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Posting Date: 07/18/2023
Medical Review: Targeted Probe and Educate Review Topics
Jurisdiction 6 Part B Targeted Probe and Educate: Medical Review Topics Topic CPT Code(s) Common Denials Resources Incision and drainage of abscess (e.g., carbuncle, suppurative hidradenitis, cutaneous or [...]
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Posting Date: 03/14/2025
MLN Connects® Newsletter: March 13, 2025
MLN Connects® Newsletter: March 13, 2025 News Medicare Shared Savings Program: Application Deadlines for January 1, 2026, Start Date Claims, Pricers & Codes ICD-10 Coordination & Maintenance Committee: Submit Procedure Code [...]
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Posting Date: 09/30/2024
What Should Be Provided if Medical Records Are Requested for Review?
What Should Be Provided if Medical Records Are Requested for Review? The following should be considered if applicable to the service being reviewed. This is not intended to be an all-inclusive list. Progress/visit notes Physician orders [...]
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Posting Date: 01/12/2024
Long-Term Care Hospitals: How to Request Adjustments of Claims Paid at the Site Neutral Rate
Long-Term Care Hospitals: How to Request Adjustments of Claims Paid at the Site Neutral Rate Table of Contents Long-Term Care Hospitals: How to Request Adjustments of Claims Paid at the Site Neutral Rate Background: Standard Payment vs. [...]
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Posting Date: 11/09/2018
Claims for Drugs Without a Product-Specific Code Assigned
Claims for Drugs Without a Product-Specific Code Assigned National Government Services has noticed that when a claim RTPs for additional information to be added to the Remarks field concerning certain drugs, some providers attempt to provide [...]
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Posting Date: 03/13/2025
Denials for HCPCS G2211
NCCI editing for HCPCS G2211 code was updated on 12/05/2024 to require HCPCS G0463 as the primary code for G2211 add-on code. This has resulted in denials of claims for the add-code G2211 when billed with CPTs 99202-99205 and 99211-99215. [...]
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Posting Date: 03/11/2025
April Code Set Update for PC Print: April 2025
April Code Set Update for PC Print: April 2025 The PC Print April code set update will be available on our website 4/9/2025. The update contains the following enhancements: CR13891 Implement Operating Rules – Phase III [...]
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Posting Date: 04/08/2025
April Code Set Update for PC Print: April 2025
April Code Set Update for PC Print: April 2025 The PC Print April code set update will be available on our website 4/9/2025. The update contains the following enhancements: CR13891 Implement Operating Rules - Phase III [...]
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Posting Date: 04/08/2025
New Version of PC-ACE: April 2025
New Version of PC-ACE: April 2025 PC-ACE Version 6.6 contains several CMS mandates and product enhancements including but not limited to the items listed below. 13891 – Implement Operating Rules – Phase III Electronic Remittance Advice [...]
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Posting Date: 05/25/2022
Illinois, Minnesota, Wisconsin
Member Name Group Email Aldrich, Elizabeth IPW (Independent Physicians of Wisconsin), Allen Family Practice ealdrich@ipw-offices.org Anderson, Benita Aurora Health Care Benita.Anderson@aurora.org [...]
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