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2012 Part A Kentucky and Ohio Medicare News Archive
December 2012
- Remittance Advice Remark and Claims Adjustment Reason Code, Medicare Remit Easy Print, and PC Print Update - MLN Matters PDF Document MM8154 – 12.31.12
- Implementation of the Hospital Value-Based Purchasing Program and Hospital Readmission Reduction Program for the Rural Community Hospital Demonstration for FY 2013 - MLN Matters PDF Document MM8076 – 12.31.12
- New Healthcare Common Procedure Coding System (HCPCS) Code for External Ventricular Assist Devices or Any Ventricular Assist Device (VAD) For Which Payment Was Not Made Under Medicare Part A - MLN Matters PDF Document MM7888 – 12.28.12
- January 2013 Integrated Outpatient Code Editor (I/OCE) Specifications Version 14.0 - MLN Matters PDF Document MM8137 – 12.28.12
- Revised: Implementing the Claims-Based Data Collection Requirement for Outpatient Therapy Services - Section 3005(g) of the Middle Class Tax Relief and Jobs Creation Act (MCTRJCA) of 2012 - MLN Matters PDF Document MM8005 – 12.28.12
- J15 Part A Claims Processing Issues Log – 12.28.12
- Reminder - Quarterly Release Temporary Hold – 12.27.12
- January 2013 Integrated Outpatient Code Editor (I/OCE) Specifications Version 14.0 - MLN Matters PDF Document MM8137 – 12.27.12
- Update to Therapy Cap Exceptions Process – 12.27.12
- The January 2013 Jurisdiction 15 Part A (J15 Part A) Medicare Bulletin is now available – 12.26.12
- Ambulance Inflation Factor for CY 2013 and Productivity Adjustment - MLN Matters PDF Document MM8156 – 12.26.12
- Direction for Therapy Cap after December 31, 2012 – 12.26.12
- Entries in Medical Records: Amendments, Corrections, and Addenda – 12.26.12
- J15 PCC To Close For Christmas Eve and Christmas Day – 12.20.12
- NOTE: CGS will continue to use our existing host for webinars and other Web-Based Training (WBT) events. Please disregard yesterday's announcement regarding a new webinar platform for CGS. – 12.20.12
- Revisions of the Financial Limitation for Outpatient Therapy Services - Section 3005 of the Middle Class Tax Relief and Job Creation Act of 2012 - MLN Matters PDF Document MM7785 – 12.20.12
- Direct Data Entry (DDE) IDs: Keep Them Active – 12.20.12
- CMS e-News: December 20, 2012 – 12.20.12
- Adjustments for ESRD Claims with Outlier Payments – 12.20.12
- January 2013 Update of the Hospital Outpatient Prospective Payment System (OPPS) - MLN Matters PDF Document MM8141 – 12.19.12
- Calendar Year (CY) 2013 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment - MLN Matters PDF Document MM8132 – 12.19.12
- Medicare Overpayments Being Generated for Beneficiaries Determined to Be Unlawfully Present in the United States – 12.19.12
- Medicare Overpayments Being Generated for Services Furnished to Incarcerated Medicare Beneficiaries – 12.19.12
- Attention Health Professionals: Information Regarding the 2013 Medicare Physician Fee Schedule – 12.19.12
- Revised: Implementation of the PWK (Paperwork) Segment for X12N Version 5010 - MLN Matters PDF Document MM7041 – 12.17.12
- Update to Medicare Deductible, Coinsurance and Premium Rates for 2013 - MLN Matters PDF Document MM8052 – 12.14.12
- CMS e-News: December 13, 2012 – 12.14.12
- Humanitarian Use Device (HUD) Coverage – 12.14.12
- Minor ESRD Facility Billing Change: Effective January 1, 2012 – 12.13.12
- Medicare Provider Enrollment Application Fee for Calendar Year (CY) 2013 – 12.13.12
- Expansion of Medicare Telehealth Services for Calendar Year (CY) 2013 - MLN Matters PDF Document MM7900 – 12.13.12
- Phase 2 of Ordering/Referring Requirement - MLN Matters PDF Document SE1221 – 12.13.12
- HIPAA Eligibility Transaction System (HETS) to Replace Common Working File (CWF) Medicare Beneficiary Health Insurance Eligibility Queries - MLN Matters PDF Document SE1249 – 12.13.12
- Update to Medicare Deductible, Coinsurance and Premium Rates for 2013 - MLN Matters PDF Document MM8052 – 12.13.12
- Calendar Year (CY) 2013 Update for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule - MLN Matters PDF Document MM8133 – 12.13.12
- November 13, 2012 Ask the Contractor Teleconference on Provider Enrollment: Questions and Answers – 12.12.12
- Revised: Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Low Back Pain (CLBP) - MLN Matters PDF Document MM7836 – 12.11.12
- Implementing the Claims-Based Data Collection Requirement for Outpatient Therapy Services - Section 3005(g) of the Middle Class Tax Relief and Jobs Creation Act (MCTRJCA) of 2012 - MLN Matters PDF Document MM8005 – 12.11.12
- CMS e-News: December 6, 2012 – 12.07.12
- Revised: Further Details on the Revalidation of Provider Enrollment Information - MLN Matters PDF Document SE1126 – 12.07.12
- Revised: Implementation of Provider Enrollment Provisions in CMS-6028-FC - MLN Matters PDF Document MM7350 – 12.06.12
- Calendar Year (CY) 2013 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment - MLN Matters PDF Document MM8132 – 12.06.12
- Therapy Caps and Additional Documentation Requests (ADRs) – 12.06.12
- Redesign of the Medicare Summary Notice (MSN) - Final Implementation - And Major Update to Chapter 21 of the Claims Processing Manual - MLN Matters PDF Document MM7676 – 12.04.12
- Therapy Cap Values for Calendar Year (CY) 2013 - MLN Matters PDF Document MM8129 – 12.04.12
- Revised: Quarterly Update to the End Stage Renal Disease (ESRD) Prospective Payment System (PPS) - MLN Matters PDF Document MM7858 – 12.04.12
- 2013 Annual Update to the Therapy Code List - MLN Matters PDF Document MM8126 – 12.04.12
- Importance of Preparing/Maintaining Legible Medical Records - MLN Matters PDF Document SE1237 – 12.03.12
- New ST PEPPER Now Available – 12.03.12
- FY 2014 Hospital Wage Index Development Timetable (October 2012 through October 2013) – 12.03.12
November 2012
- J15 Part A Claims Processing Issues Log – 11.30.12
- Bariatric Surgery for the Treatment of Morbid Obesity National Coverage Determination, Addition of Laparoscopic Sleeve Gastrectomy (LSG) - MLN Matters PDF Document MM8028 – 11.30.12
- The December 2012 Jurisdiction 15 Part A (J15 Part A) Medicare Bulletin is now available – 11.30.12
- CMS e-News: November 29, 2012 – 11.29.12
- Probe Edit Medical Review of Simple Pneumonia and Pleurisy - Diagnosis Related Group Diagnosis Related Group (DRG) 195 in Ohio – 11.29.12
- Probe Edit Medical Review of Simple Pneumonia and Pleurisy - Diagnosis Related Group Diagnosis Related Group (DRG) 195 in Kentucky – 11.29.12
- Permanent Cardiac Pacemaker Implant Diagnosis Related Group (DRG 243 and 244): Complex Medical Review – 11.29.12
- Announcement of Medicare Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Payment Rate Increases - MLN Matters PDF Document MM8119 – 11.29.12
- Importance of Preparing/Maintaining Legible Medical Records - MLN Matters PDF Document SE1237 – 11.26.12
- Medicare DMEPOS Competitive Bidding Program: Quick Reference Article - MLN Matters PDF Document SE1244 – 11.26.12
- JW HCPCS Modifier: Frequently Asked Questions – 11.26.12
- J15 Part A Claims Processing Issues Log – 11.21.12
- CMS e-News: November 21, 2012 – 11.21.12
- J15 Part A Claims Processing Issues Log – 11.20.12
- Bariatric Surgery for the Treatment of Morbid Obesity National Coverage Determination, Addition of Laparoscopic Sleeve Gastrectomy (LSG) - MLN Matters PDF Document MM8028 – 11.19.12
- Special Report for Ambulatory Surgical Center (ASC) Quality Reporting - MLN Matters PDF Document SE1248 – 11.19.12
- Additional Documentation Requests (ADRs): Tips for Submitting Electronic and Paper Documentation – 11.19.12
- Low-Volume Adjustments for End-Stage Renal
Disease Prospective Payment System (ESRD PPS) – 11.19.12
- 2011 Version of Advance Beneficiary Notice of Noncoverage Must Be Used Beginning January 1, 2012 – 11.19.12
- Inpatient Service-Specific
Complex Review of Esophagitis Gastroenteritis (Diagnosis Related Group 391 and
392): Interim Results of Complex Medical Review – 11.16.12
- Inpatient Service-Specific
Complex Review of Nutritional Metabolic (Diagnosis Related Group 640 and 641): Interim Results of Complex Medical Review – 11.16.12
- Inpatient Service-Specific Complex Review of Chest Pain and
Atherosclerosis (Diagnosis Related Group 302, 303 and 313): Interim Results of Complex Medical Review – 11.16.12
- J15 Part A Claims Processing Issues Log – 11.16.12
- Implementation of Changes in the End-Stage Renal Disease Prospective Payment System (ESRD PPS) for Calendar Year (CY) 2013 - MLN Matters PDF Document MM8120 – 11.14.12
- Other Vascular Procedures Without Major Complication or Comorbidity (MCC): Diagnosis Related Group (DRG) 253 and 254: Complex Medical Review – 11.14.12
- Frequently Asked Questions (FAQs) on the 3-Day Payment Window for Services Provided to Outpatients Who Later Are Admitted as Inpatients - MLN Matters PDF Document SE1232 – 11.14.12
- Complex Medical Review of Excisional Debridement (Procedure Code 86.22) – 11.14.12
- Recovery Auditor Prepayment Review Demonstration: Ohio Providers – 11.13.12
- Hurricane Sandy and Medicare Disaster Related Claims - MLN Matters PDF Document SE1247 – 11.13.12
- Administrative Relief for Areas Affected by Hurricane Sandy: Appeals Guidance – 11.09.12
- J15 Part A Claims Processing Issues Log – 11.09.12
- The Supplemental Security Income (SSI)/Medicare Beneficiary Data for Fiscal Year 2010 for Inpatient Prospective Payment System (IPPS) Hospitals, Inpatient Rehabilitation Facilities (IRFs) and Long Term Care Hospitals (LTCHs) - MLN Matters PDF Document MM8078 – 11.09.12
- Quarterly Update to the End Stage Renal Disease (ESRD) Prospective Payment System (PPS) - MLN Matters PDF Document MM7858 – 11.09.12
- Implementation of Changes to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) Consolidated Billing Requirements for Daptomycin and a Clarification of Outlier Services for Calendar Year 2013 - MLN Matters PDF Document MM7869 – 11.09.12
- Affordable Care Act Section 3025 Expansion of a Field in the Inpatient Provider Specific File (PSF) - MLN Matters PDF Document MM8067 – 11.09.12
- Meet the New CGS Medical Directors – 11.09.12
- Alert Concerning Impacts Arising from Having Non-Compliant Physical or Practice Address Information on File with Medicare - MLN Matters PDF Document SE1245 – 11.08.12
- CMS Medical Identity Theft Web-Based Training Course for Providers Available – 11.08.12
- CMS e-News: November 8, 2012 – 11.08.12
- Reason Code 31265: Clarification – 11.08.12
- FY 2014 Hospital Wage Index Development Timetable
(October 2012 through October 2013) – 11.07.12
- Forms Enhancement: The Ability to Save! – 11.07.12
- Coordination of Benefits Contractor Toll Free Customer Service Telephone Number Now Operating – 11.07.12
- New Erythropoietin Stimulating Agent (ESA) Peginesatide Requirements for End-Stage Renal Disease (ESRD) - MLN Matters PDF Document MM8050 – 11.06.12
- Inpatient Service-Specific Review of Lymphoma and Nonacute Leukemia with Major Complication or Comorbidity (MCC) (Diagnosis Related Group 840): Completion of Probe Medical Review – 11.06.12
- New Informational Unsolicited Response (IUR) Process to Identify Previously Paid Claims for Services Furnished to Incarcerated Medicare Beneficiaries - MLN Matters PDF Document MM8007 – 11.06.12
- Enforcing Interim Billing for Partial Hospitalization Services - MLN Matters PDF Document MM8048 – 11.06.12
- Medicare System Update to Include Rendering Line Level National Provider Identifiers (NPIs) for Primary Care Incentive Program (PCIP) Payments to Critical Access Hospitals (CAHs) - MLN Matters PDF Document MM8030 – 11.06.12
- New Informational Unsolicited Response (IUR) Process to Identify Previously Paid Claims for Services Furnished to Medicare Beneficiaries Classified as 'Unlawfully Present' in the United States - MLN Matters PDF Document MM8009 – 11.06.12
- CMS Issues ESRD and Home Health Payment Rules: CMS e-News – 11.05.12
- Jurisdiction 15 Part A/Resources/Medical Review/Complex Medical Review of Cardiac Rehabilitation with Continuous ECG Monitoring (CPT Code 93798) – 11.05.12
- Change in Date! November 20, 2012: J15 Part A Ask-the-Contractor Teleconference (ACT) - 935: Overpayment Limitation on the Recoupment Process – 11.05.12
- EDI FTP Users: We have identified an issue with connectivity to our EDI Gateway (GPNet) via FTP. Submitters connecting to our EDI Gateway (GPNET) via FTP may experience sporadic connectivity issues. Please monitor our website for updates.
- Editing Update for Annual Wellness Visit (AWV) - MLN Matters PDF Document MM8107 – 11.02.12
- Revised: Phase 2 of Ordering/Referring Requirement - MLN Matters PDF Document SE1221 – 11.02.12
- Effect of Beneficiary Agreements Not to Use Medicare Coverage and When Payment May be Made to a Beneficiary for Service of an Opt-Out Physician/Practitioner - MLN Matters PDF Document MM8100 – 11.02.12
- Manual Updates to Clarify Skilled Nursing Facility (SNF) Claims Processing - MLN Matters PDF Document MM8044 – 11.02.12
- January 2013 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files - MLN Matters PDF Document MM8116 – 11.02.12
- New Look for the CMS Medicare FFS Provider e-News – 11.02.12
- Complex Medical Review of Cardiac Defibrillator Implant without Major Complications and Comorbidity (MCC): Diagnosis Related Group (DRG) 227 – 11.02.12
- CMS Issues 2 Payment Rules: November 1, 2012 – 11.02.12
- CMS e-News: November 1, 2012 – 11.01.12
- Billing Instructions for Suppliers that Wish to Obtain a Medicare Denial for Non-Covered Codes Subject to ESRD PPS Consolidated Billing Requirements – 11.01.12
- Overpayments for Trastuzumab (Herceptin) – 11.01.12
- Section 935 Overpayment Recoupment Process – 11.01.12
October 2012
- The November 2012 Jurisdiction 15 Part A (J15 Part A) Medicare Bulletin is now available – 10.31.12
- Medicare Guidance Regarding Meningitis Outbreak - MLN Matters PDF Document SE1246 – 10.31.12
- Coordination of Benefits Contractor Toll Free Customer Service Telephone Number Not Available: Due to the impact of Hurricane Sandy, the Coordination of Benefits Contractor toll free customer service is currently unavailable. Efforts are underway to restore service. – 10.31.12
- J15 Part A Claims Processing Issues Log – 10.30.12
- Upcoming J15 EDI Help Desk Training Closure – 10.30.12
- Medicare Guidance Regarding Meningitis Outbreak - MLN Matters PDF Document SE1246 –10.29.12
- Inpatient Closed Endoscopic Biopsy of Lung: Results of Probe Medical Review – 10.29.12
- General Update to Chapter 15 of the Program Integrity Manual (PIM) - Part IX - MLN Matters PDF Document MM8019 – 10.26.12
- Inpatient Service-Specific Review of Seizures with Major Complication or Comorbidity (MCC) (Diagnosis Related Group 100): Completion of Probe Medical Review – 10.25.12
- CMS e-News: October 25, 2012 – 10.25.12
- Inpatient Hospital Claims for Other and Unspecified Coagulation Defect (ICD Principal Diagnosis Code 96.9): Completion of Probe Medical Review – 10.25.12
- Reason Code 15202 – 10.24.12
- Reason Code 32018: When No Termination Date on the Provider File – 10.24.12
- Notice of New Interest Rate for Medicare Overpayments and Underpayments – 10.24.12
- November 13, 2012: J15 Part A Ask-the-Contractor Teleconference (ACT) – Provider Enrollment and Revalidation Attention J15 – 10.24.12
- November 6, 2012: J15 Part A Ask-the-Contractor Teleconference (ACT) – 935: Overpayment Limitation on the Recoupment Process – 10.24.12
- J15 Part A Claims Processing Issues Log – 10.19.12
- myCGS Ask-the-Contractor Teleconference (ACT) – 10.19.12
- CMS e-News: October 18, 2012 – 10.18.12
- Reasonable Charge Update for 2013 for Splints, Casts and Certain Intraocular Lenses - MLN Matters PDF Document MM8051 – 10.17.12
- Complex Medical Review of Trastuzumab (HCPCS Code J9355) for Type of Bill 13x – 10.17.12
- 2012 - 2013 Seasonal Influenza (Flu) Resources for Health Care Professionals - MLN Matters PDF Document SE1242 – 10.17.12
- Experiencing Missing or Duplicate files? – 10.16.12
- Denosumab (Prolia, Xgeva) Update – 10.16.12
- New Fiscal Intermediary Standard System (FISS) Reason Code 39132 to Review Medicare Outpatient Prospective Payment System (OPPS) Payments Exceeding Charges – 10.15.12
- Bidding is Now Open for the Round 1 Recompete of the DMEPOS Competitive Bidding Program – 10.15.12
- J15 Part A Claims Processing Issues Log – 10.12.12
- Now Available: New Education Materials for Round 1 Recompete Bidders – 10.12.12
- Only 7 Days Left to Register for the Round 1 Recompete of the DMEPOS Competitive Bidding Program – 10.12.12
- Certain End-Stage Renal Disease Claims Incorrectly Returning to Provider – 10.12.12
- Correct Provider Billing of Line Item Rendering Physician on the Paper UB-04 Claims Form - MLN Matters PDF Document SE1241 – 10.12.12
- Complex Medical Review of Kidney and Urinary Tract Infections Without MCC: Diagnosis Related Group (DRG) 690 – 10.11.12
- CMS e-News: October 11, 2012 – 10.11.12
- Completion of Inpatient Continuous Invasive Mechanical Ventilation for 96 Consecutive Hours or More (Procedure Code 96.72): Results of Probe Medical Review – 10.10.12
- Inpatient Closed Endoscopic Biopsy of Lung: Results of Probe Medical Review – 10.08.12
- Inpatient Service-specific Probe Review of Permanent Cardiac Pacemaker Implants: Results of Probe Medical Review – 10.08.12
- Inpatient Closed Endoscopic Biopsy of Lung: Results of Probe Medical Review – 10.08.12
- Inpatient Service-specific Probe Review of Permanent Cardiac Pacemaker Implants: Results of Probe Medical Review – 10.08.12
- Complex Medical Review of Syncope & Collapse Diagnosis Related Group Diagnosis Related Group (DRG) 312 – 10.08.12
- Manual Medical Review of Therapy Services – 10.08.12
- Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Pricer Update Fiscal Year (FY) 2013 – 10.08.12
- Annual Clotting Factor Furnishing Fee Update 2013 - MLN Matters PDF Document MM8049 – 10.05.12
- Only 14 Days Left to Register for the Round 1 Recompete of the DMEPOS Competitive Bidding Program – 10.05.12
- Revised: Influenza Vaccine Payment Allowances: Annual Update for 2012 - 2013 Season - MLN Matters PDF Document MM8047 – 10.05.12
- Complex Medical Review of Kidney & Urinary Tract Infections Without MCC: Diagnosis Related Group (DRG) 690 – 10.05.12
- J15 Part A Claims Processing Issues Log – 10.05.12
- System Issues with Occurrence Code 55 – 10.05.12
- Reporting Multiple Outpatient Visits that Occur the Same Day – 10.04.12
- Reason Code 11503 – 10.04.12
- Revised: New Fiscal Intermediary Shared System (FISS) Consistency Edit to Validate Attending Physician National Provider Identifier (NPI) - MLN Matters PDF Document MM7902 – 10.04.12
- October 2012 Integrated Outpatient Code Editor (I/OCE) Specifications Version 13.3 - MLN Matters PDF Document MM8035 – 10.04.12
- Influenza Vaccine Payment Allowances: Annual Update for 2012 - 2013 Season - MLN Matters PDF Document MM8047 – 10.04.12
- Annual Clotting Factor Furnishing Fee Update 2013 - MLN Matters PDF Document MM8049 – 10.04.12
- CMS e-News: October 4, 2012 – 10.04.12
- Attention myCGS Users! – 10.03.12
- CMS Quarterly Provider Update – 10.02.12
- Provider Contact Center will be closed October 19, 2012 from 10:15 a.m. to 12:15 p.m. ET – 10.02.12
- Revised: Manual Medical Review of Therapy Services - MLN Matters PDF Document MM8036 – 10.02.12
- Revised: Systematic Validation of Payment Group Codes for Prospective Payment Systems (PPS) Based on Patient Assessments - MLN Matters PDF Document MM7760 – 10.02.12
- Revised: National Coverage Determination (NCD) for Transcatheter Aortic Valve Replacement (TAVR) - MLN Matters PDF Document MM7897 – 10.02.12
- EDI Requirements for Paperwork (PWK) Implementation – 10.01.12
September 2012
- Reminder - Quarterly Release Temporary Hold – 09.28.12
- The October 2012 Jurisdiction 15 Part A (J15 Part A) Medicare Bulletin is now available – 09.28.12
- New CMS Edits Effective October 1, 2012 – 09.28.12
- Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy Print (MREP) and PC Print Update - MLN Matters PDF Document MM7775 – 09.27.12
- Revised: Important Reminders about HIPAA 5010 & D.0 Implementation - MLN Matters PDF Document SE1106 – 09.27.12
- Revised: Important Update Regarding 5010/D.0 Implementation: Action Needed Now - MLN Matters PDF Document SE1131 – 09.27.12
- Revised: Extracorporeal Photopheresis (ICD-10) - MLN Matters PDF Document MM7806 – 09.27.12
- Medicare Fee-For-Service Version 5010 Specialty Types Transition Information – 09.27.12
- Updated ICD-10 Implementation Information - MLN Matters PDF Document SE1239 – 09.27.12
- Partial Code Freeze Prior to ICD-10 Implementation - MLN Matters PDF Document SE1240 – 09.27.12
- CMS e-News: September 26, 2012 – 09.27.12
- Revised: Non-Specific Procedure Code Description Requirement for HIPAA Version 5010 Claims - MLN Matters PDF Document SE1138 – 09.27.12
- Versions 5010 and D.0: Important Medicare Fee-for-Service Statement – 09.27.12
- Not Otherwise Classified (NOC) Code Set Website – 09.27.12
- Provider Contact Center will be closed October 19, 2012 from 10:15 a.m. to 12:15 p.m. ET – 09.26.12
- Skin Substitute- Apligraf Update – 09.26.12
- myCGS: O vs. 0 – 09.26.12
- Medicare's Prior Authorization for Power Mobility Devices Demonstration CMS Teleconference: September 26 – 09.25.12
- Manual Medical Review of Therapy Claims CMS Teleconference: September 26 – 09.25.12
- International Classification of Diseases, 10th Edition (ICD-10) Conversion from ICD-9 and Related Code Infrastructure of the Medicare Shared Systems as They Relate to CMS National Coverage Determinations (NCDs) (CR 1 of 3) - MLN Matters PDF Document MM7818 – 09.25.12
- Provider Contact Center will be closed October 19, 2012 from 10:15 a.m. to 12:15 p.m. ET – 09.25.12
- J15 Part A Claims Processing Issues Log – 09.25.12
- Therapy Caps Ask-the-Contractor Teleconference (ACT): Part A – 09.25.12
- Revised: Phase 2 of Ordering/Referring Requirement - MLN Matters PDF Document SE1221 – 09.24.12
- Erythropoiesis Stimulating Agents (ESA) L31867 – 09.24.12
- Cardiac Rehabilitation: Coverage and Documentation Requirements – 09.24.12 - Revised: 12.26.12
- myCGS is Currently Unavailable – 09.24.12
- Edits on the Ordering/Referring Providers in Medicare Part B, DME and Part A HHA Claims (Change Requests 6417, 6421, 6696 and 6856) - MLN Matters PDF Document SE1011 – 09.21.12
- MOHs Micrographic Surgery L31877 – 09.21.12
- CMS e-News for Wednesday, September 19, 2012 – 09.20.12
- GPNet Alert! – 09.19.12
- Important Information Concerning the Medicare Crossover Process and State Medicaid Agency Requirements for National Drug Codes (NDCs) Associated with Physician-Administered Part B Drugs - MLN Matters PDF Document SE1234 – 09.19.12
- Documenting Medical Necessity for Major Joint Replacement (Hip and Knee) - MLN Matters PDF Document SE1236 – 09.19.12
- 2013 Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Update - MLN Matters PDF Document MM8037 – 09.19.12
- Revised: Contractor and Common Working File (CWF) Additional Instructions Related to Change Request (CR) 7633 - Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse - MLN Matters PDF Document MM7791 – 09.19.12
- Claim Status Category and Claim Status Codes Update - MLN Matters PDF Document MM8045 – 09.19.12
- Clarification: Coverage Guidelines for Positron Emission Tomography (PET) and Computed Tomography (CT) Scans – 09.19.12
- ICD-9-CM Coordination and Maintenance Committee Materials and Long-Term Care Hospital Announcements and Updates – 09.18.12
- Jurisdiction 5 Part A and Part B Medicare Administrative Contractor (J5 A/B MAC) Reprocurment Awarded – 09.17.12
- Ask-the-Contractor Teleconference: Part A Therapy Caps – 09.17.12
- J15 Part A Claims Processing Issues Log – 09.14.12
- Probe Edit Medical Review of Cardiac Arrhythmia Diagnosis Related Group Diagnosis Related Group (DRG) 308, 309 and 310 – 09.14.12
- CMS e-News for Wednesday, September 12, 2012 – 09.13.12
- 5010 Remittance Advice (835) Companion Guide Update – 09.13.12
- Updates to IRIS Software – 09.13.12
- Completion of Inpatient Lung Biopsy (Procedure Code 33.27) – 09.13.12
- Probe Edit Medical Review of Percutaneous Transluminal Coronary Angioplasty (PTCA) with Stent, Diagnosis Related Group Diagnosis Related Group (DRG) 246-249 – 09.13.12
- Revised: Extracorporeal Photopheresis (ICD-10) - MLN Matters PDF Document MM7806 – 09.11.12
- Remittance Advice Remark Code (RARC) and Claim Adjustment Reason Code (CARC) Update – 09.11.12
- Ask the Contractor Teleconference on September 13: Rescheduled – 09.11.12
- Announcing…..myCGS! – 09.11.12
- September 13, 2012, J15 Part A Ask-the-Contractor Teleconference (ACT) – Provider Enrollment and Revalidation – 09.10.12
- Ordering and Certifying Documentation - Maintenance Requirements - MLN Matters PDF Document MM7890 – 09.10.12
- Fiscal Year (FY) 2013 Inpatient Prospective Payment System (IPPS), Long Term Care Hospital (LTCH) PPS Changes - MLN Matters PDF Document MM8041 – 09.10.12
- Manual Medical Review of Therapy Services - MLN Matters PDF Document MM8036 – 09.07.12
- Therapy Cap Exception – 09.07.12
- CMS e-News: September 5, 2012 – 09.06.12
- Revisions of the Financial Limitation for Outpatient Therapy Services - Section 3005 of the Middle Class Tax Relief and Job Creation Act of 2012 – 09.06.12
- Electronic Medical Record Tips – 09.06.12
- 2013 Annual Update for the Health Professional Shortage Area (HPSA) Bonus Payments - MLN Matters PDF Document MM7883 – 09.06.12
- Leuprolide Acetate: HCPCS Codes J9217 and J9219 – 09.05.12
- Medicare Part B Outpatient Therapy Cap and Exceptions Process Extended Through December 31, 2012 – 09.05.12
- Revised: Prohibition on Balance Billing Qualified Medicare Beneficiaries (QMBs)- MLN Matters PDF Document SE1128 – 09.05.12
- Expiration of 2012 Therapy Cap Revisions and User-Controlled Mechanism to Identify Legislative Effective Dates - MLN Matters PDF Document MM7881 – 09.05.12
- New Fiscal Intermediary Shared System (FISS) Consistency Edit to Validate Attending Physician National Provider Identifier (NPI) - MLN Matters PDF Document MM7902 – 09.04.12
August 2012
- Urgent Update Needed for PC-ACE Pro 32 Users – 08.31.12
- October 2012 Update of the Hospital Outpatient Prospective Payment System (OPPS) - MLN Matters PDF Document MM8031 – 08.31.12
- The September 2012 Jurisdiction 15 Part A (J15 Part A) Medicare Bulletin is now available – 08.30.12
- CMS e-News: August 29, 2012 – 08.30.12
- PCC to Close on September 3rd for Labor Day: The J15 Part A Provider Contact Center (PCC) will be closed on Monday, September 3, 2012, in observance of Labor Day. The PCC will reopen on Tuesday, September 4 – 08.30.12
- Overpayment Letters: Look for Blue Envelopes – 08.30.12
- LCD for Transthoracic Echocardiography (TTE) – 08.30.12
- Update-Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) Fiscal Year 2013 - MLN Matters PDF Document MM8000 – 08.28.12
- Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC) and Medicare Remit Easy Print (MREP) and PC Print Update - MLN Matters PDF Document MM8029 – 08.28.12
- New Health Care Standards to Save up to $6 Billion – 08.28.12
- J15 Part A Claims Processing Issues Log – 08.28.12
- National Provider Call: Stage 2 Requirements for the Medicare and Medicaid EHR Incentive Programs – Save the Date – 08.24.12
- Inpatient Prospective Payment System PC Pricer Updated – 08.23.12
- Provider Contact Center Training and Holiday Closure Schedule – 08.23.12
- CMS e-News for Wednesday, August 22, 2012 – 08.23.12
- myCGS: Some Remittance Advices (RAs) May Not Be Available – 08.23.12
- Version 5010 Remittance Advice (835) Companion Guide Update – 08.22.12
- New webinar: Comprehensive Error Rate Testing (CERT) Program – CGS Facts and Findings from Recent Medicare Audits. Register now on the Part A Kentucky or Part A Ohio webinar pages. – 08.22.12
- Registration Now Open for DMEPOS Competitive Bidding – 08.20.12
- J15 Part A Claims Processing Issues Log – 08.20.12
- Revised: National Coverage Determination (NCD) for Transcatheter Aortic Valve Replacement (TAVR) - MLN Matters PDF Document MM7897 – 08.17.12
- Inpatient Rehabilitation Facility (IRF) Annual Update: Prospective Payment System (PPS) Pricer Changes for Fiscal Year (FY) 2013 - MLN Matters PDF Document MM7901 – 08.17.12
- CMS Announces Timeline for DMEPOS Competitive Bidding Round 1 Recompete; Begins Bidder Education Program – 08.17.12
- 90-Day Period of Enforcement Discretion for Compliance with New HIPAA Transaction Standards – 08.17.12
- Addition of Digital Document Repository to Provider Enrollment Chain and Ownership System (PECOS) - MLN Matters PDF Document SE1230 – 08.16.12
- Special Open Door Forum Series: IRF Quality Reporting Program Thursday, August 16, 1-2:30pm ET – 08.16.12
- CMS e-News: August 15, 2012 – 08.16.12
- Reducing Medicare and Medicaid Fraud and Abuse: Protecting Practices and Patients – 08.16.12
- How CMS Is Fighting Fraud: Major Program Integrity Initiatives – 08.16.12
- August 16 Special Open Door Forum for Long-Term Care Hospital Providers – Rescheduled for August 30 – 08.16.12
- Additional Document Request (ADR) Barcode Enhancement – 08.15.12
- Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Low Back Pain (CLBP) - MLN Matters PDF Document MM7836 – 08.15.12
- Revised: Clarification of Medicare Conditional Payment Policy and Billing Procedures for Liability, No-Fault and Workers' Compensation (WC) Medicare Secondary Payer (MSP) Claims - MLN Matters PDF Document MM7355 – 08.15.12
- Liver Transplantation for Patients with Malignancies - MLN Matters PDF Document MM7908 – 08.15.12
- National Coverage Determination (NCD) for Transcatheter Aortic Valve Replacement (TAVR) - MLN Matters PDF Document MM7897 – 08.15.12
- Category III CPT Code Updates – 08.14.12
- J15 Part A Claims Processing Issues Log – 08.14.12
- Payment of Global Surgical Split-Care in a Method II Critical Access Hospital (CAH) Submitted with Modifier 54 and/or 55 - MLN Matters PDF Document MM7872 – 08.13.12
- October 2012 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files - MLN Matters PDF Document MM7885 – 08.13.12
- Overpayment Letters: Look for Blue Envelopes – 08.10.12
- J15 Part A Claims Processing Issues Log – 08.10.12
- Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Pricer Update Fiscal Year (FY) 2013 - MLN Matters PDF Document MM7907 – 08.09.12
- Complex Medical Review of Kidney & Urinary Tract Infections W/O MCC Diagnosis Related Group (DRG) 690 – 08.09.12
- Claim Status Category and Claim Status Codes Update - MLN Matters PDF Document MM7905 – 08.09.12
- CMS e-News: August 8, 2012 – 08.09.12
- Complex Medical Review of Syncope and Collapse Diagnosis Related Group Diagnosis Related Group (DRG) 312 – 08.09.12
- CMS Quarterly Provider Update – 08.08.12
- Experiencing Duplicate Files or Missing Data? – 08.06.12
- Medicare Shared Savings Program Electronic Application Process through Health Plan Management System Call – 08.03.12
- J15 Part A Claims Processing Issues Log – 08.03.12
- CMS e-News: August 1, 2012 – 08.02.12
- Corrections to the Skilled Nursing Facility Consolidated Billing File for Healthcare Common Procedure Coding System Code J9033 – 08.02.12
- Remit Alert! Reminder to EDI Electronic
Remit Receivers. Your remits posted to your mailbox are only available
for 14 days. Be sure to download them immediately so reruns and restores
are not necessary at the end of the month. — 08.02.12
- Complex Medical Review of Outpatient Pulmonary Rehabilitation, Including Exercise (Includes Monitoring), One Hour, Therapeutic, Prophylactic or Diagnostic (G0424) – 08.02.12
- Probe Medical Review of Medical Back Problems without MCC Diagnosis Related Group (DRG) 552 – 08.01.12
- 0308T added to Category III Coverage Article A50740 – 08.01.12
July 2012
- Complex Medical Review of Outpatient Pulmonary Rehabilitation, including exercise (includes monitoring), one hour, therapeutic, prophylactic, or diagnostic (G0424) – 07.31.12
- ERS Reminder – 07.31.12
- J15 Part A Claims Processing Issues Log – 07.31.12
- Revisions of the Financial Limitation for Outpatient Therapy Services – Section 3005 of the Middle Class Tax Relief and Job Creation Act of 2012 - MLN Matters PDF Document MM7785 – 07.31.12
- Complex Medical Review of Outpatient Pulmonary Rehabilitation, Including Exercise (Includes Monitoring), One Hour, Therapeutic, Prophylactic or Diagnostic (G0424) – 07.30.12
- The August 2012 Jurisdiction 15 Part A (J15 Part A) Medicare Bulletin is now available – 07.30.12
- Revised: Reporting of Recoupment for Overpayment on the Remittance Advice (RA) with Patient Control Number - MLN Matters PDF Document MM7499 – 07.27.12
- Update to Hospice Payment Rates, Hospice Cap, Hospice Wage Index and the Hospice Pricer for FY 2013 - MLN Matters PDF Document MM7857 – 07.27.12
- Category III CPT Code Covered Article A50740 Update for LCD L31832 – 07.27.12
- CGS Retirement of Local Coverage Determinations – 07.26.12
- Collagen Implantation for Urinary Incontinence – 07.25.12
- J15 Part A Claims Processing Issues Log – 07.25.12
- Release of SSI Ratio and Cost Report Settlement – 07.25.12
- CGS Administrator LLC Contractor Number – 07.24.12
- Complex Medical Review of Circulatory Disorders Diagnosis Related Group (DRG 287) – 07.23.12
- Complex Medical Review of Cellulitis without MCC (MS Diagnosis Related Group [DRG] 603) Short Stay Dates of Service – 07.23.12
- Inpatient Service Specific Review of Short Stays Diagnosis Related Group (DRG) for Heart Failure and Shock without CC/MCC (DRG 293) – 07.23.12
- Inpatient Service Specific Review of Short Stays Diagnosis Related Group (DRG) for Percutaneous Cardiovascular Procedure without Coronary Artery Stent without MCC (DRG 251) – 07.23.12
- Revised: Pulmonary Rehabilitation (PR) Services - MLN Matters PDF Document MM6823 – 07.20.12
- Proposed Rule Related to the Inpatient Rehabilitation Facility Quality Reporting Program Update – 07.20.12
- Complex Medical Review of Outpatient Pulmonary Rehabilitation, Including Exercise (Includes Monitoring), One Hour, Therapeutic, Prophylactic, or Diagnostic – 07.17.12
- Complex Medical Review of Outpatient Cardiac Rehabilitation with Continuous ECG Monitoring (93798) – 07.17.12
- Revised: Pulmonary Rehabilitation (PR) Services - MLN Matters PDF Document MM6823 – 07.13.12
- Revised: Extracorporeal Photopheresis (ICD-10) - MLN Matters PDF Document MM7806 – 07.13.12
- J15 Part A Claims Processing Issues Log – 07.13.12
- MAXIMUS Federal Services: Qualified Independent Contractor (QIC) for Part A East and West Jurisdictions – 07.12.12
- Notice of New Interest Rate for Medicare Overpayments and Underpayments – 07.12.12
- Implementation of the Paperwork Segment within the 5010 837 Professional and Institutional Electronic Transactions – 07.09.12
- Revised: Reporting of Recoupment for Overpayment on the Remittance Advice (RA) with Patient Control Number - MLN Matters PDF Document MM7499 – 07.06.12
- The Supplemental Security Income (SSI) Ratios for Fiscal Year (FY) 2006 through FY 2009 for Inpatient Prospective Payment System (IPPS) Hospitals, Inpatient Rehabilitation Facilities (IRFs), and Long Term Care Hospitals (LTCHs) - MLN Matters PDF Document SE1225 – 07.06.12
- 5010 Tip of the Day – 07.05.12
- Revised: IDE Request Requirements Form – 07.03.12
- 5010 Tip of the Day – 07.02.12
June 2012
- J15 Part A Claims Processing Issues Log – 06.29.12
- 5010 Tip of the Day – 06.29.12
- May 31, 2012, J15 Part A Ask the Contractor Teleconference (ACT) Questions and Answers – 06.29.12
- The July 2012 Jurisdiction 15 Part A (J15 Part A) Medicare Bulletin is now available. – 06.29.12
- Immediate Offset Changes – 06.28.12
- Revised: Contractor and Common Working File (CWF) Additional Instructions Related to Change Request (CR) 7633 - Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse - MLN Matters PDF Document MM7791 – 06.27.12
- 5010: Are You Ready? – 06.27.12
- 5010 Tip of the Day – 06.27.12
- Don't Forget to Register for the CGS Jurisdiction 15 (J15) Part A Summer Workshop Series – 06.22.12
- Ohio and Kentucky Part Ask the Contractor Teleconference (ACT) Schedule: July 2012 - January 2013 – 06.22.12
- J15 Part A Claims Processing Issues Log – 06.22.12
- Revised: Important Reminders about HIPAA 5010 & D.0 Implementation - MLN Matters PDF Document SE1106 – 06.21.12
- Revised: Edits on the Ordering/Referring Providers in Medicare Part B, DME and Part A HHA Claims (Change Requests 6417, 6421, 6696 and 6856) - MLN Matters PDF Document SE1011 – 06.21.12
- Changes to the Hospice Aggregate Cap Calculation Method - MLN Matters PDF Document MM7838 – 06.21.12
- Revised: Important Update Regarding 5010/D.0 Implementation: Action Needed Now - MLN Matters PDF Document SE1131 – 06.21.12
- Phase 2 of Ordering and Referring Requirement - MLN Matters PDF Document SE1221 – 06.21.12
- Inpatient Service Specific Complex Review of Short Stays Diagnosis Related Group (DRG) for Chest Pain and Atherosclerosis (DRG Codes 302, 303 and 313) – 06.20.12
- CGS Fax Lines – 06.20.12
- 5010 Tip Of The Day - Anesthesia Claims – 06.20.12
- Inpatient Service Specific Complex Review of Short Stays Diagnosis Related Group (DRG) for Nutritional Metabolic (DRG Codes 640 and 641) – 06.20.12
- Medicare Fee-For-Service Version 5010 Specialty Types Transition Information – 06.19.12
- The May 10, 2012, J15 Part A (J15 Part A) Ask-the-Contractor Teleconference Questions and Answers are now available – 06.19.12
- 5010 Tip Of The Day - Line Item Control Number – 06.19.12
- J15 Part A Claims Processing Issues Log – 06.15.12
- Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, Updated Manual Instructions - MLN Matters PDF Document MM7821 – 06.15.12
- Additional Dates and Locations Added to the CGS Jurisdiction 15 (J15) Part A Summer Workshop Series – 06.15.12
- Appeals for Denied Claims Submitted by an Ordering and Referring Opt-out Physician/Non-physician Practitioners Who Are Excluded by the Office of Inspector General (OIG) - MLN Matters PDF Document SE1223 – 06.14.12
- Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) - MLN Matters PDF Document MM7863 – 06.14.12
- July 2012 Update of the Hospital Outpatient Prospective Payment System - MLN Matters PDF Document MM7847 – 06.13.12
- 5010 Tip of the Day: P.O. Boxes – 06.12.12
- J15 Part A Claims Processing Issues Log – 06.12.12
- 5010 Tip Of The Day - Nine Digit Zip Codes – 06.11.12
- July Update to the CY 2012 Medicare Physician Fee Schedule Database (MPFSDB) - MLN Matters PDF Document MM7844 – 06.08.12
- Extracorporeal Photopheresis (ICD-10) - MLN Matters PDF Document MM7806 – 06.08.12
- J15 Part A Claims Processing Issues Log – 06.08.12
- IMPORTANT: 5010 Electronic Claim Submission – 06.06.12
- Revised: New Occurrence Code to Report Date of Death - MLN Matters PDF Document MM7792 – 06.05.12
- J15 Part A Claims Processing Issues Log – 06.01.12
- Revised: Clarification of Medicare Conditional Payment Policy and Billing Procedures for Liability, No-Fault and Workers' Compensation (WC) Medicare Secondary Payer (MSP) Claims - MLN Matters PDF Document MM7355 – 06.01.12
- Modifying the Timely Filing Exceptions on Retroactive Medicare Entitlement and Retroactive Medicare Entitlement Involving State Medicaid Agencies - MLN Matters PDF Document MM7834 – 06.01.12
May 2012
- Revised: Screening for Sexually Transmitted Infections (STIs) and High Intensity Behavioral Counseling (HIBC) to Prevent STIs - MLN Matters PDF Document MM7610 – 05.31.12
- Revised: Examining the Difference between a National Provider Identifier (NPI) and a Provider Transaction Access Number (PTAN) - MLN Matters PDF Document SE1216 – 05.31.12
- Inpatient Service Specific Complex Review of Short Stay Diagnosis Related Group (DRG) for Cardiac Arrhythmia (DRG Codes 308, 309 and 310) – 05.31.12
- Inpatient Service Specific Complex Review of Short Stays Diagnosis Related Group (DRG) for Esophagitis Gastroenteritis (DRG Codes 391 and 392) – 05.31.12
- Complex Medical Review of Outpatient Cardiac Rehabilitation with Continuous ECG Monitoring (93798) – 05.31.12
- The June 2012 Jurisdiction 15 Part A (J15 Part A) Medicare Bulletin is now available. – 05.31.12
- October 2012 Quarterly Update for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP) - MLN Matters PDF Document MM7768 – 05.25.12
- J15 Part A Claims Processing Issues Log – 05.25.12
- The Summer 2012 edition of the EDI Connection is now available – 05.25.12
- New Short-Term (ST) PEPPER Now Available – 05.24.12
- Tips for Resolving Reason Code 15202 - Units of Service Edit – 05.23.12
- Clarification of Medicare Conditional Payment Policy and Billing Procedures for Liability, No-Fault and Workers' Compensation (WC) Medicare Secondary Payer (MSP) Claims – MLN Matters PDF Document MM7355 – 05.23.12
- Negative Pressure Wound Therapy (NPWT) Interpretive Guidelines - MLN Matters PDF Document SE1222 – 05.22.12
- Revised: Reporting of Recoupment for Overpayment on the Remittance Advice (RA) with Patient Control Number - MLN Matters PDF Document MM7499 – 05.22.12
- Completion of Inpatient Service Specific Review of Short Stays Diagnosis Related Group (DRG) for Septicemia (DRG Codes 870, 871 and 872) – 05.22.12
- Examining the Difference between a National Provider Identifier (NPI) and a Provider Transaction Access Number (PTAN) - MLN Matters PDF Document SE1216 – 05.22.12
- July 2012 Integrated Outpatient Code Editor (I/OCE) Specifications Version 13.2 - MLN Matters PDF Document MM7841 – 05.21.12
- LCD for Polysomnography &Sleep Studies Revised – 05.21.12
- July Quarterly Update for 2012 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule - MLN Matters PDF Document MM7822 – 05.18.12
- J15 Part A Claims Processing Issues Log – 05.18.12
- Medicare Billing Regulations in Relation to Inpatient Only Procedures Administered in an Outpatient Setting – 05.17.12
- Hospice Cap Calculations and Resumption of Aggregate Cap Calculation – 05.17.12
- J15 Part A Claims Processing Issues Log – 05.15.12
- Systematic Validation of Payment Group Codes for Prospective Payment Systems (PPS) Based on Patient Assessments - MLN Matters PDF Document MM7760 – 05.15.12
- Hints for Submitting Medical ADR (Additional Documentation Requests) or Appeal Requests – 05.14.12
- CGS J-15 A/B MAC to No Longer Require the Use of the –JW modifier to Track Drug Wastage – 05.11.12
- Revisions of the Financial Limitation for Outpatient Therapy Services - Section 3005 of the Middle Class Tax Relief and Job Creation Act of 2012 - MLN
Matters PDF Document MM7785 – 05.11.12
- New Fiscal Intermediary Shared System (FISS) Edit to Review Medicare Outpatient Prospective Payment System (OPPS) Payments Exceeding Charges - MLN
Matters PDF Document MM7771 – 05.11.12
- CGS Retirement of Local Coverage Determinations – 05.11.12
- Retiring the Bariatric Surgery LCD – 05.11.12
- New Influenza Virus Vaccine Code - MLN
Matters PDF Document MM7794 – 05.09.12
- J15 Part A Claims Processing Issues Log – 05.09.12
- REVISED: Allowing Physician Assistants to Perform Skilled Nursing Facility (SNF) Level of Care Certifications and Recertifications - MLN
Matters PDF Document MM7701 – 05.09.12
- Update to the Fiscal Intermediary Shared Systems (FISS) Processing for the End Stage Renal Disease (ESRD) Quality Incentive Program (QIP) for Children's Hospitals - MLN
Matters PDF Document MM7798 – 05.07.12
- Ensuring Hospice Certifying Physician Identifiers Are Fully Processed - MLN
Matters PDF Document MM7755 – 05.07.12
- Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes – July 2012 Update - MLN
Matters PDF Document MM7831 – 05.04.12
- Modification to CWF, FISS, MCS and VMS to Return Submitted Information When There is a CWF Name and HIC Number Mismatch - MLN
Matters PDF Document MM7260 – 05.04.12
- Anesthesiologist Services with a Modifier GC in a Method II Critical Access Hospital (CAH) - MLN
Matters PDF Document MM7764 – 05.04.12
- Inpatient Service Specific Complex Review of Short Stay Diagnosis Related Group (DRG) for Cardiac Arrhythmia (DRG Codes 308, 309 and 310) – 05.04.12
- Inpatient Service Specific Complex Review of Short Stay Diagnosis Related Group (DRG) for PTCA with Stent (DRG Codes 246, 247, 248 and 249) – 05.04.12
- REVISED: Revised Editing for Hepatitis B Administration Code G0010 - MLN
Matters PDF Document MM7692 – 05.03.12
- Hospital Dialysis Services for Patients with and without End-Stage Renal Disease (ESRD) - MLN
Matters PDF Document MM7762 – 05.02.12
- Contractor and Common Working File (CWF) Additional Instructions Related to Change Request (CR) 7633 - Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse - MLN
Matters PDF Document MM7791 – 05.02.12
- New Occurrence Code to Report Date of Death - MLN
Matters PDF Document MM7792 – 05.02.12
- Temporary Directions to Accommodate Organ Donor Complications Billing on 837I Claims - MLN
Matters PDF Document MM7816 – 05.02.12
- New Influenza Virus Vaccine Code - MLN
Matters PDF Document MM7794 – 05.02.12
- J15 Part A Claims Processing Issues Log – 05.02.12
- Don't Forget to Attend the May 10, 2012, Jurisdication 15 Part A (J15 Part A) Ask-the-Contractor Teleconference (ACT) - Specialty Topic: Medical Review – 05.02.12
April 2012
March 2012
February 2012
- The March 2012 issue of the Medicare Bulletin is now available – 02.29.12
- President Obama Signs the Middle Class Tax Relief and Job Creation Act of 2012 - New Law Includes Physician Update Fix through December 2012 – 02.29.12
- Automatic Reprocessing of Specific Long-Term Care Hospital Short Stay Outlier Claims – 02.29.12
- Fiscal Intermediary Shared System (FISS) and Common Working File (CWF) System Enhancement for Storing Line Level Rendering Physicians/Practitioners National Provider Identifier (NPI) Information - MLN
Matters PDF Document MM7578 – 02.29.12
- Revised: The Role of the Zone Program Integrity Contractors (ZPICs), Formerly the Program Safeguard Contractors (PSCs) - MLN
Matters PDF Document SE1204 – 02.29.12
- Recovery Auditors Findings Resulting from Medical Necessity Reviews of Renal and Urinary Tract Disorders - MLN
Matters PDF Document SE1210 – 02.28.12
- Revised: Updates to the Internet Only Manual Publication 100-04, Chapter 15: Ambulance to include Medicare and Medicaid Extenders Act of 2010 (MMEA) Provisions - MLN
Matters PDF Document MM7558 – 02.28.12
- Revised: January 2012 Update of the Hospital Outpatient Prospective Payment System (OPPS) - MLN
Matters PDF Document MM7672 – 02.28.12
- Revised: Summary of Policies in the Calendar Year (CY) 2012 Medicare Physician Fee Schedule (MPFS) Final Rule and the Telehealth Originating Site Facility Fee Payment Amount - MLN
Matters PDF Document MM7671 – 02.28.12
- The Winter 2012 edition of the EDI Connection is now available – 02.28.12
- Revised: Additional Provider and Supplier Enrollment Requirements for Fixed Wing and Helicopter Air Ambulance Operators - MLN
Matters PDF Document MM7363 – 02.27.12
- Revisd: The Role of the Zone Program Integrity Contractors (ZPICs), Formerly the Program Safeguard Contractors (PSCs) - MLN
Matters PDF Document SE1204 – 02.27.12
- Important Information About Your Clearinghouse – 02.27.12
- Part A to Part B Rebilling Demonstration – 02.24.12
- Revised: Intensive Behavioral Therapy (IBT) for Obesity - MLN
Matters PDF Document MM7641 – 02.24.12
- Important Information for Institutional Providers Regarding the Billing of Hospital Outpatient and Inpatient Ancillary Services – 02.24.12
- New Short-Term (ST) PEPPER Now Available – 02.24.12
- Medicare Medical Records: Signature Requirements, Acceptable and Unacceptable Practices – 02.23.12
- Appeals, Adjustments and the D9 Claim Change Reason (Condition) Code – 02.23.12
- Probe Medical Review of Cellulitis without Major Complaints Co-morbidities (MCC) (MS DRG 603) Short Stay Dates of Service Less than Three Days – 02.22.12
- Revised: Immediate Recoupment for Fee for Service Claims Overpayments - MLN
Matters PDF Document MM7688 – 02.20.12
- Screening for Sexually Transmitted Infections (STIs) and High Intensity Behavioral Counseling (HIBC) to Prevent STIs - MLN
Matters PDF Document MM7610 – 02.20.12
- Payment Alert! 5010 is Here. Are you ready? – 02.20.12
- Intensive Behavioral Therapy (IBT) for Obesity - MLN
Matters PDF Document MM7641 – 02.17.12
- Common Working File (CWF) Dark Day: February 18, 2012 – 02.17.12
- J15 Part A Claims Processing Issues Log – 02.17.12
- Inpatient Rehabilitation Facility (IRF) No-Pay Billing for Medicare Advantage (MA) Patients Update - MLN
Matters PDF Document MM7674 – 02.16.12
- Inpatient Service Specific Probe Review of Short Stays (less than Three Days) for Excisional Debridement (Procedure Code 86.22) – 02.15.12
- Updating Beneficiary Information with the Coordination of Benefits Contractor (COBC) - MLN
Matters PDF Document SE1205 – 02.14.12
- J15 Part A Claims Processing Issues Log – 02.13.12
- Denosumab (Prolia, Xgeva) Update – 02.10.12
- Probe Medical Review of Outpatient Cardiac Rehabilitation with Continuous ECG Monitoring (93798) – 02.10.12
- Probe Medical Review of Outpatient Pulmonary Rehabilitation, Including Exercise (includes monitoring), One Hour, Therapeutic, Prophylactic or Diagnostic (G0424) – 02.10.12
- DDE Password Changes Effective February 12, 2012 – 02.10.12
- Revised: Update to Abortion Condition Codes Associated With Reason Code 32809 - MLN
Matters PDF Document MM7687 – 02.09.12
- Electronic Prescribing (eRx) Incentive Program Updates – 02.09.12
- International Classification of Diseases: 10th Edition (ICD-10), Inclusion of Type of Bill 33X - MLN
Matters PDF Document MM7704 – 02.09.12
- LCD for Scanning Computerized Ophthalmic Revised – 02.09.12
- Chiropractic Services – 02.09.12
- Revised: Clarification for Skilled Nursing Facility (SNF) and Swing Bed (SB) Part A Billing Updating System Requirements for Assessment Date Reporting and Removal of the Occurrence Code 16 Reporting Requirement - MLN
Matters PDF Document MM7717 – 02.08.12
- Update to Publication 100-04, 'Medicare Claims Processing Manual,' Chapter 3: Inpatient Hospital Billing - MLN
Matters PDF Document MM7706 – 02.07.12
- Probe Medical Review of Inpatient Closed Endoscopic Biopsy of Lung – 02.07.12
- Probe Medical Review of Inpatient Principal Diagnosis for Other and Unspecified Coagulation Defect – 02.07.12
- Revised: Announcement of Medicare Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Payment Rate Increases - MLN
Matters PDF Document MM7533 – 02.07.12
- Revised: Update to Abortion Condition Codes Associated With Reason Code 32809 - MLN
Matters PDF Document MM7687 – 02.07.12
- Revised: Medicare System Update to Include a Rendering Provider Field to Allow Correct Physician National Provider Identifier (NPI) Reporting for the Primary Care Incentive Program (PCIP) for Critical Access Hospitals (CAHs) Reimbursed Under the Optional Method - MLN
Matters PDF Document MM7686 – 02.06.12
- J15 Part A Claims Processing Issues Log – 02.03.12
- Determining Eligibility for the Medicare Health Professional Shortage Area Physician Bonus Payment – 02.03.12
- Common Working File (CWF) Dark Day: February 18, 2012 – 02.03.12
- Revised Editing for Hepatitis B Administration Code G0010 - MLN
Matters PDF Document MM7692 – 02.03.12
- January 13, 2012, Jurisdiction 15 (J15) Part A Provider Outreach and Education Advisory Group (POE-AG) Meeting Minutes – 02.032.12
- Revised: Claim Status Category and Claim Status Codes Update - MLN
Matters PDF Document MM7670 – 02.02.12
- Update to the Fiscal Year (FY) 2012 List of Codes Exempt from Reporting Present on Admission (POA) - MLN
Matters PDF Document MM7680 – 02.02.12
- Common Working File (CWF) Dark Day: February 18, 2012 – 02.02.12
- Jurisdiction 15 Part A/Articles/Renal Dialysis Facilities (RDF)/Cost Report Filing Extension for Independent Renal Dialysis Facilities - Form CMS-265-11 – 02.01.12
- Common Working File (CWF) Dark Day: February 18, 2012 – 02.01.12
- Clarification for Skilled Nursing Facility (SNF) and Swing Bed (SB) Part A Billing Updating System Requirements for Assessment Date Reporting and Removal of the Occurrence Code 16 Reporting Requirement - MLN
Matters PDF Document MM7717 – 02.01.12
- Probe Medical Review of Inpatient Continuous Invasive Mechanical Ventilation for 96 Consecutive Hours or More – 02.01.12
- Multiple Procedure Payment Reduction (MPPR) for Physician Services for Certain Diagnostic Imaging Procedures in Critical Access Hospitals (CAHs) - MLN
Matters PDF Document MM7684 – 02.01.12
January 2012
- REVISED: Additional Provider and Supplier Enrollment Requirements for Fixed Wing and Helicopter Air Ambulance Operators - MLN
Matters PDF Document MM7363 –
01.31.12
- April 2012 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files - MLN
Matters PDF Document MM7734 –
01.31.12
- Medicare System Update to Include a Rendering Provider Field to Allow Correct Physician National Provider Identifier (NPI) Reporting for the Primary Care Incentive Program (PCIP) for Critical Access Hospitals (CAHs) Reimbursed Under the Optional Method - MLN
Matters PDF Document MM7686 –
01.31.12
- The February 2012 Jurisdiction 15 Part A (J15 Part A) Medicare Bulletin is now available. –
01.31.12
- Top Five EDI Application Errors –
01.31.12
- Iron Sucrose, Iron Dextran and Ferumoxytol, (Intravenous Iron Therapy) Update –
01.31.12
- Revised: Claim Status Category and Claim Status Codes Update - MLN
Matters PDF Document MM7670 –
01.30.12
- Inpatient Rehabilitation Facility (IRF) No-Pay Billing for Medicare Advantage (MA) Patients Update - MLN
Matters PDF Document MM7674 –
01.30.12
- Updates to 'Intern and Resident Information System (IRIS)' Software –
01.30.12
- Revised: Instructions
to Teaching Hospitals for Reporting the Internal Revenue Service (IRS)
Refund of Medical Resident FICA Taxes - MLN
Matters PDF Document MM7685 –
01.30.12
- Emergency Update to the CY 2012 Medicare Physician Fee Schedule Database (MPFSDB) - MLN Matters PDF Document MM7737 – 01.27.12
- ATTENTION VERSION 4010A1 SUBMITTERS! – 01.27.12
- Balloon Sinusplasty in the Physician Office – 01.27.12
- J15 Part A Claims Processing Issues Log – 01.26.12
- LCD for Polysomnography &Sleep Studies Revised – 01.24.12
- REVISED: Provider-Based: General Information – 01.24.12
- HPSA Surgical Incentive Payment (HSIP) CMS Web Site – 01.24.12
- Fiscal Intermediary Standards System (FISS) Claims Processing Updates For Ambulance Services - MLN Matters PDF Document MM7557 – 01.24.12
- Direct Data Entry (DDE) Eligibility Information Option Issue – 01.24.12
- Allowing Physician Assistants to Perform Skilled Nursing Facility (SNF) Level of Care Certifications and Recertifications - MLN Matters PDF Document MM7701 – 01.20.12
- Non-Specific Procedure Code Description Requirement for HIPAA Version 5010 Claims - MLN Matters PDF Document SE1138 – 01.20.12
- J15 Part A Claims Processing Issues Log – 01.20.12
- Revalidation Initiative: Frequently Asked Questions (FAQs) – 01.20.12
- Revised: Fiscal Intermediary Standards System (FISS) Claims Processing Updates For Ambulance Services - MLN Matters PDF Document MM7557 – 01.20.12
- Reporting of Recoupment for Overpayment on the Remittance Advice (RA) with Patient Control Number - MLN Matters PDF Document MM7499 – 01.20.12
- Additional Health Insurance Portability and Accountability Act (HIPAA) 837 5010 Transitional Changes and Further Modifications to the Coordination of Benefits Agreement (COBA) National Crossover Process - MLN Matters PDF Document SE1137 – 01.20.12
- Information for Outpatient Prospective Payment System Providers Regarding the Billing of CPT Code 33249 – 01.19.12
- Notice of New Interest Rate for Medicare Overpayments and Underpayments: Second Notification for FY 2012 – 01.19.12
- J15 Part A Claims Processing Issues Log – 01.13.12
- Health Professional Shortage Area (HPSA) Bonus Payment Policy Reminders - MLN Matters PDF Document SE1202 – 01.13.12
- Revised: Autologous Cellular Immunotherapy Treatment of Metastatic Prostate Cancer - MLN Matters PDF Document MM7431 – 01.13.12
- Revised: Reminder - Quarterly
Release Temporary Hold Reminder - Quarterly Release Temporary Hold –
01.13.12
- Revised: Instructions
to Teaching Hospitals for Reporting the Internal Revenue Service (IRS)
Refund of Medical Resident FICA Taxes - MLN
Matters PDF Document MM7685 –
01.13.12
- Revised: Recovery
Audit Program: Medicare Administrative Contractor (MAC)-issued Demand
Letters - MLN Matters PDF Document MM7436 –
01.13.12
- Implementation of Reason
Codes 70033 and 70034 for Kentucky and Ohio Part A Providers –
01.12.12
- Instruction on Billing
for Non-covered Items/Services – 01.12.12
- Jurisdiction 15 Part
A/Learning Education/Job Aids/Appeals Adjustments and the D9 Claim
Change Reason (Condition) Code – 01.12.12
- Summary
of Policies in the Calendar Year (CY) 2012 Medicare Physician Fee Schedule
(MPFS) Final Rule and the Telehealth Originating Site Facility Fee
Payment Amount - MLN Matters PDF Document
MM7671 – 01.12.12
- Bundling
of Payments for Services Provided to Outpatients Who Later Are Admitted
as Inpatients: Three-Day Payment Window Policy and the Impact on Wholly
Owned or Wholly Operated Physician Offices -
MLN Matters PDF Document MM7502 – 01.12.12
- January
2012 Update of the Hospital Outpatient Prospective Payment System (OPPS) -
MLN Matters PDF Document MM7672 – 01.12.12
- Temporary Workaround for the Assessment Reference Date Reason Code
31742 for Skilled Nursing Facility and Swing Bed Claims –
01.11.12
- Use
of Revised Remittance Advice Remark Code (RARC) N103 When Denying Services
Furnished to Federally Incarcerated Beneficiaries -
MLN Matters PDF Document MM7678 – 01.11.12
- Kentucky J15 Part A (J15A) 2012 Medicare Physician Fee Schedules (MPFS)
Containing a Zero Percent (0%) Update – 01.11.12
- Ohio J15 Part A (J15A)
2012 Medicare Physician Fee Schedules (MPFS) Containing a Zero Percent
(0%) Update – 01.11.12
- HHS Adopts HIPAA Standard
for Electronic Funds Transfers/Remittance Advice – 01.10.12
- CMS Quarterly Provider
Update – 01.10.12
- Inpatient Service Specific
Review of Short Stays DRGs for Chest Pain and Atherosclerosis (DRG
Codes 302, 303 and 313) – 01.06.12
- Inpatient Service Specific
Review of Short Stays DRGs for Esophagitis Gastroenteritis (DRG Codes
391 and 392) – 01.06.12
- Inpatient Service Specific
Review of Short Stays DRGs for Nutritional Metabolic (DRG Codes 640
and 641) – 01.06.12
- Important Information About the
CGS IVR System: January 13 – 16, 2012 – 01.06.12
- Important Information About CGS
E-Mail Changes: January 13 – 16, 2012 – 01.06.12
- J15 Part A Claims Processing
Issues Log – 01.06.12
- Instructions
to Teaching Hospitals for Reporting the Internal Revenue Service (IRS)
Refund of Medical Resident FICA Taxes - MLN
Matters PDF Document MM7685 – 01.06.12
- President Obama Signs
the Temporary Payroll Tax Cut Continuation Act of 2011 - Revised –
01.05.12
- The acceptance of a voluntary refund as repayment for the claims specified
in no way affects or limits the rights of the Federal Government, or
any of its agencies or agents, to pursue any appropriate criminal, civil,
or administrative remedies arising from or relating to these or any other
claims. – 01.05.12
- President Obama Signs
the Temporary Payroll Tax Cut Continuation Act of 2011 –
01.04.12
- Additional Way to Submit
Medical Record Documentation: Update – 01.03.12
- Inpatient Service Specific
Review of Short Stay DRGs for Two-Day Stay for Cardiac Arrhythmia (DRG
Codes 308, 309 and 310) – 01.03.12
- Inpatient Service Specific
Review of Short Stays DRGs for Percutaneous Transluminal Coronary Angioplasty
(PTCA) with Stent (DRG Codes 246, 247, 248 and 249) – 01.03.12
- Recovery Auditor Prepay and
Power Mobility Device Demonstrations Web site – 01.03.12
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