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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 is regarding a new payment model being tested by selected nursing facilities and practitioners in Alabama, Colorado, Indiana, Missouri, Nevada, New York, and Pennsylvania. The article is informational for other nursing facilities and practitioners. [SE1636]
Beginning January 2019, CMS will implement a multifaceted, strategic-phased approach to align enforcement of the Part D prescriber enrollment requirements with other ongoing initiatives.
Change request 9864 implements 2017 update to Chapter 13 of the Medicare Benefit Policy Manual related to rural health clinics and federally qualified health centers. [MM9864]
This article is intended for providers who bill Medicare for mammogram services provided to Medicare beneficiaries.
This special edition article provides information on the next generation accountable care organization model’s benefit enhancement waiver initiatives and supplemental claim processing direction. [SE1613]
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]
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. [MM9771]
Change request (CR) 9817 provides Medicare administrative contractors steps required when providers erroneously charge beneficiaries enrolled in the qualified Medicare beneficiary program (QMB). This article was revised November 18 to reflect the revised CR 9817 issued that same day. In addition to the CR details, the sample letters have slight wording changes to show that the Medicaid program also helps low-income beneficiaries pay their Medicare premiums. [MM9817]
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]
To correct claims returned for beneficiary name and number mismatch, take the following action. [CR 7260]
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 Centers for Medicare & Medicaid Services (CMS) recently issued the 2015 deductibles, coinsurance, and premium rates for beneficiaries covered through the Medicare fee for service program. [MM8982]
The interest period begins on the day after payment is due and ends on the day of payment. The new rate of 1.875 percent is in effect, from July 1, 2016, through December 31, 2016. [Publication 100-04, Chapter 1, Section 80.2.2]
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.