Anesthesia Billing Inc
1715 Medical Pkwy
Newton KS 67114
December 7, 2010
Effective January 1, 2011, CPT 77003 (fluoroguide) can no longer be billed in addition to CPT’s 64479-64484 (injections), the fluoroguide will be considered inclusive to the injection; therefore, you will not be reimbursed separately for 77003. We have started contacting the various payors to see how they will be handling this change, especially where reimbursement is concerned (i.e. if they will be adjusting the allowables for 64479-64484 to account for the loss in revenue from 77003). We will keep you updated as new information arises.
CMS Provider Change Reporting Responsibility:
Just as a reminder, CMS (Centers for Medicare and Medicaid Services) requires they be notified of all changes made within a Provider’s office that are considered reportable events. A reportable event is any change that affects information in a Medicare enrollment record.
Reportable Events that must be reported within 30 days:
• Change in Ownership or Control
• Changes in Practice Location (includes adding Practice Locations) - establish a new practice location, move an existing practice location, close an existing practice location, or change any portion of an existing practice location address where Medicare information is sent
• Change in Final Adverse Action – debarment or exclusion by any Federal or State healthcare program, have his or her medical license suspended or revoked by a State licensing authority, convicted of a felony within the last 10 years, have his or her Medicare billing privileges revoked by a Medicare contractor, or have a revocation or suspension by an accreditation organization.
Reportable Events that must be reported within 90 days:
• Change of Business Structure – any change to his or her business structure (e.g., sole proprietorship to sole incorporated owner or vice versa).
• Change in Organization Legal/Tax ID Number - when a business owner changes the organization’s legal business name and/or Taxpayer Identification Number with the Internal Revenue Service.
• Change in Practice Status - decides to retire or voluntarily withdraw from the Medicare Program. This type of change is referred to as a voluntary withdrawal.
• Change in Reassignment of Benefits - adds or voluntarily withdraws his or her reassignment of Medicare benefits.
• Change in Banking Arrangements or any Payment Information - changes to his or her bank or bank account or makes other payment information changes. This type of change should be reported immediately to the Medicare contractor. A non-physician practitioner can update his or her electronic funds transfer information by submitting the Electronic Funds Transfer Authorization Agreement (CMS-588) to his or her Medicare contractor.
Please be advised if these changes are not reported to CMS in a timely fashion, the following could be affected:
• Claims Processing
• Claims Payment
• Provider’s eligibility to participate in the Medicare program for up to two years
If you would like more information, please feel free to call our office or go to:
http://www.cms.hhs.gov/MedicareProviderSupEnroll - Scroll towards the bottom of the page and open the pdf link for “Individual Physician (or Non-Physician) Reporting Responsibilities Fact Sheet”.
Please be sure all reportable events are sent to CMS. If you would like our office to assist in reporting your change(s), please be sure to contact us. We can help fill out the necessary paperwork and in turn send you what you need to sign and send to CMS. We are more than happy to help anyway we can.
abinsights readers are invited to submit comments, questions, tips, and suggestions for articles on any subject related to billing, collections, coding, reimbursement, and compliance. Send to: Anesthesia Billing, Inc., P O Box 388, Newton, KS 67114-0388.
Our purpose is to help you meet inevitable challenges. We hope to deliver practical knowledge and solutions drawn from top resources and business publications in every issue, knowledge you can use today.
Reasonable attempts have been made to be accurate. However, medical billing, collections, coding and compliance are part science, part art, and even experts sometimes differ. Neither Anesthesia Billing, Inc., the editors, publisher, contributors, or consultants warrant or guarantee the information contained will be applicable or appropriate in all situations. For information specific to your practice, consult a qualified professional.
The information included in this publication is provided, among other things, to alert you to legal developments and should not be considered legal advice. Specific questions about how this information affects your particular situation should be addressed to your attorney.
Editor: Philip Blann (firstname.lastname@example.org).