MLN Connects® Newsletter: February 16, 2023

MLN Connects® Newsletter: February 16, 2023     News Billing Medicare Part B for Insulin with New Limits on Patient Monthly Coinsurance Unprecedented Efforts to Increase Transparency of Nursing Home Ownership CMS Proposes [...]

New Service Added to the Hospital Outpatient Department Prior Authorization Program

New Service Added to the Hospital Outpatient Department Prior Authorization Program Effective for dates of service rendered on or after 7/1/2023, facet joint interventions are added to the HOPD services requiring prior authorization as a [...]

MLN Connects® Newsletter: Public Health Emergency 1135 Waivers: Updated Guidance for Providers - February 23, 2023

MLN Connects®Newsletter: Public Health Emergency 1135 Waivers: Updated Guidance for Providers -  February 23, 2023     News Public Health Emergency (PHE) 1135 Waivers: Updated Guidance for Providers Posted 2/23/2023

MLN Connects® Newsletter: COVID-19 Public Health Emergency (PHE) New Overview Fact Sheet — Feb 27, 2023

MLN Connects® Newsletter: COVID-19 Public Health Emergency (PHE) New Overview Fact Sheet — Feb 27, 2023     News COVID-19 Public Health Emergency (PHE) New Overview Fact Sheet​​​​​​​ Posted 2/28/2023

MLN Connects® Newsletter: March 2, 2023

MLN Connects® Newsletter: March 2, 2023 News The Future of Medicare Enrollment: Save Time with PECOS's Consolidated Application Voluntary Prior Authorization Process for Certain Power Mobility Device Accessory Items Expanded Home [...]

MLN Connects® Newsletter: March 9, 2023

MLN Connects® Newsletter: March 9, 2023 News Nutrition-Related Health Conditions: Recommend Medicare Preventive Services Compliance Advance Care Planning: Bill Correctly for Services Claims, Pricers and Codes Medicare [...]

E/M Coding: Medical Decision Making Moderate Point Scoring for Data Elements

Evaluation and Management Coding: Medical Decision Making Moderate Point Scoring for Data Elements On 1/1/2021, CMS approved and issued modifications to E/M coding guidelines that were originally developed and adopted by the AMA. This change [...]

DDE Logon ID and Password Reminders

DDE Logon ID and Password Reminders CMS’ information security policy strictly prohibits the sharing or loaning of Medicare assigned IDs and passwords. Users should take appropriate measures to prevent unauthorized disclosure or modification of [...]

Knee Orthosis: A/B and DME Collaborative Presentation

Knee Orthosis: A/B and DME Collaborative Presentation View the A/B and DME Knee Orthosis YouTube video for information on knee orthosis. Posted 3/23/2023

Resolved: Home Health Claims Editing for Reason Codes U5210/U5220

Resolved: Home Health Claims Editing for Reason Codes U5210/U5220 Some home health NOAs and claims were incorrectly hitting reason codes U5210 and U5220. These reason codes state there is no Medicare entitlement for the dates of service when [...]

(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

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​​​​​​​

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

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 [...]

CR13105 - Technical Revisions Only to the National Coverage Determination (NCD) Manual

CR13105 - Technical Revisions Only to the National Coverage Determination (NCD) Manual

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 [...]

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 [...]

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

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 [...]

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 [...]

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 [...]

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 [...]

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

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 [...]

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 [...]

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 [...]

DSMT: Documentation & Physician Order Requirements

DSMT: Documentation & Physician Order Requirements Table of Contents DSMT: Documentation & Physician Order Requirements Documentation & Physician Order Requirements Provider Actions Related Content [Return to Top] DSMT: [...]

Billing for Drug Wastage: JW and JZ Modifier

Billing for Drug Wastage: JW and JZ Modifier Properly billing for drug wastage and associated modifiers helps to prevent claims processing errors and denials while ensuring you receive correct reimbursement. Providers and suppliers are to [...]

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 [...]

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 [...]

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 [...]

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

Medicare Hospice Quick Reference Sheet

Medicare Hospice Quick Reference Sheet The codes listed below are only those most frequently applicable to hospice claims. For a complete list of codes, see the NUBC manual. The NUBC maintains the UB-04 data element specifications and revenue [...]

JK Part A Immediate Recoupment Request Form

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 [...]

Procedure Code 99211 Job Aid

Procedure Code 99211 Job Aid Table of Contents Definition for 99211 Definition for Established Patient Face-to-Face Encounter Requirements Presence of Physician Requirements Evaluation and Management Services Provider-Patient [...]

Incident to Office Guidelines

“Incident to” Office Guidelines The CMS rules for billing office services as “incident to” a physician’s services are summarized within this document. Of note, the concept does not apply to services performed in the hospital environment, which [...]

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 [...]

Nonphysician Practitioners Billing for Surgical Procedures

Nonphysician Practitioners Billing for Surgical Procedures Several providers have asked about the Medicare guidance for NPPs include billing for surgical procedures. For the purpose of this education, NPPs include NPs, PA, and CNSs. State law [...]

Medical Review Audits

Medicare Coverage of Chiropractic Services Medical Review Audits Medicare contractors perform medical review audits to ensure Medicare is paying providers for appropriately covered Medicare services. Medical review examines documentation [...]