Railroad Medicare Provider News for Thursday 9/21/17

Accepting Payment from Patients with a Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA), a Liability Insurance Medicare Set-Aside Arrangement (LMSA), or a No-Fault Insurance Medicare Set-Aside Arrangement (NFMSA)

This article is based on information received from Medicare beneficiaries, their legal counsel, and other entities that assist these individuals indicating that physicians, providers, and other suppliers are often reluctant to accept payment directly from Medicare beneficiaries who state they have a Medicare Set-Aside Arrangement (MSA) and must pay for their services themselves. This article explains what a MSA is and explains why it is appropriate to accept payment from a patient that has a funded MSA. Please review your billing practices to be sure they are in line with the information provided.

Billing in Medicare Secondary Payer (MSP) Liability Insurance Situations

This article is based on information received from Medicare beneficiaries, their legal counsel and other entities that assist these individuals, indicating that providers, physicians, and other suppliers that elect to seek payment from the beneficiary’s liability insurance claim instead of submitting the claim for items or services to Medicare have not generally billed in accordance with the instructions provided or referenced in this article. The FAQs in this article are intended to remind providers, physicians, and other suppliers of the fundamental guidance governing billing where liability insurance (including self-insurance) is involved. Please review your billing practices to be sure they are in line with the information below.

Annual Clotting Factor Furnishing Fee Update 2018

Change Request (CR) 10254 announces the clotting factor furnishing fee for 2018 is $0.215 per unit. Make sure that your billing staffs are aware of this update to the annual clotting factor furnishing fee for 2018.

Guidance on Coding and Billing Date of Service on Professional Claims

This MLN Matters Article is intended for physicians, non-physician practitioners, and others submitting claims on a CMS-1500 form or the X12 837 Professional Claim to Medicare Administrative Contractors (MACs) for reimbursement for Medicare Part B services.

October 2017 Railroad Medicare News

The October 2017 Railroad Medicare News is now available. Please review this issue for the latest Medicare updates and upcoming provider education opportunities. Please remember to share this information with your staff.

Top Medical Review Denials and How to Avoid Them: Recorded Presentation

Register for the on-demand recorded presentation of our September 19, 2017, webcast focused on the top Railroad Medicare Medical Review denials, including tips and resources to help you avoid these denials.


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Jurisdiction M Home Health & Hospice News for Thursday 9/21/17

October 2017 Home Health and Hospice Medicare Advisory

The October 2017 Home Health and Hospice Medicare Advisory is now available. Please review this issue for Medicare policy and coverage updates as well as announcements for upcoming provider education opportunities. Please remember to share this information with your staff.

Accepting Payment from Patients with a Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA), a Liability Insurance Medicare Set-Aside Arrangement (LMSA), or a No-Fault Insurance Medicare Set-Aside Arrangement (NFMSA)

This article is based on information received from Medicare beneficiaries, their legal counsel, and other entities that assist these individuals indicating that physicians, providers, and other suppliers are often reluctant to accept payment directly from Medicare beneficiaries who state they have a Medicare Set-Aside Arrangement (MSA) and must pay for their services themselves. This article explains what a MSA is and explains why it is appropriate to accept payment from a patient that has a funded MSA. Please review your billing practices to be sure they are in line with the information provided.

Billing in Medicare Secondary Payer (MSP) Liability Insurance Situations

This article is based on information received from Medicare beneficiaries, their legal counsel and other entities that assist these individuals, indicating that providers, physicians, and other suppliers that elect to seek payment from the beneficiary’s liability insurance claim instead of submitting the claim for items or services to Medicare have not generally billed in accordance with the instructions provided or referenced in this article. The FAQs in this article are intended to remind providers, physicians, and other suppliers of the fundamental guidance governing billing where liability insurance (including self-insurance) is involved. Please review your billing practices to be sure they are in line with the information below.


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This post applies to: JM HHH

Jurisdiction M Part B News for Thursday 9/21/17

Accepting Payment from Patients with a Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA), a Liability Insurance Medicare Set-Aside Arrangement (LMSA), or a No-Fault Insurance Medicare Set-Aside Arrangement (NFMSA)

This article is based on information received from Medicare beneficiaries, their legal counsel, and other entities that assist these individuals indicating that physicians, providers, and other suppliers are often reluctant to accept payment directly from Medicare beneficiaries who state they have a Medicare Set-Aside Arrangement (MSA) and must pay for their services themselves. This article explains what a MSA is and explains why it is appropriate to accept payment from a patient that has a funded MSA. Please review your billing practices to be sure they are in line with the information provided.

Billing in Medicare Secondary Payer (MSP) Liability Insurance Situations

This article is based on information received from Medicare beneficiaries, their legal counsel and other entities that assist these individuals, indicating that providers, physicians, and other suppliers that elect to seek payment from the beneficiary’s liability insurance claim instead of submitting the claim for items or services to Medicare have not generally billed in accordance with the instructions provided or referenced in this article. The FAQs in this article are intended to remind providers, physicians, and other suppliers of the fundamental guidance governing billing where liability insurance (including self-insurance) is involved. Please review your billing practices to be sure they are in line with the information below.

Annual Clotting Factor Furnishing Fee Update 2018

Change Request (CR) 10254 announces the clotting factor furnishing fee for 2018 is $0.215 per unit. Make sure that your billing staffs are aware of this update to the annual clotting factor furnishing fee for 2018.

October 2017 Medicare Advisory

The October 2017 Medicare Advisory is now available. Please review this issue for Medicare policy and coverage updates as well as announcements for upcoming provider education opportunities. Please remember to share this information with your staff.

Guidance on Coding and Billing Date of Service on Professional Claims

This MLN Matters Article is intended for physicians, non-physician practitioners, and others submitting claims on a CMS-1500 form or the X12 837 Professional Claim to Medicare Administrative Contractors (MACs) for reimbursement for Medicare Part B services.


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Jurisdiction M Part A News for Thursday 9/21/17

Accepting Payment from Patients with a Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA), a Liability Insurance Medicare Set-Aside Arrangement (LMSA), or a No-Fault Insurance Medicare Set-Aside Arrangement (NFMSA)

This article is based on information received from Medicare beneficiaries, their legal counsel, and other entities that assist these individuals indicating that physicians, providers, and other suppliers are often reluctant to accept payment directly from Medicare beneficiaries who state they have a Medicare Set-Aside Arrangement (MSA) and must pay for their services themselves. This article explains what a MSA is and explains why it is appropriate to accept payment from a patient that has a funded MSA. Please review your billing practices to be sure they are in line with the information provided.

Billing in Medicare Secondary Payer (MSP) Liability Insurance Situations

This article is based on information received from Medicare beneficiaries, their legal counsel and other entities that assist these individuals, indicating that providers, physicians, and other suppliers that elect to seek payment from the beneficiary’s liability insurance claim instead of submitting the claim for items or services to Medicare have not generally billed in accordance with the instructions provided or referenced in this article. The FAQs in this article are intended to remind providers, physicians, and other suppliers of the fundamental guidance governing billing where liability insurance (including self-insurance) is involved. Please review your billing practices to be sure they are in line with the information below.

October 2017 Part A Medicare Advisory

The October 2017 Part A Medicare Advisory is now available. Please review this issue for Medicare policy and coverage updates as well as other announcements for upcoming provider education opportunities. Please remember to share this information with your staff.

Annual Clotting Factor Furnishing Fee Update 2018

Change Request (CR) 10254 announces the clotting factor furnishing fee for 2018 is $0.215 per unit. Make sure that your billing staffs are aware of this update to the annual clotting factor furnishing fee for 2018.


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Railroad Medicare Provider News for Wednesday 9/20/17

Revision to Publication 100.06, Chapter 3, Medicare Overpayment Manual, Section 200, Limitation on Recoupment

Change Request (CR) 9815 (revised) updates the Centers for Medicare & Medicaid Services (CMS) ‘Medicare Financial Management Manual,’ Chapter 3, Sections 200-200.2.1, Limitation on Recoupment Overpayments. CR9815 is the first of four CRs that are forthcoming and incorporated into this manual. Make sure your billing staffs are aware of these updates that relate to the limitation on recovery of certain overpayments.

Updated Editing of Always Therapy Services – MCS

Change Request (CR) 10176 (revised) implements revised editing of Part B ‘Always Therapy’ services to require the appropriate therapy modifier in order for the service to be accurately applied to the therapy cap. CR10176 contains no new policy. Instead, the guidelines presented in the CR improve the enforcement of longstanding, existing instructions. Make sure your billing staffs are aware of these revisions.


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Jurisdiction M Home Health & Hospice News for Wednesday 9/20/17

Revision to Publication 100.06, Chapter 3, Medicare Overpayment Manual, Section 200, Limitation on Recoupment

Change Request (CR) 9815 (revised) updates the Centers for Medicare & Medicaid Services (CMS) ‘Medicare Financial Management Manual,’ Chapter 3, Sections 200-200.2.1, Limitation on Recoupment Overpayments. CR9815 is the first of four CRs that are forthcoming and incorporated into this manual. Make sure your billing staffs are aware of these updates that relate to the limitation on recovery of certain overpayments.

October 2017 Update of the Hospital Outpatient Prospective Payment System (OPPS)

This article is based on Change Request (CR) 10236 (revised), which describes changes to the OPPS to be implemented in the October 2017 update. Make sure your billing staffs are aware of these changes.


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This post applies to: JM HHH

Jurisdiction M Part B News for Wednesday 9/20/17

Revision to Publication 100.06, Chapter 3, Medicare Overpayment Manual, Section 200, Limitation on Recoupment

Change Request (CR) 9815 (revised) updates the Centers for Medicare & Medicaid Services (CMS) ‘Medicare Financial Management Manual,’ Chapter 3, Sections 200-200.2.1, Limitation on Recoupment Overpayments. CR9815 is the first of four CRs that are forthcoming and incorporated into this manual. Make sure your billing staffs are aware of these updates that relate to the limitation on recovery of certain overpayments.

Updated Editing of Always Therapy Services – MCS

Change Request (CR) 10176 (revised) implements revised editing of Part B ‘Always Therapy’ services to require the appropriate therapy modifier in order for the service to be accurately applied to the therapy cap. CR10176 contains no new policy. Instead, the guidelines presented in the CR improve the enforcement of longstanding, existing instructions. Make sure your billing staffs are aware of these revisions.


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Jurisdiction M Part A News for Wednesday 9/20/17

Revision to Publication 100.06, Chapter 3, Medicare Overpayment Manual, Section 200, Limitation on Recoupment

Change Request (CR) 9815 (revised) updates the Centers for Medicare & Medicaid Services (CMS) ‘Medicare Financial Management Manual,’ Chapter 3, Sections 200-200.2.1, Limitation on Recoupment Overpayments. CR9815 is the first of four CRs that are forthcoming and incorporated into this manual. Make sure your billing staffs are aware of these updates that relate to the limitation on recovery of certain overpayments.

October 2017 Update of the Hospital Outpatient Prospective Payment System (OPPS)

This article is based on Change Request (CR) 10236 (revised), which describes changes to the OPPS to be implemented in the October 2017 update. Make sure your billing staffs are aware of these changes.


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Railroad Medicare Provider News for Tuesday 9/19/17

Medicare Secondary Payer Inquiry Form

As a reminder, A Medicare Secondary Payer Inquiry Form is available in the Medicare Secondary Payer forms section of our website. To ensure timely processing of your request, this form should be used for any Medicare Secondary Payer (MSP) request pertaining to Primary or Secondary payment of claims. Please share with appropriate staff.

E/M Weekly Tip: Risk of Significant Complications, Morbidity and/or Mortality (Risk Assessment)

The risk of significant complications, morbidity, and/or mortality is based on the risks associated with the following categories: presenting problem (s), diagnostic procedure(s), and possible management options. The highest level of risk in any one category determines the overall risk. The level of risk of significant complications, morbidity and/or mortality can be: minimal, low, moderate or high. Please share with appropriate staff.


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Jurisdiction M Home Health & Hospice News for Tuesday 9/19/17

Email and Faxed Inquiries

CMS requires all providers to utilize the Provider Contact Center (PCC) (855-696-0705) as their point of contact with their Medicare Administrative Contractors. If you submit an unsolicited fax or email inquiry directly to a specific department or individual your inquiry will be routed to the written correspondence area within the PCC for proper logging, tracking, research and response. An escalation process is used for complex issues. Submitting inquires directly to the PCC will assure CMS compliance and allow for the most timely response.

Medicare Secondary Payer Inquiry Form

As a reminder, A Medicare Secondary Payer Inquiry Form is available in the Medicare Secondary Payer forms section of our website. To ensure timely processing of your request, this form should be used for any Medicare Secondary Payer (MSP) request pertaining to Primary or Secondary payment of claims. Please share with appropriate staff.


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This post applies to: JM HHH