Cms Manual 100-04

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Cms Manual 100-04

The CMS program components, providers, contractors, Medicare Advantage organizations and state survey agencies use the IOMs to administer CMS programs. If yes, upvote this post. You may also be using compatibility mode. Our site was not designed to run in IE 7 or below but you can still continue to use it. To disable compatibility mode - View our Instructions. CR 11554 does not convey any Medicare policy changes. If you are not re-directed, please click here. Please let us know if this article was helpful. When you rate our articles as most helpful, we know that we are on the right track for providing you with important news and information. We'll use your feedback to review this article to try to revise or expand it. Contact us with more feedback or a question on this topic. CPT is a trademark of the AMA. You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. Applications are available at the AMA website. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT.The AMA is a third party beneficiary to this license. All rights reserved. CDT is a trademark of the ADA.http://epponline.com/mentorfinancial/page_images/5-speed-manual-transmission-design.xml

You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT-4. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. Applications are available at the American Dental Association website. Please click here to see all U.S. Government Rights Provisions. The sole responsibility for the software, including any CDT-4 and other content contained therein, is with (insert name of applicable entity) or the CMS; and no endorsement by the ADA is intended or implied. This Agreement will terminate upon notice to you if you violate the terms of this Agreement. The ADA is a third-party beneficiary to this Agreement. Any questions pertaining to the license or use of the CDT-4 should be addressed to the ADA. End users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT-4. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. If you do not agree to the terms and conditions, you may not access or use the software.For more detailed information about FISS, refer to the Chapters 1-5 of the FISS Guide. You may also submit NOEs via Electronic Data Interchange (EDI) effective with the January 2, 2018, implementation of Change Request (CR) 10064. Refer to CMS 837I NOE Companion Guide for the required elements. The NOE is submitted after the beneficiary has signed the election statement and is only submitted once.http://phantasos.org/userfiles/5-speed-manual-isuzu-4jb1t-4wd-transmission.xml

Hospices must submit the NOE within 5 calendar days after the hospice admission (refer to the Change Request 8877 CGS Web page for additional information). To be timely, the NOE must be submitted to, and accepted by, CGS. To be accepted by CGS, the NOE must be free of billing or keying errors that would cause the NOE to be returned or rejected. The first hospice claim for a beneficiary may be submitted only after the NOE has processed (P B9997). After the first claim processes (pays, denies or rejects), the subsequent claim can then be submitted. Due to sequential billing, hospice claims must be submitted monthly and processed in date order. Review the Hospice Sequential Billing Web page for additional information. You may also submit NOTRs via Electronic Data Interchange (EDI) effective with the January 2, 2018, implementation of Change Request (CR) 10064. Refer to CMS 837I NOE Companion Guide for the required elements. Use our feedback form to submit general comments regarding our website, or to seek technical assistance if you encounter problems. All Rights Reserved. The Medicare Internet-only Manuals (IOMs) are a replica of the Agency's official record copy. They are CMS' program issuances, day-to-day operating instructions, policies, and procedures that are based on statutes, regulations, guidelines, models, and directives. The CMS program components, providers, contractors, Medicare Advantage organizations and state survey agencies use the IOMs to administer CMS programs. They are also a good source of Medicare and Medicaid information for the general public. Please continue to use the Paper-Based Manual to make your selection.) (not shown in list) Use the two drop-down list boxes at the top of this page to navigate to a manual and section. We’ve made big changes to make the eCFR easier to use. Be sure to leave feedback using the 'Help' button on the bottom right of each page!

The Public Inspection page may alsoWhile every effort has been made to ensure thatUntil the ACFR grants it official status, the XMLCounts are subject to sampling, reprocessing and revision (up or down) throughout the day. This information is not part of the official Federal Register document. These can be usefulOnly official editions of theUse the PDF linked in the document sidebar for the official electronic format. Consequently, we are providing contact persons to answer general questions concerning each of the addenda published in this notice. Administration and oversight of these programs involves the following: (1) Furnishing information to Medicare and Medicaid beneficiaries, health care providers, and the public; and (2) maintaining effective communications with CMS regional offices, state governments, state Medicaid agencies, state survey agencies, various providers of health care, all Medicare contractors that process claims and pay bills, National Association of Insurance Commissioners (NAIC), health insurers, and other stakeholders. To implement the various statutes on which the programs are based, we issue regulations under the authority granted to the Secretary of the Department of Health and Human Services under sections 1102, 1871, 1902, and related provisions of the Social Security Act (the Act) and Public Health Service Act. We also issue various manuals, memoranda, and statements necessary to administer and oversee the programs efficiently. This is the most current up-to-date information and will be available earlier than we publish our quarterly notice. We believe the Web site list provides more timely access for beneficiaries, providers, and suppliers. We also believe the Web site offers a more convenient tool for the public to find the full list of qualified providers for these specific services and offers more flexibility and “real time” accessibility.

In addition, many of the Web sites have listservs; that is, the public can subscribe and receive immediate notification of any updates to the Web site. These listservs avoid the need to check the Web site, as notification of updates is automatic and sent to the subscriber as they occur. If assessing a Web site proves to be difficult, the contact person listed can provide information. We expect this notice to be used in Start Printed Page 28073 concert with previously published notices.The publication dates of the previous four Quarterly Listing of Program Issuances notices are: April 24, 2015 ( 80 FR 23013 ) August 3, 2015 ( 80 FR 45980 ) November 13, 2015 ( 80 FR 70218 ) and February 4, 2016 ( 81 FR 6009 ). For the purposes of this quarterly notice, we are providing only the specific updates that have occurred in the 3-month period along with a hyperlink to the Web site to access this information and a contact person for questions or additional information. In 2003, we transformed the CMS Program Manuals into a web user-friendly presentation and renamed it the CMS Online Manual System. Paper-based manuals are CMS manuals that were officially released in hardcopy. The majority of these manuals were transferred into the Internet-only manual (IOM) or retired. Pub 15-1, Pub 15-2 and Pub 45 are exceptions to this rule and are still active paper-based manuals. The remaining paper-based manuals are for reference purposes only. If you notice policy contained in the paper-based manuals that was not transferred to the IOM, send a message via the CMS Feedback tool. Under the FDL program, government publications are sent to approximately 1,400 designated libraries throughout the United States. Some FDLs may have arrangements to transfer material to a local library not designated as an FDL. Contact any library to locate the nearest FDL.These libraries provide reference services and interlibrary loans; however, they are not sales outlets.

Individuals may obtain information about the location of the nearest regional depository library from any library. CMS publication and transmittal numbers are shown in the listing entitled Medicare and Medicaid Manual Instructions. To help FDLs locate the materials, use the CMS publication and transmittal numbers. For example, to find the manual for Quarterly Update for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP)—January 2016 (CMS-Pub. 100-04) Transmittal No. 3377. A transmittal may consist of a single or multiple instruction(s). Often, it is necessary to use information in a transmittal in conjunction with information currently in the manual. For the purposes of this quarterly notice, we list only the specific updates to the list of manual instructions that have occurred in the 3-month period.Standardized Terminology for Claims Processing Systems. Standard Terminology Chart. Release Software. Implementing Validated Workarounds for Shared System Claims Processing by All Medicare DME MACs. Shared System Testing Requirements for Shared System Maintainers, Single Testing Contractor (STC), and DME MACs. Testing Standards Applicable to all Beta Testers. Timeframe Requirements for all Testing Entities. Testing Documentation Requirements. Definitions. Test Case Specification Standard. Next Generation Desktop (NGD) Requirements. Medicare Benefit Policy (CMS-Pub. 100-02) 218 Calendar Year (CY) 2016 Eligibility Changes to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) Low-Volume Payment Adjustment (LVPA). ESRD PPS Case-Mix Adjustments. 219 Calendar Year (CY) 2016 Eligibility Changes to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) Low-Volume Payment Adjustment ESRD PPS Case-Mix Adjustments (LVPA). 220 Rural Health Clinic and Federally Qualified Health Center—Medicare Benefit Policy Manual Update. 221 Telehealth Services.

Medicare National Coverage Determination (CMS-Pub. 100-03) 189 Screening for Cervical Cancer With Human Papillomavirus (HPV) Testing-National Coverage Determination (NCD). 190 Screening for the Human Immunodeficiency Virus (HIV) Infection. Purpose of Chapter. Definition of Provider and Supplier. General Admission and Registration Rules. Changes to HICNs. Contractor Procedures for Obtaining Missing or Incorrect Claim Numbers. Prohibition Against Waiver of Health Insurance Benefits as a Condition of Admission. Hospital and Skilled Nursing Facility (SNF) Verification of Prior Hospital Stay. Information for Determining Deductible and Benefit Period Status. B MAC (A) or (HHH) Learns Beneficiary is an HMO Enrollee. Health Insurance (HI) Card. Temporary Eligibility Notice. Reserved. Part A Inquiry (HIQA) Screen Display. Part A Inquiry Reply (HUQAR) Data. Health Insurance Query for Home Health Agencies (HIQH). Reserved. Reserved. Reserved. Reserved. Reserved. Reserved. Reserved. Reserved. Reserved. Reserved. Reserved. Reserved. Reserved. Reserved. Reserved. Reserved. Reserved. HMO-Related Master File Corrections. Payments on the MPFS for Providers With Multiple Service Locations. Testing—National Coverage Determination (NCD). Screening for Cervical Cancer with Human Palillomavirus Testing. Screening Pap Smears: Healthcare Common Procedure Coding. System (HCPCS) Codes for Billing. Screening Pap Smears: Diagnoses Codes. TOB and Revenue Codes for Form CMS-1450. MSN Messages. Remittance Advice Codes. 3461 Screening for the Human Immunodeficiency Virus (HIV) Infection. Healthcare Common Procedure Coding System (HCPCS) for HIV Screening Tests. Billing Requirements. Payment Method. Types of Bill (TOBs) and Revenue Code. Diagnosis Code Reporting. Advice Messages. Remittance Advice Coding Used in this Manual. Editing Of Hospital Part B Inpatient Services: Reasonable and Necessary Part A Hospital Inpatient Denials.

Editing Of Hospital Part B Inpatient Services: Other Circumstances in Which Payment Cannot Be Made under Part A. Assistant at Surgery Medicare Summary Notice (MSN) and Remittance Advice (RA) Messages. Start Printed Page 28076 Coding Guidance for Certain CPT Codes—All Claim Advice Messages. 3476 Telehealth Services. List of Medicare Telehealth Services. Payment for ESRD-Related Services as a Telehealth Service. Payment for Subsequent Hospital Care Services and Subsequent Nursing Facility Care Services as Telehealth Services. Payment for Diabetes Self-Management Training (DSMT) as a Telehealth Service. Originating Site Facility Fee Payment Methodology. Payment for Blood Clotting Factor Administered to Hemophilia. Inpatients. Pancreas Transplants Kidney Transplants. Pancreas Transplants Alone (PA). Intestinal and Multi-Visceral Transplants. Billing for Abortion Services. Remittance Advices. Remittance Advice Impact. Reject and Unsolicited Response Edits. Edit for Clinical Social Workers (CSWs). Editing of Skilled Nursing Facilities Part B Inpatient Services. Additional Introductory Guidelines. ZIP Code Determines Fee Schedule Amounts. Medicare Secondary Payer (CMS-Pub. 100-05) 00 None. Medicare Financial Management (CMS-Pub. 100-06) 258 Notice of New Interest Rate for Medicare Overpayments and Underpayments 2nd Qtr Notification for FY 2016. 259 Internet Only Manual Pub. 100-06, Chapter 4 Revisions to Reflect the New Debt Referral Requirements Mandated by the Digital Accountability and Transparency Act of 2014 (DATA Act). Requirements for Collecting Part A and B Non-MSP Provider Overpayments. Required Timeframes for Debt Collection Process for Provider Non-MSP Overpayments. Referral Requirements. Establishing an Extended Repayment Schedule (ERS)—(formerly known as an Extended Repayment Plan (ERP). ERS Required Documentation—Physician is a Sole Proprietor. ERS Required Documentation—Provider is an Entity Other Than a Sole Proprietor.

265 Contractor Reporting of Operational and Workload Data (CROWD) Form 5. Update with Revisions to Pub. 100-06 Medicare Financial Management Manual, Chapter 6. Medicare Contractor Transaction Report (CROWD Form 5). Heading. Body of Report. Medicare State Operations Manual (CMS-Pub. 100-07) 152 Revisions to the State Operations Manual (SOM) Chapter 2 Numbering System for CMS Certification Numbers (CCN). Start Printed Page 28077 CCN for Medicare Providers. 153 Revisions to the State Operations Manual (SOM) Chapter 9 Exhibits. Medicare Program Integrity (CMS-Pub. 100-08) 635 Clarification to Language Regarding Proof of Delivery Requirements in Pub. 100-08, Chapter 4, Section 4.26.1. Proof of Delivery and Delivery Methods. 636 Update to Pub. 100-08, Chapter 15. Medicare Contractor Duties. Correspondence Address and E-mail Addresses. Tax Identification Numbers (TINs) of Owning and Managing. Organizations and Individuals. Form CMS-855A and Form CMS-855B Signatories. Delegated Officials. Technicians. Supervising Physicians. Processing Form CMS-855R Applications. Inter-Jurisdictional Reassignments. Form CMS-855 Applications That Require a Site Visit. Form CMS-855 Applications That Do Not Require a Site Visit. General Timeliness Principles. Special Program Integrity Procedures. Processing of Registration Applications. Disposition of Registration Applications. Revocation of Registration. Registration Letters. Returns. Denials. Non-Certified Suppliers and Individual Practitioners. Existing or Delinquent Overpayments. Contractor Communications. Application Fees. Movement of Providers and Suppliers into the High Level. Web Sites. Release of Information. Model Letter Guidance. Approval Letter Guidance. Appeals Process. Corrective Action Plans (CAPs). Corrective Action Plans (CAPs). Reconsideration Requests—Certified Providers and Certified Suppliers. HHA Ownership Chang. Revocations. Other Identified Revocations. External Reporting Requirements.

Information Security Acceptable Risk Safeguards (CMS-Pub. 100-25) None. The online database is updated by 6 a.m. each day the Federal Register is published.They provide clarification and interpretation of complex or ambiguous provisions of the law or regulations relating to Medicare, Medicaid, Utilization and Quality Control Peer Review, private health insurance, and related matters. For questions or additional information, contact Tiffany Lafferty (410-786-7548). Completed decisions are identified by the section of the NCD Manual (NCDM) in which the decision appears, the title, the date the publication was issued, and the effective date of the decision. An NCD is a determination by the Secretary for whether or not a particular item or service is covered nationally under the Medicare Program (title XVIII of the Act), but does not include a determination of the code, if any, that is assigned to a particular covered item or service, or payment determination for a particular covered item or service. The entries below include information Start Printed Page 28080 concerning completed decisions, as well as sections on program and decision memoranda, which also announce decisions or, in some cases, explain why it was not appropriate to issue an NCD. Information on completed decisions as well as pending decisions has also been posted on the CMS Web site. For the purposes of this quarterly notice, we are providing only the specific updates that have occurred in the 3-month period. For questions or additional information, contact Wanda Belle (410-786-7491). The listings are organized according to the categories to which the devices are assigned (that is, Category A or Category B), and identified by the IDE number. For the purposes of this quarterly notice, we list only the specific updates to the Category B IDEs as of the ending date of the period covered by this notice and a contact person for questions or additional information.

For questions or additional information, contact John Manlove (410-786-6877). To assist CMS under this categorization process, the FDA assigns one of two categories to each FDA-approved investigational device exemption (IDE). Category A refers to experimental IDEs, and Category B refers to non-experimental IDEs. To obtain more information about the classes or categories, please refer to the notice published in the April 21, 1997 Federal Register ( 62 FR 19328 ). A single control number may apply to several related information collections. For questions or additional information, contact Mitch Bryman (410-786-5258). All facilities listed meet CMS standards for performing carotid artery stenting for high risk patients. On March 17, 2005, we issued our decision memorandum on carotid artery stenting. We determined that carotid artery stenting with embolic protection is reasonable and necessary only if performed in facilities that have been determined to be competent in performing the evaluation, procedure, and follow-up necessary to ensure optimal patient outcomes. We have created a list of minimum standards for facilities modeled in part on professional society statements on competency. All facilities must at least meet our standards in order to receive coverage for carotid artery stenting for high risk patients. For the purposes of this quarterly notice, we are providing only the specific updates that have occurred in the 3-month period.The following facilities have editorial changes (in bold) FROM: Saint Joseph Medical Center, TO: St.We cover implantable cardioverter defibrillators (ICDs) for certain clinical indications, as long as information about the procedures is reported to a central registry. Detailed descriptions of the covered indications are available in the NCD. In January 2005, CMS established the ICD Abstraction Tool through the Quality Network Exchange (QNet) as a temporary data collection mechanism.

On October 27, 2005, CMS announced that the American College of Cardiology's National Cardiovascular Data Registry (ACC-NCDR) ICD Registry satisfies the data reporting requirements in the NCD. Hospitals needed to transition to the ACC-NCDR ICD Registry by April 2006. Patients may be enrolled either in an Investigational Device Exemption trial studying ICDs as identified by the FDA or in the ACC-NCDR ICD registry. Therefore, for a beneficiary to receive a Medicare-covered ICD implantation for primary prevention, the beneficiary must receive the scan in a facility that participates in the ACC-NCDR ICD registry.For questions or additional information, contact Marie Casey, BSN, MPH (410-786-7861). Start Printed Page 28082 CGH Medical Center Sterling IL. Longmont United Hospital Longmont CO. La Paz Regional Hospital Parker AZ. Carlsbad Medical Center Carlsbad NM. Pacific Surgery Center Costa Mesa CA. Memorial Care Outpatient Surgical Center of Long Beach Long Beach CA. Pearland Medical Center (HCA) Pearland TX. Alaska Native Medical Ctr Anchorage AK. Bronx-Lebannon Hospital Center Bronx NY. Kentuckiana Medical Center Clarksville IN. Wheaton Franciscan Healthcare—Franklin, Inc Milwaukee WI. Andalusia Regional Hospital Andalusia AL. Bay Area Regional Medical Center Webster TX. Sanford Bemidji Medical Center Bemidji MN. Flushing Hospital Medical Center Flushing NY. Garden Park Medical Center Gulfport MS. Silicon Valley Interventional Surgery Center Houston TX. Surgery Center of Enid, Inc. Enid OK. UPMC East Monroeville PA. Straith Hospital For Special Surgery Southfield MI. Bay Area Hospital Coos Bay OR. Kaiser Permanente Irvine Medical Center Irvine CA. Cohen Children's Medical Center New Hyde Park NY. The following facilities are terminated St. Elizabeth Healthcare Florence Florence KY. Lakewood Hospital Lakewood OH. Mease Dunedin Hospital Dunedin FL. Baylor All Saints Medical Center Dallas TX. Regional Medical Center of Acadiana Lafayette LA. CHI Health St.

Elizabeth Lincoln NE. Ochsner North Shore Covington Covington LA. Central Carolina (LifePoint) Sanford NC. Mohammed Bin Khalifa Cardiac Centre Riffa International. Rockdale Medical Center Conyers GA. Although CMS has several policy vehicles relating to evidence development activities including the investigational device exemption (IDE), the clinical trial policy, national coverage determinations and local coverage determinations, this guidance document is principally intended to help the public understand CMS's implementation of coverage with evidence development (CED) through the national coverage determination process. For questions or additional information, contact JoAnna Baldwin (410-786-7205). We cover positron emission tomography (PET) scans for particular oncologic indications when they are performed in a facility that participates in the NOPR. We have since recognized the National Oncologic PET Registry as one of these clinical studies. Therefore, in order for a beneficiary to receive a Medicare-covered PET scan, the beneficiary must receive the scan in a facility that participates in the registry. There were no additions, deletions, or editorial changes to the listing of National Oncologic Positron Emission Tomography Registry (NOPR) in the 3-month period. Start Printed Page 28083 All facilities were required to meet our standards in order to receive coverage for VADs implanted as destination therapy. On October 1, 2003, we issued our decision memorandum on VADs for the clinical indication of destination therapy. We determined that VADs used as destination therapy are reasonable and necessary only if performed in facilities that have been determined to have the experience and infrastructure to ensure optimal patient outcomes. We established facility standards and an application process. All facilities were required to meet our standards in order to receive coverage for VADs implanted as destination therapy.

Until May 17, 2007, facilities that participated in the National Emphysema Treatment Trial were also eligible to receive coverage. The following three types of facilities are eligible for reimbursement for Lung Volume Reduction Surgery (LVRS): There were no updates to the listing of facilities for lung volume reduction surgery published in the 3-month period.All facilities must meet our standards in order to receive coverage for bariatric surgery procedures. On February 21, 2006, we issued our decision memorandum on bariatric surgery procedures. We determined that bariatric surgical procedures are reasonable and necessary for Medicare beneficiaries who have a body-mass index (BMI) greater than or equal to 35, have at least one co-morbidity related to obesity and have been previously unsuccessful with medical treatment for obesity. This decision also stipulated that covered bariatric surgery procedures are reasonable and necessary only when performed at facilities that are: (1) certified by the American College of Surgeons (ACS) as a Level 1 Bariatric Surgery Center (program standards and requirements in effect on February 15, 2006); or (2) certified by the American Society for Bariatric Surgery (ASBS) as a Bariatric Surgery Center of Excellence (BSCOE) (program standards and requirements in effect on February 15, 2006).