The Medicare Monthly Review, MMR-2011-01, January 2011 - CGS

staff, please visit http://www.cms.gov/MLNProducts/Downloads/Flu_Products.pdf andhttp://www.cms.gov/AdultImmunizations on the CMS Web site.DisclaimerThis article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links tostatutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of eitherthe written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statementof their contents. CPT only copyright 2009 American Medical Association.Instructions for PLB Code Reporting on Remittance Advice and RACRecoupment Reporting on Remittance Advice for Durable MedicalEquipment, Prosthetics, Orthotics, and Supplies ClaimsMLN Matters® Number: MM7068Related Change Request (CR) #:7068Related CR Release Date: November 12, 2010Effective Date: April 1, 2011Related CR Transmittal #: R812OTNImplementation Date: April 4, 2011; July 5, 2011 for Institutional providers and DME SuppliersProvider Types AffectedAll physicians, providers and suppliers submitting claims to Medicare contractors (fiscal intermediaries[FIs], regional home health intermediaries [RHHIs], carriers, A/B Medicare administrative contractors[MACs] and durable medical equipment MACs [DME MACs]) for Medicare beneficiaries are affected...Provider Action NeededChange Request (CR) 7068 provides instructions to Medicare carriers, MACs, FIs, and RHHIs about usingand reporting provider adjustment codes (PLB codes) on the remittance advice (RA). It also includesinstruction for DME MACs for reporting recovery audit contractor (RAC) recoupment when there is atime difference between the creation of the accounts receivable and actual recoupment of money.The attachment in CR 7068 provides a list of PLB codes to be reported on the 835 as well as the paperremittance advice and a crosswalk between the Healthcare Integrated General Ledger Accounting System(HIGLAS) PLB codes and the ASC X12 Transaction 835 PLB codes to ensure that PLB code reporting onthe RA is consistent and uniform across the board.BackgroundIn the Tax Relief and Health Care Act of 2006, Congress required a permanent and national RAC programto be in place by January 1, 2010. The goal of the recovery audit program is to identify improperpayments made on claims of health care services provided to Medicare beneficiaries. The RACs reviewclaims on a post-payment basis, and can go back three years from the date the claim was paid. Tominimize provider burden, the maximum look back date is October 1, 2007.Section 935 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA)(Publication. L.108-173) which amended Title XVIII of the Social Security Act (the Act) has added a newparagraph (f) to §1893 of the Act, the Medicare Integrity Program. The statute requires Medicare tochange how certain overpayments are recouped. These new changes to recoupment and interest are tiedto the Medicare fee-for-service claims appeal process and structure.CPT codes and descriptors are only copyright 2010 American Medical Association (or such other date publication of CPT)The Medicare Monthly Review 41 MMR 2011-01, January 2011