Reminder for Using Modifier GZ

Modifier GZ must be used when physicians, practitioners, or suppliers want to indicate that they expect that Medicare will deny an item or service as not reasonable and necessary, and they do not have an...

Request Permanent Immediate Recoupment/Offset for Medicare Overpayments and Streamline Your Processing

Providers can elect to request Permanent Immediate Recoupment/Offset of their demanded overpayments to avoid making payment by check or avoid the assessment of interest if the immediate recoupment pays the debt in full before day 31...

Transition and Flexibility-QPP 2018 Proposed Rule

CMS released the proposed 2018 Quality Payment Program (QPP) rule on June 20. To sum up the 1,000+ pages, 2018 will be something of a transition year like 2017 was for QPP, which was established under MACRA...

Revised Local Determination (LCD): Routine Foot Care and Debridement of Nails (L33636)

On 6/26/2017, a revision was published for LCD L33636 in the Medicare Coverage Database (MCD). To allow sufficient notice of the change to providers, the revised LCD can be found in the MCD on the Centers for Medicare & Medicaid Services (CMS) website...

New Medicare Cards with New Numbers: 3 Changes You May Need to Make

The Medicare Access and CHIP Reauthorization Act of 2015 requires CMS to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. CMS will begin mailing new Medicare cards with...

Redetermination Requests Which Contain Multiple ICNs

When submitting a Redetermination request that contains multiple Internal Control Numbers (ICNs), include and follow the below to ensure proper review and prompt response...

Important Notice Regarding Handwriting on Claims Submitted to Medicare

Effective 7/1/2017, NGS will return any paper claims submitted with handwriting on the face of the claim that is not a signature field...

New Process for Providers and Suppliers Submitting Redeterminations and Reopenings via NMP

Noridian has added a feature to the Noridian Medicare Portal (NMP). Providers and suppliers who submit their Redetermination and/or Reopening requests through NMP will now receive Level 1 Medicare...

Advance Beneficiary Notice of Non CoverageNew Version Effective June 21, 2017

Effective June 21, 2017, providers must use the most recent version of the Advance Beneficiary Notice of Noncoverage (ABN) Form CMS-R-131 with the March.....

Tips Regarding Therapeutic Shoes

Supplier Billing for Custom Made Items Ordered but not Furnished:

Suppliers will bill the claim for the shoes/inserts with the supplier's expense at the time the order was cancelled or beneficiary expired for the custom made items...........

Tips Regarding Therapeutic Shoes

How criterion 2 of the Local Coverage Determination (LCD) is met:

In order to meet criterion 2, the certifying physician must either:

Personally document one or more of criteria 2a–2f..............

QMB Indicator in the Medicare Fee-For-Service Claims Processing System-Revised

Change Request (CR) 9911 modifies the Medicare claims processing systems to help providers identify the Qualified Medicare Beneficiary (QMB) status of each patient and to support providers' ability to follow QMB billing requirements. Beneficiaries enrolled in the QMB program are not liable to pay Medicare cost-sharing for all Medicare A/B claims...........

MIPS Participation Status Letter

CMS is reviewing claims and letting practices know which clinicians need to take part in the Merit-based Incentive Payment System (MIPS), an important part of the new Quality Payment Program (QPP). In late April through May, you will get a letter from your Medicare Administrative Contractor that processes......

Mandatory Payment Reduction of 2% Continues for the Medicare FFS Program-Sequestration

For the Fee-for-Service (FFS) program, claims with dates of service or dates of discharge on or after April 1, 2013 will continue to incur a 2 percent reduction in the Medicare payment until further notice....

Final LCD Policy: Injections-Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton’s Neuroma

Medicare Coverage Database (MCD) Number/Contractor Determination Number: L34218

LCD Title: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma

Effective Date: May 22, 2017.........

Medicare Reporting & Returning of Self-Identified Overpayments-60 Days & 6 Years

Under this rule, providers and suppliers who receive Medicare funds have to report and return overpayments by the later of these two:

Tricare Changes Coming in October

There are changes coming to Tricare! Tricare is currently divided into 3 regions – North, South & West. The North is handled by Health Net Federal Service (HNFS), South is handled by Humana Military and West by United Healthcare.....

Appealing Medicare Demand Letters

When Medicare has determined that an overpayment has occurred, a Demand Letter is issued. Providers are given 30 days from the date of the Demand Letter to pay the requested overpayment amount. Timely payment is needed to avoid interest from accruing.......

Multi-Factor Authentication Required on Noridian Medicare Portal

Beginning April 1, 2017 the Noridian Medicare Portal (NMP) will require a multi-factor authentication (MFA) process for users each time you need to log into NMP. MFA adds a second layer of security to your NMP account. The MFA process issues a one-time passcode that will be delivered to you........

Claims Denied for Duplicate or Bundling

The Noridian Medicare Portal (NMP) offers Part B providers accessibility to obtain more information about a finalized claim that was denied or received a reduced payment due to related services. Types of claim situations providers can research include National Correct Coding Initiative edits, pre- or post-operative......

Potential 2018 MACRA Coding Requirement for Patient Relationship Category

There could be new HCPCS modifiers approaching as part of MACRA to identify patient relationship categories...

1099s Returned with Insufficient Address

Offer Medicaid Prior Authorization of DMEPOS for Dual Eligible Beneficiaries

CMS encourages states to offer a process for suppliers to request prior authorization of more costly DMEPOS for dual eligible beneficiaries. Many states have already instituted Medicaid prior authorization processes, but.....

What You Should Know About a Significant Change to Type 2 Diabetes ICD-10 Coding

There have been some changes to the ICD-10-CM Official Guidelines for Coding and Reporting that impact podiatrists. These changes are for the 2017 fiscal year and went into effect October 1, 2016. In addition to the specific......

Ensure DMEPOS Claims for Dual Eligible Beneficiaries are Assessed Against Medicaid's Broader Criteria

Ensure DMEPOS Claims for Dual Eligible Beneficiaries are assessed against Medicaid’s Broader Criteria. On February 2, 2016, CMS issued updated regulations stating that Medicaid must cover appropriate medical supplies, equipment and......

Revised Announcement Regarding DEA Renewal Applications

Starting January 2017, DEA will no longer send its second renewal notification by mail. Instead, an electronic reminder to renew will be sent to the email address associated with the DEA registration......

Judge Blocks Aetna's $37 Billion Deal for Humana

A federal judge has made a ruling on Monday January 23, 2017 that a $37 billion merger between will not be completed due to antitrust reasons in accordance with the U.S. Department of Justice. This ruling has taken place six.......

ICD-10 Humor for the Holidays

Nothing like some ICD-10 humor to keep us in festive spirits...

HCPCS Modifier That Will Affect Reimbursement for 2017

The Centers for Medicare & Medicaid Services (CMS) has established a new HCPCS modifier that will affect reimbursement rates for the year 2017...

The Quick CMS Approved Way to Avoid a MACRA Penalty

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) involves a shift to value based payment models...

Medicare Number (HICN) Format Changes

Since the start of the Medicare program, beneficiaries have used their social security number in order to claim benefits with a suffix that designated how they are receiving their benefits (retired, disabled, railroad worker, etc.)...

Pre-Payment of Prologned Service E&M Codes

The New York State Medicare Part B contractor, NGS Medicare, has been performing a complex medical review of add-on services related to evaluation and management codes...

Documentation Checklist - Knee Ankle Foot Orthoses

Simple checklist that puts the language of LCD in simpler terms to ensure that suppliers are meeting medical necessity requirements.

Documentation Checklist - Theraputic Shoes

Simple checklist that puts the language of LCD in simpler terms to ensure that suppliers are meeting medical necessity requirements.

Billing for Custom DMERC Products Not Picked Up By Patient

If a custom-made item was ordered but not furnished to a beneficiary due to individual passing away, order cancellation by the beneficiary, beneficiary's condition and the item is no longer being reasonable, necessary or appropriate...

Medicare Revalidations

As of this year, all Medicare part B providers and DME suppliers were subject to a revalidation of their credentials in order to maintain their billing privileges with the program as part of the Accountable Care Act...

Noridian Healthcare Solutions: HCPCS Codes Pre-Payment Audits

Noridian Healthcare Solutions is implementing a service-specific pre-payment targeted audit of claims for selected HCPCS codes...

2017 MACRA Final Rule Hits!

The Department of Health & Human Services (HHS) released its final rule on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This act, which will go into effect January 01, 2017...

Correct Usage of CCI Edits to Prevent Improper Bundling and Denials

CCI includes two different sets of edits: Column 1 / Column 2 edits identify code pairs that should not be billed together because one service inherently includes the other... causing..

Life Care Centers of America Agrees to $145 Million Settlement!

The Department of Justice announced that Life Care Centers of America Inc. (Life Care) and its owner, Forrest L. Preston, have agreed to pay $145 million to resolve a government lawsuit that alleged that Life Care violated the False Claims Act, by intentionally causing..

Don't Forget Medicaid Revalidation!

With the provisions in the Affordable Care Act, Medicaid participating providers are now required to revalidate every 5 years in order to retain their billing...

How 'Cigna vs. Humble' Ruling Impacts the OON Providers

Recently, a major law decision in Texas will impact OON reimbursement with smaller physician owned medical groups and hospitals. On June 1st, in the case of ’Cigna vs. Humble’, a judge ordered...

Anti Trust Lawsuits Filed

The Department of Justice has filed antitrust lawsuits in response to Anthem’s $54 billion proposal to acquire Cigna and Aetna's $37 billion takeover of...

Merit-Based Incentive Payment System

Enacted in April 2015, MACRA (Medicare Access & CHIP Reauthorization Act) is a law that will begin to make some significant changes in Medicare part B reimbursement in the coming years. Moving away from a traditional FFS system and...

JW Modifier

Effective July 1, 2016, NGS, along with all other Medicare carriers across the country are requiring an additional modifier to be reported on certain...

Noridian Implementation Time

Effective July 1, 2016, the NHIC JA DME MAC workload will be transitioned to the new JA MAC, Noridian Healthcare Solutions. LLC (Noridian). In order to transition this workload successfully, it is necessary to...

Medically Unlikely Edits

CMS developed Medically Unlikely Edits (MUEs) to reduce the paid claims error rate for Part B claims. They represent an upper limit that unquestionably requires...