LCD and Article Updates for April/May 2024

LCD and Article Updates for April/May 2024 Billing and Coding Articles Billing and Coding: Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin and Non-Hodgkin Lymphoma with B-cell or T-cell Origin (A59311) [...]

Billing for Drug Wastage: JW and JZ Modifier

Billing for Drug Wastage: JW and JZ Modifier Properly billing for drug wastage and associated modifiers helps to prevent claims processing errors and denials while ensuring you receive correct reimbursement. Providers and suppliers are to [...]

National Government Services Proposed LCDs for Comment (4/25/2024-6/8/2024)

National Government Services Proposed LCDs for Comment (4/25/2024-6/8/2024) The proposed LCDs listed below are being presented for comment for the Jurisdiction 6 and Jurisdiction K MACs. The formal comment period extends from 4/25/2024 through [...]

Covered Medicare Part B Drugs/Biologicals

Covered Medicare Part B Drugs/Biologicals Each drug and biologic that can be considered for coverage under Medicare Part B has its own set of coverage guidelines. Below are examples of covered Medicare Part B drugs and biologicals, which may [...]

Maximum Payment Limits for Rural Health Centers

Maximum Payment Limits for Rural Health Centers Payment Limit Annual Adjustment Period Covered $190.00 TBD 1/1/2028–12/31/2028 $178.00 TBD 1/1/2027–12/31/2027 $165.00 TBD [...]

2024 Medicare Cost Report Due Dates

2024 Medicare Cost Report Due Dates FYE 12/31/2023 cost reports are due by 5/31/2024. We strongly encourange early filing of the cost report. Early-filed cost reports that are rejected will receive a grace period to re-submit prior to [...]

Vaccines

Vaccines Medicare covers some preventive vaccines at no cost to the beneficiary. CMS and National Government Services provide detailed educational and billing information for providers. Medicare also covers vaccines that are directly related [...]

EDI Guided Enrollment Form

MLN Connects® Newsletter: May 2, 2024

MLN Connects® Newsletter: May 2, 2024 News CMS Statement on Proposed Local Coverage Determination for Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers Quality in [...]

May 2024

In This Issue National Government Services Articles for Part A and Part B Providers LCD and Article Updates for April/May 2024 National Government Services Proposed LCDs for Comment (4/25/2024-6/8/2024) Top Tobacco Counseling Claim Errors [...]

Important Reminders for Your EDI Enrollment

Important Reminders for Your EDI Enrollment When completing the EDI Enrollment application, it’s important that the entity name and address you enter on the EDI enrollment form matches exactly to the information contained in the CMS-855/PECOS [...]

Join Us for ‘Real Time” with CMS Chicago

Join Us for ‘Real Time' with CMS Chicago The CMS Chicago LEA would like to invite you to our “Real Time” with CMS Chicago, a bi- weekly webinar that occurs on the 2nd & 4th Wednesday of every Month at 9 a.m. CT. These 30-minute calls are [...]

About Prior Authorization

About Prior Authorization CMS has implemented Prior Authorization (PA) programs nationwide to ensure that Medicare beneficiaries continue to receive medically necessary care while protecting the Medicare Trust Fund from improper payments. PA [...]

OPD Facility/Physician Communication

OPD Facility/Physician Communication What does this mean for the Part B Provider who will be performing the service in the hospital OPD? The performing provider, must work alongside the hospital OPD staff to obtain PA for the services to be [...]

Billing Reminder: When a Skilled Nursing Facility Payment Ban is in Effect

Billing Reminder: When a Skilled Nursing Facility Payment Ban is in Effect CMS may impose a DPNA against the SNF when the facility is not in compliance with the requirements of participation under the Social Security Act at Sections 1819(h) [...]

PS&R/Cost Report Crosswalk

PS&R/Cost Report Crosswalk Did you know you have access to crosswalks between the PS&R Summary Report and the Medicare cost report? Our Medicare Audit and Reimbursement Department created crosswalk tools for hospitals and [...]

Save the Dates! National Government Services 2024 Spring/Summer Virtual Conference

Save the Dates! National Government Services 2024 Spring/Summer Virtual Conference Mastering Medicare: Tuesday Tutorials for Part B Providers Coming to you soon on 6/4/2024, 6/11/2024, 6/18/2024 and 6/25/2024, four full days of virtual [...]

Save the Dates! CMS National Provider Enrollment Conference in San Diego: 8/28/2024-8/29/2024

Save the Dates! CMS National Provider Enrollment Conference in San Diego: 8/28/2024-8/29/2024 Wednesday, 8/28/2024 and Thursday, 8/29/2024 from 8:00 a.m.–5:00 p.m. PT Register for the CMS National Provider Enrollment Conference at the San [...]

SNFs: Missing Medicare Health Insurance Claim Number on Minimum Data Set Can Cause Potential Claim Denials

SNFs: Missing Medicare Health Insurance Claim Number on Minimum Data Set Can Cause Potential Claim Denials Our Medical Review department has noted many cases where the HIC number is missing from the MDS that is in the repository. MDS Overview [...]

Get Your PS&R Reports

Table of Contents Get Your PS&R Reports Register to Receive the PS&R Report Instructions on How to Use Redesign Detail Reports [Return to Top] Get Your PS&R Reports The PS&R report is a tool used by Part A providers [...]

Get Your PS&R Reports

The PS&R report is a tool used by Part A providers and MACs to prepare and process Medicare cost reports. Table of Contents Register to Receive the PS&R Report Instructions on How to Use Redesign Detail Reports [Return to Top] [...]

Request a Due Date Extension

It may be necessary to request an extension for your cost report due date because of an extraordinary circumstance. An example of an extraordinary circumstance would be a flood or fire that forces a provider to cease operations and transfer [...]

Request a Due Date Extension

It may be necessary to request an extension for your cost report due date because of an extraordinary circumstance. An example of an extraordinary circumstance would be a flood or fire that forces a provider to cease operations and transfer [...]

MLN Connects® Newsletter: May 9, 2024

MLN Connects® Newsletter: May 9, 2024 News HHS Releases New Data Showing Over 10 million People with Medicare Received a Free Vaccine Because of the President’s Inflation Reduction Act; Releases Draft Guidance for the Second Cycle of [...]

Submission of a Medicare Cost Report Reopening Request

Submission of a Medicare Cost Report Reopening Request In accordance with CMS policy (42 Code of Federal Regulations 405.1885 and CMS IOM Publication 15-1, The Provider Reimbursement Manual, Section 2931), a provider may request a reopening of [...]

Hospice Certifying Physician Medicare Enrollment Information

Hospice Certifying Physician Medicare Enrollment Information Under CMS' current regulations, the hospice medical director or the physician member of the hospice interdisciplinary group (the “hospice physician”) and the attending physician (if [...]

Request an Accelerated Payment

Medicare Part A guidelines provide for accelerated payments under highly exceptional circumstances. Accelerated payment criteria and eligibility requirements are outlined in the CMS Paper-Based Manuals Publication 15-1, Medicare Provider [...]

Request an Interim Rate Adjustment

When requesting an interim rate adjustment, it's important to submit your interim financial data to National Government Services using the appropriate Interim Rate Review Documentation Request Form. These forms are designed to capture important [...]

Request an Interim Rate Adjustment

When requesting an interim rate adjustment, it's important to submit your interim financial data to National Government Services using the appropriate Interim Rate Review Documentation Request Form. These forms are designed to capture important [...]

CMS Medicare Administrative Contractor Information

CMS Medicare Administrative Contractor Information Note: Please do not include PHI such as Medicare numbers within emails. Navigation [Part A] [Part B] [DME MAC] [Federally Qualified Health Center] [Home [...]

Physicians: Are You Ordering Knee Orthosis for Your Patients?

Physicians: Are You Ordering Knee Orthosis for Your Patients? This is your opportunity to hear directly from the Medicare contractors regarding documentation required for the coverage criteria to be met. You’ll also learn how to help your [...]

Staying Up To Date on Vaccines

Staying Up To Date on Vaccines It's important to stay up to date on vaccines. Vaccines protect your patients from serious illness and can keep them out of the hospital. Talk with your patients about which vaccines may be right for them, many [...]

File an Amended Cost Report

Table of Contents File an Amended Cost Report Timeframe to Amend the Medicare Cost Report [Return to Top] File an Amended Cost Report A provider may elect to submit an amended cost report subsequent to the initial filing. The Centers [...]

File an Amended Cost Report

A provider may elect to submit an amended cost report subsequent to the initial filing. The CMS Medicare Paper-Based Manuals Publication 15-1, Provider Reimbursement Manual—Part I, Chapter 29 Section 2931.2A, allows the Medicare Administrative [...]