National Provider Identifier (NPI)
As of May 23, 2005, all health care providers can apply for
a National Provider Identifier (NPI). The NPI will replace the
current provider numbers used today in standard health
care transactions. All Health Insurance Portability and
Accountability Act (HIPAA) covered entities except small
health plans must begin using the NPI on or before May 23,
2007; small health plans have one additional year to
implement the NPI.
For more information, visit https://nppes.cms.hhs.gov Bonus Payments for Professional Component
Claims transmittal 556, dated May 6, 2005, (which replaces
transmittal 547dated April 29, 2005) notifies professionals
that CMS will allow a bonus payment for the professional
component (-26) of a service. The bonus payment will be
allowed even when a global service code is submitted on
the claim. The bonus payment is limited to professionals
who render services in areas identified as a health
professional shortage area (HPSA) or a physician scarcity
area (PSA).
For more information, visit: http://www.cms.hhs.gov/
manuals/pm_trans/R556CP.pdf
Billing and Payment for Drugs and Biologicals
Transmittal 557 implements revisions to Chapter 4, Section
230 “Billing and Payment for Drugs and Biologicals” of
the Medicare Claims Processing Manual. The revisions include
updated coding information and the use of modifier -59
for drugs and biologicals.
For more information, visit: http://www.cms.hhs.gov/
manuals/pm_trans/R557CP.pdf Average Sales Price (ASP) Revisions
CMS claims transmittal 561 revises the payment allowance
limits for the first and second quarter ASP files. The update
includes ASP for the HCPCS code Q9954 Oral MR Contrast.
This code was omitted from the initial April 2005 ASP file.
For more information, visit: http://www.cms.hhs.gov/
manuals/pm_trans/R561CP.pdf High Osmolar Contrast Material (HOCM)
CMS recently released new Healthcare Common
Procedural Codes (HCPCS) temporary “Q” category codes for HOCM.
Transmittal 564 notifies fiscal intermediaries (FI) of these
new codes. The transmittal also instructs the FI to update
their Outpatient Code Editors (OCE) systems by adding these
codes with an effective date of July 1, 2005.
For more information, visit: http://www.cms.hhs.gov/
manuals/pm_trans/R564CP.pdf |