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There will be a common working file (CWF) “dark day” on Friday, March 30.
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]
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 MAC implementation date, CR release date, transmittal numbers and the web addresses of the transmittals were revised. The article was revised April 5 to reflect a revised CR. The MAC implementation date, CR release date, transmittal numbers, and the web addresses of the transmittals were revised. In addition, the article and CR were revised 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 (place of service code 11). All other information remains the same. [MM10295]
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.
This special edition article reminds laboratories and other providers about how to properly bill for specimen validity testing done in conjunction with drug testing. [SE18001]
Change request (CR) 10521 provides clarification for billing Part A claims that do not contain a covered/billable drug charge. [MM10521]
Change request (CR) 10494 provides Medicare administrative contractors directions to initiate non-monetary mass adjustments to qualified Medicare beneficiaries (QMB) claims impacted by CR 9911. The goal is to produce replacement Medicare RAs that providers can submit to supplemental payers to coordinate benefits as necessary. Last sentence in “Note” added to clarify when this change will be seen. [MM10494]
All Medicare physicians, providers, and suppliers who offer services and supplies to qualified Medicare beneficiaries (QMB) may not bill QMBs for Medicare cost-sharing. This article was revised March 22 to include updated information about the remittance advice and Medicare summary notice for all Medicare fee-for-service QMB claims. It also includes new statistics on the number of beneficiaries enrolled in QMB. [SE1128]
Change request (CR) 10433 reestablishes all changes in CR 9911 to the Medicare remittance advice and Medicare summary notice by including qualified Medicare beneficiary (QMB) messages and reflecting $0 cost-sharing liability for the period beneficiaries are enrolled in QMB. This article was revised March 13 to reflect an updated CR. That CR added CARCs 66, 247, and 248. Durable medical equipment Medicare contractors (DME MACs) were added to the “Providers Affected” section. The QMB enrollment numbers were also updated to reflect 2016 statistics and pharmacies were included in the “Background” section. The CR date, transmittal number, and link to the transmittal also changed. [MM10433]
Appropriate-use criteria for advanced diagnostic imaging -- voluntary participation and reporting period -- claim processing requirements -- modifier QQ
Change request (CR) 10481 releases information regarding the new modifier QQ that may be reported on the same claim line as the procedure code for an advanced diagnostic imaging service furnished in an applicable setting and paid for under an applicable payment system. [MM10481]
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]
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.