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Secure Provider Online Tool (SPOT)
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There will be a common working file (CWF) “dark day” on Friday, March 30.
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]
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. All other information remains the same. [MM10295]
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]
Review information from CMS about its action regarding recently expired Medicare legislative provisions.
This special edition article provides information on the next generation accountable care organization model’s benefit enhancement waiver initiatives and supplemental claim processing direction. This article was revised January 23 to revise the “Telehealth Expansion” portion of the article and to add Attachment A to the article. [SE1613]
Change request (CR) 10044 provides instruction to Medicare administrative contractors to implement two new benefit enhancements for performance year three of the next generation accountable care organization (NGACO) model. This article was revised January 23 to reflect the revised CR 10044 issued November 22, 2017. In the article, the CR release date, transmittal number, and the web address of the CR are revised. All other information remains the same. [MM10044]
This information outlines the process for the 935 recoupment.
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 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.
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.