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Stimulus Act Forces Providers to Reissue their Business Associate Agreements The U.S. Department of Health and Human Services (HHS) has issued new regulations enacted from the American Recovery and Reinvestment Act of 2009 (ARRA - the economic stimulus act). Within the ARRA, the Health Information Technology for Economic and Clinical Health (HITECH) act was enacted. These Acts have created additional requirements for all health care providers in regards to the information security and breach reporting. The first phase of this new law requires all Business Associate Agreements (BA's) are to be reissued. By clicking the link below, you will be brought to a blank BS which is already signed by our Responsible Business Associate Officer. You can print the document, record the information for your providership, and file the document immediately. You could print two copies if you wish and send one to IHS Network in some future mailing to our office for our files. Click here for the BLANK PREPARED BA AGREEMENT |
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Medicare Power Mobility Device 7-Element Policy Medicare national policies specify that physicinan's complete a face-to-face examination of patients being prescribed power mobility devices. The physician then must complete a written order containing seven specific elements. You may provide a form that lists the seven elements, but the physician must provide all of the requested information. You may not "fill in" anything, or provide "check boxes". To view the Medicare "7 - Element Policy" on Power Mobility Devices, click here |
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2010 Medicare Fee Schedules Integrated is currently working on modifying for easy viewing the most recent Medicare Fee Schedules. These are available by state or All States. |
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Levalbuterol - BAD PRODUCT ! Providers that have patients using Levalbuterol, and inhalation drug NEED TO GET THE DOCTOR TO SWITCH THE PATIENT to Albuterol or some other inhalation drug. It's most likely going to be a looser products Medicare does not pay even half of what it will cost you. To view our Nebulizer and Inhalation Drugs content, click here |
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Medicare Accreditation Deadline Is Extended !
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Eastern Pennsylvania HMO Opportunity Providers in the Philadelphia, Pennsylvania area that are Medicare Accredited have a limited opportunity to go "in-network" with Independent Blue Cross. You will have to provide them with an enrollment form which is available on our site. Note, the open eligibility period will end by the end of 2009. there are a significant number of IBC patients in Eastern PA, and you can support them only if you are in=network with IBC. For a copy of the IBC Provider Enrollment Application click here |
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For providers that participate with HMO's: If you are participating with an HMO or Medicare Advantage insurance carrier, it is vital that you inform them that you are a Medicare Accredited provider, and that you have a Surety Bond. Blue Advantage, an Alabama Medicare Advantage HMO is requiring their providers to be be participating in traditional Medicare and provide them with that information. Logically, other HMO's, PPO's and Medicare Advantage Plans will also have this requirement. If you are able to support those types of patients now, for your own sake, you should determine if you need to provide your Accreditation and Surety bond information to continue to be paid. If we generate a clam and it is denied because you have to provide that first, there will be an unnecessary delay in payment. Look on any remittance advice from that carrier for a phone number for their PROVIDER RELATIONS, contact them and ensure that you are still eligible for payments if you render services to their patients. Below we have a copy f the Alabama letter to one of our providers. Please review it to understand the requirement being imposed on providers. For a copy of the Alabama Blue Advantage Letter to Providers click here |
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For providers being accredited, or who have a Surety Bond: Providers need
to have their accreditation and a surety bond by today (by Oct.
1 and Oct. 2 respectively), CMS is now telling providers who
are currently in the process what to do. According to a document
dated Aug. 10, here's what the agency says providers need to
do if they are in the process of being accredited or obtaining
a surety bond: |
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For
providers opting out of Medicare Part B:
Send to: Provider Enrollment
What to do if you are dropping out of the Medicare Part B program Here's the advice
CMS gives providers who are not going to be accredited or get
a bond: |
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Flu Shots and more: Medicare Part B pays 100 percent for pneumococcal vaccines, influenza virus vaccines, and their administration. The Part B deductible and coinsurance do not apply for influenza virus and pneumococcal vaccine. Remember the following
regarding the influenza vaccine: ·
administration; and Remember the following
with regard to the pneumococcal vaccine, effective for services
furnished on or after July 1, 2000: ·
administration, and Typically, the
pneumococcal vaccine is administered once in a lifetime. Claims
for pneumococcal vaccines are paid for beneficiaries who: |
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Medicare versions of the PATIENT COMPLAINT LOG and COMPLAINT PROTOCOL We have prepared for our clients to use a Medicare version of the PATIENT COMPLAIN LOG and their PATIENT COMPLAINT HANDLING PROTOCOL. They both differ slightly from the versions we gave you when you started with us. They are INTERACTIVE so you can add your provider name and address if you wish. Look for them near the bottom of our HEALTHCARE PROVIDER MENU. |
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Interactive CMN's available on our site We have prepared for our clients to use new CMN's that are INTERACTIVE. You can plug information in, and print them out. with the information you entered for professional presentation to your physician or to give to your patient to bring to their doctor. You can also save them to your computer, then enter your provider info one time, save it again, and they will retain your provider data for future use without needing to go online and visit our site. You will need to have Adobe Acrobat ® on your computer for these to work properly.
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Medicare Documentation Checklists Below, find a link that will bring you to the Medicare Region C Documentation Checklists. These provide valuable information on the coverage and documentation required for various products that Medicare covers. This is really good stuff!
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Manual Wheelchair Redeterminations for Same or Similar Issues On average, manual wheelchair issues make up 8% of all redeterminations submitted. Our analysis finds that 54% of all of these manual wheelchair cases involve same or similar issues (Remittance Advice Remark Code M3). Wheelchair claims are frequently denied because the equipment involved is the same as or similar to equipment currently or previously in possession of the beneficiary.
Below, please find a link to Medicare's brief on this subject:
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Clarification for Emend© Part B Billing vs: Part D Clarification for Billing Part B versus Part D for the Anti-emetic Aprepitant (Emend®) Provider Types Affected Providers and suppliers rendering services to beneficiaries with cancer chemotherapy-induced nausea and vomiting.
Below, please find a link to a PDF on our site with information about this Anti-emetic drug: |
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Accreditation Deadline and Revocation CMS just released this information. If you have a Medicare Part B number, pharmacies must submit a new Medicare application, CMS 855S not later than September 30, 2009 to prevent "disbarment" from Medicare. A CMS 855S must be completed if: * Received an accreditation certificate from an accreditation board * New application requirements Submitted a CMS 855S prior to April 1, 2009 indicating an accreditation certificate was received * New application requirements Working for accreditation, but will not have an accreditation certificate prior to September 30, 2009 * Must voluntarily terminate the Medicare Part B number and then re-activate once an accreditation certificate is received Dispensing only Medicare Part B pharmaceuticals * Indicate only pharmaceuticals being dispensed Giving up a Medicare Part B billing capability * Voluntarily terminating Medicare enrollment
Below, please find a link to a PDF on our site with information about having your Part B Billing Privileges revoked: |
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Budesonide - Coding and Coverage Below, please find a link to a PDF on our site with the most current Budesonide - Coding and Coverage information. |
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Medicare Coverage Rules Below, please find a valuable web address that lists many things, notably the COVERAGE / MEDICAL GUIDELINES. This page also contains links to the LCD documentation requirements and the CMS DMEPOS coverage manuals. You can find the exact rule governing the quantities allowed and the documentation required for most Part B Medicare items. |
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NPI Database Updates Health care providers can apply for an NPI online at https://nppes.cms.hhs.gov. Health care providers needing assistance updating their data in NPPES records may contact the NPI Enumerator at 1.800.465.3203 or email the request to the NPI Enumerator at CustomerService@NPIEnumerator.com |
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All Medicare providers should have selected an ACCREDITATION ORGANIZATION (AO) by January 31st, 2009. Integrated needs to report to CEDI (the EMC agency for all Medicare claims) your AO selection. We need your selection faxed to our office by Friday March 15th or you may enter this information over the internet at our website. If you do not become accredited you will not be able to support Medicare patients |
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DMEPOS Accreditation The guidance regarding
the Medicare Improvements for Patients and Providers Act of 2008
(MIPPA) for Durable Medical Equipment, Prosthetics, Orthotics
and Supplies (DMEPOS) providers and suppliers has been added
to the "Downloads" section below. Deemed Accreditation Organizations [PDF, 41KB] DMEPOS Accreditation Standards [PDF, 72KB] DMEPOS Accreditation Deadlines [PDF, 63KB] |
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Proof of Delivery
- Recent claim reviews by members of the Medical Review staff
have revealed widespread deficiencies in proof of delivery documentation.
Some of the issues identified include:
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Elastic Garments Non-covered - CMS has determined that elastic garments do not meet the statutory definition of a brace because they are not rigid or semi-rigid devices. Therefore, effective for claims with dates of service on or after April 1, 2009, these items will be denied as non-covered, no benefit category. This determination also applies to elastic spinal garments. Currently, both elastic spinal garments and nonelastic spinal orthoses are billed using the same HCPCS codes.
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The Centers for Medicare & Medicaid Services (CMS) announced regulations requiring suppliers of certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) to post a surety bond as a condition of new or continued Medicare enrollment. The regulation states that beginning May 4, 2009, suppliers seeking to enroll or changing the ownership of a DMEPOS supplier must submit a $50,000 surety bond for each assigned NPI for which the DMEPOS supplier is seeking to obtain Medicare billing privileges. Existing DMEPOS suppliers must submit to the NSC a $50,000 surety bond for each assigned NPI no later than October 2, 2009.
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ZOSTAVAX is a herpes zoster vaccine. It reduces the risk of getting herpes zoster "shingles" in individuals 60 years of age and older. In people who were 70 years of age and older, and still developed shingles even though they had been vaccinated, Zostavax reduced the frequency of post herpetic neuralgia (PHN). Zostavax will not work to treat PHN. The benefit of Zostavax in preventing PHN is due to the effect of the vaccine on reducing the risk of developing herpes zoster (shingles). We have had some inquiries in relation to coverage of Zostavax and have received some claims for Zostavax. This Part B Medicare contractor cannot pay for a preventive vaccine which has not had a legislative exemption. |
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Patient Declaration of Hardship form ( CMS Approved Version ) if you patient CANNOT PAY their deductibles or copayments to you, you should obtain one of these for your files: Patient Declaration of Hardship form ( CMS Version ) ( PDF ) |
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What Kind Of Walkers Are Covered
By Medicare?
