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Notice

Medicare and Medicaid Programs; Quarterly Listing of Program Issuances-Fourth Quarter, 1999 through First Quarter, 2002

Document Details

Information about this document as published in the Federal Register.

Published Document

This document has been published in the Federal Register. Use the PDF linked in the document sidebar for the official electronic format.

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AGENCY:

Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION:

Notice.

SUMMARY:

This notice lists CMS manual instructions, substantive and interpretive regulations, and other Federal Register notices that were published from October 1999, through March 2002, relating to the Medicare and Medicaid programs. This notice also identifies certain devices with investigational device exemption numbers approved by the Food and Drug Administration that potentially may be covered under Medicare, and provides information on national coverage determinations affecting specific medical and health care services under Medicare.

Section 1871(c) of the Social Security Act requires that we publish a list of Medicare issuances in the Federal Register at least every 3 months. Although we are not mandated to do so by statute, for the sake of completeness of the listing, we are also including all Medicaid issuances and Medicare and Medicaid substantive and interpretive regulations (proposed and final) published during this timeframe.

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FOR FURTHER INFORMATION CONTACT:

It is possible that an interested party may have a specific information need and not be able to determine from the listed information whether the issuance or regulation would fulfill that need. Consequently, we are providing information contact persons to answer general questions concerning these items. Copies are not available through the contact persons.

Questions concerning Medicare items in Addendum III may be addressed to Karen Bowman, Office of Communications and Operations Support, Division of Regulations and Issuances, Centers for Medicare & Medicaid Services, C5-13-27, 7500 Security Boulevard, Baltimore, MD 21244-1850, (410) 786-5252.

Questions concerning Medicaid items in Addendum III may be addressed to Cindy Potter, Center for Medicaid State Operations, Policy Coordination and Planning Group, Centers for Medicare & Medicaid Services, S2-01-01, 7500 Security Boulevard, Baltimore, MD 21244-1850, (410) 786-6714.

Questions concerning Food and Drug Administration-approved investigational device exemptions may be addressed to Sharon Hippler, Office of Clinical Standards and Quality, Coverage and Analysis Group, Centers for Medicare & Medicaid Services, C4-11-04, 7500 Security Boulevard, Baltimore, MD 21244-1850, (410) 786-4633.

Questions concerning national coverage determinations should be directed to Kimberly Long, Office of Clinical Standards and Quality, Coverage and Analysis Group, Centers for Medicare & Medicaid Services, S3-11-15, 7500 Security Boulevard, Baltimore, MD 21244-1850, (410) 786-5702.

Questions concerning all other information may be addressed to Christopher McClintick, Office of Communications and Operations Support, Division of Regulations and Issuances, Centers for Medicare & Medicaid Services, C5-13-15, 7500 Security Boulevard, Baltimore, MD 21244-1850, (410) 786-4682.

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SUPPLEMENTARY INFORMATION:

I. Program Issuances

The Centers for Medicare & Medicaid Services (CMS) is responsible for administering the Medicare and Medicaid programs. These programs pay for health care and related services for 39 million Medicare beneficiaries and 35 million Medicaid recipients. Administration of these programs involves (1) furnishing information to Medicare beneficiaries and Medicaid recipients, health care providers, and the public and (2) maintaining effective communications with regional offices, State governments, State Medicaid agencies, State survey agencies, various providers of health care, fiscal intermediaries and carriers that process claims and pay bills, and others. 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). We also issue various manuals, memoranda, and statements necessary to administer the programs efficiently.

Section 1871(c)(1) of the Act requires that we publish a list of all Medicare manual instructions, interpretive rules, statements of policy, and guidelines of general applicability not issued as regulations at least every 3 months in the Federal Register. We published our first notice June 9, 1988 (53 FR 21730). Although we are not mandated to do so by statute, for the sake of completeness of the listing of operational and policy statements, we are continuing our practice of including Medicare substantive and interpretive regulations (proposed and final) published during the 3-month time frame.

II. How To Use the Addenda

This notice is organized so that a reader may review the subjects of manual issuances, memoranda, substantive and interpretive regulations, and Food and Drug Administration-approved investigational device exemptions, and national coverage determinations published during the timeframe to determine whether any are of particular interest. We expect this notice to be used in concert with previously published notices. Those unfamiliar with a description of our Medicare manuals may wish to review Table I of our first three notices (53 FR 21730, 53 FR 36891, and 53 FR 50577) published in 1988, and the notice published March 31, 1993 (58 FR 16837). Those desiring information on the Medicare Coverage Issues Manual may wish to review the August 21, 1989 publication (54 FR 34555). Those interested in the procedures used in making national coverage determinations may review the April 27, 1999 publication (64 FR 22619). In this publication, the 1989 proposed rule affecting national coverage procedures and decisions (54 FR 4302) was withdrawn, and the procedures for national coverage determinations established.

To aid the reader, we have organized and divided this current listing into six addenda:

  • Addendum I lists the publication dates of the most recent quarterly listings of program issuances.
  • Addendum II identifies previous Federal Register documents that contain a description of all previously published CMS Medicare and Medicaid manuals and memoranda.
  • Addendum III lists a unique CMS transmittal number for each instruction in our manuals or Program Memoranda and its subject matter. A transmittal may consist of a single instruction or many. Often, it is necessary to use information in a transmittal in conjunction with information currently in the manuals.
  • Addendum IV lists all substantive and interpretive Medicare and Medicaid regulations and general notices published in the Federal Register during the quarters covered by this notice. For each item we list the—
  • Date published; Start Printed Page 43763
  • Federal Register citation;
  • Parts of the Code of Federal Regulations (CFR) that have changed (if applicable);
  • Agency file code number;
  • Title of the regulation;
  • Ending date of the comment period (if applicable); and
  • Effective date (if applicable).
  • Addendum V includes listings of the Food and Drug Administration-approved investigational device exemption numbers that have been approved or revised during the quarters covered by this notice. On September 19, 1995, we published a final rule (60 FR 48417) establishing in regulations at 42 CFR 405.201 et seq. that certain devices with an investigational device exemption approved by the Food and Drug Administration and certain services related to those devices may be covered under Medicare. It is our practice to announce all investigational device exemption categorizations, using the investigational device exemption numbers the Food and Drug Administration assigns. The listings are organized according to the categories to which the device numbers are assigned (that is, Category A or Category B, and identified by the investigational device exemption number).
  • Addendum VI includes completed national coverage determinations from June 28, 1999, the effective date of Medicare's new coverage process. Completed decisions are identified by title, a brief description, effective date, and section in the appropriate federal publication.

III. How To Obtain Listed Material

A. Manuals

Those wishing to subscribe to program manuals should contact either the Government Printing Office (GPO) or the National Technical Information Service (NTIS) at the following addresses:

Superintendent of Documents, Government Printing Office, ATTN: New Orders, P.O. Box 371954, Pittsburgh, PA 15250-7954, Telephone (202) 512-1800, Fax number (202) 512-2250 (for credit card orders); or

National Technical Information Service, Department of Commerce, 5825 Port Royal Road, Springfield, VA 22161, Telephone (703) 487-4630.

In addition, individual manual transmittals and Program Memoranda listed in this notice can be purchased from NTIS. Interested parties should identify the transmittal(s) they want. GPO or NTIS can give complete details on how to obtain the publications they sell. Additionally, most manuals are available at the following Internet address: http://www.hcfa.gov/​pubforms/​progman.htm.

B. Regulations and Notices

Regulations and notices are published in the daily Federal Register. Interested individuals may purchase individual copies or subscribe to the Federal Register by contacting the GPO at the address given above. When ordering individual copies, it is necessary to cite either the date of publication or the volume number and page number.

The Federal Register is also available on 24x microfiche and as an online database through GPO Access. The online database is updated by 6 a.m. each day the Federal Register is published. The database includes both text and graphics from Volume 59, Number 1 (January 2, 1994) forward. Free public access is available on a Wide Area Information Server (WAIS) through the Internet and via asynchronous dial-in. Internet users can access the database by using the World Wide Web; the Superintendent of Documents home page address is http://www.access.gpo.gov/​nara/​index.html, by using local WAIS client software, or by telnet to swais.access.gpo.gov, then log in as guest (no password required). Dial-in users should use communications software and modem to call (202) 512-1661; type swais, then log in as guest (no password required).

C. Rulings

We publish rulings on an infrequent basis. Interested individuals can obtain copies from the nearest CMS Regional Office or review them at the nearest regional depository library. We have, on occasion, published rulings in the Federal Register. Rulings, beginning with those released in 1995, are available online, through the CMS Home Page. The Internet address is http://www.hcfa.gov/​regs/​rulings.htm.

D. CMS's Compact Disk-Read Only Memory (CD-ROM)

Our laws, regulations, and manuals are also available on CD-ROM and may be purchased from GPO or NTIS on a subscription or single copy basis. The Superintendent of Documents list ID is HCLRM, and the stock number is 717-139-00000-3. The following material is on the CD-ROM disk:

  • Titles XI, XVIII, and XIX of the Act.
  • CMS-related regulations.
  • CMS manuals and monthly revisions.
  • CMS program memoranda.

The titles of the Compilation of the Social Security Laws are current as of January 1, 1999. (Updated titles of the Social Security Laws are available on the Internet at http://www.ssa.gov/​OP_​Home/​ssact/​comp-toc.htm.) The remaining portions of CD-ROM are updated on a monthly basis.

Because of complaints about the unreadability of the Appendices (Interpretive Guidelines) in the State Operations Manual (SOM), as of March 1995, we deleted these appendices from CD-ROM. We intend to re-visit this issue in the near future and, with the aid of newer technology, we may again be able to include the appendices on CD-ROM.

Any cost report forms incorporated in the manuals are included on the CD-ROM disk as LOTUS files. LOTUS software is needed to view the reports once the files have been copied to a personal computer disk.

IV. How To Review Listed Material

Transmittals or Program Memoranda can be reviewed at a local Federal Depository Library (FDL). 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.

In addition, individuals may contact regional depository libraries that receive and retain at least one copy of most Federal Government publications, either in printed or microfilm form, for use by the general public. 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.

Superintendent of Documents numbers for each CMS publication are shown in Addendum III, along with the CMS publication and transmittal numbers. To help FDLs locate the materials, use the Superintendent of Documents number, plus the transmittal number. For example, to find the Intermediary Manual, Part 3—Claims Process, (HCFA Pub. 13-3) transmittal entitled “Mammography Screening,” use the Superintendent of Documents No. HE 22.8/6 and the transmittal number 1782.

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(Catalog of Federal Domestic Assistance Program No. 93.773, Medicare—Hospital Insurance, Program No. 93.774, Medicare—Supplementary Medical Insurance Program, and Program No. 93.714, Medical Assistance Program)

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Dated: June 20, 2002.

Jacquelyn Y. White,

Director, Office of Communications and Operations Support.

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Addendum I

This addendum lists the publication dates of the most recent quarterly listings of program issuances.

June 4, 1998 (63 FR 30499)

August 11, 1998 (63 FR 42857)

September 16, 1998 (63 FR 49598)

December 9, 1998 (63 FR 67899)

May 11, 1999 (64 FR 25351)

November 2, 1999 (64 FR 59185)

December 7, 1999 (64 FR 68357)

January 10, 2000 (65 FR 1400)

May 30, 2000 (65 FR 34481)

Addendum II—Description of Manuals, Memoranda, and HCFA Rulings

An extensive descriptive listing of Medicare manuals and memoranda was published on June 9, 1988, at 53 FR 21730 and supplemented on September 22, 1988, at 53 FR 36891 and December 16, 1988, at 53 FR 50577. Also, a complete description of the Medicare Coverage Issues Manual was published on August 21, 1989, at 54 FR 34555. (Please note that in this publication the 1989 proposed rule referred to, concerning the criteria for national coverage determinations, was withdrawn (64 FR 22619)). A brief description of the various Medicaid manuals and memoranda that we maintain was published on October 16, 1992 (57 FR 47468).

Addendum III.—Medicare and Medicaid Manual Instructions

Transmittal No.Manual/Subject/Publication No.
October 1999 through December 1999
Intermediary Manual
Part 3—Claims Process
(HCFA Pub. 13-3)
(Superintendent of Documents No. HE 22.8/6)
1782Mammography Screening
1783Clarification of Reimbursement for Transfers That Result in Same Day Hospice Discharge and Admission
1784Bill Review for Partial Hospitalization Services Provided in Community Mental Health Centers
1785Payment Calculation for Outpatient Claims
Medicare Secondary Payment Modules
1786Pneumococcal Pneumonia, Influenza Virus and Hepatitis B Vaccines
1787Review of Form HCFA—1450 for Inpatient and Outpatient Bills
Inpatient Part B Services
Outpatient Services
Calculating the Part B Payment
HCFA Common Procedure Coding System
Addition, Deletion, and Change of Local Codes
Reporting Hospital Outpatient Services Using HCFA Common Procedure
Coding System
Hospital Outpatient Partial Hospitalization Services
Carriers Manual
Part 3—Claims Process
(HCFA Pub. 14-3)
(Superintendent of Documents No. HE 22.8/7)
1650Services Eligible for HPSA Bonus Payments
Post-Payment Review
1651Identifying a Screening Mammography Claim
1652Medicare Physician Fee Schedule Database 2000 File Layout
1653Type of Service
1654Cryosurgery of the Prostate Gland
1655HCFA Common Procedure Coding System
1656Coverage of Chiropractic Services
1657Review of the Health Insurance Claim Form—HCFA-1500, Item 24
Program Memorandum
Intermediaries (HCFA Pub. 60A)
(Superintendent of Documents No. HE 22.8/6-5)
A-99-43File Descriptions and Instructions for Retrieving the 2000 Physician,
Clinical Lab, Durable Medical Equipment, Prosthetics/Orthotics and
Supplies Fee
Schedule Payment Amounts through HCFA's Mainframe
Telecommunications Systems
A-99-44Discharges to Swing Bed Units and other Post-Acute Care Providers
A-99-45Requirements for Billing and Processing Claims for Services Subject to Line Item Data of Service Reporting
A-99-46Implementation and Corrections to the Federal Register Notice Published August 5, 1999 for Home Health Agency Cost Limitation Effective October 1, 1999
A-99-47Extended Repayment Schedules for Home Health Agencies Affected by the Interim Payment System
A-99-48Renewal of Program Memorandum A-97-8—Instructions to Implement the New Medicare Summary Notice Combined with Program Memorandum AB-98-31
A-99-49Proper Reporting and Acceptance of Non-covered Changes and Related Revenue Codes
A-99-50Policy Clarification: Coding for Adequacy of Hemodialysis
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A-99-51FY 2000 Prospective Payment System Tax, Equity, and Fiscal Responsibility Act Hospital, and Other Bill Processing Changes
A-99-52Home Health Agency Instructions for the Provision of Advance Beneficiary Notices And for Mandatory Claims Submission (Demand Bills)
A-99-53Skilled Nursing Facility Election of Immediate Transition to 100% Federal Rate and Special Rules for Certain Skilled Nursing Facilities
A-99-54Advance Beneficiary Notices Must Be Given To Beneficiaries and Demand Bills Must Be Submitted Promptly By Home Health Agencies
A-99-55HAS BEEN RESCINDED AND WILL NOT BE RELEASED
A-99-56Reopenings for Sole Community Hospital and Medicare Dependent Hospital Cost Reports Due to the Change to the Cost Report Instructions in Calculating the Hospital Specific Amount on Form HCFA-2552-96 and Form HCFA-2552-92
A-99-57Hospital Outpatient Procedures: Billing for Contrast Material (Clarification)
A-99-58Hospital Outpatient Procedures: Medicare Changes for Radiology and Other Diagnostic Coding Due to the 1999 HCFA Common Procedure Coding System Update; Revised Modifiers
A-99-59New Composite Payment Rates Effective January 1, 2000, and Reopening of the Exception Process Under the End Stage Renal Disease Composite Rate System
A-99-60Implementation of H.R. 3426, the Medicare, Medicaid, and the State Child Health Insurance Program Balanced Budget Refinement Act of 1999, P.L. 106-113, Section 303 (a) Which Revises the Per-Beneficiary Limitations on Home Health Agency Costs for Certain Home Health Agencies
A-99-61Special Adjustment for Federal Skilled Nursing Facility Prospective Payment Rates and Special Payment Rules Applicable to Certain Skilled Nursing Facilities
A-99-62Clarification of Allowable Medicaid Days in the Medicare Disproportionate Share Hospital Adjustment Calculation
Program Memorandum
Carriers
(HCFA Pub. 60B)
(Superintendent of Documents No. HE 22.8/6-5)
B-99-35Enrollment of Independent Diagnostic Testing Facilities
B-99-36Schedule for Completing the Calendar Year 2000 Update and Enrollment Process for the Medicare Physician Fee Schedule Database
B-99-37Calendar Year 2000 Participation Enrollment and Medicare Participating Physicians and Suppliers Directory Procedures
B-99-38Addition of Current Procedural Terminology Code 00300 to Use with G8 Monitored Anesthesia Care Modifier
B-99-39Corrections to Calendar Year 2000 Medicare Physician Fee Schedule Database and Year 2000 Fact Sheet
B-99-40Delay of Change to Form HCFA-1500 Instructions for Processing Physician Claims in Global Payment Systems (Change Request #457)
B-99-41Instructions to Implement the New Medicare Summary Notice Program Memorandum B-98-4 and AB-98-31
B-99-42Calculation of National Standard Format for Electronic Remittance Advice Amount Fields and Balancing of Data; and Clarification to Claim Field EAO 21 for Coordination of Benefits
B-99-43Issues Related to Critical Care Policy
B-99-44Medicare Enrollment of Physical Therapists in Private Practice and Occupational Therapists in Private Practice Effective on or after January 1, 1999
B-99-45Emergency Changes to the 2000 Medicare Physician Fee Schedule Database
Program Memorandum
Intermediaries/Carriers
(HCFA Pub. 60A/B)
(Superintendent of Documents No. HE 22.8/6-5)
AB-99-72Instructions for Implementing and Updating 2000 Payment Amounts for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
AB-99-732000 Payment Limit for Ambulance Services
AB-99-74Clarification to Medicare Carrier Manual § 2130 Prosthetic Devices and Coverage Issues Manual § 60-9 Durable Medical Equipment Reference List—Coverage Intermittent Catheterization
AB-99-75Interim Instructions for Processing Claims for Factor VIIa (Coagulation Factor, Recombinant)
AB-99-76Education of Medicare Providers on the Adoption of Standard Electronic Health Care Transaction Formats in the United States
AB-99-77Implementation of Edits for Prostate Cancer Screening
AB-99-78Notice of New Interest Rate for Medicare Overpayments and Underpayments
AB-99-79Collection of Comprehensive Encounter Data for Long-Term Care Demonstrations (Social Health Maintenance Organization, EverCare), Dual Eligible Demonstrations and Department of Defense Subvention Demonstration
AB-99-80Clinical Diagnostic Laboratory Organ or Disease Panel Codes Billing Procedures for January 2000
AB-99-81Calculation of Average Allowed Charges for Residual Items and Services Excluding Ambulance Services, Subject to the Reasonable Charge Payment Methodology
AB-99-82Procedures for Reporting of Medicare Contractor NON-Medicare Secondary Payer Currently Not Collectible Debts
AB-99-83Final Rule Revising and Updating Medicare Policies Concerning Ambulance Services
AB-99-84Implementation of Calendar Year 2000 Clinical Diagnostic Laboratory Fee Schedule and Laboratory and Ambulance Costs Subject to Reasonable Charge Payment Methodology in 2000
AB-99-85Clinical Diagnostic Laboratory Organ or Disease Panel Codes Claims Processing Procedures for April 2000
AB-99-86Durable Medical Equipment Regional Carrier Operating Instructions for New National Coverage of the Continuous Subcutaneous Insulin Infusion Pump, Effective for Services Performed on or after April 1, 2000
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AB-99-87Clarification of Medicare Coverage of Abortion Services Instruction
AB-99-88Program Memorandum on Statements of Intent to File Claims for Claims Filing Periods That End on December 31, 1999
AB-99-89Start Date Options for Processing Year 2000 Services
AB-99-90Clarification of Program Memorandum Transmittal No. AB-98-35 (Consolidated Billing for Skilled Nursing Facilities) and Revision to Transmittal No. AB-98-18 (Consolidated Billing for Skilled Nursing Facilities)
AB-99-91Instructions for Implementing and Tracking the Medicare Fraud and Abuse Incentive Reward Program
AB-99-92Temporary Conversion from Bundled Payments to Regular Medicare Payments for The Participating Centers of Excellence Demonstration Testing Beginning with Discharges after December 31, 1998
AB-99-93Extension of the Limitation on Payment for Services to Individuals Entitled to Benefits On the Basis of End Stage Renal Disease Who Are Covered by Group Health Plans
AB-99-94Reimbursement for Ambulance Services to Non-hospital-Based Dialysis Facilities
AB-99-95Access to Eligibility Data by Eligibility Verification Vendors
AB-99-96Data Collection for Program Integrity Y2K Contingency Planning
AB-99-97HCFA Office of the Inspector General Hotline Referrals
AB-99-98Extension of Medicare Benefits for Immunosuppressive Drugs
AB-99-99Cervical or Vaginal Smear Tests (Pap Smears) Included in Calendar Year 2000 Clinical Diagnostic Laboratory Fee Schedule
AB-99-100Model Acknowledgment Letters for Valid and Invalid Written Statements of Intent to Claim Medicare Benefits (As Referenced In PM Transmittal AB-99-88)
AB-99-101Section 221 of the Balanced Budget Refinement Act of 1999 “Revision of Provisions Relating to Therapy Services”
Program Memorandum
State Survey Agencies
(HCFA Pub. 65)
(Superintendent of Documents No. HE 22.8/6-5)
99-2Guideline and Exhibits Regarding Regulatory Requirements for Comprehensive Assessment and Use of the Outcome and Assessment Information Set
State Operations Manual
Provider Certification
(HCFA Pub. 7)
(Superintendent of Documents No. HE 22.8/12)
11State Agency Identification of Potential Provider and Suppliers
Provider-Based Designation
Hospital Merger/Multiple Campus Criteria
Certification of Hospitals with Multiple Components as Single Hospital
12Appendix A, Survey Procedures for Hospitals
13Introduction
Definitions and Acronyms
Emphasis, Components and Applicability
Informal Dispute Resolution
Certification of Compliance and Noncompliance for Skilled Nursing
Facility and Nursing Facilities
Action When Facility is not in Substantial Compliance
Appeal of Certification of Noncompliance
Certification—Related Terms
Notice Requirements
Timing of Civil Money Penalties
Enforcement Action When Immediate Jeopardy Exists
Key Dates When Immediate Jeopardy Exists
Enforcement Action When Immediate Jeopardy Does Not Exist
Special Procedures for Recommending and Providing Notice of Category 1
Remedies and Denial of Payment for New Admissions
Key Dates When Immediate Jeopardy Does Not Exist
Response to the Plan of Correction
New Deficiencies Identified
Action When There is Substandard Quality of Care
Skilled Nursing Facility/Nursing Facility Readmission to Medicare or Medicaid Program After Termination
Enforcement Remedies for Skilled Nursing Facilities and Nursing Facilities
Life Safety Code Enforcement Guidelines for Skilled Nursing Facilities and Nursing Facilities
Denial of Payment for All New Medicare and Medicaid Admissions for Skilled Nursing Facilities and Nursing Facilities
Basis for Imposing Civil Money Penalties
Determining Amount of Civil Money Penalty
Effective Date of Civil Money Penalty
Duration of Civil Money Penalty
Appeal of Noncompliance Which Led to Imposition of Civil Money Penalty
Notice of Amount Due and Collectible
Continuation of Payment During Remediation
Sanctions for Inadequate State Survey Performance
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Peer Review Organization Manual
(HCFA Pub. 19)
(Superintendent of Documents No. HE 22.8/8-15)
77Introduction
Assistants at Cataract Surgery
Hospital and Medicare+Choice Organization Notices of Non-coverage
Hospital-Requested Higher-Weighted Diagnostic Related Group Assignments
Potential Concerns Identified During Project Data Collection
Referrals
78Introduction
Quality Improvement Project Process
Selecting a Clinical Topic
Identifying Quality Indicators
Measuring Baseline Performance on Quality Indicators
Developing and Conducting Interventions
Remeasuring Performance on Quality Indicators
Documenting and Disseminating Results
National and Regional Projects
Local Projects
Medicare+Choice Organization Projects
Related Activities through Peer Review Organization, Carrier,
Intermediary, and End-Stage Renal Disease Network Cooperation
Information Collection
Publication Policy
Project Data Collection
79Notice of Discharge and Medicare Appeal Rights Citations and Authority
Notice of Discharge and Medicare Appeal Rights
Medicare Enrollee Request for Peer Review Organization Immediate Review
80Physician/Provider Meeting Activities Required by Statute
Physician/Provider Meeting Activities Required by Peer Review
Organization Contract
Peer Review Organization/Intermediary/Carrier Coordination Activities
Additional Peer Review Organization/Carrier Coordination Activities
Background
Confidentiality Requirements
Report Requirements
Publication Requirements
Hospital Manual
(HCFA Pub. 10)
(Superintendent of Documents No. HE 22.8/2)
745Billing for Mammography Screening
746Pneumococcal Pneumonia, Influenza Virus, and Hepatitis B Vaccines
747HCFA Common Procedure Coding System
Reporting Outpatient Services Using HCFA Common Procedure Coding System
Billing for Hospital Outpatient Partial Hospitalization Services
Completion of Form HCFA—1450 for Inpatient and/or Outpatient Billing
Home Health Agency Manual
(HCFA Pub. 11)
Superintendent of Documents No. HE 22.8/5
291Billing for Pneumococcal Pneumonia, Influenza Virus, and Hepatitis B Vaccines
Skilled Nursing Facility Manual
(HCFA Pub. 12)
Superintendent of Documents No. HE 22.8/3
361Special Billing Instructions for Pneumococcal Pneumonia, Influenza Virus, and Hepatitis B Vaccines
Start Printed Page 43768
Medicare Rural Health Clinic & Federally Qualified
Health Centers Manual
(HCFA Pub. 27)
Superintendent of Documents No. HE 22.8/19:985
34Billing for Mammography Screening by Rural Health Clinics and Federally Qualified Health Centers
Medicare Renal Dialysis Facility Manual
(Non-Hospital Operated)
(HCFA Pub. 29)
Superintendent of Documents No. HE 22.8/13
87Pneumococcal Pneumonia, Influenza Virus and Hepatitis B Vaccines
Hospice Manual
(HCFA Pub. 21)
Superintendent of Documents No. HE 22.8/18
56Billing for Covered Medicare Services After Hospice Benefits are Exhausted
Clarification of Reimbursement for Transfers That Result in Same Day Hospice Discharge and Admission
57Special Billing Instructions for Pneumococcal Pneumonia, Influenza Virus and Hepatitis B Vaccines
Outpatient Physical Therapy and Comprehensive
Outpatient Rehabilitation Facility Manual
(HCFA Pub. 9)
Superintendent of Documents No. HE 22.8/9
7Billing Instructions for Partial Hospitalization Services Provided in Community Mental Health Centers
8Pneumococcal Pneumonia, Influenza Virus, and Hepatitis B Vaccines
Coverage Issues Manual
(HCFA Pub. 6)
Superintendent of Documents No. HE 22.8/14
120Infusion Pumps
121Adult Liver Transplantation
Provider Reimbursement Manual—Part 1
(HCFA Pub. 15-1)
(Superintendent of Documents No. HE 22.8/4)
410Dismissal for Lack of Board Jurisdiction
Provider Reimbursement Review Board Jurisdiction
411Development of Skilled Nursing Facility Inpatient Routine Service Cost Limits
Provider Requests Regarding Applicability of Cost Limits
Requests Regarding New Provider Exemption
General Requirements
Intermediary Responsibilities Regarding Exceptions
Provider-Based Designation
Classification of Skilled Nursing Facilities for Cost Limit Application
412Regional Medicare Swing-Bed Skilled Nursing Facility Rates
Provider Reimbursement Manual—Part 2
Provider Cost Reporting Forms and Instructions
Chapter 32—Form HCFA-1728-94
(HCFA Pub. 15-2-32)
(Superintendent of Documents No. HE 22.8/4)
8Home Health Agency Cost Report
Provider Reimbursement Manual—Part 2
Provider Cost Reporting Forms and Instructions
Chapter 35—Form HCFA-2540-96
(HCFA Pub. 15-2-35)
(Superintendent of Documents No. HE 22.8/4)
6Skilled Nursing Facility and Skilled Nursing Facility Complex Cost Report
7Skilled Nursing Facility and Skilled Nursing Facility Complex Cost Report
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Provider Reimbursement Manual—Part 2
Provider Cost Reporting Forms and Instructions
Chapter 36—Form HCFA-2552-96
(HCFA Pub. 15-2-36)
(Superintendent of Documents No. HE 22.8/4)
6Hospital and Hospital Health Care Complex, Cost Reporting Form
Provider Reimbursement Manual—Part 2
Provider Cost Reporting Forms and Instructions
Chapter 37—Form HCFA-2540S-97
(HCFA Pub. 15-2-37)
(Superintendent of Documents No. HE 22.8/4)
2Skilled Nursing Facility Cost Report
State Medicaid Manual—Part 4
Services
(HCFA Pub. 45-5)
Superintendent of Documents No. HE 22. 8/10
73Personal Care Services
Medicare/Medicaid
Sanction—Reinstatement Report
(HCFA Pub. 69)
99-10Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—September 1999
99-11Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—October 1999
99-12Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—November 1999
January 2000 through March 2000
Intermediary Manual
Part 3—Claims Process
(HCFA Pub. 13-3)
(Superintendent of Documents No. HE 22.8/6)
1788Provider Electronic Billing File Record Formats
1789HCFA Common Procedure Coding System for Hospital Outpatient Radiology Services and Other Diagnostic Procedures
1790Oral Cancer Drugs
1791Claims Processing Timeliness
Carriers Manual
Part 2—Program Administration
(HCFA Pub. 14-2)
(Superintendent of Documents No. HE 22.8/7-3)
140Function Standards for Claims Processing Claims Operations
Carriers Manual
Part 3—Program Administration
(HCFA Pub. 14-3)
(Superintendent of Documents No. HE 22.8/7)
1658Billing Requirement for Global Surgeries
1659External Counterpulsation
1660Clinical Psychologists Services
1661National Emphysema Treatment Trial
Background
Coverage Summary
Beneficiaries Participating in the Study
Sites of Service
Format for Submitted Claims
Identifying National Emphysema Treatment Trial
Bypassing Existing Edits in Your System
Common Working File Processing of National Emphysema Treatment Trial
Dates of Service
Late Claim Submission
Termination of the Beneficiary's Participation
Coding
Payment
Managed Care
Start Printed Page 43770
Responding to Billing Questions
Denied Claims
Participating Clinical Center
1662Transmyocardial Revascularization
Medicare Coverage of Abortion Services
1663Pancreas Transplants
Billing Instructions Pancreas Transplants
Program Memorandum
Intermediaries (HCFA Pub. 60A)
(Superintendent of Documents No. HE 22.8/6-5)
A-00-01Consolidated Billing for Skilled Nursing Facility Patients When Receiving Outpatient Emergency Care in a Medicare-Participating Hospital or Critical Access Hospital
A-00-02Installation of the Medicare Outpatient Code Editor Version 15.1
A-00-03Implementation of H. R. 3426, the Medicare, Medicaid, and the State Child Health Insurance Program Balanced Budget Refinement Act of 1999, P.L 106-113, Section 301 (a) Which Provides an Adjustment to Defray the Cost Incurred by a Home Health Agency Attributable to Data Collection and Reporting Requirements Under the Outcome and Assessment Information Set
A-00-04Provider Statistical and Reimbursement Report Unibill Record
A-00-05Claims Processing Instructions for the National Institutes of Health National Emphysema Treatment Trial
A-00-06Instructions for an End-Stage Renal Disease Facility to Retain Its Previously Approved Exception Payment Rate
A-00-07Addition of Modifiers 25, 58, 78, and 79 to the List of Modifiers Approved for Hospital Outpatient Use and Correction to Program Memorandum A-99-41
A-00-08Payment Safeguard Review of Skilled Nursing Facility Prospective Payment Bills—Updated Instructions
A-00-09Hospital Outpatient Services Prospective Payment System Background
A-00-10Discarding Program Memoranda on Surety Bonds
A-00-11Medicare Home Health Benefit-Section 4615 of the Balanced Budget Act of 1997, Clarification That No Home Health Benefits Are Authorized Based Solely on Drawing Blood
A-00-12Revision of Final Date to Accept Abbreviated Version of the UB-92 for Encounter Data Collection
A-00-13Procedures for Financial Reporting of Medicare Letter of Credit Draws and Collections between the Hospital Insurance and Supplemental Medicare Insurance Trust Funds
A-00-14Hospital Outpatient Radiology Services
A-00-15Hospital Outpatient Procedures: Medicare Changes for Radiology and Other Diagnostic Coding Due to the 1998 HCFA Common Procedure Coding System Update: Changes Miscellaneous
A-00-16The Balanced Budget Refinement Act Revision to PM Trasmittal No. A-99-51: FY 2000 Prospective Payment System and Excluded Hospital Bill Processing Changes—Wage Adjust 75th Percentile Cap of the Target Amounts or Excluded Hospitals and Units
Program Memorandum
Carriers
(HCFA Pub. 60B)
(Superintendent of Documents No. HE 22.8/6-5)
B-00-01Paramedic Intercept Provisions of the Balanced Budget Act of 1997
B-00-02Payment for Teleconsultations in Rural Health Professional Shortage Areas
B-00-03Emergency Change to the 2000 Medicare Physician Fee Schedule Database
B-00-04Fee-for Services Enrollment of Managed Care Organizations for the Indirect Payment Procedure
B-00-05Adjustment to Remittance Advice Explanation of Medicare Benefits and Medicare Summary Notice Messages Generated by Carriers for Services Subject to the Facility/Non-Facility Payment Differential on the Medicare Physician Fee Schedule Database
B-00-06Matrix to Complete Provider/Supplier Enrollment Application (Form HCFA-855 )
B-00-07Change to Correct Coding Edits, Version 6.1, Effective April 1, 2000
B-00-08Instruction for Usage of the Revised Oxygen Certificate of Medical Necessity Form 484.2 (11/99)
B-00-09Clarification of Medicare Policies Concerning Ambulance Services
B-00-10First Quarterly Update to the 2000 Medicare Physician Fee Schedule Database
B-00-11Paramedic Intercept—New Definition for Rural
B-00-12Notification Process for Changes to Health Professional Shortage Area Designations
B-00-13Calculation of National Standard Format for Electronic Remittance Advice Amount Fields and Balancing of National Standard Format Data; and Clarification to Claim National Standard Format Field EAO 21 for Coordination of Benefits—Modification of Program Memorandum B-99-42 (CR1016) of December 1999
Program Memorandum
Intermediaries/Carriers
(HCFA Pub. 60A/B)
(Superintendent of Documents No. HE 22.8/6-5)
AB-00-01Prospective Payment System for Outpatient Rehabilitation Services and Application of Financial Limitation
AB-00-02Durable Medical Equipment Regional Carrier—Pre Discharge Delivery of Durable Medical Equipment Prosthetic, Orthotics & Supplies for Fitting and Training
AB-00-03Notice of New Interest Rate for Medicare Overpayments and Underpayments
Start Printed Page 43771
AB-00-04April Quarterly Update for 2000 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Fee Schedule
AB-00-05Operating Instructions for Expanded Coverage of the Electrical Osteogenic Stimulator for Fracture Healing. Effective for Services Performed on or after 4/1/2000
AB-00-06Do not Forward Initiative
AB-00-07Moratorium on Data Center Movements
AB-00-08Payment for All Comprehensive Outpatient Rehabilitation Facility Services Under the Medicare Physician Fee Schedule
AB-00-09Transmittal number AB-00-09 has been reserved for Y2k contingency planning and will have a limited distribution.
AB-00-10Implementing Instructions for Services Provided in Religious Nonmedical Health Care Institutions
AB-00-11Medicare Secondary Payer—Identification and Write Off/Adjustment of Medicare Secondary Payer Settlement Related Group Health Plan Based Accounts Receivable, and Write Off of Unsupportable
AB-00-12Correction to Coordination of Benefits Contractor Numbers
AB-00-13New Waived Tests—Effective Data Receipt
AB-00-14Questions and Answers Regarding the Prospective Payment System for Outpatient Rehabilitation Services and Physical Medicine Current Procedural Terminology Coding Guidance
AB-00-15Delay of Hyperbaric Oxygen Therapy Coverage Policy
AB-00-16Instructions to All Medicare Contractors for Reporting Audited Year 2000 Costs on the Final Administrative Costs Proposals
AB-00-17Clarification of Liver Transplant Policy
AB-00-18Consolidated Billing for Skilled Nursing Facilities—The Balanced Budget Refinement Act of 1999
AB-00-19Access to Eligibility Data by Eligibility Verification Vendors
AB-00-20Guidance on April Release Implementation
State Operations Manual
Provider Certification
(HCFA Pub. 7)
(Superintendent of Documents No. HE 22.8/12)
14Nurse Aid Training and Competency Evaluation Programs and Competency Evaluation Programs
Peer Review Organization Manual
(HCFA Pub. 19)
(Superintendent of Documents No. HE 22.8/8-15)
81Peer Review Organization Responsibilities
Background
Statutory Authority for Memorandum of Agreement
Scope
Provider Memorandum of Agreement Specifications
Introduction
Intermediary/Carrier Memorandum of Agreement Specifications
Hospital Manual
(HCFA Pub. 10)
(Superintendent of Documents No. HE 22.8/2)
748HCFA Common Procedure Coding System for Hospital Outpatient Radiology Services and Other Diagnostic Procedures
749Oral Cancer Drugs
Oral Anti-Nausea Drugs as Full Therapeutic Replacements for Intravenous Dosage Forms as Part of a Cancer Chemotherapeutic Regimen
750Claims Processing Timelines
Home Health Agency Manual
(HCFA Pub. 11)
Superintendent of Documents No. HE 22.8/5
292Claims Processing Timeliness
Skilled Nursing Facility Manual (HCFA Pub. 12)Superintendent of Documents No. HE 22.8/3
362Claims Processing Timeliness
Rural Health Clinic Manual & Federally Qualified Health Centers Manual (HCFA Pub. 27) Superintendent of Documents No. He 22.8/19:985
35Claims Processing Timeliness
Renal Dialysis Facility Manual (Non-Hospital Operated) (HCFA Pub. 29) Superintendent of Documents No. 22. 8/13
88Claims Processing Timeliness
Start Printed Page 43772
Hospice Manual (HCFA Pub. 21) Superintendent of Documents No. HE 22. 8/18
58Claims Processing Timeliness
Outpatient Physical Therapy and Comprehensive Outpatient Rehabilitation Facility Manual (HCFA Pub. 9) Superintendent of Documents No. HE 22. 8/9
9Claims Processing Timeliness
Coverage Issues Manual (HCFA Pub. 6)Superintendent of Documents No. HE 22. 8/14
122External Counterpulsation for Severe Angina
123Osteogenic Stimulation
Provider Reimbursement Manual—Part 1 (HCFA Pub. 15-1)
413Travel Expense
State Medicaid Manual
92Compliance with Disclosure of Information on Physician Incentive Plan Regulations
Medicare/Medicaid
00-01Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—December 1999
00-02Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—January 2000
00-03Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—February 2000
[April 2000 through June 2000]
Intermediary Manual
413Assessment of Benefit Savings Attributable to Medical Review Activities
414These Manual Changes Reflect Budget Performance Requirements implemented in Fiscal Year 2000 for the Beneficiary Telephone Customer Service
Intermediary Manual
1792Payment for Blood Clotting Factor Administered to Hemophilia Inpatients
1793Clarification of Reimbursement for Transfers That Result in Same Day Hospice Discharge and Admission
1794Billing for Abortion Services
1795Review of Form HCFA-1450 for Inpatient and Outpatient Bills Review of Hospice Bills
1796Provider Electronic Billing File and Record Formats
1797Routine Services and Appliances
Pneumococcal Pneumonia, Influenza Virus and Hepatitis B Vaccines
1798Limitation of Liability for Provider Claims Under Parts A and B of Medicare Program
Medical Review for Coverage of Skilled Nursing Facility Services
1799Medicare Rural Hospital Flexibility Program
Requirements for Critical Access Hospital Services and Critical Access Hospital Long-Term Care Services
Payment for Services Furnished by a Critical Access Hospital Services
Carriers Manual
141These Manual Changes Reflect Budget Performance Requirements Implemented in Fiscal Year 2000 for Beneficiary Telephone Customer Service
Start Printed Page 43773
Carriers Manual
1664Payment for Oral Anti-Emetic Drugs When Used as Full Replacement for Intravenous Anti-Emetic Drugs as Part of a Cancer Chemotherapeutic Regimen Claims Processing Jurisdiction
1665Correction in Section G, to the Type of Service for 78267 and 78268
1666Chiropractic Services
1667Reasonableness and Necessity
Billing for Pneumococcal, Hepatitis B, and Influenza Virus Vaccines
Billing Requirements
Payment Requirements
Simplified Roster Bills
1668Durable Medical Equipment, Prosthetic, and Orthotic Supplies: Contents have been moved to the Program Integrity Manual (Pub. 83)
Medical Review Program General Information: Contents have been moved to the Program Integrity Manual (Pub. 83)
Fraud and Abuse Background, Exhibits and Appendices: Contents have been moved to the Program Integrity Manual (Pub. 83)
1669Durable Medical Equipment Regional Carrier Billing Procedures
Program Memorandum
Intermediaries (HCFA Pub. 60A)
(Superintendent of Documents No. HE 22.8/6-5)
A-00-17Change to FY 2000 Hospital Prospective Payment System Policies as Required by the Medicare, Medicaid, and State Child Health Insurance Program Balanced Budget Refinement Act of 1999, P. L. 106-113
A-00-18Fiscal Intermediary Community Mental Health Center Enrollment and Change of Ownership Site Visit Process and Coordination with National Site Visit Contractor
A-00-19Implementation of Provider Enrollment, Chain and Ownership System
A-00-20The Report of Benefit Savings
A-00-21Revised Outpatient Code Editor Specifications for the Outpatient Prospective Payment System
A-00-22Instructions For Reporting Additional Detailed Information of Form HCFA-750 Contractor Financial Report (Fiscal Intermediaries Only)
A-00-23Hospital Outpatient Prospective Payment System Implementation Instructions
A-00-24Upcoming Training on Home Health Prospective Payment System, Outpatient Prospective Payment System and Skilled Nursing Prospective Payment System Refinements and Consolidated Billing
A-00-25Provider Statistical and Reimbursement Report
A-00-26Payment of Skilled Nursing Facility Claims for Beneficiaries Disenrolling from Terminating Medicare+Choice Plans Who Have Not Met the 3-Day Stay Requirement
A-00-27Permitting Reclassification of Certain Urban Hospitals as Rural Application Procedures
A-00-28Clarification of Provider Cost Report Filing Requirements
A-00-29Electronic Filing of Provider Cost Reports; Home Health Agencies and Skilled Nursing Facilities
A-00-30Announcement of Medicare Rural Health Clinics and Federally Qualified Health Centers Payment Rate Increases and Policy Clarifications and Guidance for Services Furnished by Rural Health Clinics and Federally Qualified Health Centers
A-00-31Reporting a Patient's Reason for Visit on a Part A Outpatient Claim
A-00-32Effectuating Favorable Final Appellate Decisions That a Beneficiary is “Confined to Home”—Regional Home Health Intermediaries Only
A-00-33Education and Outreach to Coordination of Benefits Trading Partners
A-00-34Provider Statistical and Reimbursement Report
A-00-35Revised Outpatient Code Editor Specifications for the Outpatient Prospective Payment System
A-00-36Hospital Outpatient Prospective Payment System Implementation Instructions
A-00-37Line Item Denials and the Reporting of Savings Generated by Claim Expansion and Line Item Processing
Program Memorandum
Carriers
(HCFA Pub. 60B)
(Superintendent of Documents No. HE 22.8/6-5)
B-00-14Revisions to Durable Medical Equipment Regional Carrier Information Form (DIF) Immunosuppressive Drugs Durable Medical Equipment Regional Carrier Form (latest revision 7/25/95)
B-00-15Change to Health Insurance Claim Form HCFA-1500 Instructions for Processing Physician Claims in Global Payment Systems
B-00-16Provider Education Article: Role of Physicians in the Home Health Prospective Payment System
B-00-17Emergency Changes to the 2000 Medicare Physician Fee Schedule Database
B-00-18Emergency Changes to the 2000 Medicare Physician Fee Schedule Database
B-00-19Durable Medical Equipment Regional Carrier Report on Expansion of Immunosuppressive Drugs
B-00-20Collection and Submission of Data for the Provider Enrollment and Chain Ownership System
B-00-212000 Jurisdiction List
B-00-22Durable Medical Equipment Regional Carriers and New Oral Anti-Cancer Drugs Approved for Use by Medicare
Start Printed Page 43774
B-00-23Business Requirements For Processing Physician Encounter Data In The HCFA Data Center
B-00-24Issues Involving Certificates of Medical Necessity Certified Medical Necessity and Cover Letters for Certified Medical Necessity
B-00-25New Temporary K Codes for Hydrogel Impregnated Gauze
B-00-26Carrier Adjustments to be Made for Payment for HCFA Common Procedure Coding System Code 90669, Pneumococcal Conjugate Vaccine, Polyvalent, for Intramuscular Use
B-00-27Durable Medical Equipment Regional Carriers Common Working File Changes for Codes J8999, E0784, E0781, A4230-4232, E0616, and E0749
B-00-28Billing of Influenza (Flu) and Pneumococcal Pneumonia Vaccine Virus Claims for Authorized Centralized Billing Providers to be Processed Through One Designated Carrier
B-00-29Correct Effective Date for Adjustment in Payment Amounts for New Technology Intraocular Lenses Furnished by Medicare-Approved Ambulatory Surgical Centers
B-00-30Clarification of Billing for G0170 and G0171
B-00-31Use of Common Procedural Terminology Code 33999 for Transmyocardial Revascularization
B-00-32Common Procedural Terminology Codes 99214 and 99233
B-00-33Changes to Correct Coding Edits, Version 6.2, Effective July 1, 2000
Program Memorandum
Intermediaries/Carriers
(HCFA Pub. 60A/B)
(Superintendent of Documents No. HE 22.8/6-5)
AB-00-21Self-Administered Injectable Drugs and Biologicals
AB-00-22“No Fee” Policy for Medicare Contractors' Provider Education and Training Activities Program Management and Medicare Integrity Program Funded Activities
AB-00-23Medigap (Medicare Supplemental Insurance) Insurers Fraud Referrals
AB-00-24Development and Dissemination of a Product Classification List for HCFA Common Procedure Coding System Code L0430
AB-00-25Contractor Testing Requirements
AB-00-26July Quarterly Update for 2000 Durable Medical Equipment, Prosthetics Orthotics, and Supplies
AB-00-27Medicare Secondary Payer Government Performance and Results Act Goal for Fiscal Year 2000
AB-00-28Update of Rates for Ambulatory Surgical Center Payments
AB-00-29Comprehensive Error Rate Testing Program—Medicare Contractor Change Requirements and Medicare Part B/Durable Medical Equipment Regional Carrier Standard System Change Requirements
AB-00-30Implementing Instructions for Services Provided in Religious Nonmedical Health Care Institutions
AB-00-31Sending Common Working File Referrals for Initial Enrollment Questionnaire and Internal Revenue Services/Social Security Administration/Health Care Financing Administration Data Match Records to the Coordination of Benefits Contractor
AB-00-32New Waived Tests
AB-00-33Processing of Medicare+Choice Encounter Data at the Health Care Financing Administration Data Center
AB-00-34Program Integrity Management Reporting System
AB-00-35Further Guidance on April Release Implementation
AB-00-36Transfer of Initial Medicare Secondary Payer Development Activities to the Coordination of Benefits Contractor
AB-00-37Notice of New Interest Rate for Medicare Overpayments and Underpayments
AB-00-38Consolidation of Program Memorandums for Outpatient Rehabilitation Therapy Services
AB-00-39Consolidation of Program Memorandums for Outpatient Rehabilitation Therapy Services
AB-00-40Written Statements of Intent to Claim Medicare Benefits; 60-Day Grace Period
AB-00-41Procedures for the Benefit Integrity and Medical Review Units on Unsolicited Voluntary Refund Checks
AB-00-42Claims Processing Instructions for the Medicare Coordinated Care Demonstration
AB-00-43Program Memorandum on Written Statements of Intent to Claim Medicare Benefits
AB-00-44Medicare Coverage of Non-Invasive Vascular Studies When Used to Monitor the Access Site of End-Stage Renal Disease Patients
AB-00-45Award of Medicare+Choice Contract to Sterling Life Insurance Co., Inc. for Medicare+Choice Private Fee-for-Service Plan
AB-00-46Health Care Financing Administration Policy for Disclosure of Individually Identifiable Information
AB-00-47Release to Be Implemented June 5, 2000
AB-00-48Model Acknowledgment Letters for Valid and Invalid Written Statements of Intent to Claim Medicare Benefits (As Referenced in PM Transmittal AB-99-88)
AB-00-49Program Memorandum on Statements of Intent to File Claims for Claims Filing Periods that End on December 31, 1999
AB-00-50Medicare Fraud Information Specialist Position
AB-00-51Claims Processing Instructions for Claims Submitted With a Written Statement of Intent
AB-00-52Assisted Suicide Funding Restriction Act of 1997 (P. L. 105-12)
AB-00-53Suspension of National Coverage Policy on Electrostimulation for Wound Healing
AB-00-54Modified Procedures for Sharing Health Care Financing Administration Data with the Department of Justice
AB-00-55Hemodialysis Flow Study
AB-00-56Memorandum of Understanding Between the Office of Inspector General and the Department of Justice—Sharing Fraud Referrals
AB-00-57Contractor Updating of the International Classification of Diseases, Ninth Revision, Clinical Modification
AB-00-58Guidance on Implementation of the Calendar Year 2000 Third Quarter Release
AB-00-59Correction to July Quarterly Update for 2000 Durable Medical Equipment Prosthetics, Orthotics, and Supplies Fee Schedule
AB-00-60Future Software Releases
Start Printed Page 43775
AB-00-61New Waived Tests
AB-00-62Rescinding Change Requests Numbers 1001, 1108, 1116, and 1163
AB-00-63Ocular Photodynamic Therapy
AB-00-64Medicare Summary Notice Implementation at Seven Contractor Sites
AB-00-65Business and System Requirements for the Home Health Prospective Payment System
State Operations Manual—Provider Certification
(HCFA Pub. 7)
Superintendent of Documents No. HE 22.8/12
16Medicare/Medicaid Certification and Transmittal, Form HCFA-1539
Change in Size or Location of Participating Skilled Nursing Facility and/or Nursing Facility
Regional Office Verifying Continued Compliance with Exclusion Criteria by Currently Excluded Hospitals or Units
Change in Size or Location of Participating Skilled Nursing Facility and/or Nursing Facility
Change in Provider Location and/or Bed Complement—Other Than Distinct Part
17Condition of Participation: Patients' Rights
Hospice Manual
(HCFA Pub. 10)
(Superintendent of Documents No. HE 22.8/2)
751Payment for Blood Clotting Factor Administered to Hemophilia Inpatients
752Billing for Mammography Screening
753Billing for Abortion Services
754Pneumococcal Pneumonia, Influenza Virus, and Hepatitis B Vaccines
755Disclosure of Itemized Statement to an Individual for Any Item or Service Provided
756Fraud and Abuse—General: Contents have been moved to the Program Integrity Manual (Pub. 83)
Focused Medical Review: Contents have been moved to the Program Integrity Manual (Pub. 83)
Billing for Part B Intermediary Outpatient Occupational Therapy Services: Contents have been moved to the Program Integrity Manual (Pub. 83)
Special Instructions for Billing Dysphagia: Contents have been moved to the Program Integrity Manual (Pub. 83)
757Medicare Rural Hospital Flexibility Program
Requirements for Critical Access Hospital Services and Critical Access Hospital Long-term Care Services
Payment for Services Furnished by a Critical Access Hospital
Home Health Agency Manual
(HCFA Pub. 11)
Superintendent of Documents No. HE 22.8/5
293Billing for Pneumococcal Pneumonia, Influenza Virus, and Hepatitis B Vaccines
294Disclosure of Itemized Statement to an Individual for Any Item or Service Provided
295Fraud and Abuse—General: Contents have been moved to the Program Integrity Manual (Pub. 83)
Billing for Part B—Outpatient Physical Therapy Services: Contents have been moved to the Program Integrity Manual (Pub. 83)
Focused Medical Review: Contents have been moved to the Program Integrity Manual (Pub. 83)
Skilled Nursing Facility Manual
(HCFA Pub. 12)
Superintendent of Documents No. HE 22.8/3
363Special Billing Instructions for Pneumococcal Pneumonia, Influenza Virus and Hepatitis B Vaccines
364Distinct Part of an Institution as a Skilled Nursing Facility
365Disclosure of Itemized Statement to an Individual for Any Item or Service Provided
366Fraud and Abuse—General: Contents have been moved to the Program Integrity Manual (Pub. 83)
Focused Medical Review: Contents have been moved to the Program Integrity Manual (Pub. 83)
Billing Part B Intermediary Outpatient Physical Therapy Bills: Contents have been moved to the Program Integrity Manual (Pub. 83)
Rural Health Clinic Manual & Federally Qualified
Health Centers Manual
(HCFA Pub. 27)
Superintendent of Documents No. He 22. 8/19:985
36Disclosure of Itemized Statement to an Individual for Any Item or Service Provided
Renal Dialysis Facility Manual
(Non-Hospital Operated)
(HCFA Pub. 29)
Superintendent of Documents No. 22.8/13
89Pneumococcal Pneumonia, Influenza Virus and Hepatitis B Vaccines
90Disclosure of Itemized Statement to an Individual for Any Item or Service Provided
Start Printed Page 43776
ESRD Network Organizations Manual
(HCFA Pub. 81)
Superintendent of Documents No. HE 22.9/4
10Organizational Structure
Medical Review Board
Other Committees
Network Staff
Administrative Reports
Health Care Financing Administration Meeting
Cooperative Activities with State Survey Agencies and Peer Review Organizations
Annual Report Format
Hospice Manual
(HCFA Pub. 21)
Superintendent of Documents No. HE 22.8/18
59Completion of the Uniform (Institutional Provider) Bill (HCFA-1450) for Hospice Bills
60Special Billing Instructions for Pneumococcal Pneumonia, Influenza Virus and Hepatitis B Vaccines
61Disclosure of Itemized Statement to an Individual for Any Item or Services Provided
62Fraud and Abuse: Contents have been moved to the Program Integrity Manual (Pub. 83)
Focused Medical Review: Contents have been moved to the Program Integrity Manual (Pub. 83)
Outpatient Physical Therapy and Comprehensive
Outpatient Rehabilitation Facility Manual
(HCFA Pub. 9)
Superintendent of Documents No. HE 22.8/9
10Pneumococcal Pneumonia, influenza Virus, and Hepatitis B Vaccines
11Disclosure of Itemized Statement to an Individual for Any Item or Service Provided
12Fraud and Abuse—General: Contents have been moved to the Program Integrity Manual (Pub. 83)
Medical Review of Comprehensive Outpatient Rehabilitation Facility Claims: Contents have been moved to the Program Integrity Manual (Pub. 83)
Focused Medical Review: Contents have been moved to the Program Integrity Manual (Pub. 83)
Intermediary Medical Review of Part B Outpatient Physical Therapy: Contents have been moved to the Program Integrity Manual (Pub. 83)
Coverage Issues Manual
(HCFA Pub. 6)
Superintendent of Documents No. HE 22.8/14
124Pancreas Transplants
Provider Reimbursement Manual—Part 1
(HCFA Pub. 15-1)
(Superintendent of Documents No. HE 22.8/4)
414Effective Date of Change in Bed Size and/or Bed Designation(s) of Participating Skilled Nursing Facility and/or Nursing Facility Requirements for Distinct Part Certification
Changes in Bed Size of Participating Skilled Nursing Facility and/or Nursing Facility
General Request Filing Requirements
Exceptions
Change in Designated Bed Location(s)
Cost Report Requirement after Change in Bed Size and/or Change in Designated Bed Location(s)
415Historical Costs
Purchase of Facility as Ongoing Operation
Useful Life of Depreciable Assets
Salvage Value
Disposal of Assets
Gains or Loss on Disposal of Depreciable Assets (Excluding Involuntary Conversions)
Bona Fide Sale
Sale and Leaseback and Lease-Purchase Agreement
416Right to Board Hearing
Individual Appeals
Group Appeals
Expedited Judicial Review
Request for Board Hearing or for Expedited Judicial Review
Start Printed Page 43777
Provider Reimbursement Manual—Part 2
Provider Cost Reporting Forms and Instructions
Chapter 18—Form HCFA-2088-92
(HCFA Pub. 15-2-32)
(Superintendent of Documents No. HE 22.8/4)
9Home Health Agency Cost Reporting Form HCFA-1728-94
State Medicaid Manual—Part 4/Services
(HCFA Pub. 45-6)
Superintendent of Documents No. HE 22.8/10
36Updates ingredient prices used by States to establish upper limits for prescription drugs
Medicare Program Integrity Manual
(HCFA Pub. 83)
1Medical Review and Benefit Integrity Programs
Sources to Identify Aberrancies, and Developing Fraud or Abuse Cases
Corrective Actions
Examples of Fraudulent Activities
Items and Services Having Special Durable Medical Equipment Regional
Carrier Review Considerations
Intermediary Medical Review Guidelines for Specific Services
Medical Review Reports
Program Memoranda
Medical Review Information Reported Electronically
Medicare/Medicaid
Sanction—Reinstatement Report
(HCFA Pub. 69)
00-04Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded Reinstated—March 2000
00-05Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—April 2000
00-06Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—May 2000
[July through September 2000]
Intermediary Manual
Part 3—Claims Process
HCFA Pub. 13-3)
(Superintendent of Documents No. HE 22.8/6)
1800Provider Electronic Billing File and Record Formats
1801Prostate Cancer Screening Tests and Procedures
1802Bill Review for Partial Hospitalization Services Provided in Community Mental Health Centers
1803Information Regarding the Release of Medicare Eligibility Data
New Policy on Releasing Eligibility Data
Advise Your Providers and Network Service Vendors
Network Service Agreement
1804Review of Form HCFA-1450 for Inpatient and Outpatient Bills
Outpatient Services
Hospital Outpatient Partial Hospitalization Services
Calculating the Part B Payment
Addition, Deletion and Change of Local Codes
Reporting Hospital Outpatient Services Using Health Care Financing Administration Common Procedure Coding System
1805Stem Cell Transplantation
Allogeneic Stem Cell Transplantation
Autologous Stem Cell Transplantation
Acquisition Costs
1806Pancreas Transplants
1807Screening Pap Smears and Screening Pelvic Examinations
1808Billing by Home Health Agencies Under Cost/Interim Payment System Reimbursement
Billing by Home Health Agencies Under the Home Health Prospective Payment System
When Bills Are Submitted
Billing for Nonvisit Charges
Durable Medical Equipment Furnished as a Home Health Benefit
More Than One Agency Furnished Home Health Services
Home Health Services Are Suspended or Terminated Then Reinstated
Preparation of a Home Health Billing Form in No-Payment Situations
Billing for Part B Medical and Other Health Services
Reimbursement of Home Health Agency Claims
Start Printed Page 43778
Osteoporosis Injections as Home Health Agency Benefit
Completion of Form HCFA-1450 for Home Health Agency Billing Under Home Health Prospective Payment
Requests for Anticipated Payment
Home Health Prospective Payment System Claims
Home Health Prospective Payment System Claims When No Request for Anticipated Payment Was Submitted
Background on Home Health Prospective Payment System
Creation of Home Health Prospective Payment System
Regulatory Implementation of Home Health Prospective Payment System
Commonalities of the Cost Reimbursement and Home Health Prospective Payment System Environment
Effective Date and Scope of Home Health Prospective Payment System for Claims
Configuration of the Home Health Prospective Payment System Environment
New Software for the Home Health Prospective Payment System Environment
The Home Health Prospective Payment System Episodes
Effect of Election of Health Maintenance Organization and Eligibility Changes on Home Health Prospective Payment System Episodes
Split Percentage Payment of Episodes and Development of Episode Rates
Basis of Medicare Prospective Payment System and Case Mix
Coding of Home Health Prospective Payment System Episode Case-Mix Groups
On Home Health Prospective Payment System Claims: Research Group and Health Insurance Prospective Payment System Codes
Composition of Health Insurance Prospective Payment System Codes for Home Health Prospective Payment System
Significance of Health Insurance Prospective Payment Systems
Overview of the Provider Billing Process Under Home Health Prospective Payment
Overview—Grouper Links Assessment and Payment
Overview—Health Insurance Query Access System Shows Primary Home Health Agency
Overview—Request for Anticipated Payment: Submission and Processing Establishes Home Health Prospective Payment System Episode and Provides First Percentage Payment
Overview—Claim Submission and Processing Completes Home Health Prospective Payment System Payment, Closes Episode and Performs A-B Shift
Overview—Payment, Claim Adjustments and Cancellations
Definition of the Request for Anticipated Payment
Definition of Transfer Situation Under Home Health Prospective Payment System
Payment Effects
Payment When Death Occurs During a Home Health Prospective Payment System Episode
Adjustments of Episode Payment—Low Utilization Payment Adjustments
Adjustments of Episode Payment—Low Utilization Payment Adjustment
Adjustments of Episode Payment—Special Submission Case: “No-Request Anticipated Payment” Low Utilization Payment Adjustments
Adjustments of Episode Payment—Therapy Threshold
Adjustments of Episode Payment—Partial Episode Payment
Adjustments of Episode Payment—Significant Change in Condition
Adjustments of Episode Payment—Outlier Payments
Adjustments of Episode Payment—Exclusivity and Multiplicity of Adjustments
Seven Scenarios for Home Health Prospective Payment Adjustment
General Guidance on Line Item Billing Under Home Health Prospective Payment System
Acronym Table
Home Health Prospective Payment System Consolidated Billing and Primary Home Health Agency
New Common Working File Requirements for the Home Health Prospective Payment System
Creation of the Health Insurance Query System for Home Health Agencies And Hospices in the Common Working File—Replacement of Health Insurance Query System for Home Health Agencies
Health Insurance Query Access System Inquiry and Response
Timeliness and Limitations of Health Insurance Query System for Home Health Agency Responses
Inquiries to Regional Home Health Intermediaries Based on Health Insurance Query System for Home Health Agency Responses
National Home Health Prospective Payment Episode History File
Opening and Length of Home Health Prospective Payment System Episodes
Closing, Adjusting and Prioritizing Home Health Prospective Payment System
Episodes Based on Request for Anticipated Payment and Home Health Prospective Payment System
Episodes Based on Request for Anticipated Payment and Home Health Agency Claim Activity
Other Editing and Changes for Home Health Prospective Payment System Episodes
Priority Among Other Claim Types and Home Health Prospective Payment System
Consolidated Billing for Episodes
Medicare Secondary Payment and the Home Health Prospective Payment System Episode File
Chart Summarizing Effects of Request for Anticipated Payment/Claim Actions on the Home Health Prospective Payment System Episode File
Home Health Prospective Payment System Episode File Pricer Program
Outpatient Prospective Payment System Remittance Advice Instructions and 3753, Home Health Prospective Payment System Remittance Advice Instructions
1809Under Arrangements
Outpatient Hospital Psychiatric Services
Partial Hospitalization Services
Start Printed Page 43779
1810Definition of Medicare Secondary Payer/Common Working File
Medicare Secondary Payer Maintenance Transaction Record Processing
Carriers Manual
Part 3—Claims Process
(HCFA Pub. 14-3)
(Superintendent of Documents No. HE 22.8/7)
1670Echocardiography Services (Codes 93303—93350)
1671Magnetic Resonance Angiography
Magnetic Resonance Angiography Coverage Summary
Coding Requirements
Payment Requirements and Methodology
Format for Submitting Medicare Carrier Claims
Claims Editing
1672Claims Processing Jurisdiction
1673Information Regarding the Release of Medicare Eligibility Data
New Policy on Releasing Eligibility Data
Advise Your Provider and Network Services Vendors
Network Service Agreement
1674Stem Cell Transplantation
General
HCFA Common Procedure Coding System and Diagnosis Code
Non-Covered Conditions
Edits
Suggested Medicare Summary Notice/Explanation of Medicare Benefits and Regional Administrator Messages
1675Screening Pap Smear and Pelvic Examination
Screening Pap Smears
Billing Requirements
Common Working File Edits
Medicare Summary Notices and Explanation of Your Medicare Benefits Message
Remittance Advice Notices
Screening Pelvic Examination
1676HCFA Common Procedure Coding System and Payments Requirements
Calculating the Frequency
Common Working File Edits
Correct Coding Requirements
Diagnosis Coding Requirements
Denial Messages
1677Definition of Medicare Secondary Payor/Common Working File Terms
Medicare Secondary Payor Maintenance Transaction Record Processing
1678Medicare Physician Fee Schedule Database 2001 File Layout
Carriers Manual
Part 4—Professional Relations
(HCFA Pub. 14-4)
(Superintendent of Documents No. HE 22.8/7-4
22Enrollment Procedures for General Application
Program Memorandum
Intermediaries (HCFA Pub. 60A)
(Superintendent of Documents No. HE 22.8/6-5)
A-00-38Change in Hospice Payment Rates, Update to the Hospice Cap, Revised Hospice Wage Index and Hospice Pricer
A-00-39Monitoring Process for Skilled Nursing Facility Exception Determinations
A-00-40Further Information on the Use of Modifier -25 in Reporting Hospital Outpatient Services
A-00-41Transition to the Home Health Prospective Payment System
A-00-42Coding Information for Hospital Outpatient Prospective Payment System
A-00-43Advance Beneficiary Notices for Services for Which Institutional Part B Claims Will be Processed by Fiscal Intermediaries
A-00-44Outpatient Prospective Payment System Contingency Plans and Instructions
A-00-45Interim Process for Certain “Inpatient Only” Code Changes
A-00-46Skilled Nursing Facility Adjustment Billing: Adjustments to Health Insurance Prospective Payment System Codes Resulting From Minimum Data Set Corrections
A-00-47Skilled Nursing Facility Annual Update: Prospective Payment System Pricer and Health Insurance Prospective Payment System Coding Changes
A-00-48Drugs, Biologicals, Devices and New Technology HCFA Common Procedure Coding System Codes For Use Under the Hospital Outpatient Prospective Payment System
A-00-49Payment of Skilled Nursing Facility Claims for Beneficiaries Disenrolling From Terminating Medicare+Choice Plans Who Have Not Met the 3-Day Hospital Stay Requirement
A-00-50Department of Veterans Affairs Claims Adjudication Services Project: Systems Changes Needed
Start Printed Page 43780
A-00-51Q Codes For Use Under the Hospital Outpatient Prospective Payment System
A-00-52Community Mental Health Centers Payment Instructions For Outpatient Prospective System Contingency Plans
A-00-53Proper Billing of Units for Intrathecal Baclofen Under the Outpatient Prospective Payment System
A-00-54The Supplemental Security Income Medicare Beneficiary Data for Fiscal Year 1999 for Prospective Payment System Hospitals
A-00-55Provider Statistical and Reimbursement Report
A-00-56Update of Rates for Ambulatory Surgical Center Payment
A-00-57Payment of Skilled Nursing Facility Claims for Beneficiaries Disenrolling from Terminating Medicare+Choice Plans Who Have Not Met the 3-Day Stay Required
A-00-58Destroy Outdated Stock of Medicare Summary Notices and Part A Explanation of Medicare Benefits Under the Hospital Outpatient Prospective Payment System
A-00-59Home Health Prospective Payment System Phase in Plan, Contingency Plan, and Instructions
A-00-60Standard Questions and Answers for Beneficiary Inquiries Related to the Hospital Outpatient Prospective Payment System
A-00-61Update 1—Coding Information for Hospital Outpatient Prospective Payment System
A-00-62File Descriptions and Instructions for Retrieving the 2001 Physician, Clinical Lab, Durable Medical Equipment, Prosthetics/Orthotics and Supplies Fee Schedule Payment Amounts Through Health Care Financing Administration's Mainframe Telecommunications Systems
A-00-63Cost-to-Charge Ratios for Calculating Certain Payments Under the Hospital Outpatient Prospective Payment System
A-00-64Terminating State Access to the Common Working File Eligibility Data
A-00-65Release of Internal Revenue Service Data Elements on Eligibility Queries
A-00-66Fiscal Year 2001 Prospective Payment System Hospital and Other Bill Processing Changes
A-00-67Deactivation of Inactive Community Mental Health Center Medicare Numbers
A-00-68Provider Statistical and Reimbursement Report
A-00-69Background and Documentation for Correct Coding Initiative and Unit of Service Edits
A-00-70Provider Statistical and Reimbursement Report
Program Memorandum
Carriers
(HCFA Pub. 60B)
(Superintendent of Documents No. HE 22.8/6-5)
B-00-34This Transmittal Number Was Inadvertently Skipped and Will Not Be Used In the Future
B-00-35Addition of Five “WW” Codes to Identify a New Source for Methotrexate
B-00-36Returned Mail—Unique Physician Identification Number
B-00-37Standard System Acceptance of Primary Payer Information at the Line Level
B-00-38Addition of “WW” Codes to Identify a New Source for an Oral Anti-Cancer Drug in Dosages of 25mg and 100mg
B-00-39Department of Veterans Affairs Claims Adjudication Services Project: Systems Changes Needed
B-00-40Final Update to the 2000 Medicare Physician Fee Schedule Database
B-00-41Changes to Correct Coding Edits, Version 6.3, Effective October 1, 2000
B-00-42Analysis of Services Provided in Congregate Settings
B-00-43New Temporary “K” Codes for Negative Pressure Wound Therapy Pumps
B-00-44Site Visits and Enrollment of Independent Diagnostic Testing Facilities
B-00-45Reporting of Carrier Pricing Methodology for Influenza and Pneumococcal Vaccinations to Health Care Financing Administration
B-00-46Changes to Correct Coding Edits, Version 6.2, Effective September 5, 2000
B-00-47Addition of Special Processing Number 39 (Centralized Billing of Flu and Pneumococcal Pneumonia Vaccine Claims) to the Common Working File
B-00-48Claims Processing Instructions for the DME Prosthetic, Orthotics & Supplies Competitive Bidding Demonstration
B-00-49Implementation of the Health Insurance Portability and Accountability Act Transaction Standards
Program Memorandum
Intermediaries/Carriers
(HCFA Pub. 60A/B)
(Superintendent of Documents No. HE 22.8/6-5)
AB-00-66Coverage of Diabetes Outpatient Self-Management Training Services, Effective: July 1, 1998
AB-00-67Implementation of § 4105 of the Balanced Budget Act Regarding Coverage of Diabetes Outpatient Self-Management Training Services
AB-00-68Current Status of Medicare Program Memoranda Issued Before Calendar Year 2000
AB-00-69Notice of New Interest Rate for Medicare Overpayments and Underpayments
AB-00-70Program Safeguard Contractor for Corporate Integrity Agreements
AB-00-71Claims Processing Instructions for the Medicare Coordinated Care Demonstration
AB-00-72Medical Review Progressive Corrective Action
AB-00-73Proper Billing of Outpatient Pathology Services Under the Outpatient Prospective Payment System
AB-00-74Transfer of Initial Medicare Secondary Payer Development Activities to the Coordination of Benefits Contractor
AB-00-75The Internal Control Certification Statement Required by the Budget and Performance Requirements for the Fiscal Year Ending September 30, 2000
AB-00-76Modification of Medicare Policy for Erythropoietin
AB-00-77New State Code for Maryland Provider Numbers
AB-00-78Reasonable Charge Update for 2001 for Items and Services, Other than Ambulance Services, Still Subject to the Reasonable Change Payment Methodology
Start Printed Page 43781
AB-00-79Establishment of Contractor Numbers for Program Safeguard Contractors
AB-00-80Instruction Implementation Reporting
AB-00-81Self-Administered Injectable Drugs and Biologicals
AB-00-82Update of Rates and Wage Index for Ambulatory Surgical Center Payments Effective October 1, 2000
AB-00-83Verteporfin (Visudyne)
AB-00-84Provider Toll-Free Telephone Inquiry Service
AB-00-85Guidance on Implementation of the Calendar Year 2000 Fourth Quarter Release
AB-00-86An Additional Source of Average Wholesale Price Data in Pricing Drugs and Biologicals Covered by the Medicare Program
AB-00-872001 Payment Limit for Ambulance Services
AB-00-88Implementation of the Ambulance Fee Schedule
AB-00-89Claims Processing Instructions for Carriers, Durable Medical Equipment Regional Carrier, Intermediaries and Regional Home Health Intermediaries for Claims Submitted for Medicare Beneficiaries Participating in Medicare Qualifying Clinical Trials
AB-00-90Year 2001 Health Care Financing Common Procedure Coding System Annual Update Reminder
Program Memorandum
Medicaid State Agencies
(HCFA Pub. 17)
Superintendent of Documents No. HE 22.8/6-5
00-01Current Status of Medicaid Program Memoranda and Action Transmittals Issued Before Calendar Year 2000
State Operations Manual—Provider Certification
(HCFA Pub. 7)
Superintendent of Documents No. HE 22.8/12
18Religious Nonmedical Healthcare Institutions
Certification of Religious Nonmedical Healthcare Institutions
Interpretive Guidelines for Responsibilities of Medicare-Participating Religious Nonmedical Healthcare Institutions
19Guidelines for Determining Immediate Jeopardy
20Guidance to Surveyors—Long-Term Care Facilities
Peer Review Organization
(HCFA Pub. 19)
Superintendent of Documents No.HE 22.8/8-15
82Disclosure of Quality Review Information to Complainants
Scope of Review
Complaints That Do Not Meet Statutory Requirements
Referrals
Review Process
Notice of Disclosure
Final Response to Complainants
Disclosure of Quality Review Information to Complainants
Request for Information Model Form
Final Response to Inquirer Model Notice (Concern Involved Practitioners)
Potential Quality Concern Model Notice
Hospice Manual
(HCFA Pub. 10)
(Superintendent of Documents No. HE 22.8/2)
758Prostate Cancer Screening Tests and Procedures
759Reporting Hospital Outpatient Services Using Health Care Financing Administration Common Procedure Coding System
Billing for Hospital Outpatient Partial Hospitalization Services
Completion of Form HCFA-1450 for Inpatient and/or Outpatient Billing
Addition, Deletion and Change of Local Codes
Reporting Hospital Outpatient Services Using Health Care Financing Administration Common Procedures Coding System
760Screening Pap Smears and Screening Pelvic Examinations
761Outpatient Hospital Psychiatric Services
Outpatient Partial Hospitalization Programs
Skilled Nursing Facility Manual
(HCFA Pub. 12)
Superintendent of Documents No. HE 22.8/3
367Distinct Part of an Institution as a Skilled Nursing Facility
Start Printed Page 43782
ESRD Network Organizations Manual
(HCFA Pub. 81)
Superintendent of Documents No. HE 22.9/4
11End Stage Renal Disease Health Care Quality Improvement Program Responsibilities
Quality Improvement Projects
Background and Project Topics
Quality Improvement Program Frequency, Project Consultant, and Required Reporting
Project Idea
Quality Improvement Program Narrative Project Plan
Final Project Report
Identifying Additional Opportunities for Improvement
Quarterly Progress and Status Report
Clinical Performance Measures
Clinical Performance Measures—Network/National Sample
Clinical Performance Measures—Sampling Method
Clinical Performance Measures—Data Collection
Clinical Performance Measures—Data Validation
Clinical Performance Measures—Data Validating Reports
Health Care Financing Administration—Compiled Data Reports
Network Resources to Support the United States Renal Data System
End Stage Renal Disease Clinical Performance Measures
Annual Estimate of Patient Sample Per Network for United States Renal Data System Special Studies
End Stage Renal Disease Network—Project Idea Document Format
End Stage Renal Disease Network—Narrative Project Plan Format
End Stage Renal Disease Network—Final Project Report Format
Hospice Manual
(HCFA Pub. 21)
Superintendent of Documents No. HE 22.8/18
63Reducing Barriers to Pneumococcal Vaccines
Outpatient Physical Therapy and Comprehensive
Outpatient Rehabilitation Facility Manual
(HCFA Pub. 9)
Superintendent of Documents No. HE 22.8/9
13Billing Instructions for Partial Hospitalization Services Provided in Community Mental Health Centers
14General
Partial Hospitalization Defined
Patient Eligibility Criteria
Documentation Requirements and Physician Supervision
Community Mental health Center Requirements
Outpatient Mental Health Treatment Limitation
Documentation Requirements and Physician Supervision
Coverage Issues Manual
(HCFA Pub. 6)
Superintendent of Documents No. HE 22.8/14
125Stem Cell Transplantation
126Routine Costs of Clinical Trials
Provider Reimbursement Manual—Part 1
(HCFA Pub. 15-1)
(Superintendent of Documents No. HE 22.8/4)
417Special Treatment of Sole Community Hospitals Under Prospective Payment System
Provider Reimbursement Manual—Part 2
Provider Cost Reporting Forms and Instructions
Chapter 1—General—2088-92
(HCFA Pub. 15-2-1)
(Superintendent of Documents No. HE 22.8/4)
20Electronic Submission of Hospital Cost Reports
Requirement To File Cost Report
Initial Cost Reporting Period
Cessation of Participation in Program
Cost Report Forms
Start Printed Page 43783
Use of Substitute Cost Reporting Forms
Provider Reimbursement Manual—Part 2
Provider Cost Reporting Forms and Instructions
Chapter 35—Form HCFA-2540-96
(HCFA Pub. 15-2-35)
(Superintendent of Documents No. HE 22.8/4)
8Skilled Nursing Facility & Complex Cost Report
Provider Reimbursement Manual—Part 2
Provider Cost Reporting Forms and Instructions
Chapter 38—Form HCFA-1984-99
(HCFA Pub. 15-2-38)
(Superintendent of Documents No. HE 22.8/4)
2Hospice Cost Report
Medicare Program Integrity Manual
(HCFA Pub. 83)
2Medical Review of Partial Hospitalization Claims
Medicare/Medicaid
Sanction—Reinstatement Report
(HCFA Pub. 69)
00-07Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded Reinstated—June 2000
00-08Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—July 2000
00-09Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—August 2000
October through December 2000
Intermediary Manual
Part 3—Claims Process
(HCFA Pub. 13-3)
(Superintendent of Documents No. HE 22.8/6)
1811Extracorporeal Immunoadsorption Using Protein A Columns
Hospital Outpatient Partial Hospitalization Services
1812Dialysis for End-Stage Renal Disease—General
1813Provider Electronic Billing File and Record Formats
1814Claims Processing Timeliness
Beneficiary-Driven Demand Billing Under Home Health Prospective Payment System
Prospective Payment System Pricer Program
Home Health Agency Bills
Denials and Conditional Payments in Medicare Secondary Payer Situations
Provider Specific Payment Data
Provider Specific Payment Data Record Layout and Description
Intermediary Responsibilities
The Cancel Only Adjustment Code (Action Code 4)
1815Payment for Blood Clotting Factor Administered to Hemophilia Inpatients
1816Bill Review for Partial Hospitalization Services Provided In Community Mental Health Centers
Hospital Outpatient Partial Hospitalization Services
1817Heart Transplants
1818Oral Anti-Nausea Drugs as Full Therapeutic Replacements for Intravenous Dosage Forms As Part of a Cancer Chemotherapeutic Regimen
1819Pneumococcal Pneumonia, Influenza Virus and Hepatitis B Vaccines
1820Review of Form HCFA-1450 for Inpatient and Outpatient Bills
1821Beneficiary-Driven Demand Billing Under Home Health Prospective Payment System
Carriers Manual
Part 3—Claims Process
(HCFA Pub. 14-3)
(Superintendent of Documents No. HE 22.8/7)
1679Extracorporeal Immunoadsorption Using Protein A Columns
Coverage Summary
Coding and Payment
Denial Messages
1680Beneficiaries Previously Enrolled in Managed Care Who Return to Traditional Fee For Service
1681Type of Service
Start Printed Page 43784
1682Furnishing Medicare Physician Fee Schedule Database Pricing Files
Furnishing Physician Fee Schedule Data for Local and Carrier Price Codes
Furnishing Physician Fee Schedule Data for National Codes
Furnishing Fee Schedule (Excluding Physician Fee Schedule), Prevailing Charge and Conversion Factor Data to Palmetto GBA, Fiscal Intermediaries, State Agencies, Indian Health Services and United Mine Workers Health Maintenance Organization Processing Requirements
Specialty Code/Place of Service
1683Durable Medical Equipment Regional Carrier Instructions for Denying Claims For Prescription Drugs Billed and/or Paid to Suppliers Not Licensed to Dispense Prescription Drugs
1684Responsibility to Download and Implement Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Fee Schedules
1685Home Use of Durable Medical Equipment
Evidence of Medical Necessity
Incurred Expenses for Durable Medical Equipment and Orthotic and Prosthetic Devices
Evidence of Medical Necessity Oxygen Claims
1686Type of Service
1687End-Stage Renal Disease Bill Processing Procedures
Home Dialysis Patients Options for Billing
1688Durable Medical Equipment Regional Carrier Instructions for Denying Claims for Prescription Drugs Billed and/or Paid to Suppliers Not Licensed to Dispense Prescription Drugs
1689Payment and Coding Requirements
Processing Claims to Ensure That Payment Conditions Are Met
Carriers Manual
Part 4—Professional Relations
(HCFA Pub. 14-4)
(Superintendent of Documents No. HE 22.8/7-4)
23Registry Customer Information Control System
Program Memorandum
Intermediaries (HCFA Pub. 60A)
(Superintendent of Documents No. HE 22.8/6-5)
A-00-71Medical Review of Home Health Services—For Regional Home Health Intermediaries
A-00-72Technical Correction to Coding Information for Hospital Outpatient Prospective Payment System
A-00-73Clarification of Modifier Usage in Reporting Outpatient Hospital Services
A-00-74October Outpatient Code Editor
A-00-75Corrections to Calculation of Inpatient Payment Amounts
A-00-76Clarification of the Application of the Regulations at 42 Code of Federal Regulations 413.134(l) to Mergers and Consolidations Involving Non-Profit Providers
A-00-77Change in Hospice Payment Rates, Update to the Hospice Cap, Revised Hospice Wage Index and Hospice Pricer
A-00-78Provider Statistical and Reimbursement Report
A-00-79Settlement Agreement Between the Health Care Financing Administration and National Medical Care, Inc. d/b/a Fresenius Medical Care North America for Payment of Medicare End-Stage Renal Disease Bad Debts
A-00-80Notification to Outpatient Hospital Service Providers Concerning Deductible and Coinsurance Amounts on Electronic Remittance Advice Version 3051.4a
A-00-81Resolution of Outpatient Prospective Payment System Implementation Issues
A-00-82January 2001 Update: Coding Information for Hospital Outpatient Prospective Payment System
A-00-83Business Requirements for Processing Outpatient Encounter Data in the Health Care Financing Administration Data Center
A-00-84Medicare+Choice Inpatient Encounter Data—Migration of Data Processing to the Health Care Financing Administration Data Center
A-00-85The Report of Benefit Savings
A-00-86Changes to Fiscal Year 2000 Nursing and Allied Health Education Payment Policies as Required by the Medicare, Medicaid, and State Child Health Insurance Program Balanced Budget Refinement Act of 1999, P. L. 106-113
A-00-87Off-Label Use of Oral Chemotherapy Drugs Methotrexate and Cyclophosphamide
A-00-88Fee Schedule and Consolidated Billing for Skilled Nursing Facility Services
A-00-89Implementation of Health Insurance Portability and Accountability Act Transaction Standards—Overview and Specific Instruction for Implementing the Inbound Claim
A-00-90Policy Clarification: Coding for Adequacy of Hemodialysis
A-00-91Inpatient Rehabilitation Facility Prospective Payment System
A-00-92Corrections to Calculation of Federal Fiscal Year 2001 Inpatient Payment Amounts
A-00-93Do Not Forward Initiative, Change Request 681, Transmittal No. AB-00-06, Dated February 2000
A-00-94New End Stage Renal Disease Composite Payment Rates Effective January 1, 2001
A-00-95Renewal of Program Memorandum A-97-8—Instructions to Implement the New Medicare Summary Notice Combined with Program Memorandum AB-98-31
A-00-96Clarification of C-Code Reportable Under the Hospital Outpatient Prospective Payment System
A-00-97Partial Implementation of Change Request 1119
A-00-98Reporting of Outpatient Prospective Payment System and Home Health Prospective Payment System Data in Provider Remittance Advice Transactions
Start Printed Page 43785
A-00-99Medicare Contractor Use of the Regional Home Health Intermediary Outcomes and Assessment Information Set Verification Protocol for Review of Home Health Agency Prospective Payment Bills
A-00-100Conversion to the UB-92 Version 6.0 and Continued Use of Version 5.0
A-00-101Medicare Outpatient Code Editor Version 16.1
A-00-102Hospital Outpatient Prospective Payment System Pass-Through Payment Corrections for Two Radiopharmaceuticals
Program Memorandum
Carriers
(HCFA Pub. 60B)
(Superintendent of Documents No. HE 22.8/6-5)
B-00-50Home Health Prospective Payment System
B-00-51Changes to Correct Coding Edits, Version 7.0, Effective January 1, 2001
B-00-52Schedule for Completing the Calendar Year 2001 Fee Schedule Updates and the Participating Physician Enrollment Procedures
B-00-53Calendar Year 2001 Participation Enrollment and Medicare-Participating Physicians and Suppliers Directory Procedures
B-00-54Program Integrity Management Reporting System
B-00-55Durable Medical Equipment Regional Carrier Common Working File to Add ICD-9 Diagnosis Code for Oral Anti-Cancer Drugs
B-00-56Durable Medical Equipment Regional Carrier Common Working File Edit# 5211 Services after the Date of Death for Durable Medial Equipment Rental Items
B-00-57Part B Outbound X12N 837 Coordination of Benefits Mapping
B-00-58Durable Medical Equipment Regional Carriers—Change in Common Working File for Code K0009
B-00-59Durable Medical Equipment Regional Carrier—Common Working File Revision for Oxygen Certificate of Medical Necessity
B-00-60New Temporary “K” Codes for Augmentative and Alternative Communication Devices
B-00-61Comprehensive Error Rate Testing Program Requirements for Medicare Contractor Operations
B-00-62Promoting Influenza and Pneumococcal Vaccinations
B-00-63Medicare Payment Allowance for Flu Vaccine
B-00-64Program Integrity Sampling Module for Part B and Durable Medical Equipment Carriers
B-00-652001 Physician Fee Schedule for Payment Policies
B-00-66Durable Medical Equipment Regional Carrier Operating Instructions for Coverage of the Ultrasonic Osteogenic Stimulators for Fracture Healing: Effective for Services Performed on or after 1/1/2001
B-00-67Consolidated Billing for Skilled Nursing Facility Residents
B-00-68X12N Professional Flat File
B-00-69Blood Glucose Test Strips—Marketing to Medicare Beneficiaries
B-00-70Changes to Correct Coding Edits, Version 7.1, Effective April 1, 2001
B-00-71Addition of a Miscellaneous “WW” Code and National Drug Code for Oral Anti-Cancer Drugs
B-00-72Instructions to Implement the New Medicare Summary Notice—Program Memorandum B-98-4 and PM AB-98-31
B-00-73Correct Coding Initiative Edits Correction: Influenza (G0008), Pneumococcal (G0009), and Hepatitis B (G0010) Vaccine Codes
B-00-74Claims Processing Instructions for Carriers To Make Available Claims and Medical Records for a Program Safeguard Contractor Task Order Request for Medical Record Review
B-00-75Emergency Changes to the 2001 Medicare Physician Fee Schedule Database
B-00-76Revised 2001 Anesthesia Conversion Factors
Program Memorandum
Intermediaries/Carriers
(HCFA Pub. 60A/B)
(Superintendent of Documents No. HE 22.8/6-5)
AB-00-91Mammography Screening Payment Limit for Calendar Year 2001
AB-00-92Sending Common Working File Referrals for Initial Enrollment Questionnaire and Internal Revenue Services/Social Social Security Administration/Health Care Financing Administration Data Match Records to the Coordination of Benefits Contractor
AB-00-93Coordination With the Y2K Program Safeguard Contractor
AB-00-94Urokinase (Abbokinas) Shortage
AB-00-95Facility Requirements for Transplantation Centers
AB-00-96Clarification of Fiscal Intermediary and Durable Medical Equipment Regional Carrier Responsibilities Concerning Home Dialysis Method Election and Claims Processing
AB-00-97Notification to Providers and Suppliers of Transaction and Code Set Rule Promulgated In Accordance With the Health Insurance Portability and Accountability Act
AB-00-98Medicare Deductible and Premium Rates for Calendar Year 2001
AB-00-99Glucose Monitoring Note
AB-00-100Mandatory Training on Ambulance Fee Schedule
AB-00-101Notice of Interest Rate for Medicare Overpayments and Underpayments
AB-00-102Clarification to Medicare Carriers Manual § 2130 Prosthetic Devices and Coverage Issues Manual § 60-9 Durable Medical Equipment Reference List—Coverage of Intermittent Catheterization
AB-00-103Final Rule Revising and Updating Medicare Polices Concerning Ambulance Services
AB-00-104Autologous Stem Cell Transplantation for Patients with Multiple Myeloma
AB-00-105New Waived Test—November 9, 2000
AB-00-106Establishment of Provider/Supplier Information and Education Resource Directory
Start Printed Page 43786
AB-00-107Transfer of Initial Medicare Secondary Payer Development Activities to the Coordination of Benefits Contractor
AB-00-108Glucose Monitoring
AB-00-1092001 Clinical Laboratory Fee Schedule an Laboratory Costs Subject to Reasonable Charge Payment Methodology
AB-00-110Implementation of the New Payment Limit for Drugs and Biologicals
AB-00-111Revised Claims Processing Instructions for Medicare Qualifying Clinical Trial Claims for Managed Care Enrollees
AB-00-112Home Health Prospective Payment System/Consolidated Billing Edits and Systems Changes—Instructions for Standard Systems, Common Working File, and Contractors Part II
AB-00-113Instructions for Implementing and Updating 2001 Payment Amounts for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
AB-00-114Update of Codes and Payments for Ambulatory Surgical Centers
AB-00-115Source of Average Wholesale Price Data in Pricing Drugs and Biologicals Covered by the Medicare Program
AB-00-116Local Medical Review Policy Development and Format
AB-00-117Payment of Drugs, Biologicals and Supplies in a Comprehensive Outpatient Rehabilitation Facility
AB-00-118Delay Implementation of the Ambulance Fee Schedule
AB-00-119Change in the Collection of Comprehensive Encounter Data for the Medicare Choices Demonstration, Long-Term Care Demonstrations (Social Health Maintenance Organization Evercare, Department of Defense Subvention Demonstration, and Dual Eligible Demonstrations
AB-00-120Operating Instructions for Coverage of Non-Implantable Pelvic Floor Electrical Stimulators
AB-00-121Medicare Intermediary Claims Processing Standard Systems Delay of Calendar Year 2001 Quarter Release
AB-00-122Appeals of Medicare Part A/Part B Coverage Determinations
AB-00-123Use of Beneficiary Question & Answers on www.hcfa.gov
AB-00-124Payment for Method II Home Dialysis Supplies
AB-00-125Accelerated Referral of Non-Medicare Secondary Payor Delinquent Debts (Active and Currently Not Collectible to Debt Collection Center for Cross Servicing and Treasury Offset Program)
AB-00-126Use of the American Medical Associations' Physicians' Current Procedural Terminology, Fourth Edition Codes on Contractors' Web Sites
AB-00-127Reimbursement for Ambulance Services to Nonhospital-Based Dialysis Facilities
AB-00-128Extension of the Limitation on Payment for Services to Individuals Entitled to Benefits on the Basis of End-Stage Renal Disease Who Are Covered by Group Health Plan
AB-00-129Coordination of Benefits Contractor Fact Sheet for Providers
AB-00-130Intestinal Transplantation
AB-00-131Clarification to Implementation of the Ambulance Fee Schedule
AB-00-132Clarification Regarding Release of Medicare Eligibility Data
AB-00-133Coordination With Provider Education Program Safeguard Contractor
AB-00-134Cervical or Vaginal Smear Tests (Pap Smears) in Calendar Year 2001 Clinical Diagnostic Laboratory Fee Schedule
Program Memorandum
State Survey Agencies
(HCFA Pub. 65)
(Superintendent of Documents No. HE 22.8/6-5)
99-2Guidelines and Exhibits Regarding Regulatory Requirements for Comprehensive Assessment and Use of the Outcome and Assessment Information Set
State Operations Manual
Provider Certification
(HCFA Pub. 7)
(Superintendent of Documents No. HE 22.8/12)
21List of Appendices
Interpretive Guidelines and Survey Procedures—Hospital—Table of Contents
Interpretive Guidelines for Home Health Agencies
22Minimum Data Set System
System Description
Administration Requirements
Validation and Editing Process
Correction of Errors in Minimum Data Set Records That Have Been Accepted by the Standard Minimum Data Set System at the State
23Hospice—Citations and Description
Community Mental Health Centers—Citations and Description
Attestation Statement
Provider Agreement
Fiscal Intermediary Medicare Provider Billing Number Deactivation Letter Used by Fiscal Intermediary
Model Denial Letter for Community Mental Health Center Applicants—State Restrictions on Screening
Model Letter, Notice of Findings of Non-Compliance
Model Letter, Notice of Termination of Provider Agreement
Model Letter, Community Mental Health Center That Has Ceased Operating
Model Letter, Participation in Medicare as a Community Mental Health Center Providing Partial Hospitalization Services (Including Threshold and Service Requirements)
Model Letter, Notice of Failure to Meet Threshold and Service Requirements
Start Printed Page 43787
Peer Review Organization Manual
(HCFA Pub. 19)
(Superintendent of Documents No. HE 22.8/8-15)
83Introduction
Review Responsibilities to Handle Clinical Data Abstraction Center Referrals
Developing the Capacity to Estimate Local Payment Error Rates
Determining the Types of Errors and Developing the Interventions Necessary to Reduce or Eliminate Errors
Developing, Applying, and Assessing the Effect of Interventions
Collaborating With Provider and Practitioner Groups
Collaborating Efforts with Federal and State Agencies and Other Medicare Contractors
84Review Process
Notice of Disclosure
Final Response to Complainants
Disclosure of Quality Review Information to Complainants
Request for Information Model Form
Final Response to Inquirer Model Notice (Concern Involved Practitioner)
Final Response to Inquirer Model Notice (Concern Involved Provider Facility)
Hospital Manual
(HCFA Pub. 10)
(Superintendent of Documents No. HE 22.8/2)
762Extracorporeal Immunoadsorption Using Protein A Columns
763Billing for Sodium Ferric Gluconate Complex in Sucrose Injection
764Payment for Blood Clotting Factor Administered to Hemophilia Inpatients
765Billing for Hospital Outpatient Partial Hospitalization Services
766Heart Transplants
767Completion of Form HCFA-1450 for Inpatient and/or Outpatient Billing
Renal Dialysis Facility Manual
(Non-Hospital Operated)
(HCFA Pub. 29)
(Superintendent of Documents No. 22.8/13)
91Billing for Sodium Ferric Gluconate Complex in Sucrose Injection
ESRD Network Organizations Manual
(HCFA Pub. 81)
(Superintendent of Documents No. HE 22.9/4)
12List of Commonly Used Acronyms, and Glossary Authority
Purpose of End-Stage Renal Disease Network Organizations
Requirements for End-Stage Renal Disease Network Organization
Responsibilities of End-Stage Renal Disease Network Organizations Goals
Network Organization's Role in Health Care Quality Improvement Program
Annual Report Format
Quarterly Progress and Status Report Format
Outpatient Physical Therapy and Comprehensive
Outpatient Rehabilitation Facility Manual
(HCFA Pub. 9)
(Superintendent of Documents No. HE 22.8/9)
15Billing Instructions for Partial Hospitalization Services Provided in Community Mental Health Centers
Coverage Issues Manual
(HCFA Pub. 6)
(Superintendent of Documents No. HE 22.8/14)
127Extracorporeal Immunoadsorption Using Protein A Columns
128Air-Fluidized Beds
129Hyperbaric Oxygen Therapy
130Intravenous Iron Therapy
131Osteogenic Stimulation
132Durable Medical Equipment Reference List
Speech Generating Devices
133Non-Implantable Pelvic Floor Electrical Stimulator
134Artificial Hearts and Related Devices
Start Printed Page 43788
Provider Reimbursement Manual—Part 1
(HCFA Pub. 15-1)
(Superintendent of Documents No. HE 22.8/4)
418Requirements for Distinct Part Certification
419Regional Medicare Swing-Bed Skilled Nursing Facility Rates
Provider Reimbursement Manual—Part 2
Provider Cost Reporting Forms and Instructions
Chapter 35—Form HCFA-2540-96
(HCFA Pub. 15-2-35)
(Superintendent of Documents No. HE 22.8/4)
9Skilled Nursing Facility, and Skilled Nursing Facility Health Care Complex Cost Report, Form HCFA-2540-96
Provider Reimbursement Manual—Part 2
Provider Cost Reporting Forms and Instructions
Chapter 36—Form HCFA-2552-96
(HCFA Pub. 15-2-36)
(Superintendent of Documents No. HE 22.8/4)
7Hospital and Hospital Health Care Complex Cost Report, Form HCFA-2552-96
Medicare Program Integrity Manual
(HCFA Pub. 83)
(Superintendent of Documents No. HE 22)
3Types of Claims For Which Contractors Are Responsible
The Medicare Medical Review Program
National Coverage Policy and Local Medical Review Policy and Individual Claim Determinations
Individual Claim Determinations
Identification of Services for Which A Local Medical Review Policy is Needed
Coding Rules in Local Medical Review Policy
Local Medical Review Policy Notice Process
Manual Review Personnel and Levels of Review
The Contractor Advisory Committee
Medicare Fraud Information Specialist
Medicare Integrity Program—Provider Education and Training Activities
Contractor Medical Director
Office of Inspector General Referrals and Appropriate Fraud Information Database Entries
Introduction
Provider Tracking System
Evaluating Effectiveness of Corrective Actions
Verifying Potential Errors and Setting Priorities
Determining Whether the Problem is Widespread or Provider-Specific
Provider Education
Prepayment Review of Selected Claims
Automated and Manual Prepayment Review
Prepayment Edits
Development of Claims for Additional Documentation
Location of Postpay Reviews
Advance Determination of Medicare Coverage of Customized Durable Medical Equipment
Effectuating Favorable Final Appellate Decisions That A Beneficiary is “Confined to Home”
Contractor Advisory Committee Structure
Contractor Advisory Committee Process
The Medicare Fraud Program
Staffing of the Fraud Unit and Security Training
Durable Medical Equipment Fraud Functions
Identifying Potential Errors—Introduction
Data Analysis
Resources Needed for Data Analysis
Determine Indicators to Identify Norms and Deviations
Overview of Prepayment and Postpayment Review
Automated and Manual Prepayment Review
Categories of Medical Review Edits
Overpayment Assessment Procedures
Consent Settlement Offer Based on Potential Projected Overpayment
Certified Medical Necessity as the Written Order
Pick-up Slips
Incurred Expenses for Durable Medical Equipment and Orthotics and Prosthetic Devices
List of Medical Review Codes, Categories, and Conversion Factors for Fiscal Year 2000
Description of Carrier Advisory Committee
Start Printed Page 43789
Consent of Settlement Documents
HCFA Forms 700 and 701
Medicare/Medicaid
Sanction—Reinstatement Report
(HCFA Pub. 69)
00-10Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded Reinstated—September 2000
00-11Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—October 2000
00-12Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—November 2000
January 2001 through March 2001
Intermediary Manual
Part 1—Claims Process
(HCFA Pub. 13-1)
(Superintendent of Documents No. HE 22.8/6-3)
130Principles of Reimbursement for Administrative Costs
Intermediary Manual
Part 2—Claims Process
(HCFA Pub. 13-2)
(Superintendent of Documents No. HE 22.8/6-3)
415System Security Authority, Exhibits, and Appendices: www.hcfa.gov/​pubforms/​pim/​pimtoc.htm
416Recovery of Overpayments Due to a Pattern of Furnishing Excessive or Noncovered Services
417This Transmittal contains no updated information
Intermediary Manual
Part 3—Claims Process
(HCFA Pub. 13-3)
(Superintendent of Documents No. HE 22.8/6)
1822No Legal Obligation To Pay For Or Provide Services
Review of Form HCFA-1450 For Inpatient And Outpatient Bills
Medicare Secondary Payor Maintenance Transaction Record Processing
Alphabetic Listing Of Data Elements
1823Screening Pap Smears and Screening Pelvic Examinations
1824Colorectal Screening
1825Hospital Outpatient Partial Hospitalization Services
1826Review of Form HCFA-1450 For Inpatient and Outpatients Bills
1827Beneficiary-Driven Demand Billing Under Home Health Prospective Payment System
Carriers Manual
Part 2—Program Administration
(HCFA Pub. 14-1)
(Superintendent of Documents No. HE 22.8/7-2)
124Principles of Reimbursement for Administrative Costs
Budget Preparation
Budget Preparation
Carriers Manual
Part 3—Program Administration
(HCFA Pub. 14-2)
(Superintendent of Documents No. HE 22.8/7)
142System Security Authority, Exhibits, and Appendices: www.hcfa.govpubforms/​83_​pim/​pimtoc.htm
Carriers Manual
Part 3—Program Administration
(HCFA Pub. 14-3)
(Superintendent of Documents No. HE 22.8/7)
1690Claims for Anesthesia Services Performed on and After January 1, 1992
Entities/Suppliers Whose Physicians' Services Are Paid for Under Fee Schedule
Method for Computing Fee Schedule Amounts
Payment Conditions for Anesthesiology Services
Assisted Suicide
Site-of-Service Payment Differential
Optometry Services
Start Printed Page 43790
Allowable Adjustments
Evaluation and Management Service Codes—General
Payment for Office/Outpatient Visits
Consultations
Payment For Physician's Visits To Residents of Skilled Nursing Facilities and Nursing Facilities
Home Care and Domiciliary Care Visits
Prolonged Services
Home Services
Geographic Practice Cost Indices by Medicare Carrier and Locality
Determining Reasonable Charges for Services of Nurse Practitioners and Clinical Nurse Specialists
1691No Legal Obligation To Pay For Or Provide Services
Medicare Secondary Payer General Provisions
Medicare Secondary Payer General Provisions Applicable To Individuals Covered By Group Health Plans and Large Group Health Plans
Limitation On Payment For Services To Individuals Eligible For Or Entitled To Benefits On Basis Of End Stage Renal Disease Who Are Covered By Group Health Plans
1692Patient and Insured Information
Physician or Supplier Information
Place of Service Codes and Definitions Exhibits
1693Physicians Billing for Purchased Diagnostic Tests (Other Than Clinical Diagnostic Laboratory Tests
1694Screening Pap Smear Coverage and Payment Requirements
Screening Pelvic Examination Coverage and Payment Requirements
Diagnosis Coding
Billing Requirements
Calculating Frequency Limitations
Common Working File Edits
Medicare Summary Notices and Explanations of Your Part B Medicare Benefits
Remittance Advice Notices
1695Coding Changes Became Effective for Hepatitis B Vaccines Through the Health Care Financing Administration Common Procedure Coding System
Annual Updates
1696Evidence of Medical Necessity Oxygen Claims
1697Covered Services and Health Care Financing Administration Common
Procedure Coding System Codes
Coverage Criteria
Determining Whether or Not the Beneficiary is at High Risk for Developing Colorectal Cancer
Determining Frequency Standards
Noncovered Services
Payment Requirements
Common Working File Edits
Medicare Summary Notices and Explanations of Your Part B Medicare Benefits
Remittance Advice Notices
Ambulatory Surgical Center Facility Fee
1698Dual Eligibility/Entitlement Situations
Program Memorandum
Intermediaries (HCFA Pub. 60A)
(Superintendent of Documents No. HE 22.8/6-5)
A-01-01January Outpatient Code Editor Specifications Version (V2.0)
A-01-02Use of Telehealth In Delivery of Home Health Services
A-01-03Temporary 2-Month Extension of Periodic Interim Payment for Home Health Providers
A-01-04Change in Hospice Payment Rates As Required by the Benefits Improvement and Protection Act
A-01-05Advance Beneficiary Notices Must Be Given To Beneficiaries and Demands Bills Must Be Submitted By Home Health Agencies
A-01-06Restoration of Full Home Health Market Basket Update for Home Health Services for Fiscal Year 2001 and Temporary 10 Percent Payment Increase for Home Health Services Furnished in a Rural Area For 24 Months Under the Home Health Prospective Payment System
A-01-07Application of Wage Index for Wichita, Kansas, Metropolitan Statistical Area Hospice Providers
A-01-08Adjustments to the Federal Skilled Nursing Facility Prospective Payment System Rates for Fiscal Year 2001
A-01-09Exemption of Critical Access Hospital Swing Beds From Skilled Nursing Facility Prospective Payment System
A-01-10Technical Corrections to the January 2001 Update: Coding Information for Hospital Outpatient Prospective Payment System
A-01-11Changes to Federal Fiscal Year 2001 Inpatient Hospital Payment As Required By the Benefits Improvement And Protection Act of 2000 (Public Law 106-554)
A-01-12Provider Statistical and Reimbursement Report
A-01-13Clarification of Allowable Medicaid Days in the Medicare Disproportionate Share Hospital Adjustment Calculation
A-01-14Clarifications to Transmittal A-01-03, Change Request 1437, Temporary 2-Month Extension of Periodic Interim Payment for Home Health Providers
A-01-15Implementation of Sections 111, 401, 403, and 405 of the Medicare, Medicaid, and State Child Health Insurance Program Benefits Improvement and Protection Act of 2000
Start Printed Page 43791
A-01-16Claims Guidance Related to Outpatient Code Editor Edit 27
A-01-17Impact of the Benefits Improvement and Protection Act on Devices Eligible for Transitional Pass-Through Payments Under the Hospital Outpatient Prospective Payment System
A-01-18Effective Dates for all Medicare Secondary Payer Sub-Modules Found in the Medicare Secondary Payer Pay Module
A-01-19New Composite Payment Rates Effective April 1, 2001, through December 31, 2001, and the Application of Exceptions Under the End Stage Renal Disease Composite Rate System
A-01-20Health Insurance Portability and Accountability Act Health Care Claim and Coordination of Benefits
A-01-21Clarification of the Homebound Definition Under the Medicare Home Health Benefit
A-01-22Extension of Due Date for Filing Provider Cost Reports
A-01-23Modification to Home Health Prospective Payment System Date Matching Edit in Medicare Standard System Software
A-01-24Further Guidance on Handling Outpatient Code Editor Error 13
A-01-25New Processing and Reporting Requirements for Resolution of Outpatient Prospective Payment System Implementation Issues
A-01-26Clarification of Exclusions to the Temporary 2-Month Extension of Periodic Interim Payments For Home Health Providers
A-01-27Problems with Processing of Non-Outpatient Prospective Payment System Claims Through the Outpatient Code Editor
A-01-28Addendum to Periodic Interim Payments For Home Health Providers
A-01-29Medicare Review of Certification and Re-Certifications of Residents in Skilled Nursing Facilities
A-01-30Advance Beneficiary Notices Must Be Given To Beneficiaries and Demand Bills Must Be Submitted By Home Health Agencies
A-01-31Clinical Diagnostic Laboratory Tests Furnished by Critical Access Hospitals
A-01-32Biweekly Interim Payments for Certain Hospital Outpatient Items and Services That Are Paid On A Cost Basis, and Direct Medical Education Payment, Not Included in the Hospital Outpatient Prospective Payment System
A-01-33Fiscal Intermediary Community Mental Health Center Enrollment and Change of Ownership Site Visit Process and Coordination With National Community Mental Health Center Site Visit Contractor
A-01-34Salary Equivalency Guidelines Update Factors
A-01-35Medicare+Choice Inpatient Encounter Data-Migration of Data Processing to the Health Care Financing Administration Data Center
A-01-36April Outpatient Code Editor Specifications Version (V2.1)
A-01-37Change in the Standard Paper Remittance Advice for Home Health Agencies
A-01-38Changes to Fiscal Year 2001 and Fiscal Year 2002 Graduate Medical Education Policies as Required by the Medicare, Medicaid, and State Child Health Insurance Program Balanced Budget Refinement Act of 1999, P.L. 106-113, and the Medicare, Medicaid, and State Child Health Insurance Program Benefits Improvement and Protection Act of 2000, P.L. 106-554
A-01-39Postacute Care Transfer Policy
A-01-40Additional Information on Transitional Pass-Through Devices and Drugs
A-01-41Categories for Use in Coding Devices Eligible for Transitional Pass-Through Payments Under the Hospital Outpatient Prospective Payment System
A-01-42Indian Health Service Hospital Payment Rates for Calendar Years 2000 and 2001
A-01-43This Transmittal Has Been Rescinded
A-01-44Standard Systems Changes Required to Incorporate Provider-Specific Payment-to-Cost Ratios into the Calculation of Interim Transitional Corridor Payment Outpatient Prospective Payment System
A-01-45Clarification and HCFA Common Procedure Coding System Coding Update: Part B Fee Schedule and Consolidated Billing for Skilled Nursing Facility Services
A-01-46Further Guidance on Handling the Outpatient Code Editor Edit 43
A-01-47Implementation of Updates to the Federal Fiscal Year 2001 Inpatient Hospital Payments and Disproportionate Share Hospital Thresholds and Adjustments as Required by the Benefits Improvement and Protection Act of 2000 (Public Law 106-554)
Program Memorandum
B-01-01Use of Statistical Sampling for Overpayment Estimation When Performing Administrative Reviews of Part B Claims
B-01-02Medicare Requirements for Payment for Medicare-Covered Drugs Administrative Reviews of Part B Claims
B-01-03Request for Carriers to Include a Message on Paper Remittance Notices
B-01-04New Temporary “K” Codes for Insulin Lispro
B-01-05Matrix to Complete Provider/Supplier Enrollment Application (HCFA-855)
B-01-06Health Insurance Portability and Accountability Act Health Care Claim and Coordination of Benefits
B-01-07Apligraf (Graftskin)
B-01-08Change in Effective Data For Five “WW” Codes For Methotrexate
B-01-09Suspension of Recently Implemented Correct Coding Initiative Edits Bundling Evaluation and Management Codes and Ophthalmologic Codes Revision to Version 7.0
B-01-10Systems Requirements for the Benefits Improvement and Protection Act of 2000 for Drugs and Biologicals Covered by Medicare, Section 114, Mandatory Submission of Assigned Claims for Drugs and Biologicals
B-01-11Supplier Billing for Glucose Test Strips
B-01-12Initial Viable Information Processing Systems Virtual Multiple Storage Changes Necessary to Allow for “Full Program Safeguard Contractor Implementation”
B-01-13Explanation of Medicare Benefits, Medicare Summary Notice and Supplier Remittance Message Durable Medical Equipment Regional Carriers Must Use on Claims for Drugs and Related Equipment Supplied by a Supplier Not Licensed to Dispense the Drug
Start Printed Page 43792
B-01-14New Oral Anti-Cancer Drugs Approved for Use by Medicare
B-01-15Durable Medical Equipment Regional Carrier System Requirements to Implement § 114 of the Benefits Improvement and Protection Act of 2000
B-01-16Clarification of Medicare Policies Concerning Ambulance Services
B-01-17Durable Medical Equipment Regional Carrier System Changes to Enforce Medicare Requirements for Payment for Medicare-Covered Drugs
B-01-18Changes to Correct Coding Edits, Version 7.2, Effective July 1, 2001
B-01-19Additional Information for Trail Blazer Health Enterprise for Centralized Billing of Flu and Pneumococcal Vaccinations
B-01-20Two New “K” Codes for Heavy Duty Hospital Beds
B-01-21Durable Medical Equipment Regional Carrier System Requirements to Implement § 114 of Benefits Improvement and Protection Act of 2000 (Additional Requirements for Change Request (CR) 1562, Transmittal B-01-15)
B-01-22Initial Viable Information Processing System Medicare System Virtual Multiple Storage Changes Necessary to Allow for Full Program Safeguard Contractor Implementation
Program Memorandum
AB-01-01Upcoming Train the Trainer Sessions on Skilled Nursing Facility Prospective Payment System and Consolidated Billing Updates
AB-01-02Managing Medicare Appeals Workloads in Fiscal Year 2001
AB-01-03April Quarterly Update for 2001 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Fee Schedule
AB-01-04Implementation of the National Drug Code to Process Claims for Prescription Drugs and Biologicals and Request for Comments
AB-01-05New Waived Tests—Effective Date of Receipt
AB-01-06Replacement of Prosthetic Devices and Parts
AB-01-07Contractor Testing Requirements
AB-01-08Program Safeguard Contractor for Corporate Integrity Agreements
AB-01-09Clarification of Physician Certification Requirements for Medicare Hospice
AB-01-10Elimination of Time Limit for Coverage of Immunosuppressive Drugs Under Medicare
AB-01-11Health Care Financing Administration Business Partner Systems Security Manual
AB-01-12Charging Fees to Providers for Medicare Education and Training Activities Program Management
AB-01-13Pap Test for Women Aged 65 and Older: Dispelling the Myths
AB-01-14Notification to Beneficiaries About Cervical Cancer Month and the Benefit of Pap Tests
AB-01-15Instructions to All Medicare Contractors for Reporting Audited Year 2000 Costs on the Final Administrative Costs Proposals
AB-01-16Implementation of Benefits Improvement and Protection Act of 2000 Requirements for Drugs and Biologicals Covered by Medicare
AB-01-17Medicare Coverage of Epoetin Alfa (Procrit) for Preoperative Use
AB-01-18New Automatic Notice of Change to Medicare Secondary Payer Auxiliary File
AB-01-19First Update to the 2001 Medicare Physician Fee Schedule Database
AB-01-20Payment Revisions For Diagnostic and Screening Mammograms Performed With New Technologies—Effectuated By Benefits Improvement and Protection Act 2000
AB-01-21Form HCFA-1522, Monthly Contractor Financial Report, Reconciliation
AB-01-222001 Payment Limit Update for Ambulance Services
AB-01-23Medicare Summary Notices Programming Errors
AB-01-24Medicare Secondary Payer: (1) Procedures for “Write-Off—Closed” of Medicare Secondary Payer Accounts Receivable; (2) Elimination of Automated/Systems “Write-Off—Closed” Actions for Medicare Secondary Payer Accounts Receivable; Zero Backend Tolerance for Medicare Secondary Payer Accounts Receivable (Reminder); and (3) Date for Establishment of Medicare Secondary Payer Accounts Receivable (Reminder)
AB-01-25Clarification of Transmittal AB-00-107, Change Request 1163, and Transmittal AB-00-129, Change Request 1460, Regarding the Coordination of Benefits Contract of Benefits Contractor and Medicare Secondary Payer Prepay Work Activities for Customer Service, Medicare Secondary Payer and Standard Systems Contractor Staff
AB-01-26Changes to the 2001 Payment Amounts for Durable Medical Equipment Prosthetics, Orthotics, and Supplies
AB-01-27Notice of Interest Rate for Medicare Overpayments and Underpayments
AB-01-28Current Status of Medicare Program Memoranda Issued Before Calendar Year 2001
AB-01-29Free Electronic Billing Software
AB-01-30Claims Processing Instructions for the Medicare Coordinated Care Demonstration—Correction and Enhancement
AB-01-31Fraud Investigation Database
AB-01-32Promoting Colorectal Cancer Screening as a Part of Colorectal Cancer Awareness Month
AB-01-33Delay of Carrier and Intermediary Actions Required in Change Requests 1256 and 1323, Consolidated Billing for Skilled Nursing Facility Residents, and Fee Schedule for Part B Residents and Outpatients
AB-01-34Health Care Financing Administration Office of the Inspector General Hotline Referrals
AB-01-35Delay of Carrier and Intermediary Action Required in Change Request 1412, Transmittal AB-00-112, Dated November 16, 2000, Consolidated Billing for Home Health Agencies
AB-01-36Extension of Moratorium on the Application of the Financial Limitation for Outpatient Rehabilitation Services
AB-01-37Verteporfin
AB-01-38Transmittal number AB-01-38, has been rescinded and will not be released
AB-01-39Salary Equivalency Guidelines Update Factors
Start Printed Page 43793
AB-01-40Correction to Change Request 1500 (Transmittal AB-01-26)—Changes to the 2001 Payment Amounts for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
AB-01-41Correction to April Quarterly Update for 2001 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Fee Schedule
AB-01-42Changes to 2001 Clinical Laboratory Fee Schedule Required by the Benefits Improvement and Protection Act of 2000
AB-01-43Revision to Carrier/Intermediary Provider Training for Skilled Nursing Facility Prospective Payment System and Consolidated Billing
AB-01-44Binding Contractor Hearing Officers to Local and Regional Medical Review Policies
AB-01-45Retention of HCFA Common Procedure Coding System Level III Codes
AB-01-46New Waived Test—Effective Date of Receipt
AB-01-47Independent Laboratory Billing for the Technical Component of Physician Pathology Services to Hospital Patients
AB-01-48Remittance Advice and Medicare Summary Notice Messages for the Home Health Prospective Payment System
AB-01-49Follow On Instructions to Health Care Financing Administration Business Partners Systems Security Requirements
Program Memorandum
Medicaid State Agencies
(HCFA Pub. 17)
Superintendent of Documents No. HE 22. 8/6-5
01-01Current Status of Medicaid Program Memoranda and Action Transmittal Issued Before Calendar Year 2001
Medicare Regional Office Manual—Part 2
(HCFA Pub. 23-3)
Superintendent of Documents No. HE 22.8/8
330Security Oversight Manual—
www.hcfa.gov/​pubforms/​progma.htm.
State Operations Manual
Provider Certification
(HCFA Pub. 7)
(Superintendent of Documents No. HE 22.8/12)
24Psychiatric Hospitals
Conducting Initial Surveys and Scheduled Resurveys
25Citations and Description
Organization of Home Health Agency
Characteristics Differentiating Branches From Subunits of Home Health Agency
Guidelines for Determining Parent, Branch, or Subunit
Processing Change from Branch to Subunit
Health Care Financing Administration Approval Necessary for Non-Parent Locations
Separate Entities
Operation of the Home Health Agencies
Consumer Awareness
Staff Awareness
Operation of Home Health Agencies Across State Lines
Surveying Health Maintenance Organization—Operated Home Health Agency
Guidelines for Determining Survey Frequency
Home Health Agency Survey Process for Determining Quality of Care Definitions
Home Health Functional Assessment Instrument
Outcome and Assessment Information Set Requirements
Clinical Laboratory Improvement Amendments
Standard Survey—Structure
Survey Tasks
Resident Assessment Protocols
26Regional Office Assignment of Provider and Supplier Identification Numbers
Peer Review Organization Manual
(HCFA Pub. 19)
(Superintendent of Documents No. HE 22.8/8-15)
85Statutory Background
Hospital Requirements
Hospital Penalties For Noncompliance
Regional Offices Responsibilities
State Agency Surveys
Peer Review Organization Review Responsibilities
Physician Review Outline
60-Day Peer Review Organization Review: Opportunity for Discussion (Sample Letter to Physician/Hospital),
86Quality Review
Admission Review
Coverage Review
Start Printed Page 43794
Discharge Review
Outlier Review
Limitation on Liability Determinations
Readmission Review
Circumvention of Prospective Payment System
Introduction
Review Setting
Using Screening Criteria
Providing Opportunity for Discussion
Profiling Case Review Results
Physician Reviewers
Health Care Practitioners Other Than Physicians
Conflict of Interest
When an Action Plan is Not Need
Additional Performance Improvement Activities
Denial and Reopening Time Frames
Hospice Manual
(HCFA Pub. 10)
(Superintendent of Documents No. HE 22.8/2)
768Screening Pap Smears and Screening Pelvic Examinations
769Billing for Colorectal Screening
770Billing for Hospital Outpatient Partial Hospitalization Services
771Completion of Form HCFA-1450 for Inpatient and /or Outpatient Billing
Coverage Issues Manual
(HCFA Pub. 6)
Superintendent of Documents No. HE 22. 8/14
135Photodynamic Therapy
Photosensitive Drugs
Provider Reimbursement Manual—Part 1
(HCFA Pub. 15-1)
(Superintendent of Documents No. HE 22.8/4)
420Travel Expenses
Provider Reimbursement Manual—Part 2
Chapter 31, Form HCFA-287-92
(HCFA Pub. 15-2-31)
(Superintendent of Documents No. HE 22.8/4)
4Home Office Equity Capital—General Form HCFA-287-92 Worksheets
Provider Reimbursement Manual—Part 2
Chapter 18, Form HCFA-2088-92
(HCFA Pub. 15-2-18)
(Superintendent of Documents No. HE 22.8/4)
4Outpatient Rehabilitation Provider Cost Reporting Form
Provider Reimbursement Manual—Part 2
Provider Cost Reporting Forms and Instructions
Chapter 35/Form HCFA-2540-96
(HCFA Pub. 15-2-35)
10Skilled Nursing Facility and Skilled Nursing Facility Complex Cost Report
State Medicaid Manual—Part 4/Elegibility
(HCFA Pub. 45-3)
Superintendent of Documents No. HE 22.8/10
75Medicaid Estate Recoveries
Medicare Program Integrity Manual
(HCFA Pub. 83)
4Physician Assistant Rules Concerning Orders and Certificates of Medical Necessity
5Advance Determination of Medicare Coverage of Customized Durable Medical Equipment
Definitions of Customized Durable Medical Equipment
Items Eligible for Advance Determination of Medicare Coverage
Start Printed Page 43795
Instructions for Processing Advance Determination of Medical Coverage Requests
Affirmative Advance Determination of Medical Coverage Decisions
Negative Advance Determination of Medical Coverage Decisions
Durable Medical Equipment Regional Carrier Tracking
Business Partners Systems Security Manual
(HCFA Pub. 84)
1Introduction
Information Technology Systems Security Roles and Responsibilities
Information Technology Systems Program Management
Health Care Financing Administration Core Security Requirements, and an overview the Contractor Assessment Security Tool
An Approach to Risk Assessment
An Approach to Business Continuity and Contingency Planning
An Approach to Fraud Control
Acronyms and Abbreviations
Glossary
Business Partners Security Oversight Manual
(HCFA Pub. 85)
1Introduction
2Information Technology Systems Security Roles and Responsibilities
Information Technology Systems Security Program Management
Audit Protocols and the Contractor Assessment Security Tool
Medicare/Medicaid
Sanction—Reinstatement Report
(HCFA Pub. 69)
01-01Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—December 2000
02-01Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—January 2001
03-01Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—February 2001
April 2001 through June 2001
Intermediary manual
Part 1—Claims Process
(HCFA Pub. 13-1)
(Superintendent of Documents No. HE 22.8/6-3)
131General
Instructions for Completing the HCFA-750A/B Contractor Financial Reports
Instructions for Completing the HCFA-751A/B Status of Accounts Receivable
Instructions for Completing the HCFA-C751A/B Status of Non-Medicare Secondary Payer Debt Currently Not Collectible
Instruction for Completing the HCFA-M751A/B Status of Medicare Secondary Payer Accounts Receivable
Instruction for Completing the HCFA-MC751 A/B Status of Medicare Secondary Payer Debt Currently Not Collectible
Provides Exhibits to be used to Prepare Contractor Financial Reports
Intermediary Manual
Part 2—Claims Process
(HCFA Pub. 13-2)
(Superintendent of Documents No. HE 22.8/6-3)
418Beneficiary Services
Intermediary Manual
Part 3—Claims Process
(HCFA Pub. 13-3)
(Superintendent of Documents No. HE 22.8/6)
1828Prospective Payment for Outpatient Rehabilitation Services and the Financial Limitation
1829Overpayment for Provider Services—General
1830Review of Form HCFA-1450 for Inpatient And Outpatient Bills
1831Type of Bill
Body of Report
1832Requirements for Critical Access Hospital Services and Critical Access
Start Printed Page 43796
Hospital Long Term Care Service
Payment for Services Furnished by a Critical Access Hospital
Payment for Post-Hospital Skilled Nursing Facility Care Furnished by a Critical Access Hospital
1833Provider Enrollment
1834Dialysis for End Stage Renal Disease—General
1835Cryosurgery of the Prostate Gland
1836Diabetes Outpatient Self-Management Training Services
1837Checking Reports
Body of Report
Quarterly Supplement to the Intermediary Workload Report—HCFA-1566A, Pages 1, 2, and 3
1838Drugs and Biologicals
1839Request for Anticipated Payment
Home Health Prospective Payment System Claims
Effective Date and Scope of Home Health Prospective Payment System for Claims
Split Percentage Payment of Episodes and Development of Episode Rates
Coding of Home Health Prospective Payment System Episode Case—Mix
Groups on Home Health Prospective Payment System Claims: Health Research Groups and Health Insurance Prospective Payment System Codes
Overview—Health Insurance Query System for Home Health Agency Inquiry System Shows Primary Home Health Agency
Overview—Request for Anticipated Payment Submission and Processing
Establishes Home Health Prospective Payment System Episode and Provides First Percentage Payment
Overview—Claim Submission and Processing Complete Home Health Prospective Payment System Payment Closes Episode and Performs A-B Shift
Definition of Transfer Situation Under Home Health Prospective Payment System Payment Effects
Payment When Death Occurs During a Home Health Prospective Payment System Episode
Adjustments of Episode Payment—“Special Submission Case: “No Resource Allocation Plan” Low Utilization Payment Adjustment
Adjustment of Episode Payment—“Significant Change in Condition
General Guidance on Line Item Billing under Home Health Prospective Payment System Home Health Prospective Payment System Consolidated Billing and Primary Home Health Agency
Creation of the Health Insurance Query System for Home Health Agencies and hospices in the Common Working File—Replacement of Health Insurance Query System for Home Health Agencies
Health Insurance Query System for Home Health Agencies Inquiry and Response
Timeliness and Limitations of Health Insurance Query System for Home Health Agencies Responses
Inquiries to Regional Home Health Intermediaries Based on Health Insurance Query System for Home Health Agencies Responses
National Home Health Prospective Payment Episode History File
Closing, Adjusting and Prioritizing Home Health Prospective Payment System Episodes Based on Resource Allocation Plan and Home Health Agencies Claim Activity
Other Editing and Changes for Home Health Prospective Payment System Episodes
Priority Among Other Claim Types and Home Health Prospective Payment System Consolidated Billing for Episodes
Version 3051.4A.01 Line Level Reporting Requirements for the Claim Payment in an Episode (More than 4 Visits)
Carriers Manual
Part 1—Program Administration
(HCFA Pub. 14-1)
(Superintendent of Documents No. HE 22.8/7-2)
125General
Instructions for Completing the HCFA-750B Contractor Financial Reports
Instructions for Completing the HCFA-751B Status of Accounts Receivable
Instructions for Completing the HCFA-C751B Status of Non-Medicare Secondary Payer Debt Currently Not Collectible
Instructions for Completing the HCFA-C751B Status of Medicare Secondary Payer Accounts Receivable
Instructions for Completing the HCFA-M751B Status of Medicare Secondary Payer Accounts Receivable
Carriers Manual
Part 2—Program Administration
(HCFA Pub. 14-2)
(Superintendent of Documents No. HE 22.8/7)
143Beneficiary Services
Carriers Manual
Part 3—Program Administration
(HCFA Pub. 14-3)
(Superintendent of Documents No. HE 22.8/7)
1699Overpayments—General
1700Billing for Pneumococcal, Hepatitis B, And Influenza Virus Vaccines
General Claims Processing Requirements
Billing Requirements
Start Printed Page 43797
Simplified Roster Bills
1701The Do Not Forward Initiative
1702Durable Medical Equipment Regional Carrier Pre-Discharge Delivery of DME Prosthetic, & Supplies for Fitting and Training
1703Correct Coding Initiative
1704Coverage of Medical Devices under Medicare
Appeals Process for Investigational Device Exemption Categorization Decisions
Certain Devices with a Food and Drug Administration Investigational Device Exemption
Certain Devices with an Food & Drug Administration Investigational Device Exemption
Payment of Certain Investigational Devices
HCFA's Master File of Investigational Devices
Adjudicating the Claim Executive Office of Management & Budget Messages
Executive Office of Management & Budget Messages
1705Professional Relations
Professional Relations for HCFA Common Procedure Coding System
1706Dual Eligibility/Entitlement Situations
1707Preoperative Services Paid Under the Physician Fee Schedule
1708Payment for Intravenous Iron Replacement Therapy Drugs
Sodium Ferric Gluconate Complex in Sucrose Injection
Iron Sucrose Injection
Messages for Use with Denials
1709Home Care And Domiciliary Care Visits
1710Summary
Payment and Coding Requirements
Processing Claims to Ensure That Payment Conditions Are Met
1711Simplified Roster Bills
1712Review of Health Insurance Claim Form HCFA-1500
1713Definition of Drug of Biologicals
1714Billing Procedures and Modifiers for Certified Registered Nurse Anesthetist and Anesthesiologist in a Single Anesthesia Procedure
Exempt Certified Registered Nurse Anesthetist as Rural Hospitals
1715Responsibility to Download and Implement DME Prosthetic, Orthotics & Supplies Fee Schedules
Carriers Manual
Part 4—Program Administration
(HCFA Pub. 14-4)
(Superintendent of Documents No. HE 22.8/7)
24Provider Enrollment
Program Memorandum
Intermediaries (HCFA Pub. 60A)
(Superintendent of Documents No. HE 22.8/6-5)
A-01-48Requirement for Line-Item Dates of Service for Ambulance Claims
A-01-49Announcement of Medicare Rural Health Clinic and Federally Qualified Health Centers Payment Rate Increases, Changes to the Rural Health Clinic Benefit Made By the Medicare, Medicaid, and State Child Health Insurance Program Benefits Improvement and Protection Act (BIBA) of 2000 and Clarification Regarding Drugs Furnished by Rural Health Clinics Federally Qualified Health Center Manuals
A-01-50Further Guidance Regarding Billing Under the Outpatient Prospective Payment System
A-01-51Calculating Payment-to-Cost Ratios for Purposes of Determining Transitional Corridor Payment Under the Outpatient Prospective Payment System and Revising the Criteria Under Which a Provider May Request a Recalculation of Its Cost-to-Change Ratio
A-01-52Medicare Payment for Ambulance Services Furnished by Certain Critical Access Hospitals
A-01-53Discontinuing the Recognition and Financial Reporting of Accounts Receivables Due
A-01-54Elimination of the Initial Request for Anticipated Payment Medicare Summary Notice Explanation of Medicare Benefits
A-01-55Accelerated Referral of Non-Medicare Secondary Payor Active Delinquent Debts to the Debt Collection Center for Cross Servicing and Treasury Offset Program
A-01-56Clarification to Health Insurance Prospective Payment System Coding and Billing Instructions
A-01-57Health Insurance Portability Accountability Act of 1996 Administrative Simplification Implementation of Version 4010 of the Accredited Standards Committee X12N 835 (Payment/Remittance Advice) Transaction Standard Format
A-01-58Clarification of Provider Cost Report Filing Requirements
A-01-59Correction of Some Fiscal Year 2001 Hospice Wage Indices
A-01-60Revised Processing and Reporting Requirement Timeframes for Resolution of Outpatient Prospective Payment System Implementation Issues
A-01-61Processing of 1999 Bills Under the End Stage Renal Disease Composite Rate System
A-01-62Extension of Due Date for Filling Provider Cost Reports
A-01-63Further Guidance Regarding Health Insurance Portability and Accountability Act Health Care Claim and Coordination of Benefits
A-01-64Providers Statistical and Reimbursement Report
A-01-65HCFA Common Procedure Coding System Codes for Wheelchairs and Accessories
Instructions for Regional Home Health Intermediaries
Start Printed Page 43798
A-01-66July Outpatient Code Editor Specifications Version (V2.2)
A-01-67July Medicare Outpatient Code Editor Version 16.2
A-01-68Adjusting Clinical Diagnostic Laboratory Test Claims Furnished by Critical Access Hospitals
A-01-69Inclusion of Medicare Paid Provider Message and Removal of the Ambulatory Payment Classification Code from Medicare Summary Notice
A-01-70Frequently Asked Questions About Home Health Advance Beneficiary Notice Form HCFA-R-296
A-01-71Medicare Transitional Pass-Through Payments Under the Hospital Outpatient Prospective Payment System for Pacemakers and Neurostimulators
A-01-72Additional Problems with Processing of Non-Outpatient Prospective Payment System Claims Through the Outpatient Prospective Payment System Outpatient Code Editor
A-01-73July 2001 Update to the Hospital Outpatient Prospective Payment System
A-01-74Replace Therapy Abstract File
A-01-75Children's Hospital Graduate Medical Education
A-01-76Scheduled Release for October Updates to Software Programs and Pricing/Coding
A-01-77Advance Beneficiary Notices for Services for Which Institutional Part B Claims Will Be Processed by Fiscal Intermediaries
A-01-78Special Handling of Outpatient Prospective Payment System Claims Containing HCFA Common Procedure Coding System Code G0121 (Screening Colonoscopy)
A-01-79Medicare Program-Update to the Prospective Payment System for Home Health
A-01-80Use of Modifier—25 and Modifier—27 in the Hospital Outpatient Prospective Payment System
A-01-81Change in Hospice Payment Rates, Update to the Hospice Cap, Revised Hospice Wage Index and Hospice Pricer
Program Memorandum
Carriers
(HCFA Pub. 60B)
(Superintendent of Documents No. HE 22.8/6-5)
B-01-23New Temporary “K” Code for the Residual Limb Support System
B-01-24Notification to Providers of Centralized Influenza and Pneumococcal Vaccination Billing
B-01-25Implementation of Carrier Jurisdiction Manual Instructions Based on the Medicare Carriers Manual Part 3, §§ 3100-3101 for the Multi-Carrier System Standard System And Associated Medicare Carriers
B-01-26Claims Processing Instructions for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Demonstration
B-01-27Durable Medical Equipment Regional Carrier Common Working File
B-01-28Physician Supervision of Diagnostic Tests
B-01-292001 Jurisdiction List
B-01-30Deletion of the HCFA Common Procedure Coding System Codes A9160, A9170, and A9190 and the GX Modifier and Replacement with New Codes and Modifiers; Status Change to HCFA Common Procedure Coding System Code A9270
B-01-31Accelerated Referral of Non-Medicare Secondary Payor Delinquent Active Debts
B-01-32Health Insurance Portability and Accountability Act Health Care Claim and Coordination of Benefits
B-01-33Suspend the Transmission of Box 10 Development Inquiries to the Coordination of Benefits Contractor
B-01-34Payment for Services Furnished by Audiologists
B-01-35Health Insurance Portability and Accountability Act of 1996 Administrative Simplification—Implementation of Version 4010 of the Accredited Standards Committee X12 835 (Payment/Remittance Advice) Transaction Standard Format
B-01-36Corrections to the Correct Coding Edits, Version 7.2, Effective July 1, 2001
B-01-37Systems Changes for New Oxygen Testing Requirements
B-01-38Adjustment to Messages Required by Change Request 1553, Transmittal B-01-10, Systems Requirements for the Benefits Improvement and Protection Act of 2000 for Drugs and Biologicals Covered by Medicare, § 114, Mandatory Submission of Assigned Claims for Drugs and Biologicals
B-01-39Quarterly Do Not Forward Reports
B-01-40Expanded Coverage of Diabetes Outpatient Self-Management Training (This Change Request Replaces the Draft Change request 1423 and Includes Full Implementation Instructions.)
B-01-41Clarification—Durable Medical Equipment Regional Carrier Implementation of Mandatory Assignment for Drug Claims
B-01-42Changes to Correct Coding Edits, Version 7.3, Effective October 1, 2001
Program Memorandum
Intermediaries/Carriers
(HCFA Pub. 60A/B)
(Superintendent of Documents No. HE 22.8/6-5)
AB-01-50Release of Version 2.1.1 of the Electronic Correspondence Referral System
AB-01-51Clarification Related to Troponin
AB-01-52Payment of Physician and Nonphysician Services in Certain Indian Providers
AB-01-53July Updates for 2001 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Fee Schedule
AB-01-54Expanded Coverage of Positron Emission Tomography Scans and Related Claims Processing Changes
AB-01-55Information Collection Requirements from Medicare Contractor Call Centers
AB-01-56Questions and Answers Regarding Payment for the Services of Therapy Students under Part B of Medicare
AB-01-57Registration Process for, and Expectations for Use of, the Healthcare Integrity and Protection Data Bank
AB-01-58Intestinal and Multi-Visceral Transplantation
AB-01-59Second Update to the 2001 Medicare Physician Fee Schedule Database
Start Printed Page 43799
AB-01-60New Temporary “Q” Codes for Splints and Casts Used for Reduction of Fractures and Dislocations
AB-01-62Fiscal Intermediary Durable Medical Equipment Regional Carrier and Common
AB-01-61Administrative Law Judge Case File Preparation, Request From the Department Appeals Board for Case File, and Retrieval of Master Files for the Departmental Appeals Board
AB-01-63Change of Interest Citation in the Overpayment Sections of the Medicare Intermediary Manual and the Medicare Carriers Manual from 42 Code of Federal Regulations § 405.376 to 42 Code of Federal Regulations § 405.378.
AB-01-64Notice of Interest Rate for Medicare Overpayments and Underpayments
AB-01-65Procedures Subject to Home Health Consolidated Billing
AB-01-66Implementation of Medicare, Medicaid, and State Child Health Insurance Program Benefits Improvement and Protection Act of 2000 Requirements for Payment Allowance of Drugs and Biologicals Covered by Medicare
AB-01-67Program Memorandum on Written Statements of Intent to Claim Medicare Benefits
AB-01-68Consolidation of Program Memorandums for Outpatient Rehabilitation Therapy Services
AB-01-69Revision of Medicare Reimbursement for Telehealth Services
AB-01-70Revision of Existing Home Health Prospective Payment System Consolidated Billing Edits
AB-01-71Billing for Audiologic Function Tests for Beneficiaries That are Patients of a Skilled Nursing Facility
AB-01-72New Zip Code File
AB-01-73Payment Instructions for Intestinal Transplants Furnished to Beneficiaries Enrolled in Medicare+Choice Plans With Dates of Service on or After April 1, 2001, but Before January 1, 2002
AB-01-74Claims Processing Instructions for Clinical Trials on Carotid Stenting With Category B Investigational Device Exemptions
AB-01-75Common Working File Access Change
AB-01-76Coordination of Benefits Contractor Fact Sheet for Providers
AB-01-77The Certification Package for Internal Controls for Fiscal Year Ending September 30, 2001
AB-01-78Common Working File Beneficiary Other Insurer Auxiliary File
AB-01-79Instructions for Coverage and Billing of Biofeedback Training for the Treatment of Urinary Incontinence
AB-01-80Data Center Management Controls and Standard System Source Code
AB-01-81Update of Codes and Payments for Ambulatory Surgical Centers
AB-01-82Clarification of Health Care Financing Administration Core Security Requirements
AB-01-83Medicare Secondary Payer Debt Collection Improvement Act of 1996 Activities
AB-01-84Correction to Second Update to the 2001 Medicare Physician Fee Schedule Database
AB-01-85Health Insurance Portability and Accountability Act Release Testing/Production
AB-01-86Deletion of Temporary “K” Codes K0008 and K0013
AB-01-87Disclosure Desk Reference for Call Centers
AB-01-88Prior Approval Requirement for Data Center and Front End Movement
AB-01-89Future Software Releases
AB-01-90Ocular Photodynamic Therapy
AB-01-91Contractor Updating of the International Classification of Diseases, Ninth Revision, Clinical Modification
AB-01-92Use of the American Dental Association's Current Dental Terminology Third Edition Codes on Medicare Contractors Web Sites
AB-01-93Claims Processing Instructions for the Medicare Coordinated Care Demonstration—Correction and Enhancement
Program Memorandum
Medicaid State Agencies
(HCFA-Pub. 17)
Superintendent of Documents No. HE 22.8/6-5
01-02Title XIX, Social Security Act, Medicaid Coverage and Payment
Medicare Regional Office Manual—Part 2
(HCFA Pub. 23-2)
Superintendent of Documents No. HE 22. 8/8
331Contractor Performance Evaluation
Contractor Performance Evaluation Strategy and Planning Process
Conducting the Contractor Performance Evaluation Review
Contractor Notification of Performance Evaluation
Entrance and Exit Conferences
Pre-Contractor Performance Evaluation Report Rebuttals from Medicare Contractors
Team Dynamics/Professional Behavior on Contractor Performance Evaluation Reviews
Contractor Performance Evaluation Review Protocols
Hospice Manual
(HCFA Pub. 10)
(Superintendent of Documents No. HE 22.8/2)
772Criteria and Payment for Sole Community Hospitals and for Medicare Dependent Hospitals
Start Printed Page 43800
Requirements for Critical Access Hospital Services and Critical Access Hospital Long Term Care Services
Payment for Services Furnished by a Critical Access Hospital
Payment for Post-Hospital Skilled Nursing Facility Care Furnished by a Critical Access Hospital
773Billing for Intravenous Iron Therapy
774Cryosurgery of the Prostate Gland
775Diabetes Outpatient Self-Management Training Services
776Drugs and Biologicals
Home Health Agency Manual
(HCFA Pub. 11)
(Superintendent of Documents No. HE 22.8/5)
297Effective Date and Scope of Home Health Prospective Payment System for Claims
Number, Duration and Claims Submission of Home Health Prospective Episodes
Split Percentage Payment of Episodes and Development of Episode Rates
Coding of Home Health Prospective Payment System Episode Case-Mix Groups on Home Health Prospective Payment System Claims Health
Research Group and Home Health Prospective Payment System Codes
Health Insurance Query System for Health Agencies Inquiry Systems Shows Primary Home Health Agency
Request for Anticipated Payment
Claim Submission and Processing
Payment When Death Occurs During an Home Health Prospective Payment System Episode
Adjustments of Episode Payment—Special Submission Case “No-Request for Anticipated Payment Low Utilization Payment Adjustment
Adjustments of Episode Payment—Therapy Threshold
Adjustment of Episode Payment—Significant Change in Condition
Adjustment of Episode Payment—Outlier Payments
General Guidance on Line Item Billing Under Home Health Prospective Payment System
Home Health Prospective Payment System Consolidated Billing and Primary Home Health Agency
Creation of the Health Insurance Query for Home Health Agencies
Health Insurance Query Access System Inquiry and Response
Timeliness and Limitations of Health Insurance Query Access System Responses
Inquiries to Regional Home Health Intermediary Health Insurance Query System for Home Health Agencies Responses
National Home Health Prospective Payment Episode History File
Closing, Adjusting and Prioritizing Home Health Prospective Payment
System Episodes Based on Resource Allocation Plans and Home Health Agency Claim Activity
Other Editing and Changes for Home Health Prospective Payment System Episodes
Priority Among Other Claim Types and Home Health Prospective Payment System Consolidated Billing for Episodes
Request for Anticipated Payment
Home Health Prospective Payment System Claims
Durable Medical Equipment and Other Items Not included in Home Health Prospective Payment System Episode Payment
Line Level Reporting Requirements for Resource Allocation Plan Payments
Line Level Reporting Requirements for the Claim Payment in an Episode (More than 4 Visits)
Instructions for Versions Subsequent to Electronic 835 Version 3051.4A.01
Submitting the HCFA-838
Skilled Nursing Facility Manual
(HCFA-Pub. 12)
Superintendent of Documents No. HE 22. 8/3
368Hospital Insurance A Brief Description
Inpatient Hospital Services
Posthospital Home Health Services
Benefits
Annual Part B Deductible and Coinsurance
Delayed Certification and Recertifications
Disposition of Certifications and Recertifications Statements
Coverage of Outpatient Physical Therapy, Occupational Therapy, and Services
Speech Pathology Services
Services Furnished under Arrangements with Providers
Signature on the Request for Payment by Someone Other Than the Patient
Time Limits For Requests Claims For Payment for Services Paid Under Prospective Payment System, Fee Schedule or a Reasonable Cost Basis Usual Time Limit
Extension of Time Limit Where Late Filing is Due to Administrative Error
Part B Services (HCFA-1450 Billings), and Section 315, Time Limit for Filing Part B Claims
Rules Governing Charges to Beneficiaries
3-Day Stay and 30-Day Transfer Requirements
Billing Medicare for the Professional Component of Skilled Nursing Facility-Based Physician's Services
Skilled Nursing Facility Prospective Payment System Billing Where Charges Which Include Accommodation Charges Are Incurred in Different Accounting Years
Start Printed Page 43801
Retention of Health Insurance Records
Duplicate Edits and Resolution
369Drugs and Biologicals
Renal Dialysis Facility Manual (Non-Hospital Operated)
(HCFA Pub. 29)
(Superintendent of Documents No. HE 22.8/13)
92Billing for Intravenous Iron Therapy
Coverage Issues Manual
(HCFA Pub. 6)
(Superintendent of Documents No. HE 22.8/14)
136Positron Emission Tomography Scans
137Percutaneous Transluminal Angioplasty
138Biofeedback Therapy for the Treatment of Urinary Incontinence
139Intravenous Iron Therapy
140Cryosurgery of the Prostate
141Diabetes Outpatient Self-Management Training
Provider Reimbursement Manual—Part 2
Provider Cost Reporting Forms and Instructions
Chapter 32/Form HCFA-1728-94
(HCFA Pub. 15-2-32)
10Home Health Agency Cost Reporting Form HCFA 1728-94
Medicare Program Integrity Manual
(HCFA Pub. 83)
6Maintaining the Confidentiality of Medical Review Records
Business Partners Security Oversight Manual
1Information Technology Systems Security Roles and Responsibilities
Information Technology Systems Security Program Management
Audit Protocols and the Contractor Assessment Security Tool
Medicare/Medicaid
Sanction—Reinstatement Report
(HCFA Pub. 69)
04-01Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—March 2001
05-01Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—April 2001
06-01Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—May 2001
July 2001 through September 2001
Intermidiary Manual
Part 3—Claims Process
(CMS Pub. 13-3)
(Superintendent of Documents No. HE 22.8/6)
1840Review of Form CMS-1450 for Inpatient and Outpatient Bills
Alphabetic Listing of Data Elements
1841Prospective Payment System Pricer Program
Provider-Specific Payment Data
Provider-Specific Data Record Layout and Description
1842Mammography Screening
Diagnostic Mammography
Diagnostic and Screening Mammograms Performed with New Technologies
Carriers Manual
Part 3—Program Administration
(CMS Pub. 14-3)
(Superintendent of Documents No. HE 22.8/7)
1716Medicare Physician Fee Schedule Database 2002 File Layout
1717Roster Billing
Specialty Code/Place of Service Processing Requirements
Centralized Billing for Flu and Pneumococcal Vaccination Claim
1718Review of Health Insurance Claim Form CMS-1500
1719Preoperative Services Paid under the Physician Fee Schedule
Start Printed Page 43802
1720Evidence of Medical Necessity for Durable Medical Equipment
1721Introduction to the Appeals Process
Initial Determination
Steps in the Appeals Process: Overview
Carrier Correspondence with Beneficiaries or Other Parties Regarding—Appeals
Parties to an Appeal
Appointment of Representative
Introduction
Who May Be a Representative
How to Make and Revoke an Appointment
When to Submit the Appointment
Where to Submit the Appointment
Rights and Responsibilities of a Representative
Validity of an Appointment Over Time
Timeliness of an Appeal Request and Completeness of Appointment
Powers of Attorney
Incapacitation or Death of Beneficiary
Disclosure of Individually Identifiable Beneficiary Information to Representatives
Amount in Controversy
Defined
General Requirements
Calculating the Amount in Controversy
Additional Considerations for Calculation of the Amount in Controversy
Aggregation of Claims to Meet the Amount in Controversy
Extension of Time Limit for Filing a Request for Review or Hearing Officer Hearing
Good Cause
General Procedure to Establish Good Cause
Conditions that May Establish Good Cause for Late Filing by Beneficiaries
Example of Situations Where Good Cause for Late Filing Exists for Physicians or Other Suppliers
Conditions that May Establish Good Cause for Late Filing by Physicians or Other Suppliers
Example of Situations Where Good Cause for Late Filing Exists for Physicians or Other Supplier
Good Cause Not Found for Beneficiary, or for Physician or Other Supplier
Fraud and Abuse
Authority
Inclusion and Consideration of Evidence of Fraud and /or Abuse
Claims Where There Is Evidence That Items or Services Were Not Furnished, or Were Not Furnished as Billed
Responsibilities or Reviewers and Hearing Officers
Requests to Suspend the Appeals Process
Continuing Appeals of Physicians or Other Suppliers who are Under Fraud or Abuse Investigations
Appeals of Claims Involving Excluded Physicians or Other Suppliers
Guidelines for Writing Appeals Correspondence
General Guidelines
Letter Format
Required Elements in Appeals Correspondence
Disclosure of Information
General Information
Fraud and Abuse Investigations
Medical Consultants Used
Multiple Beneficiaries
The First Level of Appeal
Filing a Request for Review
Time Limit for Filing a Request for Review
Recording of Inquires and Other Actions on the Carriers Appeal Report (Form Center for Medicare Services-2590)
The Review
The Review Determination
Review Determination Letter
Effect of the Review Determination
Telephone Review Procedures
Informing the Beneficiary and Provider Communities About Your Telephone Review Process
Issues for Telephone Review
Issues During the Telephone Review
Time Limit for Requesting a Telephone Review
Review Request Made on Behalf of the Party on the Telephone
Conducting the Telephone Review
Documenting the Call
Timely Processing Requirements
Review Determination Letters
Education
Monitoring Telephone Reviews
Hearing Officers Hearing—The Second Level of Appeal
Filing a Request for Hearing Officer Hearing
Start Printed Page 43803
Time Limit for Filing A Request for Hearing Officer Hearing
Request for Hearing Officer Hearing Filed Prior to a Review Determination
Exceptions to Filing Requirements
Request for Hearing Officer Hearing
Timely Processing Requirements
Carrier Responsibilities
Requests for Transfer of In-Person Hearings
Acknowledgment of Request for HO Hearing
Case File Development
Case File Preparation
Types of Hearing Officer Hearings
In-Person Hearing
Telephone Hearing
On-the-Record Hearing and Decision
Preliminary On-the-Record Hearing and Decision
Hearing Officer Authority and Responsibilities
Hearing Officer Authority
Qualifications and General Responsibilities
Disqualification of Hearing Officer
Hearing Officer Hearing Procedures
Preparation for the Hearing Officer Hearing
Scheduling the Date, Time and Place of Hearing
Adjournment and/or Postponement of Telephone or In-Person Hearing
Pre-Hearing Review of the Evidence
Forwarding Copies of Cast File Prior to Telephone Hearing
In-Person and Telephone Hearing Procedures
The Hearing Officer Hearing Decision Timeliness
Effectuation of Hearing Officer Hearing Decisions
General Rule
Delaying Effectuation
Elements of Written Request for Reopening
Notice to Parties of Reopening Requests
Hearing Officer Reply to Reopening Request
Notice to Parties of Hearing Officer Determinations
Requests for Part B Administrative Law Judge Hearing
Right to Part B Administrative Law Judge Hearing
Forwarding Requests to Social Security Administration/Office of Hearings & Appeals
Case File Preparation
Acknowledgement of Request for Part B Administrative Law Judge Hearings
Model Format for Acknowledgement of Administrative Law Judge Hearing Request
Review and Effectuation of Part B Administrative Law Judge Decisions/ Dismissals
Review and Effectuation of Administrative Law Judge Decisions—General Effectuation Time Limits
Administrative Law Judge Data Extraction Form
Misrouted Administrative Law Judge Case Files
Duplicate Administrative Law Judge Decisions
Recommending Agency Referral of Part B Administrative Law Judge Decisions or Dismissals to the Centers for Medicare and Medicaid Services Regional Office (formerly known as the Agency Protest Process)
Time Limits for Forwarding Agency Referral Memorandum to Centers for Medicare and Medicaid Services Regional Office
Guidelines for Reviewing Administrative Law Judge Decisions/Dismissals
Draft Agency Referral Memorandum Content
Draft Memorandum Format
Submission of Draft Agency Referral Memorandum to Centers for Medicare and Medicaid Services Regional Office
Effectuation of Departmental Appeals Board Orders and Decisions
1722Diagnosis or Nature of Illness of Injury
1723Billing Procedures for Teaching Physician Services
1724Screening Mammography and Diagnostic Mammography
Identifying a Screening Mammography Claim and A Diagnostic
Mammography Claim
Adjudicating the Claim
Diagnostic and Screening Mammograms Performed with New Technologies
1724Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests
Program Memorandum
Intermediaries (CMS Pub. 60A)
(Superintendent of Documents No. HE 22.8/6-5)
A-01-82Centers for Medicare and Medicaid Services Audit and Cost Report Settlement Expectations
A-01-83Skilled Nursing Facility Annual Updated for Fiscal Year 2002
A-01-84Problem With Processing Certain Clinical Diagnostic Laboratory Claims and Other Claims through the July Outpatient Code Editor
A-01-85Notification of Access to Eligibility Vendor
A-01-86New Patient Status Codes
A-01-87Comprehensive Error Rate Testing Program—Requirements for Medicare Part A Contractor Operation
Start Printed Page 43804
A-01-88Extension of Due Date for Filing Provider Cost Reports
A-01-89Payment for Blood Clotting Factor Administered to Hemophilia Inpatients
A-01-90Home Health Agency Prospective Payment System Correction in Financial Reporting For Trust Funds
A-01-91Clarification of Provider Billing Requirements Under the Outpatient Prospective Payment System
A-01-92Instructions for Implementing the Inpatient Rehabilitation Facility Prospective Payment System
A-01-93Hospital Outpatient Prospective Payment System Implementation Instructions
A-01-94Implementation of Fee Schedule for Additional Part B Services Furnished by a Skilled Nursing Facility or Another Entity Under Arrangements with the Skilled Facility
A-01-95Workaround for Home Health Prospective Payment System Transfer Claims Received Out of Sequence-Regional Home Health Intermediaries Only
A-01-96Clarification of the Regulations at 42 Code of Federal Regulations 413.134(1) To Mergers and Consolidations Involving Non-profit Providers
A-01-97Technical Corrections Under the Hospital Outpatient Prospective Payment System
A-01-98October Outpatient Code Editor Specifications Version (V2.3)
A-01-99Changes in the Paid Claim Record—Notification Process
A-01-100Upcoming Train the Trainer Session for Inpatient Rehabilitation Facility Prospective Payment System
A-01-101Changes to Fiscal Year 2001 Hospital Inpatient and Outpatient Prospective Payment System Policies As Required by the Medicare, Medicaid, and State Child Health
Insurance Program Balanced Budget Refinement Act of 1999, P.L. 106-113
A-01-102Fiscal Year 2002 Prospective Payment System Hospital, Skilled Nursing Facility and Other Bill Processing Changes
A-01-103October Medicare Outpatient Code Editor Specifications Version 17.0 for Bills from
A-01-104File Descriptions and Instructions for Retrieving the 2002 Physician, Clinical Laboratory Durable Medical Equipment, Prosthetics/Orthotics and Supplies, and Therapy Fee
Schedule Payment Amounts through Centers for Medicare & Medicaid Services Telecommunications System
A-01-105Screening Glaucoma Services
A-01-106Instructions for Billing and Processing of Hospital Outpatient Claims Containing Charges for Epoetin Alfa Tradenames: Epogen and Procrit
A-01-107October 2001 Update to the Hospital Outpatient Prospective Payment System
A-01-108The Report of Benefit Savings
A-01-109The Supplemental Security Income/Medicare Beneficiary Data for Fiscal Year 2000
For Prospective Payment System Hospitals
A-01-110Instructions for Implementing the Inpatient Rehabilitation Facility Prospective Payment System
A-01-111Clarification of Activity Therapy (HCPC G0176) and Patient Education/Training Services (HCPC G0177) Under the Hospital Outpatient Prospective Payment System
A-01-112Removal of Category Code C1723 from the Pass-Through Device Category List under The Hospital Outpatient Prospective Payment System
A-01-113Prospective Payment System Patient Transfers Improperly Paid as Hospital Discharges
A-01-114Handling of Claims Containing CMS Common Procedure Coding System Codes G0204 and G0205
A-01-115Bypassing Medicare Secondary Payer Edits on Indirect Medical Education Claims for Medicare+Choice Organization Enrollees
A-01-116Medicare Secondary Payer Policies Relaxed for Hospitals
A-01-117Production Dates for the Provider Statistical and Reimbursement Report and Extension Of Due Date for Filing Provider Cost Reports
A-01-118Clarification of Cost Reporting Policy in Charge Request 1468, Concerning Submission of Home Office Cost Statements for Chain Home Offices
A-01-119Correction to Program Memorandum (PM) A-01-94 (CR 1689: Implementation of Fee Schedule for Additional Part B Services Furnished by a Skilled Nursing Facility Or Another Entity Under Arrangements with the Skilled Nursing Facilities
A-01-120Removal of CMS Common Procedure Coding System/Revenue Code Editing under The Outpatient Prospective Payment
A-01-121Skilled Nursing Facility Adjustment Billing: Adjustments to Health Insurance Prospective Payment System
A-01-122Payment of Skilled Nursing Facility Claims for Beneficiaries Disenrolling from Terminating Medicare+Choice Plans Who Have Not Met the 3-Day Hospital Stay Requirement
A-01-123Fiscal Year 2001 Prospective Payment System Hospital and Other Bill Processing Changes
A-01-124Clarification to Health Insurance Prospective Payment System Coding and Billing Instructions
A-01-125Guidance Regarding a Change in Reimbursement for Part B Inpatient Ancillary Services
Program Memorandum Carriers
(CMS Pub. 60B)
(Superintendent of Documents No. HE 22.8/6-5)
B-01-43Clarification of Payment and Place of Service Requirements for Ambulatory Surgical Center Claims
B-01-44Medicare TeleMedicine Demonstration Ending Date
B-01-45Tracking and Reporting Requirements for Advance Determinations of Medicare Coverage
B-01-46Instructions for Billing for Claims for Screening Glaucoma Services
B-01-47Comprehensive Error Rate Testing Program—Requirements Update for Medicare Part B Contractor Operations
B-01-48Medical Nutrition Therapy Services for Beneficiaries with Diabetes or Renal Disease
B-01-49Additional Information Regarding Medicare Payment Allowance for Flu Vaccine
B-01-50Attestation Option for Submission Requirement for Clinical Laboratories Billing The Technical Component of Physician Pathology Services to Hospital Patients
B-01-51Common Working File Changes Required for Processing Native American and Alaskan Native Railroad Retiree Claims
B-01-52Changes to the Center for Medicare & Medicaid Services Part B Standard System Carrier CMS Part B Standard System Responsibility (Accelerate, Claims Collection Software)
B-01-53Change in Jurisdiction for Pessary Codes
B-01-54Implementation of New Fee Schedule for Parenteral and Enteral Nutrition Items and Services
Start Printed Page 43805
B-01-55Changes to Correct Coding Edits, Version 8.0, Effective January 1, 2002
B-01-56Payment for Home Dialysis Supplies and Equipment
B-01-57New Specialty Code for Pain Management
B-01-58Coding for Non-Covered Services and Services Not Reasonable and Necessary
B-01-59Clarification of Medicare Contractor Financial Reporting Instructions Outlined In § 4923.2 of the Medicare Carriers Manual. (Issued May 2001)
B-01-60Schedule for Completing the Calendar Year 2002 Fee Schedule Updates and the Participating Physician Enrollment Procedures
B-01-61Interface Control Document
Program Memorandum
Intermediaries/Carriers
(CMS Pub. 60A/B)
(Superintendent of Documents No. HE 22.8/6-5)
AB-01-94Profiling Medicare Contractor Call Center
AB-01-95New Waived Test—July 12, 2001
AB-01-96Health Insurance Portability and Accountability Act Electronic Data Interchange Testing and Reporting Requirements
AB-01-97Claims Processing Instructions for the Medicare Participating Center of Excellence Demonstration and the Medicare Provider Partnership Demonstration
AB-01-98Durable Medical Equipment Regional Carrier Denial Code for Durable Medical Equipment Furnished in Skilled Nursing Facilities
AB-01-99This Transmittal Has Been Rescinded
AB-01-100Common Working File Health Master Record Redesign & Beneficiary Master File Expansion
AB-01-101Harkin Grants: Complaint Tracking System
AB-01-102Common Working File Y2K Wrapper Logic Removal Changes
AB-01-103Revised Guidelines for Processing Claims for Clinical Trial Routine Care Services
AB-01-104Modifications to the Common Working File to: (1) Suppress Hust Type Total Cost Transactions for Medicare+Choice and Adjustment Claims; and (2) Activate Coordination of Benefits Contractor #11100
AB-01-105Medical Review Progressive Corrective Action
AB-01-106Implementation of the Health Insurance Portability and Accountability Act Claims Status Request/Response Transaction Standard
AB-01-107Customer Services Plans Reporting Procedures
AB-01-108Final Update to the 2001 Medicare Physician Fee Schedule Database
AB-01-109Correction of Payment for Diabetes Outpatient Self-Management Training Services
AB-01-110Notice of Interest Rate for Medicare Overpayments and Underpayments
AB-01-111Completion of Home Health Prospective Payment System Consolidated Billing Enforcement
AB-01-112Installation of Digital Satellite Dishes at Medicare Contractors
AB-01-113Clarification of Comprehensive Error Rate Testing Program Requirements for Medicare Contractor Operations Regarding Prepayment Random Medical Review
AB-01-114Data Center Testing—Electronic Correspondence Referral System Software Version 3.0
AB-01-115Payment Instructions for Intestinal Transplants Furnished to Beneficiaries Enrolled in Medicare+Choice Plans With Dates of Service on or After April 1, 2001, but Before January 1, 2002
AB-01-116Provider/Supplier Plan Quarterly Report Format
AB-01-117Instruction Implementation Reporting
AB-01-118Reasonable Charge Update for 2002 for Items and Services, Other Than Ambulance and Laboratory Services
AB-01-119New Zip Code File
AB-01-120Correction to the Revision of Medicare Reimbursement for Telehealth Services
AB-01-121Update of Rates and Wage Index for Ambulatory Surgical Center Payments Effective October 1, 2001
AB-01-122Procedures for Re-issuance and Stale Dating of Medicare Checks
AB-01-123Useful Lifetime Expectancy for Breast Prosthesis
AB-01-124Health Insurance Portability and Accountability Act Budget Requests for Electronic Data Interchange Testing and Reporting
AB-01-125Clarification and Update to Medicare Payment for Code Q3014 (Telehealth Facility Fee)
AB-01-126Instructions for Implementing and Updating 2002 Payment Amounts for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
AB-01-127Year 2002 Healthcare Common Procedure Coding System Annual Update Reminder
AB-01-128Annual Update of Non-Routine Medical Supply and Therapy Codes for Home Health Consolidated Billing
AB-01-129Medicare Coverage of Non-Invasive Vascular Studies for End Stage Renal Disease Patients
AB-01-130Claims Processing Instructions for Carriers, Durable Medical Equipment Regional Carrier, Intermediaries and Regional Home Health Intermediaries for Claims Submitted for Medicare Beneficiaries Participating in Medicare Qualifying Clinical Trials
AB-01-131Fiscal Intermediary Instructions on Applying Payment Bans on Skilled Nursing Facility Admissions
AB-01-132Further Guidance Concerning Implementation of the Health Insurance Portability and Accountability Act Transactions
AB-01-133Interim Instructions—Document and Correspondence Name Transition from Health Care Financing Administration to Centers for Medicare & Medicaid Services
AB-01-134New Source of Provider Information to be Available on CMS Website October 1, 2001
AB-01-135Medical Review of Services for Patients with Dementia
AB-01-136Supplemental Instructions on CMS Business Partners Systems Security Requirements
AB-01-137CMS Policy for Disclosure of Individually Identifiable Information: Provider Telephone Inquiries for Medicare Eligibility Information
Start Printed Page 43806
AB-01-138New Zip Code File
AB-01-139Claims Processing Instructions for Claims Submitted With a Written Statement of Intent
AB-01-140Claims Processing Instructions for the Medicare Participating Centers of Excellence Demonstration and the Medicare Provider Partnership Demonstration
State Operations Manual—Provider Certification
(CMS-Pub. 7)
27Surveying Health Maintenance Organization Operated Home Health Agencies Providing Home Health Services Through Medicare Survey and Certification Process
Classification of Maintenance Dialysis Facilities as Hospital-Based or Independent Prospective Pay
Regional Office Assessment of Provider and Supplier Identification Number
Hospice Manual
(CMS Pub. 10)
(Superintendent of Documents No. HE 22.8/2)
777General Admission Procedures
Identifying Other Primary Payers During The Admission Process
Types of Admission Questions to Ask Medicare Beneficiaries
Policy For Provider Records Retention of Medicare Secondary Payer Information
Skilled Nursing Facility Manual
(CMS-Pub. 12)
(Superintendent of Documents No. HE 22. 8/3)
370This Transmittal is notification that the printed copy of Transmittal 368, Change Request 1323, dated May 24, 2001, is a final copy. The stamp “Advance Copy of Final Issues” was inadvertently printed on the Transmittal page.
Coverage Issues Manual
(CMS Pub. 6)
(Superintendent of Documents No. HE 22.8/14)
142Adult Liver Transplantation
143Infusion Pumps
Provider Reimbursement Manual—Part 1
(CMS Pub. 15-1)
(Superintendent of Documents No. HE 22.8/4)
421Regional Medicare Swing-Bed Rates
422Reasonable Cost of Therapy and Other Services Furnished by Outside Suppliers
Provider Reimbursement Manual—Part 2
Provider Cost Reporting Forms and Instructions
Chapter 18/Form CMS-2088-92
(CMS Pub. 15-2-18)
5Outpatient Rehabilitation Provider Cost Reporting Form CMS-2088-92
Provider Reimbursement Manual—Part 2
Provider Cost Reporting Forms and Instructions
Chapter 35/Form CMS-2540-96
(CMS Pub. 15-2-35)
11Skilled Nursing Facility Cost Report Form CMS 2540-96
Provider Reimbursement Manual—Part 2
Provider Cost Reporting Forms and Instructions
Chapter 36/Form CMS-2552-96
(CMS Pub. 15-2-36)
8Hospital and Hospital Health Care Complex Cost Report
ESRD Network Organizations Manual
(CMS Pub. 81)
(Superintendent of Documents No. HE 22.9/4)
13Background/Authority
Responsibilities
System Capacity
Start Printed Page 43807
Hardware/Software Requirements
Center Medicaid Services System Access
Data Security
Confidentiality of Data
Database Management
Patient Database Updates
Center Medicaid Services-Directed changes to Your Patient Database
Medicare Program Integrity Manual
(CMS-Pub. 83)
8The Medicare Medical Review Program
Quality of Care Issues
Goal of the Medical Review Program
Medical Review Manager
Annual Medical Review Strategy
Annual Quality Indicator Program Report
National Coverage Decisions, Coverage Provisions in Interpretive Manual, Local Medical Review Policy, and Individual Claim Determinations
National Coverage Decisions
Coverage Provisions in Interpretive Manuals
Local Medical Review Policy
Individual Claim Determinations
Local Medical Review Policy Development Process
Identification of Services For Which a New or Revised Local Medical
Review Process is Needed
Techniques for Writing Local Medical Review Policies
Evidence Supporting Local Medical Review Policy
Benefit Category
Statutory Exclusions on Grounds Other Than Section 1862
Reasonable and Necessary
Coding Provisions in Local Medical Review Policies
9Local Medical Review Policy Comment Process
Local Medical Review Policy Notice Process
Local Medical Review Policy Format
Retired Local Medical Review Policy
American Medical Association Common Procedural Terminology
Copyright Agreement
Local Medical Review Policy Notice Process Format
Local Medical Review Policy Notice Process Submission/Requirements
10Contractor Advisory Committees Process
11Certificates of Medical Necessity as the Written Order
Cover Letters for Certificate of Medical Necessity
Completing a Certificates of Medical Necessity
DME Regional Carrier Authority to Assess an Overpayment and /oCMP
When Invalid Certificates of Medical Necessity
Acceptability of Faxed Orders and Facsimile or Electronic Certificates of
Medical Necessity
12Certificates of Medical Necessity as the Written Order
Cover Letters for Certificates of Medical Necessity
Completing a Certificate of Medical Necessity
Durable Medical Equipment Regional Coordinator's Authority to Assess an Overpayment and/or Civil Monetary Penalty When Invalid Certificates of Medical Necessity's are Identified
Certificates of Medical Necessity
Acceptability of Faxed Orders and Facsimile or Electronic Certificates of Medical Necessity
12Fiscal Intermediary, Carrier Durable Medical Equipment Regional Carriers and Regional Home Health Intermediary Interaction and Coordination with Program Safeguard Contractors Introduction
Program Safeguard Contractors for Corporate Integrity Agreements
13Administrative Relief from Medical Review and Benefit Integrity in Disaster Situations
14Local Medical Review Policy Format
Local Medical Review Policy Submission/Requirements
Medicare/Medicaid
Sanction—Reinstatement Report
(CMS Pub. 69)
07-01Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—June 2001
08-01Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—July 2001
09-01Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—August 2001
Start Printed Page 43808
October 2001 through December 2001
Intermediary Manual
Part 3—Claims Process
(CMS Pub. 13-1)
(Superintendent of Documents No. HE 22.8/6-3)
132Overpayments for Provider Services—General
Intermediary Manual
Part 3—Claims Process
(CMS Pub. 13-3)
(Superintendent of Documents No. HE 22.8/6)
1843Payment for Services Furnished by A Critical Access Hospital
1844Overpayments for Provider Services
1845CMS Common Procedure Coding System for Hospital Outpatient Radiology Services and Other Diagnostic Procedures
1846Special Coverage Requirements
1847Payment for Blood Clotting Factor Administered to Hemophilia Inpatients
1848CMS Common Procedure Coding System for Hospital Outpatient Radiology Service and Other Diagnostic Procedures
Outpatient Therapeutic Services
Immunosuppressive Drugs Furnished to Transplant Patients
1849Therapeutic Pheresis (Apheresis)
Carriers Manual
Part 3—Claims Process
(CMS Pub. 14-3)
(Superintendent of Documents No. HE 22.8/7)
1726The Destination
1727Overpayments—General
1728Claims Involving Beneficiaries Who Have Elected Hospice Coverage
Processing Claims For Attending Physician Services Furnished to Hospice Patients
Services Unrelated to a Hospice Patients Terminal Condition
Non-Hospice Services Furnished to Hospice Patients Who Are M+C Enrollees
Payment Safeguard
Medicare Summary Notices and Explanation of Medicare Benefits and Remittance Advice Messages
1729End Stage Renal Disease Bill Processing Procedures
1730Durable Medical Equipment Regional Carrier Billing Procedures
1731Centralized Billing for Flu and Pneumococcal Vaccination Claims
1732Type of Service
1733Mandatory Submission of Assigned Claims for Drugs and Biologicals Claims for Drugs and Biologicals.
1734Physician Assistant Services
Nurse Practitioner Services
Clinical Nurse Specialist Services
Billing for Physician Assistant Nurse Practitioner Or Clinical Nurse Specialist Services
Billing Requirements for Physician Assistant Services
Billing Requirements for Nurse Practitioner or Clinical Nurse Specialist Services
Billing for Teaching Physician Services
1735Coverage Criteria
Ambulatory Surgical Center Fee
1736Paying Claims Without Common Working File Approval
Requesting to Pay Claims Without Common Working File Approval
Procedures for Paying Claims Without Common Working File Approval
1737Glaucoma Screening
Conditions of Coverage
Claims Submission Requirements and Applicable HCPCS Codes
Calculating the Frequency
Common Working File Edits
Claims Editing
Diagnosis Coding Requirements
Payment Methodology
Remittance Advice Notices
Medicare Summary Notice and Explanation of Medicare Benefits Messages
Carriers Manual
Part 4—Professional Relations
(CMS Pub. 14-4)
(Superintendent of Documents No. HE 22.8/7-4)
25The Attestation statement has been replaced by a new GV modifer
Start Printed Page 43809
Program Memorandum
Intermediaries (CMS Pub. 60A)
(Superintendent of Documents No. HE 22.8/6-5)
A-01-126Scheduled Release for January Updates to Software Programs and Pricing/Coding Files
A-01-127Common Working File Processing of Home Health Prospective Payment System Transfer Episodes Received Out of Sequence
A-01-128Common Working File Processing of Home Health Prospective Payment System (HH PPS) Transfer Episodes Received Out of Sequence
A-01-129Reporting Claims Accounting Information to the Healthcare Integrated General Ledger Accounting System (HIGLAS)
A-01-130Receipt and Processing of Non-Covered Charges on Other Than Part A Inpatient Claims
A-01-131Additional Instructions for Implementing the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS)
A-01-132Screening Glaucoma Services
A-01-133Clarification of Payments Made to Hospital Outpatient Departments Under the Outpatient Prospective Payment System (OPPS)
A-01-134January Medicare Outpatient Code Editor (OCE) Specifications Version 17.1 For Bills From Hospitals That Are Not Paid Under the Outpatient Prospective Payment System (OPPS)
A-01-135HCPCS Code Updates and Corrections for SNF Part A PPS Consolidated Billing and SNF Part B Fee Schedule for 2002.
A-01-136Do not Forward Initiative
A-01-137Modifications to Form CMS-339 Requirements, Provider Cost Report
A-01-138Announcement of Medicare Rural Health Clinics and Federally Qualified Health Centers Payment Rate Increases, Changes to the Exception Criteria for the Payment Limit for Rural Health Clinics Based in Rural Hospitals
A-01-139Special Instructions for Handling of Outpatient Pa
A-01-140Special Payment for Outpatient Prospective Payment System Due to Delay in Implementing System Updates
A-01-141Center for Medicare and Medicaid Services Audit and Cost Report Settlement Expectations
A-01-142Clarification and HCPCs Coding Update: Part B Fee Schedule And Consolidated Billing For Skilled Nursing Facility Services
A-01-143Provider Education Article: CY 2002 Outpatient PPS Rate Implementation
A-01-144Additional Information Related to Section 212 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (Public Law 106-554) Affecting Medicare-Dependent, Small Rural Hospitals. Also, Clarifications and Corrections to: Changes to the Hospital Inpatient Prospective Payment Systems and Rates and Costs of Graduate Medical Education; Fiscal Year 2002 Rates, Etc.; Final Rules, as Published in the Federal Register on August 1, 2001 (66 FR 39828)
A-01-145Delay of the 2002 Update to the Outpatient Prospective Payment System
A-01-146Inpatient Rehabilitation Facility Prospective Payment System Revenue Code File Update
A-01-147Federal Fiscal Year (FY) 2003 Wage Index: Request for FY 1999 Wage Data from Hospitals Affected by the Filing Extensions Provided by Transmittal Numbers A-01-88 and A-01-117
A-01-148Changes to Fiscal Year (FY) 2001 Nursing and Allied Health Education Payment Policies as Required by the Benefits Improvement and Protection Act of 2000 (BIPA), P. L. 106-554
A-01-149Amended Production Dates for the Provider Statistical and Reimbursement Report and Extension of Due for Filing Provider Cost Reports
A-01-150Provider Education Article: CY2002 Outpatient Prospective Payment System Rate Implementation Delay
Program Memorandum
Carriers
(CMS Pub. 60B)
(Superintendent of Documents No. HE 22.8/6-5)
B-01-62Problem Resolution to Issues Raised by Implementation of Change Request 1646 for The Medicare Carriers Processing on the Multi-Carrier System
B-01-63New Modifier for Rental Items
B-01-64DMERCs—Advance Beneficiary Notices for Upgrades
B-01-65Calendar Year 2002 Participation Enrollment and Medicare Participating Physicians and Suppliers Directory Procedures
B-01-66Program Integrity Sampling Module for Part B and DME Carriers
B-01-67Updated Correct Coding Initiative Coding Policy Manual
B-01-68Provider Upgrades of Durable Medical Equipment, Prosthetics, Othotics and Supplies Without Any Extra Charge
B-01-692002 Anesthesia Conversion Factor
B-01-70Reporting Claims Accounting information to the Healthcare Integrated General Ledger Accounting System
B-01-71American National Standards Institute X12N 837 Professional Health Care Claims Companion Document
B-01-72Change in Common Working File for two immunosuppressive Drugs
B-01-73Reviewing Deceased Physicians' Unique Physician Identification Numbers on Durable Medical Equipment Regional Carrier Claims
B-01-74Supplier Billing for Glucose Test Strips and Supplies (Revised)
B-01-75Changes to Correct Coding Edits, Version 8.1, Effective April, 2002
B-01-76Issuance of Standard Paper Remittance Advice Notices and SPR-X12835V4010 Crosswalk
B-01-77Correction to Correct Coding Edits, Version 8.0, Effective January 1, 2002
B-01-78Correction to Fee Schedule File for Parenteral and Enteral Nutrition Items and Services
Start Printed Page 43810
Program Memorandum
Intermediaries/Carriers
(CMS Pub. 60A/B)
(Superintendent of Documents No. HE 22.8/6-5)
AB-01-141Update of Codes and Payments for Ambulatory Surgical Centers (ASCs)
AB-01-142Revised Guidelines for Processing Claims for Clinical Trial Routine Care Services
AB-01-143Coverage and Billing of Sacral Nerve Stimulation
AB-01-144International Classification of Diseases, Ninth Revision, Clinical Modification Coding for Diagnostic Tests
AB-01-145New Waived Tests—September 13, 2001
AB-01-146Distribution of Revised Form CMS-855s—Medicare Provider/Supplier Enrollment Applications—(Formerly Form CMS-855) Dated November 1, 2001
AB-01-147Electronic Correspondence Referral System User Manual 3.0.1 and Electronic Correspondence Referral System Quick Reference Card
AB-01-148Ambulance Inflation Factor for 2002
AB-01-149Unsolicited Response and Auto Adjustment of Claims for the Medicare Participating Centers of Excellence Demonstration and the Medicare Provider Partnership Demonstration
AB-01-150Breakdown of the American Medical Association's Physicians' Current Procedural Terminology, Fourth Edition 2002 Codes
AB-01-151Clarification of Common Working File Y2K Wrapper Logic Removal Changes (Change Request 1774)
AB-01-152Breakdown of the American Medical Association's Physicians' Current Procedural Terminology, Fourth Edition 2002 Codes
AB-01-153Tracking the Number of Diabetes Outpatient Self-Management Training and Medical Nutrition Therapy Hour by the Common Working File
AB-01-154Medical Deduction and Premium Rates Calendar Year 2002
AB-01-155Information Collection Requirements from Medicare Contractor Call Centers
AB-01-156Expanding the Number of Source Identifiers for Common Working File MSP Records
AB-01-157New Common Working File Medicare Secondary Payer Edit to Reject Medicare Secondary Payer Records for Medicare Beneficiaries Who Are Only Entitled to Medicare Part B, and Are Covered by a Group Health Plan
AB-01-158New Common Working File Edits and Standard System Responses on Skilled Nursing Facility Claims
AB-01-159Common Working File Reject and Utilization Edits and Carrier Resolution for Consolidated Billing for Skilled Nursing Facility Residents
AB-01-160Standardize Common Working File Hosts' Processes and Procedures With Standard Software (AMEN Program)
AB-01-161Notice of Interest Rate for Medicare Overpayments and Underpayments
AB-01-1622002 Clinical Laboratory Fee Schedule and Laboratory Costs Subject to Reasonable Charge Payment Methodology
AB-01-163Expand Standard Date Format and Remove Common Working File,Y2K Wrapper Logic for Part B Eligibility File, Part B (HUBC), and DME (HUDC) Incoming and Reponse Transactions
AB-01-164Correction to Program Memorandum AB-01-53: Elimination of DMEPOS Fee Schedules for Repair Codes E1340, L4205, L7520, and L8049
AB-01-165Implementation of an Ambulance Fee Schedule
AB-01-166Coverage and Billing of Sacral Nerve Stimulation
AB-01-167Correction to 2nd Update to 2001 Medicare Physician Fee Schedule Database
AB-01-168The Use of Gamma Cameras and Full Ring and Partial Ring Positron Emission Tomography Scanners for Positron Emission Tomography Scans
AB-01-169Transaction Certification and Testing
AB-01-170Clarification to Medicare Carrier Manual § 2130 Prosthetic Devices and Coverage Issues Manual § 60-9 Durable Medical Equipment Reference List—Coverage of Intermittent Catheterization
AB-01-171Request for Contractor's Business Contingency Plan—January 15, 2002
AB-01-172Promoting Medicare's Screening Pap Test Benefit in Support of Cervical Health Month (January)
AB-01-173Name Transition From Health Care Financing Administration to Centers for Medicare & Medicaid Services—Identity Mark Guidelines
AB-01-174The Certification Package for Internal Controls for Fiscal Year Ending September 30, 2002
AB-01-175Payment for Method II Home Dialysis Supplies
AB-01-176The Medicare Exclusion Database Replaces Publication 69
AB-01-177Emergency Changes to the 2002 Medicare Physician Fee Schedule Database
AB-01-178April Quarterly Updates for 2002 Durable Medical Equipment, Prosthetics, Orthotics, and Suppliers Fee Schedule
AB-01-179Zip Code File on the Direct Connect
AB-01-180Payment for Method II Home Dialysis Supplies
AB-01-181Coordination of Benefits Contractor Fact Sheet for Provider
AB-01-182Use of the American Medical Association's Physicians' Current Procedural Terminology, Fourth Edition Codes on Contractors' Web Sites
AB-01-183Appeals of Medicare Part A/Part B Coverage Determinations
AB-01-184Clarifications to Implementation of the Ambulance Fee Schedule
AB-01-185Implementation of the Ambulance Fee Schedule
AB-01-186Suspension of National coverage Policy on Electrical Stimulation for Wound Healing
AB-01-187Update to Waived Test—November 21, 2001
AB-01-188Coverage and Billing of Ambulatory Blood Pressure Monitoring
AB-01-189Medicare Coverage of Non-Invasive Vascular Studies for End Stage Renal Disease Patients
Start Printed Page 43811
Hospital Manual
(CMS Pub. 10)
(Superintendent of Documents No. HE 22.8/2)
778Critical Access Hospital
779CMS Common Procedure Coding System for Hospitals Outpatient Radiology Services and Other Diagnostic Procedures
780Payment for Blood Clotting Factor Administered to Hemophilia Inpatients
781Outpatient Therapeutic Services, and Section 439, Billing for Immunosuppressive Drugs Furnished to Transplant Patients
782Completion of Form CMS-1450 for Inpatient and/or Outpatient Billing Provider Electronic Billing File and Record Formats
783Addendum B—Alphabetic Listing of Data Elements
Home Health Agency Manual
(CMS Pub. 11)
(Superintendent of Documents No. HE 22.8/5)
298Home Health Agency
Arrangements by Home Health Agencies
Home Health Prospective Payment System
National 60 Day Episode Rate
Adjustments to the 60 Day Episode Rate
Continuous 60 Day episode Recertification
Counting 60 Day Episodes
Split Percentage Payment Approach to the 60 Day Episode
Physician Signature Requirements for the Split Percentage Payment
Low Utilization Payment Adjustment
Partial Episode Payment Adjustment
Significant Change in Condition Payment Adjustment
Outlier Payment
Discharge Issues
Consolidated Billing
Telehealth
Change of Ownership Relationship to Episodes under Prospective Payment System
Reasonable and Necessary Services
Confined to the Home
Services Are Provided Under a Plan of Care Established and Approved by a Physician
Needs Skilled Nursing Care on an Intermittent Basis (Other than Solely Venipuncture For the Purposes of Obtaining a Blood Sample) or Physical Therapy or Speech-Language Pathology Services or Has Continued Need for Occupational Therapy
Physician Certification
Skilled Nursing Care
Skilled Therapy Service
Home Health Aide Services
Medical Supplies (Except for Drugs and Biologicals) and the Use of Durable Medical Equipment
Part-time or Intermittent Home Health Aide and Skilled Nursing Services
Special Conditions for Coverage and Payment of Home Health Services
Under Hospital Insurance (Part A) and Supplementary Medical Insurance (Part B)
Beneficiaries Who Are Enrolled in Part A and Part B, but do Not Meet the Threshold for Post-Institutional Home Health Services
Beneficiaries Who Are Part A Only or Part B Only
Coinsurance, Copayments, and Deductibles
Number of Home Health Visits under Hospital Insurance (Part A),
Number of Home Health Visits under Supplementary Medical Insurance (Part B)
Counting Visits
Evaluation Visits
Medical and Other Health Services
Surgical Dressings, and Other Dressings Used for Reduction of Fractures and Dislocations
Prosthetic Devices
Outpatient Physical Therapy, Occupational Therapy, and Speech Pathology Services
Skilled Nursing Facility Manual
(CMS-Pub. 12)
Superintendent of Documents No. HE 22. 8/3
371Drugs and Biologicals, and Section 542, Billing for Immunosupressive
Drugs Furnished to Transplant Patients
Hospice Manual
(CMS-Pub. 21)
Superintendent of Documents No. HE 22. 8/18
64Inpatient Respite Care
Start Printed Page 43812
Coverage Issues Manual
(CMS-Pub. 6)
Superintendent of Documents No. HE 22. 8/14
144Sacral Nerve Stimulation for Urinary Incontinence
145Treatment of Actinic Keratosis
146External Counterpulsation for Severe Angina
147Positron Emission Tomography
148Pneumatic Compression Devices
149Ambulatory Blood Pressure Monitoring
150Continuous Positive Airway Pressure
Medicare Program Integrity Manual
(CMS-Pub. 83)
15Medical Records of Partial Hospitalization Claims
16Medicare Benefits Integrity Unit
Organizational Requirements
Anti-Fraud Training
Procedural Requirements
Medicare Fraud Information Specialist
Coordination of Medical Records and Benefit Integrity Units
Request for Information from Outside Organizations Agency Agreement Memorandum of Understanding Between the Office of the Inspector General and the Department of Justice—Sharing Fraud Complaints
Development of Complaints and Cases
Fraud Alerts
Types of Fraud Alerts
Alert Specifications Editorial Requirements
Coordination
Distribution of Alerts
Offices of the Inspector General Referrals and Appropriate Fraud Investigation Database Entries
Table of Contents
Consent Settlement Instructions
Consent Settlement Budget and Performance Requirements
Basis of Authority
Purpose
Enforcement
Administrative Actions
Documents
Civil Monetary Penalty Authorities
Civil Monetary Penalty Delegated to Centers for Medicare & Medicaid Services
Civil Monetary Penalty Delegated to Offices of the Inspector General
Referral Process to Centers for Medicare & Medicaid Services
Referral to Offices of the Inspector General
Centers for Medicare & Medicaid Services Generic Civil Monetary Penalty Case Contents
Beneficiary Right to Itemized Statement
Medicare Limiting Charge Violations
Table of Contents
Quality Improvement Program Reporting
Vulnerability Report
Table of Contents
Definitions
Request for Information from Outside Organizations
Memorandum of Understanding Regarding Requests form Federal Bureau Investigation /Department of Justice Reporting Requirements
Periodic Exchange of Information Among Offices of the Inspector General, Federal Bureau Investigation Department of Justice Reporting Requirements
Periodic Exchange of Information Among Offices of the Inspector General, Federal Form Letter for Department of Justice Request
Department of Justice Report (Excel Spreadsheet)
National Medicare Fraud Alert
Restricted Medicare Fraud Alert Organizational Requirements
Request for Information from Outside Organizations
Procedures for the benefit Integrity and Medical Review Units on Unsolicited Voluntary Refund Checks
Anti-Kickback Statute Implications
17Overview of Prepayment and Postpayment Review for Medical Review Purpose
Determinations Made During Prepayment and Postpayment Medial Review
Documentation Specifications for Areas Selected to Prepayment or Postpayment or Postpayment Medical Review
Additional Documentation Requests During Prepayment or Postpayment Medical Review
Completing Complex Reviews
Handling Late Documentation
Start Printed Page 43813
Denials
Documenting That A Claim Should be Denied
Internal Medical Review Guidelines
Types of Prepayment and Postpayment Review
Spreading Workload Evenly
New Provider/ New Benefit Monitoring
Review That Involves Utilization Parameters
Prepayment Review of Claims for Medical Review Purposes
Automated Prepayment Review
Prepayment Edits
Categories of Medical Review Edits
Postpayment Review of Claims for Medical Review Purposes
Postpayment Review Case Selection
Location of Postpayment Reviews
Re-adjudication of Claims
Estimate of the Correct Payment Amount and Subsequent Over/Underpayment
Notification of Provider (s) Rebuttal(s) of Findings
Recovery of Overpayments
Evaluation of the Effectiveness of Postpayment Review and Next Steps Postpayment Files
Effect of Sections 1879 and 1870 of the Social Security Act During Postpayment Reviews
Medicare Managed Care Manual
(CMS-Pub. 86)
1Payments to Medicare+Choice Organizations
Effect of Change of Ownership and Leasing
Contract Determination and Appeals
2Minimum Specified Amount or “Floor Rate
Transition to a Comprehensive Risk Adjustment Method
Transition Schedule for Implementation of the Risk Adjustment Method
Exclusions from Risk Adjustment Factor
Two Required Quality Indicators Designated Must be Met
Reporting Extra Payment
Questions About the Extra payment in Recognition of the Cost of Successful Outpatient Chief Care
Implementation of 100 Percent Risk—Adjusted Payment for Qualifying Congestive Heart Failure Enrollees in 2001
Encounter Data Collection for the Risk Adjustment Model
Hospital Inpatient Encounter Data Requirements
Deadlines for Submission of Encounter Data
Announcement of Annual Capitation Rates and Methodology Changes
Clarification of the Definition of “Certified Institution” for Adjusting Payments Under the Demographic-Only Method
Payment for Institutional Status
Previously Underserved Payment Area
Eligibility for Bonus Payment-the Period of Application
Reconciliation Process for Changes in Risk Adjustment Factors
Reconciliation Schedule and Late Submission of Encounter Data
Quality Indicators for Extra Payment in Recognition of the Costs of Successful Outpatient Treatment of Congestive Heart Failure
3Quality Assurance
4Marketing
Medicare/Medicaid
Sanction—Reinstatement Report
(CMS Pub. 69)
01-10Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded Reinstated—September 2001
01-11Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—October 2001
01-12Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—November 2001
January 2002 through March 2002
Intermediary Manual
Part 3—Claims Process
(CMS Pub. 13-3)
(Superintendent of Documents No. 22.8/6)
1850Ambulance Service
1851Payment for Blood Clotting Factor Administered to Hemophilia Inpatients
1852Release Software Diagnostic Mammography Diagnostic and Screening Mammograms Performed With New Technologies
1853Clinical Laboratory Improvement Amendments
Request for Anticipated Payment
Home Health Perspective Payment System Claims
Start Printed Page 43814
Special Billing Situations Involving Outcome and Assessment Information Set
Beneficiary-Driven Demand Billing Under Home Health Perspective Payment System
New Software for the Home Health Perspective Payment System Environment
Adjustments of Episode Payment—Exclusivity and Multiplicity of Adjustments
General Guidance on Line Item Billing Under Home Health Prospective Payment System
Carriers Manual
Part 3—Program Administration
(CMS Pub. 14-3)
(Superintendent of Documents No. HE 22.8/7)
1738Transmittal 1738 has been rescinded and will not be printed or issued in the future
1739Air Ambulance Services
1740Beneficiaries Previously Enrolled In a Medicare Health Maintenance Organization Managed Care Program Who Transition to Traditional Fee for Service
1741Durable Medical Equipment Regional Carrier Instructions for Denying Claims for Drugs Billed and/or Paid to Suppliers Not Licensed To Dispense Drugs
1742Evidence of Medical Necessity Oxygen Claims
1743Home Dialysis Supplies and Equipment Payment for Method II Home Dialysis Supplies When the Beneficiary Is an Inpatient
1744Physician Assistant Services
1745Release Software Contractor Testing Requirements
Program Memorandum
Intermediaries (CMS Pub. 60A)
(Superintendent of Documents No. HE 22.8/6-5)
A-02-001January Outpatient Code Editor Specifications Version
A-02-002Discontinuance of Contract With Integriguard To Conduct Community Mental Health Centers Site Visits After January 15, 2002
A-02-003Handling of Inpatient Claims Containing Healthcare Common Procedure Codes J7198, J7199, and Q2022 for Payment for Blood Clotting Factor Administered to Hemophilia Inpatients
A-02-004Critical Access Hospitals Exempt From the Ambulance Fee Schedule
A-02-005Correction of Production Problem With Home Health Prospective Payment System Claims Involving Medicare Secondary Payer
A-02-006Extended Repayment Schedules for Home Health Agencies Affected by the Interim Payment System
A-02-007Addendum to Periodic Interim Payments for Home Health Providers
A-02-008Processing of Home Health Prospective Payment System Mass Adjustments—Regional Home Health Intermediaries Only
A-02-009Payment of Skilled Nursing Facility Claims for Beneficiaries Disenrolling From Terminating Medicare+Choice Plans Who Have Not Met the 3-day Stay Requirement
A-02-010Changes to Common Working File Beneficiary Eligibility Checks for Medicare+Choice Encounter Data
A-02-011Receipt of Payment Data from the Healthcare Integrated General Ledger Accounting System by the Fiscal Intermediary Standard System
A-02-012Do Not Forward Initiative
A-02-013Implementation of the Health Insurance Portability and Accountability Act Health Care Eligibility Benefit Inquiry/Response Transaction (270/271) Standard
A-02-014Health Insurance Portability and Accountability Act Institutional 837 Health Care Claim Implementation Updates
A-02-015Installation of Version 27.1 of the Provider Statistical and Reimbursement Report
A-02-016Conversion of Hospital Swing Bed Facilities to the Skilled Nursing Facility Prospective Payment System Effective for Cost Reporting Periods Starting July 1, 2002
A-02-017Advance Beneficiary Notices Must Be Given to Beneficiaries and Demand Bills Must Be Submitted By Home Health Agencies
A-02-018Advance Beneficiary Notices Must Be Given To Beneficiaries and Demand Bills Must Be Submitted By Home Health Agencies
A-02-019Scheduled Release for April Updates to Software Program and Pricing/Coding Files
A-02-020Coverage and Billing of Sacral Nerve Stimulation
A-02-021Medicare Secondary Payer Information Collection Policies Changed for Hospitals
A-02-022Clarification of Program Memorandum A-01-86, New Patient Status Codes 62 and 63
A-02-023Accelerated Referral of Non-Medicare Secondary Payer Active Delinquent Debts to the Collection Center for Cross Servicing and Treasury Offset Program
A-02-024Off Label Use of Oral Chemotherapy Drugs Methotrexate and Cyclophosphamide
A-02-025April Outpatient Code Editor Specifications Version 9V3.0)
A-02-0262002 Update of the Hospital Outpatient Prospective Payment System
Program Memorandum
Carriers
(CMS Pub. 60B)
(Superintendent of Documents No. HE 22.8/6-5)
B-02-001Transmittal B-02-001 has been rescinded and will not be printed or issued in the future
Start Printed Page 43815
B-02-002Notification to Carriers and Providers of Skilled Nursing Facility Consolidated Billing Coding Information on Centers for Medicare and Medicaid Services Web site
B-02-003New Permanent Modifier for “Specific Required Documentation on File”
B-02-004Payment for Services Furnished by Audiologists
B-02-005Transmittal B-02-005 has been rescinded and will not be printed or issued in the future
B-02-006Receipt of Payment Data from the Healthcare Integrated General Ledger Accounting System by the Fiscal Intermediary Standard System
B-02-007Use of Statistical Sampling for Overpayment Estimation When Performing Administrative Reviews of Part B Claims
B-02-008Type of Service Corrections
B-02-009Payment for Therapy Services Wrongfully Denied
B-02-010Correct Payment for Medical Nutrition Therapy Services Rendered by Registered Dietitians or Nutrition Professionals
B-02-011Revision and Clarification of Requirements for Quarterly Do Not Forward Reports
B-02-012Transmittal B-02-012 has been rescinded and will not be printed or issued in the future
B-02-013Changes to Correct Coding Edits, Version 8.2, Effective July 1, 2002
B-02-014Common Working File Changes for Emergency Home Dialysis Supplies for Method II Beneficiaries
B-02-0152002 Jurisdiction List
B-02-016Addition of Four “WW” Codes to Identify a New Source for Methotrexate
B-02-017Standard System Acceptance of Primary Payer Information at the Line Level
B-02-018Implementation of Carrier Jurisdiction Manual Instructions Based On the Medicare Carriers Manual Part 3, §§ 3100-3101 for the Multi-Carrier System, Standard System and Associated Medicare Carriers
B-02-019Accelerated Referral of Non-Medicare Secondary Payer Active Delinquent Debts to the Debt Collection Center for Cross Servicing and Treasury Offset Program
B-02-020Coding for Non-Covered Services and Services Not Reasonable and Necessary
B-02-021Problem Resolution to Issues Raised By Implementation of Change Request 1646 for the Medicare Carriers Processing on the Multi-Carrier System
Program Memorandum
Intermediaries/Carriers
(CMS Pub. 60A/B)
(Superintendent of Documents No. HE 22.8/6-5)
AB-02-001New Temporary “K” Codes for Ostomy Devices and Supplies
AB-02-002Claims Processing Instructions for the Medicare Quality Partnerships Demonstration (formerly referred to as “Centers of Excellence”) and the Medicare Provider Partnership Demonstration
AB-02-003Transmittal AB-02-003 has been rescinded and will not be printed or issued in the future
AB-02-004Harkin Grantees: Aggregate Report Dates
AB-02-005Elimination of Official Level III Healthcare Common Procedure Coding System Codes/Modifiers and Unapproved Local Codes/Modifiers
AB-02-006Customer Service Assessment Management System for Medicare Call Centers
AB-02-007Children's Hospital Graduate Medical Education Amendment to Change Request 1736
AB-02-008Form CMS-1522, Monthly Contractor Financial Report, Reconciliation
AB-02-009Clarification of Physician Certification Requirements for Medicare Hospice
AB-02-010Promoting Colorectal Cancer Screening as a Part of Colorectal Cancer Awareness Month
AB-02-011Notice of Interest Rate for Medicare Overpayments and Underpayments
AB-02-012Revised Backup Withholding Tax Rate
AB-02-013Improve the Out-of-Service-Area Claims Process in the Common Working File
AB-02-014Implementation of Common Working File Edits for Flu and Pneumonia Claims
AB-02-015Clarification of Payment Responsibilities for Fee-for-Service Contractors as it Relates to Hospice Members Enrolled in Managed Care Organizations and Claims Processing Instructions for Processing Rejected Claims
AB-02-016Effective Date for Q3017
AB-02-017Sending of HUSC Files from Common Working File to Recovery Management and Accounting System
AB-02-018First Update to the 2002 Medicare Physician Fee Schedule Database
AB-02-019Supplemental Systems Security Information for FY 02
AB-02-020Revised Timeliness for Health Insurance Portability and Accountability Act Requirements
AB-02-021Common Working File Unsolicited Response Edit and Carrier Resolution for Consolidated Billing for Skilled Nursing Facility Residents
AB-02-022Clarification of Transmittal AB-00-107, Change Request 1163, and Transmittal AB-00-129, Change Request 1460, Regarding the Coordination of Benefits Contractor and Medicare Secondary Payer Prepay Work Activities for Customer Service, Medicare Secondary Payer and Standard Systems Contractor Staff
AB-02-023Common Working File Edits with Unsolicited Responses for Skilled Nursing Facility Consolidated Billing
AB-02-024New Waived Tests—January 18, 2002
AB-02-025Non-Contact Normothermic Wound Therapy
AB-02-026System Networking Electronic Correspondence Referral System User Guide
AB-02-027Corrections to Program Memorandum A-01-135—Codes Billable by Skilled Nursing Facilities and Suppliers for Skilled Nursing Facility Residents
AB-02-028Centers for Medicare and Medicaid Services Office of the Inspector General Hotline Referrals
AB-02-029Electronic Medicare Provider/Supplier Enrollment Forms
AB-02-030Administrative Policies Related to Processing Claims for Clinical Diagnostic Laboratory Services
AB-02-031Payment Policy for Air Ambulance Transportation of Deceased Beneficiary
AB-02-032Data Center Testing and Production—Electronic Correspondence Referral System User Manual 4.0
AB-02-033Provider Education Training Activities to Implement Updates to the Ambulance Fee Schedule
Start Printed Page 43816
AB-02-034Managing Medicare Appeals Workloads in FY 2001
AB-02-035Notification of Updates to Coding Files on Centers for Medicare and Medicaid Services Web Site for Skilled Nursing Facility Consolidated Billing
AB-02-036Temporary Codes for Ambulance Fee Schedule
AB-02-037Reissue of Information in Change Request 1955, Transmittal AB-02-021, Common Working File Unsolicited Response Edit and Carrier Resolution for Consolidated Billing for Skilled Nursing Facility Residents
AB-02-038Billing for Audiologic Function Tests for Beneficiaries That Are Patients of a Skilled Nursing Facility
AB-02-039Amplification of Annual Compliance Audit Requirements
AB-02-040Intestinal and Multi-Visceral Transplantation
AB-02-041Correction of Remark Code Message for Home Health Consolidated Billing
State Operations Manual
Provider Certification
(CMS—Pub. 7)
(Superintendent of Documents No. 22.8/12)
28Federally Qualified Health Centers—Citations and Description
Regional Office Approval Process for Federally Qualified Health Centers Attestation Statement for Federally Qualified Health Centers, and Model Letter to Applicants for Participation in Medicare as a Federally Qualified Health Center
Federally Qualified Health Center Crucial Data Extract
Notice to Accredited Psychiatric Hospital of Involuntary Termination
29Federal Monitoring Surveys—Definition and Purpose
Federal Monitoring Surveys—Expectations and Responsibility
Hospital Manual
(CMS Pub. 10)
(Superintendent of Documents No. HE 22.8/2)
783Payment for Blood Clotting Factor Administered to Hemophilia Inpatients
Home Health Agency Manual
(CMS Pub. 11)
(Superintendent of Documents No. HE 22.8/5)
299Excluded Foot Care Services
300Billing Procedures for an Agency Being Assigned Multiple Provider Numbers or a Change in Provider Number
More Than One Agency Furnished Home Health Services Transfer to Another Agency Under the Same Plan of Treatment Clinical Laboratory Improvement Amendments
New Software for the Home Health Prospective Payment System
Adjustments of Episode Payment—Significant Change in Condition Adjustments of Episode Payment—Exclusivity and Multiplicity of Adjustments
General Guidance on Line Item Billing Under Home Health Prospective Payment System
Request for Anticipated Payment
Home Health Prospective Payment System Claims
Special Billing Situations Involving Outcome and Information Assessment Set
Beneficiary-Driven Demand Billing Under Home Health Prospective Payment System
No-Payment Billing and Receipt of Denial Notices Under Home Health Prospective Payment System
Billing and Payment for Medicare Secondary Payer Claims Under the Home Health Prospective Payment System
Skilled Nursing Facility Manual
(CMS-Pub. 12)
(Superintendent of Documents No. HE 22. 8/3)
372Recertification
Coverage and Patient Classification
Coverage Issues Manual
(CMS Pub. 6)
(Superintendent of Documents No. HE 22.8/14)
151Pneumatic Compression Devices
152Noncontact Normothermic Wound Therapy
Start Printed Page 43817
Provider Reimbursement Manual—Part 2
Provider Cost Reporting Forms and Instructions Chapter 29/Form CMS-222-92
(CMS Pub. 15-2-29)
5Cost Report Forms
Provider Reimbursement Manual—Part 2
Provider Cost Reporting Forms and Instructions Chapter 34/Form CMS-265-94
(CMS Pub. 15-2-34)
6Cost Report Forms
Provider Reimbursement Manual—Part 2
Provider Cost Reporting Forms and Instructions Chapter 38/Form CMS-1894-99
(CMS Pub. 15-2-38)
3Worksheet A—Reclassification and Adjustment of Trial Balance Expenses
Program Integrity Manual
(CMS-Pub. 83)
18Medical Review of Skilled Nursing Facility Prospective Payment System
Types of Review
Bill Review Requirements
Bill Review Process
Workload
Data Analysis
Medicare Integrity Program-Provider Education and Training
Quality Issues in Skilled Nursing Facility and Referral to Other Agencies Reporting
19Security Requirements
2020 Medical Review of Ambulance Services
2121 Types of Claims for Which Contractors Are Responsible
2222 Medical Review Workload, Cost, and Savings Allocations
Medical Review Overview
Reporting Medical Review Workload and Cost Information and
Documentation in Contractor Administrative Budget and Financial Management
Prepay Review for Medical Review Purposes
Automated Prepay Review Workload and Cost (Activity Code 21001)
Routine Manual Prepay Review Workload and Cost (Activity Code 21002)
Complex Manual Prepay Reviews Workload and Cost (Activity Code 21003)
Data Analysis Costs (Activity Code 21007)
Policy Development Activities Workload and Costs (Activity Code 21008)
Third Party Liability or Demand Bills Workload and Cost (Activity Code 21010)
Postpayment Claim Review Activities for Medical Review Purposes
Routine Manual Postpayment Claims Review Workload and Cost (Activity Code 21030)
Complex Manual Service-Specific Postpayment Claims Review Workload And Cost (Activity Code 21032)
Program Safeguard Contractor Support Services (Activity Code 21100)
Reporting Medical Review Savings in Contractor Reporting of Operational and Workload Data
Benefit Integrity Workload, Cost, and Savings Allocation
Medicare Integrity Program Provider Education and Training Workload, Cost and Savings Allocation
Medicare Integrity Program Provider Education and Training Overview
Reporting Medicare Integrity Program Provider Education and Training
Workload and Cost Information in Contractor Administrative Budget and Financial Management
Reporting Medicare Integrity Program Provider Education and Training
Savings in Contractor Reporting of Operational Workload and Data
Provider Enrollment Workload, Cost, and Savings Allocation
23Home Health Certification and Plan of Care Data
Plan of Care
Medical Review of Home Health Claims General
Types of Review
Medical Review Process
Claim Selection
Record Request
Record Review
Outcome of Review
Start Printed Page 43818
Data Analysis
Medical Review of Skilled Nursing and Home Health Aide Hours for Determining
Part-Time or Intermittent Care
Treatment Codes for Home Health Services
Effectuating Favorable Final Appellate Decision That A Beneficiary is “Confined to Home” Reporting
Description of Items on Form CMS-485
Treatment Codes
Home Health Certification and Plan of Care
Managed Care Manual
(CMS Pub. 86)
5Guidelines for Advertising (Pre-enrollment) Materials
Must Use/Can't Use/Can Use Chart
Final Verification Review Process
Nominal Gifts
Operational Considerations Related to Value-Added Items and Services
Specific Guidance About the Use of Independent Insurance Agents
Marketing of Multiple Lines of Business Under Medicare+Choice Performance Improvement Projects
Non-Clinical Focus Areas—Non-Clinical Focus Areas Applicable to All Enrollees
Sustained Improvement Over Time
Process for Centers for Medicare and Medicaid Services Multi-Year QAIP Project Approvals
Centers for Medicare and Medicaid Services Regional Office Representatives
Subsection “Project Completion Report”
Subsection “When to Report”
Subsection “Project Review Report”
Subsection “Other Tools”
Subsection “Corrective Action Process”
Obligations of Deemed Medicare+Choice Organizations
6Medicare+Choice Enrollment and Disenrollment
7Organization Compliance with State Law and Pre-emption by Federal Law
8Medicare+Choice Contract Requirements
Medicare/Medicaid
Sanction—Reinstatement Report
(CMS Pub. 69)
01-02Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated-December 2001
02-02Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated-January 2002
03-02Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated-February 2002

Addendum IV.—Regulation Documents Published in the Federal Register

[October 1999 through March 2002]

Publication dateFR Vol. 64 pageCFR* Part(s)File code**Regulation titleEnd of comment periodEffective date
10/1/9953394-53396HCFA-1058-FNMedicare Program; Sustainable Growth Rate for Fiscal Year 200010/1/99
10/1/9953394HCFA-3025-NMedicare Program; Notice of the Implementation of the Medicare Lifestyle Modification Program Demonstration Project
10/5/9954030-54031HCFA-1056-CNMedicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities—Update; Correction10/1/99
10/6/9954263-54268HCFA-2004-PMedicaid Program; Flexibility in Payment Methods for Services of Hospitals, Nursing Facilities, and Intermediate Care Facilities for the Mentally Retarded12/6/99
10/14/9955738HCFA-1092-NMedicare Program; October 29, 1999, Meeting of the Competitive Pricing Advisory Committee
Start Printed Page 43819
10/14/9955738-55739HCFA-3023-NMedicare Program; Meeting of the Laboratory and Diagnostic Services Panel of the Medicare Coverage Advisory Committee—November 15 and 16, 1999
10/15/9955949-55950HCFA-1091-NMedicare Program; Open Public Meeting on November 1, 1999 to Discuss Activities Related to the Collection of Encounter Data from Medicare+Choice Organizations for Risk Adjustment
10/19/9956353HCFA-5001-NMedicare Program; Establishment of the Health Care Financing Administration's Management Advisory Committee
10/19/9956353-56354Notice of Hearing: Reconsideration of Disapproval of New Mexico Children's Health Insurance Program State Plan Amendment
10/22/9957101-57103HCFA-1060-NCorrection— Notice—Schedules of Per-Visit and Per-Beneficiary Limitations on Home Health Agency Costs for Cost Reporting Periods Beginning on or After October 1, 1999 and Portions of Cost Reporting Periods Beginning Before October 1, 200010/1/99
10/22/9957110-57112HCFA-8004-NMedicare Program; Part A Premium for 2000 for the Uninsured Aged and for Certain Disabled Individuals Who Have Exhausted Other Entitlement1/1/00
10/22/9957103-57104HCFA-8005-NMedicare Program; Inpatient Hospital Deductible and Hospital and Extended Care Services Coinsurance Amounts for 20001/1/00
10/22/9957105-57110HCFA-8006-NMedicare Program; Monthly Actuarial Rates and Monthly Supplementary Medical Insurance Premium Rate Beginning January 1, 20001/1/00
10/25/9957431-57436HCFA-6003-PMedicare Program; Appeals of Carrier Determinations That a Supplier Fails to Meet the Requirements for a Medicare Billing Number12/27/99
10/25/9957473-57474HCFA-1105-NMedicare Program; November 9, 1999 Notice of Meeting of the Competitive Pricing Demonstration Area Advisory Committee, Maricopa County, AZ
10/26/9957612-57613HCFA-1103-NMedicare Program; Open Town Hall Meeting on November 8, 1999 to Present an Overview of the Home Health Prospective Payment System Proposed Rule Followed by a General Home Health Listening Session
10/28/9958134-58209409, 410, 411, 413, 424, 484HCFA-1059-PMedicare Program; Prospective Payment System for Home Health Agencies12/27/99
10/29/9958419HCFA-3026-NMedicare Program; Open Town Hall Meeting to Discuss Transplant Center Criteria
11/2/9959379-59590410, 411, 414, 415, 485HCFA-1065-FCMedicare Program; Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 20001/3/001/1/00
Start Printed Page 43820
11/4/9960122409, 411, 413, 489HCFA-1913-CNMedicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Correction9/28/99
11/8/9960821-60822HCFA-1093-NMedicare Program; Request for Nominations for the Practicing Physicians Advisory Council12/15/99
11/8/9960882-60963431, 433, 435, 457HCFA-2006-PSCHIP Program; Implementing Regulations for the State Children's Health Insurance Program1/7/00
11/15/9961892-61893HCFA-3027-NMedicare Program; Meeting of the Executive Committee of the Medicare Coverage Advisory Committee—December 8, 199911/18/99
11/22/9963819HCFA-1079-NMedicare Program; December 13, 1999, Meeting of the Practicing Physicians Advisory Council
11/24/9966233-66304460, 462, 466, 473, 476HCFA-1903-IFCMedicare and Medicaid Programs; Programs of All-Inclusive Care for the Elderly (PACE); Final Rule1/24/0011/24/99
11/26/9966396-66402420HCFA-4000-FCMedicare Program; Suggestion Program on Methods to Improve Medicare Efficiency1/25/0012/27/99
11/30/9967028-67052403, 412, 431, 440, 442, 446, 456, 488, 489HCFA-1909-IFCMedicare and Medicaid Programs; Religious Nonmedical Health Care Institutions and Advance Directives; Interim Rule1/31/001/31/00
12/1/9967223-67235433, 438HCFA-2015-PMedicaid Program; External Quality Review of Medicaid Managed Care Organizations1/31/00
12/3/9967920-67925HCFA-4009-GNCMedicare Program; Criteria and Standards for Evaluating Intermediary and Carrier Performance During FY 20001/3/00
12/7/9968357-68364HCFA-9004-NMedicare and Medicaid Programs; Quarterly Listing of Program Issuances—First Quarter, 1999
12/13/9969538-69539HCFA-3029-NMedicare Program; Meeting of the Medical and Surgical Procedures Panel of the Medicare Coverage Advisory Committee—January 19 and 20, 200012/29/99
12/20/9971148-71149HCFA-3024-NCMedicare Program; Adjustment in Payment Amounts for New Technology Intraocular Lenses Furnished by Ambulatory Surgical Centers1/19/00
12/22/9971673-71678422HCFA-1011-FMedicare Program; Solvency Standards for Provider-Sponsored Organizations1/21/00
12/23/9972086HCFA-1109-NMeeting of the Competitive Pricing Advisory Committee, January 12, 2000
12/29/9973057Office of Strategic Planning; Statement of Organization, Functions, and Delegations of Authority
12/30/9973561HCFA-2024-FC2CLIA Program; Transfer of Clinical Laboratory Complexity Categorization Responsibility1/31/00
1/5/00498HCFA-3029-WNMedicare Program; Cancellation of the Meeting of the Medical & Surgical Procedures Panel of the MCAC—January 19 and 20, 2000
1/5/00495HCFA-3028-NMedicare Program; Notice of the Solicitation for Proposals to Expand the Medicare Lifestyle Modification Program Demonstration
1/5/00494HCFA-1094-NGME Consortia Demonstration
Start Printed Page 43821
1/7/001081HCFA-1125-NMedicare Program; Meetings of the Negotiated Rulemaking Committee on the Ambulance Fee Schedule
1/10/001400HCFA-9005-NMedicare and Medicaid Programs; Quarterly Listing of Program Issuances—Second Quarter, 1999
1/12/001817412, 413, 483, and 485HCFA-1053-CN2Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2000 Rates; Correction
1/20/003136412HCFA-1124-IFCMedicare Program; Medicare Inpatient Disproportionate Share Hospital Adjustment Calculation: Change in the Treatment of Medicaid Patient Days in States with Section 1115 Expansion Waivers3/20/00
1/28/004545HCFA-1002-N3Medicare Program; Meeting of the Negotiated Rulemaking Committee on the Ambulance Fee Schedule
2/2/004986HCFA-3031-NMedicare Coverage Advisory Committee—Executive Committee Meeting on March 1, 2000
2/7/005933412, 413, 483, and 485HCFA-1053-CN2Medicare Program; Changes to the Hospital Inpatient Prospective Payment System and Fiscal Year 2000 Rates
2/9/006380HCFA-1085-NUpdate of Ambulatory Surgical Center Payment Rates Effective for Services on or after October 1, 1999
2/15/004617HCFA-4012-NMeeting of the Advisory Panel on Medicare Education—February 15, 2000
2/22/008725HCFA-2059-FNMedicare and Medicaid Programs; Reapproval of the Deeming Authority of the Community Health Accreditation Program, Incorporated (CHAP) for Home Health Agencies (HHAs)2/22/00
2/22/008722HCFA-2058-FNMedicare and Medicaid Programs; Reapproval of the Deeming Authority of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) for Application of the JCAHO for Home Health Agencies2/22/00
2/22/008727HCFA-2057-FNMedicare and Medicaid Programs; Recognition of the American Osteopathic Association (AOA) for Continued Approval of Deeming Authority of the Community Health Accreditation Program, Incorporated (CHA) for Hospitals2/22/00
2/22/008660413HCFA-1860-FCMedicare Program; Payment Amount if Customary Charges are Less than Reasonable Costs: Technical Amendments
2/22/008722HCFA-1060-N2Medicaid Program; Additional Comment Period for the Schedules of Per-Visit and Per-Beneficiary Limitations on HHA Costs for Cost Reporting Periods Beginning on or After October 1, 1999 and Portions Beginning October 1, 2000
Start Printed Page 43822
2/28/0010450405, 491HCFA-1910-PMedicare Program; Rural Health Clinics: Amendments to Participation Requirements and Payment Provisions; and Establishment of a Quality Assessment and Performance Improvement Program5/1/00
2/29/0010812HCFA-1127-NMedicare Program; Open Public Meeting on March 15, 2000 to Provide Overview of Data Requirements for Collection of Physician and Hospital Outpatient Encounter Data from Medicare+Choice Organizations for Risk Adjustment
3/10/0013082410HCFA-3250-PMedicare Program; Coverage and Administrative Policies for Clinical, Diagnostic, and Laboratory Services5/9/00
3/10/0013012HCFA-1130-NMeeting of the Practicing Physicians Advisory Council; March 27, 2000
3/15/0013983HCFA-3032-NMedicare Program; Meeting of the Medical and Surgical Procedures Panel of the Medicare Coverage Advisory Committee—April 12 and 13, 2000
3/15/0013911405, 410HCFA-1813-FMedicare Program; Coverage of, and Payment for, Paramedic Intercept Ambulance Services
3/17/0014510HCFA-2233-NCLIA Program; Cytology Proficiency Testing
4/7/0018342HCFA-3028-N2Medicare Program; Notice of the Solicitation for Proposals to Expand the Medicare Lifestyle Modification Demonstration Project; Cancellation Notice4/7/00
4/7/0018341HCFA-1128-NMedicare Program; Process for Requesting Recognition of New Technologies and Certain Drugs, Biologicals, and Medical Devices for Special Payment Under the Hospital Outpatient Prospective Payment System
4/7/0018434409, 410, 411, 412, 413, 419, 424, 489, 498, and 1003HCFA-1005-FCMedicare Program; Prospective Payment Systems for Hospital Outpatient Services6/6/007/1/00
4/10/200018999HCFA-2893-NMedicare Program; Deductible Amount for Medigap High Deductible Options for Calendar Year 20011/1/00
4/10/0019188411, 489HCFA-1112-PMedicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities—Update6/9/00
4/10/0019000HCFA-1110-NMedicare Program; Sustainable Growth Rate for Year 2000
4/11/0019329HCFA-1065-CNMedicare Program; Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2000, Correction Notice
4/27/0024707HCFA-1133-NMedicare Program; May 12, 2000 Meeting of the Citizens Advisory Panel on Medicare Education
4/27/0024666414HCFA-1084-PMedicare Program; Payment for Upgraded Durable Medical Equipment6/26/00
Start Printed Page 43823
4/28/0024971HCFA-3053-NMedicare Program; Open Town Hall Meeting to Promote and Establish Partnerships Between the Medicare Peer Review Organizations (PROs) and Entities in the Health Care Community to Foster Health Care Quality Improvement—May 15, 2000
4/28/0024970HCFA-1132-NMedicare Program; May 23, 2000 Notice of Meeting of the Competitive Pricing Advisory Committee
5/2/0025492HCFA-2117-NMedicare, Medicaid, and CLIA Programs; CLIA of 1988 Removal of Exemptions of Labs in the State of Oregon
5/3/0025738HCFA-3030-NMedicare Program; Lenses Eligible for an Adjustment in Payment Amount for New Technology Lenses Furnished by Ambulatory Surgical Centers
5/3/0025493HCFA-1134-NMedicare Program; Open Public Meeting on May 18, 2000 to Discuss the Coverage of Drugs and Biologicals that Cannot be Self-Administered
5/3/0025664414HCFA-1111-IFCMedicare Program; Criteria for Submitting Supplemental Practice Expense Survey Data7/3/00
5/5/0026282412, 413, and 485HCFA-1118-PMedicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2001 Rates7/5/00
5/16/0031124HCFA-3432-NOIMedicare Program; Criteria for Making Coverage Decisions Under Medicare7/17/00
5/19/0031917HCFA-1136-NMedicare Program; June 5, 2000 Meeting of the Practicing Physicians Advisory Council
5/24/0033616447, 457HCFA-2114-FState Children's Health Insurance Program; State Children's Health Allotments and Payment to States6/23/00
5/24/0033638HCFA-2067-NState Children's Health Insurance Program; Final Allotments to States, the District of Columbia, and U.S. Territories and Commonwealths for Fiscal Year 2000
5/24/0033634HCFA-2064-NState Children's Health Insurance Program; Final Allotments to States, Commonwealths, and Territories for Fiscal Years 1998 and 1999
5/30/0034481HCFA-9001-NMedicare and Medicaid Programs; Quarterly Listing of Program Issuances for Third Quarter, 1999
5/31/0034715HCFA-2076-NMedicaid Infrastructure Grant Program to Support the Competitive Employment of People with Disabilities
5/31/0034478HCFA-2063-NMedicaid Program; State Allotments for Payment of Medicare Part B Premiums for Qualifying Individuals: Federal Fiscal Year 2000
6/1/0034983403HCFA-4005-IFCMedicare Program; State Health Insurance Assistance Program (SHIP)7/31/007/3/00
Start Printed Page 43824
6/5/0035654HCFA-1137-NMedicare Program; Announcement of a Series of National and Regional Training Sessions to Provide Training to Medicare+Choice Organizations and Others Concerning Data Requirements, and the Timely and Accurate Submission of Physician and Hospital Outpatient Encounter Data to Support a Comprehensive Risk Adjustment Model
6/6/0035947HCFA-1138-NMedicare Program; Town Hall Meeting to Discuss the Documentation Guidelines for Evaluation and Management Services—June 22, 2000
6/15/0037507HCFA-3432-N3Medicare Program; Criteria for Making Coverage Decisions; Extension of Comment Period7/17/00
6/26/0039314HCFA-1139-NMedicare Program; Town Hall Meeting on July 18, 2000 to Present an Overview of the Home Health Prospective Payment System Final Rule
6/29/0040112HCFA-1030-NMedicare Program; Medicare+Choice Deeming Authority
6/29/0040170HCFA-1030-FCMedicare Program; Medicare+Choice Program8/28/007/31/00
6/30/0040535409, 410, 411, 412, 413, 419, 424, 489, 498, and 1003HCFA-1005-N5Medicare Program; Hospital Outpatient Prospective Payment Systems, Request for Delay of Effective Date8/1/00
7/3/0058134HCFA-1059-FMedicare Program; Prospective Payment System for Home Health Agencies
7/5/0041477HCFA-1141-NMedicare Program; Open Public Meeting on July 25, 2000 to Discuss the Coverage of Drugs and Biologicals that Cannot be Self Administered
7/7/0042022HCFA-1140-NMedicare Program; Question and Answer Session on July 24, 2000 to Discuss Remaining Concerns About the Implementation of the Hospital Outpatient Prospective Payment System
7/17/0044176410, 414HCFA-1120-PMedicare Program; Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 20019/15/00
7/28/0046473HCFA-1144-NMedicare Program; Announcement of a Series of Regional Training Sessions to Provide Training to Medicare+Choice Organizations, Physicians, Medicare+Choice Organization Non-Physician Practitioners, and Medicare+Choice Organization Medicare Directors, as well as Physician Organizations and Billing Associations Involved in the Timely and Accurate Submission of Physician Encounter Data to Support a Comprehensive Risk Adjustment Model
7/28/0046466HCFA-1115-NMedicare Program; Solicitation for Proposals for the Medicare Coordinated Care Demonstration
Start Printed Page 43825
7/31/0046770411, 413, and 489HCFA-1112-FMedicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities—Update
8/1/0047026-47211410, 412, 413, 482, and 485HCFA-1131-IFCMedicare Program; Provisions of the Balanced Budget Refinement Act of 1999, Hospital Inpatient Payments and Rates and Costs of Graduate Medical Education8/31/008/1/00
8/1/0047054410, 412, 413 and 485HCFA-1118-FMedicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2001 Rates10/1/00
8/3/0047706-47709413HCFA-1143-PMedicare Program; Prospective Payment System for Hospital Outpatient Services: Revision of the Provider-Based Location Criteria for Certain PPS-Exempt Facilities10/2/00
8/3/0067798-68020413, 419HCFA-1005-IFCMedicare Program; Prospective Payment System for Hospital Outpatient Services: Revisions to Criteria to Define New or Innovative Medical Devices, Drugs, and Biologicals Eligible for Pass-Through Payments and Corrections to the Criteria for the Grandfather Provision for Certain Federally Qualified Health Centers9/5/001/1/01
8/17/0050171HCFA-3432-N4Medicare Program; Open Town Hall Meeting to Discuss Criteria for Making Coverage Decisions—August 31, 2000
8/17/0050373HCFA-0149-NAdministrative Simplification; Health Insurance Reform: Announcement of Designated Standard Maintenance Organizations10/16/00
8/17/005031245 CFR Parts 160 and 162HCFA-0149-FHealth Insurance Reform; Standards for Electronic Transactions10/16/00
8/25/0051839HCFA-1149-NMedicare Programs; September 11, and 12, 2000, Meeting of the Practicing Physicians Advisory Council
8/28/0052042-52043457HCFA-2114-CNState Children's Health Insurance Program; Allotments and Payments to States; Correction6/23/00
8/29/0052432HCFA-3432-N5Medicare Program; Postponent of Open Town Hall Meeting to Discuss Criteria for Making Coverage Decisions from August 31, 2000 to September 31, 2000
9/1/0053320-53321HCFA-1146-NMedicare Program; September 21, 2000, Meeting of the Advisory Panel on Medicare Education
9/6/0053936405HCFA-6003-NMedicare Program; Appeals of Carrier Determinations That a Physician or Other Supplier Fails to Meet the Requirements for Medicare Billing Privileges; Reopening of Comment Period1/4/01
9/8/0054537HCFA-3036-NMedicare Program; Meeting of the Medical and Surgical Procedures Panel of the Medicare Coverage Advisory Committee—October 17 and 18, 2000
9/8/0054537HCFA-1153-NMedicare Program; Open Town Hall Meeting to Discuss Medicare Policy for Community Mental Health Centers on September 25, 2000
Start Printed Page 43826
9/12/0055076HCFA-2006-CNState Children's Health Insurance Program; Allotments and Payments to States
9/12/0055078-55100410, 414HCFA-1002-PMedicare Program; Fee Schedule for Payment of Ambulance Services and Revisions to Physician Certification Requirements for Coverage of Nonemergency Ambulance Services11/13/00
9/27/0058992-58093HCFA-1145-NCMedicare and Medicaid Programs; Announcement of Additional Applications from Hospitals Requesting Waivers for Organ Procurement Service Areas11/13/00
10/3/0058919-58920413, 489, and 498HCFA-1005-CN4Medicare Program; Prospective Payment System and Hospital Outpatient Services: Provider-Based Criteria; Delay of Effective Date and Correction1/10/01
10/6/0060072HCFA-1135-NMedicare Program; Hospice Wage Index10/1/00
10/6/0059748-59749422HCFA-1030-CN2Medicare Program; Establishment of the Medicare+Choice Program; Correction7/31/00
10/6/0059748412, 413 and 489HCFA-1005-CN2Medicare Program; Prospective Payment System for Hospital Outpatient Services; Delay of Effective Date8/1/00
10/10/0060151447HCFA-2071-PMedicaid Program; Revision to Medicaid Upper Payment Limit Requirements for Hospital Services, Nursing Facility Services, Intermediate Care Facility Services for the Mentally Retarded, and Clinic Services11/9/00
10/10/0060105-60108440, 441HCFA-2010-FCMedicaid Program; Home and Community-Based Services12/11/0010/1/97
10/10/0060104-60105413HCFA-1883-F2Medicare Program; Revision of the Procedures for Requesting Exceptions to Cost Limits for Skilled Nursing Facilities and Elimination of Reclassifications, Corrections9/9/99
10/11/0060366-60378424HCFA-6004-FCMedicare Program; Additional Supplier Standards12/11/0012/11/00
10/16/006112-6113413, 489, and 498HCFA-1155-NMedicare Program; Open Town Hall Meeting to Discuss Implementation of Provider-Based Regulations; October 31, 2000
10/19/0062727-62733HCFA-8009-NMedicare Program; Monthly Actuarial Rates and Monthly Supplementary Medical Insurance Premium Rate Beginning January 1, 20011/1/01
10/19/0062733HCFA-8008-NMedicare Program; Part A Premium for 2001 for the Uninsured Aged and for Certain Disabled Individuals Who Have Exhausted Other Entitlement
10/19/006725-6727HCFA-8007-NMedicare Program; Inpatient Hospital Deductible and Hospital and Extended Care Services Coinsurance Amounts for 20011/1/01
10/19/0062645-62646409, 410, 489, and 498HCFA-3045-FMedicare Program; Removal of the Requirements for the Cardiac Pacemaker Registry10/19/00
10/19/0062681410HCFA-1088-PMedicare Program; Clinical Social Worker Services12/18/00
Start Printed Page 43827
10/24/0063604-63605HCFA-3058-NMedicare Program; Meeting of the Executive Committee of the Medicare Coverage Advisory Committee—November 7, 200010/31/00
10/31/0064968-64974HCFA-4010-GNCMedicare Program; Criteria and Standards for Evaluating Intermediary and Carrier Performance During Fiscal Year 200111/30/0010/1/00
10/31/0064966-64968HCFA-2118-NMedicare, Medicaid Programs and CLIA Programs; Continuance of the Approval of COLA as a CLIA Accreditation Organization10/31/00
10/31/0064919-64924435HCFA-2086-PMedicaid Program; Change in Application of Federal Financial Participation Limits11/30/00
11/02/0065376410, 414HCFA-1120-FCMedicare Program; Revisions to Payment Policies under the Physician Fee Schedule for Calendar Year 20011/2/011/1/01
11/03/0066304-66442412, 413HCFA-1069-PMedicare Program; Prospective Payment System for Inpatient Rehabilitation Facilities2/1/01
11/13/0067798419HCFA-1005-IFCMedicare Program; Prospective Payment System for Hospital Outpatient Services1/12/01
11/16/0069416-69424482HCFA-3014-PMedicare and Medicaid Programs; Hospital Conditions of Participation: Laboratory Services1/16/01
11/21/0069946-69947HCFA-1157-NMedicare Program; December 12, 2000, Meeting of the Competitive Pricing Advisory Committee12/12/00
11/21/0069945-69946HCFA-1151-NMedicare Program; Ambulance Services Demonstration3/21/00
11/24/0070575HCFA-2118-CNMedicare and Medicaid Programs; Continuance of the Approval of COLA as a CLIA Accreditation Organization; Correction11/24/00
11/24/007050745 CFR 160, 162HCFA-0149-CNHealth Insurance Reform; Standards for Electronic Transactions; Correction11/24/00
11/27/0070729HCFA-1165-NMedicare Program; December 11, 2000, Meeting of the Practicing Physicians Advisory Council12/11/00
12/4/0075720HCFA-1156-NMedicare Program; Request for Nominations for the Practicing Physicians Advisory Council12/30/00
12/5/0075943-75944HCFA-1162-NMedicare Program; Establishment of the Advisory Panel on Ambulatory Payment Classification Groups and Request for Nominations for Members12/26/00
12/21/0080442-80443HCFA-2092-NMedicare Program; Deductible Amount for Medigap High Deductible Policy Options for Calendar Year 20011/1/01
12/21/0080443-80444HCFA-1172-NMedicare Program; January 10, 2001, Meeting of the Advisory Panel on Medicare Education1/10/01
12/27/0081878-81879HCFA-9006-NMedicare Program; Correction of HHS Regulatory Plan and Unified Agenda12/27/00
12/27/0081813422HCFA-1160-PMedicare Program; Requirements for the Recredentialing of Medicare+Choice Organization Providers1/26/01
Start Printed Page 43828
12/27/0081813412, 413HCFA-1069-NMedicare Program; Medicare; Prospective Payment System for Inpatient Rehabilitation Facilities; Extension of Comment Period
12/28/008246245 CFR 160, 164HCFA-0177-FStandards for Privacy of Individually Identifiable Health Information2/26/01
12/29/0083155HCFA-3002-NMedicare Program; Application Process for National Organizations to Obtain Deeming Authority for Diabetes Self-Management Training Programs1/29/01
1/3/01376HCFA-2089-NState Children's Health Insurance Program; Final Allotments to States, the District of Columbia, and U.S. Territories and Commonwealths for Fiscal Year, 2001.
1/4/01856411, 424HCFA-1809-FCMedicare and Medicaid Programs; Physicians' Referrals to Health Care Entities With Which They Have Financial Relationships,
1/9/011599413, 489HCFA-1005-F3Medicare Program; Prospective Payment System for Hospital Outpatient Services; Correction
1/11/012490431, 433, 435HCFA-2006-FState Children's Health Program; Implementing Regulations for the State Children's Health Insurance Program, Part II.
1/11/012432HCFA-2112-NMedicaid Program; Infrastructure Grant Program to Support the Competitive Employment of People with Disabilities.
1/12/012316435HCFA-2086-FMedicaid Program; Change in Application of Federal Financial Participation Limits
1/12/013377413HCFA-1089-PMedicare Program; Payment for Clinical Psychology Training Programs
1/12/013358413, 422HCFA-1685-FMedicare Program; Payment for Nursing and Allied Health Education
1/12/013148447HCFA-2071-FMedicaid Program; Revision to Medicaid Upper Payment Limit Requirements for Hospital Services, Nursing Facility Services, Intermediate Care Facility Services for the Mentally Retarded, and Clinical Services
1/16/013497411, 413, 489HCFA-1112-CNMedicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities—Update; Correction
1/18/014674416, 482, 485HCFA-3049-FMedicare and Medicaid Programs; Hospital Conditions of Participation: Anesthesia Services
1/19/016228400, 430, 431,434, 435, 438, 440, 447HCFA-2001-FCMedicaid Program; Medicaid Managed Care
1/22/017148441,483HCFA-2065-IFCMedicaid Program; Use of Restraint and Seclusion in Psychiatric Residential Treatment Facilities Providing Psychiatric Services to Individuals Under Age 21
1/22/016630HCFA-2089-FCState Children's Health Insurance Program; Final Allotments to States, the District of Columbia, and U.S. Territories and Commonwealths for Fiscal Year 2001; Correction
Start Printed Page 43829
1/24/017593422, 489HCFA-4024-PMedicare Program; Improvements to the Medicare+Choice Appeal and Grievance Procedures
2/2/018771411, 424HCFA-1809-F2Medicare and Medicaid Programs; Physicians' Referrals to Health Care Entities with which They Have Financial Relationships: Delay of Effective Date of Final Rule and Technical Amendment
2/5/018974HCFA-3061-NMedicare Program; Meetings of the Medical Devices and Prosthetics Panel and the Executive Committee of the Medicare Coverage Advisory Committee; February 21 and 22, 2001
2/12/019857HCFA-1174-NMedicare Program; Meeting of the Advisory Panel on Ambulatory Payment Classification Groups
2/26/0111547431, 433, 435, 436, 457HCFA-2006-NState Children's Health Insurance Program; Implementing Regulations for the State Children's Health Insurance Program: Delay of Effective Date
2/26/0111546400, 430, 431, 434, 435, 438, 440, 447HCFA-2001-F2Medicaid Program; Medicaid Managed Care: Delay of Effective Date
3/2/0113021410, 412, 413, 485HCFA-1118-CN1Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2001 Rates; Correction
3/2/0113020410, 412, 413, 485HCFA-1118-CN2Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2001 Rates; Midyear Corrections Effective
3/5/0113328HCFA-2068-NMedicare, Medicaid, and CLIA Programs; Continuance of the Approval of the American Society for Histocompatibility and Immunogenetics as a CLIA Accreditation Organization
3/9/0114157HCFA-1188-NMedicare Program; March 26, 2001, Meeting of the Practicing Physicians Advisory Council
3/12/0114343435HCFA-2086-F2Medicaid Program; Change in Application of Federal Financial Participation Limits: Delay of Effective Date
3/12/0114342413, 422HCFA-1685-F2Medicare Program; Payment for Nursing and Allied Health Education: Delay of Effective Date
3/14/0214906HCFA-2079-PNMedicare and Medicaid Programs; Recognition of the American Osteopathic Association for Ambulatory Surgical Centers Program
3/14/0114861410, 414, 424, 480, 498HCFA-3002-CNMedicare Program; Expanded Coverage for Outpatient Diabetes Self-Management Training and Diabetes Outcome Measurements
3/19/0115352416, 482, 485HCFA-3049-F2Medicare and Medicaid Programs; Hospital Conditions of Participation: Anesthesia Services; Delay of Effective Date
Start Printed Page 43830
3/21/0115800441,483HCFA-2065-FMedicare Program; Use of Restraint and Seclusion in Residential Treatment Facilities Providing Inpatient Psychiatric Services to Individuals under Age 21: Delay of Effective Date
3/27/0116607410,414HCFA-1120-CNMedicare Program; Revisions to Payment Policies under the Physician Fee Schedule for Calendar Year 2001
3/28/0116950HCFA-4020-NMedicare Program; Renewal of the Advisory Panel for Medicare Education (APME)
4/3/0117657447HCFA-2100-PMedicaid Program; Modification of the Medicaid Upper Payment Limit Transition Period for Inpatient Hospital Services, Outpatient Hospital Services, Nursing Facility Services, Intermediate Care Facility Services for the Mentally Retarded, and Clinic Services
4/4/0117813411,424HCFA-1809-NMedicare and Medicaid Programs; Physicians' Referrals to Health Care Entities with which they have Financial Relationships; Extension of Comment Period
4/12/0118959HCFA-3057-NMedicare Program; Annual Review of the Appropriateness of Payment Amounts for New Technology Intraocular Lenses (NTIOLS) Furnished by Ambulatory Surgical Centers (ASCs)
4/13/0119178HCFA-3068-NMedicare Program; Educational Symposium to Discuss the Use of Evidence-Based Medicine in the Medicare Coverage Decision Process—May 3, 2001
4/16/0119509HCFA-2099-NMedicare and Medicaid Programs; Application by the American Osteopathic Association (AOA) for Approval of Deeming Authority for Critical Access Hospitals
4/18/0119961HCFA-9007-NNotice of Change of Address for the Provider Reimbursement Review Board, the Medicare Geographic Classification Review Board, the Health Care Financing Administration Hearing Officer, and the Office of Hearings
4/26/0120997HCFA-1561Medicare Program; Evaluation Criteria and Standards for Peer Review Organization 6th Round Contract
4/30/0121403HCFA-3066-NMedicare Program; Meeting of the Diagnostic Imaging Panel of the Medicare Coverage Advisory Committee—June 19, 2001
4/30/0121402HCFA-3067-NMedicare Program; Request for Nominations for Members for the Medicare Coverage Advisory Committee (MCAC)
5/1/0121770HCFA-1182-PNMedicare Program; Revision of Payment Rates for End-Stage Renal Disease (ESRD) Patients Enrolled in Medicare+Choice Plans
Start Printed Page 43831
5/4/0122646405, 412, 413, 485, 486HCFA-1158-PMedicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2002 Rates Parts I-IV
5/10/0123984410, 411, 413, 424, 482, 489HCFA-1163-PMedicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities—Update, Part II
5/10/0123946HCFA-10037Emergency Clearance: Public Information Collection Requirements Submitted to the Office of Management and Budget (OMB)
5/18/0127662HCFA-3069-NMedicare Program; Meeting of the Executive Committee of the Medicare Coverage Advisory Committee—June 14, 2001
5/18/0127598416, 482, 485HCFA-Medicare and Medicaid Programs: Hospital Conditions of Participation: Anesthesia Services: Delay of Effective Date
5/22/0128183HCFA-2125-NMedicaid Program; Infrastructure Grant Program to Support the Design and Delivery of Long Term Services and Supports that Permit People and any Age who have a Disability or Long-Term Illness to Live in the Community
5/22/0128110441, 483HCFA-2065-IFC2Medicaid Program; Use of Restraint and Seclusion in Psychiatric Residential Treatment Facilities Providing Inpatient Psychiatric Services to Individuals Under Age 21
6/1/0129824HCFA-3071-NMedicare Program; Meeting of the Drugs, Biologics, and Therapeutics Panel of the Medicare Coverage Advisory Committee—June 20, 2001
6/8/0131028HCFA-1170-PNMedicare Program; Five-Year Review of Work Relative Value Units Under the Physician Fee Schedule, Part III
6/8/0130936HCFA-1194-NMedicare Program; Meeting of the Practicing Physicians Advisory Council on June 25, 2001
6/11/0131178431, 433, 435, 436, 457HCFA-2006-F3State Children's Health Program, Implementing Regulations for the State Children's Health Insurance Program: Further Delay of Effective Date
6/13/0132172410, 412, 413, 485HCFA-1178-IFC]Medicare Program; Provisions of the Benefits Improvement and Protection Act of 2000; Inpatient Payments and Rates and Costs of Graduate Medical Education, Part VII
6/18/0132777409, 410, 411, 413, 424, 484HCFA-1059-F2Medicare Program; Prospective Payment System for Home Health Agencies; Correction
6/18/0132776400, 430, 431, 434, 435, 438, 440, 447HCFA-2001-F3Medicaid Program; Medicaid Managed Care: Further Delay of Effective Date
Start Printed Page 43832
6/20/0133030405HCFA-3074-FMedicare and Medicaid Programs; End-Stage Renal Disease—Waiver of Conditions for Coverage under a State of Emergency in Houston, TX area
6/21/0133257HCFA-2124-NState Children's Health Insurance Program; Redistribution and Continued Availability of Unexpended SCHIP Funds from the Appropriation for FY 1998
6/25/0133810431, 433, 435, 436, 457HCFA-2006-IFCState Children's Health Program; Revisions to the Regulations Implementing the State Children's Health Insurance Program, Part IV
6/26/0133966HCFA-4019-NMedicare Program; Meeting of the Advisory Panel on Medicare Education—July 12, 2001
6/27/0134223HCFA-3072-PNMedicare Program; Application by the American Diabetes Association for Recognition as a National Accreditation Program for Accrediting Entities to Furnish Outpatient Diabetes Self-Management Training
6/29/0134693HCFA-1186-NMedicare Program; Public Meeting for New Clinical Laboratory Tests—Payment Determinations for Calendar Year 2002
6/29/0134687HCFA-1147-NCMedicare Program; Update to the Prospective Payment System for Home Health Agencies for FY 2002
7/5/0135395416, 482, 485HCFA-3070-PMedicare and Medicaid Programs; Hospital Conditions of Participation: Anesthesia Services
7/5/0135442HCFA-1060-N3Medicare Program; Cost-of-Living Adjustment for the Territory of Guam in the Schedules of Per-Visit Limitations on Home Health Agency Costs
7/3/0135253HCFA-1147-CNMedicare Program; Update to the Prospective Payment System for Home Health Agencies for FY 2002, Correction
7/3/0135260HCFA-3073-NMedicare Program; Town Hall Meeting on Physician Query Forms
7/30/0139322CMS-1135-CNMedicare Program; Hospice Wage Index Fiscal Year 2001, Correction
7/31/0139562410, 411, 413, 424, 489CMS-1163-FMedicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities—Update
7/31/0139450CMS-9010-FCMedicare and Medicaid Programs; Change of Agency Name: Technical Amendments
8/1/0139828405, 410, 412, 413, 482, 485, 486CMS-1131-F, CMS-1158-F, CMS-1178-FMedicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Rates and Costs of Graduate Medical Education: Fiscal Year 2002 Rates; Provisions of the Balanced Budget Refinement Act of 1999; and Provisions of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000
Start Printed Page 43833
8/1/0139755CMS-4025-PNMedicare Program; Medicare+Choice Programs—Application by the National Committee for Quality Assurance (NCQA) for Approval of Deeming Authority for Medicare+Choice Organizations That are Licensed as a Health Maintenance Organization
8/1/0139773CMS-4023-PNMedicare Program; Medicare+Choice Organizations—Application by the Accreditation Association for Ambulatory Health Care, Inc. for Approval of Deeming Authority for Medicare+Choice Organizations That are Licensed as a Health Maintenance Organization or a Preferred Provider Organization
8/2/0140372405, 410, 411, 414, 415CMS-1169-PMedicare Program; Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2002, Part III
8/2/0140289CMS-1196-NMedicare Program; Notice of Practicing Physicians Advisory Council Rechartering and Request for Nominations
8/3/0240706CMS-1193-NCMedicare and Medicaid Programs; Announcement of Applications From Hospitals Requesting Waivers for Organ Procurement Service Areas
8/10/0242229CMS-1107-NMedicare and Medicaid Programs; Notice for the Solicitation of Proposals for the Private, For-Profit Demonstration Project for the Program of All-Inclusive Care for the Elderly
8/17/0143090400, 430, 431, 434, 435, 438, 440, 447CMS-2001-IFCMedicaid Program; Medicaid Managed Care; Further Delay of Effective Date
8/20/0143614400, 430, 431, 434, 435, 438, 440, 447CMS-2104-PMedicaid Program; Medicaid Managed Care, Part II
8/24/0144672413, 419, 489CMS-1159-PMedicare Program; Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2002 Payment Rates, Part II
8/24/0144585416, 482, 485CMS-3070-CNMedicare and Medicaid Programs; Hospital Conditions of Participation: Anesthesia Services
8/28/0145173414CMS-1010-FMedicare Program; Replacement of Reasonable Charge Methodology by Fee Schedules for Parenteral and Enteral Nutrients, Equipment, and Supplies
8/31/0146015CMS-1195-NMedicare Program; September 17, 2001, Meeting of the Practicing Physicians Advisory Council
9/5/0146397447CMS-2100-FMedicaid Program; Modification of the Medicaid Upper Payment Limit Transition Period for Inpatient Hospital Services, Outpatient Hospital Services, Nursing Facility Services, Intermediate Care Facility Services for the Mentally Retarded, and Clinic Services
Start Printed Page 43834
9/7/0146902412CMS-1176-FMedicare Program; Payments for New Medical Services and New Technologies Under the Acute Care Hospital Inpatient Prospective Payment System, Part III
9/7/0146763431CMS-2128-PMedicaid Program; Continue to Allow States an Option Under the Medicaid Spousal Impoverishment Provisions to Increase the Community Spouse's Income When Adjusting the Protected Resource Allowance
9/12/0147493CMS-2119-NMedicare, Medicaid, and CLIA Programs; Continuance of the Approval of the College of American Pathologists as a CLIA Accreditation Organization
9/12/0147410422CMS-1160-FMedicare Program; Requirements for the Recredentialing of Medicare+Choice Organization Providers
9/17/0148078411CMS-1163-FMedicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities-Update
9/18/0148147CMS-4026-NMedicare Program; Medicare+Choice Organizations—Application by the Joint Commission on Accreditation of Healthcare Organizations for Approval of Deeming Authority for Medicare+Choice Organizations That Are Licensed as Health Maintenance Organizations or Preferred Provider Organizations
9/19/0148262CMS-3075-NMedicare Program; Meeting of the Executive Committee of the Medicare Coverage Advisory Committee—October 17, 2001
9/27/0149454CMS-1175-NMedicare Program; Hospice Wage Index Fiscal Year 2002, Part II
9/28/0149677CMS-2099-FNMedicare Program; Approval of Deeming Authority for Critical Access Hospitals by the American Osteopathic Association
9/28/0149544402, 405CMS-6145-FCMedicare Program; Civil Money Penalties, Assessments, and Revised Sanction Authorities
10/1/0149958CMS-1182-FNMedicare Program; Revision of Payment Rates for End-Stage Renal Disease Patients Enrolled in Medicare+Choice Plans
10/03/0150440CMS-4029-NMedicare Program; Request for Nomination for the Advisory Panel on Medicare Education
10/04/0150658CMS-4028-NMedicare Program; Meeting of the Advisory Panel on Medicare Education—Thursday, October 25, 2001
10/05/0151095CMS-1175-NMedicare Program; Hospice Wage Index Fiscal Year 2002 (correction notice)
10/12/0152189CMS-1175-NMedicare Program; Hospice Wage Index Fiscal Year 2002 (correction notice)
Start Printed Page 43835
10/26/0154266CMS-1197-NMedicare Program; December 10-11, 2001 Meeting of the Practicing Physicians Advisory Council and Request for Nominations
10/26/0154264CMS-8012-NMedicare Program; Part A Premium for 2002 for the Uninsured Aged and for Certain Disabled Individuals Who Have Exhausted Other Entitlement
10/26/0154263CMS-3072-FNMedicare Program; Approval of Application by the American Diabetes Association for Recognition as a National Accreditation Program for Accrediting Entities to Furnish Outpatient Diabetes Self-Management
10/26/0154262CMS-3076-PNMedicare Program; Application by the Indian Health Service for Recognition as a National Accreditation Organization for Accrediting American Indian and Alaska Native Entities to Furnish Outpatient Diabetes Self-Management Training
10/26/0154261CMS-3061-NCMedicare Program; Adjustment in Payment Amounts for New Technology Intraocular Lenses Furnished by Ambulatory Surgical Centers
10/26/0254255CMS-8010-NMedicare Program; Monthly Actuarial Rates and Monthly Supplementary Medical Insurance Premium Rate Beginning January 1, 2002
10/26/0154253CMS-3080-NRMedicare Program; The National and Local Coverage Determination Review Process for an Individual With Standing as Defined in Section 522 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000
10/26/0154251CMS-8011-NMedicare Program; Inpatient Hospital Deductible and Hospital Extended Care Services Coinsurance Amounts for 2002
10/26/0154246CMS-2133-NState Children's Health Insurance Program; Final Allotments to States, the District of Columbia, and U.S. Territories and Commonwealths for Fiscal Year 2002
10/26/0154186408CMS-4007-PMedicare Program; Supplementary Medical Insurance Premium Surcharge Agreements
10/26/0154179403, 416, 418, 460, 482, 483CMS-3047-PMedicare and Medicaid Programs; Fire Safety Requirements for Certain Health Care Facilities
11/01/0155246405, 410, 411, 414, 415CMS-1169-FCMedicare Program; Revisions to Payment Policies and Five-Year Review of and Adjustments to the Relative Value Units Under the Physician Fee Schedule for Calendar Year 2002, Part II
Start Printed Page 43836
11/02/0155857419CMS-1159-F1Medicare Program; Announcement of the Calendar Year 2002 Conversion Factor for the Hospital Outpatient Prospective Payment System and Pro Rata Reduction on Transitional Pass-Through Payments, Part V
11/02/0155850419CMS-1179-IFCMedicare Program; Prospective Payment System for Hospital Outpatient Services: Criteria for Establishing Additional Pass-Through Categories for Medical Devices, Part V
11/02/0155677CMS-9012-NCMedicare and Medicaid Programs; Plan to Create an Open and Responsive Federal Agency
11/13/0156902CMS-2133-NState Children's Health Insurance Program; Final Allotments to States, the District of Columbia; and U.S. Territories and Commonwealths for Fiscal Year 2002
11/13/0156762416, 482, 485CMS-3070-FMedicare and Medicaid Programs; Hospital Conditions of Participation: Anesthesia Services
11/23/0158788410CMS-3250-FMedicare Program; Negotiated Rulemaking: Coverage and Administrative Polices for Clinical Diagnostic Laboratory Services, Part II
11/23/0158786411CMS-1163-FMedicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities—Update (Correction)
11/23/0158743CMS-1190-NCMedicare Program; Establishment of Procedures That Permit Public Consultation Under the Existing Process for Making Coding and Payment Determinations for New Clinical Laboratory Tests and for New Durable Medical Equipment
11/23/0158742CMS-3079-NMedicare Program; Meeting of the Diagnostic Imaging Panel of the Medicare Coverage Advisory Committee—January 10, 2002
11/23/0158741CMS-3077-NMedicare Program; Withdrawal of Medicare Coverage of Certain Positron Emission Tomography Scanners
11/23/0158694447CMS-2134-PMedicaid Program; Modification of the Medicaid Upper Payment Limit for Non-State Government-Owned or Operated Hospitals
11/30/0158694413, 419, 489CMS-1159-F2Medicare Program; Changes to the Hospital Outpatient Prospective Payment System for Calendar Year 2002, Part III
12/3/0160154411CMS-1809-IFCMedicare and Medicaid Programs; Physicians' Referrals to Health Care Entities With Which They Have Financial Relationships: Partial Delay of Effective Date
12/14/0164839CMS-4031-NMedicare Program; Open Public Meeting on January 16, 2002 to Discuss Activities Related to the Collection of Diagnostic Data from Medicare+Choice Organizations for Risk Adjustment
Start Printed Page 43837
12/14/0164838CMS-1191-NMedicare Program; Meeting of the Advisory Panel on Ambulatory Payment Classification Groups
12/28/0167266CMS-2135-NMedicare Program; Deductible Amount for Medigap High Deductible Options for Calendar Year 2002
12/28/0167257CMS-4021-GNCMedicare Program; Criteria and Standards for Evaluating Intermediary, Carrier, and Durable Medical Equipment, Prosthetics, Orthotics and Supplies Regional Carrier Performance During Fiscal Year 2002
12/28/0167109486CMS-3064-IFCMedicare and Medicaid Programs; Emergency Recertification for Coverage for Organ Procurement Organizations
12/31/0167494413, 419, 489CMS-1159-F3Medicare Program; Prospective Payment System for Hospital Outpatient Services; Delay in Effective Date of Calendar Year 2002 Payment Rates and the Pro Rata Reduction on Transitional Pass-Through Payments
1/18/022602447CMS-2134-FMedicaid Program; Modification of the Medicaid Upper Payment Limit for Non-State Government-Owned or Operated Hospitals
1/25/023720CMS-4034-NMedicare Program; Meeting of the Advisory Panel on Medicare Education—February 13, 2002
1/25/023719CMS-3081-NMedicare Program; Peer Review Organization Contracts: Solicitation of Statements of Interest From In-State Organizations—Alaska, Hawaii, Idaho, Illinois, Kentucky, Maine, Nebraska, South Carolina, Vermont, and Wyoming
1/25/023716CMS-4025-FNMedicare Program; Medicare+Choice Organizations—Approval of the Deeming Authority of the National Committee for Quality Assurance for Medicare+Choice Managed Care Organizations That Are Licensed as Health Maintenance Organizations
1/25/023713CMS-2087-PNMedicaid Program; State Allotments for Payment of Medicare Part B Premiums for Qualifying Individuals: Federal Fiscal Year 2001
1/25/023712CMS-2139-NMedicaid Program; Infrastructure Grant Program To Support the Competitive Employment of People with Disabilities
1/25/023662401CMS-6011-PMedicare Program; Reporting and Repayment of Overpayments
Start Printed Page 43838
1/25/023641CMS-9877-PMedicare and Medicare Programs; Terms, Definitions, and Addresses: Technical Amendments
2/22/028272CMS-1214-NMedicare Program; March 25-26, 2002, Meeting of the Practicing Physicians Advisory Council
2/22/028272CMS-3087-NMedicare Program; Meeting of the Executive Committee of the Medicare Coverage Advisory Committee—April 16, 2002
2/22/028270CMS-3061-FNMedicare Program; Disapproval of Alcon Laboratories' Request for an Adjustment in Payment Amounts for New Technology Intraocular Lenses Furnished by Ambulatory Surgical Centers
2/22/028267CMS-4030-NMedicare Program; Solicitation for Proposals for the Demonstration Project for Disease Management for Severely Chronically I11 Medicare Beneficiaries With Congestive Heart Failure, Diabetes, and Coronary Heart Disease
2/27/029100410, 414CMS-1002-FCMedicare Program; Fee Schedule for Payment of Ambulance Services and Revisions to the Physician Certification Requirements for Coverage of Nonemergency Ambulance Services, Part IV
3/1/029556413, 419, 489CMS-1159-F4Medicare Program; Correction of Certain Calendar Year 2002 Payment Rates Under the Hospital Outpatient Prospective Payment System and the Pro Rata Reduction on Transitional Pass-Through Payments; Correction of Technical and Typographical Errors, Part V
3/5/029936457CMS-2127-PState Children's Health Insurance Program; Eligibility for Prenatal Care for Unborn Children
3/6/0210293403CMS-4032-ANPRMMedicare Program; Medicare-Endorsed Prescription Drug Discount Card Assistance Initiative for State Sponsors, Part II
3/6/0210262403CMS-4027-PMedicare Program; Medicare-Endorsed Prescription Drug Card Assistance Initiative, Part II
3/14/0211549410, 411, 413, 424, 489CMS-1163-FMedicare Program; Prospective Payment System and consolidated Billing for Skilled Nursing Facilities—Update
3/15/0211745403CMS-4027-PMedicare Program; Medicare-Endorsed Prescription Drug Card Assistance Initiative (correction)
3/18/0211969CMS-1206-NMedicare Program; Town Hall Meeting on Payment for Certain Drugs, Biologicals, and Devices under the Hospital Outpatient Prospective Payment System for Calendar Year 2003
3/19/0212479447CMS-2134-NMedicaid Program; Modification of the Medicaid Upper Payment Limit for Non-State Government-Owned or Operated Hospitals: Delay of Effective Date
Start Printed Page 43839
3/22/0213416412, 413, 476CMS-1177-PMedicare Program; Prospective Payment System for Long-Term Care Hospitals: Proposed Implementation and FY 2003 Rates, Part II
3/22/0213347CMS-3089-NMedicare Program; Annual Review of the Appropriateness of Payment Amounts for New Technology Intraocular Lenses Furnished by Ambulatory Surgical Centers
3/22/0213345CMS-3076-FNMedicare Program; Approval of the Indian Health Service as a National Accreditation Organization for Accrediting American Indian and Alaska Native Entities To Furnish Outpatient Diabetes Self-Management Training
3/22/0213344CMS-2140-PNMedicare and Medicaid Programs; Application by the Joint Commission on Accreditation of Healthcare Organization for Approval of Deeming Authority for Critical Access Hospitals
3/22/0213341CMS-2138-NMedicare, Medicaid, and CLIA Programs; Continuance of Approval of the American Osteopathic Association as an CLIA Accreditation Organization
3/22/0213337CMS-4026-FNMedicare Program; Medicare+Choice Organizations—Approval of the Joint Commission on Accreditation of Healthcare Organizations for Medicare+Choice Deeming Authority for Managed Care Organizations That Are Licensed as Health Maintenance Organizations or Preferred Provider Organizations
3/22/0213297CMS-6012-NOIMedicare Program; Establishment of Special Payment Provisions and Standards for Suppliers of Prosthetics and Certain Custom-Fabricated Orthotics; Intent to Form Negotiated Rulemaking Committee
3/22/0213278417, 422CMS-1181-FMedicare Program; Modifications to Managed Care Rules Based on Payment Provisions of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, and Technical Corrections
3/22/0213278410, 411, 413, 424, 489CMS-1163-CNMedicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Correction
3/28/0215011410, 411, 413, 424, 489CMS-1163-NMedicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Correction
3/29/0215149483, 488CMS-2131-PMedicare and Medicaid Programs; Requirements for Paid Feeding Assistants in Long Term Care Facilities
* 42 CFR except where noted
** N—General Notice; PN—Proposed Notice; NC—Notice with Comment Period; FN—Final Notice; P—Notice of Proposed Rulemaking (NPRM); F—Final Rule; FC—Final Rule with Comment Period; CN—Correction Notice; IFC—Interim Final Rule with Comment Period; GNC—General Notice with Comment Period
Start Printed Page 43840

Addendum V—Categorization of Food and Drug Administration—Allowed Investigational Device Exemptions

Under the Food, Drug, and Cosmetic Act (21 U.S.C. 360c), devices fall into one of three classes. Also, under the new categorization process to assist CMS, the Food and Drug Administration assigns each device with a Food and Drug Administration-approved investigational device exemption to one of two categories. To obtain more information about the classes or categories, please refer to the Federal Register notice published on April 21, 1997 (62 FR 19328).

The following information presents the device number, category (A or B), and criterion code.

Investigational Device Exemption Numbers, October 1999-December 1999

G980094 B4

G990047 A1

G990118 B2

G990128 A

G990135 B2

G990151 B2

G990179 B

G990212 B

G990215 B

G990216 B2

G990217 B4

G990220 B3

G990221 B4

G990224 B4

G990226 A1

G990228 B4

G990234 B2

G990235 A2

G990240 B2

G990243 B2

G990247 B2

G990248 B1

G990250 B4

G990251 B2

G990252 B1

G990258 B4

G990261 B2

G990263 A2

G990267 A1

G990268 B2

G990269 B2

G990270 B2

G990273 B4

G990272 B3

G990275 B4

G990279 B1

G990280 B2

G990282 B4

G990283 B4

G990287 B1

G990288 B4

G990290 B4

G990292 B5

G990294 B3

G990296 B4

G990299 B3

G990300 B4

G990301 B4

G990303 A1

Investigational Device Exemption Numbers, January 2000-March 2000

G 970009 B

G 980242 B

G 990038 A

G 990110  B

G 990154 B

G 990190 B

G 990193 B

G 990208 B

G 990256 A

G 990257 B

G 990259 B

G 990260 B

G 990281 A

G 990304 B

G 990306 B

G 990307 B

G 990309 B

G 990313 B

G 990317 B

G 990321 B

G 990322 B

G 990323 B

G 990324 B

G 990327 B

G 990328 B

G 990329 B

G 990330 B

G 990331 B

G 990332 B

G 990333 B

G 000001 B

G 000002 B

G 000003 B

G 000004 B

G 000005 A

G 000006 B

G 000008 B

G 000010 B

G 000011 B

G 000013 B

G 000014 B

G 000015 B

G 000016 A

G 000017 B

G 000018 B

G 000019 B

G 000020 A

G 000021 B

G 000022 B

G 000023 A

G 000025 B

G 000026 B

G 000030 B

G 000032 B

G 000035 B

G 000036 B

G 000037 B

G 000039 B

G 000042 B

G 000043 B

G 000046 B

G 000049 B

G 000053 B

G 000054 B

G 000055 B

G 000057 B

G 000058 B

G 000059 B

Investigational Device Exemption Numbers, April 2000-June 2000

G 990060 B

G 990092 A

G 990227 B

G 990238 B

G 990297 B

G 990318 B

G 990325 B

G 000007 B

G 000050 B

G 000062 B

G 000063 B

G 000064 B

G 000065 B

G 000070 B

G 000073 B

G 000075 B

G 000076 B

G 000077 B

G 000078 B

G 000079 B

G 000080 B

G 000081 B

G 000082 B

G 000083 B

G 000084 B

G 000085 B

G 000094 B

G 000097 B

G 000101 B

G 000102 B

G 000106 B

G 000107 B

G 000108 B

G 000111 B

G 000112 B

G 000115 A

G 000118 B

G 000119 B

G 000121 B

G 000122 B

G 000125 A

G 000126 B

G 000128 B

G 000136 B

G 000139 B

G 000140 B

G 000141 B

G 000143 B

G 000145 B

G 000147 B

Investigational Device Exemption Numbers, July 2000-September 2000

G 99027 B

G 990320 B

G 000052 B

G 000068 B

G 000074 B

G 000109 B

G 000129 A

G 000152 B Start Printed Page 43841

G 000153 B

G 000156 B

G 000157 B

G 000158 B

G 000162 B

G 000164 B

G 000165 B

G 000168 B

G 000173 B

G 000175 B

G 000177 B

G 000179 B

G 000184 B

G 000190 B

G 000192 B

G 000195 B

G 000200 B

G 000201 B

G 000202 B

G 000204 B

G 000206 B

G 000207 A

G 000210 A

G 000211 B

G 000219 B

G 000221 B

G 000223 B

G 000224 A

G 000225 B

G 000231 B

Investigational Device Exemption Numbers, October 2000-December 2000

G 980253 B

G 990021 B

G 990191 B

G 990235 B

G 990302 B

G 000061 B

G 000137 A

G 000169 B

G 000176 B

G 000178 B

G 000217 B

G 000228 B

G 000229 B

G 000230 B

G 000234 B

G 000237 B

G 000238 B

G 000240 B

G 000245 B

G 000246 B

G 000248 A

G 000249 A

G 000253 B

G 000255 B

G 000256 B

G 000257 B

G 000258 B

G 000261 B

G 000264 B

G 000265 B

G 000266 B

G 000267 B

G 000268 B

G 000269 A

G 000272 B

G 000275 B

G 000276 B

G 000277 B

G 000278 B

G 000280 B

G 000281 B

G 000282 B

G 000284 B

G 000285 B

G 000287 B

G 000290 B

G 000203 B

G 000296 B

G 000297 B

G 000298 B

G 000299 B

G 000308 B

G 000311 B

Investigational Device Exemption Numbers, January 2001-March 2001

G000012 B

G000071 B

G000187 B

G000209 B

G000247 B

G000291 B

G000307 B

G000309 B

G000312 B

G000315 B

G000316 B

G000319 B

G000320 B

G000322 B

G000323 B

G000324 A

G000325 B

G000326 B

G000328 B

G000329 A

G000331 B

G000332 A

G000333 B

G010002 B

G010003 B

G010007 B

G010012 B

G010013 A

G010018 B

G010020 B

G010021 B

G010024 B

G010025 B

G010027 B

G010028 B

G010031 B

G010037 B

G010039 B

G010040 B

G010041 B

G010042 B

G010043 B

G010045 B

G010048 B

G010050 B

G010051 B

G010053 B

G010054 B

G010056 A

G010057 B

G090014 A

G960194 B

G970097 B

G980034 B

G980223 B

G990025 B

G990034 B

G990188 B

Investigational Device Exemption Numbers, April 2001-June 2001

G000103 B

G010006 B

G010011 B

G010019 B

G010032 B

G010059 A

G010060 B

G010061 B

G010062 B

G010064 A

G010067 B

G010068 B

G010070 B

G010071 B

G010072 B

G010073 B

G010074 B

G010077 B

G010078 B

G010081 B

G010083 B

G010084 B

G010088 B

G010089 B

G010090 B

G010091 B

G010099 A

G010101 B

G010102 B

G010103 B

G010104 B

G010107 B

G010108 B

G010109 B

G010110 B

G010113 B

G010115 B

G010116 B

G010120 B

G010121 A

G010122 B

G010123 B

G010124 B

G010125 B

G010126 B

G010128 B

G010129 B

G010132 B

G010136 B

G010136 B

G010138 B

G010139 B

G010140 B

G010141 B

G010142 B

G010145 B

G010149 B Start Printed Page 43842

G980228 B

Investigational Device Exemption Numbers, July 2001-September 2001

G960015 B

G970299 B

G980164 B

G990092 B

G990263 B

G000060 B

G000243 A

G000321 B

G010017 B

G010079 B

G010114 B

G010133 B

G010147 B

G010148 B

G010151 B

G010152 B

G010156 B

G010160 B

G010164 B

G010166 B

G010167 B

G010169 B

G010174 B

G010177 B

G010180 B

G010184 B

G010185 B

G010186 B

G010189 B

G010190 B

G010191 B

G010195 B

G010198 B

G010199 B

G010200 A

G010202 B

G010204 B

G010205 B

G010206 B

G010208 A

G010211 B

G010213 B

G010214 B

G010219 B

G010224 B

G010225 B

G010226 B

G010229 B

G010232 B

G010236 B

G010253 B

Investigational Device Exemption Numbers, October 2001-December 2001

G000123 B

G001027 B

G010066 B

G010196 B

G010208 B

G010209 B

G010234 B

G010237 B

G010238 B

G010239 B

G010240 B

G010243 B

G010244 B

G010245 B

G010246 B

G010247 B

G010248 B

G010251 B

G010254 B

G010257 B

G010259 B

G010262 B

G010263 B

G010264 B

G010268 B

G010269 B

G010270 A

G010272 B

G010276 B

G010277 B

G010278 B

G010280 B

G010282 B

G010283 B

G010284 B

G010285 B

G010286 B

G010287 B

G010288 B

G010289 B

G010291 B

G010292 B

G010294 B

G010295 B

G010296 B

G010297 B

G010300 B

G010301 B

G010302 B

G010303 B

G010304 B

G010308 B

G010310 B

G010311 B

G010313 A

G010315 B

G010316 B

G010318 B

G010319 B

G010333 B

G010334 B

Investigational Device Exemption Numbers, January 2002-March 2002

G990204 B

G000279 B

G010033 B

G010075 B

G010197 B

G010250 B

G010252 A

G010255 B

G010261 B

G010273 B

G010274 B

G010290 B

G010312 B

G010324 B

G010330 B

G010331 B

G010337 B

G010338 B

G010340 A

G010341 B

G010343 B

G010344 B

G010345 B

G010348 B

G010349 A

G010351 B

G010356 B

G020001 B

G020002 B

G020003 B

G020005 B

G020004 B

G020006 B

G020008 B

G020009 B

G020010 B

G020011 B

G020016 B

G020017 B

G020019 B

G020022 B

G020024 B

G020026 B

G020027 B

G020028 B

G020029 B

G020033 B

G020036 B

G020037 B

G020040 A

G020041 B

G020044 B

Addendum VI—National Coverage Determinations

A national coverage determination (NCD) is a determination by the Secretary with respect to whether or not a particular item or service is covered nationally under Title XVIII of the Social Security Act, but does not include a determination of what code, if any, is assigned to a particular item or service covered under this title or a determination with respect to the amount of payment made for a particular item or service so covered. We include below all of the NCDs that have been effective since June 28, 1999, the effective date of Medicare's new coverage process. Please note that because we order the NCDs by effective date, some of the decisions are dated later than March 2002, the terminus for most of the other information listed in this notice. The entries below include information concerning completed decisions as well as sections on program and decision memoranda, which also announce impending decisions or, in some cases, explain why it was not appropriate to issue a NCD. We identify completed decisions by title, effective date, and section of the publication where the decision can be found. Also, Start Printed Page 43843please note that in some cases more than one NCD was made affecting a single procedure. Information on completed decisions as well as pending decisions has also been posted on the CMS website at http://www.hcfa.gov/​coverage.

National Coverage Determinations

[July 1999-July 2002]

Coverage Issues Manual HCFA Pub. 06 SectionTitleEffective date
35-74Enhanced External Counterpulsation (EECP)July 1, 1999.
35-82Pancreas TransplantsJuly 1, 1999.
35-85.1Implantation of Automatic DefibrillatorsJuly 1, 1999.
Transmyocardial Revascularization (TMR) for Treatment of Severe AnginaJuly 1, 1999.
35-96Cryosurgery of the ProstateJuly 1, 1999.
50-14Magnetic Resonance AngiographyJuly 1, 1999.
50-36Positron Emission Tomography (PET)July 1, 1999.
50-54Cardiac Output Monitoring by Electrical BioimpedanceJuly 1, 1999.
Vagus Nerve Stimulation for the Treatment of SeizuresJuly 1, 1999.
35-53Adult Liver TransplantationDecember 10, 1999.
50-55Prostate Cancer Screening TestsJanuary 1, 2000.
StimulationApril 1, 2000.
35-48.1 35-74External Counterpulsation (ECP) for Severe AnginaApril 1, 2000.
60-14Infusion PumpsApril 1, 2000.
30-1Routine Costs of Clinical TrialsSeptember 19, 2000.
35-30.1Stem Cell TransplantationOctober 1, 2000.
35-82Pancreas TransplantsOctober 1, 2000.
35-90Extracorporeal Immunoadsorption (ECI) Using Protein A ColumnsOctober 1, 2000.
60-19Air-Fluidized Beds (AFB's)November 1, 2000.
45-29Intravenous Iron TherapyDecember 1, 2000.
35-48Osteogenic StimulationJanuary 1, 2001.
60-9Durable Medical Equipment Reference ListJanuary 1, 2001.
60-23Speech Generating DevicesJanuary 1, 2001.
65-15Artificial Hearts & Related DevicesJanuary 1, 2001.
80-2Diabetes Outpatient Self-Management TrainingFebruary 27, 2001.
60-24Non-Implantable Pelvic Floor Electrical StimulationApril 1, 2001.
35-100Photodynamic TherapyJuly 1, 2001.
45-30Photosensitive DrugsJuly 1, 2001.
50-36Position Emission Tomography (PET) ScansJuly 1, 2001.
50-32Percutaneous Transluminal Angioplasty (PTA)July 1, 2001.
35-27.1Biofeedback Therapy for the Treatment of Urinary IncontinenceJuly 1, 2001.
35-96Cryosurgery of the ProstateJuly 1, 2001.
35-53Adult Liver TransplantationSeptember 1, 2001.
45-29Intravenous Iron TherapyOctober 1, 2001.
35-74External Counterpulsation (ECP) for Severe AnginaNovember 15, 2001.
35-101Treatment of Actinic Keratosis (AK)November 26, 2001.
60-14Infusion PumpsJanuary 1, 2002.
65-18Sacral Nerve StimulationJanuary 1, 2002.
50-36Position Emission Tomography (PET) ScansJanuary 1, 2002.
60-16Pneumatic Compression DevicesJanuary 14, 2002.
50-42Ambulatory Blood Pressure MonitoringApril 1, 2002.
60-17Continuous Positive Airway Pressure (CPAP)April 1, 2002.
60-25Warm-Up Wound TherapyJuly 1, 2002.
50-8.1Services Provided for the Diagnosis and Treatment of Diabetic Sensory Neuropathy With Loss of Protective Sensation (aka Diabetic Peripheral Neuropathy)July 1, 2002.
50-56Home Prothrombin Time International Normalized Ration (INR) Monitoring for Anticoagulation ManagementJuly 1, 2002.

Program Memorandum

PM No.TitleEffective date
AB-01-58, reissued as AB-02-040Intestinal and Multivisceral TransplantationJuly 1, 2001.
AB-00-95, reissued as AB-01-150Criteria for Medical Approval of Transplant CentersOctober 11, 2000.

Joint Letter and Federal Register Publications

DateTitleEffective date
June 15, 2001Liver Transplants in Non-Approved Centers During the Emergency in HoustonJune 15, 2001.
Start Printed Page 43844
66 FR 33030-33031HCFA-3074-F: Medicare Program; End Stage Renal Disease—Waiver of Conditions for Coverage under a State of Emergency in Houston, Texas AreaJune 15, 2001.

Decision Memoranda Announcing Maintenance of Existing National Coverage Determination

The following decision memoranda announce the agency's intention to issue NCDs or they announce the agency's determination that NCDs are inappropriate and thus reasonable and necessary determinations are left to contractor discretion. The relevant sections of the Coverage Issues Manual, however, have not yet been revised. The revisions will occur at a later date.

Date of MemoTitleCIM section
September 27, 1999Prolotheraphy for Chronic Low Back Pain35-13
October 18, 1999Helicobactor Pylori Testingn/a
March 20, 2001Cardiac Pacemakers65-6
May 21, 2001Noninvasive Positive Pressure RADs for COPD Patientsn/a
November 1, 2001Cardiac Pacemakers65-6
February 19, 2002Air Fluidized Beds60-19
February 28, 2002Home Biofeedback for Urinary Incontinence35-27.1
March 29, 2002Ocular Photodynamic Therapy with Verteporfin35-100, 45-30
April 30, 2002Adult Liver Transplantation35-53
End Supplemental Information

[FR Doc. 02-16147 Filed 6-27-02; 8:45 am]

BILLING CODE 4120-01-P