Quarterly Provider Updates

QPU January 2007

The Quarterly Provider Update provides a listing of Agency regulations and meeting notices. Non-regulatory changes to the Medicare and Medicaid programs, consisting of manual instructions, are also included in this listing.

File Name Subject Publication/Implementation Date Quarterly Release Date
CMS-3169-N Request for Nominations for Members for the Medicare Coverage Advisory Committee 01/26/2007 01/02/2007
CMS-4126-FN Reapproval of Deeming Authority of the Accreditation Association for Ambulatory Health Care, Inc. (AAAHC) for Medicare Advantage HMOs and Local PPOs 01/26/2006 01/02/2007
R1099CP New Edits Established to Enforce Proper Transfer Coding and Payment in Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) Claims 04/02/2007 01/02/2007
R1107CP Notification and Testing of an Integrated Outpatient Code Editor (OCE) for the July 2007 Release 07/02/2007 04/02/2007
R1107CP Notification and Testing of an Integrated Outpatient Code Editor (OCE) for the July 2007 Release 07/02/2007 01/02/2007
R1107CP Notification and Testing of an Integrated Outpatient Code Editor (OCE) for the July 2007 Release 07/02/2007 01/02/2007
R1109CP Skilled Nursing Facility (SNF) Consolidated Billing (CB) Common Working File (CWF) Edit Bypass Instructons for Hospital Emergency Room (ER) Services Spanning Multiple Service Dates 04/02/2007 01/02/2007
R50DEMO Laboratory Competitive Bidding Demonstration (Second Phase of Implementation) 04/02/2007 01/02/2007
R1098CP Common Working File (CWF) Duplicate Claim Edit for the Technical Component (TC) of Radiology and Pathology Laboratory Services Provided to Hospital Patients 04/02/2007 01/02/2007
R62BP Private Contracting- Definition of Physician/Practitioner 04/02/2007 01/02/2007
R1136CP Revisions to Procedure to Establish Good Cause and Qualified Independent Contractor Jurisdictions 04/02/2007 01/02/2007
CMS-3140-P Requirements for Long Term Care Facilities: Hospice Services N/A 01/02/2007
R1107CP Notification and Testing of an Integrated Outpatient Code Editor (OCE) for the July 2007 Release 07/02/2007 04/02/2007
R243OTN Reporting the National Provider Identifier (NPI) on Physician Claims for Diagnostic Services Purchased Outside of the Local Carrier's Jurisdiction 04/02/2007 01/02/2007
CMS-4124-P Revisions to the Medicare Advantage and Part D Prescription Drug Contract (Compliance Rule) N/A 01/02/2007
R1107CP Notification and Testing of an Integrated Outpatient Code Editor (OCE) for the July 2007 Release 07/02/2007 04/02/2007
R1098CP Common Working File (CWF) Duplicate Claim Edit for the Technical Component (TC) of Radiology and Pathology Laboratory Services Provided to Hospital Patients 04/02/2007 01/02/2007
R1081CP Electronic Data Interchange (EDI) Media Changes 04/02/2007 01/02/2007
R1107CP Notification and Testing of an Integrated Outpatient Code Editor (OCE) for the July 2007 Release 07/02/2007 01/02/2007
CMS-1810-F Physician Referrals to Health Care Entities With Which They Have Financial Relationships N/A 01/02/2007
CMS-4130-P Policy and Technical Changes to the Medicare Prescription Drug Benefit N/A 01/02/2007
R1107CP Notification and Testing of an Integrated Outpatient Code Editor (OCE) for the July 2007 Release 07/02/2007 04/02/2007
R1109CP Skilled Nursing Facility (SNF) Consolidated Billing (CB) Common Working File (CWF) Edit Bypass Instructons for Hospital Emergency Room (ER) Services Spanning Multiple Service Dates 04/02/2007 01/02/2007
R243OTN Reporting the National Provider Identifier (NPI) on Physician Claims for Diagnostic Services Purchased Outside of the Local Carrier's Jurisdiction 04/02/2007 01/02/2007
R1107CP Notification and Testing of an Integrated Outpatient Code Editor (OCE) for the July 2007 Release 07/02/2007 04/02/2007
R1107CP Notification and Testing of an Integrated Outpatient Code Editor (OCE) for the July 2007 Release 07/02/2007 01/02/2007
R1098CP Common Working File (CWF) Duplicate Claim Edit for the Technical Component (TC) of Radiology and Pathology Laboratory Services Provided to Hospital Patients 04/02/2007 01/02/2007
R1107CP Notification and Testing of an Integrated Outpatient Code Editor (OCE) for the July 2007 Release 07/02/2007 04/02/2007
R1107CP Notification and Testing of an Integrated Outpatient Code Editor (OCE) for the July 2007 Release 07/02/2007 01/02/2007
CMS-1270-F Competitive Acquisition for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies N/A 01/02/2007
R1107CP Notification and Testing of an Integrated Outpatient Code Editor (OCE) for the July 2007 Release 07/02/2007 04/02/2007
R1084CP Line Item Billing Requirement for End Stage Renal Disease (ESRD) Claims 04/01/2007 01/02/2007
CMS-2258-P Cost Limit for Providers Operated by Units of Government and Provisions To Ensure the Integrity of Federal-State Financial Partnership 01/18/2007 01/02/2007
CMS-1529-P Prospective Payment System for Long-Term Care Hospitals RY 2008: Annual Payment Rate Updates 02/01/2007 01/02/2007
R1144CP Elimination of CMS-1491 and CMS-1490U Forms 04/02/2007 01/02/2007
R1144CP Elimination of CMS-1491 and CMS-1490U Forms 04/02/2007 01/02/2007
R1144CP Elimination of CMS-1491 and CMS-1490U Forms 04/02/2007 01/02/2007
R1144CP Elimination of CMS-1491 and CMS-1490U Forms 04/02/2007 01/02/2007
R1144CP Elimination of CMS-1491 and CMS-1490U Forms 04/02/2007 01/02/2007
R1144CP Elimination of CMS-1491 and CMS-1490U Forms 04/02/2007 01/02/2007
R1144CP Elimination of CMS-1491 and CMS-1490U Forms 04/02/2007 01/02/2007
CMS-1488-CN2 Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2007 Rates; Final Fiscal Year 2007 Wage Indices and Payment Rates After Application of Revised Occupational Mix Adjustment to the Wage Index; Corrections 01/05/2007 01/02/2007
R1147CP Intracranial Percutaneous Transluminal Angioplasty (PTA) With Stenting 02/05/2007 01/02/2007
R1147CP Intracranial Percutaneous Transluminal Angioplasty (PTA) With Stenting 02/05/2007 01/02/2007
R64NCD Intracranial Percutaneous Transluminal Angioplasty (PTA) With Stenting 02/05/2007 01/02/2007
R64NCD Intracranial Percutaneous Transluminal Angioplasty (PTA) with Stenting 02/05/2007 01/02/2007
R259OTN Additional Codes for Physician Voluntary Reporting Program (PVRP) 01/02/2007 01/02/2007
R1148CP Tax Relief and Health Care Act of 2006 Changes to Independent Laboratory Billing for the Technical Component (TC) of Physician Pathology Services 02/05/2007 01/02/2007
R1153CP Claim Status Category Code and Claim Status Code Update 04/02/2007 01/02/2007
R1153CP Claim Status Category Code and Claim Status Code Update 04/02/2007 01/02/2007
R1156CP Revised Medicare Zip Code File to Download 02/05/2007 01/02/2007
R1156CP Revised Medicare Zip Code File to Download 02/05/2007 01/02/2007
R1156CP Revised Medicare Zip Code File to Download 02/05/2007 01/02/2007
R1156CP Revised Medicare Zip Code File to Download 02/05/2007 01/02/2007
R1154CP Healthcare Provider Taxonomy Codes (HPTC) Update 04/02/2007 01/02/2007
R1154CP Healthcare Provider Taxonomy Codes (HPTC) Update 04/02/2007 01/02/2007
R113FM Notice of New Interest Rate for Medicare Overpayments and Underpayments-2nd Qtr. FY 2007 01/19/2007 01/02/2007
R1151CP Skilled Nursing Facility (SNF) Consolidated Billing (CB) Common Working File (CWF) Edit Bypass Instructons for Hospital Emergency Room Services Spanning Multiple Service Dates 04/02/2007 01/02/2007
R1151CP Skilled Nursing Facility (SNF) Consolidated Billing (CB) Common Working File (CWF) Edit Bypass Instructons for Hospital Emergency Room Services Spanning Multiple Service Dates 04/02/2007 01/02/2007
R52DEMO Chiropractic Demonstration 2007 Rate Change 01/02/2007 01/02/2007
R1155CP January 2007 Outpatient Prospective Payment System (OPPS) Outpatient Code Editor (OCE) Specifications Version 8.0 01/02/2007 01/02/2007
R1155CP January 2007 Outpatient Prospective Payment System (OPPS) Outpatient Code Editor (OCE) Specifications Version 8.0 01/02/2007 01/02/2007
R1155CP January 2007 Outpatient Prospective Payment System (OPPS) Outpatient Code Editor (OCE) Specifications Version 8.0 01/02/2007 01/02/2007
R1155CP January 2007 Outpatient Prospective Payment System (OPPS) Outpatient Code Editor (OCE) Specifications Version 8.0 01/02/2007 01/02/2007
R1155CP January 2007 Outpatient Prospective Payment System (OPPS) Outpatient Code Editor (OCE) Specifications Version 8.0 01/02/2007 01/02/2007
R1155CP January 2007 Outpatient Prospective Payment System (OPPS) Outpatient Code Editor (OCE) Specifications Version 8.0 01/02/2007 01/02/2007
R1155CP January 2007 Outpatient Prospective Payment System (OPPS) Outpatient Code Editor (OCE) Specifications Version 8.0 01/02/2007 01/02/2007
R1155CP January 2007 Outpatient Prospective Payment System (OPPS) Outpatient Code Editor (OCE) Specifications Version 8.0 01/02/2007 01/02/2007
R1155CP January 2007 Outpatient Prospective Payment System (OPPS) Outpatient Code Editor (OCE) Specifications Version 8.0 01/02/2007 01/02/2007
R1150CP January 2007 Non-Outpatient Prospective Payment System (Non-OPPS) Outpatient Code Editor (OCE) Specifications Version 22.1 01/02/2007 01/02/2007
R1152CP Emergency Update to the 2007 Medicare Physician Fee Schedule Database 01/02/2007 01/02/2007
R1152CP Emergency Update to the 2007 Medicare Physician Fee Schedule Database 01/02/2007 01/02/2007
R1152CP Emergency Update to the 2007 Medicare Physician Fee Schedule Database 01/02/2007 01/02/2007
R23SOMA Revisions to Chapter 4 02/20/2007 01/19/2007
CMS-1535-CN2 Hospice Wage Index for Fiscal Year 2007; Correction 01/26/2007 01/02/2007
CMS-4105-CN Medicare Program; Notification of Hospital Discharge Appeal Rights 01/26/2007 01/02/2007
CMS-1386-N Medicare Program; Meeting of the Practicing Physicians Advisory Council, March 5, 2007 01/26/2007 01/02/2007
R1161CP Additional Changes to the 2007 Medicare Physician Fee Scheduled Database 02/24/2007 01/02/2007
R1161CP Additional Changes to the 2007 Medicare Physician Fee Scheduled Database 02/24/2007 01/02/2007
R1161CP Additional Changes to the 2007 Medicare Physician Fee Scheduled Database 02/24/2007 01/02/2007
R1163CP Remittance Advice Remark Code (RARC) and Claim Adjustment Reason Code CARC) Update 04/02/2007 01/02/2007
R1165CP Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from CLIA Edits 04/02/2007 01/02/2007
R1164CP Coding Change for Lumbar Artificial Disc Replacement (LADR) 03/13/2007 01/02/2007
R1166CP Correction to the Inpatient Psychiatric Facility Prospective Payment System (1PF PPS) Pricer 04/02/2007 01/02/2007
R187PI Implementation of New Compliance Standards for Independent DTFs 02/26/2007 01/02/2007
R1168CP Use of 9-Digit Zip Codes for Determining the Correct Payment Locality for Services Paid Under the MPFS and Anesthesia Services 04/26/2007 01/02/2007
R24SOMA Sunset of Policies for Provider Nominations for an Intermediary and the Provider Requests for a Change of Intermediary 02/26/2007 01/02/2007
R65BP Inpatient Hospital Therapeutic Services 04/02/2007 01/02/2005
R1183CP Infrared Therapy Devices 01/16/2007 01/02/2007
R1183CP Infrared Therapy Devices 01/16/2007 01/02/2007
R1183CP Infrared Therapy Devices 01/16/2007 01/02/2007
R1183CP Infrared Therapy Devices 01/16/2007 01/02/2007
R1182CP April Quarterly Update to 2007 Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement 04/02/2007 01/02/2007
CMS-1391-NC Announcement of an Application From a Hospital Requesting Waiver for Organ Procurement Service Area 02/23/2007 01/02/2007
CMS-1542-N Announcement of New Members of the Advisory Panel on Ambulatory Payment Classification (APC) Groups 02/23/2007 01/02/2007
CMS-1553-N Notice of Supplemental Election Period for Provider Participation in Competitive Acquisition Plan for Part B Drugs 02/23/2007 01/02/2007
CMS-2221-N Medicare, Medicaid, and CLIA Programs; Approval of COLA (Formerly the Commission on Office Laboratory Accreditation) as a CLIA Accreditation Organization 02/23/2007 01/02/2007
CMS-2218-N CLIA Continuance of Approval of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) as an Accrediting Organization 02/23/2007 01/02/2007
CMS-1544-N Public Meetings in CY 2007 for All New Public Requests for Revisions to the Healthcare Procedure Coding System (HCPCS) Coding and Payment Determinations 02/23/2007 01/02/2007
CMS-1383-N2 Listening Session on the Draft Plan for Medicare Hospital Value Based Purchasing, April 12, 2007 02/23/2007 01/02/2007
R1186CP Update Chapter 30 Language: New QIC Process and New Amount in Controversy (AIC) 05/23/2007 01/02/2007
R1187CP Revisions to Incomplete or Invlid Claims Instructions Necessary to Implementt Revised Health Insurance Form CMS-1500 05/23/2007 01/02/2007
R65NCD INDEPENDENCE iBOT 4000 Mobility System 04/02/2007 01/02/2007
R66BP Services Not Provided Within United States 04/02/2007 01/02/2007
R66BP Services Not Provided Within United States 04/02/2007 01/02/2007
R66BP Services Not Provided Within United States 04/02/2007 01/02/2007
R66BP Services Not Provided Within United States 04/02/2007 01/02/2007
R1185CP Ambulance Fee Schedule-Medical Conditions List - Manualization Revisions 04/02/2007 01/02/2007
CMS-6003-P2 Appeals of CMS or Contractor Determination When a Provider or Supplier Fails to Meet the Requirements for Medicare Billing 03/02/2007 01/02/2007
R1188CP April Update to the 2007 Medicare Physician Fee Schedule Database 04/02/2007 01/02/2007
R1188CP April Update to the 2007 Medicare Physician Fee Schedule Database 04/02/2007 01/02/2007
R1192CP Payment and Billing for Islet Isolation Add-On in National Institutes of Health (NIH) Clinical Trial 04/02/2007 01/02/2007
R1194CP Temporary Addition to the ASCA Exception List for MSP Claims 04/09/2007 01/02/2007
R1194CP Temporary Addition to the ASCA Exception List for MSP Claims 04/09/2007 01/02/2007
R1194CP Temporary Addition to the ASCA Exception List for MSP Claims 04/09/2007 01/02/2007
R1194CP Temporary Addition to the ASCA Exception List for MSP Claims 04/09/2007 01/02/2007
R1194CP Temporary Addition to the ASCA Exception List for MSP Claims 04/09/2007 01/02/2007
R1194CP Temporary Addition to the ASCA Exception List for MSP Claims 04/09/2007 01/02/2007
R1194CP Temporary Addition to the ASCA Exception List for MSP Claims 04/09/2007 01/02/2007
R1194CP Temporary Addition to the ASCA Exception List for MSP Claims 04/09/2007 01/02/2007
R1194CP Temporary Addition to the ASCA Exception List for MSP Claims 04/09/2007 01/02/2007
R1195CP New Waived Tests 04/02/2007 01/02/2007
R1197CP New Waived Test 04/02/2007 01/02/2007
R1198CP 04/2007 Outpatient Prospective Payment System (OPPS) Outpatient Code Edition Specifications Version 8.1 04/02/2007 01/02/2007
R1198CP 04/2007 Outpatient Prospective Payment System (OPPS) Outpatient Code Edition Specifications Version 8.1 04/02/2007 01/02/2007
R1198CP 04/2007 Outpatient Prospective Payment System (OPPS) Outpatient Code Edition Specifications Version 8.1 04/02/2007 01/02/2007
R1198CP 04/2007 Outpatient Prospective Payment System (OPPS) Outpatient Code Edition Specifications Version 8.1 04/02/2007 01/02/2007
R1198CP 04/2007 Outpatient Prospective Payment System (OPPS) Outpatient Code Edition Specifications Version 8.1 04/02/2007 01/02/2007
R1198CP 04/2007 Outpatient Prospective Payment System (OPPS) Outpatient Code Edition Specifications Version 8.1 04/02/2007 01/02/2007
R1198CP 04/2007 Outpatient Prospective Payment System (OPPS) Outpatient Code Edition Specifications Version 8.1 04/02/2007 01/02/2007
R1198CP 04/2007 Outpatient Prospective Payment System (OPPS) Outpatient Code Edition Specifications Version 8.1 04/02/2007 01/02/2007
R1198CP 04/2007 Outpatient Prospective Payment System (OPPS) Outpatient Code Edition Specifications Version 8.1 04/02/2007 01/02/2007
R1199CP 04/2007 Non-Outpatient Prosp Payment Sys Outpatient Code Editor Specifications Version 22.2 04/02/2007 01/02/2007
R1200CP Changes to the Laboratory NCD Edit Software April 2007 04/02/2007 01/02/2007
R1201CP Quarterly Update to Correct Coding Initiative Edits, Version 13.1, Effective April 1, 2007 04/02/2007 01/02/2007
R1202CP Quarterly Update to MUEs 04/02/2007 01/02/2007
R265OTN Program Overview: 2007 Physician Quality Reporting Initiative 04/09/2007 01/02/2007
R67BP 2007 Update to the ESRD Composite Payment Rates 04/02/2007 01/02/2007
R1204CP April 2007 Quarterly ASP Medicare Part B Drug Pricing File, Effective April 1, 2007, and Revisions to January 2006, April 2006, July 2006, etc 04/02/2007 01/02/2007
R1204CP April 2007 Quarterly ASP Medicare Part B Drug Pricing File, Effective April 1, 2007, and Revisions to January 2006, April 2006, July 2006, etc 04/02/2007 01/02/2007
R1204CP April 2007 Quarterly ASP Medicare Part B Drug Pricing File, Effective April 1, 2007, and Revisions to January 2006, April 2006, July 2006, etc 04/02/2007 01/02/2007
R1204CP April 2007 Quarterly ASP Medicare Part B Drug Pricing File, Effective April 1, 2007, and Revisions to January 2006, April 2006, July 2006, etc 04/02/2007 01/02/2007
R1204CP April 2007 Quarterly ASP Medicare Part B Drug Pricing File, Effective April 1, 2007, and Revisions to January 2006, April 2006, July 2006, etc 04/02/2007 01/02/2007
R1206CP Extracorporeal Photopheresis 04/02/2007 01/02/2007
R1206CP Extracorporeal Photopheresis 04/02/2007 01/02/2007
R66NCD Extracorporeal Photopheresis 04/02/2007 01/02/2007
R66NCD Extracorporeal Photopheresis 04/02/2007 01/02/2007
CMS-1305-N2 Request for Nominations to the Advisory Panel on Ambulatory Payment Classification (APC) Groups 03/23/2007 01/02/2007
CMS-1810-RCN Physicians' Referrals to Health Care Entities With Which They Have Financial Relations -- Phase II; Continuation of Effectiveness and Extension of Timeline for Publication of Final Rule 03/23/2007 01/02/2007
CMS-2275-P Medicaid Program; Health Care-Related Taxes 03/23/2007 01/02/2007
CMS-7004-N Announcement of Rechartering and Meeting of the Advisory Panel on Medicare Education, April 17, 2007... 03/23/2007 01/02/2007
CMS-1384-N Extension of Certain Hospital Wage Index Reclassifications 03/23/2007 01/02/2007
CMS-4083-NR Applicability of Part 405 Medicare Appeals Council Own Motion Review Provisions to the Part 423 Medicare Prescription Drug, Part D, Appeals Process 03/23/2007 01/02/2007
CMS-1398-NC Announcement of an Application From a Hospital Requesting Waiver for Organ Procurement Service Area 03/23/2007 01/02/2007
CMS-1481-N3 Emergency Medical Treatment and Labor Act, Technical Advisory Group, Meeting, May 3-4, 2007 03/23/2007 01/02/2007
CMS-1488-CN3 Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2007 Rates; Final Fiscal Year 2007 Wage Indices and Payment Rates After Application of Revised Occupational Mix Adjustment to the Wage Index; CorrectionsThis document corrects wage index values and a relative weighting factor error that appeared in the correction notice published in the Federal Register on January 5, 2007 entitled ``Medicare Program; Changes to the Hospital 03/23/2007 01/02/2007
R1208CP Extension for Acceptance of Form CMS-1500 (12-90) 04/02/2007 01/02/2007
R1208CP Extension for Acceptance of Form CMS-1500 (12-90) 04/02/2007 01/02/2007
R1208CP Extension for Acceptance of Form CMS-1500 (12-90) 04/02/2007 01/02/2007
R1208CP Extension for Acceptance of Form CMS-1500 (12-90) 04/02/2007 01/02/2007
R1208CP Extension for Acceptance of Form CMS-1500 (12-90) 04/02/2007 01/02/2007
R1209CP 04/07 Update of the Hosp Outpatient Prospective Payment System: Summary of Payment Policy Changes 04/02/2007 01/02/2007
R191PI Provider/Supplier Enrollment Approval Letter 05/23/2007 01/02/2007
R266OTN New Contractor Number for CIGNA Government Services, LLC-Jurisdiction C DME MAC Workload 06/01/2007 01/02/2007
CMS-3835-F Hospital Conditions of Participation: Requirements for Approval and Reapproval of Transplant Centers to Perform Organ Transplants 03/30/2007 01/02/2007
CMS-9039-N Quarterly Issuance Notice - Oct - Dec 2006 03/30/2007 01/02/2007
R266OTN New Contractor Number for CIGNA Government Services, LLC-Jurisdiction C DME MAC Workload 06/01/2007 01/02/2007
R1212CP Requirement for Providing Route of Administration Codes for Erythropoiesis Stimulating Agents 06/29/2007 01/02/2007
R1215CP Revisions to Form CMS-1500 Submission Requirements 04/30/2007 01/02/2007
R1215CP Revisions to Form CMS-1500 Submission Requirements 04/30/2007 01/02/2007
R1215CP Revisions to Form CMS-1500 Submission Requirements 04/30/2007 01/02/2007
R1216CP Provider Education for Handling Issues Related to Deceased Providers 04/30/2007 01/02/2007
R1216CP Provider Education for Handling Issues Related to Deceased Providers 04/30/2007 01/02/2007
R1216CP Provider Education for Handling Issues Related to Deceased Providers 04/30/2007 01/02/2007
R1216CP Provider Education for Handling Issues Related to Deceased Providers 04/30/2007 01/02/2007
R68BP Ambulance Fee Schedule-Ground Ambulance Services-Manualization Revision to the Specialty Care Transport Definition 04/30/2007 01/02/2007
R1215CP Revisions to Form CMS-1500 Submission Requirements 04/30/2007 01/02/2007