Billing and Coding Article Updates for January 2023

Billing and Coding Article Updates for January 2023 Billing and Coding: Bevacizumab and biosimilars (A52370) The reference for Bevacizumab-adcd (Vegzelma®) listed under the Ophthalmologic Guidelines section of the article has been removed. [...]

Contractor Advisory Committee Meeting 3/16/2023: Hyaluronans

Contractor Advisory Committee Meeting 3/16/2023: Hyaluronans National Government Services will host a CAC Meeting via teleconference on 3/16/2023, from 1:00–4:00 p.m. ET. Discussions will focus on the treatment of patients with Hyaluronans for [...]

Prior Authorization Outpatient Department Self-Service Inquiry Tools

Prior Authorization Outpatient Department Self-Service Inquiry Tools National Government Services continues to see PARs submitted for non-prior authorization HCPCS codes as well as requests submitted on behalf of providers on exemption.  [...]

View Outstanding Overpayments

View Outstanding Overpayments The View Outstanding Overpayments selection will provide a list of current outstanding overpayments for the provider account selected. In this section you have the opportunity to view/print an overpayment demand [...]

View Provider Earnings to Date

View Provider Earnings to Date Select the Financials button on the home page. In the Select a Provider panel, click the Select button next to the applicable provider account.  Select Provider Earnings to Date from the [...]

Overlap/Dispute Process

Steps for Success in a Targeted Probe and Educate Review

Steps for Success in a Targeted Probe and Educate Review We’ve provided tips and tricks to assist you with succeeding in a TPE review and the post-probe educational process. Content presented includes: Getting started with TPE Updating the [...]

End of Public Health Emergency Brings Change

End of Public Health Emergency Brings Change The end of the PHE is near and you may have questions. CMS and National Government Services want to ensure a seamless transition from the flexibilities enacted as a result of the COVID-19 [...]

Hospice Cap Self-Reporting Reminder for the 2022 Cap Year

Hospice Cap Self-Reporting Reminder for the 2022 Cap Year The hospice cap self-reporting for the 2022 cap year (10/1/2021-9/30/2022) is due no later than 2/28/2023. Hospice providers should submit the pro-forma calculation along with [...]

CMS Updates to Clinical Lab Fee Schedule for 2023 Reminder

CMS Updates to Clinical Lab Fee Schedule for 2023 Reminder National Government Services has received many calls in relation to the CMS updates to the Clinical Laboratory Fee Schedule for 2023. Providers have identified instances of not [...]

MLN Connects® Newsletter: Prescription Drug Inflation Rebate Program Guidance – Feb 9, 2023

MLN Connects® Newsletter: Prescription Drug Inflation Rebate Program Guidance – Feb 9, 2023     News Medicare Part B Drug Inflation Rebates HHS Releases Initial Guidance for Medicare Prescription Drug Inflation Rebate [...]

2023 Evaluation and Management Services – Prolonged Services

2023 Evaluation and Management Services – Prolonged Services Based on recent CMS clarifications for 2023 Evaluation and Management Services, particularly for prolonged services, National Government Services is now revising some previously [...]

Home Health Claims Incorrectly Receiving Reason Code U538E

HH final and adjusted claims with 2022 dates of service are receiving U538E incorrectly, when there is an older period on file. This prevents providers from being able to adjust these claims and update patient status from “06” to any other [...]

MLN Connects® Newsletter: February 16, 2023

MLN Connects® Newsletter: February 16, 2023     News Billing Medicare Part B for Insulin with New Limits on Patient Monthly Coinsurance Unprecedented Efforts to Increase Transparency of Nursing Home Ownership CMS Proposes [...]

New Service Added to the Hospital Outpatient Department Prior Authorization Program

New Service Added to the Hospital Outpatient Department Prior Authorization Program Effective for dates of service rendered on or after 7/1/2023, facet joint interventions are added to the HOPD services requiring prior authorization as a [...]

Bibliography for Hyaluronans CAC Meeting on 3/16/2023

Bibliography for Hyaluronans CAC Meeting on 3/16/2023 George E. Intra-articular hyaluronan treatment for osteoarthritis. Ann Rheum Dis. Nov 1998;57(11):637-40. doi:10.1136/ard.57.11.637. https://ard.bmj.com/content/57/11/637.  [...]

Important Steps When Responding to Additional Development Response Letters

Important Steps When Responding to Additional Development Response Letters When National Government Services requests documentation, you must send us only what has been requested. We are receiving numerous unnecessary documents from providers [...]

View 1099s

View 1099s The Internal Revenue Service 1099 form is a collection of tax forms documenting different types of payments made by an individual or a business that typically isn't your employer. The 1099 portal forms are a courtesy copy and are [...]

MLN Connects® Newsletter: Public Health Emergency 1135 Waivers: Updated Guidance for Providers - February 23, 2023

MLN Connects®Newsletter: Public Health Emergency 1135 Waivers: Updated Guidance for Providers -  February 23, 2023     News Public Health Emergency (PHE) 1135 Waivers: Updated Guidance for Providers Posted 2/23/2023

Chimeric Antigen Receptor (CAR) T-cell Therapy Billing Instructions

Chimeric Antigen Receptor (CAR) T-cell Therapy Billing Instructions Effective for dates of service on or after 8/7/2019, Medicare will pay claims from approved providers for administration of autologous T-cells expressing at least one CAR for [...]

LCD, Billing and Coding Article Updates for March 2023

LCD, Billing and Coding Article Updates for March 2023 Billing and Coding: Billing and Coding: Implantable Automatic Defibrillators (A56326) Based on Transmittal 11832 (CR13070) ICD-10-CM and Other Coding Revisions to NCDs - July 2023 Update, [...]

April 2023 Release "Dark Days" for the Common Working File Hosts

April 2023 Release "Dark Days" for the Common Working File Hosts For the upcoming April 2023 Release: For Production, CWF will be observing the Gray Day on Thursday, 3/30/2023 and Dark Days starting Friday, 3/31/2023 through Sunday, 4/2/2023 [...]

Credit Balance Report Reminder for Jurisdiction 6 Part A Providers

Credit Balance Report Reminder for Jurisdiction 6 Part A Providers For the quarter ending 12/31/2022, CBR must be submitted and received by the ORU by 3/1/2023 to be considered timely. Failure to submit the CBR will result in the provider [...]

MLN Connects® Newsletter: COVID-19 Public Health Emergency (PHE) New Overview Fact Sheet — Feb 27, 2023

MLN Connects® Newsletter: COVID-19 Public Health Emergency (PHE) New Overview Fact Sheet — Feb 27, 2023     News COVID-19 Public Health Emergency (PHE) New Overview Fact Sheet​​​​​​​ Posted 2/28/2023

MLN Connects® Newsletter: March 2, 2023

MLN Connects® Newsletter: March 2, 2023 News The Future of Medicare Enrollment: Save Time with PECOS's Consolidated Application Voluntary Prior Authorization Process for Certain Power Mobility Device Accessory Items Expanded Home [...]

LCD Archived Open Meeting Records

Open Meeting Records Jurisdiction 6 Open Meeting Records Meeting Date Audio Transcript 10/15/2020 ‒  J6/JK Open Meeting Recording Transcript 6/24/2020 ‒  J6/JK Open Meeting [...]

Audiology Services

Audiology Services CMS finalized an exception to the physician order requirement for certain diagnostic testing services to broaden patient access to services furnished by audiologists in the CY 2023 Physician Fee Schedule Final Rule. Visit [...]

Audiology

Resolving PECOS Common Errors and Warnings

Medicare Provider/Supplier Specialty Codes

Medicare Provider/Supplier Provider Type Codes

MLN Connects® Newsletter: March 9, 2023

MLN Connects® Newsletter: March 9, 2023 News Nutrition-Related Health Conditions: Recommend Medicare Preventive Services Compliance Advance Care Planning: Bill Correctly for Services Claims, Pricers and Codes Medicare [...]

2023 Evaluation and Management Services – New Frequently Asked Questions

2023 Evaluation and Management Services – New Frequently Asked Questions Based on recent CMS clarifications for 2023 evaluation and management services, we’ve added new frequently asked questions for the following evaluation and management [...]

Tip Sheet #3

Tip Sheet #3 Below are the most common issues handled by the SSA. These Medicare-related issues should be handled by your local SSA office: Change of address requests Medicare beneficiary eligibility status for Medicare Effective dates of [...]

Sacroiliac Joint Injections and Procedures

Sacroiliac Joint Injections and Procedures

Sacroiliac Joint Injections and Procedures Frequently Asked Questions

Sacroiliac Joint Injections and Procedures Frequently Asked Questions  We’ve added frequently asked questions related to New Local Coverage Determination for Sacroiliac Joint Injections and Procedures. We encourage our providers to view [...]

MLN Connects® Newsletter: March 15, 2023

MLN Connects® Newsletter: March 15, 2023     News Inflation Reduction Act Tamps Down on Prescription Drug Price Increases Above Inflation Posted 3/15/2023

Frequently Asked Questions

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 [...]