CMS News

New
CMS has posted a Security paper for small providers on their website.
http://www.cms.hhs.gov/EducationMaterials/Downloads/SmallProvider4final.pdf

SEO744 – Medicare rejection of Part B claims if unable to match NPI and PIN combination
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0744.pdf
Provider Types Affected: Physicians and other practitioners who submit Medicare fee-for-service (FFS) claims to Medicare Carriers or Part A/B Medicare Administrative Contractors (A/B MACs).

SE0726 – Clarification About the Medical Privacy of Protected Health Information
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0726.pdf
Provider Types Affected: Physicians, providers, and suppliers who bill Medicare contractors (carriers, durable medical equipment Medicare Administrative Contractors (DME MACs), fiscal intermediaries (FIs), regional home health intermediaries (RHHIs), and/or Part A/B Medicare Administrative Contractors (A/B MACs) for services provided to Medicare beneficiaries.

MM5532 – Update to Medicare Benefit Policy Manual, (Publication 100-02), Chapter 8,
Coverage of Extended Care Services under Hospital Insurance.
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5532.pdf
Provider Types Affected: Skilled Nursing Facilities (SNF) who bill fiscal intermediaries (FI) or Medicare Administrative Contractors (A/B MACs) for physical therapy, occupational therapy, or speech-language pathology services to Medicare beneficiaries.

MM5586 – Electronic Funds Transfer Standardizations and Revisions to the Medicare Claims
Processing Manual (Chapter 24)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5586.pdf
Provider Types Affected: Physicians, providers, and suppliers submitting claims to Medicare contractors (carriers, DME Medicare Administrative Contractors (DME MACs), Fiscal Intermediaries (FIs), Part A/B Medicare Administrative Contractors (A/B MACs), and/or Regional Home Health Intermediaries (RHHIs)) for services provided to Medicare beneficiaries.

Revised:
MM5597 – Revision to Medicare Publication 100-09, Chapter 3 – Provider Inquiries and
Chapter 6 - Provider Customer Service Program Updates.
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5597.pdf
Provider Types Affected: All physicians, suppliers, and providers who submit written inquiries to, or contact the toll-free lines at, their Medicare contractors [fiscal intermediaries (FIs), carriers, Part A/B Medicare Administrative Contractors (A/B MACs), DME Medicare Administrative Contractors (DME/MACs), and/or regional home health intermediaries (RHHIs).]

MM5527 – Instructions for Implementing the Centers for Medicare & Medicaid (CMS) Ruling
CMS 1536-R; Astigmatism-Correcting Intraocular Lens (A-C IOLs)
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5527.pdf
Provider Types Affected: Physicians, providers, and suppliers submitting claims to Medicare contractors (carriers, Fiscal Intermediaries (FIs), or Part A/B Medicare Administrative Contractors (A/B MACs) for services provided to Medicare beneficiaries.

The NPI is here. The NPI is now. Are you using it?
New MLN Matters Article Available!
A new Special Edition MLN Matters article is now posted on the CMS website with important information for Medicare providers and suppliers. Some of the topics include:

• Common Enumeration Errors in NPPES
• Dos and Don’ts When Reporting “Other Provider Identification Numbers” in NPPES
• How to Use Your NPI When Billing Medicare Part A (Institutional) Claims to a Fiscal Intermediary (FI) or A/B MAC
• How to Use Your NPI When Billing Medicare Part B (Professional) Claims to Carriers and A/B MACs

You can view this article by visiting http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0725.pdf
on the CMS website.

June 14, 2007 NPI Data Dissemination Roundtable Transcript Available Now
The transcript for the 6/14/2007 NPI Data Dissemination Roundtable can be found at http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/6-14NPITranscript.pdf on the CMS website.

Important Reminders Regarding 835 Remittance Advice Changes Effective July 2, 2007 for DME
Suppliers Submitting Claims to DME MACS Only.
It contains loop-by-loop detail explaining how NPIs will be mapped from the 837 to the 835.

• The billing/pay-to NPI will be reported at the Payee level (Loop 1000B in N104 with the XX qualifier in N103 of the 835),
• The TIN (EIN/SSN) will be reported in the REF segment (Loop 1000B, data field REF 02 with qualifier TJ in REF 01 of the 835) as Payee Additional ID,
  
• Any relevant Rendering Provider NPI will be reported at the claim level (Loop 2100, data field NM 109 with qualifier XX in NM 108 on the 835) if different from the Payee NPI, and
• Any relevant Rendering NPI(s) will be reported at the service line level (Loop 2110, data field REF 02 with qualifier HPI in REF 01 on the 835) when different from the claim level Rendering NPI.

But you're not a DME provider? Read on. Below this comes the following...
Important NOTE: The 835 Remittance Advice changes listed above will be effective for other providers submitting Part A Institutional claims and Part B Professional claims, at a later date. Medicare will notify submitters when a date is determined.