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Posting Date: 10/17/2024
Nettings/Offsets Across Organization Affiliations
Effective 1/4/2016, CMS implemented a change to begin netting/offsetting provider money across affiliated providers within the same and also across workloads within a single organization. This CMS change brings consistency to all Part B [...]
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Posting Date: 10/17/2024
Overpayment Rebuttal Process
You’ll need to know what the rebuttal process is before initiating and know that the outcome of the rebuttal may not change the National Government Services recoupment process. The overpayment rebuttal process is a protocol used when an [...]
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Posting Date: 10/17/2024
Overpayment Request
Table of Contents Forms You'll Need Large Scale Overpayments Overpayment Notification Process Timeline for Processing a Demand Letter [Return to Top] Forms You'll Need Forms for non MSP-related are generally done via NGSConnex, but [...]
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Posting Date: 10/17/2024
Respond to a Demand Letter
Table of Contents Form(s) you’ll need Timeline for Processing a Demand Letter [Return to Top] Form(s) you’ll need Providers on Automatic immediate Recoupments Do nothing as this automation process will automatically be done and [...]
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Posting Date: 10/17/2024
Request an Immediate Recoupment
Forms You’ll Need These forms apply to providers that are NOT on Automatic Immediate Recoupments. Electronic Submissions JK or J6 Immediate Recoupment Request Form - Electronic/E-mail Paper Submissions Jurisdiction K [...]
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Posting Date: 10/10/2024
Navigating Medicare Part B Insights for Providers Podcast
Navigating Medicare Part B Insights for Providers Podcast Listen to our podcast, Navigating Medicare Part B Insights for Providers, on Spotify and Apple Podcasts! We will be posting a new episode on the 2nd and 4th Wednesday of each [...]
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Posting Date: 10/21/2024
Initiate a Prior Authorization Request for OPD Services for Part A Facility
Initiate a Prior Authorization Request for OPD Services for Part A Facility Table of Contents Initiate a Prior Authorization Request Request Details Requestor’s Information Rendering Physician Information Attachments [...]
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Posting Date: 10/17/2024
MLN Connects® Newsletter: October 17, 2024
MLN Connects® Newsletter: October 17, 2024 News Inpatient Psychiatric Facilities: Guidance on All-Inclusive Cost Reporting No-Pay Medicare Summary Notice Mailing Frequency Changed to Every 120 Days Health Literacy: Help Your Patients Get [...]
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Posting Date: 11/12/2021
Interactive Voice Response System
Interactive Voice Response System CMS requires that Medicare contractors offer self-service options to their providers for general inquiries. CMS also requires providers to utilize those self-service options, such as the IVR. National [...]
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Posting Date: 11/16/2021
Skilled Nursing Facility Consolidated Billing
Skilled Nursing Facility Consolidated Billing Back in 1997 as part of the Balanced Budget Act, Congress mandated that payment for the majority of services provided to beneficiaries in a Medicare-covered SNF stay be included in a bundled [...]
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Posting Date: 11/12/2021
Local Coverage Determination
Local Coverage Determination LCDs are developed by the local Medicare contractor in the absence of a national Medicare payment policy. These policies describe specific criteria which determine whether an item or service is covered by Medicare [...]
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Posting Date: 11/12/2021
ABN Modifiers
ABN Modifiers Modifier Description GA Waiver of liability statement issued, as required by payer policy, individual case GX Notice of liability issued, voluntary under payer policy GY Item [...]
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Posting Date: 11/12/2021
American Medical Association and Current Procedural Terminology
American Medical Association and Current Procedural Terminology The AMA is your trusted source for official CPT. The most widely accepted medical nomenclature used to report medical procedures and services under public and private health [...]
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Posting Date: 11/12/2021
CMS Forms and Publications
CMS Forms and Publications CMS publishes and maintains numerous Medicare forms that are used daily by the provider community. Some commonly used forms are: Provider Enrollment CMS-855 forms (CMS-855B, CMS-855I and CMS-855O) Medicare [...]
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Posting Date: 11/12/2021
CMS Regional Offices
CMS Regional Offices CMS has ten RO reorganized in a Consortia structure based on the agency’s key lines of business: Medicare Health Plans Operations Financial Management and Fee-for-Service Operations Medicaid and Children’s Health [...]
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Posting Date: 11/12/2021
Clinical Lab Improvement AmendmentÂ
Clinical Lab Improvement Amendment CMS regulates all laboratory testing (except research) performed on humans in the U.S. through the CLIA. The objective of the CLIA program is to ensure quality laboratory testing. Although all [...]
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Posting Date: 11/11/2021
Comprehensive Error Rate Testing
Comprehensive Error Rate Testing The CERT program was established by CMS to monitor the accuracy of claim payment in the Medicare FFS Program. The intent of the CERT program is to protect the Medicare Trust Fund by identifying errors and [...]
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Posting Date: 11/12/2021
Electronic Health Records
Electronic Health Records Eligible professionals under the Medicare EHR Incentive Program include: Doctor of medicine or osteopathy Doctor of dental surgery or dental medicine Doctor of podiatry Doctor of optometry Chiropractor If [...]
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Posting Date: 11/12/2021
Electronic Prescribing
Electronic Prescribing In 2013, the eRx Incentive Program for participating and reporting in the Medicare Electronic Prescribing (eRx) Incentive Program ended. The six-month 2014, eRx payment adjustment reporting period began on 1/1/2013 and [...]
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