New Patient Visits by Same Physician or Physician Group: Overpayments
Medicare's Common Working File (CWF) system detects erroneous billings when there are two new patient CPT codes being billed within a three-year period of time by the same physician or physician...
View ArticleMedicare Billing: 837P and Form CMS-1500
What are the 837P and Form CMS-1500?837P: The 837P (Professional) is the standard format used by health care professionals and suppliers to transmit health care claims electronically. Review the chart...
View ArticleNew Timeframe for Response to Additional Documentation Requests
Provider Types AffectedThis MLN Matters Article is intended for physician, providers and suppliers submitting claims to Medicare Administrative Contractors (MACs), including Durable Medical Equipment...
View ArticleJ3590/C9399 Vimizim™ (elosulfase alfa) and Diagnostic Tests- CMS Requirements
J3590/C9399 Vimizim™ (elosulfase alfa)Vimizim™ (elosulfase alfa) injection, for intravenous use is a hydrolytic lysosomal glycosaminoglycan (GAG) specific enzyme indicated for patients with...
View ArticleMedicare Billing: 837I and Form CMS-1450
What are the 837I and Form CMS-1450?The 837I (Institutional) is the standard format used by institutional providers to transmit health care claims electronically. The Form CMS-1450, also known as the...
View ArticleNew Timeframe for Response to Additional Documentation Requests AND Payment...
Payment for G0101 and Q0091 in Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) that Bill Under the All-Inclusive Rate (AIR) System.Provider Types AffectedThis MLN Matters...
View ArticleTention Health Professionals: Information Regarding the 2015 Medicare...
On April 1, 2015, the Medicare Physician Fee Schedule (MPFS) was updated using the Sustainable Growth Rate (SGR) methodology as required by current law. The SGR methodology required a 21% decrease in...
View ArticleItems and Services Furnished Outside the United States (U.S.) - Medicare
Most items and services furnished or delivered outside the U.S. are not covered, including when the beneficiary was within the U.S. when the contract to purchase the item was made or the item was...
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How to Complete CMS-838 Credit Balance Reports
As your Medicare Administrative Contractor, Novitas Solutions, Inc. is responsible to ensure compliance with the Credit Balance reporting process. The information provided below offers a brief...
View ArticleManual Updates to Clarify Requirements for Physician Certification and...
The Centers for Medicare & Medicaid Services (CMS) finalized clarifications and revisions to policies regarding physician certification and recertification of patient eligibility for Medicare home...
View ArticleDefinition of Emergency Care Services and Appeals of Opt Out Determinations
This Article is intended for physicians and practitioners who opt-out of Medicare, and beneficiaries that receive services from opt out physicians and practitioners.Note: The private contracting...
View ArticleRehabilitation Therapy Billing Guidelines , calculation of units
Practitioner billing for Part B rehab therapy services on a 1500 claim form or electronic equivalent:Healthcare Common Procedure Coding System (HCPCS)/Current Procedural Terminology (CPT) codes that...
View ArticleImportant News - Attention Health Professionals: Information Regarding the...
On April 14 , 2015, Congress passed the Medicare Access and CHIP Reauthorization Act of 2015; the President is expected to sign it shortly. This law eliminates the negative update of 21% scheduled to...
View ArticleNew field qualifiers on 17
CMS 1500 Claim Form Instructions: Revised for Form Version 02/12Form Version 02/12 will replace the current CMS 1500 claim form, 08/05, effective withclaims received on and after April 1, 2014:•...
View ArticleProposed fiscal year 2016 payment and policy changes for Medicare Skilled...
OverviewOn April 15, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule [CMS-1622-P] outlining proposed Fiscal Year (FY) 2016 Medicare payment rates for skilled nursing...
View ArticleAnnouncement About Medicare Participation for Calendar Year 2015
We wish to emphasize the importance and advantages of being a Medicare participating (PAR) provider, and we are pleased that the favorable trend of participation continued into 2014 with a...
View ArticleICD-10 Conversion/Coding Infrastructure Revisions/ICD-9 Updates to National...
This article is the second maintenance update of ICD-10 conversions and coding updates specific to National Coverage Determinations (NCDs). The majority of the NCDs included are a result of feedback...
View ArticleNot able to submit ICD 10 What is alternative method? what is alternative...
This MLN Matters® Special Edition article offers physicians, providers, and suppliers information that will assist them in avoiding claims processing disruptions after implementation of International...
View ArticleLCD Guidelines for cpt 76492, 36470 and 22856, 76999
The local coverage determination (LCD) for noncovered services was revised to remove several CPT® codes from noncoverage. CPT® code 76999 (ultrasound guided sclerotherapy) was removed from the...
View ArticleCMS 1500 box 24a, 24b and 24c Detailed view
24a Dates of Service-unshaded NDC number-shaded (required when billing CPT/HCPCS codes for a drug)Unshaded area: Enter date of service in the block, MMDDYY.Shaded area: Drug codes require NDC. See...
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