April 18, 2008
2nd Quarter 2008 Part B Customer Service Frequently Asked Questions
Q: There has been a change in your 2008 physician fee schedule. What's the correct physician allowed amounts for 2008?
A: The new payment rates for services under the Medicare Physician Fee Schedule, changed to provide a 0.5 percent increase to the physician fee schedule conversion factor for January 1, 2008 through June 30, 2008, instead of the -10.1 percent that was previously scheduled. As of July 1, 2008, the -10.1 percent update to the physician fee schedule will go into effect. The current physician fee schedule can be viewed on our web site at http://www.cignagovernmentservices.com/partb/coverage/fees/index.html.
Q: What services are payable in an Ambulatory Surgical Center for 2008?
A: The Centers for Medicare & Medicaid Services (CMS) published in the August 2, 2007, Federal Register (CMS-1517-F) the final rule that established the Ambulatory Surgical Center (ASC) list of covered surgical procedures, identifies the covered ancillary services under the ASC payment system, and sets the amounts and factors that will be used to determine the ASC payment rates for calendar year 2008.
The 2008 list of ASC covered surgical procedures, covered ancillary services, and payment rates can be viewed on the CMS Web site at http://www.cms.hhs.gov/ASCPayment/.
Addendum AA - List of covered surgical procedures under the revised ASC payment system, including Category I and Category III CPT and Level II HCPCS codes.
Addendum BB - List of radiology services and other covered ancillary services eligible for ASC payment under the revised ASC payment system when provided integral to an ASC covered surgical procedure.
Addendum DD1 –List of ASC payment indicators used in Addenda AA and BB to provide payment information regarding covered surgical procedures and covered ancillary services, respectively, under the revised ASC payment system.
Complete information and guidelines regarding the revised payment rates and covered services, can be viewed in the Medicare Claims Processing Manual, on the CMS Web site at http://www.cms.hhs.gov/manuals/downloads/clm104c14.pdf.
Q: Is an NPI required in Item 32a for all services rendered?
A: It is not required to give NPI information in Item 32a for services, other than purchased diagnostic tests. Please refer to the Centers for Medicare & Medicaid Services (CMS) instructional guidelines for completing the CMS 1500 (08-05) claim form located on their Web site at http://www.cms.hhs.gov/manuals/downloads/clm104c26.pdf.
Q: How long does it take for the Medicare NPI Crosswalk to receive information that has been updated in NPPES (National Plan and Provider Enumeration System)?
A . The process usually takes 5-10 days.
Q . Which states do your contractor handled for DME and who do I contact for DME questions?
A: Our contractor (CIGNA Government Services) handles Jurisdiction C for durable medical equipment and supplies. The Jurisdiction C states and insular areas are: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, U.S. Virgin Islands, Virginia, and West VirginiA: Please refer to following link for contact information for Jurisdiction C http://www.cignagovernmentservices.com/jc/help/contact/contactinfo.html. You may also forward your inquiries to Jurisdiction C using the online help center at http://www.cignagovernmentservices.com/jc/help/contact/onlinehelp.html.
Q . How do I obtain information for the 2008 fee schedule (i.e. global days, assist-at-surgery, etc.)?
A: The Medicare Physician Fee Schedule Database gives information regarding the payment indicators for procedure codes. Please refer to the CMS web site at http://www.cms.hhs.gov/PFSlookup/.
From this page, in the upper left box, "Physician Fee Schedule Look-up," click on the link "Physician Fee Schedule Search." On the page that follows, select the year, Healthcare Common Procedure Code (HCPC) criteria, e.g. "Single HCPC Code, and "Payment Policy Indicators" under "Type of Information," and hit the "Next" button. The "Select Fields Option" will display, hit the "Next" button. For your next page, enter the code, and select "All modifiers" from the Modifier drop-down box, then hit the "Submit" button. This will display the procedure code indicators, including global information for the HCPC selected.
To understand the indicators, please refer to the CMS Internet Only Manual (IOM) System, Publication 100-04, Medicare Claims Processing Manual, Chapter 23 – Fee Schedule Administration and Coding Requirements, (http://www.cms.hhs.gov/manuals/downloads/clm104c23.pdf).
Q: Does Medicare have a list of covered modifiers?
A: The CMS does not have a listing of covered modifiers. Providers can refer to the American Medical Association (AMA) Current Procedural Terminology (CPT) Coding Book for a listing of the modifiers. Also please refer to the new Modifier Finder tool that is now available on the CIGNA Government Services Web site at http://www.cignagovernmentservices.com/partb/pubs/news/2008/0308/cope6319.html.
Q: Do we have to bill our drug codes with modifier JW? Do we have to list the unused portion on a separate line with the JW modifier?
A: CIGNA Government Services will accept the JW modifier. The JW modifier is used when submitting a claim for drugs that were discarded. When submitting a claim, the used and unused portions of the drug or biological are billed on a single line.
CMS encourages providers to schedule patients in such a way they can use drugs or biologicals most efficiently. However, if a provider must discard the remainder of a single vial or other single use package after administering the drug or biological, Medicare provides payment for the amount of drug or biological discarded along with the amount administered. Please refer to the Medicare Claims Processing Manual, Pub-100, Chapter 17; http://www.cms.hhs.gov/manuals/downloads/clm104c17.pdf) for complete guidelines
Q . Who does the patient contact if Medicare has not updated their MSP files?
A: The Medicare patient should contact the Coordination of Benefits (COB) Contractor to have their Medicare Secondary Payer files updated. They can call toll-free at 1-800-999-1118.
Q: I need to check the status of my claim; do I have to use the automated system? Can Customer Service help me?
A: The CMS mandates that providers use the contractor's automated system to check the status of their Medicare claims. CIGNA Government Services Interactive Voice Response (IVR) system is set-up to give claim status. The IVR will also give, but is not limited to, patient eligibility, deductible and outstanding check information, and other inquiries. To access instructions on how to use the IVR, please refer to our web site at http://www.cignagovernmentservices.com/partb/claims/ivr.html.
Q: How do I obtain the Medicare HMO plan information given on your IVR?
A: The Medicare Advantage Plans are maintained and updated through CMS. You may access a list of the Health Maintenance Organizations on their web site at http://www.cms.hhs.gov/MCRAdvPartDEnrolData/EP/list.asp#TopOfPage. In the left side menu bar, please select "Plan Directory for MA, Cost, PACE, and Demo Organizations."
