This MLN Matters article is for hospitals, providers, and suppliers billing Medicare administrative contractors (MACs), including the home health and hospice MACs, for services provided to Medicare beneficiaries. [MM12114]
This article describes changes to and billing instructions for various payment policies implemented in the January 2021 ambulatory surgical center (ASC) payment system update. CR 12129 also includes updates to HCPCS. [MM12129]
This MLN Matters article is for hospitals billing Medicare administrative contractors (MACs) for hospital outpatient services provided to Medicare beneficiaries. [MM12120]
This article informs you of updates to the list of codes that sometimes or always describe therapy services. The additions, changes, and deletions to the therapy code list reflect those made in the calendar year 2021 CPT and Level II HCPCS. [MM12126]
This article was revised to reflect a revised change request (CR) 11880 issued December 31. In the article, two codes were added (J1559 JB and J7799 JB). Also, the CR release date, transmittal numbers, and the web addresses of the transmittals were revised. All other information remains the same. [MM11880]
This article informs you about actions CMS is taking to help health care providers contain the spread of COVID-19 with the COVID-19 emergency declaration blanket waivers for health care providers. [MM12070]
This MLN Matters article is for organizations enrolled as Medicare diabetes prevention program (MDPP) suppliers billing Medicare administrative contractors (MACs) for MDPP services provided to Medicare beneficiaries [MM12030]
This article was revised due to a revised change request (CR) 11870, issued December 22. The CR revision updated some denial edits; that information was added starting near the bottom of page 3. The CR release date, transmittal number, and web address of the CR were updated. All other information remains the same. [MM11870]
Change request (CR) 12080 provides instructions for the calendar year (CY) 2021 Clinical Laboratory Fee Schedule (CLFS), mapping for new codes for clinical laboratory tests, and updates for laboratory costs subject to the reasonable charge payment. [MM12080]
This article was revised due to a revised CR12027 that CMS issued on December 10. The CR revision didn’t impact the substance of the article. The CR release date, transmittal number, and the web address of the CR were revised. All other information remains the same. [MM12027]
CR 12071 provides a summary of the policies in the calendar year (CY) 2021 MPFS final rule and makes other policy changes that apply to Medicare Part B. These changes are effective January 1, 2021, and applicable to services you provide throughout CY 2021. [MM12071]
This article provides the calendar year (CY) 2021 annual update for the Medicare DMEPOS fee schedule. The article includes information on the data files, update factors, and other information related to the update of the fee schedule. [MM12063]
Related CR 12014 updates the annual per-beneficiary incurred expenses amounts now called the KX modifier thresholds and related policy for calendar year (CY) 2021. [MM12014]
This article provides the CY 2021 payment limit for RHCs. Effective January 1 through December 31, 2021, the RHC payment limit per visit for CY 2021 is $87.52. The CY 2021 RHC payment limit reflects a 1.4% increase above the CY 2020 payment limit of $86.31. [MM12035]
This article informs you about updates to the prospective payment system (PPS) base payment rate and the geographic adjustment factors (GAFs) for the federally qualified health center (FQHC) pricer. [MM12046]
This article further explains the billing procedures and provides additional resources to avoid incorrect billing for outpatient services within 3 days before date of admission and on the date of admission. [SE20024]
This article was revised to add information for reporting the use of cinacalcet by ESRD facilities (on page 8). Beginning January 1, 2021, cinacalcet is an oral drug eligible for consideration as an ESRD outlier service. ESRD facilities should report revenue code 250 with the drug’s NDC. All other information remains the same. [MM12011]
The current Office of Inspector General (OIG) audit, August 2020 Report No. A-04-18-04067, identifies Medicare overpayments to hospitals that did not comply with Medicare's post-acute-care transfer policy (transfer policy). This article reminds hospitals of proper coding of the patient discharge status code and the use of condition codes 42 and 43. [SE20025]
This article was revised to reflect the revised CR 11889 issued on August 14. The CR revision updated the codes in the CR spreadsheet for NCD 190.15. In the article, the CR release date, transmittal number, and the web address of the CR were also revised. All other information is the same. [MM11889]
This article updates the remittance advice remark code (RARC) and claims adjustment reason code (CARC) lists and instructs the Medicare’s system maintainers to update Medicare remit easy print (MREP) and PC Print. [MM11943]
This article informs you of updates, as needed, to the claim status and claim status category codes used for the accredited standards committee (ASC) X12 276/277 health care claim status request and response and ASC X12 277 health care claim acknowledgment transactions. [MM11957]
This article was revised to reflect an updated change request (CR 12017) that revised the policy section (page 4 in this article) and updated the payment rate tables to include information on the cost per-unit table for outlier payments (Table 6). All references to Table 6 in the previous CR (and article) were changed to table 7. The CR release date, transmittal number and link to the CR were also changed. All other information remains the same. [MM12017]
This article was revised to show that the model will not end on December 1, 2020. The model no longer has an end date and will remain in effect for the nine model states. All other information is unchanged. [SE1514]
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.
