Washington Report –April, 2005



Washington Report –April, 2005

Bill Finerfrock

Capitol Associates

Congress Approves 2006 Budget

After weeks of wrangling, the House and Senate approved a Budget Resolution outlining spending for Fiscal Year 2006 (October 1, 2005 – September 30, 2006). Because this is a resolution and not a bill, it did not require the signature of the President. For some, this was a significant event. For others, it was greeted with yawns of - so what!

In 2005, we will see something we have not seen for several years – Congress will debate and possibly pass a “reconciliation” bill making reductions in “mandatory” programs. Specifically, the Budget Resolution directs several Committees to pass legislation saving $35 Billion from “mandatory” programs over the next 5 years (2006 – 2010).

The passage of the 2006 budget and some of the recommendations included in that budget are of interest to HBMA members.

Discussed below are some things that we will need to watch.

Budget Significance

As I have reported in the past, there are two types of federal spending: discretionary and mandatory spending.

Discretionary spending

Discretionary spending is just what the term implies – discretionary. The federal government is not legally obligated to spend money on disease research, highway construction, farm price supports, aircraft carriers and tanks, etc. The federal government spends money on these activities, but does so only because Congress appropriates money for these purposes each year. Once the money that is appropriated for a particular discretionary spending program runs out, the agency administering that program cannot spend any more on that program.

Discretionary spending accounts for approximately 41 percent of total federal spending and mandatory spending (Social Security, Medicare, Medicaid/S-CHIP and others) accounts for 59% of the federal budget. The budget identifies broad general categories of spending for discretionary programs but does not go into detail on exactly how that money should be spent. Those decisions are left up to the Appropriations Committees. Now that the Budget has been passed, the Appropriations Subcommittees will begin work on putting together the 13 appropriations bills necessary to fund all discretionary spending.

Mandatory spending

Mandatory spending is money the federal government is REQUIRED to spend – by law. Medicare and Medicaid are the most well-known mandatory spending programs. Unlike discretionary spending which must be approved annually, mandatory spending occurs annually regardless of whether or not Congress passes legislation. How much is spent on these programs annually is not determined by the federal budget but rather by how many individuals qualify for participation in a particular program or how frequently individuals who are entitled to benefits seek to use these benefits.

The government makes estimates of the number of people eligible for Medicare or Medicaid, how often they will seek care, what types of care they will seek, who will provide that care, etc. But these are all estimates. We don’t turn people away towards the end of the year because there’s no more money in the Medicare budget or the Medicaid budget.

Both Discretionary and Mandatory spending must be reconciled with the budget. Discretionary spending is reconciled through the appropriations process and mandatory spending is reconciled through the budget reconciliation process.

The 2006 budget calls for changes in mandatory spending programs and directs the committees with jurisdiction over those programs to reconcile the statutory requirements of a program with the assumptions made in the budget.

The Budget Resolution DIRECTS committees with jurisdiction over the Medicare and Medicaid programs to make changes in programs within the Committee’s jurisdiction to achieve certain savings targets. There are three committees that have jurisdiction over Medicare and Medicaid and therefore of interest to HBMA – House Energy and Commerce, House Ways and Means and Senate Finance.

Prospects for Change

Technically, the Budget Resolution makes no recommendations with regard to the Medicare program, the Medicaid program or any other specific program. The Resolution only stipulates dollars savings from programs within a Committee’s jurisdiction.

For example, the Senate Finance Committee is directed to report changes in laws within its jurisdiction sufficient to reduce outlays by $10 Billion for the period of fiscal years 2006 through 2010. By contrast, the House Energy and Commerce Committee is directed to pass legislation achieving savings of approximately $15 Billion over the 2006 – 2010 time frame and the House Ways & Means Committee is charged with achieving savings of $1 Billion between 2006 and 2010.

The EXPECTATION is that the bulk of the changes will occur in the Medicaid program. No details have emerged as of early May as to possible Medicaid changes. The National Governor’s Association has been working on possible Medicaid reforms but again very little in the way of details have been made available.

As part of the budget negotiations, Senate Republicans forced the Bush Administration and House Republicans to agree to the creation of a Medicaid Commission that will look at long-term, structural reforms of the Medicaid program.

Senator Gordon Smith (R-OR), one of the leading proponents of the Reform Commission, has been pushing the Commission idea for several weeks in lieu of more drastic Medicaid cuts proposed by the House. It was not clear when the Commission would be expected to submit it’s recommendations.

As details emerge, we will keep you informed of possible options for change.

You Asked, We Answered!

During the recent HBMA Spring meeting in Phoenix, Arizona, Dr. Bill Rogers, Director of the Physicians Regulatory Issues Team (PRIT) at CMS was a featured speaker. In addition to his responsibilities as Director of PRIT, Dr. Rogers is a practicing Emergency Room physician.

PRIT was formed to serve as a forum where physician issues could be resolved more quickly and efficiently then if they had to go through the normal bureaucratic process. Dr. Rogers staff are affectionately known as the “fix it” folks.

Following Dr. Rogers’ formal presentation, a period for questions and answers ensued. During this period, concern was expressed by an HBMA member that the HIPAA complaint process did not provide sufficient anonymity to individuals wishing to file a complaint against a third-party payer who was not HIPAA compliant with regard to their transaction standards. More specifically, if a third party payer was made aware of the accusers, there could be repercussions for the billing company and the company’s physician clients for “complaining”.

Dr. Rogers took this concern back to his colleagues at CMS and within 48 hours, the system for protecting the anonymity of individuals or businesses who file complaints was strengthened. In particular, the CMS website acknowledges HBMA assistance in bringing this problem to their attention.

HBMA appreciates the timely response of CMS and looks forward to continuing to work with the PRIT staff to resolve billing, coding and other payment issues.

HBMA and CMS work together on NPI

The Healthcare Billing and Management Association was asked by the Centers for Medicare and Medicaid Services to assist the agency in pilot testing the soon to be released National Provider Identifier enrollment process. HBMA was one of a handful of organizations contacted by CMS to work with them to identify bugs in the system.

CMS has developed both an on-line, as well as a paper enrollment process and participating companies were asked to have staff participate in both processes in order to identify potential problems. Also, certain HBMA member companies were issued “dummy” Social Security Numbers by CMS to test the SSN enrollment portion of the process as well.

The pilot testing occurred during the week of May 2 – 6 and preliminary reports indicate that for the most part, the testing went well. Testers were able to identify some glitches in the system and have reported those problems to CMS for correction. CMS has contracted with a private company to actually handle the issuance of the NPIs. This company, called an enumerator, will be responsible for processing the paperwork on behalf of the Centers for Medicare and Medicaid Services.

The offer of assistance grew out of last years experience with the PECOS disaster. In certain regions of the country, providers were experiencing delays of six to nine months in obtaining a Medicare Provider Number and causing serious cash flow problems. At the time, HBMA criticized CMS staff for not pilot testing the PECOS system prior to going live. The current request for assistance from CMS grew out of that earlier dialogue.

HBMA appreciated the opportunity to work with CMS on this important project and looks forward to similar opportunities in the future.

CMS Tries to Improve Access to New Technology

The Centers for Medicare and Medicaid Services (CMS) has clarified its payment rules to give beneficiaries the option to receive presbyopia-correcting intraocular lenses (IOLs) that can replace lenses clouded by cataracts and minimize the need for corrective lens.

Prior to this ruling, limitations on Medicare payment prevented beneficiaries from receiving these lenses.

According to a CMS press release, “Payment for conventional IOLs furnished in an outpatient setting is covered by Medicare. However, providers have generally not offered beneficiaries presbyopia-correcting IOLs because the costs for this advanced technology substantially exceed Medicare's payment.” Now beneficiaries who choose to purchase this additional feature will be able to do so.

This ruling clarifies that a beneficiary may request insertion of a presbyopia-correcting IOL in place of a conventional IOL following cataract surgery. In this case, the presbyopia-correcting IOL device and associated services for fitting one lens are considered partially covered by Medicare. The beneficiary is responsible for payment of that portion of the charge for the presbyopia-correcting IOL and associated services that exceed the charge for insertion of a conventional IOL following cataract surgery.

HHS Releases money to hospitals for care of undocumented aliens

Federal law provides $250 million per year for fiscal years (FY) 2005-2008 for payments for emergency health services provided to undocumented aliens. Two-thirds of the funds will be divided among all 50 states and the District of Columbia based on their relative percentages of undocumented aliens.

To view the actual state-by-state allotments, go to:



From these allotments, payments can be made to hospitals, certain qualified physicians and ambulance providers for some or all of the costs of providing emergency health care and related hospital inpatient, outpatient and ambulance services to eligible individuals. A critical access hospital (CAH) is a hospital under the statutory definition. Payments may only be made to the extent that care was not otherwise reimbursed (through insurance or otherwise) for such services during that fiscal year.

Payments may be made for services furnished to certain individuals described in the statute as: 1) undocumented aliens; 2) aliens who have been paroled into the United States at a United States port of entry for the purpose of receiving eligible services; and 3) Mexican citizens permitted to enter the United States for not more than 72 hours under the authority of a biometric machine readable border crossing identification card (also referred to as a "laser visa") issued in accordance with the requirements of regulations prescribed under a specific section of the Immigration and Nationality Act.

For more information, see the CMS web site at .

It’s official, CMS Estimates 4.3% cut in Physician Payments for 2006

In a letter to the Medicare Payment Advisory Commission (MedPAC), the Centers for Medicare and Medicaid Services (CMS) has announced that their actuaries estimate that physician fee schedule payments will be reduced 4.3% for 2006. Absent any changes, the conversion factor for 2006 will be $36.2679.

To view the letter CMS transmitted to MedPAC announcing their estimates and the methodology used to arrive at those conclusions, go to:



Many Members of Congress have already expressed concern about the possibility of a cut in Medicare physician payments of this magnitude. It would require legislation to prevent this cut from occurring and a change in the formula would result in higher Medicare payments then called for in the recently adopted budget. It is not clear whether Congress will be able to take actions consistent with its rhetoric.

Pay For Performance

First, it was Total Quality Management, then it was Quality Assurance Performance Improvement, now, the latest initiative attempting to link quality and payment is Pay-For-Performance.

The Medicare Payment Advisory Commission (MedPAC) is recommending that Congress adopt changes in the Medicare program to more closely link payment and performance.

In it’s March report to Congress, MedPAC concluded:

“The Commission has concluded that it is time for the Medicare program to start to differentiate among providers when making payments. Currently, Medicare pays providers the same regardless of their quality. We recommend that Medicare pay more for higher quality performance. Last year we recommended pay for performance for Medicare Advantage plans and dialysis providers. This year we add hospitals, home health agencies, and physicians. As another example of differentiating among providers, the Commission recommends for the first time that providers who perform imaging studies and physicians who interpret them meet quality standards as a condition of Medicare payment.”

The recommendations have met with some resistance in the physician community. In an article appearing in the American Medical News, the American Medical Association announced a series of principles that would have to be met in order for the AMA to support pay-for-performance. These were:

“…the programs must focus on quality improvement, allow physicians to opt out,

and use payment incentives, rather than penalties.”

In addition to the general concerns about pay-for-performance, a major battle appears to be looming between Radiologists and other physicians who interpret medical images. The American College of Radiology, in a separate move, has announced that it will seek federal legislation restricting Medicare payments for the interpretation of CAT Scans, MRI and PET Scans to those physician who can demonstrate competence in these areas. Other physician organizations, particularly cardiologists and family physicians, have vowed to opposed the ACRs efforts.

NEW FEATURE

Beginning this month, we will publish a table of CMS MedLearn Matters articles that have been released during the previous month. MedLearn Matters articles are published by CMS and intended to expand on policy questions or provide additional information on Medicare coverage or policy. The articles below go back to April 1, 2005. To visit the Medlearn Matters website, go to:



Medlearn Matters Articles Table

| | | |

| |Article Release |Title |

|Article #   |Date | |

|[pic] | | |

|SE0533 |05/10/2005 |Further Clarification of CR3648, Which Revised the Medicare Benefit Policy Manual (Pub 100-02), Chapter 15, Regarding|

| | |Therapy Services |

|MM3785 |05/10/2005 |Correction of 2005 Payment Fees for Clinical Laboratory Travel – Codes P9603 and P9604 |

|MM3648 |05/10/2005 |Revisions to the Medicare Benefit Policy Manual (Pub 100-02), Chapter 15, Sections 220 and 230 Regarding Therapy |

| | |Services |

|MM3830 |05/06/2005 |MMA - Supply Codes and Payments for Immunosuppressive Drugs |

|MM3866 |05/06/2005 |Fiscal Intermediary (FI) Reporting of Add-on-Payments That Do Not Result in a Specific Increase or Decrease in the |

| | |Amount Reported as Payable for a Claim or a Service on a Remittance Advice |

|MM3779 |05/06/2005 |July Quarterly Update for 2005 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule |

| | |Revised: 5/06/2005 |

|MM3809 |05/06/2005 |Teaching Adjustment for the Inpatient Psychiatric Facility (IPF) Prospective Payment System (PPS) |

|MM3812 |05/06/2005 |Instructions to Revise the Comprehensive Error Rate Testing (CERT) Shared System Module Including Instructions to |

| | |Install and Operate the Revised CERT Module for Calculating Fiscal Intermediary (FI) Line Level Error Rates |

|MM3735 |05/05/2005 |Modification of Roster Billing for Mass Immunizers Billing for Inpatient Part B Services (Type of Bills 12X and 22X) |

|MM3415 |05/05/2005 |3rd Update to the 2004 Medicare Physician Fee Schedule Database |

| | |Revised: 05/04/2005 |

| | |Rescinded; replaced by: MM3505 |

|MM3811 |05/04/2005 |Expansion of Coverage for Percutaneous Transluminal Angioplasty (PTA) |

|MM3803 |05/04/2005 |Healthcare Provider Taxonomy Code (HPTC) Update |

|MM3427 |05/04/2005 |Change to the Common Working File Skilled Nursing Facility Consolidated Billing Edits for Ambulance Transports to or |

| | |from a Diagnostic or Therapeutic Site |

| | |Revised: 5/04/2005 |

|MM3767 |05/04/2005 |Expansion of Various Alpha and Numeric Fields Within the Outpatient Prospective Payment System (OPPS) Outpatient Code|

| | |Editor (OCE) |

|MM3815 |05/04/2005 |Correction to the Use of Group Codes for the Enforcement of Mandatory Electronic Submission of Medicare Claims |

|MM3761 |05/04/2005 |New HCPCS Codes and System Edits for Supplies and Accessories for Ventricular Assist Devices |

|MM3366 |05/04/2005 |Editing of Hospital and Skilled Nursing Facility Part B Inpatient Services |

| | |Revised: 5/04/2005 |

|MM3774 |05/04/2005 |Addition to Chapter 6 of the Medicare Claims Processing Manual - Skilled Nursing Facility (SNF) Inpatient Part A |

| | |Billing: SNF Prospective Payment System Pricer Software |

|MM3572 |05/04/2005 |MMA – New Case-Mix Adjusted End Stage Renal Disease (ESRD) Composite Payment Rates and New Composite Rate Exceptions |

| | |Window for Pediatric ESRD Facilities |

| | |Revised: 05/04/2005 |

| | |Rescinded; replaced by: MM3720 |

|MM3806 |05/04/2005 |Changes to the Laboratory National Coverage Determination (NCD) Edit Software for July 2005 |

|MM3300 |04/29/2005 |2005 DMEPOS Pricing File Record Layout Expansion and New Pricing Procedures for Certain DMEPOS Items based on |

| | |Modifiers |

| | |Revised: 3/4/2005 |

|SE0524 |04/29/2005 |Electronically Requesting and Receiving Information Regarding Claims Using the ASC X12N276/277 Claims Status |

| | |Inquiry/Response Transactions |

|MM3705 |04/29/2005 |Infusion Pumps: C-Peptide Levels as a Criterion for Use |

| | |Revised: 4/25/2005 |

|SE0526 |04/29/2005 |Centers for Medicare & Medicaid Services (CMS) Comprehensive Error Rate Testing (CERT) Program - The Importance of |

| | |Complying with Requests for Claim Documentation |

| | |Revised: 5/02/2005 |

|MM3800 |04/29/2005 |Billing Requirements for Physician Services Rendered in Method II Critical Access Hospitals (CAHs) – Replacement of |

| | |CR 3559 |

|MM3794 |04/29/2005 |Update to Current National Uniform Billing Committee (NUBC) Codes |

|MM3783 |04/29/2005 |MMA - July 2005 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing File, Effective July 1, 2005 |

|MM3775 |04/29/2005 |Abarelix for the Treatment of Prostate Cancer |

|MM3459 |04/29/2005 |Fiscal Year (FY) 2005 Inpatient Prospective Payment System (IPPS), Long Term Care Hospital (LTCH) and Other Bill |

| | |Processing Changes Related to the IPPS Final Rule |

| | |Revised: 4/28/2005 |

|MM3818 |04/28/2005 |Revised Coding Guidelines for Drug Administration Codes |

| | |Revised: 4/28/2005 |

|MM3301 |04/28/2005 |Coverage by Medicare Advantage Organizations for National Coverage Determination (NCD) Services Not Previously |

| | |Included in Medicare Advantage&s Capitated Rates |

| | |Revised: 4/22/2005 |

|MM3452 |04/26/2005 |Indian Health Service (IHS) or Tribal Hospitals Including Critical Access Hospitals (CAHs) Payment Methodology for |

| | |Inpatient Social Admissions and Outpatient Services Rendered at a Separate Facility |

| | |Revised: 4/22/2005 |

|MM3789 |04/26/2005 |Payment Policy Clarification Regarding the Healthcare Common Procedure Coding System (HCPCS) Code Q3001 Performed in |

| | |an Ambulatory Surgery Center (ASC) |

| | |Revised: 4/22/2005 |

|SE0516 |04/22/2005 |Modified Edits for Matching Claims Data to Beneficiary Records |

| | |Revised: 4/22/2005 |

|SE0527 |04/22/2005 |Billing for Syringes Used in the Treatment of End Stage Renal Disease (ESRD) Patients |

|MM3426 |04/22/2005 |Billing Requirements for Positron Emission Tomography (PET) Scans for Dementia and Neurodegenerative Diseases |

| | |Revised: 4/22/2005 |

|MM3790 |04/22/2005 |MMA - Implementation of the Physician Scarcity Area (PSA) Bonus and Revision to the Health Professional Shortage Area|

| | |(HPSA) Payment to a Critical Access Hospital (CAH) |

|MM3736 |04/20/2005 |Clarification to the Health Professional Shortage Area (HPSA) Language in the Medicare Claims Processing Manual |

|MM3704 |04/20/2005 |Clarification of the Verification Process To Be Used to Determine if the Inpatient Rehabilitation Facility (IRF) |

| | |Meets the IRF Classification Criteria |

|MM3741 |04/20/2005 |Expanded Coverage for PET Scans for Cervical and Other Cancers, New Coding for PET Scans, and Billing Requirements |

| | |for PET Scans for Specific Indications of Cervical and Other Cancers |

| | |Revised: 4/20/2005 |

|MM3382 |04/20/2005 |Update to the Frequency of Billing |

| | |Revised: 4/20/2005 |

|MM3726 |04/13/2005 |1st Update to the 2005 Medicare Physician Fee Schedule Database |

| | |Revised: 4/08/2005 |

|MM3647 |04/13/2005 |Update to 100-04 and Therapy Code Lists |

| | |Revised: 4/08/2005 |

|MM3755 |04/12/2005 |Billing for Hemophilia Blood Clotting Factors (Medicare Claims Processing Manual (Pub. 100-04), Chapter 17, Section |

| | |80.4) |

|MM3530 |04/12/2005 |MMA - Revisions to Medicare Appeals Process for Fiscal Intermediaries (CR Title-Appeals Transition – BIPA 521 |

| | |Appeals) |

| | |Revised: 4/12/2005 |

|SE0529 |04/12/2005 |Importance of Supplying Correct Provider Identification Information Required in Items 17, 17a, 24K, and 33 of the |

| | |Form CMS-1500, and the Electronic Equivalent |

|MM3756 |04/08/2005 |MMA - April 2005 Update of the Hospital Outpatient Prospective Payment System (OPPS): Summary of Payment Policy |

| | |Changes |

|MM3771 |04/08/2005 |MMA - Clarification for Outpatient Prospective Payment System (OPPS) Hospitals Billing the Initial Preventive |

| | |Physical Exam (IPPE) |

|MM3747 |04/08/2005 |List of Medicare Telehealth Services |

|MM3745 |04/08/2005 |New HCPCS Codes for Intravenous Immune Globulin (IVIG) |

|SE0531 |04/07/2005 |Medicare Announces Delay in Processing Certain Claims No Later Than April 18, 2005 |

|MM3679 |04/01/2005 |New Remittance Advice (RA) Message for Referred Clinical Diagnostic/Purchased Diagnostic Service Duplicate Claims |

OLD Feature

Medicare & Medicaid 2005 Program Transmittals (April 1 – May 10)

Program transmittals are used to communicate new or changed policies, and/or procedures that are being incorporated into a specific CMS program manual. The cover page (or transmittal page) summarizes the new changed material, specifying what is changed.

Table of Contents

|FILE [pic] |SUBJECT |IMPL DATE |

|R23GI |Procedures for Modifying Shared Systems Edits and Capturing Audit Trail Data |10/3/2005 |

|R34BP |Pub. 100-02, Chapter 15, Sections 220 and 230 Therapy Services |6/6/2005 |

|R35NCD |Continuous Positive Airway Pressure (CPAP) Therapy for Obstructive Sleep Apnea (OSA) |6/6/2005 |

|R556CP |Revision to the Health Professional Shortage Area (HPSA) and Physician Scarcity Area (PSA) Payment |10/3/2005 |

| |Rules | |

|R557CP |Clarifying Manual Instructions for Coding and Payment for Drug Administration Under the Hospital |6/1/2005 |

| |Outpatient Prospective Payment System (OPPS) | |

|R558CP |July Update to the 2005 Medicare Physician Fee Schedule Database |7/5/2005 |

|R9COM |Additions and Corrections to Provider Inquiry and Provider Communications Program Requirements |6/6/2005 |

|R23DEMO |Low Vision Rehabilitation Demonstration |10/3/2005 |

|R153OTN |Payment to Ambulatory Surgery Centers (ASCs) for New CPT Code 66711 |6/6/2005 |

|R154OTN |Correction 2005 Clinical Laboratory Travel Fee (P9603 P9604) |7/5/2005 |

|R22GI |Provider Extract File |10/3/2005 |

|R555CP |Fiscal Intermediary (FI) Reporting of Add-on-Payments that do not Result in a Specific Increase or |10/3/2005 |

| |Decrease in the Amount Reported as Payable for a Claim or a Service on a Remittance Advice | |

|R110PI |Revise CERT Shared Systems Modules to Retrieve Claims Files Using Only Internal Control Number as a |10/3/2005 |

| |Key | |

|R111PI |Revising the FISS Shared System |10/3/2005 |

|R112PI |Requirement that Part B/Carriers Submit All Provider Addresses to the Comprehensive Error Rate |10/3/2005 |

| |Testing (CERT) Program Contractor | |

|R20GI |"Medicare Authorization to Disclose Personal Health Information" form and "Information to Help You |5/31/2005 |

| |Fill Out the Medicare Authorization to Disclose Personal Health Information Form" | |

|R21GI |Removal of Medicare Number from Reimbursement Checks |10/3/2005 |

|R537CP |Instructions for Downloading the Medicare Zip Code File |10/3/2005 |

|R538CP |New Waived Tests |7/5/2005 |

|R540CP |Addition to Chapter 6 of the Claims Processing Manual - Skilled Nursing Facility (SNF) Inpatient Part|8/1/2005 |

| |A Billing: SNF Prospective Payment System (PPS) Pricer Software | |

|R542CP |Modification of Roster Billing for Mass Immunizers Billing for Inpatient Part B Services (Type of |10/3/2005 |

| |Bills 12x and 22x) | |

|R546CP |Number of DMEPOS Pricing Files That Must Be Maintained Online for Medicare - DMERC, FI, and RHHI Only|10/3/2005 |

|R547CP |Revision to the Health Professional Shortage Area (HPSA) and Physician Scarcity Area (PSA) Payment |10/3/2005 |

| |Rules | |

|R539CP |Expansion of Various Alpha and Numeric Fields with in the Outpatient Prospective Payment System |10/3/2005 |

| |(OPPS) Outpatient Code Editor (OCE) | |

|R543CP |Healthcare Provider Taxonomy Code (HPTC) Update |10/3/2005 |

|R541CP |Correction to the use of Group Codes for The Enforcement of Mandatory Electronic Submission of |7/5/2005 |

| |Medicare Claims | |

|R548CP |New Healthcare Common Procedure Coding System (HCPCS) Codes and Systems Edits for Supplies and |10/3/2005 |

| |Accessories for Ventricular Assist Devices (VADs) | |

|R536CP |July Quarterly Update for 2005 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies |7/5/2005 |

| |(DMEPOS) Fee Schedule | |

|R549CP |Update to the Place of Service (POS) Code Set to Add a Code for Pharmacy |10/3/2005 |

|R533CP |Modification to the Common Working File (CWF) Edit Process for Non-Assigned Medicaid Coordination of |7/5/2005 |

| |Benefits Agreement (COBA) Crossover Claims | |

|R534CP |Changes to the Laboratory National Coverage Determination (NCD) Edit Software for July 2005 |7/5/2005 |

|R535CP |Modification to Appeals Language on Medicare Summary Notice |10/3/2005 |

|R551CP |Dispensing/Supply Fee Code, Payment, and Common Working File (CWF) Editing for Immunosuppressive |10/3/2005 |

| |Drugs | |

|R553CP |Expansion of State Codes for OSCAR Provider Numbers |10/3/2005 |

|R544CP |Modification of FISS Edits for Colorectal Cancer Screening Services (HCPCS Codes G0104, G0106, G0107,|10/3/2005 |

| |G0120, and G0328) Furnished at Skilled Nursing Facilities (SNFs) | |

|R545CP |The Teaching Adjustment for Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) |10/3/2005 |

|R552CP |Changing the Order of Medicare System Edits Affecting Hospice Claims |10/3/2005 |

|R29MSP |Assignment of Non-Payment/Denial Code specific to the Recovery Audit Contractor (RAC) Created Group |10/3/2005 |

| |Health Plan (GHP) Occurrences | |

|R6SOM |Expansion of State Codes for OSCAR Provider Numbers |10/3/2005 |

|R108PI |Change in Statistical Sampling Instructions |5/31/2005 |

|R109PI |Updated Standard System Changes for Provider Enrollment Chain Ownership System (PECOS) and MCS |10/3/2005 |

|R22DEMO |Assignment of Non-Payment/Denial Code specific to the Recovery Audit Contractor (RAC) Created Group |10/3/2005 |

| |Health Plan (GHP) Occurrences | |

|R150OTN |Shared System Maintainer Hours for Resolution of Problems Detected During Health Insurance |10/3/2005 |

| |Portability and Accountability Act (HIPAA) Transaction Release Testing | |

|R151OTN |Common Working File (CWF) Calculation of Next Eligible Date for Preventive Services |10/3/2005 |

|R34NCD |Abarelix for the Treatment of Prostate Cancer |5/25/2005 |

|R532CP |Abarelix for the Treatment of Prostate Cancer |5/25/2005 |

|R33NCD |Percutaneous Transluminal Angioplasty (PTA) |7/5/2005 |

|R529CP |Update to Current National Uniform Billing Committee (NUBC) Codes |7/5/2005 |

|R528CP |July 2005 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing File, Effective July 1, |7/5/2005 |

| |2005 | |

|R530CP |Billing Requirements for Physician Services Rendered in Method II Critical Access Hospitals (CAHs) |7/5/2005 |

|R531CP |Percutaneous Transluminal Angioplasty (PTA) |7/5/2005 |

|R67FM |Notice of New Interest Rate for Medicare Overpayments and Underpayments |4/25/2005 |

|R32NCD |Autologous Stem Cell Transplantation (AuSCT) |5/16/2005 |

|R524CP |Clarification to the Health Professional Shortage Area Language in the Medicare Claims Processing |5/16/2005 |

| |Manual | |

|R523CP |Implementation of the Physician Scarcity Areas and Revision to the Health Professional Shortage |7/15/2005 |

| |(HPSA) | |

|R527CP |New Coding for FDG PET Scans and Billing Requirements for Specific Indications of Cervical Cancer |4/18/2005 |

|R526CP |Updated Requirements for Autologous Stem Cell Transplantation (AuSCT) |5/16/2005 |

|R525CP |Flu/PPV Revision |N/A |

|R148OTN |Revised Coding Guidelines for Drug Administration Codes |5/16/2005 |

|R519CP |Flu/PPV Revisions |N/A |

|R520CP |Payment Policy Clarification Regarding the Healthcare Common Procedure Coding System (HCPCS) Q3001 |5/9/2005 |

| |Performed in an Ambulatory Surgery Center (ASC) | |

|R521CP |Hemophilia Blood Clotting Factors |5/9/2005 |

|R28MSP |Working Aged Exception for Small Employers in Multi-Employer Group Health Plans (GHPs) |5/20/2005 |

|R107PI |Updated Chapter 1 to Reflect Changes in Program Requirements |5/9/2005 |

|R147OTN |Medicare HIPAA Electronic Claims Report - Second Reporting Timeframe Extension |5/6/2005 |

|R31BP |List of Medicare Telehealth Services |5/2/2005 |

|R31NCD |PET for Brain, Cervical, Ovarian, Pancreatic, Small Cell Lung, and Testicular Cancers |4/18/2005 |

|R515CP |Update to 100-04 and Therapy Code Lists |7/5/2005 |

|R517CP |List of Medicare Telehealth Services |5/2/2005 |

|R516CP |Clarification for OPPS Hospitals Billing Initial Preventive Physical Exam (IPPE) |10/3/2005 |

|R518CP |New Coding for FDG PET Scans and Billing Requirements for Specific Indications of Cervical Cancer |4/18/2005 |

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