Third Party Newsletter

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1 NEBRASKA OPTOMETRIC ASSOCIATION December 006 Third Party Newsletter Medicare Regulations on Durable Medical Equipment Noridian Administrative Services (NAS) is our new Durable Medical Equipment (DME) Medicare Administrative Contactor (MAC). [The acronym DMERC has now been replace by DME MAC.] Their regulations on refractive lenses, difficult to find when navigating the Noridian web site, can be found at: ARTICLE_ID=3900&ARTICLE_VERSION=4&SHOW=ALL Inside this issue: YOUR NOA 3RD PARTY RESOURCE Misuse of DEA Number Fortunately these regulations are very similar, if not identical, to the CIGNA refractive lens LCD that Nebraska ODs were required to follow prior to the change from CIGNA to NAS on October 1st of this year. Dr. Quack plans to print these NAS regulations, in their entirety, in next month s third party newsletter. The misuse of DEA registration numbers by the insurance industry, and the inappropriate requirement of DEA numbers by pharmacies, continues to be a concern and a top priority for the AOA Washington Office. Recently, we were made aware of the inappropriate requirement for DEA registration numbers in connection with prescriptions written for patients eligible for the Medicare Part D drug discount program. Medicare patients have been reporting back to their optometrists that they were unable to get their prescriptions filled because their pharmacy required DEA numbers even though these prescriptions were for non-controlled substances. If you have experienced such misuse of your DEA number, please use the form published in our September, 006 3rd party newsletter to report your experience to the AOA. The 007 traditional Medicare Part B deductible is $ per year; coinsurance continues to be 0 percent. Medicare Advantage plans differ. The new, revised CMS 1500 claim forms, designed to allow for use of the National Provider Identifier (NPI), are now available from the AOA Order Department. Effective December 1, 006, Medicare will charge providers when they request a duplicate copy of a Medicare remittance advice. The October issue of our Medicare carrier s Communiqué contains detailed instructions on correct completion of the new CMS-1500 form. Found on pages 9-16 of that document. The Centers for Medicare & Medicaid Services (CMS) is accepting use of the new CMS-1500 form effective January 1, 007, but its use is not mandated until April, 007. CMS plans to begin testing the new software that has been developed to use the National Provider Identifier (NPI) in the existing Medicare fee-for-service claims processing systems. Annual Index of our NOA 001 thru 006 3rd Party Newsletters articles 3-6 Volume 6 Issue 1 Correction of Dr. Quack s Kearney presentation: The form you need to update for Noridian electronic funds transfer is CMS form 588, NOT 855. When enrolling with 3rd parties, they will be the ones to assign, or not assign, their legacy numbers. However, CMS may not want legacy numbers on claims after May of next year. 7 7

2 Medicare Potpourri 007 Traditional Medicare Part B Deductible and Coinsurance Deductible $ per year Coinsurance 0 percent Medicare Advantage plans differ. Revised CMS-1500 Claim Forms Now Available from AOA New, revised CMS 1500 claim forms, designed to allow use of National Provider Identifier (NPI) numbers, are now available from the AOA Order Department. Health care providers will be able to use the new forms, formally known as the CMS 1500 (08-05), to file Medicare paper claims beginning January 1, 007. Use of the new form will be required for the filing of Medicare paper claims effective May 3, 007. Medicare To Charge for Duplicate Remittance Advice Notices Effective December 1, 006, Medicare will charge providers when they request a duplicate copy of a Medicare remittance advice. Requests for duplicate remittance advice copies should be submitted to Medicare with a completed Duplicate Remittance Advice Request form. The cost will be $6.00 per remittance. Please make your check payable to Wheatlands Administrative Services. Requests received without a check will be returned to the provider. This form is available on the Wheatlands Administrative Services web site at: PARTB_FORMS/DUPLICATEREMITTANCEREQ.PDF In the future they will be adding a feature to our Interactive Voice Response (IVR) System that will allow you to order Remittance Advice notices via the IVR at no cost. They will inform you when this service is available. New CMS-1500 Paper Form Required Beginning April, 007 The Centers for Medicare & Medicaid Services (CMS) is implementing the revised Form CMS-1500 effective January 1, 007, but will not be mandated for use until April, 007. During this transition time there will be a dual acceptability period of the current and the revised forms. A major difference between Form CMS-1500 (08-05) and the prior form CMS-1500 is the split provider identifier fields, allowing NPI reporting in the fields labeled as NPI, and corresponding legacy number reporting in the unlabeled block above each NPI field. 4J (replacing item 4K, Form CMS-1500 (1-90)); 17B (replacing item 17 or 17A, Form CMS-1500 (1-90)); 3a (replacing item 3, Form CMS-1500 (1-90)); and 33a (replacing item 33, Form CMS-1500 (1-90)). Source Reference: MLN Matters MM5060 When CAN you use the NPI, and When MUST you use Only the NPI CMS plans to begin testing the new software that has been developed to use the National Provider Identifier (NPI) in the existing Medicare fee-forservice claims processing systems. Providers have until May 3, 007, before they are required to submit claims with only an NPI. Until testing is complete within the Medicare processing systems, CMS urges providers to continue submitting Medicare fee-for-service claims in one of two ways: Use your legacy number, such as your Provider Identification Number (PIN), NSC number, OSCAR number or UPIN; or Use both your NPI and your legacy number. Detailed Instructions on New CMS-1500 in October Communiqué The October issue of our Medicare carrier s Communiqué contains detailed instructions on correct completion of the new CMS-1500 form. Look on pages PAGE THIRD PARTY NEWSLETTER

3 Annual INDEX For 3rd Party Newsletter and Web Page Brackets with numbers [03-0] indicate the month and year the topic was covered in the 3rd Party Newsletter. Brackets with words or instructions [1997 E&M GUIDELINES] indicate there is a hyperlink to this subject on the 3rd Party Web Page. By double clicking on these words on the web page you will go directly to the site containing this topic E & M GUIDELINES [1997 E&M GUIDELINES] 1997 E & M GUIDELINES WALL CHART (CHART PAGES LISTED WITH NEWSLETTERS UNDER APRIL 00) 4 MODIFIER: E&M NOT RELATED TO POST-OP CARE [11-03] 5 MODIFIER: HOW TO FILE A SERVICE ALONG WITH A PROCEDURE [0-01] [07-04] 5 AND 57 MODIFIERS [07-0] 50 MODIFIER (BILATERAL MODIFIER) EXPLANATION USING THE MEDICARE FEE SCHEDULE DATABASE [07-05] 50-5 MODIFIERS (OLD QUACK TABLE--BILATERAL VS. REDUCED SERVICES) [05-01 TABLE] 57 AND 5 MODIFIERS [07-0] 9004 AND 9014 COMPREHENSIVE EXAM REQUIREMENTS [08-01] [11-0] [05-06] 9000 VS EXAM CODES [05-06] 9135 CODING [04-06] VS EXAM CODES [05-06] A A46 AND A463-- SEE PUNCTAL PLUG CODING ABN ---SEE ADVANCED BENEFICIARY NOTICE ACCEPTED STANDARD OF CARE [05-04] ADVANCED BENEFICIARY NOTICE (ABN): [MEDICARE: FIND]...SEE ALSO GA MODIFIER ABNS AND NON-COVERED ITEMS (DMERC) [05-04] [06-04] DMERC EXAMPLES [05-05] MEDICARE B EXAMPLE [08-05] NEMB FORM [08-05] ADVANCEMED AND CERT [05-04] ADVERTISING [004 NE OPT RULES/REGS: FIND] AMERICA ACADEMY OF OPHTHALMOLOGY (AAO) AMERICAN OPTOMETRIC ASSOCIATION (AOA) AMERICAN SOCIETY OF CATARACT & REFRACTIVE SURGEONS (ASCRS) AOA AMERICAN OPTOMETRIC ASSOCIATION (AOA) ANTI-KICKBACK AND SELF-REFERRAL STATUTES [09-01] AQ MODIFIER [09-05] AUDIT BY OIG [OIG] AUDIT BY NOA [11-04] [01-05] [1-05] AUTHORIZATION FROM 3RD PARTY PRIOR TO APPOINTMENT TIME [03-04] B BILATERAL MODIFIER (50 MODIFIER) --WHEN TO USE 50 MODIFIER USAGE VIA THE MEDICARE FEE SCHEDULE DATABASE [07-05] QUACK SUMMARY TABLE (OLD) [05-01 TABLE] BILLING ERRORS [07-01] BILLING INSTRUCTIONS: [MEDICARE CLAIMS PROCESSING MANUAL] [POST-OP CLAIMS] BLUE CROSS BLUE SHIELD OF NEBRASKA HOME PAGE PRIMARY CARE PLUS (MEDICAID) RULES FOR REFERRAL [11-04] ROUTINE VISION CARE [11-04] [UPDATE 1-04] POST-OP POLICY CHANGE [03-03] VISION THERAPY CODING [11-06] BOARD CERTIFICATION [OPTOMETRY LAW ADOBE FIND] [004 NE OPT RULES/REGS: FIND] C CAPSULOTOMY POST-OP CARE [1-0] CASH DISCOUNTS VS. INSURANCE FRAUD [10-03] CCI [11-03] [1-03] [03-04] SEE MEDICARE UNDER RECENT BULLETINS & MANUALS CERT: MEDICARE CLAIMS OVERVIEW [05-04] [08-05] [10-05] CHARGES, FEES, AND PAYMENTS [MEDICAID VISION CARE RULES] [MEDICAID FEE SCHEDULE AND RULES] [MEDICARE CLAIMS PROCESSING MANUAL] [MEDICARE REIMBURSEMENT & FEE SCHEDULE] CHIEF COMPLAINT [1997 E&M GUIDELINES] CL (SEE UNDER CONTACT LENS) CLAIMS ERROR RATE TESTING (CERT) [05-04] [08-05] [10-05] CLAIMS--MEDICARE CMS-1500 CLAIM FORMS [10-06] NEW FORM REQUIRE FOR 007 [07-06] [09-06] [10-06] [06-01] [01-03] [10-04] BOX 4K BOX 4K AND BOX 33 (MCS INSTRUCTIONS) BOX 33 DMERC PAPER CLAIM GUIDELINES [0-04] [07-04] CIGNA: FILING PAPER CLAIMS [POST-OP CLAIMS] CMS-1500 NPI CHANGES FOR 007 [10-06] CMS FORM DOWNLOADS ADVANCE BENEFICIARY NOTICE FORM DOWNLOAD NEMB FORM DOWNLOAD RECONSIDERATION REQUEST FORM DOWNLOAD REDETERMINATION REQUEST FORM DOWNLOAD [CMS HOMEPAGE] CMS ONLINE MANUAL SYSTEM CMS QUARTERLY PROVIDER UPDATE CODING FOR MAXIMUM PROFIT [08-05] CODING SIDEWAYS (ILLEGALLY) [08-05] CONDITION CODES--MEDICAID [07-05] CODING FRAUD [06-0] [08-05] CODING TRAUMA: EDITS [09-03] CO-MANAGEMENT (POST-OP CARE) [MEDICARE LCD: FIND POST-OP] COMMUNIQUÉS [MEDICARE] COMPLIANCE AOA COMPLIANCE MANUAL [10-04] (AOA) COMPLIANCE: ADVANCED BENEFICIARY NOTICE AND CERTIFICATE OF MEDICAL NECESSITY [08-0] COMPLIANCE: ADVERTISING [06-03] COMPLIANCE: AFTER AN OFFENSE HAS BEEN DETECTED [07-0] COMPLIANCE: ANTI-KICKBACK AND SELF-REFERRAL STATUTES [09-01] COMPLIANCE: APPLICATION OF COMPLIANCE PROGRAM GUIDANCE [0-01] COMPLIANCE: AUDITING AND MONITORING [05-0] COMPLIANCE: BILLING FOR NON-COVERED SERVICE S [09-0] COMPLIANCE: BILLING, FINES, AND JAIL [11-0] COMPLIANCE CHECKLIST (DERIVED FROM AOA COMPLIANCE MANUAL) COMPLIANCE: CIVIL MONETARY PENALTIES LAW [11-03] COMPLIANCE: CODING AND BILLING ERRORS [07-01] [06-01] COMPLIANCE: CONDUCTING EFFECTIVE TRAINING & EDUCATION [1-01] COMPLIANCE: CONTINUING EDUCATION AND COMMUNICATION [01-0] COMPLIANCE: COVER-UP; UNNECESSARY TESTS; FRAUD [08-03] COMPLIANCE: DESIGNATION OF A COMPLIANCE OFFICER/CONTACT [11-01] COMPLIANCE: DOCUM==ENTATION [08-01] COMPLIANCE: ENFORCING COMPLIANCE STANDARDS [0-0] [06-0] COMPLIANCE: FALSE CLAIMS ACT [10-03] COMPLIANCE: FRAUD [08-03] COMPLIANCE: FRAUDULENT AND ``ERRONEOUS'' CLAIMS [03-01] COMPLIANCE: KICKBACKS [09-03] COMPLIANCE: LIMITATIONS ON REFERRALS [01-04] COMPLIANCE: MISLEADING STATEMENTS; KICKBACKS [09-03] COMPLIANCE: OFFICER OR CONTACT PERSON [11-01] COMPLIANCE: PENALTIES [11-0] COMPLIANCE: PROFESSIONAL COURTESY---WHEN IS IT LEGAL [05-03] COMPLIANCE: RENTAL ARRANGEMENTS [06-03] COMPLIANCE: RETENTION OF RECORDS [10-01] COMPLIANCE: SELF DISCLOSURE AND SELF ASSESSMENT [03-04] COMPLIANCE: THE SEVEN BASIC COMPLIANCE ELEMENTS [04-01] COMPLIANCE: UNNECESSARY TESTS; FRAUD [08-03] COMPLIANCE: WRITTEN POLICIES AND PROCEDURES [05-01] COMPREHENSIVE EXAM REQUIREMENTS-- CODING: 9004 AND 9014 [08-01] [11-0] COMPREHENSIVE OPHTHALMOLOGICAL SERVICE [MEDICARE LCD] CONFOCAL SCANNING LASER GLAUCOMA TEST, GDX, SCANNING LASER POLARIMETRY [MEDICARE LCD] CONJUNCTIVAL FB REMOVAL CODING [04-01] CONSOLIDATED BILLING (MEDICARE B AND DMERC) [07-03] [0-04] [06-04] CONSULTATION AND REFERRAL CODING [0-0] [01-06] CONTACT LENSES BANDAGE CONTACT LENSES [MEDICARE BANDAGE] CONTACT LENSES -- REGULATION OF PLANO CONTACT LENSES [11-05] CONTACT LENS RULE (FTC FINAL RULE, 10 PAGES) [FTC CONTACT LENS RULE] CONTACT LENS RX RELEASE [FTC CONTACT LENS RULE] [NEBRASKA MAIL ORDER CL ACT ADOBE FIND] FAIRNESS TO CONTACT LENS CONSUMERS ACT (FTC FINAL DECISION, 118 PAGES) [FEDERAL REGIS- TER] REPORTING VIOLATIONS TO...[01-05] FEDERAL CONTACT LENS RULE (FTC FINAL RULE, 10 PAGES) [FTC CONTACT LENS RULE] [09-04] MEDICAID CL RULES [MEDICAID VISION CARE RULES] [NEBRASKA OPT RULES/REGS: FIND] [POST CATARACT DMERC] CORNEAL SENSATION [MEDICARE LCD FIND] CORNEAL TOPOGRAPHY [MEDICARE LCD] CORRECT CODING INITIATIVE [11-03] [1-03] [03-04] SEE MEDICARE UPDATES PAGE CPT [CPT ONLINE (FEE REQUIRED)] UPDATING YEARLY [09-04] CUSTOMARY CHARGE [MEDICARE] [MEDICAID FEE SCHEDULE AND RULES] (Continued on page 4) VOLUME 6 PAGE 3

4 Annual INDEX For 3rd Party Newsletter and Web Page Brackets with numbers [03-0] indicate the month and year the topic was covered in the 3rd Party Newsletter. Brackets with words or instructions [1997 E&M GUIDELINES] indicate there is a hyperlink to this subject on the 3rd Party Web Page. By double clicking on these words on the web page you will go directly to the site containing this topic. (Continued from page 3) D DATE OF SERVICE [1997 E&M GUIDELINES] DEA CONTROLLED SUBSTANCES NUMBER [10-01] [04-04] MISUSE OF DEA NUMBER BY PHARMACIES, ETC [09-06] DECEASED PATIENTS: CODING FOR SERVICES [0-04] DELEGATION, SUPERVISION, AND CODING [06-06] [11-06] DIABETES [MEDICARE OPTOMETRY LCD FIND] DIABETES--COMMUNICATING WITH PCP [09-05] DIABETIC EYE EXAMS AND OPTOMAPS [1-05] DIABETES, MEDICARE, AND FUNDUS PHOTOS [03-05] DIABETIC REPORTING FORMS [09-05] DIAGNOSTIC AND TREATMENT PROGRAM [1997 E&M GUIDELINES ADOBE FIND] DILATION AND OPTOMAPS--DIABETES PATIENTS [1-05] DISCOUNTS FOR CASH VS. INSURANCE FRAUD [10-03] DMERC DME MAC [OLD DMERC HOMEPAGE] [NEW NORIDIAN DME MAC HOME PAGE] NOTE: ON OCTOBER 1, 006 NORIDIAN REPLACED CIGNA AS THE DURABLE MEDICAL EQUIPMENT MEDICARE ADMINISTRATIVE CARRIER FOR OUR REGION. MOST OF THE LINKS BELOW RELATE TO THE OLD CARRIER, CIGNA. THE NEW NORIDIAN DME MAC HOME PAGE IS [NEW NORIDIAN DME MAC HOME PAGE] THE PAGES BELOW WILL BE REPLACE WITH NORIDIAN LINKS ONCE THEY HAVE BEEN ESTABLISHED. DMERC CIGNA DROPPED; NORIDIAN NEW DMERC [06-06] [08-06] [09-06] DMERC: ABN CORRECT FORMAT [06-04] EXAMPLES [05-05] DMERC CLAIM REQUIREMENTS, QUACK SUMMARY OF [POST-OP CLAIMS] [08-06] DMERC CONTACT LENSES [EYEGLASSES AND CLS] [NORIDIAN] DMERC CHECKING CLAIM STATUS [0-06] DMERC CURRENT FEES DMERC DIALOGUES DMERC [EYEGLASSES AND CLS] [1-04] DMERC DOCUMENTATION REQUIREMENTS [07-03] [0-04] DMERC EYE PROSTHESIS CODING [07-04] DMERC VS. MEDICAID ON SCRATCH-COAT [08-03] DMERC MODIFIER TABLE: [05-04] WITH EXAMPLE ABNS [05-05] DME MAC NORIDIAN [08-06] [09-06] DMERC PAPER CLAIM GUIDELINES [0-04] [07-04] [POST-OP CLAIMS] DMERC PROOF OF DELIVERY [0-04] [07-05] DMERC POST OP CODING [POST-OP CLAIMS] DMERC REFRACTIVE LENSES [EYEGLASSES AND CLS] [1-04] [NORIDIAN] DMERC SUPPLIER MANUAL DMERC (DMEPOS) SUPPLIER STANDARDS [11-0] [07-05] DMERC TRANSITIONS LENSES [0-05] DMERC UV COATING ON PLASTIC LENSES [01-06] DOCUMENTATION, ADEQUATE RECORD [07-06] DOCUMENTATION GUIDELINES [1997 E&M GUIDELINES] DOCUMENTATION FLOWCHART -MEDICARE CERT [CERT DOCUMENTATION FLOWCHART] DOCUMENTATION MEDICARE E & M SCORE SHEET [OUR MEDICARE CARRIER'S E&M SCORESHEET] DRIVER'S VISION REQUIREMENTS MOTORIST'S VISION REQUIREMENTS FOR NEBRASKA DRUG USE: LONG TERM USE OF DRUGS AND CODING [0-05] E E & M GUIDELINES [1997 E&M GUIDELINES] E & M DOCUMENTATION SCORE SHEET (OUR MEDICARE CARRIER'S) [E&M SCORESHEET] [05-04] E & M WALL CHART *** CODE CHART 1 - HISTORY *** CODE CHART - HISTORY SCORE *** CODE CHART 3 - NEW PT SCORE *** CODE CHART 4 - EXAMINATION *** CODE CHART 5 - EXAMINATION SCORE *** CODE CHART 6 - ESTABLISHED PT SCORE *** CODE CHART 7 - DECISION MAKING *** CODE CHART 8 - DECISION MAKING SCORE *** CODE CHART 9 - DR. QUACK'S DIRECTIONS EDI--HIPAA EDI SEE ON HIPAA PAGE ELECTRONIC CLAIMS -- LOOK UNDER EDI SEE ON HIPAA PAGE ENCRYPTING [10-04] EXOPHTHALMOMETRY [MEDICARE LCD FIND] EXTENDED OPHTHALMOSCOPY 95 [CMS NATIONAL COVERAGE DATABASE] [03-03] [03-04] EY MODIFIER [05-04] EYE PROSTHESIS DMERC CODING [07-04] F FAIRNESS TO CONTACT LENS CONSUMERS ACT ---SEE CONTACT LENSES FALSE CLAIMS ACT [10-03] FAXING PATIENT INFORMATION VS. HIPAA PRIVACY [08-03] FEES, CHARGES, AND PAYMENTS [MEDICAID VISION CARE RULES] [MEDICAID FEE SCHEDULE AND RULES] [MEDICARE BILLING INSTRUCTIONS] [MEDICARE CLAIMS PROCESSING] [MEDICARE FEE SCHEDULE] [MEDICARE REIMBURSEMENT] FEE DISCOUNTS [03-01] FEE LIMITS--MEDICARE: FOR NON-PARTICIPATING PROVIDERS [08-01] FEE SCHEDULE-- [MEDICAID FEE SCHEDULE AND RULES] FIELDS, VISUAL ---SEE VISUAL FIELDS FLUORESCEIN ANGIOGRAPHY [MEDICARE LCD] FOREIGN BODY CODING [0-06] [03-06] FORMS CMS FORMS ADVANCE BENEFICIARY NOTICE FORM DOWNLOAD NEMB FORM DOWNLOAD RECONSIDERATION REQUEST FORM DOWNLOAD REDETERMINATION REQUEST FORM DOWNLOAD FRAMES MEDICARE[EYEGLASSES AND CLS] [MEDICAID VISION CARE RULES] V-CODES HCPCS II V-CODES FRAUD ALERT (MEDICARE) [0-05] FRAUDULENT VERSUS ``ERRONEOUS'' CLAIMS [03-01] [06-0] FREQUENCY OF SERVICES [MEDICAID VISION CARE RULES] FTC RELEASE OF A CL RX---SEE CONTACT LENSES FUNDUS PHOTOS [MEDICARE LCD] [1-01] [03-06]...AND V58.69 DIAGNOSIS [01-01].MEDICARE AND DIABETICS [03-05] G G-CODES AND MEDICARE QUALITY INITIATIVE [0-06] GA MODIFIER [01-0] [04-03] [05-04] GW MODIFIER [04-03] GX MODIFIER [01-0] GY MODIFIER [01-0] [04-03] [0-04] [05-04] GZ MODIFIER [01-0] [04-03] GDX SCANNING LASER GLC TEST [MEDICARE OCT LCD] [AUDITS] [11-04] GLAUCOMA SCREENINGS FOR MEDICARE [11-01] [0-04] [07-06] GLAUCOMA CODING [03-06] GLOBAL FEE [MEDICARE FAQ] H HCFA--- SEE CMS HCFA SEE CMS-1500 HCPCS CODES LEVEL I: LEVEL I HCPCS CODES ARE THE AMA'S CPT CODES. SEE [CPT ONLINE (FEE REQUIRED)] LEVEL II: OVERVIEW LEVEL II LISTING (ZIPPED FILE) LEVEL III: LOCAL HCPCS CODES. THERE ARE NONE AT THIS TIME. HIPAA SPECIAL PAGE ON THIS WEB SITE HPSA (HEALTH PROFESSIONAL SHORTAGE AREA) [MEDICARE MANUAL] [09-05] [11-05] [04-06] [06-06] [08-06] AQ MODIFIER [09-05] [11-05] HISTORY OF PRESENT ILLNESS (HPI) [1997 E&M GUIDELINES ADOBE FIND] HOSPICE PATIENT CODING [11-0] HRT [AUDITS] [MEDICARE OCT LCD] [11-04] I ICD-9-CM ALPHABETIC INDEX TO DISEASES [ONLINE TABLE (FREE)} UPDATING YEARLY IN OCTOBER [09-04] INCIDENT TO PHYSICIAN SERVICES, BILLING (MEDICARE LANGUAGE, PG 39, 1-04 COMMUNIQUÉ) CMS MEDLEARN MATTERS INSURANCE FRAUD VS. CASH DISCOUNTS [10-03] INTERGUEARD AND CERT : MEDICARE CLAIMS OVERVIEW [07-03] INTERNET CLAIMS--FILING ROUTINE VISION CARE CLAIMS [05-0] K KX MODIFIER REPLACES ZX MODIFIER [07-0] L LASER CAPSULOTOMY POST-OP CARE [1-0] LASER INTERFEROMETRY [MEDICARE LCD FIND] LASER -- SCANNING (GDX, HRT, OCT) [MEDICARE LCD] LASIK: PRUDENT REFERRALS [FDA WEBSITE] [04-01] LCDS (LOCAL) [NEBRASKA MEDICARE'S LOCAL MEDICAL REVIEW POLICIES] LENS -REFRACTIVE--CODES [DME MAC EYEGLASSES AND CLS] [MEDICAID VISION CARE RULES] PAGE 4 THIRD PARTY NEWSLETTER

5 Annual INDEX For 3rd Party Newsletter and Web Page Brackets with numbers [03-0] indicate the month and year the topic was covered in the 3rd Party Newsletter. Brackets with words or instructions [1997 E&M GUIDELINES] indicate there is a hyperlink to this subject on the 3rd Party Web Page. By double clicking on these words on the web page you will go directly to the site containing this topic. (Continued from page 4) LENS--FRAMES HCPCS II V-CODES LICENSURE LAWS [OPTOMETRY LAW & OTHER LICENSURE LAWS] LCDS SUPPLANTED BY NCDS (NATIONAL) [NCDS} LMRPS ---SEE LCDS LOCAL COVERAGE DETERMINATIONS --- SEE LCDS LOCAL MEDICAL REVIEW POLICY MANUAL: SEE LCDS LONG TERM USE OF DRUGS AND CODING [0-05] LOW VISION AIDS--SALES TAX [01-04] M MAIL ORDER CONTACT LENS ACT. SEE UNDER CONTACT LENSES MALPRACTICE CLAIMS AND OPTOMETRY [11-06] MCS --- SEE MEDICARE MCS MEDICAID (NEBRASKA MEDICAID HOME PAGE) MEDICAID APPOINTMENTS, MISSED [07-01] MEDICAID BILLING UPDATES MEDICAID CONDITION CODES [07-05] MEDICAID: BILLING FOR MULTIPLE EYE EXAMS [05-06] MEDICAID CO-PAY [06-0] MEDICAID AND EXTENDED OPHTHALMOSCOPY [03-04] MEDICAID FEE SCHEDULE: SEE UNDER FEES, CHARGES & PAYMENTS MEDICAID INVOICE REQUIREMENTS [08-0] MEDICAID MANAGED CARE--PATIENTS OUT OF AREA [11-01] MEDICAID PATIENTS WITH VSP COVERAGE [11-01] MEDICAID PAYMENTS [MEDICAID VISION CARE RULES] [MEDICAID PAYMENT RULES] [MEDICAID VISION CARE FEE SCHEDULE] MEDICAID POLYCARBONATE LENSES FOR CHILDREN [11-05] [1-05] MEDICAID PRIMARY CARE PROVIDER--COMMUNICATING WITH THE [11-01] MEDICAID REPLACEMENT EYEWEAR NEW REGULATIONS [10-03] MEDICAID VS. DMERC ON SCRATCH-COAT [08-03] MEDICAID PRIMARY CARE + : PRIOR AUTHORIZATION FOR FB REMOVAL [1-03] MEDICAID VISION CARE MANUAL [MEDICAID VISION CARE RULES] 11/003 VISION CARE BULLETIN 01/004 VISION CARE BULLETIN 7/005 VISION CARE BULLETIN MEDICAID & VSP [11-01] MEDICAID V-CODES HCPCS II V-CODES MEDICAL RECORD DOCUMENTATION [07-01] MEDICARE MEDICARE [NEBRASKA MEDICARE HOME] MEDICARE ADVANTAGE PLANS [04-06] [CARRIER EXPLANATION] [CMS OVERVIEW] [MEDICARE PLAN FINDER] [09-06] MEDICARE APPEALS -- NEW FOR 006 [1-05] MEDICARE BILLING INSTRUCTIONS SECTION [04-06] MEDICARE CORRECT CODING INITIATIVE (CCI) EDITS [CMS WEBPAGE] MEDICARE CLAIM DENIAL REASON CODES [CMS REASON CODES] MEDICARE CLAIM DENIAL DUE TO MEDICAL NECESSITY [05-06] MEDICARE CLAIMS ERROR RATE TESTING (CERT) [05-04] [08-05] [DOCUMENTATION FLOWCHART] MEDICARE CLAIM FORM CHANGES FOR 007 [07-06] [10-06] MEDICARE CLAIMS PROCESSING MANUAL [SEE ITEM CMS MANUAL LIST] MEDICARE CLAIMS: UNPROCESSABLE [06-05] [08-05] MEDICARE CODING: 9004 AND 9014 COMPREHENSIVE EXAM REQUIREMENTS [05-06] MEDICARE B COMMUNIQUÉS [MEDICARE B WEBSITE] MEDICARE D -- SEE MEDICARE PART D MEDICARE -- DELEGATION TO EMPLOYEES [11-06] MEDICARE EDUCATION [05-04] [10-05] MEDICARE ENROLLMENT [07-06] MEDICARE B ENROLLMENT [CARRIER WEBSITE] MEDICARE FEE LIMITS FOR NON-PARTICIPATING PROVIDERS [08-01] MEDICARE FEE SCHEDULE MEDICARE FEE SCHEDULES MEDICARE FEE SCHEDULE DATABASE [07-05] INDICATOR DESCRIPTIONS [CARRIER INDICATOR DESCRIPTIONS] MPFSDB MEDICARE PHYSICIAN FEE SCHEDULE [CMS SEARCH PAGE] MEDICARE FORMS CMS FORMS ADVANCE BENEFICIARY NOTICE FORM DOWNLOAD NEMB FORM DOWNLOAD RECONSIDERATION REQUEST FORM DOWNLOAD REDETERMINATION REQUEST FORM DOWNLOAD MEDICARE G-CODES USED IN QUALITY INITIATIVE [0-06] MEDICARE GLAUCOMA SCREENINGS [CMS WEBPAGE] [07-06] MEDICARE HOSPICE PATIENT CODING [11-0] MEDICARE HPSA AREA: SEE HPSA MEDICARE BILLING "INCIDENT TO" A PHYSICIAN (MEDICARE LANGUAGE, PG 39, 1-04 COMMUNIQUÉ) CMS MEDLEARN MATTERS MEDICARE LATEST NEWS MEDICARE LOW VISION ASSISTANTS [06-05] MEDICARE LCDS INDEX (NEBRASKA) [MEDICARE LCD INDEX] MEDICARE MANUALS (CMS) [CMS MANUAL LIST] MEDICARE MANAGED CARE: SEE MEDICARE ADVANTAGE MEDICARE MCS CLAIMS [08-05] [11-05] [03-06] MEDICARE MEDLEARN MATTERS [05-04] MEDICARE MODIFIER CHANGES: SEE MODIFIERS MEDICARE MPFSDB: SEE MEDICARE FEE SCHEDULE MEDICARE MULTI-CARRIER SYSTEM [11-05] MEDICARE NATIONAL COVERAGE DETERMINATIONS (NCDS) MEDICARE NEMB FORM [08-05] NEMB FORM DOWNLOAD MEDICARE OPTOMETRY SERVICES [MEDICARE LCD-LMRP] MEDICARE PART D (DRUG BENEFIT) [11-05] MEDICARE PHYSICIAN'S GUIDE [11-06]] MEDICARE POST-OP CODING AND RULES [PHYS MANUAL SURGERY SECTION] [08-06] MEDICARE POST-OP CLAIM ERRORS [08-06] MEDICARE PROVIDER IDENTIFICATION [06-05] [08-05] MEDICARE QUALITY INITIATIVE AND THE G-CODES [0-06] MEDICARE REASON CODES [CMS REASON CODES] MEDICARE RECIPROCAL BILLING [08-06] MEDICARE RECOUPMENT [06-04] [07-04] MEDICARE REMARK CODES [CMS] MEDICARE REMITTANCE ADVICE [07-05] [10-05] [08-06] MEDICARE AND S-CODES [06-05] MEDICARE SECONDARY PAYER [CMS MANUAL LIST] [06-04] [QUESTIONNAIRE 04-05] MEDICARE SUPERVISION REQUIREMENTS [03-03] [06-06] MEDICARE SURROGATE UPIN NUMBERS [07-06] MEDICARE TRICARE CLAIMS [04-05] MEDICARE V-CODES HCPCS II V-CODES MIDLANDS CHOICE ADDRESS CHANGE [10-06] MODIFIERS--MEDICARE [MEDICARE PHYSICIAN'S MANUAL] [MODIFIERS--BRIEF DESCRIPTION] 4 MODIFIER: E&M NOT RELATED TO POST-OP CARE [11-03] 5 MODIFIER: HOW TO FILE A SERVICE ALONG WITH A PROCEDURE [07-0] [07-04] 5 AND 57 MODIFIERS [07-0] 6 AND TC MODIFIERS IN HPSAS [11-05] 50-5 MODIFIERS (BILATERAL VS. REDUCED SERVICES) SEE MPFSDB PAYMENT POLICY INDICATORS UNDER COLUMN "BILAT SURG" FOR CODE "" OR "3"...CODE "" = PAID ONCE FOR BOTH EYES....CODE "3'= PAID FOR EACH EYE (USE 50 MODIFIER FOR BOTH EYES). 57 AND 5 MODIFIERS [07-0] A970 [04-03] AQ MODIFIER [09-05] EY MODIFIER [05-04] GA MODIFIER [COMMUNIQUÉ DESCRIPTION ] [04-03] [05-04] GW MODIFIER [04-03] GY MODIFIER [04-03] [05-04] GZ MODIFIER [04-03] KX MODIFIER [07-0] [05-04] QB AND AQ FOR HPSA [09-05] TC AND 6 MODIFIERS IN HPSAS [11-05] ZX MODIFIER [01-0] [07-0] MODIFIERS-- DMERC TABLE OF MODIFIERS [05-04] MOTHER OF AN UNBORN CHILD--MEDICAID [06-01] MOTORIST'S VISION REQUIREMENTS FOR NEBRASKA MULTI CARRIER SYSTEM--MEDICARE [SEE UNDER MEDICARE] N NATIONAL COVERAGE DETERMINATIONS [NCDS} NATIONAL PROVIDER IDENTIFIER [03-04] [08-05] [10-05] [0-06] [06-05] [06-06] [09-06] [10-06] [11-06] NEBRASKA CONTROLLED SUBSTANCES NUMBER [10-01] NEBRASKA DEPARTMENT OF REVENUE [SALES TAX EXEMPTIONS -SEARCH] NEBRASKA LICENSURE LAWS [OPTOMETRY LAW & OTHER LICENSURE LAWS] NEMB FORM FOR NON-COVERED MEDICARE ITEMS [11-04] NEMB FORM DOWNLOAD NEW LICENSEE PAGE [10-04] NONE-COVERED MATERIALS ABNS, AND DMERC[DMERC ABN] [05-04] [06-04] (SEE ALSO MEDICARE FORMS) NEMB FORM [11-04] (SEE ALSO MEDICARE FORMS) NONE-COVERED SERVICES - NOT MEDICALLY NECESSARY PAGE 5 THIRD PARTY NEWSLETTER

6 Annual INDEX For 3rd Party Newsletter and Web Page Brackets with numbers [03-0] indicate the month and year the topic was covered in the 3rd Party Newsletter. Brackets with words or instructions [1997 E&M GUIDELINES] indicate there is a hyperlink to this subject on the 3rd Party Web Page. By double clicking on these words on the web page you will go directly to the site containing this topic. (Continued from page 5) [MEDICARE WAIVER OF LIA BILITY (ABN)] [06-04] (SEE ALSO MEDICARE FORMS) [MEDICAID ADOBE FIND "COVERED"] NORIDIAN NEW DME MAC SEE UNDER DMERC NOTICE OF PRIVACY PRACTICES--GIVING TO PATIENT [04-03] NPI SEE NATIONAL PROVIDER IDENTIFIER NURSING HOME CODES [01-06] [03-06] O OCR HIPAA GUIDELINES HIPAA SPECIAL PAGE ON THIS WEB SITE OCT [MEDICARE LCD] [11-04] [03-06] [04-06] OFFICE OF THE INSPECTOR GENERAL (OIG) [OIG HOME PAGE] OPHTHALMOLOGICAL COMPREHENSIVE SERVICE [MEDICARE LCD-LMRP] [11-0] OPTOMETRY PRACTICE ACT IN NEBRASKA [OPTOMETRY LAW & OTHER LICENSURE LAWS] OPTOMETRY RULES AND REGULATIONS [NE OPT RULES/REGS] OPTOMETRY SERVICES [MEDICARE LCD] OPTOMAP AND DILATION [1-05] OPTOMAP AND RETINAL PHOTOS [06-04] [1-05] OPTOMAP MEDICARE CLAIMS [09-06] OTH000 DISCONTINUED PIN [04-06] P PACHYMETRY [MEDICARE LCD] [11-04] POTENTIAL ACUITY METER [MEDICARE LCD FIND POTENTIAL] PAPER CLAIMS--- SEE CMS-1500 PATIENT INFORMATION, PATIENT RECORDS [1997 E&M GUIDELINES ADOBE FIND RECORD] HIPAA HIPAA SPECIAL PAGE ON THIS WEB SITE SIGNING AND DATING [04-03] PAYMENTS, FEES, AND CHARGES --LOOK UNDER FEES PLACE OF SERVICE [MEDICARE AND MEDICAID] [03-06] POLYCARBONATE [MEDICAID ADOBE FIND POLYCARB] [11-05] [1-05] POLYCARBONATE LENSES FOR MEDICAID CHILDREN [11-05] [1-05] POS ---SEE PLACE OF SERVICE POST-CATARACT SURGERY GLASSES--- SEE UNDER DMERC POST OP CARE BCBS POLICY CHANGE [03-03] CLAIM REQUIREMENTS [POST-OP CLAIMS] CO-MANAGEMENT FOR CATARACT SURGERY [MEDICARE LCD: SEARCH FOR POST-OP] CO-MANAGEMENT FOR LASER CAPSULOTOMY [1-0] REFRACTION CHARGES [0-01] VOLUNTARY GUIDELINES FROM AOA [11-03] PRACTICE GUIDELINES--SEE PRACTICE GUIDELINES AT AOA WEBS SITE (AOA) PRIMARY CARE PROVIDER, COMMUNICATION WITH [11-01] PRIMARY REASON FOR VISIT [1997 E&M GUIDELINES ADOBE FIND] PRIMARY CARE + PRIOR AUTHORIZATION FOR SURGERY PROCEDURES [1-03] PRISM [DMERC] [MEDICAID ADOBE FIND] PROFESSIONAL COURTESY---WHEN IS IT LEGAL [05-03] PUNCTAL PLUG CODING [08-04] PUNCTAL PLUG INSERTION PLUS E&M FEES [09-01] PURCHASED SERVICES, BILLING OF [MEDICARE PHYSICIANS MANUAL] [03-05] Q QB MODIFIER FOR HEALTH PROFESSIONS SHORTAGE AREA [09-04] [1-04] R REASON CODES SEE MEDICARE REASON CODES RECORD DOCUMENTATION [07-01] [07-06] RECORDS RETENTION [06-03] RECOUPMENT BY MEDICARE [06-04] REDUCED SERVICE MODIFIER SEE UNDER MEDICARE--MODIFIERS 50 AND 5 REFERRAL AND CONSULTATION CODING [0-0] REFERRALS--LEGAL LIMITATIONS ON [01-04] REFRACTION GY MODIFIER NEEDED [0-04] MEDICARE PATIENTS [0-04] [04-04] POST-OP CHARGE [0-01] REFRACTIVE LENSES & DMERC [EYEGLASSES AND CLS] [1-04] REGULATIONS OF OPTOMETRY IN NEBRASKA--SEE OPTOMETRY RULES AND REGS RELEASE OF A CL RX (FTC)--SEE CONTACT LENSES RELEASE OF MEDICAL RECORDS & PATIENT INFORMATION HIPAA PRIVACY HIPAA SPECIAL PAGE ON THIS WEB SITE [NEBRASKA LAW] (SEE ALSO HIPAA PRIVACY) RELEASE TO CORPORATIONS [08-0] REMARK CODES --SEE UNDER MEDICARE REMARK CODES REMITTANCE ADVICE--SEE MEDICARE RENT, RENTAL PAYMENTS [OIG FRAUD ALERT] RETINAL PHOTOS [MEDICARE LCD] RETINAL PHOTOS AND OPTOS [06-04] REVENUE-- NEBRASKA DEPARTMENT OF [SALES TAX EXEMPTIONS -SEARCH] RUST REMOVAL [03-06] S S-CODES [03-05] [06-05] SALES TAX LOW VISION AIDS---SALES TAX ON [01-04] NEBRASKA DEPARTMENT OF REVENUE [SALES TAX EXEMPTIONS -SEARCH] SCANNING LASER GLAUCOMA TEST (SGLT) [MEDICARE LCD] [AUDITS] [03-06] [04-06] SEE ALSO OCT SCHIRMER TEAR TESTING [MEDICARE LCD FIND SCHIRMER] SCRATCH-COAT: MEDICAID VS. DMERC [08-03] SECURE HORIZONS MEDICARE ADVANTAGE ERRORS [09-06] SLAB-OFF --- SEE UNDER DMERC -- REFRACTIVE LENSES SKILLED NURSING FACILITY CONSOLIDATED BILLING: SEE CONSOLIDATED BILLING STANDARDS OF CARE [05-04] STARK II: EYEGLASSES AND CONTACT LENSES EXCLUDED BY [01-01] SUBSTITUTE PROVIDERS [08-06] SUPERVISION REQUIREMENTS [03-03] [06-06] SUPPLIER MANUAL [DMERC] SURETY BOND [DMERC] T THIRD PARTY PAYERS IN NEBRASKA [THIRD PARTY PAYERS PAGE] THIRD PARTY PAYER PROBLEMS: REPORTING FORM: [07-06] TOPOGRAPHY [MEDICARE LCD] TRANSITIONS LENSES AND DMERC [0-05] TRAUMA CODE EDITS [09-03] TREATMENT: DIAGNOSTIC AND TREATMENT PROGRAM [1997 E&M GUIDELINES ADOBE FIND] TRICARE VS. MEDICARE CLAIMS [04-05] U [UPIN DIRECTORY] UNITED HEALTHCARE AND RAILROAD COVERAGE LIMITATIONS [09-06] UV COATING ON PLASTIC LENSES (DMERC) [07-05] V V-00 [MEDICAID VISION CARE RULES] ALSO, SEE UNDER DMERC -- REFRACTIVE LENSES V-05 [MEDICAID VISION CARE RULES] ALSO, SEE UNDER DMERC -- REFRACTIVE LENSES V-CODES...HCPCS II V-CODES V58.69 DIAGNOSIS [01-01] VACATION COVERAGE OF ODS [08-06] VISION THERAPY -- BCBS CODING NOTICE [11-06] VISUAL FIELDS [MEDICARE LCD] VSP AND MEDICAID [11-01] W WALL CHART FOR EVALUATION AND MANAGEMENT CODING *** CODE CHART 1 - HISTORY *** CODE CHART - HISTORY SCORE *** CODE CHART 3 - NEW PT SCORE *** CODE CHART 4 - EXAMINATION *** CODE CHART 5 - EXAMINATION SCORE *** CODE CHART 6 - ESTABLISHED PT SCORE *** CODE CHART 7 - DECISION MAKING *** CODE CHART 8 - DECISION MAKING SCORE *** CODE CHART 9 - DR. QUACK'S DIRECTIONS WIDE SEGMENTS [MEDICAID VISION CARE RULES] ALSO, SEE UNDER DMERC -- REFRACTIVE LENSES WORKERS COMP REIMBURSEMENT [NEBRASKA STATUTE] Z ZX MODIFIER SEE MODIFIERS ZY MODIFIER SEE MODIFIERS PAGE 6 THIRD PARTY NEWSLETTER

7 Dr. Quentin Quack s Queries and Questionable Quotes ~~~~~~~~~~~~~~~~~~~~~~~~~~ Third Party Questions from NOA Doctors and Staff ~~~~~~~~~~~~~~~~~~~~~~~~~~ Dr. Quentin Quack Update Medicare Form 588, Not 855, for Noridian EFT Dear Dr. Quack, When we were in Kearney last month you mentioned something about needing to file a new CMS- 855 form before Dec. 1 with our new DMERC Carrier, Noridian. Can you provide more details on this subject so that I have a better idea of what exactly I need to do? I would really appreciate it. Dr Quack s Quote: Sorry. Dr. Quack mis-spoke at his presentation at Kearney regarding this form from a couple of aspects. The form you need to complete is CMS form 588, for Noridian, our new Durable Medical Equipment MAC. NOT 855. And you only need to complete a new 588 if you participate in EFT (electronic funds transfer). Noridian cannot transfer funds electronically to you based on the 588 you previously completed for CIGNA. So, if you currently get paid electronically from DME MAC (used to be called DMERC), then you need to complete a new CMS form 588. If you are paid by check, ignore the whole topic (at least for now). You can find more on completing the CMS-588 at this web site... ENROLL/CMS588.HTML Dr. Quack realized his error while driving home from Kearney. The NOA office immediately sent out a mass and inserted a special bulletin in last month s 3rd party newsletter explaining the error, but obviously not everyone has had an opportunity to read the corrections. Dr. Quack regrets the error. Dr. Quack bombs regarding Form 588 Enrolling with NPIs versus Legacy Numbers Dear Dr. Quack: By next summer two new doctors will be joining our practice. If they each get an NPI number, will that be sufficient or will they have to have all the individual numbers; examples: Medicare, Noridian (DME MAC), Medicaid, BCBS, private insurance. Dr. Quack s Quote: Wow! Two new doctors sounds really exciting!! The new doctors will need to apply to be providers for each of the 3rd parties that you mentioned, of course. Whether those 3rd parties will provide a number separate from the NPI is another question...there is a place on the new CMS-1500 for both the NPI and also for "legacy" numbers, so I suppose they might. However, at least one source states that CMS will not want legacy numbers on their claims after May of next year (see page ). We should learn more as time passes. At any rate, you don't need to worry about it, because the 3rd parties will be the ones to assign, or not assign, a legacy number when they make your new doctors providers on their panel. By the way, especially for new grads, be sure to get the new doctors' applications in as soon as you collect all the needed data [diploma, license number, insurance data, DEA number, NPI, etc]...it takes weeks to months to get approval from some third parties. VOLUME 6 PAGE 7

8 NEBRASKA OPTOMETRIC ASSOCIATION 1633 Normandy Court, Suite A, Lincoln, NE 6851 ABSTRACTS OF THIS MONTH S ISSUE MEDICARE REGULATIONS ON DURABLE MEDICAL EQUIPMENT Noridian Administrative Services (NAS) is our new Durable Medical Equipment (DME) Medicare Administrative Carrier (MAC). [The acronym DMERC has now been replace by DME MAC.] Their regulations on refractive lenses can be found at ARTICLE_ID=3900&ARTICLE_VERSION=4&SHOW=ALL which is difficult to find when navigating the Noridian web site. MISUSE OF DEA NUMBERS Reminder: if you have experience misuse of your DEA number by pharmacies or insurers, please use the form published in our September, 006 3rd party newsletter to report your experience to the AOA. 007 MEDICARE PART B DEDUCTIBLE AND COINSURANCE Deductible $ per year; Coinsurance 0 percent. Medicare Advantage plans differ. REVISED CMS-1500 CLAIM FORMS AVAILABLE FROM AOA New, revised CMS 1500 claim forms, designed to allow use of National Provider Identifier (NPI) numbers, are now available from the AOA Order Department. MEDICARE TO CHARGE FOR DUPLICATE REMITTANCE ADVICE Effective December 1, 006, Medicare will charge providers $6 when they request a duplicate copy of a Medicare remittance advice. Requests for duplicate remittance advice copies should be submitted to Medicare with a completed Duplicate Remittance Advice Request form. DETAILED INSTRUCTIONS ON NEW CMS-1500 The October issue of our Medicare carrier s Communiqué contains detailed instructions on correct completion of the new CMS-1500 form. Look on pages NEW CMS-1500 PAPER FORM REQUIRED ON APRIL, 007 The Centers for Medicare & Medicaid Services (CMS) is implementing the revised Form CMS-1500 effective January 1, 007, but will not be mandated for use until April, 007. WHEN CAN YOU USE THE NPI, AND WHEN MUST YOU USE ONLY THE NPI CMS plans to begin testing the new software that has been developed to use the National Provider Identifier (NPI) in the existing Medicare fee-for-service claims processing systems. Providers have until May 3, 007, before they are required to submit claims with only an NPI. CORRECTION: UPDATE MEDICARE FORM 588, NOT 855, FOR NORIDIAN EFT Dr. Quack erred in his Kearney presentation. The form you need to update for Noridian electronic funds transfer is CMS form 588, NOT 855. ENROLLING WITH NPIs VERSUS LEGACY NUMBERS When you enroll with 3rd parties, they will be the ones to assign, or not assign, their legacy numbers. There is a place on the new CMS-1500 for both the NPI and also for "legacy" numbers. However, CMS may not want legacy numbers on claims after May of next year. Keep tuned. Dr. Quentin Quack s Queries...continued O ccasionally Dr. Quack s fax machine or contains a question or story that is interesting, but may not pertain directly to third party care. Dr. Quack feels that he should share some of these humorous thoughts. leave Minnesota, son? They re all just whores and hockey players up there, sir, said the boy. My wife is from Minnesota! said the manager. Really! said the boy. And what team did she play for? A boy worked in the produce section of a supermarket. A man came in wanting to buy a half a head of lettuce. The boy explained that they only sold whole heads lettuce, but the man insisted. The boy went to the back room and told the manager, Some idiot out there wants to buy a half a head of lettuce. As soon as he said this, he noted the man had followed him and was now standing right behind him, so he added, And this gentleman wants to buy the other half. The manager okayed the deal, and later the manager said the boy, You almost got yourself into a lot of trouble back there, and I noticed how quickly you thought on your feet and got yourself out of trouble. We like that around here. Where are you from, son? The boy replied, Minnesota, sir. The manager asked, And why did you The NOA Third Party Newsletter is published monthly by the Nebraska Optometric Association with the assistance of Ed Schneider, O.D., Third Party Consultant. To reach Ed (aka Dr. Quack): > (BEST): SchneiderEd@msn.com (HIPAA Compliant) > Ed s mobile phone is Voic available. > Fax number is Call Ed before faxing. To reach the NOA (New address as of November 1, 006) Nebraska Optometric Association 1633 Normandy Court Suite A Lincoln NE 6851 Phone: Fax: VOLUME 6 PAGE 6