Medicare “Heads-Up” Notes to Start 2014

Here are some need-to-know Medicare reminders and tips to start out 2014.

Medicare Will Deny Ordered/Referred Claims Without Enrollment  Starting Jan. 6, 2014, Medicare will deny claims for services ordered or referred by a physician who is not enrolled in Medicare. To avoid denied claims for you and for those to whom you refer, make sure you and physicians from whom you receive order/referrals have an enrollment record in the Centers for Medicare & Medicaid Services (CMS) Provider Enrollment, Chain and Ownership System (PECOS).

2014 Medicare Participation Deadline Extended — Jan. 31 is the new deadline for physicians to decide whether to participate in the Medicare program in 2014. The deadline originally was Dec. 31 but CMS extended the deadline because it released the 2014 physician fee schedule later than usual. You do not have to do anything if you participate currently and wish to continue participating in Medicare next year. You have three options in deciding whether to participate in 2014. You can find additional information on Novitas 2014 Medicare Part B Participation page.

2014 Medicare Deductible Holds Steady — The Medicare Part B deductible for patients is not changing for 2014. It will remain at $147. See MLM Matters No. MM8527 (PDF) for information about Medicare deductible, coinsurance, and premium rates for 2014.

New Influenza Virus Vaccine Code — The revised Quick Reference Information: Medicare Immunization Billing (PDF) fact sheet is now available for download. Note that CPT code 90673 will replace HCPCS code Q2033 for claims with dates of service on or after Jan. 1, 2014. Also, the effective date of code Q2033 changed from Jan. 1, 2013, to July 1, 2013. For details about the code changes, see MLN Matters No. MM8473 (PDF). Medicare also has released the downloadable Vaccine Payments Under Medicare Part D (PDF). This fact sheet explains the difference between Part B and Part D vaccine coverage, what Part D covers, and more about vaccine coverage under Part D plans.While you are at it, you might want to download the new MLN Matters Special Edition Article No. SE1338 (PDF), "Improve Your Patients' Health with the Initial Preventive Physical Examination (IPPE) and Annual Wellness Visit (AWV)."

Tip From TMA's Payment Advocacy Team — TMA strongly encourages you to request reference numbers when documenting telephone calls with Novitas staff for tracking purposes. Novitas does not automatically provide a reference number and will only issue a number upon request. 

Novitas LCD Updates The following Novitas local coverage determinations (LCDs) are now in effect: 

This Novitas LCD has been revised: Vertebroplasty, Vertebral Augmentation, Percutaneous (L32685).  This Novitas LCD has been retired for dates of service on and after Dec. 5, 2013: Transcranial Magnetic Stimulation for Depression (L32752). You can find LCD updates on the Novitas LCD Update History for Jurisdiction H webpage.

National Correct Coding Initiative (NCCI) Reminder — The annual updated version of the National Correct Coding Initiative Policy Manual for Medicare Services, effective Jan. 1, 2014, is posted on the CMS NCCI website. Remember to check NCCI updates quarterly; next update is Jan. 1 (see MLN Matters No. MM8477 [PDF]).

Physician CCI edits are on the CMS website; learn How to Use the Medicare National Correct Coding Initiative (NCCI) Tools  (PDF).

If you have questions about any of these topics, contact TMA's reimbursement specialists at or (800) 880-1330, ext. 1414, or call TMA Knowledge Center at (800) 880-7955.

Published Dec. 10, 2013


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