Palmetto GBA E-mail Update: Tuesday, April 11, 2017

Provider Enrollment Revalidation – Cycle 2
Section 6401 (a) of the Affordable Care Act established a requirement for all enrolled providers/suppliers to revalidate their Medicare enrollment information under new enrollment screening criteria. In an effort to streamline the revalidation process and reduce provider/supplier burden, CMS has implemented several revalidation processing improvements that are captured within this article. Make sure your staff is aware.

Applies to:

  • JM Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//General

Local Coverage Determination (LCD) Update: Part A and Part B
The Minimally Invasive Treatment for Benign Prostatic Hyperplasia Involving Prostatic Urethral Lift (Urolift) L36109 for JM A/B MAC LCDs was revised. Please share with appropriate staff.

Applies to:

  • JM Part A//General
  • JM Part B//General

July 2017 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
Change Request (CR) 10016 provides the July 2017 ASP drug pricing files and quarterly updates, and if released by the Centers for Medicare & Medicaid Services (CMS), the revised April 2017, January 2017, October 2016, and July 2016 Average Sales Price (ASP) drug pricing files for Medicare Part B drugs. Medicare will use these files to determine the payment limit for claims for separately payable Medicare Part B drugs processed or reprocessed on or after July 3, 2017, with dates of service July 1, 2017, through September 30, 2017. MACs will not search and adjust claims previously processed unless brought to their attention.

Applies to:

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

Local Coverage Determination (LCD) Updates Part B
The Hyaluronate Polymers L33432 LCD for JM Part B LCD, was revised. Please share with appropriate staff.

Applies to:

  • JM Part B//General

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: