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Posting Date: 10/14/2024
Reminder – Beginning 11/18/2024, Beneficiary Eligibility Information Not Offered on the IVR
Reminder – Beginning 11/18/2024, Beneficiary Eligibility Information Not Offered on the IVR To help protect Medicare beneficiaries against fraud, CMS is instructing all MACs to remove beneficiary eligibility information from our IVR [...]
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Posting Date:
Inpatient Hospital Issued Notices
Inpatient Hospital Issued Notices Applies to: All hospitals Medicare beneficiaries and hospitals have certain rights and protections related to financial liability and appeals under the Medicare Program. These financial liability and appeal [...]
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Posting Date: 10/31/2022
Modifier Usage
Modifier Usage Table of Contents E/M Services Within a Global Surgical Period – Modifiers 24, 25 and 57 24 – Unrelated E/M Service by the Same Physician During a Postoperative Period 25 – Significant, Separately Identifiable E/M [...]
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Posting Date: 08/05/2022
Proper Use of Modifiers 59 and 91
Proper Use of Modifiers 59 and 91 Table of Contents Modifier 59 Appropriate Usage Inappropriate Usage Modifier 91 Appropriate Usage Inappropriate Usage Additional Information Related Content [Return to Top] [...]
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Posting Date: 08/04/2022
Repeat Procedures - Modifiers 76 and 77
Repeat Procedures - Modifiers 76 and 77 Exact duplicate data fields submitted for claims include: Same beneficiary Same provider Same dates of service Same types of services Same place of service Same procedure codes Same billed [...]
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Posting Date: 10/26/2022
Deceased Beneficiary Claims
Medicare Part B 101 Deceased Beneficiary Claims Table of Contents Deceased Beneficiary Claims Unpaid Bills Paid Bills Assigned Claims [Return to Top] Deceased Beneficiary Claims Medicare law outlining the payment of the medical [...]
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Posting Date: 10/07/2022
Payment Floor Standards
Medicare Part B 101 Manual Payment Floor Standards The “payment floor” establishes a waiting period during which time the contractor may not pay, issue, mail or otherwise finalize the initial determination on a clean claim. The “payment [...]
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Posting Date: 10/06/2021
Limiting Charge
Medicare Part B 101 Manual Limiting Charge Table of Contents Federal Limiting Charge Federal Limiting Charge for Medicare Secondary Payer [Return to Top] Federal Limiting Charge As part of the Omnibus Budget Reconciliation Act of [...]
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Posting Date: 10/07/2021
Nonphysician Practitioners
Medicare Part B 101 Manual Nonphysician Practitioners Table of Contents Nonphysician Practitioners Direct Billing/Payment for NPP Services Furnished to Inpatients and Outpatients Related Content [Return to Top] Nonphysician [...]
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Posting Date: 10/28/2022
Standard Remittance ANSI Codes and Remittance Advice
Medicare Part B 101 Manual Standard Remittance ANSI Codes and Remittance Advice Table of Contents What Is a Remittance Advice? What are the Uses for a Remittance Advice? What are the Different Types of Remittance Advice? What You [...]
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Posting Date: 10/06/2021
Appendix 1: Forms
Medicare Part B 101 Manual Appendix 1: Forms Appeals Coverage Customer Care Documentation EDI Enrollment Other Advance Payments CMS Forms Investigational Device Exemption Requests Medicare Privacy Statement Form Vaccine [...]
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Posting Date: 10/14/2022
Appendix 2: Glossary
Medicare Part B 101 Manual Appendix 2: Glossary of Terms The Glossary of Terms listed below are in alphabetical order. Term Definition ABN Advance Beneficiary Notice: A formal notice of noncoverage that a [...]
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Posting Date: 10/07/2022
Evaluation and Management Services
Medicare Part B 101 Manual Evaluation and Management Services Table of Contents Evaluation and Management Services General Principles of Medical Record Documentation New Patient and Established Patient What Should Be Provided if [...]
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Posting Date: 10/07/2022
Participation Program
Medicare Part B 101 Manual Participation Program Table of Contents Eligibility Participation Enrollment Period/Participating Status Changes Participation Program Participating Provider Nonparticipating Provider When [...]
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Posting Date: 10/07/2022
Ordering and Referring Claims Information
Medicare Part B 101 Manual Ordering and Referring Claims Information Table of Contents Ordering and Referring Claims Information How to Identify the Ordering or Referring Provider on a Claim Ordering and Referring Eligible Provider [...]
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Posting Date: 03/04/2021
Refunds and Overpayments
Medicare Part B 101 Manual Refunds and Overpayments Table of Contents Medicare Contractor Initiated Demand Letters Providers Not on Automatic Recoupments Jurisdiction K (CT, MA, ME, NH, NY, RI , VT) Jurisdiction 6 (IL, MN, WI) [...]
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