Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers-Register Today!

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers-Register Today! We’ve dedicated Tuesdays for the month of June to deliver valuable educational topics that will help our provider [...]

CR13566 - Outlier Reconciliation and Cost-to-Charge Ratio (CCR) Updates for the Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) PPS

CR13566 - Outlier Reconciliation and Cost-to-Charge Ratio (CCR) Updates for the Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) PPS Posted 5/16/2024

Accelerated Payments to Providers

Advance Payments to Providers

Disposable Negative Pressure Wound Therapy Services Under Home Health

Disposable Negative Pressure Wound Therapy Services Under Home Health Effective for services furnished on or after 1/1/2017, Medicare will make separate payment to HHAs for dNPWT services for patients under the home health benefit. NPWT [...]

Home Health Third Party Liability Demand Billing

Home Health Third Party Liability Demand Billing Table of Contents Background What is a Demand Bill? Requirements for Submission How to Submit a TPL Demand Bill Claim Page 1: Claim Page 2 – Covered and Noncovered Charges Claim [...]

Billing the Home Health Notice of Admission via DDE

Billing the Home Health Notice of Admission via DDE Table of Contents Billing the Home Health Notice of Admission via DDE NOA Claim Page 1 NOA Claim Page 4 Notes Patients Continuing Care in 2022 Related Content [Return to [...]

Home Health Transfers

Home Health Transfers Table of Contents Background What To Do As a Receiving HHA What To Do As the Initial HHA What To Do In Case of a Dispute Related Content [Return to Top] Background A home health transfer occurs when a [...]

Home Health Agency Transfer and Dispute Protocol

Home Health Agency Transfer and Dispute Protocol Specific protocol and steps must be followed prior to opening an admission period for a new patient. Step One: Verify the patient’s eligibility You must ensure the patient is not [...]

Billing Overlap/Dispute Resolution Process

Billing Overlap/Dispute Resolution Process Table of Contents Billing Overlap/Dispute Resolution Process Mailing Addresses and Fax Number JK: J6: General Inquiries JK: J6: [Return to Top] Billing Overlap/Dispute [...]

National Government Services: Raising Awareness About Care Management

National Government Services: Raising Awareness about Care Management According to the Center for Disease Control, six in ten adults in the U.S. have a chronic disease and four in ten adults have two or more. As your MAC for Jurisdiction 6 [...]

Filing an Electronic Notice of Change of Ownership (TOB 8XE)

Filing an Electronic Notice of Change of Ownership (TOB 8XE) The Notice of Change of Ownership (TOB 8XE) is submitted when the hospice has a change of ownership that results in a change of the PTAN. Please refer to the Hospice Change of [...]

Filing an Electronic Notice of Transfer (Type of Bill 8XC)

Filing an Electronic Notice of Transfer (Type of Bill 8XC) Table of Contents Filing an Electronic Notice of Transfer (Type of Bill 8XC) Correcting the Transfer Date on a Previous Submitted Notice of Transfer Related Content [Return to [...]

Hospice Quality Reporting Program

Hospice Quality Reporting Program Along with the other MACs, National Government Services has received several requests from new hospice providers, as well as national and state hospice associations, regarding training and assistance for [...]

Filing an Electronic Notice of Election (Type of Bill 8XA)

Filing an Electronic Notice of Election (Type of Bill 8XA) The NOE, TOB 8XA, is submitted when the hospice receives a signed election statement from the beneficiary acknowledging that he/she wishes to enroll in the Medicare hospice benefit. [...]

Value-Based Insurance Design Model Hospice Benefit Component Overview

Value-Based Insurance Design Model Hospice Benefit Component Overview Beginning on 1/1/2021, CMS is testing the inclusion of the Part A Hospice Benefit within the MA benefits package through the Hospice Benefit Component of the VBID Model. [...]

Avoiding Reason Code 38200

Avoiding Reason Code 38200 Claims are rejected with reason code 38200 when the FISS finds a previously submitted billing transaction that is a duplicate of the recently submitted billing transaction where all of the following fields on the [...]

Billing the Home Health Period of Care Claim - PDGM

Billing the Home Health Period of Care Claim – PDGM Table of Contents Billing the Home Health Period of Care Claim – PDGM Claim Page 1: Claim Page 2: Claim Page 3 Claim Page 4 Claim Page 5 Related Resources [Return to Top] [...]

Home Health Demand Billing

Home Health Demand Billing Table of Contents Background What is a Demand Bill? Requirements for Submission How to Submit a Demand Bil Claim Page 1: Claim Page 2: Covered and Noncovered Charges Claim Page 2: All Noncovered Charges [...]

Notice of Admission Questions and Answers

Notice of Admission Questions and Answers Medicare requires HHAs to submit a one-time NOA instead of RAPs for new admissions starting on or after 1/1/2022. HHAs shall no longer submit RAPs, TOB 0322 for any HH periods of care with a “From” [...]

Billing the Home Health Notice of Admission Electronically

Billing the Home Health Notice of Admission Electronically Table of Contents Billing the Home Health Notice of Admission Electronically NOA Claim Page 1 NOA Claim Page 2 NOA Claim Page 3 NOA Claim Page 4 NOA Claim Page 5 Notes [...]

Late Notice of Admission - The Exception Process

Late Notice of Admission - The Exception Process Table of Contents Timeliness of the NOA and the Penalty Requirements for Submission of the NOA Exception Process Canceling a Timely NOA to Correct an Error Reasons Not to Cancel an NOA [...]

Telehealth Home Health Services: New G-Codes

Telehealth Home Health Services: New G-Codes Prior to 1/1/2023, data on telecommunications technology used during a 30-day period of care at the patient level was not collected on HH claims. Effective 1/1/2023, HHAs may begin voluntarily [...]

Home Health Therapy Billing

Home Health Therapy Billing Table of Contents Home Health Therapy Billing 32X TOB: Billing Therapy Under a Home Health Plan of Care Discipline Revenue Codes (UB-04 FLs 42-43) Discipline HCPCS Codes (UB-04 FL 44) Service Units [...]

Overlapping Claim Tips for Resolution

Overlapping Claim Tips for Resolution Table of Contents Overlapping Claim Tips for Resolution Type of Bills Impacted Inpatient Hospital Overlap Tips Hospital Discharge Coding Hospital Overlapping with Home Health Care Hospital [...]

Medicare Beneficiary Identifier

The MBI is the patient identification number assigned to Medicare beneficiaries. Claims submitted to Medicare contractors must contain the MBI. In 2020, CMS removed the SSN based identifier from the Medicare card to protect beneficiaries and [...]

Exceptions

The official transition period for the new Medicare Number has ended. The MBI should be used for all of your transactions and inquires. CMS will continue to accept the HICN on the following data exchanges after 1/1/2020. These are the only [...]

Medicare Hospice Quick Reference Sheet

Medicare Hospice Quick Reference Sheet The codes listed below are only those most frequently applicable to hospice claims. For a complete list of codes, see the NUBC manual. The NUBC maintains the UB-04 data element specifications and revenue [...]

Professional Services During a Patient Hospice Election

Professional Services During a Patient Hospice Election Table of Contents Article Overview Hospice Election Medicare Payment During Hospice Election Determining the Correct Entity to Bill Separately Payable Part B Services [...]

Hospice Change of Ownership

Hospice Change of Ownership Table of Contents Hospice Change of Ownership What is Not a CHOW The Provider Enrollment Process Purchase Agreement Merger/Acquisition [Return to Top] Hospice Change of Ownership CHOW is defined [...]

Filing an Electronic Notice of Cancelation (Type of Bill 8XD)

Filing an Electronic Notice of Cancelation (Type of Bill 8XD) Table of Contents Filing an Electronic Notice of Cancelation (Type of Bill 8XD) Steps to Cancel a NOE Steps to Cancel a Benefit Period Submitting the 8XD Related Content [...]

Avoiding Reason Code 7C625: Appropriate Use of Remarks on Final Hospice Claims

Avoiding Reason Code 7C625: Appropriate Use of Remarks on Final Hospice Claims Once a hospice chooses to admit a Medicare beneficiary, it may not automatically or routinely discharge the beneficiary at its discretion, even if the care promises [...]

Canceling a Hospice Notice of Election

Canceling a Hospice Notice of Election When a patient elects hospice, the hospice submits a NOE to the MAC to notify the MAC and all other providers that the patient is now utilizing the Medicare hospice benefit for all services related to the [...]

Appropriate Use of Occurrence Code 27 and Occurrence Span Code 77

Appropriate Use of Occurrence Code 27 and Occurrence Span Code 77 Table of Contents Appropriate Use of Occurrence Code 27 and Occurrence Span Code 77 Example of the Proper Use of OC 27 Example of the Proper Use of OC 27 with OSC 77 [...]

Completing the Advance Beneficiary Notice for Home Health Agency Demand Claims

Completing the Advance Beneficiary Notice of Noncoverage for Home Health Agency Demand Claims The purpose of the ABN is to appropriately notify a Medicare beneficiary of services that the HHA believes Medicare will not cover. In order for the [...]

Hospice Billing Codes Chart

Hospice Billing Codes Chart Table of Contents Hospice Billing Codes Chart Condition Codes (CC) (UB-04 FL 18-28) Occurrence Codes (OC) and Dates (UB-04 FLs 31-34) Occurrence Span Code and Date (UB-04 FLs 35-36) Value Codes (VCs) and CBSA [...]

Hospice Room and Board Denials

Hospice Room and Board Denials Medicare does not pay the room and board fees for hospice beneficiaries that reside in a SNF or a nursing facility (NF), as these charges are statutorily excluded from Medicare coverage. However, these charges [...]

Education Partnership Request Form

Hospice Site of Service Codes

Hospice Site of Service Codes Table of Contents Hospice Site of Service Codes HCPCS Codes Site of Service Location Notes Edits Related Content [Return to Top] Hospice Site of Service Codes Hospice agencies must report an HCPCS [...]

Reporting Hospice Discharges, Revocations and Transfers

Reporting Hospice Discharges, Revocations and Transfers Medicare regulations at 42 CFR 418.26 outline three reasons for discharge from hospice care: The beneficiary moves out of the hospice’s service area or transfers to another [...]