Search Results - NGSMEDICARE

Posting Date: 10/21/2024

Initiate a Prior Authorization Request for OPD Services for Part A Facility

Initiate a Prior Authorization Request for OPD Services for Part A Facility Table of Contents Initiate a Prior Authorization Request Request Details Requestor’s Information Rendering Physician Information Attachments [...]

Posting Date: 10/17/2024

MLN Connects® Newsletter: October 17, 2024

MLN Connects® Newsletter: October 17, 2024 News Inpatient Psychiatric Facilities: Guidance on All-Inclusive Cost Reporting No-Pay Medicare Summary Notice Mailing Frequency Changed to Every 120 Days Health Literacy: Help Your Patients Get [...]

Posting Date: 11/12/2021

Interactive Voice Response System

Interactive Voice Response System CMS requires that Medicare contractors offer self-service options to their providers for general inquiries. CMS also requires providers to utilize those self-service options, such as the IVR. National [...]

Posting Date: 11/16/2021

Skilled Nursing Facility Consolidated Billing

Skilled Nursing Facility Consolidated Billing Back in 1997 as part of the Balanced Budget Act, Congress mandated that payment for the majority of services provided to beneficiaries in a Medicare-covered SNF stay be included in a bundled [...]

Posting Date: 11/12/2021

Local Coverage Determination

Local Coverage Determination LCDs are developed by the local Medicare contractor in the absence of a national Medicare payment policy. These policies describe specific criteria which determine whether an item or service is covered by Medicare [...]

Posting Date: 11/12/2021

ABN Modifiers

ABN Modifiers Modifier Description GA Waiver of liability statement issued, as required by payer policy, individual case GX Notice of liability issued, voluntary under payer policy GY Item [...]

Posting Date: 11/12/2021

American Medical Association and Current Procedural Terminology

American Medical Association and Current Procedural Terminology The AMA is your trusted source for official CPT. The most widely accepted medical nomenclature used to report medical procedures and services under public and private health [...]

Posting Date: 11/12/2021

CMS Forms and Publications

CMS Forms and Publications CMS publishes and maintains numerous Medicare forms that are used daily by the provider community. Some commonly used forms are: Provider Enrollment CMS-855 forms (CMS-855B, CMS-855I and CMS-855O) Medicare [...]

Posting Date: 11/12/2021

CMS Regional Offices

CMS Regional Offices CMS has ten RO reorganized in a Consortia structure based on the agency’s key lines of business: Medicare Health Plans Operations Financial Management and Fee-for-Service Operations Medicaid and Children’s Health [...]

Posting Date: 11/12/2021

Clinical Lab Improvement Amendment

Clinical Lab Improvement Amendment CMS regulates all laboratory testing (except research) performed on humans in the U.S. through the CLIA. The objective of the CLIA program is to ensure quality laboratory testing. Although all [...]

Posting Date: 11/11/2021

Comprehensive Error Rate Testing

Comprehensive Error Rate Testing The CERT program was established by CMS to monitor the accuracy of claim payment in the Medicare FFS Program. The intent of the CERT program is to protect the Medicare Trust Fund by identifying errors and [...]

Posting Date: 11/12/2021

Electronic Health Records

Electronic Health Records Eligible professionals under the Medicare EHR Incentive Program include: Doctor of medicine or osteopathy Doctor of dental surgery or dental medicine Doctor of podiatry Doctor of optometry Chiropractor If [...]

Posting Date: 11/12/2021

Electronic Prescribing

Electronic Prescribing In 2013, the eRx Incentive Program for participating and reporting in the Medicare Electronic Prescribing (eRx) Incentive Program ended. The six-month 2014, eRx payment adjustment reporting period began on 1/1/2013 and [...]

Posting Date: 11/12/2021

Evaluation and Management Documentation Guidelines

Evaluation and Management Documentation Guidelines Health care professionals may use the most current documentation guidelines for the date of service performed. Refer to these resources for guidance: CMS Evaluation and Management AMA [...]

Posting Date: 11/12/2021

Federal Register

Federal Register The OFR provides access to the official text of: Federal laws Presidential documents Administrative regulations and notices The ACFR oversees the functions of the Federal Register publications system. For more [...]

Posting Date: 11/12/2021

Health Insurance Portability and Accountability Act of 1996

Health Insurance Portability and Accountability Act of 1996 The HIPAA was signed in to law to improve and simplify the administration of the Medicare Program under title XVIII of the Social Security Act, the Medicaid program under title XIX [...]

Posting Date: 11/12/2021

Limitation of Liability (Advance Beneficiary Notice of Noncoverage)

Limitation of Liability (Advance Beneficiary Notice of Noncoverage) Services denied as not reasonable and medically necessary, under section 1862(a) (1) of the Social Security Act, are subject to the Limitation of Liability (ABN) provision. [...]

Posting Date: 11/12/2021

Medically Unlikely Edits

Medically Unlikely Edits In January 2007, CMS developed MUEs to reduce the paid claims error rate for Part B claims. An MUE for a HCPCS /CPT code is the maximum units of service that a provider would report under most circumstances for a [...]

Posting Date: 11/12/2021

Medicare Coverage Database

Medicare Coverage Database The Medicare Coverage Database is an administrative and educational tool to assist providers, physicians and suppliers in submitting correct claims for payment. The Medicare Coverage Database features LCDs developed [...]

Posting Date: 11/12/2021

Medicare Electronic Data Interchange

Medicare Electronic Data Interchange Information about how providers can communicate electronically with the Medicare Program can be found on the CMS website at Medicare Electronic Billing & EDI Transactions. This web page contains EDI [...]