Guidelines for Submitting Prior Authorization Certain Hospital Outpatient Department

General PAR Documentation Requesters must include the following data elements in all PARs to avoid potential delays in processing. Your MAC may request additional, optional elements for submission of the PAR. Initial Submission Documentation: [...]

Dispute Request for Assistance (RFA) Form

CMS Links

  Administrative Simplification Overview Ambulatory Surgical Centers (ASC) Center  Clinical Laboratory Improvement Amendments (CLIA)  Beneficiary Notices Initiative (BNI)  CMS.gov Email Updates CMS.gov Open [...]

Proper Medicare Part B Claim Submissions Due to the Change Healthcare Security Incident

Proper Medicare Part B Claim Submissions Due to the Change Healthcare Security Incident With many providers submitting paper claims due to the Change Healthcare security incident, it is important to submit your claims correctly. Failure to do [...]

MLN Connects® Newsletter: April 11, 2024

MLN Connects® Newsletter: April 11, 2024 Proposed Payment Rules CMS Proposes New Policies to Support Underserved Communities, Ease Drug Shortages, and Promote Patient Safety News CMS Roundup (Apr. 5, 2024) Medicare Shared Savings [...]

NGSConnex Medicare Part B Remittances

NGSConnex Medicare Part B Remittances We’ve added an enhancement that offers providers the option to view/print remittance advices in NGSConnex for up to 24 months from the date of search. You are required to complete the EDI enrollment to [...]

Social Security Income Ratios

Social Security Income Ratios The federal fiscal year 2022 SSI ratios for IPPS hospitals, IRFs and LTCHs were posted on the CMS website. IPPS IRF LTCH We will update the latest published 2022 SSI ratios in the Provider Specific File of [...]

Reimbursing Place of Service 10 at the Nonfacility Rate for Medicare Telehealth Services

In CY 2024, CMS issued a change to processing for telehealth services billed with POS 10. As of 1/1/2024, these claims are to be paid at the nonfacility PFS rate. A system processing issue resulted in incorrect payments at the facility rate and [...]