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  • Posting Date: 12/04/2024
    Medicare Diabetes Prevention Program

    Stop diabetes before it begins. Join us and learn about the Medicare diabetes program to help people with Medicare stay healthy and prevent diabetes.

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  • Posting Date: 11/21/2024
    All Part B Providers – Register Now!

    All Part B Providers – Register Now! Don't miss your chance to attend! Don't miss your chance to attend the National Government Services Medicare Part B 2024 Preventive Services Virtual Conference! Registration is happening now, and seats are [...]

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  • Posting Date: 02/24/2022
    Request a Redetermination

    Request a Redetermination The first level of appeal is carried out by the affiliated contractor/MAC. Time limit to initiate = 120 days from date of receipt of the initial determination notice Time limit to complete the review = 60 days [...]

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  • Posting Date: 06/30/2021
    Submit a Reconsideration

    Submit a Reconsideration The second level of appeal is the reconsideration request 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 [...]

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  • Posting Date: 06/30/2021
    Medicare Appeals Council Review

    Medicare Appeals Council Review The fourth level of appeal is carried out by the MAC; this may also be referred to as the Department Appeals Board or DAB. Time limit to initiate = 60 days from date of receipt of ALJ decision Time limit to [...]

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  • Posting Date: 01/04/2021
    Reopenings for Minor Errors and Omissions

    Reopenings for Minor Errors and Omissions Providers may request a reopening of the original claims processing decision by contacting the TRU. The TRU can be used when you wish to revise the initial determination of a specific service or [...]

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  • Posting Date: 12/20/2016
    Reopening Request Timeframes

    Reopening Request Timeframes According to the CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 34, Section 10.6.2, Timeframes for Party Requested Reopenings: A party may request a contractor reopen and revise its initial [...]

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  • Posting Date: 10/06/2022
    ALJ Hearing

    ALJ Hearing The third level of appeal is an ALJ hearing. Time limit to initiate = 60 days from the date of receipt of reconsideration (QIC decision) Time limit to complete the review = 90 days Amount in controversy = The amount that must [...]

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  • Posting Date: 01/18/2022
    Federal Court Review

    Federal Court Review The fifth level of appeal is carried out by the Federal District Court (U.S. District Court). Time limit to initiate = 60 days from date of receipt of Medicare Appeals Council decision Amount in Controversy = The [...]

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  • Posting Date: 11/21/2024
    MLN Connects® Newsletter: November 21, 2024

    MLN Connects® Newsletter: November 21, 2024 News Medicare-Funded Physician Residency Positions CMS Roundup (November 15, 2024) Hepatitis B Vaccine: Billing Requirement Update Effective January 1 Hospitals: Use Renewed Beneficiary Notices [...]

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  • Posting Date: 12/04/2024
    Bone Mass Measurements, Colorectal and Prostate Cancer Screenings

    During this webinar, we'll review the coverage, coding and billing guidelines for bone mass measurements, colorectal and prostate cancer screenings.

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  • Posting Date: 12/04/2024
    Top Part B Claim Errors for Preventive Services

    Join us for a discussion of the top Part B claim denials for preventive services. We'll share the denial reasons, how to correct the denials, and solutions to prevent them from occurring on future claim submissions.

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  • Posting Date: 02/07/2018
    Prolonged Preventive Services

    Preventive Services Guide Prolonged Preventive Services Effective for claims with dates of service on or after 1/1/2018, prolonged preventive services will be payable by Medicare when billed as an add-on to an applicable preventive service [...]

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  • Posting Date: 11/21/2024
    Incarcerated or Unlawfully Present in the U.S. Claim Rejections (U538H, U538Q)

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  • Posting Date: 12/04/2024
    Counseling to Prevent Tobacco Use and Lung Cancer Screening

    During this webinar, we'll review the coverage, coding and billing guidelines for the Medicare preventive services benefits of counseling to prevent tobacco use.

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  • Posting Date: 12/04/2024
    2024 Health Equity Services

    With the addition of health equity services in 2024, we are raising awareness on the benefits available for Medicare beneficiaries. During this webinar, we’ll discuss the new care management services that were included for Medicare coverage in [...]

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  • Posting Date: 11/21/2024
    Utilizing Third Party Billing Companies

    During this webinar, we’ll provide education related to using third party billers for your Medicare claims. We’ll identify vulnerabilities, share how to identify inappropriate third-party activities and reduce costs.

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  • Posting Date: 11/25/2024
    Obtaining Beneficiary Eligibility Information Through NGSConnex

    Obtaining Beneficiary Eligibility Information Through NGSConnex  As a reminder, our Customer Service Representatives aren’t permitted to share eligibility information because it’s available through NGSConnex. If you need help, we [...]

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  • Posting Date: 08/05/2020
    Physicians: Are You Ordering Surgical Dressings for Your Patient?

    Physicians: Are You Ordering Surgical Dressings for Your Patient? In order for a DME supplier to provide surgical dressings to your patients, there are actions you can take to make sure that all the required supporting medical record [...]

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  • Posting Date: 05/12/2020
    Practitioners: Are You Ordering Nebulizers and Inhalation Medication for Your Patient?

    Practitioners: Are You Ordering Nebulizers and Inhalation Medication for Your Patient? Medicare will consider coverage of a nebulizer, compressor and related accessories when the patient’s medical record verifies that the patient has a [...]

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  • Posting Date: 08/10/2020
    Physicians: Are You Ordering Glucose Monitors and Supplies for Your Patients?

    Physicians: Are You Ordering Glucose Monitors and Supplies for Your Patients? The CERT program has noted claim errors for glucose monitors. The following information is provided to assist you in reducing these types of errors. Medicare will [...]

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  • Posting Date: 08/23/2022
    Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)

    Durable Medical Equipment, Prosthetics, Orthotics and Supplies To help providers and suppliers gain a better understanding of the roles of billing, coverage, documentation requirements and medical necessity when providing DMEPOS to Medicare [...]

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  • Posting Date: 08/10/2020
    Clinicians: Are You Ordering PAP Devices and Related Accessories for Your Patients?

    Clinicians: Are You Ordering PAP Devices and Related Accessories for Your Patients? Medicare can make payment for PAP devices and related accessories when the patient’s medical record shows the patient has OSA and meets medical documentation, [...]

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  • Posting Date: 09/10/2019
    Practitioners: Are You Ordering Spinal Orthoses for Your Patient?

    Practitioners: Are You Ordering Spinal Orthoses for Your Patients? The DME MACs are providing helpful guidance to assist the supplier in providing a spinal orthosis to your patient. Medicare must be able to verify there is supporting medical [...]

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  • Posting Date: 04/15/2021
    Clinicians: Are You Ordering Oxygen for Your Patient?

    Clinicians: Are You Ordering Oxygen for Your Patient? Home use of oxygen and oxygen equipment is eligible for Medicare reimbursement only when a beneficiary meets all of the requirements set out in the CMS IOM, Publication 100-03, Medicare [...]

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  • Posting Date: 06/03/2021
    Clinicians: Are You Ordering Diabetic Shoes for Your Patients?

    Clinicians: Are You Ordering Diabetic Shoes for Your Patients? The following section outlines roles of various practitioners that are involved in the decision-making and provision process for diabetic shoes: Certifying physician: The [...]

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  • Posting Date: 02/08/2019
    Physicians Ordering Oxygen and Oxygen Equipment - Quick Tips

    Physicians Ordering Oxygen and Oxygen Equipment - Quick Tips The following is a quick reference guide for physicians and nonphysician practitioners concerning Medicare’s coverage of oxygen and oxygen equipment. For Medicare to consider [...]

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  • Posting Date: 03/09/2020
    Physicians: Are You Ordering DMEPOS for Your Patients?

    Physicians: Are You Ordering DMEPOS for Your Patients? Physicians provide the foundation for correctly billing services and/or supplies to Medicare. DMEPOS suppliers rely on prescribing providers to substantiate the need for services and/or [...]

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  • Posting Date: 08/10/2020
    Physicians: Are You Ordering External Breast Prostheses for Your Patient?

    Physicians: Are You Ordering External Breast Prostheses and Supplies for Your Patient? Following this guidance will help your patients and the Medicare Program by verifying there is medical documentation to support the provision of external [...]

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  • Posting Date: 11/22/2024
    Long-Term Care Hospital

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  • Posting Date: 12/04/2024
    Initial Preventive Physical Examination and Annual Wellness Visit

    Ensure that your patients obtain the wellness examinations they are eligible for by knowing the differences between the initial preventive physical examination and annual wellness visit. During this webinar, we'll review the coverage, coding [...]

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  • Posting Date: 11/25/2024
    Artificial Intelligence Enabled CT Based Quantitative Coronary Topography (AI-QCT)/Coronary Plaque Analysis (AI-CPA)

    Artificial Intelligence Enabled CT Based Quantitative Coronary Topography (AI-QCT)/Coronary Plaque Analysis (AI-CPA) N/A L39863 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39863 A59733 [...]

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  • Posting Date: 11/25/2024
    Transesophageal Echocardiography (TEE)

    Transesophageal Echocardiography (TEE) ultrasound, esophagus, doppler, color flow, contrast, heart L33579 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33579 A52868 [...]

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  • Posting Date: 05/15/2024
    Stay of Enrollment

    Stay of Enrollment The individual provider or authorized/delegated official of a group/facility agrees to adhere to all Medicare requirements when enrolling. CMS implemented a preliminary, interim status representing a pause in enrollment [...]

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  • Posting Date: 11/25/2024
    Reminder: The Self-Service Pulse Has Ended

    Reminder: The Self-Service Pulse Has Ended We sincerely thank you for being a loyal reader of our Self-Service Pulse each week. To continue receiving updates on our latest self-service tools and services, please subscribe to our general Email [...]

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  • Posting Date: 11/25/2024
    Health Equity Vaccination Efforts: Achieving the Highest Level of Health and Well-Being for Your Patients

    Health Equity Vaccination Efforts: Achieving the Highest Level of Health and Well-Being for Your Patients Health equity is the concept that all people should have a fair and just chance to be as healthy as possible, regardless of their [...]

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  • Posting Date: 02/02/2021
    Who May File an Appeal?

    Who May File an Appeal? Who May File an Appeal? Appointment of Representative Who May Be a Representative How to Make and Revoke an Appointment Attorney Representatives Required Elements When to Submit the Appointment Validity of an [...]

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  • Posting Date: 07/13/2021
    About Appeals

    About Appeals Providers, suppliers and beneficiaries have the right to appeal claim determinations made by National Government Services. The purpose of the appeals process is to ensure the correct adjudication of claims. Appeals activities [...]

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  • Posting Date: 02/02/2021
    MSP Overpayments

    MSP Overpayments If you are appealing or correcting a claim that you have received an overpayment on because Medicare paid as the primary insurer and another insurance carrier should be the primary payer, follow the instructions on the [...]

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  • Posting Date: 02/02/2021
    What Documents are Needed

    What Documents are Needed? What Documents are Needed? Medical Records to Support an Appeal Anesthesia Biofeedback Blepharoplasty Cardiac Rehabilitation Services Chiropractic Services Concurrent Care Cosmetic [...]

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