Modifiers

Medicare Part B 101 Manual Modifiers What Is a Modifier? Modifiers are two-digit codes used to report additional information used during claims processing. Modifiers may be alpha-alpha, alphanumeric or numeric-numeric. Modifiers are used [...]

Nonphysician Practitioners

Medicare Part B 101 Manual Nonphysician Practitioners Table of Contents Nonphysician Practitioners Direct Billing/Payment for NPP Services Furnished to Inpatients and Outpatients Related Content [Return to Top] Nonphysician [...]

Standard Remittance ANSI Codes and Remittance Advice

Medicare Part B 101 Manual Standard Remittance ANSI Codes and Remittance Advice Table of Contents What Is a Remittance Advice? What are the Uses for a Remittance Advice? What are the Different Types of Remittance Advice? What You [...]

Appendix 1: Forms

Medicare Part B 101 Manual Appendix 1: Forms Appeals Coverage Customer Care Documentation EDI Enrollment Other Advance Payments CMS Forms Investigational Device Exemption Requests Medicare Privacy Statement Form Vaccine [...]

Appendix 2: Glossary

Medicare Part B 101 Manual Appendix 2: Glossary of Terms The Glossary of Terms listed below are in alphabetical order. Term Definition ABN Advance Beneficiary Notice: A formal notice of noncoverage that a [...]

Evaluation and Management Services

Medicare Part B 101 Manual Evaluation and Management Services Table of Contents Evaluation and Management Services General Principles of Medical Record Documentation New Patient and Established Patient What Should Be Provided if [...]

Hospice

Medicare Part B 101 Manual Hospice Table of Contents General Requirements Coinsurance Coinsurance on Outpatient Drugs and Biologicals Respite Care Coinsurance Physicians’ Services Attending Physician Services Care Plan Oversight [...]

Participation Program

Medicare Part B 101 Manual Participation Program Table of Contents Eligibility Participation Enrollment Period/Participating Status Changes Participation Program Participating Provider Nonparticipating Provider When [...]

Ordering and Referring Claims Information

Medicare Part B 101 Manual Ordering and Referring Claims Information Table of Contents Ordering and Referring Claims Information How to Identify the Ordering or Referring Provider on a Claim Ordering and Referring Eligible Provider [...]

Refunds and Overpayments

Medicare Part B 101 Manual Refunds and Overpayments Table of Contents Medicare Contractor Initiated Demand Letters Providers Not on Automatic Recoupments Jurisdiction K (CT, MA, ME, NH, NY, RI , VT) Jurisdiction 6 (IL, MN, WI) [...]

Return/Reject

Medicare Part B 101 Manual Return/Reject While it's easy to group processed claims as either approved or denied, there are differences in the way claims are returned unpaid by Medicare. Only claims that are filed with complete and correct [...]

Health Professional Shortage Area

Medicare Part B 101 Manual Health Professional Shortage Area What is a HPSA? What is the HPSA Incentive Bonus? Who is Eligible for the Incentive Bonus? How is the Bonus Billed? What Else You Should Know To Learn More [Return to [...]

Assignment of Benefits

Medicare Part B 101 Manual Assignment of Benefits Table of Contents Assignment of Benefits Mandatory Assignment Collecting from Medicare Patients on Assigned Claims Related Content [Return to Top] Assignment of Benefits An [...]

Advance Beneficiary Notice of Noncoverage for Not Reasonable and Necessary Denials

Medicare Part B 101 Manual Advance Beneficiary Notice of Noncoverage for Not Reasonable and Necessary Denials Table of Contents Limited Coverage Medical Necessity Expectations ICD-10-CM Coding Reasons for Noncoverage Beneficiary [...]

Set Up a Beneficiary's Medicare Secondary Payer Record

Table of Contents Background: Set Up a Beneficiary’s Medicare Secondary Payer Record Step 1: Provider Receives New MSP Information for a Beneficiary Step 2: Check for a Matching Medicare Secondary Payer Record for the Beneficiary in the [...]

Modifier 90 Reference to Outside Laboratory

Modifier 90: Reference to Outside Laboratory Modifier 90 is to be used when the billing laboratory refers a specimen to another laboratory for testing. In these cases, the billing laboratory is titled the “referring laboratory” while the [...]

Initiate Patient Status Lookup

Initiate Patient Status Lookup Click the Eligibility Lookup button from the NGSConnex homepage. In the Select a Provider panel, click the Select button next to the applicable provider account. In the Select a Beneficiary panel, [...]

Hospice Payment Rates

MSP Post-Pay Overpayments

Forms You’ll Need Jurisdiction K CT-MA-ME-NH-NY-RI-VT Medicare Part B MSP Overpayment Request Form Jurisdiction 6 IL-MN-WI Medicare Part B MSP Overpayment Request Form JK or J6 Medicare Secondary Payer Part B Voluntary [...]