Palmetto GBA E-mail Update: Wednesday, February 22, 2017

New Common Working File (CWF) Medicare Secondary Payer (MSP) Type for Liability Medicare Set-Aside Arrangements (LMSAs) and No-Fault Medicare Set-Aside Arrangements (NFMSAs)
This article is based on Change Request (CR) 9893. To comply with the Government Accountability Office (GAO) final report entitled Medicare Secondary Payer (MSP): Additional Steps Are Needed to Improve Program Effectiveness for Non-Group Health Plans (GAO 12-333), the Centers for Medicare & Medicaid Services (CMS) will establish two (2) new set-aide processes: a Liability Insurance Medicare Set-Aside Arrangement (LMSA), and a No-Fault Insurance Medicare Set-Aside Arrangement (NFMSA). Please be sure your billing staffs are aware of these changes.

Applies to:

  • JM Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//Gene ral
  • Railroad Medicare (RRB)//General – Railroad Medicare

Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) – April CY 2017 Update
Change Request (CR) 9977 informs MACs about changes to the MPFS payment files. While the changes will be implemented in Medicare systems on April 3, the changes are effective January 1, 2017. Note that MACs need not search their files to either retract payment for claims already paid or to retroactively pay claims already processed. However, the MACs will adjust such claims that you bring to their attention. Make sure that your billing staffs are aware of these changes.

Applies to:

  • JM Home He alth and Hospice//General
  • JM Part A//General
  • JM Part B//General
  • Railroad Medicare (RRB)//General – Railroad Medicare

Clinical Laboratory Fee Schedule – Medicare Travel Allowance Fees for Collection of Specimens
Change Request (CR) 9960 revises the payment of travel allowances when billed on a per mileage basis using Health Care Common Procedure Coding System (HCPCS) code P9603 and when billed on a flat-rate basis using HCPCS code P9604 for Calendar Year (CY) 2017. Make sure that your billing staffs are aware of these changes.

Applies to:

  • JM Part A//General
  • JM Part B//General
  • Railroad Medicare (RRB)//General – Railroad Medicare

ICD-10 Coding Revisions to National Coverage Determination (NCDs)
Change Request (CR) 9861 is the tenth maintenance update of ICD-10 conversions and other coding updates specific to national coverage determinations (NCDs). The majority of the NCDs included are a result of feedback received from previous ICD-10 NCD CRs, specifically CR7818, CR8109, CR8197, CR8691, CR9087, CR9252, CR9540, CR9631, and CR 9751; while others are the result of revisions required to other NCD-related CRs released separately. Make sure your staff is aware.

Applies to:

  • JM Part A//General
  • JM Part B//General
  • Railroad Medicare (RRB)//General – Railroad Medicare

Implementation of New Influenza Virus Vaccine Code
Change Request (CR) 9876 provides instructions for payment for a new influenza virus vaccine code for intramuscular use, for claims with dates of service on or after July 1, 2017. Make sure that your billing staffs are aware of these instructions.

Applies to:

  • JM Part A//General
  • JM Part B//General
  • Railroad Medicare (RRB)//General – Railroad Medicare
  • JM Home Health and Hospice//General

March 2017 Medicare Part B Updates, Changes and Reminders: March 9
Palmetto GBA will host the Medicare Administrative Contract Part B March 2017 Quarterly Updates, Changes and Reminders Webcast on March 9, 2017, at 10 am. ET. These updates, changes and reminders include any new billing regulations, hot topics that impact provider billing, and a Q & A segment for questions on covered material. Note: An NPI and PTAN are required to register. You should only enter ‘n/a’ if you do not have an NPI or PTAN. Please share with your staff, and register today.

Applies to:

  • JM Part B//General

Updated Editing of Professional Therapy Services
Change request (CR) 9933 instructs the MACs to apply certain coding edits to the new Current Procedural Terminology (CPT) codes that are used to report physical therapy (PT) and occupational therapy (OT) evaluations and re-evaluations, effective January 1, 2017. Make sure your billing staffs are aware of these coding changes.

Applies to:

  • JM Part B//General
  • Railroad Medicare (RRB)//General – Railroad Medicare
  • JM Part B//Physical/Occupational Therapy
  • Railroad Medicare (RRB)//Physical/Occupational Therapy

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