Provider Action Needed Change Request (CR) 9979, from which this article was developed, clarifies the rulemaking language of the Centers for Medicare & Medicaid Services (CMS) as it relates to “Admission and Medical Review Criteria for Hospital Inpatient Services Under Medicare Part A; Requirements for Physician Orders.” The updated language...
This article was rescinded on March 15, 2017. Information on the inpatient transfer policy is located in the “Medicare Claims Processing Manual” (100-04), Chapter 3. For questions concerning clarification on the proper usage of patient discharge status codes, providers should be utilizing the “UB-04 Manual” which is maintained by the...
Change Request (CR) 9876 provides instructions for payment and edits for the common working file (CWF) to include influenza virus vaccine code 90682 (Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use) for claims with dates of service on...
CMS is hosting a call on Tuesday, February 21 on the subject of: “Understanding and Promoting the Value of Chronic Care Management Services. During this call, CMS experts will discuss the benefits of providing Chronic Care Management (CCM) services and changes for CCM in the Physician Fee Schedule final rule....
CMS has published the Telehealth Services Fact Sheet – Revised. Please share within your department and/or region as appropriate. Learn about: • Originating sites • Distant site practitioners • Telehealth services • Billing and payment for professional services furnished via telehealth and the originating site facility fee Download a PDF...
Please see the CMS information regarding “Inpatient Rehabilitation Facility Prospective Payment System Fact Sheet — Revised“ and share within your department and/or region as appropriate. The Fact Sheet provides an update to the Inpatient Rehabilitation Facility Quality Reporting Program section. Download a PDF of the Inpatient Rehabilitation Facility Prospective Payment...
A revised Skilled Nursing Facility Prospective Payment System Booklet is available. Learn about...
The Centers for Medicare & Medicaid Services (CMS) released a final rule that modernizes the Home Health Agency Conditions of Participation (CoPs). The final rule, effective on July 13, 2017, will improve the quality of health care services for all home health patients and strengthen patients’ rights. The regulation reflects...
This article is intended for Medicare Part B clinical laboratories that submit claims to Medicare Administrative Contractors (MACs) for services furnished to Medicare beneficiaries and are required to report private payor rate data to the...
This article is based on Change Request (CR) 9930 which describes changes to the OPPS to be implemented in the January 2017 update. Make sure your billing staffs...
Terry Paff
Gloryanne Bryant