National Government Services

	Medicare Monthly Review

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	National Government Services, Inc. Medicare Monthly Review Part A and B
A Combined Part A and Part B Newsletter

March 2007

MIR-2007-3AB

CPT five-digit codes, descriptions, and other data only are copyright 2007American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS clauses apply.

In This Issue:

KEY		Part A & B Contents
Part A	Part B	Title
A	A	Additional Changes to the 2007 Medicare Physician Fee Schedule Database (CR#5498)
A	A	American Heart Month (PE200702-04)
A	A	CMS Actions to Reverse Invalid Overpayment Generated by MCIURs – Invalid MCIURs from CWF (CR#5507)
H	A	Colorectal Cancer Screening Flexible Sigmoidoscopy and Colonoscopy Coinsurance Payment Change (CR#5387-Revised)
A	A	Flu Shot Reminder (PE200701-13)
A	A	Infrared Therapy Devices (CR#5421-Revised)
A	A	Medicare Physician Fee Schedule Fact Sheet (PE200702-02)
A	A	NPI: Get It, Share It, Use It (PE200702-14)
A	A	Physician Quality Reporting Initiative Web Page (PE200702-09)
A	A	Remittance Advice Remark Code and Claim Adjustment Reason Code Update (CR#5456)
A	A	Use of Nine-Digit ZIP Codes for Correct Payment Locality for Services Under the MPFS and Anesthesia Services (CR#5208)

Key	Part A Only
Part A	Title
A	April Quarterly Update to 2007 HCPCS Codes for SNF Consolidated Billing (CR#5502)
H	Correction to the Inpatient Psychiatric Facility PPS Pricer (CR# 5455)
H	Delaware Providers Only – CWF Edit E61#8 Update Based on CMS Instruction (JSM-07202)
H, S	Guidelines for Payment of Diabetes Self-Management Training (DSMT) (CR#5433)
H, S	Inpatient Psychiatric Facility PPS for Oncology Treatment Payment Adjustment (CR#5470)
A	Institutional Value Code Changes (CR#5411)
H	Outpatient Clinical Laboratory Tests Furnished by Hospitals with Fewer than 50 Beds in Qualified Rural Areas (CR#5493)
H	Proposed Rule Correction Alert (PE200702-05)
H	Same-Day Transfer Claims Under the Long-Term Care Hospital Prospective Payment System (CR#5323)
H, S	Skilled Nursing Facility Spell of Illness Quick Reference Chart (PE200701-14)

Key	Part B Only Content
Part B	Title
A	Additional Requirements Necessary to Implement the Revised Health Insurance Claim Form CMS-1500 (CR#5060-Revised)
A	Alert: MCS Issue with 835 Electronic Remittance Advice and Crossover Claims (PE200702-06)
A	Coding Changes for Lumbar Artificial Disc Replacement (CR#5462)
A	Competitive Acquisition Program – Claim Processing for Not Otherwise Classified Drugs (CR#5259)
A	Direct Billing and payment for Non-Physician Practitioner Services Furnished to Hospital Inpatients and Outpatients (CR#5221)
A	HCPCS Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments Edits (CR#5457)
A	Processing All Diagnosis Codes Reported on Claims Submitted to Carriers (CR#5441)
A	Timeliness Standards for Processing Other-Than-Clean Claims (CR#5355)

Part A Contact Information

*Automated IVR Inquiries*	1 (877) 567-7205
Monday - Friday	6:00 a.m. to 6:00 p.m.
Saturdays	9:00 a.m. to 2:00 p.m.

These hours represent minimum availability. System access is generally available until 10:00 p.m. on weekdays and 6:00 p.m. on weekends.

*Provider Inquiries*:	1 (888) 855-4356
Monday & Friday	9:00 a.m. to 4:00 p.m.
Tuesday - Thursday	8:00 a.m. to 4:00 p.m.

You will be able to transfer to a provider representative only during these hours. Please have your provider number, the HIC number and service dates available when you call.

The Provider Inquiries TTY number for the Hearing Impaired is:	1 (877) 425--2370
Monday & Friday	9:00 a.m. to 4:30 p.m.
Tuesday - Thursday	8:00 a.m. to 4:30 p.m.

*Beneficiary Inquiries:*
English and Spanish	1-800-MEDICARE (1-800-633-4227)
TTY for the Hearing-Impaired:	1 (877) 486-2048

EDI Help Desk:	1 (877) 273-4334
Monday-Wednesday, Friday	8:00 -11:30 a.m. (EST) 12:00 Noon - 4:00 p.m.
Thursday	8:00 - 11:30 a.m. (EST) 12:00 Noon - 3:00 p.m.
EDI Part A Web Address NGS.EDI.A@Anthem.com EDI Part B Web Address NGS.EDI.B@Anthem.com

Medicare Fraud Hotline:

To report fraud and abuse in the Medicare and Medicaid programs:

1(800) HHS-TIPS/1(800) 447-8477

The Hotline TTY Number for the Hearing-Impaired is:

1(877) 623-6190

Part B Information

Part B New Jersey Contact Information

Beneficiary TDD:	(800) 992-0165
Beneficiary Telephone Inquiries & ARU:	(800) 633-4227
DMERC:	(866) 419-9458
EMC:	(866) 488-0546
Fax-on-Demand (FOD):	(888) 281-8586
Part B Provider IVR:	(877) 567-9235
Part B Provider Customer Service:	(888) 855-4346
Part B Enrollment:	(866) 309-0486
Provider TDD:	(888) 897-7542

Provider Enrollment

Mail claims to:

National Government Services
Provider Enrollment
P.O. Box 69218
Harrisburg, PA 17106-9218

National Government Services
Provider Claims
P.O. Box 69201
Harrisburg, PA. 17106-9201

Part B Appeals & Correspondence

National Government Services.
P.O. Box 69202
Harrisburg, PA 17106-9202

Part B New York Contact Information

Part B Provider Telephone Inquiries (STAR) Claim Status and information, eligibility deductible, pricing and seminar information:	(877) 869-6504
DMERC:	(866) 419-9458
EMC Technical Support Help Desk:	(866) 889-7322
Fax-on-Demand (FOD):	(866) 709-1905
General Provider Enrollment Information:	(866) 837-0241
Health Professional Shortage Area (HPSA) and EMC Audit:	(315) 442-4600

Provider Enrollment:	Mail Assigned Claims to:
National Government Services Reimbursement Dept. P.O. Box 1200 Crompond, NY 10517-1200	National Government Services, P.O. Box 100 Yorktown Heights, NY 10598

Unassigned Claims to:	Health Professional Shortage Area (HPSA) & EMC Audit:
National Government Services P.O. Box 355 Crompond, NY 10517	National Government Services P.O. Box 4716 Syracuse, NY 13221-4716

UPIN Directories (CD/ROM version)

Quality Assurance and Coordination Dept.
P.O. Box 1201
Crompond, NY 10517

Back Issue Requests	Part B Appeals & Correspondence
National Government Services MIR-Back Issues 800 2nd Avenue 3rd Floor New York, NY 10017	National Government Services P.O. Box 2280 Peekskill, NY 10566

Part A Key: A-All Providers, C-Community Mental Health Centers (CMHC), E-Renal Dialysis (ESRD) Providers, H-Hospitals, M-Home Health Providers, O-Comprehensive Outpatient Rehabilitation Facilities (CORF) and Outpatient Physical Therapy Providers, P-Hospice Providers, S-Skilled Nursing Facilities (SNF), NA-Not Applicable

Part B Key: A-All Providers, B-Ambulance, C-Cardiovascular, D-DMEPOS, E-Drugs & Biologicals, F-ASC, G-Anesthesia, H-Physical & Occupational Therapy, I-Beneficiaries, J-Insurers, K-Home Health Care, L-Laboratory, M-Medicine, N-Non-Physician Practitioner, O-Nuclear Medicine, P-Physicians, R-Radiology, S-Surgery, U-Urology, V-Chiropractor, W-Ophthalmology, X-Podiatry, Q-Oncology, NA-Not Applicable

This bulletin should be shared with all health care practitioners and managerial members of the provider staff. Bulletins are available at no cost from our Web site at www.NGSMedicare.com.

This key is provided as a convenience to alert providers/suppliers to articles with topics that may pertain to their particular field. This key is not a guarantee that information in other articles will not also apply. It is each provider’s/supplier’s responsibility to become familiar with the contents of each newsletter.

Part A Key: A-All Providers, C-Community Mental Health Centers (CMHC), E-Renal Dialysis (ESRD) Providers, F-Federally Qualified Health Centers (FQHC), H-Hospitals, M-Home Health Providers,
O-Comprehensive Outpatient Rehabilitation Facilities (CORF) and Outpatient Physical Therapy Providers, P-Hospice Providers, R-Rural Health Center (RHC), S-Skilled Nursing Facilities (SNF), NA-Not Applicable

Part B Key: A-All Providers, B-Ambulance, C-Cardiovascular, D-DMEPOS, E-Drugs & Biologicals, F-ASC, G-Anesthesia, H-Physical & Occupational Therapy, I-Beneficiaries, J-Insurers, K-Home Health Care, L-Laboratory, M-Medicine, N-Non-Physician Practitioner, O-Nuclear Medicine, P-Physicians, Q-Mental Health R-Radiology, S-Surgery, T-Nephrology, U-Urology, V-Chiropractor, W-Ophthalmology & Optometry, X-Podiatry, Y-Radiation Z-Oncology, NA-Not Applicable

Contact Information can be found on each of the National Government Services legacy Web sites which can be accessed though: http://www.NGSMedicare.com.

Medicare policies can be found on our Web site in the Local Coverage Determination section. You can access these through the http://www.NGSMedicare.com homepage. Providers without access to the Internet can request hard copies from National Government Services.

This bulletin should be shared with all health care practitioners and managerial members of the provider staff. Bulletins are available at no cost from our Web site at www.NGSMedicare.com.