Railroad Medicare Provider News for Friday 7/21/17

Chiropractic Services: Overview of Coverage and Documentation Requirements

This Comparative Billing Report (CBR) focuses on chiropractic services. 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 coverage guidelines.


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Jurisdiction M Part A News for Friday 7/21/17

If our off-campus outpatient provider-based department (PBD) is only providing services paid under the Medicare Physician Fee Schedule (MPFS) (i.e. outpatient therapy), are we still required to report modifier PO or PN?

Effective January 1, 2017, off-campus PBD are required to use the PN for non-excepted items and services such as separately payable drugs, clinical laboratory tests, and therapy services. The use of modifier PN will trigger a payment rate under the Medicare Physician Fee Schedule (MPFS).


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Railroad Medicare Provider News for Thursday 7/20/17

Internet Only Manual Update to Pub. 100-04, Chapter 15

CR10143 corrects errors in Chapter 15, Section 20.1.4 of the Medicare Claims Processing Manual. These changes are being made to correct minor typographical errors. No policy, processing, or system changes are anticipated. The change specifies that the year that is associated with the Medicare Modernization Act 2003. Make sure that your billing staffs are aware of this update.


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Jurisdiction M Home Health & Hospice News for Thursday 7/20/17

Prepayment Service Specific Probe Results for, The Health Insurance Prospective Payment System (HIPPS) Codes For Claims Utilizing the 2CHL* HIPPS Code in North Carolina and South Carolina

Palmetto GBA performed service-specific pre-payment probe medical review on Home Health claims for HIPPS code 2CHL*. The results for the probe edits in North Carolina and South Carolina, for claims processed between November 2016 and May 2017, are presented here.

Prepayment Service Specific Probe Results for, The Health Insurance Prospective Payment System (HIPPS) Codes For Claims Utilizing the 3CHP* HIPPS Code in Ohio

Palmetto GBA performed service-specific pre-payment probe medical review on Home Health claims for HIPPS code 3CHP*. The results for Ohio, for claims processed between November 2016 and May 2017, are presented here.

CMS National Provider Enrollment Conference

The Centers for Medicare & Medicaid Services (CMS) will hold a National Provider Enrollment Conference on Wednesday, September 6, 2017 from 8 a.m. to 5 p.m. EDT and Thursday, September 7, 2017 from 8 a.m. to 3 p.m. EDT. This session will be held at the Charleston Area Convention Center located at 5000 Coliseum Dr., North Charleston, SC 29418. Don’t miss this opportunity to interact directly with CMS and Medicare Administrative Contractor provider enrollment experts. Please mark your calendars and continue to watch your inbox for additional event information.


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This post applies to: JM HHH

Jurisdiction M Part B News for Thursday 7/20/17

CMS National Provider Enrollment Conference

The Centers for Medicare & Medicaid Services (CMS) will hold a National Provider Enrollment Conference on Wednesday, September 6, 2017 from 8 a.m. to 5 p.m. EDT and Thursday, September 7, 2017 from 8 a.m. to 3 p.m. EDT. This session will be held at the Charleston Area Convention Center located at 5000 Coliseum Dr., North Charleston, SC 29418. Don’t miss this opportunity to interact directly with CMS and Medicare Administrative Contractor provider enrollment experts. Please mark your calendars and continue to watch your inbox for additional event information.

Internet Only Manual Update to Pub. 100-04, Chapter 15

CR10143 corrects errors in Chapter 15, Section 20.1.4 of the Medicare Claims Processing Manual. These changes are being made to correct minor typographical errors. No policy, processing, or system changes are anticipated. The change specifies that the year that is associated with the Medicare Modernization Act 2003. Make sure that your billing staffs are aware of this update.


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Jurisdiction M Part A News for Thursday 7/20/17

CMS National Provider Enrollment Conference

The Centers for Medicare & Medicaid Services (CMS) will hold a National Provider Enrollment Conference on Wednesday, September 6, 2017 from 8 a.m. to 5 p.m. EDT and Thursday, September 7, 2017 from 8 a.m. to 3 p.m. EDT. This session will be held at the Charleston Area Convention Center located at 5000 Coliseum Dr., North Charleston, SC 29418. Don’t miss this opportunity to interact directly with CMS and Medicare Administrative Contractor provider enrollment experts. Please mark your calendars and continue to watch your inbox for additional event information.

Internet Only Manual Update to Pub. 100-04, Chapter 15

CR10143 corrects errors in Chapter 15, Section 20.1.4 of the Medicare Claims Processing Manual. These changes are being made to correct minor typographical errors. No policy, processing, or system changes are anticipated. The change specifies that the year that is associated with the Medicare Modernization Act 2003. Make sure that your billing staffs are aware of this update.


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Railroad Medicare Provider News for Wednesday 7/19/17

Quarterly Update to the National Correct Coding Initiative (CCI) Edits, Version 23.3, Effective October 1, 2017

Change Request (CR) 10183 instructs MACs about the release of the latest package of Correct Coding Initiative (CCI) Procedure to Procedure (PTP) edits, Version 23.3, effective October 1, 2017. The National Correct Coding Initiative (NCCI) developed by the Centers for Medicare & Medicaid (CMS) helps promote national correct coding methodologies and controls improper coding. Make sure that your billing staffs are aware of these changes.


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Jurisdiction M Part B News for Wednesday 7/19/17

Hemophilia Clotting Factors: Submitting the Number of Units

When submitting claims for hemophilia clotting factors it is essential to submit the correct Quantity Billed (QB) to receive the correct reimbursement. To calculate the correct QB, divide the number of International Units (IUs) administered by 100 and round to the nearest whole number. This applies to physicians and Ambulatory Surgical Centers billing clotting factor procedure codes. Please share with appropriate staff.

Influenza, Pneumococcal and Hepatitis B Vaccines and Administration Reimbursement

These immunizations are paid at 100 percent of the established fee schedule amount. Coinsurance and the annual deductible do not apply. Please share with appropriate staff.

Diabetic Shoes Webinar Scheduled for August 16!

Physicians! Do you see patients that require diabetic shoes? Your A/B MAC has collaborated with the jurisdictional DME MAC to bring you a webinar which will review all aspects of Medicare’s coverage for diabetic shoes. The webinar will begin with an overview of different physician’s roles for diabetic shoes. Then, the POE representative will detail the coverage criteria outlined in the LCD and related Policy Article. There will be plenty of time for questions at the conclusion of the presentation portion of the webinar. The webinar is scheduled for 12:30 PM ET (11:30 AM CT) to minimize the impact on your work schedule.

Quarterly Update to the National Correct Coding Initiative (CCI) Edits, Version 23.3, Effective October 1, 2017

Change Request (CR) 10183 instructs MACs about the release of the latest package of Correct Coding Initiative (CCI) Procedure to Procedure (PTP) edits, Version 23.3, effective October 1, 2017. The National Correct Coding Initiative (NCCI) developed by the Centers for Medicare & Medicaid (CMS) helps promote national correct coding methodologies and controls improper coding. Make sure that your billing staffs are aware of these changes.


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Railroad Medicare Provider News for Tuesday 7/18/17

Signature Log Can Be the Key

Do you have questions regarding the signature log? A signature log is a typed listing of the provider(s) identifying their name with a corresponding handwritten signature. This may be an individual log or a group log. A signature log may be used to establish signature identity as needed throughout the medical record documentation.

E/M Weekly Tip: History Component ‘Unable to Obtain’

If you are unable to obtain the review of systems (ROS) and past, family and social history from the patient/source, the documentation must clearly describe the patient’s condition or other circumstance. Please share with appropriate staff.


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