Medicare and Medicaid Programs; Quarterly Listing of Program Issuances-July 2003 Through September 2003
This notice lists CMS manual instructions, substantive and interpretive regulations, and other Federal Register notices that were published from July 2003 through September 2003...
Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION:
Notice.
SUMMARY:
This notice lists CMS manual instructions, substantive and interpretive regulations, and other
Federal Register
notices that were published from July 2003 through September 2003, relating to the Medicare and Medicaid programs. This notice provides information on national coverage determinations affecting specific medical and health care services under Medicare. Additionally, this notice identifies certain devices with investigational device exemption numbers approved by the Food and Drug Administration that potentially may be covered under Medicare. Finally, this notice also includes listings of all approval numbers from the Office of Management and Budget for collections of information in CMS regulations.
Section 1871(c) of the Social Security Act requires that we publish a list of Medicare issuances in the
Federal Register
at least every 3 months. Although we are not mandated to do so by statute, for the sake of completeness of the listing, and to foster more open and transparent collaboration efforts, we are also including all Medicaid issuances and Medicare and Medicaid substantive and interpretive regulations (proposed and final) published during this 3-month time frame.
FOR FURTHER INFORMATION CONTACT:
It is possible that an interested party may have a specific information need and not be able to determine from the listed information whether the issuance or regulation would fulfill that need. Consequently, we are providing information contact persons to answer general questions concerning these items. Copies are not available through the contact persons. (
See
Section III of this notice for how to obtain listed material.)
Questions concerning items in Addendum III may be addressed to Karen Bowman, Office of Strategic Operations and Regulatory Affairs, Centers for Medicare & Medicaid Services, C5-16-03, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-5252.
Questions concerning national coverage determinations in Addendum V may be addressed to Patricia Brocato-Simons, Office of Clinical Standards and Quality, Centers for Medicare & Medicaid Services, C1-09-06, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-0261.
Questions concerning Investigational Device Exemptions items in Addendum VI may be addressed to Sharon Hippler, Office of Clinical Standards and Quality, Centers for Medicare & Medicaid Services, C5-13-27, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-4633.
Questions concerning approval numbers for collections of information in Addendum VII may be addressed to Dawn Willinghan, Office of Strategic Operations and Regulatory Affairs, Regulations Development and Issuances Group, Centers for Medicare & Medicaid Services, C5-09-26, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-6141.
Questions concerning all other information may be addressed to Gwendolyn Johnson, Office of Strategic Operations and Regulatory Affairs, Regulations Development and Issuances Group, Centers for Medicare & Medicaid Services, C5-12-26, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-6954.
SUPPLEMENTARY INFORMATION:
I. Program Issuances
The Centers for Medicare & Medicaid Services (CMS) is responsible for administering the Medicare and Medicaid programs. These programs pay for health care and related services for 39 million Medicare beneficiaries and 35 million Medicaid recipients. Administration of the two programs involves (1) Furnishing information to Medicare beneficiaries and Medicaid recipients, health care providers, and the public and (2) maintaining effective communications with regional offices, State governments, State Medicaid agencies, State survey agencies, various providers of health care, all Medicare contractors that process claims and pay bills, and others. To implement the various statutes on which the programs are based, we issue regulations under the authority granted to the Secretary of the Department of Health and Human Services under sections 1102, 1871, 1902, and related provisions of the Social Security Act (the Act). We also issue various manuals, memoranda, and statements necessary to administer the programs efficiently.
Section 1871(c)(1) of the Act requires that we publish a list of all Medicare manual instructions, interpretive rules, statements of policy, and guidelines of general applicability not issued as regulations at least every 3 months in the
Federal Register
. We published our first notice June 9, 1988 (53 FR 21730). Although we are not mandated to do so by statute, for the sake of completeness of the listing of operational and policy statements, and to foster more open and transparent collaboration, we are continuing our practice of including Medicare substantive and interpretive regulations (proposed and final) published during the respective 3-month time frame.
II. How To Use the Addenda
This notice is organized so that a reader may review the subjects of manual issuances, memoranda,
( printed page 74591)
substantive and interpretive regulations, national coverage determinations (NCDs), and Food and Drug Administration (FDA)-approved investigational device exemptions (IDEs) published during the subject quarter to determine whether any are of particular interest. We expect this notice to be used in concert with previously published notices. Those unfamiliar with a description of our Medicare manuals may wish to review Table I of our first three notices (53 FR 21730, 53 FR 36891, and 53 FR 50577) published in 1988, and the notice published March 31, 1993 (58 FR 16837). Those desiring information on the Medicare National Coverage Determination Manual (NCDM, formerly the Medicare Coverage Issues Manual (CIM)) may wish to review the August 21, 1989, publication (54 FR 34555). Those interested in the revised process used in making NCDs under the Medicare program may review the September 26, 2003, publication (68 FR 55634).
To aid the reader, we have organized and divided this current listing into six addenda:
Addendum I lists the publication dates of the most recent quarterly listings of program issuances.
Addendum II identifies previousFederal Register
documents that contain a description of all previously published CMS Medicare and Medicaid manuals and memoranda.
Addendum III lists a unique CMS transmittal number for each instruction in our manuals or Program Memoranda and its subject matter. A transmittal may consist of a single or multiple instruction(s). Often, it is necessary to use information in a transmittal in conjunction with information currently in the manuals.
Addendum IV lists all substantive and interpretive Medicare and Medicaid regulations and general notices published in theFederal Register
during the quarter covered by this notice. For each item, we list the—
Date published;
Federal Register
citation;
Parts of the Code of Federal Regulations (CFR) that have changed (if applicable);
Agency file code number; and
Title of the regulation.
Addendum V includes completed NCDs, or reconsiderations of completed NCDs, from the quarter covered by this notice. Completed decisions are identified by the section of the NCDM (or CIM) in which the decision appears, the title, the date the publication was issued, and the effective date of the decision.
Addendum VI includes listings of the FDA-approved IDE categorizations, using the IDE numbers the FDA assigns. The listings are organized according to the categories to which the device numbers are assigned (that is, Category A or Category B), and identified by the IDE number.
Addendum VII includes listings of all approval numbers from the Office of Management and Budget (OMB) for collections of information in CMS regulations in title 42; title 45, subchapter C; andtitle 20 of the CFR.
III. How To Obtain Listed Material
A. Manuals
Those wishing to subscribe to program manuals should contact either the Government Printing Office (GPO) or the National Technical Information Service (NTIS) at the following addresses:
Superintendent of Documents, Government Printing Office, Attn: New Orders, PO Box 371954, Pittsburgh, PA 15250-7954, Telephone (202) 512-1800, Fax number (202) 512-2250 (for credit card orders); or
National Technical Information Service, Department of Commerce, 5825 Port Royal Road, Springfield, VA 22161, Telephone (703) 487-4630.
In addition, individual manual transmittals and Program Memoranda listed in this notice can be purchased from NTIS. Interested parties should identify the transmittal(s) they want. GPO or NTIS can give complete details on how to obtain the publications they sell. Additionally, most manuals are available at the following Internet address:
https://cms.hhs.gov/manuals/default.asp.
B. Regulations and Notices
Regulations and notices are published in the daily
Federal Register
. Interested individuals may purchase individual copies or subscribe to the
Federal Register
by contacting the GPO at the address given above. When ordering individual copies, it is necessary to cite either the date of publication or the volume number and page number.
The
Federal Register
is also available on 24x microfiche and as an online database through
GPO Access.
The online database is updated by 6 a.m. each day the
Federal Register
is published. The database includes both text and graphics from Volume 59, Number 1 (January 2, 1994) forward. Free public access is available on a Wide Area Information Server (WAIS) through the Internet and via asynchronous dial-in. Internet users can access the database by using the World Wide Web; the Superintendent of Documents home page address is
https://www.gpoaccess.gov/fr/index.html, by using local WAIS client software, or by telnet to
swais.gpoaccess.gov, then log in as guest (no password required). Dial-in users should use communications software and modem to call (202) 512-1661; type swais, then log in as guest (no password required).
C. Rulings
We publish rulings on an infrequent basis. Interested individuals can obtain copies from the nearest CMS Regional Office or review them at the nearest regional depository library. We have, on occasion, published rulings in the
Federal Register
. Rulings, beginning with those released in 1995, are available online, through the CMS Home Page. The Internet address is
https://cms.hhs.gov/rulings.
D. CMS's Compact Disk-Read Only Memory (CD-ROM)
Our laws, regulations, and manuals are also available on CD-ROM and may be purchased from GPO or NTIS on a subscription or single copy basis. The Superintendent of Documents list ID is HCLRM, and the stock number is 717-139-00000-3. The following material is on the CD-ROM disk:
Titles XI, XVIII, and XIX of the Act.
CMS-related regulations.
CMS manuals and monthly revisions.
CMS program memoranda.
The titles of the Compilation of the Social Security Laws are current as of January 1, 1999. (Updated titles of the Social Security Laws are available on the Internet at
https://www.ssa.gov/OP_Home/ssact/comp-toc.htm.) The remaining portions of CD-ROM are updated on a monthly basis.
Because of complaints about the unreadability of the Appendices (Interpretive Guidelines) in the State Operations Manual (SOM), as of March 1995, we deleted these appendices from CD-ROM. We intend to re-visit this issue in the near future and, with the aid of newer technology, we may again be able to include the appendices on CD-ROM.
Any cost report forms incorporated in the manuals are included on the CD-ROM disk as LOTUS files. LOTUS software is needed to view the reports once the files have been copied to a personal computer disk.
IV. How To Review Listed Material
Transmittals or Program Memoranda can be reviewed at a local Federal Depository Library (FDL). Under the
( printed page 74592)
FDL program, government publications are sent to approximately 1,400 designated libraries throughout the United States. Some FDLs may have arrangements to transfer material to a local library not designated as an FDL. Contact any library to locate the nearest FDL.
In addition, individuals may contact regional depository libraries that receive and retain at least one copy of most Federal Government publications, either in printed or microfilm form, for use by the general public. These libraries provide reference services and interlibrary loans; however, they are not sales outlets. Individuals may obtain information about the location of the nearest regional depository library from any library.
Superintendent of Documents numbers for each CMS publication are shown in Addendum III, along with the CMS publication and transmittal numbers. To help FDLs locate the materials, use the Superintendent of Documents number, plus the transmittal number. For example, to find the Hospice Manual, (CMS Pub. 21) transmittal entitled “Payment of Amounts Owed Medicare,” use the Superintendent of Documents No. HE 22.8/18 and the transmittal number 69.
(Catalog of Federal Domestic Assistance Program No. 93.773, Medicare—Hospital Insurance, Program No. 93.774, Medicare—Supplementary Medical Insurance Program, and Program No. 93.714, Medical Assistance Program)
Dated: December 2, 2003.
Jacquelyn Y. White,
Director, Office of Strategic Operations and Regulatory Affairs.
Addendum I
This addendum lists the publication dates of the most recent quarterly listings of program issuances.
Addendum II—Description of Manuals, Memoranda, and CMS Rulings
An extensive descriptive listing of Medicare manuals and memoranda was published on June 9, 1988, at 53 FR 21730 and supplemented on September 22, 1988, at 53 FR 36891 and December 16, 1988, at 53 FR 50577. Also, a complete description of the former CIM (now the NCDM) was published on August 21, 1989, at 54 FR 34555. A brief description of the various Medicaid manuals and memoranda that we maintain was published on October 16, 1992, at 57 FR 47468.
Addendum III.—Medicare and Medicaid Manual Instructions
[July 2003 through September 2003]
Transmittal No.
Manual/Subject/Publication No.
Intermediary Manual
Part 3—Audits, Reimbursement Program Administration
(CMS-Pub. 13-3)
(Superintendent of Documents No. HE 22.8/6)
1892
•
Frequency of Billing
Provider Education
1893
•
Release Software
1894
•
Review of Form CMS-1450 (previously Form HCFA-1450) for Inpatient and
Outpatient Bills
1895
•
Diabetes Outpatient Self-Management Training Services
1896
•
Mammography Screening
Diagnostic Mammography
Diagnostic and Screening Mammography Performed With New Technologies
Mammography Billing Charts for Billing for Computer Aided Detection Devices
Common Working File Application of Age and Frequency Edits
Limitation on Payment for Services to Individuals Entitled to Benefits on the Basis of End-Stage Renal Disease Who Are Covered by Group Health Plans
Definitions
Retroactive Implementation
Processing Claims
Determining the 30-Month Coordination Period During Which Medicare May Be Secondary Payer
Effect of Dual Entitlement
Subsequent Periods of End-Stage Renal Disease Eligibility or Entitlement
Amount of Secondary Medicare Payments Where Group Health Payments in Part for Items and Services
Limitation on Right of Provider or Facility to Charge a Beneficiary
Responsibility of Provider/Providers of Service and Renal Dialysis Facilities
Action When Group Health Payments Erroneously Pay Primary Benefits
Referral to Regional Offices of Cases Involving Taking Into Account Medicare Eligibility or Entitlement and Benefit Differentiation During Coordination Period
Claimant's Right To Take Legal Action Against a Group Health Plan
Medical Services Furnished to End-Stage Renal Disease Beneficiaries by Source Outside Group Health Plan Managed Care Plan
Limitations on Payment for Services to Aged Beneficiaries Who are Covered by a Group Health Plan on the Basis of Current Employment Status
Definitions
Individuals Subject to Limitation on Payment, General
Individuals Not Subject to Limitation on Payment, General
Identification of Cases by Providers of Services
Identification of Cases and Action Where There Is Indication of Possible Group Health Plan Coverage
Action by Provider Where Medicare Is Secondary to Group Health Plan
Limitation on Right of Provider or Facility to Charge a Beneficiary
( printed page 74593)
Employer Plan Denies Claim for Primary Benefit
Referral of Cases to Regional Offices
Recovery of Mistaken Primary Medicare Payments
Advice to Providers, Physicians, and Beneficiaries
Mistaken Group Health Plan Primary Payments
Claimant's Right to Take Legal Action Against a Group Health Plan
Special Rules for Services Furnished by Source Outside Group Health Plan
Managed Care Health Plan
Medicare as Secondary Payer for Disabled Individuals
1898
•
Payment for Services Furnished by a Critical Access Hospital
Carriers Manual
Part 3—Program Administration
(CMS Pub. 14-3) (Superintendent of Documents No. HE 22.8/7)
1808
•
Mandatory Assignment and Participation Program
Participation Program
Limiting Charge
1809
•
Durable Medical Equipment Regional Carriers—Billing Procedures Related to Advance Beneficiary Notice Upgrades
Providing Upgrades of Durable Medical Equipment Prosthetic, Orthotics, and Supplies Without Any Extra Charge
1810
•
Payment for Physician Services Furnished to Dialysis Inpatients
Dialysis Services (Codes 90935-90999)
1811
•
Release Software
Contractor Testing Requirements
1812
•
Definitions of Lines 1 through 115
Checking Reports
Exhibits
1813
•
Data Element Requirements
Payment to Physician for Purchased Diagnostic Tests
Area Carriers—Physician's Services
Payment Jurisdiction for Services Paid Under the Physician Fee Schedule and Anesthesia Services
Claims Processing Instructions for Payment Jurisdiction for Claims Received On or After April 1, 2004
Payment Jurisdiction for Purchased Services
Jurisdiction for Shipboard Services
Exceptions to Jurisdictional Payment
Exhibit 10
Items 14-33 Physician or Supplier Information
1814
•
Screening Mammography Examinations
Identifying a Screening Mammography Claim and a Diagnostic Mammography Claim
Adjudicating the Claim
Diagnostic and Screening Mammograms Performed With New Technologies
1815
•
Repairs, Maintenance, Replacement, and Delivery
1816
•
Correct Coding Initiative
1817
•
Medicare Secondary Payment General Provisions
Third Party Payer Pays Charges in Full
Physician, Supplier, or Beneficiary Bills Medicare for Primary Benefits
Multiple Insurers
Third Party Payer Pays Primary Benefits When Not Required
Right of Physician or Supplier to Charge Beneficiary
General
Definitions
Current Employment Status
Employer-Sponsored Managed Care Health Plan
Nonconforming Group Health Plan
Recovery of Mistaken Primary Medicare Payments
Advice to Physicians/Suppliers and Beneficiaries
Mistaken Group Health Plan Primary Payments
Claimant's Right to Take Legal Action Against a Group Health Plan
Special Rules for Services Furnished by Source Outside Group Health Plan
Managed Care Health Plan
Medicare Secondary Payer Provisions for Working Aged Individuals
Individual Not Subject to Medicare Secondary Payer Provision
Exception for Small Employers in Multi-Employer and Multiple Employer Group Health Plan
Dually Entitled Individuals
General
Individuals Not Subject to Medicare Secondary Payer Provision
Items and Services Furnished On or After January 1, 1987 and Before August 10, 1993 (Date of Enactment of Omnibus Budget Reconciliation Act of 1993)
1818
•
Filing the Request for Payment
1819
•
Special Requirements for Claims for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
Maintenance Process for the Medicare Physician Fee Schedule Database
Carriers Manual
Part 4—Professional Relations
(CMS Pub. 14-4)
(Superintendent of Documents No. HE 22.8/7-4)
28
•
Provider of Services or Supplier Information
Program Memorandum Intermediaries
(CMS Pub. 60A)
(Superintendent of Documents No. HE 22.8/6-5)
A-03-057
•
Medicare Program-Update to the Hospice Payment Rates, Hospice Cap, Hospice Wage Index and the Hospice for Fiscal Year 2004
A-03-058
•
Change in Methodology for Determining Payment for Outliers Under the Acute Care Hospital Inpatient and Long-Term Care Hospital Prospective Payment System
A-03-059
•
Addition of Patient Status Code 43, Deletion of Patient Status Codes 71 and 72, and Information on New Patient Status Code 65
A-03-060
•
Medicare Program—Update to the Prospective Payment System for Home Health Agencies for Fiscal Year 2004
A-03-061
•
Tentative Settlement Requirements for Cost Reports from Home Health Agencies and Skilled Nursing Facilities That Have No Reimbursement Impact
A-03-062
•
Department of Veterans Affairs Claims Adjudication Services Project System Changes Needed
A-03-063
•
Installation of Version 30 of the Provider Statistical and Reimbursement Reporting System
A-03-064
•
X12N 837 Institutional Health Care Claim Companion Document
A-03-065
•
New Common Working File Edits to Ensure Accurate Coding and Payments for Discharge and/or Transfer Policies Under the Inpatient Prospective Payment System
A-03-066
•
Hospital Outpatient Prospective Payment System Implementation Instructions
A-03-067
•
The Supplemental Security Income Medicare Beneficiary Data for Fiscal Year 2002 for Inpatient Prospective Payment System Hospitals
A-03-068
•
Informing Beneficiaries About Which Local Medical Review Policy and/or National Coverage Determination Is Associated With Their Claim Denial
A-03-069
•
October Outpatient Code Editor Specification Version (V4.3)
A-03-070
•
Inclusion of the State of New York in Demonstration for Settlement of Payments for Home Health Services to Dual Eligibles and Instructions for Processing Fiscal Year 2000 Claims Under the Demonstration. Regional Home Health Intermediaries Only.
A-03-071
•
Retroactive Correction of Provider Statistical and Reimbursement System Report Data Related to Mammography and Outpatient Therapy Services
A-03-072
•
Instructions for Provider Credit Balance Reporting Related Activities
A-03-073
•
Fiscal Year 2004 Inpatient Prospective Payment System, Long Term Care Hospital, and Other Billing Changes
A-03-074
•
Inpatient Rehabilitation Facility Annual Update: Prospective Payment System Pricer Changes for Fiscal Year 2004
A-03-075
•
Medicare Part A Skilled Nursing Facility Prospective Payment System Update
A-03-076
•
October 2003 Update of the Hospital Outpatient Prospective Payment System
A-03-077
•
October Medicare Outpatient Code Editor Specification Version 19.0 for Bills From Hospitals That Are Not Paid Under the Outpatient Prospective Payment System
A-03-078
•
Reimbursement for Automated Multi-Channel Chemistry Tests for End-Stage Renal Disease Beneficiaries
A-03-079
•
Installation of Version 31 of the Provider Statistical and Reimbursement Reporting System
A-03-080
•
End-Stage Renal Disease Reimbursement for Automated Multi-Channel Chemistry Test
A-03-081
•
Conflicting Policies With Provider Reimbursement Manual 15-1, Section 2771
A-03-082
•
Clarification for Billing Under the 2300 Provider Number by Hospital-Based Renal Dialysis Facilities
Program Memorandum
Carriers
(CMS Pub. 60B)
(Superintendent of Documents No. HE 22.8/6-5)
B-03-050
•
Multiple Primary Payers on Part B Claims-Revision to Change Request 2050
B-03-051
•
Therapy Modifier Bypass for Ambulance Claims
B-03-052
•
Addition of Temporary “Q” Codes for Drugs Used in Infusion Pumps
B-03-053
•
Healthcare Provider Taxonomy Codes Crosswalk
B-03-054
•
Establishing and Maintaining Provider and Supplier Enrollment Data in Provider kEnrollment, Chain and Ownership System as Needed for Use By the Railroad Medicare Carrier to Pay Claims
B-03-055
•
Common Working File crossover Editing for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Claims During an Inpatient Stay
B-03-056
•
Durable Medical Equipment Regional Carriers—Additional Instructions for Health Insurance Portability and Accountability Act Implementatyion on National Drug Codes and the National Council of Prescription Drug Programs
B-03-057
•
Additional Guidelines for Implementing the National Council for Prescription Drug Program Format
B-03-058
•
Procedures for the Reconciliation of Total Funds Expended for Multi-Carriers Systems Medicare Contractors Used in the Preparation of Form CMS-1522, Monthly Contractor Financial Report
( printed page 74595)
B-03-059
•
Minimum Number of Pricing Files That Must Be Maintained Online for Medicare Single Drug Pricer
B-03-060
•
Expansion of Beneficiary History and Claims in Process Files in the Voucher Insurance Plan Viable Medicare System. Phase 2—Adjudication Claims in Process File Expansion
B-03-061
•
Durable Medical Equipment Regional Carriers National Council of Prescription of Drug Programs Crosswalk Requirements
B-03-062
•
Procedures for Non-Medicare Secondary Payer Overpayments With Original Balance Less than $10
B-03-063
•
Healthcare Provider Taxonomy Codes Crosswalk
B-03-064
•
Clarification—ICD-9 Coding
B-03-065
•
Changes to Code List for Therapy Services
B-03-066
•
Durable Medical Equipment Regional Carriers—Eliminate Combined Working File Edit for Cancer Diagnosis for National Drug Codes
B-03-067
•
National Council for Prescription Drug Programs Batch Transmittal Standard 1.1 Billing Request Companion Document
B-03-068
•
2004 Annual Update for Skilled Nursing Facility Consolidated Billing for the Common Working File and Medicare Carriers
B-03-069
•
Schedule for Completing the Calendar Year 2004 Fee Schedule Updates and the Participating Physician Enrollment Procedures
Program Memorandum
Intermediaries/Carriers
(CMS Pub. 60A/B)
(Superintendent of Documents No. HE 22.8/6-5)
AB-03-094
•
October 2003 Quarterly Updates for Skilled Nursing Facility Consolidated Billing
AB-03-095
•
Remittance Advice Remark and Reason Code Update
AB-03-096
•
Quarterly Update of Healthcare Common Procedure Coding System Codes Used for Home Health Consolidated Billing Enforcement
AB-03-097
•
Delay in Implementation of Outpatient Therapy Caps to September 1, 2003
AB-03-098
•
Medicare Summary Notice Implementation for Contractors Using Arkansas Part A Standard System and HCFA Part B Standard System
AB-03-099
•
Instructions for Fiscal Intermediary Standard System and Multi-Carriers System Healthcare Integrated General Ledger Accounting System Changes
AB-03-100
•
October Quarterly Update for 2003 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Fee Schedule
AB-03-101
•
Clarification for CR 2562: Collection of Fee-for-Service Payments Made During Periods of Managed Care Enrollment
AB-03-102
•
Clarifications Regarding Coverage of Hyperbaric Oxygen Therapy for the Treatment of Diabetic Wounds of the Lower Extremities
AB-03-103
•
Medicare Secondary Payer Debt Referral and Write-Off Closed Instructions
AB-03-104
•
Changes to the Laboratory National Coverage Determination Edit Software for October 1, 2003
AB-03-105
•
Harkin Grantees: Complaint Tracking System and Aggregate Reports
AB-03-106
•
Third Clarification of Medicare Policy Regarding the Implementation of the Ambulance Fee Schedule
AB-03-107
•
Federal Bankruptcy/State Insurer Liquidation Actions and Medicare Secondary Payer Debt
AB-03-108
•
Medicare Secondary Payer—(1) Use of Inter-Contractor Notices and the Common Working File for the Development of the Medicare Secondary Payer Conditional Payment Amount for Liability, No-Fault, Worker's Compensation, and Federal Tort Claims Act Cases; (2) Reminder Regarding Termination Updates to the Common Working File; (3) Reminder Regarding Savings Information to Non-Lead Contractors
AB-03-109
•
Discontinue Use of the Healthcare Integrity and Protection Data Bank for Provider Enrollment Only
AB-03-110
•
Adjustment to the Rural Mileage Payment Rate for Ground Ambulance Services
AB-03-111
•
Shared System Maintainer Hours for Resolution of Problems Detected During Health Insurance Portability and Accountability Act Transaction Release Testing
AB-03-112
•
Transmittal AB-03-112 Has Been Rescinded
AB-03-113
•
Update of Codes in the Program Integrity Management Reporting System and the Contractor Administrative Cost and Financial Management System
AB-03-114
•
Claims Processing and Payment of Incomplete Screening Colonoscopies
AB-03-115
•
Payment Denial for Medicare Services Furnished to Alien Beneficiaries Who Are Not Lawfully Present in the United States
AB-03-116
•
Update of Rates and Wage Index for Ambulatory Surgical Center Payment Effective October 1, 2003
AB-03-117
•
Contractor Guidance for Connection to the Medicare Data Communication Network for Real-time Eligibility Inquiries (270/271) Via a Route Other Than Insurance Value-Added Network Services
AB-03-118
•
Cease Further Work on the Eligibility File-Based Standard Trading Partner Agreement for the Purpose of Coordination of Benefits
AB-03-119
•
Final Update to the 2003 Medicare Physician Fee Schedule Database
AB-03-120
•
Medicare Secondary Payer—(1) Copy of Recovery Demand Packages Resulting From a Data Match or Non-Data Match Group Health Plan Recovery Action to Insurers/Third Party Administrators of Employers; (2) Documentation Required When an Insurer/Third Party Administrator Wishes to Resolve a Debt on Behalf of Its Client, an Employer Debtor
AB-03-121
•
Requirement to Cross Claims Over to Multiple Supplemental Insurers
AB-03-122
•
Notice of Interest Rate for Medicare Overpayments and Underpayments
AB-03-123
•
Scheduled Release for October Updates to Software Programs and Pricing/Coding Files
AB-03-124
•
Standard System Automation of the Notice of Change to Medicare Secondary Payer Auxiliary File Process
AB-03-125
•
Consolidation of Claims Cross-Over Process
AB-03-126
•
Change in Type of Service for L04080
AB-03-127
•
Payment for Fecal Leukocyte Examination Under Clinical Laboratory Improvement Amendments of 1988 Certificate for Provider-Performed Microscopy Procedures During Calendar Year 2003
( printed page 74596)
AB-03-128
•
Clarification to Transmittal AB-03-044 (CR 2611), Addition of New Temporary “K” Codes
AB-03-129
•
Addition of Three New International Classifications of Diseases, Ninth Revision, Clinical Modification Diagnosis Codes To Be Effective as Part of the October 1, 2003, International Classification of Diseases, Clinical Update
AB-03-130
•
Levocarnitine for Use in the Treatment of Carnitine Deficiency in End-Stage Renal Disease Patients
AB-03-131
•
Update to Health Care Claims Status Category Codes and Health Care Claim Status Codes for Use With the Health Care Claim Status Request and Response ASCX12N 276/277
AB-03-132
•
Provider Education Article: Guidelines for Medicare Part B Laboratory Testing
AB-03-133
•
Managing Medicare Appeals Workloads in Fiscal Year 2004
AB-03-134
•
Modifier and Condition Code for Providers to Use When Billing for Implantable Automatic Defibrillators for Beneficiaries in Medicare+Choice Plan
AB-03-135
•
Darbepoetin Alfa (Trade Name Aranesp) and Epoetin Alfa (Trade Name Epogen) for Treatment of Anemia in End-Stage Renal Disease Patients on Dialysis
AB-03-136
•
Correction to Quarterly Update of Health Care Common Procedure Coding System Codes Used for Home Health Consolidated Billing Enforcement
AB-03-137
•
Update of Home Care Common Procedure Coding System Codes and Payment for Ambulatory Surgical Centers and File Names, Descriptions and Instructions for Retrieving the 2004 Ambulatory Surgical Center Home Health Care Common Procedure Coding System Additions, Deletions, and Master Listing
AB-03-138
•
Modification of Medicare Policy for Erythropoietin
AB-03-139
•
Appeals Quality Improvement and Data Analysis Activities
AB-03-140
•
2004 Healthcare Common Procedure Coding System Annual Update Reminder
AB-03-141
•
CMS Companion Document for the Accredited Standards Committee X12N276/277 Health Care Claim Status Request and Response
AB-03-142
•
The Coordination of Benefits Contractor Will Post the Lead Medicare Contractor in the Group Name Field on the Common Working File and Expansion of Lead Contractor Viewing in the Electronic Correspondence Referral System
AB-03-143
•
Implementation of Certain Initial Determination and Appeal Provisions Within Section 521 of the Medicare, Medicaid and State Child Health Insurance Program Benefits Improvement and Protection Act of 2000
AB-03-144
•
Establishing a Uniform Process for the Preparation and Mailing of Case Files From the Contractor to the Office of Hearings and Appeals of the Social Security Administration
AB-03-145
•
Instructions for Contractors Other Than the Religious Nonmedical Health Care Institution Specialty Intermediary Regarding Claims For Beneficiaries With Religious Nonmedical Health Care Institution Elections
AB-03-146
•
Reminder Notice of the Implementation of the Ambulance Transition Schedule
AB-03-147
•
Core Elements and Required Statements for a Valid Privacy Authorization
State Operations Manual
(CMS Pub. 7)
(Superintendent of Documents No. HE 22.8/12)
31
•
Regional Offices Assignment of Provider and Supplier Identification Number
Case Review and Health Care Quality Improvement Program—has been moved to Corresponding Internet-Only Manual chapter in Pub. 100-10, Medicare Quality Improvement Organizations Manual, which can be found at
https://www.cms.hhs.gov/manuals.
92
•
Denials, Reconsiderations and Appeals—has been moved to corresponding Internet-Only Manual chapters in Pub. 100-10, Medicare Quality Improvement Organization Manual, which can be found at
https://www.cms.hhs.gov/manuals.
93
•
Agreements—has been moved to Corresponding Internet-Only Manual chapter in Pub. 100-10, Medicare Quality Improvement Organization Manual, which can be found at
https://www.cms.hhs.gov/manuals.
94
•
Confidentiality and Disclosure—has been moved to the Corresponding Internet-Only Manual, which can be found at
https://www.cms.hhs.gov/manuals.
95
•
Outreach Activities—has been moved to corresponding Internet-Only Manual chapters in Pub. 100-10, Medicare Quality Improvement Organizations Manual, which can be found at
https://www.cms.hhs.gov/manuals.
96
•
Payment Error Prevention Program—has been moved to corresponding Internet-Only Manual chapter in Pub.100-10, Medicare Improvement Organizations Manual, which can be found at
https://www.cms.hhs.gov/manuals.
97
•
Beneficiary Complaint Review—has been moved to corresponding Internet-Only Manual chapter in Pub. 100-10, Medicare Quality Improvement Organizations Manual, which can be found at
https://www.cms.hhs.gov/manuals.
98
•
Data Management—has been moved to corresponding Internet-Only Manual chapter in Pub. 100-10, Medicare Quality Improvement Organizations Manual, which can be found at
https://www.cms.hhs.gov/manuals.
Renal Health Clinic Manual, Credit Balance Reporting Requirement—General Provisions
Completing the Centers for Medicare & Medicaid Services-838
Payment of Amounts Owed Medicare
Medicare Credit Balance Report Certification Page
( printed page 74598)
Provider Reimbursement Manual
Part 2 Provider Cost Reporting Forms and Instructions
(CMS Pub. 15-2-11)
5
•
Reimbursement Information
ESRD Network Organizations Manual
(CMS Pub. 81)
(Superintendent of Documents No. HE 22.9/4)
15
•
Background and Responsibilities
Administration
Confidentiality and Disclosure
Information Management
Quality Improvement
Community Information and Resource
Sanctions and End-Stage Renal Disease Grievances
Publication Policy
Information Collection
Medicare Claims Processing Manual
(CMS Pub. 100-04)
3
•
New Effective Data for CR2112 (Revisions to the Outpatient Prospective Payment System Pricer Software and Outpatient Code Editor for Blood Deductible and Technician)
Financial Management
(CMS Pub. 100-06)
19
•
Intermediary Claims Accounts Receivable
Medicare Program Integrity
(CMS Pub. 100-08)
44
•
When to Develop New/Revised Local Medical Review Policy
Coverage Provisions in Local Medical Review Policy
Contractor Medical Director
Local Medical Review Policy Development Process
Final Local Medical Review Policy Web Site Requirements
45
•
Focused Medical Review Activity Report
46
•
Prepayment Edits
47
•
Data Analysis
Centers for Medicare & Medicaid Services Mandated Edits
48
•
Written Orders Prior to Delivery
49
•
Denial Notices
50
•
Instructions for Processing Advance Determination of Medicare Coverage Request
51
•
Update of Codes in the Program Integrity Management Reporting System and the Contractor Administrative Cost and Financial Management System
Quality Improvement Organization
(CMS Pub. 100-10)
2
•
Introduction
Referrals
Quality Review
Diagnostic Related Group
Limitation on Liability Determinations
Third-Level Physician Review
Use of the Physician Reviewer Assessment Format
Review Setting
Requesting Medical Records/Reviewing Documentation
Medicare Program; Modifications to Managed Care Rules.
August 22, 2003
50794
CMS-1236-N
Medicare Program; September 15 and 16, 2003, Meeting of the Practicing Physicians Advisory Council and Request for Nominations.
August 22, 2003
50793
CMS-4053-N
Medicare Program: Meeting of the Advisory Panel on Medicare Education—September 18, 2003.
August 22, 2003
50790
CMS-2136-FN
Medicaid Program; State Allotments for Payment of Medicare Part B Premiums for Qualifying Individuals: Federal Fiscal Year 2002.
August 22, 2003
50784
CMS-2166-N
State Children's Health Insurance Program; Final Allotments to States, the District of Columbia, and U.S. Territories and Commonwealths for Fiscal Year 2004.
Medicare Program; Clarifying Policies Related to the Responsibilities of Medicare-Participating Hospitals in Treating Individuals With Emergency Medical Conditions.
September 26, 2003
55634
CMS-3062-N
Medicare Program; Revised Process for Making Medicare National Coverage Determinations.
September 26, 2003
55618
CMS-9018-N
Medicare and Medicaid Programs; Quarterly Listing of Program Issuances—April 2003 Through June 2003.
September 26, 2003
55616
CMS-2182-FN
Medicare and Medicaid Programs; Reapproval of the Community Health Accreditation Program (CHAP) for Deeming Authority for Hospices.
Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Correction.
September 30, 2003
56478
CMS-1233-N
Medicare Program; Hospice Wage Index for Fiscal Year 2004.
September 30, 2003
56383
CMS-1473-NC OFR Correction
Medicare Program; Home Health Prospective Payment System Rate Update for FY 2004; Correction.
Addendum V—National Coverage Determinations [July 2003 Through September 2003]
A national coverage determination (NCD) is a determination by the Secretary with respect to whether or not a particular item or service is covered nationally under Title XVIII of the Social Security Act, but does not include a determination of what code, if any, is assigned to a particular item or service covered under this title, or determination with respect to the amount of payment made for a particular item or service so covered. We include below all of the NCDs that were issued during the quarter covered by this notice. The entries below include information concerning completed decisions as well as sections on program and decision memoranda, which also announce pending decisions or, in some cases, explain why it was not appropriate to issue an NCD. We identify completed decisions by the section of the NCDM (or CIM) in which the decision appears, the title, the date the publication was issued, and the effective date of the decision. Information on completed decisions as well as pending decisions has also been posted on the CMS Web site at
https://cms.hhs.gov/coverage.
National Coverage Decisions [July 2003 Through September 2003]
Coverage Issues Manual (CIM) (CMS Pub. 06)
CIM section
Title
Issue date
Effective date
35-85.1
Implantable Automatic
08/22/03
10/01/03
Defibrillators
09/22/03 (correction)
10/01/03
Program Memorandum (PM)
PM No.
Title
Issue date
Effective date
AB-03-104
Changes to the Laboratory NCD Edit Software For 10/03
07/25/03
10/01/03
Federal Register Publications
Title
Publication date
Effective date
CMS-3062-N—Revised Process for Making National Coverage Determinations
09/26/03
N/A
Addendum VI—Categorization of Food and Drug Administration-Allowed Investigational Device Exemptions
Under the Food, Drug, and Cosmetic Act (21 U.S.C. 360c), devices fall into one of three classes. Also, under the new categorization process to assist CMS, the Food and Drug Administration (FDA) assigns each device with an FDA-approved investigational device exemption (IDE) to one of two categories. Category A refers to experimental/investigational device exemptions, and Category B refers to nonexperimental/investigational device exemptions. To obtain more information about the classes or categories, please refer to the
Federal Register
notice published on April 21, 1997 (62 FR 19328).
The following information presents the device number and category (A or B) for the second quarter, July through September 2003.
Addendum VII—Approval Numbers for Collections of Information
Below we list all approval numbers for collections of information in the referenced sections of CMS regulations in Title 42; Title 45, Subchapter C; and Title 20 of the Code of Federal Regulations, which have been approved by the Office of Management and Budget:
OMB control Nos.
Approved CFR sections in Title 42, Title 45, and Title 20 (
Note:
sections in Title 45 are preceded by “45 CFR,” and sections in Title 20 are preceded by “20 CFR”)
Use this for formal legal and research references to the published document.
68 FR 74590
Web Citation
Suggested Web Citation
Use this when citing the archival web version of the document.
“Medicare and Medicaid Programs; Quarterly Listing of Program Issuances-July 2003 Through September 2003,” thefederalregister.org (December 24, 2003), https://thefederalregister.org/documents/03-30756/medicare-and-medicaid-programs-quarterly-listing-of-program-issuances-july-2003-through-september-2003.