APPEALS: How would one submit a paper appeal?

APPEALS: Is documentation required for an appeal?

APPEALS: Can one appeal a claim that rejected with MA130?

APPEALS: How can I get status of my redetermination or reopening request?

APPEALS: Another denial we see is “This service has been provided at a frequency that is more than the medically appropriate indication by policy or regulation.” How can we avoid these denials?

APPEALS: We are a large group with many physician and nonphysician practitioners. When we submit claims for nonphysician practitioners working in different sub-specialties, we receive denials that state: D984: Coverage/program guidelines not met, N20: Service not payable with other service rendered on the same day.

CAR-T: Is the KX modifier required for Part A and Part B claims?

CAR-T: Will the Part A claim for CAR-T deny if it is submitted with the KX modifier?

CAR-T: What is the effective date for the requirement of the KX modifier for administration of CAR-T?

CAR-T: Is Risk Evaluation and Mitigation Strategy (REMS) verified by the facility’s site name or address?

Jurisdiction 6 Part B Top Claim Errors are Updated

Jurisdiction 6 Part B Top Claim Errors are Updated Using data analysis we update the Top Claim Errors on a quarterly basis and provide: the error reason code; a description of the error; the error type; details that include steps you can [...]

Jurisdiction K Part B Top Claim Errors are Updated

Jurisdiction K Part B Top Claim Errors are Updated Using data analysis we update the Top Claim Errors on a quarterly basis and provide: the error reason code; a description of the error; the error type; details that include steps you can [...]

Submitting Revalidation via PECOS

During this webinar, we’ll provide an understanding of how to utilize the CMS Internet-based Provider Enrollment Chain & Ownership System (PECOS) to be comfortable in navigating the system to submit a provider enrollment electronic application.

Repetitive Scheduled Non-Emergent Ambulance Transports Prior Authorization

Attention All Independent Ambulance Suppliers! If you are providing repetitive, scheduled, non-emergent ambulance transports (RSNAT), you'll want to attend this webinar. Join us to learn everything you need to know about the RSNAT program.

MLN Connects® Newsletter: October 10, 2024

MLN Connects® Newsletter: October 10, 2024 News Resources & Flexibilities to Assist with the Public Health Emergency in Florida CMS Roundup (October 4, 2024) Clinical Laboratory Fee Schedule: Reporting Delayed Until 2026 Respiratory [...]

PECOS: In PECOS, how do I know what enrollment information Medicare currently has on file for a provider or supplier?

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

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

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)

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

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

SIGNATURES: Who signs the CMS-855I application?

APPROVAL RECOMMENDATION STATUS: The status of my application is approval recommendation, how can I verify if the state agency or CMS has completed their process?

APPROVAL RECOMMENDATION STATUS: Whom can I contact for questions about an application in approval recommendation status?

Local Coverage Determination Retirement

Local Coverage Determination Retirement An LCD is a policy decision made by a MAC concerning whether to allow coverage of a particular item or service. The Centers for Medicare & Medicaid Services, Internet-Only Manual Publication 100-08, [...]

Utilizing Modifiers for Medicare Part B Dental Services

The purpose of this webinar is to discuss the modifiers that are currently allowed to be appended to inextricably linked dental services. We’ll also review the correct placement and billing guidelines for these modifiers when submitting [...]

Lab National Coverage Determinations (NCDs) Alphabetical Index

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?

APPLICATION FEE: Who needs to pay an application fee?

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

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

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

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

10/14/2024

table, td, th table { border-collapse: collapse; width: 50%; } Self-Service Pulse: What You Need To Know This Week As your MAC, National Government Services wants to provide you with a comprehensive source containing the most [...]

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

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

Tobacco Cessation Telehealth Guide

Tobacco Cessation Telehealth Guide Tobacco use is the leading cause of preventable disease, disability, and death in the United States. Each year, nearly half a million Americans die prematurely of smoking or exposure to secondhand smoke. [...]

Overcoming Barriers to Tobacco Counseling 

Overcoming Barriers to Tobacco Counseling Healthcare providers do face several challenges when implementing tobacco cessation counseling into a clinical practice routine. These various factors influence the healthcare professionals’ [...]

Tobacco Counseling Documentation

Tobacco Counseling Documentation Many healthcare providers perform tobacco use counseling, but they may not be documenting or reporting it appropriately. Providers must ensure all performed services are claimed and supported by complete [...]

Clinical Guidelines and Recommendations

Clinical Guidelines and Recommendations Treating Tobacco Use and Dependence All health care providers, especially those with direct patient contact, have a unique opportunity to help tobacco users quit. Smokers cite a doctor's advice to quit [...]

Rural Health Clinic

Rural Health Clinic Table of Contents Counseling to Prevent Tobacco Use Diagnosis Coding Billing RHC for Smoking and Tobacco Cessation Services Billing Multiple Visits on the Same Day Related Content [Return to Top] [...]

Tobacco and Health Effects

Tobacco and Health Effects Tobacco use is the leading cause of preventable disease, disability and death in the United States. Tobacco dependence is a chronic, relapsing disorder that, like other chronic diseases, often requires repeated [...]

Benefits of Quitting

Benefits of Quitting Table of Contents Benefits of Quitting Health Benefits of Quitting Smoking Economical Benefits of Quitting Smoking Related Content [Return to Top] Benefits of Quitting Quitting tobacco use in any form is one of [...]

Lung Cancer Screening Counseling and Annual Screening for Lung Cancer with Low-Dose Computed Tomography

Preventive Services Guide Lung Cancer Screening Counseling and Annual Screening for Lung Cancer with Low-Dose Computed Tomography Table of Contents Lung Cancer Screening Counseling and Annual Screening for Lung Cancer with Low-Dose [...]

Resources

Resources You Can Help Your Patients Quit Tobacco Use Smoking Cessation Tools and Resources Smokefree.gov BeTobaccoFree.gov Centers for Disease Control and Prevention: Tips from Former Smokers campaign Centers for Disease Control and [...]

PR-204

Avoiding/Correcting This Error Medicare Fee-for-Service does not cover the service that has been billed for the condition. The CPT/HCPCS on the claim is not a covered Medicare service/equipment or drug. There are multiple reasons for denial [...]

Take Advantage of Tobacco Counseling When Performing Medicare Wellness Visits 

Take Advantage of Tobacco Counseling When Performing Medicare Wellness Visits Medicare providers can optimize revenue and improve patient outcomes with Medicare's Annual Wellness Visits. These visits help identify gaps in healthcare, increase [...]

Navigating Medicare: Part B Insights for Providers Podcast

NGSConnex: Inquiries and Remittance Advice

Did you know you can initiate general claim inquiries through the NGSConnex portal? Do you have trouble understanding the remittance advice? If you answered yes, this session is for you! During this webinar, we’ll provide instruction on how to [...]

Coverage Criteria and Frequency Limits

Coverage Criteria and Frequency Limits Table of Contents Counseling to Prevent Tobacco Use Diagnosis Coding Cost Sharing Reimbursement Nonparticipating Providers Related Content [Return to Top] Counseling to Prevent Tobacco Use [...]

Federally Qualified Health Center

Federally Qualified Health Center Table of Contents Counseling to Prevent Tobacco Use Diagnosis Coding Billing FQHC for Smoking and Tobacco Cessation Services Related Content [Return to Top] Counseling to Prevent Tobacco [...]

CO-119

Avoiding/Correcting This Error The beneficiary has reached their therapy cap limit for the year. The Bipartisan Budget Act of 2018 repealed application of the Medicare outpatient therapy caps but retains the former cap amounts as a threshold [...]

Why is radiofrequency ablation (RFA) noncovered?

Can SIJIs be performed under sedation? How about monitored anesthesia care (MAC)? Is “twilight” allowed?

Emergency Department

Emergency Department When a consultant has seen a patient in the ED and billed an ED code, how are subsequent services billed when the patient is then admitted to inpatient status? Answer: The ED consult (billed with an ED code [...]

Will there be a minimal amount of time between SI joint steroid injections?

Will prior authorization be required?

Will RFA be an acceptable treatment?