Changes In Bypass Payment Edits For Kidney Donor Transplant

Changes In Bypass Payment Edits For Kidney Donor Transplant

The MACs to implement logic that ensures they bypass payment window edits (3-days and 1-day) when processing claims for donor post-kidney transplant complications services. MACs will hold certain claims, as noted below, until Medicare’s Common Working File (CWF) system edits these claims correctly. 3-Day Payment Window Edits: 7109: Outpatient Diagnostic Service against Inpatient in history…

Decision Memo for Transcatheter Mitral Valve Repair (TMVR)

Decision Memo for Transcatheter Mitral Valve Repair (TMVR)

The Centers for Medicare & Medicaid Services (CMS) covers transcatheter mitral valve repair (TMVR) under Coverage with Evidence Development (CED) with the following conditions:  TMVR is covered for the treatment of significant symptomatic degenerative mitral regurgitation when furnished according to an FDA approved indication and when all of the following conditions are met. 1. The…

New CMS Announcement For EHR Incentive Program Changes

New CMS Announcement For EHR Incentive Program Changes

The Centers for Medicare & Medicaid Services (CMS) intends to engage in rulemaking this spring to help ensure providers continue to meet meaningful use requirements. In response to input from health care providers and other stakeholders, CMS is considering the following changes to the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs: Shortening the…

Sequestration mandatory payment reduction of two percent continues

Sequestration mandatory payment reduction of two percent continues

For the Medicare fee-for-service (FFS) program, claims with dates-of-service or dates-of-discharge on or after April 1, 2013, will continue to incur a two percent reduction in Medicare payment through March 31, 2015. Claims for durable medical equipment (DME), prosthetics, orthotics, and supplies, including claims under the DME competitive bidding program, will continue to be reduced…

CMS Evaluation & Management Claims On Hold For New Patients

CMS Evaluation & Management Claims On Hold For New Patients

The Centers for Medicare & Medicaid Services (CMS) has identified issues with the implementation of change request (CR) 8165, which has impacted evaluation and management (E/M) claims for new patient visits. To address these issues, CMS instructed its Medicare administrative contractors (MAC) to hold all claims for Current Procedural Terminology ® (CPT) codes CPT 99201-99205,…