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 [...]

Home Health Diagnosis Codes Grouper Update for 4/1/2023

Home Health Diagnosis Codes Grouper Update for 4/1/2023 Effective 4/1/2023, CMS is implementing new HH Grouper edits. The HH Grouper program has various data validity edits that make sure it uses consistent and accurate data when calculating [...]

Clarification on the Proper Use of the CS Modifier

Clarification on the Proper Use of the CS Modifier Per MLN Matters® article SE20011, the CS modifier (cost-sharing waiver for COVID-19 testing) is applicable to certain services furnished beginning on 3/18/2020 through the end of the PHE, [...]

New Fiscal Intermediary Shared System Consistency Edit to Validate Attending Physician National Provider Identifier

New Fiscal Intermediary Shared System Consistency Edit to Validate Attending Physician National Provider Identifier Effective 4/1/2023, CMS implemented a new consistency edit to validate that the attending physician NPI. An Attending Provider [...]