This week’s updates include July quarterly update to 2016 annual update of HCPCS codes used for SNF Consolidated Billing (CB) enforcement; updates to Pub. 100-04, Medicare Claims Processing Manual, Chapters 4 and 5 to correct remittance advice messages; and more!
CMS proposed a test this week for a new Medicare Part B prescription drug plan that would replace its previous policy of paying physicians and outpatient hospital departments the average sales price (ASP) plus 6%.
CMS will require revenue code and HCPCS code reporting for rural health clinics starting April 1. CMS created more questions than answers during the recent Rural Health Open Door Forum call and in the guidance published in the last few months. This article will help sort through the issue.
Q: Last week you talked about the MAC editing for medically necessary services related to the local coverage determination (LCD). What do we do if we have a situation where we believe that the list of covered diagnoses is not complete? How do we get our MAC to consider that information? We placed a call, but nothing has happened and we’ve received no response.
One of several issues involving CMS receiving inconsistent provider data has arisen due to differing MAC guidance on whether providers should report a nonchemotherapy vs. chemotherapy injection code when injecting monoclonal antibodies and/or biologic response modifiers.
