LCDs and articles can be found by using the First Coast interactive LCD index.
In addition to using the interactive LCD index, First Coast’s LCDs and articles are available using the CMS Medicare Coverage Database. NCDs can also be found on the Medicare Coverage Database.
After notice of a valid appeal request, if limitation of recoupment (Section 935 of the Medicare Modernization Act) provisions apply, all collection activities are ceased, including the withholding of future claim payments. Interest, however, will continue to accrue during the appeal process.
Reference
The CMS Medicare Claims Processing Manual states:
Emergency or urgent situations: In general, a notifier may not issue an ABN to a beneficiary who has a medical emergency or is under similar duress. Forcing delivery of an ABN during an emergency may be considered coercive. ABN usage in the ER may be appropriate in some cases where the beneficiary is medically stable with no emergent health issues.
An overpayment letter is a formal request to repay a debt owed to the Medicare Trust Fund. Payment is due upon receipt of the notice. Send the payment with a copy of the overpayment letter received or request an immediate offset. Interest will accrue 30 days from the date on the overpayment letter and every thirty days thereafter. On day 40, we will immediately begin offsetting and claim payments will be withheld and applied until the entire debt is collected.
Once an overpayment has been determined, providers are required to repay the debt. Complete the return of monies voluntary refund form (see below) and attach a check for the amount. Specific data such as patient name, Medicare ID # and Medicare claim number must be included for claim correction and remittance revision, where appeal rights are afforded. If this data is not returned and Medicare is unable to correct records, claim(s) included in the refund may be identified as an overpayment and demanded in the future.
Yes. Medicare requires the signature of the beneficiary, or that of his or her representative, for both the purpose of accepting assignment and submitting a claim to Medicare. The IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 10, section 20.1.2 lists multiple options relating to how and when authorization can be obtained and submitted.
Reference
Medicare Part B pays only for physician services not performed for the hospice-related condition or paid under arrangement with a hospice entity. Services related to the terminal condition are billed by the hospice facility to the appropriate home health intermediary (Part A).
Electing or revoking the Medicare hospice benefit is the beneficiary’s choice. The patient or their representative may elect or revoke Medicare hospice care at any time in writing. The hospice entity cannot revoke the beneficiary’s election, nor request or demand that the patient revoke their election. If the patient revokes their hospice election, Medicare coverage of all benefits waived when hospice care was initially elected resumes under the original Medicare program.
No. Although the injections are billed under the supervising physician’s NPI, he or she is not required to see the patient or document any notes in the patient’s medical record.
A service that is billed as “incident to” is one that is furnished as an incidental but integral part of the physician’s professional services in the course of the diagnosis or treatment of the patient’s injury or illness.
Therefore, in order to bill for injections provided “incident to” by an NP or NPP, the following criteria must be met:
Review these FAQs to learn more about the prior authorization for repetitive scheduled non-emergency ambulance transport.
