Department of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 3438 Date: January 8, 2016

Transcription

1 anual ystem Pub edicare laims Processing epartment of ealth & uman ervices () enters for edicare & edicaid ervices () Transmittal 3438 ate: January 8, 2016 hange Request 9495 UBJT: mergency Update to the Y 2016 edicare Physician ee chedule atabase (PB). URY O NG: Payment files were issued to contractors based on the Y 2016 edicare Physician ee chedule inal Rule. This change request amends those payment files in order to correct technical errors to the P update files, and to include corrections described in the Y 2016 P inal Rule orrection Notice. Please note that the work related to this hange Request has already been done by the edicare contractors via a previous direction, which was implemented on January 4, Therefore, the implementation date is prior to the release date of this hange Request. TV T: January 1, 2016 *Unless otherwise specified, the effective date is the date of service. PLNTTON T: January 4, 2016 isclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. ny other material was previously published and remains unchanged. owever, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents.. NG N NUL NTRUTON: (N/ if manual is not updated) R=RV, N=NW, =LT-Only One Per Row. R/N/ N/ PTR / TON / UBTON / TTL N/. UNNG: or edicare dministrative ontractors (s): The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements. V. TTNT: Recurring Update Notification

2 ttachment - Recurring Update Notification Pub Transmittal: 3438 ate: January 8, 2016 hange Request: 9495 UBJT: mergency Update to the Y 2016 edicare Physician ee chedule atabase (PB) TV T: January 1, 2016 *Unless otherwise specified, the effective date is the date of service. PLNTTON T: January 4, GNRL NORTON. Background: Payment files were issued to contractors based upon the alendar Year (Y) 2016 edicare Physician ee chedule (P) inal Rule, displayed on October 30, 2015, and published in the ederal Register on November 16, This change request amends those payment files in order to include corrections described in the Y 2016 P orrection Notice, and correct technical errors to the P update files. B. Policy: ome Relative Value Units published in the Y 2016 P inal Rule have been revised to align their values with the Y 2016 P inal Rule policies. These changes are discussed in the Y 2016 P inal Rule orrection Notice. n addition, there were corrections made to invalid or missing payment indicators for several procedure codes. The amended 2016 P payment files reflect all these changes for services furnished on or after January 1, BUN RQURNT TBL "hall" denotes a mandatory requirement, and "should" denotes an optional requirement. Number Requirement Responsibility /B hared- ystem aintainers ontractors shall retrieve the revised payment files, as identified in this R, from the ainframe Telecommunications ystem. ontractors will be notified via when these files are available for retrieval. B V W Other Notification of successful receipt shall be sent via to price_file_receipt@cms.hhs.gov stating the name of the file received and the entity for which it was received (e.g., edicare contractor name and number) ontractors shall begin to pay claims using these new files no later than January 4, 2016, unless otherwise directed by The revised P fees are effective January 1, 2016.

3 Number Requirement Responsibility /B hared- ystem aintainers ontractors shall disclose the revised P fees on their Web sites as soon as possible, but no later than 10 business days after installing the new files into production. B V W Other will send W files to facilitate duplicate billing edits: 1) uplicate Radiology editing; 2) uplicate iagnostic editing; 3) uplicate Pathology editing, and; 4) RVU and payment indicator files. W will be notified via when these files have been sent to them. W shall compare the existing file to the new file and install any necessary changes. X. PROVR UTON TBL Number Requirement Responsibility LN rticle: provider education article related to this instruction will be available at Network-LN/LNattersrticles/ shortly after the R is released. You will receive notification of the article release via the established "LN atters" listserv. ontractors shall post this article, or a direct link to this article, on their Web sites and include information about it in a listserv message within 5 business days after receipt of the notification from announcing the availability of the article. n addition, the provider education article shall be included in the contractor's next regularly scheduled bulletin. ontractors are free to supplement LN atters articles with localized information that would benefit their provider community in billing and administering the edicare program correctly. /B B V. UPPORTNG NORTON ection : Recommendations and supporting information associated with listed requirements: "hould" denotes a recommendation. X-Ref Requirement Number Recommendations or other supporting information:

4 X-Ref Requirement Number Recommendations or other supporting information: N/ ection B: ll other recommendations and supporting information: The following 2016 PB correction notice files for changes effective January 1, 2016, are available on the mainframe: bstract iles nesthesia onversion actors Physician ee chedule s a courtesy, the following change files will be available as a reference for the s on the mainframe as soon as 1/7/16, and the WG will be notified as soon as they are posted: U00.@B PRNT1.V0106 U00.@B PRNT1.V0106 V. ONTT Pre-mplementation ontact(s): Kathleen Kersell, or kathleen.kersell@cms.hhs.gov (ontact for payment policy questions.), harles ampbell, or charles.campbell@cms.hhs.gov (ontact for PB file issues.) Post-mplementation ontact(s): ontact your ontracting Officer's Representative (OR). V. UNNG ection : or edicare dministrative ontractors (s): The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements.

5 TTNT: 0