Incident to Quick Reference Chart

Incident to Quick Reference Chart Location PT Status Scenario Who Bills Comments Office New patient NPP sees patient - MD not present in office suite NPP bills for the service under the NPP NPI NPP [...]

ASCA Requirements for Paper Claim Submissions

Table of Contents ASCA Requirements for Paper Claim Submissions Submitting Electronic Claims Submitting Paper Claims ASCA Exception Criteria Related Content [Return to Top] ASCA Requirements for Paper Claim Submissions [...]

“Incident to” Services

“Incident to” Services This article has been specially designed for our providers who perform services “Incident to” the services of a physician/NPP. Table of Contents The “Incident to” Provision of Medicare Your Office Hospital or [...]

Home Health Referrals

Home Health Referrals Table of Contents Home Health Referrals Order for Home Health Services Documentation to Support Homebound Status Documentation to Support the Need for Skilled Services Documentation Regarding the Face-to-Face [...]

Supplemental Security Income Ratio Realignment for Cost Reporting Periods Starting Before 10/1/2013

Supplemental Security Income Ratio Realignment for Cost Reporting Periods Starting Before 10/1/2013 On 6/9/2023, in response to the Supreme Court’s ruling in Azar v. Allina Health Services, 139 S. Ct. 1804 (2019), the CMS issued a final rule [...]

About Appeals

About Appeals Table of Contents About Appeals Reopening vs. Redetermination Reopening Redetermination [Return to Top] About Appeals Providers and beneficiaries have the right to appeal claim determinations made by National [...]

Home Health Forms – Which is Required?

Home Health Forms – Which is Required? The Advance Beneficiary Notice/Home Health Change of Care Notice/Notice of Medicare Noncoverage Scenario ABN HHHCN NOMNC Patient met goals under the POC and is being [...]

Homebound Status

Homebound Status A Medicare beneficiary must be confined to the home in order to use their Medicare home health benefit. CMS defines homebound status in the CMS IOM Publication 100-02, Medicare Benefit Policy [...]

Home Health Certification Statement

Home Health Certification Statement What is a home health certification statement? It is an attestation that the Medicare beneficiary is eligible for home health services. It is a CMS requirement and condition of payment for a home health [...]

Wound Care Under the Medicare Home Health Benefit

Wound Care Under the Medicare Home Health Benefit Wound care treatment typically involves three skilled nursing interventions, which may be performed at the same time or separately from each other. The three services are: Performing the [...]

Medical Unlikely Edits Implemented for Some HCPCS and CPT Codes

Medical Unlikely Edits Implemented for Some HCPCS and CPT Codes Table of Contents Medical Unlikely Edits Implemented for Some HCPCS and CPT Codes Looking Up MUEs Accessing MUE Tables Common Questions [Return to Top] Medical Unlikely [...]

Education Partnership Request Form

Education Partnership Request Form

Education Partnership Request Form

Education Partnership Request Form

MLN Connects® Newsletter: August 8, 2024

MLN Connects® Newsletter: August 8, 2024 Final Payment Rule Hospital Inpatient Prospective Payment System & Long-Term Care Hospital Prospective Payment System FY 2025 Final Rule News Transitional Coverage for Emerging Technologies [...]

Maine, Massachusetts, New Hampshire, Rhode Island and Vermont

Maine, Massachusetts, New Hampshire, Rhode Island, Vermont Member Name Professional Title Association Business Name/Address Email Bedard, Brenda Insurance Compliance & Training Supervisor Maine [...]

Removal of Facet HCPCS Codes

Removal of Facet HCPCS Codes Prior Authorization Outpatient Department Update  Effective 8/16/2024, the CMS is removing two current procedural terminology codes from the OPD Facet Joint Injection list of codes: 64492 – Facet joint [...]

Prior Authorization OPD Alerts

Prior Authorization OPD Alerts Month/Year Topic August 2024  Removal of Facet HCPCS Codes July 2023 Prior Authorization Outpatient Department Rejections Alert July 2023 Prior [...]

Medical Policy Contact Information

Medical Policy Contact Information Please Note: General inquiries related to Medicare coverage policies, including clinical issues, drugs, radiopharmaceuticals, local and national coverage determinations, billing and reimbursement must be [...]