February 1, 2010, Home Health & Hospice Medicare A ... - CGS

m. Pricer will update the payment rates for drugs, biologicals, and therapeutic radiopharmaceuticals whenthose payment rates are based on ASP on a quarterly basis.n. Effective January 1, 2010, CMS is adopting the FY 2010 Inpatient Prospective Payment System (IPPS)post-reclassification wage index values with application of out-commuting adjustment authorized bysection 505 of Pub. L. 108-173 to non-IPPS hospitals discussed below.Wage Indices for Non-IPPS Hospitals Eligible for the Out-Commuting Adjustment Authorized bySection 505 of Pub. L. 108-173Wage indexes for Non-IPPS hospitals eligible for the Out-Commuting Adjustment authorized by Section505 of Public Law 108-173 can be found in Table 12 of CR 6751.Coverage DeterminationsThe fact that a drug, device, procedure or service is assigned a HCPCS code and a payment rate under theOPPS does not imply coverage by the Medicare program, but indicates only how the product, procedure, orservice may be paid if covered by the program. Fiscal intermediaries (FIs)/Medicare administrativecontractors (MACs) determine whether a drug, device, procedure, or other service meets all programrequirements for coverage. For example, FIs/MACs determine that it is reasonable and necessary to treat thebeneficiary’s condition and whether it is excluded from payment.Additional InformationIf you have questions regarding this issue, refer to the “Contact Us” page of our Web site and select“Telephone Us” to call the Provider Contact Center.The official instruction (CR 6751) was issued to your Medicare A/B MAC and/or fiscal intermediary viatwo transmittals. The first transmittal, R1882CP, modifies the Medicare Claims Processing Manual and islocated at http://www.cms.hhs.gov/Transmittals/downloads/R1882CP.pdf on the CMS Web site. Thesecond transmittal, R116BP, provides the revisions to the Medicare Benefit Policy Manual and thattransmittal is located at http://www.cms.hhs.gov/Transmittals/downloads/R116BP.pdf on that same site.DisclaimerThis article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article maycontain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be ageneral summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review thespecific statutes, regulations and other interpretive materials for a full and accurate statement of their contents. CPT onlycopyright 2009 American Medical Association.News from CMS for Hospice ProvidersTracking the Hospice Attending Physician’s National Provider Identifier (NPI) forValidating Hospice Part B Payments—RevisedThe Centers for Medicare & Medicaid Services (CMS) has issued a revision to the Medicare LearningNetwork (MLN) Matters article, “Tracking the Hospice Attending Physician’s National Provider IdentifierHome Health & Hospice February 1, 2010 36Medicare A Newsline Vol. 17, No. 5