Introduction to Medicare

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This website provides information and news about the Medicare program for health care professionals only. All communication and issues regarding your Medicare benefits are handled directly by Medicare and not through this website. For the most comprehensive experience, we encourage you to visit Medicare.gov or call 1-800-MEDICARE. In the event your provider fails to submit your Medicare claim, please view these resources for claim assistance.

Home ► Introduction to Medicare

Last Modified: 9/22/2023 Location: FL, PR, USVI Business: Part A, Part B

Introduction to Medicare

The Provider Outreach and Education team at First Coast welcomes you to Medicare. Providers are responsible for knowing and following the rules and regulations that apply to all services billed to Medicare under their provider number. To assist our providers, their staff and billing companies, we designed the Welcome to Medicare page where you will find the following:

• New Visitor Center for help on how to navigate around our website

• eNews: Subscribe to keep informed

• LCDs/Medical Affairs: LCDs and NCDs are policies that specify the criteria for Medicare coverage and payment of certain items and services. We emphasize the importance of reviewing and understanding the LCDs and NCDs that may impact your practice. Please note that this is not a one-time review, as new NCDs and LCDs may be developed, and existing policies may also be modified and/or deleted.

• SPOT: Register for the convenience of online access to Medicare data, including claim status, payment history, benefits/eligibility information, MBI (Medicare beneficiary identifier) lookup, remittance advice details, duplicate remittance advice, status of medical review related ADRs (additional development requests), secure messaging (including Part A/B claim redetermination requests and Part A claim reopening requests), and data reports

• Information on medical documentation, compliance programs, and CMS Medicare billing certificate programs, designed to provide education on Medicare Part A and Part B

Please refer to the First Coast provider website for more information:

• Billing

• Per Medicare guidelines, claims must be filed with the appropriate Medicare claims processing contractor no later than 12 months (one calendar year) after the date of service (DOS). Claims must be processed (paid or denied/rejected) by Medicare to be considered filed/submitted. Therefore, claims with missing, invalid, or incomplete information that prevents Medicare from processing them, also known as “returned to provider/RTPs” (Part A) and “return unprocessable claims/RUCs” (Part B), are not considered filed/submitted. RUCs and RTPs must be corrected and resubmitted for processing. Claims submitted after one calendar year from the DOS will be denied or rejected. Timely filing is determined by the “from date” for Part B claims, and the “through date” for Part A claims.

• Coding

• Part A providers: Refer to the UB-04 Form Locator code lookup to bill right the first time and prevent RTPs and rejects.

• Claims resources

• Part B providers: Refer to the CMS-1500 (02/12) data element requirements to bill right the first time and prevent RUCs and denials.

• Electronic data interchange (EDI)

• Learning center

• Evaluation & management (E/M)

• Interactive voice response (IVR)

• Provider enrollment

We hope the information on our Welcome to Medicare page and provider website is helpful to you and your team. Again, welcome to Medicare!

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.