CALENDAR OF ARTICLES - Home - Centers for Medicare ... · PDF fileThe calendar represents 12 months ... Chapter 3, Section 90 (Provider ... Rural Health Clinic and Federally Qualified

CALENDAR OF ARTICLES by EFFECTIVE DATES As of May 2, 2018

Introduction

This document organizes MLN Matters® Article by effective date with descriptive information. The calendar represents 12 months (rolling months) of articles that have been posted. It can be used to review upcoming Medicare changes. Since many of the articles are posted and Change Requests (CRs) released months before the effective dates, the calendar can serve as a reminder of pending Medicare changes.

Tips on Using the Calendar

Review the calendar for upcoming Medicare changes, in order to anticipate where errors may be introduced due to billing changes.

Review the calendar for upcoming Medicare changes, to assist in anticipating where complex changes may increase the number of calls to Call Centers. This could be due to effective dates of complicated regulation changes that are scheduled.

Review the calendar to ensure staff and provider partners (if appropriate) are prepared for the upcoming change (for example, ICD-10).

The calendar is updated weekly to reflect the posted MLN articles and CRs.

April 2017 CALENDAR OF MEDICARE PROCESSING and BILLING CHANGES

Effective Date

Article Number

Article Title Providers Affected

Description

4/1/2017 MM9358 Affordable Care Act – Operating Rules – Requirements for Phase II and Phase III Compliance for Batch Processing

Physicians and providers submitting claims to MACs, including HH&H MACs, for services provided to Medicare beneficiaries

Requires MACs to meet the connectivity and security requirement for the Phases II and III CAQH CORE Operating Rules as well as the batch processing requirements for the Phase II CAQH CORE Operating Rules

4/1/2017 MM9681 Modifications to the National Coordination of Benefits Agreement Crossover Process

Providers, including hospices, submitting institutional claims to MACs requiring COB for services provided to Medicare beneficiaries

Modifies Medicare’s Part A claims processing system

4/1/2017 MM9585 Denial of Home Health Payments When Required Patient Assessment Is Not Received

Intended for HHAs submitting claims to MACs for home health services provided to Medicare beneficiaries

Directs MACs to automate the denial of HH PPS claims when the condition of payment for submitting patient assessment data has not been met

4/1/2017 MM9716 New Physician Specialty Code for Hospitalist

Physicians, other providers, and suppliers submitting claims to MACs for services to Medicare beneficiaries

Announces that CMS has established a new physician specialty code for Hospitalist

4/1/2017 MM9848 Payment for Oxygen Volume Adjustments and Portable Oxygen Equipment

Providers and suppliers submitting claims to DME MACs for oxygen services provided to Medicare beneficiaries

Updates Chapter 20, Section 130.6 of the “Medicare Claims Processing Manual” to provide additional instructions in processing claims for oxygen and oxygen equipment

4/1/2017 MM9774 Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update

Physicians, providers, and suppliers submitting claims to MACs for services provided to Medicare beneficiaries

Updates the RARC and CARC lists and instructs Medicare system maintainers to update MREP and PC Print

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9358.pdf









Effective Date

Article Number


Description

4/1/2017 MM9769 Claim Status Category and Claim Status Codes Update


Informs MACs about system changes to update, as needed the Claim Status and Claim Status Category Codes used for the ASC X12 276/277 Health Care Claim Status Request and Response and ASC X12 277 Health Care Claim Acknowledgement transactions

4/1/2017 MM9767 Implement Operating Rules - Phase III Electronic Remittance Advice (ERA) Electronic Funds Transfer (EFT): CORE 360 Uniform Use of Claim Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC) and Claim Adjustment Group Code (CAGC) Rule - Update from Council for Affordable Quality Healthcare (CAQH) Committee on Operating Rules for Information Exchange (CORE)

Physicians, other providers, and suppliers who submit claims to MACs, including DME MACs and HH&H MACs, for services provided to Medicare beneficiaries

Informs MACs of the regular update in the CAQH CORE defined code combinations per Operating Rule 360 - Uniform Use of Claim Adjustment Reason Codes and Remittance Advice Remark Codes (835) Rule

4/1/2017 MM9945 April 2017 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files


Provides the April 2017 quarterly update and instructs MACs to download and implement the April 2017 ASP drug pricing files and, if released by CMS, the revised January 2017, October 2016, July 2016, and April 2016 Average Sales Price (ASP) drug pricing files for Medicare Part B drugs

4/1/2017 MM9956 New Waived Tests Clinical diagnostic laboratories submitting claims to MACs for services provided to Medicare beneficiaries

Informs MACs of new CLIA waived tests approved by the FDA









Effective Date

Article Number


Description

4/1/2017 MM9928 Payment for Oxygen Volume Adjustments and Portable Oxygen Equipment – FISS


Reminds DME MACs of instructions found in Chapter 20, Section 130.6 of the “Medicare Claims Processing Manual”

4/1/2017 MM9970 Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure to Procedure (PTP) Edits, Version 23.1, Effective April 1, 2017

Physicians, other providers, and suppliers who submit claims to MACs for services provided to Medicare beneficiaries

Instructs MACs about the release of the latest package of CCI PTP edits, Version 23.1, effective 4/1/2017

4/1/2017 MM9971 Quarterly Update for the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program – April 2017

Providers and suppliers submitting claims to MACs for DMEPOS items or services paid under the DMEPOS fee schedule

Provides the April 2017 quarterly update for the Medicare DMEPOS fee schedule

4/1/2017 MM9988 April Quarterly Update for 2017 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule


Provides the April 2017 quarterly update for the Medicare DMEPOS fee schedule, and it includes information, when necessary, to implement fee schedule amounts for new codes and correct any fee schedule amounts for existing codes

4/1/2017 MM9998 April 2017 Update of the Ambulatory Surgical Center (ASC) Payment System

Physicians, other providers, and suppliers submitting claims to MACs for ASC services to Medicare beneficiaries

Describes changes to and billing instructions for various payment policies implemented in the April 2017 ASC payment system update

4/1/2017 MM10005 April 2017 Update of the Hospital Outpatient Prospective Payment System (OPPS)

Providers and suppliers who submit claims to MACs, including HH&H MACs, for services provided to Medicare beneficiaries paid under the OPPS

Describes changes to and billing instructions for various payment policies implemented in the April 2017 OPPS update










Effective Date

Article Number


Description

4/1/2017 MM10002 April 2017 Integrated Outpatient Code Editor (I/OCE) Specifications Version 18.1

Providers who submit institutional claims to MACs including HH&H MACs for services provided to Medicare beneficiaries

Provides instructions for the I/OCE used for OPPS and non-OPPS claims

4/1/2017 SE170009 Denial of Home Health Payments When Required Patient Assessment Is Not Received – Additional Information

HHAs submitting claims to MACs for home health services provided to Medicare beneficiaries

A reminder of the upcoming change in which CMS directed MACs to automate the denial of HH PPS claims when the condition of payment for submitting patient assessment data has not been met

4/1/2017 SE17010 Improvements to the Adjudication Process of Serial Claims

DME suppliers who submit claims to DME MACs for items provided to Medicare beneficiaries

Informs suppliers of the Serial Claims initiative, in which CMS is implementing changes to improve the processing and adjudication of Medicare FFS recurring (or serial) claims for capped rental items and certain IRP items

Claims MM9826 Correcting Editing Physicians, other Informs MACs about corrections to received for Condition Code providers, and Medicare systems to require condition on or after 54 and Updating suppliers code 54 on HH appropriately 4/1/2017 Remittance Advice

Messages on Home Health Claims

submitting claims to MACs for services provided to Medicare beneficiaries

4/3/2017 MM10220 Hyperbaric Oxygen (HBO) Therapy (Section C, Topical Application of Oxygen)

Physicians, providers, and suppliers billing MACs for services provided to Medicare beneficiaries

Informs MACs that effective 4/3/2017, coverage for topical oxygen for the treatment of chronic wounds will be determined by the MACs

4/24/2017 MM9886 DMEPOS Order Requirements for Changing Suppliers

Providers and suppliers submitting claims to MACs for DMEPOS items of services paid under the DMEPOS fee schedule

Instructs MACs to accept timely orders and medical documentation (so long as it meets Medicare requirements), regardless of whether the supplier received the documentation directly from the beneficiary’s eligible practitioner or from another, transferring supplier


https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE17009.pdf









May 2017 CALENDAR OF MEDICARE PROCESSING and BILLING CHANGES

Effective Date

Article Number


Description

5/12/2017 MM10090 Changes to the Payment Policies for Reciprocal Billing Arrangements and Fee-For-Time Compensation Arrangements (formerly referred to as Locum Tenens Arrangements)

Physicians, physical therapists, and other providers submitting claims to MACs for services provided to Medicare beneficiaries

Implements the 21st Century Cures Act (Section 16006)

5/15/2017 SE17012 Updated Manual Guidelines for Electronic Funds Transfer (EFT) Payments and Change of Ownership (CHOW)

Providers involved in a CHOW submitting claims to Part A & B MACs for services provided to Medicare beneficiaries

Clarifies language in Chapter 15, Section 15.7.7.1.5 of the “Medicare Program Integrity Manual” related to EFT Payments and CHOWs

5/25/2017 MM9906 Updates to the “Medicare Claims Processing Manual,” Pub. 100-04, Chapters 12, 17 and 23 to Correct Remittance Advice Messages


Revises Chapters 12, 17, and 23 of the “Medicare Claims Processing Manual” (the manual) to ensure that all remittance advice coding is consistent with national standard operating rules

5/25/2017 MM10295 Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD)


Informs MACs that effective 5/25/2017, CMS issued an NCD to cover SET for beneficiaries with IC for the treatment of symptomatic PAD







June 2017 CALENDAR OF MEDICARE PROCESSING and BILLING CHANGES

Effective Date

Article Number


Description

6/13/2017 MM10080 Clarifying Medical Review of Hospital Claims for Part A Payment

Providers that submit institutional claims to MACs for inpatient hospital services provided to Medicare beneficiaries

Clarifies the medical review requirements for Part A payment of short stay hospital claims (more commonly referred to as the “Two-Midnight” Rule) for MACs, SMRC, Recovery Audit Contractors and the CERT contractors


July 2017 CALENDAR OF MEDICARE PROCESSING and BILLING CHANGES

Effective Date

Article Number


Description

7/1/2017 MM9932 Preventing Hospice Notices of Election with Future Dates

Hospices submitting claims to MACs for services provided to Medicare beneficiaries

Advises MACs that there is currently no edit in place to prevent a future date from being posted to the admission and from the date fields when a hospice is inputting a notice type of bill

7/1/2017 MM9876 Implementation of New Influenza Virus Vaccine Code

Physicians, other providers, and suppliers submitting claims to MACs for services provided to Medicare beneficiaries

Provides instructions for payment and edits for the CWF to include influenza virus vaccine code 90682 (Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use) for claims with dates of service on or after 7/1/2017


Physicians, other providers, and suppliers who submit claims to MACs for services provided to Medicare beneficiaries

Updates the RARC and CARC lists

7/1/2017 MM9869 Healthcare Provider Taxonomy Codes (HPTCs) April 2017 Code Set Update

Physicians, other providers, and suppliers submitting claims to MACs, including HH&H MACs and DME MACs, for services provided to Medicare beneficiaries

Instructs MACs to obtain the most recent HPTC set to update their internal HPTC tables and/or reference files

7/1/2017 MM9916 Episode Payment Model Operations

Physicians and acute care hospitals that submit claims to MACs for services provided to Medicare beneficiaries

Prepares Medicare’s claims processing systems for implementation of EPMs

7/1/2017 MM9904 Guidance on Implementing System Edits for Certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)

Physicians, providers, and suppliers submitting claims to MACs, including DME MACs, for services provided to Medicare beneficiaries

Updates CR7333 and CR9371 and informs MACs about changes related to Section 302 of the Medicare Modernization Act of 2003 (MMA)








Effective Date

Article Number


Description

7/1/2017 MM10021 Federally Qualified Health Centers (FQHC) Prospective Payment System (PPS) – Recurring File Updates

FQHCs submitting claims to MACs for services provided to Medicare beneficiaries

Instructs MACs to adjust all FQHC claims (77X) for GFT FQHCs submitted with dates of service on or after 1/1/2017, through 6/30/2017, paid at the previous rate

7/1/2017 MM10004 Quarterly Update for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP) – July 2017

Suppliers submitting claims to DME MACs for DMEPOS provided to Medicare beneficiaries

Provides the DMEPOS CBP July 2017 update

7/1/2017 MM10016 July 2017 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revision to Prior Quarterly Pricing Files


Provides the July 2017 quarterly update and instructs MACs to download and implement the July 2017 ASP drug pricing files and, if released by CMS, the revised April 2017, January 2017, October 2016, and July 2016 ASP drug pricing files for Medicare Part B drugs.

7/1/2017 MM10082 Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure to Procedure (PTP) Edits, Version 23.2, Effective July 1, 2017

Physicians, other providers, and suppliers submitting claims to MACs for services provided to Medicare beneficiary

Informs MACs about the update to the NCCI PTP edits

7/1/2017 MM10013 Two New “K” Codes for Therapeutic Continuous Glucose Monitors

Providers and suppliers submitting claims to MACs for services provided to Medicare beneficiaries

Provides the two codes for therapeutic CGM that will be added to the HCPCS code set, effective 7/1/2017

7/1/2017 MM10071 July Quarterly Update for 2017 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule


Provides the July 2017 quarterly update for the Medicare DMEPOS fee schedule, and it includes information, when necessary, to implement fee schedule amounts for new codes and correct any fee schedule amounts for existing codes











Effective Date

Article Number


Description

7/1/2017 MM10107 Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes – July 2017 Update


Informs MACs of updating specific drug/biological HCPCS codes

7/1/2017 MM10115 July 2017 Integrated Outpatient Code Editor (I/OCE) Specifications Version 18.2

Providers who submit claims to MACs, including HH&H MACs, for services provided to Medicare beneficiaries

Informs providers that the I/OCE is being updated 7/1/2017

7/1/2017 MM10122 July 2017 Update of the Hospital Outpatient Prospective Payment System (OPPS)

Providers and suppliers that submit claims to MACs, including HH&H MACs, for services provided to Medicare beneficiaries and paid under the OPPS

Describes changes to the OPPS to be implemented in the July 2017 update

7/1/2017 MM10138 July 2017 Update of the Ambulatory Surgical Center (ASC) Payment System

ASCs submitting claims to MACs for services provided to Medicare beneficiaries

Informs MACs about changes to the ASC payment center and billing instructions for various payment policies implemented in the July 2017 ASC payment system update

7/1/2017 MM9982 ICD-10 Coding Physicians and The 11th maintenance update of ICD-10 (Unless Revisions to other providers conversions and other coding updates otherwise National Coverage submitting claims specific to NCDs noted in Determinations to MACs for individual (NCDs) services provided NCDs) to Medicare

beneficiaries 7/24/2017 MM10234 Quarterly Healthcare

Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - October 2017 Update


Informs MACs about the new modifier, ZA, Merck/Samsung Bioepis











Effective Date

Article Number


Description

7/25/2017 MM10143 Internet Only Manual Update to Pub. 100-04, Chapter 15

Physicians, providers and suppliers submitting claims to MACs for services provided to Medicare beneficiaries

Corrects errors in Chapter 15, Section 20.1.4 of the Medicare Claims Processing Manual

7/31/2017 MM10026 The Supplemental Security Income (SSI)/Medicare Beneficiary Data for Fiscal Year 2015 for Inpatient Prospective Payment System (IPPS) Hospitals, Inpatient Rehabilitation Facilities (IRFs), and Long Term Care Hospitals (LTCHs)

Providers submitting claims to MACs for services provided to Medicare beneficiaries

Informs MACs about updated data for determining the disproportionate share adjustment for IPPS hospitals and the LIP adjustment for IRFs as well as payments as applicable for LTCH discharges (for example, discharges paid the IPPS comparable amount under the short-stay outlier payment adjustment)





August 2017 CALENDAR OF MEDICARE PROCESSING and BILLING CHANGES

Effective Date

Article Number


Description

8/1/2017 MM10196 Quarterly Influenza Virus Vaccine Code Update – January 2018

Physicians, providers and suppliers billing MACs for services provided to Medicare beneficiaries

Provides instructions for payment and edits for the CWF and FISS to include and update new or existing influenza virus vaccine codes

8/1/2017 MM10224 Influenza Vaccine Payment Allowances – Annual Update for 2017-2018 Season

Physicians and other providers submitting claims to MACs for influenza vaccines provided to Medicare beneficiaries

Informs MACs about the payment allowances for seasonal influenza virus vaccines, which are updated on August 1 of each year

8/7/2017 SE17015 Guidance to Providers that Submit Outpatient Facility Claims and Those That enter Claims Data via Direct Data Entry (DDE) Screens to Reduce incidence of Claims Not Crossing Over

Two types of institutional provider billers: those who submit HIPAA ASC 837 X12N institutional claims for outpatient hospital facility services to Medicare, and those who submit claims to Medicare via DDE

Instructs provider billing offices to correctly submit HIPAA ASC X12N 837 institutional claims to Medicare to reduce the incidence of receiving RTP edits on incoming 837 outpatient hospital facility claims as well as DDE claims due to edits that will be enforced as of 8/7/2017

8/14/2017 MM9944 Fiscal Year 2018 and After Payments to Skilled Nursing Facilities That Do Not Submit Required Quality Data

SNFs submitting claims to MACs for services provided to Medicare beneficiaries

Reminds SNFs of payment reductions in Fiscal Year 2018, and each subsequent year, for SNFs that do not submit required quality data to Medicare

8/21/2017 SE17014 Required Workaround for Hospices Submitting Routine Home Care (RHC) and Service Intensity Add-On (SIA) Payments at the End of Life

Hospices that submit claims to MACs for services provided to Medicare beneficiaries

Corrects two errors with regard to hospice payments by Medicare that could result in overpayments









September 2017 CALENDAR OF MEDICARE PROCESSING and BILLING CHANGES

Effective Date

Article Number


Description

9/18/2017 MM10110 “Medicare Benefit Policy Manual” – Chapter 10, Ambulance Locality and Advanced Life Support (ALS) Assessment

Ambulance providers and suppliers submitting Medicare Part B claims to MACs for services provided to Medicare beneficiaries

Revises the “Medicare Benefit Policy Manual” (Chapter 10, Sections 10.3.5 and 30.1.1) to clarify the definitions for locality and ground ambulance services for ALS assessment

9/30/2017 SE17008 Scheduled End of the Intravenous Immune Globulin (IVIG) Demonstration

Suppliers submitting claims to DME MACs for IVIG drugs and services provided to beneficiaries under the Medicare IVIG Demonstration

A reminder of the scheduled end date for the IVIG demonstration




October 2017 CALENDAR OF MEDICARE PROCESSING and BILLING CHANGES

Effective Date

Article Number


Description

10/1/2017 MM10012 Update to Common Working File (CWF) Blood Editing on Medicare Advantage (MA) Enrollees’ Inpatient Claims for Indirect Medical Education (IME) Payment

Approved teaching hospitals submitting claims to MACs for services provided to Medicare beneficiaries

Informs MACs about the changes to the CWF to bypass blood services editing on claims submitted by approved teaching hospitals for MA enrollees for IME payment (TOB 11x, PPS indicator Y, condition code 04 and condition code 69)

10/1/2017 MM9957 New Physician Specialty Code for Advanced Heart Failure and Transplant Cardiology, Medical Toxicology, and Hematopoietic Cell Transplantation and Cellular Therapy

Physicians and providers submitting claims to MACs for services to Medicare beneficiaries

Establishes new physician specialty codes for Advanced Heart Failure and Transplant Cardiology (C7), Medical Toxicology (C8), and Hematopoietic Cell Transplantation and Cellular Therapy (C9)

10/1/2017 MM9753 Update FISS Editing to Include the Admitting Diagnosis Code Field

Intended for providers submitting to MACs for services to Medicare beneficiaries

Informs MACs about changes to system edits by the maintainer of Medicare’s FISS

10/1/2017 MM9880 Implementing the Remittance Advice Messaging for the 20 Hour Weekly Minimum for Partial Hospitalization Program Services

OPPS providers submitting PHP claims to MACs for PHP services provided to Medicare beneficiaries

Implements informational messaging, effective 10/1/2017, that conveys supplemental and education information to the provider submitting claims for PHP services where the patient did not receive the minimum 20 hours per week of therapeutic services his plan of care indicates is required, on claims with LIDOS on or after 10/1/2017

10/1/2017 MM9989 Implementation of Modifier CG for Type of Bill 72x

Physicians, other providers, and suppliers submitting claims to MACs for dialysis services provided o Medicare beneficiaries

Informs MACs about the implementation of modifier CG for dialysis claim lines that do not meet the MAC’s medical justification requirements for dialysis treatments

10/1/2017 MM10040 Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP), and PC Print Update


Updates the RARC and CARC lists and also instructs ViPS Medicare System and FISS maintainers to update MREP and PC Print











Effective Date

Article Number


Description

10/1/2017 MM10041 Implement Operating Rules – Phase III Electronic Remittance Advice (ERA) Electronic Funds Transfer (EFT): CORE 360 Uniform Use of Claim Adjustment Reason Codes (RARC), Remittance Advice Remark Codes (RARC) and Claim Adjustment Group Code (CAGC) Rule – Update from Council for Affordable Quality Healthcare (CAQH) Committee on Operating Rules for Information Exchange (CORE)

Physicians, other providers, and suppliers who submit claims to MACs, including DME MACs and HH&H MACs, for services provided to Medicare beneficiaries

Instructs MACs and Medicare’s SSMs to update systems based on the CORE 360 Uniform Use of CARC, RARC and CAGC Rule publication


Physicians, providers and suppliers submitting claims to MACs for services provided to Medicare beneficiaries

Informs MACs about system changes to update, as needed, the Claim Status and Claim Status Category Codes used for the ASC X12 276/277 Health Care Claim Status Request and Response and ASC X12 277 Health Care Claim Acknowledgement transactions

10/1/2017 MM10086 ICD-10 Coding Revisions to National Coverage Determinations (NCDs)


A maintenance update of ICD-10 conversions and other coding updates specific to NCDs

10/1/2017 MM10128 Quarterly Update for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP) – October 2017

Providers and suppliers submitting claims to DME MACs for DMEPOS items or services paid under the DMEPOS fee schedule

Provides the October 2017 quarterly update for the Medicare DMEPOS fee schedule







Effective Date

Article Number


Description

10/1/2017 MM10118 Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Pricer Update FY 2018

SNFs submitting claims to MACs for services provided to Medicare beneficiaries paid under the SNF PPS

Informs MACs about the updates to the payment rates under the PPS for SNFs, for FY 2018, as required by statute

10/1/2017 MM10156 Changes to the Laboratory National Coverage Determination (NCD) Edit Software for October 2017


Informs MACs about the changes that will be included in the October 2017 quarterly release of the edit module for clinical diagnostic laboratory services

10/1/2017 MM10183 Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure to Procedure (PTP) Edits, Version 23.3, Effective October 1, 2017


Informs the MACs about the update to the NCCI PTP edits

10/1/2017 MM10187 October 2017 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files


Instructs MACs to download and implement the October 2017 and, if released, the revised July 2017, April 2017, and January 2017, and October 2016, ASP drug pricing files for Medicare Part B drugs via the CMS CDC


Informs MACs of CLIA waived tests approved by the FDA

10/1/2017 MM10163 October Quarterly Update to 2017 Annual Update of HCPCS Codes Used for SNF CB Enforcement

Providers who submit claims to MACs including DME MACs for services provided in a SNF to Medicare beneficiaries

Provides updates to the lists of HCPCS codes that are subject to the CB provision of the SNF PPS

10/1/2017 MM10214 Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) Fiscal Year (CY) 2018


Identifies changes that are required as part of the annual IPF PPS update from the FY 2018 IPF PPS Notice, displayed on 8/2/2017















Effective Date

Article Number


Description

10/1/2017 MM10193 Quarterly Update to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS)

ESRD facilities that submit claims to MACs for ESRD services provided to Medicare beneficiaries

Provides the 10/1/2017 update to the lists of items and services that are subject to Part B CB and are therefore no longer separately payable when provided to ESRD beneficiaries by providers other than ESRD facilities

10/1/2017 MM10131 Update to Hospice Payment Rates, Hospice Cap, Hospice Wage Index and Hospice Pricer for FY 2018

Physicians and providers submitting claims to MACs including HH&H MACs for services provided to Medicare beneficiaries

Updates the hospice payment rates, hospice wage index, and Pricer for FY 2018

10/1/2017 MM10141 Healthcare Provider Taxonomy Codes (HPTCs) October 2017 Code Set Update

Physicians, other providers, and suppliers submitting claims to MACs including HH&H MACs and DME MACs for services provided to Medicare beneficiaries

Instructs MACs to obtain the most recent HPTC set and to update their internal HPTC tables and/or reference files

10/1/2017 MM10230 October 2017 Integrated Outpatient Code Editor (I/OCE) Specifications Version 18.3

Physicians, providers, and suppliers billing MACs, including HH&H MACs for services provided to Medicare beneficiaries

Provides the I/OCE instructions and specifications that will be used under the OPPS and Non-OPPS for hospital outpatient departments, community mental health centers, all non-OPPS providers, and for limited services when provided in an HHA not under the Home Health PPS or to a hospice patient for the treatment of non-terminal illness

10/1/2017 MM10125 Inpatient Rehabilitation Facility (IRF) Annual Update: Prospective Payment System (PPS) PRICER Changes for FY 2018

IRFs submitting claims to MACs for services provided to Medicare beneficiaries

Notifies you that a new IRF PRICER software package will be released prior to 10/1/2017 that will contain the updated rates that are effective for claims and discharges that fall within 10/1/2017 through 9/30/2018

10/1/2017 MM10236 October 2017 Update of the Hospital Outpatient Prospective Payment System (OPPS)

Providers and suppliers that submit claims to MACs including HH&H MACs for services provided to Medicare beneficiaries and paid under the OPPS

Describes changes to the OPPS to be implemented in the July 2017 update










Effective Date

Article Number


Description

10/1/2017 MM10273 Fiscal Year (FY) 2018 Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) PPS Change

Hospitals that submit claims to MACs for inpatient hospital services provided to Medicare beneficiaries by short team acute care and LTCHs

Implements policy changes for the FY 2018 IPPS and LTCH PPS

10/1/2017 MM10248 October Quarterly Update for 2017 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule


Provides instructions regarding the October quarterly update for the 2017 DMEPOS and PEN fee schedules and the October 2017 DMEPOS Rural ZIP code file containing the Quarter 4, 2017 Rural ZIP code changes

10/1/2017 MM10309 Changes to the Laboratory National Coverage Determination (NCD) Edit Software for January 2018

Physicians, providers, and suppliers submitting claims to Medicare contractors (RHHIs and A/B MACs) for services to Medicare beneficiaries

Informs MACs about the changes that will be included in the January 2018 quarterly release of the edit module for clinical diagnostic laboratory services

10/1/2017 MM10343 IVIG Demonstration: Payment Update for 2018

Suppliers billing DME MACs for IVIG service provided to Medicare beneficiaries under the IVIG Demonstration

Specifies the payment rate for 2018 and allows for continued payments from 10/1/2017-12/31/2017 at the current 2017 payment rate

10/1/2017 MM10377 Off-Cycle Update to the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Fiscal Year (FY) 2018 Pricer

Freestanding SNFs, SNFs affiliated with acute care facilities and all non-CAH swing-bed rural hospitals submitting claims to MACs for services provided to Medicare beneficiaries

Adds logic into the SNF PPS Pricer to apply QRP payment reduction for FY 2018 for those facilities that do not submit require quality data


https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10248-.pdf

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10248-.pdf








Effective Date

Article Number


Description

10/1/2017 MM10424 Changes to the Laboratory National Coverage Determination (NCD) Edit Software for April 2018


Informs MACs about the changes that will be included in the April 2018 quarterly release of the edit module for clinical diagnostic laboratory services

Claims MM9672 Update FISS Editing Providers Informs MACs about changes that update received to Include All Three submitting logic in the FISS (Medicare’s system for on or after Patient Reason for outpatient hospital processing institutional claims) to allow 10/1/2017 Visit Code Fields claims to MACs

for services to Medicare beneficiary

editing of the expanded Patient Reason for Visit (PRV) fields

For claims MM9911 Qualified Medicare Physicians, Modifies the Medicare claims processing processed Beneficiary providers, and systems to help providers more readily on or after Indicator in the suppliers identify the QMB status of each patient 10/2/2017 Medicare Fee-For-

Service Claims Processing System

submitting claims to MACs including Home Health & Hospice MACs and DME MACs for services provided to Medicare beneficiaries

and to support providers’ ability to follow QMB billing requirements

10/23/2017 MM10240 Calculating Interim Rates for Graduate Medical Education (GME) Payments to New Teaching Hospitals

Teaching hospitals billing MACs for services provided to Medicare beneficiaries

Provides instructions to the MACs on calculating interim rates for GME payments to new teaching hospitals








November 2017 CALENDAR OF MEDICARE PROCESSING and BILLING CHANGES

Effective Date

Article Number


Description

11/6/2017 MM10095 Provider-Based Determination

Providers submitting institutional claims to MACs for services provided to Medicare beneficiaries

Advises MACs to use a uniform electronic Provider-Based (PB) checklist to perform uniform review of PB applications



January 2018 CALENDAR OF MEDICARE PROCESSING and BILLING CHANGES

Effective Date Article Number

Article Title Providers Affected Description

1/1/2018 MM10323 Ambulance Inflation Factor for CY 2018 and Productivity Adjustment

Ambulance providers and suppliers submitting claims to MACs for Medicare Part B ambulance services provided to Medicare beneficiaries

Furnishes the Calendar Year (CY) 2018 Ambulance Inflation Factor (AIF) for determining the payment limit for ambulance services. The AIF for CY 2018 is 1.1 percent

1/1/2018 MM9837 FISS Implementation of the Restructured Clinical Lab Fee Schedule

Clinical laboratory providers submitting claims to MACs for services paid under the CLFS

Informs MACs about the changes to the FISS to incorporate the revised CLFS containing the National fee schedule rates

1/1/2018 MM10057 MCS Implementation of the Restructured Clinical Laboratory Fee Schedule

Clinical laboratories and other providers submitting claims to MACs for clinical laboratory services provided to Medicare beneficiaries

Instructs Medicare’s MCS maintainer to incorporate into the shared system, the revised CLFS containing the National fee schedule rates

1/1/2018 MM10145 Correcting Payment of Inpatient Prospective Payment System (IPPS) Transfer Claims Assigned to Medicare Severity-Diagnosis Related Group (MS DRG) 385

Inpatient hospitals submitting transfer claims assigned to MS DRG 385 to MACs for services provided to Medicare beneficiaries

Informs the MACs about a correction to Medicare’s FISS assignment of review code for IPPS transfer claims assigned MS-DRG 385, so that the IPPS Pricer will calculate the per diem transfer payment

1/1/2018 MM10098 Common Working File (CWF) to Modify CWF Provider Queries to Only Accept National Provider Identifier (NPI) as Valid Provider Number

Physicians, providers, and suppliers querying Medicare’s CWF for checking eligibility and entitlement status for Medicare beneficiaries

Informs the MACs about modifications CWF Provider Queries, ELGA, ELGH, HIQA, HIQH, and HUQA, to only accept the NPI as a valid Provider Number

1/1/2018 MM10176 Updated Editing of Always Therapy Services – MCS

Therapists, physicians, and certain other practitioners billing MACs for therapy services provided to Medicare beneficiaries

Implements revised editing of Part B “Always Therapy” services to require the appropriate therapy modifier in order for the service to be accurately applied to the therapy cap

1/1/2018 MM10167 Revisions to the Home Health Pricer to Support Value-Based Purchasing and Payment Standardization

HHA providers who submit claims to MACs for services provided to Medicare beneficiaries

Revises Medicare’s Home Health Pricer to implement value-based purchasing (in nine states) and payment standardization

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10323.pdf












1/1/2018 MM10151 Suppression of the Standard Paper Remittance Advice (SPR) in 45 Days if Also Receiving Electronic Remittance Advice (ERA)


Provides notice that beginning 1/2/2018, Medicare’s SSMs must eliminate issuance of SPRs to those providers/suppliers (or a billing agent, clearinghouse, or other entity representing those providers/suppliers) who also have been receiving ERA transactions for 45 days or more

1/1/2018 MM10184 ICD-10 Coding Revisions to National Coverage Determinations (NCDs)

Intended for physicians and other providers submitting claims to MACs for services provided to Medicare beneficiaries

Outlines edits to ICD-10 and other coding updates specific to NCDs that will be included in subsequent, quarterly releases as needed

1/1/2018 MM10044 Next Generation Accountable Care Organization (NGACO) Year Three Benefit Enhancements

Providers who are participating in NGACOs and submitting claims to MACs for services provided to Medicare beneficiaries

Provides instruction to MACs to implement two new benefit enhancements for performance year three (calendar year 2018) of the NGACO Model

1/1/2018 MM10065 Implementation of the Transition Drug Add-On Payment Adjustment for ESRD Drugs

ESRD facilities submitting claims to MACs for certain ESRD drugs provided to Medicare beneficiaries

Directs the MACs to implement the Transition Drug Add-On Payment Adjustment



Updates, as needed, the Claim Status and Claim Status Category Codes used for the ASC X12 276/277, Health Care Claim Status Request and Response and ASC X12 277 Health Care Claim Acknowledgment transactions














1/1/2018 MM10140 Implement Operating Rules – Phase III Electronic Remittance Advice (ERA) Electronic Funds Transfer (EFT): CORE 360 Uniform Use of Claim Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC) and Claim Adjustment Group Code (CAGC) Rule – Update from Council for Affordable Quality Healthcare (CAQH) Committee on Operating Rules for Information Exchange (CORE)

Physicians, providers, and suppliers submitting claims to MACs including DME MACs and HH&H MACs for services provided to Medicare beneficiaries

Instructs MACs and Medicare’s SSMs to update systems based on the CORE 360 Uniform Use of CARC, RARC and CAGC Rule publication

1/1/2018 MM10262 2018 Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Update

Physicians, other providers, and suppliers submitting claims to MACs, including HH&H MACs and DME MACs for services provided to Medicare beneficiaries who are in a Part A SNF stay

Makes changes to HCPCS codes and Medicare Physician Fee Schedule designations that will be used to revise CWF edits to allow A/B MACs to make appropriate payments in accordance with policy for SNF CB in Chapter 6, Section 110.4.1 and Chapter 6, Section 20.6 in the “Medicare Claims Processing Manual”

1/1/2018 MM10254 Annual Clotting Factor Furnishing Fee Update 2018

Physicians, providers, and suppliers submitting claims to MACs for services related to the administration of clotting factors provided to Medicare beneficiaries

Announces the clotting factor furnishing fee for 2018 is $0.215 per unit

1/1/2018 MM10233 Quarterly Update for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP) - January 2018


Provides the January 2018 quarterly update for the Medicare DMEPOS fee schedule









1/1/2018 MM10317 2018 Annual Update for the Health Professional Shortage Area (HPSA) Bonus Payment

Physicians submitting claims to MACs for services provided in HPSAs to Medicare beneficiaries

Alerts you that CMS will make the annual HPSA bonus payment file for 2018 available to your MAC to use for HPSA bonus payments on applicable claims with dates of service on or after 1/1/2018 through 12/31/2018

1/1/2018 MM10306 Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure to Procedure (PTP) Edits, Version 24.0, Effective January 1, 2018


Informs the MACs about the update to the NCCI PTP edits

1/1/2018 MM10320 January 2018 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files

Physicians, providers, and suppliers submitting claims to MACs for Medicare Part B drugs provided to Medicare beneficiaries

Instructs MACs to download and implement the January 2018 and, if released, the revised October 2017, July 2017, April 2017, and January 2017, ASP drug pricing files for Medicare Part B drugs via the CMS CDC

1/1/2018 MM10312 Implementation of Changes in the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Payment for Dialysis Furnished for Acute Kidney Injury (AKI) in ESRD Facilities for Calendar Year (CY) 2018

ESRD facilities that submit claims to MACs for renal dialysis services provided to Medicare beneficiaries

Implements the CY 2018 rate updates for the ESRD PPS and updates the payment for renal dialysis services furnished to beneficiaries with AKI in ESRD facilities



1/1/2018 MM10098 Common Working File (CWF) to Modify CWF Provider Queries to Only Accept National Provider Identifier (NPI) as Valid Provider Number

Physicians, provider, and suppliers querying Medicare’s CWF for checking eligibility and entitlement status for Medicare beneficiaries

Informs the MACs about modifications to the CWF Provider Queries, ELGA, ELGH, HIQA, HIQH, and HUQA, to only accept the NPI as a valid Provider Number















1/1/2018 MM10310 Home Health Prospective Payment System (HH PPS) Rate Update for Calendar Year (CY) 2018

HHAs billing MACs for services provided to Medicare beneficiaries

Updates the 60-day national episode rates, the national per-visit amounts, LUPA add-on amounts, the non-routine medical supply payment amounts, and the cost-per-unit payment amounts used for calculating outlier payments under the HH PPS for CY 2018

1/1/2018 MM10175 Care Coordination Services and Payment for Rural Health Clinics (RHCs) and Federally-Qualified Health Centers (FQHCs)

RHCs and FQHCs submitting claims to MACs for services provided to Medicare beneficiaries

Provides instructions for payment to RHCs billing under the AIR and FQHCs billing under the PPS for care coordination services for dates of service on or after 1/1/2018

1/1/2018 MM10341 Therapy Cap Values for Calendar Year (CY) 2018

Physicians, therapists, and other providers submitting claims to MACs, including HH&H MACs for outpatient therapy services provided to Medicare beneficiaries

Provides the amounts for outpatient therapy caps for CY 2018

1/1/2018 MM10333 Update to Rural Health Clinic (RHC) All Inclusive Rate (AIR) Payment Limit for Calendar Year (CY) 2018

RHCs billing MACs for services provided to Medicare beneficiaries

The RHC payment limit per visit for CY 2018 is $83.45 effective 1/1/2018 through 12/31/2018

1/1/2018 MM10308 Annual Update of HCPCS Codes Used for Home Health Consolidated Billing Enforcement

HHAs and other providers submitting claims to MACs for services to Medicare beneficiaries in home health period of coverage

Provides the 2018 annual update to the list of HCPCS codes used by Medicare systems to enforce consolidated billing of home health services

1/1/2018 MM10334 Update to the Federally Qualified Health Center (FQHC) Prospective Payment System (PPS) for Calendar Year (CY) 2018 – Recurring File Update

FQHCs billing MACs for services provided to Medicare beneficiaries

Informs MACs of changes that will apply to FQHC claims effective 1/1/2018











1/1/2018 MM10303 2018 Annual Update to the Therapy Code List

Physicians, therapists, and other providers, including CORFs submitting claims to MACs including HH&H MACs for outpatient therapy services provided to Medicare beneficiaries

Updates the list of codes that sometimes or always describe therapy services and their associate policies

1/1/2018 MM10319 New Positron Emission Tomography (PET) Radiopharmaceutical/ Tracer Unclassified Codes


Explains the update to the two temporary Pet HCPCS codes effective 1/1/2017

1/1/2018 MM10181 Replacement of Mammography HCPCS Codes, Waiver of Coinsurance and Deductible for Preventive and Other Services, and Addition of Anesthesia and Prolonged Preventive Services

Providers submitting claims to Part A & B MACs for services furnished to Medicare beneficiaries

Provides for the replacement of HCPCS codes G0202, G0204, and G0206 with CPT codes 77067, 77066, and 77065, effective 1/1/2018

1/1/2018 MM10188 Payment Reduction for X-Rays Taken Using Computed Radiography

Physicians and other providers submitting claims to MACs for computed radiography services provided to Medicare beneficiaries

Announces that beginning 1/1/2018 and including CY 2018-CY 2022, a payment reduction of 7 percent applies to the technical component (and the technical component of the global fee) for computed radiography services that would otherwise be made under the PFS (without application of subparagraph (B)(i) and before application of any other adjustment), or under the hospital OPPS

1/1/2018 MM10152 Elimination of the GT Modifier for Telehealth Services

Providers who submit claims to MACs for telehealth services provided to Medicare beneficiaries

Eliminates the requirement to use the GT modifier (via interactive audio and video telecommunications systems) on professional claims for telehealth services











1/1/2018 MM10409 Calendar Year (CY) 2018 Annual Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment

Clinical diagnostic laboratories that submit claims to MACs for services provided to Medicare beneficiaries

Provides instructions for the CY 2018 clinical laboratory fee schedule, mapping for new codes for clinical laboratory tests and updates for laboratory costs subject to the reasonable charge payment

1/1/2018 MM10448 Clinical Laboratory Fee Schedule - Medicare Travel Allowance Fees for Collection of Specimens

Clinical diagnostic laboratories submitting claims to MACs for services provided to Medicare beneficiaries

Revises the payment of travel allowances when billed on a per mileage basis using HCPCS code P9603 and when billed on a flat-rate basis using HCPCS code P0604 for CY 2018

1/1/2018 MM10395 Calendar Year (CY) 2018 Update for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule

Providers and suppliers submitting claims to MACs for DMEPOS items provided to Medicare beneficiaries and paid under the DMEPOS fee schedule

Provides the CY 2018 annual update for the Medicare DMEPOS fee schedule

1/1/2018 MM10441 January 2018 Update of the Ambulatory Surgical center (ASC) Payment System

ASCs billing MACs for services provided to Medicare beneficiaries

Informs MACs about updates to the ASC payment system for January 2018

1/1/2018 MM10416 2018 Durable Medical Equipment Prosthetics, Orthotics, and Supplies Healthcare Common Procedure Coding System (HCPCS) Code Jurisdiction List

Providers and suppliers submitting claims to MACs including DME MACs for DMEPOS items or services paid under the DMEPOS fee schedule

Updates the list of HCPCS codes for the MACs and DME MACs

1/1/2018 MM10446 Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) Edits

Clinical Laboratories submitting claims to MACs or for laboratory services provided to Medicare beneficiaries

Informs providers and MACs about the new HCPCS codes for 2018 that are subject to and excluded from CLIA edits
















1/1/2018 MM10405 Update to Medicare Deductible, Coinsurance and Premium Rates for 2018

Physicians, providers, and suppliers submitting claims to MACs, including HH&H MACs and DME MACs for services to Medicare beneficiaries

Provides instruction for MACs to update the claims processing system with the new CY 2018 Medicare deductible, coinsurance, and premium rates

1/1/2018 MM10448 Clinical Laboratory Fee Schedule - Medicare Travel Allowance Fees for Collection of Specimens

Clinical diagnostic laboratories submitting claims to MACs for services to Medicare beneficiaries

Revises the payment of travel allowances when billed on a per mileage basis using HCPCS code P9603 and when billed on a flat-rate basis using HCPCS code P9604 for CY 2018

1/1/2018 MM10412 E/M Service Documentation Provided By Students (Manual Update)

Teaching physicians billing MACs for services provided to Medicare beneficiaries

Revises the Medicare Claims Processing Manual to allow the teaching physician to verify in the medical record any student documentation of components of E/M services, rather than re-documenting the work

1/1/2018 MM10488 Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2018 Update


Amends payment files issued to MACs based upon the calendar year 2018 MPFS Final Rule

1/1/2018 MM10531 Claims Processing Actions to Implement Certain Provisions of the Bipartisan Budget Act of 2018


Provides direction to MACs to reprocess claims related to several provisions of the Bipartisan Budget Act of 2018, referred to as Medicare Extenders

1/1/2018, for MM10445 Quarterly Update for Clinical diagnostic Informs the MACs about the new HCPCS Clinical Laboratory laboratories submitting changes in the April 2018 codes, Fee Schedule and claims to MACs for quarterly update to the CLFS otherwise Laboratory Services services provided to 4/1/2018 Subject to

Reasonable Charge Payment

Medicare beneficiaries

1/2/2018 MM10378 Fiscal Year (FY) 2014 and 2015 Worksheet S-10 Revisions: Further Extension for All Inpatient Prospective Payment System (IPPS) Hospitals

IPPS hospitals billing MACs for services provided to Medicare beneficiaries

Clarifies deadlines for uploading revised or initial Worksheet S-10 submissions to the HCRIS for FY 2014 or FY2015 cost reports that have not been final settled
















1/16/2018 MM10232 Clinical Laboratory Fee Schedule Not Otherwise Classified, Not Otherwise Specified or Unlisted Service or Procedure Code Data Collection


Instructs MACs to assure that providers submit private payor data or unique tests currently being paid as NOC cod, NOS code, or Unlisted Service or Procedure code



February 2018 CALENDAR OF MEDICARE PROCESSING and BILLING CHANGES



2/15/2018 MM10350 Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Medicare Benefit Policy Manual Chapter 13 Update

RHCs and FQHCs billing MACs for services provided to Medicare beneficiaries

Notifies RHCs and FQHCs of updates to Chapter 13 of the Medicare Benefit Policy Manual (Pub. 100-02)


March 2018 CALENDAR OF MEDICARE PROCESSING and BILLING CHANGES



3/23/2018 MM10355 Form CMS-855O Processing Guide

Eligible ordering, certified physicians, and other eligible professionals who order or certify items or services for Medicare beneficiaries

Adds a supplementary guide that educations physicians and other eligible professionals on the preparation and submission of form CMS-855O to the Medicare Program Integrity Manual





4/1/2018 MM10281 Transitional Drug Add-on Payment Adjustment (TDAPA) for Patients with Acute Kidney Injury (AKI)

Dialysis facilities submitting claims to MACs provided to Medicare beneficiaries with Acute Kidney Injury (AKI)

Updates the AKI payment policy regarding Transitional Drug Add-on Payment Adjustments (TDAPA)

4/1/2018 MM10238 Correction to Prevent Payment on Inpatient Information Only Claims for Beneficiaries Enrolled in Medicare Advantage Plans

Hospitals billing MACs for inpatient services provided to Medicare beneficiaries enrolled in a MA plan

Instructs MACs to allow the Common Working File (CWF) to set edit 5233 on inpatient information only claims billed with condition codes 04 and 30 for Investigational Device Exemption (IDE) Studies and Clinical Studies Approved Under Coverage with Evidence Development (CED), which will in turn allow the FISS to zero out payment

4/1/2018 MM10124 Revision of PWK (Paperwork) Fax/Mail Cover Sheets

Physicians, providers, and suppliers who submit claims to MACs, including DME MACs and HH&H MACs, for services provided to Medicare beneficiaries

Alerts providers that their MAC will provide revised fax/mail cover sheets via hardcopy and/or electronic download

4/1/2018 MM10270 Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP), and PC Print Update


Updates the RARC and CARC lists and instructs SSMs to update MREP and PC Print

4/1/2018 MM10271 Claim Status Category Codes and Claim Status Codes Update


Informs MACs about system changes to update, as needed, the Claim Status Codes and Claim Status Category Codes used for the ASC X12 276/277 Health Care Claim Status Request and Response and ASC X12 277 Health Care Claim Acknowledgment transactions









4/1/2018 MM10268 Implement Operating Rules - Phase III Electronic Remittance Advice (ERA) Electronic Funds Transfer (EFT): CORE 360 Uniform Use of Claim Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC), and Claim Adjustment Group Code (CAGC) Rule - Update from Council for Affordable Quality Healthcare (CAQH) Committee on Operating Rules for Information Exchange (CORE)

Physicians, providers, and suppliers submitting claims to MACs, including DME MACs and HH&H MACs for services provided to Medicare beneficiaries

Instructs MACs and SSMs to update systems based on the CORE 360 Uniform Use of CARC, RARC, and CAGC Rule publication

4/1/2018 MM10374 Quarterly Update of HCPCS Codes Used for Home Health Consolidated Billing Enforcement

HHAs and other providers submitting claims to MACs for home health services provided to Medicare beneficiaries

Provides the quarterly update of HCPCS codes used for HH consolidated billing effective 4/1/2018

4/1/2018 MM10447 April 2018 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files

Physicians, providers, and suppliers submitting claims to MACs for Medicare Part B drugs provided to Medicare beneficiaries

Instructs MACs to download and implement the April 2018 and, if released, the revised January 2018, October 2017, July 2017, and April 2017 ASP drug pricing files for Medicare Part B drugs via the CMS CDC

4/1/2018 MM10418 New Waived Tests Intended for clinical diagnostic laboratories submitting claims to MACs for services provided to Medicare beneficiaries


4/1/2018 MM10436 New “K” Code for Therapeutic Shoe Inserts


Establishes a “K” code (K0903) for a new type of therapeutic shoe inserts












4/1/2018 MM10454 Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - April 2018 Update


Informs MACs of the April 2018 updates of specific biosimilar biological product HCPCS code, modifiers used with these biosimilar biologic products and an autologous cellular immunotherapy treatment

4/1/2018 MM10472 Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 24.1, Effective April 1, 2018


Includes the normal update to the NCCI PTP edits

4/1/2018 MM10480 Update to the Federally Qualified Health Center (FQHC) Prospective Payment System (PPS) for Calendar Year (CY) 2018 – Recurring File Update

FQHCs billing MACs for services provided to Medicare beneficiaries

Updates the FQHC PPS grandfathered tribal FQHC base payment rate in the FQHC Pricer

4/1/2018 MM10158 Revised and New Modifiers for Oxygen Flow Rate


Revises and introduces new pricing modifiers for oxygen flow rate

4/1/2018 MM10514 April 2018 Integrated Outpatient Code Editor (I/OCE) Specifications Version 19.1

Physicians, providers and suppliers billing MACs, including HH&H MACs, for services provided to Medicare beneficiaries

Provides the I/OCE instructions and specifications for the I/OCE that will be used in the OPPS and non-OPPS for hospital inpatient departments

4/1/2018 MM10515 April 2018 Update of the Hospital Outpatient Prospective Payment System (OPPS)

Providers and suppliers submitting claims to MACs, including HH&H MACs, for services provided to Medicare beneficiaries and paid under the OPPS

Describes changes to the OPPS to be implemented in the April 2018 update

4/1/2018 MM10530 April 2018 Update of the Ambulatory Surgical Center (ASC) Payment System

ASCs billing MACs for services provided to Medicare beneficiaries

Informs MACs about updates to the ASC payment system for January 2018















4/1/2018 MM10503 April Quarterly Update for 2018 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule


Provides the April 2018 Medicare DMEPOS fee schedule quarterly update

4/1/2018 – MM10318 ICD-10 and Other Physicians and other Constitutes a maintenance Unless Coding Revisions to providers submitting update of ICD-10 conversions otherwise noted National Coverage claims to MACs for and other coding updates in CR10318 Determinations

(NCDs) services provided to Medicare beneficiaries

specific to NCDs

4/16/2018 MM10527 The Supplemental Security Income (SSI)/Medicare Beneficiary Data for Fiscal Year 2016 for Inpatient Prospective Payment System (IPPS) Hospitals, Inpatient Rehabilitation Facilities (IRFs), and Long Term Care Hospitals (LTCH)

Providers billing MACs for services provided to Medicare beneficiaries

Informs MACs about updated data for determining the disproportionate share adjustment for IPPS hospitals and the low-income patient adjustment for IRFs, as well as payments, as applicable, for LTCH discharges (for example, discharges paid the IPPS comparable amount under the short-stay outlier payment adjustment)

4/30/2018 MM10567 Skilled Nursing Facility Advantage Beneficiary Notice of Non-Coverage (SNF ABN)

SNFs billing MACs for services provided to Medicare beneficiaries

Advises you that CMS has revised the SNF ABN, Form CMS-10055






June 2018 CALENDAR OF MEDICARE PROCESSING and BILLING CHANGES



6/19/2018 MM10512 Internet Only Manual Updates to Pub. 100-01, 100-02 and 100-04 to Correct Errors and Omissions (SNF) (2018)

Physicians, other providers, and suppliers submitting claims to MACs for services to Medicare beneficiaries

Informs MACs about an update to the Medicare manuals to correct various minor technical errors and omissions





7/1/2018 MM10372 Ensuring Correct Processing of Home Health Disaster Related Claims and Claims for Denial

Home Health Agencies submitting claims to MACs for services provided to Medicare beneficiaries

Informs MACs about revisions to the edit that matches claims and assessments, creating a bypass when condition code DR is reported on the claim

7/1/2018 MM10425 Global Surgical Days for Critical Access Hospital (CAH) Method II

CAH Method II providers submitting claims to A/B MACs for services provided to Medicare beneficiaries

Discusses the global surgical days for Method II CAH providers

7/1/2018 MM10433 Reinstating the Qualified Medicare Beneficiary Indicator in the Medicare Fee-For-Service Claims Processing System from CR9911

Providers and suppliers who submit claims to Part A/B MACs

CMS will reintroduce QMB information in the Medicare RA and MSN

7/1/2018 MM10474 Diagnosis Code Update for Add-on Payments for Blood Clotting Factor Administered to Hemophilia Inpatients

Providers who submit claims to MACs for inpatient services to Medicare beneficiaries with hemophilia

Provides updates to diagnosis codes required in order to allow add-on payments under the IPPS for blood clotting factor administered to hemophilia inpatients

7/1/2018 MM10402 Healthcare Provider Taxonomy Codes (HPTCs) April 2018 Code Set Update


Directs MACs to obtain the most recent HPTCs code set and use it to update their internal HPTC tables and/or reference files

7/1/2018 MM10397 Modifications to the Implementation of the Paperwork (PWK) Segment of the Electronic Submission of Medical Documentation (esMD) System

Physicians, suppliers, and providers submitting electronic medical documentation to MACs for services provided to Medicare beneficiaries

Updates the business requirements to enable MACs to receive unsolicited documentation (PWK) via the esMD system



Updates the RARC and CARC lists and instructs SSMs to update MREP and PC Print

7/1/2018 MM10473 ICD-10 and Other Coding Revisions to National Coverage Determinations (NCDs)

Physicians and other providers submitting claims to MACs for services provided to Medicare beneficiaries

Constitutes a maintenance update of the ICD-10 conversions and other coding updates specific to NCDs


















7/1/2018 MM10481 Appropriate Use Criteria for Advanced Diagnostic Imaging – Voluntary Participation and Reporting Period – Claims Processing Requirements – HCPCS Modifier QQ

Physicians, facilities, and other practitioners billing Part B services to MACs for advanced diagnostic imaging provided to Medicare beneficiaries

Informs the MACs of the appropriate HCPCS modifier (QQ) that may be reported on the same claim line as the CPT code for an advanced diagnostic imaging service that is furnished in an applicable setting and paid for under the applicable payment system



7/1/2018 MM10593 Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 24.2 Effective July 1, 2018


Includes the normal update to the NCCI PTP edits

7/1/2018 MM10624 Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes – July 2018 Update

Physicians, providers and suppliers billing Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries

Informs MACs of updated drug/biological HCPCS codes

7/2/2018 MM10426 Implementation of Automating First Claim Review in Serial Claims for DMEPOS

Providers and suppliers who submit claims to DME MACs for DMEPOS service provided to Medicare beneficiaries

Alerts providers of a system solution initiative intended to reduce provider burden, MAC burden and appeals by increasing the consistency of medical review decisions when the same item/supply is provided to the same beneficiary on a recurring basis

7/16/2018 MM10550 Ambulance Transportation for a SNF Resident in a Stay Not Covered by Part A - Medicare Benefit Policy Manual, Chapter 10, and Medicare Claims Processing Manual, Chapter 15

SNF, ambulance providers and suppliers providing ambulance services to patients and billing MACs for services provided to Medicare beneficiaries who are not in a covered Part A stay

Provides clarification on coverage of an ambulance transport for a SNF resident in a stay not covered by Part A, who has Part B benefits, to the nearest supplier of medically necessary services not available at the SNF, including the return trip












September 2018 CALENDAR OF MEDICARE PROCESSING and BILLING CHANGES



9/20/2018 for Part A and DME MAC claims, 12/20/2018 for Part B MAC claims

MM10494 Adjustments to Qualified Medicare Beneficiary (QMB) Claims Processed Under CR 9911

Providers and suppliers submitting claims to MACs, including HH&H MACs and DME MACs, for services provided to Qualified Medicare Beneficiaries

Directs MACs to mass adjust QMB claims impacted by CR9911



Effective Date

Article Number


10/1/2018 MM10457 New Physician Specialty Code for Medical Genetics and Genomics

Physicians, other providers, and suppliers submitting claims to Medicare Administrative Contractors (MACs) for services to Medicare beneficiaries

Informs MACs that CMS has established a new physician specialty code for Medical Genetics and Genomics ( D3)

10/1/2018 MM10583 Revisions to the Telehealth Billing Requirements for Distant Site Services

Providers who submit claims to Medicare Administrative Contractors (MACs) for telehealth services provided to Medicare beneficiaries

Implements requirements for billing modifier GT for Telehealth Distant Site Services. As of January 1, 2018, the GT modifier is only allowed on institutional claims billed by a Critical Access Hospital (CAH) Method II

10/1/2018 MM10565 Processing Instructions to Update the Identification Code Qualifier Being Used in the NM108 Data Element at the 2100 Loop, NM1- Patient Name Segment in the 835 Guide

Physicians, providers and suppliers billing Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries

Provides instructions to the MACs to update the Identification Code Qualifier in Data Element NM108 currently being used in the 2100 Loop, NM1- Patient Name Segment of the 835 guide

10/1/2018 MM10422 Removal of KH Modifier from Capped Rental Items

Suppliers that submit claims to Durable Medical Equipment (DME) Medicare Administrative Contractors (MACs) for capped rental DME or parenteral/enteral items and services provided to Medicare beneficiaries

Suppliers no longer need to append the KH rental modifier on purchased capped rental durable medical equipment or parenteral/enteral items and services






Effective Date

Article Number


10/1/2018 MM10314 Comprehensive ESRD Care (CEC) Model Telehealth -Implementation

Physicians, providers, and suppliers billing Medicare Administrative Contractors (MACs) and participating in the Comprehensive ESRD Care (CEC) Model for telehealth services provided to Medicare End-Stage Renal Disease (ESRD) beneficiaries associated with the CEC Model

Details the CEC Model telehealth program

10/1/2018 MM10573 Enhancements to Processing of Hospice Routine Home Care Payments

Providers billing Medicare Administrative Contractors (MACs) for hospice services provided to Medicare beneficiaries

Creates new fields on the hospice Pricer output to display the number of days paid at the high, and at the low, Routine Home Care rates. It also instructs the maintainer of the Fiscal Intermediary Shared System (FISS) to create an output record to match the updates to the hospice Pricer output, and for the Common Working File (CWF), to store with FISS the number of prior days retained for the life of the claim.

10/1/2018 MM10604 Inexpensive or Routinely Purchased Durable Medical Equipment (DME) Payment Classification for Speech Generating Devices (SGD) and Accessories

Suppliers of Durable Medical Equipment, Prosthetics, Orthotics and Suppliers (DMEPOS) submitting claims to Medicare Administrative Contractors (MACs) for speech generating devices (SGDs) and accessories provided to Medicare beneficiaries

Ensures that the use of SGDs and accessories continue to be classified under the inexpensive or routinely purchased DME payment category




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CALENDAR OF ARTICLES - Home - Centers for Medicare ... · PDF fileThe calendar represents 12 months ... Chapter 3, Section 90 (Provider ... Rural Health Clinic and Federally Qualified