Patient Driven Payment Model

Patient Driven Payment Model Table of Contents Assessment Schedule Administrative Presumption Lookback Period (Observation Period) Examples General PDPM Resources [Return to Top] Assessment Schedule Learn more about the [...]

NGS Medical Review Process

NGS Medical Review Process Medicare contractors, like NGS, operate the medical review program to prevent improper payments and protect the Medicare Trust Fund. Medical reviews involve the collection and clinical review of medical records and [...]

LCD and Article Updates for June/July 2024

LCD and Article Updates for June/July 2024 Articles Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms A56867  Due to the quarterly CPT/HCPCS code update, PLA code 0204U was deleted from CPT/HCPCS Codes [...]

MLN Connects® Newsletter: June 27, 2024

MLN Connects Newsletter: June 27, 2024 News CY 2025 Home Health Prospective Payment System Proposed Rule PrEP Using Antiretroviral Therapy to Prevent HIV Infection: Technical FAQs for Pharmacies Claims, Pricers, & Codes Medicare [...]

July 2024

In This Issue National Government Services Articles for Part A and Part B Providers National Government Services Proposed LCDs for Comment - July 18, 2024 Improving Customer Experience New Version of PC-ACE: July 2024 Common Working File [...]

Medical Documentation Requirements

Medical Documentation Requirements When filing a claim to Medicare for payment, please include all applicable diagnosis codes to the highest level of specificity to establish the medical necessity of the services provided. National Government [...]

Daily Treatment Notes Requirement for Inpatient SNF Services

Therapy Treatment Note Requirement for Inpatient SNF Services The Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-2, Medicare Benefit Policy Manual, Chapter 15 is the primary source for therapy [...]

National Government Services Proposed LCDs for Comment - July 18, 2024

National Government Services Proposed LCDs for Comment - July 18, 2024 The proposed LCDs listed below are being presented for comment for the Jurisdiction 6 and Jurisdiction K MACs. The formal comment period extends from 6/27/2024 through [...]

Additional Development Request Letters Guide

Outpatient Institutional Providers Reimbursed Under MPFS: When to Split Claims for Updated Rates

Outpatient Institutional Providers Reimbursed Under MPFS: When to Split Claims for Updated Rates If you have monthly outpatient and/or inpatient ancillary claims with DOS 3/1/2024 – 3/31/2024, you may take the following steps to ensure correct [...]