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Posting Date: 12/23/2020
(SE20024) FAQs on the 3-Day Payment Window for Services Provided to Outpatients Who Later Are Admitted as Inpatients
MLN Matters®: SE20024 FAQs on the 3-Day Payment Window for Services Provided to Outpatients Who Later Are Admitted as Inpatients
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Posting Date: 03/31/2023
CR12669 - Instructions Relating to the Evaluation of Section 1115 Waiver Days in the Calculation of Disproportionate Share Hospital Reimbursement
CR12669 - Instructions Relating to the Evaluation of Section 1115 Waiver Days in the Calculation of Disproportionate Share Hospital Reimbursement
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Posting Date: 03/31/2023
CR13122 - Implementation of Consolidated Appropriations Act (CAA) of 2023, Section 4143: Waiver of Cap on Annual Payments for Nursing and Allied Health Education Payments
CR13122 - Implementation of Consolidated Appropriations Act (CAA) of 2023, Section 4143: Waiver of Cap on Annual Payments for Nursing and Allied Health Education Payments
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Posting Date: 07/27/2020
Modifiers Used During the COVID-19 Public Health Emergency
Modifiers Used During the COVID-19 Public Health Emergency Modifier Part A Billed on UB04? Part B Billed on 1500? Details References Exceptions/Special Usage CS Exception Yes Waives [...]
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Posting Date: 04/14/2023
CR13105 - Technical Revisions Only to the National Coverage Determination (NCD) Manual
CR13105 - Technical Revisions Only to the National Coverage Determination (NCD) Manual
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Posting Date: 04/19/2023
Telehealth Frequently Asked Questions are Updated
Telehealth Frequently Asked Questions are Updated We’ve updated our telehealth frequently asked questions to include changes and flexibilities due to the end of the PHE on 5/11/2023. Please view these FAQs for the answers you need to common [...]
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Posting Date: 11/15/2023
Fraud Awareness Week and National Rural Health Day
Fraud Awareness Week and National Rural Health Day Since this week is Fraud Awareness Week and National Rural Health Day is tomorrow on 11/16/2023, we wanted to share these valuable resources with you. Fraud Awareness Week Traditional [...]
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Posting Date: 12/08/2023
CR13468 - Payment of Codes for Chemotherapy Administration and Nonchemotherapy Injections and Infusions
CR13468 - Payment of Codes for Chemotherapy Administration and Nonchemotherapy Injections and Infusions Posted 12/8/2023
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Posting Date: 07/13/2022
A/B MACs Team Up with DME MACs for Glucose Monitor and Supplies Webinar on August 25
A/B MACs Team Up with DME MACs for Glucose Monitor and Supplies Webinar on August 25 Local A/B MACs and the DME MACs are excited to announce a collaboration webinar coming Thursday, August 25. This webinar will focus on what providers need to [...]
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Posting Date: 03/29/2022
Molecular Pathology Procedures Reminder
Molecular Pathology Procedures Reminder National Government Services has been receiving many claims submitted for redetermination that were submitted for Group 3 Molecular Pathology Procedures. The Group 3 codes from LCD (L35000/A56199) are [...]
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Posting Date: 12/14/2023
Medicare Demand Letter Rebuttals
Medicare Demand Letter Rebuttals National Government Services has seen an influx of overpayment rebuttal inquiries and here’s what you need to know. Rebuttals should be rare and only approved if NGS has processed an account(s) receivable [...]
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Posting Date: 04/21/2022
CMS Region 2 Office Hours
CMS Region 2 Office Hours The CMS Region 2 Office recently began conducting a series of “Office Hours” calls. The purpose of these sessions is to provide brief updates on Medicare topics of current interest to Part A facilities, physicians and [...]
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Posting Date: 01/11/2024
MLN Matters® MM13331: Incorporation of Recent Provider Enrollment Regulatory Changes into Chapter 10 of CMS Publication (Pub.) 100-08 - Physician Fee Schedule (PFS) Final Rule
MLN Matters® MM13331 - Incorporation of Recent Provider Enrollment Regulatory Changes into Chapter 10 of CMS Publication (Pub.) 100-08 - Physician Fee Schedule (PFS) Final Rule Revised 1/12/2024
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Posting Date: 03/23/2021
Low and No Medicare Utilization Cost Report
Low and No Medicare Utilization Cost Report No Utilization Cost Reports To comply with program cost reporting requirements, a provider that has not furnished any covered Medicare services during a cost reporting period must only complete the [...]
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Posting Date: 01/26/2024
A/B DME MAC Collaborative Webinar: General Documentation Requirements
A/B DME MAC Collaborative Webinar: General Documentation Requirements Physicians/Practitioners! Are you ordering durable medical equipment, prosthetics, orthotics and supplies for your patients? This is your opportunity to hear directly from [...]
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Posting Date: 09/29/2022
National Government Services Proposed LCDs for Comment 9/29/2022-11/12/2022
National Government Services Proposed LCDs for Comment 9/29/2022-11/12/2022 The proposed LCDs listed below are being presented for comment for the Jurisdiction 6 and Jurisdiction K MACs. The formal comment period extends from [...]
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Posting Date: 04/29/2024
National Government Services Proposed LCDs for Comment (4/25/2024-6/8/2024)
National Government Services Proposed LCDs for Comment (4/25/2024-6/8/2024) The proposed LCDs listed below are being presented for comment for the Jurisdiction 6 and Jurisdiction K MACs. The formal comment period extends from 4/25/2024 through [...]
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Posting Date: 04/30/2024
2024 Medicare Cost Report Due Dates
2024 Medicare Cost Report Due Dates FYE 12/31/2023 cost reports are due by 5/31/2024. We strongly encourange early filing of the cost report. Early-filed cost reports that are rejected will receive a grace period to re-submit prior to [...]
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Posting Date: 08/15/2022
Staying Up To Date on Vaccines
Staying Up To Date on Vaccines It's important to stay up to date on vaccines. Vaccines protect your patients from serious illness and can keep them out of the hospital. Talk with your patients about which vaccines may be right for them, many [...]
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Posting Date: 05/16/2024
CR13566 - Outlier Reconciliation and Cost-to-Charge Ratio (CCR) Updates for the Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) PPS
CR13566 - Outlier Reconciliation and Cost-to-Charge Ratio (CCR) Updates for the Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) PPS Posted 5/16/2024
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Posting Date: 05/03/2022
National Government Services: Raising Awareness about Care Management
National Government Services: Raising Awareness about Care Management According to the CDC, six in ten adults in the U.S. have a chronic disease and four in ten adults have two or more. As your Medicare Contractor for Jurisdiction 6 and [...]
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Posting Date: 10/19/2022
Answers to Common Fee-for-Time Compensation Arrangements Questions
Answers to Common Fee-for-Time Compensation Arrangements Questions Does a fee-for-time compensation arrangement physician need to enroll with Medicare prior to acting as a physician? Answer: Currently, a fee-for-time compensation [...]
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Posting Date: 10/19/2022
Reminder for Avoiding Claim Denials for Positron Emission Tomography Scans
Reminder for Avoiding Claim Denials for Positron Emission Tomography Scans Background It has been noted that a high volume of PET scan claims falling between the CPT code range 78811–78816 are being denied upon original claim submission due [...]
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Posting Date: 11/11/2021
Documentation to Support Spinal Manipulation for CPT Code 98942
Documentation to Support Spinal Manipulation for CPT Code 98942 It is not uncommon for chiropractic doctors to perform a full-spine or multi-level manipulation, even when the symptoms or diagnosis reflect a single region. This is a matter of [...]
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Posting Date: 05/23/2019
Performance Standards
Performance Standards If providers are credentialing as an IDTF, then the performance standards shall be reviewed thoroughly before submitting a Medicare application. Refer to the IDTF Performance Standards and Attachment 2 beginning on page [...]
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Posting Date: 10/24/2024
Notification of the 2025 Dollar Amount in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge Hearing or Federal District Court Review
Notification of the 2025 Dollar Amount in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge Hearing or Federal District Court Review The amount that must remain in controversy for ALJ hearing requests filed on or [...]
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Posting Date: 11/07/2024
November is Lung Cancer Awareness Month
November is Lung Cancer Awareness Month Lung cancer is the leading cause of cancer death in the United States and worldwide. Although education, research and treatment options for lung cancer have dramatically improved in recent years, lung [...]
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Posting Date: 01/21/2021
No Documentation Received
No Documentation Received National Government Services has experienced an increasing number of CERT errors due to “no documentation” received. The provider either does not respond to the CERT documentation request letter(s), or the provider [...]
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Posting Date: 09/20/2019
Signature Requirements
Signature Requirements National Government Services has experienced an increasing number of CERT errors due to “signature requirements” not being met. Providers are not signing orders, certification/recertification forms or office visit notes. [...]
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Posting Date: 05/18/2020
Home Prothrombin Time International Normalized Ratio Monitoring for Anticoagulation Management
Home Prothrombin Time International Normalized Ratio Monitoring for Anticoagulation Management Insufficient Documentation Causes Most Improper Payments. Insufficient documentation means that something was missing from the medical records. [...]
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Posting Date: 08/23/2021
Psychological and Neuropsychological Testing
Psychological and Neuropsychological Testing Insufficient Documentation Causes Most Improper Payments. Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT [...]
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Posting Date: 11/04/2020
Patient Discharge Disposition Code
Patient Discharge Disposition Code Improper payments due to discharge disposition codes are costly to the Medicare Program and are easily preventable. The CERT contractor has issued errors related to the discharge disposition codes that may [...]
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Posting Date: 09/29/2020
Debridement Services
Debridement Services Insufficient documentation causes most improper payments. Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT determined there was [...]
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Posting Date: 09/24/2020
Chronic Care Management
Chronic Care Management Insufficient documentation causes most improper payments. Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT determined there was [...]
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Posting Date: 07/09/2020
Total Joint Arthroplasty
Total Joint Arthroplasty Insufficient documentation causes most improper payments. Insufficient documentation means that something was missing from the medical records. Providers can help prevent CERT errors on total joint arthroplasty by [...]
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Posting Date: 05/12/2020
Botulinum Toxin Injections for Chronic Headaches
Botulinum Toxin Injections for Chronic Headaches Insufficient documentation causes most improper payments. Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT [...]
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Posting Date: 05/05/2020
Home Health Care Requirements for a Plan of Care
Home Health Care Requirements for a Plan of Care The HHA must be acting upon a physician plan of care that meets the requirements of this section for HHA services to be covered. For HHA services to be covered, the individualized plan of care [...]
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Posting Date: 05/18/2020
Amending Medical Records
Amending Medical Records Amendments, Corrections and Delayed Entries in Medical Documentation All services provided to beneficiaries are expected to be documented in the medical record at the time they are rendered. [...]
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Posting Date: 12/17/2019
Continuous Cycling Peritoneal Dialysis
Continuous Cycling Peritoneal Dialysis We have experienced an increasing number of CERT errors due to documentation requirements not being met. Below is a list of the most common reasons CERT determined there was insufficient documentation [...]
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Posting Date: 01/29/2021
Psychiatry and Psychology Services
Psychiatry and Psychology Services CERT has determined that insufficient documentation caused improper payments for psychiatry and psychotherapy; insufficient documentation means that information was missing from the medical [...]
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