MLN Connects® Special Edition for Tuesday, March 30, 2021

MLN Connects® Special Edition for Tuesday, March 30, 2021 Temporary Claims Hold Pending Congressional Action to Extend 2% Sequester Reduction Suspension In anticipation of possible Congressional action to extend the 2% sequester reduction [...]

NPPES

Modifiers

Home Health Core-Based Statistical Area Payment issue (Code 50007)

CBSA Code 50007 was loaded into the CY 2021 wage index table of the home health (HH) Pricer with an incorrect effective date. This error is causing incorrect payment on claims with CBSA 50007 in the Value Code 61 amount field by using the wrong [...]

Part A 11X Claims Returned to Provider

11X claims with DOS prior to 10/1/2021 with ICD-10 diagnosis code Z515 and POA indicator of Y have RTP with edit message 34931.

Enrollment

Enrollment

Service Specific Post Payment Review of Darbepoetin Alfa Injection, 1 microgram (Non-ESRD Use)

National Government Services Part B MR Department analyzes national and local data to identify possible improper payment for Medicare services. In an effort to reduce the Part B CERT error rate, the MR Department will be conducting a service [...]

Announcing Service Specific Post-Payment Audits of Hyperbaric Oxygen (HBO) Services for J6 A Regions: IL, WI, and MN

Edit Reason Code: 5FPJP Bill Type = 13X CPT/HCPCS/Modifiers: G0277 Overview The Medical Review Department of National Government Services will be performing service specific post-payment reviews for claims submitted to Medicare Part A. When a [...]

Hospice Beneficiary Election Statement Addendum Frequently Asked Questions

Hospice Beneficiary Election Statement Addendum Frequently Asked Questions National Government Services, in collaboration with Palmetto GBA, CGS and CMS, developed these FAQs to assist providers in a better understand of the federal [...]

Multi-Jurisdictional Contractor Advisory Committee (CAC)/Subject Matter Expert Meeting

Multi-Jurisdictional Contractor Advisory Committee (CAC)/Subject Matter Expert Meeting March 10, 2022 Topic: SIJ Interventions and Procedures Questions for SIJ Interventions For all questions, answers must be based on clinical literature [...]

MLN Connects® Special Edition for Thursday, January 7, 2021

MLN Connects® Special Edition for Thursday, January 7, 2021 Physician Fee Schedule Update On December 27, the Consolidated Appropriations Act, 2021 modified the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS): Provided a [...]

MLN Connects® for Thursday, January 7, 2021

MLN Connects® for Thursday, January 7, 2021 COVID-19 Vaccines: CDC Long-Term Care Facility Toolkit View this edition as a: Webpage | PDF News COVID-19 Vaccines: CDC Long-Term Care Facility Toolkit MLN Web-Based Training: Complete [...]

Modifier 95 as it Relates to Medicare Part B and COVID-19 Billing

Modifier 95 as it Relates to Medicare Part B and COVID-19 Billing Modifier 95 Defined: Synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system. During the COVID-19 PHE, and through CY 2023 [...]

Modifier CR as it Relates to Medicare Part B and COVID-19 Billing

Modifier CR as it Relates to Medicare Part B and COVID-19 Billing In 2005, CMS created modifier “CR” (description: Catastrophe/disaster related) to assist MACs in processing claims as a result of Hurricane Katrina. This modifier was also [...]

Home Health Diagnosis Codes Grouper Update for 4/1/2023

Home Health Diagnosis Codes Grouper Update for 4/1/2023 Effective 4/1/2023, CMS is implementing new HH Grouper edits. The HH Grouper program has various data validity edits that make sure it uses consistent and accurate data when calculating [...]

Clarification on the Proper Use of the CS Modifier

Clarification on the Proper Use of the CS Modifier Per MLN Matters® article SE20011, the CS modifier (cost-sharing waiver for COVID-19 testing) is applicable to certain services furnished beginning on 3/18/2020 through the end of the PHE, [...]

New Fiscal Intermediary Shared System Consistency Edit to Validate Attending Physician National Provider Identifier

New Fiscal Intermediary Shared System Consistency Edit to Validate Attending Physician National Provider Identifier Effective 4/1/2023, CMS implemented a new consistency edit to validate that the attending physician NPI. An Attending Provider [...]

The Advance Beneficiary Notice of Noncoverage

The Advance Beneficiary Notice of Noncoverage We’ve updated our Advance Beneficiary Notice of Noncoverage article to include examples for using an ABN for outpatient therapy and using the KX and GA modifiers appropriately. We encourage you to [...]

MLN Connects® Newsletter: April 13, 2023

MLN Connects® Newsletter:  April 13, 2023 News COVID-19: End of Public Health Emergency CMS Roundup (Apr. 07, 2023) Medicare Shared Savings Program: Application Toolkit Materials Inpatient Rehabilitation Facility [...]