Revised NCD list

Revised NCD list

This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to NCDs effective from January 2020 These NCD codes changes are the results of newly available code sets and coding revisions to NCDs released separately. The revised NCD codes lists are, NCD110.18 Aprepitant: Contractors shall add J9036 as covered effective July…

HCPCS Code Changes

HCPCS Code Changes

The HCPCS code set is updated on a quarterly basis. CR 11296 informs MACs and providers ofthe updated specific drug/biological HCPCS codes. The April 5, 2019, HCPCS file includes 10new HCPCS codes. Beginning on July 1, 2019, these HCPCS codes will be established andmay be used in submitting claims under Medicare effective for claims with…

Medicare deductible, coinsurance, and premium rates

Medicare deductible, coinsurance, and premium rates

The Centers for Medicare & Medicaid Services (CMS) issued the 2016 deductibles, coinsurance, and premium rates for beneficiaries covered through the Medicare fee for service program. The 2016 deductible, coinsurance and base premium rates are: 2016 PART A – HOSPITAL INSURANCE (HI Deductible:$1,288.00 Coinsurance: $322.00 a day for 61st-90th day $644.00 a day for 91st-150th…

Providers and Suppliers to Comply with MAC Request for Fingerprints within 30 Days

Providers and Suppliers to Comply with MAC Request for Fingerprints within 30 Days

CMS implemented the fingerprint-based background requirement on August 6, 2014, as discussed in the rule published on February 2, 2011. Fingerprint-based background checks are required for all individuals with a 5 percent or greater ownership interest in a provider or supplier that falls into the high risk category and is currently enrolled in Medicare or…

HCPCS codes P9603 and P9604 for Medicare Travel Allowance for Collection oof Specimens

HCPCS codes P9603 and P9604 for Medicare Travel Allowance for Collection oof Specimens

HCPCS travel codes allow for payment on either a per mileage basis (HCPCS P9603) or a flat rate per trip basis (HCPCS P9604). Payment of the travel allowance is made only if a specimen collection fee is also payable. The travel allowance is intended to cover the estimated travel costs of collecting a specimen including…

Phase III ERA EFT: CORE 360 Uniform Use of Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC) Rule

Phase III ERA EFT: CORE 360 Uniform Use of Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC) Rule

The Implementation of Phase III CORE 360 CARCs and RARCs rule – version 3.0.3 has been for A/B Medicare administrative contractors has been delayed to May 5, 2014. To promote implementation of electronic transactions and achieve cost reduction and efficiency improvements, the Affordable Care Act (ACA) mandates the adoption of a set of operating rules…

Pulmonary Procedures and Evaluation & Management (E/M) Services performed on the same day

Pulmonary Procedures and Evaluation & Management (E/M) Services performed on the same day

Recovery Auditors have identified overpayments associated with Evaluation and Management (E/M) Services (Common Procedure Terminology (CPT) 99211-99213) for Pulmonary Diagnostic Procedures. These overpayments occurred due to claims billed without Modifier 25 on the same date of service as a pulmonary diagnostic, therapeutic, or monitoring procedure (94010-94799).  You and your staff should be familiar with the…

Medicare releases guidelines for model 4 bundled payments for care improvement

Medicare releases guidelines for model 4 bundled payments for care improvement

The Centers for Medicare & Medicaid Services (CMS) is conducting a pilot program to test bundling payment for services that patients receive during a single episode of care, such as heart bypass surgery or a hip replacement. The Bundled Payments for Care Improvement (BPCI) program seeks to encourage doctors, hospitals, and other health care providers…