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

• Doctor of podiatric medicine;• Doctor of optometry;• Doctor of chiropractic medicine;• Physician assistant;• Certified clinical nurse specialist;• Nurse practitioner;• Clinical psychologist;• Certified nurse midwife; and• Clinical social worker.In addition, the following supplier types, regardless of their employment, are excluded from thedeactivation process:• Pediatric medicine physicians (specialty 37); and• Oral surgery (dentist only, specialty 19)Additional InformationIf you have questions, contact your designated Medicare contractor at its toll free number, which isavailable at http://www.cms.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip on theCMS 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.Recovery Audit Contractor Demonstration High-Risk Vulnerabilities forPhysiciansMLN Matters® Number: SE1036Related Change Request (CR) #: N/ARelated CR Release Date: N/AEffective Date: N/ARelated CR Transmittal #: N/AImplementation Date: N/AThis is the fourth in a series of articles that will disseminate information on recovery audit contractor(RAC) demonstration high dollar improper payment vulnerabilities. The purpose of this article is toprovide education to physicians on two vulnerabilities in an effort to prevent these same problems fromoccurring in the future. With the expansion of the RAC Program nationally, it is essential that physiciansunderstand the lessons learned from the demonstration and implement appropriate corrective actions.Physician Types AffectedThis article is for all physicians that submit Fee-For-Service claims to Medicare carriers or Part A/BMedicare administrative contractors (MACs).Physician Action NeededReview the article and take steps, if necessary, to meet Medicare’s billing requirements to avoidunnecessary denial of your claims.CPT codes and descriptors are only copyright 2010 American Medical Association (or such other date publication of CPT)The Medicare Monthly Review 95 MMR 2011-01, January 2011