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Posting Date: 04/18/2024
MLN Connects® Newsletter: April 18, 2024
MLN Connects® Newsletter: April 18, 2024 News PrEP for HIV: Prepare for Potential Medicare Part B Coverage Events Clinical Laboratory Fee Schedule Upcoming Meetings: Register to Present, Speak, or Attend in Person by June 1 [...]
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Posting Date: 06/26/2023
Helpful Reminders on Advance Care Planning
Helpful Reminders on Advance Care Planning ACP billing codes: 99497: Advance care planning, including the first 30 minutes of face-to-face explanation and discussion (when performed) of advance directives such as standard forms. 99498: [...]
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Posting Date: 04/19/2024
Reminders for the New Hospice Certifying Physician Claim Edit Effective 5/1/2024
Reminders for the New Hospice Certifying Physician Claim Edit Effective 5/1/2024 Effective for hospice claim "From" dates on or after 5/1/2024, CMS implemented edits to enforce a new rule that would deny hospice claims if the certifying [...]
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Posting Date: 04/22/2024
Top Claim Errors Have Been Reviewed and Updated
Top Claim Errors Have Been Reviewed and Updated Our top claim errors are updated on a quarterly basis to reflect current information. Visit Top Claim Errors under Resources > Claims and Appeals to learn what you can do to avoid claim [...]
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Posting Date: 04/23/2024
Receive and Respond to Audit and Reimbursement Correspondence via NGSConnex
Table of Contents Receive and Respond to Audit and Reimbursement Correspondence via NGSConnex What are the benefits? [Return to Top] Receive and Respond to Audit and Reimbursement Correspondence via NGSConnex National Government [...]
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Posting Date: 04/24/2024
Home Office Cost Statements
A home office of a chain organization is a related organization to its participating providers. Home offices usually furnish central management and administrative services, e.g., centralized accounting, purchasing, personnel services, [...]
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Posting Date: 04/25/2024
MLN Connects® Newsletter: April 25, 2024 (UPDATE)
MLN Connects® Newsletter: April 25, 2024 (UPDATE) Editor's Note: CMS updated a message because we delayed the effective date that physicians who certify hospice services must enroll in or opt-out of Medicare until 6/3/2024. You may have to [...]
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Posting Date: 04/29/2024
LCD and Article Updates for April/May 2024
LCD and Article Updates for April/May 2024 Billing and Coding Articles Billing and Coding: Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin and Non-Hodgkin Lymphoma with B-cell or T-cell Origin (A59311) [...]
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Posting Date: 04/29/2024
Billing for Drug Wastage: JW and JZ Modifier
Billing for Drug Wastage: JW and JZ Modifier Properly billing for drug wastage and associated modifiers helps to prevent claims processing errors and denials while ensuring you receive correct reimbursement. Providers and suppliers are to [...]
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Posting Date: 04/29/2024
National Government Services Proposed LCDs for Comment (4/25/2024-6/8/2024)
National Government Services Proposed LCDs for Comment (4/25/2024-6/8/2024) The proposed LCDs listed below are being presented for comment for the Jurisdiction 6 and Jurisdiction K MACs. The formal comment period extends from 4/25/2024 through [...]
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Posting Date: 04/29/2024
What Are the Recovery Auditors' Responsibilities_Part A-B-FQHC-HHH
What Are the Recovery Auditors' Responsibilities? What Are the Recovery Auditors' Responsibilities? Recovery Auditors review claims on a postpayment basis using the same Medicare policies as MACs: NCDs LCDs and CMS manuals/regulations To ensure [...]
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Posting Date: 04/29/2024
How Will I Know When a Payment Determination Has Been Issued_Part A-B-FQHC-HHH
How Will I Know When a Payment Determination Has Been Issued? How Will I Know When a Payment Determination Has Been Issued? When a Recovery Auditor finds that improper payments have been made, they will submit claim adjustments to your MAC. The [...]
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Posting Date: 04/29/2024
ALOB_What Are My Options When I Receive the Recovery Auditor Demand Letter
What Are My Options When I Receive the Recovery Auditor Demand Letter? What Are My Options When I Receive the Recovery Auditor Demand Letter? If you agree with the Recovery Auditor’s determination you can: repay the overpayment amount by check; [...]
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Posting Date: 03/26/2024
Covered Medicare Part B Drugs/Biologicals
Covered Medicare Part B Drugs/Biologicals Each drug and biologic that can be considered for coverage under Medicare Part B has its own set of coverage guidelines. Below are examples of covered Medicare Part B drugs and biologicals, which may [...]
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Posting Date: 04/30/2024
Biomarker Testing for Prostate Cancer Diagnosis
Biomarker Testing for Prostate Cancer Diagnosis N/A L37733 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=37733 A56609 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=56609 A59220 [...]
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Posting Date: 12/10/2021
Maximum Payment Limits for Rural Health Centers
Maximum Payment Limits for Rural Health Centers Payment Limit Annual Adjustment Period Covered $190.00 TBD 1/1/2028–12/31/2028 $178.00 TBD 1/1/2027–12/31/2027 $165.00 TBD [...]
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Posting Date: 04/30/2024
2024 Medicare Cost Report Due Dates
2024 Medicare Cost Report Due Dates FYE 12/31/2023 cost reports are due by 5/31/2024. We strongly encourange early filing of the cost report. Early-filed cost reports that are rejected will receive a grace period to re-submit prior to [...]
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Posting Date: 04/30/2024
Water Vapor Thermal Therapy for LUTS/BPH
Water Vapor Thermal Therapy for LUTS/BPH N/A L37808 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=37808 A56590 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=56590 A59340 [...]
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Posting Date: 04/30/2024
ALOB_Supplemental Medical Review Contractor
Supplemental Medical Review Contractor Supplemental Medical Review Contractor Supplemental Medical Review Contractor Table of Contents Supplemental Medical Review Contractor Avoid Claim Denials: Ensure Your Address is Accurate and Up-to-Date [...]
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