Hospice Billing Instructions for Influenza, Pneumococcal and Hepatitis B Vaccines

Hospice Billing Instructions for Influenza, Pneumococcal and Hepatitis B Vaccines Medicare covers influenza virus, pneumococcal and hepatitis B vaccines in accordance with coverage requirements, when furnished by a hospice to those [...]

Exemption Process for the Prior Authorization Program for Certain Hospital Outpatient Department Services

The Centers for Medicare & Medicaid Services (CMS) implemented a prior authorization program for certain hospital outpatient department (OPD) services for date of service (DOS) on or after 7/1/2020 and subsequently added an exemption process. [...]

Home Health Claims Returned to Providers with Reason Code 31755

CMS reactivated RC 31755 effective 1/3/2023 and some HH claims are being RTP due to billing errors. These claims need to be corrected with the information provided in the Provider Action section of this article. Medicare is still receiving [...]

MLN Connects® Newsletter: June 13, 2024

MLN Connects® Newsletter: June 13, 2024 News Medicare Shared Savings Program: Apply for January 1 Start Date by June 17 Men’s Health: Encourage Your Patients to Prioritize Their Health Compliance Hospital Beds & Accessories: [...]

Paper Enrollment Process

Paper Enrollment Process Enrollment via paper is an option, but PECOS is the preferred method to process the application with streamlining features. Paper-based enrollment applications are available. Determine which CMS Paper Form you will [...]

Complete All Topics

Complete All Topics Instructions for completing all PECOS topics: Select the ‘Topic View’ tab and add information in every topic Note: The electronic funds transfer (EFT) topic must be completed by: groups suppliers sole owner group [...]

Upload Supporting Documents

Upload Supporting Documents Instructions for PECOS to upload required supporting documentation: Select the ‘Topic View’ tab Select “Required and/or Supporting Documents” Upload documents Mandatory for all provider/supplier types: [...]

Resolve All Errors and Verify Warnings

Resolve all Errors and Verify Warnings Instructions for resolving all errors and warnings: Select the ‘Errors/Warning Check’ Tab.   Correct all errors identified and verify any warnings.   Related Content Resolving PECOS [...]

Verify and Manage Signature(s)

Verify and Manage Signature(s) Verify signatures on all application(s) submitted including applications that were “Return for Corrections”, by returning to the enrollment box in PECOS. Important: The reassignments are viewed by selecting [...]

Determine your Business Structure

Determine your Business Structure When starting a business, you must decide what form of business entity you wish to establish. The legal structure you choose for your business has more to do with tax, liability and management arrangements. [...]

Individual (Group Member) Reassigning Benefits Only

Individual (Group Member) Reassigning Benefits Only Download CMS-855I: Complete sections 1, 2, 3, 4, 4F, 12, 13 and 15 (B and C). Reassignment means that an individual physician, nonphysician practitioner, or other supplier has granted [...]

Ordering/Referring Provider Only

Ordering/Referring Provider Only Download CMS-855O. Complete sections 1, 2, 3, 4, 5, 6 and 8. Note: Ordering and referring providers are only required to be enrolled in one state. Be sure to include supporting documentation for [...]

Adding a New Reassignment of Benefits Using the CMS-855I

Adding a New Reassignment of Benefits Using the CMS-855I Download CMS-855I version (5/23): Complete sections 1A and B, 2A, 3, 4F (add, terminate, change reassignment), 13, and 15B and 15C IMPORTANT: If an individual is new to the [...]

Electronic Funds Transfer Agreement

Electronic Funds Transfer Agreement Download and complete the CMS-588 EFT Authorization Agreement. Physicians and nonphysician practitioners who are reassigning all of their payments to another entity are not required to submit the CMS-588. [...]

Medicare Participating Physician or Supplier Agreement

Medicare Participating Physician or Supplier Agreement Download and complete CMS-460 Medicare Participating Physician or Supplier Agreement. Note: CMS-460 must have a signature and date of participant or authorized representative of [...]

1-800-MEDICARE Authorization to Disclose Personal Health Information

Medicare Correspondence Request Form

Prior Authorization Request for Outpatient Services: Implanted Spinal Neurostimulators

Hospice Visit Reporting

Hospice Visit Reporting Table of Contents Background Discipline Visits Reporting Visits in the Routine Home Care, Continuous Home Care and Inpatient Respite Care Levels of Care Discipline Revenue and HCPCS Coding Required Detail for [...]