Reopening Request Timeframes

Reopening Request Timeframes According to the CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 34, Section 10.6.2, Timeframes for Party Requested Reopenings: A party may request a contractor reopen and revise its initial [...]

ALJ Hearing

ALJ Hearing The third level of appeal is an ALJ hearing. Time limit to initiate = 60 days from the date of receipt of reconsideration (QIC decision) Time limit to complete the review = 90 days Amount in controversy = The amount that must [...]

Federal Court Review

Federal Court Review The fifth level of appeal is carried out by the Federal District Court (U.S. District Court). Time limit to initiate = 60 days from date of receipt of Medicare Appeals Council decision Amount in Controversy = The [...]

MLN Connects® Newsletter: November 21, 2024

MLN Connects® Newsletter: November 21, 2024 News Medicare-Funded Physician Residency Positions CMS Roundup (November 15, 2024) Hepatitis B Vaccine: Billing Requirement Update Effective January 1 Hospitals: Use Renewed Beneficiary Notices [...]

Bone Mass Measurements, Colorectal and Prostate Cancer Screenings

During this webinar, we'll review the coverage, coding and billing guidelines for bone mass measurements, colorectal and prostate cancer screenings.

Top Part B Claim Errors for Preventive Services

Join us for a discussion of the top Part B claim denials for preventive services. We'll share the denial reasons, how to correct the denials, and solutions to prevent them from occurring on future claim submissions.

Medicare Telehealth Changes for 2022

Medicare Telehealth Changes for 2022 The CY 2022 MPFS Final Rule indicated that Section 123 of the CAA removed the geographic restrictions and added the home of the beneficiary as a permissible originating site for telehealth services [...]

Telehealth Services

Telehealth Services Table of Contents General Information Originating Site Distant Site List of Covered Medicare Telehealth Services Billing Facility Fee for Originating Site Payment for Professional Fee Place of [...]

Medicare Telehealth Changes for 2024/2025

Medicare Telehealth Changes for 2024/2025 Table of Contents Major Medicare Telehealth Flexibilities Not Affected by the End of the PHE Reporting Home Address Expiration of PHE Flexibilities for Direct Supervision Requirements Teaching [...]

NGSConnex: Overview, Access, Navigation and Eligibility Look Up

This webinar is geared toward all lines of business. Come join us and see how NGSConnex can make your life a little easier. We’ll review what NGSConnex has to offer, including registration, access, navigation and beneficiary eligibility look [...]

NGSConnex: Overview, Access, Navigation and Eligibility Look Up

This webinar is geared toward all lines of business. Come join us and see how NGSConnex can make your life a little easier. We’ll review what NGSConnex has to offer, including registration, access, navigation and beneficiary eligibility look [...]

NGSConnex: Overview, Access, Navigation and Eligibility Look Up

This webinar is geared toward all lines of business. Come join us and see how NGSConnex can make your life a little easier. We’ll review what NGSConnex has to offer, including registration, access, navigation and beneficiary eligibility look [...]

Prolonged Preventive Services

Preventive Services Guide Prolonged Preventive Services Effective for claims with dates of service on or after 1/1/2018, prolonged preventive services will be payable by Medicare when billed as an add-on to an applicable preventive service [...]

Incarcerated or Unlawfully Present in the U.S. Claim Rejections (U538H, U538Q)

Counseling to Prevent Tobacco Use and Lung Cancer Screening

During this webinar, we'll review the coverage, coding and billing guidelines for the Medicare preventive services benefits of counseling to prevent tobacco use.

2024 Health Equity Services

With the addition of health equity services in 2024, we are raising awareness on the benefits available for Medicare beneficiaries. During this webinar, we’ll discuss the new care management services that were included for Medicare coverage in [...]

Utilizing Third Party Billing Companies

During this webinar, we’ll provide education related to using third party billers for your Medicare claims. We’ll identify vulnerabilities, share how to identify inappropriate third-party activities and reduce costs.

Obtaining Beneficiary Eligibility Information Through NGSConnex

Obtaining Beneficiary Eligibility Information Through NGSConnex  As a reminder, our Customer Service Representatives aren’t permitted to share eligibility information because it’s available through NGSConnex. If you need help, we [...]

Targeted Probe and Educate

During this webinar, we'll help the Medicare provider community understand the targeted probe and educate program.

Physicians: Are You Ordering Surgical Dressings for Your Patient?

Physicians: Are You Ordering Surgical Dressings for Your Patient? In order for a DME supplier to provide surgical dressings to your patients, there are actions you can take to make sure that all the required supporting medical record [...]