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

Payments for independent laboratories are not affected by CR 7061.Your Medicare contractor will deny the TC or globally billed physician pathology service line items thatshould be bundled to the hospital. The denied services are the TC or globally billed radiology andphysician pathology service line items that fall within the admission and discharge dates, inclusive, of acovered hospital inpatient stay or outpatient service billed on type of bill 11X, 12X, 13X, or 85X (exceptthose billed by specialty code 69 [independent laboratory]). Appeal rights are offered on all denials.When denying these services/line items, Medicare will use a CARC of 96 (Noncovered Charge[s]) and aRARC of N70 (Consolidated Billing and Payment Applies).Additional InformationFor complete details regarding this change request (CR) please see the official instruction (CR 7061)issued to your Medicare carrier or A/B MAC. That instruction may be viewed by going tohttp://www.cms.gov/Transmittals/downloads/R795OTN.pdf on the CMS Web site.If you have any questions, please contact your carrier or A/B MAC at their toll-free number, which maybe found at http://www.cms.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip on the CMSWeb site.News Flash - Each Office Visit is an Opportunity. Medicare patients give many reasons for not gettingtheir annual flu vaccination, but the fact is that there are 36,000 flu-related deaths in the United Stateseach year, on average. More than 90% of these deaths occur in people 65 years of age and older. Pleasetalk with your Medicare patients about the importance of getting their annual flu vaccination. ThisMedicare-covered preventive service will protect them for the entire flu season. And remember,vaccination is important for health care workers too, who may spread the flu to high risk patients. Don’tforget to immunize yourself and your staff. Protect your patients. Protect your family. Protect yourself.Get Your Flu Vaccine - Not the Flu. Remember – Influenza vaccine plus its administration are coveredPart B benefits. Note that influenza vaccine is NOT a Part D covered drug. For information aboutMedicare’s coverage of the influenza vaccine and its administration, as well as related educationalresources for health care professionals and their staff, please visithttp://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.Section 5501(b) Incentive Payment Program for Major SurgicalProcedures Furnished in Health Professional Shortage Areas Under theAffordable Care ActMLN Matters® Number: MM7063Related Change Request (CR) #: 7063Related CR Release Date: August 27, 2010Effective Date: January 1, 2011Related CR Transmittal #: R2040CPImplementation Date: January 3, 2011CPT codes and descriptors are only copyright 2010 American Medical Association (or such other date publication of CPT)The Medicare Monthly Review 84 MMR 2011-01, January 2011