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Posting Date: 10/10/2024
Navigating Medicare Part B Insights for Providers Podcast
Navigating Medicare Part B Insights for Providers Podcast Listen to our podcast, Navigating Medicare Part B Insights for Providers, on Spotify and Apple Podcasts! We will be posting a new episode on the 2nd and 4th Wednesday of each [...]
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Posting Date: 10/21/2024
Initiate a Prior Authorization Request for OPD Services for Part A Facility
Initiate a Prior Authorization Request for OPD Services for Part A Facility Table of Contents Initiate a Prior Authorization Request Request Details Requestor’s Information Rendering Physician Information Attachments [...]
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Posting Date: 10/17/2024
MLN Connects® Newsletter: October 17, 2024
MLN Connects® Newsletter: October 17, 2024 News Inpatient Psychiatric Facilities: Guidance on All-Inclusive Cost Reporting No-Pay Medicare Summary Notice Mailing Frequency Changed to Every 120 Days Health Literacy: Help Your Patients Get [...]
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Posting Date: 11/12/2021
Interactive Voice Response System
Interactive Voice Response System CMS requires that Medicare contractors offer self-service options to their providers for general inquiries. CMS also requires providers to utilize those self-service options, such as the IVR. National [...]
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Posting Date: 11/16/2021
Skilled Nursing Facility Consolidated Billing
Skilled Nursing Facility Consolidated Billing Back in 1997 as part of the Balanced Budget Act, Congress mandated that payment for the majority of services provided to beneficiaries in a Medicare-covered SNF stay be included in a bundled [...]
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Posting Date: 11/12/2021
Local Coverage Determination
Local Coverage Determination LCDs are developed by the local Medicare contractor in the absence of a national Medicare payment policy. These policies describe specific criteria which determine whether an item or service is covered by Medicare [...]
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Posting Date: 11/12/2021
ABN Modifiers
ABN Modifiers Modifier Description GA Waiver of liability statement issued, as required by payer policy, individual case GX Notice of liability issued, voluntary under payer policy GY Item [...]
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Posting Date: 11/12/2021
American Medical Association and Current Procedural Terminology
American Medical Association and Current Procedural Terminology The AMA is your trusted source for official CPT. The most widely accepted medical nomenclature used to report medical procedures and services under public and private health [...]
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Posting Date: 11/12/2021
CMS Forms and Publications
CMS Forms and Publications CMS publishes and maintains numerous Medicare forms that are used daily by the provider community. Some commonly used forms are: Provider Enrollment CMS-855 forms (CMS-855B, CMS-855I and CMS-855O) Medicare [...]
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Posting Date: 11/12/2021
CMS Regional Offices
CMS Regional Offices CMS has ten RO reorganized in a Consortia structure based on the agency’s key lines of business: Medicare Health Plans Operations Financial Management and Fee-for-Service Operations Medicaid and Children’s Health [...]
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Posting Date: 11/12/2021
Clinical Lab Improvement Amendment
Clinical Lab Improvement Amendment CMS regulates all laboratory testing (except research) performed on humans in the U.S. through the CLIA. The objective of the CLIA program is to ensure quality laboratory testing. Although all [...]
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Posting Date: 11/11/2021
Comprehensive Error Rate Testing
Comprehensive Error Rate Testing The CERT program was established by CMS to monitor the accuracy of claim payment in the Medicare FFS Program. The intent of the CERT program is to protect the Medicare Trust Fund by identifying errors and [...]
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Posting Date: 11/12/2021
Electronic Health Records
Electronic Health Records Eligible professionals under the Medicare EHR Incentive Program include: Doctor of medicine or osteopathy Doctor of dental surgery or dental medicine Doctor of podiatry Doctor of optometry Chiropractor If [...]
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Posting Date: 11/12/2021
Electronic Prescribing
Electronic Prescribing In 2013, the eRx Incentive Program for participating and reporting in the Medicare Electronic Prescribing (eRx) Incentive Program ended. The six-month 2014, eRx payment adjustment reporting period began on 1/1/2013 and [...]
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Posting Date: 11/12/2021
Evaluation and Management Documentation Guidelines
Evaluation and Management Documentation Guidelines Health care professionals may use the most current documentation guidelines for the date of service performed. Refer to these resources for guidance: CMS Evaluation and Management AMA [...]
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Posting Date: 11/12/2021
Federal Register
Federal Register The OFR provides access to the official text of: Federal laws Presidential documents Administrative regulations and notices The ACFR oversees the functions of the Federal Register publications system. For more [...]
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Posting Date: 11/12/2021
Health Insurance Portability and Accountability Act of 1996
Health Insurance Portability and Accountability Act of 1996 The HIPAA was signed in to law to improve and simplify the administration of the Medicare Program under title XVIII of the Social Security Act, the Medicaid program under title XIX [...]
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Posting Date: 11/12/2021
Limitation of Liability (Advance Beneficiary Notice of Noncoverage)
Limitation of Liability (Advance Beneficiary Notice of Noncoverage) Services denied as not reasonable and medically necessary, under section 1862(a) (1) of the Social Security Act, are subject to the Limitation of Liability (ABN) provision. [...]
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Posting Date: 11/12/2021
Medically Unlikely Edits
Medically Unlikely Edits In January 2007, CMS developed MUEs to reduce the paid claims error rate for Part B claims. An MUE for a HCPCS /CPT code is the maximum units of service that a provider would report under most circumstances for a [...]
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Posting Date: 11/12/2021
Medicare Coverage Database
Medicare Coverage Database The Medicare Coverage Database is an administrative and educational tool to assist providers, physicians and suppliers in submitting correct claims for payment. The Medicare Coverage Database features LCDs developed [...]
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Posting Date: 11/12/2021
Medicare Electronic Data Interchange
Medicare Electronic Data Interchange Information about how providers can communicate electronically with the Medicare Program can be found on the CMS website at Medicare Electronic Billing & EDI Transactions. This web page contains EDI [...]
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Posting Date: 11/12/2021
Medicare Fraud and Abuse
Medicare Fraud and Abuse As the CMS MAC for J6 and JK, National Government Services fully supports the CMS initiative for program safeguards and shares the following information for your use: Fraud is the intentional deception or [...]
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Posting Date: 11/12/2021
Medicare Learning Network®
Medicare Learning Network® You will see the MLN logo on our website. The MLN is a registered trademark of the CMS and the brand name for official information health care professionals can trust. CMS’ Catalog of products is available on the [...]
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Posting Date: 11/12/2021
Medicare Provider-Supplier Enrollment with NGS
Medicare Provider-Supplier Enrollment with NGS A Medicare enrollment application would follow the NPI application. CMS is responsible for NPI application processes and NGS is responsible for processing enrollment applications for [...]
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Posting Date: 11/12/2021
NGS Internet Resources
NGS Internet Resources The NGSMedicare.com website was established by National Government Services in response to the increased usage of the internet as a learning resource for health care professionals. This website is designed to provide [...]
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Posting Date: 10/21/2024
NGSConnex: Overview, Access, Navigation and Eligibility Look Up
NGSConnex: Overview, Access, Navigation and Eligibility Look Up As we’ve communicated, beginning 11/18/2024, Beneficiary Eligibility information will not be offered on the IVR. This includes all beneficiary eligibility information that was [...]
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Posting Date: 02/26/2022
Medicare Advantage
Medicare Advantage Select Medicare Advantage from the left-side navigation. Information will display if the beneficiary is currently enrolled in a Part C Medicare Advantage plan, also commonly referred to as a Medicare HMO or Medicare [...]
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Posting Date: 04/06/2022
Medicare Secondary Payer
Medicare Secondary Payer Select Medicare Secondary Payer from the left-side navigation. The Medicare Secondary Payer section will display information about other insurance coverage the beneficiary may have, that is primary to Medicare. The [...]
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Posting Date: 02/26/2022
Qualified Medicare Beneficiary
Qualified Medicare Beneficiary Select Qualified Medicare Beneficiary from the left-side navigation. People with Medicare who are in the QMB program are also enrolled in Medicaid and get help with their Medicare premiums and cost-sharing. [...]
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Posting Date: 02/26/2022
Home Health Plan
Home Health Plan Select Home Health Plan from the left-side navigation. The Home Health Plan information section will display information if the beneficiary is currently in a home health episode of care. The Home Health Plan information will [...]
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Posting Date: 02/26/2022
Inpatient and SNF Spell History
Inpatient and SNF Spell History Select Inpatient and SNF Spell History from the left-side navigation. The Inpatient and SNF Spell History section will display information if the beneficiary is currently receiving inpatient or SNF care or has [...]
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Posting Date: 02/26/2022
End Stage Renal Disease
End Stage Renal Disease Select End Stage Renal Disease (ESRD) from the left-side navigation. The ESRD information panel provides information when a beneficiary is eligible for Medicare due to ESRD. This information is important because some [...]
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Posting Date: 02/26/2022
Preventive Services
Preventive Services Select Preventive Services from the left-side navigation. The Preventive Services section provides a list of Medicare-covered preventive services that are eligible for coverage for the beneficiary and when they are next [...]
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Posting Date: 09/27/2023
Audiology Screening
Audiology Screening Select Audiology Screening from the left-side navigation. The Audiology Screening section provides a list of Medicare-covered audiology screening services that are eligible for coverage for the beneficiary and when they [...]
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Posting Date: 02/26/2022
COVID-19 Vaccine
COVID-19 Vaccine Select Covid-19 Vaccine from the left-side navigation. The COVID-19 Vaccine Information panel provides information for the following HCPCS codes. 91300 – Pfizer-Biontech Covid-19 Vaccine 91301 – Moderna Covid-19 Vaccine [...]
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Posting Date: 02/26/2022
Pneumococcal Vaccine
Pneumococcal Vaccine Select Pneumococcal Vaccine from the left-side navigation. The Pneumococcal Vaccine panel provides information for the following HCPCS codes. 90670 ‒ Pneumococcal conjugate vaccine, 13-valent, for intramuscular use [...]
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Posting Date: 02/26/2022
Cardiac Rehabilitation
Cardiac Rehabilitation Select Cardiac Rehabilitation from the left-side navigation. Medicare Part B (Medical Insurance) provides coverage for a cardiac rehabilitation or physical therapy program if a Medicare beneficiary has had at least [...]
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Posting Date: 02/26/2022
Pulmonary Rehabilitation
Pulmonary Rehabilitation Select Pulmonary Rehabilitation from the left-side navigation. Medicare Part B (Medical Insurance) covers a comprehensive pulmonary rehabilitation program if a Medicare beneficiary has moderate to very severe COPD. [...]
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Posting Date: 02/26/2022
Acupuncture Benefits
Acupuncture Benefits Select Acupuncture Benefits from the left-side navigation. Medicare Part B (Medical Insurance) covers up to 12 acupuncture visits in 90 days for chronic low back pain. Medicare covers an additional eight sessions if [...]
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Posting Date: 02/26/2022
Diabetes Self Management Training (DSMT)
Diabetes Self Management Training (DSMT) Select Diabetes Self Management Training (DSMT) from the left-side navigation. Medicare Part B (Medical Insurance) covers outpatient DSMT if a patient has been diagnosed with diabetes. Medicare may [...]
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Posting Date: 02/26/2022
Medical Nutrition Therapy (MNT)
Medical Nutrition Therapy (MNT) Select Medical Nutrition Therapy (MNT) from the left-side navigation. Medicare Part B (Medical Insurance) may cover MNT services and certain related services if a patient has diabetes or kidney disease, or has [...]
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Posting Date: 02/26/2022
Accessing Eligibility for MDPP in NGSConnex
Accessing Eligibility for MDPP in NGSConnex Select Medicare Diabetes Prevention Program from the left-side navigation. The Medicare Diabetes Prevention Program expanded model is a structured intervention with the goal of preventing type 2 [...]
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Posting Date: 02/26/2022
Hospice Notice of Elections
Hospice Notice of Elections Select Notice of Elections Information from the left-side navigation. The Hospice Notice of Elections information section will display information if the beneficiary has currently elected to receive hospice care or [...]
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Posting Date: 02/26/2022
Hospice Benefit Periods
Hospice Benefit Periods Select Hospice Benefit Periods from the left-side navigation. The Hospice Benefit Periods information section will display information if the beneficiary has elected to receive hospice care or has elected to receive [...]
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Posting Date: 02/26/2022
Smoking Cessation Counseling
Smoking Cessation Counseling Select Smoking Cessation Counseling from the left-side navigation. Medicare Part B (Medical Insurance) covers up to eight visits of smoking and tobacco-use cessation counseling visits in a 12-month [...]
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Posting Date: 11/12/2021
NGSConnex Online Web Application Can Save Time and Money
NGSConnex Online Web Application Can Save Time and Money NGSConnex is a free, secure web-based system that allows providers and suppliers to conduct business via online instead of calling into an IVR or contact center. NGSConnex provides [...]
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Posting Date: 11/19/2021
NGS Check Provider Enrollment Application Status Tool
NGS Check Provider Enrollment Application Status Tool The Check Provider Enrollment Application Status Tool can be used to check on the status of your CMS-855 enrollment application. Reviewed 10/21/2024
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Posting Date: 11/15/2021
National Correct Coding Initiative
National Correct Coding Initiative In 1996, CMS developed the NCCI to promote national correct coding methodologies and to eliminate improper coding. NCCI edits are developed based on coding conventions defined in the American Medical [...]
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Posting Date: 11/15/2021
National Coverage Determination
National Coverage Determination NCDs are policies developed by CMS that indicates whether and under what circumstances certain services are covered under the Medicare Program. NCDs are the same for all contractors across the country. [...]
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Posting Date: 11/15/2021
National ICD-10-CM-PCS: The Next Generation of Coding
National ICD-10-CM-PCS: The Next Generation of Coding The ICD-10-CM-PCS classification system provides significant improvements through greater detailed information and the ability to expand to capture additional advancements in clinical [...]
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Posting Date: 11/15/2021
National Provider Calls and Events
National Provider Calls and Events MLN Connects® National Provider Calls (MLN Connects® Calls) are educational conference calls held by CMS for the Medicare provider and supplier community to educate and inform participants about new policies [...]
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Posting Date: 11/19/2021
National Provider Identifier
National Provider Identifier A National Provider Identifier is a unique 10-digit identification number issued to health care providers in the United States by the CMS. The NPI has replaced the UPIN as the required identifier for Medicare [...]
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Posting Date: 11/15/2021
National Provider Identifier Registry
National Provider Identifier Registry The NPI Registry is free and enables providers to search provider National Plan & Provider Enumeration System information. All information produced by the NPI Registry is provided in accordance with [...]
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Posting Date: 11/15/2021
National Uniform Claim Committee
National Uniform Claim Committee The NUCC is a voluntary organization that replaced the Uniform Claim Form Task Force in 1995. The committee was created to develop a standardized data set for use by the noninstitutional health care [...]
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Posting Date: 11/15/2021
Open Door Forums
Open Door Forums CMS conducts ODFs. The ODF addresses the concerns and issues of providers. Providers may participate via conference call and have the opportunity to express concerns and ask questions. For more information, including signing [...]
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Posting Date: 11/15/2021
P.O. Box Mailing Addresses
P.O. Box Mailing Addresses For the P.O. Box mailing addresses, please visit the Contact Us page on our website. Reviewed 10/21/2024
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Posting Date: 11/15/2021
Patient Protection and Affordable Care Act of 2010
Patient Protection and Affordable Care Act of 2010 For information related to the HIPAA Privacy and Security Rules, visit the Office for Civil Rights website. The Privacy and Security Rules are available for download, and you will find [...]
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