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 [...]

APPLICATION FEE: Who needs to pay an application fee?

PECOS: In PECOS, how do I know what enrollment information Medicare currently has on file for a provider or supplier?

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 [...]

Counseling to Prevent Tobacco Use

In an effort to raise awareness and increase utilization of tobacco use counseling, we’ll focus on the effects of nicotine dependence including affected health consequences during this webinar. Medicare coverage, coding, billing and [...]

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 [...]

Provider Enrollment

Medicare Part B 101 Manual Provider Enrollment Table of Contents National Provider Identifier Required Tips for Successfully Enrolling with the Medicare Part B Contractor When Mailing Paper Applications Tip 1: Submit the correct [...]

APPLICATION STATUS: Where can I find the status of a submitted application?

APPROVAL RECOMMENDATION STATUS: The status of my application is approval recommendation, how can I verify if the state agency or CMS has completed their process?

APPROVAL RECOMMENDATION STATUS: Whom can I contact for questions about an application in approval recommendation status?

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, [...]