Medical Review and Local Provider Education and Training
MM Article #: N/A
MM Article Release Date: N/A

Timeframes for Processing 855 Enrollment Applications

Thu, 10 Nov 2005 14:32:00 EST

Transmittal #: R88PI
Subject: Timeframes for Processing 855 Enrollment Applications
MM Article #: N/A
MM Article Release Date: N/A

Revised instructions on contractor procedures for provider audit and the Provider Statistical & Reimbursement Report (PSRR)

Thu, 10 Nov 2005 14:32:00 EST

Transmittal #: R60FM
Subject: Revised instructions on contractor procedures for provider audit and the Provider Statistical & Reimbursement Report (PSRR)
MM Article #: N/A
MM Article Release Date: N/A

Independent Laboratory Billing for the Technical Component (TC) of Physician Pathology Services to Hospital Patients

Thu, 10 Nov 2005 14:33:00 EST

Transmittal #: R382CP
Subject: Independent Laboratory Billing for the Technical Component (TC) of Physician Pathology Services to Hospital Patients
MM Article #: MM3467
MM Article Release Date: 01/04/2005

MMA Drug Pricing Update - Payment Limit for J0207 (Amifostine)

Thu, 10 Nov 2005 14:35:00 EST

Transmittal #: R361CP
Subject: MMA Drug Pricing Update - Payment Limit for J0207 (Amifostine)
MM Article #: MM3552
MM Article Release Date: 11/16/2004

Implementation of Coverage of Religious Nonmedical Health Care Institution Items and Services Furnished in the Home, MMA section 706.

Thu, 10 Nov 2005 14:36:00 EST

Transmittal #: R357CP
Subject: Implementation of Coverage of Religious Nonmedical Health Care Institution Items and Services Furnished in the Home, MMA section 706.
MM Article #: MM3529
MM Article Release Date: 11/23/2004

Implementation of Coverage of Religious Nonmedical Health Care Institution (RNHCI) Items and Services Furnished in the Home, MMA section 706.

Thu, 10 Nov 2005 14:37:00 EST

Transmittal #: R25BP
Subject: Implementation of Coverage of Religious Nonmedical Health Care Institution (RNHCI) Items and Services Furnished in the Home, MMA section 706.
MM Article #: MM3529
MM Article Release Date: 11/23/2004

Chapter 5 and Chapter 17B

Thu, 10 Nov 2005 14:38:00 EST

Transmittal #: R63MCM
Subject: Chapter 5 and Chapter 17B
MM Article #: N/A
MM Article Release Date: N/A

Instructions for Completion of Form CMS-1450

Thu, 10 Nov 2005 14:40:00 EST

Transmittal #: R368CP
Subject: Instructions for Completion of Form CMS-1450
MM Article #: MM3543
MM Article Release Date: 11/29/2004

Guidance to Surveyors for Long Term Care Facilities

Thu, 10 Nov 2005 14:40:00 EST

Transmittal #: R4SOM
Subject: Guidance to Surveyors for Long Term Care Facilities
MM Article #: N/A
MM Article Release Date: N/A

Revisions to Appendix P (Survey Protocols for Long Term Care Facilities) and Appendix PP (Guidance to Surveyors for Long Term Care Facilities)

Thu, 10 Nov 2005 14:42:00 EST

Transmittal #: R5SOM
Subject: Revisions to Appendix P (Survey Protocols for Long Term Care Facilities) and Appendix PP (Guidance to Surveyors for Long Term Care Facilities)
MM Article #: N/A
MM Article Release Date: N/A

Section 630 of the Medicare Modernization Act (MMA) allows for the reimbursement for ambulance services provided by IHS/Tribal Hospitals, including CAHs, which manage and operate hospital-based ambulances.

Thu, 10 Nov 2005 14:42:00 EST

Transmittal #: R367CP
Subject: Section 630 of the Medicare Modernization Act (MMA) allows for the reimbursement for ambulance services provided by IHS/Tribal Hospitals, including CAHs, which manage and operate hospital-based ambulances.
MM Article #: N/A
MM Article Release Date: N/A

New Case-Mix Adjusted End Stage Renal Disease (ESRD) Composite Payment Rates and New Composite Rates and New Composite Rate Exceptions Window for Pediatric ESRD Facilities

Thu, 10 Nov 2005 14:44:00 EST

Transmittal #: R370CP
Subject: New Case-Mix Adjusted End Stage Renal Disease (ESRD) Composite Payment Rates and New Composite Rates and New Composite Rate Exceptions Window for Pediatric ESRD Facilities
MM Article #: MM3572
MM Article Release Date: 01/06/2005

New ESRD Composite Payment Rates Effective January 1, 2005

Thu, 10 Nov 2005 14:44:00 EST

Transmittal #: R373CP
Subject: New ESRD Composite Payment Rates Effective January 1, 2005
MM Article #: N/A
MM Article Release Date: N/A

Long Act Implant, Bcg Live Intravesical Vac, and Gallium ga 67; Adjustments Due to Misclassification

Thu, 10 Nov 2005 14:45:00 EST

Transmittal #: R377CP
Subject: Long Act Implant, Bcg Live Intravesical Vac, and Gallium ga 67; Adjustments Due to Misclassification
MM Article #: MM3540
MM Article Release Date: 12/06/2004

Changes to the Laboratory National Coverage Determination (NCD) edit Software for January 2005

Thu, 10 Nov 2005 14:48:00 EST

Transmittal #: R380CP
Subject: Changes to the Laboratory National Coverage Determination (NCD) edit Software for January 2005
MM Article #: MM3429
MM Article Release Date: 12/06/2004

Low Osmolar Contrast Material/Laboratory Tests/Payment for Inpatient Services Furnished by a Critical Access Hospital (CAH)

Thu, 10 Nov 2005 14:49:00 EST

Transmittal #: R379CP
Subject: Low Osmolar Contrast Material/Laboratory Tests/Payment for Inpatient Services Furnished by a Critical Access Hospital (CAH)
MM Article #: MM3439
MM Article Release Date: 12/02/2004

Revisions and Corrections, Chapter 29 of the IOM, Claims Processing Manual - Appeals

Thu, 10 Nov 2005 14:50:00 EST

Transmittal #: R381CP
Subject: Revisions and Corrections, Chapter 29 of the IOM, Claims Processing Manual - Appeals
MM Article #: N/A
MM Article Release Date: N/A

Payment for Emergency Medical Treatment and Labor Act (EMTALA) - Mandated Screening and Stabilization Services

Thu, 10 Nov 2005 14:51:00 EST

Transmittal #: R86PI
Subject: Payment for Emergency Medical Treatment and Labor Act (EMTALA) - Mandated Screening and Stabilization Services
MM Article #: N/A
MM Article Release Date: N/A

DMERC - Revision to CR 2631 Requirements for DMERC claims

Thu, 10 Nov 2005 15:15:00 EST

Transmittal #: R353CP
Subject: DMERC - Revision to CR 2631 Requirements for DMERC claims
MM Article #: N/A
MM Article Release Date: N/A

Three Places after the Decimal Point for ASP drug file

Thu, 10 Nov 2005 15:16:00 EST

Transmittal #: R352CP
Subject: Three Places after the Decimal Point for ASP drug file
MM Article #: N/A
MM Article Release Date: N/A

Notice of New Interest Rate for Medicare Overpayments and Underpayments.

Thu, 10 Nov 2005 15:18:00 EST

Transmittal #: R59FM
Subject: Notice of New Interest Rate for Medicare Overpayments and Underpayments.
MM Article #: N/A
MM Article Release Date: N/A

Inclusion of Forteo as a Covered Osteoporosis Drug and Clarification of Manual Instructions Regarding Osteoporosis Drugs

Thu, 10 Nov 2005 15:19:00 EST

Transmittal #: R358CP
Subject: Inclusion of Forteo as a Covered Osteoporosis Drug and Clarification of Manual Instructions Regarding Osteoporosis Drugs
MM Article #: MM3524
MM Article Release Date: 12/08/2004

Annual Type of Service (TOS)

Thu, 10 Nov 2005 15:21:00 EST

Transmittal #: R349CP
Subject: Annual Type of Service (TOS)
MM Article #: N/A
MM Article Release Date: N/A

Three Places after the Decimal Point for ASP drug file

Thu, 10 Nov 2005 15:22:00 EST

Transmittal #: R346CP
Subject: Three Places after the Decimal Point for ASP drug file
MM Article #: N/A
MM Article Release Date: N/A

Inclusion of Forteo as a Covered Osteoporosis Drug and Clarification of Manual Instructions Regarding Osteoporosis Drugs

Thu, 10 Nov 2005 15:27:00 EST

Transmittal #: R26BP
Subject: Inclusion of Forteo as a Covered Osteoporosis Drug and Clarification of Manual Instructions Regarding Osteoporosis Drugs
MM Article #: MM3524
MM Article Release Date: 12/08/2004

Instructions Applicable to the Audit of Hospitals that are Part of an Affiliated Group in Relation to the "Redistribution of Unused Resident Positions," Section 422 of the Medicare Modernization Act of 2003 (MMA), P.L. 108-173, for Purposes of Graduate Medical Education (GME) Payments

Thu, 10 Nov 2005 15:28:00 EST

Transmittal #: R125OTN
Subject: Instructions Applicable to the Audit of Hospitals that are Part of an Affiliated Group in Relation to the "Redistribution of Unused Resident Positions," Section 422 of the Medicare Modernization Act of 2003 (MMA), P.L. 108-173, for Purposes of Graduate Medical Education (GME) Payments
MM Article #: N/A
MM Article Release Date: N/A

Implementation of the Medicare Physician Fee Schedule (MPFS) National Abstract File for Purchased Diagnostic Tests and Interpretations

Thu, 10 Nov 2005 15:30:00 EST

Transmittal #: R341CP
Subject: Implementation of the Medicare Physician Fee Schedule (MPFS) National Abstract File for Purchased Diagnostic Tests and Interpretations
MM Article #: MM3481
MM Article Release Date: 03/21/2005

Manualization NCD: Acupuncture for Fibromyalgia/Osteoarthritis

Thu, 10 Nov 2005 15:31:00 EST

Transmittal #: R11NCD
Subject: Manualization NCD: Acupuncture for Fibromyalgia/Osteoarthritis
MM Article #: MM3250
MM Article Release Date: 04/28/2004

Annual Update of HCPCS Codes Used for Home Health Consolidated Billing Enforcement

Thu, 10 Nov 2005 15:31:00 EST

Transmittal #: R340CP
Subject: Annual Update of HCPCS Codes Used for Home Health Consolidated Billing Enforcement
MM Article #: MM3525
MM Article Release Date: 11/04/2004

Remonal of the Skilled Nursing Facility (SNF) No Pay File

Thu, 10 Nov 2005 15:32:00 EST

Transmittal #: R338CP
Subject: Remonal of the Skilled Nursing Facility (SNF) No Pay File
MM Article #: N/A
MM Article Release Date: N/A

Change in Hospital Type of Bill for Billing Diagnostic and Screening Mammographics

Thu, 10 Nov 2005 15:33:00 EST

Transmittal #: R337CP
Subject: Change in Hospital Type of Bill for Billing Diagnostic and Screening Mammographics
MM Article #: MM3469
MM Article Release Date: 11/15/2004

DMERC - Revision to CR 2631 Requirements for DMERC claims

Thu, 10 Nov 2005 15:34:00 EST

Transmittal #: R345CP
Subject: DMERC - Revision to CR 2631 Requirements for DMERC claims
MM Article #: N/A
MM Article Release Date: N/A

Indian Health Service (IHS) or Tribal Hospitals including Critical Access Hospitals (CAH) Payment Methodology for Inpatient Social Admissions and Outpatient Services Occurring During Concurrent Stays

Thu, 10 Nov 2005 15:35:00 EST

Transmittal #: R336CP
Subject: Indian Health Service (IHS) or Tribal Hospitals including Critical Access Hospitals (CAH) Payment Methodology for Inpatient Social Admissions and Outpatient Services Occurring During Concurrent Stays
MM Article #: N/A
MM Article Release Date: N/A

Incorrect Reporting of Miles, Times, Units, Services (MTUS) Indicator When a Drug is Billed in the NCPDP Format Using an NDC Code

Thu, 10 Nov 2005 15:36:00 EST

Transmittal #: R335CP
Subject: Incorrect Reporting of Miles, Times, Units, Services (MTUS) Indicator When a Drug is Billed in the NCPDP Format Using an NDC Code
MM Article #: N/A
MM Article Release Date: N/A

Change to the Common Working File (CWF) Skilled Nursing Facility (SNF) Consolidated Billing (CB) Edits for Ambulance Transports to or from a Diagnostic or Therapeutic Site

Thu, 10 Nov 2005 15:37:00 EST

Transmittal #: R342CP
Subject: Change to the Common Working File (CWF) Skilled Nursing Facility (SNF) Consolidated Billing (CB) Edits for Ambulance Transports to or from a Diagnostic or Therapeutic Site
MM Article #: MM3427
MM Article Release Date: 11/29/2004

Editing of Hospitals and Skilled Nursing Facilities Part B Inpatient Services (Full Replacement of Change Request 3366)

Thu, 10 Nov 2005 15:38:00 EST

Transmittal #: R351CP
Subject: Editing of Hospitals and Skilled Nursing Facilities Part B Inpatient Services (Full Replacement of Change Request 3366)
MM Article #: MM3531
MM Article Release Date: 11/16/2004

Inpatient Rehabilitation Facility (IRF) Classification Requirements

Thu, 10 Nov 2005 15:39:00 EST

Transmittal #: R347CP
Subject: Inpatient Rehabilitation Facility (IRF) Classification Requirements
MM Article #: MM3503
MM Article Release Date: 11/08/2004

January 2005 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing File, Effective January 1, 2005

Thu, 10 Nov 2005 15:40:00 EST

Transmittal #: R348CP
Subject: January 2005 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing File, Effective January 1, 2005
MM Article #: MM3539
MM Article Release Date: 11/08/2004

Clarification: Modifiers for Transportation of Portable X-rays (R0075)

Thu, 10 Nov 2005 15:41:00 EST

Transmittal #: R343CP
Subject: Clarification: Modifiers for Transportation of Portable X-rays (R0075)
MM Article #: MM3280
MM Article Release Date: 11/19/2004

Editing for Part B Carriers and Durable Medical Equipment Regional Carriers (DMERCs) for Duplicate Claims in Process at the Same Time

Thu, 10 Nov 2005 15:41:00 EST

Transmittal #: R350CP
Subject: Editing for Part B Carriers and Durable Medical Equipment Regional Carriers (DMERCs) for Duplicate Claims in Process at the Same Time
MM Article #: N/A
MM Article Release Date: N/A

Revision of Section 300.5.1, Chapter 15 of the Medicare Benefit Policy Manual to include 22x TOB as an applicable TOB for Diabetes Self-Management Training.

Thu, 10 Nov 2005 15:42:00 EST

Transmittal #: R24BP
Subject: Revision of Section 300.5.1, Chapter 15 of the Medicare Benefit Policy Manual to include 22x TOB as an applicable TOB for Diabetes Self-Management Training.
MM Article #: N/A
MM Article Release Date: N/A

Medicare Termination of Beneficiaries With End Stage Renal Disease (ESRD)

Thu, 10 Nov 2005 15:43:00 EST

Transmittal #: R13GI
Subject: Medicare Termination of Beneficiaries With End Stage Renal Disease (ESRD)
MM Article #: MM2923
MM Article Release Date: 11/04/2004

Medicare Secondary Payer (MSP) Savings Report Redesign

Thu, 10 Nov 2005 15:44:00 EST

Transmittal #: R21MSP
Subject: Medicare Secondary Payer (MSP) Savings Report Redesign
MM Article #: N/A
MM Article Release Date: N/A

Medicare Secondary Payer (MSP) Savings Report Redesign

Thu, 10 Nov 2005 15:46:00 EST

Transmittal #: R20MSP
Subject: Medicare Secondary Payer (MSP) Savings Report Redesign
MM Article #: N/A
MM Article Release Date: N/A

Rewrite of the Program Integrity Manual (except Chapter 10), Chapters 5 and 6

Thu, 10 Nov 2005 16:45:00 EST

Transmittal #: R71PI2
Subject: Rewrite of the Program Integrity Manual (except Chapter 10), Chapters 5 and 6
MM Article #: N/A
MM Article Release Date: N/A

New Requirements for Self-Administered Drug (SAD) Exclusion List Articles in the Medicare Coverage Database (MCD)

Thu, 10 Nov 2005 16:46:00 EST

Transmittal #: R70PI
Subject: New Requirements for Self-Administered Drug (SAD) Exclusion List Articles in the Medicare Coverage Database (MCD)
MM Article #: N/A
MM Article Release Date: N/A

Rewrite of the Program Integrity Manual (except Chapter 10), Transmittal Page, Business Requirements, Table of Contents, Chapters 1 and 2.

Thu, 10 Nov 2005 16:46:00 EST

Transmittal #: R71PI
Subject: Rewrite of the Program Integrity Manual (except Chapter 10), Transmittal Page, Business Requirements, Table of Contents, Chapters 1 and 2.
MM Article #: N/A
MM Article Release Date: N/A

Electrical Stimulation and Electromagnetic Therapy for the Treatment of Woundsq

Thu, 10 Nov 2005 16:48:00 EST

Transmittal #: R7NCD
Subject: Electrical Stimulation and Electromagnetic Therapy for the Treatment of Woundsq
MM Article #: MM3149
MM Article Release Date: 04/28/2004

New Requirements for payment of drugs furnished in independent dialysis facilities and paid outside of the composite rate for dates of service (DOS) starting on January 1, 2004. Drugs furnished in this setting will be paid at the lower of billed charges or 95 percent Average Wholesale Price (AWP) for the calendar year 2004. These changes have been established with the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003, PL 108-173.

Thu, 10 Nov 2005 16:48:00 EST

Transmittal #: R110CP
Subject: New Requirements for payment of drugs furnished in independent dialysis facilities and paid outside of the composite rate for dates of service (DOS) starting on January 1, 2004. Drugs furnished in this setting will be paid at the lower of billed charges or 95 percent Average Wholesale Price (AWP) for the calendar year 2004. These changes have been established with the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003, PL 108-173.
MM Article #: MM3078
MM Article Release Date: 03/05/2004

Type of Service (TOS) Corrections

Thu, 10 Nov 2005 16:49:00 EST

Transmittal #: R108CP
Subject: Type of Service (TOS) Corrections
MM Article #: N/A
MM Article Release Date: N/A

Medicare Business Partners Systems Security (a.k.a. CMS Business Partners Systems Security Manual)

Thu, 10 Nov 2005 16:50:00 EST

Transmittal #: R4SSM
Subject: Medicare Business Partners Systems Security (a.k.a. CMS Business Partners Systems Security Manual)
MM Article #: N/A
MM Article Release Date: N/A

Provider/Supplier Communications - Revisions and Additions to Existing Contractor Requirements

Thu, 10 Nov 2005 16:51:00 EST

Transmittal #: R4COM
Subject: Provider/Supplier Communications - Revisions and Additions to Existing Contractor Requirements
MM Article #: N/A
MM Article Release Date: N/A

Implementation of Section 508(f) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173)

Thu, 10 Nov 2005 16:51:00 EST

Transmittal #: R65OTN
Subject: Implementation of Section 508(f) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173)
MM Article #: N/A
MM Article Release Date: N/A

Implementation of Sections 401, 402, 504 and 508(a) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173

Thu, 10 Nov 2005 16:52:00 EST

Transmittal #: R64OTN
Subject: Implementation of Sections 401, 402, 504 and 508(a) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173
MM Article #: MM3158
MM Article Release Date: 04/05/2004

Durable Medical Equipment Regional Carriers (DMERCs) - DeWall Posture Protector Orthotic Body Jacket (L0430): Continuation of CMS' Policy Stated in CR 2711 (B-03-025) dated April 11, 2003.

Thu, 10 Nov 2005 16:53:00 EST

Transmittal #: R63OTN
Subject: Durable Medical Equipment Regional Carriers (DMERCs) - DeWall Posture Protector Orthotic Body Jacket (L0430): Continuation of CMS' Policy Stated in CR 2711 (B-03-025) dated April 11, 2003.
MM Article #: N/A
MM Article Release Date: N/A

Interim Non-Systems Solution: Converting Health Insurance Portability and Accountability Act (HIPAA) Individual Relationship Codes to Common Working File (CWF) Patient Relationship Codes

Thu, 10 Nov 2005 16:53:00 EST

Transmittal #: R12MSP
Subject: Interim Non-Systems Solution: Converting Health Insurance Portability and Accountability Act (HIPAA) Individual Relationship Codes to Common Working File (CWF) Patient Relationship Codes
MM Article #: N/A
MM Article Release Date: N/A

Streamlining Enrollment Requirements

Thu, 10 Nov 2005 16:54:00 EST

Transmittal #: R69PI
Subject: Streamlining Enrollment Requirements
MM Article #: N/A
MM Article Release Date: N/A

New Payment Allowance Percentages for DMERC Drugs

Thu, 10 Nov 2005 16:55:00 EST

Transmittal #: R131CP
Subject: New Payment Allowance Percentages for DMERC Drugs
MM Article #: MM3153
MM Article Release Date: 04/05/2004

Frequency Limitations for Darbepoetin Alfa (trade name Aranesp) For Treatment Of Anemia In End Stage Renal Disease (ESRD) Patients On Dialysis.

Thu, 10 Nov 2005 16:56:00 EST

Transmittal #: R118CP
Subject: Frequency Limitations for Darbepoetin Alfa (trade name Aranesp) For Treatment Of Anemia In End Stage Renal Disease (ESRD) Patients On Dialysis.
MM Article #: N/A
MM Article Release Date: N/A

Chapter 32, Billing Instructions for Special Services

Thu, 10 Nov 2005 16:57:00 EST

Transmittal #: R130CP
Subject: Chapter 32, Billing Instructions for Special Services
MM Article #: N/A
MM Article Release Date: N/A

Instructions for downloading the Medicare zip code file.

Thu, 10 Nov 2005 16:58:00 EST

Transmittal #: R117CP
Subject: Instructions for downloading the Medicare zip code file.
MM Article #: N/A
MM Article Release Date: N/A

Additional Information and Corrections to Previous Transmittals Regarding Healthcare Common Procedure Coding System (HCPCS) Codes and Modifiers for Low Osmolar Contrast Material, Orthotics, and Durable Medical Equipment

Thu, 10 Nov 2005 16:58:00 EST

Transmittal #: R129CP
Subject: Additional Information and Corrections to Previous Transmittals Regarding Healthcare Common Procedure Coding System (HCPCS) Codes and Modifiers for Low Osmolar Contrast Material, Orthotics, and Durable Medical Equipment
MM Article #: N/A
MM Article Release Date: N/A

Manualization of Deep Brain Stimulation

Thu, 10 Nov 2005 17:00:00 EST

Transmittal #: R128CP
Subject: Manualization of Deep Brain Stimulation
MM Article #: N/A
MM Article Release Date: N/A

2004 Jurisdiction List

Thu, 10 Nov 2005 17:01:00 EST

Transmittal #: R127CP
Subject: 2004 Jurisdiction List
MM Article #: MM3139
MM Article Release Date: 03/31/2004

Manualization Clarification of ICD-9 Coding

Thu, 10 Nov 2005 17:02:00 EST

Transmittal #: R126CP
Subject: Manualization Clarification of ICD-9 Coding
MM Article #: N/A
MM Article Release Date: N/A

Manualization of the Sacral Nerve Stimulation

Thu, 10 Nov 2005 17:03:00 EST

Transmittal #: R125CP
Subject: Manualization of the Sacral Nerve Stimulation
MM Article #: N/A
MM Article Release Date: N/A

ESRD- Miscellaneous Code Processing Clarification

Thu, 10 Nov 2005 17:04:00 EST

Transmittal #: R116CP
Subject: ESRD- Miscellaneous Code Processing Clarification
MM Article #: N/A
MM Article Release Date: N/A

Manual Revision Regarding Waiver of Annual Deductible and Coinsurance for Both ASC Facility, and ASC/Hospital Outpatient Department Physician Services

Thu, 10 Nov 2005 17:05:00 EST

Transmittal #: R11GI
Subject: Manual Revision Regarding Waiver of Annual Deductible and Coinsurance for Both ASC Facility, and ASC/Hospital Outpatient Department Physician Services
MM Article #: MM3471
MM Article Release Date: 10/27/2004

DMERCs and VIPS, Processing NDC Numbers - Clarification to CR 3141

Thu, 10 Nov 2005 17:05:00 EST

Transmittal #: R115CP
Subject: DMERCs and VIPS, Processing NDC Numbers - Clarification to CR 3141
MM Article #: N/A
MM Article Release Date: N/A

Changes to the FY 2004 Graduate Medical Education (GME) Payments as Required by the Medicare Modernization Act of 2003 (MMA), P.L. 108-173

Thu, 10 Nov 2005 17:06:00 EST

Transmittal #: R61OTN
Subject: Changes to the FY 2004 Graduate Medical Education (GME) Payments as Required by the Medicare Modernization Act of 2003 (MMA), P.L. 108-173
MM Article #: MM3071
MM Article Release Date: 03/19/2004

Policy Changes to Reflect Billing for Darbepoetin Alfa and Epoetin

Thu, 10 Nov 2005 17:06:00 EST

Transmittal #: R8BP
Subject: Policy Changes to Reflect Billing for Darbepoetin Alfa and Epoetin
MM Article #: MM2984
MM Article Release Date: 03/25/2004

Payment of Beneficiary Submitted Flu Claims and Flu Claims Submitted by Non-Enrolled Providers

Thu, 10 Nov 2005 17:08:00 EST

Transmittal #: R334CP
Subject: Payment of Beneficiary Submitted Flu Claims and Flu Claims Submitted by Non-Enrolled Providers
MM Article #: N/A
MM Article Release Date: N/A

Chapter 7, Sanctions and ESRD Complaints and Grievances

Thu, 10 Nov 2005 17:09:00 EST

Transmittal #: R7ESRD
Subject: Chapter 7, Sanctions and ESRD Complaints and Grievances
MM Article #: N/A
MM Article Release Date: N/A

Chapter 6, Community Information and Resources

Thu, 10 Nov 2005 17:10:00 EST

Transmittal #: R6ESRD
Subject: Chapter 6, Community Information and Resources
MM Article #: N/A
MM Article Release Date: N/A

Calendar Year (CY) 2005 Participation Enrollment and Medicare Participating Physicians and Suppliers Directory (MEDPARD) Procedures

Thu, 10 Nov 2005 17:10:00 EST

Transmittal #: R339CP
Subject: Calendar Year (CY) 2005 Participation Enrollment and Medicare Participating Physicians and Suppliers Directory (MEDPARD) Procedures
MM Article #: N/A
MM Article Release Date: N/A

Chapter 4, Information Management

Thu, 10 Nov 2005 17:11:00 EST

Transmittal #: R5ESRD
Subject: Chapter 4, Information Management
MM Article #: N/A
MM Article Release Date: N/A

Common Working File (CWF) Duplicate Claim Edit for Referred Clinical Diagnostic and Purchased Diagnostic Services

Thu, 10 Nov 2005 17:13:00 EST

Transmittal #: R124OTN
Subject: Common Working File (CWF) Duplicate Claim Edit for Referred Clinical Diagnostic and Purchased Diagnostic Services
MM Article #: MM3551
MM Article Release Date: 12/10/2004

Contractor Reporting of Operations and Workload Data (CROWD) for EDI

Thu, 10 Nov 2005 17:13:00 EST

Transmittal #: R36FM
Subject: Contractor Reporting of Operations and Workload Data (CROWD) for EDI
MM Article #: N/A
MM Article Release Date: N/A

New Part B Annual Deductible

Thu, 10 Nov 2005 17:14:00 EST

Transmittal #: R3GI
Subject: New Part B Annual Deductible
MM Article #: MM3121
MM Article Release Date: 03/16/2004

Instructions For Pricing Trepostinil (Q4077)

Thu, 10 Nov 2005 17:15:00 EST

Transmittal #: R123OTN
Subject: Instructions For Pricing Trepostinil (Q4077)
MM Article #: MM3533
MM Article Release Date: 11/04/2004

Electronic Reporting Specifications for Form CMS-1984-99

Thu, 10 Nov 2005 17:15:00 EST

Transmittal #: R5P238
Subject: Electronic Reporting Specifications for Form CMS-1984-99
MM Article #: N/A
MM Article Release Date: N/A

MMA Drug Pricing Update-Drug Exceptions

Thu, 10 Nov 2005 17:15:00 EST

Transmittal #: R119CP
Subject: MMA Drug Pricing Update-Drug Exceptions
MM Article #: MM3161
MM Article Release Date: 03/24/2004

Home Health Agency Cost Report

Thu, 10 Nov 2005 17:16:00 EST

Transmittal #: R12P232
Subject: Home Health Agency Cost Report
MM Article #: N/A
MM Article Release Date: N/A

Shared System and CWF Renovation of Override Code Process and Recognition of Four 2-byte Modifier Fields on the Part B Query Record - For MCS Phased Implementation Approach Only

Thu, 10 Nov 2005 17:16:00 EST

Transmittal #: R122OTN
Subject: Shared System and CWF Renovation of Override Code Process and Recognition of Four 2-byte Modifier Fields on the Part B Query Record - For MCS Phased Implementation Approach Only
MM Article #: N/A
MM Article Release Date: N/A

Physician Self-Referral Prohibition; 18-Month Moratorium on Physician Investment in Specialty Hospitals

Thu, 10 Nov 2005 17:17:00 EST

Transmittal #: R62OTN
Subject: Physician Self-Referral Prohibition; 18-Month Moratorium on Physician Investment in Specialty Hospitals
MM Article #: MM3036
MM Article Release Date: 04/07/2004

Installation of Version 33 of the Provider Statistical and Reimbursement (PS&R) Reporting System.

Thu, 10 Nov 2005 17:17:00 EST

Transmittal #: R37FM
Subject: Installation of Version 33 of the Provider Statistical and Reimbursement (PS&R) Reporting System.
MM Article #: N/A
MM Article Release Date: N/A

Modification to Fiscal Intermediary Standard System (FISS) Regarding Common Working File Initiated Adjustments

Thu, 10 Nov 2005 17:17:00 EST

Transmittal #: R121OTN
Subject: Modification to Fiscal Intermediary Standard System (FISS) Regarding Common Working File Initiated Adjustments
MM Article #: N/A
MM Article Release Date: N/A

Updates to the Electronic Correspondence Referral System (ECRS) User Guide v7.0 and Quick Reference Card v7.0

Thu, 10 Nov 2005 17:18:00 EST

Transmittal #: R13MSP
Subject: Updates to the Electronic Correspondence Referral System (ECRS) User Guide v7.0 and Quick Reference Card v7.0
MM Article #: N/A
MM Article Release Date: N/A

Electrical Stimulation and Electromagnetic Therapy for the Treatment of Wounds

Thu, 10 Nov 2005 17:19:00 EST

Transmittal #: R124CP
Subject: Electrical Stimulation and Electromagnetic Therapy for the Treatment of Wounds
MM Article #: N/A
MM Article Release Date: N/A

April Outpatient Code Editor (OCE) Specifications Version 5.1

Thu, 10 Nov 2005 17:20:00 EST

Transmittal #: R123CP
Subject: April Outpatient Code Editor (OCE) Specifications Version 5.1
MM Article #: MM3170
MM Article Release Date: 03/30/2004

Revision to Required Messages in Change Request (CR) 2944, Implementation of Skilled Nursing Facility (SNF) Consolidated Billing Edit for Therapy Codes Considered Separately Payable Physician Services

Thu, 10 Nov 2005 17:21:00 EST

Transmittal #: R122CP
Subject: Revision to Required Messages in Change Request (CR) 2944, Implementation of Skilled Nursing Facility (SNF) Consolidated Billing Edit for Therapy Codes Considered Separately Payable Physician Services
MM Article #: N/A
MM Article Release Date: N/A

Current Perception Threshold/Sensory Nerve Conduction Threshold Test (sNCT)

Thu, 10 Nov 2005 17:22:00 EST

Transmittal #: R8NCD
Subject: Current Perception Threshold/Sensory Nerve Conduction Threshold Test (sNCT)
MM Article #: MM2988
MM Article Release Date: 08/31/2004

Optional Method for Outpatient Services: Cost-Based Facility Services Plus 115 percent Fee Schedule Payment for Professional Services

Thu, 10 Nov 2005 17:23:00 EST

Transmittal #: R103CP
Subject: Optional Method for Outpatient Services: Cost-Based Facility Services Plus 115 percent Fee Schedule Payment for Professional Services
MM Article #: MM3114
MM Article Release Date: 02/26/2004

New Waived Tests--April 1, 2004

Thu, 10 Nov 2005 17:24:00 EST

Transmittal #: R102P
Subject: New Waived Tests--April 1, 2004
MM Article #: MM3571
MM Article Release Date: 02/03/2005

Restoring Composite Rate Exceptions for Pediatric Facilities Under the ESRD Composite Rate System

Thu, 10 Nov 2005 17:26:00 EST

Transmittal #: R101CP
Subject: Restoring Composite Rate Exceptions for Pediatric Facilities Under the ESRD Composite Rate System
MM Article #: MM3119
MM Article Release Date: 03/05/2004

Health Insurance Portability and Accountability Act (HIPAA) X12N 837 Health Care Claim Implementation Guide (IG) Editing Additional Instruction

Thu, 10 Nov 2005 17:27:00 EST

Transmittal #: R107CP
Subject: Health Insurance Portability and Accountability Act (HIPAA) X12N 837 Health Care Claim Implementation Guide (IG) Editing Additional Instruction
MM Article #: MM3031
MM Article Release Date: 08/31/2004

Restoring Composite Rate Exceptions for Pediatric Facilities Under the ESRD Composite Rate System

Thu, 10 Nov 2005 17:27:00 EST

Transmittal #: R7BP
Subject: Restoring Composite Rate Exceptions for Pediatric Facilities Under the ESRD Composite Rate System
MM Article #: MM3119
MM Article Release Date: 03/04/2004

April 2004 Changes to the Hospital Outpatient Prospective Payment System (OPPS): Payment for Drugs, Biologicals and Radiopharmaceuticals, Generic Versus Brand Name

Thu, 10 Nov 2005 17:28:00 EST

Transmittal #: R112CP
Subject: April 2004 Changes to the Hospital Outpatient Prospective Payment System (OPPS): Payment for Drugs, Biologicals and Radiopharmaceuticals, Generic Versus Brand Name
MM Article #: MM3144
MM Article Release Date: 03/19/2004

The Medicare Coverage Database

Thu, 10 Nov 2005 17:29:00 EST

Transmittal #: R67PI
Subject: The Medicare Coverage Database
MM Article #: MM2976
MM Article Release Date: 06/23/2004

General Policy

Thu, 10 Nov 2005 17:30:00 EST

Transmittal #: R11MSP
Subject: General Policy
MM Article #: MM3064
MM Article Release Date: 03/05/2004

Claims Requiring Adjustment As a Result of April 2004 Changes to the Outpatient Prospective Payment System (OPPS)

Thu, 10 Nov 2005 17:31:00 EST

Transmittal #: R113CP
Subject: Claims Requiring Adjustment As a Result of April 2004 Changes to the Outpatient Prospective Payment System (OPPS)
MM Article #: MM3145
MM Article Release Date: 03/31/2004

Modification of CMS' Medicare Contingency Plan for HIPPA Implementation

Thu, 10 Nov 2005 17:31:00 EST

Transmittal #: R114CP
Subject: Modification of CMS' Medicare Contingency Plan for HIPPA Implementation
MM Article #: MM2981
MM Article Release Date: 03/01/2004

Payment For Services Provided Under a Contractual Agreement

Thu, 10 Nov 2005 17:32:00 EST

Transmittal #: R111CP
Subject: Payment For Services Provided Under a Contractual Agreement
MM Article #: MM3083
MM Article Release Date: 03/17/2004

April 2004 Update of the Hospital Outpatient Prospective Payment System

Thu, 10 Nov 2005 17:32:00 EST

Transmittal #: R132CP
Subject: April 2004 Update of the Hospital Outpatient Prospective Payment System
MM Article #: MM3154
MM Article Release Date: 04/05/2004

NCD - Ocular Photodynamic Therapy (OPT) With Verteporfin for Age-Related Macular Degeneration (AMD)

Thu, 10 Nov 2005 17:33:00 EST

Transmittal #: R9NCD
Subject: NCD - Ocular Photodynamic Therapy (OPT) With Verteporfin for Age-Related Macular Degeneration (AMD)
MM Article #: MM3191
MM Article Release Date: 12/16/2004

Requirement for Carriers, Durable Medical Equipment Regional Carriers (DMERCs), Fiscal Intermediaries (FIs), and Full Program Safeguard Contractors (PSCs) to Encourage Providers to Submit Medical Records to the Comprehensive Error Rate Testing (CERT) Contractor for Use in the November 2004 Improper Medicare Fee-For-Service (FFS) Payments Report

Thu, 10 Nov 2005 17:34:00 EST

Transmittal #: R67OTN
Subject: Requirement for Carriers, Durable Medical Equipment Regional Carriers (DMERCs), Fiscal Intermediaries (FIs), and Full Program Safeguard Contractors (PSCs) to Encourage Providers to Submit Medical Records to the Comprehensive Error Rate Testing (CERT) Contractor for Use in the November 2004 Improper Medicare Fee-For-Service (FFS) Payments Report
MM Article #: N/A
MM Article Release Date: N/A

Transmittal 49 Implementation Date Extension

Thu, 10 Nov 2005 17:34:00 EST

Transmittal #: R68OTN
Subject: Transmittal 49 Implementation Date Extension
MM Article #: MM3197
MM Article Release Date: 04/12/2004

Grievances, Organization Determinations, and Appeals

Thu, 10 Nov 2005 17:35:00 EST

Transmittal #: R48MCM
Subject: Grievances, Organization Determinations, and Appeals
MM Article #: N/A
MM Article Release Date: N/A

Purchased Diagnostic Test - Carriers

Thu, 10 Nov 2005 17:36:00 EST

Transmittal #: R135CP
Subject: Purchased Diagnostic Test - Carriers
MM Article #: N/A
MM Article Release Date: N/A

Instructions for Downloading the Medicare Zip Code File.

Thu, 10 Nov 2005 17:37:00 EST

Transmittal #: R134CP
Subject: Instructions for Downloading the Medicare Zip Code File.
MM Article #: N/A
MM Article Release Date: N/A

Billing NonCovered Charges to Fiscal Intermediaries - Summary and New Instructions - Clarification

Thu, 10 Nov 2005 17:37:00 EST

Transmittal #: R133CP
Subject: Billing NonCovered Charges to Fiscal Intermediaries - Summary and New Instructions - Clarification
MM Article #: N/A
MM Article Release Date: N/A

How Fiscal Intermediary's are to Record Coinsurance Amounts from The Provider Statistical and Reimbursement (PS&R) Report for Providers Who Elected to Accept Reduced Coinsurance for Outpatient Prospective Payment System (OPPS) Services

Thu, 10 Nov 2005 17:38:00 EST

Transmittal #: R70OTN
Subject: How Fiscal Intermediary's are to Record Coinsurance Amounts from The Provider Statistical and Reimbursement (PS&R) Report for Providers Who Elected to Accept Reduced Coinsurance for Outpatient Prospective Payment System (OPPS) Services
MM Article #: N/A
MM Article Release Date: N/A

NCD is being released

Thu, 10 Nov 2005 17:38:00 EST

Transmittal #: R10NCD
Subject: NCD is being released
MM Article #: N/A
MM Article Release Date: N/A

Carrier Only* Shared System Maintainer Hours for Resolution of Problems Detected As A Result of Implementation of CR 2525 and CR 2527

Thu, 10 Nov 2005 17:39:00 EST

Transmittal #: R69OTN
Subject: Carrier Only* Shared System Maintainer Hours for Resolution of Problems Detected As A Result of Implementation of CR 2525 and CR 2527
MM Article #: N/A
MM Article Release Date: N/A

Chapter 20, Managed Care and M+C Systems Business Requirements

Thu, 10 Nov 2005 17:40:00 EST

Transmittal #: R50MCM
Subject: Chapter 20, Managed Care and M+C Systems Business Requirements
MM Article #: N/A
MM Article Release Date: N/A

Rewrite of the Program Integrity Manual (except Chapter 10), Exhibits

Thu, 10 Nov 2005 17:42:00 EST

Transmittal #: R71PI5
Subject: Rewrite of the Program Integrity Manual (except Chapter 10), Exhibits
MM Article #: N/A
MM Article Release Date: N/A

Rewrite of the Program Integrity Manual (except Chapter 10), Chapters 13 and 11

Thu, 10 Nov 2005 17:42:00 EST

Transmittal #: R71PI4
Subject: Rewrite of the Program Integrity Manual (except Chapter 10), Chapters 13 and 11
MM Article #: N/A
MM Article Release Date: N/A

Rewrite of the Program Integrity Manual (except Chapter 10), Chapters 7, 8, 9 and 12

Thu, 10 Nov 2005 17:43:00 EST

Transmittal #: R71PI3
Subject: Rewrite of the Program Integrity Manual (except Chapter 10), Chapters 7, 8, 9 and 12
MM Article #: N/A
MM Article Release Date: N/A

Rewrite of the Program Integrity Manual (except Chapter 10), Chapters 3 and 4

Thu, 10 Nov 2005 17:44:00 EST

Transmittal #: R71PI1
Subject: Rewrite of the Program Integrity Manual (except Chapter 10), Chapters 3 and 4
MM Article #: N/A
MM Article Release Date: N/A

April Update to the January Medicare Outpatient Code Editor (OCE) Specifications Version 19.1 R1 For Bills From Hospitals That Are Not Paid Under The Outpatient Prospective Payment System

Thu, 10 Nov 2005 17:45:00 EST

Transmittal #: R120CP
Subject: April Update to the January Medicare Outpatient Code Editor (OCE) Specifications Version 19.1 R1 For Bills From Hospitals That Are Not Paid Under The Outpatient Prospective Payment System
MM Article #: MM3155
MM Article Release Date: 08/31/2004

Manualization of Place of Service (POS) Code Set Program Memorandum; Revision to Group Home Code Description

Thu, 10 Nov 2005 17:45:00 EST

Transmittal #: R121CP
Subject: Manualization of Place of Service (POS) Code Set Program Memorandum; Revision to Group Home Code Description
MM Article #: MM3087
MM Article Release Date: 04/13/2004

Processing of Claims for Referred Services for a Independent Clinical Diagnostic Laboratory

Thu, 10 Nov 2005 17:46:00 EST

Transmittal #: R85P
Subject: Processing of Claims for Referred Services for a Independent Clinical Diagnostic Laboratory
MM Article #: MM3090
MM Article Release Date: 04/05/2004

Additional Guidelines for Implementing the National Council for Prescription Drug Program

Thu, 10 Nov 2005 17:47:00 EST

Transmittal #: R84CP
Subject: Additional Guidelines for Implementing the National Council for Prescription Drug Program
MM Article #: MM3095
MM Article Release Date: 02/13/2004

Expansion of Transfer Policy Under Inpatient Payment Prospective System

Thu, 10 Nov 2005 17:47:00 EST

Transmittal #: R87CP
Subject: Expansion of Transfer Policy Under Inpatient Payment Prospective System
MM Article #: MM2934
MM Article Release Date: 03/01/2004

X12N 837 Professional Implementation Guide (IG) Edits

Thu, 10 Nov 2005 17:48:00 EST

Transmittal #: R86CP
Subject: X12N 837 Professional Implementation Guide (IG) Edits
MM Article #: MM3050
MM Article Release Date: 02/10/2004

Unsolicited/Voluntary Refunds

Thu, 10 Nov 2005 17:49:00 EST

Transmittal #: R35FM
Subject: Unsolicited/Voluntary Refunds
MM Article #: N/A
MM Article Release Date: N/A

Scheduled Release for April Updates to Software Programs and Pricing/Coding Files

Thu, 10 Nov 2005 17:49:00 EST

Transmittal #: R2GI
Subject: Scheduled Release for April Updates to Software Programs and Pricing/Coding Files
MM Article #: N/A
MM Article Release Date: N/A

Health Insurance Portability and Accountability Act (HIPAA) X12N 837 Coordination of Benefits (COB) Gap Fill Additional Instruction

Thu, 10 Nov 2005 17:50:00 EST

Transmittal #: R99CP
Subject: Health Insurance Portability and Accountability Act (HIPAA) X12N 837 Coordination of Benefits (COB) Gap Fill Additional Instruction
MM Article #: N/A
MM Article Release Date: N/A

DMERC-Beneficiary Submitted Claims, Process First Claim

Fri, 11 Nov 2005 09:58:00 EST

Transmittal #: R330CP
Subject: DMERC-Beneficiary Submitted Claims, Process First Claim
MM Article #: N/A
MM Article Release Date: N/A

New Policy and Refinements on Billing Noncovered Charges to Fiscal Intermediaries (FIs)

Fri, 11 Nov 2005 10:00:00 EST

Transmittal #: R332CP
Subject: New Policy and Refinements on Billing Noncovered Charges to Fiscal Intermediaries (FIs)
MM Article #: N/A
MM Article Release Date: N/A

DMERC Only - Payment to Providers/Suppliers Qualified to Bill Medicare for Prosthetics and Certain Custom-Fabricated Orthotics

Fri, 11 Nov 2005 10:01:00 EST

Transmittal #: R329CP
Subject: DMERC Only - Payment to Providers/Suppliers Qualified to Bill Medicare for Prosthetics and Certain Custom-Fabricated Orthotics
MM Article #: N/A
MM Article Release Date: N/A

2005 Annual Update for Skilled Nursing Facility (SNF) Consolidated Billing for the Common Working File (CWF) and Medicare Carriers

Fri, 11 Nov 2005 10:02:00 EST

Transmittal #: R328CP
Subject: 2005 Annual Update for Skilled Nursing Facility (SNF) Consolidated Billing for the Common Working File (CWF) and Medicare Carriers
MM Article #: MM3535
MM Article Release Date: 12/29/2004

This transmittal rescinded and replaced by R374CP

Fri, 11 Nov 2005 10:03:00 EST

Transmittal #: R327CP
Subject: This transmittal rescinded and replaced by R374CP
MM Article #: N/A
MM Article Release Date: N/A

New Waived Tests-January 1, 2005

Fri, 11 Nov 2005 10:03:00 EST

Transmittal #: R325CP
Subject: New Waived Tests-January 1, 2005
MM Article #: N/A
MM Article Release Date: N/A

Instructions for Downloading the Medicare Zip Code File

Fri, 11 Nov 2005 10:04:00 EST

Transmittal #: R321CP
Subject: Instructions for Downloading the Medicare Zip Code File
MM Article #: N/A
MM Article Release Date: N/A

Reminder Notice of the Implementation of the Ambulance Transition Schedule

Fri, 11 Nov 2005 10:06:00 EST

Transmittal #: R320CP
Subject: Reminder Notice of the Implementation of the Ambulance Transition Schedule
MM Article #: N/A
MM Article Release Date: N/A

CORF/OPT Edit for Billing Inappropriate Supplies

Fri, 11 Nov 2005 10:17:00 EST

Transmittal #: R319CP
Subject: CORF/OPT Edit for Billing Inappropriate Supplies
MM Article #: MM3468
MM Article Release Date: 10/28/2004

Clarification of Messgaes in Chapter 1, Section 10.1.1.1 to Match Official Listing on the WPC-EDI Web Site

Fri, 11 Nov 2005 10:18:00 EST

Transmittal #: R316CP
Subject: Clarification of Messgaes in Chapter 1, Section 10.1.1.1 to Match Official Listing on the WPC-EDI Web Site
MM Article #: N/A
MM Article Release Date: N/A

Clarification of CR 3176 - Payment amounts for ESRD drug administration supplies: HCPCS A4657 and A4913

Fri, 11 Nov 2005 10:23:00 EST

Transmittal #: R318CP
Subject: Clarification of CR 3176 - Payment amounts for ESRD drug administration supplies: HCPCS A4657 and A4913
MM Article #: N/A
MM Article Release Date: N/A

Clarification to Chapter 26 of the Internet Only Manual (IOM)

Fri, 11 Nov 2005 10:27:00 EST

Transmittal #: R317CP
Subject: Clarification to Chapter 26 of the Internet Only Manual (IOM)
MM Article #: N/A
MM Article Release Date: N/A

Temporary Change in Carrier Jurisdictional Pricing Rules for Purchased Diagnostic Services

Fri, 11 Nov 2005 10:28:00 EST

Transmittal #: R315CP
Subject: Temporary Change in Carrier Jurisdictional Pricing Rules for Purchased Diagnostic Services
MM Article #: N/A
MM Article Release Date: N/A

Invalid Diagnosis Code Editing - Second Phase

Fri, 11 Nov 2005 10:30:00 EST

Transmittal #: R326CP
Subject: Invalid Diagnosis Code Editing - Second Phase
MM Article #: MM3260
MM Article Release Date: 10/28/2004

New Policy and Refinements on Billing Noncovered Charges to Fiscal Intermediaries (FIs)

Fri, 11 Nov 2005 10:30:00 EST

Transmittal #: R12GI
Subject: New Policy and Refinements on Billing Noncovered Charges to Fiscal Intermediaries (FIs)
MM Article #: MM3416
MM Article Release Date: 10/28/2004

Quarterly Update to Correct Coding Initiative (CCI) edits, Version 11.0, Effective January 1, 2005

Fri, 11 Nov 2005 10:32:00 EST

Transmittal #: R324CP
Subject: Quarterly Update to Correct Coding Initiative (CCI) edits, Version 11.0, Effective January 1, 2005
MM Article #: MM3491
MM Article Release Date: 10/28/2004

Update Regarding the Use of American Dental Association's (ADA) Current Dental Terminology (CDT) Codes on Medicare Contractors' Web Sites and Other Electronic Media

Fri, 11 Nov 2005 10:32:00 EST

Transmittal #: R323CP
Subject: Update Regarding the Use of American Dental Association's (ADA) Current Dental Terminology (CDT) Codes on Medicare Contractors' Web Sites and Other Electronic Media
MM Article #: N/A
MM Article Release Date: N/A

Release Medlearn Article for Change Request (CR) 2813 (End Stage Renal Disease Reimbursement for Automated Multi-channel Chemistry Test(s)).

Fri, 11 Nov 2005 10:33:00 EST

Transmittal #: R322CP
Subject: Release Medlearn Article for Change Request (CR) 2813 (End Stage Renal Disease Reimbursement for Automated Multi-channel Chemistry Test(s)).
MM Article #: N/A
MM Article Release Date: N/A

Revised Reporting Requirements for Contractor Reporting of Operational Workload Data (CROWD) Health Professional Shortage Area (HPSA) Quarterly Report (CMS Form 1565E, CROWD Form S)

Fri, 11 Nov 2005 10:34:00 EST

Transmittal #: R57FM
Subject: Revised Reporting Requirements for Contractor Reporting of Operational Workload Data (CROWD) Health Professional Shortage Area (HPSA) Quarterly Report (CMS Form 1565E, CROWD Form S)
MM Article #: N/A
MM Article Release Date: N/A

Informing Beneficiaries About Which Local Medical Review Policy (LMRP) and/or Local Coverage Determination (LCD) and/or National Coverage Determination (NCD) is Associated with Their Claim Denial

Fri, 11 Nov 2005 10:35:00 EST

Transmittal #: R85PI
Subject: Informing Beneficiaries About Which Local Medical Review Policy (LMRP) and/or Local Coverage Determination (LCD) and/or National Coverage Determination (NCD) is Associated with Their Claim Denial
MM Article #: N/A
MM Article Release Date: N/A

Revision to Balancing Requirement on Form 5, Line 10, of the Contractor Reporting of Operational and Workload Data (Crowd)

Fri, 11 Nov 2005 10:37:00 EST

Transmittal #: R56FM
Subject: Revision to Balancing Requirement on Form 5, Line 10, of the Contractor Reporting of Operational and Workload Data (Crowd)
MM Article #: N/A
MM Article Release Date: N/A

Two New Medicare Summary Notice (MSN) Messages for Parental Pumps - DMERC only

Fri, 11 Nov 2005 13:09:00 EST

Transmittal #: R308CP
Subject: Two New Medicare Summary Notice (MSN) Messages for Parental Pumps - DMERC only
MM Article #: N/A
MM Article Release Date: N/A

Disabling the CWF 57x3 Consistency Error Code

Fri, 11 Nov 2005 13:10:00 EST

Transmittal #: R305CP
Subject: Disabling the CWF 57x3 Consistency Error Code
MM Article #: N/A
MM Article Release Date: N/A

Payment Allowances for the Influenza Virus Vaccine (CPT 90658) and the Pneumoccocal Vaccine (CPT 90732)

Fri, 11 Nov 2005 13:12:00 EST

Transmittal #: R114OTN
Subject: Payment Allowances for the Influenza Virus Vaccine (CPT 90658) and the Pneumoccocal Vaccine (CPT 90732)
MM Article #: MM3490
MM Article Release Date: 11/19/2004

Nurse Practitioners As Attending Physicians in the Medicare Hospice Benefit

Fri, 11 Nov 2005 13:14:00 EST

Transmittal #: R304CP
Subject: Nurse Practitioners As Attending Physicians in the Medicare Hospice Benefit
MM Article #: MM3226
MM Article Release Date: 10/15/2004

Nurse Practitioners As Attending Physicians in the Medicare Hospice Benefit

Fri, 11 Nov 2005 13:15:00 EST

Transmittal #: R22BP
Subject: Nurse Practitioners As Attending Physicians in the Medicare Hospice Benefit
MM Article #: N/A
MM Article Release Date: N/A

Medicare Comprehensive Outpatient Rehabilitation Facility Coverage

Fri, 11 Nov 2005 13:15:00 EST

Transmittal #: R21BP
Subject: Medicare Comprehensive Outpatient Rehabilitation Facility Coverage
MM Article #: MM3315
MM Article Release Date: 10/15/2004

New Remark Code Message for Use with Claims for Parenteral Pumps - (DMERC) Only

Fri, 11 Nov 2005 13:16:00 EST

Transmittal #: R117OTN
Subject: New Remark Code Message for Use with Claims for Parenteral Pumps - (DMERC) Only
MM Article #: N/A
MM Article Release Date: N/A

Billing Requirements for Positron Emission Tomography (PET) Scans for Dementia and Neurodegenerative Diseases

Fri, 11 Nov 2005 13:17:00 EST

Transmittal #: R310CP
Subject: Billing Requirements for Positron Emission Tomography (PET) Scans for Dementia and Neurodegenerative Diseases
MM Article #: N/A
MM Article Release Date: N/A

For Assets Acquired On or After May 1, 2004

Fri, 11 Nov 2005 13:18:00 EST

Transmittal #: R426PR1
Subject: For Assets Acquired On or After May 1, 2004
MM Article #: N/A
MM Article Release Date: N/A

Reporting Appeals Redetermination Information On Forms CMS-2591 and 2590

Fri, 11 Nov 2005 13:19:00 EST

Transmittal #: R55FM
Subject: Reporting Appeals Redetermination Information On Forms CMS-2591 and 2590
MM Article #: N/A
MM Article Release Date: N/A

Revised Requirements for Chiropractic Billing of Active/Corrective Treatment and Maintenance Therapy. Full Replacement of CR 3063

Fri, 11 Nov 2005 13:21:00 EST

Transmittal #: R23BP
Subject: Revised Requirements for Chiropractic Billing of Active/Corrective Treatment and Maintenance Therapy. Full Replacement of CR 3063
MM Article #: MM3449
MM Article Release Date: 11/19/2004

Instructions for Completion of Form CMS-1450

Fri, 11 Nov 2005 13:22:00 EST

Transmittal #: R311CP
Subject: Instructions for Completion of Form CMS-1450
MM Article #: MM3417
MM Article Release Date: 10/15/2004

Shared Systems Maintainers Hours for Resolution of Problems Detected as a Result of Implementation of Change Request 2525 and Change Request 2527

Fri, 11 Nov 2005 13:23:00 EST

Transmittal #: R118OTN
Subject: Shared Systems Maintainers Hours for Resolution of Problems Detected as a Result of Implementation of Change Request 2525 and Change Request 2527
MM Article #: N/A
MM Article Release Date: N/A

Percutaneous Transluminal Angioplasty (PTA)

Fri, 11 Nov 2005 13:24:00 EST

Transmittal #: R314CP
Subject: Percutaneous Transluminal Angioplasty (PTA)
MM Article #: MM3489
MM Article Release Date: 10/20/2004

Percutaneous Transluminal Angioplasty (PTA)

Fri, 11 Nov 2005 13:26:00 EST

Transmittal #: R25NCD
Subject: Percutaneous Transluminal Angioplasty (PTA)
MM Article #: MM3489
MM Article Release Date: 10/20/2004

Override of Common Working File (CWF) Edit for Observation Services Exceeding 48 Hours

Fri, 11 Nov 2005 13:27:00 EST

Transmittal #: R120OTN
Subject: Override of Common Working File (CWF) Edit for Observation Services Exceeding 48 Hours
MM Article #: MM3311
MM Article Release Date: 10/13/2005

Nursing Facility Visits (Codes 99301 -99313)

Fri, 11 Nov 2005 13:28:00 EST

Transmittal #: R302CP
Subject: Nursing Facility Visits (Codes 99301 -99313)
MM Article #: N/A
MM Article Release Date: N/A

Instructions for Completion of Form CMS-1450

Fri, 11 Nov 2005 13:29:00 EST

Transmittal #: R303CP
Subject: Instructions for Completion of Form CMS-1450
MM Article #: N/A
MM Article Release Date: N/A

Fiscal Year (FY) 2005 Inpatient Prospective Payment System (IPPS), Long Term Care Hospital (LTCH) and Other Bill Processing Changes Related to the IPPS Final Rule

Fri, 11 Nov 2005 13:30:00 EST

Transmittal #: R309CP
Subject: Fiscal Year (FY) 2005 Inpatient Prospective Payment System (IPPS), Long Term Care Hospital (LTCH) and Other Bill Processing Changes Related to the IPPS Final Rule
MM Article #: MM3459
MM Article Release Date: 04/29/2005

Full Replacement of CR 3415, 3rd Update to the 2004 Medicare Physician Fee Schedule Database.

Fri, 11 Nov 2005 13:31:00 EST

Transmittal #: R306CP
Subject: Full Replacement of CR 3415, 3rd Update to the 2004 Medicare Physician Fee Schedule Database.
MM Article #: MM3505
MM Article Release Date: 10/05/2004

Revisions to Chapter 13 - Medicare+Choice Beneficiary Grievances, Organization Determinations and Appeals

Fri, 11 Nov 2005 13:32:00 EST

Transmittal #: R62MCM
Subject: Revisions to Chapter 13 - Medicare+Choice Beneficiary Grievances, Organization Determinations and Appeals
MM Article #: N/A
MM Article Release Date: N/A

Use of Condition Code 44, "Inpatient Admission Changed to Outpatient"

Fri, 11 Nov 2005 13:33:00 EST

Transmittal #: R299CP
Subject: Use of Condition Code 44, "Inpatient Admission Changed to Outpatient"
MM Article #: N/A
MM Article Release Date: N/A

Reasonable Charge Update for 2005 for Splints, Casts, Dialysis Supplies, Dialysis Equipment, Therapeutic Shoes, and Certain Intraocular Lenses

Fri, 11 Nov 2005 13:34:00 EST

Transmittal #: R297CP
Subject: Reasonable Charge Update for 2005 for Splints, Casts, Dialysis Supplies, Dialysis Equipment, Therapeutic Shoes, and Certain Intraocular Lenses
MM Article #: MM3430
MM Article Release Date: 09/30/2004

MSN and ANSI Messages for Mammography Claims

Fri, 11 Nov 2005 13:35:00 EST

Transmittal #: R298CP
Subject: MSN and ANSI Messages for Mammography Claims
MM Article #: MM2617
MM Article Release Date: 06/25/2004

Magnetic Resonance Spectroscopy for Diagnosing Brain Tumors

Fri, 11 Nov 2005 13:36:00 EST

Transmittal #: R21NCD
Subject: Magnetic Resonance Spectroscopy for Diagnosing Brain Tumors
MM Article #: MM3425
MM Article Release Date: 09/27/2004

Hospital Services Covered Under Part B

Fri, 11 Nov 2005 13:37:00 EST

Transmittal #: R19BP
Subject: Hospital Services Covered Under Part B
MM Article #: N/A
MM Article Release Date: N/A

Crossover Patients in New Long Term Care Hospitals (LTCH)

Fri, 11 Nov 2005 13:38:00 EST

Transmittal #: R267CP
Subject: Crossover Patients in New Long Term Care Hospitals (LTCH)
MM Article #: MM3391
MM Article Release Date: 09/27/2004

Update to Medicare Deductible, Coinsurance and Premium Rates for Calendar Year 2005

Fri, 11 Nov 2005 13:38:00 EST

Transmittal #: R10GI
Subject: Update to Medicare Deductible, Coinsurance and Premium Rates for Calendar Year 2005
MM Article #: MM3463
MM Article Release Date: 09/21/2004

Editing Of Hospital And Skilled Nursing Facility Part B Inpatient Services

Fri, 11 Nov 2005 13:40:00 EST

Transmittal #: R301CP
Subject: Editing Of Hospital And Skilled Nursing Facility Part B Inpatient Services
MM Article #: MM3366
MM Article Release Date: 09/27/2004

Notification of Medlearn Matters (MM) Article for Confidential Change Request (CR) 3301

Fri, 11 Nov 2005 13:41:00 EST

Transmittal #: R116OTN
Subject: Notification of Medlearn Matters (MM) Article for Confidential Change Request (CR) 3301
MM Article #: N/A
MM Article Release Date: N/A

Notification to Providers of Intent to Complete a Post-Payment Audit

Fri, 11 Nov 2005 13:42:00 EST

Transmittal #: R54FM
Subject: Notification to Providers of Intent to Complete a Post-Payment Audit
MM Article #: N/A
MM Article Release Date: N/A

Clarification of MSP Rules in Relation to a Temporary Leave of Absence

Fri, 11 Nov 2005 13:43:00 EST

Transmittal #: R19MSP
Subject: Clarification of MSP Rules in Relation to a Temporary Leave of Absence
MM Article #: MM3447
MM Article Release Date: 09/29/2004

Fiscal Year (FY) 2005 Payment for Services Furnished in Ambulatory Surgical Centers (ASCs)

Fri, 11 Nov 2005 13:45:00 EST

Transmittal #: R288CP
Subject: Fiscal Year (FY) 2005 Payment for Services Furnished in Ambulatory Surgical Centers (ASCs)
MM Article #: MM3394
MM Article Release Date: 09/02/2004

2005 Healthcare Common Procedure Coding System (HCPCS) Annual Update reminder

Fri, 11 Nov 2005 13:45:00 EST

Transmittal #: R283CP
Subject: 2005 Healthcare Common Procedure Coding System (HCPCS) Annual Update reminder
MM Article #: MM3422
MM Article Release Date: 09/02/2004

Addition of Physician Assistants, Nurse Practitioners and Clinical Nurse Specialists as Emergency On-Call Providers for Critical Access Hospitals (CAHs)

Fri, 11 Nov 2005 13:46:00 EST

Transmittal #: R285CP
Subject: Addition of Physician Assistants, Nurse Practitioners and Clinical Nurse Specialists as Emergency On-Call Providers for Critical Access Hospitals (CAHs)
MM Article #: MM3228
MM Article Release Date: 09/02/2004

For Cost Reporting Periods End On or After March 31, 2002

Fri, 11 Nov 2005 13:47:00 EST

Transmittal #: R6P229
Subject: For Cost Reporting Periods End On or After March 31, 2002
MM Article #: N/A
MM Article Release Date: N/A

Emergency and Urgently Needed Services

Fri, 11 Nov 2005 13:48:00 EST

Transmittal #: R61MCM
Subject: Emergency and Urgently Needed Services
MM Article #: N/A
MM Article Release Date: N/A

Payment Denial for Medicare Services Furnished to Alien Beneficiaries Who Are Not Lawfully Present in the United States

Fri, 11 Nov 2005 13:49:00 EST

Transmittal #: R296CP
Subject: Payment Denial for Medicare Services Furnished to Alien Beneficiaries Who Are Not Lawfully Present in the United States
MM Article #: N/A
MM Article Release Date: N/A

MSN Messages and Reason Codes for Mammography

Fri, 11 Nov 2005 13:50:00 EST

Transmittal #: R295CP
Subject: MSN Messages and Reason Codes for Mammography
MM Article #: MM2617
MM Article Release Date: 06/25/2004

Billing Instructions for ADVATE rAHF-PFM on Medicare Claims

Fri, 11 Nov 2005 13:51:00 EST

Transmittal #: R112OTN
Subject: Billing Instructions for ADVATE rAHF-PFM on Medicare Claims
MM Article #: MM3331
MM Article Release Date: 10/04/2004

Implementation of Section 921 of the Medicare Modernization Act (MMA) - Provider Customer Service Program

Fri, 11 Nov 2005 13:51:00 EST

Transmittal #: R113OTN
Subject: Implementation of Section 921 of the Medicare Modernization Act (MMA) - Provider Customer Service Program
MM Article #: MM3376
MM Article Release Date: 12/23/2004

Medicare Physician Fee Schedule Database (MPFSDB) 2005 File Layout

Fri, 11 Nov 2005 13:52:00 EST

Transmittal #: R286CP
Subject: Medicare Physician Fee Schedule Database (MPFSDB) 2005 File Layout
MM Article #: N/A
MM Article Release Date: N/A

Schedule for Completing the Calendar Year (CY) 2005 Fee Schedule Updates and the Participating Physician Enrollment Procedures

Fri, 11 Nov 2005 13:53:00 EST

Transmittal #: R287CP
Subject: Schedule for Completing the Calendar Year (CY) 2005 Fee Schedule Updates and the Participating Physician Enrollment Procedures
MM Article #: N/A
MM Article Release Date: N/A

DMERCs Only-Appeals of Duplicate claims

Fri, 11 Nov 2005 13:55:00 EST

Transmittal #: R284CP
Subject: DMERCs Only-Appeals of Duplicate claims
MM Article #: N/A
MM Article Release Date: N/A

Program Integrity Management Reporting (PIMR) System Program Integrity Management Reporting System (PIMR) FY 2004 F and T Codes

Mon, 14 Nov 2005 10:16:00 EST

Transmittal #: R58OTN
Subject: Program Integrity Management Reporting (PIMR) System Program Integrity Management Reporting System (PIMR) FY 2004 F and T Codes
MM Article #: N/A
MM Article Release Date: N/A

Chapter 19, Managed Care and M+C Systems Requirements

Mon, 14 Nov 2005 10:17:00 EST

Transmittal #: R46MCM
Subject: Chapter 19, Managed Care and M+C Systems Requirements
MM Article #: N/A
MM Article Release Date: N/A

Chapter 13, Grievances Organization Determinations and Appeals

Mon, 14 Nov 2005 10:18:00 EST

Transmittal #: R45MCM
Subject: Chapter 13, Grievances Organization Determinations and Appeals
MM Article #: N/A
MM Article Release Date: N/A

Update the Part B Shared Systems to Send the Appropriate Medicare Fee Schedule Amounts to the Medicare Secondary Payer Payment (MSPPAY) Software for Psychiatric MSP Claims

Mon, 14 Nov 2005 10:18:00 EST

Transmittal #: R10MSP
Subject: Update the Part B Shared Systems to Send the Appropriate Medicare Fee Schedule Amounts to the Medicare Secondary Payer Payment (MSPPAY) Software for Psychiatric MSP Claims
MM Article #: N/A
MM Article Release Date: N/A

Outpatient Clinical Laboratory Tests Furnished by Hospitals With Fewer Than 50 beds in Qualified Rural Areas

Mon, 14 Nov 2005 10:19:00 EST

Transmittal #: R100CP
Subject: Outpatient Clinical Laboratory Tests Furnished by Hospitals With Fewer Than 50 beds in Qualified Rural Areas
MM Article #: MM3130
MM Article Release Date: 03/31/2004

Appendix C-Survey Procedures and Interpretive Guidelines for Laboratories and Laboratory Services

Mon, 14 Nov 2005 10:20:00 EST

Transmittal #: R32SOM
Subject: Appendix C-Survey Procedures and Interpretive Guidelines for Laboratories and Laboratory Services
MM Article #: N/A
MM Article Release Date: N/A

Temporary 5 Percent Payment Increase for Home Health Services Furnished in a Rural Area for One Year Under the Home Health Prospective Payment System (HH PPS), Change of HH PPS Annual Update from a Fiscal Year Update to a Calendar Year Update, and Adjustment of HH PPS Annual Update to the Home Health Market Basket Percentage Increase Minus 0.8 Percent

Mon, 14 Nov 2005 10:21:00 EST

Transmittal #: R59OTN
Subject: Temporary 5 Percent Payment Increase for Home Health Services Furnished in a Rural Area for One Year Under the Home Health Prospective Payment System (HH PPS), Change of HH PPS Annual Update from a Fiscal Year Update to a Calendar Year Update, and Adjustment of HH PPS Annual Update to the Home Health Market Basket Percentage Increase Minus 0.8 Percent
MM Article #: MM3085
MM Article Release Date: 03/16/2004

Regional Medicare Swing-Bed Rates

Mon, 14 Nov 2005 10:21:00 EST

Transmittal #: R425PR1
Subject: Regional Medicare Swing-Bed Rates
MM Article #: N/A
MM Article Release Date: N/A

Chapter 7--Medicare+Choice-Enrollment and Disenrollment

Mon, 14 Nov 2005 10:22:00 EST

Transmittal #: R47MCM
Subject: Chapter 7--Medicare+Choice-Enrollment and Disenrollment
MM Article #: N/A
MM Article Release Date: N/A

Progressive Corrective Action Program Memorandum and Providing Updated Instructions on How Contractors Must Identify, Verify, and Correct Billing Errors.

Mon, 14 Nov 2005 10:23:00 EST

Transmittal #: R66PI
Subject: Progressive Corrective Action Program Memorandum and Providing Updated Instructions on How Contractors Must Identify, Verify, and Correct Billing Errors.
MM Article #: N/A
MM Article Release Date: N/A

1st Update to the 2004 Medicare Physician Fee Schedule Database

Mon, 14 Nov 2005 10:23:00 EST

Transmittal #: R105CP
Subject: 1st Update to the 2004 Medicare Physician Fee Schedule Database
MM Article #: N/A
MM Article Release Date: N/A

DMERCs and VIPS, Processing NDC Numbers

Mon, 14 Nov 2005 10:24:00 EST

Transmittal #: R104CP
Subject: DMERCs and VIPS, Processing NDC Numbers
MM Article #: MM3141
MM Article Release Date: 05/06/2004

Change in Methodolgy for Determining Payment for Outliers

Mon, 14 Nov 2005 10:25:00 EST

Transmittal #: R77CP
Subject: Change in Methodolgy for Determining Payment for Outliers
MM Article #: N/A
MM Article Release Date: N/A

New "K" Codes for Wheelchair Cushions

Mon, 14 Nov 2005 10:26:00 EST

Transmittal #: R83CP
Subject: New "K" Codes for Wheelchair Cushions
MM Article #: MM3069
MM Article Release Date: 02/28/2004

SNF Inpatient Part A Billing

Mon, 14 Nov 2005 10:26:00 EST

Transmittal #: R76CP
Subject: SNF Inpatient Part A Billing
MM Article #: N/A
MM Article Release Date: N/A

ESRD Data for Use in Adjusting Claims

Mon, 14 Nov 2005 10:27:00 EST

Transmittal #: R82CP
Subject: ESRD Data for Use in Adjusting Claims
MM Article #: N/A
MM Article Release Date: N/A

Update of UB-92 Codes

Mon, 14 Nov 2005 10:28:00 EST

Transmittal #: R81CP
Subject: Update of UB-92 Codes
MM Article #: N/A
MM Article Release Date: N/A

Extend Medicare Coverage for Certain Colorectal Cancer Screenings at SNFs

Mon, 14 Nov 2005 10:28:00 EST

Transmittal #: R80CP
Subject: Extend Medicare Coverage for Certain Colorectal Cancer Screenings at SNFs
MM Article #: MM2874
MM Article Release Date: 02/27/2004

Implementation of Changes to Payment for Ambulance Services Required by Section 414 of MMA

Mon, 14 Nov 2005 10:29:00 EST

Transmittal #: R88CP
Subject: Implementation of Changes to Payment for Ambulance Services Required by Section 414 of MMA
MM Article #: MM3099
MM Article Release Date: 07/14/2004

The Elimination of the 90-Day Grace Period for HCPCS Codes

Mon, 14 Nov 2005 10:29:00 EST

Transmittal #: R89CP
Subject: The Elimination of the 90-Day Grace Period for HCPCS Codes
MM Article #: MM3093
MM Article Release Date: 02/12/2004

Common Working File MSP Modifications

Mon, 14 Nov 2005 10:39:00 EST

Transmittal #: R8MSP
Subject: Common Working File MSP Modifications
MM Article #: N/A
MM Article Release Date: N/A

Sending the Primary Payer Covered Charge Amount to the Medicare Secondary Payment (MSPPAY) Module for MSP Home Health Prospective Payment System (HH PPS) Claims

Mon, 14 Nov 2005 10:39:00 EST

Transmittal #: R7MSP
Subject: Sending the Primary Payer Covered Charge Amount to the Medicare Secondary Payment (MSPPAY) Module for MSP Home Health Prospective Payment System (HH PPS) Claims
MM Article #: N/A
MM Article Release Date: N/A

Claims Status Codes in ASC X12N 276/277 Claims Status Health Insurance Portability and Accountability Act (HIPAA) Transactions

Mon, 14 Nov 2005 10:40:00 EST

Transmittal #: R96CP
Subject: Claims Status Codes in ASC X12N 276/277 Claims Status Health Insurance Portability and Accountability Act (HIPAA) Transactions
MM Article #: N/A
MM Article Release Date: N/A

Elimination of the 90-Day Grace Period for ICD-9-CM Codes

Mon, 14 Nov 2005 10:41:00 EST

Transmittal #: R95CP
Subject: Elimination of the 90-Day Grace Period for ICD-9-CM Codes
MM Article #: MM3094
MM Article Release Date: 02/10/2004

Consolidation of the Claims Crossover Process: Additional Common Working File (CWF) Functionality

Mon, 14 Nov 2005 10:42:00 EST

Transmittal #: R98CP
Subject: Consolidation of the Claims Crossover Process: Additional Common Working File (CWF) Functionality
MM Article #: MM3109
MM Article Release Date: 03/05/2004

Implementation of New Medicare Redetermination Notice (MRN)

Mon, 14 Nov 2005 10:42:00 EST

Transmittal #: R97CP
Subject: Implementation of New Medicare Redetermination Notice (MRN)
MM Article #: MM2620
MM Article Release Date: 10/04/2004

Additional Information in Medicare Summary Notices (MSNs) to Beneficiaries about Skilled Nursing Facility (SNF) Benefits

Mon, 14 Nov 2005 10:43:00 EST

Transmittal #: R94CP
Subject: Additional Information in Medicare Summary Notices (MSNs) to Beneficiaries about Skilled Nursing Facility (SNF) Benefits
MM Article #: MM3098
MM Article Release Date: 02/25/2004

Remittance Advice Remark Code and Claim Adjustment Reason Code Update

Mon, 14 Nov 2005 11:06:00 EST

Transmittal #: R93CP
Subject: Remittance Advice Remark Code and Claim Adjustment Reason Code Update
MM Article #: N/A
MM Article Release Date: N/A

Updates to the January 2004 Annual Update of HCPCS Codes Used for Skilled Nursing Facility Consolidated Billing Enforcement

Mon, 14 Nov 2005 11:08:00 EST

Transmittal #: R92CP
Subject: Updates to the January 2004 Annual Update of HCPCS Codes Used for Skilled Nursing Facility Consolidated Billing Enforcement
MM Article #: N/A
MM Article Release Date: N/A

Revisions to Processing of Non-covered Charges on Certain Home Health Prospective Payment System Claims

Mon, 14 Nov 2005 11:09:00 EST

Transmittal #: R91CP
Subject: Revisions to Processing of Non-covered Charges on Certain Home Health Prospective Payment System Claims
MM Article #: N/A
MM Article Release Date: N/A

Implementation of Skilled Nursing Facility Consolidated Billing CWF Edit for Therapy Codes Considered Separately Payable Physician Services

Mon, 14 Nov 2005 11:10:00 EST

Transmittal #: R90CP
Subject: Implementation of Skilled Nursing Facility Consolidated Billing CWF Edit for Therapy Codes Considered Separately Payable Physician Services
MM Article #: N/A
MM Article Release Date: N/A

ESRD Reimbursement for AMCC Tests

Mon, 14 Nov 2005 11:11:00 EST

Transmittal #: R79CP
Subject: ESRD Reimbursement for AMCC Tests
MM Article #: N/A
MM Article Release Date: N/A

April Quarterly DMEPOS Fee Schedule Update

Mon, 14 Nov 2005 11:12:00 EST

Transmittal #: R58CP
Subject: April Quarterly DMEPOS Fee Schedule Update
MM Article #: N/A
MM Article Release Date: N/A

Medicare Incentive Payments for Physician Care

Mon, 14 Nov 2005 11:12:00 EST

Transmittal #: R78CP
Subject: Medicare Incentive Payments for Physician Care
MM Article #: MM3108
MM Article Release Date: 02/26/2004

Implementation Guide (IG) Edits

Mon, 14 Nov 2005 11:13:00 EST

Transmittal #: R57CP
Subject: Implementation Guide (IG) Edits
MM Article #: N/A
MM Article Release Date: N/A

Announcement of Medicare Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Payment Rate Increases

Mon, 14 Nov 2005 11:14:00 EST

Transmittal #: R49OTN
Subject: Announcement of Medicare Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Payment Rate Increases
MM Article #: N/A
MM Article Release Date: N/A

Special Rules for Critical Access Hospital (CAH) Outpatient Billing

Mon, 14 Nov 2005 11:14:00 EST

Transmittal #: R63CP
Subject: Special Rules for Critical Access Hospital (CAH) Outpatient Billing
MM Article #: MM3051
MM Article Release Date: 12/06/2004

Transfer of "WW" Codes for Oral Anti-Cancer Drugs Billed Using National Drug Codes (NDCs) on Durable Medical Equipment Regional Carrier (DMERC) Claims

Mon, 14 Nov 2005 11:15:00 EST

Transmittal #: R48OTN
Subject: Transfer of "WW" Codes for Oral Anti-Cancer Drugs Billed Using National Drug Codes (NDCs) on Durable Medical Equipment Regional Carrier (DMERC) Claims
MM Article #: N/A
MM Article Release Date: N/A

Role Conditions of Participation (COPs) Requirements When Making a Payment Decision

Mon, 14 Nov 2005 11:16:00 EST

Transmittal #: R64PI
Subject: Role Conditions of Participation (COPs) Requirements When Making a Payment Decision
MM Article #: N/A
MM Article Release Date: N/A

Fiscal Intermediaries to Perform Medical Review on Long Term Care Hospitals

Mon, 14 Nov 2005 11:16:00 EST

Transmittal #: R65PI
Subject: Fiscal Intermediaries to Perform Medical Review on Long Term Care Hospitals
MM Article #: N/A
MM Article Release Date: N/A

Installation of Version 31 of the Provider Statistical and Reimbursement (PS&R) Reporting System

Mon, 14 Nov 2005 11:17:00 EST

Transmittal #: R31FM
Subject: Installation of Version 31 of the Provider Statistical and Reimbursement (PS&R) Reporting System
MM Article #: N/A
MM Article Release Date: N/A

MMA Pricing File Clarifications

Mon, 14 Nov 2005 11:18:00 EST

Transmittal #: R75CP
Subject: MMA Pricing File Clarifications
MM Article #: MM3105
MM Article Release Date: 03/10/2004

Program Integrity Management Reporting (PIMR) System for Part A - Phase 4

Mon, 14 Nov 2005 11:18:00 EST

Transmittal #: R56OTN
Subject: Program Integrity Management Reporting (PIMR) System for Part A - Phase 4
MM Article #: N/A
MM Article Release Date: N/A

Shared System Maintainer Hours for Resolution of Problems Detected During HIPAA Transaction Release Testing

Mon, 14 Nov 2005 11:20:00 EST

Transmittal #: R55OTN
Subject: Shared System Maintainer Hours for Resolution of Problems Detected During HIPAA Transaction Release Testing
MM Article #: N/A
MM Article Release Date: N/A

Surgical Lines with No Charges

Mon, 14 Nov 2005 11:21:00 EST

Transmittal #: R53OTN
Subject: Surgical Lines with No Charges
MM Article #: N/A
MM Article Release Date: N/A

Provider Education Article: 2004 Medicare Physician Fee Schedule Increase and Extension of the Annual Participation Enrollment Period

Mon, 14 Nov 2005 11:21:00 EST

Transmittal #: R38OTN
Subject: Provider Education Article: 2004 Medicare Physician Fee Schedule Increase and Extension of the Annual Participation Enrollment Period
MM Article #: N/A
MM Article Release Date: N/A

Clarification of Proof of Delivery Requirements

Mon, 14 Nov 2005 11:22:00 EST

Transmittal #: R61PI
Subject: Clarification of Proof of Delivery Requirements
MM Article #: N/A
MM Article Release Date: N/A

Home Health Cost Reporting Processes

Mon, 14 Nov 2005 11:22:00 EST

Transmittal #: R37OTN
Subject: Home Health Cost Reporting Processes
MM Article #: MM2993
MM Article Release Date: 02/03/2004

Revisions to Chapter 3 & 4

Mon, 14 Nov 2005 11:23:00 EST

Transmittal #: R29FM
Subject: Revisions to Chapter 3 & 4
MM Article #: N/A
MM Article Release Date: N/A

New HCPCS Code for Ambulance Night Differential Charges

Mon, 14 Nov 2005 11:24:00 EST

Transmittal #: R59CP
Subject: New HCPCS Code for Ambulance Night Differential Charges
MM Article #: N/A
MM Article Release Date: N/A

Dentists, podiatrists, and optometrists are added to the definition/list of physicians who may opt out of Medicare

Mon, 14 Nov 2005 11:26:00 EST

Transmittal #: R4BP
Subject: Dentists, podiatrists, and optometrists are added to the definition/list of physicians who may opt out of Medicare
MM Article #: MM3016
MM Article Release Date: 01/15/2004

Provider Education Article: Renewed Moratorium on Outpatient Rehabilitation Therapy Caps

Mon, 14 Nov 2005 11:26:00 EST

Transmittal #: R40OTN
Subject: Provider Education Article: Renewed Moratorium on Outpatient Rehabilitation Therapy Caps
MM Article #: N/A
MM Article Release Date: N/A

Change in Coding on Medicare Claims for Darbepoetin Alfa (trade name Aranesp) and Epoetin Alfa (trade name Epogen, EPO) For Treatment Of Anemia In End Stage Renal Disease (ESRD) Patients On Dialysis

Mon, 14 Nov 2005 11:28:00 EST

Transmittal #: R39OTN
Subject: Change in Coding on Medicare Claims for Darbepoetin Alfa (trade name Aranesp) and Epoetin Alfa (trade name Epogen, EPO) For Treatment Of Anemia In End Stage Renal Disease (ESRD) Patients On Dialysis
MM Article #: MM2963
MM Article Release Date: 02/13/2004

Provider Education Article: New Enrollee Rights, New Provider Responsibilities in M+C Program

Mon, 14 Nov 2005 11:28:00 EST

Transmittal #: R41OTN
Subject: Provider Education Article: New Enrollee Rights, New Provider Responsibilities in M+C Program
MM Article #: N/A
MM Article Release Date: N/A

Chapter 6, Relationships With Providers

Mon, 14 Nov 2005 11:29:00 EST

Transmittal #: R44MCM
Subject: Chapter 6, Relationships With Providers
MM Article #: N/A
MM Article Release Date: N/A

Chapter 4, Benefits and Beneficiary Protection

Mon, 14 Nov 2005 11:30:00 EST

Transmittal #: R43MCM
Subject: Chapter 4, Benefits and Beneficiary Protection
MM Article #: N/A
MM Article Release Date: N/A

Chapter 3, Marketing

Mon, 14 Nov 2005 11:30:00 EST

Transmittal #: R42MCM
Subject: Chapter 3, Marketing
MM Article #: N/A
MM Article Release Date: N/A

Chapter 2, Enrollment and Disenrollment

Mon, 14 Nov 2005 11:31:00 EST

Transmittal #: R41MCM
Subject: Chapter 2, Enrollment and Disenrollment
MM Article #: N/A
MM Article Release Date: N/A

Chapter 18, Preventive and Screening Services

Mon, 14 Nov 2005 11:32:00 EST

Transmittal #: R60CP
Subject: Chapter 18, Preventive and Screening Services
MM Article #: N/A
MM Article Release Date: N/A

Payment to Ambulatory Surgical Centers (ASCs) for G0260 and to Physicians for 27096 When 27096 is Performed in an ASC

Mon, 14 Nov 2005 11:33:00 EST

Transmittal #: R42OTN
Subject: Payment to Ambulatory Surgical Centers (ASCs) for G0260 and to Physicians for 27096 When 27096 is Performed in an ASC
MM Article #: MM2979
MM Article Release Date: 02/13/2004

Chapter 15, Covered Medical and Other Health Services

Mon, 14 Nov 2005 11:33:00 EST

Transmittal #: R5BP
Subject: Chapter 15, Covered Medical and Other Health Services
MM Article #: N/A
MM Article Release Date: N/A

Automatic Notice of Change to MSP Auxiliary File

Mon, 14 Nov 2005 11:34:00 EST

Transmittal #: R6MSP
Subject: Automatic Notice of Change to MSP Auxiliary File
MM Article #: N/A
MM Article Release Date: N/A

Revision to CR 2912: Coding, Testing, and Implementation Phases of CR 2631 for Jurisdiction

Mon, 14 Nov 2005 11:35:00 EST

Transmittal #: R67CP
Subject: Revision to CR 2912: Coding, Testing, and Implementation Phases of CR 2631 for Jurisdiction
MM Article #: N/A
MM Article Release Date: N/A

Quarterly Update to Correct Coding Initiative (CCI) edits, Version 10.1, Effective April 1, 2004

Mon, 14 Nov 2005 11:36:00 EST

Transmittal #: R66CP
Subject: Quarterly Update to Correct Coding Initiative (CCI) edits, Version 10.1, Effective April 1, 2004
MM Article #: N/A
MM Article Release Date: N/A

ANSI X12 Transaction 835 Companion Document Change for Carriers, Durable Medical Equipment Regional Carriers (DMERCs), and Fiscal Intermediaries (Fis)

Mon, 14 Nov 2005 11:36:00 EST

Transmittal #: R65CP
Subject: ANSI X12 Transaction 835 Companion Document Change for Carriers, Durable Medical Equipment Regional Carriers (DMERCs), and Fiscal Intermediaries (Fis)
MM Article #: N/A
MM Article Release Date: N/A

Coding Change for Ventricular Assist Devices (VADs) for Beneficiaries in an Medicare+Choice (M+C) Plan

Mon, 14 Nov 2005 11:37:00 EST

Transmittal #: R64CP
Subject: Coding Change for Ventricular Assist Devices (VADs) for Beneficiaries in an Medicare+Choice (M+C) Plan
MM Article #: MM3068
MM Article Release Date: 02/04/2004

January 2004 annual update of HCPCS codes used for Home Health Consolidated Billing Enforcement

Mon, 14 Nov 2005 11:38:00 EST

Transmittal #: R62CP
Subject: January 2004 annual update of HCPCS codes used for Home Health Consolidated Billing Enforcement
MM Article #: N/A
MM Article Release Date: N/A

Diagnosis coding instructions for anticipated payment and claims to conform with HIPAA requirements

Mon, 14 Nov 2005 11:39:00 EST

Transmittal #: R61CP
Subject: Diagnosis coding instructions for anticipated payment and claims to conform with HIPAA requirements
MM Article #: N/A
MM Article Release Date: N/A

Implementation of the Occupational Mix Survey

Mon, 14 Nov 2005 11:39:00 EST

Transmittal #: R47OTN
Subject: Implementation of the Occupational Mix Survey
MM Article #: N/A
MM Article Release Date: N/A

Railroad Medicare Carrier Collection of Data

Mon, 14 Nov 2005 11:40:00 EST

Transmittal #: R46OTN
Subject: Railroad Medicare Carrier Collection of Data
MM Article #: N/A
MM Article Release Date: N/A

October 2004 Update of the Hospital Outpatient Prospective Payment System (OPPS)

Mon, 14 Nov 2005 11:40:00 EST

Transmittal #: R290CP
Subject: October 2004 Update of the Hospital Outpatient Prospective Payment System (OPPS)
MM Article #: MM3420
MM Article Release Date: 09/08/2004

Correction-CWF Edits for Inserts for Therapeutic Shoes

Mon, 14 Nov 2005 11:41:00 EST

Transmittal #: R44OTN
Subject: Correction-CWF Edits for Inserts for Therapeutic Shoes
MM Article #: N/A
MM Article Release Date: N/A

File Descriptions and Instructions for Retrieving the 2005 Pricing Files through CMS's Mainframe Telecommunications System

Mon, 14 Nov 2005 11:41:00 EST

Transmittal #: R289CP
Subject: File Descriptions and Instructions for Retrieving the 2005 Pricing Files through CMS's Mainframe Telecommunications System
MM Article #: N/A
MM Article Release Date: N/A

Emergency Correction to Healthcare Common Procedure Coding System (HCPCS) Codes for Low Osmolar Contrast Material

Mon, 14 Nov 2005 11:41:00 EST

Transmittal #: R45OTN
Subject: Emergency Correction to Healthcare Common Procedure Coding System (HCPCS) Codes for Low Osmolar Contrast Material
MM Article #: MM3053
MM Article Release Date: 03/20/2004

Correction To The Effective Date On 9 Code Pairs in Correct Coding Initiative (CCI) Version 9.3 (Cardiology edits)

Mon, 14 Nov 2005 11:42:00 EST

Transmittal #: R43OTN
Subject: Correction To The Effective Date On 9 Code Pairs in Correct Coding Initiative (CCI) Version 9.3 (Cardiology edits)
MM Article #: N/A
MM Article Release Date: N/A

The Focused Medical Review Report

Mon, 14 Nov 2005 11:43:00 EST

Transmittal #: R62PI
Subject: The Focused Medical Review Report
MM Article #: N/A
MM Article Release Date: N/A

Expansion of the Existing Interrupted Stay Policy Under Long Term Care Hospital (LTCH) Prospective Payment System

Mon, 14 Nov 2005 11:43:00 EST

Transmittal #: R240CP
Subject: Expansion of the Existing Interrupted Stay Policy Under Long Term Care Hospital (LTCH) Prospective Payment System
MM Article #: N/A
MM Article Release Date: N/A

Benefit Improvement Protection Act (BIPA)

Mon, 14 Nov 2005 11:43:00 EST

Transmittal #: R63PI
Subject: Benefit Improvement Protection Act (BIPA)
MM Article #: N/A
MM Article Release Date: N/A

Intravenous Immune Globulin

Mon, 14 Nov 2005 11:44:00 EST

Transmittal #: R74CP
Subject: Intravenous Immune Globulin
MM Article #: MM3060
MM Article Release Date: 02/10/2004

MCE and IPPS Transfers Between Hospitals

Mon, 14 Nov 2005 11:47:00 EST

Transmittal #: R73CP
Subject: MCE and IPPS Transfers Between Hospitals
MM Article #: N/A
MM Article Release Date: N/A

Changes to the Laboratory National Coverage Determination (NCD) Edit Software

Mon, 14 Nov 2005 11:48:00 EST

Transmittal #: R71CP
Subject: Changes to the Laboratory National Coverage Determination (NCD) Edit Software
MM Article #: N/A
MM Article Release Date: N/A

Update of Address for the Railroad Retirement Board (RRB)

Mon, 14 Nov 2005 11:48:00 EST

Transmittal #: R72CP
Subject: Update of Address for the Railroad Retirement Board (RRB)
MM Article #: N/A
MM Article Release Date: N/A

Criteria for Using the CB Modifier

Mon, 14 Nov 2005 11:49:00 EST

Transmittal #: R69CP
Subject: Criteria for Using the CB Modifier
MM Article #: N/A
MM Article Release Date: N/A

Cardiac Output Monitoring by Thoracic Electrical Bioimpedance

Mon, 14 Nov 2005 11:50:00 EST

Transmittal #: R6NCD
Subject: Cardiac Output Monitoring by Thoracic Electrical Bioimpedance
MM Article #: N/A
MM Article Release Date: N/A

Intravenous Immune Globulin

Mon, 14 Nov 2005 11:51:00 EST

Transmittal #: R6BP
Subject: Intravenous Immune Globulin
MM Article #: MM3060
MM Article Release Date: 02/10/2004

Notice of New Interest Rates for Medicare Overpayments and Underpayments

Mon, 14 Nov 2005 11:52:00 EST

Transmittal #: R30FM
Subject: Notice of New Interest Rates for Medicare Overpayments and Underpayments
MM Article #: N/A
MM Article Release Date: N/A

New Requirements for Critical Access Hospitals. These changes have been established with the "Medicare Prescription Drug, Improvement, and Modernization Act" (MPDIMA) of 2003, Pub.L. 108-173

Mon, 14 Nov 2005 11:52:00 EST

Transmittal #: R68CP
Subject: New Requirements for Critical Access Hospitals. These changes have been established with the "Medicare Prescription Drug, Improvement, and Modernization Act" (MPDIMA) of 2003, Pub.L. 108-173
MM Article #: MM3052
MM Article Release Date: 02/06/2004

Provider Data on Outbound Coordination of Benefit (COB) Files

Mon, 14 Nov 2005 11:53:00 EST

Transmittal #: R52OTN
Subject: Provider Data on Outbound Coordination of Benefit (COB) Files
MM Article #: N/A
MM Article Release Date: N/A

Changes in Payment for Services Furnished in Ambulatory Surgical Centers for Fiscal Year 2004

Mon, 14 Nov 2005 11:54:00 EST

Transmittal #: R51OTN
Subject: Changes in Payment for Services Furnished in Ambulatory Surgical Centers for Fiscal Year 2004
MM Article #: MM3082
MM Article Release Date: 05/06/2004

ANSI X12 Transaction 270/271 Changes

Mon, 14 Nov 2005 11:54:00 EST

Transmittal #: R50OTN
Subject: ANSI X12 Transaction 270/271 Changes
MM Article #: N/A
MM Article Release Date: N/A

Coordination of Medicare and Complementary Insurance Programs

Mon, 14 Nov 2005 11:55:00 EST

Transmittal #: R33FM
Subject: Coordination of Medicare and Complementary Insurance Programs
MM Article #: MM3109
MM Article Release Date: 02/29/2004

Expanded Identification and Workload Reporting for CMS Medicare Systems

Mon, 14 Nov 2005 11:56:00 EST

Transmittal #: R32FM
Subject: Expanded Identification and Workload Reporting for CMS Medicare Systems
MM Article #: N/A
MM Article Release Date: N/A

Chapter 7 - Internal Control Requirements Update

Mon, 14 Nov 2005 11:56:00 EST

Transmittal #: R34FM
Subject: Chapter 7 - Internal Control Requirements Update
MM Article #: N/A
MM Article Release Date: N/A

Notice of New Interest Rate for Medicare Overpatments and Underpatyments

Mon, 14 Nov 2005 12:09:00 EST

Transmittal #: R51FM
Subject: Notice of New Interest Rate for Medicare Overpatments and Underpatyments
MM Article #: N/A
MM Article Release Date: N/A

Notice of New Insterest Rate for Medicare Overpayments and Underpayments

Mon, 14 Nov 2005 12:52:00 EST

Transmittal #: R52FM
Subject: Notice of New Insterest Rate for Medicare Overpayments and Underpayments
MM Article #: N/A
MM Article Release Date: N/A

Converting Health Insurance Portability and Accountability ct (HIPAA) Individual Relationship Codes to Common Working File (CWF) Patient Relationship Codes

Mon, 14 Nov 2005 12:54:00 EST

Transmittal #: R9MSP
Subject: Converting Health Insurance Portability and Accountability ct (HIPAA) Individual Relationship Codes to Common Working File (CWF) Patient Relationship Codes
MM Article #: N/A
MM Article Release Date: N/A

Update to the Frequency of Billing

Mon, 14 Nov 2005 13:09:00 EST

Transmittal #: R270CP
Subject: Update to the Frequency of Billing
MM Article #: N/A
MM Article Release Date: N/A

Number of Drug Pricing Files That Must Be Maintained Online for Medicare

Mon, 14 Nov 2005 13:10:00 EST

Transmittal #: R269CP
Subject: Number of Drug Pricing Files That Must Be Maintained Online for Medicare
MM Article #: MM3231
MM Article Release Date: 12/16/2004

Medicare Program-Update to the Hospice Payment Rates, Hospice Cap, Hospice Wage Index and the Hospice Pricer for FY 2005

Mon, 14 Nov 2005 13:11:00 EST

Transmittal #: R271CP
Subject: Medicare Program-Update to the Hospice Payment Rates, Hospice Cap, Hospice Wage Index and the Hospice Pricer for FY 2005
MM Article #: N/A
MM Article Release Date: N/A

October Quarterly Update For 2004

Mon, 14 Nov 2005 13:12:00 EST

Transmittal #: R272CP
Subject: October Quarterly Update For 2004
MM Article #: MM3377
MM Article Release Date: 08/18/2004

Use of Group Health Plan Payment System to Pay Capitated Payments to Non-Health Plan Demonstration/Program Sites Serving Medicare Fee For Service Beneficiaries- Updated List of Plan Numbers

Mon, 14 Nov 2005 13:13:00 EST

Transmittal #: R5DEMO
Subject: Use of Group Health Plan Payment System to Pay Capitated Payments to Non-Health Plan Demonstration/Program Sites Serving Medicare Fee For Service Beneficiaries- Updated List of Plan Numbers
MM Article #: N/A
MM Article Release Date: N/A

Chapter 5 Revisions

Mon, 14 Nov 2005 13:14:00 EST

Transmittal #: R58MCM
Subject: Chapter 5 Revisions
MM Article #: N/A
MM Article Release Date: N/A

Chapter 7 Revisions

Mon, 14 Nov 2005 13:15:00 EST

Transmittal #: R57MCM
Subject: Chapter 7 Revisions
MM Article #: N/A
MM Article Release Date: N/A

3rd Update to the 2004 Medicare Physician Fee Schedule Database

Mon, 14 Nov 2005 13:16:00 EST

Transmittal #: R278CP
Subject: 3rd Update to the 2004 Medicare Physician Fee Schedule Database
MM Article #: MM3415
MM Article Release Date: 08/21/2004

Further Information Related to CR 3175, Distinct Part Units of Critical Access Hospitals (CAHs)

Mon, 14 Nov 2005 13:23:00 EST

Transmittal #: R276CP
Subject: Further Information Related to CR 3175, Distinct Part Units of Critical Access Hospitals (CAHs)
MM Article #: MM3399
MM Article Release Date: 08/23/2004

The Supplemental Security Income (SSI)/Medicare Beneficiary Data for Fiscal Year 2003 for Inpatient Prospective Payment System (IPPS) Hospitals

Mon, 14 Nov 2005 13:24:00 EST

Transmittal #: R275CP
Subject: The Supplemental Security Income (SSI)/Medicare Beneficiary Data for Fiscal Year 2003 for Inpatient Prospective Payment System (IPPS) Hospitals
MM Article #: N/A
MM Article Release Date: N/A

Good Cause Waiver of Late Claim Filing Payment Reduction Penalty

Mon, 14 Nov 2005 13:25:00 EST

Transmittal #: R274CP
Subject: Good Cause Waiver of Late Claim Filing Payment Reduction Penalty
MM Article #: N/A
MM Article Release Date: N/A

Good Cause Waiver of Late Claim Filing Payment Reduction Penalty

Mon, 14 Nov 2005 13:26:00 EST

Transmittal #: R282CP
Subject: Good Cause Waiver of Late Claim Filing Payment Reduction Penalty
MM Article #: N/A
MM Article Release Date: N/A

MMA Drug Pricing Update-Payment Limits for J9045 (Carboplatin injection) and J9310 (Rituximab cancer treatment)

Mon, 14 Nov 2005 13:27:00 EST

Transmittal #: R106OTN
Subject: MMA Drug Pricing Update-Payment Limits for J9045 (Carboplatin injection) and J9310 (Rituximab cancer treatment)
MM Article #: MM3419
MM Article Release Date: 09/02/2004

Creation of CWF Auxilliary Files and Associated Logic to Properly Calculate Medicare-Equivalent Deductibles for VA Claims

Mon, 14 Nov 2005 13:28:00 EST

Transmittal #: R111OTN
Subject: Creation of CWF Auxilliary Files and Associated Logic to Properly Calculate Medicare-Equivalent Deductibles for VA Claims
MM Article #: N/A
MM Article Release Date: N/A

MMA Drug Pricing Update-Payment Limits for J1000 (Depo-estradiol cypionate inj)

Mon, 14 Nov 2005 13:29:00 EST

Transmittal #: R110OTN
Subject: MMA Drug Pricing Update-Payment Limits for J1000 (Depo-estradiol cypionate inj)
MM Article #: MM3418
MM Article Release Date: 09/02/2004

CWF Analysis to Process Claims Per the Renovated Override Code Billing Instructions for ADVATE rAHF-PFM on Medicare Claims

Mon, 14 Nov 2005 13:30:00 EST

Transmittal #: R109OTN
Subject: CWF Analysis to Process Claims Per the Renovated Override Code Billing Instructions for ADVATE rAHF-PFM on Medicare Claims
MM Article #: N/A
MM Article Release Date: N/A

New Remark Code Message for Use with Claims for Parenteral Pumps - Durable Medical Equipment Regional Carrier (DMERC) Only

Mon, 14 Nov 2005 13:31:00 EST

Transmittal #: R108OTN
Subject: New Remark Code Message for Use with Claims for Parenteral Pumps - Durable Medical Equipment Regional Carrier (DMERC) Only
MM Article #: N/A
MM Article Release Date: N/A

CWF Analysis to Process Claims Per the Renovated Override Code Processing (re: CR3190) and CWF Analysis to Review System Edits for Additional 2-byte Modifiers Added in CR3190. (Phase 2)

Mon, 14 Nov 2005 13:32:00 EST

Transmittal #: R107OTN
Subject: CWF Analysis to Process Claims Per the Renovated Override Code Processing (re: CR3190) and CWF Analysis to Review System Edits for Additional 2-byte Modifiers Added in CR3190. (Phase 2)
MM Article #: N/A
MM Article Release Date: N/A

Revision of CR 3269 for the Demonstration Project to Clarify the Definition of Homebound (Homebound Demonstration)

Mon, 14 Nov 2005 13:33:00 EST

Transmittal #: R6DEMO
Subject: Revision of CR 3269 for the Demonstration Project to Clarify the Definition of Homebound (Homebound Demonstration)
MM Article #: N/A
MM Article Release Date: N/A

PIM Revisions for Chapter 4

Mon, 14 Nov 2005 13:34:00 EST

Transmittal #: R83PI
Subject: PIM Revisions for Chapter 4
MM Article #: N/A
MM Article Release Date: N/A

Change Request 3367, Debt Collection System (DCS), replaces Change Request 2952, Debt Collection System (DCS)

Mon, 14 Nov 2005 13:35:00 EST

Transmittal #: R53FM
Subject: Change Request 3367, Debt Collection System (DCS), replaces Change Request 2952, Debt Collection System (DCS)
MM Article #: N/A
MM Article Release Date: N/A

Application of the Medicare Secondary Payer for the Working Aged Provision and the Medicare Secondary for the Disabled Provision to Former Spouses and Certain Family Members with Coverage Under the Federal Employees Health Benefits (FEHB) Program

Mon, 14 Nov 2005 13:36:00 EST

Transmittal #: R18MSP
Subject: Application of the Medicare Secondary Payer for the Working Aged Provision and the Medicare Secondary for the Disabled Provision to Former Spouses and Certain Family Members with Coverage Under the Federal Employees Health Benefits (FEHB) Program
MM Article #: MM3120
MM Article Release Date: 09/02/2004

Additional Clarification of Bill Types 22x and 23x Submitted by Skilled Nursing Facilities (SNFs) With Instructions for Involuntarily Moving a Beneficiary Out of the SNF and Ending a Benefit Period

Mon, 14 Nov 2005 13:38:00 EST

Transmittal #: R229CP
Subject: Additional Clarification of Bill Types 22x and 23x Submitted by Skilled Nursing Facilities (SNFs) With Instructions for Involuntarily Moving a Beneficiary Out of the SNF and Ending a Benefit Period
MM Article #: MM3323
MM Article Release Date: 08/02/2004

Use of Transmission Date in the Service Date/Assessment Date Field for Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) Claims

Mon, 14 Nov 2005 13:39:00 EST

Transmittal #: R291CP
Subject: Use of Transmission Date in the Service Date/Assessment Date Field for Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) Claims
MM Article #: N/A
MM Article Release Date: N/A

This transmittal is rescinded and replaced with Transmittal 103, dated July 30, 2004

Mon, 14 Nov 2005 13:40:00 EST

Transmittal #: R100OTN
Subject: This transmittal is rescinded and replaced with Transmittal 103, dated July 30, 2004
MM Article #: N/A
MM Article Release Date: N/A

This One-Time Notification is a Full Replacement for Transmittal 86 (CR 3142) Interface File from Recovery Management and Accounting System (ReMAS

Mon, 14 Nov 2005 13:41:00 EST

Transmittal #: R99OTN
Subject: This One-Time Notification is a Full Replacement for Transmittal 86 (CR 3142) Interface File from Recovery Management and Accounting System (ReMAS
MM Article #: N/A
MM Article Release Date: N/A

Change to Previous Transmittal Regarding the Discontinued Use of Revenue Code 0910

Mon, 14 Nov 2005 13:42:00 EST

Transmittal #: R98OTN
Subject: Change to Previous Transmittal Regarding the Discontinued Use of Revenue Code 0910
MM Article #: MM3343
MM Article Release Date: 08/03/2004

Annual Changes to the Amount in Controversy (AIC) Thresholds for the Administrative Law Judge (ALJ) and Judicial Review Levels of the Claim Appeals Process as Required by Section 940 of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003

Mon, 14 Nov 2005 13:43:00 EST

Transmittal #: R96OTN
Subject: Annual Changes to the Amount in Controversy (AIC) Thresholds for the Administrative Law Judge (ALJ) and Judicial Review Levels of the Claim Appeals Process as Required by Section 940 of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003
MM Article #: N/A
MM Article Release Date: N/A

Shared System Maintainer Hours for Resolution of Problems Detected During Health Insurance Portability and Accountability Act (HIPAA) Transaction Release Testing

Mon, 14 Nov 2005 13:44:00 EST

Transmittal #: R94OTN
Subject: Shared System Maintainer Hours for Resolution of Problems Detected During Health Insurance Portability and Accountability Act (HIPAA) Transaction Release Testing
MM Article #: N/A
MM Article Release Date: N/A

Implementation of the Business Segment Identifier (BSI) in the Healthcare Integrated General Ledger Accounting System (HIGLAS)

Mon, 14 Nov 2005 13:46:00 EST

Transmittal #: R97OTN
Subject: Implementation of the Business Segment Identifier (BSI) in the Healthcare Integrated General Ledger Accounting System (HIGLAS)
MM Article #: N/A
MM Article Release Date: N/A

Clarification of CR 3064

Mon, 05 Dec 2005 11:32:00 EST

Transmittal #: R17MSP
Subject: Clarification of CR 3064
MM Article #: MM3267
MM Article Release Date: 07/28/2004

Procedures For Re-Issuance and Stale Dating of Medicare Checks

Mon, 05 Dec 2005 11:36:00 EST

Transmittal #: R49FM
Subject: Procedures For Re-Issuance and Stale Dating of Medicare Checks
MM Article #: MM2951
MM Article Release Date: 07/21/2004

Provider Identification Numbers

Mon, 05 Dec 2005 11:39:00 EST

Transmittal #: R2SOM
Subject: Provider Identification Numbers
MM Article #: N/A
MM Article Release Date: N/A

Chapter 2

Mon, 05 Dec 2005 11:42:00 EST

Transmittal #: R59MCM
Subject: Chapter 2
MM Article #: N/A
MM Article Release Date: N/A

Hospital Outpatient Billing and Payment under OPPS for New, Unclassified Drugs or Biologicals Approved by the FDA After January 1, 2004, But Before Assignment of a Product-Specific Drug/Biological HCPCS Code

Mon, 05 Dec 2005 11:44:00 EST

Transmittal #: R188CP
Subject: Hospital Outpatient Billing and Payment under OPPS for New, Unclassified Drugs or Biologicals Approved by the FDA After January 1, 2004, But Before Assignment of a Product-Specific Drug/Biological HCPCS Code
MM Article #: MM3287
MM Article Release Date: 07/09/2004

Chapter 3

Mon, 05 Dec 2005 11:44:00 EST

Transmittal #: R60MCM
Subject: Chapter 3
MM Article #: N/A
MM Article Release Date: N/A

Modification of CMS's Medicare Contingency Plan for HIPAA Implementation

Mon, 05 Dec 2005 11:45:00 EST

Transmittal #: R273CP
Subject: Modification of CMS's Medicare Contingency Plan for HIPAA Implementation
MM Article #: N/A
MM Article Release Date: N/A

Update to the Claims Status Codes

Mon, 05 Dec 2005 11:47:00 EST

Transmittal #: R230CP
Subject: Update to the Claims Status Codes
MM Article #: MM3361
MM Article Release Date: 07/28/2004

Standardized Responses to Provider Inquiries Regarding the Negotiated Laboratory National Coverage Determinations (NCDs) Edit Software

Mon, 05 Dec 2005 11:48:00 EST

Transmittal #: R234CP
Subject: Standardized Responses to Provider Inquiries Regarding the Negotiated Laboratory National Coverage Determinations (NCDs) Edit Software
MM Article #: MM3374
MM Article Release Date: 08/05/2004

Billing Requirements for Hyperbaric Oxygen (HBO) Therapy for the Treatment of Diabetic Wounds of the Lower Extremities

Mon, 05 Dec 2005 11:48:00 EST

Transmittal #: R187CP
Subject: Billing Requirements for Hyperbaric Oxygen (HBO) Therapy for the Treatment of Diabetic Wounds of the Lower Extremities
MM Article #: MM3172
MM Article Release Date: 06/04/2004

Change to the Common Working File (CWF) Skilled Nursing Facility (SNF) Consolidated Billing (CB) Edits for Drugs and Electrocardiogram (EKG) Testing Provided During an Ambulance Transport

Mon, 05 Dec 2005 11:50:00 EST

Transmittal #: R185CP
Subject: Change to the Common Working File (CWF) Skilled Nursing Facility (SNF) Consolidated Billing (CB) Edits for Drugs and Electrocardiogram (EKG) Testing Provided During an Ambulance Transport
MM Article #: N/A
MM Article Release Date: N/A

2005 DMEPOS Pricing File Record Layout Expansion and New Pricing Procedures for Certain DMEPOS Items Based on Modifiers

Mon, 05 Dec 2005 11:50:00 EST

Transmittal #: R236CP
Subject: 2005 DMEPOS Pricing File Record Layout Expansion and New Pricing Procedures for Certain DMEPOS Items Based on Modifiers
MM Article #: MM3300
MM Article Release Date: 04/29/2005

Implementation of Patient Status Code 65, Discharged/Transferred to a Psychiatric Hospital or Psychiatric Distinct Part Unit of a Hospital

Mon, 05 Dec 2005 11:52:00 EST

Transmittal #: R237CP
Subject: Implementation of Patient Status Code 65, Discharged/Transferred to a Psychiatric Hospital or Psychiatric Distinct Part Unit of a Hospital
MM Article #: MM3364
MM Article Release Date: 08/23/2004

Expanded Identification and Workload Reporting for CMS Medicare Systems

Mon, 05 Dec 2005 11:53:00 EST

Transmittal #: R47FM
Subject: Expanded Identification and Workload Reporting for CMS Medicare Systems
MM Article #: N/A
MM Article Release Date: N/A

Implementation of Skilled Nursing Facility Consolidated Billing CWF Edit for Therapy Codes Considered Separately Payable Physician Services

Mon, 05 Dec 2005 11:54:00 EST

Transmittal #: R215CP
Subject: Implementation of Skilled Nursing Facility Consolidated Billing CWF Edit for Therapy Codes Considered Separately Payable Physician Services
MM Article #: N/A
MM Article Release Date: N/A

Health Insurance Portability and Accountability Act (HIPAA) X12N 837 Institutional Health Care Claim Implementation Guide (IG) Additional Updates

Mon, 05 Dec 2005 11:54:00 EST

Transmittal #: R238CP
Subject: Health Insurance Portability and Accountability Act (HIPAA) X12N 837 Institutional Health Care Claim Implementation Guide (IG) Additional Updates
MM Article #: MM3321
MM Article Release Date: 07/28/2004

Implementation of Section 414 of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003

Mon, 05 Dec 2005 11:55:00 EST

Transmittal #: R220CP
Subject: Implementation of Section 414 of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003
MM Article #: N/A
MM Article Release Date: N/A

Update to the Frequency of Billing

Mon, 05 Dec 2005 11:56:00 EST

Transmittal #: R239CP
Subject: Update to the Frequency of Billing
MM Article #: MM3382
MM Article Release Date: 08/16/2005

Payment to Bank

Mon, 05 Dec 2005 11:57:00 EST

Transmittal #: R213CP
Subject: Payment to Bank
MM Article #: MM3079
MM Article Release Date: 07/26/2004

Quarterly Update to Correct Coding Initiative (CCI) edits, Version 10.3, Effective October 1, 2004.

Mon, 05 Dec 2005 11:57:00 EST

Transmittal #: R242CP
Subject: Quarterly Update to Correct Coding Initiative (CCI) edits, Version 10.3, Effective October 1, 2004.
MM Article #: MM3349
MM Article Release Date: 09/08/2004

Cardiac Pacemaker

Mon, 05 Dec 2005 11:59:00 EST

Transmittal #: R16NCD
Subject: Cardiac Pacemaker
MM Article #: N/A
MM Article Release Date: N/A

Patient Status Code and Reason for Patient Visit for the Hospital Outpatient Prospective Payment System (OPPS)

Mon, 05 Dec 2005 12:00:00 EST

Transmittal #: R243CP
Subject: Patient Status Code and Reason for Patient Visit for the Hospital Outpatient Prospective Payment System (OPPS)
MM Article #: N/A
MM Article Release Date: N/A

Temporary SNF Extension

Mon, 05 Dec 2005 12:00:00 EST

Transmittal #: R93OTN
Subject: Temporary SNF Extension
MM Article #: N/A
MM Article Release Date: N/A

July Update to the Medicare Outpatient Code Editor (OCE) Version 19.2 For Bills From Hospitals That Are Not Paid Under The Outpatient Prospective Payment System

Mon, 05 Dec 2005 12:01:00 EST

Transmittal #: R186CP
Subject: July Update to the Medicare Outpatient Code Editor (OCE) Version 19.2 For Bills From Hospitals That Are Not Paid Under The Outpatient Prospective Payment System
MM Article #: MM3319
MM Article Release Date: 06/09/2004

Change to the Common Working File (CWF) Skilled Nursing Facility (SNF) Consolidated Billing (CB) Edits for Drugs and Electrocardiogram (EKG) Testing Provided During an Ambulance Transport

Mon, 05 Dec 2005 12:32:00 EST

Transmittal #: R184CP
Subject: Change to the Common Working File (CWF) Skilled Nursing Facility (SNF) Consolidated Billing (CB) Edits for Drugs and Electrocardiogram (EKG) Testing Provided During an Ambulance Transport
MM Article #: MM3314
MM Article Release Date: 06/09/2004

DMERC/Local Carriers/SADMERC - Drug Pricing Limits as of January 1, 2005

Mon, 05 Dec 2005 12:33:00 EST

Transmittal #: R248CP
Subject: DMERC/Local Carriers/SADMERC - Drug Pricing Limits as of January 1, 2005
MM Article #: MM3232
MM Article Release Date: 12/21/2004

Medicare IRF Classification Requirements

Mon, 05 Dec 2005 12:35:00 EST

Transmittal #: R221CP
Subject: Medicare IRF Classification Requirements
MM Article #: MM3334
MM Article Release Date: 07/26/2004

Number of Drug Pricing Files That Must Be Maintained Online for Medicare

Mon, 05 Dec 2005 12:36:00 EST

Transmittal #: R244CP
Subject: Number of Drug Pricing Files That Must Be Maintained Online for Medicare
MM Article #: N/A
MM Article Release Date: N/A

MSN Messages

Mon, 05 Dec 2005 12:36:00 EST

Transmittal #: R214CP
Subject: MSN Messages
MM Article #: MM2617
MM Article Release Date: 06/25/2004

Local Medical Review Policy/ Local Coverage Determination Medicare Summary Notice (MSN) Message Revision

Mon, 05 Dec 2005 12:37:00 EST

Transmittal #: R227CP
Subject: Local Medical Review Policy/ Local Coverage Determination Medicare Summary Notice (MSN) Message Revision
MM Article #: N/A
MM Article Release Date: N/A

New Medicare Summary Notice Message 31.18

Mon, 05 Dec 2005 12:38:00 EST

Transmittal #: R249CP
Subject: New Medicare Summary Notice Message 31.18
MM Article #: N/A
MM Article Release Date: N/A

Coordination of Benefits Agreement (COBA) Claims Selection Options

Mon, 05 Dec 2005 12:39:00 EST

Transmittal #: R250CP
Subject: Coordination of Benefits Agreement (COBA) Claims Selection Options
MM Article #: N/A
MM Article Release Date: N/A

October Quarterly Update to 2004 Annual Update of HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing Enforcement

Mon, 05 Dec 2005 12:40:00 EST

Transmittal #: R224CP
Subject: October Quarterly Update to 2004 Annual Update of HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing Enforcement
MM Article #: N/A
MM Article Release Date: N/A

Quarterly Update of HCPCS Codes Used for Home Health Consolidated Billing Enforcement

Mon, 05 Dec 2005 12:40:00 EST

Transmittal #: R226CP
Subject: Quarterly Update of HCPCS Codes Used for Home Health Consolidated Billing Enforcement
MM Article #: MM3350
MM Article Release Date: 08/16/2004

Paper Remittance Advice format change to accommodate the forced balancing amount to balance at the claim level as well as the provider level, a flat file change, and a change in the companion document for fiscal intermediaries (FIs).

Mon, 05 Dec 2005 12:41:00 EST

Transmittal #: R252CP
Subject: Paper Remittance Advice format change to accommodate the forced balancing amount to balance at the claim level as well as the provider level, a flat file change, and a change in the companion document for fiscal intermediaries (FIs).
MM Article #: MM3344
MM Article Release Date: 09/02/2004

Changes to the Laboratory National Coverage Determination (NCD)Edit Software for October 2004

Mon, 05 Dec 2005 12:42:00 EST

Transmittal #: R225CP
Subject: Changes to the Laboratory National Coverage Determination (NCD)Edit Software for October 2004
MM Article #: MM3358
MM Article Release Date: 07/14/2004

Editing Of Hospital And Skilled Nursing Facility Part B Inpatient Services

Mon, 05 Dec 2005 12:43:00 EST

Transmittal #: R251CP
Subject: Editing Of Hospital And Skilled Nursing Facility Part B Inpatient Services
MM Article #: N/A
MM Article Release Date: N/A

Fiscal Intermediary Shared System (FISS) Changes to Allow for Provider Liability Days on Skilled Nursing Facility (SNF) and Swing Bed Facility Inpatient Bills

Mon, 05 Dec 2005 12:44:00 EST

Transmittal #: R253CP
Subject: Fiscal Intermediary Shared System (FISS) Changes to Allow for Provider Liability Days on Skilled Nursing Facility (SNF) and Swing Bed Facility Inpatient Bills
MM Article #: N/A
MM Article Release Date: N/A

Additional Health Insurance Health Insurance Portability and Accountability Act (HIPAA) Coordination of Benefits (COB) Information for Trading Partners

Mon, 05 Dec 2005 12:46:00 EST

Transmittal #: R83OTN
Subject: Additional Health Insurance Health Insurance Portability and Accountability Act (HIPAA) Coordination of Benefits (COB) Information for Trading Partners
MM Article #: N/A
MM Article Release Date: N/A

Implementation of the Quarterly Strategy Analysis

Mon, 05 Dec 2005 12:47:00 EST

Transmittal #: R81PI
Subject: Implementation of the Quarterly Strategy Analysis
MM Article #: N/A
MM Article Release Date: N/A

Use of Group Health Plan Payment System to Pay Capitated Payments to Non Health Plan Demonstrations Serving Medicare Fee For Service Beneficiaries

Mon, 05 Dec 2005 12:47:00 EST

Transmittal #: R4DEMO
Subject: Use of Group Health Plan Payment System to Pay Capitated Payments to Non Health Plan Demonstrations Serving Medicare Fee For Service Beneficiaries
MM Article #: MM3283
MM Article Release Date: 05/21/2004

Home Health Demand Bills

Mon, 05 Dec 2005 12:49:00 EST

Transmittal #: R82PI
Subject: Home Health Demand Bills
MM Article #: N/A
MM Article Release Date: N/A

Removal of Coding from National Coverage Determination on Stem Cell Transplantation

Mon, 05 Dec 2005 12:50:00 EST

Transmittal #: R13NCD
Subject: Removal of Coding from National Coverage Determination on Stem Cell Transplantation
MM Article #: N/A
MM Article Release Date: N/A

Changes in the Medicare Benefit Policy Manual-Chapter 10

Mon, 05 Dec 2005 12:52:00 EST

Transmittal #: R14BP
Subject: Changes in the Medicare Benefit Policy Manual-Chapter 10
MM Article #: N/A
MM Article Release Date: N/A

Diabetes Self Management Training Services

Mon, 05 Dec 2005 12:54:00 EST

Transmittal #: R13BP
Subject: Diabetes Self Management Training Services
MM Article #: MM3185
MM Article Release Date: 06/04/2004

CMS policy for testing quarterly release of the Medicare shared systems and the CWF

Mon, 05 Dec 2005 12:56:00 EST

Transmittal #: R6GI
Subject: CMS policy for testing quarterly release of the Medicare shared systems and the CWF
MM Article #: N/A
MM Article Release Date: N/A

Chiropractic Billing

Mon, 05 Dec 2005 12:56:00 EST

Transmittal #: R12BP
Subject: Chiropractic Billing
MM Article #: N/A
MM Article Release Date: N/A

End Stage Renal Disease (ESRD) Reimbursement for Automated Multi-Channel Chemistry Test(s)

Mon, 05 Dec 2005 12:58:00 EST

Transmittal #: R198CP
Subject: End Stage Renal Disease (ESRD) Reimbursement for Automated Multi-Channel Chemistry Test(s)
MM Article #: MM2813
MM Article Release Date: 12/23/2004

Emergency Hospital Outpatient billing of Epotein Alfa (EPO) and Darbepoetin Alfa (Aranesp)

Mon, 05 Dec 2005 13:01:00 EST

Transmittal #: R197CP
Subject: Emergency Hospital Outpatient billing of Epotein Alfa (EPO) and Darbepoetin Alfa (Aranesp)
MM Article #: MM3184
MM Article Release Date: 06/10/2004

Payment Denial for Medicare Services Furnished to Alien Beneficiaries Who Are Not Lawfully Present in the U. S.

Mon, 05 Dec 2005 13:04:00 EST

Transmittal #: R196CP
Subject: Payment Denial for Medicare Services Furnished to Alien Beneficiaries Who Are Not Lawfully Present in the U. S.
MM Article #: N/A
MM Article Release Date: N/A

Clarification and Revision of Change Request (CR) 3084, Implementation of Section 508(f) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173)

Mon, 05 Dec 2005 13:05:00 EST

Transmittal #: R88OTN
Subject: Clarification and Revision of Change Request (CR) 3084, Implementation of Section 508(f) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173)
MM Article #: N/A
MM Article Release Date: N/A

July 2004 Update of the Hospital Outpatient Prospective Payment System (OPPS)

Mon, 05 Dec 2005 13:07:00 EST

Transmittal #: R195CP
Subject: July 2004 Update of the Hospital Outpatient Prospective Payment System (OPPS)
MM Article #: MM3324
MM Article Release Date: 06/30/2004

October 2004 Outpatient Prospective Payment System Code Editor (OPPS OCE) Specifications Version 5.3

Mon, 05 Dec 2005 13:07:00 EST

Transmittal #: R254CP
Subject: October 2004 Outpatient Prospective Payment System Code Editor (OPPS OCE) Specifications Version 5.3
MM Article #: MM3395
MM Article Release Date: 08/05/2004

Medical Review (MR) Progressive Corrective Action (PCA) for Part A

Mon, 05 Dec 2005 13:09:00 EST

Transmittal #: R78PI
Subject: Medical Review (MR) Progressive Corrective Action (PCA) for Part A
MM Article #: N/A
MM Article Release Date: N/A

October Update to the Medicare Outpatient Code Editor (OCE) Version 20.0 for Bills From Hospitals that are not Paid Under the Outpatient Prospective Payment System (OPPS)

Mon, 05 Dec 2005 13:09:00 EST

Transmittal #: R255CP
Subject: October Update to the Medicare Outpatient Code Editor (OCE) Version 20.0 for Bills From Hospitals that are not Paid Under the Outpatient Prospective Payment System (OPPS)
MM Article #: MM3396
MM Article Release Date: 08/05/2004

Use of Group Health Plan Payment System/MMCS to Pay Capitated Payments to Chronic Care Improvement Organizations Serving Medicare Fee-For-Service Beneficiaries under Section 721 of the MMA

Mon, 05 Dec 2005 13:10:00 EST

Transmittal #: R256CP
Subject: Use of Group Health Plan Payment System/MMCS to Pay Capitated Payments to Chronic Care Improvement Organizations Serving Medicare Fee-For-Service Beneficiaries under Section 721 of the MMA
MM Article #: MM3410
MM Article Release Date: 09/01/2004

Medicare HIPAA Electronic Claims Compliance Report

Mon, 05 Dec 2005 13:10:00 EST

Transmittal #: R204CP
Subject: Medicare HIPAA Electronic Claims Compliance Report
MM Article #: N/A
MM Article Release Date: N/A

New Waived Tests - October 1, 2004

Mon, 05 Dec 2005 13:11:00 EST

Transmittal #: R258CP
Subject: New Waived Tests - October 1, 2004
MM Article #: N/A
MM Article Release Date: N/A

Shared Systems Changes for Medicare Part B Drugs for ESRD Independent Dialysis Facilities

Mon, 05 Dec 2005 13:12:00 EST

Transmittal #: R257CP
Subject: Shared Systems Changes for Medicare Part B Drugs for ESRD Independent Dialysis Facilities
MM Article #: MM3332
MM Article Release Date: 08/03/2004

Scheduled Release for October Updates to Software Programs and Pricing/Coding Files

Mon, 05 Dec 2005 13:14:00 EST

Transmittal #: R259CP
Subject: Scheduled Release for October Updates to Software Programs and Pricing/Coding Files
MM Article #: N/A
MM Article Release Date: N/A

Cryosurgery of the Prostate

Mon, 05 Dec 2005 13:16:00 EST

Transmittal #: R260CP
Subject: Cryosurgery of the Prostate
MM Article #: MM3168
MM Article Release Date: 08/03/2004

Billing and Requirements for Islet Cell Transplantation for Beneficiaries in a National Institutes of Health (NIH) Clinical Trial

Mon, 05 Dec 2005 13:18:00 EST

Transmittal #: R261CP
Subject: Billing and Requirements for Islet Cell Transplantation for Beneficiaries in a National Institutes of Health (NIH) Clinical Trial
MM Article #: MM3385
MM Article Release Date: 08/13/2004

Inpatient Rehabilitation Facility (IRF) Annual Update: Prospective Payment System (PPS) Pricer Changes for FY 2005

Mon, 05 Dec 2005 13:19:00 EST

Transmittal #: R263CP
Subject: Inpatient Rehabilitation Facility (IRF) Annual Update: Prospective Payment System (PPS) Pricer Changes for FY 2005
MM Article #: N/A
MM Article Release Date: N/A

Medicare Program-Update to the Hospice Payment Rates, Hospice Cap, Hospice Wage Index and the Hospice Pricer for FY 2005

Mon, 05 Dec 2005 13:20:00 EST

Transmittal #: R264CP
Subject: Medicare Program-Update to the Hospice Payment Rates, Hospice Cap, Hospice Wage Index and the Hospice Pricer for FY 2005
MM Article #: N/A
MM Article Release Date: N/A

Billing Payment in a Health Professional Shortage Area

Mon, 05 Dec 2005 13:20:00 EST

Transmittal #: R203CP
Subject: Billing Payment in a Health Professional Shortage Area
MM Article #: MM3336
MM Article Release Date: 06/28/2004

Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Pricer Update FY 2005

Mon, 05 Dec 2005 13:21:00 EST

Transmittal #: R268CP
Subject: Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Pricer Update FY 2005
MM Article #: N/A
MM Article Release Date: N/A

Revision of Common Working File (CWF) Editing for Same-Day, Same- Provider Acute Care Readmissions

Mon, 05 Dec 2005 13:22:00 EST

Transmittal #: R266CP
Subject: Revision of Common Working File (CWF) Editing for Same-Day, Same- Provider Acute Care Readmissions
MM Article #: MM3389
MM Article Release Date: 10/20/2004

Revised Updated SNF NO PAY File for July 2004

Mon, 05 Dec 2005 13:23:00 EST

Transmittal #: R202CP
Subject: Revised Updated SNF NO PAY File for July 2004
MM Article #: MM3338
MM Article Release Date: 06/21/2004

Unsolicited/Voluntary Refunds

Mon, 05 Dec 2005 13:24:00 EST

Transmittal #: R50FM
Subject: Unsolicited/Voluntary Refunds
MM Article #: MM3274
MM Article Release Date: 12/10/2004

IOM Manualization of Indian Health Services

Mon, 05 Dec 2005 13:24:00 EST

Transmittal #: R201CP
Subject: IOM Manualization of Indian Health Services
MM Article #: N/A
MM Article Release Date: N/A

Modification to Post-payment Adjustment Process for Home Health Prospective Payment System Claims Failing to Report Prior Inpatient Discharges

Mon, 05 Dec 2005 13:25:00 EST

Transmittal #: R95OTN
Subject: Modification to Post-payment Adjustment Process for Home Health Prospective Payment System Claims Failing to Report Prior Inpatient Discharges
MM Article #: MM3400
MM Article Release Date: 08/05/2004

Update to the Common Working File Edits for Skilled Nursing Facility (SNF) Consolidated Billing (CB) to Expand the Bypass for Pharmacy Services.

Mon, 05 Dec 2005 13:26:00 EST

Transmittal #: R200CP
Subject: Update to the Common Working File Edits for Skilled Nursing Facility (SNF) Consolidated Billing (CB) to Expand the Bypass for Pharmacy Services.
MM Article #: MM3277
MM Article Release Date: 07/21/2004

Medicare Need for a Specific Line Item Date of Service (LIDOS) for Each Revenue Code on ALL Outpatient and Inpatient Part B Claims

Mon, 05 Dec 2005 13:27:00 EST

Transmittal #: R199CP
Subject: Medicare Need for a Specific Line Item Date of Service (LIDOS) for Each Revenue Code on ALL Outpatient and Inpatient Part B Claims
MM Article #: MM3337
MM Article Release Date: 06/18/2004

Change of the Premera Blue Cross Medicare Part A Plan Under Contract to BCBSA to a Part A Fiscal Intermediary Contract with Noridian Mutual Insurance Company in the States of Washington and Alaska

Mon, 05 Dec 2005 13:28:00 EST

Transmittal #: R101OTN
Subject: Change of the Premera Blue Cross Medicare Part A Plan Under Contract to BCBSA to a Part A Fiscal Intermediary Contract with Noridian Mutual Insurance Company in the States of Washington and Alaska
MM Article #: N/A
MM Article Release Date: N/A

Arthroscopic Lavage and Arthroscopic Debridement for the Osteoarthritic Knee

Mon, 05 Dec 2005 13:30:00 EST

Transmittal #: R14NCD
Subject: Arthroscopic Lavage and Arthroscopic Debridement for the Osteoarthritic Knee
MM Article #: MM3281
MM Article Release Date: 06/28/2004

Nurse Practitioners As Attending Physicians in the Medicare Hospice Benefit

Mon, 05 Dec 2005 13:31:00 EST

Transmittal #: R205CP
Subject: Nurse Practitioners As Attending Physicians in the Medicare Hospice Benefit
MM Article #: N/A
MM Article Release Date: N/A

Nurse Practitioners As Attending Physicians in the Medicare Hospice Benefit

Mon, 05 Dec 2005 13:35:00 EST

Transmittal #: R15BP
Subject: Nurse Practitioners As Attending Physicians in the Medicare Hospice Benefit
MM Article #: N/A
MM Article Release Date: N/A

Installation of Version 33.0 of the Provider Statistical and Reimbursement (PS&R) Reporting System-Modification of CR 3131

Mon, 05 Dec 2005 13:37:00 EST

Transmittal #: R46FM
Subject: Installation of Version 33.0 of the Provider Statistical and Reimbursement (PS&R) Reporting System-Modification of CR 3131
MM Article #: N/A
MM Article Release Date: N/A

Chapter 36, Hospital and Hospital Healthcare Complex Cost Report, Form CMS 2552-96

Mon, 05 Dec 2005 13:40:00 EST

Transmittal #: R12P236
Subject: Chapter 36, Hospital and Hospital Healthcare Complex Cost Report, Form CMS 2552-96
MM Article #: N/A
MM Article Release Date: N/A

Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)

Mon, 05 Dec 2005 13:43:00 EST

Transmittal #: R210CP
Subject: Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)
MM Article #: MM3303
MM Article Release Date: 06/24/2004

Correction to CR 2944, Transmittal 90, Issued on February 6, 2004

Mon, 05 Dec 2005 13:46:00 EST

Transmittal #: R209CP
Subject: Correction to CR 2944, Transmittal 90, Issued on February 6, 2004
MM Article #: MM3333
MM Article Release Date: 06/24/2004

Long Term Care Hospital Prospective Payment System (LTCH PPS) Fiscal Year 2005-Update

Mon, 05 Dec 2005 13:48:00 EST

Transmittal #: R208CP
Subject: Long Term Care Hospital Prospective Payment System (LTCH PPS) Fiscal Year 2005-Update
MM Article #: MM3335
MM Article Release Date: 07/15/2004

Expansion of Policy Where Patient is a Member of a Medicare Advantage (MA) Organization For Only a Portion of the Billing Period to Include Inpatient Rehabilitation Facilities (IRF) and Long Term Care Hospitals (LTCH)

Mon, 05 Dec 2005 13:50:00 EST

Transmittal #: R207CP
Subject: Expansion of Policy Where Patient is a Member of a Medicare Advantage (MA) Organization For Only a Portion of the Billing Period to Include Inpatient Rehabilitation Facilities (IRF) and Long Term Care Hospitals (LTCH)
MM Article #: MM3309
MM Article Release Date: 06/24/2004

NCD: Sensory Nerve Conduction Threshold Test (sNCTs) (NOTE THAT Change Request (CR) 3339 CONSTITUTES A TECHNICAL CORRECTION TO PREVIOUSLY ISSUED CR 2988 dated 03/19/04. CR 2988 ORIGINALLY COMMUNICATED ON MARCH 19, 2004 VIA RO-2541, SHOULD BE DISCARDED AND REPLACED WITH CR 3339.

Mon, 05 Dec 2005 13:52:00 EST

Transmittal #: R15NCD
Subject: NCD: Sensory Nerve Conduction Threshold Test (sNCTs) (NOTE THAT Change Request (CR) 3339 CONSTITUTES A TECHNICAL CORRECTION TO PREVIOUSLY ISSUED CR 2988 dated 03/19/04. CR 2988 ORIGINALLY COMMUNICATED ON MARCH 19, 2004 VIA RO-2541, SHOULD BE DISCARDED AND REPLACED WITH CR 3339.
MM Article #: MM3339
MM Article Release Date: 06/24/2004

MMA Drug Pricing Update-Payment Limits for J7308 (Levulan Kerastick) and J9395 (Faslodex)

Mon, 05 Dec 2005 13:54:00 EST

Transmittal #: R90OTN
Subject: MMA Drug Pricing Update-Payment Limits for J7308 (Levulan Kerastick) and J9395 (Faslodex)
MM Article #: MM3312
MM Article Release Date: 07/07/2004

Chapter 4, Benefits and Beneficiary Protection

Mon, 05 Dec 2005 13:55:00 EST

Transmittal #: R49MCM
Subject: Chapter 4, Benefits and Beneficiary Protection
MM Article #: N/A
MM Article Release Date: N/A

Incident-To Services on Form CMS-1500

Mon, 05 Dec 2005 13:56:00 EST

Transmittal #: R17BP
Subject: Incident-To Services on Form CMS-1500
MM Article #: N/A
MM Article Release Date: N/A

Medicare Systems Acceptance of New Provider Numbers for Federally Qualified Health Centers (FQHC)

Mon, 05 Dec 2005 13:57:00 EST

Transmittal #: R3SOM
Subject: Medicare Systems Acceptance of New Provider Numbers for Federally Qualified Health Centers (FQHC)
MM Article #: N/A
MM Article Release Date: N/A

Shared System Maintainer Hours for Resolution of Problems Detected As A Result of Implementation of CR 2525 and CR 2527

Mon, 05 Dec 2005 13:57:00 EST

Transmittal #: R89OTN
Subject: Shared System Maintainer Hours for Resolution of Problems Detected As A Result of Implementation of CR 2525 and CR 2527
MM Article #: N/A
MM Article Release Date: N/A

Informing Beneficiaries About Which Local Medical Review Policy (LMRP) and/or Local Coverage Determination (LCD) and/or National Coverage Determination (NCD) is Associated with Their Claim Denial

Mon, 05 Dec 2005 13:59:00 EST

Transmittal #: R75PI
Subject: Informing Beneficiaries About Which Local Medical Review Policy (LMRP) and/or Local Coverage Determination (LCD) and/or National Coverage Determination (NCD) is Associated with Their Claim Denial
MM Article #: N/A
MM Article Release Date: N/A

Distinct Part Units for Critical Access Hospitals

Mon, 05 Dec 2005 14:01:00 EST

Transmittal #: R144CP
Subject: Distinct Part Units for Critical Access Hospitals
MM Article #: MM3175
MM Article Release Date: 04/30/2004

Hospital Partial Hospitalization Services Billing Requirements

Mon, 05 Dec 2005 14:02:00 EST

Transmittal #: R180CP
Subject: Hospital Partial Hospitalization Services Billing Requirements
MM Article #: N/A
MM Article Release Date: N/A

Data Element Requirements Matrix - Carrier

Mon, 05 Dec 2005 14:04:00 EST

Transmittal #: R145CP
Subject: Data Element Requirements Matrix - Carrier
MM Article #: N/A
MM Article Release Date: N/A

Evaluation and Management Service Codes

Mon, 05 Dec 2005 14:08:00 EST

Transmittal #: R178CP
Subject: Evaluation and Management Service Codes
MM Article #: N/A
MM Article Release Date: N/A

Payment for Chemotherapy Administration Services, Nonchemotherapy Drug Infusion Services, and Drug Injection Services

Mon, 05 Dec 2005 14:08:00 EST

Transmittal #: R147CP
Subject: Payment for Chemotherapy Administration Services, Nonchemotherapy Drug Infusion Services, and Drug Injection Services
MM Article #: MM3192
MM Article Release Date: 05/06/2004

Instructions for Downloading the Medicare Zip Code File

Mon, 05 Dec 2005 14:11:00 EST

Transmittal #: R176CP
Subject: Instructions for Downloading the Medicare Zip Code File
MM Article #: N/A
MM Article Release Date: N/A

General Instructions for Completion of Form CMS-1450 for Billing

Mon, 05 Dec 2005 14:11:00 EST

Transmittal #: R149CP
Subject: General Instructions for Completion of Form CMS-1450 for Billing
MM Article #: MM3183
MM Article Release Date: 04/30/2004

Updated SNF NO PAY File for July 2004

Mon, 05 Dec 2005 14:13:00 EST

Transmittal #: R177CP
Subject: Updated SNF NO PAY File for July 2004
MM Article #: N/A
MM Article Release Date: N/A

Updated SNF NO PAY File for July 2004

Mon, 05 Dec 2005 14:15:00 EST

Transmittal #: R182CP
Subject: Updated SNF NO PAY File for July 2004
MM Article #: N/A
MM Article Release Date: N/A

Revised American National Standards Institute X12N 837 Professional Health Care Claim Companion Document

Mon, 05 Dec 2005 14:16:00 EST

Transmittal #: R73OTN
Subject: Revised American National Standards Institute X12N 837 Professional Health Care Claim Companion Document
MM Article #: MM3177
MM Article Release Date: 05/12/2004

Retirement of Manual

Mon, 05 Dec 2005 14:18:00 EST

Transmittal #: R16HMO
Subject: Retirement of Manual
MM Article #: N/A
MM Article Release Date: N/A

Emergency Correction Regarding Correction to Healthcare Common Procedure Coding System (HCPCS) Codes for Low Osmolar Contrast Material

Mon, 05 Dec 2005 14:18:00 EST

Transmittal #: R74OTN
Subject: Emergency Correction Regarding Correction to Healthcare Common Procedure Coding System (HCPCS) Codes for Low Osmolar Contrast Material
MM Article #: MM3187
MM Article Release Date: 05/01/2004

Chapter 10, Organization Compliance With State Law and Pre-emption by Federal Law

Mon, 05 Dec 2005 14:19:00 EST

Transmittal #: R55MCM
Subject: Chapter 10, Organization Compliance With State Law and Pre-emption by Federal Law
MM Article #: N/A
MM Article Release Date: N/A

One time instructions for audit intermediary cost reporting processes to accommodate claims processing error that prevented some supply charges from being reported on home health prospective payment system claims

Mon, 05 Dec 2005 14:20:00 EST

Transmittal #: R75OTN
Subject: One time instructions for audit intermediary cost reporting processes to accommodate claims processing error that prevented some supply charges from being reported on home health prospective payment system claims
MM Article #: N/A
MM Article Release Date: N/A

Updated SNF NO PAY File for April 2004

Mon, 05 Dec 2005 14:23:00 EST

Transmittal #: R143CP
Subject: Updated SNF NO PAY File for April 2004
MM Article #: N/A
MM Article Release Date: N/A

Chapter 19, Managed Care and M+C Systems Requirements

Mon, 05 Dec 2005 14:23:00 EST

Transmittal #: R54MCM
Subject: Chapter 19, Managed Care and M+C Systems Requirements
MM Article #: N/A
MM Article Release Date: N/A

Informing Beneficiaries About Which Local Medical Review Policy (LMRP) and/or Local Coverage Determination (LCD) and/or National Coverage Determination (NCD) is Associated with Their Claim Denial

Mon, 05 Dec 2005 14:25:00 EST

Transmittal #: R87PI
Subject: Informing Beneficiaries About Which Local Medical Review Policy (LMRP) and/or Local Coverage Determination (LCD) and/or National Coverage Determination (NCD) is Associated with Their Claim Denial
MM Article #: N/A
MM Article Release Date: N/A

Chapter 11, Contracts With Medicare+Choice Organizations

Mon, 05 Dec 2005 14:25:00 EST

Transmittal #: R53MCM
Subject: Chapter 11, Contracts With Medicare+Choice Organizations
MM Article #: N/A
MM Article Release Date: N/A

Provider/Supplier Communications - Revisions and Additions to Existing Contractor Requirements

Mon, 05 Dec 2005 14:27:00 EST

Transmittal #: R6COM
Subject: Provider/Supplier Communications - Revisions and Additions to Existing Contractor Requirements
MM Article #: N/A
MM Article Release Date: N/A

Hospital Concerns Regarding Changing of Patient Status Code Due to Common Working File Edit 7272

Mon, 05 Dec 2005 14:28:00 EST

Transmittal #: R140CP
Subject: Hospital Concerns Regarding Changing of Patient Status Code Due to Common Working File Edit 7272
MM Article #: MM3240
MM Article Release Date: 04/28/2004

Skilled Nursing Facility (SNF) Consolidated Billing: Services Furnished Under an "Arrangement" With an Outside Entity

Mon, 05 Dec 2005 14:29:00 EST

Transmittal #: R183CP
Subject: Skilled Nursing Facility (SNF) Consolidated Billing: Services Furnished Under an "Arrangement" With an Outside Entity
MM Article #: MM3248
MM Article Release Date: 04/01/2004

Release of Basic Manual

Mon, 05 Dec 2005 14:29:00 EST

Transmittal #: R1SOM
Subject: Release of Basic Manual
MM Article #: N/A
MM Article Release Date: N/A

Installation of Version 34.0 of the Provider Statistical and Reimbursement (PS&R) Reporting System

Mon, 05 Dec 2005 14:30:00 EST

Transmittal #: R39FM
Subject: Installation of Version 34.0 of the Provider Statistical and Reimbursement (PS&R) Reporting System
MM Article #: N/A
MM Article Release Date: N/A

Automated Prepayment

Mon, 05 Dec 2005 14:31:00 EST

Transmittal #: R72PI
Subject: Automated Prepayment
MM Article #: N/A
MM Article Release Date: N/A

Chapter 2, End Stage Renal Disease

Mon, 05 Dec 2005 14:33:00 EST

Transmittal #: R51MCM
Subject: Chapter 2, End Stage Renal Disease
MM Article #: N/A
MM Article Release Date: N/A

Rescission of Transmittal 16

Mon, 05 Dec 2005 14:33:00 EST

Transmittal #: R17HMO
Subject: Rescission of Transmittal 16
MM Article #: N/A
MM Article Release Date: N/A

Update to the Healthcare Provider taxonomy Codes (HPTC) Version 4.0

Mon, 05 Dec 2005 14:34:00 EST

Transmittal #: R71OTN
Subject: Update to the Healthcare Provider taxonomy Codes (HPTC) Version 4.0
MM Article #: MM3188
MM Article Release Date: 04/28/2004

Instructions Related to "Redistribution of Unused Resident Positions," Section 422 of the Medicare Modernization Act of 2003 (MMA), P.L. 108-173, for Purposes of Graduate Medical Education (GME) Payments

Mon, 05 Dec 2005 14:35:00 EST

Transmittal #: R87OTN
Subject: Instructions Related to "Redistribution of Unused Resident Positions," Section 422 of the Medicare Modernization Act of 2003 (MMA), P.L. 108-173, for Purposes of Graduate Medical Education (GME) Payments
MM Article #: N/A
MM Article Release Date: N/A

Changes in Determining Rural Status of Hospitals for Transitional Outpatient Payments (TOPs) for 2004

Mon, 05 Dec 2005 14:36:00 EST

Transmittal #: R72OTN
Subject: Changes in Determining Rural Status of Hospitals for Transitional Outpatient Payments (TOPs) for 2004
MM Article #: MM3214
MM Article Release Date: 05/06/2004

Interface File from Recovery Management and Accounting System (ReMAS)

Mon, 05 Dec 2005 14:36:00 EST

Transmittal #: R86OTN
Subject: Interface File from Recovery Management and Accounting System (ReMAS)
MM Article #: N/A
MM Article Release Date: N/A

Addition of Two "WW" Codes to Identify Xeloda (Capecitabine)

Mon, 05 Dec 2005 14:39:00 EST

Transmittal #: R136CP
Subject: Addition of Two "WW" Codes to Identify Xeloda (Capecitabine)
MM Article #: N/A
MM Article Release Date: N/A

CD-ROM Initiative for Distribution of the Annual Disclosure, Dear Doctor Letter and Participation Enrollment Material

Mon, 05 Dec 2005 14:39:00 EST

Transmittal #: R85OTN
Subject: CD-ROM Initiative for Distribution of the Annual Disclosure, Dear Doctor Letter and Participation Enrollment Material
MM Article #: N/A
MM Article Release Date: N/A

Instructions for Carriers, DMERCs, FIs, and full PSCs when interacting with the Comprehensive Error Rate Testing (CERT) Contractor (i.e., handling appeals of CERT-initiated denials, contacting non-responders, tracking over/underpayments

Mon, 05 Dec 2005 14:41:00 EST

Transmittal #: R77PI
Subject: Instructions for Carriers, DMERCs, FIs, and full PSCs when interacting with the Comprehensive Error Rate Testing (CERT) Contractor (i.e., handling appeals of CERT-initiated denials, contacting non-responders, tracking over/underpayments
MM Article #: N/A
MM Article Release Date: N/A

Manualization of Section 4118 of the Medicare Carriers Manual, Part 3

Mon, 05 Dec 2005 14:41:00 EST

Transmittal #: R137CP
Subject: Manualization of Section 4118 of the Medicare Carriers Manual, Part 3
MM Article #: MM3134
MM Article Release Date: 04/29/2004

Addition of Instructions for Form CMS-2591 to Chapter 6

Mon, 05 Dec 2005 14:42:00 EST

Transmittal #: R45FM
Subject: Addition of Instructions for Form CMS-2591 to Chapter 6
MM Article #: N/A
MM Article Release Date: N/A

Clarification of Complex Medical Review

Mon, 05 Dec 2005 14:43:00 EST

Transmittal #: R76PI
Subject: Clarification of Complex Medical Review
MM Article #: N/A
MM Article Release Date: N/A

The Consolidation of the Claims Crossover Process: Smaller-Scale Initial Implementation

Mon, 05 Dec 2005 14:43:00 EST

Transmittal #: R138CP
Subject: The Consolidation of the Claims Crossover Process: Smaller-Scale Initial Implementation
MM Article #: MM3218
MM Article Release Date: 04/20/2004

Skilled Nursing Facility Consolidated Billing L Codes - DMERCs and Fis

Mon, 05 Dec 2005 14:45:00 EST

Transmittal #: R191CP
Subject: Skilled Nursing Facility Consolidated Billing L Codes - DMERCs and Fis
MM Article #: MM3295
MM Article Release Date: 06/04/2004

Chapter 1, Budget Preparation

Mon, 05 Dec 2005 14:45:00 EST

Transmittal #: R38FM
Subject: Chapter 1, Budget Preparation
MM Article #: N/A
MM Article Release Date: N/A

Shared System Maintainer Hours for Resolution of Problems Detected During Health Insurance Portability and Accountability Act (HIPAA) Transaction Release Testing

Mon, 05 Dec 2005 14:46:00 EST

Transmittal #: R76OTN
Subject: Shared System Maintainer Hours for Resolution of Problems Detected During Health Insurance Portability and Accountability Act (HIPAA) Transaction Release Testing
MM Article #: N/A
MM Article Release Date: N/A

Healthcare Common Procedure Coding System (HCPCS) Correction

Mon, 05 Dec 2005 14:47:00 EST

Transmittal #: R192CP
Subject: Healthcare Common Procedure Coding System (HCPCS) Correction
MM Article #: N/A
MM Article Release Date: N/A

Virginia Cardiac Surgery Initiative Demonstration - Modifications & Corrections to Change Request 2382

Mon, 05 Dec 2005 14:48:00 EST

Transmittal #: R2DEMO
Subject: Virginia Cardiac Surgery Initiative Demonstration - Modifications & Corrections to Change Request 2382
MM Article #: N/A
MM Article Release Date: N/A

Instructions Related to "Redistribution of Unused Resident Positions," Section 422 of the Medicare Modernization Act of 2003 (MMA), P.L. 108-173, for Purposes of Graduate Medical Education (GME) Payments

Mon, 05 Dec 2005 14:50:00 EST

Transmittal #: R77OTN
Subject: Instructions Related to "Redistribution of Unused Resident Positions," Section 422 of the Medicare Modernization Act of 2003 (MMA), P.L. 108-173, for Purposes of Graduate Medical Education (GME) Payments
MM Article #: N/A
MM Article Release Date: N/A

End Stage Renal Disease (ESRD) Reimbursement for Automated Multi-Channel Chemistry (AMCC) Tests

Mon, 05 Dec 2005 14:51:00 EST

Transmittal #: R190CP
Subject: End Stage Renal Disease (ESRD) Reimbursement for Automated Multi-Channel Chemistry (AMCC) Tests
MM Article #: MM3239
MM Article Release Date: 11/26/2004

Renovate Override Code Processing In Common Working File

Mon, 05 Dec 2005 14:51:00 EST

Transmittal #: R78OTN
Subject: Renovate Override Code Processing In Common Working File
MM Article #: N/A
MM Article Release Date: N/A

Unsolicited/Voluntary Refunds

Mon, 05 Dec 2005 14:53:00 EST

Transmittal #: R42FM
Subject: Unsolicited/Voluntary Refunds
MM Article #: N/A
MM Article Release Date: N/A

Expanded Identification and Workload Reporting for CMS Medicare Systems

Mon, 05 Dec 2005 14:56:00 EST

Transmittal #: R43FM
Subject: Expanded Identification and Workload Reporting for CMS Medicare Systems
MM Article #: N/A
MM Article Release Date: N/A

Requirement for Carriers, Durable Medical Equipment Regional Carriers (DMERCs), Fiscal Intermediaries (FIs), and Full Program Safeguard Contractors (PSCs) to Encourage Providers to Submit Medical Records to the Comprehensive Error Rate Testing (CERT) Contractor for Use in the November 2004 Improper Medicare Fee-For-Service (FFS) Payments Report

Mon, 05 Dec 2005 14:58:00 EST

Transmittal #: R81OTN
Subject: Requirement for Carriers, Durable Medical Equipment Regional Carriers (DMERCs), Fiscal Intermediaries (FIs), and Full Program Safeguard Contractors (PSCs) to Encourage Providers to Submit Medical Records to the Comprehensive Error Rate Testing (CERT) Contractor for Use in the November 2004 Improper Medicare Fee-For-Service (FFS) Payments Report
MM Article #: N/A
MM Article Release Date: N/A

Informing Beneficiaries about whicl local Medical Review Policy (LMRP) and /or Local Coverage Determinatin (LCD) and o/or National Coverage Determination (NCD) is associated with their claim denia

Mon, 05 Dec 2005 14:58:00 EST

Transmittal #: R161CP
Subject: Informing Beneficiaries about whicl local Medical Review Policy (LMRP) and /or Local Coverage Determinatin (LCD) and o/or National Coverage Determination (NCD) is associated with their claim denia
MM Article #: N/A
MM Article Release Date: N/A

Chapter 7 - Contract Administrative Requirements

Mon, 05 Dec 2005 15:03:00 EST

Transmittal #: R5GI
Subject: Chapter 7 - Contract Administrative Requirements
MM Article #: N/A
MM Article Release Date: N/A

Changes in Determining Rural Status of Hospitals for Transitional Outpatient Payments (TOPs) for 2004

Mon, 05 Dec 2005 15:04:00 EST

Transmittal #: R82OTN
Subject: Changes in Determining Rural Status of Hospitals for Transitional Outpatient Payments (TOPs) for 2004
MM Article #: N/A
MM Article Release Date: N/A

Chapter 6, Hospital Services Covered Under Part B

Mon, 05 Dec 2005 15:07:00 EST

Transmittal #: R10BP
Subject: Chapter 6, Hospital Services Covered Under Part B
MM Article #: N/A
MM Article Release Date: N/A

Change to the Common Working File (CWF) Skilled Nursing Facility (SNF) Consolidated Billing (CB) Edits for Ambulance Transports to or from a Diagnostic or Therapeutic Site Other than a Physician's Office or Hospital

Mon, 05 Dec 2005 15:07:00 EST

Transmittal #: R163CP
Subject: Change to the Common Working File (CWF) Skilled Nursing Facility (SNF) Consolidated Billing (CB) Edits for Ambulance Transports to or from a Diagnostic or Therapeutic Site Other than a Physician's Office or Hospital
MM Article #: MM3196
MM Article Release Date: 06/06/2004

Chapter 1, General Billing Requirements

Mon, 05 Dec 2005 15:08:00 EST

Transmittal #: R169CP
Subject: Chapter 1, General Billing Requirements
MM Article #: SE0429
MM Article Release Date: 07/09/2004

Key Shop and Optical Character Recognition (OCR)/Image Character Recognition (ICR) Output Mapping

Mon, 05 Dec 2005 15:09:00 EST

Transmittal #: R162CP
Subject: Key Shop and Optical Character Recognition (OCR)/Image Character Recognition (ICR) Output Mapping
MM Article #: N/A
MM Article Release Date: N/A

Chapter 12, Physician/Practitioner Billing

Mon, 05 Dec 2005 15:10:00 EST

Transmittal #: R168CP
Subject: Chapter 12, Physician/Practitioner Billing
MM Article #: N/A
MM Article Release Date: N/A

End Stage Renal Disease (ESRD) Reimbursement for Automated Multi-Channel Chemistry Test(s)

Mon, 05 Dec 2005 15:10:00 EST

Transmittal #: R164CP
Subject: End Stage Renal Disease (ESRD) Reimbursement for Automated Multi-Channel Chemistry Test(s)
MM Article #: N/A
MM Article Release Date: N/A

Healthcare Common Procedure Coding System (HCPCS) Corrections Involving 0040T and A9603

Mon, 05 Dec 2005 15:12:00 EST

Transmittal #: R174CP
Subject: Healthcare Common Procedure Coding System (HCPCS) Corrections Involving 0040T and A9603
MM Article #: N/A
MM Article Release Date: N/A

Program Integrity Management Reporting System (PIMR) Section 7.2 of the Program Integrity Manual (PIM)

Mon, 05 Dec 2005 15:13:00 EST

Transmittal #: R73PI
Subject: Program Integrity Management Reporting System (PIMR) Section 7.2 of the Program Integrity Manual (PIM)
MM Article #: N/A
MM Article Release Date: N/A

2nd Update to the 2004 Medicare Physician Fee Schedule Database

Mon, 05 Dec 2005 15:15:00 EST

Transmittal #: R173CP
Subject: 2nd Update to the 2004 Medicare Physician Fee Schedule Database
MM Article #: MM3286
MM Article Release Date: 05/20/2004

Change in Interest Calculation for Medicare Overpayments and Underpayments and Medicare Secondary Payer (MSP) Recoveries

Mon, 05 Dec 2005 15:16:00 EST

Transmittal #: R41FM
Subject: Change in Interest Calculation for Medicare Overpayments and Underpayments and Medicare Secondary Payer (MSP) Recoveries
MM Article #: N/A
MM Article Release Date: N/A

New Waived Tests - July 1, 2004

Mon, 05 Dec 2005 15:16:00 EST

Transmittal #: R172CP
Subject: New Waived Tests - July 1, 2004
MM Article #: N/A
MM Article Release Date: N/A

July Quarterly Update for 2004 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule

Mon, 05 Dec 2005 15:17:00 EST

Transmittal #: R171CP
Subject: July Quarterly Update for 2004 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule
MM Article #: MM3253
MM Article Release Date: 05/12/2004

Chapter 1, General Billing Requirements

Mon, 05 Dec 2005 15:19:00 EST

Transmittal #: R170CP
Subject: Chapter 1, General Billing Requirements
MM Article #: N/A
MM Article Release Date: N/A

Demonstration Project to Clarify the Definition of Homebound - Section 702 of MMA

Mon, 05 Dec 2005 15:20:00 EST

Transmittal #: R3DEMO
Subject: Demonstration Project to Clarify the Definition of Homebound - Section 702 of MMA
MM Article #: MM3269
MM Article Release Date: 07/23/2004

Announcement of Medicare Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Payment Rate Increases - Skilled Nursing Facility (SNF) Consolidated Billing (CB) as it Applies to RHC and FQHC Service

Mon, 05 Dec 2005 15:20:00 EST

Transmittal #: R390CP
Subject: Announcement of Medicare Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Payment Rate Increases - Skilled Nursing Facility (SNF) Consolidated Billing (CB) as it Applies to RHC and FQHC Service
MM Article #: MM3575
MM Article Release Date: 12/17/2004

Chapter 17, Subchapter A, TEFRA Cost-Based Payment Process and Principles

Mon, 05 Dec 2005 15:22:00 EST

Transmittal #: R52MCM
Subject: Chapter 17, Subchapter A, TEFRA Cost-Based Payment Process and Principles
MM Article #: N/A
MM Article Release Date: N/A

The Supplemental Security Income (SSI) Medicare Beneficiary Data for Fiscal Year 2003 for Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS)

Mon, 05 Dec 2005 15:22:00 EST

Transmittal #: R392CP
Subject: The Supplemental Security Income (SSI) Medicare Beneficiary Data for Fiscal Year 2003 for Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS)
MM Article #: N/A
MM Article Release Date: N/A

18-Month Moratorium on Physician Self-Referrals to Specialty Hospitals; Processing of Form CMS-855A Applications to Become a Medicare Certified Hospital

Mon, 05 Dec 2005 15:23:00 EST

Transmittal #: R79OTN
Subject: 18-Month Moratorium on Physician Self-Referrals to Specialty Hospitals; Processing of Form CMS-855A Applications to Become a Medicare Certified Hospital
MM Article #: N/A
MM Article Release Date: N/A

Consolidation of the Claims Crossover Process: Full-scale Implementation of the Coordination of Benefits Agreement (COBA) Initiative

Mon, 05 Dec 2005 15:25:00 EST

Transmittal #: R158CP
Subject: Consolidation of the Claims Crossover Process: Full-scale Implementation of the Coordination of Benefits Agreement (COBA) Initiative
MM Article #: N/A
MM Article Release Date: N/A

Clarification of payments and billing procedures for hospitals subject to the Maryland waiver.

Mon, 05 Dec 2005 15:26:00 EST

Transmittal #: R156CP
Subject: Clarification of payments and billing procedures for hospitals subject to the Maryland waiver.
MM Article #: MM3200
MM Article Release Date: 05/07/2004

Inclusion of Core-Based Statistical Area (CBSA) Data Elements to the Provider Specific Files

Mon, 05 Dec 2005 15:30:00 EST

Transmittal #: R152CP
Subject: Inclusion of Core-Based Statistical Area (CBSA) Data Elements to the Provider Specific Files
MM Article #: N/A
MM Article Release Date: N/A

Enhancement to Home Health Consolidated Billing Edits

Mon, 05 Dec 2005 15:30:00 EST

Transmittal #: R165CP
Subject: Enhancement to Home Health Consolidated Billing Edits
MM Article #: N/A
MM Article Release Date: N/A

Quarterly Update to Correct Coding Initiative (CCI) edits, Version 10.2, Effective July, 1, 2004.

Mon, 05 Dec 2005 15:32:00 EST

Transmittal #: R150CP
Subject: Quarterly Update to Correct Coding Initiative (CCI) edits, Version 10.2, Effective July, 1, 2004.
MM Article #: MM3244
MM Article Release Date: 06/30/2004

Cardiac Pacemakers

Mon, 05 Dec 2005 15:33:00 EST

Transmittal #: R12NCD
Subject: Cardiac Pacemakers
MM Article #: N/A
MM Article Release Date: N/A

Scheduled Release for July Updates to Software Programs and Pricing/Coding Files

Mon, 05 Dec 2005 15:34:00 EST

Transmittal #: R4GI
Subject: Scheduled Release for July Updates to Software Programs and Pricing/Coding Files
MM Article #: N/A
MM Article Release Date: N/A

Medicare Systems Acceptance of New Provider Numbers for Home Health Agencies

Mon, 05 Dec 2005 15:35:00 EST

Transmittal #: R80OTN
Subject: Medicare Systems Acceptance of New Provider Numbers for Home Health Agencies
MM Article #: N/A
MM Article Release Date: N/A

Type of Service Corrections

Mon, 05 Dec 2005 15:36:00 EST

Transmittal #: R153CP
Subject: Type of Service Corrections
MM Article #: N/A
MM Article Release Date: N/A

Information and Education Resources for Medicare Providers, Suppliers, and Physicians

Wed, 07 Dec 2005 17:19:00 EST

Transmittal #: SE0454
Subject: Information and Education Resources for Medicare Providers, Suppliers, and Physicians
MM Article #: SE0454
MM Article Release Date: 09/13/2004

Guidance Regarding Elimination of Standard Paper Remittance (SPR) Advice Notices in the Old Format

Wed, 07 Dec 2005 17:19:00 EST

Transmittal #: SE0451
Subject: Guidance Regarding Elimination of Standard Paper Remittance (SPR) Advice Notices in the Old Format
MM Article #: SE0451
MM Article Release Date: 12/06/2004

Clarification of Medicare's Transfer Policy Under the Inpatient Prospective Payment System (IPPS)

Wed, 07 Dec 2005 17:19:00 EST

Transmittal #: SE0459
Subject: Clarification of Medicare's Transfer Policy Under the Inpatient Prospective Payment System (IPPS)
MM Article #: SE0459
MM Article Release Date: 12/27/2004

Inappropriate Access to or Use of Electronic Data Interchange (EDI) Transaction Data by Third Party Entities

Wed, 07 Dec 2005 17:19:00 EST

Transmittal #: SE0461
Subject: Inappropriate Access to or Use of Electronic Data Interchange (EDI) Transaction Data by Third Party Entities
MM Article #: SE0461
MM Article Release Date: 11/08/2004

"Incident to" Services

Wed, 07 Dec 2005 17:19:00 EST

Transmittal #: SE0441
Subject: "Incident to" Services
MM Article #: SE0441
MM Article Release Date: 11/03/2004

Use Condition Code 59 When an ESRD Beneficiary Receives Non-Scheduled or Emergency Dialysis Services at a Non-Primary ESRD Dialysis Facility

Wed, 07 Dec 2005 17:19:00 EST

Transmittal #: SE0452
Subject: Use Condition Code 59 When an ESRD Beneficiary Receives Non-Scheduled or Emergency Dialysis Services at a Non-Primary ESRD Dialysis Facility
MM Article #: SE0452
MM Article Release Date: 09/02/2004

MMA - Drug Administration Coding Changes and Reimbursement

Wed, 07 Dec 2005 17:19:00 EST

Transmittal #: SE0462
Subject: MMA - Drug Administration Coding Changes and Reimbursement
MM Article #: SE0462
MM Article Release Date: 11/04/2004

Guidance for Part A Providers Switching to Electronic Remittance Advices (ERAs)

Wed, 07 Dec 2005 17:19:00 EST

Transmittal #: SE0447
Subject: Guidance for Part A Providers Switching to Electronic Remittance Advices (ERAs)
MM Article #: SE0447
MM Article Release Date: 09/27/2004

MMA - Medicare Prescription Drug, Improvement and Modernization Act of 2003 Information for Medicare Rural Health Providers, Suppliers, and Physicians

Wed, 07 Dec 2005 17:19:00 EST

Transmittal #: SE0450
Subject: MMA - Medicare Prescription Drug, Improvement and Modernization Act of 2003 Information for Medicare Rural Health Providers, Suppliers, and Physicians
MM Article #: SE0450
MM Article Release Date: 12/14/2004

Temporary Hold of Outpatient Claims Subject to the Outpatient Prospective Payment System (OPPS) in April 2004

Thu, 08 Dec 2005 08:13:00 EST

Transmittal #: SE0413
Subject: Temporary Hold of Outpatient Claims Subject to the Outpatient Prospective Payment System (OPPS) in April 2004
MM Article #: SE0413
MM Article Release Date: 04/01/2004

Non-Physician Practitioner Questions and Answers

Thu, 08 Dec 2005 08:13:00 EST

Transmittal #: SE0418
Subject: Non-Physician Practitioner Questions and Answers
MM Article #: SE0418
MM Article Release Date: 08/16/2005

Skilled Nursing Facility Consolidated Billing as It Relates to Certain Types of Exceptionally Intensive Outpatient Hospital Services

Thu, 08 Dec 2005 08:13:00 EST

Transmittal #: SE0432
Subject: Skilled Nursing Facility Consolidated Billing as It Relates to Certain Types of Exceptionally Intensive Outpatient Hospital Services
MM Article #: SE0432
MM Article Release Date: 02/22/2005

Reminder: Hospital Discounts Permitted for Indigent, Uninsured, and Underinsured Patients

Thu, 08 Dec 2005 08:13:00 EST

Transmittal #: SE0405
Subject: Reminder: Hospital Discounts Permitted for Indigent, Uninsured, and Underinsured Patients
MM Article #: SE0405
MM Article Release Date: 03/24/2004

Temporary Hold of Inpatient Claims in April 2004

Thu, 08 Dec 2005 08:13:00 EST

Transmittal #: SE0411
Subject: Temporary Hold of Inpatient Claims in April 2004
MM Article #: SE0411
MM Article Release Date: 03/31/2004

Centers for Medicare & Medicaid Services (CMS) Working to Improve Provider Enrollment Process

Thu, 08 Dec 2005 08:13:00 EST

Transmittal #: SE0417
Subject: Centers for Medicare & Medicaid Services (CMS) Working to Improve Provider Enrollment Process
MM Article #: SE0417
MM Article Release Date: 05/04/2004

Skilled Nursing Facility Consolidated Billing

Thu, 08 Dec 2005 08:13:00 EST

Transmittal #: SE0431
Subject: Skilled Nursing Facility Consolidated Billing
MM Article #: SE0431
MM Article Release Date: 02/18/2005

Skilled Nursing Facility Consolidated Billing as It Relates to Dialysis Coverage

Thu, 08 Dec 2005 08:13:00 EST

Transmittal #: SE0435
Subject: Skilled Nursing Facility Consolidated Billing as It Relates to Dialysis Coverage
MM Article #: SE0435
MM Article Release Date: 02/02/2004

Skilled Nursing Facility Consolidated Billing as It Relates to Certain Diagnostic Tests

Thu, 08 Dec 2005 08:13:00 EST

Transmittal #: SE0440
Subject: Skilled Nursing Facility Consolidated Billing as It Relates to Certain Diagnostic Tests
MM Article #: SE0440
MM Article Release Date: 02/18/2004

Reminder of the Required Three-day Hospital Stay for SNF Admissions

Thu, 08 Dec 2005 08:13:00 EST

Transmittal #: SE0403
Subject: Reminder of the Required Three-day Hospital Stay for SNF Admissions
MM Article #: SE0403
MM Article Release Date: 02/03/2004

Medicare Resources for Researching Inpatient Discharges within 14 Days of a Home Health Admission

Thu, 08 Dec 2005 08:13:00 EST

Transmittal #: SE0410
Subject: Medicare Resources for Researching Inpatient Discharges within 14 Days of a Home Health Admission
MM Article #: SE0410
MM Article Release Date: 04/20/2004

OIG Alert About Charging Extra for Covered Services

Thu, 08 Dec 2005 08:13:00 EST

Transmittal #: SE0421
Subject: OIG Alert About Charging Extra for Covered Services
MM Article #: SE0421
MM Article Release Date: 07/30/2004

Clarification of Change Request 2631

Thu, 08 Dec 2005 08:13:00 EST

Transmittal #: SE0429
Subject: Clarification of Change Request 2631
MM Article #: SE0429
MM Article Release Date: 07/09/2004

Medicare Providers: Their Vendors, Clearinghouses, or Other Third-Party Billers and the HIPAA/Medicare Contingency Plan

Thu, 08 Dec 2005 08:13:00 EST

Transmittal #: SE0414
Subject: Medicare Providers: Their Vendors, Clearinghouses, or Other Third-Party Billers and the HIPAA/Medicare Contingency Plan
MM Article #: SE0414
MM Article Release Date: 04/16/2004

MMA - CMS to Increase Payments to Hospitals Reclassified Under Medicare Reform Law

Thu, 08 Dec 2005 08:13:00 EST

Transmittal #: SE0419
Subject: MMA - CMS to Increase Payments to Hospitals Reclassified Under Medicare Reform Law
MM Article #: SE0419
MM Article Release Date: 05/01/2004

Clarification for Billing Left Ventricular Assist Devices

Thu, 08 Dec 2005 08:13:00 EST

Transmittal #: SE0424
Subject: Clarification for Billing Left Ventricular Assist Devices
MM Article #: SE0424
MM Article Release Date: 07/07/2004

Clarification of Epoetin Alfa (EPO) Billing Procedures and Codes in ESRD

Thu, 08 Dec 2005 08:13:00 EST

Transmittal #: SE0406
Subject: Clarification of Epoetin Alfa (EPO) Billing Procedures and Codes in ESRD
MM Article #: SE0406
MM Article Release Date: 08/23/2004

Modification of Requirements in CR2716, CWF Edits to Ensure Accurate Coding and Payments for Discharge and/or Transfer Policies

Thu, 08 Dec 2005 08:13:00 EST

Transmittal #: SE0408
Subject: Modification of Requirements in CR2716, CWF Edits to Ensure Accurate Coding and Payments for Discharge and/or Transfer Policies
MM Article #: SE0408
MM Article Release Date: 03/11/2004

Reminder to Stop Duplicate Billings

Thu, 08 Dec 2005 08:13:00 EST

Transmittal #: SE0415
Subject: Reminder to Stop Duplicate Billings
MM Article #: SE0415
MM Article Release Date: 04/29/2004

MMA - Section 937 - Correction of Minor Errors and Omissions Without Appeals

Thu, 08 Dec 2005 08:13:00 EST

Transmittal #: SE0420
Subject: MMA - Section 937 - Correction of Minor Errors and Omissions Without Appeals
MM Article #: SE0420
MM Article Release Date: 04/30/2004

Use of Group Health Plan Payment System for Medicare Disease Management Demonstration Serving Medicare Fee For Service Beneficiaries

Thu, 08 Dec 2005 08:13:00 EST

Transmittal #: SE0425
Subject: Use of Group Health Plan Payment System for Medicare Disease Management Demonstration Serving Medicare Fee For Service Beneficiaries
MM Article #: SE0425
MM Article Release Date: 03/10/2005

MMA - Medicare Prescription Drug, Improvement, and Modernization Act - Skilled Nursing Facility Consolidated Billing and Services of Rural Health Clinics and Federally Qualified Health Centers

Thu, 08 Dec 2005 08:13:00 EST

Transmittal #: SE0438
Subject: MMA - Medicare Prescription Drug, Improvement, and Modernization Act - Skilled Nursing Facility Consolidated Billing and Services of Rural Health Clinics and Federally Qualified Health Centers
MM Article #: SE0438
MM Article Release Date: 02/18/2004

Announcing the New Medlearn MattersInformation for Medicare Providers Educational Resource for Medicare Providers

Thu, 08 Dec 2005 08:13:00 EST

Transmittal #: SE0401
Subject: Announcing the New Medlearn MattersInformation for Medicare Providers Educational Resource for Medicare Providers
MM Article #: SE0401
MM Article Release Date: 02/05/2004

Skilled Nursing Facility Consolidated Billing and Erythropoietin (EPO, Epoetin Alfa) and Darbepoetin Alfa (Aranesp)

Thu, 08 Dec 2005 08:13:00 EST

Transmittal #: SE0434
Subject: Skilled Nursing Facility Consolidated Billing and Erythropoietin (EPO, Epoetin Alfa) and Darbepoetin Alfa (Aranesp)
MM Article #: SE0434
MM Article Release Date: 03/01/2005

Skilled Nursing Facility Consolidated Billing as It Relates to Clinical Social Workers

Thu, 08 Dec 2005 08:13:00 EST

Transmittal #: SE0439
Subject: Skilled Nursing Facility Consolidated Billing as It Relates to Clinical Social Workers
MM Article #: SE0439
MM Article Release Date: 02/18/2004

Treatment of Certain Dental Claims as a Result of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003

Thu, 08 Dec 2005 08:13:00 EST

Transmittal #: SE0402
Subject: Treatment of Certain Dental Claims as a Result of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003
MM Article #: SE0402
MM Article Release Date: 02/03/2004

Cost Reporting Forms, Chapter 18

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R7P218
Subject: Cost Reporting Forms, Chapter 18
MM Article #: N/A
MM Article Release Date: N/A

Good Cause Waiver of Late Claim Filing Payment Reduction Penalty and Monitoring of Late Claims Submissions. Full Replacement of CR 3402, Which Was Rescinded

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R420CP
Subject: Good Cause Waiver of Late Claim Filing Payment Reduction Penalty and Monitoring of Late Claims Submissions. Full Replacement of CR 3402, Which Was Rescinded
MM Article #: N/A
MM Article Release Date: N/A

Modification of CROWD Form 5

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R40FM
Subject: Modification of CROWD Form 5
MM Article #: N/A
MM Article Release Date: N/A

July 2004 Update of the Hospital Outpatient Prospective Payment System (OPPS): Payment for Drugs, Biologicals and Radiopharmaceuticals

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R194CP
Subject: July 2004 Update of the Hospital Outpatient Prospective Payment System (OPPS): Payment for Drugs, Biologicals and Radiopharmaceuticals
MM Article #: N/A
MM Article Release Date: N/A

Manualization for 2502

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R142CP
Subject: Manualization for 2502
MM Article #: N/A
MM Article Release Date: N/A

PIM Fraud and Abuse Complaint Screening Revisions

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R80PI
Subject: PIM Fraud and Abuse Complaint Screening Revisions
MM Article #: N/A
MM Article Release Date: N/A

Indian Health Service (IHS) or Tribal Critical Access Hospital (CAH) Payment Methodology for Inpatient and Outpatient Services

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R231CP
Subject: Indian Health Service (IHS) or Tribal Critical Access Hospital (CAH) Payment Methodology for Inpatient and Outpatient Services
MM Article #: N/A
MM Article Release Date: N/A

Section 511 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 Special Adjustment for Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Rates for Acquired Immune Deficiency Syndrome (AIDS)

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R160CP
Subject: Section 511 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 Special Adjustment for Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Rates for Acquired Immune Deficiency Syndrome (AIDS)
MM Article #: MM3291
MM Article Release Date: 05/10/2004

Incident-To Services on Form CMS-1500

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R148CP
Subject: Incident-To Services on Form CMS-1500
MM Article #: N/A
MM Article Release Date: N/A

Ambulance Inflation Factor (AIF)

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R411CP
Subject: Ambulance Inflation Factor (AIF)
MM Article #: N/A
MM Article Release Date: N/A

Processing Part B Claims for Indian Health Services (HIS)

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R241CP
Subject: Processing Part B Claims for Indian Health Services (HIS)
MM Article #: N/A
MM Article Release Date: N/A

Discontinued Use of Revenue Code 0910

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R167CP
Subject: Discontinued Use of Revenue Code 0910
MM Article #: N/A
MM Article Release Date: N/A

ANSI X12 Transaction 835 Flat File and Companion Document Correction for Carriers and DMERCs, and Deletion of a Hard Coded Reason Code A2 that Has Been Deactivated

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R103OTN
Subject: ANSI X12 Transaction 835 Flat File and Companion Document Correction for Carriers and DMERCs, and Deletion of a Hard Coded Reason Code A2 that Has Been Deactivated
MM Article #: N/A
MM Article Release Date: N/A

Blood-Derived Products for Chronic Non-Healing Wounds

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R19NCD
Subject: Blood-Derived Products for Chronic Non-Healing Wounds
MM Article #: MM3384
MM Article Release Date: 08/11/2004

Update Medicare Secondary Payer (MSP) Group Health Plan Recovery Demand Letters to Employers and Insurers for Data Match and Non-Data Match Debts

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R16MSP
Subject: Update Medicare Secondary Payer (MSP) Group Health Plan Recovery Demand Letters to Employers and Insurers for Data Match and Non-Data Match Debts
MM Article #: N/A
MM Article Release Date: N/A

Arrangements for Physical, Occupational, and Speech Language Pathology Services (PT, OT, SLP)

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R9BP
Subject: Arrangements for Physical, Occupational, and Speech Language Pathology Services (PT, OT, SLP)
MM Article #: MM3134
MM Article Release Date: 04/29/2004

Standard Terminology for Claims Processing Systems

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R8GI
Subject: Standard Terminology for Claims Processing Systems
MM Article #: N/A
MM Article Release Date: N/A

Introduction of "Medlearn Matters - Information for Medicare Providers" and Instructions for Carrier/Intermediary Use of This New Provider Education Vehicle

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R54OTN
Subject: Introduction of "Medlearn Matters - Information for Medicare Providers" and Instructions for Carrier/Intermediary Use of This New Provider Education Vehicle
MM Article #: N/A
MM Article Release Date: N/A

Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Pricer Update FY 2005 for 9 Metropolitan Statistical Areas (MSAs) with New Wage Index Values Effective January 1, 2005

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R413CP
Subject: Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Pricer Update FY 2005 for 9 Metropolitan Statistical Areas (MSAs) with New Wage Index Values Effective January 1, 2005
MM Article #: N/A
MM Article Release Date: N/A

Medicare HIPAA Electronic Claims Compliance Report - Reporting Timeframe Extension

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R410CP
Subject: Medicare HIPAA Electronic Claims Compliance Report - Reporting Timeframe Extension
MM Article #: N/A
MM Article Release Date: N/A

Instructions for Downloading the Medicare Zip Code File

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R235CP
Subject: Instructions for Downloading the Medicare Zip Code File
MM Article #: N/A
MM Article Release Date: N/A

New DMERC/VIPS Systems Requirement

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R166CP
Subject: New DMERC/VIPS Systems Requirement
MM Article #: N/A
MM Article Release Date: N/A

Update to the Healthcare Provider Taxonomy Codes (HPTC)/Medicare Specialty Code Crosswalk

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R102OTN
Subject: Update to the Healthcare Provider Taxonomy Codes (HPTC)/Medicare Specialty Code Crosswalk
MM Article #: N/A
MM Article Release Date: N/A

Annual Type of Service (TOS)

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R359CP
Subject: Annual Type of Service (TOS)
MM Article #: N/A
MM Article Release Date: N/A

General Policy

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R228CP
Subject: General Policy
MM Article #: N/A
MM Article Release Date: N/A

Instructions for Downloading the Medicare Zip Code File

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R181CP
Subject: Instructions for Downloading the Medicare Zip Code File
MM Article #: N/A
MM Article Release Date: N/A

Chapter 32, Billing Instructions for Special Services

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R130aCP
Subject: Chapter 32, Billing Instructions for Special Services
MM Article #: N/A
MM Article Release Date: N/A

SNF Certification and Recertification

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R74PI
Subject: SNF Certification and Recertification
MM Article #: N/A
MM Article Release Date: N/A

Manualization of INR Monitoring

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R216CP
Subject: Manualization of INR Monitoring
MM Article #: N/A
MM Article Release Date: N/A

National 1-800-MEDICARE (1-800-633-4227) Implementation (section 923(d) of MMA)

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R159CP
Subject: National 1-800-MEDICARE (1-800-633-4227) Implementation (section 923(d) of MMA)
MM Article #: N/A
MM Article Release Date: N/A

Electrocardiographic Services

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R26NCD
Subject: Electrocardiographic Services
MM Article #: MM3590
MM Article Release Date: 12/27/2004

Change in Interest Calculation for Medicare Overpayments and Underpayments and Medicare Secondary Payer (MSP) Recoveries

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R15MSP
Subject: Change in Interest Calculation for Medicare Overpayments and Underpayments and Medicare Secondary Payer (MSP) Recoveries
MM Article #: N/A
MM Article Release Date: N/A

Shared System Maintainer Hours for Resolution of Problems Detected During Health Insurance Portability and Accountability Act (HIPAA) Transaction Release Testing

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R119OTN
Subject: Shared System Maintainer Hours for Resolution of Problems Detected During Health Insurance Portability and Accountability Act (HIPAA) Transaction Release Testing
MM Article #: N/A
MM Article Release Date: N/A

Introduction of "Medlearn Matters - Information for Medicare Providers" and Instructions for Carrier/Intermediary Use of This New Provider Education Vehicle

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R5COM
Subject: Introduction of "Medlearn Matters - Information for Medicare Providers" and Instructions for Carrier/Intermediary Use of This New Provider Education Vehicle
MM Article #: N/A
MM Article Release Date: N/A

Clarification to CR 3069 - New "K" Codes for Wheelchair Cushions

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R179CP
Subject: Clarification to CR 3069 - New "K" Codes for Wheelchair Cushions
MM Article #: N/A
MM Article Release Date: N/A

Chapter 5, Contractor Prepayment Processing Requirements

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R14MSP
Subject: Chapter 5, Contractor Prepayment Processing Requirements
MM Article #: N/A
MM Article Release Date: N/A

Updated Policy and Claims Processing Instructions for Ambulatory Blood Pressure Monitoring (ABPM)

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R109CP
Subject: Updated Policy and Claims Processing Instructions for Ambulatory Blood Pressure Monitoring (ABPM)
MM Article #: MM2726
MM Article Release Date: 03/31/2004

Notice of New Interest Rate for Medicare Overpayments and Underpayments

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R44FM
Subject: Notice of New Interest Rate for Medicare Overpayments and Underpayments
MM Article #: N/A
MM Article Release Date: N/A

Skilled Nursing Facility (SNF) Consolidated Billing Service Furnished under an Arrangement with an Outside Entity

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R412CP
Subject: Skilled Nursing Facility (SNF) Consolidated Billing Service Furnished under an Arrangement with an Outside Entity
MM Article #: N/A
MM Article Release Date: N/A

Manualization of the Negotiated Clinical Diagnostic Laboratory National Coverage Determinations

Mon, 12 Dec 2005 14:38:00 EST

Transmittal #: R17NCD
Subject: Manualization of the Negotiated Clinical Diagnostic Laboratory National Coverage Determinations
MM Article #: N/A
MM Article Release Date: N/A

Remittance Advice Remark Code and Claim Adjustment Reason Code Update

Wed, 11 Jan 2006 15:16:00 EST

Transmittal #: R154CP
Subject: Remittance Advice Remark Code and Claim Adjustment Reason Code Update
MM Article #: MM3227
MM Article Release Date: 05/12/2004

Remittance Advice Remark Code and Claim Adjustment Reason Code Update

Wed, 11 Jan 2006 15:21:00 EST

Transmittal #: R313CP
Subject: Remittance Advice Remark Code and Claim Adjustment Reason Code Update
MM Article #: MM3466
MM Article Release Date: 10/20/2004

Emergency Update to the 2005 Medicare Physician Fee Schedule Database

Thu, 12 Jan 2006 08:30:00 EST

Transmittal #: R414CP
Subject: Emergency Update to the 2005 Medicare Physician Fee Schedule Database
MM Article #: MM3595
MM Article Release Date: 01/12/2006

Update to Chapter 1, Section 220.6 - Dementia and Neurodegenerative Diseases

Tue, 07 Feb 2006 11:21:00 EST

Transmittal #: R24NCD
Subject: Update to Chapter 1, Section 220.6 - Dementia and Neurodegenerative Diseases
MM Article #: MM3426
MM Article Release Date: 04/22/2005

Payment for Emergency Medical Treatment and Labor Act (EMTALA) - Mandated Screening and Stabilization Services

Tue, 07 Feb 2006 11:24:00 EST

Transmittal #: R84PI
Subject: Payment for Emergency Medical Treatment and Labor Act (EMTALA) - Mandated Screening and Stabilization Services
MM Article #: MM3437
MM Article Release Date: 10/28/2004

Coverage of Routine Costs of Clinical Trials Involving Investigational Device Exemption (IDE) Category A Devices

Fri, 15 Jun 2007 14:27:00 EST

Transmittal #: R131OTN
Subject: Coverage of Routine Costs of Clinical Trials Involving Investigational Device Exemption (IDE) Category A Devices
MM Article #: MM3548
MM Article Release Date: 12/21/2004

Updated SNF Help File Available for Calendar Year 2004

Tue, 21 Aug 2007 07:11:00 EST

Transmittal #: R189CP
Subject: Updated SNF Help File Available for Calendar Year 2004
MM Article #: MM3252
MM Article Release Date: 06/04/2004

Additional Health Insurance Portability and Accountability Act (HIPAA) X12N 837 Institutional Health Care Claim Implementation Guide (IG) Instruction and Clarification of Transmittal 107/100-04 (CR 3031)

Tue, 21 Aug 2007 07:12:00 EST

Transmittal #: R175CP
Subject: Additional Health Insurance Portability and Accountability Act (HIPAA) X12N 837 Institutional Health Care Claim Implementation Guide (IG) Instruction and Clarification of Transmittal 107/100-04 (CR 3031)
MM Article #: MM3264
MM Article Release Date: 06/03/2004

Liability Days on Skilled Nursing Facility (SNF) and Swing Bed Facility Inpatient Bills

Tue, 21 Aug 2007 07:13:00 EST

Transmittal #: R378CP
Subject: Liability Days on Skilled Nursing Facility (SNF) and Swing Bed Facility Inpatient Bills
MM Article #: MM3568
MM Article Release Date: 01/04/2005

MMA - Medicare Replacement Drug Demonstration

Tue, 21 Aug 2007 07:15:00 EST

Transmittal #: SE0443
Subject: MMA - Medicare Replacement Drug Demonstration
MM Article #: SE0443
MM Article Release Date: 08/18/2004

Skilled Nursing Facility Consolidated Billing as It Relates to Prosthetics and Orthotics

Tue, 21 Aug 2007 07:16:00 EST

Transmittal #: SE0437
Subject: Skilled Nursing Facility Consolidated Billing as It Relates to Prosthetics and Orthotics
MM Article #: SE0437
MM Article Release Date: 02/18/2004

Referral of Patients for X-rays by Chiropractors

Tue, 28 Aug 2007 08:08:00 EST

Transmittal #: SE0416
Subject: Referral of Patients for X-rays by Chiropractors
MM Article #: SE0416
MM Article Release Date: 08/31/2005

Skilled Nursing Facility Consolidated Billing as It Relates to Ambulance Services

Thu, 02 Jul 2009 07:34:00 EST

Transmittal #: SE0433
Subject: Skilled Nursing Facility Consolidated Billing as It Relates to Ambulance Services
MM Article #: SE0433
MM Article Release Date: 02/18/2005

Skilled Nursing Facility Consolidated Billing and Preventive/Screening Services

Tue, 11 Aug 2009 08:44:00 EST

Transmittal #: SE0436
Subject: Skilled Nursing Facility Consolidated Billing and Preventive/Screening Services
MM Article #: SE0436
MM Article Release Date: 02/18/2004

MMA - New Medicare-Approved Drug Discount Cards and Transitional Assistance Program: A Summary for Physicians and Other Health Care Professionals

Tue, 01 Sep 2009 09:54:00 EST

Transmittal #: SE0422
Subject: MMA - New Medicare-Approved Drug Discount Cards and Transitional Assistance Program: A Summary for Physicians and Other Health Care Professionals
MM Article #: SE0422
MM Article Release Date: 11/08/2004

MMA - New Medicare-Approved Drug Discount Cards and Transitional Assistance Program: A Summary for Pharmacists and Other Pharmacy Professionals

Tue, 01 Sep 2009 09:55:00 EST

Transmittal #: SE0423
Subject: MMA - New Medicare-Approved Drug Discount Cards and Transitional Assistance Program: A Summary for Pharmacists and Other Pharmacy Professionals
MM Article #: SE0423
MM Article Release Date: 10/28/2004

MMA - Medicare-Approved Drug Discount Cards and Transitional Assistance Program: A Summary of New Initiative of Interest to Physicians and Other Health Care Professionals

Tue, 01 Sep 2009 09:56:00 EST

Transmittal #: SE0457
Subject: MMA - Medicare-Approved Drug Discount Cards and Transitional Assistance Program: A Summary of New Initiative of Interest to Physicians and Other Health Care Professionals
MM Article #: SE0457
MM Article Release Date: 10/22/2004

MMA - Medicare-Approved Drug Discount Cards and Transitional Assistance Program: A Summary of New Initiative of Interest to Pharmacists and Pharmacy Professionals

Tue, 01 Sep 2009 09:56:00 EST

Transmittal #: SE0458
Subject: MMA - Medicare-Approved Drug Discount Cards and Transitional Assistance Program: A Summary of New Initiative of Interest to Pharmacists and Pharmacy Professionals
MM Article #: SE0458
MM Article Release Date: 10/22/2004

Treatment of Obesity

Thu, 10 Sep 2009 08:07:00 EST

Transmittal #: R23NCD
Subject: Treatment of Obesity
MM Article #: MM3502
MM Article Release Date: 10/12/2004

Payment For Outpatient End Stage Renal Disease (ESRD)-Related Services

Thu, 15 Oct 2009 10:15:00 EST

Transmittal #: R300CP
Subject: Payment For Outpatient End Stage Renal Disease (ESRD)-Related Services
MM Article #: MM3414
MM Article Release Date: 09/27/2004

Clarification of Billing for Separately Billable ESRD Drugs

Fri, 20 Nov 2009 07:54:00 EST

Transmittal #: R146CP
Subject: Clarification of Billing for Separately Billable ESRD Drugs
MM Article #: MM3176
MM Article Release Date: 05/12/2004