Integrating Behavioral Health Care with Primary Care

Integrating Behavioral Health Care with Primary CareWhat is BHI? Medicare Behavioral Health Integration is a service for your patient that does not require the use of a behavioral health care team.Primary care physicians who are treating [...]

Psychiatric Collaborative Care Education for the Provider and Beneficiary

Psychiatric Collaborative Care Education for the Provider and BeneficiaryDid you know that the psychiatric CoCM integrates primary and behavioral health care and is considered an effective strategy in improving outcomes for beneficiaries [...]

End-Stage Renal Disease Laboratory Tests Job Aid

End-Stage Renal Disease Laboratory Tests Job AidDialysis Type: Hemodialysis, CCPD, IPD, HemofiltrationNon-AMCC Laboratory TestsFrequency/CPT CodesTest Name/AbbreviationPer treatment:85013 or 8501485018VariousHematocrit (Hct)Hemoglobin [...]

What Physicians Need to Know: Home Health Patient-Driven Groupings Model

What Physicians Need to Know: Home Health Patient-Driven Groupings ModelIn November 2018, CMS finalized a new case-mix classification model, the PDGM, effective beginning 1/1/2020. The PDGM relies more heavily on clinical characteristics and [...]

Medicare & You

Medicare & YouDownload the official Medicare & You handbook with important information about what’s covered by Medicare, preventive services, health plans, prescription drug plans, and your rights and appeals.

National Correct Coding Initiatives Edits - Physicians

Correcting and Avoiding Reason Code C7080: Inpatient Overlap

Correcting and Avoiding Reason Code C7080: Inpatient OverlapThis edit is applied to a home health episode claim that overlaps an inpatient claim in the system. A home health agency may bill for a visit on the day of inpatient admission and/or [...]

Home Health Prospective Payment System Booklet

Counting 90-Day Election Periods

Counting 60-Day Election Periods

Counting 60-Day Election Periods - Leap Year

Billing Hospice Physician, Nurse Practitioner and Physician Assistant Services (Related To Terminal Diagnosis)

Hospice Notice of Change of Ownership

Hospice Claim Submission Job Aid

Notification Letters

Notification Letters Prior to the start of the TPE, providers are being placed on medical review will receive a notification letter. The notification will have the edit name, the reason for review, instructions for sending in the ADR and [...]

LVAM Request Form

Counting 90-Day Election Periods - Leap Year

Who May File an Appeal?

Who May File an Appeal?Any of the following persons or entities is considered a party to an appeal of a claim for items or services payable under Medicare and, therefore, may appeal the initial claim determination and any subsequent appeal [...]

What Documents are Needed

What Documents are NeededYou are required to submit all necessary medical documentation to support the services billed on your claim as part of your participation agreement; you must submit a complete medical record when requesting an appeal. [...]