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The Centers for Medicare & Medicaid Services (CMS) will establish two new Medicare secondary payer types for set-aside processes when a Medicare beneficiary receives an allocation of funds from a liability settlement, judgement, award, or other payment that is to be used to pay for a beneficiary’s future medical expenses. [MM9893]
Change request 9911 releases information regarding the qualified Medicare beneficiary (QMB) indicator that modifies the Medicare claim processing systems to help providers more readily identify the QMB status of each patient. [MM9911]
Change request 9935 provides instructions to providers regarding the Medicare outpatient observation notice, which is used to inform beneficiaries when they are an outpatient receiving observation services, and are not an inpatient of the hospital or a critical access hospital. [MM9935]
Medicare billing systems will reject the procedure code 96377 as an invalid code for dates of service on or after January 1, 2017. Medical providers should report this service using procedure code 96372.
The Centers for Medicare & Medicaid Services (CMS) recently issued the 2016 deductibles, coinsurance, and premium rates for beneficiaries covered through the Medicare fee for service program. [MM9410]
Learn which modifier to use when you expect Medicare will deny a claim that does not meet medical necessity criteria and whether you have or do not have an advanced beneficiary notice (ABN) signed by the beneficiary.
The interest period begins on the day after payment is due and ends on the day of payment. The new rate of 2.5 percent is in effect, from January 1, 2017, through June 30, 2017. [Publication 100-04, Chapter 1, Section 80.2.2]
The Centers for Medicare & Medicaid Services (CMS) recently released the annual home health (HH) consolidated billing updates. The new consolidated billing codes take effect January 1, 2017. CMS updated this article January 13, 2017, to correct a typo with the listing of HCPCS added to the HH consolidated billing therapy code list. All other information is unchanged. [MM9771]
This article provides information regarding unsolicited/voluntary refunds; that is, monies received by Medicare not related to an open account receivable.
The 2017 updated list of healthcare common procedure coding system (HCPCS) codes for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) jurisdictions is now available. This article was revised January 6 to reflect the revised change request (CR) 9903 issued January 5. In the article, the CR release date, transmittal number and the web address for accessing the CR are revised. [MM9903]
Change request (CR) 9681 updates the claim processing system to correct billing issues where providers do not receive claim adjustment reason codes and remittance advice remark codes with certain claim denials. This article was revised January 9 to reflect the revised CR 9681 issued January 9. In the article, references to type of bill 82x are deleted from the last paragraph of the Background section. In addition, the CR release date, transmittal number, and the web address of CR 9681 are revised. [MM9681]
This information outlines the process for the 935 recoupment.
This article reviews specific points that providers should consider regarding CCM guidelines, along with a link to a Medicare Learning Network® (MLN®) article that outlines the CCM guidelines in more detail.
To determine if a claim was medically reviewed, providers should look at certain fields on the claim screen. [Provider Outreach and Education]
First Coast implemented a pre-payment edit on April 16, 2012, that applies to office visit E/M claims (codes 99201-99205 and 99212-99215) billed with the 24 modifier.
The Centers for Medicare & Medicaid Services (CMS) recently issued the 2017 deductibles, coinsurance, and premium rates for beneficiaries covered through the Medicare fee for service program. [MM9902]
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.