E/M Coding: Medical Decision Making Moderate Point Scoring for Data Elements

Evaluation and Management Coding: Medical Decision Making Moderate Point Scoring for Data Elements On 1/1/2021, CMS approved and issued modifications to E/M coding guidelines that were originally developed and adopted by the AMA. This change [...]

DDE Logon ID and Password Reminders

DDE Logon ID and Password Reminders CMS’ information security policy strictly prohibits the sharing or loaning of Medicare assigned IDs and passwords. Users should take appropriate measures to prevent unauthorized disclosure or modification of [...]

Knee Orthosis: A/B and DME Collaborative Presentation

Knee Orthosis: A/B and DME Collaborative Presentation View the A/B and DME Knee Orthosis YouTube video for information on knee orthosis. Posted 3/23/2023

The Medicare Home Infusion Therapy Benefit and Home Health Agencies

Resolved: Home Health Claims Editing for Reason Codes U5210/U5220

Resolved: Home Health Claims Editing for Reason Codes U5210/U5220 Some home health NOAs and claims were incorrectly hitting reason codes U5210 and U5220. These reason codes state there is no Medicare entitlement for the dates of service when [...]

Changes in G2066 Pricing Effective April 1, 2023

Changes in G2066 Pricing Effective April 1, 2023 After reviewing Medicare claims data for G2066 (Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system, implantable loop recorder [...]

Change in Pricing for Electroencephalogram Long-Term Monitoring Effective 4/1/2023

Change in Pricing for Electroencephalogram Long-Term Monitoring Effective 4/1/2023 After reviewing Medicare claims data for EEG continuous recording (CPT codes 95700 through 95718) as well as seeking input from providers, industry, [...]

(SE20024) FAQs on the 3-Day Payment Window for Services Provided to Outpatients Who Later Are Admitted as Inpatients

MLN Matters®: SE20024 FAQs on the 3-Day Payment Window for Services Provided to Outpatients Who Later Are Admitted as Inpatients

MLN Connects® Newsletter: March 30, 2023

MLN Connects® Newsletter: March 30, 2023 News COVID-19: Booster Dose for Children 6 months – 4 years Identity & Access Management System: Easier for Surrogates Medicare Advantage Value-Based Insurance Design Model Extended [...]

CR12669 - Instructions Relating to the Evaluation of Section 1115 Waiver Days in the Calculation of Disproportionate Share Hospital Reimbursement

CR12669 - Instructions Relating to the Evaluation of Section 1115 Waiver Days in the Calculation of Disproportionate Share Hospital Reimbursement​​​​​​​

CR13122 - Implementation of Consolidated Appropriations Act (CAA) of 2023, Section 4143: Waiver of Cap on Annual Payments for Nursing and Allied Health Education Payments

CR13122 - Implementation of Consolidated Appropriations Act (CAA) of 2023, Section 4143: Waiver of Cap on Annual Payments for Nursing and Allied Health Education Payments

EDI Enrollment Spotlights Top Rejections

EDI Enrollment Spotlights Top Rejections Part A, Part B and DDE Periodically, EDI ​​​​enrollment will publish articles to help eliminate the number of EDI applications that are denied.  This month we are spotlighting the denial for [...]

Bill Correctly: Power Mobility Device Repairs

Bill Correctly: Power Mobility Device Repairs An Office of Inspector General report stated that Medicare improperly paid claims for PMD repairs when suppliers didn’t provide sufficient documentation to support billing charges. The Power [...]

Clinical Trials

Improving Customer Experience

Improving Customer Experience We are committed to improving your experience. Please watch this two-minute video that explains how each day we review comments from providers who submit surveys to let us know what is working well and how we [...]

MLN Connects® Newsletter: April 6, 2023

MLN Connects® Newsletter:  April 6, 2023 News Resources & Flexibilities to Assist with Public Health Emergency in Mississippi Due to Recent Storms Program for Evaluating Payment Patterns Electronic Reports Advance Beneficiary [...]

MSP Payment and Savings Calculator Top

Medicare Secondary Payer Payment Calculator The MSP payment calculator is intended to provide an approximation of what an MSP payment may be for assigned claims. This calculator does not reflect applicable coinsurance, deductible, or other [...]

Reminder: Maintaining Ownership Consistency of Multiple Medicare Enrollments with same Tax Identification Number

Reminder: Maintaining Ownership Consistency of Multiple Medicare Enrollments with same Tax Identification Number View CMS’ “Medicare Enrollment: Maintain the Same Owners in All Enrollment Records” article within MLN Connects® Newsletter: [...]

Modifiers Used During the COVID-19 Public Health Emergency

Modifiers Used During the COVID-19 Public Health Emergency Modifier Part A Billed on UB04? Part B Billed on 1500? Details References Exceptions/Special Usage CS Exception Yes Waives [...]

Modifier 95 as it Relates to Medicare Part B and COVID-19 Billing

Modifier 95 as it Relates to Medicare Part B and COVID-19 Billing Modifier 95 Defined: Synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system. During the COVID-19 PHE, and through CY 2023 [...]

Modifier CR as it Relates to Medicare Part B and COVID-19 Billing

Modifier CR as it Relates to Medicare Part B and COVID-19 Billing In 2005, CMS created modifier “CR” (description: Catastrophe/disaster related) to assist MACs in processing claims as a result of Hurricane Katrina. This modifier was also [...]

Home Health Diagnosis Codes Grouper Update for 4/1/2023

Home Health Diagnosis Codes Grouper Update for 4/1/2023 Effective 4/1/2023, CMS is implementing new HH Grouper edits. The HH Grouper program has various data validity edits that make sure it uses consistent and accurate data when calculating [...]

Clarification on the Proper Use of the CS Modifier

Clarification on the Proper Use of the CS Modifier Per MLN Matters® article SE20011, the CS modifier (cost-sharing waiver for COVID-19 testing) is applicable to certain services furnished beginning on 3/18/2020 through the end of the PHE, [...]

New Fiscal Intermediary Shared System Consistency Edit to Validate Attending Physician National Provider Identifier

New Fiscal Intermediary Shared System Consistency Edit to Validate Attending Physician National Provider Identifier Effective 4/1/2023, CMS implemented a new consistency edit to validate that the attending physician NPI. An Attending Provider [...]

The Advance Beneficiary Notice of Noncoverage

The Advance Beneficiary Notice of Noncoverage We’ve updated our Advance Beneficiary Notice of Noncoverage article to include examples for using an ABN for outpatient therapy and using the KX and GA modifiers appropriately. We encourage you to [...]

MLN Connects® Newsletter: April 13, 2023

MLN Connects® Newsletter:  April 13, 2023 News COVID-19: End of Public Health Emergency CMS Roundup (Apr. 07, 2023) Medicare Shared Savings Program: Application Toolkit Materials Inpatient Rehabilitation Facility [...]

Top Tobacco Counseling Claim Denials and How to Avoid/Correct Them

Top Tobacco Counseling Claim Denials and How to Avoid/Correct Them Providers, are your claims being denied for tobacco counseling services utilizing codes 99406 and 99407? In order to assist our providers in getting claims processed [...]

CR13105 - Technical Revisions Only to the National Coverage Determination (NCD) Manual

CR13105 - Technical Revisions Only to the National Coverage Determination (NCD) Manual

Telehealth Frequently Asked Questions are Updated

Telehealth Frequently Asked Questions are Updated We’ve updated our telehealth frequently asked questions to include changes and flexibilities due to the end of the PHE on 5/11/2023. Please view these FAQs for the answers you need to common [...]

Providers Using NGSConnex to Submit Appeals and Supporting Documentation

Providers Using NGSConnex to Submit Appeals and Supporting Documentation We strongly recommend our providers use NGSConnex to submit your redetermination requests and any supporting documentation. Please be aware that if you do not submit [...]

Medicare University Continuing to Experience Intermittent Issues

Medicare University Continuing to Experience Intermittent Issues We are continuing to experience intermittent outages with Medicare University. You do not need to report these issues with Medicare University to our Provider Contact Center. We [...]

MLN Connects® Newsletter: April 20, 2023

MLN Connects® Newsletter:  April 20, 2023 News Billing Medicare Part B for Insulin with New Limits on Patient Monthly Coinsurance Medical Review & Compliance: Respond to Additional Documentation Requests Hospice: [...]

Hot Topics

Medicare Important Hot Topics Medicare and Coronavirus Medicare and Coronavirus – How to stay up-to-date! Medicare Beneficiary Fact Sheets Beneficiary Fact Sheets for Medicare Cost and Coverage Medicare Coverage Database The MCD [...]

Introduction

Introduction The Congressional Affairs Outreach team at National Government Services, Inc. and our partners are committed to ensuring that congressional offices receive a timely response to all inquiries. For your convenience, National [...]

LCD, Billing and Coding Article Updates for April and May 2023

LCD, Billing and Coding Article Updates for April and May 2023 Billing and Coding Article (A56937): Psychiatry and Psychology Services Removed sentence from article text section - “For psychotherapy sessions lasting 90 minutes or longer, the [...]

Medicare Secondary Payer

Medicare Secondary Payer CMS transitioned COB activities for GHP and non-GHPs from the COBC and Non-GHP recovery functions from the BCRC to the new Medicare Secondary Payer Contractor. There will be no change to any of the COB processes under [...]

Congressional Offices

Congressional Offices Home Communications Hot Topics MAC Directory Contacts Resources

Fraud Awareness Week and National Rural Health Day

Fraud Awareness Week and National Rural Health Day Since this week is Fraud Awareness Week and National Rural Health Day is tomorrow on 11/16/2023, we wanted to share these valuable resources with you. Fraud Awareness Week Traditional [...]

MLN Connects Newsletter: Take Our Provider Survey Today - November 15, 2023

MLN Connects® Newsletter: Take Our Provider Survey Today - November 15, 2023 You helped us before, and we want to learn more about your information needs. CMS is conducting a study to help us improve your experience with the Medicare [...]

Submit a Reconsideration

Submit a Reconsideration The second level of appeal is the reconsideration and is carried out by the QIC. Time limit to initiate = 180 days from date of receipt of redetermination decision Time limit to complete the review = 60 days [...]