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Repeal of Section 20.10, Publication 100-03, National Coverage Determinations (NCD) Manual, Cardiac Rehabilitation Programs Reference: Trans. 116, CR #6855, Pub. 100-03, MLN: MM6855 This article is based on Change Request (CR) 6855, which repeals Section 20.10 from the Medicare National Coverage Determinations (NCD) Manual (Pub. 100-03), effective February 22, 2010. You may review the revised section of the Medicare Claims Processing Manual (pages 73-80) at http://www.cms.hhs.gov/manuals/downloads/clm104c32.pdf on the CMS website. Make certain your billing staffs are aware of these coverage changes in the cardiac rehabilitation program. Published Online: Thursday, March 11, 2010

Percutaneous Transluminal Angioplasty (PTA) of the Carotid Artery Concurrent with Stenting Reference: Trans. 1925, CR #6839, Pub. 100-04, MLN: MM6839 This article is based on Change Request (CR) 6839 which announces that for claims with dates of service on and after December 9, 2009, contractors will be aware that there is revised language specific to embolic protection devices (EPDs) for percutaneous transluminal angioplasty (PTA) concurrent with carotid artery stenting (CAS) system placement in Food and Drug Administration-Approved post-approval studies, and PTA Concurrent with CAS system placement in patients at high risk for carotid endarterectomy. The revised language specific to EPDs is located in Pub. 100-03, National Coverage Determination (NCD) 20.7.B.3 and 20.7.B.4, and Pub. 100-04, Chapter 32, Section 160. Make sure your billing staff is aware of the revised language. Published Online: Thursday, March 11, 2010

July 2010 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files Reference: Trans. 1922, CR #6805, Pub. 100-04, MLN: MM6805 This article is based on Change Request (CR) 6805 which instructs Medicare contractors to download and implement the July 2010 ASP drug pricing file for Medicare Part B drugs; and if released by the Centers for Medicare & Medicaid Services (CMS), also the revised April 2010, January 2010, October 2009, and July 2009 files. Medicare will use the July 2010 ASP and not otherwise classified (NOC) drug pricing files to determine the payment limit for claims for separately payable Medicare Part B drugs processed or reprocessed on or after July 6, 2010, with dates of service July 1, 2010, through September 30, 2010. Published Online: Thursday, March 11, 2010

One-Time Mailing of Supplier Responsibilities Letter - Individual Practitioners Only Reference: Trans. 568, CR #6278, Pub. 100-20, MLN: MM6278 Note: This article was revised on February 23, 2010, to reflect changes made to CR 6278 on January 29, 2010. The article was revised to include the three scenarios on pages 2 and 3. The CR release date, transmittal number, and the Web address for accessing CR 6278 were also revised. All other information remains the same.All physicians and non-physician practitioners must comply with Medicare reporting responsibilities and report relevant address and other enrollment changes in a timely manner. For example, failure to report an address change timely may affect your billing privileges and payment of claims. The Centers for Medicare & Medicaid Services (CMS) has directed Medicare contractors (carriers and Medicare Administrative Contractors (MACs)) to notify all sole proprietor physicians and non-physician practitioners of their reporting responsibilities with a one-time mailing. Contractors must complete this mailing to physicians, who are sole proprietors, by November 30, 2009, and to sole proprietor non-physician practitioners by December 31, 2009. You need to review the mailing and ensure that you have complied with the reporting responsibilities. Make sure your billing staffs are aware of these responsibilities. Published Online: Thursday, March 11, 2010

Revised Medicare Physician Fee Schedule Fact Sheet Reference: CMS List-Serv Message 031010 The Medicare Physician Fee Schedule Fact Sheet (March 2010) has been revised to include information about the two month zero percent (0%) update to the 2010 Medicare Physician Fee Schedule (MPFS) effective for dates of service January 1, 2010 through March 31, 2010. This fact sheet, which also provides information about MPFS payment rates and the MPFS payment rates formula, is available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/MedcrePhysFeeSchedfctsht.pdf. Published Online: Thursday, March 11, 2010

Internet-based Provider Enrollment, Chain and Ownership System (PECOS) Reference: CMS List-Serv Message 030910 Due to scheduled maintenance, Internet-based Provider Enrollment, Chain and Ownership System (PECOS) will be unavailable from Monday, March 29, 2010 through Monday, April 5, 2010. Internet-based PECOS allows physicians, non-physician practitioners, providers, and other suppliers (except suppliers of durable medical equipment, prosthetics, orthotics, and supplies [DMEPOS]) to enroll or make a change to their existing Medicare enrollment information over the Internet. Published Online: Wednesday, March 10, 2010

Medicare Preventive Services Quick Reference Information Charts Reference: CMS List-Serv Message 030910 The Medicare Preventive Services Quick Reference Information Charts have been updated and are now available in downloadable format. To view the revised charts, please visit the "Preventive Services Educational Products" page at: http://www.cms.hhs.gov/MLNProducts/35_PreventiveServices.asp and select the "Educational Products" link in the "Downloads" section. Published Online: Wednesday, March 10, 2010

DMEPOS Fact Sheet Reference: CMS List-Serv Message 030910 A new fact sheet entitled "The Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program - A Better Way for Medicare to Pay for Medical Equipment" (February 2010), is now available in downloadable format on the DMEPOS Competitive Bidding website. This fact sheet gives providers and suppliers an overview of the DMEPOS Competitive Bidding program as well as useful information regarding the benefits and inherit qualities of the program. The fact sheet may be downloaded from the following web page: http://www.cms.hhs.gov/DMEPOSCompetitiveBid/04_Educational_Resources.asp. Published Online: Wednesday, March 10, 2010

Medicare Ends Contract with Fox Insurance Company Drug Plan Reference: CMS List-Serv Message 030910 Members Will Be Provided Access to Drugs While Transitioning to New Plans - The Centers for Medicare & Medicaid Services (CMS) today terminated its contract with Fox Insurance Company. After an onsite review of the plan and its services, CMS determined that the plan’s significant deficiencies – not meeting Medicare’s requirements to provide enrollees with prescription drugs according to recognized standards of care – jeopardized the health and safety of Fox enrollees. CMS found that Fox committed a series of violations, including improperly denying its enrollees coverage of critical HIV, cancer, and seizure medications. The termination of the contract is effective immediately. The immediate termination will not impact or delay access to drugs for the more than 123,000 Medicare beneficiaries currently enrolled in Fox plans. Beginning tomorrow, all enrollees will obtain their drugs through LI-NET, a program run by Medicare and administered by Humana, to ensure that beneficiaries receive their Medicare prescription drugs. Fox enrollees will be able to choose a new Medicare prescription drug plan through May 1, 2010. Current enrollees who do not choose a plan will be enrolled into a new plan by Medicare. Published Online: Wednesday, March 10, 2010

Basic Introduction to ICD-10-CM National Provider Conference Call Reference: CMS List-Serv Message 030810 The Basic Introduction to ICD-10-CM National Provider Conference Call will be conducted on Tuesday, March 23, 2010 from 1:00 p.m. – 2:30 p.m. Eastern Daylight Time. This conference call will provide an overview of ICD-10-CM/PCS requirements and a basic introduction to ICD-10-CM. Registration information and discussion materials for this conference call can be accessed at http://www.cms.hhs.gov/ICD10/07_CMS_Sponsored_Calls.asp. Published Online: Monday, March 08, 2010

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