 Posted: March 13, 2005
ASCO has compiled a comprehensive set of FAQ's on the use and implementation of the current Medicare coding requirements for infusion administration.
As reported by ASCO, the CPT Editorial Panel met on February 13-13, 2005. Much of the discussion focused on the new coding guideline for a short
infusion.The Panel addressed this issue by stating that an
infusion of less than 15 minutes duration should be reported with the
appropriate CPT code for the push technique (90775, 90776, 96409, 96411 or
96420) and that infusions lasting longer than 15 minutes should be reported with
the appropriate infusion code.The Panel also redefined an intravenous or
intra-arterial push as: an injection in which the healthcare professional who
administers the substance/drug is continuously present to administer the
injection and observe the patient; or an infusion of 15 minutes or less.
The March 2005 edition of Medicare B Resource is now available.
CMS has recently changed instructions to the Carriers (in Change Request 3127, dated November 26, 2004) regarding what should be considered for a redetermination (appeal). Specifically, any item which is found, on the face of the evidence, to be a processing error on the part of the Carrier, should be handled as a reopening to the initial determination rather than subject to a redetermination. Since NHIC’s Telephone Redetermination line does not generally handle reopenings to an initial determination, any error on the Carrier’s part should be handled on our general Provider Customer Service line (866-502-9054 for Southern California or 877-591-1587 for Northern California).
Effective March 19, 2005, NHIC Telephone Redeterminations (Appeals) in Northern California will only review 5 ICN/claims per call. Southern California Telephone Redeterminations currently process a maximum of 5 claims per call. As of June 1, 2005, both Southern and Northern California Telephone Redeterminations will only process 3 ICN’s per phone call. These changes are to support upcoming BIPA requirements for FY 2005. There are no limits on the number of claims that may be considered on a written redetermination request.
The new Interactive Voice Recognition (IVR) system will be effective March 21, 2005. The IVR is simple and easy to use. Complete instructions are available for your reference.
Mark McClellan, MD, PhD, administrator of the Centers for Medicare and Medicaid Services (CMS), addressed almost 500 attendees at the Association of Community Cancer Centers’ 31st Annual National Meeting in Alexandria, Va., March 9. During his keynote address, Dr McClellan touched on several key policy issues including payments to physicians, drug coverage, and delivery of cancer care to Medicare patients.
The Association of Community Cancer Centers’ (ACCC) Center for Provider Education is pleased to announce a series of regional educational sessions to help oncology practices respond to recent changes in reimbursement policies. From beginning coders and billers to veteran practice managers to physician owners…all will benefit from this FREE three-hour course.
On January 10th, 2005, Governor Schwarzenegger released his proposed 2005-06 State Budget, which includes a proposal to redesign the Medi-Cal program.
Starting in January 2005, Medi-Cal will issue new Benefits Identification Cards (BICs) with a 14-character alphanumeric ID. The new cards will be phased in statewide. Current BICs have either a 10-character numeric or a 10-character alphanumeric ID number.
The Medi-Cal March 2005 Bulletin 368 includes expanded coverage for Carboplatin and revised ESRD guidelines EPO.
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