Medicare Bulletin - Tennessee, GR 06-02

April 2006 Medicare Bulletin - Tennessee Insert

Posted April 3, 2006

<< Back to the April 2006 Main Table of Contents

2006 Tennessee Medicare Clinical Psychologist Fee Schedule
2006 Tennessee Medicare Clinical Social Worker Fee Schedule
Comprehensive Error Rate Testing program (CERT) Required Documentatin for Chiropractors
Tennessee Health Professional Shortage Areas
Tennessee Mental Health Professional Shortage Areas

Comprehensive 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 6 months prior to the date of service for this claim, if the services in those 6 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

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2006 Tennessee Medicare Clinical Social Worker Fee Schedule

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2006 Tennessee Medicare Clinical Psychologist Fee Schedule

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Tennessee Mental Health Professional Shortage Areas (HPSAs)

Designated Geographic Areas

COUNTY	AREA NAME/PARTS	RURAL/URBAN
Bedford	MHCA 19 Bedford	Rural
Benton	MHCA 21 Benton	Rural
Bledsoe	MHCA 12 Bledsoe	Rural
Bradley	MHCA 10 Bradley	Rural
Cannon	MHCA 9 Cannon	Rural
Carroll	MHCA 21 Carroll	Rural
Cheatham	Catchment Area 14 Cheatham	Rural
Chester	MHCA 24 Chester	Rural
Claiborne	MHCA 5 Claiborne	Rural
Clay	MHCA 9 Clay	Rural
Cocke	MHCA 5 Cocke	Rural
Coffee	MHCA 19 Coffee	Rural
Crockett	Catchment Area 22 Crockett	Rural
Cumberland	MHCA 9 Cumberland	Rural
Decatur	MHCA 24 Decatur	Rural
Dekalb	MHCA 9 Dekalb	Rural
Dickson	Catchment Area 14 Dickson	Rural
Dyer	Catchment Area 22 Dyer	Rural
Fayette	MHCA 25 Fayette	Rural
Fentress	MHCA 9 Fentress	Rural
Franklin	MHCA 19 Franklin	Rural
Gibson	MHCA 21 Gibson	Rural
Giles	MHCA 20 Giles	Rural
Grainger	MHCA 5 Grainger	Rural
Greene	MHCA 4 Greene	Rural
Grundy	MHCA 12 Grundy	Rural
Hamblen	MHCA 5 Hamblen	Rural
Hancock	MHCA 4 Hancock	Rural
Hardeman	MHCA 24 Hardeman	Rural
Hardin	MHCA 24 Hardin	Rural
Hawkins	MHCA 4 Hawkins	Rural
Haywood	Catchment Area 23 Haywood	Urban
Henderson	Catchment Area 23 Henderson	Urban
Henry	MHCA 21 Henry	Rural
Hickman	MHCA 20 Hickman	Rural
Houston	Catchment Area 14 Houston	Rural
Humphreys	Catchment Area 14 Humhreys	Rural
Jackson	MHCA 9 Jackson	Rural
Jefferson	MHCA 5 Jefferson	Rural
Lake	Catchment Area 22 Lake	Rural
Lauderdale	MHCA 25 Lauderdale	Rural
Lawerence	MHCA 20 Lawerence	Rural
Lewis	MHCA 20 Lewis	Rural
Lincoln	MHCA 19 Lincoln	Rural
McMinn	MHCA 10 McMinn	Rural
McNairy	MHCA 24 McNairy	Rural
Macon	MHCA 9 Macon	Rural
Madison	Catchment Area 23 Madison	Urban
Marion	MHCA 12 Marion	Rural
Marshall	MHCA 20 Marshall	Rural
Maury	MHCA 20 Maury	Rural
Meigs	MHCA 10 Meigs	Rural
Montgomery	Catchment Area 14 Montgomery	Rural
Moore	MHCA 19 Moore	Rural
Obion	Catchment Area 22 Obion	Rural
Overton	MHCA 9 Overton	Rural
Perry	MHCA 20 Perry	Rural
Pickett	MHCA 9 Pickett	Rural
Polk	MHCA 10 Polk	Rural
Putman	MHCA 9 Putman	Rural
Rhea	MHCA 12 Rhea	Rural
Robertson	Catchment Area 14 Robertson	Rural
Sequatchie	MHCA#12 Sequatchie	Rural
Smith	MHCA 9 Smith	Rural
Stewart	Catchment Area 14 Stewart	Rural
Sumner	MHCA 31 Sumner	Urban
Tipton	MHCA 25 Tipton	Rural
Trousdale	MHCA 31 Trousdale	Urban
Union	MHCA 5 Union	Rural
Van Buren	MHCA 9 Van Buren	Rural
Warren	MHCA 9 Warren	Rural
Wayne	MHCA 20 Wayne	Rural
Weakley	Catchment Area 22 Weakley	Rural
White	MHCA 9 White	Rural
Wilson	MHCA 31 Wilson	Urban

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Tennessee Health Professional Shortage Areas (HPSAs)

Designated Geographic Areas

COUNTY	AREA NAME/PARTS	RURAL/URBAN
Anderson	Briceville - Lake City Lake City West City Division New River City Division Lake City East City Division	Urban
Bledsoe	Dayton/Pikeville/Decataur/Bledsoe	Rural
Cheatham	All	Rural
Chester³	All	Rural
Claiborne¹	All	Rural
Crockett	All	Rural
Decatur	All	Rural
Dickson	Vanleer/Shiloh Vanleer CCD	Urban
Fayette	All	Urban
Giles⁴	All	Rural
Grainger²	All	Urban
Greene	Baileyton Baileyton CCD Jearoldstown Division	Rural
Grundy	All	Rural
Hamilton	Middle Valley Soddy Daisy Division Middle Valley Division Sale Creek Division	Urban
Hancock	All	Rural
Hardeman	All	Rural
Hawkins	All	Urban
Haywood	All	Rural
Henderson²	All	Rural
Hickman	All	Rural
Jackson	All	Rural
Johnson	All	Rural
Knox	Mechanicsville - Census Tracts 1, 2, 3, 4, 5, 6, 7, 11, 12, 13, 14, 20, 28	Urban
Lake²	All	Rural
Lauderdale	All	Rural
Lincoln³	Cash Point - Blanche Cash Point/Blanche CCD	Rural
Macon⁵	All	Rural
Madison	East Jackson - Census Tracts 5 and 8-12	Rural
Maury	Fairview/Boston/Santa Fe/Santa Fe Division	Rural
Meigs	Dayton/Pikeville/Decatur/Meigs	Rural
Montgomery	Vanleer/Shiloh Palmyra/Shiloh CCD	Urban
Moore	All	Rural
Morgan	All	Rural
Obion	Hornbeak/Samburg Hornbeak/Samburg CCD Dixie Division Elbridge-Cloverdale Division	Rural
Perry	All	Rural
Pickett	All	Rural
Polk¹	Benton/Parkville Benton Division Parkville Division	Rural
Rhea	Dayton/Pikeville/Decatur/Rhea	Rural
Rutherford	Eagleville Eagleville CCD Bethesda/Eagleville	Urban
Unicoi	All	Urban
Union	All	Urban
Van Buren	All	Rural
Williamson	Bethesda/Eagleville Bethesda Division/Fairview/Boston/Santa Fe/Fairview Division /Boston Division	Rural

¹ Classified as a HPSA, effective March 1, 2002.
² No longer classified as a HPSA, effective March 1, 2002.
³ Classified as a HPSA, effective June 1, 2002.
⁴ Classified as a HPSA, effective February 1, 2004.
⁵ No longer classified as a HPSA, effective February 1, 2005

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