Medicare Part B Newsline March 2012 - Cahaba GBA

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5. Providers can terminate the immediate recoupment process at anytime. The request to terminatemust be in writing.Providers should note that Medicare contractors will not consider any recoupment after QualifiedIndependent Contractor (QIC) proceedings (30 days after a QIC decision) as voluntary payments. Medicarecontractors will follow the rules proscribed by Section 935 of the MMA for all recoupment activity after aQIC decision. These rules are explained in Chapter 3, Section 200 of the “Medicare Financial ManagementManual” that is available at http://www.cms.gov/manuals/downloads/fin106c03.pdf on the Centers forMedicare & Medicaid Services (CMS) website.You may further review all of the specifics of this change along with the applicable manual section changesby reading the official instruction for CR7688 issued to your Medicare contractor. The web address forCR7688 is listed in the ‘Additional Information’ section of this article.Additional InformationThe official instruction, CR7688, issued to your Medicare contractor regarding this change may be viewedat http://www.cms.gov/Transmittals/downloads/R205FM.pdf on the Centers for Medicare & MedicaidServices (CMS) website.MLN Matters® MM7688Medicare B Newsline March 2012 56
New Waived TestsProvider Types AffectedThis MLN Matters® Article is intended for clinical laboratories and providers who submit claims toMedicare contractors (carriers and Medicare Administrative Contractors (MACs)) for laboratory testservices provided to Medicare beneficiaries are affected.Provider Action NeededThere are eleven newly waived tests under the Clinical Laboratory Improvement Amendments of 1988(CLIA).Change Request (CR) 7694 from which this article is taken announces that (effective April 2, 2012,) theFood and Drug Administration (FDA) has approved new waived tests under CLIA.The codes for these tests are in a table in the ‘Background’ section.You should ensure that your billing staffs are aware of these new waived tests.BackgroundClinical Laboratory Improvement Amendments of 1988 (CLIA) regulations require a facility to beappropriately certified for each test that it performs. To ensure that Medicare and Medicaid only pay forlaboratory tests categorized as waived complexity under CLIA in facilities with a CLIA certificate ofwaiver, laboratory claims are currently edited at the CLIA certificate level.CR7694, from which this article is taken, announces the latest 11 tests approved by the FDA as waived testsunder CLIA (effective April 2, 2012). The Current Procedural Terminology (CPT) codes for the followingnew tests must have the modifier QW, defined as CLIA waived test, to be recognized as a waived test.However, the tests displayed at the beginning of the following table (i.e., CPT codes: 81002, 81025, 82270,82272, 82962, 83026, 84830, 85013, and 85651) do not require a QW modifier to be recognized as a waivedtest.TESTS GRANTED WAIVED STATUS UNDER CLIACPT Code Effective Date Description82274QWSeptember 8, 2004 Hemosure One-Step Fecal Occult Blood TestG0328QW81003QW October 28, 2009 Acon Mission U120 Urine AnalyzerG0434QW May 5, 2011 Premier Integrity Solutions P/Tox Drug ScreenCup {OTC}81003QW June 2, 2011 BTNX Rapid Response U120 Urine AnalyzerG0434QW July 7, 2011 Instant Technologies, Inc. iCassette DX DrugScreen TestG0434QW July 19, 2011 Express Diagnostic Int’l Inc DrugCheck WaiveRT (Model 9308z)80061QW, 82465QW,82947QW, 82950QW,82951QW, 82952QW,August 16, 2011 Alere Cholestech LDX {Whole Blood}Medicare B Newsline March 2012 57
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Medicare Part B Newsline March 2012 - Cahaba GBA

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