Duplicate Claim Submission Reminder
National Government Services has an important reminder regarding duplicate
claim submissions. Services that have been processed for payment or denial
should not be refiled as a new claim to correct submissions errors...
Implementation of Automating First Claim Review in Serial
Claims for Durable Medical Equipment, Prosthetics, Orthotics
and Supplies (DMEPOS)
CMS considers serial claims to be claims that are so closely related to one another that the same payment decision should be applied to each claim. In general, serial claims are for...
Tips to Prevent Rejection of Certification Forms-New York
New York Medicaid policy requires that each provider annually recertify their Electronic Transmitter Identification Number (ETIN). If the certification is not renewed annually, claims and other transactions will be rejected after ETIN the decertification date....
This section provides the latest and essential industry updates as they become available.
Medicare Claims Processing Manual
Medicare is prohibited from paying claims submitted in a non-electronic manner
that do not meet the limited exception criteria. The issuance of waivers under this limited exception criteria to is discussed in Chapter 24, Section 90 of the Medicare Claims Processing Manual....
Medicare Will Likely Face Pushback on Physician Pay Changes
Federal officials will likely encounter some resistance to a proposed overhaul of
Medicare's payment for evaluation and management (E/M) services, which could
raise this reimbursement for some specialties while lowering it for others...
Provider Enrollment-Unlicensed Residents
This news alert is intended for unlicensed resident physicians who need to enroll in the Medicare program through Medicare
Administrative Contractors (MACs). The news alert is also intended for the providers for whom these residents will practice....
Jurisdiction K Part B Providers Receiving Hardcopy Standard
Paper Remittances Moving to Weekly Mailing Schedule
Beginning 7/2/2018, NGS will change from a daily to weekly mailing schedule for JK Part B hard copy SPRs. The only exception will be SPRs that include a hard-copy check which will continue to be mailed daily....
When Will Patients Get Their New Card?
At the beginning of April, CMS began the mailing process of the new Medicare cards. The
first beneficiaries to receive the new card are those that are newly eligible for Medicare.
For Medicare beneficiaries that were entitled to Medicare prior to 4/1/2018, they have a
different mailing time...
Now Available! NGSConnex MBI Lookup Tool
On 4/2/2018, CMS started mailing new Medicare cards with the Medicare Beneficiary Identifier (MBI) to all people with Medicare and will continue to mail new Medicare cards in phases by geographic location. This means that some of your patients may have already
received their new Medicare card containing the MBI...
E/M Service Documentation Provided By Students
The Centers for Medicare & Medicaid Services (CMS) is revising the Medicare Claims Processing Manual, Chapter 12, Section 100.1.1, to update policy on Evaluation and Management (E/M) documentation to allow the teaching physician to verify in the medical record....
LCD and Policy Article Revisions Summary for April 26,
2018-Therapeutic Shoes for Persons with Diabetes
Outlined below are the principal changes to the DME MAC Local Coverage Determinations
(LCD) and Policy Articles (PA) for Therapeutic Shoes for Persons with Diabetes that has
been revised and posted...
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When Will Patients Get Their New Card?
At the beginning of April, CMS began the mailing process of the new Medicare cards. The first beneficiaries to receive the new card are those that are newly eligible for Medicare. For Medicare beneficiaries that were entitled to Medicare prior to 4/1/2018, they have a different mailing times...
Reminder-GuildNet Discontinuing Managed Long Term Care Business in Long Island and Westchester Counties
GuildNet, a Medicaid provider of long-term care, has announced that it will no longer accept new enrollees from Suffolk, Nassau and Westchester Counties. This may well be an indication of things to come. According to GuildNet...
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...
Suppression of the Standard Paper Remittance Advice in 45 Days if Also Receiving Electronic Remittance Advice
On 8/4/2017, CMS issued MLN article MM1015: Suppression of the Standard Paper Remittance Advice (SPR) in 45 days if also Receiving Electronic Remittance Advice (ERA)which stated beginning 1/2/2018, MACs must eliminate issuance of SPRs to providers/suppliers (or a billing agent, clearinghouse...” ...
Payment Reduction for X-Rays Taken Using Computed Radiography
Beginning January 1, 2018, and including Calendar Years (CY) 2018-2022, a payment reduction of 7 percent applies to the technical component (and the technical component of the global fee) for computed radiography services that would otherwise be made under the Physician Fee Schedule (PFS) ...
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...
UnitedHealthcare Commercial Medical Record Review-ACA-Covered Commercial Plans for 2017 Dates of Service
UHC is required by the Department of Health & Human Services (HHS), under the Affordable Care Act (ACA), to submit complete diagnostic information about members enrolled in certain Commercial ACA-covered health plans...