Magnacare-Insufficient Funding from Local 342 Affects Claim Payments

Due to insufficient funding from Local 342,

Magnacare has faced difficulty in paying provider claims...

A5512 or A5513 Incorrectly Denied by NoridianJurisdiction

A & D DMERC

Noridian is incorrectly denying A5513 or A5512

with the denial for incorrect modifier (4). This is

a system error....

NGSCONNEX Redetermination Request Tips

Do you utilize NGSConnex to submit redetermination requests? If so, below are a few tips to follow to help ensure your request is submitted correctly..

Liability Clarification for Routine Foot Care

For a routine foot care claim, when the date last seen is more than six months prior to the date of service, the claim will deny the patient responsibility because it does not meet Medicare criteria...

MIPS Reporting Deadlines

Deadlines are fast approaching if you plan to submit data for the 2017 Merit-based Incentive Payment System (MIPS)...

FX and FY Modifiers

CMS initially required the use of the FX modifier to indicate the use of plain film X-ray in 2017. Effective January 1, 2018, the Centers for Medicare and Medicaid Services (CMS) require a new FY modifier for the technical...

Provider Compliance-Reporting Changes In Ownership

Providers must update their enrollment information to reflect changes in ownership within 30 days...

Yea or Nay? See Which QPP 2018 Proposals Came Through in the Final Rule

Back in July, there was the proposed 2018 Quality Payment Program (QPP) rule, a program established under MACRA. Now that the final rule (with comment period) is out, let’s see how some of those proposals fared..

CMS Responds to Concerns Regarding Custom Fabricated Diabetic Inserts

The Centers for Medicare and Medicaid Services (CMS) has proposed a change to the DMEPOS Quality Standards that addresses the concern regarding the recent DME MAC/PDAC interpretation of the term “molded to patient model” ...

Multiple Procedure Payment Reduction Adjustments-Resolved

Applies To: Providers submitting procedure codes subject to multiple procedure payment rules.

Background: Two services with the same fee schedule amount, with an MPFSDB amount lower than the billed amount, are processed on the same day (same or different claims). The Medicare Multi-Carrier...

Emblem Health-Medicaid Eligibility Look Up Discrepancy

Some Medicaid members may appear on the Eligibility Look Up to have been terminated even though their coverage is still active...

6 Major Takeaways From the 2018 MACRA Proposed Rule

1. Only 36% of clinicians will be eligible for MIPS after all exclusions, but they make up 58% of Medicare Part B charges

MACRA/QPP is a massive piece of legislation...

Policy Article Revisions Summary for April 05, 2018

Outlined below are the principal changes to the DME MAC Policy Article (PA) that have been revised and posted.

New ‘K’ Code for Therapeutic Shoe Inserts

CMS recently revised Appendix C of the DMEPOS Quality Standards to include a new type of therapeutic shoe insert for individuals with diabetes ...

Important Notice Regarding

Handwriting on Claims Submitted to Medicare

NGS has been rolling out the return of paper claims with unacceptable

handwriting on a state/locality basis and by June 2018, all handwritten claims...

Provider Enrollment Application Process Timeline

All MACs have a goal to finalize an Internetbased PECOS application within 45 days and a CMS-855 paper application within 60 days, if all required information is available...

Voluntary Refunds Sent to Noridian

A voluntary refund is a situation that causes a supplier to owe money to Medicare on previously paid claims. Medicare may have not notified the supplier...

New CMS-588 Electronic Funds Transfer Authorization Agreement (1/17) Version

Effective 1/1/2018 the MACs may only accept the CMS-588 EFT (1/17) version; all outdated forms will be returned...

Improve Your Knowledge of the MIPS Improvement Activities Category

Background: MIPS focuses on the categories of quality, cost, practicebased improvement activities (IA), and advancing care information (ACI), the last of which focuses on use of certified electronic health record...

Bankers Medicare Supplemental Insurance Now Offering Electronic Payment & Electronic Explanation of Benefits

Bankers has now partnered with JP Morgan to utilize the Healthcare LinkSM. The Healthcare LinkSM is JP Morgan Chase's easy-to-use, convenient web-based solution that enhances providers' ability to...

2018 Medicare Parts A & B Premiums and Deductibles Announced

The Centers for Medicare & Medicaid Services (CMS) announced the 2018 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs...

MIPS Virtual Group Election Period Ends December 1st

The election period is open to form a virtual group for the 2018 Merit-based Incentive Payment System (MIPS) performance period. As proposed in the 2018 Quality Payment Program proposed rule, solo practitioners and...

How to Choose Between Modifiers 25 and 57

When reporting an evaluation and management (E&M) service on the same claim with another service or procedure, you must append either modifier 25 "Significant, separately identifiable evaluation and management service...

CMS-1500 Claim Form Must Be the 02/12 Version

Effective August 30, 2017 any CMS-1500 paper claim form submitted for Part B claims that is on a version other than the current 02/12 version will be returned to the provider. Per CMS...