04/03/2018

"Ask MSHO"

April 2018, Frequently Asked Questions

Question:  Are modifiers still required for the Biosimilar products?

Answer: Beginning on April 1, 2018, modifiers that describe the manufacturer of a biosimilar product (for example, ZA, ZB and ZC) will no longer be required on Medicare claims for HCPCS codes for biosimilars. However, HCPCS code Q5102 and the requirement to use biosimilar modifiers remain in effect for dates of service prior to April 1, 2018. Q5102 will be discontinued on April 1 and replaced with the following:

Q5103 -Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg
Q5014 - Injection, infliximab-abda, biosimilar, (renflexis), 10 mg

Question:  Will the new Medicare cards be released by region all at once?

Answer:  The replacement cards for Medicare patients will not come out all at once.  Patients will receive their new “Medicare Benefit Identifier” (MBI) (which replaced the healthcare identification number- HICN) throughout 2018.  CMS has posted a “Mailing Strategy” which I have provided a link; CLICK HERE 

Question: How long will Medicare give us to make the changes in our system? I’m worried about a TON of rejections!

Answer: According to the Medicare website, they will have a “transition period” from April 1, 2018, through December 31, 2019, and during this transition will allow either the HICN or the BMI number.  Here is a link to the Medicare Provider Page for more information:  CLICK HERE

Question:  I am starting to hear more about a CMS program called TPE. What does this stand for and what is its purpose?

Answer:  The Centers for Medicare & Medicaid Services (CMS) designed the Targeted Probe and Educate (TPE) program to help providers and suppliers reduce claim denials and appeals through one-on-one help. The program goal: to help you quickly improve. Medicare Administrative Contractors (MACs) work with you, in person, to identify errors and help you correct them. Many common errors are simple—such as a missing physician’s signature—and are easily corrected.

Question: Does Medicare pay for an office visit so that the patient could receive an injection?

Answer: Here’s what the Centers for Medicare & Medicaid Services included in the Medicare Claims Processing Manual, Chapter 17, Section 20.5.7:

Where the sole purpose of an office visit was for the patient to receive an injection, payment may be made only for the injection service (if it is covered). Conversely, injection services (codes 90782, 90783, 90784, 90788, and 90799) included in the Medicare Physician Fee Schedule (MPFS) are not paid for separately, if the physician is paid for any other physician fee schedule service furnished at the same time. Pay separately for those injection services only if no other physician fee schedule service is being paid.

Question:  Where can we find the evaluation and management documentation guidelines?

Answer:  The Centers for Medicare & Medicaid Services (CMS) offer a publication on E&M services; CLICK HERE

Resources for both the 1995 and 1997 guidelines can be found beginning on page 19.