April 2006 Medicare Bulletin - Idaho Insert
Posted April 3, 2006
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Table of Contents
- Comprehensive Error Rate Testing Program (CERT) Required Documentation for Chiropractors
- 2006 Idaho Ambulance Fee Schedule
- 2006 Medicare Clinical Psychologist Fee Schedule
- 2006 Medicare Clinical Social Worker Fee Schedule
- Idaho Health Professional Shortage Areas (HPSAs)
- Idaho Mental Health Professional Shortage Areas
TopComprehensive Error Rate Testing Program (CERT) Required Documentation for Chiropractors
In order to monitor and report the accuracy of the Medicare FFS payments, CMS established two programs for this purpose: 1) The Comprehensive Error Rate Testing (CERT) program and the 2) Hospital Payment Monitoring Program (HPMP). The national error rate is calculated using a combination of data from the CERT contractor and HPMP with each component representing about 60% and 40% of the total Medicare FFS dollars paid, respectively. The CERT program measures the error rate for claims submitted to Carriers, Durable Medical Equipment Regional Carriers (DMERCs), and Fiscal Intermediaries (FIs). The HPMP measures the error rate for the Quality Improvement Organizations (QIOs).
The calculated error rate is interpreted by some as a measure of fraud and abuse within the Medicare system thereby casting a negative shadow on the involved providers.
CMS calculates the Medicare Fee-For-Service error rate and estimate of improper claim payments using a methodology approved by the Office of the Inspector General (OIG). The CERT methodology includes:
- Randomly selecting a sample of approximately 120,000 submitted claims
- Requesting medical records from providers who submitted the claims
- Reviewing the claims and medical records for compliance with Medicare coverage, coding, and billing rules
For Chiropractic services please submit all of the following:
- Documentation to support the service billed on the CERT sampled claim.
- Along with this documentation CERT requires all related medical records/documentation for the period covering the preceding six months prior to the date of service for this claim, if the services in those six months are associated with the same condition.
- Initial evaluation for this episode of care
- Plan of care to support chiropractic services rendered for this course of treatment.
For more information:
- TN LCD Title: Chiropractic Service (manual spinal manipulations)
- Contractor's LCD Number 9617-04
- www.CERTprovider.org is a Web site run by the CERT documentation contractor. Monthly CERT newsletters, medical record request example letters, and more are available at the CERTprovider.org link.
2006 Idaho Ambulance Fee Schedule
REVISED—2/7/2006
| PROCEDURE | URBAN RATE | RURAL RATE |
| A0425 | 6.05 | 6.11 |
| A0426 | 215.24 | 217.37 |
| A0427 | 340.80 | 344.17 |
| A0428 | 179.37 | 181.14 |
| A0429 | 286.99 | 289.83 |
| A0430 | 2362.69 | 3544.04 |
| A0431 | 2746.97 | 4120.45 |
| A0432 | 313.89 | 317.00 |
| A0433 | 493.26 | 498.14 |
| A0434 | 582.94 | 588.71 |
| A0435 | 7.18 | 10.77 |
| A0436 | 19.14 | 28.71 |
| A0998 | Invalid for | Medicare |
2006 Idaho Medicare Clinical Social Worker Fee Schedule
2006 Idaho Medicare Clinical Social Worker Fee Schedule
2006 Idaho Medicare Clinical Psychologist Fee Schedule
2006 Idaho Medicare Clinical Psychologist Fee Schedule
Mental Health Professional Shortage Areas
Designated Geographic Areas
Effective July 1, 2004
Idaho
| County | Area Name/Parts | Rural/Urban |
| Ada | Mental Hlth Region IV Ada |
Rural |
| Adams | Catchment Area # 3 Adams |
Rural |
| Bannock | Mental Hlth Region VI Bannock |
Rural |
| Bear Lake | Mental Hlth Region VI Bear Lake |
Rural |
| Benewah | Mental Hlth Region I Benewah |
Urban |
| Bingham | Mental Hlth Region VI Bingham |
Rural |
| Blaine | Mental Hlth Region V Blaine |
Rural |
| Boise | Mental Hlth Region IV Boise |
Rural |
| Bonner | Mental Hlth Region I Bonner |
Urban |
| Bonneville | Mental Hlth Region VII Bonneville |
Rural |
| Boundary | Mental Hlth Region I Boundary |
Urban |
| Butte | Mental Hlth Region VII Butte |
Rural |
| Camas | Mental Hlth Region V Camas |
Rural |
| Canyon | Catchment Area # 3 Canyon |
Rural |
| Caribou | Mental Hlth Region VI Caribou |
Rural |
| Cassia | Mental Hlth Region V Cassia |
Rural |
| Clark | Mental Hlth Region VII Clark |
Rural |
| Clearwater | Mental Hlth Region II Clearwater |
Rural |
| Custer | Mental Hlth Region VII Custer |
Rural |
| Elmore | Mental Hlth Region IV Elmore |
Rural |
| Franklin | Mental Hlth Region VI Franklin |
Rural |
| Fremont | Mental Hlth Region VII Fremont |
Rural |
| Gem | Catchment Area # 3 Gem |
Rural |
| Gooding | Mental Hlth Region V Gooding |
Rural |
| Idaho | Mental Hlth Region II Idaho |
Rural |
| Jefferson | Mental Hlth Region VII Jefferson |
Rural |
| Jerome | Mental Hlth Region V Jerome |
Rural |
| Kootenai | Mental Hlth Region I Kootenai |
Urban |
| Latah | Mental Hlth Region II Latah |
Rural |
| Lemhi | Mental Hlth Region VII Lemhi |
Rural |
| Lewis | Mental Hlth Region II Lewis |
Rural |
| Lincoln | Mental Hlth Region V Lincoln |
Rural |
| Madison | Mental Hlth Region VII Madison |
Rural |
| Minidoka | Mental Hlth Region V Minidoka |
Rural |
| Nez Perce | Mental Hlth Region II Nez Perce |
Rural |
| Oneida | Mental Hlth REgion VI Oneida |
Rural |
| Owyhee | Catchment Area #3 Owyhee |
Rural |
| Payette | Catchment Area # 3 Payette |
Rural |
| Power | Mental Hlth Region VI Power |
Rural |
| Shoshone | Mental Hlth Region I Shoshone |
Urban |
| Teton | Mental Hlth Region VII Teton |
Rural |
| Twin Falls | Mental Hlth Region V Twin Falls |
Rural |
| Valley | Mental Hlth Region IV Valley |
Rural |
| Washington | Catchment Area # 3 Washington |
Rural |
Idaho Health Professional Shortage Areas (HPSAs)
Designated Geographic Areas
|
1 Classified as HPSA, effective 5/1/04
2No longer classified as a HPSA, effective April 12, 2005
3
Classified as a HPSA, effective November 30, 2004
4No longer classified as a HPSA, effective January 7, 2005
5 Classified as a HPSA, effective September 8, 2005
6 Classified as a HPSA, effective November 18, 2005
7 No longer classified as a HPSA, effective March 3, 2006
