As stated in the June 6, 2002 Provider Bulletin, the Medicare contractors have been instructed to discontinue the printing and mailing of any bulletins or newsletters, effective July 1, 2002. We will continue to develop bulletin and newsletter materials, which will be posted on our provider website, www.marylandmedicare.com.

In order to make it easier for providers to obtain information quickly, several additions have been made to the main page of the website. These additions include:

• A window for urgent messages.
• A new page for Intermediary and CMS updates.
• Frequently Asked Questions (FAQs)

Medical Review will utilize the "Urgent Message" window and the "What's New/CMS Update" page to keep the provider community informed of medical review activities.

PROVIDERS ARE RESPONSIBLE FOR MONITORING THE MARYLAND MEDICARE WEBSITE ON A REGULAR BASIS TO OBTAIN UPDATED MEDICARE INFORMATION.

Medical Review Updates

• The following services are now under prepayment review:
  • Screening Glaucoma Services (Provider Bulletin 11/15/2001)
  • Enhanced External Counterpulsation (Provider Bulletin 10/01/1999)
  • Observation Services billed under OPPS (Provider Bulletin (04/04/2002)
• New Providers
  • Once a new provider receives a provider number, they are placed on prepayment review. This review is a limited probe sample performed to determine that services billed to Medicare are:
    • Performed and documented in the medial records.
    • Reasonable and necessary.
    • Meeting all other coverage requirements.
• Local Medical Review Policy
  • A draft policy for "Diabetes Outpatient Self-Management Training" will be on the Maryland Medicare website for review and comment by the end of June.
  • Hyaluronate polymers (Policy No. 99-06)
    • Effective for dates of service on or after July 1, 2002:
      • Delete J7316 (Sodium Hyaluronate, 5mg for intra-articular injection). This code will be discontinued as of July 1, 2002 with a 90-day grace period.
      • Add Q3030 (Sodium Hyaluronate , 20-25 mg for intra-articular injection).
    • Providers should submit a claim with one code or the other, but not both.

     

   

Should you have any questions, contact Provider Relations at 1-866-488-0545. Questions related to Claims should be directed to Donald Doyle, (410-561-4036; Audit and Reimbursement to Adam Weber, (410) 561-7948; and Medical Review to Dotty Sewll, (410) 561-4108.

THIS BULLETIN SHOULD BE SHARED WITH ALL HEALTH CARE PRACTITIONERS AND MANAGERIAL MEMBERS OF THE PROVIDER/SUPPLIER STAFF.  BULLETINS ISSUED AFTER OCTOBER 1,1999 ARE AVAILBABLE AT NO-COST FROM OUR WEBSITE AT http://www.marylandmedicare.com/.

Italicized and or quoted material is excerpted from the American Medical Association Current Procedural Terminology CPT codes, descriptions and other data only are copyrighted 1999 American Medical Association (or such other publication of CPT). All rights reserved. Applicable FARS/DFARS apply.