Additional Development Requests for Part A Claims for CPT J9299

Additional Development Requests for Part A Claims for CPT J9299 A system error on 7/25/2024 caused ADR letters to be issued in error on Part A claims for CPT J9299 with DOS on or after 3/1/2024. The issue has been resolved and all impacted [...]

End-Stage Renal Disease: Medicare Part A Quick Reference Manual

End-Stage Renal Disease: Medicare Part A Quick Reference Manual Table of Contents ESRD Provider PTAN Number Range: Third through sixth digit FL 04 Type of Bill FL 6 Statement Covers Period FL 18-28 Condition Codes FL 18-28 Condition [...]

Claim Submission Guidelines

Claim Submission Guidelines CMS developed and transmitted HCPCS and PFS payment and coding files to include revisions to add other CDT codes and indicated parameters for payment to implement the finalized Medicare Parts A and B payment for [...]

Disproportionate Share Hospital

The Medicare DSH adjustment provision under Section 1886(d) (5) (F) of the Act was enacted by section 9105 of the COBRA of 1985 and became effective for discharges occurring on or after 5/1/1986. According to section 1886(d) (5) (F) of the Act, [...]

Electronically Submitted Claims that Exceed $99,999.99 Reminder

Electronically Submitted Claims that Exceed $99,999.99 Reminder Electronically submitted claims containing a dollar amount in excess of 99,999.99 will be rejected as a front-end EDI edit. The Standard Companion Guide for Health Care Claim: [...]

MLN Connects® Newsletter: August 22, 2024

MLN Connects® Newsletter: August 22, 2024 News Commemorating the 2nd Anniversary of the Lower Cost Prescription Drug Law MolDx Local Coverage Determination Statement Hospital Price Transparency: Get Resources to Help You Comply New [...]

Facet Joint Interventions

Facet Joint Interventions National Government Services will begin accepting PARs for Facet Joint Intervention codes on 6/15/2023 for services provided beginning on or after 7/1/2023.   To meet coverage criteria, the patient’s medical [...]

Part B

Part B  Home Education Help and FAQs Manuals Medicare Monthly Review Medicare Topics Medicare University News POE Advisory Group Specialties Resources Claims and Appeals Contact Us EDI Enrollment EDI Solutions Forms [...]

FQHC

FQHC and RHC  Home Education Help and FAQs Manuals Medicare Monthly Review Medicare Topics Medicare University News POE Advisory Group Specialties Resources Claims and Appeals Contact Us Cost Reports EDI Enrollment EDI [...]

Part A

Part A  Home Education Help and FAQs Manuals Medicare Monthly Review Medicare Topics Medicare University News POE Advisory Group Specialties Resources Claims and Appeals Contact Us Cost Reports EDI Enrollment EDI [...]

Home Health and Hospice

Home Health and Hospice  Home Education Help and FAQs Manuals Medicare Monthly Review Medicare Topics Medicare University News POE Advisory Group Specialties Resources Claims and Appeals Contact Us Cost Reports EDI [...]

Direct Graduate Medical Education/Indirect Medical Education

Direct Graduate Medical Education Table of Contents Direct Graduate Medical Education Indirect Medical Education [Return to Top] Direct Graduate Medical Education Section 1886(h) of the Act as added by section 9202 of the COBRA of [...]

Original Medicare Coverage Costs

Original Medicare Coverage Costs Important Links Medicare News Fact Sheet Your Medicare Costs Your Medicare Benefits Your Medicare Coverage Your Medicare Coverage for Home Health Services Your Medicare Coverage for Hospice Care [...]

Physician Fee Schedule Look-Up

Clinical Trial Services and Modifiers Q0 and Q1

Clinical Trial Services and Modifiers Q0 and Q1 Table of Contents Clinical Trial Services and Modifiers Q0 and Q1 Q0 and Q1 Modifiers Use in Approved Clinical Trials Modifier Q0 Modifier Q1 Clinical Service Billing May Include [...]

"What If" and Scenario Questions

"What If" and Scenario Questions Physician offices often contact us with different scenarios and "what if?" questions regarding coding and documentation for a particular service(s). Providers ask the contractors for a definitive response on [...]

Medically Unlikely Edits Billing and Processing

Medically Unlikely Edits Billing and Processing Table of Contents Medically Unlikely Edits Billing and Processing Notes on MUE Processing Instructions MUE Program Inquires Related Content [Return to Top] Medically Unlikely Edits [...]

Avoid Processing Delays by Following Proper Submission Guidelines

Avoid Processing Delays by Following Proper Submission Guidelines Table of Contents Avoid Processing Delays by Following Proper Submission Guidelines Claims Appeals Responding to an ADR Consider Submission via NGSConnex or Electronic [...]

Acceptable Electronic Signatures Reminder

Acceptable Electronic Signatures Reminder Table of Contents Acceptable Electronic Signatures Reminder Examples of Acceptable Electronic Signature Examples [Return to Top] Acceptable Electronic Signatures Reminder CMS issued [...]