Jurisdiction M Home Health & Hospice News for 4/25/2018

Open Draft Local Coverage Determination (LCD) Meeting

The JM Open Draft Local Coverage Determination (LCD) Meeting will be held on June 4 from 10 – 12 EDT. The general public is invited to submit information for Palmetto GBA’s consideration for the proposed LCDs. Registration will close on May 23. Please plan to attend.


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This post applies to: JM HHH

Jurisdiction M Part B News for 4/25/2018

Open Draft Local Coverage Determination (LCD) Meeting

The JM Open Draft Local Coverage Determination (LCD) Meeting will be held on June 4 from 10 – 12 EDT. The general public is invited to submit information for Palmetto GBA’s consideration for the proposed LCDs. Registration will close on May 23. Please plan to attend.

Opt Out Listing

This article includes a listing of those providers who have elected to opt out of the Medicare program. If you’ve recently opted out of the Medicare Program it’s possible that your name will not appear on the website until the next quarterly update. Please share with appropriate staff.


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Jurisdiction M Part A News for 4/25/2018

Open Draft Local Coverage Determination (LCD) Meeting

The JM Open Draft Local Coverage Determination (LCD) Meeting will be held on June 4 from 10 – 12 EDT. The general public is invited to submit information for Palmetto GBA’s consideration for the proposed LCDs. Registration will close on May 23. Please plan to attend.


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Jurisdiction J Part B News for 4/25/2018

Do You Have a Pending Provider Enrollment Application?

On Friday March 30, 2018, Palmetto GBA sent Provider Enrollment (PE) acknowledgment emails to all Jurisdiction J (JJ) Part B providers with a pending application on file. Providers that did not enter a valid email address on the CMS Form 855 will receive an acknowledgment letter via regular mail. This correspondence serves as notification and confirmation that Palmetto GBA is in receipt of your enrollment application received from Cahaba as part of the JJ transition. Please review this information and share it with your staff.

Opt Out Listing

This article includes a listing of those providers who have elected to opt out of the Medicare program. If you’ve recently opted out of the Medicare Program it’s possible that your name will not appear on the website until the next quarterly update. Please share with appropriate staff.


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Railroad Medicare Provider News for 4/24/2018

CMS Quarterly Provider Update

The Quarterly Provider Update is a comprehensive resource published by the Centers for Medicare & Medicaid Services (CMS) on the first business day of each quarter. It is a listing of all non-regulatory changes to Medicare including program memoranda, manual changes and any other instructions that could affect providers. Regulations and instructions published in the previous quarter are also included in the update. Please share with appropriate staff.

Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes – July 2018 Update

Change Request (CR) 10624 informs MACs of updated drug/biological HCPCS codes. The HCPCS code set is updated on a quarterly basis. The July 2018 HCPCS file includes four new HCPCS codes: Q9991, Q9992, Q9993 and Q9995. Please make sure your billing staffs are aware of these updates. Be sure your staffs are aware of these updates.

Requesting Immediate Offset

Palmetto GBA has updated this article about the immediate offset process and the Immediate Offset Request Form. The immediate offset process allows providers the opportunity to request an immediate offset each time you receive a demanded overpayment or you can make a permanent request for all future demanded overpayments. Please review the updated article and form and share it with your staff.


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Jurisdiction M Home Health & Hospice News for 4/24/2018

CMS Quarterly Provider Update

The Quarterly Provider Update is a comprehensive resource published by the Centers for Medicare & Medicaid Services (CMS) on the first business day of each quarter. It is a listing of all non-regulatory changes to Medicare including program memoranda, manual changes and any other instructions that could affect providers. Regulations and instructions published in the previous quarter are also included in the update. Please share with appropriate staff.

Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes – July 2018 Update

Change Request (CR) 10624 informs MACs of updated drug/biological HCPCS codes. The HCPCS code set is updated on a quarterly basis. The July 2018 HCPCS file includes four new HCPCS codes: Q9991, Q9992, Q9993 and Q9995. Please make sure your billing staffs are aware of these updates. Be sure your staffs are aware of these updates.

Submitting the Credit Balance (838) Report and Due Dates

Credit Balance Reports (CMS 838) for the quarter ending March 31, 2018, are due no later than by April 30, 2018. Be sure to submit the report with all required information. The reports can now be submitted via the eServices portal at www.palmettogba.com/eServices. These features are easily accessible from the Financial Tools tab within eServices. Please share with appropriate staff.

Non-Cancer Length of Stay (NCLOS) Rates

This electronic Comparative Billing Report (eCBR) focuses on Non-Cancer Length of Stay (NCLOS) rates from October 1, 2017 to March 31, 2018. CBR information is one of the many tools used to assist individual providers to become proactive in addressing potential billing issues and performing internal audits to ensure compliance with Medicare guidelines. Please share with appropriate staff.


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This post applies to: JM HHH

Jurisdiction M Part B News for 4/24/2018

CMS Quarterly Provider Update

The Quarterly Provider Update is a comprehensive resource published by the Centers for Medicare & Medicaid Services (CMS) on the first business day of each quarter. It is a listing of all non-regulatory changes to Medicare including program memoranda, manual changes and any other instructions that could affect providers. Regulations and instructions published in the previous quarter are also included in the update. Please share with appropriate staff.

Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes – July 2018 Update

Change Request (CR) 10624 informs MACs of updated drug/biological HCPCS codes. The HCPCS code set is updated on a quarterly basis. The July 2018 HCPCS file includes four new HCPCS codes: Q9991, Q9992, Q9993 and Q9995. Please make sure your billing staffs are aware of these updates. Be sure your staffs are aware of these updates.

Claims Payment Issues Log Webcast: April 24

Palmetto GBA will host a JJ/JM Part B Claims Payment Issues Log (CPIL) webcast on Tuesday, April 24, 2018 at 11 am, ET. This 60-minute Webcast is designed to provide an overview of the CPIL available on the Part B Palmetto GBA websites. The live webcast will include a question and answer period for questions related to accessing and using the CPIL.

May 3, 2018, Medicare Part B Top 10 Medical Review Denials Webcast

Please join Palmetto GBA on Thursday, May 3, 2018, at 11:00 am, ET, as we share the Top 10 Medical Review Denials for Jurisdiction J and Jurisdiction M (combined) and provide a better understanding of medical review denial reasons. Please review this announcement and registration instructions and share it with your staff.

Physicians – Are You Ordering DMEPOS for Your Patient? Webcast: May 3

Plan to attend one of the ‘Physicians – Are You Ordering DMEPOS for Your Patient?’ webcast sessions held on May 3, 2018. This is your opportunity to hear directly from the Medicare contractors regarding documentation required for coverage criteria to be met and allow your patients to receive the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) that you prescribe in a timely manner. Representatives from all four DME MAC jurisdictions will join the education staff you are familiar with for Part A/B to explain what is required in medical records following evaluation of your patient for DMEPOS, order requirements, signature compliance and the acceptability of amendments, corrections and deleted entries to medical records.

eUtilization: See Who Has Been Using Your NPI

Electronic Utilization (eUtilization) reports are now available in the eServices portal. eUtilization reports provide rendering providers and ordering and referring providers access to their personal data. This data can be reviewed to ensure providers are aware of when and by whom their NPI is being used for billing Medicare services and when their NPI is entered on a Medicare claim as the ordering referring physician.

Gain Insight Into Your Billing Patterns and Utilization Services: Use Electronic Comparative Billing Reports (eCBRs)

Palmetto GBA uses electronic Comparative Billing Reports (eCBRs) as an educational tool for providers to use in order to provide insight into your billing patterns and utilization of services in comparison to your peers. eCBR will provide you with the ability to view and download your individual CBR online.


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Jurisdiction M Part A News for 4/24/2018

Skilled Nursing Facility (SNF) Consolidated Billing Webcast: April 25

Please join Palmetto GBA for an informative Part A Skilled Nursing Facility (SNF) Consolidated Billing (CB) webcast on April 25, 2018 at 10 a.m. ET. This webcast is designed to provide an overview of SNF Coverage, SNF CB, MDS Resource Utilization Groups (RUGs), claim submission, and documentation.

CMS Quarterly Provider Update

The Quarterly Provider Update is a comprehensive resource published by the Centers for Medicare & Medicaid Services (CMS) on the first business day of each quarter. It is a listing of all non-regulatory changes to Medicare including program memoranda, manual changes and any other instructions that could affect providers. Regulations and instructions published in the previous quarter are also included in the update. Please share with appropriate staff.

Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes – July 2018 Update

Change Request (CR) 10624 informs MACs of updated drug/biological HCPCS codes. The HCPCS code set is updated on a quarterly basis. The July 2018 HCPCS file includes four new HCPCS codes: Q9991, Q9992, Q9993 and Q9995. Please make sure your billing staffs are aware of these updates. Be sure your staffs are aware of these updates.

May 15, 2018, Part A Ask the Contractor Teleconference (ACT): Specialty Clinical Topic – Hyperbaric Oxygen (HBO) Therapy

Palmetto GBA will host the Part A Ask the Contractor Teleconference (ACT) on Tuesday, May 15, 2018, from 11 a.m. – 12 p.m. ET. The ACT Specialty Topic is Hyperbaric Oxygen (HBO) Therapy. Join our clinical consultants as they provide information concerning Medical Review Targeted Probe & Educate (TPE) findings for HBO and how to improve your documentation. Please review this announcement and share it with your staff.

May 23, 2018, Part A Inpatient Psychiatric Facility (IPF) Coverage and Documentation Webcast

Join Palmetto GBA in an informative Part A Inpatient Psychiatric Facility (IPF) Coverage and Documentation webcast on Wednesday, May 23, 2018, at 10 a.m. ET! This webcast is designed to provide overview of IPF coverage, billing and documentation requirements. Please review this announcement and share it with your staff.

Submitting the Credit Balance (838) Report and Due Dates

Credit Balance Reports (CMS 838) for the quarter ending March 31, 2018, are due no later than by April 30, 2018. Be sure to submit the report with all required information. The reports can now be submitted via the eServices portal at www.palmettogba.com/eServices. These features are easily accessible from the Financial Tools tab within eServices. Please share with appropriate staff.


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Jurisdiction J Part B News for 4/24/2018

CMS Quarterly Provider Update

The Quarterly Provider Update is a comprehensive resource published by the Centers for Medicare & Medicaid Services (CMS) on the first business day of each quarter. It is a listing of all non-regulatory changes to Medicare including program memoranda, manual changes and any other instructions that could affect providers. Regulations and instructions published in the previous quarter are also included in the update. Please share with appropriate staff.

Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes – July 2018 Update

Change Request (CR) 10624 informs MACs of updated drug/biological HCPCS codes. The HCPCS code set is updated on a quarterly basis. The July 2018 HCPCS file includes four new HCPCS codes: Q9991, Q9992, Q9993 and Q9995. Please make sure your billing staffs are aware of these updates. Be sure your staffs are aware of these updates.

Claim Rejections: Required ICD-10 Diagnosis Code Indicator Not Included on CMS 1500 Form

Are you receiving paper claim rejections with Claim Adjustment Reason Code CO-11 and Remarks Advice Remarks Code N657? If so, you should know that CMS requires all paper claims include the necessary ‘ICD Indicator’ in Item 21 of the CMS 1500 claim form to prevent claim rejection. A claim rejected for omission of the ‘ICD Indictor’ must be corrected and resubmitted as a new claim. Please share with appropriate staff.

Claims Payment Issues Log Webcast: April 24

Palmetto GBA will host a JJ/JM Part B Claims Payment Issues Log (CPIL) webcast on Tuesday, April 24, 2018 at 11 am, ET. This 60-minute Webcast is designed to provide an overview of the CPIL available on the Part B Palmetto GBA websites. The live webcast will include a question and answer period for questions related to accessing and using the CPIL.

May 3, 2018, Medicare Part B Top 10 Medical Review Denials Webcast

Please join Palmetto GBA on Thursday, May 3, 2018, at 11:00 am, ET, as we share the Top 10 Medical Review Denials for Jurisdiction J and Jurisdiction M (combined) and provide a better understanding of medical review denial reasons. Please review this announcement and registration instructions and share it with your staff.

Physicians – Are You Ordering DMEPOS for Your Patient? Webcast: May 3

Plan to attend one of the ‘Physicians – Are You Ordering DMEPOS for Your Patient?’ webcast sessions held on May 3, 2018. This is your opportunity to hear directly from the Medicare contractors regarding documentation required for coverage criteria to be met and allow your patients to receive the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) that you prescribe in a timely manner. Representatives from all four DME MAC jurisdictions will join the education staff you are familiar with for Part A/B to explain what is required in medical records following evaluation of your patient for DMEPOS, order requirements, signature compliance and the acceptability of amendments, corrections and deleted entries to medical records.


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Jurisdiction J Part A News for 4/24/2018

Skilled Nursing Facility (SNF) Consolidated Billing Webcast: April 25

Please join Palmetto GBA for an informative Part A Skilled Nursing Facility (SNF) Consolidated Billing (CB) webcast on April 25, 2018 at 10 a.m. ET. This webcast is designed to provide an overview of SNF Coverage, SNF CB, MDS Resource Utilization Groups (RUGs), claim submission, and documentation.

CMS Quarterly Provider Update

The Quarterly Provider Update is a comprehensive resource published by the Centers for Medicare & Medicaid Services (CMS) on the first business day of each quarter. It is a listing of all non-regulatory changes to Medicare including program memoranda, manual changes and any other instructions that could affect providers. Regulations and instructions published in the previous quarter are also included in the update. Please share with appropriate staff.

Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes – July 2018 Update

Change Request (CR) 10624 informs MACs of updated drug/biological HCPCS codes. The HCPCS code set is updated on a quarterly basis. The July 2018 HCPCS file includes four new HCPCS codes: Q9991, Q9992, Q9993 and Q9995. Please make sure your billing staffs are aware of these updates. Be sure your staffs are aware of these updates.

May 15, 2018, Part A Ask the Contractor Teleconference (ACT): Specialty Clinical Topic – Hyperbaric Oxygen (HBO) Therapy

Palmetto GBA will host the Part A Ask the Contractor Teleconference (ACT) on Tuesday, May 15, 2018, from 11 a.m. – 12 p.m. ET. The ACT Specialty Topic is Hyperbaric Oxygen (HBO) Therapy. Join our clinical consultants as they provide information concerning Medical Review Targeted Probe & Educate (TPE) findings for HBO and how to improve your documentation. Please review this announcement and share it with your staff.

May 23, 2018, Part A Inpatient Psychiatric Facility (IPF) Coverage and Documentation Webcast

Join Palmetto GBA in an informative Part A Inpatient Psychiatric Facility (IPF) Coverage and Documentation webcast on Wednesday, May 23, 2018, at 10 a.m. ET! This webcast is designed to provide overview of IPF coverage, billing and documentation requirements. Please review this announcement and share it with your staff.


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