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Special edition article SE18007 summarizes Medicare improvements to hospice billing and claim processing, which includes changes that will be implemented July 2 and will impact the common working file (CWF) and direct data entry (DDE) inquiry screens. [SE18007]
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.
Change request 10626 instructs all Medicare administrative contractors to add new Healthcare Common Procedure Coding System (HCPCS) code Q9994 to its system for processing, effective July 1. [MM10626]
The Centers for Medicare & Medicaid Services (CMS) recently issued the 2018 deductibles, coinsurance, and premium rates for beneficiaries covered through the Medicare fee for service program. [MM10405]
The Centers for Medicare & Medicaid Services (CMS) has issued a national coverage determination (NCD) to cover SET for beneficiaries with intermittent claudication (IC) for the treatment of symptomatic PAD. The article was revised March 5 to reflect a revised change request (CR). The article was revised April 5 to delete place of service codes 19 and 22 as acceptable places of service for CPT 93668. The article was revised April 11 to clarify that the SET program must be provided in a physician’s office. The article was revised May 14 to reflect a revised CR, which removes place of service code edit requirements. The article was revised May 15 to clarify that services must be conducted in a hospital outpatient setting or in a physician’s office. [MM10295]
Change request (CR) 10619 initiates both Medicare manual and operational changes related to the new Medicare card, which includes replacing references to the health insurance claim number (HICN) with patient identifier. [MM10619]
Change request 10611 informs Medicare administrative contractors and providers of the new MCR e-filing (MCRef) system, which is controlled by the EIDM system and available for electronic transmission of cost reports. [MM10611]
Change request 10314 provides the details and benefits of this new model, which is designed to improve care for beneficiaries with end-stage renal disease (ESRD). [MM10314]
Change request 10583 provides information regarding reject information when requirements for modifier GT are not met; modifier GT is only allowed on institutional claims billed by a critical access hospital method II. [MM10583]
This information outlines the process for the 935 recoupment.
To determine if a claim was medically reviewed, providers should look at certain fields on the claim screen. [Provider Outreach and Education]
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.
This article provides information regarding unsolicited/voluntary refunds; that is, monies received by Medicare not related to an open account receivable.
Change request (CR) 10567 revises the skilled nursing facility (SNF) advance beneficiary notice of non-coverage (ABN) and discontinuing the five SNF denial letters. [MM10567]
To correct claims returned for beneficiary name and number mismatch, take the following action. [CR 7260]
The interest period begins on the day after payment is due and ends on the day of payment. The new rate of 2.625 percent is in effect, from January 1, 2018, through June 30, 2018. [Publication 100-04, Chapter 1, Section 80.2.2]
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]
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.