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...
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...
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) ...
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...
News Alerts
This section provides the latest and essential industry updates as they become available.
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...
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...
Proper Billing for Modifier 24 and Documentation Requirements
There have been many provider submissions recently of modifier 24 without proper indication of the E/M service being unrelated to prior surgical procedure. NGS has seen this through the appeals and/or reopening process as well. As a reminder, review the CMS regulation for...
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...
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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...