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Posting Date: 03/03/2023
LCD Open Meeting Records
Open Meeting Records Jurisdiction 6 and Jurisdiction K Open Meeting Records Meeting Date Audio Transcript 10/24/2024- J6/JK Open Meeting Recording Transcript 7/18/2024 - J6/JK Open Meeting [...]
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Posting Date: 02/18/2014
Fundamentals of Medicare: Participating Providers
Section 1: Introduction Participating Providers Providers receiving Medicare reimbursement are known as “participating providers.” To become a participating provider, a provider must be in compliance with applicable provisions of Title VI of [...]
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Posting Date: 11/03/2020
Voluntary and Involuntary Termination of Provider Agreement
Section 1: Introduction Voluntary and Involuntary Termination of Provider Agreement Table of Contents Voluntary and Involuntary Termination of Provider Agreement Voluntary (Provider-Requested) Termination of Agreement Involuntary [...]
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Posting Date: 04/28/2015
Disclosure of Health Insurance Information
Section 1: Introduction Disclosure of Health Insurance Information Providers have restrictions on the information that they may disclose. The CMS IOM, Publication 100, Medicare General Information, Eligibility and Entitlement Manual, Chapter [...]
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Posting Date: 04/24/2015
Privacy Act
Section 1: Introduction Privacy Act The purpose of the Privacy Act of 1974 (Act), Title 5, United States Code, Section 552a, is to balance the government’s need to maintain information about individuals with the rights of individuals to be [...]
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Posting Date: 02/14/2014
National Provider Identifier
Section 1: Introduction National Provider Identifier The NPI is a HIPAA Administrative Simplification standard. The NPI is a unique identification number for covered health care providers that have replaced the legacy provider number. [...]
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Posting Date: 11/03/2020
Legacy Provider Numbers/Provider Transaction Access Numbers (PTANs)
Section 1: Introduction Legacy Provider Numbers/Provider Transaction Access Numbers Table of Contents Legacy Provider Numbers/Provider Transaction Access Numbers State Code Facility Type Third-Digit Specialty Unit Designations [...]
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Posting Date: 05/31/2024
Medicare Administrative Contractors
Section 1: Introduction Medicare Administrative Contractors What's A MAC Who are the MACs Table of Contents Medicare Administrative Contractors Who Is National Government Services? The Focus of the Provider Outreach & Education [...]
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Posting Date: 04/24/2015
Fundamentals of Medicare: Information References
Section 1: Introduction Information References Table of Contents Information References Telephone Inquiries Interactive Voice Response Eligibility Information Claim Status Information Check and Remittance Information General [...]
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Posting Date: 04/24/2015
Fundamentals of Medicare: Glossary of Terms
Section 1: Introduction Glossary of Terms Beneficiary: An individual who is eligible for Medicare. Benefit Period: The way that Medicare measures the use of hospital and SNF inpatient days. Claim: A bill for services rendered by a provider [...]
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Posting Date: 04/24/2015
The History of Medicare
Section 2: Medicare Basics The History of Medicare During the 30 years following the passage of the SSA in 1935, many attempts were made to include health insurance as part of the Social Security system. It was not until the bill H.R. 6675 [...]
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Posting Date: 04/24/2015
What Is the Medicare Program and How Is It Funded?
Section 2: Medicare Basics What Is the Medicare Program and How Is it Funded? Medicare is a federally funded health insurance program for: People age 65 or older Certain individuals under age 65 who qualify due to disability People with [...]
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Posting Date: 04/24/2015
Medicare Eligibility and Premiums
Section 2: Medicare Basics Medicare Eligibility and Premiums The following groups of people are eligible for Medicare: Individuals aged 65 or older (or their spouse) who have worked at least 40 quarters, or ten years, in Medicare-covered [...]
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Posting Date: 04/24/2015
The Social Security Administration and Medicare Enrollment
Section 2: Medicare Basics The Social Security Administration and Medicare Enrollment The SSA office has the responsibility for handling Medicare enrollment and managing premium billing and payment. Premiums may be deducted from a [...]
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Posting Date: 04/24/2015
The Medicare Card
Section 2: Medicare Basics The Medicare Card Once a person is enrolled in Medicare, they are issued a card that indicates they are covered by Medicare. The Medicare card is red, white and blue in color. It is issued (and can be reissued) [...]
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Posting Date: 04/24/2015
Medicare Part A
Section 2: Medicare Basics Medicare Part A Table of Contents Medicare Part A Benefit Periods—Medicare Part A Ending a Benefit Period Benefit Period Examples [Return to Top] Medicare Part A Medicare Part A is referred to as Hospital [...]
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Posting Date: 05/31/2024
Inpatient Hospital Care
Section 2: Medicare Basics Inpatient Hospital Care Table of Contents Inpatient Hospital Care Inpatient Benefit Days and Cost-Sharing Full Days—Renewable Coinsurance Days—Renewable Lifetime Reserve Days—Nonrenewing Inpatient [...]
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Posting Date: 04/24/2015
Skilled Nursing Facility Inpatient Care
Section 2: Medicare Basics Skilled Nursing Facility Inpatient Care Table of Contents Skilled Nursing Facility Inpatient Care Requirements for Coverage Technical Requirements Medical Requirements Inpatient SNF/Swing Bed Benefit [...]
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Posting Date: 04/24/2015
Home Health Care Benefit
Section 2: Medicare Basics Home Health Care Benefit Table of contents Home Health Care Benefit Responsibilities of Hospitals Discharging Medicare Beneficiaries Home Health Prospective Payment System Responsibilities of Providers [...]
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