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  • Posting Date: 11/15/2021
    Patient Protection and Affordable Care Act of 2010

    Patient Protection and Affordable Care Act of 2010 ​​​For information related to the HIPAA Privacy and Security Rules, visit the Office for Civil Rights website. The Privacy and Security Rules are available for download, and you will find [...]

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  • Posting Date: 11/16/2021
    Physician Quality Payment Program

    Physician Quality Payment Program The MACRA ended the SGR formula for clinician payment under the MPFS and established a quality payment incentive program, the QPP. This program provides clinicians with two ways to participate: through [...]

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  • Posting Date: 11/16/2021
    Provider Contact Center

    Provider Contact Center For information about the Provider Contact Center, please visit the Contact Us page on our website.  Reviewed 10/21/2024

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  • Posting Date: 11/16/2021
    Provider Enrollment

    Provider Enrollment The Provider Enrollment Customer Service Department has direct telephone lines available for provider enrollment inquiries. Toll-Free Provider Enrollment Numbers Please use the following toll-free provider enrollment [...]

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  • Posting Date: 11/16/2021
    Reconsideration (Second Level of Appeal)

    Reconsideration (Second Level of Appeal) A written reconsideration request must be filed with a QIC within 180 days of receipt of the redetermination. When providers receive an unfavorable redetermination, providers shall follow the [...]

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  • Posting Date: 11/16/2021
    Recovery Audit Program

    Recovery Audit Program The Recovery Audit Program’s mission is to identify and correct Medicare improper payments through the efficient detection and collection of overpayments made on claims of health care services provided to Medicare [...]

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  • Posting Date: 11/16/2021
    Redetermination (First Level of Appeal)

    Redetermination (First Level of Appeal) A redetermination is an examination of a claim by National Government Services personnel who are different from the personnel who made the initial claim determination. The appellant (the provider filing [...]

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  • Posting Date: 11/16/2021
    U.S. Government Printing Office

    U.S. Government Printing Office The GPO is responsible for the production and distribution of information products and services including the official publications of Congress, the White House and other federal agencies in digital and print [...]

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  • Posting Date: 11/16/2021
    Washington Publishing Company

    Washington Publishing Company Washington Publishing Company, Inc. is a private company categorized under the commercial Printing and Newspaper Publishing Combined company that is an established health care IT and consulting company. WPC [...]

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  • Posting Date: 01/14/2022
    Meeting Schedules

    Meeting Schedule Jurisdiction 6 ‒ Home Health and Hospice (Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Michigan, Minnesota, Nevada, New Jersey, New York, Northern Mariana Island, Oregon, Puerto Rico, U.S. Virgin [...]

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  • Posting Date: 10/22/2024
    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.

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  • Posting Date: 07/20/2023
    Contractor Advisory Committee Meeting

    Contractor Advisory Committee Meeting As part of the 21st Century Cures Act, contractors are mandated to base an LCD on robust evidence. Part of the process is to convene SMEs as necessary to review the literature and provide input that [...]

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  • Posting Date: 09/07/2021
    CMS-1500 Claim Form Completion Instructions

    CMS-1500 Claim Form Completion Instructions Table of Contents General Information Claim Filing Instructions for Paper and Electronic Submission Regulations on Charging for Claim Form Completion Optical Character Recognition System [...]

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  • Posting Date: 01/27/2022
    General E/M Information

    General E/M Information Please explain the terms “auxiliary personnel” and “clinical staff” in the context of Medicare services.   Answer: These terms are often used in defining which staff members can perform Medicare services [...]

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  • Posting Date: 10/22/2024
    32243

    Avoiding/Correcting This Error Review the claim and either update the charges or remove the line containing zero or blank charges. Return the claim for processing. 

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  • Posting Date: 10/22/2024
    W7088

    Avoiding/Correcting This Error Each FQHC PPS claim must be billed with a qualifying visit code, and associated line-item charges, along with all other FQHC services furnished during the encounter. A qualifying visit code is the code that [...]

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  • Posting Date: 10/22/2024
    37098

    Avoiding/Correcting This Error Verify billing and, if appropriate, correct and return the claim. Related Content Billing for FQHC MAO Plan Supplemental Payment (PPS Providers) CMS Internet-Only Manual 100-04, Medicare Claims Processing [...]

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  • Posting Date: 10/22/2024
    31836

    Avoiding/Correcting This Error Verify billing and, if appropriate, correct and resubmit the claim for payment. Related Content MLN® Booklet: How to Use the PFS Look-up Tool

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  • Posting Date: 10/22/2024
    31605

    Avoiding/Correcting This Error The occurrence span code 77 should only be used to indicate the span of days that were not covered on claims. Related Content Appropriate Use of Occurrence Code 27 and Occurrence Span Code 77  

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  • Posting Date: 10/22/2024
    37402

    Avoiding/Correcting This Error Hospice – This error occurs when a claim is submitted and the previous month's claim has not been found in the system or there is a gap between Through date of the previous claim and From date on this claim. [...]

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