Medicare Part B Newsline March 2012 - Cahaba GBA

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Advanced Diagnostic Imaging (ADI)Remember: Beginning Sunday, January 1, 2012, suppliers who furnish the Technical Component (TC) ofAdvanced Diagnostic Imaging (ADI) must be accredited to bill Medicare for certain services. MRI, CT,nuclear medicine imaging, and positron emission tomography. X-ray, ultrasound, fluoroscopy, and hospitaloutpatient procedures are excluded. For Dates of Service on or after Sunday, January 1, 2012, MedicareAdministrative Contractors (MACs) will deny claims for the Technical Component of ADI that aresubmitted under the Physician Fee Schedule by suppliers who have not yet been accredited. For moreinformation, please refer to the Advanced Diagnostic Imaging Accreditation web page and MLN Matters®Special Edition Article #SE1122.Medicare B Newsline March 2012 34
News from CMS For Part B ProvidersHealthcare Provider Taxonomy Codes (HPTC) Update April 2012BackgroundThe Healthcare Provider Taxonomy Code (HPTC) set is maintained by the National Uniform ClaimCommittee (NUCC) for standardized classification of health care providers. The NUCC updates the code settwice a year with changes effective April 1 and October 1. The HPTC list is available for view or fordownload from the Washington Publishing Company (WPC) Web site at www.wpc-edi.com/codes.The changes to the code set include the addition of a new code and addition of definitions to existing codes.When reviewing the Health Care Provider Taxonomy code set online, revisions made since the last releasecan be identified by the color code; new items are green, modified items are orange, and inactive items arered.PolicyHealth Insurance Portability and Accountability Act (HIPAA) requires that covered entities comply with therequirements in the electronic transaction format implementation guides adopted as national standards. Theinstitutional and professional claim electronic standard implementation guides (X12 837-I and 837-P) eachrequire use of valid codes contained in the HPTC set when there is a need to report provider type orphysician, practitioner, or supplier specialty for a claim. Valid HPTCs are those codes approved by theNUCC for current use. Terminated codes are not approved for use after a specific date and newly approvedcodes are not approved for use prior to the effective date of the code set update in which each new code firstappears. Although the NUCC generally posts their updates on the WPC Web page 3 months prior to theeffective date, changes are not effective until April 1 or October 1 as indicated in each update. Specialtyand/or provider type codes issued by any entity other than the NUCC are not valid, and Medicare would beguilty of non-compliance with HIPAA if Medicare contractors accepted claims that contain invalid HPTCs.Change Request (CR) 7742Medicare B Newsline March 2012 35
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Page 4 and 5: Holiday Closure Schedule-2012Cahaba
Page 6 and 7: Using the Interactive Voice Respons
Page 8 and 9: Cahaba’s E-mail Notification Serv
Page 10 and 11: Alabama Medicare Part BTop Five Rea
Page 12 and 13: Mississippi Medicare Part BTop Five
Page 14 and 15: Alabama Medicare Part BTop Ten EDI
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Page 20 and 21: Mississippi Medicare Part BTop Ten
Page 22 and 23: Provider Identifier(NPI).X222.403.2
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Page 26 and 27: LCD - Pathology and Laboratory: Syp
Page 28 and 29: Claim Specific CERT Errors- January
Page 30 and 31: inpatient and outpatient hospital p
Page 32 and 33: HHS Announces Intent to Delay ICD-1
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Page 38 and 39: Screening for syphilis:Pregnant wom
Page 40 and 41: G0445 on institutional claims in ho
Page 42 and 43: Revised and Clarified Place of Serv
Page 44 and 45: Inpatient Psychiatric Facility (POS
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Page 50 and 51: If your specialty type is not one o
Page 52 and 53: Claim Adjustment Reason Code (CARC)
Page 54 and 55: Change Request (CR) 7681 establishe
Page 56 and 57: 5. Providers can terminate the imme
Page 58 and 59: 83718QW, 84450QW,84460QW, 84478QW82
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Page 62 and 63: April 2012 Quarterly Average Sales
Page 64 and 65: Emergency Update to the CY 2012 Med
Page 66 and 67: The therapy caps are determined on
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Medicare Part B Newsline March 2012 - Cahaba GBA

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