Can the patient can have two diagnostic SIJI and then four therapeutic SIJI within a 12-month rolling period for a total of six per year?

Preventive Services: Screening for STIs/HIBC to Prevent STIs, Hepatitis B, Hepatitis C Virus and HIV including HIV PrEP

This webinar is the latest in a series of Medicare preventive services webinars. During this session, we’ll review the Medicare coverage, coding and billing guidelines for screening for sexually transmitted infections (STIs)/high intensity [...]

Hospital, CMHC, CORF/ORF and ESRD Facilities Quarterly Top Claim Errors

Do you struggle with your claim denials, rejections and return to provider (RTP) claims? Do you want to be proactive in preventing unnecessary errors? Join us in a review of top claim errors for your provider type based on recent data analysis [...]

Checks <3>

table, td, th { border: 1px solid black; } table { border-collapse: collapse; width: 50%; } Checks <3> Table of Contents Checks <3> My Checks Information Checks Navigation Check Number Check Status [...]

Checks <3>

table, td, th table { border-collapse: collapse; width: 50%; } Checks <3> If you are part of a group, remember to use the group NPI, PTAN and TIN for authentication purposes. Upon selecting Checks, the provider will need to [...]

Claim Status <2>

Claim Status <2> If you are part of a group, remember to use the group NPI, PTAN and TIN for authentication purposes. When Claim Status is selected, the IVR will request and collect the following elements: NPI PTAN Last five [...]

Fast Track Access

Fast Track Access You will be prompted for the fast-track access when you use a feature that requires provider authentication (NPI, PTAN, TIN).  Features: Claim Status, Checks, Remittance Statements, Appeal Status You can obtain [...]

Remittance Statements <4>

table, td, th table { border-collapse: collapse; width: 50%; } Remittance Statements <4> Upon selecting Remittance Statements, the provider will need to authenticate the following information: NPI PTAN Last five (5) digits of [...]

General Information <8>

table, td, th table { border-collapse: collapse; width: 50%; } General Information <8> When the general information option is selected, the IVR will prompt you to choose from the following options: Phone numbers Addresses [...]

Main Menu Options

table, td, th table { border-collapse: collapse; width: 50%; } Main Menu Options The main menu and subsequent menus can be navigated by using your voice or using touch‐tone on your telephone keypad. You can also use touch‐tone entry for [...]

Provider Enrollment <6>

table, td, th table { border-collapse: collapse; width: 50%; } Provider Enrollment <6> When Provider Enrollment is selected, the IVR will request and collect the following information: Case number (If case number is unavailable, [...]

Tips for Success

Tips for Success Speak naturally and clearly in a quiet environment. Use mute when you're not speaking. Avoid the use of cellular phones or speaker phones. Have information available and organized before you call. Switch to [...]

Tips for Success

Tips for Success Speak naturally and clearly in a quiet environment. Use mute when you're not speaking. Avoid the use of cellular phones or speaker phones. Have information available and organized before you call. Switch to touch‐tone if [...]

Smoking Cessation

Smoking Cessation Please clarify appropriate codes for smoking cessation services. Answer: CPT codes 99406 and 99407 may be used for smoking and tobacco-use cessation counseling visits. Please clarify what constitutes a session which [...]

Split/Shared and Incident To Services

Split/Shared and Incident To Services Please define the substantive portion of a split (or shared) visit. Answer: The following factors apply in determining the substantive portion of a split (or shared) visit:   Total time [...]

Teaching Environment E/M Services

Teaching Environment E/M Services Please define levels of care for E/M services that can be performed by residents in a hospital outpatient setting under the PCE rules. Answer: CMS PCE guidelines for the hospital outpatient setting permit [...]

Telehealth Services

Telehealth Services Please explain Medicare’s definition of a telehealth service. Answer: Medicare defines a telehealth service as a service provided by a Medicare-enrolled practitioner from an approved distant site for a beneficiary who [...]

Time-Based Services

Time-Based Services Please define rules for using time to level-set a service. Answer: In both the office and observation/inpatient setting, the provider’s time is calculated based on pre-visit, intra-visit, and post-visit activities [...]

Transitional Care Management

Transitional Care Management Please clarify responsibility for the TCM interactive contact. Can this be performed by a hospital-employed nurse prior to discharge? Answer: The provider who is billing the TCM service is responsible for the [...]

Urgent Care

Urgent Care Please explain the concepts of split/shared and incident to E/M services in the urgent care setting. Answer: The urgent care setting is defined by CMS as a nonfacility setting. This means the split/shared concept does not [...]

MLN Connects® Newsletter: July 15, 2025

MLN Connects® Newsletter: July 15, 2025 CMS Proposes Physician Payment Rule to Significantly Cut Spending Waste, Enhance Quality Measures, and Improve Chronic Disease Management for People with Medicare Posted 7/15/2025

[RESOLVED] NGSConnex and IVR Experiencing Outages

[RESOLVED] NGSConnex and IVR Experiencing Outages We were experiencing outages with our web portal, NGSConnex and the IVR System. Part B providers were unable to check claim status, appeal status or submit appeal and reopening requests via [...]

Modifier 22 Supporting Documentation for Part B claims

Modifier 22 Supporting Documentation for Part B claims The Centers for Medicare & Medicaid Services, Internet-Only-Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Section 40.2.10 Unusual Circumstances states: [...]

APPEALS: How would one submit a paper appeal?

APPEALS: What is the appeal process?

CAR-T: Will the Part A claim for CAR-T deny if it is submitted with the KX modifier?

CAR-T: What is the effective date for the requirement of the KX modifier for administration of CAR-T?

CAR-T: Is the KX modifier required for Part A and Part B claims?

CAR-T: Is Risk Evaluation and Mitigation Strategy (REMS) verified by the facility’s site name or address?

Home Health Top Claim Errors

Do you see the same rejections and return to providers over and over? Do you know how to correct the most common errors and more importantly how to avoid them in the future? In this session we’ll review the most common reason codes assigned to [...]

Admission and Discharge Services

Admission and Discharge Services Is it permissible for an NPP to perform an initial hospital admission or discharge service on behalf of the attending physician, or on a split/shared basis, when both are members of the same provider [...]

Advanced Care Planning

Advanced Care Planning Please define documentation requirements when billing advanced care planning (CPT 99497 and 99498). Answer: ACP codes may be used with or without a base E/M code on the same date of service, based on whether a [...]

Behavioral/Mental Health Services

Behavioral/Mental Health Services Please explain the parameters for mental health services delivered via telehealth to a beneficiary who is at home. Answer: As of 1/1/2025, CMS has permanently extended permission for behavioral and mental [...]

Chronic Care Management

Chronic Care Management The guidelines state moderate or high complex MDM. Do the E/M guidelines apply here? Answer: Yes, the E/M guidelines for MDM are applicable, since chronic care management (CPT 99490) is included within the E/M [...]

Complex and Chronic Care - HCPCS Code G2211

Complex and Chronic Care - HCPCS Code G2211 Please define appropriate usage and billing for HCPCS code G2211. Answer: CPT G2211 is an approved add-on code representing complex and/or continuous management in the office and outpatient [...]

Consultations

Consultations Does CMS permit payment for consultative E/M services? Answer: CMS permits payment for medically necessary consultative E/M services. The specific E/M codes previously used to represent consultative services were [...]

Critical Care Services

Critical Care Services Please define the time requirement for billing CPT code 99292. Answer: Whether critical care is performed by a single provider or on a split (or shared) basis, the time requirement for CPT code 99292 remains the [...]

Documentation

Documentation What are the basic documentation requirements for a service submitted to Medicare for payment? Answer: For all services submitted to Medicare, the medical record (whether electronic or paper) must clearly define the provider [...]

Emergency Department

Emergency Department When a consultant has seen a patient in the ED and billed an ED code, how are subsequent services billed when the patient is then admitted to inpatient status? Answer: The ED consult (billed with an ED code [...]

Examination

As of 1/1/2023, CMS has eliminated prior specifications for the scope of examination and associated documentation in the outpatient office and hospital settings. The provider is expected to perform and document a medically necessary and [...]