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November 2007 Client Newsletter

NPI #’s
CMS finally released the NPI number registry on September 5, 2007 & we are working on loading all referring physician NPI #’s in our database. CPB, as has nearly every other practice and billing service, continues to deal with various related minor insurance company NPI # issues. This is because CMS gave every insurance company in the USA (over 2,000 of them!) the latitude to decide when they will require various NPI # & related fields to be sent. So far, all such issues have been successfully addressed.

New Patient Visits Definition

The CPT book defines New Patient as a patient not seen within the previous 3 years. Billing a new patient office visit code (99201-99205) within that timeframe is considered fraud. Even if a patient was seen for an MVA or a Workman's Comp case, this does not make them a new patient unless they are beyond the three-year period.

If a CPB client sends through such a charge we will fax you a request to verify the proper established office visit code (99211-99215) to bill.

Medicare Edits

NGS Medicare – the NJ Medicare Carrier sent this email on October 11, 2007.

“The following is effective immediately and also impacts pending claims already in the Multi-Carrier System (MCS).

If the beneficiary name and the Health Insurance Claim Number (HICN) submitted on a claim do not exactly match what appears on the patient's Medicare card, then the claim will reject. For example, if the submitted claim reads "Jane Doe" but the Medicare card reads "Jane M. Doe'" the claim will not process. It is required that the information match exactly.

The Claims Processing Manual, Chapter 1, Section - Carrier Data Element Requirements, states: "Carriers must return a claim as unprocessable to a provider of service or supplier and use the indicated remark codes if the claim is returned through remittance advice or notice process."

Item #2 under this paragraph goes on to state: "If a claim lacks a valid patient's last and first name as seen on the patient's Medicare card or contains an invalid patient's last and first name as seen on the patient's Medicare card."

CPB STRONGLY recommends that your staff begin to make a copy of ALL patient Medicare cards and send them to CPB – even for established patients – so we can ensure all patient files are current to avoid rejections.


Received via email on October 12, 2007 from NHIC – the DMERC A Carrier (yes it was after the fact!):

“Effective October 2, 2007, provider's receiving EFT payments from NHIC will no longer see "NHIC MEDICARE PART B" printed on their bank statements. This wording will be replaced with NHIC's tax identification number (751532981). The check number will continue to be printed.


NEW TRN*1*881234567*751532981

These changes will have no effect on a provider's Medicare payments.”

CMS Proposes A New System of Records

On Wednesday, September 12, 2007, the Department of Health and Human Services through the Centers for Medicare and Medicaid proposed to establish a new system of records titled, "Performance Measurement and Reporting System (PMRS), System No. 09-70-0584."

The PMRS will serve as a master system of records to assist in projects to provide transparency in health care on a broad-scale. This enables consumers to compare the quality and the price of health care services so they can make informed choices among individual physicians, practitioners and providers of services.

CMS or a non-Quality Improvement Organization (non-QIO) contractor would make individual physician-level performance measurement results available to Medicare beneficiaries by posting it on a public Website and other various methods of data dissemination. The purpose of disclosing individual-specific information is to promote more informed choices by Medicare beneficiaries about their Medicare coverage options. Furthermore, CMS does not anticipate an unfavorable effect on individual privacy because PMRS would be established in accordance with the principles and requirements of the Privacy Act of 1974.

The new system, including routine uses, will become effective 30 days from the September 12th Federal Register publication of the notice, or from the date it was submitted to the OMB and Congress, whichever is later, unless CMS receives comments that require alterations to the notice. CMS accepts comments on all portions of the notice.

The public should address comments to: CMS Privacy Officer, Division of Privacy Compliance, Enterprise Architecture and Strategy Group, Office of Information Services, CMS, Room N2-04-27, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.

The September 12, 2007, Federal Register announcement includes detailed descriptions of each section of the notice. It is available at:
2007 Client Newsletter Archive