DETERMINATION LETTER: Where are the determination (approval/denial) letters sent?

Lab National Coverage Determinations (NCDs) Alphabetical Index

PECOS: Manage Signatures and Additional Information Requests

During this webinar, we’ll give direction for the Provider Enrollment, Chain and Ownership System (PECOS) application on understanding how to manage signatures and respond to additional information request from submitted applications.

Medicare Part B Top Claim Denials

During this webinar, we’ll review the current top ten claim denials which are identified by internal claim data and provide guidance for correcting them, and solutions to prevent them from occurring on future claims. There will be time for your [...]

Pneumococcal Vaccine and Administration

Preventive Services Guide Pneumococcal Vaccine and Administration Pneumonia affects approximately 450 million people globally (seven percent of the population) and results in about four million deaths per year. Pneumonia was regarded by [...]

Vaccinations

Vaccinations Part B Medicare provides coverage for specific vaccination types: Seasonal Influenza Virus Pneumococcal Hepatitis B COVID-19 Vaccines and Administration [Return to Top] Seasonal Influenza Virus Annual Influenza Vaccine [...]

Assistants at Surgery at Teaching Hospitals

Assistants at Surgery at Teaching Hospitals CMS instructs providers to use specific modifiers on claims representing assistance during a surgical procedure: Modifier 80 denotes service by an assistant surgeon Modifier 82 denotes service by [...]

Bundled Services Missing Appropriate Modifiers at Time of Initial Claim Submission

Bundled Services Missing Appropriate Modifiers at Time of Initial Claim Submission Accurate coding and reporting of services are critical aspects of proper billing. Services denied based on the NCCI code pair edits or MUEs may not be billed to [...]

Clarification for Billing Services on Fingers and Toes Using Modifiers F1-F9, FA, T1-T9 and TA vs. Modifier 50

Clarification for Billing Services on Fingers and Toes Using Modifiers F1-F9, FA, T1-T9 and TA vs. Modifier 50 National Government Services has identified some providers who have been billing for services on the fingers and/or the toes with [...]

Modifier 25

Modifier 25 National Government Services has identified problems common with claims submitted for evaluation and management (E/M) services where modifier 25 was appended. This article is designed to provide education regarding the correct [...]

Modifier 33

Modifier 33 Table of Contents Preventive Services Anesthesia Services Moderate Sedation Related Content [Return to Top] Preventive Services When the primary purpose of the service is the delivery of an evidence-based service in [...]

COVID-19

COVID-19 The 2019 Novel Coronavirus (COVID-19) was declared a PHE on 3/13/2020 and it was officially expired on 5/11/2023. Please visit CMS' Current emergencies web page for complete details on the PHE. Email Updates To keep you informed [...]

COVID-19 Vaccine and Monoclonal Antibody

COVID-19 Vaccine and Monoclonal Antibody With the end of the PHE, as of 5/11/2023, this information no longer applies. We will keep the information available for PHE-related services that occurred prior to the expiration date that have not yet [...]

Medicare Part A and B Billing for the COVID-19 Vaccine and Monoclonal Antibody

Medicare Part A and B Billing for the COVID-19 Vaccine and Monoclonal Antibody Table of Contents Medicare Part A and B Billing for the COVID-19 Vaccine and Monoclonal Antibody Roster Billing How to Submit a Centralized Bill Medicare [...]

Medicare Coverage of Over-the-Counter COVID-19 Tests

Medicare Coverage of Over-the-Counter COVID-19 Tests The OTC COVID-19 test demonstration ended on 5/11/2023. Starting on 5/12/2023, Medicare no longer covers or pays for OTC COVID-19 tests for those with Medicare Part B benefits. Beginning [...]

Electronic Data Interchange

Medicare Part B 101 Manual Electronic Data Interchange Table of Contents Electronic Data Interchange Transactions Benefits of Submitting Electronically Becoming an Electronic Submitter PC-ACE EDI: Beyond Claims and Extra Features [...]

National Provider Identifier

Medicare Part B 101 Manual National Provider Identifier Table of Contents National Provider Identifier Background Application Process Sharing Your NPI NPI Contractor Mailing Address NPI Registry [Return to Top] National [...]

About Provider Outreach and Education

Medicare Part B 101 Manual About Provider Outreach and Education Table of Contents About Provider Outreach and Education Educational Activities Provider Outreach and Education Advisory Group [Return to Top] About Provider Outreach [...]

Appendix 3: Place of Service Codes

Medicare Part B 101 Manual Appendix 3: Place of Service Codes Table of Contents Place of Service Codes Health Insurance Portability and Accountability Act Special Considerations Homeless Shelter (Code 04) Indian Health Service [...]

Reminder – Beginning 11/18/2024, Beneficiary Eligibility Information Not Offered on the IVR

Reminder – Beginning 11/18/2024, Beneficiary Eligibility Information Not Offered on the IVR To help protect Medicare beneficiaries against fraud, CMS is instructing all MACs to remove beneficiary eligibility information from our IVR [...]

Inpatient Hospital Issued Notices

Inpatient Hospital Issued Notices Applies to: All hospitals Medicare beneficiaries and hospitals have certain rights and protections related to financial liability and appeals under the Medicare Program. These financial liability and appeal [...]

REVALIDATION: Do I need to revalidate if it has not been five years since my last revalidation?

REVALIDATION: How do I know I need to revalidate?

REVALIDATION: Where is the revalidation notification letter sent?

SIGNATURES: Who signs the CMS applications and forms for an entity? (ex. 855A, 855B, 20134, 460, 588)

SIGNATURES: Who signs the CMS applications and forms for an entity? (ex. 855A, 855B, 20134, 460, 588)

Split/Shared and Incident To Services

Split/Shared and Incident To Services Please define the substantive portion of a split (or shared) visit in 2024? Answer: The following factors apply in 2024 in determining the substantive portion of a split (or shared) visit:   [...]

PECOS: In PECOS, please advise how to respond when the MAC needs additional information or supporting documentation for a submitted application.

Complex and Chronic Care - HCPCS Code G2211

Complex and Chronic Care - HCPCS Code G2211 Please define appropriate usage and billing for HCPCS code G2211. Answer: CMS has approved G2211 for 2024 as an add-on code for complex and/or continuous office and outpatient E/M services [...]

Documentation

Documentation What are the basic documentation requirements for a service submitted to Medicare for payment? Answer: For all services submitted to Medicare, the medical record (whether electronic or paper) must clearly define the provider [...]

APPLICATION FEE: What is the amount of the application fee?

DETERMINATION LETTER: How can I get a copy of the determination (approval/denial) letter for a submitted application?

PECOS: I received an email to sign an application; how do I do this?

PECOS: In PECOS, how do I know if the authorized/delegated official or individual provider signed the application?

PECOS: In PECOS, how do I submit an application?

PECOS: In PECOS, how do you find an enrollment to submit an application?

PC-ACE: Is there a resource I can use to assist me with Medicare Secondary Payer (MSP) claims when using PC-ACE?